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Sample records for central venous access

  1. Placement of an implantable central venous access device

    International Nuclear Information System (INIS)

    To evaluate the efficacy and safety of placement of a central venous catheter with infusion port into the superior vena cava. Central venous catheters with a infusion port were implanted in 21 patients (M:F=4:17, age range:15-63, mean age: 41) diagnosed as suffering from breast cancer (n=9), lymphoma (n=7), thymoma (n=2) rhabdomyosarcoma(n=2) and rectal cancer (n=1). The per(n=9), lymphoma(n=7), thymoma (n=2) rhabdomyosarcoma (n=2) and rectal cancer (n=1). The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance during injection of contrast media at the site of the ipsilateral peripheral vein (20 cases) and under ultrasonographic guidance (1 case). 9.6F central venous catheters placed in the superior vena cava via the subclavian vein and the connected infusion ports were implanted in the subcutaneous pocket near the puncture site of the right anterosuperior chest wall. Radiologic placement under fluoroscopic guidance of a central venous catheter with a infusion port is easy, safe and useful for patients requiring long-term venous access. (author). 21 refs., 2 figs

  2. Managing Inadvertent Arterial Catheterization During Central Venous Access Procedures

    International Nuclear Information System (INIS)

    Purpose: Approximately 200,000 central venous catheterizations are carried out annually in the National Health Service in the United Kingdom. Inadvertent arterial puncture occurs in up to 3.7%. Significant morbidity and death has been reported. We report on our experience in the endovascular treatment of this iatrogenic complication. Methods: Retrospective analysis was carried out of 9 cases referred for endovascular treatment of inadvertent arterial puncture during central venous catheterization over a 5 year period. Results: It was not possible to obtain accurate figures on the numbers of central venous catheterizations carried out during the time period. Five patients were referred with carotid or subclavian pseudoaneurysms and hemothorax following inadvertent arterial catheter insertion and subsequent removal. These patients all underwent percutaneous balloon tamponade and/or stent-graft insertion. More recently 4 patients were referred with the catheter still in situ and were successfully treated with a percutaneous closure device. Conclusion: If inadvertent arterial catheterization during central venous access procedures is recognized and catheters removed, sequelae can be treated percutaneously. However, once the complication is recognized it is better to leave the catheter in situ and seal the artery percutaneously with a closure device

  3. Pain and efficacy of local anesthetics for central venous access

    Directory of Open Access Journals (Sweden)

    William C Culp Jr

    2008-11-01

    Full Text Available William C Culp Jr1, Mohammed Yousaf2, Benjamin Lowry1, Timothy C McCowan3, William C Culp21Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; 2Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USAPurpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L, buffered 1% lidocaine (LB, or 2% chloroprocaine (CP injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine

  4. Pyoderma gangrenosum after totally implanted central venous access device insertion

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    Hagen Monica E

    2008-03-01

    Full Text Available Abstract Background Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25–50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents. Case presentation A 90 years old patient with myelodysplastic syndrome, seeking regular transfusions required totally implanted central venous access device (Port-a-Cath® insertion. Fever and inflammatory skin reaction at the site of insertion developed on the seventh post-operative day, requiring the device's explanation. A rapid progression of the skin lesions evolved into a circular skin necrosis. Intravenous steroid treatment stopped the necrosis' progression. Conclusion Early diagnosis remains the most important step to the successful treatment of pyoderma gangrenosum.

  5. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

    Directory of Open Access Journals (Sweden)

    Felipe Jose Skupien

    2014-03-01

    Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

  6. Symptomatic Central Venous Stenosis in a Hemodialysis Patient Leading to Loss of Arteriovenous Access: A Case Report and Literature Review

    OpenAIRE

    Tatapudi, Vasishta S.; Spinowitz, Noam; Goldfarb, David S.

    2014-01-01

    Central venous stenosis is a well-described sequel to the placement of hemodialysis catheters in the central venous system. The presence of an ipsilateral arteriovenous fistula or graft often leads to severe venous dilatation, arm edema and recurrent infections. Vascular access thrombosis, compromised blood flow and inadequate dialysis delivery are dreaded complications that eventually render the access unusable. We report the case of a 58-year-old male hemodialysis patient who developed symp...

  7. Use of a Peripherally Inserted Central Catheter as a Conduit for Central Venous Access Across Thrombosed Great Veins

    International Nuclear Information System (INIS)

    This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.

  8. Safety of a Totally Implantable Central Venous Port System with Percutaneous Subclavian Vein Access

    OpenAIRE

    Keum, Dong-Yoon; Kim, Jae-Bum; Chae, Min-Cheol

    2013-01-01

    Background The role of totally implantable central venous port (TICVP) system is increasing. Implantation performed by radiologist with ultrasound-guided access of vein and fluoroscope-guided positioning of catheter is widely accepted nowadays. In this article, we summarized our experience of TICVP system by surgeon and present the success and complication rate of this surgical method. Materials and Methods Between March 2009 and December 2010, 245 ports were implanted in 242 patients by surg...

  9. Central venous access through the external jugular vein in children submitted to bone marrow transplantation

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    José Luiz de Godoy

    2005-01-01

    Full Text Available Establishment of long-term central venous access is a sine qua non step for bone marrow transplantation in children. Most frequently, long-term central venous access has been obtained via blind percutaneous cannulation of subclavian and internal jugular veins or via internal jugular vein cutdown. In order to avoid some potential minor and major complications associated with the subclavian or internal jugular approaches, the authors describe an easy, simple and safe method for central venous access through an external jugular vein cutdown that should be of interest to readers involved in the field of bone marrow transplantation. It should be also considered for children as well as adults needing central venous access via an external catheter - or totally implantable port - for reasons other than bone marrow transplantation, such as total parenteral nutrition and administration of chemotherapeutic agents.O estabelecimento de um acesso venoso central de longa duração é uma condição sine qua non para realizar o transplante de medula óssea em crianças. Com frequência, este acesso tem sido obtido através da punção percutânea das veias subclávia e jugular interna ou via dissecção da jugular interna. Com o objetivo de evitar algumas complicações maiores e menores associadas com a subclávia e a jugular interna, os autores descrevem um método simples, fácil e seguro para o acesso venoso central através de dissecção da veia jugular externa. Este método deveria ser de interesse dos leitores envolvidos com o transplante de medula óssea e ser considerado também para crianças e/ou adultos que necessitem de cateter venoso central de longa permanência (externo ou totalmente implantável devido a outras razões, como a nutrição parenteral ou a administração de agentes quimioterápicos.

  10. Evaluation of ultrasound for central venous access in ICU by an in experienced trainee

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    Neeta Bose

    2014-01-01

    Full Text Available Background and Aims: Central venous catheter placement is an important procedure for ICU (Intensive Care Unit patients. We studied the usefulness of ultrasonography for placement of central venous catheter by in-experienced anesthetists. Materials and Methods: A prospective observational study of 32 patients requiring central venous access (CVA in surgical ICU (SICU. Data collected were patient′s demographics, indication, type of catheter, success rate, attempts, complication rate and access time were recorded and compared with other studies. Result: The overall success rate was 89.5% in the IJV (Internal Jugular Vein and 92.3% for SCV (Subclavian Vein group. The success rates for insertion at first, second, and third attempt were 52.6%, 31.6%, and 5.2% for IJV and 46.2% and 53.8% for SCV. Average number of attempts made for IJV cannulation was 1.74 +/- 1.04 and 1.54 +/- 0.51 for SCV. The total time taken for IJV access was 858.78 +/- 381.9 sec, whereas in the SCV group, it was 984 +/- 328.98 seconds. In our study, overall rate of complication was 21.05% (4/19 patients for IJV and 23.07% (3/13 patients for SCV insertion. Incidence of various complications like arterial puncture, misplacement of CVC, hematoma, pneumothorax, and hemothorax were also noted. Conclusion: This study concludes that real time ultrasound guidance during IJV and SCV cannulation can achieve higher success rate, fewer complications, number of attempts, and failure rate among inexperienced anesthetists.

  11. Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: Experience in a single hospital

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical presentation of dislodged totally implantable central venous access system (central venous port-catheter) fragments and the efficacy and safety of percutaneous retrieval of them in our hospital. Materials and methods: Ninety-two cancer patients, mean age of 53.8 years old with 51.1% male, were enrolled from January 2005 to March 2007. They were referred to our catheterization laboratory for retrieval of fractured central venous port-catheter in our hospital. All patients were followed in the outpatient department for at least 1 month after surgical insertion. The characteristics of disrupted central venous port-catheter were recorded. The procedure-related clinical condition was evaluated. Results: The most common presentation of central venous port-catheter dislodgement is irrigation resistance to infusion (51/92). The most common location of fractured fragments is between superior vena cava and right atrium (i.e. proximal end remained in superior vena cava and distal end in right atrium) (22/92). The most common fracture site of the catheter is at the anastomosis between injection port and catheter (77/92). The retrieval set used mostly is loop snare. The success rate of the percutaneous retrieval of dislodged fragment was 97.8% and the complication rate was 3.3% only. Conclusion: The faulty connection between catheter and injection port contributes mainly to dislodgement of central venous port-catheter. Percutaneous retrieval of dislodged catheter is a highly successful, safe and efficient method

  12. Peripheral insertion of a central venous access device under fluoroscopic guidance using a Peripherally Accessed System (PAS) port in the forearm

    International Nuclear Information System (INIS)

    Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm.Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route.Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheterrelated phlebitis occurred.Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

  13. Peripheral Insertion of a Central Venous Access Device Under Fluoroscopic Guidance Using a Peripherally Accessed System (PAS) Port in the Forearm

    International Nuclear Information System (INIS)

    Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis

  14. Challenges in the Management of Pediatric Central Venous Access Devices in the Community.

    LENUS (Irish Health Repository)

    Wallace, Elaine

    2012-05-25

    Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital\\/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care ("home care") teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.

  15. Aspiration of parenteral nutrition – a previously unreported complication of central venous access in an infant: a case report

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    Jardine Luke A

    2008-02-01

    Full Text Available Abstract Introduction The insertion of percutaneous central venous catheters is a common procedure in neonatal intensive care nurseries. Placement of the catheter tip in a large central vein is most desirable. Occasionally, due to difficult venous access, catheter tips are left in places that are less than ideal. Case presentation A female infant with a complicated gastroschisis developed signs of short bowel syndrome post surgery. She was treated with a combination of parenteral nutrition and enteral feeds. A central venous line was inserted through a scalp vein. The tip was noted to be in a vessel at the level of the mandible. She subsequently became unwell with large milky pharyngeal aspirates and episodes of bradycardia. Chest radiography revealed aspiration. The central venous line was removed because of presumed extravasation. This is the first reported case of parenteral nutrition extravasation into the pharynx causing aspiration in an infant. Conclusion This complication may have been prevented by recognising that the tip of the catheter was not correctly placed. When catheters are in unusual positions it may be useful to obtain a second radiograph from a different angle or an ultrasound scan to confirm the positioning of the catheter tip.

  16. Direct contrast enhanced Venography MR in the study of central venous accesses in children receiving total parenteral nutrition

    International Nuclear Information System (INIS)

    Purpose. To present direct contrast enhanced Magnetic Resonance Venography, a recently developed method for the study of central venous accesses. Materials and methods. Six patients (4 males and 2 females; age range 15-18 Years) with severe intestinal failure treated with indwelling central Venous catheter since childhood were studied by MR-angiography. The examination was carried out with a 1.5 Philips Gyroscan Intera Magnet, sequences during the simultaneous injection of about 60 ml/limb paramagnetic contrast material, Gd DTPA, diluted with saline solution at a ratio of 1:12. The images were processed with maximum intensity coronal projections and compared with the phlebographic images obtained earlier. Results. In 4 cases the method demonstrated superior vena cava occlusion, in 2 cases inferior vena cava occlusion. The examination was well tolerated by all patients and image quality was very similar to that of the gold standard Study, conventional phlebography. Conclusions. We believe direct contrast-enhanced MR-venography to be a minimally invasive, panoramic and diagnostically reliable method, which should be considered the first choice in the study of central venous accesses of patients receiving total parental nutrition for the medical treatment of intestinal failure. The method does not expose the patients to ionizing radiation or require iodinated contrast material, and is relatively short with a room lime of about 30-40 minutes

  17. Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects

    OpenAIRE

    Kalińczuk, Łukasz; Chmielak, Zbigniew; Dębski, Artur; Kępka, Cezary; Rudziński, Piotr N.; Bujak, Sebastian; Skwarek, Mirosław; Kurowski, Andrzej; Dzielińska, Zofia; Demkow, Marcin

    2016-01-01

    Introduction Totally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization. Aim To present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the...

  18. Pneumothorax as a complication of central venous catheter insertion

    OpenAIRE

    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

    2015-01-01

    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...

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

    OpenAIRE

    Alicia Oliva Cesar; Rafael Muriana Jiménez; Jesús Manuel González Caro; Ramona Rodríguez Flores

    2007-01-01

    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 reaso...

  20. Remifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.

    LENUS (Irish Health Repository)

    Burlacu, Crina L

    2012-02-01

    STUDY OBJECTIVE: To determine the analgesic efficacy of three different rates of remifentanil infusion in patients undergoing insertion or removal of long-term central venous access devices during monitored anesthesia care and local anesthetic field infiltration. DESIGN: Double-blinded, randomized, controlled study. SETTING: Operating theatre of an University hospital. PATIENTS: 44 unpremedicated, ASA physical status 1 and 2 patients, aged 18-65 years, undergoing insertion or removal of a Port-a-Cath or Hickman catheter. INTERVENTIONS: Patients sedated with a propofol target-controlled infusion were randomly allocated to three groups: Group R25 (n = 14), Group R50 (n = 15), and Group R75 (n = 15), to receive remifentanil 0.025, 0.05, and 0.075 mug\\/kg\\/min, respectively. Rescue remifentanil 0.5 mug\\/kg was administered for pain scores > 3. The remifentanil infusion rate was maintained constant unless respiratory and\\/or cardiovascular unwanted events occurred, whereupon the rate was adjusted in 0.01 mug\\/kg\\/min decrements as necessary. MEASUREMENTS: Pain scores (primary outcome), sedation, and movement scores (secondary outcomes) were assessed during local anesthetic infiltration of the anterior chest wall and 5 other procedural steps. MAIN RESULTS: All infusion rates had equal analgesic efficacy, as shown by comparable pain scores, number of rescue boluses, and number of patients requiring rescue analgesia. Excessive sedation was associated with the highest remifentanil rate such that Group R75 patients were significantly more sedated than Groups R25 or R50 at selective procedural steps (P < 0.05). More Group R75 patients (6\\/15) required remifentanil rate reduction than did patients from Group R50 (1\\/15) or Group R25 (0\\/14), P < 0.01, most commonly because of respiratory depression. CONCLUSIONS: For the insertion or removal of long-term central venous access devices, all three remifentanil infusion rates proved to be equally analgesic

  1. Comparison of two indwelling central venous access catheters in dogs undergoing fractionated radiotherapy

    International Nuclear Information System (INIS)

    Twenty dogs with neoplasms requiring multiple radiation treatments received either percutaneous vascular access catheters (PVACs; Cook, Bloomington, IN) or subcutaneous vascular access ports (SVAPs; Vascular-Access-Ports, Norfolk Medical Products, Inc., Skokie, IL); 10 dogs were entered in each group. All catheters were implanted and removed aseptically and the catheter tips were cultured during implant removal. Complications with PVACs included mild incisional swelling and redness and accidental severance or rupture of the catheter. Complications with SVAPs included incisional or port swelling, bruising or redness, hematoma formation, and pain. Ports in 4 of these dogs could not be used for 1 to 3 days after surgery because of swelling and pain. Surgical wound complications, when pooled for comparison, occurred significantly more frequently with the SVAPs (P = .023). Wound complications associated with both catheters were self-limiting and resolved within 7 days. Bacterial cultures were positive in two PVACs and four SVAP tips, however, none of these dogs had clinical signs of infection or sepsis. Although both types of indwelling catheters were functional in a clinical setting, PVACs were preferred to SVAPs for dogs undergoing radiation therapy because of decreased time for implantation and fewer overall complications

  2. Fracture and atypical migration of an implantable central venous access device.

    Science.gov (United States)

    Mery, Mirela; Palengat, Stéphanie; Loffroy, Romaric; Vernet, Magali; Matet, Pascal; Cherblanc, Violaine

    2016-06-01

    Distal embolization of a fractured indwelling central catheter is a rare complication. The pinch-off syndrome (POS) should be known, prevented and early detected. We present a case in which further radiological exams were required to find the fragmented catheter with an atypical migration, requiring local surgery for removing. After chest and abdominal CT scan, neck X-ray, and heart echography, the catheter was found on the lower limbs X-ray on the internal side of right knee corresponding to a location of saphenous vein. Implanted catheters should be removed after completion of treatment and the integrity of the system should be monitored. To avoid POS, a catheter must be inserted into the subclavian vein as laterally as possible. PMID:27429915

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Radiological placement of peripheral central venous access ports at the forearm. Technical results and long term outcome in 391 patients

    International Nuclear Information System (INIS)

    To retrospectively analyze the technical result and long term outcome of central venous arm ports placed by radiologists. Over a 5-year period, 399 arm ports were implanted by radiologists in 391 patients. The system consists of a low profile titanium chamber and a silicone catheter. Ports were placed at the forearm after puncture of a vein proximally to the elbow under fluoroscopic guidance. In a retrospective analysis the technical results and the long term outcome were evaluated. Complications were documented according to the standards of the society of interventional radiology. In 391 patients a total of 98 633 catheter days were documented (1 - 1325 days, mean 252 days). Primary technical success was 99.25 % (396 / 399) with a 100 % secondary technical success rate. No severe procedural complications, e. g. pneumothorax or severe hemorrhage, were found. A total of 45 complications occurred (11.28 %, 0.45 / 1000 catheter days), including 8 portal pocket infections (27 - 205 days, mean 115 days). Fifteen ports were explanted because of complications. The complication rate corresponds to the data from subclavian ports and is less than the complication rates published in large surgical trials. Implantation of central-venous arm ports by radiologists is safe and minimally invasive. No severe immediate procedural complications occur due to the peripheral implantation site. Long term complication rates are comparable to other studies of radiological or surgical port implantation at different sites. (orig.)

  5. Transpleural central venous catheter discovered during thoracotomy

    OpenAIRE

    Ashima Malhotra; Prakash Sharma; Ashvini Kumar; Nikhil Malhotra

    2014-01-01

    We report an uncommon complication of subclavian central venous catheterization, discovered at thoracotomy. The central venous catheter (CVC) was placed by left infraclavicular route after induction of general anesthesia. CVC was secured after aspiration of blood and satisfactory central venous tracing. On thoracotomy, CVC was noticed to traverse the pleural cavity while the tracing was normal. CVC was thus removed consequent to which bleeding from each puncture site was noticed, that were se...

  6. Scheme for Creating a Subcutaneous Tunnel to Place an Indwelling Implantable Central Venous Access System in the Forearm

    International Nuclear Information System (INIS)

    We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.

  7. Entrapment of guidewire during central venous catheterization

    Directory of Open Access Journals (Sweden)

    Tarun S.

    2016-07-01

    Full Text Available Central venous catheterization (CVC is common in the setting of ICU for various reasons like monitoring of CVP, fluid administration and vasopressor or drug infusions. Guidewires are routinely used in the Seldinger technique during central venous catheter placement CVC placement is not innocuous as numerous complications may occur, with varying frequency and severity. [Int J Res Med Sci 2016; 4(7.000: 3080-3081

  8. Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

    International Nuclear Information System (INIS)

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  9. Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients

    International Nuclear Information System (INIS)

    Purpose: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data.Methods: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data.Results: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant

  10. Peripheral venous access ports: Outcomes analysis in 109 patients

    International Nuclear Information System (INIS)

    Purpose: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data.Methods: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gammaglobulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data.Results: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p=0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant (p

  11. Effects of radiotherapy on central venous ports

    International Nuclear Information System (INIS)

    During radiotherapy of patients with implant able central venous ports we are often afraid of complications resulting from ports damage on the one hand and their interaction with surrounding tissues on the other hand. In experimental conditions venous ports were exposed to radiation. It was found that radiation reflected from a port is negligible and should not put patients at risk. Radiotherapy does not cause any changes within a port chamber, however it substantially affects elasticity of a polyurethane port catheter and to a minimal extent affects silicone catheter. (authors)

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

    Science.gov (United States)

    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. PMID:25815301

  13. Imaging and management of complications of central venous catheters

    International Nuclear Information System (INIS)

    Central venous catheters (CVCs) provide valuable vascular access. Complications associated with the insertion and maintenance of CVCs includes pneumothorax, arterial puncture, arrhythmias, line fracture, malposition, migration, infection, thrombosis, and fibrin sheath formation. Image-guided CVC placement is now standard practice and reduces the risk of complications compared to the blind landmark insertion technique. This review demonstrates the imaging of a range of complications associated with CVCs and discusses their management with catheter salvage techniques

  14. Long-term venous access using a subcutaneous implantable drug delivery system.

    OpenAIRE

    Soo, K. C.; Davidson, T I; Selby, P; Westbury, G

    1985-01-01

    To facilitate long-term venous access in patients receiving chemotherapy, a subcutaneous totally implantable system (Port-a-Cath, Phamacia) has been used in 14 patients. The method of implantation and the advantages over conventional central venous catheters are discussed. The expense of the system necessitates careful patient selection.

  15. Central Venous Catheters for Chemotherapy of Solid Tumors – Our Results in the Last 5 Years

    OpenAIRE

    Žganjer, Mirko; Čizmić, Ante; Butković, Diana; MATOLIĆ, MARTINA; Karaman-Ilić, Maja; Stepan, Jasminka

    2008-01-01

    Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment. There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the last 5 years we...

  16. Case report: Unilateral conduction hearing loss due to central venous occlusion.

    Science.gov (United States)

    Ribeiro, Phillip; Patel, Swetal; Qazi, Rizwan A

    2016-01-01

    Central venous stenosis is a well-known complication in patients with vascular access for hemodialysis. We report two cases involving patients on hemodialysis with arteriovenous fistulas who developed reversible unilateral conductive hearing loss secondary to critical stenosis of central veins draining the arteriovenous dialysis access. A proposed mechanism for the patients' reversible unilateral hearing loss is pterygoid venous plexus congestion leading to decreased Eustachian tube patency. Endovascular therapy was conducted to treat the stenosis and the hearing loss of both patients was returned to near normal after successful central venous angioplasty. PMID:27079669

  17. The Malposition of Central Venous Catheters in Children

    International Nuclear Information System (INIS)

    Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. A total number of 309 CVCs were implanted at Children’s University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them

  18. 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)....

  19. DELAYED BILATERAL HYDROTHORAX AFTER CENTRAL VENOUS CATHERIZATION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Arpana

    2014-09-01

    Full Text Available : Central venous catheterization is a common procedure in anesthetic management of patients undergoing major surgery or care of critically ill patients. Delayed complication such as hydrothorax, hydromediastinum or cardiac tamponade is extremely rare with a few case reports. We report a case of bilateral hydrothorax due to migration of the tip of the central venous catheter from within the vein into the mediastinum following subclavian vein catheterization.

  20. 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.

  1. Ultrasonography: A novel approach to central venous cannulation

    Directory of Open Access Journals (Sweden)

    Agarwal Ankit

    2009-01-01

    Full Text Available Background: Portable ultrasound machines are highly valuable in ICUs, where a patient′s condition might not permit shifting the patient to the USG department for imaging. Traditionally central lines are put blindly using anatomical landmarks, which often result in complications such as difficulty in access, misplaced lines, pneumothorax, bleeding from inadvertent arterial punctures, etc. Ultrasonography provides "real time" imaging, i.e., the needle can be visualized entering the vein. Aims: We performed a study to compare USG guided central venous cannulation (CVC and conventional anatomical landmark approach to CVC, in terms of ease of cannulation, time consumed, and associated complications. Settings and Design: The study was performed in a 16-bed open ICU. Eighty patients were randomly divided in two groups. Materials and Methods: The right internal jugular vein (IJV was cannulated in all. In Group I, a portable ultrasound machine was used during cannulation. The vessels were visualized in the transverse section with the internal carotid artery (ICA identified as a circular pulsatile structure, while the IJV as a lateral, oval nonpulsatile structure. The needle was inserted perpendicular to the skin under visualization on the US screen. Central venous line was then inserted by the Seldinger technique. In Group II, CVC was performed by the conventional landmark approach. The parameters studied included time for insertion, attempts required, and complications encountered. Statistical Analysis: The database of all parameters was analyzed using SPSS software version 10.5. Results: The mean time to successful insertion was 145 and 176.4 sec in groups I and II, respectively (p = 0.00. An average of 1.2 attempts per cannulation was required for group I, while 1.53 for group II (p = 0.03: 10% witnessed arterial puncture and 2.5% pneumothorax in group I and none in group II. Conclusion: USG-guided CVC is thus easier, quicker, and safer than

  2. Central Venous Disease in Hemodialysis Patients: An Update

    Energy Technology Data Exchange (ETDEWEB)

    Modabber, Milad, E-mail: mmodabber@gmail.com [McMaster University, Michael G. DeGroote School of Medicine (Canada); Kundu, Sanjoy [Scarborough Hospital and Scarborough Vascular Ultrasound, The Vein Institute of Toronto (Canada)

    2013-08-01

    Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.

  3. Central Venous Disease in Hemodialysis Patients: An Update

    International Nuclear Information System (INIS)

    Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD

  4. Radiological evaluation of complications of implantable venous access port

    International Nuclear Information System (INIS)

    Objective: Clinical signs and symptoms sometimes throw suspicion on functional complications and venous thrombosis due to implantable venous access ports. Objective was to determine frequency of these problems using radiologic imaging. Methods: 61 patients were examined by means of fluoroscopy. If indication was given we injected radiopaque (contrast) medium. In the case of suspected vascular thrombosis the radiological finding was verified by sonography, phlebography or by venous magnetic resonance imaging angiography. Results: Altogether 46 complications were documented in 37 out of 61 examined patients (61%). Occlusions of port-catheter were proved in 24 cases. It was the radiologically most frequently recorded complication (52%) and found coincident with other problems in 9 patients (37%). Pain frequently indicates break of catheters. Implantation of catheters into jugular and axillary veins predisposes to break of catheters just as port-catheters lateral implanted into subclavian veins ('pinch-off-sign'). Conclusions: Functional tests of venous access systems using fluoroscopy and phlebography give information that helps to decide if clinically problematic port-systems should be used furthermore. Directions of catheter which are predestined to complications should be avoided. (orig.)

  5. Evaluation of the Necessity of Port Fixation in Central Venous Port Implantation

    International Nuclear Information System (INIS)

    The technical success and complications were especially focused on and evaluated the need for fixation of a port under fluoroscopic guidance placement of the totally implantable central venous access ports for long term central venous access. Two hundred eighty nine consecutive patients (170 men, 119 women, mean age: 52-year-old) who underwent venous port implantation for the administration of chemotherapy were followed over a 1-month period. The procedures were performed in the angiographic suite by an interventional radiologist and all access was through the right jugular vein, except for the patients who had undergone a right mastectomy. The procedures were performed in the following order: 1) venous puncture, 2) making a pocket, 3) catheter tunneling, 4) port insertion, 5) catheter sizing, and 6) insertion. A port which was connected to the tunneled catheter was inserted into the minimally sized subcutaneous pocket with the aid of a small retractor. A follow-up was performed with medical records and chest radiographs. The follow-up period for evaluating the venous port ranged from 59 to 329 days (mean: 175 days) The procedures performed to gain right jugular vein access were successful without difficulty in all cases. The 18 patients that underwent procedures to gain left jugular vein access encountered some difficulty upon insertion of a catheter into the SVC due to encountering the tortuous left brachiocephalic vein. No complications occurred during and immediately after the procedure. In one case the port chamber rotated within the subcutaneous pocket; however, no catheter migration or malfunction occurred. If port insertion was followed by catheter insertion, the port chamber can be tightly implanted in the minimally sized pocket. This would avoid the need for fixation of the catheter to the port chamber leading into the pocket

  6. Central venous catheters for chemotherapy of solid tumors--our results in the last 5 years.

    Science.gov (United States)

    Zganjer, Mirko; Cizmić, Ante; Butković, Diana; Matolić, Martina; Karaman-Ilić, Maja; Stepan, Jasminka

    2008-09-01

    Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment. There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the last 5 years we inserted 194 catheters in 175 children. We inserted 121 Broviac catheters and 73 PAC catheters. During the follow up of 39382 catheter days 44 complications were observed. In Broviac group the median follow up was 155 days and in PAC group was 230 days. We observed differences in the incidence between two devices. In Broviac group infections were more frequent and in PAC group other complications were more frequent than infections. PMID:18982750

  7. [Medium- and long-term use of central venous catheters in pediatrics. Personal experience].

    Science.gov (United States)

    Orfei, P; Pinto, G; Properzi, E; Piccardo, A; Cerroni, A; Prosperi, M; Cozzi, F

    1996-04-01

    From January 1992 to October 1994, 74 central venous catheters were inserted, in the University Hospital of Rome: Polyclinic Umberto I - "La Sapienza", in 62 paediatric patients (15.17 +/- 1.64 years old), admitted to the paediatric surgery division. The authors used a large amount of CVC: totally implanted devices (34 Groshong, 7 Broviac, 2 Hickman, 3 Port) and percutaneous catheters (28 Arrow). The choice of the infusional devices has been influenced by the length of the treatment, the primitive disease, the age and the size of the patient. The authors used totally implanted devices in paediatric patients undergoing chemotherapeutic and nutritional therapies. External central venous access devices were used in patients undergoing central catheterization lasting less than two months. The subclavian vein has been used as venous access in patients weighing > 5 kg, the internal jugular vein in < 5, kg patients. This work reports the early (PNX, hematomas, arterial access) and the long term complications (infections, accidental unthreading, occlusions and dislocations). We can say that the medium and long last term CVC is well tolerated and accepted in paediatric patients too, for antineoplastic, nutritional and infusion therapies. PMID:8984428

  8. Radiographic signs of non-venous placement of intended central venous catheters in children

    International Nuclear Information System (INIS)

    Central venous catheters (CVCs) are commonly used in children, and inadvertent arterial or extravascular cannulation is rare but has potentially serious complications. To identify the radiographic signs of arterial placement of CVCs. We retrospectively reviewed seven cases of arterially malpositioned CVCs on chest radiograph. These cases were identified through departmental quality-assurance mechanisms and external consultation. Comparison of arterial cases was made with 127 age-matched chest radiographs with CVCs in normal, expected venous location. On each anteroposterior (AP) radiograph we measured the distance of the catheter tip from the right lateral border of the thoracic spine, and the angle of the vertical portion of the catheter relative to the midline. On each lateral radiograph we measured the angle of the vertical portion of each catheter relative to the anterior border of the thoracic spine. When bilateral subclavian catheters were present, the catheter tips were described as crossed, overlapping or uncrossed. On AP radiographs, arterially placed CVCs were more curved to the left, with catheter tip positions located farther to the left of midline than normal venous CVCs. When bilateral, properly placed venous catheters were present, all catheters crossed at the level of the superior vena cava (SVC). When one of the bilateral catheters was in arterial position, neither of the catheters crossed or the inter-catheter crossover distance was exaggerated. On lateral radiographs, there was a marked anterior angulation of the vertical portion of the catheter (mean angle 37 ± 15 standard deviation [SD] in arterial catheters versus 5.9 ± 8.3 SD in normally placed venous catheters). Useful radiographic signs suggestive of unintentional arterial misplacement of vascular catheters include leftward curvature of the vertical portion of the catheter, left-side catheter tip position, lack of catheter crossover on the frontal radiograph, as well as exaggerated

  9. Radiographic signs of non-venous placement of intended central venous catheters in children

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Erin C. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2016-02-15

    Central venous catheters (CVCs) are commonly used in children, and inadvertent arterial or extravascular cannulation is rare but has potentially serious complications. To identify the radiographic signs of arterial placement of CVCs. We retrospectively reviewed seven cases of arterially malpositioned CVCs on chest radiograph. These cases were identified through departmental quality-assurance mechanisms and external consultation. Comparison of arterial cases was made with 127 age-matched chest radiographs with CVCs in normal, expected venous location. On each anteroposterior (AP) radiograph we measured the distance of the catheter tip from the right lateral border of the thoracic spine, and the angle of the vertical portion of the catheter relative to the midline. On each lateral radiograph we measured the angle of the vertical portion of each catheter relative to the anterior border of the thoracic spine. When bilateral subclavian catheters were present, the catheter tips were described as crossed, overlapping or uncrossed. On AP radiographs, arterially placed CVCs were more curved to the left, with catheter tip positions located farther to the left of midline than normal venous CVCs. When bilateral, properly placed venous catheters were present, all catheters crossed at the level of the superior vena cava (SVC). When one of the bilateral catheters was in arterial position, neither of the catheters crossed or the inter-catheter crossover distance was exaggerated. On lateral radiographs, there was a marked anterior angulation of the vertical portion of the catheter (mean angle 37 ± 15 standard deviation [SD] in arterial catheters versus 5.9 ± 8.3 SD in normally placed venous catheters). Useful radiographic signs suggestive of unintentional arterial misplacement of vascular catheters include leftward curvature of the vertical portion of the catheter, left-side catheter tip position, lack of catheter crossover on the frontal radiograph, as well as exaggerated

  10. Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

    International Nuclear Information System (INIS)

    Purpose: To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions. Materials and Methods: Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50–83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14), and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria). Results: Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9–7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4–8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14). Conclusions: This PTFE encapsulated stent

  11. Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Ji; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jeong, Woo Kyoung; Lee, Yong Ho [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    We evaluated the technical success and complication rates associated with the radiological placement of tunneled central venous catheters in pediatric patients. Between May 1, 2005 and March 31, 2008, a total of 46 tunneled central venous catheters were placed in 34 children (M:F = 22:12; mean age, 9.9 years [9 months to 16.8 years]). All procedures were performed under ultrasonographic and fluoroscopic guidance. Follow-up data were obtained through the retrospective review of the medical records. We used the Kaplan-Meier survival method for the evaluation of survival rate of the catheters. All procedures were technically successful. The observed periprocedural complications included hematoma formation in three patients. The mean catheter life was 189.3 days (total, 8710 days; range, 7-810). Catheters were removed due to death (n=9), the end of treatment (n=8), catheter sepsis (n=4), malfunction (n=8), and accidental removal (n=4). The rate of catheter sepsis and malfunction was 0.459 and 0.919 for every 1000 catheter days, respectively. The expected mean catheter life was 479.6 days as per the Kaplan- Meier analysis. The results suggest that the radiologic placement of a tunneled central venous catheter is an effective technique with a high technical success rate and low complication rate.

  12. Venous Access Ports: Indications, Implantation Technique, Follow-Up, and Complications

    Energy Technology Data Exchange (ETDEWEB)

    Walser, Eric M., E-mail: walser.eric@mayo.edu [Mayo Clinic, Department of Radiology (United States)

    2012-08-15

    The subcutaneous venous access device (SVAD or 'port') is a critical component in the care of patients with chronic disease. The modern SVAD provides reliable access for blood withdrawal and medication administration with minimal disruption to a patient's lifestyle. Because of improved materials and catheter technology, today's ports are lighter and stronger and capable of high-pressure injections of contrast for cross-sectional imaging. The majority of SVAD placement occurs in interventional radiology departments due to their ability to provide this service at lower costs, lower, complication rates, and greater volumes. Port-insertion techniques vary depending on the operator, but all consist of catheter placement in the central venous circulation followed by subcutaneous pocket creation and port attachment to the catheter with fixation and closure of the pocket. Venous access challenges occasionally occur in patients with central vein occlusions, necessitating catheterization of collateral veins or port placement in alternate locations. Complications of SVADs include those associated with the procedure as well as short- (<30 days) and long-term problems. Procedural and early complications are quite rare due to the near-universal use of real-time ultrasound guidance for vein puncture, but they can include hematoma, catheter malposition, arrhythmias, and pneumothorax. Late problems include both thrombotic complications (native venous or port-catheter thrombosis) and infections (tunnel or pocket infections or catheter-associated bloodstream infections). Most guidelines suggest that 0.3 infections/1000 catheter days is an appropriate upper threshold for the insertion of SVADs.

  13. Venous Access Ports: Indications, Implantation Technique, Follow-Up, and Complications

    International Nuclear Information System (INIS)

    The subcutaneous venous access device (SVAD or “port”) is a critical component in the care of patients with chronic disease. The modern SVAD provides reliable access for blood withdrawal and medication administration with minimal disruption to a patient’s lifestyle. Because of improved materials and catheter technology, today’s ports are lighter and stronger and capable of high-pressure injections of contrast for cross-sectional imaging. The majority of SVAD placement occurs in interventional radiology departments due to their ability to provide this service at lower costs, lower, complication rates, and greater volumes. Port-insertion techniques vary depending on the operator, but all consist of catheter placement in the central venous circulation followed by subcutaneous pocket creation and port attachment to the catheter with fixation and closure of the pocket. Venous access challenges occasionally occur in patients with central vein occlusions, necessitating catheterization of collateral veins or port placement in alternate locations. Complications of SVADs include those associated with the procedure as well as short- (<30 days) and long-term problems. Procedural and early complications are quite rare due to the near-universal use of real-time ultrasound guidance for vein puncture, but they can include hematoma, catheter malposition, arrhythmias, and pneumothorax. Late problems include both thrombotic complications (native venous or port-catheter thrombosis) and infections (tunnel or pocket infections or catheter-associated bloodstream infections). Most guidelines suggest that 0.3 infections/1000 catheter days is an appropriate upper threshold for the insertion of SVADs.

  14. SLIPPED GUIDE WIRE – CENTRAL VENOUS CANNULATION – AN UNUSUAL PRESENTATION

    Directory of Open Access Journals (Sweden)

    Ananda Rama Rao

    2013-11-01

    Full Text Available ABSTRACT: Central venous cannulation via the internal jugular vein is commonly used in critically ill patients. Numerous complications of this procedure including embolization / infections of a fragment of guide wire and its retrieval by interventional radiological techniques are well known. We report a case of a lost guide wire into the venous circulation during central venous cannulation, which was retrieved surgically

  15. Radiological placement of peripheral central venous access ports at the forearm. Technical results and long term outcome in 391 patients; Radiologische Implantation zentralvenoeser Portsysteme am Unterarm. Implantationsergebnisse und Langzeit-Follow-up bei 391 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Lenhart, M. [Sozialstiftung Bamberg (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Schaetzler, S. [Klinikum der Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik; Manke, C. [Klinikum Fulda (DE). Klinik fuer Diagnostische und Interventionelle Radiologie] (and others)

    2010-01-15

    To retrospectively analyze the technical result and long term outcome of central venous arm ports placed by radiologists. Over a 5-year period, 399 arm ports were implanted by radiologists in 391 patients. The system consists of a low profile titanium chamber and a silicone catheter. Ports were placed at the forearm after puncture of a vein proximally to the elbow under fluoroscopic guidance. In a retrospective analysis the technical results and the long term outcome were evaluated. Complications were documented according to the standards of the society of interventional radiology. In 391 patients a total of 98 633 catheter days were documented (1 - 1325 days, mean 252 days). Primary technical success was 99.25 % (396 / 399) with a 100 % secondary technical success rate. No severe procedural complications, e. g. pneumothorax or severe hemorrhage, were found. A total of 45 complications occurred (11.28 %, 0.45 / 1000 catheter days), including 8 portal pocket infections (27 - 205 days, mean 115 days). Fifteen ports were explanted because of complications. The complication rate corresponds to the data from subclavian ports and is less than the complication rates published in large surgical trials. Implantation of central-venous arm ports by radiologists is safe and minimally invasive. No severe immediate procedural complications occur due to the peripheral implantation site. Long term complication rates are comparable to other studies of radiological or surgical port implantation at different sites. (orig.)

  16. Central venous catheter malposition in the azygos vein and difficult endotracheal intubation in severe ankylosing spondylitis: a case report

    OpenAIRE

    Moon, Eunjin; Jeong, Hyungmo; Chung, Junyoung; Yi, Jaewoo

    2015-01-01

    Ankylosing spondylitis (AS) can be challenging for anesthesiologists because central venous access can be difficult, and the airway can be blocked due to the fixed flexion deformity of the spine. In this case, we attempted central access via the right subclavian vein, but the catheter was repeatedly inserted into the azygos vein, which was confirmed by radiology. After several attempts, the catheter position was corrected at the superior vena cava-atrial junction. Although several useful devi...

  17. Chlorhexidine impregnated central venous catheter inducing an anaphylatic shock in the intensive care unit.

    Science.gov (United States)

    Khoo, A; Oziemski, P

    2011-10-01

    Chlorhexidine, a bisbiguanide, is widely used as an antiseptic agent in medical practice as it has the greatest residual antimicrobial activity. Central venous catheters coated extraluminally with chlorhexidine have been made to reduce extraluminal contamination. By using both the chlorhexidine-alchohol skin preparation and antimicrobial-coated catheters during vascular cannulation, it can reduce catheter related bloodstream significantly [1]. The reduction in infection rate is especially vital in critically ill patients who require long-term vascular access. Adverse reactions to chlorhexidine are rare and uncommon, and have been under-recognised as a cause of anaphylaxis. There are several reports of allergic reactions following exposure to chlorhexidine. We report of a case of anaphylaxis shock requiring cardiopulmonary resuscitation during the placement of a chlorhexidine impregnated central venous catheters. PMID:21036666

  18. Percutaneous Placement of Central Venous Catheters: Comparing the Anatomical Landmark Method with the Radiologically Guided Technique for Central Venous Catheterization Through the Internal Jugular Vein in Emergent Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Koroglu, M.; Demir, M.; Koroglu, B.K.; Sezer, M.T.; Akhan, O.; Yildiz, H.; Yavuz, L.; Baykal, B.; Oyar, O. [Suleyman Demirel Univ., Isparta (Turkey). Depts. of Radiology, Internal Medicine and Anesthesiology

    2006-02-15

    Purpose: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. Material and Methods: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n = 40) were compared with those of the anatomical landmark method (n 40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared. Results: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. Conclusion: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.

  19. Management of venous hypertension following arteriovenous fistula creation for hemodialysis access

    Science.gov (United States)

    Mittal, Varun; Srivastava, Aneesh; Kapoor, Rakesh; Lal, Hira; Javali, Tarun; Sureka, Sanjoy; Patidar, Nitesh; Arora, Sohrab; Kumar, Manoj

    2016-01-01

    Introduction: Venous hypertension (VH) is a distressing complication following the creation of arteriovenous fistula (AVF). The aim of management is to relieve edema with preservation of AVF. Extensive edema increases surgical morbidity with the loss of hemodialysis access. We present our experience in management of VH. Methods: A retrospective study was conducted on 37 patients with VH managed between July 2005 to May 2014. Patient demographics, evaluation, and procedures performed were noted. A successful outcome of management with surgical ligation (SL), angioembolization (AE), balloon dilatation (BD) or endovascular stent (EVS) was defined by immediate disappearance of thrill and murmur with resolution of edema in the next 48–72 h, no demonstrable flow during check angiogram and resolution of edema with preservation of AVF respectively. Results: All 8 distal AVF had peripheral venous stenosis and were managed with SL in 7 and BD in one patient. In 29 proximal AVF, central and peripheral venous stenosis was present in 16 and 13 patients respectively. SL, AE, BD, and BD with EVS were done in 18, 5, 4, and 3 patients, respectively. All patients had a successful outcome. SL was associated with wound related complications in 11 (29.73 %) patients. A total of 7 AVF were salvaged. One had restenosis after BD and was managed with AE. BD, EVS, and AE had no associated morbidity. Conclusions: Management of central and peripheral venous stenosis with VH should be individualized and in selected cases it seems preferable to secure a new access in another limb and close the native AVF in edematous limb for better overall outcome. PMID:27127358

  20. Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction

    International Nuclear Information System (INIS)

    PurposeImplanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.Methods and MaterialsThrough a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new “mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.ResultsEighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.ConclusionThese IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement

  1. Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Breault, Stéphane, E-mail: stephane.breault@chuv.ch [Lausanne University Hospital, Diagnostic and Interventional Radiology Department (Switzerland); Glauser, Frédéric, E-mail: frederic.glauser@chuv.ch [Lausanne University Hospital, Angiology and Diagnostic and Interventional Radiology Departments (Switzerland); Babaker, Malik, E-mail: malik.babaker@chuv.ch; Doenz, Francesco, E-mail: francesco.doenz@chuv.ch; Qanadli, Salah Dine, E-mail: salah.qanadli@chuv.ch [Lausanne University Hospital, Diagnostic and Interventional Radiology Department (Switzerland)

    2015-06-15

    PurposeImplanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.Methods and MaterialsThrough a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new “mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.ResultsEighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.ConclusionThese IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

  2. Spontaneous migration of central venous catheter tip following extubation

    Directory of Open Access Journals (Sweden)

    Balaji Prabaharan

    2014-01-01

    Full Text Available Migration of the tip of central venous catheters is not an uncommon event and the mechanism for this is not clear. Increased intrathoracic pressure due to coughing, sneezing or weight lifting, changing the body position or physical movements such as abduction or adduction of the arms is thought to be the cause of such migration. We present here a case of a patient with a port catheter tip that migrated from the left subclavian to the superior vene cava following extubation.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Short-term and long-term outcome of radiological-guided insertion of central venous access port devices implanted at the forearm: a retrospective monocenter analysis in 1704 patients

    International Nuclear Information System (INIS)

    The objectives are to analyze the technical success rate as well as the short-term and long-term complications of totally implantable venous access ports (TIVAPs) at the forearm. Retrospective analysis of 1,704 consecutively implanted TIVAPs was performed. Primary endpoints were defined as technical success rate, clinical outcome, device service interval, and rates of major complications. Minor complications not requiring port explantation were defined as secondary endpoints. The technical success rate was 99.2 % with no major complications. During follow-up, a total of 643,200 catheter-days were documented, the mean device service interval was 380.6 days/patient. A total of 243 complications (14.4 %) in 226 patients were observed (0.4/1000 catheter-days), in 140 patients (8.3 %) the port device had to be explanted. Disconnection between the port device and the catheter (1.6 %) was more frequent than fracture (0.8 %) and leakage (0.6 %) of the catheter, which occurred more frequently when the catheter was inserted via the cephalic versus the brachial vein. TIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications. (orig.)

  5. Short-term and long-term outcome of radiological-guided insertion of central venous access port devices implanted at the forearm: a retrospective monocenter analysis in 1704 patients

    Energy Technology Data Exchange (ETDEWEB)

    Wildgruber, Moritz; Borgmeyer, Sebastian; Gaa, Jochen; Meier, Reinhard; Berger, Hermann [Technische Universitaet Muenchen, Division of Interventional Radiology, Department of Radiology, Klinikum Rechts der Isar, Muenchen (Germany); Haller, Bernhard [Technische Universitaet Muenchen, Department of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Munich (Germany); Jansen, Heike; Kiechle, Marion; Ettl, Johannes [Technische Universitaet Muenchen, Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Munich (Germany)

    2014-09-20

    The objectives are to analyze the technical success rate as well as the short-term and long-term complications of totally implantable venous access ports (TIVAPs) at the forearm. Retrospective analysis of 1,704 consecutively implanted TIVAPs was performed. Primary endpoints were defined as technical success rate, clinical outcome, device service interval, and rates of major complications. Minor complications not requiring port explantation were defined as secondary endpoints. The technical success rate was 99.2 % with no major complications. During follow-up, a total of 643,200 catheter-days were documented, the mean device service interval was 380.6 days/patient. A total of 243 complications (14.4 %) in 226 patients were observed (0.4/1000 catheter-days), in 140 patients (8.3 %) the port device had to be explanted. Disconnection between the port device and the catheter (1.6 %) was more frequent than fracture (0.8 %) and leakage (0.6 %) of the catheter, which occurred more frequently when the catheter was inserted via the cephalic versus the brachial vein. TIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications. (orig.)

  6. Endovascular treatment of central venous obstruction as a complication of prolonged hemodialysis – Preliminary experience in a tertiary care center

    Science.gov (United States)

    Yadav, Mukesh K; Sharma, Madhurima; Lal, Anupam; Gupta, Vivek; Sharma, Ashish; Khandelwal, Niranjan

    2015-01-01

    Background: Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim: To describe our initial experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis. Settings and Design: This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable. Materials and Methods: Eleven patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between July 2012 and July 2014. All the patients underwent endovascular treatment and were analyzed retrospectively. Results and Conclusion: A total of 11 patients (4 male and 7 female) underwent 18 interventions for 13 stenotic segments during a time period of 2 years. Eight stenotic segments were in brachiocephalic vein, three in subclavian vein, and two in axillary veins. The technical success rate for endovascular treatment was 81.8%. Two patients underwent percutaneous transluminal angioplasty (PTA) alone and presented with restenosis later. Balloon angioplasty followed by stenting was done in seven patients, two of which required reintervention during follow-up. We found endovascular treatment safe and effective in treating central venous disease. PMID:26752817

  7. Venous aneurysm complicating arteriovenous fistula access and matrix metalloproteinases

    Directory of Open Access Journals (Sweden)

    Serra Raffaele

    2015-01-01

    Full Text Available Introduction: An arteriovenous fistula (AVF for placed for hemodialysis may be burdened by one particular complication-the formation of a venous aneurysm. It has been shown that matrix metalloproteinases (MMPs and neutrophil gelatinase-associated lipocalin (NGAL could represent markers of disease in both venous and arterial vessels.

  8. A Forgotten Guidewire: Complication of Central Venous Catheterization

    Directory of Open Access Journals (Sweden)

    Funda Gümüş

    2011-08-01

    Full Text Available Central venous catheterization is an invasive procedure commonly preferred for hemodynamic monitorization, total parenteral nutrition, cardiac pacemaker implantation, long-term use of vasoactive or irritating agents and hemodialysis. We present a 19-year-old woman with acute renal failure scheduled for hemodialysis catheterization. A catheter guidewire extending from the right internal jugular vein to the right external iliac vein was detected in the chest X-ray, taken two hours following catheterization after occurrence of arrhythmia and hypotension. Catheteter guidewire was extracted noninvasively without any complications. Most common reasons for this complication are stated to be attention deficits, lack of experience, overtired staff, and inadequate supervision of trainees. In this paper, we discussed this complication’s causes and preventive methods. (Journal of the Turkish Society Intensive Care 2011; 9:64-7

  9. Hematologic patients' clinical and psychosocial experiences with implanted long-term central venous catheter

    DEFF Research Database (Denmark)

    Møller, Tom; Adamsen, Lis

    2010-01-01

    A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients.......A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients....

  10. Human cerebral venous outflow pathway depends on posture and central venous pressure

    DEFF Research Database (Denmark)

    Gisolf, J; van Lieshout, J J; van Heusden, K; Pott, F; Stok, W J; Karemaker, J M

    Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture...... subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the...

  11. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    International Nuclear Information System (INIS)

    The purpose of the study is to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency, a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5F angiographic catheters (pigtail, Sos Omni), goose-neck snare, or combinations thereof. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients, port catheter malposition correction was not possible because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. In migrated catheter tips, radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis, port catheter correction is often more challenging

  12. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    International Nuclear Information System (INIS)

    Purpose. The purpose of this study was to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Materials and Methods. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5-F angiographic catheters (pigtail; Sos Omni), gooseneck snares, or combinations thereof. Results. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients port catheter malposition correction was not possible, because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. Conclusions. We conclude that in migrated catheter tips radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis port catheter correction is often more challenging

  13. Important aspects of the colonization of central venous catheter.

    Science.gov (United States)

    Andreoli-Pinto, T J; Graziano, K U

    1999-01-01

    This study comprises five different kind of venous central catheters, 103 in total, made of Polyurethane Tecoflex, Polyurethane Vialon, PTFE and PVC, and the influence of their raw material on the microbial colonization. Patients age and sex, besides their clinical conditions, were taken into account, and neither considered as a sample vicious, nor associated with colonization. When the tips of the catheters were asseptically inoculated in Tryptic Soy Broth and Tioglicolate, colonization was detected in 15.5% of the catheters. Coagulase negative Staphylococcus, some of which with biofilm, were the predominant organisms found, although some bacillus have also been detected: Enterobacter aerogenes, Hafnia alvei, Pseudomonas cepacia, Xanthomonas maltophilia and Aeromonas sobria. It was not possible to notice any association between the colonization of the catheters and their raw material, probably due to the influence of a previous contact and linking with blood components. This contact causes a thin coating on the surface of the cathether, which makes all the catheters similar in respect of the attachment of a bacterial cell. So, the colonization depends on the virulence of the organism, much more then on the nature of the catheter. PMID:10326311

  14. Factors Affecting Longevity of Tunneled Central Venous Cathe

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Won; Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2011-12-15

    To evaluate factors which affect the longevity of tunneled central venous catheters (T-CVCs). A retrospective study was conducted on 363 T-CVCs. We evaluated the relevant factors affecting the longevity of the T-CVCs, such as age, gender, indication for catheterization, site of entry vessel, diameter and type of T-CVC, catheter tip position, and underlying diseases. Of the 363 T-CVCs which had been inserted, 331 (91%) were placed through the right internal jugular vein (RIJV). The catheter tip position was the strongest predictor for the longevity of the T-CVC. The short limb of the catheter tip placed either at the cavoatrial junction (CA junction) or below the lower margin of the right main bronchus had a good prognosis. The vessel through which the T-CVC was placed significantly influenced the longevity of the T-CVC; the RIJV was associated with better results than the left internal jugular vein. Also, a split-type catheter was significantly associated with a better result. A two distinct and separate type T-CVC placed through the RIJV in which the short limb catheter tip position was at the level of the CA junction, significantly increased the longevity of T-CVCs.

  15. Superior thyroid artery pseudoaneurysm and arteriovenous fistula following attempted internal jugular venous access and its management

    Directory of Open Access Journals (Sweden)

    Pushpinder Singh Khera

    2015-01-01

    Full Text Available Vascular injury during common jugular venous (IJV access is a rare complication, usually involving injury to the common carotid artery. We describe a previously unreported complication of iatrogenic injury of IJV access involving a branch of the superior thyroid artery, and its endovascular management.

  16. The accuracy of the central landmark used for central venous catheterization of the internal jugular vein.

    Science.gov (United States)

    Bailey, Peter L; Whitaker, Emmett E; Palmer, Linda S; Glance, Laurent G

    2006-05-01

    We simulated needle paths based on the central landmark used for central venous catheterization of the internal jugular vein. We obtained ultrasound images to quantify the landmark's accuracy (precision and bias) in 107 subjects placed in Trendelenburg position with their heads turned 30-35 degrees. We also determined the frequency of simulated carotid artery puncture. The simulated needle path missed the middle 80% of the lumen of the internal jugular vein in 34% of subjects (95% confidence interval [CI], 25% to 44%) and traversed the carotid artery in 26% of subjects (95% CI, 18% to 35%). Both events occurred in 20% of subjects (95% CI, 13%-29%). The landmark had a medial bias of 3.7 mm (95% CI, 2.7 to 4.8); it was more often (77 of 104 subjects) medial to the center of the right internal jugular vein (P yield frequent success on first needle pass without risk of carotid puncture because of its imprecision and bias. The measured bias should be considered when the central landmark is used for central venous catheterization. PMID:16632804

  17. Preparation of Candida albicans Biofilms Using an in vivo Rat Central Venous Catheter Model

    OpenAIRE

    Taff, Heather T; Marchillo, Karen; Andes, David R.

    2013-01-01

    In vivo biofilms grown on medical devices are necessary to understand the interactions of the fungal biofilm and the host environment in which it is most commonly found. This protocol describes a way to grow Candida albicans biofilms on the interior lumen of central venous catheters surgically implanted into rats, which mimics quite well the clinical cases of biofilms found on human central venous catheters. These infected catheters can then be studied via a multitude of different experiments...

  18. Acute effects of haemodialysis on central venous and arterial pressure characteristics

    OpenAIRE

    Thalhammer, Christoph; Segerer, Stephan; Augustoni, Marlene; Jacomella, Vincenzo; Clemens, Robert K; Wüthrich, Rudolf P.; Amann-Vesti, Beatrice R; Husmann, Marc

    2015-01-01

    BACKGROUND Hemodynamic stability of patients during dialysis sessions is of pivotal importance in daily practice and accurate determination of dry weight (DW) remains a challenge. Little information is available about central venous and aortic pressure during dialysis. In this pilot study we used a new non-invasive technique to describe the changes in central venous pressure (CVP) during dialysis. METHODS An ultrasound-assisted silicon-based pressure-manometer was used at the contralateral...

  19. Low central venous pressure reduces blood loss in hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Wei-Dong Wang; Li-Jian Liang; Xiong-Qing Huang; Xiao-Yu Yin

    2006-01-01

    AIM: To investigate the effect of low central venous pressure (LCVP) on blood loss during hepatectomy for hepatocellular carcinoma (HCC).METHODS: By the method of sealed envelope,50 HCC patients were randomized into LCVP group (n = 25) and control group (n = 25). In LCVP group,CVP was maintained at 2-4 mmHg and systolic blood pressure (SBP) above 90 mmHg by manipulation of the patient's posture and administration of drugs during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. The patients'preoperative conditions, volume of blood loss during hepatectomy, volume of blood transfusion, length of hospital stay, changes in hepatic and renal functions were compared between the two groups.RESULTS: There were no significant differences in patients' preoperative conditions, maximal tumor dimension, pattern of hepatectomy, duration of vascular occlusion, operationtime, weight of resected liver tissues, incidence of post-operative complications, hepatic and renal functions between the two groups. LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group, being 903.9±180.8 mL vs 2 329.4±2 538.4(W=495.5, P<0.01) and 672.4±429.9 mL vs1 662.6± 1932.1 (W=543.5, P<0.01). There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups. The length of hospital stay was significantly shortened in LCVP group as compared with the control group, being 16.3±6.8 d vs21.5 ± 8.6 d (W= 532.5, P<0.05).CONCLUSION: LCVP is easily achievable in technique.Maintenance of CVP≤4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function.

  20. Evaluation of a percutaneously placed 27-gauge central venous catheter in neonates weighing less than 1200 grams.

    Science.gov (United States)

    Nakamura, K T; Sato, Y; Erenberg, A

    1990-01-01

    A percutaneous 27-gauge OD central venous catheter was inserted at 4 +/- 3 (SD) days of age and left in place for up to 2 weeks in 20 neonates with birth weights less than 1200 g and greater than 24 h of age. Parenteral nutritional solutions and medications were administered through these catheters. Twenty neonates matched for birth weight and gestational age served as paired controls. In vitro studies demonstrate that the maximum infusion rate for parenteral nutrition solutions is about 20 ml/hr. Packed red blood cells could not be infused through these catheters. In vivo results demonstrate a significant (p less than 0.05) reduction in number of peripheral iv catheters inserted during study (2 +/- 1 vs 7 +/- 4, SD) with no difference in cost per day of iv access ($79.42 +/- 113.51 vs $43.91 +/- 15.99, SD). Two-dimensional ultrasound assessment of catheter thrombosis was unsuccessful. Moreover, there was no correlation between angiographic and electron microscopic evaluation of catheter tip thrombosis. Electron microscopy of catheter tips revealed 33% with complete, partial and no occlusion, respectively, and 39% with sheath thrombosis. In summary, percutaneous insertion of a 27-gauge OD Vialon central venous catheter is a feasible alternative in providing venous access in very low birth weight infants. PMID:2112646

  1. Repositioning and Leaving In Situ the Central Venous Catheter During Percutaneous Treatment of Associated Superior Vena Cava Syndrome: A Report of Eight Cases

    International Nuclear Information System (INIS)

    Purpose: To describe a combined procedure of repositioning and leaving in situ a central venous catheter followed by immediate percutaneous treatment of associated superior vena cava syndrome (SVCS). Methods: Eight patients are presented who have central venous catheter-associated SVCS (n = 6 Hickman catheters, n = 2 Port-a-cath) caused by central vein stenosis (n = 4) or concomitant thrombosis (n = 4). With the use of a vascular snare introduced via the transcubital or transjugular approach, the tip of the central venous catheter could be engaged, and repositioned after deployment of a stent in the innominate or superior vena cava. Results: In all patients it was technically feasible to reposition the central venous catheter and treat the SVCS at the same time. In one patient flipping of the Hickman catheter in its original position provoked dislocation of the released Palmaz stent, which could be positioned in the right common iliac vein. Conclusion: Repositioning of a central venous catheter just before and after stent deployment in SVCS is technically feasible and a better alternative than preprocedural removal of the vascular access

  2. Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Christidou, Fotini P. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Kalpakidis, Vasilios I. [Department of Radiology, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Iatrou, Kostas D. [Department of Radiology, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Zervidis, Ioannis A. [Department of Radiology, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Bamichas, Gerasimos I. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Gionanlis, Lazaros C. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Natse, Taisir A. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece); Sombolos, Kostas J. [Renal Unit, G.H. ' G. Papanikolaou' , Thessaloniki (Greece)]. E-mail: sobolos@spark.net.gr

    2006-05-15

    Aim of the study: To present our experience with PTA and venous stenting in hemodialysis patients with vascular access (VA) related venous stenosis or occlusion. Patients - methods: We studied retrospectively 22 hemodialysis patients with VA-related venous stenosis or occlusions that were treated with PTA and subsequent stenting. The following lesions were detected by digital subtraction venography: occlusion of the brachiocephalic and/or subclavian veins in four patients, stenosis (80-90%) of the same veins in 10 patients, stenosis (80-95%) of the axillary vein in four patients, brachial vein stenosis in two patients, and cephalic vein stenosis in two patients. The follow-up period ranged from 3 to 29 months (mean 15.4 {+-} 9.8 months). Primary and cumulative stent patency was recorded. Results: Twenty-two primary venous PTA-stent implantation procedures were performed using 25 stents. The initial deployment of these 25 stents was technically successful, with complete opening (>80%) of the vein's lumen in all but one patient (95.4%). The patency of the vein immediately after the stenting procedure was greater than 90% in 13 patients, 80-90% in eight patients, and less than 40% in the case involving failure. Seventeen episodes of re-obstruction occurred in 13 patients (59%), and all were treated with the same PTA-stent procedures. At the end of the study period 47 stents had been placed in patients. The 3, 6, 12 and 24-month primary patency rates were 88.3%, 65.3%, 45.6% and 25.5%, respectively. Overall cumulative stent patency was 95.4% after 3 months, 79% after 6 months, 74% after 12 months, and 62.8% after 24 months. Conclusion: PTA with primary venous stenting is an effective method for the treatment of VA-related stenosis or occlusion. However, repeat and sometimes multiple interventions are usually needed for the treatment of re-stenosis or re-occlusion episodes.

  3. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Shamit S., E-mail: shamit.desai@northwestern.edu [Northwestern Memorial Hospital, Department of Radiology (United States); Konanur, Meghana [Northwestern University Feinberg School of Medicine (United States); Foltz, Gretchen [Mallinckrodt Institute of Radiology at Washington University, Interventional Radiology (United States); Malaisrie, S. Chris [Northwestern Memorial Hospital, Department of Cardiothoracic Surgery (United States); Resnick, Scott, E-mail: sresnick@northwestern.edu [Northwestern University Feinberg School of Medicine, Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital (United States)

    2016-03-15

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  4. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    International Nuclear Information System (INIS)

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period

  5. Bloodstream infections related to totally implantable venous access port: What is the situation in our hospital?

    OpenAIRE

    Desgranges F.

    2012-01-01

    Port-a-Cath© (PAC) are totally implantable devices that offer an easy and long term access to venous circulation. They have been extensively used for intravenous therapy administration and are particularly well suited for chemotherapy in oncologic patients. Previous comparative studies have shown that these devices have the lowest catheter-related bloodstream infection rates among all intravascular access systems. However, bloodstream infection (BSI) still remains a major issue of port use an...

  6. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.

    Science.gov (United States)

    Frykholm, P; Pikwer, A; Hammarskjöld, F; Larsson, A T; Lindgren, S; Lindwall, R; Taxbro, K; Oberg, F; Acosta, S; Akeson, J

    2014-05-01

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should

  7. Management Of Fever And Suspected Infection In Pediatric Patients With Central Venous Catheters.

    Science.gov (United States)

    Brennan, Courtney; Wang, Vincent J

    2015-12-01

    The use of indwelling central venous catheters is essential for pediatric patients who require hemodialysis, parenteral nutrition, chemotherapy, or other medications. Fever is a common chief complaint in the emergency department, and fever in a patient with a central venous catheter may be related to a common cause of fever, or it may be due to a catheter-associated bloodstream infection. Catheter-associated bloodstream infections may also lead to additional complications such as sepsis, septic shock, or septic complications including suppurative thrombophlebitis, endocarditis, osteomyelitis, septic emboli, and abscesses. Early resuscitation as well as timely and appropriate antibiotic therapy have been shown to improve outcomes. This issue focuses on the approach to fever in pediatric patients with central venous catheters and the management and disposition of patients with possible catheter-associated bloodstream infections. PMID:26569627

  8. Clinical predictors of a low central venous oxygen saturation after major surgery: a prospective prevalence study.

    Science.gov (United States)

    Litton, E; Silbert, B; Ho, K M

    2015-01-01

    Optimising perioperative haemodynamic status may reduce postoperative complications. In this prospective prevalence study, we investigated the associations between standard haemodynamic parameters and a low central venous oxygen saturation (ScvO2) in patients after major surgery. A total of 201 patients requiring continuous arterial and central venous pressure monitoring after major surgery were recruited. Simultaneous arterial and central venous blood gases, haemodynamic and biochemical data and perfusion index were obtained from patients at a single time-point within 24 hours of surgery. A low ScvO2 (ventilation, mean arterial pressure, central venous pressure, haemoglobin concentrations, arterial pH and lactate concentrations, arterial oxygen (PaO2) and carbon dioxide tensions (PaCO2) were all associated with a low ScvO2 in the univariate analyses. In the multivariate analysis, only a higher perfusion index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78 to 0.98), PaO2 (OR 0.98 per mmHg increment, 95% CI 0.97 to 0.99) and PaCO2 (OR 0.88 per mmHg increment, 95% CI 0.82 to 0.95) and a lower central venous pressure (OR 1.14 per mmHg increment, 95% CI 1.04 to 1.25) were significantly associated with a reduced risk of a low ScvO2, all in a linear fashion. In conclusion, PaO2, PaCO2, perfusion index and central venous pressure were significant predictors of a low ScvO2 in patients after major surgery including cardiac surgery. PMID:25579290

  9. Biofilm formation in long-term central venous catheters in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter;

    2012-01-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin ...

  10. Part versus Whole: A Randomized Trial of Central Venous Catheterization Education

    Science.gov (United States)

    Chan, Angela; Singh, Sunita; Dubrowski, Adam; Pratt, Daniel D.; Zalunardo, Nadia; Nair, Parvarthy; McLaughlin, Kevin; Ma, Irene W. Y.

    2015-01-01

    Central venous catheterization (CVC) is a complex but commonly performed procedure. How best to teach this complex skill has not been clearly delineated. We conducted a randomized trial of the effects of two types of teaching of CVC on skill acquisition and retention. We randomly assigned novice internal medicine residents to learning CVC in-part…

  11. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Frydenberg, Morten;

    2010-01-01

    BACKGROUND: Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter. PROCEDURE: All...

  12. Catheter fracture and embolization from totally implanted venous access ports--case reports.

    Science.gov (United States)

    Vadlamani, P; Dawn, B; Perry, M C

    1998-12-01

    Totally implanted venous access ports are excellent devices for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter fracture and embolization are rare and potentially serious complications of these widely used devices. Retrieval of the embolized fragment is generally indicated but may not be possible. The authors report three cases of catheter embolization in their center over a period of 9 years. Catheter "pinch-off," fracture, embolization, and retrieval are discussed. PMID:9855376

  13. Incidence and Risk Factors of Infectious Complications Related to Implantable Venous-Access Ports

    OpenAIRE

    Shim, Jisue; Seo, Tae-Seok; Song, Myung Gyu; Cha, In-Ho; Kim, Jun Suk; Choi, Chul Won; Seo, Jae Hong; Oh, Sang Cheul

    2014-01-01

    Objective The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs). Materials and Methods From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were remov...

  14. Implantation of venous access devices under local anesthesia: patients’ satisfaction with oral lorazepam

    Directory of Open Access Journals (Sweden)

    Chang DH

    2015-07-01

    Full Text Available De-Hua Chang,1 Sonja Hiss,1 Lena Herich,2 Ingrid Becker,2 Kamal Mammadov,1 Mareike Franke,1 Anastasios Mpotsaris,1 Robert Kleinert,3 Thorsten Persigehl,1 David Maintz,1 Christopher Bangard1 1Department of Radiology, 2Institute of Medical Statistics, Informatics and Epidemiology, 3Department of Surgery, University Hospital of Cologne, Cologne, Germany Objective: The aim of the study reported here was to evaluate patients’ satisfaction with implantation of venous access devices under local anesthesia (LA with and without additional oral sedation.Materials and methods: A total of 77 patients were enrolled in the prospective descriptive study over a period of 6 months. Subcutaneous implantable venous access devices through the subclavian vein were routinely implanted under LA. Patients were offered an additional oral sedative (lorazepam before each procedure. The level of anxiety/tension, the intensity of pain, and patients’ satisfaction were evaluated before and immediately after the procedure using a visual analog scale (ranging from 0 to 10 with a standardized questionnaire.Results: Patients’ satisfaction with the procedure was high (mean: 1.3±2.0 with no significant difference between the group with premedication and the group with LA alone (P=0.54. However, seven out of 30 patients (23.3% in the group that received premedication would not undergo the same procedure without general anesthesia. There was no significant influence of lorazepam on the intensity of pain (P=0.88. In 12 out of 30 patients (40% in the premedication group, the level of tension was higher than 5 on the visual analog scale during the procedure. In 21 out of 77 patients (27.3%, the estimate of the level of tension differed between the interventionist and the patient by 3 or more points in 21 out of 77 patients (27.3%.Conclusion: Overall patient satisfaction is high for implantation of venous access devices under LA. A combination of LA with lorazepam administered

  15. Comparison of the Complications of Central Vein Catheters and Arterio-Venous Fistulae in Children on Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    F Ghane Sherbaf

    2006-08-01

    Full Text Available Background: Complications related to vascular access are among the most important causes of morbidity in children chronically on hemodialysis. This study was designed to determine the prevalence of the central vein catheters (CVC and arterio-venous fistulae (AVF in children on chronic hemodialysis. Methods: This study includes 68 children who have been treated with hemodialysis in Dr. Sheikh Hospital, Mashhad, Iran, during 2000-2005. Physical examination, clinical and paraclinical findings were recorded in special charts. Findings: Out of 68 patients treated with hemodialysis 29 (42.6% were female and 39 (57.3% male. The average duration time of hemodialysis was 15.8 months. Before performing AVF, the central venous catheters were placed in subclavian vein in 28 patients (41.1% and internal jugular vein in 26 patients (38.2%. The fistula placed was radio-cephalic in 29 (42.6% and brachio-basilic in 33 children (48.5%. 48 patients (77.4% underwent only one surgery for AVF. The most frequent complications of central venous catheters were: catheter infection (48.1%, inadvertent extraction of the catheters (7.4%, cardiac arrhythmia (1.8% and hemothorax (1.8%. The most common complications of AVF in decreasing order of frequency were: non-functional fistula due to thrombosis or hematoma (20.9%, infection (12.9%, aneurysms (11.2% and ischemia of the hand presenting as paresthesia, dysesthesia and pain (11.2%. Overall, 10 (18.5% patients were hospitalized due to the complications of CVC and 20 (29.4% for the complications of AVF. Conclusion: The most frequently observed complications of CVC and AVF were catheter infection and non-functional fistula. The risk factors for AVF dysfunction were young age, hypotension and hemodialysis without administration of heparin.

  16. Pyoderma gangrenosum after totally implanted central venous access device insertion

    OpenAIRE

    Hagen Monica E; Braun Rolf; Myers Patrick O; Inan Ihsan; Morel Philippe

    2008-01-01

    Abstract Background Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25–50% of cases, a triggering factor such as recent surgery or trauma is identified....

  17. Washing of gloved hands in antiseptic solution prior to central venous line insertion reduces contamination.

    Science.gov (United States)

    Kocent, H; Corke, C; Alajeel, A; Graves, S

    2002-06-01

    Glove contamination at the time a central venous catheter is handled is highly undesirable and likely to increase the risk of subsequent line infection. This study was designed to determine how frequently gloves become contaminated during central venous line insertion and to demonstrate the value of glove decontamination immediately prior to handling of the central venous catheter During twenty routine internal jugular catheter insertions the sterility of the operator's gloved fingertips (just prior to handling the intravenous catheter) was assessed by touching the fingertips onto blood agar plates. The gloved hands were then rinsed in chlorhexidine/alcohol and after drying were placed onto a further plate. Contamination was detected in 55% of the prewash plates but in none of the postwash plates. Procedures performed by less experienced resident staff had a higher contamination rate despite there being no evident breach of sterile technique. It is likely that glove contamination results from the persistance of bacteria within the deeper layers of the skin, despite surface disinfection. These bacteria may be released by manipulation of the skin when identifying landmarks. This hypothesis was supported by a subsequent observation that gloves were more highly contaminated after firm touching of the skin rather than light touching. Glove contamination during central line insertion is frequent. Catheter contamination rates could be reduced (without risk or additional cost) by rinsing gloved hands in a solution of chlorhexidine (0.5%) in alcohol (70%) prior to handling the catheter. PMID:12075642

  18. Depth of insertion of right internal jugular central venous catheter: Comparison of topographic and formula methods

    Science.gov (United States)

    Vinay, M; Tejesh, CA

    2016-01-01

    Background: Central venous catheters (CVCs) are inserted in many critically ill patients, but there is no gold standard in estimating their approximate depth of insertion. Many techniques have been described in literature. In this study, we compare the topographic method with the standard formula technique. Materials and Methods: 260 patients, in whom central venous catheterization was warranted, were randomly assigned to either topographic method or formula method (130 in each group). The position of the CVC tip in relation to carina was measured on a postprocedure chest X-ray. The primary endpoint was the need for catheter repositioning. Results: The majority of the CVCs tips positioned by the formula method were situated below the carina, and 68% of these catheters required repositioning after obtaining postprocedure chest X-ray (P formula approach in estimating the depth of insertion of right internal jugular CVCs.

  19. PROPHYLACTIC ADMINISTRATION OF DOXYCYCLINE REDUCES CENTRAL VENOUS CATHETER INFECTIONS IN PATIENTS UNDERGOING HEMATOPOIETIC CELL TRANSPLANTATION

    OpenAIRE

    Mohamed Kharfan-Dabaja; Mohamed Baydoun; Zaher Otrock; Samar Okaily; Rita Nehme; Racha Abu-Chahine; Ali Hamdan; Samar Noureddine; Souha Kanj; Zeina Kanafani; Ali Bazarbachi

    2013-01-01

    Hematopoietic stem cells are usually transfused through a central venous catheter (CVC), which also facilitates administration of medications and intravenous fluids. We had observed high rate of catheter-related blood-stream infection (CR-BSI) at our Bone Marrow Transplantation (BMT) unit despite prescribing fluoroquinolones for anti-bacterial prophylaxis. Accordingly, we implemented prophylactic use of a relatively inexpensive broad spectrum antibiotic, namely doxycycline to address this pro...

  20. Prophylactic Administration of Doxycycline Reduces Central Venous Catheter Infections in Patients Undergoing Hematopoietic Cell Transplantation

    OpenAIRE

    Baydoun, Mohamed; Otrock, Zaher K.; Okaily, Samar; Nehme, Rita; Abu-Chahine, Racha; Hamdan, Ali; Noureddine, Samar; Kanj, Souha; Kanafani, Zeina; Bazarbachi, Ali; Kharfan-Dabaja, Mohamed A.

    2013-01-01

    Hematopoietic stem cells are generally transfused through a central venous catheter (CVC), which also facilitates administration of medications and intravenous fluids. We had observed a high rate of CVC infections at our Bone Marrow Transplantation (BMT) unit. Accordingly, we evaluated the impact of administration of doxycycline as a prophylactic strategy to reduce CVC infection rates. Data was collected retrospectively on 54 consecutive patients, 26 who received doxycycline (doxycycline grou...

  1. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    Science.gov (United States)

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25507120

  2. Development and Characterization of an In Vivo Central Venous Catheter Candida albicans Biofilm Model

    OpenAIRE

    Andes, D.; Nett, J.; Oschel, P.; Albrecht, R.; Marchillo, K.; Pitula, A.

    2004-01-01

    Biofilms represent a niche for microorganisms where they are protected from both the host immune system and antimicrobial therapies. Biofilm growth serves as an increasing source of clinical infections. Candida infections are difficult to manage due to their persistent nature and associated drug resistance. Observations made in biofilm research have generally been limited to in vitro models. Using a rat central venous catheter model, we characterized in vivo Candida albicans biofilm developme...

  3. End expiratory oxygen concentrations to predict central venous oxygen saturation: an observational pilot study

    OpenAIRE

    Steuerwald Michael; Kuehne Karl; Jones Alan E; Kline Jeffrey A

    2006-01-01

    Abstract Background A non-invasive surrogate measurement for central venous oxygen saturation (ScVO2) would be useful in the ED for assessing therapeutic interventions in critically ill patients. We hypothesized that either linear or nonlinear mathematical manipulation of the partial pressure of oxygen in breath at end expiration (EtO2) would accurately predict ScVO2. Methods Prospective observational study of a convenience sample of hemodialysis patients age > 17 years with existing upper ex...

  4. Catheter-induced thrombosis in the atrium after central contrast medium injection for venous DSA

    International Nuclear Information System (INIS)

    During bolus injection for central venous DSA, the high flow rates may cause a jet effect and a whipping movement with subsequent, partial bending up of the pigtail catheter. The paper reports two cases where penetration of catheter tip into the lateral atrial wall has led to intramural contrast extravasation and subsequent formation of a thrombus adherent to the wall. In order to prevent myocardial perforation, a modified placement of the catheter is suggested as a possible and simple method. (orig.)

  5. Percutaneous transluminal angioplasty and stent insertion in central venous steno-occlusion

    International Nuclear Information System (INIS)

    To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) and stent insertion in central venous steno-occlusion. Between August 1992 and January 1998, 11 patients with symptomatic central venous steno-occlusion (six stenoses and five occlusions) underwent pereutaneous treatment. Eleven PTAs were performed and stents were introduced in two patients because of incomplete PTA. During follow-up, a total of eight revisions were performed in five patients with recurrence (six stenoses and two occlusions). Success and long term patency rates were evaluated. The length and degree of the lesion and degree of residual stenosis, as well as pressure gradient through the lesion and decrease of the gradient after PTA, were correlated with patency rates. Complications during the procedures and follow-up period were evaluated. The overall success rate was 89.5%;those of primary and revision intervention were 90. 9% and 87.5%, respectively. Primary and revision patency rates were 72.7% and 50%, respectively, at 6months, and 40% and 25% at 12 months. In five patients who underwent revision, primary and secondary patency rates were 80% and 100% at 6months, 40% and 80% at 12 months, and 0% and 60% at 18 months. Only reduction of the pressure gradient after PTA correlated significantly with patency rates. No significant complications observed during the procedures follow-up period. PTA and stent insertion is effective for the treatment of central venous steno-occlusion.=20

  6. The first reported case of central venous catheter-related fungemia caused by Cryptococcus liquefaciens.

    Science.gov (United States)

    Takemura, Hiromu; Ohno, Hideaki; Miura, Ikuo; Takagi, Taeko; Ohyanagi, Tadatomo; Kunishima, Hiroyuki; Okawara, Akiko; Miyazaki, Yoshitsugu; Nakashima, Hideki

    2015-05-01

    We describe a case of central venous catheter-related fungemia caused by Cryptococcus liquefaciens, a non-neoformans and non-gattii Cryptococcus, in a non-HIV patient. A 71-year-old man with diffuse large B-cell lymphoma receiving antineoplastic chemotherapy was febrile approximately 30 weeks after central venous port insertion, and C. liquefaciens was isolated from all three performed blood cultures as well as a central venous catheter tip culture. In vitro antifungal susceptibility tests showed that this yeast isolate was susceptible to low concentrations of amphotericin B, fluconazole, itraconazole and voriconazole yet was resistant to 5-fluorocytosine (MIC: >64 μg/ml), unlike Cryptococcus neoformans. Treatment of the patient with oral and intravenous voriconazole was effective and consistent with the susceptibility tests. Although non-neoformans and non-gattii Cryptococcus spp. are considered non-pathogenic environmental yeast, they may rarely be the causative agents of serious infections in humans, as in the present case. PMID:25499194

  7. Chlorhexidine and gauze and tape dressings for central venous catheters: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Edivane Pedrolo

    2014-10-01

    Full Text Available OBJECTIVE: to assess the effectiveness of the chlorhexidine antimicrobial dressing in comparison to the gauze and tape dressing in the use of central venous catheters.METHOD: a randomized clinical trial was conducted in the intensive care and adult semi intensive care units of a university hospital in the south of Brazil. The subjects were patients using short-term central venous catheters, randomly assigned to the intervention (chlorhexidine antimicrobial dressing or control (gauze and micro porous tape groups.RESULTS: a total of 85 patients were included: 43 in the intervention group and 42 in the control group. No statistically significant differences were found between dressings in regard to the occurrence of: primary bloodstream infections (p-value = 0.5170; local reactions to the dressing (p-value = 0.3774; and dressing fixation (p-value = 0.2739.CONCLUSION: both technologies are effective in covering central venous catheters in regard to the investigated variables and can be used for this purpose. Registry ECR: RBR-7b5ycz.

  8. (Mis)placed central venous catheter in the left superior intercostal vein

    International Nuclear Information System (INIS)

    Chest X-ray is routinely performed to check the position of the central venous catheter (CVC) inserted through the internal jugular or subclavian vein, while the further evaluation of CVC malfunction is usually performed by contrast venography. In patients with superior vena cava obstruction, the tip of the catheter is often seen in collateral mediastinal venous pathways, rather than in the superior vena cava. In such cases detailed knowledge of thoracic vessel anatomy is necessary to identify the exact location of the catheter. We report a case of 32-year-old female patient with relapsing mediastinal lymphoma and previous superior vena cava obstruction with collateral azygos-hemiazygos venous pathways. The patient had CVC inserted through the left subclavian vein and its position was detected by CT to be in the dilated left superior intercostal vein and accessory hemiazygos vein. Considering that dilated accessory hemiazygos vein can tolerate infusion, the CVC was left in place and the patient had no complaints related to CVC (mal)position. Furthermore, we present anatomical and radiological observations on the azygos-hemiazygos venous system with the special emphasis on the left superior intercostal vein. Non-contrast CT scans can be a valuable imaging tool in the detection of the CVC position, especially in patients with renal insufficiency and contrast media hypersensitivity

  9. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

    International Nuclear Information System (INIS)

    Background: Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). Purpose: To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Material and Methods: Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Results: Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. Conclusion: CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi

  10. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, Orlando; Castelguidone, Elisabetta de Lutio di; Granata, Vincenza; D' Errico, Adolfo Gallipoli (Dept. of Radiology, National Cancer Institute ' Fondazione G Pascale' (Italy)), email: orlandcat@tin.it; Sandomenico, Claudia (Dept. of Esophago-gastro-bilio-pancreatic Oncology, National Cancer Institute ' Fondazione G Pascale' (Italy)); Petrillo, Mario (Dept. of Radiology, Second Univ. of Naples (Italy)); Aprea, Pasquale (Dept. of Critical Illness and Anaesthesiology, National Cancer Institute ' Fondazione G Pascale' , Naples, (Italy))

    2011-02-15

    Background: Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). Purpose: To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Material and Methods: Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Results: Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. Conclusion: CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi

  11. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults

    OpenAIRE

    Lopez-Briz, E. (Eduardo); Ruiz Garcia, V.; Cabello, J. B.; Bort-Marti, S.; Carbonell Sanchis, R.; Burls, A

    2014-01-01

    Background Heparin intermittent flushing is a standard practice in the maintenance of patency in central venous catheters. However, we could find no systematic review examining its effectiveness and safety. Objectives To assess the effectiveness of intermittent flushing with heparin versus 0.9% sodium chloride (normal saline) solution in adults with central venous catheters in terms of prevention of occlusion and overall benefits versus harms. Search methods The Cochrane Peri...

  12. 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.

  13. Retrospective analysis of intravertebral collateral enhancement in patients with central venous obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Chang, Connie Y.; Huang, Ambrose J.; Kattapuram, Susan V.; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Bennett, Debbie L. [Saint Louis University School of Medicine, Department of Radiology, Saint Louis, MO (United States)

    2016-02-15

    To compare prevalence and patterns of intravertebral collateral enhancement in patients with and without central venous obstruction (CVO). Chest CTs performed between 1/1/2000 and 12/15/2012 with reports containing terms indicating CVO were identified. All contrast enhanced CTs were examined for the presence of CVO and collateral venous pathways. If intravertebral collateral enhancement was present, the pattern was recorded as nodular, linear, or both. In 209 suspected cases of CVO, 53 (25 %) were confirmed with obstruction and 156 (75 %) were without obstruction. In patients with CVO, 47 % (25/53) demonstrated collateral venous flow through an intravertebral marrow pathway compared to 5 % (8/156) of patients without CVO (P < 0.0001). The most common level of enhancement was the upper thoracic spine, involving only the vertebral body. Nodular, linear, and combined nodular-linear enhancement patterns were seen with similar frequency. Nodular intravertebral collateral enhancement was mistaken for sclerotic metastases in 33 % (3/9) of cases. Intravertebral collateral enhancement was seen in almost half the patients with CVO and when nodular enhancement is present, it is important to differentiate between metastatic lesions and enhancement related to CVO. (orig.)

  14. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

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    Ugas Mohamed

    2012-09-01

    Full Text Available Abstract Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

  15. Comparison of Ultrasonography-Guided Central Venous Catheterization Between Adult and Pediatric Populations

    International Nuclear Information System (INIS)

    The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, and rate of single wall puncture were 99.4%, 1.04 (range, 1-3), and 83% for adults and 90.3%, 1.25 (range, 1-5), and 49% for children, respectively. All the differences were statistically significant (p 0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups

  16. Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography; Tamponamento cardiaco durante infusao de contraste em acesso venoso central para realizacao de tomografia computadorizada do torax em lactente

    Energy Technology Data Exchange (ETDEWEB)

    Daud, Danilo Felix; Campos, Marcos Menezes Freitas de; Fleury Neto, Augusto de Padua [Hospital Geral de Palmas, TO (Brazil)

    2013-11-15

    Complications from central venous catheterization include infectious conditions, pneumothorax, hemothorax and venous thrombosis. Pericardial effusion with cardiac tamponade hardly occurs, and in infants is generally caused by umbilical catheterization. The authors describe the case of cardiac tamponade occurred in an infant during chest computed tomography with contrast infusion through a central venous catheter inserted into the right internal jugular vein. (author)

  17. Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging

    OpenAIRE

    Alberto Colombo; Giuseppe Maccari; Terenzio Congiu; Petra Basso; Andreina Baj; Antonio Toniolo

    2013-01-01

    The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC), indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-d...

  18. Risk factors associated with hemodialysis central venous catheter malfunction; a retrospective analysis of a randomized controlled trial

    OpenAIRE

    Ward, David R.; Moist, Louise M.; MacRae, Jennifer M; Scott-Douglas, Nairne; Zhang, Jianguo; Tonelli, Marcello; Lok, Charmaine E.; Soroka, Steven D; Hemmelgarn, Brenda R

    2014-01-01

    Background We previously reported a reduction in central venous catheter (CVC) malfunction when using once-weekly recombinant tissue-plasminogen activator (rt-PA) as a locking solution, compared with thrice-weekly heparin. Objectives To identify risk factors for CVC malfunction to inform a targeted strategy for rt-PA use. Design Retrospective analysis. Setting Canadian hemodialysis (HD) units. Patients Adults with newly placed tunnelled upper venous system CVCs randomized to a locking solutio...

  19. Complications after percutaneous placement of totally implantable venous access ports in the forearm

    International Nuclear Information System (INIS)

    This article focuses on radiological imaging of complications after interventional percutaneous insertion of totally implantable venous access ports (TIVAPs) which were placed in the forearm. Thus far most reviews have dealt with pectorally-placed TIVAPs. Compared with the pectoral approach, implantation in the forearm has been associated with certain complications owing to a longer route of the port catheter within a smaller vein, and owing to the route across the elbow joint, resulting in higher rates of catheter-associated thrombosis and possible mechanical complications. The purpose of this review is to describe the complications after implantation of TIVAPs in the forearm, and to make radiologists familiar with the key findings of the complications during radiological imaging, including colour-coded and compression Duplex ultrasound, computed tomography, and digital subtraction venography.

  20. Central venous infusion port inserted via high versus low jugular venous approaches: Retrospective comparison of outcome and complications

    International Nuclear Information System (INIS)

    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 puncture

  1. A Case of Unrecognized Intrathoracic Placement of a Subclavian Central Venous Catheter in a Patient with Large Traumatic Hemothorax

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    Dina Wallin

    2015-01-01

    Full Text Available Traditional recommendations suggest placement of a subclavian central venous catheter (CVC ipsilateral to a known pneumothorax to minimize risk of bilateral pneumothorax. We present the case of a 65-year-old male with a right hemopneumothorax who was found to have intrathoracic placement of his right subclavian CVC at thoracotomy despite successful aspiration of blood and transduction of central venous pressure (CVP. We thus recommend extreme caution with the interpretation of CVC placement by blood aspiration and CVP measurement alone in patients with large volume ipsilateral hemothorax.

  2. Rotura espontánea de catéter venoso central Spontaneous rupture of central venous catheter

    Directory of Open Access Journals (Sweden)

    M. A. Vidal

    2006-04-01

    retirada del catéter. El fragmento distal también debe extraerse y la técnica endovascular percutánea es de elección siempre que sea posible.Subcutaneous vascular access ports can be an alternative to conventional central venous lines, both for collection of blood samples and for the administration of intravenous therapies. In recent years, its use has become wider regardless of the possibility of risks and complications such as the rupture of the catheter. We report the case of a male patient diagnosed of oesophagous adenocarcinoma to whom a subcutaneous chamber catheter (Bard Port® Titanium Dome, catheter Groshong® for the administration of chemotherapy was implanted. One week afterwards, at the time of the first cycle of chemotherapy, the patient referred pain and signs of swelling at the implantation area. A routine x-ray control showed a rupture of the catheter at the costo-clavicular level with the distal end lodged in the superior vena cava. The findings were confirmed wit contrast x-ray. The reservoir and the proximal end of the catheter were removed in the operation room. The distal end of the catheter was removed through right femoral catheterism with a gooseneck catheter. The right subclavian vein is the central line most frequently chosen; the location of the device adjacent to the ribs and close to bone structures can facilitate the tear of its components. Diagnosis of central catheters rupture is based upon radiologic features such as the pinch off sign, caused by the friction of the catheter between the first rib and the clavicula. This complication merits an early diagnosis and the quick removal of the catheter. The distal end must also be withdrawn through a percutaneous endovas-cular technique when possible.

  3. A comparison of the priming properties of two central venous catheters and one pulmonary artery catheter.

    Science.gov (United States)

    Sanderson, P M

    1995-01-01

    The time taken to prime the individual lumina of two multilumen central venous catheters (Viggo-Spectramed 14G 20 cm Hydrocath and Vialon 14G 20 cm Deltacath) and one pulmonary artery catheter (Viggo-Spectramed 110 cm 7.5F Pentacath) at flows between 5 ml.h-1 and 99 ml.h-1 is reported. The catheters supplied by different manufacturers but of identical length and gauge have significantly different priming times (p < 0.001). A protocol which may be used to prime the individual lumina of the three catheters studied is described. By means of an in vitro test the accuracy of this protocol is validated. PMID:7702147

  4. Radiologic interventional retrieval of retained central venous catheter fragment in prematurity: case report

    International Nuclear Information System (INIS)

    The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity of air embolism occurred during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach

  5. Radiologic interventional retrieval of retained central venous catheter fragment in prematurity: case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jee Won; Jo, Jung Hyun; Park, Byeong Ho [College of Medicine, Dong-A University, Busan (Korea, Republic of)

    2007-12-15

    The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity of air embolism occurred during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach.

  6. A retrospective analysis of trabectedin infusion by peripherally inserted central venous catheters: a multicentric Italian experience.

    Science.gov (United States)

    Martella, Francesca; Salutari, Vanda; Marchetti, Claudia; Pisano, Carmela; Di Napoli, Marilena; Pietta, Francesca; Centineo, Dina; Caringella, Anna M; Musella, Angela; Fioretto, Luisa

    2015-10-01

    The European Medicines Agency strongly recommends administration of trabectedin through a central venous catheter (CVC) to minimize the risk of extravasation. However, CVCs place patients at risk of catheter-related complications and have a significant budgetary impact for oncology departments. The most frequently used CVCs are subcutaneously implanted PORT-chamber catheters (PORTs); peripherally inserted central venous catheters (PICCs) are relatively new. We reviewed data of trabectedin-treated patients to evaluate the relative cost-effectiveness of the use of PORTs and PICCs in six Italian centres. Data on 102 trabectedin-treated patients (20 with sarcoma, 80 with ovarian cancer and two with cervical cancer) were evaluated. Forty-five patients received trabectedin by a PICC, inserted by trained nurses using an ultrasound-guided technique at the bedside, whereas 57 patients received trabectedin infusion by a PORT, requiring a day surgery procedure in the hospital by a surgeon. Device dislocation and infections were reported in four patients, equally distributed between PORT or PICC users. Thrombosis occurred in a single patient with a PORT. Complications requiring devices removal were not reported during any of the 509 cycles of therapy (median 5; range 1-20). PICC misplacement or early malfunctions were not reported during trabectedin infusion. The cost-efficiency ratio favours PORT over PICC only when the device is used for more than 1 year. Our data suggest that trabectedin infusion by PICC is safe and well accepted, with a preferable cost-efficiency ratio compared with PORT in patients requiring short-term use of the device (≤1 year). PMID:26241804

  7. End expiratory oxygen concentrations to predict central venous oxygen saturation: an observational pilot study

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    Steuerwald Michael

    2006-09-01

    Full Text Available Abstract Background A non-invasive surrogate measurement for central venous oxygen saturation (ScVO2 would be useful in the ED for assessing therapeutic interventions in critically ill patients. We hypothesized that either linear or nonlinear mathematical manipulation of the partial pressure of oxygen in breath at end expiration (EtO2 would accurately predict ScVO2. Methods Prospective observational study of a convenience sample of hemodialysis patients age > 17 years with existing upper extremity central venous catheters were enrolled. Using a portable respiratory device, we collected both tidal breathing and end expiratory oxygen and carbon dioxide concentrations, volume and flow on each patient. Simultaneous ScVO2 measurements were obtained via blood samples collected from the hemodialysis catheter. Two models were used to predict ScVO2: 1 Best-fit multivariate linear regression equation incorporating all respiratory variables; 2 MathCAD to model the decay curve of EtO2 versus expiratory volume using the least squares method to estimate the pO2 that would occur at Results From 21 patients, the correlation between EtO2 and measured ScVO2 yielded R2 = 0.11. The best fit multivariate equation included EtCO2 and EtO2 and when solved for ScVO2, the equation yielded a mean absolute difference from the measured ScVO2 of 8 ± 6% (range -18 to +17%. The predicted ScVO2 value was within 10% of the actual value for 57% of the patients. Modeling of the EtO2 curve did not accurately predict ScVO2 at any lung volume. Conclusion We found no significant correlation between EtO2 and ScVO2. A linear equation incorporating EtCO2 and EtO2 had at best modest predictive accuracy for ScVO2.

  8. Defining the surface anatomy of the central venous system in children.

    Science.gov (United States)

    Tarr, Gregory P; Pak, Neda; Taghavi, Kiarash; Iwan, Tom; Dumble, Charlotte; Davies-Payne, David; Mirjalili, S Ali

    2016-03-01

    Pediatric emergency physicians, pediatric critical care specialists, and pediatric surgeons perform central venous catheterization in many clinical settings. Complications of the procedure are not uncommon and can be fatal. Despite the frequency of application, the evidence-base describing the surface landmarks involved is missing. The aim of the current study was to critically investigate the surface markings of the central venous system in children. The superior vena cava/right atrial (SVC/RA) junction, superior vena cava (SVC) formation, and brachiocephalic vein (BCV) formation were examined independently by two investigators. Three hundred computed tomography (CT) scans collected across multiple centers were categorized by age group into: 0-3 years, 4-7 years, and 8-11 years. Scans with pathology that distorted or obscured the regional anatomy were excluded. The BCV formation was commonly found behind the ipsilateral medial clavicular head throughout childhood. This contrasts with the variable levels of SVC formation, SVC length, and SVC/RA junction. In the youngest group, SVC formation was most commonly at the second costal cartilage (CC), but moved to the first CC/first intercostal space (ICS) as the child grew. The SVC/RA junction was at the fourth CC in the youngest group and moved to the third CC/third ICS as the child grew. This study demonstrates the variable anatomy of SVC formation and the SVC/RA junction with respect to rib level. This variability underscores the unreliability of surface anatomical landmarks of the SVC/RA junction as a guide to catheter tip position. Clin. Anat. 29:157-164, 2016. © 2015 Wiley Periodicals, Inc. PMID:26518452

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

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    Hanson Josh

    2011-11-01

    Full Text Available 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 support this recommendation. Methods Twenty-eight adult Indian and Bangladeshi patients admitted to the intensive care unit with severe falciparum malaria were enrolled in the study. All patients had a CVC inserted and had regular CVP measurements recorded. The CVP measurements were compared with markers of disease severity, clinical endpoints and volumetric measures derived from transpulmonary thermodilution. Results There was no correlation between the admission CVP and patient outcome (p = 0.67 or disease severity (p = 0.33. There was no correlation between the baseline CVP and the concomitant extravascular lung water (p = 0.62, global end diastolic volume (p = 0.88 or cardiac index (p = 0.44. There was no correlation between the baseline CVP and the likelihood of a patient being fluid responsive (p = 0.37. On the occasions when the CVP was in the WHO target range patients were usually hypovolaemic and often had pulmonary oedema by volumetric measures. Seven of 28 patients suffered a complication of the CVC insertion, although none were fatal. Conclusion The WHO recommendation for the routine insertion of a CVC, and the maintenance of a CVP of 0-5 cmH2O in adults with severe malaria, should be reconsidered.

  10. Stuck long-term indwelling central venous catheters in adolescents: three cases and a short topical review

    DEFF Research Database (Denmark)

    Mortensen, A; Afshari, A; Henneberg, S W;

    2010-01-01

    vessel wall and impossible to remove. In the other two cases, catheters were removed with great difficulty by the interventional radiologists. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous...

  11. Comparing the Use of Global Rating Scale with Checklists for the Assessment of Central Venous Catheterization Skills Using Simulation

    Science.gov (United States)

    Ma, Irene W. Y.; Zalunardo, Nadia; Pachev, George; Beran, Tanya; Brown, Melanie; Hatala, Rose; McLaughlin, Kevin

    2012-01-01

    The use of checklists is recommended for the assessment of competency in central venous catheterization (CVC) insertion. To explore the use of a global rating scale in the assessment of CVC skills, this study seeks to compare its use with two checklists, within the context of a formative examination using simulation. Video-recorded performances of…

  12. Importance of blood cultures from peripheral veins in pediatric patients with cancer and a central venous line

    DEFF Research Database (Denmark)

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

    2015-01-01

    When an infection is suspected in a child with cancer and a central venous line (CVL), cultures are often only obtained from the CVL and not from a peripheral vein (PV). This study was undertaken to evaluate the importance of concomitant blood cultures from the CVL and a PV....

  13. Predictors of Unattempted Central Venous Catheterization in Septic Patients Eligible for Early Goal-directed Therapy

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    David R. Vinson

    2014-02-01

    Full Text Available Introduction: Central venous catheterization (CVC can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED patients eligible for early goal-directed therapy (EGDT have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg, obesity (body mass index [BMI] ≥30, moderate thrombocytopenia (platelet count <50,000 per μL, and coagulopathy (international normalized ratio ≥2.0 with unattempted CVC in EGDT-eligible patients. Methods: This was a retrospective cohort study of 421 adults who met EGDT criteria in 5 community EDs over a period of 13 months. We compared patients with attempted thoracic (internal jugular or subclavian CVC with those who did not undergo an attempted thoracic line. We also compared patients with any attempted CVC (either thoracic or femoral with those who did not undergo any attempted central line. We used multivariate logistic regression analysis to calculate adjusted odd ratios (AORs. Results: In our study, 364 (86.5% patients underwent attempted thoracic CVC and 57 (13.5% did not. Relative normotension was significantly associated with unattempted thoracic CVC (AOR 2.6 95% confidence interval [CI], 1.6-4.3, as were moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.1 and coagulopathy (AOR 2.7; 95% CI, 1.3-5.6. When assessing for attempted catheterization of any central venous site (thoracic or femoral, 382 (90.7% patients underwent attempted catheterization and 39 (9.3% patients did not. Relative normotension (AOR 2.3; 95% CI, 1.2-4.5 and moderate thrombocytopenia (AOR 3.9; 95

  14. Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital

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    Marcelo Luiz Abramczyk

    2011-12-01

    Full Text Available Objectives: To determine the impact of an educational program on the prevention of central venous catheter-related infections in a Brazilian Pediatric Intensive Care Unit. Patients and Methods: All patients admitted to the unit between February 2004 and May 2005 were included in the cohort study in a longitudinal assessment. An educational program was developed based on the Centers for Disease Control and Prevention recommendations for prevention of catheter-associated infections and was adapted to local conditions and resources after an initial observational phase. Incidence of catheter-associated infections was measured by means of on-site surveillance. Results: One hundred eighteen nosocomial infections occurred in 253 patients (46.6 infections per 100 admissions and in 2,954 patient-days (39.9 infections per 1,000 patient-days. The incidence-density of catheter infections was 31.1 episodes per 1.000 venous central catheter-days before interventions, and 16.5 episodes per 1,000 venous central catheter-days afterwards (relative risk 0.53 [95% CI 0.28-1.01]. Corresponding rates for exit-site catheter infections were 8.0 and 2.5 episodes per 1,000 venous central catheter-days [0.32 (0.07-1.49], and the rates for bloodstream infections were 23.1 and 13.9 episodes per 1,000 venous central catheter-days, before and after interventions [0.61 (0.32-1.14]. Conclusion: A prevention strategy targeted at the insertion and maintenance of vascular access can decrease rates of vascular-access infections in pediatric intensive care unit.

  15. Incidence and risk factors of infections complications related to implantable venous-access ports

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs.) From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

  16. Incidence and risk factors of infections complications related to implantable venous-access ports

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Ji Sue; Seo, Tae Seok; Song, Myung Gyu; Cha, In Ho; Kim, Jun Suk; Choi, Chul Won; Seo, Jae Hong; Oh, Sang Cheul [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2014-08-15

    The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs.) From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

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

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    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

  18. Risk factors for venous port migration in a single institute in Taiwan

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    Fan, Wen-Chieh; Wu, Cheng-Han; Tsai, Ming-Ju; Tsai, Ying-Ming; Chang, Hsu-Liang; HUNG, JEN-YU; Chen, Pei-Huan; Yang, Chih-Jen

    2014-01-01

    Background An implantable port device provides an easily accessible central route for long-term chemotherapy. Venous catheter migration is one of the rare complications of venous port implantation. It can lead to side effects such as pain in the neck, shoulder, or ear, venous thrombosis, and even life-threatening neurologic problems. To date, there are few published studies that discuss such complications. Methods This retrospective study of venous port implantation in a single center, a Taiw...

  19. Osteosarcoma of the lumbosacral spine invading the central venous pathways, right-sided cardiac chambers, and pulmonary artery

    Energy Technology Data Exchange (ETDEWEB)

    Hines, Neely; Lantos, George; Hochzstein, Jay [Jacobi Medical Center/Albert Einstein College of Medicine, Department of Radiology, Bronx, NY (United States); Gitig, Alon [Montefiore Medical Center/Albert Einstein College of Medicine, Department of Cardiology, Bronx, NY (United States); DeAnda, Abe [Montefiore Medical Center/Albert Einstein College of Medicine, Department of Cardiothoracic Surgery, Bronx, NY (United States)

    2007-11-15

    We report an unusual case of lumbosacral osteogenic sarcoma with cauda equina syndrome and invasion into the central venous and cardiac system. A 41-year-old Hispanic man presented to the emergency department complaining of severe low back pain, cauda equina syndrome, bilateral lower extremity edema, and an extra heart sound on physical examination. CT of the lumbosacral spine done in the emergency department demonstrated a sclerotic lesion in the sacrum with cortical destruction, extension into the spinal canal and a bulky soft tissue mass containing calcifications. Supplemental MRI demonstrated marrow replacement of L4, L5, and the sacrum, soft tissue extension of the tumor, and invasion iliac veins extending into the IVC; however, the full extent of the intravascular tumor was not seen on this examination. Surgical laminectomy and biopsy of the spinal tumor provided the diagnosis of osteogenic sarcoma. A transthoracic echocardiogram was performed while the patient was recovering due to nonsustained ventricular tachycardia, which showed an echogenic mass within the right atrium and ventricle. CT pulmonary angiogram confirmed the echocardiogram showing a tumor extending through the pulmonary valve into the main pulmonary artery. The patient underwent en bloc resection of the tumor from the venous and cardiac systems. Histologic examination of the tumor confirmed osteogenic sarcoma. While vertebral osteogenic sarcoma is uncommon, invasion of the spinal canal is common in these tumors. However, tumor extending into the central venous and cardiac system is rare. The previously reported cases of central venous and cardiac involvement have been related to distant metastases or primary cardiac osteosarcomas. There is only one other reported case of direct extension into the venous system by an iliac bone osteosarcoma in an adolescent; however, the tumor did not extend into the pulmonary circulation. (orig.)

  20. New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes.

    Science.gov (United States)

    Vazquez-Padron, Roberto I; Allon, Michael

    2016-08-01

    Despite significant improvements in preoperative patient evaluation and surgical planning, vascular access failure in patients on hemodialysis remains a frequent and often unforeseeable complication. Our inability to prevent this complication is, in part, because of an incomplete understanding of how preexisting venous and arterial conditions influence the function of newly created arteriovenous fistulas and grafts. This article reviews the relationship between three preexisting vascular pathologies associated with CKD (intimal hyperplasia, vascular calcification, and medial fibrosis) and hemodialysis access outcomes. The published literature indicates that the pathogenesis of vascular access failure is multifactorial and not determined by any of these pathologies individually. Keeping this observation in mind should help focus our research on the true causes responsible for vascular access failure and the much needed therapies to prevent it. PMID:27401525

  1. Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery.

    Science.gov (United States)

    Wong, Kevin; Marks, Barry A; Qureshi, Anwer; Stemm, Joseph J

    2016-07-01

    Central venous catheterization is widely used in patients on hemodialysis. A rare complication associated with the clinical use of central venous catheters is perforation of the heart or major vessels. We report a case of inadvertent perforation of the left atrium and thrombosis after the placement of a hemodialysis catheter in the right internal jugular vein. In such cases, surgical removal of the central venous catheter from perforation sites in the heart and vessel walls poses anesthetic challenges because of the high risk of pneumothorax, hemorrhage, arrhythmias, thrombosis, and death. PMID:27224040

  2. Cost of installing and turning off hemodialysis on patients with central venous catheters

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    Gillene Santos Ferreira

    2014-12-01

    Full Text Available The objective was to identify the average total cost (ATC for installing and turning off hemodialysis on patients with central venous catheters. This quantitative, exploratory, and descriptive research, in the mode of a single-case study, was conducted in a public university hospital. The non-probabilistic sample corresponded to the observation of 100 installations and 100 terminations of hemodialysis on 42 patients during 23 days of collection. The ATC was calculated by multiplying the time spent by nurses by the unit cost of direct labor, and adding the cost of materials, solutions, and medications. The Brazilian currency (R$ was used for the calculations. The ATC for installation was R$ 80.10 and for shutting off was R$ 13.04, totaling R$ 93.14 per hemodialysis session. The results obtained will facilitate a better planning of the allocation of human, material, and financial resources enabling the increase of managerial strategies aimed at economic efficiency. doi: 10.5216/ree.v16i4.23044.

  3. Injection of gadolinium contrast through pediatric central venous catheters: a safety study

    International Nuclear Information System (INIS)

    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. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service

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    Lidiane Miotto Barretta

    2016-01-01

    Full Text Available Abstract Objective: to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications.

  5. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service

    Science.gov (United States)

    Barretta, Lidiane Miotto; Beccaria, Lúcia Marinilza; Cesarino, Cláudia Bernardi; Pinto, Maria Helena

    2016-01-01

    Abstract Objective: to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications. PMID:27276021

  6. Contrast media power injection using central venous port catheters - results of an in vitro study

    International Nuclear Information System (INIS)

    Purpose: are implanted central venous port catheters suitable for contrast media pressure (power) injection in computed tomography? Material and methods: in an in vitro study 100 ml of contrast medium (Ultravist 370, Schering, Berlin, Deutschland) was injected through 20 different port catheter systems using a power injector (Stellant, Medrad, Inianola, USA) with a pressure limit of 325 PSI. The injection rate was increased from 2 ml/s to 10 ml/s in increments of 2 ml/s. The maximum injection pressure and maximum injection rate were assessed. Results: an injection rate of 2 ml/s was possible in all catheter systems. Injection rates of 4 ml/s in 18 systems, 6 ml/s in 13 systems and 8 ml/s in 6 systems were achieved. With a given pressure limit of 325 PSI an injection rate of 10 ml/s was not possible in any of the port catheter systems. There were no catheter ruptures, catheter disconnections or contrast extravasations noted. (orig.)

  7. PROPHYLACTIC ADMINISTRATION OF DOXYCYCLINE REDUCES CENTRAL VENOUS CATHETER INFECTIONS IN PATIENTS UNDERGOING HEMATOPOIETIC CELL TRANSPLANTATION

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    Mohamed Kharfan-Dabaja

    2013-02-01

    Full Text Available Hematopoietic stem cells are usually transfused through a central venous catheter (CVC, which also facilitates administration of medications and intravenous fluids. We had observed high rate of catheter-related blood-stream infection (CR-BSI at our Bone Marrow Transplantation (BMT unit despite prescribing fluoroquinolones for anti-bacterial prophylaxis. Accordingly, we implemented prophylactic use of a relatively inexpensive broad spectrum antibiotic, namely doxycycline to address this problem. We wanted to investigate whether doxycycline prophylaxis reduces CR-BSI rate. Data was collected retrospectively on 54 consecutive patients, 26 of whom received doxycycline (doxycycline group, and we compared their outcomes to a previous cohort of 28 patients who did not receive doxycycline (comparison group. The groups were comparable in regards to age, gender, hematopoietic cell transplant type, and primary diagnosis. No CVC infection (0% was observed in the doxycycline group, while 5 infection episodes (18.5% occurred in 4 patients in the comparison group (p<0.001. Episodes of CR-BSI were due to: Escherichia-coli (EC=1, coagulase-negative Staphylococcus-spp (CNSS=2, both EC & CNSS=1. Our results demonstrate that CR-BSI was reduced significantly after introducing doxycycline. This finding suggests a beneficial role for systemic use of doxycycline prophylaxis to prevent CR-BSI in adult BMT patients. Nevertheless, a randomized controlled study is warranted to confirm these findings.

  8. Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery

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    Nasir Hussain

    2012-01-01

    Full Text Available Central venous catheters (CVC are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.

  9. 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. PMID:26977751

  10. Playing games with a thrombus: a dangerous match. Paradoxical embolism from a huge central venous cathether thrombus: a case report

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    Mariana Sylvie

    2010-03-01

    Full Text Available Abstract Thromboembolism is a major cause of death in cancer patients. The association between paraneoplastic hypercoagulability of oncological patients and long-term central venous catheters (CVC may result in CVC associated thrombosis. Patent Foramen Ovale (PFO, especially when associated with atrial septal aneurysm (ASA is a risk factor for paradoxical embolism. We report a case of paradoxical embolism with stroke in an oncological patient with a huge CVC thrombus playing "ping-pong" with an hypermobile ASA with a PFO. We review the management of hypercoagulability in oncologic patients and discuss the potential role of routine transthoracic echocardiography before the implantation of long term central venous catheters to identify predisposing conditions to paradoxical embolism and select patients for anticoagulant therapy.

  11. Do Clinicians Know Which of Their Patients Have Central Venous Catheters? A Multicenter Observational Study

    Science.gov (United States)

    Chopra, Vineet; Govindan, Sushant; Kuhn, Latoya; Ratz, David; Sweis, Randy F.; Melin, Natalie; Thompson, Rachel; Tolan, Aaron; Barron, James; Saint, Sanjay

    2016-01-01

    Background Complications associated with central venous catheters (CVCs) increase over time. Although early removal of unnecessary CVCs is important to prevent complications, the extent to which clinicians are aware that their patients have a CVC is unknown. Objective To assess how often clinicians were aware of the presence of triple-lumen or peripherally inserted central catheters (PICCs) in hospitalized patients. Design Multicenter, cross-sectional study. Setting Three academic medical centers in the United States. Patients Hospitalized medical patients in intensive care unit (ICU) and non-ICU settings. Measurements To ascertain awareness of CVCs, we first determined whether a PICC or triple-lumen catheter was present; clinicians were then queried about device presence. Differences in device awareness among clinicians were assessed by chi-square tests. Results 990 patients were evaluated, and 1881 clinician assessments were done. The overall prevalence of CVCs was 21.1% (n = 209), of which 60.3% (126 of 209) were PICCs. A total of 21.2% (90 of 425) of clinicians interviewed were unaware of the presence of a CVC. Unawareness was greatest among patients with PICCs, where 25.1% (60 of 239) of clinicians were unaware of PICC presence. Teaching attendings and hospitalists were more frequently unaware of the presence of CVCs than interns and residents (25.8% and 30.5%, respectively, vs. 16.4%). Critical care physicians were more likely to be aware of CVC presence than general medicine physicians (12.6% vs. 26.2%; P = 0.003). Limitations Awareness was determined at 1 point in time and not linked to outcomes. Patient length of stay and indication for CVC were not recorded. Conclusion Clinicians are frequently unaware of the presence of PICCs and triple-lumen catheters in hospitalized patients. Further study of mechanisms that ensure that clinicians are aware of these devices so that they may assess their necessity seems warranted. Primary Funding Source None. PMID

  12. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

    Science.gov (United States)

    Zingg, Walter; Cartier, Vanessa; Inan, Cigdem; Touveneau, Sylvie; Theriault, Michel; Gayet-Ageron, Angèle; Clergue, François; Pittet, Didier; Walder, Bernhard

    2014-01-01

    Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI. PMID:24714418

  13. Biofilm Formation by Gram-Negative Bacteria on Central Venous Catheter Connectors: Effect of Conditioning Films in a Laboratory Model

    OpenAIRE

    Murga, R.; Miller, J.M.; Donlan, R. M.

    2001-01-01

    Human blood components have been shown to enhance biofilm formation by gram-positive bacteria. We investigated the effect of human blood on biofilm formation on the inner lumen of needleless central venous catheter connectors by several gram-negative bacteria, specifically Enterobacter cloacae, Pseudomonas aeruginosa, and Pantoea agglomerans. Results suggest that a conditioning film of blood components promotes biofilm formation by these organisms in an in vitro system.

  14. Determinación de la presión venosa intra-acceso Determining intra-access venous pressure

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    Raquel Muñoz Pérez

    2009-09-01

    Full Text Available La medición de la presión venosa intraacceso es un método de vigilancia vascular que facilita la detección temprana de las disfunciones de las fístulas arteriovenosas. Nuestro objetivo fue describir como utilizamos este método de detección y exponer nuestra experiencia en el seguimiento de 31 pacientes. En 9 pacientes se observó un aumento puntual de la presión venosa intraaceso, y a 4 se les realizó una angioplastia preventiva efectiva. En 7 pacientes que continuadamente presentaban un aumento de la presión intraaceso se trombosó el acceso vascular no siendo recuperable por angiorradiología. El aumento de la presión intraaceso puede facilitar la detección precoz de problemas en el acceso vascular.Measurement of intra-access venous pressure is a vascular monitoring method that facilitates early detection of dysfunctions in arteriovenous fistulas. Our aim was to show how we use this detection method and describe our experience in monitoring 31 patients. In 9 patients a one-off increase in intra-access venous pressure was observed, and in 4 patients an effective preventive angioplasty was carried out. In 7 patients who continually showed an increase in intra-access pressure, vascular access was thrombosed and not recoverable by angio radiology. The increase in intra-access pressure can facilitate the early detection of problems in vascular access.

  15. Evaluation of alternatives for dysfunctional double lumen central venous catheters using a two-compartmental mathematical model for different solutes.

    Science.gov (United States)

    Van Canneyt, Koen; Van Biesen, Wim; Vanholder, Raymond; Segers, Patrick; Verdonck, Pascal; Eloot, Sunny

    2013-01-01

    Double lumen (DL) central venous catheters (CVC) often suffer from thrombosis, fibrin sheet formation, and/or suction towards the vessel wall, resulting in insufficient blood flow during hemodialysis. Reversing the catheter connection often restores blood flows, but will lead to higher recirculation. Single lumen (SL) CVCs have often fewer flow problems, but they inherently have some degree of recirculation. To assist bedside clinical decision making on optimal catheter application, we investigated mathematically the differences in dialysis adequacy using different modes of access with CVCs.
A mathematical model was developed to calculate reduction ratio (RR) and total solute removal (TSR) of urea, methylguanidine (MG), beta-2-microglobulin (β2M), and phosphate (P) during different dialysis scenarios: 4-h dialysis with a well-functioning DL CVC (DL-normal, blood flow QB 350 ml/min), dysfunctional DL CVC (DL-low flow, QB 250), reversed DL CVC (DL-reversed, QB 350, recirculation 
R = 10%) and 12 Fr SL CVC (effective QB 273). 
With DL-normal as reference, urea RR was decreased by 3.5% (DL-reversed), 13.0% (SL), and 15.6% (DL-low flow), while urea TSR was decreased by 3.3% (DL-reversed), 13.2% (SL), and 13.5% (DL-low flow). The same trend was found for MG and P. However, β2M RR decreased only 1.5% with SL CVC although TSR decrease was 17.2%, while RR decreased 21.1% with DL-low flow although TSR decrease was only 4.9%.
In the case of dysfunctional DL CVCs, reversing the catheter connection and restoring the blood flow did not impair TSR, with 10% recirculation. The SL CVC showed suboptimal TSR results that were similar to those of the dysfunctional DL CVC. PMID:23280082

  16. Measurement of Anterior-Posterior Diameter of Inferior Vena Cava by Ultrasonography: A Non-Invasive Method for Estimation of Central Venous Pressure

    OpenAIRE

    R Nafisi-Moghadam; Mansourian, H.R

    2007-01-01

    Background and Objective: The assessment of blood volume is now one of the most commonly needed interventions in the first line of care and severe ill patients. Measuring central venous pressure (CVP) is an invasive method, most frequently used in clinical practice for the assessment of volume status. The di-ameter of the inferior vena cava (IVC) is a parameter to estimate central venous pressure. The purpose of this study was to determine whether measurement of the anterior-posterior diamete...

  17. Adverse events and technical complaints related to central venous catheters marketed in Brazil

    Directory of Open Access Journals (Sweden)

    Luciene de Oliveira Morais

    2013-06-01

    Full Text Available Aim: The objective of this study was to critically analyze data of the National Notification System for Adverse Events and Technical Complaints (Notivisa related to central venous catheters, through an evaluation of the description of notifications recorded between 2006 and 2009. Methods: Notifications were categorized and evaluated to: (i determine the number of adverse events and technical complaints, (ii verify compliance with the classification criteria defined by the legislation, (iii reclassify notifications, when necessary, in order for them to fit in with the legal definitions, (iv verify registered companies in Brazil, (v quantify the notifications according to the registered company and product lot, and (vi identify the country of original of the notified product. Microsoft Excel® 2010 was used to categorize and systematize the data. Results: Some conceptual errors and incomplete records were found. Altogether, 228 notifications of technical complaints and 119 of adverse events were identified. Some notifications on guidewires and broken catheters were reported which led to the necessity of duplicating some medical procedures and to the occurrence of lesions/lacerations of vessels and tissue injury. Forty-seven percent of companies presented at least one notification in Notivisa and in all, 38 product lots had more than one notification. Conclusion: These data support a necessity for cooperation between all entities of the National Health Surveillance System to check compliance of this type of product and to properly report adverse events and technical complaints. It is also important to incorporate minimum standards for the management of technologies in health services, including in the acquisition of products and training of staff.

  18. Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters

    Science.gov (United States)

    Hamid, Rana S.; Kakaria, Anupam K.; Khan, Saif A.; Mohammed, Saja; Al-Sukaiti, Rashid; Al-Riyami, Dawood; Al-Mula Abed, Yasser W.

    2015-01-01

    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. PMID:26629377

  19. The safety of ultrasound guided central venous cannulation in patients with liver disease

    Directory of Open Access Journals (Sweden)

    Shweta A Singh

    2015-01-01

    Full Text Available Background: Central venous cannulation (CVC is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP. Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC in itself reduces the incidence of complications. Aim: To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy. Setting and Design: An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center. Materials and Methods: Data was collected for all the adult patients (18-60 years of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications. Results: The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683 × 10 9 /L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing. Conclusion: Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.

  20. Long-term Outcome of Peripherally Implanted Venous Access Ports in the Forearm in Female Cancer Patients

    International Nuclear Information System (INIS)

    PurposeThe aim of this retrospective study was to analyze the long-term outcome of peripherally implanted venous access ports in the forearm at our institution in a female patient collective.MethodsBetween June 2002 and May 2011, a total of 293 female patients with an underlying malignancy had 299 forearm ports implanted in our interventional radiology suite. The mean age of the cohort was 55 ± 12 years (range 26–81 years). The majority of women suffered from breast (59.5 %) or ovarian cancer (28.1 %). Complications were classified as infectious complications, thrombotic and nonthrombotic catheter dysfunction (dislocation of the catheter or port chamber, fracture with/without embolization or kinking of the catheter, port occlusion), and others.ResultsWe analyzed a total of 90,276 catheter days in 248 port systems (47 patients were lost to follow-up). The mean device service interval was 364 days per catheter (range 8–2,132, median 223 days, CI 311–415, SD 404). Sixty-seven early (≤30 days from implantation) or late complications (>30 days) occurred during the observation period (0.74/1,000 catheter days). Common complications were port infection (0.18/1,000 days), thrombotic dysfunction (0.12/1,000 days), and skin dehiscence (0.12/1,000 days). Nonthrombotic dysfunction occurred in a total of 21 cases (0.23/1,000 days) and seemed to cumulate on the venous catheter entry site on the distal upper arm.ConclusionPeripherally implanted venous access ports in the forearm are a safe alternative to chest or upper-arm ports in female oncology patients. Special attention should be paid to signs of skin dehiscence and nonthrombotic dysfunction, especially when used for long-term treatment

  1. Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients

    International Nuclear Information System (INIS)

    The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheter-days) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.

  2. Long-term Outcome of Peripherally Implanted Venous Access Ports in the Forearm in Female Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Klösges, Laura, E-mail: l.kloesges@uni-bonn.de; Meyer, Carsten, E-mail: carsten.meyer@ukb.uni-bonn.de; Boschewitz, Jack, E-mail: jack.boschewitz@ukb.uni-bonn.de; Andersson, Magnus, E-mail: magnus.andersson@ukb.uni-bonn.de [Universitätsklinikum Bonn, Department of Radiology (Germany); Rudlowski, Christian, E-mail: c.rudlowski@evk.de [Evangelisches Krankenhaus Bergisch Gladbach, Department of Gynecology (Germany); Schild, Hans H., E-mail: hans.schild@ukb.uni-bonn.de [Universitätsklinikum Bonn, Department of Radiology (Germany); Wilhelm, Kai, E-mail: kai.wilhelm@ek-bonn.de [Ev. Kliniken Bonn, Johanniter-Krankenhaus, Department of Radiology (Germany)

    2015-06-15

    PurposeThe aim of this retrospective study was to analyze the long-term outcome of peripherally implanted venous access ports in the forearm at our institution in a female patient collective.MethodsBetween June 2002 and May 2011, a total of 293 female patients with an underlying malignancy had 299 forearm ports implanted in our interventional radiology suite. The mean age of the cohort was 55 ± 12 years (range 26–81 years). The majority of women suffered from breast (59.5 %) or ovarian cancer (28.1 %). Complications were classified as infectious complications, thrombotic and nonthrombotic catheter dysfunction (dislocation of the catheter or port chamber, fracture with/without embolization or kinking of the catheter, port occlusion), and others.ResultsWe analyzed a total of 90,276 catheter days in 248 port systems (47 patients were lost to follow-up). The mean device service interval was 364 days per catheter (range 8–2,132, median 223 days, CI 311–415, SD 404). Sixty-seven early (≤30 days from implantation) or late complications (>30 days) occurred during the observation period (0.74/1,000 catheter days). Common complications were port infection (0.18/1,000 days), thrombotic dysfunction (0.12/1,000 days), and skin dehiscence (0.12/1,000 days). Nonthrombotic dysfunction occurred in a total of 21 cases (0.23/1,000 days) and seemed to cumulate on the venous catheter entry site on the distal upper arm.ConclusionPeripherally implanted venous access ports in the forearm are a safe alternative to chest or upper-arm ports in female oncology patients. Special attention should be paid to signs of skin dehiscence and nonthrombotic dysfunction, especially when used for long-term treatment.

  3. Risk of extravasation after power injection of contrast media via the proximal port of multilumen central venous catheters. Case report and review of the literature

    International Nuclear Information System (INIS)

    Multilumen central venous catheters (CVCs) are not commonly used for power injection. However, in critically ill patients, CVCs - most of which do not have FDA approval for power injection - may be the only available venous access. The pitfalls of multilumen CVCs are illustrated by a case report of a patient in whom extravasation of intravenously administered contrast medium occurred after power injection in a triple-lumen CVC using the lumen with the port furthest from the catheter tip. The underlying mechanisms for the displacement of the initially correctly placed right subclavian CVC could include elevation of both arms of the obese patient or the power injection itself. The distances between port openings and catheter tips of various commercially available multilumen CVCs are assessed. We examine the possible caveats of ECG-guided CVC placement for optimal tip position, discuss technical difficulties related to power injection via CVCs, and review commonly used drugs that may cause extravasation injury. Knowledge of the distances between CVC port openings and the catheter tip are essential for safe intravasal administration of fluids. (orig.)

  4. The use of minocycline-rifampin coated central venous catheters for exchange of catheters in the setting of staphylococcus aureus central line associated bloodstream infections

    OpenAIRE

    Chaftari, Anne-Marie; El Zakhem, Aline; Jamal, Mohamed A.; Jiang, Ying; Hachem, Ray; Raad, Issam

    2014-01-01

    Background Central venous catheters (CVC) removal and reinsertion of a new CVC in the setting of central line associated bloodstream infections (CLABSI) is not always possible in septic patients. The purpose of this study was to evaluate the outcome of patients with Staphylococcus aureus-CLABSI (SA-CLABSI) who had their CVCs exchanged over guidewire for minocycline/rifampin-coated (M/R)-CVC within seven days of bacteremia. Methods Each case was matched with two control patients who had SA-CLA...

  5. Impact of ultrasonography on central venous catheter insertion in intensive care

    International Nuclear Information System (INIS)

    The insertion of central venous catheters (CVCs) is an integral part of the management of critically ill patients. We aimed to study the impact of ultrasonography (USG) on CVC insertion in intensive care. A prospective study of 450 patients requiring CVC in the intensive care unit (ICU) of a tertiary care hospital. The patients were randomized into two groups: to have CVC insertion with USG-guidance or with the anatomic landmark technique (ALT). Data were collected on patient demographics; operator experience; and method, site and side of insertion. Outcome measures included successful insertion of CVC, number of attempts needed and complications. Internal jugular vein (IJV) cannulation was successful in 177/194 patients (91.2%) using ALT and in 200/205 patients (97.6%) using USG guidance, a significant difference of 6.4% (P = 0.006). Using ALT, 72.7% of cannulations could be accomplished in the first attempt as compared with 84.4% with USG guidance (P = 0.004). The overall complication rate was 28/399 (7%), with 19 (9.8%) complications in the ALT group and 9 (4.4%) in the USG group (age-, sex-, and operator-adjusted OR = 0.35, 95% CI: 0.13–0.96; P = 0.03). For subclavian vein catheterization, the success rate was 26/28 (92.9%) in the ALT group and 17/17 (100%) in the USG group (P = 0.52). Using ALT, 71.4% cannulation could be accomplished in the first attempt as compared with 82.4% under USG guidance (P = 0.49). The overall complication rate was 6/45 (13.3%), with 4 (14.3%) complications in the ALT group and 2 (11.8%) in the USG group (P > 0.99). Real-time USG guidance improves success rates, reduces the number of attempts and decreases the complications associated with CVC insertion, especially for the IJV, and should become the standard of care in intensive care

  6. Three-dimensional gadolinium-enhanced MR venography to evaluate central venous steno-occlusive disease in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Gao, K.; Jiang, H.; Zhai, R.Y.; Wang, J.F.; Wei, B.J. [Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing (China); Huang, Q., E-mail: hq0713@163.com [Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing (China)

    2012-06-15

    Aim: To determine the agreement and diagnostic accuracy of three-dimensional gadolinium-enhanced magnetic resonance venography (3D-Gd-MRV) in central venous steno-occlusive disease (CVSD) in haemodialysis patients. Materials and methods: Fourteen consecutive haemodialysis patients underwent interventional procedures to evaluate or treat CVSD. 3D-Gd-MRV was performed before the procedures and the results were compared with digital subtraction angiography (DSA). Results: DSA showed >50% stenosis in all 14 patients, 13 of whom were diagnosed correctly using 3D-Gd-MRV. Moderate stenosis was missed at 3D-Gd-MRV in one case whereby the indwelling dialysis central venous catheter may have caused an artefact on the images and hindered the accuracy of the result. The sensitivity of 3D-Gd-MRV in revealing stenosis was 93% (13/14). No complications caused by contrast agent toxicity occurred in any patient. Conclusion: 3D-Gd-MRV employing a non-breath-hold technique is highly sensitive in the diagnosis of CVSD and may be an alternative technique to DSA for the visualization of central veins.

  7. Verification of correct central venous catheter placement in the emergency department: comparison between ultrasonography and chest radiography.

    Science.gov (United States)

    Zanobetti, Maurizio; Coppa, Alessandro; Bulletti, Federico; Piazza, Serena; Nazerian, Peyman; Conti, Alberto; Innocenti, Francesca; Ponchietti, Stefano; Bigiarini, Sofia; Guzzo, Aurelia; Poggioni, Claudio; Taglia, Beatrice Del; Mariannini, Yuri; Pini, Riccardo

    2013-03-01

    In 210 consecutive patients undergoing emergency central venous catheterization, we studied whether an ultrasonography examination performed at the bedside by an emergency physician can be an alternative method to chest X-ray study to verify the correct central venous catheter placement, and to identify mechanical complications. A prospective, blinded, observational study was performed, from January 2009 to December 2011, in the emergency department of a university-affiliated teaching hospital. Ultrasonography interpretation was completed during image acquisition; ultrasound scan was performed in 5 ± 3 min, whereas the time interval between chest radiograph request and its final interpretation was 65 ± 74 min p correlation (Pearson's r = 0.76 %, p correlation between these two modalities to identify possible malpositioning of a catheter resulting from cannulation of central veins, and its complications. The less time required to perform ultrasonography allows earlier use of the catheter for the administration of acute therapies that can be life-saving for the critically ill patients. PMID:23242559

  8. Optoacoustic measurement of central venous oxygenation for assessment of circulatory shock: clinical study in cardiac surgery patients

    Science.gov (United States)

    Petrov, Irene Y.; Prough, Donald S.; Kinsky, Michael; Petrov, Yuriy; Petrov, Andrey; Henkel, S. Nan; Seeton, Roger; Salter, Michael G.; Esenaliev, Rinat O.

    2014-03-01

    Circulatory shock is a dangerous medical condition, in which blood flow cannot provide the necessary amount of oxygen to organs and tissues. Currently, its diagnosis and therapy decisions are based on hemodynamic parameters (heart rate, blood pressure, blood gases) and mental status of a patient, which all have low specificity. Measurement of mixed or central venous blood oxygenation via catheters is more reliable, but highly invasive and associated with complications. Our previous studies in healthy volunteers demonstrated that optoacoustic systems provide non-invasive measurement of blood oxygenation in specific vessels, including central veins. Here we report our first results of a clinical study in coronary artery bypass graft (CABG) surgery patients. We used a medical-grade OPO-based optoacoustic system developed in our laboratory to measure in real time blood oxygenation in the internal jugular vein (IJV) of these patients. A clinical ultrasound imaging system (GE Vivid e) was used for IJV localization. Catheters were placed in the IJV as part of routine care and blood samples taken via the catheters were processed with a CO-oximeter. The optoacoustic oxygenation data were compared to the CO-oximeter readings. Good correlation between the noninvasive and invasive measurements was obtained. The results of these studies suggest that the optoacoustic system can provide accurate, noninvasive measurements of central venous oxygenation that can be used for patients with circulatory shock.

  9. Ultraviolet-C Irradiation for Prevention of Central Venous Catheter Related Infections: An In-vitro Study

    OpenAIRE

    Dai, Tianhong; Tegos, George P.; St Denis, Tyler G.; Anderson, Don; Sinofsky, Ed; Hamblin, Michael R.

    2010-01-01

    Central venous catheters (CVC) are widely used in the United States and are associated with 250,000 to 500,000 CVC-related infections in hospitals annually. We used a catheter made from ultraviolet-C (UVC) transmissive material to test whether delivery of UVC from the lumen would allow inactivation of microorganisms on the outer surface of CVC. When the catheter was exposed to UVC irradiation from a cold cathode fluorescent lamp (CCFL) inside the catheter lumen at a radiant exposure of 3.6 mJ...

  10. Skin Necrosis after a Low-Dose Vasopressin Infusion through a Central Venous Catheter for Treating Septic Shock

    OpenAIRE

    Kim, Eun Hee; Lee, Sae Hwan; Byun, Seung Woon; Kang, Ho Suk; Koo, Dong Hoe; Park, Hyun-Gu; Hong, Sang Bum

    2006-01-01

    This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to n...

  11. Peripheral and Central Venous Blood Glucose Concentrations in Dogs and Cats with Acute Arterial Thromboembolism

    OpenAIRE

    S. Klainbart; Kelmer, E.; Vidmayer, B.; Bdolah‐Abram, T.; Segev, G.; Aroch, I.

    2014-01-01

    Background Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging. Hypothesis/Objectives Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval. Animals Client‐owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 ca...

  12. A Comparison of Clinical Outcomes with Regular- and Low-Profile Totally Implanted Central Venous Port Systems

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate whether low-profile totally implanted central venous port systems can reduce the late complication of skin perforation. Forty patients (age, 57 ± 13 years; 22 females, 18 males) were randomized for the implantation of a low-profile port system, and another 40 patients (age, 61 ± 14 years; 24 females, 16 males) received a regular port system as control group. Indications for port catheter implantation were malignant disease requiring chemotherapy. All port implantations were performed in the angiography suite using sonographically guided central venous puncture and fluoroscopic guidance of the catheter placement. Procedure time, number of complications (procedure-related immediate, early, and late complications), and number of explantations were assessed. Follow-up was performed for 6 months. All port implantations were successfully completed in both study groups. There were two incidents of skin perforation observed in the control group. One skin perforation occurred 13 weeks and the other 16 weeks after port implantation (incidence, 5%) in patients with regular-profile port systems. Two infections were observed, one port infection in each study group. Both infections were characterized as catheter-related infections (infection rate: 0.15 catheter-related infections per 1000 catheter days). In conclusion, low-profile port systems can be placed as safely as traditional chest ports and reduce the risk of developing skin perforations, which occurs when the port system is too tight within the port pocket.

  13. 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...... biofilms were 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 of...

  14. Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

    Directory of Open Access Journals (Sweden)

    Høiby Niels

    2008-10-01

    Full Text Available 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 hybridization. Results In accordance with previous studies, the cultivation of central venous catheters from 18 patients revealed that S. epidermidis and other coagulase-negative staphylococci were most abundant and that a few other microorganisms such as P. aeruginosa and K. pneumoniae occasionally were found on the catheters. The molecular analysis using clone libraries and sequencing, denaturant gradient gel electrophoresis and sequencing provided several important results. The species found by cultivation were confirmed by molecular methods. However, many other bacteria belonging to the phyla Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were also found, stressing that only a minor portion of the species present were found by cultivation. Some of these bacteria are known to be pathogens, some have not before been described in relation to human health, and some were not closely related to known pathogens and may represent new pathogenic species. Furthermore, there was a clear difference between the bacterial species found in biofilm on the external (exluminal and internal (luminal side of the central venous catheter, which can not be detected by Maki's method. Polymicrobial biofilms were observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. Conclusion The results show that diagnosis

  15. Alternate hemodialysis access in patients with occluded peripheral venous access sites; Alternative Zugangswege fuer Haemodialysekatheter bei Patienten mit verschlossenen peripheren venoesen Zugangswegen

    Energy Technology Data Exchange (ETDEWEB)

    Wacker, F.K. [Klinik und Hochschulambulanz fuer Radiologie und Nuklearmedizin, Charite - Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin (Germany); Dept. of Radiology, Univ. Hospitals of Cleveland, Case Western Reserve Univ., Cleveland, OH (United States); LiPuma, J.; Blum, A. [Dept. of Radiology, Univ. Hospitals of Cleveland, Case Western Reserve Univ., Cleveland, OH (United States)

    2005-08-01

    Purpose: the goal of this study was to evaluate translumbar and transhepatic placement of hemodialysis (HD) catheters for patients with occlusion of the veins that are commonly used for hemodialysis access. Method: over a 12-month period three translumbar and one transhepatic hemodialysis catheters were placed in 4 patients suffering from end-stage renal disease, who had thrombosis of the upper and lower extremity veins as well as the jugular veins. The percutaneous access was performed under fluoroscopic guidance. After successful passage of a guidewire into the right atrium and creation of a subcutaneous tunnel at the skin entry site, all patients received a 14 F double-lumen catheter that was placed with its tip in the right atrium. Results: percutaneous translumbar and transhepatic placement of the HD catheters was successful in all patients. No intervention-associated complications were observed. Hemodialysis could be started 1 to 20 hours after initial catheter placement in all patients. During an observation period of 3 to 7 months, 3 patients underwent hemodialysis without any complications. In one patient, an occlusion of an translumbar HD catheter was observed after 5 months. This catheter could be temporarily recanalized using rTPA injection and was then exchanged after 6 months. Conclusion: transhepatic and translumbar placement of HD catheters is a safe and viable alternative for patients who have exhausted conventional venous access sites. (orig.)

  16. Implantable Subcutaneous Venous Access Devices: Is Port Fixation Necessary? A Review of 534 Cases

    International Nuclear Information System (INIS)

    Conventional surgical technique of subcutaneous venous port placement describes dissection of the port pocket to the pectoralis fascia and suture fixation of the port to the fascia to prevent inversion of the device within the pocket. This investigation addresses the necessity of that step. Between October 8, 2004 and October 19, 2007, 558 subcutaneous chest ports were placed at our institution; 24 cases were excluded from this study. We performed a retrospective review of the remaining 534 ports, which were placed using standard surgical technique with the exception that none were sutured into the pocket. Mean duration of port use, total number of port days, indications for removal, and complications were recorded and compared with the literature. Mean duration of port use was 341 days (182,235 total port days, range 1-1279). One port inversion/flip occurred, which resulted in malfunction and necessitated port revision (0.2%). Other complications necessitating port removal included infection 26 (5%), thrombosis n = 2 (<1%), catheter fracture/pinch n = 1 (<1%), pain n = 2 (<1%), and skin erosion n = 3 (1%). There were two arrhythmias at the time of placement; neither required port removal. The overall complication rate was 7%. The 0.2% incidence of port inversion we report is concordant with that previously published, although many previous reports do not specify if suture fixation of the port was performed. Suture fixation of the port, in our experience, is not routinely necessary and may negatively impact port removal.

  17. 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. PMID:26138518

  18. Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging

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    Alberto Colombo

    2013-01-01

    Full Text Available The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC, indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.

  19. Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience.

    Science.gov (United States)

    Rus, Rina R; Premru, Vladimir; Novljan, Gregor; Grošelj-Grenc, Mojca; Ponikvar, Rafael

    2016-06-01

    Renal replacement treatment (RRT) is required in severe acute kidney injury, and a functioning central venous catheter (CVC) is crucial. Twenty-eight children younger than 16 years have been treated at the University Medical Centre Ljubljana between 2003 and 2012 with either acute hemodialysis (HD) and/or plasma exchange (PE), and were included in our study. The age of the patients ranged from 2 days to 14.1 years. Sixty-six CVCs were inserted (52% de novo, 48% guide wire). The sites of insertion were the jugular vein in 20% and the femoral vein in 80%. Catheters were in function from 1 day to 27 days. The most common cause for CVC removal or exchange was catheter dysfunction (50%). CVCs were mostly inserted in the femoral vein, which is the preferred site of insertion in acute HD/PE because of the smaller number of complications. PMID:27312920

  20. FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN AN INTENSIVE CARE UNIT

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    Priscilla Roberta Silva Rocha

    2012-01-01

    Full Text Available Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI, which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days, most due to gram-negative organisms (45.6%. Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, 95% CI 3.28-250, p-1 in survivors vs. 73.9 mg dL-1 in non-survivors, p = 0.001. Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative. CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.

  1. Case of recurrent Flavimonas oryzihabitans bacteremia associated with an implanted central venous catheter (Port-A-Cath): assessment of clonality by arbitrarily primed PCR.

    OpenAIRE

    Verhasselt, B; Claeys, G; Elaichouni, A; Verschraegen, G; Laureys, G; Vaneechoutte, M

    1995-01-01

    Flavimonas oryzihabitans bacteremias, which occurred immediately after the flushing or use of an implanted central venous catheter (Port-A-Cath) in two patients at the same pediatric ward, were studied by arbitrarily primed PCR. We conclude that the colonization of the Port-A-Cath with F. oryzihabitans described here lasted for several months.

  2. Platelet-Rich Plasma in the Treatment of Subcutaneous Venous Access Device Scars: A Head-to-Head Patient Survey

    Directory of Open Access Journals (Sweden)

    C. Eichler

    2015-01-01

    Full Text Available Introduction. Platelet-rich plasma (PRP is a product widely used in sports medicine, tissue repair, and general surgery. A recent meta-analysis showed this product to be beneficial when introduced into a wound area, be it intra-articular (i.e., joint-injections or direct introduction onto the wound surface. Methods. Between the years of 2012 and 2014 a questionnaire evaluating surgical outcome after port (venous access device removal was answered by 100 patients in the control group and 20 patients in a PRP group, leading to a total of 120 patients in this single center, retrospective, subjective outcome evaluation. Results. No statistical difference was shown in postsurgical complication rates, postsurgical pain, decreased mobility, and overall quality of life. A significant difference was shown in overall patient satisfaction and the desire to further improve port area scarring. Results differed significantly in favor of the PRP group. Interestingly, approximately 40.2% of patients are dissatisfied with the surgical outcome after port removal in the control group. This result, though surprising, may be improved to 10% dissatisfaction when a PRP product is used. Conclusion. PRP products such as Arthrex ACP are safe to use and present an additional option in improving surgical outcome.

  3. The impact of an “acute dialysis start” on the mortality attributed to the use of central venous catheters: a retrospective cohort study

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    Tennankore Karthik K

    2012-07-01

    Full Text Available Abstract Background Central venous catheters (CVCs are associated with early mortality in dialysis patients. However, some patients progress to end stage renal disease after an acute illness, prior to reaching an estimated glomerular filtration rate (eGFR at which one would expect to establish alternative access (fistula/peritoneal dialysis catheter. The purpose of this study was to determine if exclusion of this “acute start” patient group alters the association between CVCs and mortality. Methods We conducted a retrospective cohort study of 406 incident dialysis patients from 1 Jan 2006 to 31 Dec 2009. Patients were classified as acute starts if 1 the eGFR was >25 ml/min/1.73 m2, ≤3 months prior to dialysis initiation and declined after an acute event (n = 45, or 2 in those without prior eGFR measurements, there was no supporting evidence of chronic kidney disease on history or imaging (n = 12. Remaining patients were classified as chronic start (n = 349. Results 98 % and 52 % of acute and chronic starts initiated dialysis with a CVC. There were 148 deaths. The adjusted mortality hazard ratio (HR for acute vs. chronic start patients was 1.84, (95 % CI [1.19-2.85]. The adjusted mortality HR for patients dialyzing with a CVC compared to alternative access was 1.19 (95 % CI [0.80-1.77]. After excluding acute start patients, the adjusted HR fell to 1.03 (95 % CI [0.67-1.57]. Conclusions A significant proportion of early dialysis mortality occurs after an acute start. Exclusion of this population attenuates the mortality risk associated with CVCs.

  4. Elimination of axial venous reflux

    OpenAIRE

    Oinonen, Annamari

    2009-01-01

    Chronic venous disease (CVD), including uncomplicated varicose veins and chronic venous insufficiency, is one of the most common medical conditions in the Western world. The central feature of CVD is venous reflux, which may be primary, congenital, or result from an antecedent event, usually an acute deep venous thrombosis (DVT). When the history of DVT is clear, the clinical manifestations of secondary CVD are commonly referred to as the post-thrombotic syndrome. Regardless of the underlying...

  5. Minimally Invasive Monitoring of Chronic Central Venous Catheter Patency in Mice Using Digital Subtraction Angiography (DSA)

    OpenAIRE

    Figueiredo, Giovanna; Fiebig, Teresa; Kirschner, Stefanie; Nikoubashman, Omid; Kabelitz, Lisa; Othman, Ahmed; Nonn, Andrea; Kramer, Martin; Brockmann, Marc A.

    2015-01-01

    Background Repetitive administration of medication or contrast agents is frequently performed in mice. The introduction of vascular access mini-ports (VAMP) for mice allows long-term vascular catheterization, hereby eliminating the need for repeated vessel puncture. With catheter occlusion being the most commonly reported complication of chronic jugular vein catheterization, we tested whether digital subtraction angiography (DSA) can be utilized to evaluate VAMP patency in mice. Methods Twent...

  6. Microbiological analysis of the central venous catheter tips from hospitalized patients at Hospital Universitário of Universidade Estadual de Londrina
    Análise microbiológica de pontas de cateteres venosos centrais provenientes de pacientes internados no Hospital Universitário da Universidade Estadual de Londrina

    OpenAIRE

    Jacinta Sanchez Pelayo; Leandro Augusto Calixto; Ligia Maira dos Santos Rogeri; Raquel Girardello; Regina Mariuza Borsato Quesada; Claudia Ross

    2006-01-01

    Central Venous Catheters (CVC) are used in intravenous therapy in order to facilitate diagnosis and treatment. They allow medicine administration, parenteral nutrition and also vascular access in hemodialysis. However, the use of these catheters offers risks of systemic and local infection, including endocarditis and bacteremia. The aim of this study was to isolate microorganisms from CVC utilizing the semiquantitative culture technique, and to identify them through conventional biochemical t...

  7. Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

    International Nuclear Information System (INIS)

    To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.

  8. Radiological landmarks for optimal tip-position of the central venous port catheter inserted via peripheral vein in the left arm

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate normative data of the superior vena cava (SVC) anatomy using multi-detector row CT (MDCT) and determine the optimal tip-position of the central venous port catheter inserted via the peripheral veins in the left arm. On the coronal images of MDCT in 48 patients as a control, the SVC length and distances between the carina and cavoatrial junction and between the cephalad margin of SVC and carina were measured using a workstation. The location of a catheter-tip in twenty-three patients with a central venous port catheter inserted via a peripheral veins in the left arm was categorized into two groups: group A (above or same level as the carina, n=14), group B (below the carina, n=9). We investigated catheter-related complications such as catheter dislodgement and venous thrombosis. According to the MDCT images in the control group, the mean distance from the carina to the cavoatrial junction was 35.3 mm±7.4 mm (95% confidence interval [CI]; 30 mm, 40.6 mm). The mean distance from the cephalad margin of the SVC to the carina was 28.5 mm±5.6 mm (95% CI; 24.5 mm, 32.5 mm). The catheter tip was dislodged into the left innominate vein in seven patients of group A, and venous thrombosis was seen in two of these patients. No significant complications in group B (26.8 mm±7.6 mm below the carina, 95% CI; 21.8 mm, 31.8 mm) were seen. The position at approximately 3-4 cm below the carina is near the cavoatrial junction. The optimal tip-position of the central venous port catheter should be 2-3 cm below the carina. (author)

  9. Transhepatic venous catheters for hemodialysis

    OpenAIRE

    Mohamed El Gharib; Gamal Niazi; Waleed Hetta; Yahya Makkeyah

    2014-01-01

    Purpose: To describe our experience with the technique of transhepatic venous access for hemodialysis and to evaluate its functionality and complications. Patients and methods: From March 2012 till October 2012, 23 patients with age ranging from 12 to 71 years old having end-stage renal disease (ESRD) were included in our study and were subjected to transhepatic venous catheter insertion. In 21 patients there were not any remaining patent peripheral venous accesses. In 2 patients there wer...

  10. Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro, E-mail: ksofue@ncc.go.jp [Divisions of Diagnostic Radiology, National Cancer Center Hospital (Japan); Department of Radiology, Kobe University, Graduate School of Medicine (Japan); Arai, Yasuaki; Takeuchi, Yoshito [Divisions of Diagnostic Radiology, National Cancer Center Hospital (Japan); Sugimura, Kazuro [Department of Radiology, Kobe University, Graduate School of Medicine (Japan)

    2013-11-01

    Purpose: To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication. Materials and methods: A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port. Results: Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction. Conclusion: FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required.

  11. Comparing the use of global rating scale with checklists for the assessment of central venous catheterization skills using simulation.

    Science.gov (United States)

    Ma, Irene W Y; Zalunardo, Nadia; Pachev, George; Beran, Tanya; Brown, Melanie; Hatala, Rose; McLaughlin, Kevin

    2012-10-01

    The use of checklists is recommended for the assessment of competency in central venous catheterization (CVC) insertion. To explore the use of a global rating scale in the assessment of CVC skills, this study seeks to compare its use with two checklists, within the context of a formative examination using simulation. Video-recorded performances of CVC insertion by 34 first-year medical residents were reviewed by two independent, trained evaluators. Each evaluator used three assessment tools: a ten-item checklist, a 21-item checklist, and a nine-item global rating scale. Exploratory principal component analysis of the global rating scale revealed two factors, accounting for 84.1% of the variance: technical ability and safety. The two checklist scores correlated positively with the weighted factor score on technical ability (0.49 [95% CI 0.17-0.71] for the 10-item checklist; 0.43 [95% CI 0.10-0.67] for the 21-item checklist) and negatively with the weighted factor score on safety (-0.17 [95% CI -0.48-0.18] for the 10-item checklist; -0.13 [95% CI -0.45-0.22] for the 21-item checklist). A checklist score of 80% on both checklists. All these candidates committed serious errors. In conclusion, the practice of universal adoption of checklists as the preferred method of assessment of procedural skills should be questioned. The inclusion of global rating scales should be considered. PMID:21877217

  12. Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

    International Nuclear Information System (INIS)

    Purpose: To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication. Materials and methods: A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port. Results: Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction. Conclusion: FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required

  13. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

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    Coentrão Luis

    2012-08-01

    Full Text Available Abstract Background Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD over hemodialysis (HD, the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. Methods A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC or a functional arteriovenous fistula (HD-AVF in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42. All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Results Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (pp = 0.017 and cardiovascular disease (p = 0.020. Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069, emergency room visits (ppvs. 0.93 vs. 0.64, per patient-year; pvs. 0.07 vs. 0.14, per patient-year; p = 0.034 than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (pp = 0.024. Conclusion Our results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

  14. Lactate, endothelin, and central venous oxygen saturation as predictors of mortality in patients with Tetralogy of Fallot

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    Poonam Malhotra Kapoor

    2016-01-01

    Full Text Available Background: Lactate and central venous oxygen saturation (ScVO2 are well known biomarkers for adequacy of tissue oxygenation. Endothelin, an inflammatory marker has been associated with patient′s nutritional status and degree of cyanosis. The aim of this study was to explore the hypothesis that lactate, ScVO2 and endothelin before induction may be predictive of mortality in pediatric cardiac surgery. Methods: We conducted a prospective observational study of 150 pediatric (6 months to 12 years patients who were posted for intracardiac repair for tetralogy of fallot and measured lactate, ScVO2 and endothelin before induction (T1, 20 minutes after protamine administration (T2 and 24 hours after admission to ICU (T3. Results: Preinduction lactate and endothelin levels were found to predict mortality in patients of tetralogy of fallot with an odds ratio of 6.020 (95% CI 2.111-17.168 and 1.292(95% CI 1.091-1.531 respectively. In the ROC curve analysis for lactate at T1, the AUC was 0.713 (95% CI 0.526-0.899 P = 0.019. At the cutoff value of 1.750mmol/lt, the sensitivity and specificity for the prediction of mortality was 63.6% and 65.5%, respectively. For endothelin at T1, the AUC was 0.699 (95% CI 0.516-0.883, P = 0.028 and the cutoff value was ≤2.50 (sensitivity, 63.6%; specificity, 58.3 %. ScVO2 (odds ratio 0.85 at all three time intervals, suggested that improving ScVO2 can lead to 15% reduction in mortality. Conclusions: Lactate, ScVO2 and endothelin all showed association with mortality with lactate having the maximum prediction. Lactate was found to be an independent, reliable and cost-effective measure of prediction of mortality in patients with tetralogy of fallot.

  15. Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.

    Science.gov (United States)

    Raad, Issam; Chaftari, Anne-Marie; Zakhour, Ramia; Jordan, Mary; Al Hamal, Zanaib; Jiang, Ying; Yousif, Ammar; Garoge, Kumait; Mulanovich, Victor; Viola, George M; Kanj, Soha; Pravinkumar, Egbert; Rosenblatt, Joel; Hachem, Ray

    2016-06-01

    In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.). PMID:27001822

  16. Central venous catheter - flushing

    Science.gov (United States)

    ... of your catheter and what company made it. Write this information down and keep it handy. To flush your catheter, you will need: Clean paper towels Saline syringes (clear), and maybe heparin syringes ( ...

  17. Central venous catheter - flushing

    Science.gov (United States)

    ... the strength and dose is correct. Check the expiration date. If the syringe is not prefilled, draw ... signs of infection (fever, chills) Are short of breath Feel dizzy Also call your doctor if your ...

  18. Evaluation of adjusted central venous blood gases versus arterial blood gases of patients in post-operative paediatric cardiac surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2015-01-01

    Full Text Available Background and Aims: Central venous catheters are in situ in most of the intensive care unit (ICU patients, which may be an alternative for determining acid-base status and can reduce complications from prolonged arterial cannulation. The aim of this study was to examine the reliability between adjusted central venous blood gas (aVBG and arterial blood gas (ABG samples for pH, partial pressure of carbon-di-oxide (pCO2, bicarbonate (HCO3−, base excess (BE and lactates in paediatric cardiac surgical ICU. Methods: We applied blood gas adjustment rule, that is aVBG pH = venous blood gas (VBG pH +0.05, aVBG CO2 = VBG pCO2 - 5 mm Hg from the prior studies. In this study, we validated this relationship with simultaneous arterial and central venous blood obtained from 30 patients with four blood sample pairs each in paediatric cardiac surgical ICU patients. Results: There was a strong correlation (R i.e., Pearson's correlation between ABG and aVBG for pH = 0.9544, pCO2 = 0.8738, lactate = 0.9741, HCO3− = 0.9650 and BE = 0.9778. Intraclass correlation co-efficients (ICCs for agreement improved after applying the adjustment rule to venous pH (0.7505 to 0.9454 and pCO2 (0.4354 to 0.741. Bland Altman showed bias (and limits of agreement for pH: 0.008 (−0.04 to + 0.057, pCO2: −3.52 (–9.68 to +2.65, lactate: −0.10 (−0.51 to +0.30, HCO3−: −2.3 (–5.11 to +0.50 and BE: −0.80 (−3.09 to +1.49. Conclusion: ABG and aVBG samples showed strong correlation, acceptable mean differences and improved agreement (high ICC after adjusting the VBG. Hence, it can be promising to use trend values of VBG instead of ABG in conjunction with a correction factor under stable haemodynamic conditions.

  19. Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Chiostri Marco

    2009-05-01

    Full Text Available Abstract Background Continuous monitoring of central venous oxygen saturation (ScvO2 has been proposed as a prognostic indicator in several pathological conditions, including cardiac diseases, sepsis, trauma. To our knowledge, no studies have evaluated ScvO2 in polytraumatized patients with brain injury so far. Thus, the aim of the present study was to assess the prognostic role of ScvO2 monitoring during first 24 hours after trauma in this patients' population. Methods This prospective, non-controlled study, carried out between April 2006 and March 2008, was performed in a higher level Trauma Center in Florence (Italy. In the study period, 121 patients affected by major brain injury after major trauma were recruited. Inclusion criteria were: 1. Glasgow Coma Scale (GCS score ≤ 13; 2. an Injury Severity Score (ISS ≥ 15. Exclusion criteria included: 1. pregnancy; 2. age 2 monitoring within 2 hours from the trauma. Demographic and clinical data were collected, including Abbreviated Injury Scale (AIS, Injury Severity Score (ISS, Simplified Acute Physiologic Score II (SAPS II, Marshall score. The worst values of lactate and ScvO2 within the first 24 hours from trauma, ICU length of stay (LOS, and 28-day mortality were recorded. Results Patients who deceased within 28 days showed higher age (53 ± 16.6 vs 43.8 ± 19.6, P = 0.043, ISS core (39.3 ± 14 vs 30.3 ± 10.1, P 2 resulted significantly lower (66.7% ± 11.9 vs 70.1% ± 8.9 vs, respectively; P = 0.046. Patients with ScvO2 values ≤ 65% also showed higher 28-days mortality rate (31.3% vs 13.5%, P = 0.034, ICU LOS (28.5 ± 15.2 vs 16.6 ± 13.8, P 2 > 65%. Conclusion ScvO2 value less than 65%, measured in the first 24 hours after admission in patients with major trauma and head injury, was associated with higher mortality and prolonged hospitalization.

  20. 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

    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 in adu...

  1. Serum Lactate Is not Correlated with Mixed or Central Venous Oxygen Saturation for Detecting Tissue Hypo Perfusion During Coronary Artery Bypass Graft Surgery: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Shahrbano Shahbazi

    2013-12-01

    Full Text Available Objectives:: Effective assessment of tissue perfusion is highly important during Coronary Artery Bypass Graft (CABG. Mixed venous O2 saturation (Svo2 is one of the best and routinely used markers of tissue perfusion. However, this method is costly and leads to considerable complications. Thus, the present study aimed to determine whether the Svo2 can be substituted with central venous saturation (Scvo2 and if there is any correlation between lactate level and Svo2. Methods:: This prospective observational study was conducted on 62 patients scheduled for CABG. After induction and maintenance of anesthesia, blood samples drawn from central venous, pulmonary artery, and radial artery were used to measure Scvo2, Svo2 and serum lactate level respectively before and after Cardio Pulmonary Bypass (CPB. Pearson’s correlation test was used to determine the correlation between Svo2 and Scvo2 as well as between Svo2 and serum lactate level. Besides, P < 0.05 was considered as statistically significant. Results:: Overall, 62 Patients, 33 males (53.2% and 29 females (46.8% were enrolled into the present study. The most common coexisting illness was hypertension detected in 33 patients (53.2% followed by hypercholesterolemia in 28 ones (44.4%. In this study, Svo2 was positively correlated with Scvo2 (r = 0.63, P < 0.001. However, no correlation was found between Svo2 and lactate (r = 0.124, P = 0.348. Conclusions:: In summary, Scvo2 is considered as the best substitute of Svo2 for detecting tissue hypo perfusion during CPB. Although the lactate level had been considered as an appropriate marker of tissue perfusion and ischemia, it was not correlated to Svo2 during CABG.

  2. Feasibility of power contrast injections and bolus triggering during CT scans in oncologic patients with totally implantable venous access ports of the forearm

    International Nuclear Information System (INIS)

    Background: Conventional totally implantable venous access ports (TIVAPs) are not approved for power contrast injections but often remain the only venous access site in oncologic patients. Therefore, these devices can play an important role if patients with a TIVAP are scheduled for a contrast-enhanced computed tomography (ceCT) as vascular access may become more difficult during the course of chemotherapy. Purpose: To evaluate the feasibility and safety of power injections in conventional TIVAPs in the forearm and to analyze the feasibility of bolus triggering during CT scans. Material and Methods: In this retrospective study we analyzed 177 power injections in 141 patients with TIVAPs in the forearm. Between October 2008 and March 2010 all patients underwent power injections (1.5 mL/s, 150 psi) via the TIVAP for ceCT because conventional vascular access via a peripheral vein had failed. Adequate functioning and catheter's tip location after injection were evaluated. Peak injection pressure and attenuation levels of aorta, liver and spleen were analyzed and compared with results of 50 patients who were injected via classical peripheral cannulas (3 mL/s, 300 psi). Feasibility of automatic scan initiation was evaluated. In vitro the port was stressed with 5 mL/s (300 psi). Results: One TIVAP showed tip dislocation with catheter rupture. Three (2.1%) devices were explanted owing to assumed infection within 4 weeks after the injection. Mean injection pressure was 121.9 ±24.1 psi. Triggering with automatic scan initiation succeeded in 13/44 (29.6%) scans. Injection via classical cannulas resulted in significantly higher enhancement (p < 0.05). In vitro the port system tolerated flow rates of up to 5 mL/s, injection pressures of up to 338 psi. Conclusion: Power injection is a safe alternative for patients with TIVAPs in the forearm if classic vascular access ultimately fails. Triggering was successful in one-third of the attempts. Image quality in the arterial phase

  3. Measurement of Anterior-Posterior Diameter of Inferior Vena Cava by Ultrasonography: A Non-Invasive Method for Estimation of Central Venous Pressure

    Directory of Open Access Journals (Sweden)

    R. Nafisi-Moghadam

    2007-05-01

    Full Text Available Background and Objective: The assessment of blood volume is now one of the most commonly needed interventions in the first line of care and severe ill patients. Measuring central venous pressure (CVP is an invasive method, most frequently used in clinical practice for the assessment of volume status. The di-ameter of the inferior vena cava (IVC is a parameter to estimate central venous pressure. The purpose of this study was to determine whether measurement of the anterior-posterior diameter of the IVC by ultra-sonography, correlates with CVP. Materials and Methods: It was a descriptive and pro-spective study on 50 patients; CVP was measured in supine position by CVP manometer. Anterior – pos-terior IVC diameter was assessed by ultrasonography during inspiration and expiration. Results: The mean of CVP during inspiration and ex-piration was 11.31+5.59, 12.20 + 5.65cmH2o, respec-tively. The mean of inspiratory and expiratory IVC diameter was 7.71+3.56, 11.97+3.28 mm, respectively. There was significant relation between CVP and IVC diameter in the inspiration (r=0.664, p<0.0001 and expiration (r=0.495, p=0.001. The relation between these two variables was linear. Conclusion: Result of this study showed that IVC di-ameter measurement by ultrasonography can be used to estimate the mean of CVP.

  4. The Norwegian central administration ten years after accession

    OpenAIRE

    Trondal, Jarle

    2005-01-01

    This study demonstrates that the European Commission contribute to weaken hierarchical decision-making processes, and ultimately politico-administrative control and oversight, within the Norwegian central administration. This article studies how the Norwegian central administrative apparatus is penetrated by the European Commission through ten years of “associated EU membership” through the EEA agreement. The study outlines two complementary theoretical approaches to account for actual decisi...

  5. Factores que inciden sobre el tiempo de permanencia de un catéter endovenoso central Factors that affect the dwell time of a central venous catheter

    Directory of Open Access Journals (Sweden)

    H. Bello-Villalobos

    2006-06-01

    Full Text Available Objetivo: Determinar los factores que inciden en el tiempo de permanencia de un catéter endovenoso central. Antecedentes: En el paciente con cáncer existen factores propios del estado de inmunocompromiso por el tumor y los efectos colaterales de su tratamiento que aumentan la probabilidad de infección y consecuentemente reducen el tiempo de uso de un catéter. Sujetos: Se integró una cohorte de 306 pacientes con cáncer, con una edad promedio de 59 ± 14,5 años. Intervenciones: Se definió tiempo cero como el día de colocación del catéter. Diariamente se buscaron signos clínicos de infección por catéter, con toma de hemocultivos simultáneos cada 7 días. El desenlace primario fue infección del catéter y el alternativo fin de tratamiento, obstrucción o fallecimiento del paciente. Se comparó el tiempo de permanencia del catéter infectado vs no infectado y su relación con factores de riesgo potenciales. Resultados: Se colocaron 306 catéteres para un total de 4.043 días/catéter. Se infectaron 25 (8,2%. La sobrevida media global fue de 50 días. Se encontró que a mayor tiempo de permanencia, mayor fue la incidencia de infección. En el análisis de sobrevida ajustado, la presencia de infección a distancia (OR = 4,71, IC95% = 1,7-10,1, p = 0,002 fue el factor que mostró una asociación significativa. Conclusiones: El tiempo de vida útil de un catéter es amplia, limitada por la presencia de infección a distancia como factor de riesgo potencial de infección por catéter.Objective: To determine the factors that affect the dwell time of a central venous catheter. Background: The own immunodeficiency in cancer patient and the collateral effects of their treatment increase the probability of infection and reduce the time of use of a catheter. Subjects: Incipient cohort of 306 patients with cancer, with an average age of 59 ± 14.5 years. Interventions: Time zero like the day of the placement of the catheter was defined. Daily

  6. PubMed Central Canada: Beyond an Open Access Repository?

    Science.gov (United States)

    Nariani, Rajiv

    2013-01-01

    PubMed Central Canada (PMC Canada) represents a partnership between the Canadian Institutes of Health Research (CIHR), the National Research Council's Canada Institute for Scientific and Technical Information (NRC-CISTI), and the National Library of Medicine of the US. The present study was done to gauge faculty awareness about the CIHR Policy on…

  7. Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer.

    Science.gov (United States)

    Windich-Biermeier, Andrea; Sjoberg, Isabelle; Dale, Juanita Conkin; Eshelman, Debra; Guzzetta, Cathie E

    2007-01-01

    This study evaluates the effect of self-selected distracters (ie, bubbles, I Spy: Super Challenger book, music table, virtual reality glasses, or handheld video games) on pain, fear, and distress in 50 children and adolescents with cancer, ages 5 to 18, with port access or venipuncture. Using an intervention-comparison group design, participants were randomized to the comparison group (n = 28) to receive standard care or intervention group (n = 22) to receive distraction plus standard care. All participants rated their pain and fear, parents rated participant fear, and the nurse rated participant fear and distress at 3 points in time: before, during, and after port access or venipuncture. Results show that self-reported pain and fear were significantly correlated (P = .01) within treatment groups but not significantly different between groups. Intervention participants demonstrated significantly less fear (P distracter. The authors conclude that distraction has the potential to reduce fear and distress during port access and venipuncture. PMID:17185397

  8. Interventional radiology with venous port (chemotherapy and infusional support)

    International Nuclear Information System (INIS)

    A completely portable permanent central venous access, consisting of a steel capsule sealed with a silicone membrane and connected to a silicone catheter (Port-a-Cath), was implanted in the subcutaneous tissue of 36 patients, most of whom no longer had accessible peripheral veins and needed to continue chemotherapy or undergo total parenteral nutrition. The access vessel was mostly the subclavian vein and the capsule was sutured to the pectoral fascia. Total subcutaneous implantation seems to afford optimum safety from infection and freedom for personal hygiene, produced no noteworthy complications and proved relatively simple to maintain. (orig.)

  9. Open Access to Data - Central Role for Geoinformatics

    Science.gov (United States)

    Snyder, W. S.

    2006-12-01

    The open access to scientific information has become a contentious issue. In the United States there are calls to make all published literature available for free within 6 months of publication, the notion being that this will promote better science and policy decisions based on science. Here, I argue that this is the incorrect approach to the issue of open access to scientific information. A fundamental problem raised by the call for open access to government-supported research results is the viability of our not-for-profit professional scientific societies. These societies provide the base level framework for the exchange of scientific ideas, and hence the very core of how we do science and how scientific knowledge is advanced. Why should a scientist subscribe to a journal if they can read the article for free in six months? A large portion of a society's operational costs come from these subscriptions and the sale of specialized books, all of which contain the results of federally-funded research. Without revenue from journal subscriptions and book sales, not only will these publications disappear, but many of societies may as well. Without a broad venue to publish and in which to interact, our science suffers - many subdisciplines may fade or even die - those that don't "sell well." Very popular publications such as "Nature", "Science", "Tectonics", and "Geology" will continue to thrive, but what about the more specialized journals such as "Journal of Paleontology"? They are costly to publish yet fill a very critical niche for our science. Many will still pay for reading the Nature/Science/Tectonics/Geology article, but where do we publish the mainstream science paper? We have to guard against becoming a "Hollywood Science" - where only the glitzy gets published because those are the articles that sell. We must have peer-reviewed, independent publications and viable professional societies, or our science will severely suffer. We can better approach the need for

  10. A right atrial mass, patent foramen ovale, and indwelling central venous catheter in a patient with a malignancy: a diagnostic and therapeutic dilemma.

    Science.gov (United States)

    Funt, Samuel; Lerakis, Stamatios; McLean, Dalton S; Willis, Patrick; Book, Wendy; Martin, Randolph P

    2010-04-01

    A 33-year-old woman with a history of gestational trophoblastic disease presented for investigation of a right atrial mass. She had been receiving chemotherapy administered via a Port-a-Cath system for 2 months prior to presentation. On transesophageal echocardiography and magnetic resonance imaging, she was found to have a mass attached to the right atrial free wall, with a segment projecting across a patent foramen ovale. Because of the risk for an embolic event, the mass was surgically removed and the patent foramen ovale repaired. Pathology showed an organized thrombus. This case emphasizes the need for high suspicion for thrombus when a right atrial mass is found in a patient with a hypercoagulable state due to underlying malignancy who has a central venous catheter. PMID:19879732

  11. Venous interventions in children.

    Science.gov (United States)

    Kukreja, Kamlesh; Vaidya, Sandeep

    2011-03-01

    Advanced medical treatment options have improved pediatric survival but often require invasive vascular procedures or venous access. These procedures increase the risk for thromboembolism in children, and there has been a corresponding increase in the reported incidence of deep venous thrombosis and postthrombotic syndrome in the pediatric population. Percutaneous venous interventions using catheter-directed therapy (CDT), like mechanical thrombectomy and infusion thrombolysis, have been used much less frequently in children, even though they have shown good results in adults. A multidisciplinary team including pediatric hematology, interventional radiology, and intensive care unit is suggested for management of venous thrombosis in children. Indications and contraindications for CDT in children are similar to adults. Mechanical thrombectomy and infusion thrombolysis are some of the more commonly performed treatments. CDT in children requires adapting to patient size and locally available equipment. Ultrasound guidance for access, "cork" technique, appropriate dosing of tissue plasminogen activator for infusion/pharmacomechanical thrombolysis, and simultaneous administration of heparin, plasminogen (fresh frozen plasma), and deficient coagulation factors are some of the important variations of CDT technique in children. Postprocedure monitoring is very important for successful thrombolysis. Retrievable inferior vena cava filters are increasingly being used in children as well, for prophylaxis against pulmonary embolism (PE) if there is a significant risk of PE with/without contraindications to anticoagulation. PMID:21335289

  12. Comparative study of complications of chemotherapy by three central venous catheterizations%三种途径中心静脉置管化疗并发症比较护理研究

    Institute of Scientific and Technical Information of China (English)

    文燕舞; 徐雪萍; 钟小弟; 马明慧; 宋丹丹; 雷伶俐; 覃谦

    2011-01-01

    Objective To compare and study the complications of the central venous catheterizations(CVC) via three accesses in advanced tumors of breast and gastrointestinal tract during chemotherapy to acquire the best liquid path of chemotherapeutic drugs.Methods A total of 86 breast cancer and gastrointestinal cancer patients were selected randomly who were treated with different central venous catheterizations (CVC) .Among of them 21 cases were treated by means of internal jugular venous access (IJVA), 43 cases were treated by means of peripherally inserted central catheter (PICC) and 22 cases were treated by means of subclavian vein drug delivery system (SVADDS) .Results The total incidence rates d complications for IJVA, PICC, SVADDS group were 19.0%, 74.4%, 18.2% respectively (P < 0.01 ) .The incidence rates of extubation because of infections and embolisms for these three groups were 19.0%,44.2%, 4.5% respectively (P<0.01) .Conclusions The method of IJVA is convenient.But percutaneous catheter is wanted before chemotherapy.So many complications exist in PICC group..Relatively SVADDS is the best intravenous method of chemotherapy for few complications, a long duration and a better comfort.%目的 对进展期的乳腺癌和胃肠道癌化疗期间采用三种中心静脉置管(CVC)比较护理研究,以探讨和选择化疗药物输入的最佳护理途径.方法 选取进展期乳腺癌和胃肠道癌患者86例,分别经颈内静脉(IJVA)、外周静脉(PICC)和锁骨下静脉(SVADDS)导入CVC.其中IJVA 21例,PICC43例,SVADDS 22例.结果 IJVA、PICC和SVADDS三组并发症总发生率分别为19.0%、74.4%和18.2%,因导管阻塞和感染等并发症而拔管的发生率分别为19.0%、44.2%和4.5%.三组间比较,差异有统计学意义(P<0.01).结论 在三种途径的CVC比较中,IJVA置入虽然方便,缺点是每次化疗前需要进行穿刺置管;PICC管则并发症多;而SVADDS具有并发症少、提高患者生活质量和可以长期保留等优

  13. Analysis of the association between periportal low attenuation, as seen on CT, after blunt abdominal trauma, and elevated central venous pressure

    International Nuclear Information System (INIS)

    To assess the causes of periportal low attenuation, as seen on CT, in patients with blunt abdominal trauma. From among 812 patients who underwent abdominal CT after blunt abdominal trauma, we retrospectively analysed the findings in 124 with evidence of periportal low attenuation. Among these, hepatic injury was noted in only 87. The presence or absence, and extent of hepatic injury, and of periportal low attenuation, as seen on CT, were carefully evaluated. In each case, the ratio of the transverse diameter of the inferior vena cava(IVC) to the aorta at the level of the right adrenal gland provided an indirect measurement of central venous pressure ; for control purposes, the ratio was also obtained in 21 non-traumatic patients with no abnormal abdominal CT findings. Of the 87 patients with hepatic injury, 46 showed no periportal low attenuation, and average value of the ratio between the IVC and aorta was 1.16±0.12, while the remaining 41 patients showed periportal low attenuation with a ratio of 1.51±0.21(p<0.05). In the 37 patients with periportal low attenuation but no evidence of concomitant hepatic injury, the average ratio was 1.52±0.25, while in 21 non-traumatic patients it was 1.15±0.16. For resuscitation, all patients had received 0.5-5.0 litre of IV fluid therapy before CT, and at the time of CT, were normotensive. Rapidly elevated central venous pressure following massive IV infusion therapy in patients with blunt abdominal trauma can be one of the causes of periportal low attenuation, as seen on CT

  14. Reduced low-traumatic access thyroidectomy with central neck dissection

    Directory of Open Access Journals (Sweden)

    A. V. Shabunin

    2016-03-01

    Full Text Available Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC, the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 % cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale 68 (89.5 % patient was recognized as a excellent, and 8 (10.5 % as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results. 

  15. Van Allen Probes Science Gateway: A Centralized Data Access Point

    Science.gov (United States)

    Romeo, G.; Barnes, R. J.; Ukhorskiy, A. Y.; Sotirelis, T.; Stephens, G. K.; Kessel, R.; Potter, M.

    2015-12-01

    The Van Allen Probes Science Gateway acts a centralized interface to the instrument Science Operation Centers (SOCs), provides mission planning tools, and hosts a number of science related activities such as the mission bibliography. Most importantly, the Gateway acts as the primary site for processing and delivering the Van Allen Probes Space Weather data to users. Over the past years, the web-site has been completely redesigned with the focus on easier navigation and improvements of the existing tools such as the orbit plotter, position calculator and magnetic footprint tool. In addition, a new data plotting facility has been added. Based on HTML5, which allows users to interactively plot Van Allen Probes science and space weather data. The user can tailor the tool to display exactly the plot they wish to see and then share this with other users via either a URL or by QR code. Various types of plots can be created, including, simple time series, data plotted as a function of orbital location, and time versus L-Shell, capability of visualizing data from both probes (A & B) on the same plot. In cooperation with all Van Allen Probes Instrument SOCs, the Science Gateway will soon be able to serve higher level data products (Level 3), and to visualize them via the above mentioned HTML5 interface. Users will also be able to create customized CDF files on the fly.

  16. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems

    International Nuclear Information System (INIS)

    In this retrospective study the success and complication rates after radiologically guided port catheter implantation were evaluated. Between 2000 and 2008, 3,160 port catheter systems were implanted in our interventional suite. All interventions were imaging guided. The puncture of the preferably right internal jugular vein (IJV) was ultrasound-assisted and the catheter tip position was controlled with fluoroscopy. Catheter indwelling time and rates of periprocedural, early and late complications were evaluated. 922,599 catheter days (mean, 292 days; range, 0-2,704 days) were documented. The implantation was successful in 3,153 (99.8%) cases. A total of 374 (11.8%; 0.41/1,000 catheter days) adverse events were recorded. Of these, 42 (1.33%) were periprocedural complications. 86 (3.3%; 0.09/1,000 catheter days) early and 246 (9.4%; 0.27/1,000 catheter days) late onset complications occurred after port implantation. The most common complications were blood stream infection (n = 134; 5.1%; 0.15/1,000 catheter days), catheter-induced venous thrombosis (n = 97; 3.7%; 0.11/1,000 catheter days) and catheter migration (n = 34; 1.3%; 0.04/1,000 catheter days). A total of 193 (6.1%) port explantations were required. Ultrasound guided port implantation via the IJV results in low periprocedural complication rates. (orig.)

  17. Current perspective of venous thrombosis in the upper extremity

    OpenAIRE

    Flinterman, L.E.; Meer, van der, W.; Rosendaal, F.R.; Doggen, C.J.M.

    2008-01-01

    Venous thrombosis of the upper extremity is a rare disease. Therefore, not as much is known about risk factors, treatment and the risk of recurrence as for venous thrombosis of the leg. Only central venous catheters and strenuous exercise are commonly known risk factors for an upper extremity venous thrombosis. In this review an overview of the different risk factors, possible treatments and the complications for patients with a venous thrombosis of the upper extremity is given

  18. Comparison between distributed and centralized demand assignment TDMA satellite access schemes

    OpenAIRE

    Celandroni, Nedo; Ferro, Erina; Potort?, Francesco

    1996-01-01

    This paper presents the performance measurements from a comparison between FODAIIBEA and two other satellite access schemes, FEEDERS and DRIFS. The three schemes differ in terms of the scheduling of the channel capacity: Le. centralized control in FODA/IBEA and distributed in the other two. All these access schemes were designed at CNUCE, where the simulation tool used for the comparison was also developed. FODA/IBEA was developed and tested on several satellites (Olympus, Eutelsat and Italsa...

  19. The clinical application of head-ring type posture pad used for prone position in performing the placement of central venous catheter in patients with tumors

    International Nuclear Information System (INIS)

    Objective: to observe the effectiveness of head-ring type posture pad used for prone position in performing the procedure of peripheral insertion of central catheter (PICC) via the dorsal forearm vein in patients with neoplasm. Methods: A total of 80 consecutive tumor patients were randomly divided into two groups. PICC was carried out in all patients in prone position. In control group (n=38) PICC was performed with patient's head inclining to one side, while in study group (n=42) PICC was performed with the help of head-ring type pad to keep the patient in comfortable posture. The comfortableness, breathing rhythm, transcutaneous oxygen saturation and the change of heart rate during the procedure were observed. The results were analyzed and compared between the two groups. Results: The results is study group were much better than those in control group. Statistically significant difference in the comfortableness, breathing rhythm, transcutaneous oxygen saturation and heart rate existed between the two groups. Conclusion: The head-ring type posture pad used for prone position can make the patients more comfortable in performing peripheral insertion of central venous catheter via the dorsal forearm vein. (authors)

  20. Patients on hemodialysis are better served by a proximal arteriovenous fistula for long-term venous access.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2012-11-01

    Patients with end-stage renal disease should have arteriovenous fistula (AVF) formation 3 to 6 months prior to commencing hemodialysis (HD). However, this is not always possible with strained health care resources. We aim to compare autologous proximal AVF (PAVF) with distal AVF (DAVF) in patients already on HD. Primary end point is 4-year functional primary. Secondary end point is freedom from major adverse clinical events (MACEs). From January 2003 to June 2009, out of 495 AVF formations, 179 (36%) patients were already on HD. These patients had 200 AVF formations (49 DAVF vs 151 PAVF) in arms in which no previous fistula had been formed. No synthetic graft was used. Four-year primary functional patency significantly improved with PAVF (68.9% ± SD 8.8%) compared to DAVF (7.3% ± SD 4.9%; P < .0001). Five-year freedom from MACE was 85% with PAVF compared to 40% with DAVF (P < .005). Proximal AVF bestows long-term functional access with fewer complications compared to DAVF for patients already on HD.

  1. Venous thromboembolism: The intricacies

    Directory of Open Access Journals (Sweden)

    Dutta T

    2009-01-01

    Full Text Available Venous thromboembolism (VTE has been a subject of great interest of late. Since Rudolph Virchow described the famous Virchow′s triad in 1856, there have been rapid strides in the understanding of the pathogenesis and factors responsible for it. Discovery of various thrombophilic factors, both primary and acquired, in the last 40 years has revolutionized prognostication and management of this potentially life-threatening condition due to its associated complication of pulmonary thromboembolism. Detailed genetic mapping and linkage analyses have been underlining the fact that VTE is a multifactorial disorder and a complex one. There are many gene-gene and gene-environment interactions that alter and magnify the clinical picture in this disorder. Point in case is pregnancy, where the risk of VTE is 100-150 times increased in the presence of Factor V Leiden, prothrombin mutation (Prothrombin 20210A and antithrombin deficiency. Risk of VTE associated with long-haul air flight has now been well recognized. Thrombotic events associated with antiphospholipid syndrome (APS are 70% venous and 30% arterial. Deep venous thrombosis and pulmonary embolism are the most common venous events, though unusual cases of catastrophes due to central vein thrombosis like renal vein thrombosis and Budd-Chiari syndrome (catastrophic APS may occur.

  2. Ensaio clínico controlado sobre o curativo de cateter venoso central Ensayo clínico controlado sobre la cobertura de catéter venoso central Clinical controlled trial on central venous catheter dressings

    Directory of Open Access Journals (Sweden)

    Edivane Pedrolo

    2011-01-01

    Full Text Available OBJETIVO: Avaliar a eficácia dos curativos de gaze e fita e filme transparente de poliuretano para cobertura de cateteres venosos centrais. MÉTODOS: Ensaio clínico controlado randomizado. RESUlTADOS: Não foi identificada uma diferença significativa com relação à infecção relacionada ao cateter (p=1 e à fixação do curativo (p=0,670. Foi identificada diferença estatisticamente significativa com relação à absorção de exsudato (pOBJETIVO: Evaluar la eficacia de las curaciones de gasa y cinta y película transparente de poliuretano para la cobertura de catéteres venosos centrales. MÉTODOS: Ensayo clínico controlado randomizado. RESULTADOS: No se identificó una diferencia significativa con relación a la infección relacionada al catéter (p=1 y a la fijación de la curación (p=0,670. Fue identificada la diferencia estadísticamente significativa con relación a la absorción del exudado (pOBJECTIVE: To evaluate the effectiveness of gauze and tape as compared to transparent polyurethane film for dressing central venous catheters. METHODS: A randomized controlled clinical trial was conducted. RESULTS: No significant difference was identified in catheter-related infection (p = 1 or the stability of the dressing (p = 0.670. There was no statistically significant difference with respect to the absorption of exudate (p <0.001. The likelihood of local reaction in the control group (gauze and tape was different from the study group (p = 0.024. CONCLUSION: The type of dressing does not decrease the incidence of catheter-related infection, the binding capacity is similar, and the gauze dressing has the capacity to absorb exudate. However, the gauze dressing resulted in a higher probability of developing a local reaction. Record WHO: ACTRN12609000951257.

  3. Tegaderm CHG IV Securement Dressing for Central Venous and Arterial Catheter Insertion Sites: A NICE Medical Technology Guidance

    OpenAIRE

    Jenks, Michelle; Craig, Joyce; Green, William; Hewitt, Neil; Arber, Mick; Sims, Andrew

    2015-01-01

    Catheters are widely used for vascular access and for the administration of drugs or fluids in critically ill patients. This exposes patients to an infection risk. Tegaderm chlorhexidine gluconate (CHG) (developed by 3M)—a transparent securement dressing—covers and protects catheter sites and secures devices to the skin. It comprises a transparent adhesive dressing to act as a barrier against external contamination and an integrated gel pad containing an antiseptic agent. The Medical Technolo...

  4. Diagnosis of an infected central venous catheter with ultrasound and computed tomography; Diagnose eines infizierten Thrombus der Vena cava inferior mit Sonographie und Computertomographie

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik; Adam, G. [RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik; Sliwka, U. [RWTH Aachen (Germany). Neurologische Klinik; Klosterhalfen, B. [RWTH Aachen (Germany). Inst. fuer Pathologie; Schoendube, F. [RWTH Aachen (Germany). Klinik fuer Thorax- Herz- und Gefaesschirurgie

    1995-08-01

    The authors report the case of a 16-year-old male patient, who suffered from meningitis and Waterhouse-Friderichsen syndrome. After initial improvement in the intensive care unit, he developed septic temperatures, caused by an infected thrombus of a central venous catheter in the inferior vena cava, Color-coded ultrasound showed hyperechogenic signals and missing flow detection at the catheter tip. Computed tomography showed air bubbles in the thrombosed catheter tip and confirmed the diagnosis. Vasuclar surgery was done and an infected, 17-cm-long infected thrombus was removed. (orig./VHE) [Deutsch] Die Autoren berichten ueber den Fall eines 16jaehrigen Patienten, dem wegen einer Meningitis und der Zeichen eines Waterhouse-Friderichsen-Syndroms ein femoralvenoeser Zentralkatheter gelegt wurde. Nach initialer Entfieberung entwickelte sich eine Sepsis, deren Ursache in einem infizierten Thrombus des Zentralvenenkatheters lag. Die Diagnose wurde sonographisch gestellt und nachfolgend computertomographisch bestaetigt. In beiden Verfahren wiesen Lufteinschluesse im Katheterthrombus auf die Injektion hin. Der Befund wurde durch eine gefaesschirurgische Thrombektomie bestaetigt und therapiert. (orig./VHE)

  5. AngioVac Aspiration for Paradoxical Emboli Protection through a Fenestrated Fontan During Central Venous Thrombus Manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Al-Hakim, Ramsey, E-mail: ralhakim@mednet.ucla.edu [University of California, Department of Radiology, Division of Interventional Radiology (United States); Patel, Komal, E-mail: kdpatel@mednet.ucla.edu [University of California, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology (United States); Moriarty, John M., E-mail: jmoriarty@mednet.ucla.edu [University of California, Department of Radiology, Division of Interventional Radiology (United States)

    2015-06-15

    This case reports describes a 39-year-old female with a history of surgically repaired hypoplastic left heart syndrome who presented with a left peripherally inserted central catheter (PICC) with associated large volume subclavian and brachiocephalic vein thrombus. Due to the presence of a right-to-left shunt via a fenestrated Fontan, there was clinical concern for a paradoxical embolism during removal of the PICC. The AngioVac aspiration system was successfully utilized to aspirate thromboemboli from the level of the proximal Glenn shunt during manipulation and removal of the PICC. This is the first reported case to demonstrate the safe and effective use of the AngioVac aspiration system for protection of paradoxical emboli through a cardiac right-to-left shunt during a procedure at high risk for thromboembolism.

  6. AngioVac Aspiration for Paradoxical Emboli Protection through a Fenestrated Fontan During Central Venous Thrombus Manipulation

    International Nuclear Information System (INIS)

    This case reports describes a 39-year-old female with a history of surgically repaired hypoplastic left heart syndrome who presented with a left peripherally inserted central catheter (PICC) with associated large volume subclavian and brachiocephalic vein thrombus. Due to the presence of a right-to-left shunt via a fenestrated Fontan, there was clinical concern for a paradoxical embolism during removal of the PICC. The AngioVac aspiration system was successfully utilized to aspirate thromboemboli from the level of the proximal Glenn shunt during manipulation and removal of the PICC. This is the first reported case to demonstrate the safe and effective use of the AngioVac aspiration system for protection of paradoxical emboli through a cardiac right-to-left shunt during a procedure at high risk for thromboembolism

  7. Disconnection of chamber and catheter as a complication of central venous catheter type port-a-cath.

    Science.gov (United States)

    Kostic, S; Kovcin, V; Granić, M; Jevdic, D; Stanisavljevic, N

    2011-12-01

    The use of a central vein catheter (CVC) type port-a-cath (VPS), apart from the comfort it provides to the patient undergoing chemotherapy, also carries certain complications. In this study, our patient was subjected to chemotherapy after a radical breast cancer operation and was given a CVC type VPS. After further care, a rare complication was verified--disconnection of the chamber and catheter, which one was visually identified in the right heart chamber. As the patient was vitally endangered, she was immediately hospitalized and the catheter was removed by catheterization of the right femoral vein, with scopic imaging. Early diagnosis and localization of the problem prevented more severe complications and mortality. PMID:20607455

  8. Farmers on the move: mobility, access to land and conflict in Central and South Mali

    OpenAIRE

    Nijenhuis, K.

    2013-01-01

    In contrast to their sedentary image, farmers in Central and South Mali are surprisingly mobile. Many have settled in scattered farming hamlets where they are rapidly expanding the areas under agriculture. This study focuses on farmers’ mobility in relation to accessing land in two regions in Mali where farming conditions are very different regarding rainfall, population growth and opportunities for income generation. It is shown that differences in farming conditions in the two regions have ...

  9. Venous thrombosis.

    Science.gov (United States)

    Wolberg, Alisa S; Rosendaal, Frits R; Weitz, Jeffrey I; Jaffer, Iqbal H; Agnelli, Giancarlo; Baglin, Trevor; Mackman, Nigel

    2015-01-01

    Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism. VTE is the leading cause of lost disability-adjusted life years and the third leading cause of cardiovascular death in the world. DVT leads to post-thrombotic syndrome, whereas pulmonary embolism can cause chronic pulmonary hypertension, both of which reduce quality of life. Genetic and acquired risk factors for thrombosis include non-O blood groups, factor V Leiden mutation, oral contraceptive use, hormone replacement therapy, advanced age, surgery, hospitalization and long-haul travel. A combination of blood stasis, plasma hypercoagulability and endothelial dysfunction is thought to trigger thrombosis, which starts most often in the valve pockets of large veins. Animal studies have revealed pathogenic roles for leukocytes, platelets, tissue factor-positive microvesicles, neutrophil extracellular traps and factors XI and XII. Diagnosis of VTE requires testing and exclusion of other pathologies, and typically involves laboratory measures (such as D-dimer) and diagnostic imaging. VTE is treated with anticoagulants and occasionally with thrombolytics to prevent thrombus extension and to reduce thrombus size. Anticoagulants are also used to reduce recurrence. New therapies with improved safety profiles are needed to prevent and treat venous thrombosis. For an illustrated summary of this Primer, visit: http://go.nature.com/8ZyCuY. PMID:27189130

  10. Mead Data Central's MEDIS: medical information access in full-text.

    Science.gov (United States)

    Albright, R G

    1989-01-01

    Electronic information access is an imperative skill for the modern health professional. Mead Data Central's MEDIS overcomes the limitations of "abstract-only" information networks and provides rapid access to a large collection of full-text medical information. With its proprietary communications software, Mead can display citations in a paged format with on-screen highlighting (in "reverse video") of search terms as they appear in documents. Users can move through the electronic pages as easily as they would thumb through a journal or book. A practice section on MEDIS is billed only for connect charges for using, and a unique on-line tutorial, which, while not specific for MEDIS, introduces users to searching the Mead system. Training is available to subscribers in several major cities and training software is available. MEDIS is a unique resource to access medical literature in full-text quickly and efficiently. PMID:10303627

  11. Metastatic Carcinoma of Unknown Primary Presenting as Jugular Venous Thrombosis

    OpenAIRE

    2010-01-01

    Jugular venous thrombosis is unusual and is associated with central venous catheterisation, intravenous drug abuse and head and neck sepsis. It is rarely associated with malignancy. We report a case of metastatic carcinoma of unknown primary in a forty year old female which presented with jugular venous thrombosis. The discussion includes investigation and treatment options for this condition.

  12. Ultrasound-Guided Radiological Placement of Central Venous Port via the Subclavian Vein: A Retrospective Analysis of 500 Cases at a Single Institute

    International Nuclear Information System (INIS)

    The purpose of this study was to assess the technical success rate and adverse events (AEs) associated with ultrasound (US)-guided radiological placement (RP) of a central venous port (CVP) via the subclavian vein (SCV). Between April 2006 and May 2007, a total of 500 US-guided RPs of a CVP via the SCV were scheduled in 486 cancer patients (mean age ± SD, 54.1 ± 18.1 years) at our institute. Referring to the interventional radiology report database and patients' records, technical success rate and AEs relevant to CVP placement were evaluated retrospectively. The technical success rate was 98.6% (493/500). AEs occurred in 26 cases (5.2%) during follow-up (range, 1-1080 days; mean ± SD, 304.0 ± 292.1 days). AEs within 24 h postprocedure occurred in five patients: pneumothorax (n = 2), arterial puncture (n = 1), hematoma formation at the pocket site (n = 2), and catheter tip migration into the internal mammary vein (n = 1). There were seven early AEs: hematoma formation at the pocket site (n = 2), fibrin sheath formation around the indwelling catheter (n = 2), and catheter-related infections (n = 3). There were 13 delayed AEs: catheter-related infections (n = 7), catheter detachments (n = 3), catheter occlusion (n = 1), symptomatic thrombus in the SCV (n = 1), and catheter migration (n = 1). No major AEs, such as procedure-related death, air embolism, or events requiring surgical intervention, were observed. In conclusion, US-guided RP of a CVP via the SCV is highly appropriate, based on its high technical success rate and the limited number of AEs.

  13. Does caval aorta index correlate with central venous pressure in intravascular volume assessment in patients undergoing endoscopic transuretheral resection of prostate?

    Directory of Open Access Journals (Sweden)

    G F El-Baradey

    2016-01-01

    Full Text Available Background and Objective: Ultrasonography has been suggested as a useful noninvasive tool for intravascular volume assessment in critically ill-patients. Fluid absorption is an inevitable complication of transurethral resection of the prostate (TURP. However, there are few data comparing the caval aortic index with central venous pressure (CVP measurement for intravascular volume assessment in patients undergoing TURP. Materials and Methods: This is a prospective observer blinded study carried out on 50 patients who underwent elective TURP. The primary outcome measure of our study was the correlation of the caval aorta (Ao index with CVP, and the secondary outcome measures were the sensitivity and specificity of the caval Ao index. Results: There was a positive correlation of inferior vena cava/Ao (IVC/Ao index to CVP (R = 0.9 and significant P = 0.001FNx01. The sensitivity and specificity of the IVC/Ao index were measured to predict the CVP. A CVP ≤7 cm H 2 O correlated with IVC/Ao index 0.8 ± 0.3 mean ± standard deviation (SD (sensitivity 0.93, specificity 0.66, a CVP of 8-12 cm H 2 O correlated with IVC/Ao index 1.5 ± 0.2 mean ± SD (sensitivity 0.96, specificity 0.42, and a CVP >12 cm H 2 O correlated with IVC/Ao index 1.8 ± 0.07 mean ± SD (sensitivity 0.93, specificity 0.58. Conclusion: Sonographic caval Ao index is useful for the evaluation of preoperative and intraoperative volume status, especially in major surgeries with marked fluid shift or blood loss and had the advantage of being noninvasive, safe, quick, and easy technique with no complications.

  14. Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters; Clinical and radiological perspective from a tertiary centre in Oman

    Directory of Open Access Journals (Sweden)

    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.

  15. Centrality measures highlight proton traps and access points to proton highways in kinetic Monte Carlo trajectories

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, Rachel A. [Department of Chemistry, California Institute of Technology, Pasadena, California 91125 (United States); Haibach, Frederick G. [Confluent Science, Wilbraham, Massachusetts 01095 (United States); Fry, Dana L.; Gomez, Maria A., E-mail: magomez@mtholyoke.edu [Department of Chemistry, Mount Holyoke College, South Hadley, Massachusetts 01075 (United States)

    2015-04-21

    A centrality measure based on the time of first returns rather than the number of steps is developed and applied to finding proton traps and access points to proton highways in the doped perovskite oxides: AZr{sub 0.875}D{sub 0.125}O{sub 3}, where A is Ba or Sr and the dopant D is Y or Al. The high centrality region near the dopant is wider in the SrZrO{sub 3} systems than the BaZrO{sub 3} systems. In the aluminum-doped systems, a region of intermediate centrality (secondary region) is found in a plane away from the dopant. Kinetic Monte Carlo (kMC) trajectories show that this secondary region is an entry to fast conduction planes in the aluminum-doped systems in contrast to the highest centrality area near the dopant trap. The yttrium-doped systems do not show this secondary region because the fast conduction routes are in the same plane as the dopant and hence already in the high centrality trapped area. This centrality measure complements kMC by highlighting key areas in trajectories. The limiting activation barriers found via kMC are in very good agreement with experiments and related to the barriers to escape dopant traps.

  16. Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa Método bundle en la redución de infecciones relacionadas a catéteres centrales: una revisión integrativa Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review

    Directory of Open Access Journals (Sweden)

    Juliana Dane Pereira Brachine

    2012-12-01

    éter con su retirada inmediata cuando posible. La mayoría de los estudios analizados mostraron una reducción significante de infección sanguínea relacionadas o asociadas con catéteres intravenosos centrales.This is an integrative review of literature aimed to identify evidence-based interventions which make up care bundles to reduce central venous catheter-related or associated bloodstream infections. To collect data in Brazilian and international databases were used the key word bundle and the descriptors catheter-related infection, infection control and central venous catheterization, resulting in fifteen articles, after inclusion criteria application. This work showed five interventions as those commonly employed in the bundles methods: hand hygiene, chlorhexidine gluconate for skin antisepsis, use of maximal sterile barrier precaution during the catheter insertion, avoid the femoral access and daily review of catheter necessity with prompt removal as no longer essential. The majority of the studies showed a significant reduction in bloodstream infection related to or associated with central venous catheters.

  17. Biological therapy in inflammatory bowel diseases: access in Central and Eastern Europe.

    Science.gov (United States)

    Rencz, Fanni; Péntek, Márta; Bortlik, Martin; Zagorowicz, Edyta; Hlavaty, Tibor; Śliwczyński, Andrzej; Diculescu, Mihai M; Kupcinskas, Limas; Gecse, Krisztina B; Gulácsi, László; Lakatos, Peter L

    2015-02-14

    Biological drugs opened up new horizons in the management of inflammatory bowel diseases (IBD). This study focuses on access to biological therapy in IBD patients across 9 selected Central and Eastern European (CEE) countries, namely Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. Literature data on the epidemiology and disease burden of IBD in CEE countries was systematically reviewed. Moreover, we provide an estimation on prevalence of IBD as well as biological treatment rates. In all countries with the exception of Romania, lower biological treatment rates were observed in ulcerative colitis (UC) compared to Crohn's disease despite the higher prevalence of UC. Great heterogeneity (up to 96-fold) was found in access to biologicals across the CEE countries. Poland, Bulgaria, Romania and the Baltic States are lagging behind Hungary, Slovakia and the Czech Republic in their access to biologicals. Variations of reimbursement policy may be one of the factors explaining the differences to a certain extent in Bulgaria, Latvia, Lithuania, and Poland, but association with other possible determinants (differences in prevalence and incidence, price of biologicals, total expenditure on health, geographical access, and cost-effectiveness results) was not proven. We assume, nevertheless, that health deterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries and which may contribute to the immense diversity in the utilization of biological drugs for IBD. In conclusion, access to biologicals varies widely among CEE countries and this difference cannot be explained by epidemiological factors, drug prices or total health expenditure. Changes in reimbursement policy could contribute to better access to biologicals in some countries. PMID:25684937

  18. A Novel Particle Swarm Optimization based Algorithm for the Optimal Centralized Wireless Access Network

    Directory of Open Access Journals (Sweden)

    Dac-Nhuong Le

    2013-01-01

    Full Text Available The wireless access networks design problem is formulated as a constrained optimization problem, where the goal is to find a network topology such that an objective function is optimized, subject to a set of constraints. The objective function may be the total cost, or some performance measure like utilization, call blocking or throughput. The constraints may be bounds on link capacities, cost elements, or some network performance measure. However, the optimization problem is too complex. In this paper, we propose a novel Particle Swarm Optimization (PSO algorithm to finding the total cost of connecting the BSs to the MSCs, and connecting the MSCs to the LE called by the optimal centralized wireless access network. Numerical results show that performance of our proposed algorithm is much better than previous studies.

  19. Making metabolism accessible and meaningful: is the definition of a central metabolic dogma within reach?

    Science.gov (United States)

    LaRossa, Robert A

    2015-04-01

    Intermediary metabolism, a dominant research area before the emergence of molecular biology, is attracting renewed interest for fundamental and applied reasons as documented here. Nonetheless, the field may appear to be a thicket precluding entry to all but the most determined. Here we present a metabolic overview that makes this important and fascinating area accessible to a broad range of the molecular biological and biotechnological communities that are being attracted to biological problems crying out for metabolic solutions. This is accomplished by identifying seven key concepts, a so-called metabolic central dogma, that provide a core understanding analogous to the "Central Dogma of Molecular Biology" which focused upon maintenance and flow of genetic information. PMID:25515796

  20. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients.

    Science.gov (United States)

    Cesaro, Simone; Cavaliere, Mara; Pegoraro, Anna; Gamba, Piergiorgio; Zadra, Nicola; Tridello, Gloria

    2016-04-01

    We report our decennial experience with 1161 newly-placed long-term central venous catheters inserted in 919 hematology-oncology patients for a total of 413,901 CVC-days of observation. Most of the CVCs were partially-implanted, open-ended, Broviac-Hickman type of CVC (95 %). One thousand and twenty-four complications were recorded equal to 2.47 per 1000 CVC-days. The frequency of complications per CVC, the rate of episodes per 1000 CVC-days, and removal rate were malfunction/occlusion 42 %, 1.18/1000, and 2.3 %; mechanical (dislodgement/rupture/kinking) 18.3 %, 0.51/1000, and 77.4 %; bacteremia 14.8 %, 0.42/1000, and 18.6 %; exit-site/tunnel infection 11.5 %, 0.32/1000, and 9.7 %; thrombosis 0.86 %, 0.02/1000, and 30 %; pneumothorax 0.52 %, 0.01/1000, and 0. In multivariate analysis, the risk factors were for mechanical complications, a younger age <6.1 years at CVC insertion (HR 1.8, p = 0.0006); for bacteremia, a double lumen CVC (HR 3.1, p < 0.0001) and the surgical modality of CVC insertion (HR 1.5, p = 0.03); for exit-site/tunnel infection, a double lumen CVC (HR 2.1, p = 0.0003) and a diagnosis of leukemia or lymphoma (HR 1.8, p = 0.01); for malfunction/occlusion, an age <6.1 years (HR 1.6, p = 0.0003), the diagnosis of leukemia or lymphoma (HR 1.9, p < 0.0001) and double lumen CVC (HR 1.33, p = 0.023). The cumulative incidence of premature CVC removal was 29.2 % and the risk factors associated with this event were the surgical modality of CVC insertion (HR 1.4, p = 0.0153) and an age at CVC positioning less than 6.1 years (HR 1.6, p = 0.0025). We conclude that a best-practice set of rules resulted in reduced CVC complications. PMID:26961934

  1. In Vitro Evaluation of Access Cavity Location Effect on Fracture Resistance of Maxillary Central Endodontically Treated Teeth

    OpenAIRE

    Shirinzad, M.; Z. Khamverdi; S. Ghorbani

    2014-01-01

    Introduction & Objective: Preparation of access cavity to root canal is a critical phase in endo-dontic treatment. The purpose of this study was to evaluate the effect of access cavity loca-tion (labial or palatal) on fracture resistance of endodontically treated maxillary central teeth. Materials & Methods: In this experimental laboratorial study, 84 intact human maxillary central incisors with similar dimensions were selected. The teeth were divided into 4 test groups as follows: Group 1 : ...

  2. Bloodstream infections among patients using central venous catheters in intensive care units Infección de corriente sanguínea en pacientes con catéter venosos central en unidades de cuidado intensivo Infecções da corrente sangüínea em pacientes em uso de cateter venoso central em unidades de terapia intensiva

    OpenAIRE

    Eni Rosa Aires Borba Mesiano; Edgar Merchán-Hamann

    2007-01-01

    Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hos...

  3. Venous port catheter dislocation as an unusual cause of pneumonia

    Directory of Open Access Journals (Sweden)

    Umut Serhat Sanrı

    2014-06-01

    Full Text Available The use of central venous port catheter is a very useful method for long-term therapy in patients with malignancy. Catheter insertion technique and maintenance of equipment is very important to the prevention of catheter-related complications. The most frequent complications are deep venous thrombosis, port infection, catheter obstruction. İn this article, pneumonia occurrence after chemotherapy infusion in a patient who has a completely extravasated central venous port catheter discussed.

  4. Dilemma with the route of venous access for hemodialysis catheter insertion in a patient with dilated ischemic cardiomyopathy treated by cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Devanahalli Ashokananda

    2016-01-01

    Full Text Available A 68 year old patient requiring urgent dialysis due to raising potassium was referred to our center. He had 3 indwelling catheters in his heart via right subclavian vein. His left subclavian and interngal jugular veins were thrombosed possibly due to earlier indwelling catheters. The dilemma was if right internal jugular venous route could be used for insertion of dialysis catheter. Under fluoroscopic guidance, right internal jugular vein was cannulated with the dialysis catheter without problems. This case is being presented to highlight the need for imaging both by ultrasound and radiography during the procedure.

  5. Removal of intracardiac fractured port-A catheter utilizing an existing forearm peripheral intravenous access site in the cath lab.

    Science.gov (United States)

    Choksy, Pratik; Zaidi, Syed S; Kapoor, Deepak

    2014-02-01

    The intravenous port-A catheters are widely used for long-term central venous access in cancer patients. Spontaneous fracture and migration of implanted port catheters is a known complication and necessitates immediate removal. Percutaneous retrieval of intravascular foreign body has become a common practice and is commonly performed through central venous access, mostly using femoral, subclavian, or internal jugular veins. Although the percutaneous approach is relatively safe, it can lead to potential iatrogenic complications. We report the first case report of percutaneous removal of intravascular foreign body using forearm peripheral intravenous access. PMID:24486665

  6. Risk factors for central venous catheter-related infections in pediatric intensive care Fatores de risco para as infecções relacionadas ao caracter venoso central em terapia intensiva pediátrica

    Directory of Open Access Journals (Sweden)

    Ricardo Vilela

    2007-01-01

    Full Text Available OBJECTIVES: To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014 and duration of catheter use (p=0.0013, and protective factors included concomitant antibiotic use (p=0.0005 and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002. Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.OBJETIVOS: Identificar fatores de risco para as infecções relacionadas a cateter venoso central de curta permanência, inserido por punção, em crianças e avaliar a eficiência de um escore de mortalidade pediátrica em prever o risco

  7. Venous Thromboembolic Disease

    OpenAIRE

    Jaff, Michael R

    2002-01-01

    Physicians understand the importance of prompt diagnosis and therapy of venous thromboembolism. This is a common and potentially deadly disease. Many patients may have no symptoms of this disorder, yet face a significant risk of serious complications if undiagnosed and untreated. Venous duplex ultrasonography has become the diagnostic test of choice for deep venous thrombosis. Quantitative d-dimer levels may be very helpful in establishing the diagnosis of venous thrombosis. Helical (spiral) ...

  8. Prevenção da infecção da corrente sanguínea relacionada ao cateter venoso central: Uma revisão integrativa | Prevention of bloodstream infection related to central venous catheter: An integrative review

    Directory of Open Access Journals (Sweden)

    Alanna Gomes da Silva

    2016-05-01

    Full Text Available Objetivo: Analisar as produções científicas nacionais e internacionais sobre a adoção aos bundles para prevenção de infecção da corrente sanguínea relacionada ao cateter venoso central em unidade de terapia intensiva adulto. Métodos: Foi realizada uma revisão integrativa da literatura nas bases de dados Pubmed, Cinahl e Science Direct, publicados de 2011 a 2014. Resultados: Foram encontrados 11 artigos e em 100% deles as principais medidas adotadas foram antes da inserção do cateter, sendo: antissepsia da pele, uso de barreira máxima de precaução, preferência pela veia subclávia, higienização prévia das mãos e educação e treinamento dos profissionais de saúde. Conclusões: Os bundles estão sendo utilizados na prática clínica como estratégias para redução das infecções, contudo, as infecções da corrente sanguínea relacionadas a cateter continuam a ocorrer de forma alarmante e com grande impacto no cuidado a saúde. Desse modo, estratégias que apontem subsídios para melhoria da prática clínica e segurança do paciente devem ser incentivadas, sobretudo aquelas voltadas para o período crítico da inserção e manutenção do cateter. -----------------------------------------------------------------------------------------------Objective: To analyze the national and international scientific production on the adoption of bundles to prevent bloodstream infection related to central venous catheters in adult intensive care unit. Methods: An integrative literature review of studies published from 2011 to 2014 was conducted in the databases Pubmed, CINAHL and Science Direct. Results: 11 articles were found. In all of them the principal measures adopted before catheter insertion were: skin antisepsis, use of maximum barrier precaution, preference by the subclavian vein, previous hand hygiene, and education and training of health professionals. Conclusions: The bundles are being used in clinical practice as

  9. Centralized optical-frequency-comb-based RF carrier generator for DWDM fiber-wireless access systems

    DEFF Research Database (Denmark)

    Pang, Xiaodan; Beltran, Marta; Sanchez, Jose;

    2014-01-01

    In this paper, we report on a gigabit capacity fiber-wireless system that enables smooth integration between high-speed wireless networks and dense wavelength-division-multiplexing (DWDM) access networks. By employing a centralized optical frequency comb, both the wireline and the wireless services...... applications. For demonstration, we transmit a 2.5 Gbit/s signal through the proposed system and successfully achieve a bit-error-rate (BER) performance well below the 7% overhead forward error correction limit of the BER of 2 × 10¿3 for both the wireline and the wireless signals in the 60 GHz band after 25 km...... single-mode fiber plus up to 6 m wireless distance....

  10. Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

    Science.gov (United States)

    Watenpaugh, Donald E.

    1996-01-01

    relatively unimportant. Low calf venous compliance probably results from stiffer venous, skeletal muscle, and connective tissues, and better-developed local and central neural controls of venous distensibility. This research establishes that upper-to-lower body reduction of venous compliance can explain headward positioning of the hydrostatic indifference level in humans.

  11. An Assessment of Female Prisoners’ Perception of the Accessibility of Quality Healthcare: A Survey in the Kumasi Central Prisons, Ghana

    OpenAIRE

    Sarpong, AA; Otupiri, E.; Yeboah-Awudzi, K; Osei-Yeboah, J.; Berchie, GO; Ephraim, RKD

    2015-01-01

    Background: Accessibility of quality healthcare across the globe has generated a lot of attention among public health practitioners. Aim: This study explored the background characteristics of female prisoners and how it influences their assessment of the quality of accessible healthcare in the Kumasi Female Prison. Subjects and Methods: This descriptive cross-sectional survey was conducted at the Female section of the Kumasi Central Prisons from June to December 2011. We used pretested questi...

  12. Causes of central venous catheter associated infections and prevention countermeasures%中心静脉导管相关性感染原因分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    桂煜

    2011-01-01

    OBJECTIVE To understand the central venous catheter related infections and to propose preventive measures. METHODS From Apr 2008 to Mar 2010, the causes of 54 patients with deep catheter related infections were analyzed, and the definite preventive measures were taken in accordance with the causes. RESULTS Among 54 patients received the central venous catheterization, the infection of catheter export was found in 5 cases,accounting for 9.3%, 3 cases of catheter-related bloodstream infection, accounting for 5.6%, both of which were recovery after the corresponding disposals. CONCLUSIONS The risk factors of catheter related infections are the inserted time of the catheter,the sites, tle catheter types, the dressing and the nursing care of medical staff. To improve the training of the medical personnel, establish the preventive barrier to a maximum and strictly execute the aseptic manifestation is better propitious to prevent the occurrence of central venous catheter associated infection.%目的 了解中心静脉导管相关性感染的原因及应采取的预防措施.方法 分析医院2008年4月-2010年3月住院的54例深静脉留置管患者发生的导管相关性感染原因,并针对原因采取一定的预防措施.结果 54例行中心静脉置管术的患者中,置管出口部位感染5例,占9.3%;导管相关血流感染3例,占5.6%;经相应处理后均好转.结论 导管相关性感染的危险因素中重要是导管留置时间、插管部位、导管类型、敷料及医务人员操作护理;加强人员教育培训、最大限度的建立防护屏障、严格执行无菌操作等有利于更好的预防中心静脉导管相关性感染的发生.

  13. Antithrombotic Agents in the Prevention and Treatment of Venous Thromboembolism

    Institute of Scientific and Technical Information of China (English)

    包承鑫

    2004-01-01

    @@ Venous thromboembolism is a major health problem,carrying significant morbidity and mortality, with an incidence that exceeds I per 1 000. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, neurologic disease with extremity paresis, central venous catheter/transvenous pacemaker, prior superficial vein thrombosis, and varicose, among women, the risk factors include pregnancy, oral contraceptives, and hormone replacement therapy.

  14. Transluminally Placed Endovascular Grafts for Venous Lesions in Patients on Hemodialysis

    International Nuclear Information System (INIS)

    This report summarizes a feasibility study of transluminally placed endovascular grafts (TPEG) using pre-expanded polytetrafluoroethylene (PTFE) to treat venous abnormalities inpatients on hemodialysis. Seventeen patients with peripheral(n = 11) or central (n = 6) venous lesions were treated with TPEG devices. Covered Gianturco stents were used for the peripheral lesions and covered Palmaz stents were used for central lesions. Venous abnormalities included vascular rupture after balloon angioplasty or surgical thrombectomy (n = 4),stenosis associated with an aneurysm (n = 2) and occlusive disease and central stenoses not responsive to balloon angioplasty (n = 11). The mean primary patency period was 37 days. The mean secondary patency period was 215 days. At 60,180, and 360 days the primary and secondary patency rates were 40%,32%, and 32%, and 70%, 55%, and 39%, respectively. Follow-up studies have shown various outcomes of the implanted TPEG devices,which have included stenoses within the TPEG (n = 2),stenoses central to the TPEG (n = 1), stenoses peripheral to the TPEG (n = 3), acute thrombosis extending to the TPEG without a stenosis (n = 1), graft abandoned with patent TPEG (n = 6), and TPEG patent within primary patency period at last follow-up (n =4). The TPEG devices, made with pre-expanded PTFE, appear safe in the short term, do not prevent progressive dialysis access site failure, and need to be compared to PTA and endovascular stenting in a randomized prospective trial

  15. Diagnosis of venous disorders

    International Nuclear Information System (INIS)

    Limited accuracy in the clinic diagnosis of deep vein thrombosis (VT) makes such diagnostic tests such as duplex sonography or venography necessary. Exact information on the age and extent of the thrombus are necessary for the clinician to optimize the therapeutric management. The correct diagnosis of calf vein thrombosis and of recurrent VT in patients with postphlebitis changes also has implications for treatment. After exclusion of thrombosis, the radiologist should evaluate the leg for other possible causes of symptoms besides VT. Investigation of the venous sytem also has a role in the diagnosis in patients with suspected pulmonary embolism. In patients with chronic venous insuffficiency the deep venous system should assessed for patency and venous valve function. The superficial veins should be differentiated in segments with sufficient or insufficient venous valves, and it is also necessary to look for insufficiency of the perforrating veins. In patients with superficial phlebitis there is risk of propagation into the deep venous system. (orig.)

  16. Venous Thromboembolism Prophylaxis

    OpenAIRE

    Laryea, Jonathan; Champagne, Bradley

    2013-01-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measur...

  17. Comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system in image-guided central venous catheter placement in children weighing less than 10 kg

    Energy Technology Data Exchange (ETDEWEB)

    Miraglia, Roberto; Maruzzelli, Luigi; Cortis, Kelvin; Gerasia, Roberta; Maggio, Simona; Luca, Angelo [Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy); Piazza, Marcello [Department of Anesthesia, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy); Tuzzolino, Fabio [Department of Information Technology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy)

    2014-09-10

    Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice. The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS). A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement. Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm{sup 2} with the IIDS and 15.9 ± 44.6 cGy . cm{sup 2} with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy . cm{sup 2} with the IIDS and 37.1 ± 33.5 cGy cm{sup 2} with the FPDS (P = 0.02). The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement. (orig.)

  18. Comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system in image-guided central venous catheter placement in children weighing less than 10 kg

    International Nuclear Information System (INIS)

    Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice. The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS). A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement. Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm2 with the IIDS and 15.9 ± 44.6 cGy . cm2 with the FPDS (P 2 with the IIDS and 37.1 ± 33.5 cGy cm2 with the FPDS (P = 0.02). The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement. (orig.)

  19. Radiologically-placed venous ports in children under venous anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Joo Yeon; Jeon, Ung Bae; Choo, Ki Seok; Hwang, Jae Yeon; Kim, Yong Woo; Lee, Yun Jin; Nam, Sang Ool; Lim, Young Tak [Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2015-02-15

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  20. Radiologically-placed venous ports in children under venous anesthesia

    International Nuclear Information System (INIS)

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  1. Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters(PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwelltime and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n = 154)at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p =0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access devices

  2. Correlation of the intracranial pressure to the central venous pressure in the late phase of acute liver failure in a porcine model.

    Science.gov (United States)

    Scheuermann, Kathrin; Thiel, Christian; Thiel, Karolin; Klingert, Wilfried; Hawerkamp, Elmar; Scheppach, Johannes; Königsrainer, Alfred; Morgalla, Matthias H; Leckie, Pamela; Proven, Andrew; Jalan, Rajiv; Davies, Nathan; Schuhmann, Martin U; Schenk, Martin

    2012-01-01

    Volume loading is a common method used to ensure adequate circulation. However, in the late phase of acute liver failure complications that often lead to death are cerebral swelling and brainstem edema, which are considered to result from increasing intracranial pressure (ICP). In former studies cerebral venous pressure (CVP) and ICP were reported to be independent entities. Acute liver failure was induced in 25 German land race pigs by acetaminophen intoxication. CVP and ICP were measured continuously. Hydroxyethyl starch solution and noradrenalin were administered to stabilize the circulation at a mean arterial pressure above 60mmHg. There is an increasing correlation in quantity and quality between the CVP and ICP in the last 24 h before exitus. Beginning with a slope of 0.24 (ICP against CVP) and a low correlation coefficient of 0.08. 24h before exitus, this situation remained stable until 16 h to exitus (m = 0.22, r = 0.1). The correlation increased from 16 to 8 h prior to exitus to a slope of m = 0.5 and a correlation of r = 0.3 and remained until exitus. In late acute liver failure it seems therefore clinically reasonable to keep circulation within an adequate range by the use of noradrenalin and to avoid fluid overload. PMID:22327729

  3. Venous flow velocity, venous volume and arterial blood flow

    International Nuclear Information System (INIS)

    The relationship of arterial blood flow and venous volume to venous flow velocity was studied in normal subjects. The effects of current modes of treatment in venous thrombosis and of a vasodilator drug on venous flow velocity were also investigated. Total calf flow and venous volume were measured by venous occlusion plethysmography while venous flow axial velocity was determined by the transit time of 131I albumin from calf to inguinal region. Local intravenous epinephrine administration induced venoconstriction and increased venous flow velocity. Intra-arterial isoproterenol and angiotensin increased and decreased arterial flow, respectively, with no change in venous flow velocity or volume, but local heat increased arterial flow and venous flow velocity with no change in venous volume. Local cold, despite venoconstriction, decreased venous flow velocity accompanied by decreased arterial flow. Intravenous heparin did not affect venous flow velocity. Intravenous but not oral nylidrin increased venous flow velocity. Therefore venous flow velocity can be significantly increased by venoconstriction, by large increases in arterial flow (local heat), and by a parenteral vasodilator drug. These experiments indicate that there is a basis for applying heat but not cold in the prevention and treatment of venous thrombosis

  4. Causes of central venous catheter-related infections after cardiac surgery and intervention measures%心脏术后中心静脉导管感染的原因分析及干预措施的研究

    Institute of Scientific and Technical Information of China (English)

    郭舒婕; 王晓敏; 张瑜; 张艳丽

    2012-01-01

    OBJECTIVE To analyze the causes of central venous catheter-related infections after the cardiac surgery and to explore the intervention countermeasures. METHODS A total of 100 patients who underwent cardiac surgery were selected, and all the patients underwent the central venous catheterization. RESULTS Of the 100 patients investigated, the central venous catheter-related infections occurred in 22 patients with the infection rate of 22. 0% , including 6 cases of Staphylococcus epidermidis infections, 5 cases of S. aureus infections, 4 cases of Klebsiella pneumoniae infections, 3 cases of Enterococcus faecalis infections, 1 case of Acinetobacter baumannii infection, 1 case of Enterobacter cloacae infection, 1 case of Candida albicans infection, and 1 case of Pseudomonas aeruginosa infection. The infections disappeared after being given appropriate antibiotics on the basis of drug susceptibility testing. The incidence rate of the central venous catheter-related infections in the patients with less than 50 years of age was 12. 5%, and 26. 5% of the patients with more than 50 years, the difference was statistically significant (P<0. 05). The infection rate of the patients without complications was 9. 1 % , and 28. 3% of the patients with complications, the difference was statistically significant (P<0. 05). The infection rate of the patients with the subclavian vein as puncture site was 17. 8%. and 21. 8% of the patients with internal jugular vein as the puncture site, the difference was not statistically significant. The infection rate of the patients with the joints and sealing solution optimized was 17. 6%, the conventional 37. 5%, the difference was statistically significantP<0. 05). The infection rate of the patients with dual-chamber was 21. 4% , 27. 3% of the patients with three-cavity, the difference was not statistically significant. The infection rate of the patients with the catheterization duration less than 7 days was 9. 1% , 20. 1% of the patient with the

  5. Integrating in Silico and in Vitro Approaches To Predict Drug Accessibility to the Central Nervous System.

    Science.gov (United States)

    Zhang, Yan-Yan; Liu, Houfu; Summerfield, Scott G; Luscombe, Christopher N; Sahi, Jasminder

    2016-05-01

    Estimation of uptake across the blood-brain barrier (BBB) is key to designing central nervous system (CNS) therapeutics. In silico approaches ranging from physicochemical rules to quantitative structure-activity relationship (QSAR) models are utilized to predict potential for CNS penetration of new chemical entities. However, there are still gaps in our knowledge of (1) the relationship between marketed human drug derived CNS-accessible chemical space and preclinical neuropharmacokinetic (neuroPK) data, (2) interpretability of the selected physicochemical descriptors, and (3) correlation of the in vitro human P-glycoprotein (P-gp) efflux ratio (ER) and in vivo rodent unbound brain-to-blood ratio (Kp,uu), as these are assays routinely used to predict clinical CNS exposure, during drug discovery. To close these gaps, we explored the CNS druglike property boundaries of 920 market oral drugs (315 CNS and 605 non-CNS) and 846 compounds (54 CNS drugs and 792 proprietary GlaxoSmithKline compounds) with available rat Kp,uu data. The exact permeability coefficient (Pexact) and P-gp ER were determined for 176 compounds from the rat Kp,uu data set. Receiver operating characteristic curves were performed to evaluate the predictive power of human P-gp ER for rat Kp,uu. Our data demonstrates that simple physicochemical rules (most acidic pKa ≥ 9.5 and TPSA < 100) in combination with P-gp ER < 1.5 provide mechanistic insights for filtering BBB permeable compounds. For comparison, six classification modeling methods were investigated using multiple sets of in silico molecular descriptors. We present a random forest model with excellent predictive power (∼0.75 overall accuracy) using the rat neuroPK data set. We also observed good concordance between the structural interpretation results and physicochemical descriptor importance from the Kp,uu classification QSAR model. In summary, we propose a novel, hybrid in silico/in vitro approach and an in silico screening model for the

  6. Idiopathic venous thromboembolism and thrombophilia

    OpenAIRE

    Sinescu, C; Hostiuc, M; Bartos, D.

    2011-01-01

    During the past decade idiopathic venous thromboembolism has become a separate entity, a chronic illness which has required prolonged anticoagulation and other prevention strategies to avoid recurrences. This article reviews recent developments regarding unprovoked venous thromboembolism and its relation with thrombophilia. In the beginning, the latest definition of idiopathic venous thromboembolism is presented. The article continues with statistics about thrombophilia, related venous thromb...

  7. Venous thrombosis: an overview

    International Nuclear Information System (INIS)

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, 125I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references

  8. Cardiac tamponade and successful pericardiocentesis in an extremely low birth weight neonate with percutaneously inserted central venous line: a case report

    OpenAIRE

    Pizzuti, Alfredo; Parodi, Emilia; Abbondi, Paola; Frigerio, Mario

    2010-01-01

    Background Pericardial effusion and cardiac tamponade are rare but life-threatening complications of percutaneosuly inserted central line (PICL) use in extremely low birth weight (ELBW) neonates, with an incidence reported between 0.07% and 2% of PICLs placement. Timely diagnosis and pericardiocentesis has been proven to be life-saving. Case presentation The patient was a 620 g birth weight neonate who presented with sudden cardiac instability 18 days after the insertion of a PICL and in spit...

  9. Ultrasound-guided Central Line Insertion and Standard Peripherally Inserted Catheter Placement in Preterm Infants: Comparing Results from Prospective Study in a Single-center

    OpenAIRE

    Dany Antanios Al Hamod; Smart Zeidan; Ayah Al Bizri; Georges Baaklini; Yolla Nassif

    2016-01-01

    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 Metho...

  10. Retrieval of an intra-cardiac embolised very long wire via transhepatic access from a war victim child.

    Science.gov (United States)

    Baspinar, Osman; Sahin, Derya A; Yildirim, Ali

    2016-04-01

    We present the case report of a war victim child with severe burn scars, orthopnoea, and dyspnoea due to diffuse pulmonary thromboembolism. During ICU stay, a central venous catheter's 45-mm wire embolised into the heart. The embolised wire was successfully removed via transhepatic access through the creation of an artificial simple snare. PMID:26358097

  11. Dialysis Access in Europe and North America: Are We on the Same Path?

    OpenAIRE

    Gallieni, M.; Saxena, R.; Davidson, I.

    2009-01-01

    Large differences in dialysis access exist between Europe, Canada, and the United States, even after adjustment for patient characteristics. Vascular access care is characterized by similar issues, but with a different magnitude. Obesity, type 2 diabetes, and peripheral vascular disease, independent predictors of central venous catheter use, are growing problems globally, which could lead to more difficulties in native arteriovenous fistula placement and survival. Creation of dedicated dialys...

  12. Sustained Nitric Oxide-Releasing Nanoparticles Induce Cell Death in Candida albicans Yeast and Hyphal Cells, Preventing Biofilm Formation In Vitro and in a Rodent Central Venous Catheter Model.

    Science.gov (United States)

    Ahmadi, Mohammed S; Lee, Hiu Ham; Sanchez, David A; Friedman, Adam J; Tar, Moses T; Davies, Kelvin P; Nosanchuk, Joshua D; Martinez, Luis R

    2016-04-01

    Candida albicansis a leading nosocomial pathogen. Today, candidal biofilms are a significant cause of catheter infections, and such infections are becoming increasingly responsible for the failure of medical-implanted devices.C. albicansforms biofilms in which fungal cells are encased in an autoproduced extracellular polysaccharide matrix. Consequently, the enclosed fungi are protected from antimicrobial agents and host cells, providing a unique niche conducive to robust microbial growth and a harbor for recurring infections. Here we demonstrate that a recently developed platform comprised of nanoparticles that release therapeutic levels of nitric oxide (NO-np) inhibits candidal biofilm formation, destroys the extracellular polysaccharide matrices of mature fungal biofilms, and hinders biofilm development on surface biomaterials such as the lumen of catheters. We found NO-np to decrease both the metabolic activity of biofilms and the cell viability ofC. albicansin vitroandin vivo Furthermore, flow cytometric analysis found NO-np to induce apoptosis in biofilm yeast cellsin vitro Moreover, NO-np behave synergistically when used in combination with established antifungal drug therapies. Here we propose NO-np as a novel treatment modality, especially in combination with standard antifungals, for the prevention and/or remediation of fungal biofilms on central venous catheters and other medical devices. PMID:26810653

  13. Access to health care for Roma children in Central and Eastern Europe: findings from a qualitative study in Bulgaria

    Directory of Open Access Journals (Sweden)

    Spencer Nick J

    2009-06-01

    Full Text Available Abstract Background Despite the attention the situation of the Roma in Central and Eastern Europe has received in the context of European Union enlargement, research on their access to health services is very limited, in particular with regard to child health services. Methods 50 qualitative in-depth interviews with users, providers and policy-makers concerned with child health services in Bulgaria, conducted in two villages, one town of 70,000 inhabitants, and the capital Sofia. Results Our findings provide important empirical evidence on the range of barriers Roma children face when accessing health services. Among the most important barriers are poverty, administrative and geographical obstacles, low levels of parental education, and lack of ways to accommodate the cultural, linguistic and religious specifics of this population group. Conclusion Our research illustrates the complexity of the problems the Roma face. Access to health care cannot be discussed in isolation from other problems this population group experiences, such as poverty, restricted access to education, and social exclusion.

  14. Accessibility and Equity, Market Forces, and Entrepreneurship: Developments in Higher Education in Central and Eastern Europe

    Science.gov (United States)

    Kwiek, Marek

    2007-01-01

    This paper explores four interrelated issues: access and equity, the role and the legitimacy of the emergent, market-driven private sector in higher education, the relationships between reforming public services in general and changing public and private higher education, and entrepreneurialism of the emergent private sector in higher education.…

  15. Dilemma of Access and Provision of Quality Basic Education in Central Region, Ghana

    Science.gov (United States)

    Amakyi, Michael; Ampah-Mensah, Alfred

    2016-01-01

    A survey research was conducted to find out if reported improvements in access to education in Ghana are reflected in comparable improvements in delivery of quality education. The study examined theoretical constructs on adequacy and quality assurance in education to ascertain the state of quality provision in education, and whether there is a…

  16. Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia.

    Science.gov (United States)

    Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

    2014-12-01

    One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia. PMID:24186359

  17. Brain venous pathologies: MRI findings

    International Nuclear Information System (INIS)

    Purpose: To describe MRI findings of the different brain venous pathologies. Material and Methods: Between January 2002 and March 2004, 18 patients were studied 10 males and 8 females between 6 and 63 years old; with different brain venous pathologies. In all cases brain MRI were performed including morphological sequences with and without gadolinium injection and angiographic venous sequences. Results: 10 venous occlusions were found, 6 venous angiomas, and 2 presented varices secondary to arteriovenous dural fistula. Conclusion: Brain venous pathologies can appear in many different clinical contexts, with different prognosis and treatment. In all the cases brain MRI was the best imaging study to disclose typical morphologic abnormalities. (author)

  18. Clinical effectiveness and cost-effectiveness of central venous catheters treated with Minocycline and Rifampicin in preventing bloodstream infections in intensive care patients [Medizinische Wirksamkeit und Kosteneffektivität von Minocyclin/Rifampicin-beschichteten zentralvenösen Kathetern zur Prävention von Blutbahninfektionen bei Patienten in intensivmedizinischer Betreuung

    OpenAIRE

    Neusser, Silke; Bitzer, Eva Maria; Mieth, Ingeborg; Krauth, Christian

    2012-01-01

    [english] The use of central venous catheters coated with antibiotics can avoid bloodstream infections with intensive care patients. This is the result of a scientific examination which has been published by the DIMDI. Costs could be also saved in this way. However, according to the authors, the underlying studies do not allow absolutely valid statements.[german] Der Einsatz bestimmter Antibiotika-beschichteter Venenkatheter kann bei Intensivpatienten Blutbahninfektionen vermeiden. So das Erg...

  19. Centralized Role-Based Access Control for Federated Multi-Domain Environments

    Institute of Scientific and Technical Information of China (English)

    YU Guangcan; LU Zhengding; LI Ruixuan; MUDAR Sarem

    2006-01-01

    The secure interaction among multiple security domains is a major concern. In this paper, we highlight the issues of secure interoperability among multiple security domains operating under the widely accepted Role Based Access Control (RBAC) model. We propose a model called CRBAC that easily establishes a global policy for roles mapping among multiple security domains. Our model is based on an extension of the RBAC model. Also, multiple security domains were composed to one abstract security domain. Also roles in the multiple domains are translated to permissions of roles in the abstract security domain. These permissions keep theirs hierarchies. The roles in the abstract security domain implement roles mapping among the multiple security domains. Then, authorized users of any security domain can transparently access resources in the multiple domains.

  20. Configurbanist: Easiest paths, fuzzy accessibility, and network centrality for walking and cycling in cities

    OpenAIRE

    Nourian Ghadikolaee, P.; Rezvani, S.; Sariyildiz, I.S.; Van der Hoeven, F.D.

    2015-01-01

    In a quest for promoting sustainable modes of mobility, we have revisited how feasible and suitable is it for people to walk or cycle to their destinations in a neighbourhood. We propose a few accessibility measures based on an 'Easiest Path' algorithm that provides also actual temporal distance between locations. This algorithm finds paths that are as short, flat and straightforward as possible. Considering several 'points of interest', the methods can answer such questions as "do I have a 5...

  1. Review of the cost of venous thromboembolism

    OpenAIRE

    Fernandez MM; Hogue S; Preblick R; Kwong WJ

    2015-01-01

    Maria M Fernandez,1 Susan Hogue,1 Ronald Preblick,2 Winghan Jacqueline Kwong2 1RTI-Health Solutions, Market Access and Outcomes Strategy, Research Triangle Park, NC, 2Daiichi Sankyo, Inc., Health Economics & Outcomes Research, Parsippany, NJ, USA Background: Venous thromboembolism (VTE) is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent l...

  2. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas;

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  3. How has the financial crisis affected the Eurozone Accession Outlook in Central and Eastern Europe?

    OpenAIRE

    John Lewis

    2010-01-01

    This paper analyses how the financial crisis has affected task of meeting the Maastricht Criteria for the eight Central and Eastern European Countries which have yet to join the euro. It identifies the channels by which the crisis has fed through to deficits, debt, interest rates and inflation and seeks to provide numerical estimates of these factors. Deficits have worsened, but for most countries the problem is still primarily structural rather than cyclical. Debts have risen, but only in th...

  4. Information, Direct Access to Farmers, and Rural Market Performance in Central India

    OpenAIRE

    Goyal, Aparajita

    2010-01-01

    This paper estimates the impact of a change in procurement strategy of a private buyer in the central Indian state of Madhya Pradesh. Beginning in October 2000, Internet kiosks and warehouses were established that provide wholesale price information and an alternative marketing channel to soy farmers in the state. Using a new market-level dataset, the estimates suggest a significant increase in soy price after the introduction of kiosks, supporting the predictions of the theoretical model. Mo...

  5. Central and Eastern European Social Policy and European Union Accession: Time for Reform

    Directory of Open Access Journals (Sweden)

    Noemi Lendvai

    2005-03-01

    Full Text Available European Union enlargement and accession are reflexive of both EU and post-communist social policies. There is a unique “dialogue“ going on, indicative of fundamental aspects of post-communist, post-transitional social policy. It is also a 'mirror' that reflects shortcomings of governance, and often presents a neglected institutional landscape. Therefore, the Europeanisation of social policy is an essential transformation process for post-communist countries whereby a new language and new concepts are introduced, the outlines of new social-policy governance emerge and enter the space in which social policy is formulated and considered.

  6. Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa Método bundle en la redución de infecciones relacionadas a catéteres centrales: una revisión integrativa Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review

    OpenAIRE

    Juliana Dane Pereira Brachine; Maria Angélica Sorgini Peterlini; Mavilde da Luz Gonçalves Pedreira

    2012-01-01

    Trata-se de uma revisão integrativa da literatura, que objetivou identificar intervenções baseadas em evidência que compõem o método bundle, designados à redução de infecção de corrente sanguínea relacionada ou associada a cateter intravenoso central. Para a coleta de dados online, em bases nacionais e internacionais, foram utilizados a palavra-chave bundle e os descritores catheter-related infection, infection control e central venous catheterization, resultando, após aplicação dos critérios...

  7. Towards an Integrated Flood Preparedness and Response: Centralized Data Access, Analysis, and Visualization

    Science.gov (United States)

    Demir, I.; Krajewski, W. F.

    2014-12-01

    Recent advances in internet and cyberinfrastucture technologies have provided the capability to understand the hydrological and meteorological systems at space and time scales that are critical for making accurate understanding and prediction of flooding, and emergency preparedness. A novel example of a cyberinfrastructure platform for flood preparedness and response is the Iowa Flood Center's Iowa Flood Information System (IFIS). IFIS is a one-stop web-platform to access community-based flood conditions, forecasts, visualizations, inundation maps and flood-related data, information, and applications. An enormous volume of real-time observational data from a variety of sensors and remote sensing resources (radars, rain gauges, stream sensors, etc.) and complex flood inundation models are staged on a user-friendly maps environment that is accessible to the general public. IFIS has developed into a very successful tool used by agencies, decision-makers, and the general public throughout Iowa to better understand their local watershed and their personal and community flood risk, and to monitor local stream and river levels. IFIS helps communities make better-informed decisions on the occurrence of floods, and alerts communities in advance to help minimize flood damages. IFIS is widely used by general public in Iowa and the Midwest region with over 120,000 unique users, and became main source of information for many newspapers and TV stations in Iowa. IFIS has features for general public to improve emergency preparedness, and for decision makers to support emergency response and recovery efforts. IFIS is also a great platform for educators and local authorities to educate students and public on flooding with games, easy to use interactive environment, and data rich system.

  8. 中心静脉和动脉血气联合分析在脓毒血症患者诊疗中的预警作用%PRECAUTION OF CENTRAL VENOUS AND ARTERIAL BLOOD GAS ASSOCIATED ANALYSIS IN PATIENTS WITH SEPSIS

    Institute of Scientific and Technical Information of China (English)

    卜会驹; 杨秀洁; 杭寒皎; 陈亮

    2009-01-01

    目的 探讨中心静脉和动脉血气联合分析在脓毒血症患者诊疗中的应用价值.方法 脓毒血症患者46例,定时进行中心静脉和动脉血气分析,记录相关数据,同时记录中心静脉压(CVP)、平均动脉压(MAP)、每小时尿量.根据3d后APACHEⅢ评分是否≥80,分为A组(23例)、B组(23例),比较入院时的APACHEⅢ评分,动脉血气,静脉血气.根据治疗过程中是否发生休克,分为C组(17例)、D组(29例),比较休克前一次的动脉和静脉血气.3d后,选择生命体征平稳,疗效较好的患者,设定为E组(16例),比较每个时段的动静脉血氧饱和度,CVP、MAP、尿量变化.结果 A,B二组患者入科时,APACHEⅢ评分、动脉血气分析各项指标无差异,但静脉血气氧分压、二氧化碳分压、pH值、A-VpH(动静脉pH值差),A-VPCO2(动静脉二氧化碳分压差)差异有统计学意义(P<0.05).D组患者休克发生前血气与无休克患者比较,动脉血气值差异无统计学意义,但是A-VpH,A-VPCO2和静脉血气分析各项数据差异有统计学意义(P<0.05).在E组患者中,随着病情好转,A-VpH,A-VPCO2和静脉氧饱和度比MAP、CVP、每小时尿量等数据更快出现改善(P<0.05).结论 中心静脉和动脉血气联合分析在脓毒血症患者诊疗中,有早期判断预后,提示休克发生,快速判断疗效等几大预警作用.%Objective To investigate the precaution of central venous and arterial blood gas associated analysis in the diagnosis and treatment of patients with sepsis. Methods 46 sepsis patients were recruited, central venous blood gas and arterial gas values, central venous pressure(CVP),average arterial pressure (MAP),quantities of urine per hour were timed and recorded. Based on APACHE Ⅲ grade exceed 80 or not after 3 days , patients were divided into two groups: group A(23 cases),group B(23 cases),compared the first APACHEⅢgrade, central venous blood gas and arterial gas value of these groups. Based on

  9. Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

    Directory of Open Access Journals (Sweden)

    Pooja Binnani

    2012-01-01

    Full Text Available The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete-riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

  10. Predicted burden of venous disease.

    Science.gov (United States)

    Onida, Sarah; Davies, Alun Huw

    2016-03-01

    Chronic venous disease is a common condition with clinical signs and symptoms ranging from spider veins, to varicose veins, to active venous ulceration. Both superficial and deep venous dysfunction may be implicated in the development of this disease. Socio-economic factors are shaping our population, with increasing age and body mass index resulting in significant pressure on healthcare systems worldwide. These risk factors also lead to an increased risk of developing superficial and/or deep venous insufficiency, increasing disease prevalence and morbidity. In this chapter, the authors review the current and future burden of chronic venous disease from an epidemiological, quality of life and economic perspective. PMID:26916773

  11. Uso profilático de Mupirocina em cateter venoso central de hemodiálise: revisão sistemática e metanálise Uso profiláctico de Mupirocina en cateter venoso central de hemodiálisis: revisión sistemática y metaanálisis Prophylactic use of Mupirocin in hemodialysis central venous catheters: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Mônica Taminato

    2012-01-01

    Full Text Available OBJETIVO: Avaliar o impacto do uso de Mupirocina tópica em inserção de cateter venoso central para hemodiálise. MÉTODOS: Revisão Sistemática com Metanálise. RESULTADOS: Após uma criteriosa e extensa busca, foram incluídos três ensaios clínicos que compararam o uso de Mupirocina versus outra intervenção em cateter venoso central para hemodiálise. CONCLUSÃO: O estudo apontou que o uso de Mupirocina tópica é eficaz para redução dos episódios de infecções entre os pacientes em hemodiálise, aumentando o tempo de utilização do cateter, além de reduzir significativamente as infecções por S aureus as mais prevalentes nessa população.OBJETIVO: Evaluar el impacto del uso de Mupirocina tópica en inserción de cateter venoso central para hemodiálisis. MÉTODOS: Revisión Sistemática con Metaanálisis. RESULTADOS: Después de una criteriosa y extensa búsqueda, se incluyeron tres ensayos clínicos que compararon el uso de Mupirocina versus otra intervención en cateter venoso central para hemodiálise. CONCLUSIÓN: El estudio demostró que el uso de Mupirocina tópica es eficaz para la reducción de los episodios de infecciones entre los pacientes en hemodiálisis, aumentando el tiempo de utilización del cateter, además de reducir significativamente las infecciones por S aureus, las más prevalentes en esa población.OBJECTIVE: To evaluate the impact of the use of topical Mupirocin on the insertion of central venous catheter for hemodialysis. METHODS: This was a systematic review with meta-analysis. RESULTS: After a careful and extensive search, we included three clinical trials that compared the use of Mupirocin versus other intervention in central venous catheter for hemodialysis. CONCLUSION: The study found that the use of topical Mupirocin is effective in reducing episodes of infection among hemodialysis patients, increasing duration time for catheter, and significantly reducing S aureus infections, which are the most

  12. Central Vein Dilatation Prior to Concomitant Port Implantation

    International Nuclear Information System (INIS)

    Implantation of subcutaneous port systems is routinely performed in patients requiring repeated long-term infusion therapy. Ultrasound- and fluoroscopy-guided implantation under local anesthesia is broadly established in interventional radiology and has decreased the rate of complications compared to the surgical approach. In addition, interventional radiology offers the unique possibility of simultaneous management of venous occlusion. We present a technique for recanalization of central venous occlusion and angioplasty combined with port placement in a single intervention which we performed in two patients. Surgical port placement was impossible owing to occlusion of the superior vena cava following placement of a cardiac pacemaker and occlusion of multiple central veins due to paraneoplastic coagulopathy, respectively. In both cases the affected vessel segments were dilated with balloon catheters and the port systems were placed thereafter. After successful dilatation, the venous access was secured with a 25-cm-long, 8-Fr introducer sheath, a subcutaneous pocket prepared, and the port catheter tunneled to the venipuncture site. The port catheter was introduced through the sheath with the proximal end connected to a 5-Fr catheter. This catheter was pulled through the tunnel in order to preserve the tunnel and, at the same time, allow safe removal of the long sheath over the wire. The port system functioned well in both cases. The combination of recanalization and port placement in a single intervention is a straightforward alternative for patients with central venous occlusion that can only be offered by interventional radiology.

  13. Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion

    International Nuclear Information System (INIS)

    Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting. First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access. In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is

  14. 'Chronic cerebrospinal venous insufficiency' in multiple sclerosis. Is multiple sclerosis a disease of the cerebrospinal venous outflow system?

    International Nuclear Information System (INIS)

    Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients. (orig.)

  15. The dynamics of venous return and response to hypervolemia in the toad, Bufo marinus (L.)

    OpenAIRE

    Killorn, Erin E; Toews, Daniel P

    2001-01-01

    Background Venous return from the posterior region of amphibians travels by either two renal portal veins to the kidney or a central abdominal vein that drains into the hepatic portal system. The relative proportions of blood flow in these vessels has never been measured nor has a modification of flow been determined when venous return increases by changes in blood volume during hypervolemia or during increased volume input from the posterior lymph hearts. Results Venous return from the poste...

  16. The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter Uso de la película transparente de poliuretano en el catéter venoso central de larga permanencia O uso do filme transparente de poliuretano no cateter venoso central de longa permanência

    Directory of Open Access Journals (Sweden)

    Renata Cristina de Campos Pereira Silveira

    2010-12-01

    Full Text Available Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickman’s catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average. Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.El curativo es una intervención que tiene por objetivo la prevención de infección en el catéter venoso central. El estudio tuvo como objetivo analizar la frecuencia de infección relacionada al catéter y la toxicidad cutánea en la utilización del curativo de poliuretano en el catéter de Hickman implantado en pacientes sometidos al trasplante de células tronco hematopoyéticas alogénicas. Para esto se realizó una serie de 10 casos. El exudado estuvo presente en promedio por 12 días, siendo necesario el uso del curativo de gasa estéril con cinta adhesiva por 12,9 días (promedio. El curativo de poliuretano fue utilizado en promedio por 15,1 días. La retirada precoz del catéter debido a surgimiento de infección ocurrió en cuatro casos. El mayor grado de toxicidad cutánea ocurrió en un caso que se utilizó el curativo de gasa y en tres casos que utilizaron la película. La película transparente permitió la visualización del sitio de salida del catéter y la realización del cambio en intervalos mayores.O curativo é intervenção que visa a prevenção de infecção no cateter venoso central. O estudo teve como objetivo analisar a

  17. Malposition and complications following venous catheterization

    International Nuclear Information System (INIS)

    Malposition and complications following central venous catheterization largely depend on the site of venous approach. Malpositions are very common after subclavian vein catheterization, and even more common after left jugular vein catheterization. On the contrary, their incidence after right jugular puncture is very low. Among complications, pneumothorax is quate common after subclavian vein catheterization, and migration of the catheter towards the heart after right jugular puncture. Vascular damages may occur in any approach: their early detection on chest radiographs very much depends on a rigorous technique. Radiology plays an important role in the early detection of malposition and complications, which is greatly facilitated by a few ml of contrast medium injected through the catheter

  18. 中心静脉导管胸腔置管护理博客的建立与效果%Establishment and effect of the blog of the nursing care for central venous catheter thoracostomy

    Institute of Scientific and Technical Information of China (English)

    谷小燕; 张桐花; 谢华琴; 袁亚林; 杨青成

    2012-01-01

    Objective To explore the effect of the blog of central venous catheter thoracostomy on the health education and academic exchanges.Methods Many methods were used such as established hosted rental blog at the NetEase Web sites,managed by special administrator,and published specific nursing log on thoracostomy.Results Totals of 33 logs were published by the administrator from October 2011to January 2012.The browse rate of these logs was high and the total visit had exceed 10 000 person-times.Callers had published over 60 comments,answered inquiry on line over 40 times and replied over 10 emails.Conclusions It is an economic,convenient and shortcut method to develop health education and academic exchanges by means of the blog on nursing care of thoracostomy with strong sharing and interaction.This method can meet the requirrnents of the people with different levels of the knowledge on thoracostomy including patients families,health care workers and so on.%目的 探讨应用胸腔置管护理专科博客开展健康教育和学术交流的效果.方法 在网易网站建立托管式租用博客,由专人管理,发表胸腔置管专科护理日志、在线答疑等.结果 2011年10月至2012年1月管理员共发表33篇日志,胸腔置管护理所有的博文浏览量均较高,博客总访问量达10000余人次,访客发表评论60余篇,回答在线咨询40余次,回复邮件10余封.结论 应用博客进行胸腔置管护理健康教育和学术交流,经济、方便、快捷,共享性和互动性强,满足了患者、家属、医护人员等各层面人群对胸腔置管护理知识的需求.

  19. ScienceCentral: open access full-text archive of scientific journals based on Journal Article Tag Suite regardless of their languages

    OpenAIRE

    Huh, Sun

    2013-01-01

    ScienceCentral, a free or open access, full-text archive of scientific journal literature at the Korean Federation of Science and Technology Societies, was under test in September 2013. Since it is a Journal Article Tag Suite-based full text database, extensible markup language files of all languages can be presented, according to Unicode Transformation Format 8-bit encoding. It is comparable to PubMed Central: however, there are two distinct differences. First, its scope comprises all scienc...

  20. Management of catheter-associated upper extremity deep venous thrombosis.

    Science.gov (United States)

    Crawford, Jeffrey D; Liem, Timothy K; Moneta, Gregory L

    2016-07-01

    Central venous catheters or peripherally inserted central catheters are major risk factors for upper extremity deep venous thrombosis (UEDVT). The body and quality of literature evaluating catheter-associated (CA) UEDVT have increased, yet strong evidence on screening, diagnosis, prevention, and optimal treatment is limited. We herein review the current evidence of CA UEDVT that can be applied clinically. Principally, we review the anatomy and definition of CA UEDVT, identification of risk factors, utility of duplex ultrasound as the preferred diagnostic modality, preventive strategies, and an algorithm for management of CA UEDVT. PMID:27318061

  1. Medical management of venous ulcers.

    Science.gov (United States)

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. PMID:26358306

  2. Bloodstream infections among patients using central venous catheters in intensive care units Infección de corriente sanguínea en pacientes con catéter venosos central en unidades de cuidado intensivo Infecções da corrente sangüínea em pacientes em uso de cateter venoso central em unidades de terapia intensiva

    Directory of Open Access Journals (Sweden)

    Eni Rosa Aires Borba Mesiano

    2007-06-01

    Full Text Available Central Venous Catheters (CVC, widely used in Intensive Care Units (ICU are important sources of bloodstream infections (BSI. This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI. The hospitalization term was 3.5 times greater among these patients. Different modalities of catheter insertion and antiseptic substances use were observed. Time of CVC permanence was significantly associated to infection incidence (pLos catéteres venosos centrales (CVC utilizados principalmente en unidades de cuidados intensivos - UCIs, son importantes fuentes de infección de la corriente sanguínea (ICS. Este estudio epidemiológico analítico, de corte prospectivo, enfoca la incidencia de ICS, factores de riesgo asociados y medidas asistenciales relacionadas con el uso de estos catéteres en 7 UCIs del Distrito Federal. Del total de 630 pacientes con CVC, 6,4% presentaron ICS (1,5% relacionado al catéter y 4,9% ICS-Clínica. El tiempo de hospitalización fue 3,5 veces mayor para este grupo de pacientes. Fueron observadas diferentes conductas con relación a la inserción de catéteres y al uso de antisépticos. El tiempo de permanencia del CVC estuvo asociado a la incidencia de infección (pOs cateteres venosos centrais (CVC, utilizados, principalmente em unidades de terapia intensiva-UTIs, são importantes fontes de infecção da corrente sangüínea (ICS. Este estudo epidemiológico analítico, tipo coorte prospectiva, enfoca a incidência de ICS, fatores de risco associados e ações assistenciais relacionadas ao uso desses cateteres em 7 UTIs no Distrito Federal. Dos 630 pacientes com CVC, 6,4% apresentaram ICS (1,5% relacionadas ao cateter e 4,9% ICS

  3. Travel and venous thrombosis.

    Science.gov (United States)

    Gallus, Alexander S; Goghlan, Douglas C

    2002-09-01

    Debate continues about whether and to what extent travel predisposes to venous thrombosis and pulmonary embolism (PE). Almost certainly, the strength of any association was greatly exaggerated in recent press reports. Conclusions from case-control studies vary, with some finding no excess of recent travel among patients with venous thromboembolism and others reporting a two-four fold excess. The strongest evidence that prolonged air travel predisposes to thrombosis comes from the travel history of people who present with PE immediately after landing. Two independent analyses suggest that the risk of early embolism increases exponentially with travel times beyond 6 hours and may reach 1:200,000 passengers traveling for more than 12 hours. The most likely explanation is venous stasis in the legs from prolonged sitting, and there is evidence (preliminary and controversial) that elastic support stockings may prevent deep vein thrombosis in people who travel long-distances. There is an urgent need for more and better studies to define the absolute hazard from travel-related thrombosis and the personal risk factors that may contribute. Without these, it is difficult to give a balanced account to people who intend to travel or to consider definitive prevention trials. Case reports suggest that in most cases, travel-related thrombosis has affected people who were also at risk because of previous thrombosis, recent injury, or other predispositions. This makes it sensible to target such "at risk" people with advice about hazards and precautions, at least until formal study validates some other approach. PMID:12172438

  4. Ultrasound Evaluation Before and After Hemodialysis Access

    Directory of Open Access Journals (Sweden)

    Daryoush Saedi

    2009-01-01

    Full Text Available   "nThe basic concept of hemodialysis access is to make a route to the central circulation in CRF patients. Vascular access procedures and subsequent complications represent a major cause of morbidity, hospitalization and cost for hemodialysis patients. Native arteriovenous fistulas (AVFs are preferable to synthetic arteriovenous grafts because they are associated with a lower frequency of thrombosis and infection, as well as greater longevity. AVFs that are never usable and early graft failures are associated with the common problem of inadequate vessel (artery or vein selection. The surgeon’s preoperative physical examination is the primary basis for AVF versus graft selection. Only palpable veins are considered for construction of AVFs, and the more proximal draining venous anatomy is not known prior to the operation. Physical examination is the traditional surgical evaluation performed prior to hemodialysis access placement. Palpation and inspection are difficult in obese arms, and few patients have vessels that are visible throughout their entire course. Patients with end-stage renal disease have often had multiple venipunctures and numerous intravenous lines placed and thus have an increased likelihood of venous stenosis or occlusion. Central vein problems are difficult to detect at visual inspection. By colour Doppler analysis vessels can be assessed for size, stenosis, and occlusion. US mapping assists in surgical planning and is especially valuable in patients who are difficult surgical cases (eg, obesity, diabetes, history of prior access, elderly women.  "nThis lecture contains two separate sections: 1-Vascular mapping prior to access placement and 2-Fistula maturity by US evaluation. Ultrasonography (US is an excellent modality for hemodialysis access evaluation because it is  readily available, non-invasive and inexpensive. It avoids the risks associated with iodinated contrast material and ionizing radiation.   

  5. Cerebral sinus venous thrombosis.

    Science.gov (United States)

    Alvis-Miranda, Hernando Raphael; Milena Castellar-Leones, Sandra; Alcala-Cerra, Gabriel; Rafael Moscote-Salazar, Luis

    2013-10-01

    Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment. PMID:24347950

  6. Cerebral sinus venous thrombosis

    Directory of Open Access Journals (Sweden)

    Hernando Raphael Alvis-Miranda

    2013-01-01

    Full Text Available Cerebral sinus venous thrombosis (CSVT is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment.

  7. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  8. [Retinal venous obliteration and general pathology].

    Science.gov (United States)

    Aconiu, M; Mihălaş, G; Nemoianu, C

    1992-01-01

    The study of 148 retinal venous obliterations have shown 81 occlusions of central vein and 67 of I and II venous branch. A number of 90 was for the feminine gender (sex) and 59 for the masculine sex. The average age for the appearance of the venous occlusions was 62 years old, having extreme limits between 36-84 years old. Bilaterality has been for 3 cases. Concerning the associated medical affections, hypertension was for 67 patients, myocardiosclerosis have been mentioned for 67 patients, atherosclerosis for 21 patients, pulmonary scleroemphisis for 12 patients. Arterial hypertension with its aspersion that is arteriosclerosis are the main factors that have generated retinal circulation modifyings and have led to a degree of arterial insufficiency. Comparing the ophthalmological aspect to the pressure in the ophthalmic artery, most of the patients had a concordance of TACR and the retinal and choroidal angiosclerosis. The oscillometric examination to the inferior members has been effectuated for 21 patients and it has shown diminished values only for 3 cases. The forecast of the disease is still reserved. Following a group of 40 patients having OVR between 5 and 15 years old it has been established an average survival of 6.2 years. It is mentioned that 26% between these have dyed during the first six years. PMID:1520668

  9. Variabilidade na determinação do ponto externo de referência para a medida de pressão venosa central em crianças Variability in the establishment of an external reference point for central venous pressure measurement in children

    Directory of Open Access Journals (Sweden)

    Aline S. C. Belela

    2006-10-01

    Full Text Available OBJETIVO: Verificar variabilidade na determinação da linha axilar média como ponto externo de referência (PER, por diferentes profissionais de saú de, para a aferição de pressão venosa central em crianças. MÉTODOS: Estudo descritivo e de correlação realizado em uma unidade de cuidados intensivos pediátricos de um hospital universitário. Durante a determinação da linha axilar média como PER para a aferição da pressão venosa central, cinco avaliações realizadas no mesmo paciente por profissionais de saúde e uma realizada por um avaliador treinado foram comparadas. O resultado foi um total de 120 indicações de 44 profissionais de saúde, 17 (38,6% auxiliares e técnicos de enfermagem, 16 (36,3% enfermeiros e 11 (25,1% médicos, além de 24 identificações realizadas por avaliador treinado. Os dados foram analisados utilizando os testes do qui-quadrado, ANOVA, Kruskall-Wallis e teste t, fixando o nível de significância em 5%. RESULTADOS: Houve diferença significante entre as identificações realizadas pelos profissionais de saúde e pelo avaliador (p OBJECTIVE: To investigate the variability in the establishment of the midaxillary line as external reference point (ERP, by different healthcare workers, for the measurement of central venous pressure in children. METHODS: Descriptive and correlational study carried out in a pediatric intensive care unit of a teaching hospital. During the establishment of the midaxillary line as ERP for central venous pressure measurement, five assessments of the same patient made by healthcare workers and one assessment made by a trained evaluator were compared. A total of 120 assessments were made by 44 healthcare workers, 17 (38.6% by nursing assistants and nursing technicians, 16 (36.3% by nurses and 11 (25.1% by physicians, in addition to 24 assessments made by the trained evaluator. The data were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test and t test. Significance

  10. Management of symptomatic venous aneurysm.

    Science.gov (United States)

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  11. 肿瘤患者中心静脉导管真菌感染的相关因素分析%Related factors for central venous catheter-related fungal infections in tumor patients

    Institute of Scientific and Technical Information of China (English)

    祖璎玲; 周健; 赵霞; 张小琴; 张龑莉; 房佰俊; 魏旭东; 宋永平

    2013-01-01

    OBJECTIVE To explore the incidence, etiology, and risk factors of central venous catheter (CVC)-related fungal infections in tumor patients so as to propose the effective prevention measures. METHODS The related factors for infections in 200 tumor patients who underwent CVC from Jan to Oct, 2011 were reviewed retrospectively. RESULTS The incidence of CVC-related fungal infections was 15. 0%. There were 26 cases with single CVC-related infections and 4 cases with fungemia. Candida parapsilosis, Candida tropicalis, Candida ruffle monilia , Candida albicans, and Candida glabrata accounted for 53. 3% , 16. 7% > 13. 3%, 10. 0% and 6. 7% , respectively. The gender, age, types of tumor, and surgery were negatively correlated with the incidence of CVC-related infections, the difference in the infection rates between the different sites of catheterization was statistically significant (P<0. 05), the difference in the catheterization duration between the patients with CVC-related infections was statistically significant(P<0. 05) , totally 26 cases with infections were cured after extuba-tion of CVC, 3 of 4 patients with fungemia were cured after the antifungal treatment, and 1 case died of the mixed pulmonary Candida infections. CONCLUSION Candida parapsilosis is the predominant pathogen causing CVC-related fungal infections in the tumor patients. Timely extubation of CVC can effectively prevent catheter-related blood stream infections.%目的 探讨肿瘤患者中心静脉导管(CVC)真菌感染的分布与发生率,分析其相关因素,提出有效的预防改进措施.方法 回顾性分析2011年1-10月医院留置CVC的200例肿瘤患者的感染情况及相关因素.结果 CVC相关性真菌感染发生率为15.0%,其中26例单纯CVC感染(CVC-RI),4例合并真菌血症,其中近平滑假丝酵母菌、热带假丝酵母菌、皱褶假丝酵母菌、白色假丝酵母菌及光滑假丝酵母菌分别占53.3%、16.7%、13.3%、10.0%及6.7%;CVC感染发

  12. 批量重度烧伤患者中心静脉置管相关血流感染病例分析%Central venous catheter-related bloodstream infection in mass severe burn patients

    Institute of Scientific and Technical Information of China (English)

    黄慧敏; 徐晓莉; 尹湘毅; 方红梅; 聂牛燕; 沈小玥

    2015-01-01

    目的:了解批量重度烧伤患者中心静脉置管相关血流感染情况、危险因素及感染防控措施效果。方法某院2014年8月抢救了9例重度烧伤患者,对其行中心静脉置管术,置管全程对患者进行感染防控干预。结果9例患者共进行中心静脉置管30例次,置管总日数227 d,其中2例患者股静脉三腔置管细菌培养阳性,导管相关血流感染(CRBSI)发病率为8.81‰;其中1例患者培养出屎肠球菌,另1例患者培养出鲍曼不动杆菌和嗜麦芽窄食单胞菌。2例 CRBSI 患者均为股静脉置管,置管部位均为创面,置管时间均≥7 d,均为三腔置管,且患者Ⅲ°烧伤面积≥60%。经及时拔除导管和使用抗菌药物,2例感染患者均治愈。结论中心静脉置管有利于危重烧伤患者长期、安全、有效地补液,但其可导致 CRBSI;对中心静脉导管置管患者进行全程感染防控干预,选用少腔导管,有助于降低 CRBSI 的发生。%Objective To investigate the occurrence of central venous catheter-related bloodstream infection(CRB-SI)in mass severe burn patients,evaluate related risk factors for infection,and effectiveness of prevention and con-trol measures.Methods In August 2014,9 cases of severe burn patients were rescued in a hospital,all patients re-ceived CVC,infection prevention and control intervention measures were performed during the whole process of catheterization.Results All patients received 30 episodes of CVC,total CVC-days were 227 days,bacterial culture for three-cavity catheters of femoral veins in 2 patients were positive,incidence of CRBSI was 8.81 ‰;1 patient was isolated Enterococcus faecium ,1 isolated both Acinetobacter baumannii and Stenotrophomonas maltophilia .2 CRB-SI patients received femoral vein catheterization,catheterization site was trauma surface,duration of catheterization were both ≥7 days,both used three-cavity catheters,and third degree burns

  13. Avaliação do tipo de curativo utilizado em cateter venoso central para hemodiálise Evaluación del tipo de curativo utilizado en cateter venoso central para hemodiálisis Evaluation of tow types of dressings used on central venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Luciene de Fátima Neves Monteiro de Barros

    2009-01-01

    realizadas culturas de óstio y de la extremidad del CVC y hemocultura cuando indicado. RESULTADOS: Fueron incluídos 33 pacientes en cada grupo. No hubo diferencia estadística significante cuanto al tipo de curativo y las variables estudiadas. Los CVC posicionados a 90º en relación a la piel presentaron mayor índice de infección por S. aureus. CONCLUSIÓN: El uso del filme transparente no proporcionó reducción de infección, sin embargo el análisis cualitativo de este tipo de curativo tuvo mejor aceptación por los pacientes y profesionales.OBJECTIVES: To evaluate the efficacy of two types of dressings used on central venous catheter (CVC in patients undergoing hemodialysis and to determine the rate of local and systemic bacterial infection when using gauze and micropore dressings or transparent film dressings. METHODS: This study was a controlled randomized clinical trial with 66 subjects who were equally assigned to two groups (33 subjects per group. Group 1 used gauze and micropore dressings and group 2 used transparent film dressings. Measures consisted of a socio demographic questionnaire, clinical data, and catheter tip and blood culture tests. Subjects remained in the study until removal of the catheter. RESULTS: There were no statistically significant differences regarding the types of dressings. Positioning of CVCs at 90 degrees in relation to the skin had higher rate of infections by S. Aureus. CONCLUSION: Although the use of transparent film dressings did not reduce infection, qualitative data analysis suggested that this type of dressing was preferred by the patients and by the health care providers from a university hospital.

  14. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    conception occur together. In pregnancy, the risk of VTE is increased ~5-fold, while the use of combined hormonal contraception (CHC) doubles the risk and this relative risk is higher with the more recent pills containing desogestrel, gestodene and drospirenone when compared with those with levonorgestrel....... Similarly, hormone replacement therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT......BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed...

  15. Venous Thromboembolism. Diagnostic Guide

    International Nuclear Information System (INIS)

    The paper defines to the deep venous thrombosis (DVT) and the development of pulmonary thromboembolism (PTE) as manifestations of oneself pathology. Most of the pistons of the PTE (90%), they originate in the deep veins of the inferior members, proximal to the veins popliteas. In strange occasions, they make it in the veins of the superior members. The diagnosis, localization and extension of the DVT and of the PTE they are necessary to treat appropriately this given illness their high morbid mortality. The great majority of the PTE is symptomatic but it is necessary to know the risk of subsequent PTE examining the permeability of the deep veined system in the patient with suspicion of recent or old PTE to prevent its recurrence

  16. Phenetic relationships among natural population accessions of Glycyrrhiza glabra L. (Fabaceae in central Zagros region of Iran, based on quantitative morphology, flavonoids and glycyrrhizin contents data

    Directory of Open Access Journals (Sweden)

    Majid Sharifi-Tehrani

    2013-01-01

    Full Text Available Phenetic relationships among thirty five accessions from natural populations of two varieties of Glycyrrhiza glabra in central Zagros region of Iran were studied. Twenty one quantitative morphological characters were measured for twenty seven accessions. PCO, clustering, K-means and MDS analyses were performed on morphological dataset. Polar flavonoid constituents of twenty four accessions were extracted, purified using TLC and characterized at the skeleton class level. Glycyrrhizin contents of rhizomes in twenty four accessions were quantified using image processing methods. Results of multivariate analysis of both morphological and flavonoid spot profile data showed that accessions could be partitioned into two main groups based on geographical locality of the populations. The most variable morphological trait based on CV values, was seed area and the least variable one was Legume width in the widest portion. Accessions of both varieties produced various flavonoids of class flavones and flavonols. Seven flavonoid constituents from the two varieties were separated based on different Rf values. The results revealed that there were moderate (not prominent levels of variation between the studied accessions. Separation of the varieties based on the single qualitative character in the available literature, was confirmed. Rhizomes of both varieties showed similar amounts of glycyrrhizin and almost similar types of flavonoids in their TLC profiles, suggesting that both were equivalent as herbal drugs in folk medicine.

  17. Trade Policies in Central Asia after EU Enlargement and before Russian WTO Accession: Regionalism and Integration into the World Economy

    OpenAIRE

    Richard Pomfret

    2004-01-01

    This paper analyses the choices between regionalism and multilateralism, and the impact of WTO membership on the five Central Asian countries. The two main sections analyse (1) why the large number of regional trade agreements which the Central Asian countries have signed have had little economic impact, and (2) the consequences for the Central Asian countries of Chinese and Russian WTO membership and the consequences of the current Central Asian applicants’ (Kazakhstan, Tajikistan and Uzbeki...

  18. Epidemiology of recurrent venous thrombosis

    Directory of Open Access Journals (Sweden)

    D.D. Ribeiro

    2012-01-01

    Full Text Available Venous thrombosis, including deep vein thrombosis and pulmonary embolism, is a common disease that frequently recurs. Recurrence can be prevented by anticoagulants, but this comes at the risk of bleeding. Therefore, assessment of the risk of recurrence is important to balance the risks and benefits of anticoagulant treatment. This review briefly outlines what is currently known about the epidemiology of recurrent venous thrombosis, and focuses in more detail on potential new risk factors for venous recurrence. The general implications of these findings in patient management are discussed.

  19. Chronic cerebrospinal venous insufficiency: current perspectives

    Directory of Open Access Journals (Sweden)

    Simka M

    2014-03-01

    Full Text Available Marian Simka Department of Nursing, College of Applied Sciences, Ruda Slaska, Poland Abstract: This review summarizes the research to date on chronic cerebrospinal venous insufficiency (CCSVI. CCSVI was initially defined as a clinical syndrome comprising stenoses of the internal jugular and/or azygos veins, characterized by collateral venous outflows and reduced cerebral blood flow, and was found primarily in patients with multiple sclerosis. However, the published evidence on CCSVI is very discordant. Catheter venography studies gave a regular picture, with the majority of patients with multiple sclerosis presenting with demonstrable outflow abnormalities in the veins draining the central nervous system. The prevalence of these lesions was over 50%, and even higher (about 90% when more liberal definition of an abnormality or intravascular sonography was used. Further, the results of magnetic resonance venography studies have been quite consistent, in that stenoses of the internal jugular veins have been found in 25%–70% of patients with multiple sclerosis. In contrast, Doppler sonography studies have revealed CCSVI in 0% to 100% of patients. The research is currently suggesting that CCSVI is not a single entity, but rather a group of different anatomic and functional venous abnormalities. Regarding venous outflow from the brain, a patient can present either with diminished inflow to the internal jugular veins resulting from decreased cerebral circulation or with externally compressed or hypoplastic internal jugular veins or stenotic jugular valves. Considering these many faces of CCSVI, it becomes more comprehensible as to why the results of the studies, especially those utilizing Doppler sonography, have been so discordant. Not only were investigators using different diagnostic modalities and distinct protocols, but they were not looking for the same pathology. Since these abnormalities were indeed differently prevalent in patients and

  20. Measuring venous oxygenation using the photoplethysmograph waveform

    OpenAIRE

    Walton, Z. D.; Kyriacou, P. A.; Silverman, D. G.; Shelley, K. H.

    2010-01-01

    OBJECTIVE: We investigate the hypothesis that the photoplethysmograph (PPG) waveform can be analyzed to infer regional venous oxygen saturation. METHODS: Fundamental to the successful isolation of the venous saturation is the identification of PPG characteristics that are unique to the peripheral venous system. Two such characteristics have been identified. First, the peripheral venous waveform tends to reflect atrial contraction. Second, ventilation tends to move venous blood preferenti...

  1. Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries

    OpenAIRE

    Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

    2016-01-01

    Background: The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with...

  2. Cerebral venous thrombosis: diagnosis dilemma

    OpenAIRE

    2011-01-01

    Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging moda...

  3. Sequelae of Untreated Venous Insufficiency

    OpenAIRE

    Nicholls, Stephen C.

    2005-01-01

    Untreated venous insufficiency results not only in a gradual loss of cosmesis but also in variety of complications including persistent pain and discomfort, hemorrhage, superficial thrombophlebitis, and progressive skin changes that may ultimately lead to ulceration. In rare instances, chronic soft tissue changes may lead to stiffness of the ankle joint, fixed plantar flexion, and periostitis. This article reviews the variety of complications caused by venous insufficiency.

  4. Treatment of Chronic Venous Insufficiency

    OpenAIRE

    KÖKSAL, Cengiz; Alsalehi, Saleh; Kocamaz, Özgür; Sunar, Hasan

    2009-01-01

    Chronic venous insufficiency (CVI), with its high prevalence, high cost of diagnosis and treatment, substantial loss in manpower and negative effects on quality of life, is an important health issue. A comprehensive knowledge of the anatomy and functions of venous system is a must to understand the pathophysiology of CVI. The diagnosis of CVI is made by history, physical examination and noninvasive tests. The traditional surgical strategy for CVI treatment is high ligation of saphenofemoral v...

  5. Treatment of Chronic Venous Insufficiency

    OpenAIRE

    Cengiz Köksal; Saleh Alsalehi; Özgür Kocamaz; Hasan Sunar

    2010-01-01

    Chronic venous insufficiency (CVI), with its high prevalence, high cost of diagnosis and treatment, substantial loss in manpower and negative effects on quality of life, is an important health issue. A comprehensive knowledge of the anatomy and functions of venous system is a must to understand the pathophysiology of CVI. The iagnosis of CVI is made by history, physical examination and noninvasive tests. The traditional surgical strategy for CVI treatment is high ligation of saphenofemoral ve...

  6. Air travel and venous thromboembolism.

    OpenAIRE

    2002-01-01

    There has recently been increased publicity on the risk of venous thrombosis after long-haul flights. This paper reviews the evidence base related to the association between air travel and venous thromboembolism. The evidence consists only of case reports, clinical case-control studies and observational studies involving the use of intermediate end-points, or expert opinion. Some studies have suggested that there is no clear association, whereas others have indicated a strong relationship. On...

  7. The dynamics of venous return and response to hypervolemia in the toad, Bufo marinus (L.)

    OpenAIRE

    Toews Daniel P; Killorn Erin E

    2001-01-01

    Abstract Background Venous return from the posterior region of amphibians travels by either two renal portal veins to the kidney or a central abdominal vein that drains into the hepatic portal system. The relative proportions of blood flow in these vessels has never been measured nor has a modification of flow been determined when venous return increases by changes in blood volume during hypervolemia or during increased volume input from the posterior lymph hearts. Results Venous return from ...

  8. Duplex correlation phlebography in venous mapping of the upper limbs for artery venous fistulas for hemodialysis

    International Nuclear Information System (INIS)

    When clinical evaluation is not enough,the evaluation of the venous condition of the upper limbs for the realization of angio access for hemodialysis is classically based on phlebography,an invasive,risky method.the appear rance of non invasive techniques such as eco Doppler(duplex) makes it necessary to do research in order to determine the utility of the method and define its indications.The authors analyse 35 venous mappings of the upper limbs by phlebography and duplex and compare its results for the different venous regions.They come to the conclusion that duplex presented the best performance for the hum ero axillary subclavian region,detecting thrombosis with a sensitivity of 100% a specificity of 97% positive predictive value of 50% and negative predictive value of 100%.For superficial axis (radial and superficial ulnar,basilic and cephalic)there is low sensitivity for the determination of presence and permeability of the axis but 100% specificity.Duplex was not useful for the description of veins in order to determine utility for Avf.Finally,the authors make recommendations as regards indications of these para clinical tests

  9. 探讨应用被动抬腿试验联合中心静脉压预测老年脓毒症患者的容量反应性%To Explore the Application of Passive Leg Raising Combined With Central Venous Pressure Predict Volume Responsiveness in Elderly Patients With Sepsis

    Institute of Scientific and Technical Information of China (English)

    农忻月

    2016-01-01

    目的:研究分析应用被动抬腿试验联合中心静脉压预测老年脓毒症患者的容量反应性。方法选取2015年10月~2016年3月我院收治的老年脓毒症患者40例,通过容量负荷试验后每搏量的增加值情况分为观察组与对照组。结果观察组患者扩容后心率低于对照组患者,差异具有统计学意义(P<0.05)。观察组患者扩容后动脉压、每搏量、心输出量以及氧合指数均高于对照组患者,差异具有统计学意义(P<0.05)。结论观察组患者扩容后心输出量增加,而中心静脉压降低,所以应用被动抬腿试验联合中心静脉压能有效预测老年脓毒症患者的容量反应性。%Objective To study the analysis application of passive leg joint central venous pressure prediction capacity reactivity in elderly patients with sepsis. Methods 40 patients with sepsis were select from October 2015 to March 2016 in our hospital, through the capacity load experiment after stroke volume of added value is divided into observation group and control group.Results Observation group of patients with enlarged heart rate was signiifcantly lower than the control group patients, difference is statistically signiifcant (P<0.05). Observation group of patients expansion after arterial pressure, stroke volume, cardiac output and oxygenation index were signiifcantly higher than that of control group patients, difference is statistically signiifcant (P<0.05).Conclusion To observe the way patients expansion increased markedly, and the middle of the back the output and central venous pressure has a significant decrease, so the application of combined central venous pressure passive leg lifts test can effectively predict the capacity of the elderly patients with sepsis reactivity.

  10. 中心静脉导管胸腔闭式引流术治疗结核性胸膜炎疗效观察%Observation Curative Effect of Central Venous Catheter Pleural Closed Drainage in Treatment of Tuberculous Pleurisy

    Institute of Scientific and Technical Information of China (English)

    鲁军霖

    2015-01-01

    目的:中心静脉导管胸腔闭式引流术治疗结核性胸膜炎疗效观察。方法本文选取我院于2012年12月~2014年12月收治的80例结核性胸膜炎患者,将其随机分为治疗组和对照组,对照组采用常规胸腔穿刺针引流手术,治疗组采用中心静脉导管胸腔闭式引流术,对比两组患者的临床疗效和不良反应。结果治疗组患者的抽液总量、胸腔积液吸收时间、住院时间以及退热时间四项指标结果优于对照组对应指标结果,两组结果对比存在差异(P<0.05),具有统计学意义。结论结核性胸膜炎患者采用中心静脉导管胸腔闭式引流术实施治疗,可以减少患者的不良反应,操作更加方便、有效。%Objective Observe the curative effect of central venous catheter pleural closed drainage in the treatment of tuberculous pleurisy.Methods Selected 80 cases of tuberculous pleurisy from 2012 December to 2014 December in hospital, randomly divided into treatment group and control group, control group using conventional pleural puncture needle drainage surgery, the treatment group used the central venous catheter pleural closed drainage, compared clinical curative effect and adverse reaction in two groups. Results The treatment group of pumping liquid volume, pleural effusion absorption time, the period of hospital and fever time results is better than the control group, the results of two groups exist signiifcant difference (P<0.05), had statistical significance. Conclusion Tuberculoses pleurisy patients with central venous catheter pleural closed drainage treatment, reduce the adverse reaction of patients, operation more convenient.

  11. Investigation of central venous catheter-related infections in patients undergoing cardiac surgery%心脏术后患者中心静脉置管感染调查分析

    Institute of Scientific and Technical Information of China (English)

    马海英; 张志强; 段长虹; 李岩; 杨艳荣; 臧树志

    2013-01-01

    目的 对心脏术后患者行中心静脉置管(CVC)感染情况进行调查,为其临床的防治提供参考.方法 共纳入558例心外科行心脏手术的患者,所有患者根据病情均给予CVC,观察患者是否发生感染,并应用非条件logistic回归分析进行多因素分析.结果 558例行CVC患者中发生感染85例,感染率为15.3%;CVC尖端培养阳性28例,分离的16株病原菌中革兰阳性菌8株占50.0%,革兰阴性菌6株占37.5%,真菌2株占12.5%;85例感染患者中,65例为局部定植,12例为局部感染,8例为菌血症;单因素分析结果表明,感染患者年龄≥60岁、留置时间≥7d、导管管径≥16 G、导管管腔(多腔)、糖尿病史所占例数明显高于未发生感染患者,且感染患者白蛋白更低,差异有统计学意义(P<0.05);进一步行多因素分析结果表明,年龄≥60岁、留置时间≥7d、导管管腔(多腔)、糖尿病史及低白蛋白是CVC患者发生感染的独立危险因素(P<0.05).结论 年龄≥60岁、留置时间≥7d、导管管腔(多腔)、糖尿病史及低白蛋白是CVC患者发生感染的独立危险因素,对该类危险因素进行必要的干预具有重要的意义.%OBJECTIVE To investigate the status of the central venous catheter (CVC)-related infections in the patients undergoing cardiac surgery so as to provide reference for the clinical prevention and treatment. METHODS A total pf 558 patients who underwent the cardiac surgery were enrolled in the study, all patients were given the CVC according to the illness, the status of the infections was observed, and multivariate non-conditional logistic regression analysis was performed. RESULTS There were 85 of 558 CVC patients in whom the infections occurred. There were 28 cases with the culture of CVC positive. Of 16 strains of pathogens isolated, there were 8 (50.0%) strains of gram-positive bacteria, 6 (37. 5%) strains of gram-negative bacteria,and 2 (12. 5%) strains of fungi. Of

  12. Venous Port Salvage Utilizing Low Dose tPA

    International Nuclear Information System (INIS)

    This study was performed to evaluate the efficacy of low dose tPA for catheter salvage in cases of fibrin sheath formation in patients with venous access ports. Prospective evaluation was accomplished in patients who had venous ports with catheter malfunction. There were a total of 50 patients and 56 occlusive events.Each patient had a catheter injection documenting a fibrin sheath.Patient population included 45 for chemotherapy and 5 for antibiotics.A low dose tPA regimen was instilled into the port and upon successful return of function, a completion venogram was accomplished. Fifty patients were enrolled in the study with the average time between placement and dysfunction of 99 days. Five patients had a second occlusive event (38.5 days) and one had a third event (27 days). All patients had a venogram confirming a fibrin sheath as the cause of catheter malfunction. The average dose of tPA was 2.29 mg (range 1 mg-4 mg). Success was achieved in 52 of the 56 occlusive events(92.9%). There were no bleeding complications. Catheter occlusion is a common complication of long-term venous access ports. Aggressive therapy with low-dose tPA can salvage function. It provides safe and effective therapy for venous port malfunction secondary to fibrin sheath

  13. Effects of some pharmacological agents on the survival of unipedicled venous flaps: an experimental study.

    Science.gov (United States)

    Askar, I; Saray, A; Gurlek, A; Sevin, K; Sabuncuoglu, B T

    2001-01-01

    Clinical and experimental studies have been conducted to improve the survival of venous flaps. As a result of these studies, although various survival mechanisms were raised, none obtained satisfactory information. Venous stasis, and the resultant venous thrombosis, is a factor that decreases the survival of venous flaps. In this study, we evaluated the effects of two antiinflammatory agents, etodolac and etofenamate, on the survival of unipedicled venous flaps. In this study, 35 male New Zealand white rabbits (3,500-4,000 g) (70 ears) were used. Perichondrocutaneous flaps, 3 x 4.5 cm in size, were designed and raised, keeping the central veins intact in the middle of venous flap. Central arteries and nerves were ligated and transected both proximally and distally, to prepare unipedicled venous flaps. A silicone sheet was placed between the cartilage tissue and flap, to prevent blood flow and revascularization beneath. The subjects were divided into seven groups, consisting of five rabbits (10 ears). In the negative control group (group I), the single vascular pedicle of venous flaps, central veins were ligated and flaps sutured into their own place as the composite graft. In the positive control group (group II), after venous flaps were prepared, normal saline, 0.2 mL, was given subcutaneously. In the first of five experimental groups (group III), unfractionated heparin (100 U/day) was given subcutaneously. In the second experimental group (group IV), etodolac (5 mg/kg/day) was given subcutaneously. In the third experimental group (group V), etophenamate (5 mg/kg/day) was given orally through a feeding tube. In the fourth experimental group (group VI), parnaparin (5 anti-Xa U/kg/day) was given subcutaneously. In the fifth experimental group (group VII), nadroparin (5 anti-Xa U/kg/day) was given subcutaneously, about 7 days postoperatively. At the eighth postoperative day, surviving areas of venous flaps were measured, and the results were evaluated by Kruskal

  14. Nosocomial infections in dialysis access.

    Science.gov (United States)

    Schweiger, Alexander; Trevino, Sergio; Marschall, Jonas

    2015-01-01

    Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central line-associated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus, enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives. PMID:25676304

  15. Clinical effectiveness and cost-effectiveness of central venous catheters treated with Minocycline and Rifampicin in preventing bloodstream infections in intensive care patients [Medizinische Wirksamkeit und Kosteneffektivität von Minocyclin/Rifampicin-beschichteten zentralvenösen Kathetern zur Prävention von Blutbahninfektionen bei Patienten in intensivmedizinischer Betreuung

    Directory of Open Access Journals (Sweden)

    Neusser, Silke

    2012-10-01

    Full Text Available [english] The use of central venous catheters coated with antibiotics can avoid bloodstream infections with intensive care patients. This is the result of a scientific examination which has been published by the DIMDI. Costs could be also saved in this way. However, according to the authors, the underlying studies do not allow absolutely valid statements.[german] Der Einsatz bestimmter Antibiotika-beschichteter Venenkatheter kann bei Intensivpatienten Blutbahninfektionen vermeiden. So das Ergebnis einer wissenschaftlichen Untersuchung, die das DIMDI veröffentlicht hat. Auch ließen sich damit Kosten einsparen. Allerdings erlauben, laut den Autoren, die zugrunde gelegten Studien keine uneingeschränkt gültigen Aussagen.

  16. University Reform and Accessibility of Higher Education: Conference on University Reform and Higher Educational Accessibility with a Special Focus on Eastern and Central Europe

    Czech Academy of Sciences Publication Activity Database

    Matějů, Petr

    Praha : Sociologický ústav AV ČR, 2003, s. -. [Reforma univerzit a přístup k vysokoškolskému vzdělání: Konference k reformám terciárního vzdělávání a jeho dostupnosti se zvláštním zřetelem k situaci v zemích střední a východní Evropy. Praha (CZ), 15.06.2003-17.06.2003] R&D Projects: GA AV ČR IBS7028302 Institutional research plan: CEZ:AV0Z7028912 Keywords : reform * education * accessibility Subject RIV: AO - Sociology, Demography

  17. Physical measurements including temperature profiles of coastal Waters off Central California in October 2006 (NODC Accession 0019214)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Physical measurements of Coastal Waters off Central California in October 2006. Naval Postgraduate School, Monterey, California, Technical Report NPS-OC-07-002....

  18. Environmental Sensitivity Index (ESI) Atlas: Central California (Including Monterey Bay Sanctuary), maps and geographic information systems data (NODC Accession 0013176)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Environmental Sensitivity Index (ESI) maps have been developed for the coastal areas of Central California from Point Conception to Point Reyes National Seashore....

  19. Cerebral venous thrombosis in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Huisman, T.A.G.M.; Martin, E.; Willi, U.V. [Dept. of Diagnostic Imaging and Radiology, University Children' s Hospital Zurich (Switzerland); Holzmann, D. [Dept. of Otorhinolaryngology, University Children' s Hospital Zurich, Zurich (Switzerland)

    2001-09-01

    This was a retrospective study to determine different etiologies of cerebral venous thrombosis (CVT) in childhood and to correlate extent and location of thrombosis with the etiology and the age of the child as well as the final outcome. In addition, the radiologic approach is discussed. This was a retrospective analysis of 19 children with CVT. The children were examined by contrast-enhanced dynamic CT. Radiologic findings were correlated with the etiology of CVT. Cerebral venous thrombosis is not as infrequent in children as has been thought. Cerebral venous thrombosis in children can occur due to trauma (n=9), infections (n=7), or coagulation disorders (n=3). Extent and location of thrombosis, as well as complications, final outcome, and therapy, depend on the etiology. Computed tomography remains a valuable primary imaging modality in the diagnosis of CVT in the acutely injured or diseased child. (orig.)

  20. Cerebral venous thrombosis in childhood

    International Nuclear Information System (INIS)

    This was a retrospective study to determine different etiologies of cerebral venous thrombosis (CVT) in childhood and to correlate extent and location of thrombosis with the etiology and the age of the child as well as the final outcome. In addition, the radiologic approach is discussed. This was a retrospective analysis of 19 children with CVT. The children were examined by contrast-enhanced dynamic CT. Radiologic findings were correlated with the etiology of CVT. Cerebral venous thrombosis is not as infrequent in children as has been thought. Cerebral venous thrombosis in children can occur due to trauma (n=9), infections (n=7), or coagulation disorders (n=3). Extent and location of thrombosis, as well as complications, final outcome, and therapy, depend on the etiology. Computed tomography remains a valuable primary imaging modality in the diagnosis of CVT in the acutely injured or diseased child. (orig.)

  1. Hormonal contraceptives and venous thrombosis

    OpenAIRE

    Stegeman, Berendina Hendrika (Bernardine)

    2013-01-01

    Oral contraceptive use is associated with venous thrombosis. However, the mechanism behind this remains unclear. The aim of this thesis was to evaluate genetic variation in the first-pass metabolism of contraceptives, to identify the clinical implications of hormonal contraceptive use after a thrombotic event and to provide an overview of the risk of venous thrombosis per combined oral contraceptive. We found that the UGT2B7 gene in the first-pass metabolism may at least in part explain the r...

  2. Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis

    DEFF Research Database (Denmark)

    Blinkenberg, M; Akeson, P; Sillesen, H;

    2012-01-01

    The traditional view that multiple sclerosis (MS) is an autoimmune disease has recently been challenged by the claim that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). Although several studies have questioned this vascular theory, the CCSVI controversy is still ongoing. Our...

  3. Surveillance and medical therapy following endovascular treatment of chronic cerebrospinal venous insufficiency.

    Science.gov (United States)

    Forbes, Thomas L; Harris, Jeremy R; Kribs, Stewart W

    2012-06-01

    The debate regarding the possible link between chronic cerebrospinal venous insufficiency and multiple sclerosis (MS) is continuously becoming more and more contentious due to the current lack of level 1 evidence from randomized trials. Regardless of this continued uncertainty surrounding the safety and efficacy of this therapy, MS patients from Canada, and other jurisdictions, are traveling abroad to receive central venous angioplasty and, unfortunately, some also receive venous stents. They often return home with few instructions regarding follow-up or medical therapy. In response we propose some interim, practical recommendations for post-procedural surveillance and medical therapy, until further information is available. PMID:22577160

  4. Venous Complications of Pancreatitis: A Review

    OpenAIRE

    Yashant Aswani; Priya Hira

    2015-01-01

    Pancreatitis is notorious to cause vascular complications. While arterial complications include pseudoaneurysm formation with a propensity to bleed, venous complications can be quite myriad. Venous involvement in pancreatitis often presents with thrombosis. From time to time case reports and series of unusual venous complications associated with pancreatitis have, however, been described. In this article, we review multitudinous venous complications in the setting of pancreatitis and propose ...

  5. Neonatal peripherally inserted central catheter team. Evolution and outcomes of a bedside-nurse-designed program.

    Science.gov (United States)

    Linck, Deborah A; Donze, Ann; Hamvas, Aaron

    2007-02-01

    Percutaneously inserted central venous catheters (PICCs) have been used to provide central venous access for more than 25 years. Although these lines initially were placed by physicians, currently there are many adult, pediatric, and neonatal nurse-based PICC teams. This article describes the inception and growth of 1 team which, during the last 14 years, has placed more than 3400 catheters and trained more than 50 bedside nurses to insert PICCs. It highlights the development of the team, including details of how team members were selected and trained. Management of ongoing issues was handled by a self-directed nurse team organized into a committee structure composed of an oversight committee and education, guideline, qualifications, and quality improvement subcommittees. This team set and achieved the goals of training bedside nurses to place PICCs, providing consistent management of PICCs, and closely monitoring outcomes. PMID:17536330

  6. Obstructive hydrocephalus resulting from cerebral venous thrombosis

    OpenAIRE

    2011-01-01

    Cerebral venous thrombosis is a rare form of stroke in childhood. Increased intracranial pressure is a well-defined complication of cerebral venous thrombosis but obstructive hydrocephalus as a presentation finding of cerebral venous thrombosis is rarely described. A child case of cerebral sinus thrombosis presenting with obstructive hydrocephalus and management of clinical condition is presented with discussion of reported cases and treatment recommendations.

  7. Percutaneous Intervention of Sequential Coronary Venous Graft

    OpenAIRE

    Zeki DOGAN; Karabulut, Ahmet; Uzunlar, Bulent

    2014-01-01

    We present a case with coronary bypass grafts in which venous graft was anastomosed to obtuse marginal (OM) 1 and OM2 branches sequentially. We performed percutaneous intervention to the proximal circumflex (CX), OM1, and bridging segment of the venous graft. Finally, bridging segment of the venous graft began to function as a CX body extending between the OM1 and OM2.

  8. Hepatic venous outflow obstruction: Three similar syndromes

    Institute of Scientific and Technical Information of China (English)

    Ulas Darda Bayraktar; Soley Seren; Yusuf Bayraktar

    2007-01-01

    Our goal is to provide a detailed review of venoocclusive disease (VOD), Budd-Chiari syndrome (BCS),and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed,enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS,and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions.However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction.Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure.

  9. Food Poverty, Climate Change and Land Access in central Uganda: A focus on low-income women

    DEFF Research Database (Denmark)

    Nambuanyi, Lekunze Ransom

    2014-01-01

    of food insecurity among low-income women (farmers) in central Uganda, positing the view that the agricultural and livelihood choices women farmers make are subject to the constraints they face and the policy alternatives available for them. Uganda is burdened with rising poverty, malnutrition and...

  10. [Current treatment of venous thrombembolism].

    Science.gov (United States)

    Munteanu, Ionuţ

    2013-01-01

    Deep vein thrombosis and pulmonary embolism, considered to be different manifestations of the same disease - venous thromboembolism, have few differences regarding the anticoagulant treatment. However, there are some issues which will be discussed. The therapy objectives in patients with venous thromboembolism include: prevention of death by pulmonary embolism, relieving symptoms in the affected leg, preventing morbidity and prevention of recurrent thromboembolism or postthrombotic syndrome, or minimize symptoms of post-thrombotic syndrome. For most patients, treatment goals are achieved using appropriate anticoagulant therapy, reducing the risk of recurrence in the first three months after diagnosis from over 25% to under 4%. Using of compression socks, providing a gradient of 30-40 mmHg at the ankle for 2 years after the diagnosis, reduce the risk of postthrombotic syndrome. Thrombolysis, applied either systemic or directly by catheter, is indicated in selected cases to prevent onset of postthrombotic syndrome or remove quickly the symptoms due to high venous obstruction. Thrombolytic therapy should be continued with anticoagulant therapy to prevent recurrence of venous thromboembolism. The use of an inferior vena cava filter is indicated for prevention of death by pulmonary embolism in patients who have contraindications to anticoagulant therapy, or anticoagulant treatment that was properly administered remains inefficient. Surgical treatment is recommended in case of chronic pulmonary hypertension, due to thromboembolic disease. PMID:23781572

  11. Hormonal contraceptives and venous thrombosis

    NARCIS (Netherlands)

    Stegeman, Berendina Hendrika (Bernardine)

    2013-01-01

    Oral contraceptive use is associated with venous thrombosis. However, the mechanism behind this remains unclear. The aim of this thesis was to evaluate genetic variation in the first-pass metabolism of contraceptives, to identify the clinical implications of hormonal contraceptive use after a thromb

  12. Case of cerebral venous thrombosis with unusual venous infarcts.

    Science.gov (United States)

    Narra, Ramakrishna; Kamaraju, Susheel Kumar; Pasupaleti, Bhimeswarao; Juluri, Naganarasimharaju

    2015-04-01

    Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed. PMID:26023623

  13. Venous sinus stenting for pseudotumour cerebri with venous sinus stenosis

    International Nuclear Information System (INIS)

    Objective: To explore the relation between venous sinus stenosis and pseduotumour cerebri and to discuss the efficacy and strategy of venous sinus stenting for its treatment. Methods: Venous sinus stenting was performed in a total of 9 patients with pseudotumour cerebri accompanied by dural sinus stenosis. The clinical data, including the clinical presentations, intracranial pressure, angiographic findings, pressure of dural sinus,methods of treatment and the therapeutic results, were retrospectively analyzed. Results: Bilateral disc edema was seen in all patients. The pressure gradient in the lateral sinuses was obviously high before stenting (22.67±7.25)mmHg in all patients and a reduction in intra-sinus pressure and pressure gradient was also found (5.78±3.77)mmHg. The symptoms associated with intracranial hypertension were gradually improved or disappeared in two weeks after the placement of the stent in all cases, and the intracranial pressure dropped evidently (12.78±5.97)cm H2O. Vision was improved in 7 cases at three months, whereas it remained poor in 2 cases despite normalized intracranial pressure. There was no other permanent procedure-related morbidity. The patients were followed up for 3 months to 5 years, and no recurrence developed. Conclusion: Lateral sinus stenting is an effective method for the treatment of pseudotumour cerebri with dural sinus stenosis. (authors)

  14. Experience in percutaneous transluminal angioplasty nursing of 13 hemodialysis patients with central venous stenosis%13例中心静脉狭窄血液透析患者行经皮腔内血管成形术的护理

    Institute of Scientific and Technical Information of China (English)

    吕小林; 葛益飞; 马逊

    2016-01-01

    目的 回顾性分析13例中心静脉狭窄的血液透析患者行经皮腔内血管成形术的护理过程. 方法 术前做好沟通,消除患者的紧张心理;术中密切观察患者的生命体征,关注手术进程;术后观察患侧肢体情况,积极防范并发症,预防中心静脉再狭窄. 结果 本组13例患者经手术扩张后,患者的肢体及面部水肿等症状缓解,1例患者于术后11个月出现内瘘侧肢体肿胀,再次行经皮腔内血管成形术后症状获缓解. 结论 行经皮腔内血管成形术前,应做好患者的心理沟通,消除患者的恐惧和思想顾虑,并充分考虑手术可能发生的风险及采取的应对措施. 术中应密切关注手术进程,严密观察患者的生命体征,维持静脉通路通畅. 术后观察患者病情变化、患侧肢体情况,积极防范术后并发症,并预防中心静脉再狭窄的发生.%Objective To retrospectively analyze the process of percutaneous transluminal angioplasty nursing of 13 hemodialysis patients with central venous stenosis. Methods Preoperative communication should be prepared to eliminate the patient′s anxiety. We closely observed the patient′s vital signs and were concerned about the surgery process during operation. We observed the patient′s affected limb and prevent the complications and central venous re-stenosis after operation. Results Limb and facial edema and other symptoms eased in 13 patients after surgical expansion, and 1 patient swelled in limbs with fistula which was relieved after repeating percutaneous transluminal angioplasty. Conclusions Before percutaneous transluminal angioplasty, we should provide mental communication for patients to eliminate their fears and misgivings, and take full account of operational risks and related countermeasures. We should closely observe the patient′s vital signs, be concerned about the surgery process and keep IVs flowing smoothly in operation. Meanwhile, we should pay attention to

  15. Sepsis, venous return, and teleology.

    Science.gov (United States)

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  16. Treatment of Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Cengiz Köksal

    2010-08-01

    Full Text Available Chronic venous insufficiency (CVI, with its high prevalence, high cost of diagnosis and treatment, substantial loss in manpower and negative effects on quality of life, is an important health issue. A comprehensive knowledge of the anatomy and functions of venous system is a must to understand the pathophysiology of CVI. The iagnosis of CVI is made by history, physical examination and noninvasive tests. The traditional surgical strategy for CVI treatment is high ligation of saphenofemoral vein and saphenous vein stripping. In recent years, novel minimally invasive techniques such as ultrasound-guided foam sclerotherapy, endovenous laser and radiofrequency ablation have been more widely applied. Here, we have reviewed the various treatment strategies used in CVI.

  17. Thrombotic obstruction of the central venous catheter in patients undergoing hematopoietic stem cell transplantation Obstrucción trombótica del catéter venoso central en pacientes sometidos al trasplante de células-tronco hematopoyéticas Obstrução trombótica do cateter venoso central em pacientes submetidos ao transplante de células-tronco hematopoéticas

    Directory of Open Access Journals (Sweden)

    Kátia Michelli Bertoldi Arone

    2012-08-01

    Full Text Available This is an integrative literature review with the aim of summarizing the prevention measures and treatment of thrombotic obstruction of long-term semi-implanted central venous catheters, in patients undergoing hematopoietic stem cell transplantation. The sample consisted of seven studies, being two randomized controlled clinical trials, three cohort studies and two case series. Regarding the prevention measures, one single study demonstrated effectiveness, which was a cohort study on the oral use of warfarin. In relation to the treatment measures, three studies evidenced effectiveness, one highlighted the efficacy of streptokinase or urokinase, one demonstrated the benefit of using low-molecular-weight heparin and the other treated the obstruction with heparin or urokinase. Catheter patency research shows a restricted evolution that does not follow the evolution of transplantations, mainly regarding nursing care.Se trata de una revisión integradora de la literatura con objeto de sintetizar las medidas de prevención y tratamiento de obstrucción trombótica del catéter venosos central de larga permanencia y semi-implantado, en pacientes sometidos al trasplante de células-tronco hematopoyéticas. La muestra abarcó a siete estudios: dos ensayos clínicos controlados aleatorizados, tres estudios de cohorte y dos series de casos. Respecto a las medidas de prevención, fue identificado un único estudio efectivo, uno cohorte sobre el uso de la warfarina oral. Sobre las medidas de tratamiento, tres estudios evidenciaron efectividad, uno apuntó la eficacia de la estreptoquinasa o uroquinasa, otro mostró beneficio del uso de heparina de bajo peso molecular y otro trató la obstrucción con heparina o uroquinasa. Se observa que la evolución de la investigación sobre la permeabilidad del catéter fue limitada, no acompañando la evolución del trasplante, principalmente respecto a los cuidados de enfermería.Trata-se de revisão integrativa da

  18. Venous thromboembolism deserves your attention

    OpenAIRE

    Marc Samama, Charles

    2001-01-01

    The survey of how Canadian intensive care units (ICUs) prevent and diagnose venous thromboembolism (VTE) presented in this issue of Critical Care illustrates considerable variability. Lack of optimal patient care reflects how VTE is rated in ICUs. The discussion should no longer focus on the incidence of thrombosis, but rather on its prevention. Unfractionated heparin remains the most commonly used agent to prevent VTE, despite the recognized efficacy and safety of low-molecular-weight hepari...

  19. Heparin and normal saline solutions for measurement of central venous pressure in elderly patients with elevated D-dimer levels%肝素生理盐水用于D-二聚体升高老年患者中心静脉测压研究

    Institute of Scientific and Technical Information of China (English)

    赵陈英; 陈华; 李威

    2012-01-01

    Objective To solve the problem of catheter blockage developed after measurement of central venous pressure (CVI) in elderly patients with elevated D-dimer levels. Methods Seventy-four elderly patients with elevated D-dimer levels were divided into a control group (n = 34) and an observation group (n = 40) receiving either normal saline or 125 U/mL of heparin and normal saline solutions for CVI measurement. Results Compared with the control group, the observation group achieved less blockage of catheters, higher planned extubation, and longer indwelling time of catheters (P0. 05). Conclusion Measurement of central venous pressure in elderly patients with elevated D-dimer levels by using 125 U/mL of heparin and normal saline solutions, can reduce blockage of catheters.%目的 解决D-二聚体升高老年患者行中心静脉测压后易出现深静脉导管堵塞的问题.方法 将74例D-二聚体升高老年患者分为对照组34例、观察组40例,对照组采用生理盐水行中心静脉测压,观察组采用125 U/mL肝素生理盐水行中心静脉测压.结果 观察组堵管发生率低于对照组,计划拔管的比例高于对照组,置管时间长于对照组(均P<0.01).观察组未发生出血征象,APTT值测压前后比较,差异无统计学意义(P>0.05).结论采用125 U/mL肝素生理盐水对D-二聚体升高老年患者进行中心静脉测压,可降低测压后深静脉导管堵塞发生率,有利于静脉途径的治疗与护理.

  20. Cerebral sino-venous thrombosis

    International Nuclear Information System (INIS)

    Three cases of cerebral sino-venous thrombosis were reported. Repeated CT findings were studied and discussed on account of the treatments for those pathologic conditions. Those of studied cases are; a 22-year-old postpartum woman, a 42-year-old woman with irregular vaginal bleeding, and a 26-year-old man with severe reactive emesis after drinking alcohol. They were treated conservatively. Case 1 died in its acute stage. In the remaining ones, each had an uneventful recovery. CT scan findings of them manifested their exact clinical conditions. These findings were devided into two categories, one was direct signs expressed sino-venous occlusion, the other was indirect signs which appeared as a result of these occlusion. Direct signs cannot always get in every cases with sino-venous occlusion, but as for indirect signs, we can get various changes corresponding to the time taken CT photoes, and they are useful to decide appropriate treatments at that time. Considering suitable treatments for this disease, it is necessary to select most suitable ones according to their pathologic conditions, which may be precisely drawn with CT scans. (J.P.N.)

  1. Older Adults Accessing HIV Care and Treatment and Adherence in the IeDEA Central Africa Cohort

    Directory of Open Access Journals (Sweden)

    Jamie Newman

    2012-01-01

    Full Text Available Background. Very little is known about older adults accessing HIV care in sub-Saharan Africa. Materials and Methods. Data were obtained from 18,839 HIV-positive adults at 10 treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo. We compared characteristics of those aged 50+ with those aged 18–49 using chi-square tests. Logistic regression was used to determine if age was associated with medication adherence. Results. 15% of adults were 50+ years. Those aged 50+ were more evenly distributed between women and men (56% versus 44% as compared to those aged 18–49 (71% versus 29% and were more likely to be hypertensive (8% versus 3% (P<0.05. Those aged 50+ were more likely to be adherent to their medications than those aged 18–49 (P<0.001. Adults who were not heavy drinkers reported better adherence as compared to those who reported drinking three or more alcoholic beverages per day (P<0.001. Conclusions. Older adults differed from their younger counterparts in terms of medication adherence, sociodemographic, behavioral, and clinical characteristics.

  2. Ethnic Minority Protection and Anti-discrimination in Central Europe Before and After EU Accession: the Case of Poland

    Directory of Open Access Journals (Sweden)

    Peter Vermeersch

    2007-09-01

    Full Text Available This article explores key policy developments regarding ethnic minority protection and anti-discrimination in contemporary Poland. More specifically, it examines the relationship between domestic policy formation and the European context. Before 2004, the European Union applied membership conditionality in order to attempt to stimulate candidate member states in post-communist Central Europe to adopt special minority protection measures. As a result, most of these countries turned to the official recognition of the ethnic specificity of minority groups and the acceptance of group-related cultural entitlements, not only as norms in their own right but also as the basis for a policy of stimulating ethnocultural diversity in the new member states have been less focused on group-related rights but have emphasized the themes of social inclusion, anti-discrimination and equal opportunities. I explore how, in this new European context, Polish policies on ethnic minority protection have developed. Through a comparison of dominant Polish perceptions of minority protection issues with dominant discourses about the preservation of ethnic diversity promoted by EU institutions, this article shows the linkages between recent developments in Polish minority policy-making and the current European initiatives in this field. It also shows important points of disjuncture between the way in which European institutions have framed issues of ethnocultural diversity and the way in which Polish policy-makers have worked out minority protection.

  3. Avaliação do tipo de curativo utilizado em cateter venoso central para hemodiálise Evaluación del tipo de curativo utilizado en cateter venoso central para hemodiálisis Evaluation of tow types of dressings used on central venous catheters for hemodialysis

    OpenAIRE

    Luciene Fátima Neves Monteiro Barros; Valquíria Grego Arênas; Ana Rita de Cássia Bettencourt; Solange Diccini; Dayana Souza Fram; Angélica Gonçalves Silva Belasco; Dulce Aparecida Barbosa

    2009-01-01

    OBJETIVOS: Avaliar a efetividade de dois tipos de curativos utilizados em cateter venoso central (CVC) em pacientes submetidos à hemodiálise; identificar a taxa de infecção no local de saída e de bacteremia comparando o curativo com gaze e micropore em relação ao filme transparente. MÉTODOS: Foi realizado um ensaio clínico randomizado controlado abrangendo 66 pacientes, sendo 33 nos grupos 1 e 2, respectivamente. No Grupo 1 o curativo utilizado foi gaze e micropore e no Grupo 2 filme transpar...

  4. The state of a central inhibition system predicts access to visual targets: An ERP study on distractor-induced blindness (DIB).

    Science.gov (United States)

    Niedeggen, Michael; Busch, Niko A; Winther, Gesche N

    2015-09-01

    Distractor-induced blindness (DIB) is elicited in a temporal selection task based on rapid serial visual presentation: Following the onset of a central cue (color change of fixation), a target in a global stream has to be detected (orientation change of tilted bars). Distractors are occasional target-like events presented prior to the onset of the cue. Depending on the number of distractor episodes, a frontal ERP negativity (FN) is evoked, and the detection rate of the forthcoming target is reduced. Here, we provide a concise review of the DIBs' functional characteristics, and examine the relationship between FN activation on target processing and detectability. To this end, ERP responses collected in a set of participants (n=14) were analysed separately with respect to detection performance (hits vs. misses). A gradual increase in the amplitude of the FN with increasing number of distractor events was only observed for forthcoming misses, but not for hits. The FN activation can be linked to a target-related ERP component: The amplitude of a late centro-parietal positivity (LPC) was significantly diminished for misses. In sum, the data support the notion that the DIB reflects the controlled activation of a central inhibition system. Depending on its state of activation, conscious access to stimuli defined by distinctive visual features is restricted. PMID:25724342

  5. ICU中应用中心静脉导管行胸腔闭式引流治疗气胸的疗效观察%To Observe the Curative Effect of Treatment of Pneumothorax by Chest Closed Drainage With Central Venous Catheter in the ICU

    Institute of Scientific and Technical Information of China (English)

    马艳品

    2015-01-01

    Objective To discuss the curative effect of treatment of pneumothorax by chest closed drainage with central venous catheter in the ICU. Methods Randomly divided 90 cases of the sudden pneumothorax patients in the ICU,and retrospective analyzed the clinical treatment results. Results There were no significant difference(P>0.05)of cure effects between the two groups. But compared with the control group, prognostic effect of observation group was obviously superior to the latter,there was significant difference(P0.05);但与对照组相比,观察组预后效果优于后者,两者差异显著(P<0.05)。结论中心静脉导管行胸腔闭式引流方式治疗 ICU 中突发气胸,疗效肯定且并发症发生率低。

  6. Tendon vibration attenuates superficial venous vessel response of the resting limb during static arm exercise

    OpenAIRE

    Ooue Anna; Sato Kohei; Hirasawa Ai; Sadamoto Tomoko

    2012-01-01

    Abstract Background The superficial vein of the resting limb constricts sympathetically during exercise. Central command is the one of the neural mechanisms that controls the cardiovascular response to exercise. However, it is not clear whether central command contributes to venous vessel response during exercise. Tendon vibration during static elbow flexion causes primary muscle spindle afferents, such that a lower central command is required to achieve a given force without altering muscle ...

  7. Venous responses during exercise in rainbow trout, Oncorhynchus mykiss : [alpha]-adrenergic control and the antihypotensive function of the renin-angiotensin system

    DEFF Research Database (Denmark)

    Sandblom, E.; Axelsson, M.; McKenzie, David

    2006-01-01

    The role of the [alpha]-adrenergic system in the control of cardiac preload (central venous blood pressure; Pven) and venous capacitance during exercise was investigated in rainbow trout (Oncorhynchus mykiss). In addition, the antihypotensive effect of the renin-angiotesin system (RAS) was invest...

  8. Clinical features of central visual field defects caused by intracranial venous sinus thrombosis (report of 3 cases)%颅内静脉窦血栓形成导致中枢性视野缺损的临床特点(附3例报告)

    Institute of Scientific and Technical Information of China (English)

    唐宇凤; 段劲峰; 吴孝苹; 冯由军; 张芸; 文世全

    2013-01-01

    Objective To approach the clinical features of central visual field defects caused by intracranial venous sinus thrombosis ( CVST) . Methods The clinical data of 3 patients with central visual field defects caused by CVST were analyzed retrospectively. Results The onsets of the 3 cases were acute or subacute. The commom symptoms were impaired vision and visual field defects, and 2 patients accompanied with headache. In the early stage of the diseases, the fundus examinations and intraocular tensions were normal. CSF pressure of 2 cases increased moderately, and which of 1 case was normal. Two patients were diagnosed as CVST by MR venographic, and 1 patient was diagnosed as CVST by digital subtraction angiography. After anticoagulant therapies, 2 cases had significant progresses, and 1 cases had progress. Conclusions The central visual field defect caused by CVST often appears earlier than papilla edema and intracranial hypertension. Which indicates that the central visual field defect is an early important manifestation of CVST.%目的 探讨颅内静脉窦血栓形成(CYST)导致的中枢性视野缺损的临床特点.方法 回顾性分析3例CVST导致中枢性视野缺损患者的临床资料.结果 3例患者均为急性或亚急性起病,均表现为视野缺损和视力下降,2例伴有头痛.发病早期眼底、眼压均正常,腰穿CSF压力轻度升高2例、正常1例.2例经MR静脉成像、1例行全脑血管造影检查示CVST.经抗凝治疗显著进步2例,进步1例.结论 CVST导致的中枢性视野缺损,往往出现于视盘水肿和明显的颅内高压症之前.提示中枢性视野缺损是CVST早期的重要表现.

  9. Selective digital venous hypertension: A rare complication of hemodialysis arteriovenous fistula

    International Nuclear Information System (INIS)

    We report and document angiographically a case of selective venous hypertension, masquerading as an infection, which involved the three middle digits of the right hand in a patient with an access arteriovenous (AV) fistula. This complication arose following hemodialysis and was resolved after resection of the right radial artery at the site of AV fistula and re-anastomosis. (orig.)

  10. Análisis entre la recirculación medida por termodilución (BTM® y la presión venosa dinámica inicial como métodos para la detección de estenosis del acceso vascular protésico Analysis of recirculation measured by thermodilution (BTM® and initial dynamic venous pressure as methods for the detection of stenosis in prosthetic vascular access

    Directory of Open Access Journals (Sweden)

    Jorge Enrique Marín González

    2012-12-01

    aparición de eventos, se encontró relación significativa con la presión venosa dinámica inicial (pIntroduction: Vascular access problems represent the highest cause of morbility and mortality in haemodialysis patients. In turn, stenosis is the main cause of dysfunctions of the prosthetic vascular access, and when this problem is not detected in time, it may lead to thrombosis. There are a number of procedures for the detection of vascular access dysfunction, ranging from physical examination, pressure and flow measurements, and non-invasive and invasive imaging tests. Initial Dynamic Venous Pressure is a simple tool for monitoring vascular access. Aims: The aim of the study is to correlate initial dynamic venous pressure and recirculation as vascular access monitoring methods in haemodialysis patients. Material and methods: A prospective assessment of 21 patients with prostheses was carried out over 1 year. Clinical signs and objective measurement parameters were recorded such as recirculation by thermodilution, initial dynamic venous pressure with a blood flow of 200 ml/min, haemostasis time and KT/V by OCM, which were compared with the findings of the imaging tests. Measurements were taken monthly, with a total of 244. Results: PTFE prostheses represented 16.6% of the vascular accesses in our unit during the period of study. The average age was 63 years, and 57% of the patients studied were women. The mean dialysis time was 225 minutes with a Kt/V by OCM of 1.44. Of the clinical signs, the one with the highest incidence was the presence of pseudoaneurysms, in 42.8%. The mean recirculation was 10.46±2.68% and initial dynamic venous pressure 94.51±19.58 mmHg. A total of 21 events were recorded: 14 fistulographies + angioplasty, 4 thromboses with surgical repair, 2 fistulographies that did not require angioplasty and one thrombosis that was not recovered. When the recirculation and initial dynamic venous pressure measurements are compared with the appearance of

  11. A venous outflow method for measurement of rapid changes of the cerebral blood flow and oxygen consumption in the rat.

    Science.gov (United States)

    Nilsson, B; Siesjö, B K

    1983-01-01

    A technique for continuous measurement of cerebral venous outflow in the rat is described. The method involves cannulation of one retroglenoid vein close to its exit from the skull, and diversion of cerebral venous blood through a closed extracorporal circuit with a drop recording device, the blood being returned to the central venous circulation via a catheter in the external jugular vein. Occlusion of the contralateral retroglenoid vein increases measured flow and minimizes extracerebral contamination of the diverted cerebral venous blood. The venous outflow system is not further isolated from cerebral or potential extracerebral collaterals. Thus, the mass of tissue drained cannot be exactly defined anatomically. However, the experiments involving changes of PP, arterial CO2 tension, and induction of epileptic seizure activity, and simultaneous indirect measurements with radioactive tracer technique, indicate that significant extracerebral contamination does not occur and that in short term measurements the venous outflow represents cerebral blood flow (CBF) in a constant mass of (dorsal and central, mainly forebrain) cerebral tissue. Measurement of arterial blood pressure and pressure in the cisterna magna allows calculation of cerebral perfusion pressure (PP). By simultaneous measurement of arterial and cerebral venous oxygen content changes in cerebral oxygen consumption (CMRO2) can be calculated. The method has been applied to document several situations of transient CBF and CMRO2 changes. PMID:6658967

  12. Wartime major venous vessel injuries.

    Science.gov (United States)

    Hudorovic, Narcis

    2008-02-01

    The aim of this study is to declare our experience and to identify the important factors that influence the mortality and morbidity in patients with combat-related penetrating wounds of the abdomen (CR-PWA) with major venous vessel injuries. Twenty-six wounded with combat-related injuries of major abdominal venous vessels, admitted in the University Clinic cardiovascular surgery department during the period from 1 August 1991 through 30 October 1995, were analyzed. Patients with concomitant injured arteries and extra-abdominal injuries (n=150; 85.2%) were excluded from this study. The Penetrating Abdominal Trauma Index (PATI) score for each patient was calculated. Fifteen patients (57.69%) sustained with PATI score greater than 25 died. The mean duration of hospitalization was 16 days (range 0-86). The average hospitalization time for those surviving their complications was 17 days with a PATI of 25 or less, and 43 days with a score more than 25. Three clinical assessments of the long-term outcome were performed after a median of about 3, 5 and 10 years, respectively. Surviving patients (42.31%) were symptom free and had normal Duplex scans as well as no other surgical related complications. Higher PATI scores, postoperative complications and reoperations exert an unfavorable effect on patient outcome. PMID:18006557

  13. Venous thromboembolism in cancer patients

    Directory of Open Access Journals (Sweden)

    Mehmet Fuat Eren

    2013-09-01

    Full Text Available Venous thromboembolism (VTE is a major complication of cancer and represents an important cause of morbidity and mortality. The incidence of VTE is 0.6-7.8% in patients with cancer more than double the incidence of VTE in patients without cancer. The risk of VTE which includes deep venous thrombosis (DVT and pulmonary embolism (PE is increased two to seven fold in patients with cancer. VTE risk is especially high among certain groups such as hospitalized patients with cancer and those receiving active antineoplastic therapy. Also cancer patients, who undergoing major surgery, are increased risk of VTE. Trauma, long-haul travel, increased age, obesity, previous VTE and genetic component are also predisposing factors for VTE. Patients with cancer who develop VTE should be managed multidisciplinary treatment guidelines. The primary goal of thromboprophylaxis in patients with cancer is to prevent VTE. The large majority of cancer patients should be treated with therapeutic doses of unfractioned heparin (UFH or low molecular weight heparin (LMWH. Prophylaxis should include cancer patients who underwent major surgery for cancer and patients with a history of VTE.

  14. Risk factors for venous thromboembolism during pregnancy

    DEFF Research Database (Denmark)

    Jensen, Thomas Bo; Gerds, Thomas Alexander; Grøn, Randi; Bretler, Ditte-Marie; Schmiegelow, Michelle Dalgas; Andersson, Charlotte; Azimi, Aziza; Gislason, Gunnar; Torp-Pedersen, Christian; Olesen, Jonas Bjerring

    2013-01-01

    Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated.......Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated....

  15. Interventional management of hepatic venous outflow obstruction after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To discuss the technique and efficacy of interventional management for the treatment of hepatic venous outflow obstruction (HVO) after liver transplantation. Methods: The clinical data of 5 patients with HVO developed after liver transplantation, including split (n=2) and living donor (n =3) liver transplantation, were retrospectively analyzed. Stent placement was performed in 4 cases and percutaneous transluminal angioplasty in one case. The technical points of interventional management were discussed. Results: Interventional management was performed via the percutaneous hepatic vein approach in 3 patients and via the right internal jugular venous access in 2 patients. Judged from hepatic venography, the location of HVO was at the anastomotic stoma of left- or right-hepatic vein with inferior vena cava (n=3 ) or at the anastomotic stoma of middle hepatic vein with right hepatic vein (n=2). Interventional technical success was achieved in all 5 patients. After the procedure, the venous pressure gradient, i.e. the blood pressure difference between the hepatic artery and the right atrium, was significantly reduced from (15.4 ± 5.6)mmHg to(1.9 ±1.2) mmHg. During the follow-up period of 9-482 days, no restenosis was found on Doppler sonographic manifestations. The liver enzyme and/or bilirubin which were markedly elevated before procedure returned to normal after the procedure in 4 patients except one patient who died of multiple-organs failure at the 9th day after the treatment. In two patients with large quantity of ascites and upper digestive tract bleeding, the ascites receded and the bleeding stopped after the procedure. Conclusion: Hepatic venous outflow obstruction is a rare, but potentially fatal, complication after liver transplantation and interventional management with stent placement or percutaneous transluminal angioplasty is an effective and safe treatment for it. (authors)

  16. The Impact of the Collapse of Communism and EU Accession on Language Education Policy and Practice in Central and Eastern Europe: Two Case-Studies Focussing on English and Russian as Foreign Languages in Hungary and Eastern Germany

    Science.gov (United States)

    Bruen, Jennifer; Sheridan, Vera

    2016-01-01

    This paper considers the impact of geopolitical factors, and in particular the collapse of Communism and EU accession, on language education policy and practice in Central and Eastern Europe (CEE). CEE is understood here as referring to the former soviet-controlled, eastern bloc counties of Bulgaria, the Czech Republic, East Germany, Hungary,…

  17. Insulin resistance and risk of venous thromboembolism : results of a population-based cohort study

    NARCIS (Netherlands)

    Van Schouwenburg, I. M.; Mahmoodi, B. K.; Veeger, N. J. G. M.; Bakker, S. J. L.; Kluin-Nelemans, H. C.; Meijer, K.; Gansevoort, R. T.

    2012-01-01

    Background: Obesity is an established risk factor for venous thromboembolism (VTE), but it is uncertain how this is mediated. Insulin resistance has a central role in the pathophysiology of the metabolic effects of obesity. Objective: We aimed to investigate whether insulin resistance is a risk fact

  18. 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.

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

    International Nuclear Information System (INIS)

    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

  20. 小儿心脏术后中心静脉导管相关性感染与导管留置时间关系的探讨%Probe into relationship between central venous catheter related infection and catheter indwelling time in children af-ter pediatric cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    陈桂花; 陈付萍; 吴兰华

    2015-01-01

    [目的]探讨小儿心脏术后中心静脉导管相关性感染与导管留置时间的关系,期望能够找到置管最安全的留置时间,指导临床合理拔管,降低置管相关性感染的发生率。[方法]进行心脏直视手术的334例先心病患儿的临床资料进行回顾性分析,并对中心静脉导管相关性感染与导管留置时间的关系进行总结。[结果]334例先心病患儿均按实际病情拔除导管,其中3 d 内拔除219例,占65.56%,导管感染率为7.76%(17/219);99例在4 d~6 d 内拔出,占29.64%,导管感染率为20.20%(20/99);7 d~10 d 内拔除16例,占4.79%,导管感染率为31.25%(5/16)。[结论]随着导管留置时间的延长,导管相关性感染发生率逐渐升高,并且多组之间的比较差异有统计学意义(P <0.01)。小儿心脏外科术后适宜的置管时间应在3 d 内,可以显著减少导管相关性感染的发生。%Objective:To probe into the relationship between central venous catheter related infection and cathe-ter indwelling time in patients after pediatric cardiac surgery,in order to find the most safe indwelling time,to guide clinical rational extubation and reduce the incidence of the catheter related infections.Methods:The clinical data of 334 cases with congenital heart disease were retrospectively analyzed.And the relationship between cen-tral venous catheter related infection and catheter indwelling time was summarized.Results:The catheter in all 334 cases with congenital heart disease was removed based on the actual condition.The catheter in 21 9 cases was removed in 3 days,accounting for 65.56%,the infection rate was 7.76% (17/21 9).The catheter in 99 cases was pulled out in 4 6 days,accounting for 29.64% and the infection rate was 20.20% (20/99).1 6 cases were extracted from 7 to 10 days,accounting for 4.79%.The infection rate was 31.25% (5/1 6).Conclusion:With the prolonging of indwelling time,the incidence of catheter related infection

  1. 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.

  2. Increased rheumatoid factor and deep venous thrombosis

    DEFF Research Database (Denmark)

    Meyer-Olesen, Christine L; Nielsen, Sune F; Nordestgaard, Børge G

    2015-01-01

    general population. METHODS: We included 54628 participants from the Copenhagen City Heart Study (1981-83) and the Copenhagen General Population Study (2004-12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome......BACKGROUND: The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease in the...

  3. Measurement of venous compliance (8-IML-1)

    Science.gov (United States)

    Thirsk, R. B.

    1992-01-01

    The prime objective of this International Microgravity Laboratory (IML-1) investigation is to measure the bulk compliance (distensibility) of the veins in the lower leg before, during, and after spaceflight. It is of particular interest whether venous compliance over the range of both positive and negative transmural pressures (various states of venous distention and collapse) changes throughout the duration of spaceflight. Information concerning the occurrence and character of compliance changes could have implications for the design of improved antigravity suits and further the understanding of inflight and postflight venous hemodynamics.

  4. Improvements of Venous Tone with Pycnogenol in Chronic Venous Insufficiency: An Ex Vivo Study on Venous Segments

    OpenAIRE

    Belcaro, Gianni; Dugall, Mark; Luzzi, Roberta; Hosoi, M.; Corsi, Marcello

    2014-01-01

    This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects tha...

  5. The possibility for use of venous flaps in plastic surgery

    International Nuclear Information System (INIS)

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required

  6. The possibility for use of venous flaps in plastic surgery

    Science.gov (United States)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  7. The possibility for use of venous flaps in plastic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.; Baytinger, A. V. [Research Institute of Microsurgery, Tomsk (Russian Federation); Dzyuman, A. N. [Siberian State Medical University, Tomsk (Russian Federation)

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  8. Treatment of hepatic venous stenosis by transfemoral venous balloon dilation following living donor liver transplantation: a case report

    Institute of Scientific and Technical Information of China (English)

    Weiwei Jiang; Yangsui Liu; Lianbao Kong

    2009-01-01

    Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation (LDLT). Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT.

  9. Salvage of Intraoperative Deep Inferior Epigastric Perforator Flap Venous Congestion with Augmentation of Venous Outflow: Flap Morbidity and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Oscar Ochoa, MD

    2013-10-01

    Conclusions: Arterial and venous anatomies play unique roles in flap reliability. DIEP flap venous congestion must be treated expeditiously with venous augmentation to relieve venous congestion and mitigate flap morbidity.

  10. Intraneural Venous Malformations of the Median Nerve

    Science.gov (United States)

    González Rodríguez, Alba; Midón Míguez, José

    2016-01-01

    Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation.

  11. Case 3: chronic venous leg ulcer.

    Science.gov (United States)

    Hämmerle, Gilbert

    2016-03-01

    A non-healing, sloughy venous leg ulcer quickly responded to topical treatment including octenilin Wound Gel and octenilin Wound Irrigation Solution. Full healing occurred within 6 weeks. PMID:26949848

  12. Venous Aneurysm Complicating Dialytic Arteriovenous Fistula

    OpenAIRE

    Arjun K.Nambiar; Anand, K. T.; Jayakrishnan, A. G.

    2012-01-01

    A case of venous aneurysm complicating arteriovenous fistula created for chronic haemodialysis is presented. The patient underwent successful ligation and excision of the fistula and creation of a fistula on the opposite limb.

  13. Pathophysiology of spontaneous venous gas embolism

    Science.gov (United States)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  14. Prevention and treatment of venous ulceration.

    OpenAIRE

    Negus, D.

    1985-01-01

    Venous ulcers are related to incompetence of the direct calf and ankle perforating veins, the majority of which follow deep vein thrombosis. Prevention of the latter by intravenous micro-dose heparin (1 unit/kg/hour) is effective, safe and inexpensive. Its efficacy has been proved in two controlled clinical trials. Venous ulcers have been treated by perforating vein ligation, with saphenous ligation and stripping where necessary, and with the addition of permanent knee-length elastic compress...

  15. Treatment of pregnancy related venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Mitić Gorana

    2009-01-01

    Full Text Available Introduction. Prevention and treatment of venous thromboembolism during pregnancy are complicated since the use of antithrombotic drugs carries a certain risk to the mother, the fetus or both. Coumarins cross the placental barrier and may be responsible for bleeding, teratogenicity and central nervous system abnormalities. The risk of embriopathy is particularly high between 6 and 12 weeks of gestation. Treatement. Heparin is the treatment of choice for thrombosis during pregnancy because it is entirely safe for the fetus, unlike oral anticoagulants. The frequency of heparin-induced thrombocytopenia and osteoporosis is significantly lower if LMWH is applied, so this heparin type is preferable to UFH during pregnancy. Treatment of women with VTE during pregnancy, especially those with thrombophilia, requires individualized dosing and duration of antithrombotic thrapy. Peripartal management. In order to avoid the peripartum anticoagulant heparin effect and possible bleeding, heparin should be discontinued prior to the delivery and reintroduced after the parturition. PROPHYLACTIC REGIMEn. Prophylactic antithrombotic regimen during subsequent pregnancies should also be individualized. The use of low molecular weight heparins is becoming more widespread. They have reliable pharmacokinetics, require less frequent injections than unfractionated heparin and carry a lower risk of treatment complications. LMW heparins are safe and effective and they are replacing UFH as the anticoagulant of choice during pregnancy. Both UFH and LMWH are not secreted into breast milk and can be safely given to nursing mothers. Warfarin does not induce an anticoagulant effect in the breast-fed infant, so it can be safely used in women who require postpartum anticoagulant therapy.

  16. Venous catheterization with ultrasound navigation

    Energy Technology Data Exchange (ETDEWEB)

    Kasatkin, A. A., E-mail: ant-kasatkin@yandex.ru; Nigmatullina, A. R. [Izhevsk State Medical Academy, Kommunarov street, 281, Izhevsk, Russia, 426034 (Russian Federation); Urakov, A. L., E-mail: ant-kasatkin@yandex.ru [Institute of Mechanics Ural Branch of Russian Academy of Sciences, T.Baramzinoy street 34, Izhevsk, Russia, 426067, Izhevsk (Russian Federation); Izhevsk State Medical Academy, Kommunarov street, 281, Izhevsk, Russia, 426034 (Russian Federation)

    2015-11-17

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  17. Venous catheterization with ultrasound navigation

    Science.gov (United States)

    Kasatkin, A. A.; Urakov, A. L.; Nigmatullina, A. R.

    2015-11-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient's exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  18. Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Cheng-Xin Lin; Ya Guo; Wan Yee Lau; Guang-Ying Zhang; Yi-Ting Huang; Wen-Zheng He and Eric CH Lai

    2013-01-01

    BACKGROUND: Low  central  venous  pressure  (CVP)  affects hemodynamic stability and tissue perfusion. This prospective study  aimed  to  evaluate  the  optimal  CVP  during  partial hepatectomy for hepatocellular carcinoma (HCC). METHODS: Ninety-seven  patients  who  underwent  partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes. The average clamp time was 21.4±8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0-1 mmHg; B: 1.1-2 mmHg; C: 2.1-3 mmHg; D: 3.1-4 mmHg and E: 4.1-5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed. RESULTS: With  active  fluid  load,  a  constant  SBP  ≥90  mmHg which was considered as optimal was maintained in 18.6% in group A (95% CI: 10.8%-26.3%); 39.2% in group B (95% CI: 29.5%-48.9%); 72.2% in group C (95% CI: 63.2%-81.1%); 89.7% in group D (95% CI: 83.6%-95.7%); and 100% in group E (95% CI:  100%-100%).  The  blood  loss  per  transection  area  during hepatic parenchymal transection decreased with a decrease in CVP. Compared to groups D and E, blood loss in groups A, B and C was significantly less (analysis of variance test, P CONCLUSION: In consideration of blood loss, SBP, base excess and  HCO3-,  a  CVP  of  2.1-3  mmHg  was  optimal  in  patients undergoing partial hepatectomy for HCC.

  19. Reduction in the colonization of central venous cannulae by mupirocin

    NARCIS (Netherlands)

    R.L.R. Hill; M. W. Casewell

    1991-01-01

    textabstractIn an in-vitro simulation of an intravascular cannula enclosed in a fibrin sheath, 0.03 mg1(-1) of mupirocin prevented significant colonization [greater than 15 colony forming units (cfu)] by two clinical isolates of Staphylococcus epidermidis and one each of S. saprophyticus, S. hominis

  20. Familial risk of venous thromboembolism: a nationwide cohort study

    DEFF Research Database (Denmark)

    Sørensen, H T; Riis, A H; Diaz, L J;

    2011-01-01

    Background: Venous thromboembolism has genetic determinants, but population-based data on familial risks are limited. Objectives: To examine the familial risk of venous thromboembolism. Methods: We undertook a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary...... expected number of venous thromboembolism cases among siblings, using population-specific, gender-specific and age-specific incidence rates. Results: We identified 30 179 siblings of 19 599 cases of venous thromboembolism. The incidence among siblings was 2.2 cases per 1000 person-years, representing a...... with pulmonary embolism. Conclusion: Venous thromboembolism has a strong familial component....

  1. Venous injury in abusive head trauma

    International Nuclear Information System (INIS)

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  2. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2015-11-15

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  3. CERN Access Cards and Access Authorisations

    CERN Multimedia

    2003-01-01

    From the 01/05/2003, all problems relating to access cards and refusal of access to any zone, building or experiment within CERN must be addressed to the Centrale de Surveillance des Accès (CSA building 120) on 78877 or send an e-mail to Access.Surveillance@cern.ch. The responsibles for CERN access control have put into place a procedure with the CSA, Service Enregistrement and the Technical Control Room, to make sure that all problems get resolved in a proper and timely manner.

  4. Venous stenosis model induced by local mechanical injury with the presence of surgical arteriovenous fistula in swine

    International Nuclear Information System (INIS)

    Objective: To evaluate a new animal model of venous stenosis induced by local mechanical injury with the presence of surgical arteriovenous fistula (AVF). Methods: Twelve arteriovenous (AV) fistulae were surgically formed between the carotid artery and internal jugular vein in six adult pigs, one on each side of the neck. Direct mechanical injury was made by crush injury with fingers or forceps to the jugular vein at the sites 1-2 cm above and below the AV anastomosis. Angiographic follow-up was performed at 3 and 6 weeks, and the animals were sacrificed. Fistulae and injured veins were harvested for histopathology. Results: At angiography six AV anastomoses were patent without stenosis, five were stenosed and one had occluded. Eleven of twelve venous injury sites with open AV anastomosis and six of ten venous injury sites with AV anastomotic stenoses developed greater than 50% diameter stenosis. Dilation was found in the non-injury segment of eight jugular veins. Stenoses were caused by neo-intimal hyperplasia as seen on histologic examination. Conclusions: Neo-intimal venous stenosis can be induced by creation of a surgical AV fistula and local venous mechanical injury. This model may be used to study methods to reduce or inhibit neo-intimal hyperplasia, with particular reference to venous stenoses that occur in arteriovenous shunts created for dialysis access

  5. Automatic Measurement of Venous Pressure Using B-Mode Ultrasound.

    Science.gov (United States)

    Crimi, Alessandro; Makhinya, Maxim; Baumann, Ulrich; Thalhammer, Christoph; Szekely, Gabor; Goksel, Orcun

    2016-02-01

    Central venous pressure (CVP) information is crucial in clinical situations, such as cardiac failure, intravascular volume overload, and sepsis. The measurement of CVP, however, requires the catheterization of vena cava through the subclavian or internal jugular veins, which is an impractical and costly procedure with related risk of complications. Peripheral venous pressure (PVP), which correlates with CVP under certain patient positioning, can be measured noninvasively using ultrasound via controlled compressions of a superficial vein. This paper presents an automatic system for acquiring such noninvasive measurements. Robust signal and image processing techniques developed for this purpose are introduced in this paper. The proposed standalone mobile platform collects images in real time from the display output of any ultrasound machine, meanwhile measuring the pressure on the skin underneath the ultrasound transducer via a liquid-filled pouch. The image and pressure data are synchronized through an automated temporal calibration procedure. During forearm compressions, blood vessels are detected and tracked in the images using robust geometric (ellipse) models, the parameters of which are used further in the model-based estimation of PVP. The proposed system was tested in 56 image sequences on 14 healthy volunteers, and was shown to achieve measurements with errors comparable to or lower than the interoperator variability of expert manual assessments. PMID:26186764

  6. The Role of Platelets in Venous Thromboembolism

    DEFF Research Database (Denmark)

    Montoro-García, Silvia; Schindewolf, Marc; Stanford, Sophia; Larsen, Ole Halfdan; Thiele, Thomas

    2016-01-01

    thrombosis are evaluated to assess the role of platelets in VTE. The clinical significance of platelets for VTE risk assessment in specific patient cohorts and their role as a suitable therapeutic target for VTE prevention is acknowledged. The role of platelets in VTE is a promising field for future research.......Multiple factors contribute to the risk of venous thromboembolism (VTE). Platelets have attracted much interest in arterial cardiovascular disease, whereas their role in VTE has received much less attention. Recent evidence suggests that platelets may play a more important role in VTE than...... previously anticipated. This review discusses the mechanisms that link platelets with venous thrombotic disease and their potential applications as novel risk factors for VTE. In addition, animal studies and randomized clinical trials that highlight the potential effect of antiplatelet therapy in venous...

  7. The Role of Platelets in Venous Thromboembolism.

    Science.gov (United States)

    Montoro-García, Silvia; Schindewolf, Marc; Stanford, Sophia; Larsen, Ole Halfdan; Thiele, Thomas

    2016-04-01

    Multiple factors contribute to the risk of venous thromboembolism (VTE). Platelets have attracted much interest in arterial cardiovascular disease, whereas their role in VTE has received much less attention. Recent evidence suggests that platelets may play a more important role in VTE than previously anticipated. This review discusses the mechanisms that link platelets with venous thrombotic disease and their potential applications as novel risk factors for VTE. In addition, animal studies and randomized clinical trials that highlight the potential effect of antiplatelet therapy in venous thrombosis are evaluated to assess the role of platelets in VTE. The clinical significance of platelets for VTE risk assessment in specific patient cohorts and their role as a suitable therapeutic target for VTE prevention is acknowledged. The role of platelets in VTE is a promising field for future research. PMID:26926584

  8. Interobserver variability in the detection of cerebral venous thrombosis using CT venography with matched mask bone elimination

    NARCIS (Netherlands)

    H.A. Gratama van Andel; L.J. van Boven; M.A. van Walderveen; H.W. Venema; J.C. van Rijn; J. Stam; C.A. Grimbergen; G.J. den Heeten; C.B. Majoie

    2009-01-01

    OBJECTIVES: Computed tomography venography (CTV) has proven to be a reliable imaging method in the evaluation of cerebral venous thrombosis with good correlation to magnetic resonance (MR) imaging and digital subtraction angiography (DSA). It is fast and widely accessible, especially in the emergenc

  9. Do pregnant women have a higher risk for venous thromboembolism following air travel?

    OpenAIRE

    Morteza Izadi; Mohammad Javad Alemzadeh-Ansari; Davood Kazemisaleh; Maryam Moshkani-Farahani; Akbar Shafiee

    2015-01-01

    International travel has become increasingly common and accessible, and it is part of everyday life in pregnant women. Venous thromboembolism (VTE) is a serious public health disorder that occurs following long-haul travel, especially after air travel. The normal pregnancy is accompanied by a state of hypercoagulability and hypofibrinolysis. Thus, it seems that pregnant women are at a higher risk of VTE following air travel, and, if they have preexisting risk factors, this risk would increase...

  10. Outcomes of resections for pancreatic adenocarcinoma with suspected venous involvement: a single center experience.

    OpenAIRE

    Erkan, Murat Mert; Michalski, Christoph W.; Kong, Bo; Jaeger, Carsten; Kloe, Silke; Beier, Barbara; Braren, Rickmer; Esposito, Irene; Friess, Helmut; Kleeff, Jorg

    2015-01-01

    RESEARCH ARTICLE Open Access Outcomes of resections for pancreatic adenocarcinoma with suspected venous involvement: a single center experience Christoph W. Michalski1,4, Bo Kong1, Carsten Jäger1, Silke Kloe1, Barbara Beier1, Rickmer Braren2, Irene Esposito3,5, Mert Erkan1,6, Helmut Friess1† and Jorg Kleeff1*† Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) patients frequently present with borderline resectable disease, which can be due to invasion of the ...

  11. External beam radiation attenuates venous neointimal hyperplasia in a pig model of arteriovenous polytetrafluoroethylene (PTFE) graft stenosis

    International Nuclear Information System (INIS)

    Purpose: Hemodialysis vascular access dysfunction is an enormous clinical problem that causes great morbidity and costs well over one billion dollars per annum. The vast majority of hemodialysis vascular access dysfunction occurs as a result of venous stenosis and thrombosis at the graft-vein anastomosis. At a cellular level, this venous stenosis is the result of venous neointimal hyperplasia (VNH). There are, unfortunately, no effective therapies for VNH. The purpose of this study was to assess the role of external radiation therapy in preventing VNH and venous stenosis. Methods and Materials: Seven-centimeter polytetrafluoroethylene loop grafts were placed bilaterally between the femoral artery and vein of 12 Yorkshire Cross pigs. One side was treated with a single 16-Gy dose of external beam radiation with a linear accelerator, while the contralateral side served as an internal control. Swine were killed after 28 days, and the grafts were carefully dissected out and removed. Neointimal hyperplasia and luminal stenosis were then assessed morphometrically at the graft-vessel anastomoses. Results: External beam radiation therapy significantly reduced the amount of luminal stenosis at the graft-vein anastomosis, with minimal local and systemic toxicity. Conclusions: External beam radiation therapy could be a useful and clinically relevant local treatment for venous stenosis in polytetrafluoroethylene dialysis grafts

  12. Effect of Pingyangmycin on human venous malformation endothelial cells

    Institute of Scientific and Technical Information of China (English)

    Yi Fang Zhao; Zhi Jun Sun; Yu Lin Jia; Jun Jia; Ya Meng Si; Ji Hong Zhao; Wen Feng Zhang

    2008-01-01

    @@ Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.

  13. Thrombin Avtivable Fibrinolysis Inhibitor in Venous and Arterial Thrombosis

    OpenAIRE

    Bruijne, E.L.E.

    2011-01-01

    textabstractVenous and arterial thromboses are major causes of morbidity and mortality. Venous thrombosis is the result of pathological occlusive clot formation in the veins. It occurs mainly in the deep veins of the leg (deep vein thrombosis), from which parts of the clot frequently embolize to the lungs (pulmonary embolism). Less than 5% of all venous thromboses occur at other sites (e.g. arm or cerebral veins). Rarely occurring, but often life-threathening venous thrombosis is splanchnic v...

  14. Risk factors for a first and recurrent venous thrombosis

    OpenAIRE

    Flinterman, Linda Elisabeth

    2013-01-01

    The aim of this thesis was to identify new risk factors for first and recurrent venous thrombosis of both the upper and lower extremity, and assess the incidence of recurrence and mortality after a first venous thrombosis. An overview was provided of the current literature on risk factors and treatment for a first venous thrombosis of the upper extremity (chapter 2). We investigated the association between levels of coagulation factors, blood group and a first venous thrombosis of the upper e...

  15. Obstruction of Venous Drainage Linked to Transient Global Amnesia

    OpenAIRE

    Han, Ke; Chao, A-Ching; Chang, Feng-Chi; Chung, Chih-Ping; Hsu, Hung-Yi; Sheng, Wen-Yung; Wu, Jiang; Hu, Han-Hwa

    2015-01-01

    Abnormal extracranial venous drainage modality has been considered an etiology of transient global amnesia (TGA). Evidence suggests that the transmission of the intrathoracic/intraabdominal pressure during a Valsalva maneuver (VM) is mainly through the vertebral venous system, and patency of internal jugular vein (IJV) is essential for venous drainage and pressure releasing. We hypothesize that obstruction of IJV venous drainage is a contributing factor in TGA pathogenesis. A magnetic resonan...

  16. Venous Ulcers: New Options in Treatment: Minimally Invasive Vein Surgery

    OpenAIRE

    Poblete, Honesto; Elias, Steven

    2009-01-01

    Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the u...

  17. 21 CFR 870.1140 - Venous blood pressure manometer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  18. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt. (a) Identification. A peritoneo-venous shunt is an implanted device that consists of a catheter and a...

  19. Does Accessibility to the Central Business District (CBD Have an Impact on High-Rise Condominium Price Gradient in Kuala Lumpur, Malaysia?

    Directory of Open Access Journals (Sweden)

    Dziauddin Mohd Faris

    2016-01-01

    Full Text Available This paper uses a spatial econometric method known as Geographically Weighted Regression (GWR to investigate the impact of accessibility to the CBD on the high-rise condominium price gradient in Kuala Lumpur, Malaysia. Using a GWR method, after having controlled other factors, this study clearly reveal the impact of accessibility to the CBD on high-rise condominium varying prices across the study area, having a much larger positive impact in some areas but less and counterintuitive impact in others. In general, the results from this study show accessibility to the CBD measured by the travel times does affect high-rise condominium prices (high-rise condominium prices decrease as travel times to the CBD increase in most part of the areas, hence proved Alonso, Muth and Mills were still right.

  20. Venous congestion: are we adding insult to kidney injury in sepsis?

    OpenAIRE

    Rajendram, Rajkumar; Prowle, John R

    2014-01-01

    In critical illness, septic shock is a contributing factor in nearly half of all cases of acute kidney injury (AKI). Traditional approaches to prevention of organ dysfunction in early sepsis have focused on prevention of hypoperfusion by optimisation of systemic haemodynamics, primarily by fluid resuscitation. Fluid administration to a target central venous pressure (CVP) of 8 to 12 mmHg (12 to 15 mmHg in mechanically ventilated patients) is currently recommended for the early resuscitation o...

  1. Immunocompetent young man with cerebral abscess and cortical venous infarction mimicking cerebritis caused by Gemella morbillorum

    OpenAIRE

    Milnik, Annette; Gazis, Angelos; Tammer, Ina; Bartels, Claudius

    2013-01-01

    Gemella morbillorum is an anaerobic gram-positive diplococcus and in most cases a harmless commensal, which occasionally causes infections in the central nervous system. We report on an immunocompetent young man with focal neurological symptoms and cephalgia caused by a cerebral abscess. Although successful treatment was done with neurosurgical intervention and antibiotic therapy, he suffered from a venous infarction 5 weeks after first diagnosis, which mimicked cerebritis as an early stage o...

  2. PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ORTHOPAEDIC SURGERY

    OpenAIRE

    Leme, Luiz Eugênio Garcez; Sguizzatto, Guilherme Turolla

    2015-01-01

    The relevance of prophylaxis of venous thromboembolism and its complications in orthopedic surgery is increasingly significant. This review discusses the pathophysiology of thrombus formation in general and orthopedic surgery, its incidence, predisposing factors and complications. It also presents an updated presentation and critique of prophylaxis currently available in our environment.

  3. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T;

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel...

  4. Nonclinical aspects of venous thrombosis in pregnancy.

    Science.gov (United States)

    Struble, Evi; Harrouk, Wafa; DeFelice, Albert; Tesfamariam, Belay

    2015-09-01

    Pregnancy is a hypercoagulable state which carries an excess risk of maternal venous thrombosis. Endothelial injury, alterations in blood flow and activation of the coagulation pathway are proposed to contribute to the hypercoagulability. The risk for thrombosis may be accentuated by certain drugs and device implants that directly or indirectly affect the coagulation pathway. To help ensure that these interventions do not result in adverse maternal or fetal outcomes during pregnancy, gravid experimental animals can be exposed to such treatments at various stages of gestation and over a dosage range that would identify hazards and inform risk assessment. Circulating soluble biomarkers can also be evaluated for enhancing the assessment of any increased risk of venous thrombosis during pregnancy. In addition to traditional in vivo animal testing, efforts are under way to incorporate reliable non-animal methods in the assessment of embryofetal toxicity and thrombogenic effects. This review summarizes hemostatic balance during pregnancy in animal species, embryofetal development, biomarkers of venous thrombosis, and alterations caused by drug-induced venous thrombosis. PMID:26404176

  5. Arterial and Venous Thrombosis in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Andrew D. Blann

    2011-01-01

    Full Text Available The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin, especially in high risk groups (such as those who are immobile and on high dose chemotherapy, may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer.

  6. Incidence, determinants and the transient impact of cancer treatments on venous thromboembolism risk among lymphoma patients in Denmark

    DEFF Research Database (Denmark)

    Lund, Jennifer L; Østgård, Lene Sofie; Prandoni, Paolo;

    2015-01-01

    2-year incidence accounting for competing risks. Using Cox proportional hazards models, we identified factors associated with VTE risk. In a nested self-controlled design, we evaluated the transient effect of chemotherapy, radiation, central venous catheter use and rituximab on VTE risk using...

  7. Pycnogenol® in chronic venous insufficiency and related venous disorders.

    Science.gov (United States)

    Gulati, Om P

    2014-03-01

    The present review provides an update of the biological profile of Pycnogenol in the light of its use in the treatment of chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids. Pycnogenol is a French maritime pine bark extract produced from the outer bark of Pinus pinaster Ait. subsp. atlantica. Its strong antioxidant, anti-inflammatory and vasodilator activities, antithrombotic effects and collagen stabilizing properties make it uniquely able to target the multi facet pathophysiology of CVI and related venous disorders. Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration. This review highlights clinical research findings on the safety, compliance and efficacy of Pycnogenol, including its use in combination products. PMID:23775628

  8. Tendon vibration attenuates superficial venous vessel response of the resting limb during static arm exercise

    Directory of Open Access Journals (Sweden)

    Ooue Anna

    2012-11-01

    Full Text Available Abstract Background The superficial vein of the resting limb constricts sympathetically during exercise. Central command is the one of the neural mechanisms that controls the cardiovascular response to exercise. However, it is not clear whether central command contributes to venous vessel response during exercise. Tendon vibration during static elbow flexion causes primary muscle spindle afferents, such that a lower central command is required to achieve a given force without altering muscle force. The purpose of this study was therefore to investigate whether a reduction in central command during static exercise with tendon vibration influences the superficial venous vessel response in the resting limb. Methods Eleven subjects performed static elbow flexion at 35% of maximal voluntary contraction with (EX + VIB and without (EX vibration of the biceps brachii tendon. The heart rate, mean arterial pressure, and rating of perceived exertion (RPE in overall and exercising muscle were measured. The cross-sectional area (CSAvein and blood velocity of the basilic vein in the resting upper arm were assessed by ultrasound, and blood flow (BFvein was calculated using both variables. Results Muscle tension during exercise was similar between EX and EX + VIB. However, RPEs at EX + VIB were lower than those at EX (P P vein in the resting limb at EX decreased during exercise from baseline (P vein at EX + VIB did not change during exercise. CSAvein during exercise at EX was smaller than that at EX + VIB (P vein did not change during the protocol under either condition. The decreases in circulatory response and RPEs during EX + VIB, despite identical muscle tension, showed that activation of central command was less during EX + VIB than during EX. Abolishment of the decrease in CSAvein during exercise at EX + VIB may thus have been caused by a lower level of central command at EX + VIB rather than EX. Conclusion Diminished central command induced by tendon

  9. Study on the Correlation of Central Venous Pressure with Intrathoracic Blood Volume Index and Global End-Diastolic Volume Index after Pulmonary Lobectomy%肺手术后中心静脉压与血容量指数、全心舒张末期容积指数的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王素梅; 黎阳; 黄冰; 茅乃权; 阮林; 彭丹晖; 杜学柯

    2013-01-01

    Objective To investigate the correlation of central venous pressure ( CVP ) with intrathoracic blood volume index(ITBVI) and global end-diastolic volume index(GEDVI) after pulmonary lobectomy,and to dis-cuss the value of CVP as a parameter of volume load after pulmonary lobectomy .Methods Twenty-three cases of ASA I-II grade lung cancer who underwent radical resection were enrolled in the study .Pulse indicator continuous cardiac output ( PiCCO) monitoring technology was used to record their postoperative CVP ,GEDVI and ITBVI at the time of off-lining(T1),after tracheal extubation instantly(T2),2 hours after extubation(T3),5 hours after extubation ( T4 ) ,and 15 hours after extubation ( T5 ) .The correlation of CVP with ITBVI and GEDVI was analyzed .Results The correlation coefficient of CVP and GEDVI was equal to -0 .138 ( P>0 .05 ); The correlation coefficient of CVP and ITBVI was equal to -0.153(P>0.05).Conclusion CVP can not indicate the volume load of patients after pulmonary lobectomy .It should be based on the clinical features or using more monitoring techniques when performing load monitoring and evaluation .%目的:探讨肺手术患者术后胸腔内血容量指数( ITBVI)、全心舒张末期容积指数( GEDVI)与中心静脉压( CVP)的相关性,研究肺手术后CVP用于评价肺手术后容量负荷的价值。方法 ASAⅠ~Ⅱ级行肺癌根治术患者23例,术后应用脉搏指示剂心排量连续监测( PiCCO)技术监测患者脱机后( T1)、拔管后( T2)、拔管后2h(T3)、拔管后5 h(T4)、拔管后15 h(T5)的CVP、ITBVI、GEDVI,分析CVP与ITBVI、GEDVI的相关性。结果 CVP与GEDVI的相关系数为r=-0.138(P>0.05); CVP与ITBVI r为-0.153(P>0.05)。结论CVP不能反映肺手术后机体的容量状态,在容量监测与评估时要根据临床表现或增加其他监测手段。

  10. Open access and medicinal chemistry

    OpenAIRE

    Swain Chris

    2007-01-01

    Abstract Chemistry Central is a new open access website for chemists publishing peer-reviewed research in chemistry from a range of open access journals. A new addition, Chemistry Central Journal, will cover all of chemistry and will be broken down into discipline-specific sections, and Im delighted that Medicinal Chemistry will be a key discipline in this new journal.

  11. Increasing the Supply of Quality, Accessible, Affordable Child Care: An Economic Development Strategy for the North Central Region. NCRCRD Policy Briefs

    Science.gov (United States)

    Traill, Saskia; Brown, Brentt

    2005-01-01

    The child care industry has not been fully integrated into economic development activities despite its growing importance in the economy. This is, in large part, because child care is not usually thought of as an element of economic development. As a result, states in the North Central region are not maximizing the economic benefits from quality,…

  12. Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Pekindil, Goekhan [Department of Radiology, Trakya University School of Medicine, 22030 Edirne (Turkey); Varol, Fuesun G. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Ali Yuece, M. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Yardim, Turgut [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey)

    1999-03-01

    Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period.

  13. On Accessibility and Equity, Market Forces, and Entrepreneurship: Developments in Higher Education in Central and Eastern Europe (CPP RPS 7/2007)

    OpenAIRE

    Kwiek, Marek

    2007-01-01

    The paper explores four interrelated issues: access and equity, the role and the legitimacy of the emergent market-driven private sector in higher education, the relationships between reforming public services in general and changing public and private higher education, and entrepreneurialism of the emergent private sector in higher education. The four issues are especially closely related in those transition countries in which the market orientation of public institutions is strong, and in w...

  14. Accesso a risorse distribuite in rete: esperienze della Biblioteca Nazionale Centrale di Roma [Versione italiana presentata alla Conferenza internazionale] = Access to Networked Resources: Experiences at Biblioteca Nazionale Centrale di Roma [English version presented at the International Conference

    OpenAIRE

    Cordani, Giovanna

    2001-01-01

    Any National Library has traditionally the role of preserving documents that are part of the national cultural heritage and to provide different categories of users with advanced services to access in the most effective way the “physical objects”, often rare and perishable, that are stored in the library. More and more in the future, services offered to the users will comprise discovery and retrieve of "information resources" available in digital format both at local and at networked level. T...

  15. 全麻诱导不同通气方式对冠心病患者中心静脉压的影响%Influence of different adjuvant ventilation modes on central venous pressure in patients with coronary heart disease during the general anesthesia induction

    Institute of Scientific and Technical Information of China (English)

    程芳; 林华赋; 周毅; 元春梅

    2012-01-01

    Objective To explore the influence of different adjuvant ventilation modes (low tidal volume with high respiratory rate and high tidal volume with low respiratory rate) on central venous pressure (CVP) in patients with coronary heart disease during general anesthesia induction.And to find out an adjuvant ventilation mode which has a less influence on CVP.Methods 41 patients with coronary heart disease practised with general anesthesia in Jiangmen Central Hospital from March 2010 to July 2011 were enrolled for the study.They were randomly divided into two sets.The patients in set Ⅰ were practised the adjuvant ventilation mode of low tidal volume with high respiratory rate during the general anesthesia induction,and the patients in set Ⅱ were practised the adjuvant ventilation mode of high tidal volume with low respiratory rate.All of them were monitored HR,SpO2.MAP,CVP.The CVP of two sets were compared.Results Before general anesthesia,CVP of set Ⅰ was (8.98 ± 2.65) cmH2O,CVP of set Ⅱ was (8.86 ± 2.91) cmH2O.CVP of two sets had no significant difference (P> 0.05).During the general anesthesia induction,CVP of set Ⅰ was (7.45 ± 3.15) cmH2O、CVP of set Ⅱ was (5.86 ± 3.89) cmH2O.CVP of set Ⅱ was obviously lower than that of set Ⅰ( P< 0.05 ).After tracheal intubatiou,CVP of set Ⅰ was (7.99 ± 2.74) cmH2O,CVP of set Ⅱ was (6.09 ± 2.89) cmH2O.CVP of set Ⅱ was obviously lower than that of set Ⅰ( P< 0.05 ).Conclusion By comparing with two ventilation modes,the ventilation mode of high tidal volume with low respiratory rate has a larger influence on CVP.%目的 比较全身麻醉诱导时低潮气量高频率辅助通气与高潮气量低频率辅助通气对冠心病患者中心静脉压(CVP)的影响,选出对循环血流动力学影响较小的辅助通气方式.方法 选择2010年3月-2011年7月于我院行全身麻醉的41例冠心病患者随机分为两组,Ⅰ组在全麻诱导准备插管前低潮气量高频率辅助通气,Ⅱ

  16. Endovascular treatment for intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and risk of endovascular treatment for intracranial venous sinus thrombosis. Methods: Twenty seven patients with intracranial venous sinus thrombosis confirmed by CT, MRI, MRV and/or DSA, from 2004 September to 2006 September, were treated with anticoagulant therapy but without response and then followed by multiple modalities including endovascular treatment. Nineteen of them accepted intravenous thrombolysis and mechanical thrombus maceration, another 5 accepted intravenous thrombolysis, mechanical thrombus maceration and intraarterial thrombolysis and the last 3 with stenting. Results: After thrombolysis, symptoms and signs of 23 patients improved obviously and headache disappeared in 18 of them, but with only mild degree in other 5 and no improvement in 3. Twenty one patients among them achieved recanalization of sinuses completely as confirmed on postprocedural angiography, MRI and MRV studies taken prior to hospital discharge and other 3 achieved recanalization of sinuses partly. Conclusion: Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis. (authors)

  17. Deep venous thrombosis of the upper extremity

    DEFF Research Database (Denmark)

    Klitfod, Lotte; Broholm, R; Baekgaard, N

    2013-01-01

    Upper extremity deep venous thrombosis (UEDVT) occurs either spontaneously, as a consequence of strenuous upper limb activity (also known as the Paget-Schroetter syndrome) or secondary to an underlying cause. Primary and secondary UEDVT differs in long-term sequelae and mortality. This review will...... condition. Malignancy and therapeutic interventions are major risk factors for the secondary deep vein thrombosis in combination with the patient's characteristics, comorbidities and prior history of deep vein thrombosis. Complications: recurrent deep venous thrombosis, pulmonary embolism and Post....... Early diagnosis and treatment is essential to prevent PTS in primary UEDVT; however, there is no consensus on which treatment is the best. Anticoagulation is still considered the treatment of choice for at least 3-6 months, until Randomized Controlled Trials may have demonstrated otherwise....

  18. The State of the Great Central Valley of California-Assessing the Region via Indicators: Public Health and Access to Care

    OpenAIRE

    Porter,, F.C.; Fox, MR; Beard,, Renee L. BA; Chapman, MR

    2005-01-01

    Each year the Great Valley Center produces a report in the five part State of the Great Central Valley series. The data is updated in 5-year increments. Based on the data, the Great Valley Center recognizes the potential to improve health outcomes throughout the region. Overall, the indicators suggest five strategies: * Invest in Prevention * Be Strategic With Limited Resources * Model Healthy Lifestyles for Youth * Build Coalitions in Support of a Healthier Environment * Re...

  19. Prevalence of shiga toxin producing Escherichia coli, Salmonella enterica, and Listeria monocytogenes at public access watershed sites in a California Central Coast agricultural region

    OpenAIRE

    Cooley, Michael B.; Quiñones, Beatriz; Oryang, David; Mandrell, Robert E.; Gorski, Lisa

    2014-01-01

    Produce contaminated with enteric pathogens is a major source of foodborne illness in the United States. Lakes, streams, rivers, and ponds were sampled with Moore swabs bi-monthly for over 2 years at 30 locations in the vicinity of a leafy green growing region on the Central California Coast and screened for Shiga toxin producing Escherichia coli (STEC), Salmonella enterica, and Listeria monocytogenes to evaluate the prevalence and persistence of pathogen subtypes. The prevalence of STEC from...

  20. Basic Mechanisms and Pathogenesis of Venous Thrombosis

    OpenAIRE

    Esmon, Charles T

    2009-01-01

    In 1856 Virchow proposed a triad of causes for venous thrombosis, postulating that stasis, changes in the vessel wall or changes in the blood could lead to thrombosis. We now know that abnormally high levels of some coagulation factors and defects in the natural anticoagulants contribute to thrombotic risk. Among these, factor V Leiden, which renders factor Va resistant to activated protein C, is the most prevalent with approximately 5% of the Caucasian population having this genetic alterati...

  1. Pulmonary Venous Obstruction in Cancer Patients

    OpenAIRE

    Chuang-Chi Liaw; Hung Chang; Tsai-Sheng Yang; Ming-Sheng Wen

    2015-01-01

    Background. We study the clinical significance and management of pulmonary venous obstruction in cancer patients. Methods. We conducted a prospective cohort study to characterize the syndrome that we term “pulmonary vein obstruction syndrome” (PVOS) between January 2005 and March 2014. The criteria for inclusion were (1) episodes of shortness of breath; (2) chest X-ray showing abnormal pulmonary hilum shadow with or without presence of pulmonary edema and/or pleural effusion; (3) CT scan demo...

  2. The controversy on chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Paolo Zamboni

    2013-08-01

    Full Text Available The objective of this review is to analyze the actual scientific controversy on chronic cerebrospinal venous insufficiency (CCSVI and its association with both neurodegenerative disorders and multiple sclerosis (MS. We revised all published studies on prevalence of CCSVI in MS patients, including ultrasound and catheter venography series. Furthermore, we take into consideration other publications dealing with the pathophysiologic consequences of CCSVI in the brain, as well as ecent data characterizing the pathology of the venous wall in course of CCSVI. Finally, safety and pilot data on effectiveness of endovascular CCSVI treatment were further updated. Studies of prevalence show a big variability in prevalence of CCSVI in MS patients assessed by established ultrasonographic criteria. This could be related to high operator dependency of ultrasound. However, 12 studies, by the means of more objective catheter venography, show a prevalence >90% of CCSVI in MS. Global hypo-hypoperfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies and histology corroborate the 2009 International Union of Phlebology (UIP Consensus decision to insert CCSVI among venous malformations. Finally, safety of balloon angioplasty of the extracranial veins was certainly demonstrated, while prospective data on the potential effectiveness of endovascular treatment of CCSVI support to increase the level of evidence by proceeding with a randomized control trial (RCT. Taking into account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion and cerebro-spinal fluid flow, we conclude that CCSVI can be definitively inserted among the medical entities. Research is still inconclusive in elucidating the CCSVI role in the pathogenesis of neurological disorders. The controversy between the vascular and the

  3. Endovascular treatment of intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

  4. [Anatomic and functional features of venous valves].

    Science.gov (United States)

    Griton, P; Vanet, P; Cloarec, M

    1997-05-01

    The comparison of the venous system in the human organism, and in particular the venous valves of the lower limbs, with studies conducted in animal models helped us to understand better the mechanisms involved in adapting to the upright position and walking. We examined work conducted in several species from the horse to the dog, especially in animals who often take on an upright position such as the chimpanzee and the kangouroo, in search for structures comparable to those in man. Different types of valves can be described in man: flotting valves (bicuspid, pigeon nest valves); reinforced valves (mid-thigh); reinforcing valves (periarticular zone in the knee); finally, "flat" valves which are highly resistant formations but with little anti-back flow action. We also describe valvular structures with muscle cells found in the plantar aspect of the foot and the veins of the quadriceps muscle, these valves may have an active hematopropulsive action (Bassi). These results allowed us to identify certain common points between the structures observed in the posterior legs of certain animals and to propose models for investigating venous diseases. PMID:9480339

  5. Ethanol sclerotherapy of peripheral venous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Rimon, U. E-mail: rimonu@sheba.health.gov.il; Garniek, A.; Galili, Y.; Golan, G.; Bensaid, P.; Morag, B

    2004-12-01

    Background: venous malformations are congenital lesions that can cause pain, decreased range of movement, compression on adjacent structures, bleeding, consumptive coagulopathy and cosmetic deformity. Sclerotherapy alone or combined with surgical excision is the accepted treatment in symptomatic malformations after failed treatment attempts with tailored compression garments. Objectives: to report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%. Patients and methods: 41 sclerotherapy sessions were performed on 21 patients, aged 4-46 years, 15 females and 6 males. Fourteen patients were treated for painful extremity lesions, while five others with face and neck lesions and two with giant chest malformations had treatment for esthetic reasons. All patients had a pre-procedure magnetic resonance imaging (MRI) study. In all patients, 96% ethanol was used as the sclerosant by direct injection using general anesthesia. A minimum of 1-year clinical follow-up was performed. Follow-up imaging studies were performed if clinically indicated. Results: 17 patients showed complete or partial symptomatic improvement after one to nine therapeutic sessions. Four patients with lower extremity lesions continue to suffer from pain and they are considered as a treatment failure. Complications were encountered in five patients, including acute pulmonary hypertension with cardiovascular collapse, pulmonary embolus, skin ulcers (two) and skin blisters. All patients fully recovered. Conclusion: sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur.

  6. Developmental venous anomaly in the newborn brain

    International Nuclear Information System (INIS)

    Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age. (orig.)

  7. Developmental venous anomaly in the newborn brain

    Energy Technology Data Exchange (ETDEWEB)

    Horsch, S. [Erasmus MC-Sophia Children' s Hospital, Department of Neonatology, Rotterdam (Netherlands); Helios Klinikum Berlin-Buch, Department of Neonatology, Berlin (Germany); Govaert, P. [Erasmus MC-Sophia Children' s Hospital, Department of Neonatology, Rotterdam (Netherlands); Cowan, F.M. [Hammersmith Hospital, Department of Paediatrics, Imperial College Healthcare NHS Trust, London (United Kingdom); Benders, M.J.N.L.; Groenendaal, F.; Vries, L.S. de [University Medical Centre Utrecht, Wilhelmina Children' s Hospital, Department of Neonatology, Utrecht (Netherlands); Lequin, M.H. [Erasmus MC/Sophia Children' s Hospital, Department of Paediatric Radiology, Rotterdam (Netherlands); Saliou, G. [University Hospital, Department of Neuroradiology, Le Kremlin-Bicetre (France)

    2014-07-15

    Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA. Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed. DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity. This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age. (orig.)

  8. Ethanol sclerotherapy of peripheral venous malformations

    International Nuclear Information System (INIS)

    Background: venous malformations are congenital lesions that can cause pain, decreased range of movement, compression on adjacent structures, bleeding, consumptive coagulopathy and cosmetic deformity. Sclerotherapy alone or combined with surgical excision is the accepted treatment in symptomatic malformations after failed treatment attempts with tailored compression garments. Objectives: to report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%. Patients and methods: 41 sclerotherapy sessions were performed on 21 patients, aged 4-46 years, 15 females and 6 males. Fourteen patients were treated for painful extremity lesions, while five others with face and neck lesions and two with giant chest malformations had treatment for esthetic reasons. All patients had a pre-procedure magnetic resonance imaging (MRI) study. In all patients, 96% ethanol was used as the sclerosant by direct injection using general anesthesia. A minimum of 1-year clinical follow-up was performed. Follow-up imaging studies were performed if clinically indicated. Results: 17 patients showed complete or partial symptomatic improvement after one to nine therapeutic sessions. Four patients with lower extremity lesions continue to suffer from pain and they are considered as a treatment failure. Complications were encountered in five patients, including acute pulmonary hypertension with cardiovascular collapse, pulmonary embolus, skin ulcers (two) and skin blisters. All patients fully recovered. Conclusion: sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur

  9. Venous responses during exercise in rainbow trout, Oncorhynchus mykiss : [alpha]-adrenergic control and the antihypotensive function of the renin-angiotensin system

    DEFF Research Database (Denmark)

    Sandblom, E.; Axelsson, M.; McKenzie, David

    2006-01-01

    systemic resistance (Rsys) were derived from these variables. The mean circulatory filling pressure (MCFP) was measured at rest and at the end of the exercise challenge, to investigate potential exercise-mediated changes in venous capacitance. The protocol was repeated after [alpha]-adrenoceptor blockade......The role of the [alpha]-adrenergic system in the control of cardiac preload (central venous blood pressure; Pven) and venous capacitance during exercise was investigated in rainbow trout (Oncorhynchus mykiss). In addition, the antihypotensive effect of the renin-angiotesin system (RAS) was...... responses were in fact due to activation of the RAS, because resting Pda and Rsys were decreased further and essentially all cardiovascular changes during exercise were abolished. This study shows that the [alpha]-adrenergic system normally plays an important role in the control of venous function during...

  10. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence.

    Science.gov (United States)

    Lee, Byung B; Nicolaides, Andrew N; Myers, Kenneth; Meissner, Mark; Kalodiki, Evi; Allegra, Claudio; Antignani, Pier L; Bækgaard, Niels; Beach, Kirk; Belcaro, Giovanni; Black, Stephen; Blomgren, Lena; Bouskela, Eliete; Cappelli, Massimo; Caprini, Joseph; Carpentier, Patrick; Cavezzi, Attilio; Chastanet, Sylvain; Christenson, Jan T; Christopoulos, Demetris; Clarke, Heather; Davies, Alun; Demaeseneer, Marianne; Eklöf, Bo; Ermini, Stefano; Fernández, Fidel; Franceschi, Claude; Gasparis, Antonios; Geroulakos, George; Sergio, Gianesini; Giannoukas, Athanasios; Gloviczki, Peter; Huang, Ying; Ibegbuna, Veronica; Kakkos, Stavros K; Kistner, Robert; Kölbel, Tilo; Kurstjens, Ralph L; Labropoulos, Nicos; Laredo, James; Lattimer, Christopher R; Lugli, Marzia; Lurie, Fedor; Maleti, Oscar; Markovic, Jovan; Mendoza, Erika; Monedero, Javier L; Moneta, Gregory; Moore, Hayley; Morrison, Nick; Mosti, Giovanni; Nelzén, Olle; Obermayer, Alfred; Ogawa, Tomohiro; Parsi, Kurosh; Partsch, Hugo; Passariello, Fausto; Perrin, Michel L; Pittaluga, Paul; Raju, Seshadri; Ricci, Stefano; Rosales, Antonio; Scuderi, Angelo; Slagsvold, Carl E; Thurin, Anders; Urbanek, Tomasz; M VAN Rij, Andre; Vasquez, Michael; Wittens, Cees H; Zamboni, Paolo; Zimmet, Steven; Ezpeleta, Santiago Z

    2016-06-01

    There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein

  11. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    Science.gov (United States)

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  12. What's new: Management of venous leg ulcers: Treating venous leg ulcers.

    Science.gov (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Phillips, Tania J; Miller, O Fred; Margolis, David J; Marston, William; Woo, Kevin; Romanelli, Marco; Kirsner, Robert S

    2016-04-01

    Venous leg ulcers account for approximately 70% of all leg ulcers and affect 2.2 million Americans annually. After a comprehensive patient and wound assessment, compression therapy remains the cornerstone of standard care. Adjuvant care with topical or systemic agents is used for wounds that do not heal within 4 weeks. Once healed, long-term compression therapy with stockings or surgical intervention will reduce the incidence of recurrence. This continuing medical education article aims to outline optimal management for patients with venous leg ulcers, highlighting the role of a multidisciplinary team in delivering high quality care. PMID:26979355

  13. Transparency in Public Administration: Free Access to Public Information. A Topical Comparative Analysis of Several Jurisdictions from Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    DRAGOȘ Dacian C.

    2006-06-01

    Full Text Available Many expected freedom of information laws to be among the first priorities of the new governments of countries in transition after the 1989 changes, but instead there was little public pressure to adopt general sunshine laws relating to all categories of information. After adopting the laws, however, there are still many powerful forces that are working against extensive access to information – they can be static - opaque administrative practices, general inaptitude or the lack of sufficient human and material resources - or active – agents that resist openness due to private interests, or agents that use institutional scenarios to prevent public scrutiny over corruption and incompetence. The paper approaches the jurisdictions from Hungary, Poland, Czech Republic and Romania, emphasising aspects like: different models in regulating freedom of information regimes, obstacles in the implementation of the law, public bodies that should apply the law, timeframes, etc.

  14. Influence of Pneumoperitoneum on the Deep Venous System during Laparoscopy

    OpenAIRE

    Wazz, Gabi; Branicki, Frank; Taji, Hakam; Chishty, Imran

    2000-01-01

    Background: There is widespread concern that laparoscopic procedures that are usually performed under general anesthesia, using muscle relaxation, in a reverse Trendelenberg position and with pneumoperitoneum, may lead to venous stasis in lower limbs. Objective: To evaluate perioperative changes in the venous system and determine the frequency of deep venous thrombosis associated with minimally invasive surgery. Design: Prospective consecutive series. Subjects: Sixty-five patients undergoing ...

  15. Cerebral Venous Thrombosis in Two Patients with Spontaneous Intracranial Hypotension

    OpenAIRE

    Garcia-Carreira, M. C.; D. Cánovas Vergé; Branera, J.; Zauner, M.; J. Estela Herrero; E. Tió; G. Ribera Perpinyà

    2014-01-01

    Although few patients with spontaneous intracranial hypotension develop cerebral venous thrombosis, the association between these two entities seems too common to be simply a coincidental finding. We describe two cases of spontaneous intracranial hypotension associated with cerebral venous thrombosis. In one case, extensive cerebral venous thrombosis involved the superior sagittal sinus and multiple cortical cerebral veins. In the other case, only a right frontoparietal cortical vein was invo...

  16. Effect of peritoneo-venous shunt on portal pressure.

    OpenAIRE

    Samanta, A K; Leevy, C. M.

    1989-01-01

    The cause of variceal bleed after a peritoneo-venous shunt is not known. Portal haemodynamic consequences of a peritoneo-venous shunt are poorly understood. The most critical period after a peritoneo-venous shunt is the early postoperative period when rapid mobilisation of peritoneal fluid occurs. Serial changes in the portal pressure during the early postoperative period have not been recorded. In the present study preoperative wedge hepatic vein (WHV), right atrial (RA) and pulmonary capill...

  17. Cerebral venous thrombosis presenting as multiple lower cranial nerve palsies

    OpenAIRE

    Byju, N.; James Jose; Saifudheen, K; V Abdul Gafoor; P Jithendranath

    2012-01-01

    Cerebral venous thrombosis (CVT) is a well-recognized entity, but its clinical presentation is varied and often mimics many neurological disorders, making it a diagnostic challenge. Cerebral venous thrombosis has a wide spectrum of signs and symptoms, which may evolve suddenly or over weeks. It mimics many neurological conditions such as meningitis, encephalopathy, idiopathic intracranial hypertension, and stroke. Cerebral venous thrombosis presenting as multiple lower cranial nerve palsies, ...

  18. Magnetic resonance angiography in the diagnosis of thoracic venous obstruction.

    Science.gov (United States)

    Chang, Y C; Su, C T; Yang, P C; Wang, T C; Chiu, L C; Hsu, J C

    1998-01-01

    The aims of this study were to evaluate the diagnostic value of orthogonal magnetic resonance angiography (MRA) and to compare the results of MRA with those of digital subtraction venography (DSV) in thoracic venous diseases. Ten normal volunteers were evaluated using two-dimensional time-of-flight MRA in three orthogonal planes to determine the image quality of each venous segment. Twelve consecutive patients suspected of having thoracic venous disease were studied with both MRA and DSV. In the normal subjects, the plane perpendicular to the target vein provided the most consistent visualization. Using three orthogonal MRA images, a diagnostic-quality image was obtained in 175 (83%) of 210 venous segments in normal volunteers. In patients with thoracic venous obstructive disease, MRA was more effective than DSV in detecting total (84 vs 54), patent (56 vs 36), stenotic (13 vs 10), and obstructive (15 vs 8) venous segments, poststenotic or postobstructive veins (15 vs 10), thrombosis of the internal jugular vein (7 vs 2), intraluminal thrombus (5 vs 3), and azygos veins (12 vs 2). Using venous segments visible on DVS (n = 54) as the standard, the sensitivity and specificity of MRA were 94% and 100%, respectively, in detecting venous patency, and 100% and 98% in detecting complete venous obstruction. In the shoulder region, the sensitivity and specificity of MRA were 93% and 100%, respectively, in detecting venous patency, and 100% and 97% in detecting venous obstruction. We conclude that MRA with three orthogonal planes can provide relatively complete and reliable venous mapping, without the need for contrast medium. PMID:9481063

  19. Venous Thromboembolism in the Cancer Population: Pathology, Risk, and Prevention

    OpenAIRE

    Hawbaker, Susan

    2012-01-01

    Patients with cancer have an increased risk of developing venous thromboembolism (VTE) and the incidence of these events has been increasing over the past decade. Venous thromboembolic events include both deep venous thrombosis and pulmonary embolism. These events contribute to higher morbidity and mortality rates. Understanding the complex pathogenesis of and risk factors for cancer-associated VTE will help guide advanced practitioners to improve outcomes with prophylaxis. The American Socie...

  20. Blood-saving effect of low central venous pressure combined with acute hypervolemic hemodilution in patients undergoing hepatic lobectomy%肝叶切除术患者低中心静脉压联合急性高容量血液稀释的血液保护效应

    Institute of Scientific and Technical Information of China (English)

    杨金凤; 高星杨; 董长生; 王明德; 吴飞跃; 常业恬

    2008-01-01

    目的 评价肝叶切除术患者低中心静脉压(CVP)联合急性高容量血液稀释(AHHD)的血液保护效应.方法 择期行肝叶切除术的肝癌患者60例,随机分为3组(n=20):对照组(Ⅰ组)、AHHD组(Ⅱ组)和低CVP联合AHHD组(Ⅲ组),3组均采用硬膜外复合全麻.Ⅰ组术中按1.5∶1输注晶体液和胶体液;Ⅱ组在气管插管后静脉输注4%琥珀酰明胶50 ml·kg-1.h-130min行AHHD,然后静脉输注乳酸钠林格氏液维持CVP在正常范围;Ⅲ组入室后静脉输注乳酸钠林格氏液1 ml·kg-1·h-1,硬膜外输注1.5%利多卡因和0.2%布比卡因混合液6~8 ml,静脉输注异丙酚6 mg·kg-1·h-1,维持CVP 1~5 cm H2O,同时静脉输注去甲肾上腺素0.4~0.8 mg/h,维持MAP≥70 mm Hg,肝叶切除后10min开始行AHHD.分别于术前(基础状态)、切皮前即刻、肝叶切除前即刻、肝叶切除后10 min和术毕时测定血糖浓度,分别于上述时点及术后7 d测定血红蛋白(Hb)、红细胞压积(Hct)、白细胞(WBC)、凝血功能指标、谷丙转氨酶(GPT)和肾功能指标,并记录各时段输液量、尿量;记录术中失血、输血情况及术后并发症的发生情况.结果 与Ⅰ组和Ⅱ组比较,Ⅲ组术中血糖、WBC、GPT、失血量、异体输血量、肝叶切除前输液量、尿量及异体输血率较低,术中Hb、Hct及肝叶切除后输液量和尿量较高(P<0.05),凝血功能指标、肾功能指标、总输液量和尿量差异无统计学意义(P>0.05).所有患者术后未见并发症发生.结论 肝叶切除前低CVP联合肝叶切除后AHHD能明显减少术中失血量和异体输血,且具有良好的安全性.%Objective To evaluate the blond-saving effect of low central venous pressure(CVP) combined with acute hypervolemic hemedilution(AHHD)in patients undergoing hepatic lobectomy.Methods sixty ASA I orⅡpatients of both sexes aged 32-48 yr weighing 47-72 kg undergoing hepatic lobectomy for primary malignant hepatonm under epidural combined

  1. Levoatriocardinal vein with normal intracardiac anatomy and pulmonary venous return

    Directory of Open Access Journals (Sweden)

    Ender Odemis

    2011-01-01

    Full Text Available Levoatriocardinal vein (LACV is characterized by an abnormal connection between pulmonary and systemic venous return. This extremely rare cardiac malformation is usually associated with left-sided obstructive lesions including mitral atresia, hypoplastic left-heart syndrome, and abnormal pulmonary venous connection. Patients may have low systemic cardiac output and pulmonary venous obstruction symptoms. In this manuscript, we report a case with LACV and normal pulmonary venous return with absence of any intracardiac pathology. LACV was demonstrated with echocardiography, angiography, and computed tomography. Surgical correction was made successfully.

  2. Venous ulcers of the lower limb: Where do we stand?

    Science.gov (United States)

    Chatterjee, Sasanka S

    2012-05-01

    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

  3. Levoatriocardinal vein with normal intracardiac anatomy and pulmonary venous return

    International Nuclear Information System (INIS)

    Levoatriocardinal vein (LACV) is characterized by an abnormal connection between pulmonary and systemic venous return. This extremely rare cardiac malformation is usually associated with left-sided obstructive lesions including mitral atresia, hypoplastic left-heart syndrome, and abnormal pulmonary venous connection. Patients may have low systemic cardiac output and pulmonary venous obstruction symptoms. In this manuscript, we report a case with LACV and normal pulmonary venous return with absence of any intracardiac pathology. LACV was demonstrated with echocardiography, angiography, and computed tomography. Surgical correction was made successfully

  4. Venous ulcers of the lower limb: Where do we stand?

    Directory of Open Access Journals (Sweden)

    Chatterjee S Sasanka

    2012-01-01

    Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  5. 'Chronic cerebrospinal venous insufficiency' in multiple sclerosis. Is multiple sclerosis a disease of the cerebrospinal venous outflow system?; 'Chronische zerebrospinale venoese Insuffizienz' bei Multipler Sklerose. Ist die Multiple Sklerose eine Erkrankung des zerebrospinalen venoesen Abflusssystems?

    Energy Technology Data Exchange (ETDEWEB)

    Wattjes, M.P. [VU Univ. Medical Center, Amsterdam (Netherlands). Dept. of Radiology; Doepp, F. [Universitaetsklinik Charite, Berlin (Germany). Neurologische Klinik; Bendszus, M. [Heidelberg Univ. (Germany). Abt. fuer Neuroradiologie; Fiehler, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik fuer Neuroradiologische Diagnostik und Intervention

    2011-06-15

    Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients. (orig.)

  6. Patterns of the Cranial Venous System from the Comparative Anatomy in Vertebrates: Part II. The Lateral-Ventral Venous System

    OpenAIRE

    Aurboonyawt, T.; Pereira, V.; Kring, T.; Toulgoat, F.; Churojana, A.; Lasjaunias, P.

    2008-01-01

    Comparing the adult submammalian brain with the human embryonic brain, some patterns of venous drainage are quite similar. The veins lying on the lateral surface of the brain in submammals resemble those of the human embryo. In addition, the new longitudinal venous anastomosis ventral to the brain vesicles occurring late in human embryonic development seems to be similar to the late appearance of the basal vein and the ventral brain stem venous plexus found in adult mammals including man. The...

  7. Diagnosis and endovascular treatment of multiple cerebral venous and venous sinuses thrombosis

    International Nuclear Information System (INIS)

    Objective: Eighty-five cases with multiple cerebral venous and venous sinuses thrombosis including the diagnosis and endovascular therapy were reported. Methods: The long T2 and short T1 signals in the related regions of multiple venous sinuses on MRI and prolonged blood circulation time of the brain with tortuous dilatation of vein in angiography were the important characteristics for the diagnosis. Of the 85 cases, the treatment procedures were consisted of injecting urokinase intermittently via common carotid artery and intra-sinus contact thrombolysis as well as warfarin intake orally. Results: Intracranial pressure of 80 cases reduced down between 230 and 300 mm H2O, and clinical deficits were markedly improved within 10 days. Re-angiography of 18 cases revealed recanalization partly in 5 cases and circulation time appeared near normal i 8 cases during one week after therapy. Conclusions: Combined intraarterial thrombolysis consecutively with general anticoagulation for the treatment of multiple thrombosis in cerebral venous sinuses may be one of the effective means

  8. Naturally occurring broad-spectrum powdery mildew resistance in a Central American tomato accession is caused by loss of mlo function.

    Science.gov (United States)

    Bai, Yuling; Pavan, Stefano; Zheng, Zheng; Zappel, Nana F; Reinstädler, Anja; Lotti, Concetta; De Giovanni, Claudio; Ricciardi, Luigi; Lindhout, Pim; Visser, Richard; Theres, Klaus; Panstruga, Ralph

    2008-01-01

    The resistant cherry tomato (Solanum lycopersicum var. cerasiforme) line LC-95, derived from an accession collected in Ecuador, harbors a natural allele (ol-2) that confers broad-spectrum and recessively inherited resistance to powdery mildew (Oidium neolycopersici). As both the genetic and phytopathological characteristics of ol-2-mediated resistance are reminiscent of powdery mildew immunity conferred by loss-of-function mlo alleles in barley and Arabidopsis, we initiated a candidate-gene approach to clone Ol-2. A tomato Mlo gene (SlMlo1) with high sequence-relatedness to barley Mlo and Arabidopsis AtMLO2 mapped to the chromosomal region harboring the Ol-2 locus. Complementation experiments using transgenic tomato lines as well as virus-induced gene silencing assays suggested that loss of SlMlo1 function is responsible for powdery mildew resistance conferred by ol-2. In progeny of a cross between a resistant line bearing ol-2 and the susceptible tomato cultivar Moneymaker, a 19-bp deletion disrupting the SlMlo1 coding region cosegregated with resistance. This polymorphism results in a frameshift and, thus, a truncated nonfunctional SlMlo1 protein. Our findings reveal the second example of a natural mlo mutant that possibly arose post-domestication, suggesting that natural mlo alleles might be evolutionarily short-lived due to fitness costs related to loss of mlo function. PMID:18052880

  9. 77 FR 10748 - Scientific Information Request on Mechanical Prophylaxis of Venous Thromboembolism (VTE)

    Science.gov (United States)

    2012-02-23

    ... Prophylaxis of Venous Thromboembolism (VTE) AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS... Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations Review, which is... review of the evidence for pharmacologic and mechanical prophylaxis of venous thromboembolism (VTE)...

  10. Application of the AMPLATZER Vascular Plug in Endovascular Occlusion of Dialysis Accesses

    International Nuclear Information System (INIS)

    The purpose of this study was to share our initial experience with the AMPLATZER Vascular Plug (AVP) in occluding dialysis accesses. Between January 2007 and October 2008, five patients with autogenous and one patient with prosthetic accesses were referred for endovascular occlusion owing to central venous obstruction (n = 4) and dialysis-associated steal syndrome (n = 2) leading to disabling complications. We used a single AVP in two patients, double AVPs in two patients, and double AVPs and n-butyl 2-cyanoacrylate in one patient with an autogenous access. Two coils were deployed between two AVPs to occlude the prosthetic graft. Immediate success was achieved in all patients, with no complications. Mean follow-up time was 13 months (range, 1-21 months) and none of the patients had experienced symptom recurrence as of the time of writing. The AVP allows simple, precise, and reliable dialysis access occlusion without significant complications when surgical ligation is not preferred. It can be used with other embolizing agents to provide occlusion in the case of failure.

  11. Role of Tissue Factor in Venous Thrombosis

    Science.gov (United States)

    Manly, David A.; Boles, Jeremiah; Mackman, Nigel

    2011-01-01

    Venous thromboembolism (VTE) is a leading cause of morbidity and mortality worldwide. However, the mechanisms by which clots are formed in the deep veins have not been determined. Tissue factor (TF) is the primary initiator of the coagulation cascade and is essential for hemostasis. Under pathological conditions, TF is released into the circulation on small-membrane vesicles termed microparticles (MPs). Recent studies suggest that elevated levels of MPTF may trigger thrombosis. This review provides an overview of the role of TF in VTE. PMID:20690821

  12. [Phlebitogenicity of venous catheters of Vialon].

    Science.gov (United States)

    Fassolt, A

    1985-12-01

    During three days 132 surgical patients with postoperative infusion treatment were checked on the frequency of venous reactions in the arms when catheters/cannulas of 4 different materials were used and the outcome compared. A significant result was obtained in connection with the I-cath catheter made of vialon (a polyurethanelike resin polymer) and the L-cath of polyurethane. Phlebitis was decreased to 27.3% resp. 24.2% - approximately half of its usual frequency - when I-cath of polyvinyl-chloride and FEP-teflon vasofix cannulas were applied (both 51.5%). The different predisposing factors of infusion phlebitis are under discussion. PMID:4093198

  13. Predicting the Risk of Venous Thromboembolism Recurrence

    OpenAIRE

    Heit, John A.

    2012-01-01

    Venous thromboembolism (VTE) is a chronic disease with a 30% ten-year recurrence rate. The highest incidence of recurrence is in the first 6 months. Active cancer significantly increases the hazard of early recurrence, and the proportions of time on standard heparin (APTT≥0.2 anti-Xa U/mL) and warfarin (INR≥2.0) treatment, significantly reduce the hazard. The acute treatment duration does not affect recurrence risk after treatment is stopped. Independent predictors of late recurrence include ...

  14. Pulmonary arterio-venous micro fistulae - Diagnostic

    International Nuclear Information System (INIS)

    Four patients with pulmonary arterio-venous micro-fistulae - of which two were male (50%) - the ages varying from 10 to 43 (X sup(∼) = 22,7), were studied at the Cardiology Centre of the 6th Ward of Santa Casa da Misericordia Hospital in Rio de Janeiro. They were all basically suffering from Manson's Schistosomiasis, the hepato-splenic form in 3 cases (75%) and the Rendu Osler Weber disease with juvenile cirrhosis in 1 case (25%). All four of them had portal hypertension. The individual cases were clinically evaluate with X-rays, scintillographic and hemodynamic tests. (author)

  15. Damage of Central Catheters in Home Parenteral Nutrition Patients

    Directory of Open Access Journals (Sweden)

    Błasiak Renata

    2015-11-01

    Full Text Available According to the ESPEN and ASPEN guidelines, in the case of a long-term (>3-month parenteral nutrition should be administered via a subcutaneous central venous catheter (CVC. There are three types of mechanical complications of tunnelled central catheter: catheter rupture, occlusion by TPN depositing and thrombofibrotic occlusion.

  16. Neonatal atrial flutter after insertion of an intracardiac umbilical venous catheter

    Science.gov (United States)

    de Almeida, Marcos Moura; Tavares, Wládia Gislaynne de Sousa; Furtado, Maria Mônica Alencar Araripe; Fontenele, Maria Marcia Farias Trajano

    2016-01-01

    Abstract Objective: To describe a case of neonatal atrial flutter after the insertion of an intracardiac umbilical venous catheter, reporting the clinical presentation and reviewing the literature on this subject. Case description: A late-preterm newborn, born at 35 weeks of gestational age to a diabetic mother and large for gestational age, with respiratory distress and rule-out sepsis, required an umbilical venous access. After the insertion of the umbilical venous catheter, the patient presented with tachycardia. Chest radiography showed that the catheter was placed in the position that corresponds to the left atrium, and traction was applied. The patient persisted with tachycardia, and an electrocardiogram showed atrial flutter. As the patient was hemodynamically unstable, electric cardioversion was successfully applied. Comments: The association between atrial arrhythmias and misplaced umbilical catheters has been described in the literature, but in this case, it is noteworthy that the patient was an infant born to a diabetic mother, which consists in another risk factor for heart arrhythmias. Isolated atrial flutter is a rare tachyarrhythmia in the neonatal period and its identification is essential to establish early treatment and prevent systemic complications and even death. PMID:26525686

  17. Outcomes of Prosthetic Hemodialysis Grafts after Deployment of Bare Metal versus Covered Stents at the Venous Anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Charles Y., E-mail: charles.kim@duke.edu; Tandberg, Daniel J.; Rosenberg, Michael D.; Miller, Michael J.; Suhocki, Paul V.; Smith, Tony P. [Duke University Medical Center, Division of Vascular and Interventional Radiology (United States)

    2012-08-15

    Purpose: To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts. Methods: Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group. Results: Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01). Conclusion: The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

  18. Prevalence of shiga toxin producing Escherichia coli, Salmonella enterica, and Listeria monocytogenes at public access watershed sites in a California Central Coast agricultural region.

    Science.gov (United States)

    Cooley, Michael B; Quiñones, Beatriz; Oryang, David; Mandrell, Robert E; Gorski, Lisa

    2014-01-01

    Produce contaminated with enteric pathogens is a major source of foodborne illness in the United States. Lakes, streams, rivers, and ponds were sampled with Moore swabs bi-monthly for over 2 years at 30 locations in the vicinity of a leafy green growing region on the Central California Coast and screened for Shiga toxin producing Escherichia coli (STEC), Salmonella enterica, and Listeria monocytogenes to evaluate the prevalence and persistence of pathogen subtypes. The prevalence of STEC from 1386 samples was 11%; 110 samples (8%) contained E. coli O157:H7 with the highest prevalence occurring close to cattle operations. Non-O157 STEC isolates represented major clinical O-types and 57% contained both shiga toxin types 1 and 2 and intimin. Multiple Locus Variable Number Tandem Repeat Analysis of STEC isolates indicated prevalent strains during the period of study. Notably, Salmonella was present at high levels throughout the sampling region with 65% prevalence in 1405 samples resulting in 996 isolates with slightly lower prevalence in late autumn. There were 2, 8, and 14 sites that were Salmonella-positive over 90, 80, and 70% of the time, respectively. The serotypes identified most often were 6,8:d:-, Typhimurium, and Give. Interestingly, analysis by Pulsed Field Gel Electrophoresis indicated persistence and transport of pulsotypes in the region over several years. In this original study of L. monocytogenes in the region prevalence was 43% of 1405 samples resulting in 635 individual isolates. Over 85% of the isolates belonged to serotype 4b with serotypes 1/2a, 1/2b, 3a, 4d with 4e representing the rest, and there were 12 and 2 sites that were positive over 50 and 80% of the time, respectively. Although surface water is not directly used for irrigation in this region, transport to the produce can occur by other means. This environmental survey assesses initial contamination levels toward an understanding of transport leading to produce recalls or outbreaks. PMID

  19. Anatomical reconstructions of the human cardiac venous system using contrast-computed tomography of perfusion-fixed specimens.

    Science.gov (United States)

    Spencer, Julianne; Fitch, Emily; Iaizzo, Paul A

    2013-01-01

    A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT)(1) Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter. CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT(2). Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation. We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our

  20. Compression Stockings for Treating Venous Leg Ulcers

    Directory of Open Access Journals (Sweden)

    J. P. Benigni

    2013-01-01

    Full Text Available Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle. Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommended pressures whereas Jobst’s Ulcer Care kit does not for treating a venous leg ulcer. Jobst’s Ulcer Care transmits entirely the pressure in relation to a friction index close to 1. Conclusion. This antiulcer kit study underlines that in vivo and in vitro pressures can be different (Jobst’s Ulcer Care kit and Mediven Ulcer kit. In order not to lose pressure, it is important to take into account the friction index when superimposing two stockings.

  1. The cerebral venous system and hypoxia.

    Science.gov (United States)

    Wilson, Mark H; Imray, Christopher H E

    2016-01-15

    Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static "Monro-Kellie" doctrine, which forms the basis of the "Tight-Fit" hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure. PMID:26294747

  2. Do we have to anticoagulated patients with cerebral venous thrombosis?

    DEFF Research Database (Denmark)

    Feher, G; Illes, Z; Hargroves, D; Komoly, S

    2016-01-01

    INTRODUCTION: Cerebral venous thrombosis (CVT) is a rare form of venous thromboembolism (VTE). Although anticoagulation is recommended for the initial and long term treatment with regards to thrombotic risks for patients with CVT, the role of anticogalution has not been fully elucidated. The aim of...

  3. Septic Mesenteric Venous Thrombophlebitis: A Rare Complication of Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Stylianos Kykalos

    2011-01-01

    Full Text Available Mesenteric venous thrombophlebitis represents a very rare complication of acute appendicitis. Based on the findings of a 45-year-old patient with mesenteric venous thrombophlebitis due to acute appendicitis, we herein describe the diagnostic difficulties and therapeutic options in this uncommon disease. The treatment in our case consisted of simple appendectomy and perioperative anticoagulation therapy.

  4. Occult pulmonary embolism: a common occurrence in deep venous thrombosis

    International Nuclear Information System (INIS)

    Ventilation-perfusion scans were used in a prospective study to determine the prevalence of occult pulmonary embolus in proven deep venous thrombosis. Fifty-eight patients without symptoms of pulmonary embolism, but with venographically proven deep venous thrombosis, were subjected to chest radiographs, /sup 99m/Tc macroaggregated-albumin perfusion scans, and 133Xe ventilation scans. Of the 49 patients with deep venous thrombosis proximal to the calf veins, 17 (35%) had high-probability scans. Of all 58 patients, only 12 (21%) had normal scans. When the study population was compared with a group of 430 patients described in reports of pulmonary perfusion in asymptomatic persons, a significantly higher percentage of high-probability scans was found in the study population with deep venous thrombosis. Baseline ventilation-perfusion lung scanning is valuable for patients with proven above-knee deep venous thrombosis

  5. Functional total anomalous pulmonary venous connection via levoatriocardinal vein.

    Science.gov (United States)

    Hayashi, Taiyu; Ozawa, Katsusuke; Sugibayashi, Rika; Wada, Seiji; Ono, Hiroshi

    2016-07-01

    We report a fetal case of double outlet right ventricle, mitral atresia, and intact atrial septum. Although the pulmonary veins were connected to the left atrium, pulmonary venous blood drained into the right superior vena cava via the stenotic levoatriocardinal vein (LACV), which resulted in a circulation resembling total anomalous pulmonary venous connection (TAPVC) with pulmonary venous obstruction. Since the pulmonary veins were connected to both the stenotic LACV and the "dead-end" left atrium, the pulmonary venous flow had a to-and-fro pattern along with atrial relaxation and contraction. Postnatal echocardiography and computed tomography confirmed the diagnosis of normally connected but anomalously draining pulmonary veins via the LACV. Surgical creation of an atrial septal defect on the day of birth successfully relieved pulmonary venous obstruction. Normally connected but anomalously draining pulmonary veins via the LACV should be considered for TAPVC differential diagnosis in fetuses with a left-side heart obstruction. PMID:27460400

  6. Impact of Large-Scale Wind Power Centralized Access on System Short-Circuit Current%大规模风电集中接入对系统短路电流的影响分析

    Institute of Scientific and Technical Information of China (English)

    周专; 吕盼; 宋新甫; 张增强; 刘建亮

    2015-01-01

    Large-scale wind power centralized access to the power grid caused many problems, such as short-circuit current, equipment selec-tion and mode of operation at middle and low voltage side in booster station etc. Through the different wind turbine generator models (dual-fed and direct drive) and single wind turbine generator of different capacity, this paper analyzed the system short-circuit current. Based on wind tur-bines short-circuit PMU recorded wave curve and wind turbine generator model short-circuit simulation curve, this paper proposed an engineer-ing calculation method to calculate the different models and capacity wind turbine generator equivalent subtransient reactance. Combining with the theoretical calculation model of short-circuit current, this paper analyzed the system short-circuit current provided by the single wind farm and wind power centralized station. The result shows that the large-scale wind power centralized access provides the un-neglected short-circuit current for the system.%规模化风电集中接入电网,将对系统提供一定的短路电流,影响设备选型、升压站中低压侧的运行方式等.通过对不同风电机组型号(双馈式和直驱式)及不同容量的单个风电机组对系统提供的短路电流分析,根据风电机组短路PMU录波曲线和风电机组模型短路仿真曲线,提出了一种工程计算方法,计算出不同型号和不同容量的风电机组等值次暂态电抗,并结合短路电流理论计算模型,分析单个风电场以及风电汇集站对系统提供的短路电流,结果表明,规模化风电的集中接入,对系统提供的短路电流不可忽略.

  7. Migraine-like headache in cerebral venous sinus thrombosis.

    Science.gov (United States)

    Tan, Funda Uysal; Tellioglu, Serdar; Koc, Rabia Soylu; Leventoglu, Alev

    2015-01-01

    A 20-year-old female, university student presented with severe, throbbing, unilateral headache, nausea and vomiting that started 2 days ago. The pain was aggravated with physical activity and she had photophobia. She had been taking contraceptive pills due to polycystic ovary for 3 months. Cranial computed tomography was uninformative and she was considered to have the first attack of migraine. She did not benefit from triptan treatment and as the duration of pain exceeded 72 h further imaging was done. Cranial MRI and MR venography revealed a central filling defect and lack of flow in the left sigmoid sinus caused by venous sinus thrombosis. In search for precipitating factors besides the use of contraceptive pills, plasma protein C activity was found to be depressed (42%, normal 70-140%), homocystein was minimally elevated (12.7 μmol/L, normal 0-12 μmol/L) and anti-cardiolipin IgM antibody was close to the upper limit. PMID:25666780

  8. Magnetic Resonance Imaging in Ischemic Stroke and Cerebral Venous Thrombosis.

    Science.gov (United States)

    Krieger, Daniel A; Dehkharghani, Seena

    2015-12-01

    Imaging is indispensable in the evaluation of patients presenting with central nervous system emergencies. Although computed tomography (CT) is the mainstay of initial assessment and triage, magnetic resonance imaging (MRI) has become vital in expanding diagnostic capabilities, refining management strategies, and developing our understanding of disease processes. Ischemic stroke and cerebral venous thrombosis are 2 areas wherein MRI is actively revolutionizing patient care. Familiarity with the imaging manifestations of these 2 disease processes is crucial for any radiologist reading brain MR studies. In this review, the fundamentals of image interpretation will be addressed in-depth. Furthermore, advanced imaging techniques which are redefining the role of emergency MRI will be outlined, with a focus on the pathophysiological mechanisms that underlie image interpretation. In particular, emerging data surrounding the use of MR perfusion imaging in acute stroke management portend dramatic shifts in neurointerventional management. To this end, a review of the recent stroke literature will hopefully enhance the radiologist's role in both meaningful reporting and multidisciplinary teamwork. PMID:26636639

  9. Association of Genetic Polymorphisms of Renin–Angiotensin–Aldosterone System-Related Genes with Arterio-Venous Fistula Malfunction in Hemodialysis Patients

    OpenAIRE

    Chen, Yu-Wei; Wu, Yu-Te; Lin, Jhin-Shyaun; Yang, Wu-Chang; Hsu, Yung-Ho; Lee, Kuo-Hua; Ou, Shou-Ming; Chen, Yung-Tai; Shih, Chia-Jen; Lee, Pui-Ching; Chan, Chia-Hao; Chung, Ming-Yi; Lin, Chih-Ching

    2016-01-01

    Hemodialysis (HD) is the most commonly-used renal replacement therapy for patients with end-stage renal disease worldwide. Arterio-venous fistula (AVF) is the vascular access of choice for HD patients with lowest risk of infection and thrombosis. In addition to environmental factors, genetic factors may also contribute to malfunction of AVF. Previous studies have demonstrated the effect of genotype polymorphisms of angiotensin converting enzyme on vascular access malfunction. We conducted a m...

  10. The dynamics of venous return and response to hypervolemia in the toad, Bufo marinus (L.

    Directory of Open Access Journals (Sweden)

    Toews Daniel P

    2001-10-01

    Full Text Available Abstract Background Venous return from the posterior region of amphibians travels by either two renal portal veins to the kidney or a central abdominal vein that drains into the hepatic portal system. The relative proportions of blood flow in these vessels has never been measured nor has a modification of flow been determined when venous return increases by changes in blood volume during hypervolemia or during increased volume input from the posterior lymph hearts. Results Venous return from the posterior region of Bufo marinus was measured under resting conditions and in response to a systemic hypervolemia. Doppler flow probes were positioned on the renal portal and ventral abdominal veins, and flow was recorded as injections of artificial plasma equaling 100% of the animal's plasma volume were administered through the sciatic artery. Resting flow was found to be 5.54 ± 2.03 ml min-1 kg-1 in the paired renal portal veins, and 7.31 ± 0.89 ml min-1 kg-1 in the ventral abdominal vein. While renal portal flow was found to increase by a factor of 2.4 times during the first 10 min of hypervolemia, ventral abdominal flow only increased by a factor of 1.3. Conclusions Our results quantify the contribution to circulation from posterior venous return in the toad Bufo marinus. A preferential movement of excess fluid through the renal portal pathway was also demonstrated, supporting the possibility of water elimination via the renal portal circulation, especially during periods of high water influx into the animals.

  11. Improvements of venous tone with pycnogenol in chronic venous insufficiency: an ex vivo study on venous segments.

    Science.gov (United States)

    Belcaro, Gianni; Dugall, Mark; Luzzi, Roberta; Hosoi, M; Corsi, Marcello

    2014-03-01

    This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects that had not used the supplement) were compared with normal, unused vein segments harvested for bypass grafting. The segments were suspended and a weight was attached to the distal part of the veins for 3 minutes and dilated with pressurized water. Digital images were recorded; the veins were measured before and after stretching to evaluate elongation. The manipulation of the vein segment was minimal. Tests were completed within 20 minutes after harvesting the veins. All segments were 4 cm long. The stretching test indicated a significantly higher level of passive elongation in control, varicose segments (2.29; 0.65 mm) in comparison with 1.39; 0.2 mm in vein segments from Pycnogenol-using patients. The dilation test showed an average higher dilation (2.19; 0.3 mm) in control varicose veins in comparison with varicose veins from Pycnogenol-using patients (1.32; 0.7 mm) (p Pycnogenol-using subjects (p Pycnogenol. Varicose segments had a more significant persistent dilatation and elongation in comparison with normal vein segments. Pycnogenol seems to decrease passive dilatation and stretching and gives vein walls a greater tonic recovery and elasticity that allows the vein to recover its original shape after dynamic stresses. PMID:24627617

  12. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  13. [Ambulatory treatment of deep venous thrombosis].

    Science.gov (United States)

    Metz, D; Hezard, N; Brasselet, C

    2001-11-01

    Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation. PMID:11794978

  14. [The diagnostic scores for deep venous thrombosis].

    Science.gov (United States)

    Junod, A

    2015-08-26

    Seven diagnostic scores for the deep venous thrombosis (DVT) of lower limbs are analyzed and compared. Two features make this exer- cise difficult: the problem of distal DVT and of their proximal extension and the status of patients, whether out- or in-patients. The most popular score is the Wells score (1997), modi- fied in 2003. It includes one subjective ele- ment based on clinical judgment. The Primary Care score 12005), less known, has similar pro- perties, but uses only objective data. The pre- sent trend is to associate clinical scores with the dosage of D-Dimers to rule out with a good sensitivity the probability of TVP. For the upper limb DVT, the Constans score (2008) is available, which can also be coupled with D-Dimers testing (Kleinjan). PMID:26502582

  15. Venous thrombosis after cardiac catheterization in infants

    International Nuclear Information System (INIS)

    Factors influencing the rate of post-catheterization venous thrombosis were studied in 180 infants below one year of age. The initial cardiac catheterization was performed either with cutdown technique or percutaneously. At repeat catheterization on the ipsilateral side presence or absence of thrombosis was noted. The overall thrombosis frequency was higher than previously reported, 15.6%. The rate increased with decreasing weight. An increased rate of thrombosis was also found with indwelling femoral vein catheter left in place for more than 24 hours, and infection. In 6 cases, thrombosis involved only the catheterized side and would have been missed by recatheterization from the contralateral side. It was noteworthy that 9 of the thromboses spared the catheterized vessel and engaged only the vena cava. Among factors not influencing thrombosis rate were age, type of cardiac malformation, cyanosis, early operation, catheterization time or balloon septostomy. Percutaneous or cutdown technique did not influence thrombosis rate. (orig.)

  16. Cerebral venous anomalies: Clinical significance of so-called venous angioma

    International Nuclear Information System (INIS)

    In contrast to angiography, MRI not only allows the diagnosis of DVA (developmental venous anomaly, so-called venous angioma), but also shows up cavernomas and other angiographically occult vascular malformations. It also differentiates between DVAs and occult true malformations. This has completely changed the pathological assessment of DVAs. In a retrospective study on 31 patients with angiographically proven DVAs neighbouring cavernoma was a frequent finding (15 patients, 48% group I). Symptoms caused by cavernoma were present in 6 (40%) of these 15 patients. The following associations were also found: Cerebral arterial aneurysm (2), spinal arterio-venous dural fistula (1), dermal haemangioma (1), Klippel-Trenauny syndrome (1). Only 16 (52%) of the 31 cases with DVA were free of associated cavernoma (group II). Only 3 (19%) of these patients with a solitary DVA were symptomatic. In our series we have seen no case of bleeding from a DVA. A DVA is a vascular anomaly characterized, like other anomalies, by reduced resistance and limited capacity for regulation and adaptation. In rare cases this can result in haemodynamic disturbances, thrombosis and ischaemia. Wall rupture with bleeding does not occur in DVA. It must be assumed that bleeding reported in patients with DVAs before the availability of MRI resulted from an associated true vascular malformation in most cases. (orig.)

  17. Statins and prevention of venous thromboembolism: Myth or reality?

    Science.gov (United States)

    Gaertner, Sébastien; Cordeanu, Eléna-Mihaela; Nouri, Salah; Mirea, Corina; Stephan, Dominique

    2016-03-01

    The pleiotropic effects of statins, beyond their cholesterol-lowering properties, are much debated. In primary prevention, several observational cohort and case-control studies appear to show that statins reduce the incidence of venous thromboembolism by about 30%. In a single randomized placebo-controlled clinical trial (JUPITER), which included 17,000 patients, rosuvastatin 20mg/day reduced the risk of venous thromboembolism by 43%. However, these patients were at low risk of venous thromboembolism, and the frequency of the event was, in principle, low. In secondary prevention, several observational studies and post-hoc analyses of randomized clinical trials have suggested that statins may prevent recurrence of venous thromboembolism. However, none of these studies had enough scientific weight to form the basis of a recommendation to use statins for secondary prevention. The putative preventive effect of statins appears to be independent of plasma cholesterol concentration and could be a pharmacological property of the statin class, although a dose-effect relationship has not been demonstrated. The mechanism through which statins might prevent venous thrombosis is thought to involve their anti-inflammatory and antioxidant effects or perhaps a more specific action, by blocking the degradation of antithrombotic proteins. A mechanism involving the action of statins on interactions between risk factors for atherosclerosis and venous thromboembolism is supported by some studies, but not all. In the absence of firm evidence, statins cannot currently be recommended for primary or secondary prevention of venous thromboembolism. PMID:26778087

  18. Hepatic venous pressure gradients measured by duplex ultrasound

    International Nuclear Information System (INIS)

    AIMS: The hepatic venous pressure gradient is a major prognostic factor in portal hypertension but its measurement is complex and requires invasive angiography. This study investigated the relationship between the hepatic venous pressure gradient and a number of Doppler measurements, including the arterial acceleration index. METHOD: We measured the hepatic venous pressure gradient in 50 fasting patients at hepatic venography. Immediately afterwards, a duplex sonographic examination of the liver was performed at which multiple measurements and indices of the venous and arterial hepatic vasculature were made. RESULTS: Hepatic arterial acceleration was correlated directly with the hepatic venous pressure gradient (r = 0.83, P -2 provided a positive predictive value of 95%, a sensitivity of 65% and a specificity of 95% for detecting patients with severe portal hypertension (hepatic venous pressure gradient > 12 mmHg). A correlation between the hepatic venous pressure gradient and the congestion index of the portal vein velocity (r = 0.45,P = 0.01) and portal vein velocity (r = 0.40,P = 0.044), was also noted. CONCLUSION: Measuring the hepatic arterial acceleration index may help in the non-invasive evaluation of portal hypertension. Tasu, J.-P. et al. (2002)

  19. Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis

    International Nuclear Information System (INIS)

    The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis

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

    Directory of Open Access Journals (Sweden)

    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.