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Sample records for central venous cannulation

  1. An unusual Complication of Central Venous Cannulation

    Directory of Open Access Journals (Sweden)

    Ashvini Kumar

    2013-04-01

    Full Text Available Central venous catheter (CVC hub fracture is a rare complication of central venous cannulation. We report a case where catheter hub fracture was detected immediately after CVC insertion. Causes of catheter hub fracture and its complications are discussed.

  2. 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

  3. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

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    Suresh Babu Kale

    2013-01-01

    Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

  4. Central venous cannulation: are routine chest radiographs necessary after B-mode and colour Doppler sonography check?

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    Lanza, Cecilia; Fabrizzi, Giancarlo [Pediatric Radiology Department-Presidio Salesi, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona (Italy); Russo, Marco [Ospedale Civile Engles Profili, Servizio di Radiologia, Ancona (Italy)

    2006-12-15

    After the insertion of a central venous catheter, a chest radiograph is usually obtained to ensure correct positioning of the catheter tip. To determine in a paediatric population whether B-mode and colour Doppler sonography after central venous access is useful to evaluate catheter position, thus obviating the need for a postprocedural radiograph. A prospective study of 107 consecutive central venous access procedures placed in a paediatric intensive care unit was performed. At the end of the procedure, B-mode and colour Doppler sonography were used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients. In 96 patients postprocedural B-mode and colour Doppler sonography showed colour Doppler signals within the vena cava. Among the 11 patients predicted to have a potential complication, there was one pneumothorax and ten malpositions. Chest radiography showed a total of 13 complications - 1 pneumothorax and 12 malpositions. The concordance between colour Doppler sonography and chest radiography was 98.1% in the detection of catheter position; sonography had a sensitivity of 84.6% and a specificity of 100%. The close concordance between B-mode and colour Doppler sonography and chest radiography justifies the more frequent use of sonography to evaluate catheter position because ionizing radiation is eliminated. Chest radiography may then be performed only when there is suspected inappropriate catheter tip position after sonography. (orig.)

  5. Effects of smoking on venous cannulation pain: a randomized prospective trial

    OpenAIRE

    Volkan Hanci; Hasan Ali Kiraz; Dilek Ömür; Serpil Ekin; Berna Uyan; Derya Arslan Yurtlu; Serhan Yurtlu

    2015-01-01

    BACKGROUND AND OBJECTIVES: It has been demonstrated that smoking increases pain perception; however the effect of smoking on perception of pain during venous cannulation is not known. The purpose of this study is to determine whether or not smoking has an effect on pain perception due to peripheral venous cannulation. METHODS: 220 patients scheduled to have elective ...

  6. Effects of smoking on venous cannulation pain: a randomized prospective trial

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    Volkan Hanci

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: It has been demonstrated that smoking increases pain perception; however the effect of smoking on perception of pain during venous cannulation is not known. The purpose of this study is to determine whether or not smoking has an effect on pain perception due to peripheral venous cannulation. METHODS: 220 patients scheduled to have elective surgery were enrolled in the study and were divided into two groups (Group S and C, n = 110 for each according to their smoking habits. Numerical rating scale was introduced to the patients and then peripheral venous cannulation at the dorsum of the hand was made with a 20 G intracath. Pain perception of the patients was scored by subsequent numerical rating scale questioning. RESULTS: The demographic characteristics of the groups were identical. Numerical rating scale scores in Group S and C were 3.31 ± 1.56 and 1.65 ± 1.23, respectively (p < 0.001. CONCLUSION: Pain perception due to peripheral venous cannulation is higher in smokers. Future studies on pain treatment should consider the smoking habits of patients.

  7. Venous cannulation and topical ethyl chloride in patients receiving nitrous oxide.

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    Crecelius, C.; Rouhfar, L.; Beirne, O. R.

    1999-01-01

    The purpose of this study was to evaluate the effect of ethyl chloride spray on the anxiety and pain associated with placing an intravenous catheter in patients sedated with nitrous oxide. Eighty-eight patients scheduled for dental surgery with a combination of intravenous and nitrous oxide sedation were randomly assigned to have ethyl chloride spray or a placebo, water spray, applied before cannulation of a vein. Anxiety and pain were reported using a 10.0-cm visual analog scale before nitrous oxide administration, after nitrous oxide sedation, following application of the spray, and following venous cannulation. The first 2 assessments measured overall levels of patient anxiety and pain and confirmed that nitrous oxide sedation reduced anxiety without changing already low levels of pain. The second 2 assessments of anxiety and pain measured the reaction toward the spray and cannulation. The application of ethyl chloride spray produced significantly more anxiety and pain than did the placebo. The results of this study demonstrate that ethyl chloride spray does not significantly reduce the anxiety and pain associated with venous cannulation in patients sedated with nitrous oxide. PMID:11692346

  8. Ultrasound Guided Internal Jugular Venous Cannulation: Comparison with Land-Mark Technique

    International Nuclear Information System (INIS)

    Objective: To compare real-time ultrasonography-guided technique versus the traditional land-mark technique for internal Jugular venous cannulation. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital, Rawalpindi, from September 2013 to July 2014. Methodology:Atotal of 200 patients who required internal jugular vein cannulation were randomly assigned using either real-time ultrasound-guided technique or land-mark technique. Access time, number of attempts until successful cannulation, complications and the demographics of each patient were recorded. Results:Access time was significantly less in real-time ultrasound group (34.95 ± 11.47 vs. 146.59 ± 40.20 seconds, p < 0.001). Cannulation was performed in first attempt in 99 percentage of patients in ultrasound group as compared to 89 percentage of landmark group. Complication rate was significantly higher in the land-mark group than in the ultrasound-guided group. Carotid artery puncture rate (9 percentage vs. 1 percentage) and haematoma formation (7 percentage vs. 0 percentage) were more frequent in the land-mark group than in the ultrasound-guided group. Brachial plexus irritation was also more in land-mark group (6 percentage vs. 0 percentage). Conclusion:Access time, failure rate and procedure related complications are reduced when real-time ultrasonography is used to cannulate internal Jugular vein. (author)

  9. Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: A prospective observational study of 1,978 consecutive catheterizations

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    Gorgni Silvia

    2010-10-01

    Full Text Available Abstract Background A central venous catheter (CVC currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US guidance and to confirm its utility in clinical practice in cancer patients. Methods Consecutive adult patients attending the oncology-hematology department were eligible if they had solid or hematologic malignancies and required CVC insertion. Four types of possible complication were defined a priore: mechanical, thrombotic, infection and malfunctioning. The patient was placed in Trendelenburg's position, a 7.5 MHZ puncturing US probe was placed in the supraclavicular site and a 16-gauge needle was advanced under real-time US guidance into the last portion of internal jugular vein. The Seldinger technique was used to place the catheter, which was advanced into the superior vena cava until insertion into right atrium. Within two hours after each procedure, an upright chest X-ray and ultrasound scanning were carried out to confirm the CVC position and to rule out a pneumotorax. CVC-related infections, symptomatic vein thrombosis and malfunctioning were recorded. Results From December 2000 to January 2009, 1,978 CVC insertional procedures were applied to 1,660 consecutive patients. The procedure was performed 580 times in patients with hematologic malignancies and 1,398 times those with solid tumors. A single-needle puncture of the vein was performed on 1,948 of 1,978 procedures (98.48%; only eighteen attempts among 1,978 failed (0.9%. No pneumotorax, no major bleeding, and no nerve puncture were reported; four cases (0.2% showed self-limiting hematomas. The mean lifespan of CVC was 189

  10. The effects of venous cannulation technique and cardioplegia type on plasma potassium concentration and arterial blood pressure during cardiopulmonary bypass.

    LENUS (Irish Health Repository)

    Coleman, E T

    2012-02-03

    The cannulation method and cardioplegia solution used during cardiopulmonary bypass (CPB) may both influence plasma potassium concentrations ([K+]) and mean arterial blood pressure (MAP). Bi-caval or right atrial cannulation methods are routinely used in conjunction with crystalloid or blood cardioplegia. We investigated the influence of cannulation method and cardioplegia solutions on plasma [K+] and MAP during cardiopulmonary bypass. Sixty consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were studied. They were randomly divided into three groups of 20 patients. Patients in Group A underwent bi-caval venous cannulation and received crystalloid cardioplegia. Group B patients underwent right atrial cannulation and received crystalloid cardioplegia. Group C patients underwent right atrial cannulation and received blood cardioplegia. In each case. cardioplegia was administered antegrade via the aortic root. Plasma [K+], MAP. and hemoglobin concentration (Hb) were measured over an 8-min period following cardioplegia administration (pilot studies indicated pressure changes occuring post cardioplegia administration up to this time). The combination of bi-caval cannulation and crystalloid cardioplegia (Group A) was associated with the least increase in plasma [K+] and no decrease in MAP. The maximum [K+] for this Group was 4.2 mmol\\/L (4.6% increase). The minimum mean pressure was 57 mmHg (13.6% increase). Both right atrial cannulation groups (B and C) showed a large rise in plasma [K+] and a decrease in MAP. Group B maximum [K+] was 5.2 mmol\\/L (27.5% increase). Group C was also 5.2 mmol\\/L (26.0% increase). Group C showed the largest pressure decrease, the minimum mean pressure was 45 mmHg (21.3% decrease). The Group B minimum mean pressure was 45 mmHg (8.7% decrease). Our results show that patients undergoing CPB operations who are deemed to be at increased risk of suffering adverse effects from hypotensive episodes may

  11. Central venous line - infants

    Science.gov (United States)

    CVL - infants; Central catheter - infants - surgically placed ... plastic tube that is put into a large vein in the chest. WHY IS A ... central catheter (PICC) or midline central catheter (MCC). A CVL ...

  12. Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

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    Bucsky, Bence S.; Richardt, Doreen; Petersen, Michael; Sievers, Hans H.

    2016-01-01

    Background The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Methods Between January 2003 and December 2015, 235 patients underwent repair of AADA. All patients were evaluated for the type of arterial cannulation (femoral vs. central) for initial bypass. Demographic data and outcome parameters were accessed. Results One hundred and twenty seven (54.0%) were initially cannulated in the central aortic vessels (ascending aorta or subclavian/axillary artery) and 108 (46.0%) in the femoral artery. Patients were comparable between age (62.4±14.4 vs. 62.9±14.4 years, P=0.805), gender (male, 62.2 vs. 69.4%, P=0.152) and previous sternotomy (15.7 vs. 16.7%, P=0.861) between both cannulation groups; while EuroSCORE I (11.5±4.0 vs. 12.7±4.2, P=0.031) and ASA Score (3.5±0.81 vs. 3.8±0.57, P=0.011) were significantly higher in the femoral artery cannulation group. Bypass (249±102 vs. 240±81 min, P=0.474), X-clamp (166±85 vs. 157±67 min, P=0.418) and circulatory arrest time (51.6±28.7 vs. 48.3±21.7 min, P=0.365) were similar between the groups as were lowest temperature (18.1±2.0 vs. 18.1±2.2, P=0.775). Postoperative neurologic deficit and 30-day mortality were comparable between both cannulation groups (11.7 vs. 7.2%, P=0.449 and 20.2 vs. 16.9%, P=0.699, central vs. peripheral cannulation). Multivariate analysis revealed only EuroScore I above 13 as single preoperative predictor for mortality. Conclusions AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique.

  13. Transpleural central venous catheter discovered during thoracotomy

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    Ashima Malhotra

    2014-01-01

    Full Text Available 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 secured surgically.

  14. Forty-five-degree two-stage venous cannula: advantages over standard two-stage venous cannulation.

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    Lawrence, D R; Desai, J B

    1997-01-01

    We present a 45-degree two-stage venous cannula that confers advantage to the surgeon using cardiopulmonary bypass. This cannula exits the mediastinum under the transverse bar of the sternal retractor, leaving the rostral end of the sternal incision free of apparatus. It allows for lifting of the heart with minimal effect on venous return and does not interfere with the radially laid out sutures of an aortic valve replacement using an interrupted suture technique.

  15. Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein

    OpenAIRE

    Gentle Sunder Shrestha; Arjun Gurung; Sabin Koirala

    2016-01-01

    Context: Real-time ultrasound guidance for internal jugular (IJ) vein cannulation enhances safety and success. Aims: This study aims to compare the long- and short-axis (LA and SA) approaches for ultrasound-guided IJ vein cannulation. Subjects and Methods: Patients undergoing surgery and in intensive care unit requiring central venous cannulation were randomized to undergo either LA or SA ultrasound-guided cannulation of the IJ vein by a skilled anesthesiologist. First pass success, the numbe...

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

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    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

  17. Extra corporal membrane oxygenation in general thoracic surgery: a new single veno-venous cannulation

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    Kanaan Reem

    2011-04-01

    Full Text Available Abstract Extracorporeal membrane oxygenation (ECMO is used in severe respiratory failure to maintain adequate gas exchange. So far, this technique has not been commonly used in general thoracic surgery. We present a case using ECMO for peri-operative airway management for pulmonary resection, using a novel single-site, internal jugular, veno-venous ECMO cannula.

  18. Entrapment of guidewire during central venous catheterization

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    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

  19. Subclavian Vein Cannulation Success Rate in Neonates and Children

    Science.gov (United States)

    Aminnejad, Reza; Razavi, Seyed Sajjad; Mohajerani, Seyed Amir; Mahdavi, Seyed Alireza

    2015-01-01

    Background: Central vein cannulation allows the administration of large volumes of fluids in short times and at high osmolarities for rehydration, volume replacement, chemotherapy, and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short-term venous access in children. Objectives: The aim of our study was to delineate some aspects of this procedure as well as its success rate and relative risk in pediatrics. Patients and Methods: Totally, 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful catheterization attempts and early complication rates after the procedure retrospectively in Mofid Hospital (Tehran, Iran). Results: There were 1340 newborn patients (first 28 days of life) in our study population. In these newborns, only 55 cannulations failed; one patient was complicated with pneumothorax; guide wires malfunctioned in 21 cases; and first- attempt cannulation success was reported in only 981 cases. In the remaining 1924 patients, between one month and 8 years old, only 14 attempts at the cannulation of the subclavian vein failed and 1655 cases had first-attempt cannulation success. Conclusions: The cannulation of the central vein in neonates and children in a skilled hand would be performed with great success rate and low complications. PMID:26161322

  20. Infections associated with the central venous catheters.

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

    2014-01-01

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

  1. Accidental Carotid Artery Cannulation Detected by Bedside Ultrasound

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    Chiles, Kris

    2011-02-01

    Full Text Available This report highlights the importance of using bedside ultrasound in the emergency department to confirm guide-wire placement when performing central venous catheter placement prior to dilating and cannulating the vessel. [West J Emerg Med. 2011;12(1:100-101.

  2. 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.

  3. The use of central venous cannulae in neuroanaesthesia. A survey of current practice in the UK.

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    Mills, S J; Tomlinson, A A

    2001-05-01

    A postal questionnaire was sent to all UK consultant members of the Neuroanaesthesia Society to ascertain whether there was any consensus on indications for use and route of insertion of central venous cannulae in elective neuroanaesthetic practice. Five brief clinical scenarios were presented. Of 179 respondents, 98% indicated that they would insert a central venous cannula into patients requiring excision of an acoustic neuroma in the sitting position, 76% for clipping of an intracranial aneurysm and 75% for resection of an arteriovenous malformation. The antecubital fossa was the preferred route of insertion for 43.5% of respondents with 36.5% preferring the internal jugular approach. The subclavian (17%) and femoral (3%) routes were unpopular first-choice approaches. A significant proportion of respondents (43.5%) do not routinely order a chest X-ray at any stage following pre-operative central venous cannulation. The indications for use and advantages and disadvantages of each route of insertion, with reference to neuro-anaesthetic practice, are discussed. PMID:11350335

  4. 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)....

  5. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriette; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michael A.; Spronk, Peter E.

    2012-01-01

    Objective: The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design: Prospective observational controlled study. Setting: Nonacademic university-affiliated teac

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-08-15

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

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

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    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.

  8. 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.

  9. 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

  10. 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.

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

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

    2008-04-15

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  13. Repositioning of malpositioned or flipped central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Thalhammer, A.; Jacobi, V.; Balzer, J.; Vogl, T.J. [Institute for Diagnostic and Interventional Radiology, Central Radiology Clinic, J.W. Goethe University, Frankfurt am Main (Germany)

    2002-03-01

    Primary misplaced or secondary flipped implanted catheters are located mostly in the right jugular vein. We demonstrate an effective method to replace fix implanted catheters such as Ports, Grochomg or Hickman catheters. Using a femoral venous approach, replacement into the superior vena cava can easily be done with a Sidewinder 1 catheter which is hooked over the misplaced central venous approach. In all our patients the method was successful. The repositioning technique described is simple, fast and has low costs. We can keep sterile conditions and do not need to solve the catheters' fixation. (orig.)

  14. Serious Gaming to Improve the Safety of Central Venous Catheter Placement

    Directory of Open Access Journals (Sweden)

    Daniel Katz

    2013-06-01

    Full Text Available Approximately 5 million central venous catheters (CVCs are placed by physicians annually in the United States, with a complication rate of 15%.1 Guidelines and recommendations are continually being established and updated regarding CVC placement.2 While much has been done regarding training the technical skills of CVC placement using part-task trainers (i.e., mannequins, successfully finding and cannulating a central vein is but one part of the process. In fact, many steps designed to prevent untoward complications involve non-technical skills which are perhaps more important in training practitioners to safely place CVCs. First in aviation and now in healthcare, practitioners are being trained in realistic and highly interactive simulated environments so they can learn not just technical skills , but the key management and non-technical steps which make their task safer.3 One modality being used to improve performance is video gaming simulation, or "serious gaming." Gaming as a learning tool is being increasingly utilized in health care fields and can lead to better skill-based outcomes.4 As such, we have developed a game based around the placement of CVCs that will be used as a new teaching modality in a pilot program for instructing residents in safe CVC placement.

  15. 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

  16. Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

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    Christine Hohl Moinat

    2014-01-01

    Full Text Available Insertion of central venous port (CVP catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE. However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE, or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3% at 3 months, and 11.3% (IC95 9.4–13.2% at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3% at 3 months, and 15.3% (IC95 13.1–17.6% at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

  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. 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

  19. 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.

  20. 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.

  1. Comparison between long- and short-axis techniques for ultrasound-guided cannulation of internal jugular vein

    Directory of Open Access Journals (Sweden)

    Gentle Sunder Shrestha

    2016-01-01

    Full Text Available Context: Real-time ultrasound guidance for internal jugular (IJ vein cannulation enhances safety and success. Aims: This study aims to compare the long- and short-axis (LA and SA approaches for ultrasound-guided IJ vein cannulation. Subjects and Methods: Patients undergoing surgery and in intensive care unit requiring central venous cannulation were randomized to undergo either LA or SA ultrasound-guided cannulation of the IJ vein by a skilled anesthesiologist. First pass success, the number of needle passes, time required for insertion of guidewire, and complications were documented for each procedure. Results: The IJ vein was successfully cannulated in all patients. There are no significant differences between the two groups in terms of gender, diameter of IJ vein, margin of safety, and time required for insertion of guidewire. There was also no significant difference between the two groups in terms of side of IJ vein cannulated, patient on mechanical ventilation, number of skin puncture, number of needle redirections, first pass success, and carotid puncture. However, there is a significant relationship between the diameter of IJ vein with first pass (18.18 ± 4.72 vs. 15.21 ± 4.24; P < 0.004 and margin of safety with of incidence of carotid puncture (12.15 ± 4.03 vs. 6.59 ± 3.13; P < 0.016. Conclusions: Both techniques have similar outcomes when used for IJ vein cannulation.

  2. Knowledge of nursing students about central venous catheters

    Directory of Open Access Journals (Sweden)

    Mlinar Suzana

    2012-01-01

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

  3. 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. 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.

  5. Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

    Energy Technology Data Exchange (ETDEWEB)

    Isfort, Peter; Penzkofer, Tobias; Goerg, Fabian; Mahnken, Andreas H. [University Hospital RWTH Aachen, Aachen(Korea, Republic of)

    2011-10-15

    Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.

  6. [Ultrasound-guided peripheral venous access].

    Science.gov (United States)

    Fuzier, Régis; Rougé, Pierre; Pierre, Sébastien

    2016-02-01

    International guidelines advocate the use of first-line ultrasound for central venous catheter, particularly for the internal jugular vein. The role of ultrasound in peripheral venous access remains questionable. In some specific situations, such as pediatrics, obesity and patients with poor venous network, problems to cannulate peripheral vein may occur. Success rate of peripheral intravenous access increases with the diameter of the vein and for a depth of the vein between 0.3 and 1.5 cm. The type of puncture (long-axis or short-axis) and the type of catheters have little influence on the success rate. Specific considerations have to be taken concerning infection control.

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Mioljević Vesna

    2007-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  10. A Forgotten Guidewire: Complication of Central Venous Catheterization

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    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

  11. 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....

  12. The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure.

    Science.gov (United States)

    Saul, Turandot; Doctor, Michael; Kaban, Nicole L; Avitabile, Nicholas C; Siadecki, Sebastian D; Lewiss, Resa E

    2015-07-01

    The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound-first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location.

  13. Placement of a port catheter through collateral veins in a patient with central venous occlusion.

    Science.gov (United States)

    Teichgräber, Ulf Karl-Martin; Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-01

    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.

  14. Misplaced central venous catheters: applied anatomy and practical management.

    Science.gov (United States)

    Gibson, F; Bodenham, A

    2013-03-01

    Large numbers of central venous catheters (CVCs) are placed each year and misplacement occurs frequently. This review outlines the normal and abnormal anatomy of the central veins in relation to the placement of CVCs. An understanding of normal and variant anatomy enables identification of congenital and acquired abnormalities. Embryological variations such as a persistent left-sided superior vena cava are often diagnosed incidentally only after placement of a CVC, which is seen to take an abnormal course on X-ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after such attempts. Catheters can also be misplaced outside veins in a patient with otherwise normal anatomy with potentially disastrous consequences. We discuss the possible management options for these patients including the various imaging techniques used to verify correct or incorrect catheter placement and the limitations of each. If the course of a misplaced catheter can be correctly identified as not lying within a vulnerable structure then it can be safely removed. If the misplaced catheter is lying within or traversing large and incompressible arteries or veins, it should not be removed before consideration of what is likely to happen when it is removed. Advice and further imaging should be sought, typically in conjunction with interventional radiology or vascular surgery. With regard to misplaced CVCs, in the short term, a useful aide memoir is: 'if in doubt, don't take it out'.

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

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    Kujur Rash

    2009-01-01

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

  16. Life-threatening vascular complications after central venous catheter placement

    Energy Technology Data Exchange (ETDEWEB)

    Wicky, S.; Meuwly, J.-Y.; Doenz, F.; Uske, A.; Schnyder, P.; Denys, A. [Department of Radiology, University Hospital, Lausanne (Switzerland)

    2002-04-01

    The purpose of this retrospective study was to report 11 cases of severe vascular complications after central venous catheter misplacement. For each patient, data collection included body mass index, the diagnosis at admission, the site of the procedure, the type of catheter, coagulation parameters, the imaging modalities performed and the applied treatment. Eight patients had a lesion of the subclavian artery. Brachiocephalic vein perforations were assessed in three more patients. All patients had a chest roentgenogram after the procedure, six a CT examination, and four an angiographic procedure. Seven patients had a body mass index above 30, and 5 patients had coagulation disorders prior to the procedure. Seven patients were conservatively managed, 2 patients died despite resuscitation, 1 patient was treated with a stent graft, and one by superselective embolization. Subclavian or jugular vein temporary catheter positioning is a practical approach. Identification of any iatrogenic perforation of the subclavian artery or central veins urges obtainment a chest roentgenogram and, when required, a chest CT, selective angiograms or venograms. Body mass index superior to 30, previous unsuccessful catheterization attempts, and coagulation factor depletion seemed to account for risk factors. Recognition of clinical and radiological complications is mandatory. (orig.)

  17. Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia

    Science.gov (United States)

    Chakraborty, Arunangshu; Agrawal, Sanjit; Datta, Taniya; Mitra, Suparna; Khemka, Rakhi

    2016-01-01

    Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed. PMID:27695218

  18. How to cannulate?

    DEFF Research Database (Denmark)

    Löhr, J-Matthias; Aabaken, Lars; Arnelo, Urban;

    2012-01-01

    ERCP-endoscopists (>900 ERCPs). The first choice of cannulation is with a sphincterotome and a preinserted wire. Both less experienced and more experienced endoscopists agreed on the criteria to describe a papilla difficult to cannulate and both would choose the needle-knife sphincterotomy (NKS) to get...

  19. JUGULAR CENTRAL VENOUS CATHETER PLACEMENT THROUGH A MODIFIED SELDINGER TECHNIQUE FOR LONG-TERM VENOUS ACCESS IN CHELONIANS.

    Science.gov (United States)

    Pardo, Mariana A; Divers, Stephen

    2016-03-01

    Long-term or repeated venous access in chelonians is difficult to obtain and manage, but can be critically important for administration of medications and blood sampling in hospitalized patients. Jugular catheterization provides the most rapid and secure route for vascular access, but catheters can be difficult to place, and maintaining catheter patency may be challenging. Long multilumen polyurethane catheters provide flexibility and sampling access, and minimize difficulties, such as catheter displacement, that have been encountered with traditional over-the-needle catheters. We describe placement of 4 Fr. 13-cm polyurethane catheters in three chelonians with the use of a modified Seldinger technique. Venous access was obtained with the use of an over-the-needle catheter, which allowed placement of a 0.018-in.-diameter wire, over which the polyurethane catheter was placed. Indwelling time has ranged between 1 and 4 mo currently. All tortoises were sedated for this procedure. Polyurethane central catheters provide safe, long-term venous access that allows clinicians to perform serial blood sampling as well as intravenous administration of medications, anesthetic agents, and fluids. A jugular catheter can also allow central venous pressure measurement. Utilization of central line catheters was associated with improvements in diagnostic efficiency and therapeutic case management, with minimal risks and complications.

  20. 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

  1. Heparin Leakage in Central Venous Catheters by Hemodynamic Transport

    Science.gov (United States)

    Barbour, Michael; McGah, Patrick; Gow, Kenneth; Aliseda, Alberto

    2014-11-01

    Central venous catheters (CVCs), placed in the superior vena cava for hemodialysis, are routinely filled with heparin, an anticoagulant, while not in use to maintain patency and prevent thrombus formation at the catheter tip. However, the heparin-lock procedure places the patient at risk for systemic bleeding incidences, as heparin is known to leak into the blood stream. We propose that the driving mechanism behind heparin leakage is advective-diffusive transport due to the pulsatile blood flow surrounding the catheter tip. This novel hypothesis is based on Planar Laser Induced Fluorescence (PLIF) measurements of heparin transport from a CVC placed inside an in vitro pulsatile flow loop and validated with CFD simulations. The results show an initial, fast (catheter lumen, where concentration is still high, that is insufficient at replenishing the lost heparin at the tip. These results, which estimate leakage rates consistent with published in vivo data, predict that the concentration of heparin at the catheter tip is effectively zero for the majority of the interdialytic phase, rendering the heparin lock ineffective.

  2. 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.

  3. Hemodynamics of Central Venous Catheters: experiments and simulations

    Science.gov (United States)

    Barbour, Michael; McGah, Patrick; Clark, Alicia; Ng, Chin Hei; Gow, Kenneth; Aliseda, Alberto

    2013-11-01

    Central venous catheters (CVC) are used to provide vascular access during hemodialysis in patients with end-stage kidney disease. Despite several advantages and widespread use, CVCs have a high incidence rate of clot formation during the interdialytic phase (48 hrs). In an attempt the prevent clot formation, hospitals routinely administer heparin, an anticoagulant, into the catheter after a dialysis session. It has been reported, however, that up to 40% of the heparin solution will leak into the blood stream during the interdialytic phase, placing the patient at risk for systemic bleeding incidences. The aim of this study is to determine the role that advective-diffusive transport plays in the heparin leaking process. Numerical simulations of heparin convective mass transfer have been conducted, showing that while advective losses may be significant at the tip, previous studies may be overestimating the total amount of heparin leakage. To validate the quantitative prediction from the simulations, P.L.I.F. is used to experimentally measure heparin transport from CVCs placed in an idealized Superior Vena Cava with physically accurate pulsatile flow conditions. Improved understanding of flow near the catheter tip is applied to improve catheter design and heparin locking procedures.

  4. Chronic cannulation for intermittent intravenous fluid administration.

    Science.gov (United States)

    Mostardi, R A; Worsencroft, D; Stern, J; Vanessen, F

    1975-04-01

    A system is described for rapid and effective venous cannulation for long-term administration of fluids in rabbits. This method is completely free of any harness or sling-type apparatus and in no way interferes with the normal mobility of the animal. The animals maintained in this way have participated in programs of tri-weekly administration (2-3 ml/dose) of fluid for as long as 5 mo. PMID:1141108

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  6. 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...

  7. 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...

  8. 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.

  9. Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul [College of Medicine, Soonchunhyang Univ., Chonan (Korea, Republic of)

    2002-04-01

    To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required.

  10. A low-cost reusable phantom for ultrasound-guided subclavian vein cannulation

    Directory of Open Access Journals (Sweden)

    Varun Cheruparambath

    2012-01-01

    Full Text Available Guidelines support the use of ultrasound (US-guided central venous cannulation in the intensive care unit. Traditional techniques based on anatomical landmarks are blind procedures and inexpert USG procedures may be hazardous. Commercially available phantoms for simulation and training are expensive. The technique of making a low-cost reusable gelatin phantom which simulates subclavian vein anatomy is described. Techniques to improve eye-hand skills with this phantom are described. This phantom is easy to make, inexpensive and easily renewable.

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

    Science.gov (United States)

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

    2012-02-01

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

  12. 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.

  13. Interventional radiologic placement of tunneled central venous catheters : results and complications in 557 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chan Kyo; Do, Young Soo; Paik, Chul H. [Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)] (and others)

    1999-05-01

    To evaluate prospectively the results of interventional radiologic placement of tunneled central venous catheters, and subsequent complications. Between April 1997 and April 1998, a total of 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in an interventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23 and transfusion in one. Complications were evaluated prospectively by means of a chart review, chest radiography, central vein angiography and blood/catheter culture. The technical success rate for tunneled central venous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean, 112{+-}4.6) days; Hickman catheters were removed in 252 cases during follow-up. Early complications included 3 cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1 case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 cases of venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%), and 1 case of pseudoaneurysm(0.2%). The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50, respectively. The technical success rate of interventional radiologic placement of tunneled central venous catheters was high. In comparison to conventional surgical placement, it is a more reliable method and leads to fewer complications.

  14. [The concentration of free lidocaine in arterial, central venous and peripheral vein plasma following intravenous injection].

    Science.gov (United States)

    Nolte, H; al Saydali, B; Weissenberg, W

    1990-03-01

    Ten intensive care patients and five healthy volunteers each received a bolus injection of lidocaine HCl (100 mg, 2%) over an injection period of 5 s. After 0.5, 1, 2, 4, 8, 15 and 25 min arterial, central venous and peripheral venous blood samples were collected. In four of the volunteers, arterial and central venous samples were also taken about 10 s after the end of injection. The fluorescence polarization method by means of the Abbott-TDx system was used, and plasma concentrations of lidocaine were determined. The measurements showed that lidocaine levels in central venous plasma 10 s after the end of administration were higher than those in arterial plasma. By 30 s after administration the opposite situation had developed, so that arterial concentrations were higher than those in central venous plasma. This relation did not change throughout the study, though the two levels became closer, as is shown by the ratios (Table 3, Fig. 2). Concentrations in peripheral venous plasma increased more slowly but remained far below those in arterial and central venous plasma, at least for the first 8 min. After 15 min lidocaine levels were almost the same in all three samples. During the entire study there were no ECG changes, and neither heart rate nor blood pressure showed any significant deviation from the values obtained at the beginning. The volunteers had minor toxic manifestations, such as dizziness, tinnitus and a metallic taste in the mouth; one person had a sensation of pressure in his chest, which improved following oxygen administration.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. 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

  16. Durability of central venous catheters. A randomized trial in children with malignant diseases

    DEFF Research Database (Denmark)

    Henneberg, S W; Jungersen, D; Hole, P

    1996-01-01

    In a prospective randomized study the durability of tunnelled and non-tunnelled central venous catheters was investigated in children with malignant diseases. Twenty children were included in the study but four (two in each group) had to be excluded; three because the entry criteria turned out......, respectively. In conclusion cuffed, tunnelled central venous catheters are less prone to displacement than traditional percutaneous central venous catheters when used in children with malignant diseases....... not to be fulfilled and one because of lack of data. The median duration of the tunnelled catheters was 224 days with a range of 25-846 days which was significantly longer than that of conventional catheters (39.5 days, range 9-228 days). In addition six of eight conventional catheters were accidentally removed...

  17. 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.

  18. 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

  19. Comparison between marked versus unmarked introducer needle in real-time ultrasound-guided central vein cannulation: A prospective randomized study

    Science.gov (United States)

    Ghatak, Tanmoy; Singh, Ratender Kumar; Baronia, Arvind Kumar

    2016-01-01

    Introduction: Introducer needle tip is not clearly visible during the real-time ultrasound (US)-guided central vein cannulation (CVC). Blind tip leads to mechanical complications. This study was designed to evaluate whether real-time US-guided CVC with a marked introducer needle is superior to the existing unmarked needle. Methodology: Sixty-two critically ill patients aged 18–60 years of either sex were included in the study. The patients were randomized into two groups based on whether a marked or unmarked introducer needle was used. Both groups underwent real-time US-guided CVC by a single experienced operator. Aseptically, introducer needle was indented with markings spaced 0.5 cm (single marking) and every 1 cm (double marking). This needle was used in the marked group. Approximate depths (centimeter) of the anterior and posterior wall of the internal jugular vein, anterior wall of the internal carotid artery, and lung pleura were appreciated from the midpoint of the probe in short-axis view at the level of the cricoid cartilage. Access time (seconds) was recorded using a stopwatch. A number of attempts and complications such as arterial puncture, hematoma, and pneumothorax of either procedure were compared. Results: Both marked needle and unmarked needle groups were comparable with regard to age, gender, severity scores, platelet counts, prothrombin time, and distance from the midpoint of the probe to the vein, artery, and pleura and skin-to-guide wire insertion access time. However, an average number of attempts (P = 0.03) and complications such as hematoma were significantly lower (P = 0.02) with the marked introducer needle group. Pneumothorax was not reported in any of the groups. Conclusion: Our study supports the idea that marked introducer needle can further reduce the iatrogenic complications of US-guided CVC. PMID:27716692

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  1. Coiling of central venous catheter in the left subclavian vein, a rare complication

    Directory of Open Access Journals (Sweden)

    Vipin Goyal

    2014-01-01

    Full Text Available Invasive monitoring is the need of the hour in today′s scenario in intensive care units and perioperatively in hemodynamically unstable patients. Despite careful placement using proper landmarks and USG guided methods central venous canuulation (CVC is associated sometimes with unforeseen complications. We report a rare complication of coiling of CVC in the left subclavian vein.

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

    Directory of Open Access Journals (Sweden)

    Parikh M

    2011-01-01

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

  3. Preventing central venous catheter-related infection in a surgical intensive-care unit

    NARCIS (Netherlands)

    Bijma, R; Girbes, AR; Kleijer, DJ; Zwaveling, JH

    1999-01-01

    The cumulative effect of five measures (introduction of hand disinfection with alcohol, a new type of dressing, a one-bag system for parenteral nutrition, a new intravenous connection device, and surveillance by an infection control practitioner) on central venous catheter colonization and bacteremi

  4. Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Dharmendra Kumar

    2015-01-01

    Full Text Available Background: Central venous pressure (CVP assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP to see whether it can replace CVP. Aims: To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR in critically ill patients on mechanical ventilation. Setting and Design: Prospective observational study in Intensive Care Unit. Methods: Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°. Statistical Analysis: Pearson′s correlation and Bland-Altman′s analysis. Results: This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004 when the CVP was 10 cmH 2 O. Bland-Altman analysis showed 95% limits of agreement to be −2.912-9.472. Conclusion: PVP can replace CVP for guiding fluid therapy in critically ill patients.

  5. Calcified central venous catheter fibrin sheath: case report and review of the literature.

    Science.gov (United States)

    Keehn, Aryeh; Rabinowitz, Dan; Williams, Steve K; Taragin, Benjamin H

    2015-01-01

    We present a 6-year-old girl with acute lymphoblastic leukemia who demonstrated on chest X-ray a radiopacity in the superior vena cava after removal of an implanted venous access device. This radiopacity was initially thought to be a retained catheter fragment. On review of previous imaging, we were able to document the temporal development of a calcified catheter cast as distinct from the catheter. This case represents a rare consequence of central venous catheterization in children. Knowledge of this finding as a possible complication may help avoid performance of unnecessary follow-up imaging or invasive procedures.

  6. Central venous access for haemodialysis using the Hickman catheter.

    Science.gov (United States)

    Cappello, M; De Pauw, L; Bastin, G; Prospert, F; Delcour, C; Thaysse, C; Dhaene, M; Vanherweghem, J L; Kinnaert, P

    1989-01-01

    One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device. PMID:2516892

  7. Central venous catheterization: comparison between interventional radiological procedure and blind surgical reocedure

    Energy Technology Data Exchange (ETDEWEB)

    Song, Won Gyu; Jin, Gong Yong; Han, Young Min; Yu, He Chul [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2002-11-01

    To determine the usefulness and safety of radiological placement of a central venous catheter by prospectively comparing the results of interventional radiology and blind surgery. For placement of a central venous catheter, the blind surgical method was used in 78 cases (77 patients), and the interventional radiological method in 56 cases (54 patients). The male to female ratio was 66:68, and the patients' mean age was 48 (range, 18-80) years. A tunneled central venous catheter was used in 74 cases, and a chemoport in 60. We evaluated the success and duration of the procedures, the number of punctures required, and ensuing complications, comparing the results of the two methods. The success rates of the interventional radiological and the blind surgical procedure were 100% and 94.8%, respectively. The duration of central catheterization was 3-395 (mean, 120) day, that of chemoport was 160.9 days, and that of tunneled central venous catheter was 95.1 days. The mean number of punctures of the subclavian vein was 1.2 of interventional radiology, and 2.1 for blind surgery. The mean duration of the interventional radiology and the blind surgical procedure was, respectively, 30 and 40 minutes. The postprocedure complication rate was 27.6% (37 cases). Early complications occurred in nine cases (6.7%): where interventional radiology was used, there was one case of hematoma, and blind surgery gave rise to hematoma (n=2), pneumothorax (n=2), and early deviation of the catheter (n=4). Late complications occurred in 32 cases (23.9%). Interventional radiology involved infection (n=4), venous thrombosis (n=1), catheter displacement (n=2) and catheter obstruction (n=5), while the blind surgical procedure gave rise to infection (n=5), venous thrombosis (n=3), catheter displacement (n=4) and catheter obstruction (n=8). The success rate of interventional radiological placement of a central venous catheter was high and the complication rate was low. In comparison with the blind

  8. Long-term central venous lines and their complications; Langfristige zentralvenoese Zugaenge und deren Komplikationsmanagement

    Energy Technology Data Exchange (ETDEWEB)

    Teichgraeber, U.K.M.; Gebauer, B. [Klinik fuer Strahlenheilkunde, Charite Campus Virchow-Klinikum, Berlin (Germany); Benter, T. [Charite Campus Buch im Helios Klinikum Berlin, Robert-Roessle-Klinik, Berlin (Germany); Wagner, J. [Medizinisches Zentrum fuer Radiologie, Klinikum der Philipps-Univ. Marburg (Germany)

    2004-07-01

    The implantation of permanent (>14 days) central venous catheters is constantly increasing, accelerated by a trend toward outpatient therapies. Subcutaneous tunneled and non-tunneled catheters as well as port systems are available. The interventional radiologist plays an important role in the implantation of central venous catheters as well as in detection and treatment of any complications. Various access ways via peripheral and central veins are described and the implantation techniques for the different systems explained. The use of peel-away sheaths allows the radiologist to implant subcutaneous tunneled catheters via the Seldinger technique without surgical preparation. Procedure-related early and late complications may occur, and the radiologist plays an important role in the surveillance and management of catheter-associated complications. This review demonstrates the different catheter systems and implantation techniques. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-07-01

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

  10. Ultrasound-guided cannulation of the internal jugular vein in robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; WANG Gang; GAO Chang-qing

    2013-01-01

    Background Robotic assisted minimally invasive cardiac sugery is a new technique that uses small port sites and peripheral vessel cannulation for cardiopulmonary bypass (CPB) has been used.The right internal jugular vein (IJV)is commonly used for intraoperative venous access to the central circulation and identified with an external landmark.Previous studies have demonstrated the superiority of ultrasound guidance over external landmark technique in anaesthetic and intensive care settings.The aim of the present study was to delineate the utility of ultrasound-guided cannulation of the IJV during establishment of peripheral CPB in robotic cardiac surgery.Methods We prospectively studied 296 adult patients undergoing ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery at our institute from January 2007 to October 2012 (ultrasound group).The success rate,the first attempt success rate,access time and the complication rate of ultrasound-guided method were compared with the landmark-guided method used for 302 historical control patients (landmark group).Results In the ultrasound group,296 consecutive adult patients underwent ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery.In the landmark group,302 patients underwent right IJV cannulation using the landmark-guided technique.The success rate and the first attempt success rate in the ultrasound group were significantly higher than that in the landmark group (100% vs.88.1%,P <0.000 and 98.6% vs.38.4%,P <0.000).Average access time in the ultrasound group was shorter than that in the landmark group ((6.3±13.6) seconds;interquartile range (4-62) seconds vs.(44.5±129.5) seconds; interquartile range (5-986) seconds).The complication rate in the ultrasound group was significantly lower than that in the landmark group (0.3% vs.8.3%,P <0.000).Conclusion Compared with the landmark-guided approach

  11. 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.

  12. Lights, camera and action in the implementation of central venous catheter dressing

    Directory of Open Access Journals (Sweden)

    Maria Verônica Ferrareze Ferreira

    2015-12-01

    Full Text Available Objective: to develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters.

  13. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Su; Kim, Hyung Pil [Inje University Pusan Paik Hospital, Busan (Korea, Republic of); Bae, Jae Ik; Won, Je Hwan [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2010-06-15

    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

  15. 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...

  16. 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...

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

    Science.gov (United States)

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

    2013-12-01

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

  18. 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...

  19. Endovascular treatment of central venous stenosis and obstruction in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    SHI Ya-xue; YE Meng; LIANG Wei; ZHANG Hao; ZHAO Yi-ping; ZHANG Ji-wei

    2013-01-01

    Background Central venous stenosis and obstruction (CVD) is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemodialysis patients.This study aimed to summarize our experience of the endovascular management of the central venous stenosis or obstruction in hemodialysis patients.Methods Twenty-four haemodialysis cases of central vein stenosis or obstruction with ipsilateral functional vascular access in our hospital between July 2006 and February 2012 were treated by interventional therapy and the data were analyzed retrospectively.Results Eighteen males and six females with mean age of (66.4±13.8) years and manifesting with arm swelling and venous hypertension were enrolled; 62.5% of them had a history of catheterization.Venography showed stenotic lesion in 10 cases including eight cases of brachiocephalic vein stenosis and two cases of subclavian vein stenosis and 14 cases of obstruction lesions including seven cases of short brachiocephalic obstruction and seven cases of long segment obstruction.Interventional therapy was performed and the technique success rate was 83.3%.Percutaneous transluminal angioplasty (PTA) was performed in nine cases and stent was performed in 11 cases firstly.The symptoms of venous hypertension were resolved after intervention in all the cases.There was no major complication and death perioperatively.During follow-up,reintervention was done,the primary patency rates were (88.9±10.5)%,(64.8±10.5)% and (48.6±18.7)% at 3 months,6 months and 1 year after treatment in the PTA group; (90.0±9.5)% and (77.1±14.4)% at 6 months and 1 year after treatment in the stent group,respectively.The secondary patency rates were (48.6±18.7)% in the PTA group and (83.3±15.2)% in the stent group 1 year after treatment,respectively.There was no significant difference between the two groups (primary patency,P=0.20; secondary patency,P=0

  20. Optoacoustic monitoring of central and peripheral venous oxygenation during simulated hemorrhage

    Science.gov (United States)

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

    2014-03-01

    Circulatory shock may be fatal unless promptly recognized and treated. The most commonly used indicators of shock (hypotension and tachycardia) lack sensitivity and specificity. In the initial stages of shock, the body compensates by reducing blood flow to the peripheral (skin, muscle, etc.) circulation in order to preserve vital organ (brain, heart, liver) perfusion. Characteristically, this can be observed by a greater reduction in peripheral venous oxygenation (for instance, the axillary vein) compared to central venous oxygenation (the internal jugular vein). While invasive measurements of oxygenation are accurate, they lack practicality and are not without complications. We have developed a novel optoacoustic system that noninvasively determines oxygenation in specific veins. In order to test this application, we used lower body negative pressure (LBNP) system, which simulates hemorrhage by exerting a variable amount of suction on the lower body, thereby reducing the volume of blood available for central circulation. Restoration of normal blood flow occurs promptly upon cessation of LBNP. Using two optoacoustic probes, guided by ultrasound imaging, we simultaneously monitored oxygenation in the axillary and internal jugular veins (IJV). LBNP began at -20 mmHg, thereafter was reduced in a step-wise fashion (up to 30 min). The optoacoustically measured axillary oxygenation decreased with LBNP, whereas IJV oxygenation remained relatively constant. These results indicate that our optoacoustic system may provide safe and rapid measurement of peripheral and central venous oxygenation and diagnosis of shock with high specificity and sensitivity.

  1. 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.

  2. Predicting the optimal depth of left-sided central venous catheters in children.

    Science.gov (United States)

    Kim, H; Jeong, C-H; Byon, H-J; Shin, H K; Yun, T J; Lee, J-H; Park, Y-H; Kim, J-T

    2013-10-01

    The aim of this study was to predict the optimal depth for insertion of a left-sided central venous catheter in children. Using 3D chest computed tomography angiography, we measured the distance from a point where the internal jugular vein is at the superior border of the clavicle, and from a point where the subclavian vein is inferior to the anterior border of the clavicle, to the junction of the superior vena cava and the right atrium in 257 children. Linear regression analysis revealed that the distances correlated with age, weight and height. Simple formulae for the depth of a central venous catheter via the left internal jugular vein (0.07 × height (cm)) and the left subclavian vein (0.08 × height (cm)) were developed to predict placement of the central venous catheter tip at the junction of the superior vena cava with the right atrium. Using these fomulae, the proportion of catheter tips predicted to be correctly located was 98.5% (95% CI 96.8-100%) and 94.0% (95% CI 90.8-97.3%), respectively.

  3. 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

  4. 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

  5. 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

  6. Comparison between noninvasive measurement of central venous pressure using near infrared spectroscopy with an invasive central venous pressure monitoring in cardiac surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    N Sathish

    2016-01-01

    Full Text Available Introduction: Central venous pressure (CVP measurement is essential in the management of certain clinical situations, including cardiac failure, volume overload and sepsis. CVP measurement requires catheterization of the central vein which is invasive and may lead to complications. The aim of this study was to evaluate the accuracy of measurement of CVP using a new noninvasive method based on near infrared spectroscopy (NIRS in a group of cardiac surgical Intensive Care Unit (ICU patients. Methodology: Thirty patients in cardiac surgical ICU were enrolled in the study who had an in situ central venous catheter (CVC. Sixty measurements were recorded in 1 h for each patient. A total of 1800 values were compared between noninvasive CVP (CVPn obtained from Mespere VENUS 2000 CVP system and invasive CVP (CVPi obtained from CVC. Results: Strong positive correlation was found between CVPi and CVPn (R = 0.9272, P < 0.0001. Linear regression equation - CVPi = 0.5404 + 0.8875 × CVPn (r2 = 0.86, P < 0.001, Bland-Altman bias plots showed mean difference ± standard deviation and limits of agreement: −0.31 ± 1.36 and − 2.99 to + 2.37 (CVPi-CVPn. Conclusion: Noninvasive assessment of the CVP based on NIRS yields readings consistently close to those measured invasively. CVPn may be a clinically useful substitute for CVPi measurements with an advantage of being simple and continuous. It is a promising tool for early management of acute state wherein knowledge of CVP is helpful.

  7. 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...

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

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, C.-C.; Tsai, T.-N. [Division of Cardiology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan (China); Yang, C.-C. [Department of Medicine, Armed Forces Tao-Yuan General Hospital, Taoyuan, Taiwan (China); Han, C.-L. [Division of Cardiology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan (China)], E-mail: allexll.cheng@msa.hinet.net

    2009-02-15

    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.

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

    Directory of Open Access Journals (Sweden)

    Arsenijević Ljubica

    2007-01-01

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

  10. 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.

  11. Central venous stenosis in haemodialysis patients without a previous history of catheter placement

    Energy Technology Data Exchange (ETDEWEB)

    Oguzkurt, Levent [Baskent University, Adana Teaching and Medical Research Centre, Department of Radiology, Adana (Turkey)]. E-mail: loguzkurt@yahoo.com; Tercan, Fahri [Baskent University, Adana Teaching and Medical Research Centre, Department of Radiology, Adana (Turkey); Yildirim, Sedat [Baskent University, Adana Teaching and Medical Research Centre, Department of Surgery, Adana (Turkey); Torun, Dilek [Baskent University, Adana Teaching and Medical Research Centre, Department of Nephrology, Adana (Turkey)

    2005-08-01

    Objective: To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Material and methods: Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Results: Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Conclusion: Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

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

    Directory of Open Access Journals (Sweden)

    Mahesh Babu

    2014-01-01

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

  13. Multicenter study in monitoring central venous catheters complications in hematologic patiennts

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.)

  15. To clot or not to clot? That is the question in central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Cadman, A.; Lawrance, J.A.L. E-mail: jeremy.lawrance@btopenworld.com; Fitzsimmons, L.; Spencer-Shaw, A.; Swindell, R

    2004-04-01

    AIM: To establish the relationship between the tip position of tunnelled central venous catheters (CVC) and the incidence of venous thrombosis. MATERIALS AND METHODS: A randomly sampled, retrospective review of 428 CVC inserted into 334 patients was performed. The chest radiograph obtained post-catheter insertion, as well as follow-up radiographs, linograms, venograms and Doppler ultrasounds (US), were reviewed. RESULTS: The median follow-up was 72 days (range 1-720 days), with a total follow-up of 23,040 line days. Venous thrombosis occurred in five out of 191 (2.6%) CVC in a distal position (distal third of the superior vena cava (SVC) or right atrium (RA)), five of 95 (5.3%) in an intermediate position (middle third of the SVC) and 20 of 48 (41.7%) in a proximal position (proximal third SVC or thoracic inlet veins). There was a significant difference in thrombosis rate between lines sited with the tip in a distal compared with a proximal position (p<0.0005). CVC with tips in a proximal position were 16 times more likely to thrombose than those in a distal position. None of the 58 CVC with the tip located in the RA thrombosed or caused complications. CONCLUSION: Distal placement of tunnelled CVC, either in the distal third of the SVC or proximal RA is optimal.

  16. [Ultrasonic guided cannulation of the axillary vein in intensive care patients].

    Science.gov (United States)

    Schregel, W; Höer, H; Radtke, J; Cunitz, G

    1994-10-01

    Cannulation of the axillary vein is claimed to be an effective and relatively safe access to the central venous (CV) system [2, 4, 5, 8]. However, anatomical landmarks recommended for venous location (Muskulus pectoralis minor, processus coracoideus) are probably hard to identify in the majority of intensive care (ICU) patients. This investigation evaluated unidirectional 8 MHz Doppler ultrasound (US) in locating the axillary vein. Success rates and complications of this CV access in ICU patients is analysed. METHODS. The experimental design was approved by the local ethical committee (RUB). In 50 patients from our ICU cannulation of the axillary vein was attempted; all were in need of a CV line. Other CV puncture sites (except for the subclavian vein) were associated with contraindications. Patients were placed in a 15 degrees Trendelenburg position (15 exceptions); the arm was abducted to 45 degrees [5, 8]. The course of the axillary vein was located by Doppler US and marked on the skin with a felt pen. Prior to puncture, US intensity was judged by a score ranging from 0 to 4. After skin desinfection, sterile draping, and local anaesthesia, puncture of the axillary vein was attempted. The puncture kit LeaderCath 11,515 (Vygon, Aachen, FRG) was used. When venous blood could be aspirated, the Seldinger guidewire was inserted and the definite catheter placed. The experimental design allowed up to ten punctures, slightly modified in angle and direction of the needle, if puncture of the axillary vein or guide-wire placement failed. The cannulation attempt was classified as unsuccessful in the following cases: malposition, axillary vein not encountered by the puncture needle, guide-wire placement unsuccessful, or if identification and cannulation of the vein lasted more than 20 min. The puncture attempts were evaluated in respect to success rate, time, relation of US intensity to puncture attempts and CV pressure, complications, and malposition. RESULTS. Of the 50

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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)

  19. Modification of the HeRO Graft Allowing Earlier Cannulation and Reduction in Catheter Dependent Days in Patients with End Stage Renal Disease: A Single Center Retrospective Review

    Directory of Open Access Journals (Sweden)

    Deirdre Hart

    2014-01-01

    Full Text Available After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access.

  20. 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...

  1. When one port does not return blood: two case reports of rare causes for misplaced central venous catheters

    Directory of Open Access Journals (Sweden)

    Sandra Pereira

    2016-02-01

    Full Text Available We present two cases of misplaced central venous catheters having in common theabsence of free blood return from one lumen immediately after placement. The former is acase of right hydrothorax associated with central venous catheterization with the catheter tipin intra-pleural location. In this case the distal port was never patent. In the latter case therewas an increased aspiration pressure through the middle port due to a catheter looping.The absence of free flow on aspiration from one lumen of a central catheter should not beundervalued. In these circumstances the catheter should not be used and needs to be removed.

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

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk [Research Institute and Hospital, National Cancer Center, 809 Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-764 (Korea, Republic of); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)], E-mail: hpark@dreamwiz.com; Kim, Young Il; Lee, Sang Hyun; Kim, Jung Im; Seo, Hyobin; Lee, Sang Min; Lee, Youkyung; Lim, Min Kyung [Research Institute and Hospital, National Cancer Center, 809 Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-764 (Korea, Republic of); Park, Young Suk [Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    Purpose: To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches. Materials and methods: The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n = 7), operation scar (n = 6), radiation scar (n = 5), failure of low jugular vein puncture (n = 2), and abnormal course of right subclavian artery (n = 1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port. Results: The procedure-related complications were all minor (n = 14, 8.6%) in both groups; hematoma (n = 4, 2.8% in low jugular puncture group and n = 1, 4.8% in high jugular puncture group, p = 0.6295), air embolism (n = 2, 1.4% in low jugular puncture group and n = 0 in high jugular puncture group, p = 0.5842) and minor bleeding (n = 5, 3.5% in low jugular vein puncture group and n = 2, 9.5% in high jugular vein puncture group, p = 0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p = 0.0349). The reasons for catheter removal were patients' death (59 in low jugular puncture group and 14 in high jugular puncture group, p = 0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p = 0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p = 0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein

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

    Science.gov (United States)

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

    2014-12-23

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

  4. Central venous-arterial pCO(2) difference as a tool in resuscitation of septic patients

    NARCIS (Netherlands)

    van Beest, Paul A.; Lont, Mariska C.; Holman, Nicole D.; Loef, Bert; Kuiper, Michael A.; Boerma, E. Christiaan

    2013-01-01

    To investigate the interchangeability of mixed and central venous-arterial carbon dioxide differences and the relation between the central difference (pCO(2) gap) and cardiac index (CI). We also investigated the value of the pCO(2) gap in outcome prediction. We performed a post hoc analysis of a wel

  5. Comparison of NHSN-defined central venous catheter day counts with a method that accounts for concurrent catheters.

    Science.gov (United States)

    Talbot, Thomas R; Johnson, James G; Anders, Theodore; Hayes, Rachel M

    2015-01-01

    Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates.

  6. 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.

  7. Central Venous Catheter-Associated Pericardial Tamponade in a 6-Day Old: A Case Report

    Directory of Open Access Journals (Sweden)

    Swati O. Arya

    2009-01-01

    Full Text Available Introduction. Pericardial effusion (PCE and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts. Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space. Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE.

  8. 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...

  9. Central venous catheter-related bloodstream infections in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Harsha V Patil

    2011-01-01

    Full Text Available Context: Central venous catheter-related bloodstream infection (CRBSI is associated with high rates of morbidity and mortality in critically ill patients. Aims: This study was conducted to determine the incidence of central venous catheter-related infections (CRIs and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India. Settings and Design: This was a prospective, observational study carried out in the medical intensive care unit (MICU over a period of 1 year from January to December 2004. Materials and Methods: A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC method. Statistical analysis used SPSS-10 version statistical software. Results: A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22% catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77% catheters were positive on SQC, of which 10 (18.52% were with catheter-associated infection and four (7.41% were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P 3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53 and number of attempts required to put CVC was positively correlated (+0.39 with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20. Staphylococcus epidermidis showed maximum susceptibility to amikacin, doxycycline and amoxycillin with

  10. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Aytekin, Cueneyt E-mail: cuneytaytekin@hotmail.com; Boyvat, Fatih; Yagmurdur, Mahmut Can; Moray, Goekhan; Haberal, Mehmet

    2004-01-01

    Objective: To evaluate the efficacy of stent placement for treating upper extremity central venous obstruction in chronic hemodialysis patients. Methods and Material: Between January 1999 and October 2001, we inserted metallic stents into the upper extremity central veins of 14 patients with shunt dysfunction and/or arm swelling. The indications for stent placement were stenosis or occlusion of the central vein in the upper extremity used for dialysis. Six of the individuals were diagnosed with subclavian vein stenosis, and 5 with brachiocephalic vein stenosis. Of the remaining 3 patients, 2 had subclavian vein occlusion, and 1 had left brachiocephalic vein occlusion. Results: All the stent placement procedures were technically successful, and there were no major complications. Follow-up ranged from 2 weeks to 29 months. The 1-, 3-, 6- and 12-month primary stent patency rates were 92.8, 85.7, 50 and 14.3%, respectively. Repeat interventions, including percutaneous transluminal angioplasty and additional stent placement, were required in 9 patients. The 3-, 6-, 12-month, and 2-year assisted primary stent patency rates were 100, 88.8, 55.5 and 33.3%, respectively. Conclusion: Endovascular stent placement is an effective alternative to surgery in patients with shunt dysfunction due to obstruction of an upper extremity central vein. Repeated interventions are usually required to prolong stent patency.

  11. The thrill of success: central arterial-venous anastomosis for hypertension.

    Science.gov (United States)

    Fudim, Marat; Stanton, Alice; Sobotka, Paul A; Dolan, Eamon; Krum, Henry

    2014-12-01

    Excess blood pressure remains the most important risk factor for cardiovascular and renal disease. Poly pharmacy has been proved safe and effective under clinical trial circumstances; however, the majority of patients fail to sustain pharmaceutical persistence and adherence. The opportunity to offer patients a treatment or device in addition or perhaps instead of drug therapy alone may significantly broaden the options for patients and allow greater success in hypertensive therapy. In this review, we examine the potential of a fixed-volume central arterial-venous anastomosis to reduce blood pressure in hypertensive patients, review possible mechanisms by which the anastomosis may reduce blood pressure, and consider the unique clinical trial opportunities posed by this therapy.

  12. 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

  13. 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...... children hospitalized from January 2000 to March 2008 with newly diagnosed ALL and with double-lumen total implantable devices (TIDs) or tunneled external catheters (TEs) were included retrospectively. We only used data related to the patient's first catheter. RESULTS: We included 98 children; 35 received...... a TID and the remaining 63 received a TE. A total number of 29,566 catheter days and 93 catheter-associated blood stream infections (CABSI) was identified. We found a CABSI rate of 3.1/1,000 catheter days (5.4/1,000 catheter days for TEs and 1.4/1,000 catheter days for TIDs, incidence rate ratio (IRR) 3...

  14. 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.

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

    Science.gov (United States)

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

    2015-07-01

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

  16. 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 (n...... = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi......-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream...

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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. PMID:26518452

  19. 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.

  20. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer

    NARCIS (Netherlands)

    Debourdeau, P.; Farge, D.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Buller, H. R.; Bounameaux, H.

    2013-01-01

    . Background: Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. Objectives: To establish

  3. 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

  4. Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer

    NARCIS (Netherlands)

    M.M.J. Beckers; H.J.T. Ruven; C.A. Seldenrijk; M.H. Prins; D.H. Biesma

    2010-01-01

    Introduction: Thrombosis and infections are well known complications of central venous catheters and totally implanted access ports. These complications lead to increased costs due to prolonged hospitalisation, increased antibiotics use and need for replacement. The objectives of the study were to d

  5. 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;

    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....

  6. Central venous oxygen saturation in septic shock - a marker of cardiac output, microvascular shunting and/or dysoxia?

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders

    2011-01-01

    Shock therapy aims at increasing central venous oxygen saturation (ScvO2), which is a marker of inadequate oxygen delivery. In this issue of Critical Care, Textoris and colleagues challenge this notion by reporting that high levels of ScvO2 are associated with mortality in patients with septic...

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

    Directory of Open Access Journals (Sweden)

    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

  8. Isolation and Cannulation of Cerebral Parenchymal Arterioles.

    Science.gov (United States)

    Pires, Paulo W; Dabertrand, Fabrice; Earley, Scott

    2016-01-01

    Intracerebral parenchymal arterioles (PAs), which include parenchymal arterioles, penetrating arterioles and pre-capillary arterioles, are high resistance blood vessels branching out from pial arteries and arterioles and diving into the brain parenchyma. Individual PA perfuse a discrete cylindrical territory of the parenchyma and the neurons contained within. These arterioles are a central player in the regulation of cerebral blood flow both globally (cerebrovascular autoregulation) and locally (functional hyperemia). PAs are part of the neurovascular unit, a structure that matches regional blood flow to metabolic activity within the brain and also includes neurons, interneurons, and astrocytes. Perfusion through PAs is directly linked to the activity of neurons in that particular territory and increases in neuronal metabolism lead to an augmentation in local perfusion caused by dilation of the feed PA. Regulation of PAs differs from that of better-characterized pial arteries. Pressure-induced vasoconstriction is greater in PAs and vasodilatory mechanisms vary. In addition, PAs do not receive extrinsic innervation from perivascular nerves - innervation is intrinsic and indirect in nature through contact with astrocytic endfeet. Thus, data regarding contractile regulation accumulated by studies using pial arteries does not directly translate to understanding PA function. Further, it remains undetermined how pathological states, such as hypertension and diabetes, affect PA structure and reactivity. This knowledge gap is in part a consequence of the technical difficulties pertaining to PA isolation and cannulation. In this manuscript we present a protocol for isolation and cannulation of rodent PAs. Further, we show examples of experiments that can be performed with these arterioles, including agonist-induced constriction and myogenic reactivity. Although the focus of this manuscript is on PA cannulation and pressure myography, isolated PAs can also be used for

  9. Central venous catheters: detection of catheter complications and therapeutical options; Zentralvenoese Katheter: Diagnostik von Komplikationen und therapeutische Optionen

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Beck, A. [Universitaetsmedizin Charite, Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes-Kliniken, Friedrichshain und Am Urban, Berlin (Germany). Radiologie; Vivantes-Kliniken, Hellersdorf und Prenzlauer Berg (Germany). Radiologie

    2008-06-15

    For modern medicine central venous catheters play an important role for diagnostic and therapeutic options. Catheter implantation, complication detection and therapy of catheter complications are an increasing demand for the radiologist. The review article provides an overview of different catheter types, their indications, advantages and disadvantages. Catheter malpositions are usually detectable in conventional X-ray. Most malpositions are correctable using interventional-radiological techniques. In addition therapeutical options for thrombotic complications (venous thrombosis, catheter occlusion, fibrin sheath) are discussed. In case of an infectious catheter complication, usually a catheter extraction and re-implantation is necessary.

  10. 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...

  11. 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

  12. 中央型急性期下肢DVT置管溶栓与外周溶栓的比较%Outcomes of anticoagulation and thrombolysis for acute deep venous thrombosis via central venous catheter and peripheral venous injection

    Institute of Scientific and Technical Information of China (English)

    朱少问; 郑小兵; 冯翔

    2013-01-01

    目的:比较中央型急性期DVT经外周静脉溶栓与局部置管溶栓治疗的效果,以指导临床治疗.方法:通过回顾性分析我院及江苏南通大学附属医院2010年9月~2012年7月期间收治的共42例下肢深静脉血栓形成患者的临床资料,按照治疗方法分为置管溶栓组(A组)、外周溶栓组(B组).其中外周溶栓组共20例,左侧13例,右侧6例,双侧1例.置管溶栓组共22例,左侧15例,右侧6例,双侧1例.通过监测患者临床症状,测量下肢周径变化比较两组治疗效果.结果:置管溶栓治疗方法具有平均起效时间快、总溶栓疗程短、溶栓药物总剂量低、并发症发生率及PTS发生率低等优点,而远期复发率与外周溶栓组无明显差异.结论:置管溶栓治疗方法优于外周溶栓治疗.%Objective :To compare the curative efficacy of anticoagulation and thrombolysis for acute deep venous thrombosis( DVT ) via central venous catheter management or peripheral venous management for summary of the clinical experience. Methods :The clinical data were reviewed in 42 patients with DVT undergone treatment respectively in our institution and the Affiliated Hospital of Nantong University between Sept. 2010 and Jul. 2012. The patients were randomized into either group A( n=22; 15 were symptoms of left lower extremity,6 of right and 1 of both extremities ) by thrombolytic therapy via central venous catheter or group B( n =20; 13 were acute episode of left lower limb, 6 of right and 1 of both lower limbs. ) managed with peripheral venous anticoagulation and thrombolysis. Two groups of patients were assessed for the curative efficacy by observing the relief of clinical symptoms and measuring the changes of the limb circumference. Results:Thrombolytic therapy for acute DVT via central venous catheter demonstrated advantages by earlier effects, shortened therapy duration, requirement of lower drug dosage, fewer incidence of complications and risk of developing the

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

    Directory of Open Access Journals (Sweden)

    Rezaei J

    2009-09-01

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

  14. 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.)

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Aloka Samantaray

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Who is teaching and supervising our junior residents' central venous catheterizations?

    Directory of Open Access Journals (Sweden)

    Roberts James M

    2011-04-01

    Full Text Available Abstract Background The extent to which medical residents are involved in the teaching and supervision of medical procedures is unknown. This study aims to evaluate the teaching and supervision of junior residents in central venous catheterization (CVC by resident-teachers. Methods All PGY-1 internal medicine residents at two Canadian academic institutions were invited to complete a survey on their CVC experience, teaching, and supervision prior to their enrolment in a simulator CVC training curriculum. Results Of the 69 eligible PGY-1 residents, 32 (46% consenting participants were included in the study. There were no significant baseline differences between participants from the two institutions in terms of sex, number of ICU months completed, previous CVC training received, number of CVCs observed and performed. Only 16 participants (50% received any CVC training at baseline. Of those who received any training, 63% were taught only by senior resident-teachers. A total of 81 CVCs were placed by 17 participants. Thirty-two CVCs (45% were supervised by resident-teachers. Conclusions Resident-teachers play a significant role both in the teaching and supervision of CVCs placed by junior residents. Educational efforts should focus on preparing residents for their role in teaching and supervision of procedures.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Moriarty, John M.; Ramos, Yanerys; Finn, J.P. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); Kung, Geoffrey L. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); University of California, Biomedical Engineering Interdepartmental Program, Los Angeles, CA (United States); Moghaddam, Abbas N. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); Amirkabir University of Technology (Tehran Polytechnic), Department of Biomedical Engineering, Tehran (Iran, Islamic Republic of); Ennis, Daniel B. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); University of California, Biomedical Engineering Interdepartmental Program, Los Angeles, CA (United States); University of California, Biomedical Physics Interdepartmental Program, Los Angeles, CA (United States)

    2012-09-15

    Catheter rupture during CT angiography has prompted policies prohibiting the use of electronic injectors with peripherally inserted central venous catheters (PICCs) not only for CT but also for MRI. Consequently, many institutions mandate hand injection for MR angiography, limiting precision of infusion rates and durations of delivery. To determine whether electronic injection of gadolinium-based contrast media through a range of small-caliber, single-lumen PICCs would be safe without risk of catheter rupture over the range of clinical protocols and determine whether programmed flow rates and volumes were realized when using PICCs for contrast delivery. Experiments were performed and recorded using the Medrad Spectris Solaris EP MR Injection System. PICC sizes, contrast media and flow rates were based on common institutional protocols. No catheters were damaged during any experiments. Mean difference between programmed and delivered volume was 0.07 {+-} 0.10 mL for all experiments. Reduced flow rates and prolonged injection durations were observed when the injector's pressure-limiting algorithm was triggered, only in protocols outside the clinical range. PICCs commonly used in children can withstand in vitro power injection of gadolinium-based contrast media at protocols significantly above clinical levels. (orig.)

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. 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

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

    Science.gov (United States)

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

    2010-09-01

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

  9. Venous insufficiency

    Science.gov (United States)

    Chronic venous insufficiency; Chronic venous stasis; Chronic venous disease ... blood moving forward toward the heart. With chronic venous insufficiency, vein walls are weakened and valves are damaged. ...

  10. Nurse cannulation: introducing an advanced clinical skill.

    LENUS (Irish Health Repository)

    Hoctor, Bridget

    2012-01-31

    Many patients admitted to emergency departments (EDs) require therapy delivered by cannula. Mid-Western Regional Hospital, Tipperary, used to run a system in which many patients had to endure two invasive procedures: on arrival their blood was taken by nurses and later they were cannulated by doctors. To reduce the number of procedures, ED nurses initiated a project to extend their skills to include cannulation. The new system of nurse cannulation at triage has also helped reduce waiting times.

  11. Risk factors and current recommendations for prevention of infections associated with central venous catheters: a literature review

    Directory of Open Access Journals (Sweden)

    Danielle de Mendonça Henrique

    2014-04-01

    Full Text Available Backgound and Objectives: Infections related to central venous catheter (CVC use constitute an important a problem. It is estimated that approximately 90% of bloodstream infections (BSI are caused by CVC use. This study aims at reviewing the risk factors and current recommendations for prevention of infections associated with central venous catheter use. Methods: A total of 12 articles published in the last 5 years and indexed in the databases of the Latin American and Caribbean Literature on Health Sciences (LILACS, Nursing Database (BDENF, International Literature on Health Sciences (Medline/Pubmed were selected, as well as publications related to the recommendations for BSI prevention, such as: Institute for Healthcare Improvement (IHI, Centers for Disease Control and Prevention (CDC and the National Health Surveillance Agency (ANVISA. Results: Two categories were identified: prevention and control measures and risk factors for BSI associated with central venous catheter use. Conclusions: Some recommendations that were well-defined over the years have been questioned by some authors and continuing training and education of the multidisciplinary team are the most important factors for the prevention of bloodstream infections associated with CVC use.

  12. 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

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

    Science.gov (United States)

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

    2011-01-01

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

  14. 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...

  15. 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.

  16. Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children.

    Science.gov (United States)

    Sol, Jeanine J; Knoester, Hennie; de Neef, Marjorie; Smets, Anne M J B; Betlem, Aukje; van Ommen, C Heleen

    2015-08-01

    Prescription of thromboprophylaxis is not a common practice in pediatric intensive care units. Most thrombi are catheter-related and asymptomatic, without causing acute complications. However, chronic complications of these (a)symptomatic catheter-related thrombi, that is, postthrombotic syndrome (PTS) and residual thrombosis have not been studied. To investigate these complications, critically ill children of 1 tertiary center with percutaneous inserted femoral central venous catheters (FCVCs) were prospectively followed. Symptomatic FCVC-thrombosis occurred in 10 of the 134 children (7.5%; 95% confidence interval [CI], 2.4-9.5). Only FCVC-infection appeared to be independently associated (P=0.001) with FCVC-thrombosis. At follow-up 2 of the 5 survivors diagnosed with symptomatic thrombosis developed mild PTS; one of them had an occluded vein on ultrasonography. A survivor without PTS had a partial occluded vein at follow-up. Asymptomatic FCVC-thrombosis occurred in 3 of the 42 children (7.1%; 95% CI, 0.0-16.7) screened by ultrasonography within 72 hours after catheter removal. At follow-up, mild PTS was present in 6 of the 33 (18.2%; 95% CI, 6.1-30.3) screened children. Partial and total vein occlusion was present in 1 (3%) and 4 (12%) children, respectively. In conclusion, children on pediatric intensive care units are at risk for (a)symptomatic FCVC-thrombosis, especially children with FCVC-infection. Chronic complications of FCVC-thrombosis are common. Therefore, thromboprophylaxis guidelines are warranted in pediatric intensive care units to minimize morbidity as a result of FCVC-thrombosis.

  17. Going with the flow or swimming against the tide: should children with central venous catheters swim?

    Science.gov (United States)

    Miller, Jessica; Dalton, Meghan K; Duggan, Christopher; Lam, Shirley; Iglesias, Julie; Jaksic, Tom; Gura, Kathleen M

    2014-02-01

    Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.

  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. 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

  20. Patterns of central venous oxygen saturation, lactate and veno-arterial CO 2 difference in patients with septic shock

    Directory of Open Access Journals (Sweden)

    Rubina Khullar Mahajan

    2015-01-01

    Full Text Available Background and Aims: Tissue hypoperfusion is reflected by metabolic parameters such as lactate, central venous oxygen saturation (ScvO 2 and the veno-arterial CO 2 (vaCO 2 difference. We studied the relation of these parameters over time and with outcome in patients with severe septic shock. Materials and Methods: In this single-center, prospective observational cohort study, adult patients (≥18 years with circulatory shock were included. Echocardiography and simultaneous arterial and venous blood gases were done on enrolment (0 h and at 24, 48 and 72 h. The partial pressure of CO 2 , lactate and ScvO 2 were recorded from the central venous blood samples. The vaCO 2 was calculated as the difference in CO 2 between paired venous and arterial blood gas samples. Results: Of the 104 patients with circulatory shock, 79 patients (44 males with septic shock aged 49.8 (standard deviation ± 14.6 years and with sequential organ failure assessment (SOFA score of 11.0 ± 3.4 were included. 71 patients (89.9% were ventilated (11.4 ± 12.3 ventilator-free days. The duration of hospitalization was 16.6 ± 12.8 days and hospital mortality 50.6%. Lactate significantly decreased over time with a greater decrement in survivors than nonsurvivors (−0.35 vs. −0.10, P 70% and not in ScvO 2 ≤70%. Conclusion: In septic shock, vaCO 2 ≤6 mmHg is independently associated with mortality, particularly in those with normalized ScvO 2 consistent with metabolic microcirculatory abnormalities in these patients.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    in the 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......We present three cases of fixated vascular injection ports. Two patients had cystic fibrosis and one had an immunological defect. All catheters were made from polyurethane and implanted in adolescent patients. Indwelling time were 6-8 years. One patient's catheter was entirely integrated...... catheters (CVCs) in adolescents. Furthermore, it highlights the importance of not breaking a CVC in the attempt to remove it....

  7. Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy

    Science.gov (United States)

    Berkowitz, Joshua C.; Bhusal, Sushma; Desai, Deepak; Cerulli, Maurice A.

    2016-01-01

    Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices. PMID:27807564

  8. Ultrasound guidance for central vascular access in the neonatal and pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Al Sofyani Khouloud

    2012-01-01

    Full Text Available Background: Percutaneous central venous cannulation (CVC in infants and children is a challenging procedure, and it is usually achieved with a blinded, external landmark-guided technique. Recent guidelines from the National Institute for Clinical Excellence (NICE recommend the use of ultrasound guidance for central venous catheterization in children. The purpose of this study was to evaluate this method in a pediatric and neonatal intensive care unit, assessing the number of attempts, access time (skin to vein, incidence of complication, and the ease of use for central venous access in the neonatal age group. Methods: After approval by the local departmental ethical committee, we evaluated an ultrasound-guided method over a period of 6 months in 20 critically ill patients requiring central venous access in a pediatric intensive care unit and a neonatal intensive care unit (median age 9 (0-204 months and weight 9.3 (1.9-60 kg. Cannulation was performed after locating the puncture site with the aid of an ultrasound device (8 MHz transducer, Vividi General Electrics® Burroughs, USA covered by a sterile sheath. Outcome measures included successful insertion rate, number of attempts, access time, and incidence of complications. Results: Cannulation of the central vein was 100% successful in all patients. The right femoral vein was preferred in 60% of the cases. The vein was entered on the first attempt in 75% of all patients, and the median number of attempts was 1. The median access time (skin to vein for all patients was 64.5 s. No arterial punctures or hematomas occurred using the ultrasound technique. Conclusions: In a sample of critically ill patients from a pediatric and neonatal intensive care unit, ultrasound-guided CVC compared with published reports on traditional technique required fewer attempts and less time. It improved the overall success rate, minimized the occurrence of complications during vein cannulation and was easy to apply in

  9. 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...

  10. Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

    Science.gov (United States)

    Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

    2016-05-01

    To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P catheter within 72 h after insertion of the tube are lowest, compared with alginate dressing and gauze was significant (P<0.05). Conclusion: The choice of compression hemostasis material for the puncture site after PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

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

    DEFF Research Database (Denmark)

    Larsen, M.K.; Thomsen, T.R.; Moser, C.;

    2008-01-01

    ABSTRACT: BACKGROUND: Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. METHODS: In this study traditional semiquantitative...... culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ...... observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. CONCLUSION: The results show that diagnosis based on molecular methods improves the detection of microorganisms involved in central catheter-related infections. The importance...

  12. 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

  13. Safety and feasibility in highly concentrated contrast material power injections for CT-perfusion studies of the brain using central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Macht, Stephan, E-mail: stephan.macht@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Beseoglu, Kerim, E-mail: beseoglu@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Neurosurgery, D-40225 Dusseldorf (Germany); Eicker, Sven, E-mail: sven.eicker@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Neurosurgery, D-40225 Dusseldorf (Germany); Rybacki, Konrad, E-mail: rybacki@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Braun, Sebastian, E-mail: sebastian.braun@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Anaesthesiology, D-40225 Dusseldorf (Germany); Mathys, Christian, E-mail: mathys@uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Antoch, Gerald, E-mail: antoch@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Turowski, Bernd, E-mail: bernd.turowski@uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany)

    2012-08-15

    Introduction: CT perfusion studies play an important role in the early detection as well as in therapy monitoring of vasospasm after subarachnoid hemorrhage. High-flow injections via central venous catheters are not recommended but may sometimes be the only possibility to obtain high-quality images. Materials and methods: We retrospectively analyzed our data for CT perfusions performed with power injection of contrast material with an iodine concentration of 400 mg/ml via the distal 16G lumen of the Arrow three and five lumen central venous catheter with preset flow rates of 5 ml/s. Results: 104 examinations with central venous catheters were evaluated (67 with five lumen and 37 with three lumen). No complications were observed. Mean flow rates were 4.4 {+-} 0.5 ml/s using the three lumen catheter and 4.6 {+-} 0.6 ml/s using the five lumen catheter respectively. The mean injection pressure measured by the power injector was 200.7 {+-} 17.5 psi for the three lumen central venous catheter and 194.5 {+-} 6.5 psi for the five lumen catheter, respectively. Conclusion: Following a strict safety protocol there were no complications associated with power injections of contrast material containing 400 mg iodine/ml with preset flow rates up to 5 ml/s via the distal 16G lumen of the Arrow multi-lumen central venous catheter. However, since power-injections are off-label use with Arrow central venous catheters, this procedure cannot be recommended until potential safety hazards have been ruled out by the manufacturer.

  14. 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.

  15. 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.

  16. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter.

    Science.gov (United States)

    Chuang, Ming-Tsung; Wu, Ding-Kwo; Chang, Cheng-Ang; Shih, Ming-Chen Paul; Ou-Yang, Fu; Chuang, Chien-Han; Tsai, Yi-Fan; Hsu, Jui-Sheng

    2011-11-01

    The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010), a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days). The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days). All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

  17. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness

    DEFF Research Database (Denmark)

    Eskesen, T G; Wetterslev, M; Perner, A

    2016-01-01

    PURPOSE: Central venous pressure (CVP) has been shown to have poor predictive value for fluid responsiveness in critically ill patients. We aimed to re-evaluate this in a larger sample subgrouped by baseline CVP values. METHODS: In April 2015, we systematically searched and included all clinical...

  20. Sonication for diagnosis of catheter-related infection is not better than traditional roll-plate culture: a prospective cohort study with 975 central venous catheters.

    Science.gov (United States)

    Erb, Stefan; Frei, Reno; Schregenberger, Katharina; Dangel, Marc; Nogarth, Danica; Widmer, Andreas F

    2014-08-15

    This prospective randomized controlled study with 975 nontunneled central venous catheters (CVCs) showed that the semiquantitative roll-plate culture technique (SQC) was as accurate as the sonication method for diagnosis of catheter-related infections. Sonication is difficult to standardize, whereas SQC is simpler, faster, and as reliable as the sonication method for culturing CVCs.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-08-01

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

  2. Ileal cannulation and associated complications in dogs.

    Science.gov (United States)

    Hill, R C; Ellison, G W; Burrows, C F; Bauer, J E; Carbia, B

    1996-02-01

    Accurate measurement of small intestinal digestibility is important in dogs because it allows the formulation of pet foods that provide optimal nutrition at minimal cost. Digestibility measured by comparing nutrient intake to fecal excretion in intact animals does not distinguish small intestinal digestion from large intestinal bacterial fermentation. Ileal cannulation allows small intestinal digestion to be measured alone by comparing nutrient intake with ileal excretion of chyme. Nevertheless, ileal cannulation and its associated complications are not well documented in dogs. We describe the implantation of a simple T-cannula in the ileum of nine dogs for an average duration of 26 weeks. Established cannulas were well tolerated, and one dog retained the cannula for 14 months. Nevertheless, ileal effluent proved extremely caustic, and the incidence of complications in the immediate postoperative period was high. Only one dog had an unremarkable postoperative course. Complications included abscessation and cannula extrusion, followed by severe excoriation and ulceration of the skin. This excoriation could be prevented only by immediate surgical closure of the fistula. Chronic ileal cannulation is therefore a viable technique in dogs, but careful monitoring of the cannula site is essential. Dogs should be subjected to this procedure only if adequate veterinary and nursing care is available. It is preferable to maintain a colony of long-term cannulated dogs rather than to implant cannulas as needed. PMID:8699825

  3. [Artefacts in the CT scan caused by surgical clips and central venous catheters and the use of new materials].

    Science.gov (United States)

    Schadel, A; Böttcher, H D; Haverkamp, U; Wagner, W; Schmilowski, G M

    1984-03-01

    When metal clips and venous catheters have been used the computerized tomography shows artifacts, which make it computerized tomography shows artifacts, which make it difficult to have a reliable and accurate diagnosis, because the X- raying of the metal clips and the venous catheter gives radiating lines, so called streaking. We have tested new materials for the metal clips and a new polymer to replace the substance of the venous catheter with the intention that the materials should have the same density as the normal tissues. With a new metal for the clips and a new polymer for the venous catheters, mixed with metal ions, the computerized tomography does not show streaking.

  4. STUDY ON COMPARISON BETWEEN LANDMARK GUIDED (BRINKMAN'S TECHNIQUE ) AND ULTRASOUND GUIDED INTERNAL JUGULAR VEIN CANNULATION

    OpenAIRE

    Vinod; Sashi Walling

    2015-01-01

    Technique of cannulating the central veins , until recently has been based on landmark guided technique . Recently ultrasound machines with high frequency probes are being used to increase success rate and reducing complications. OBJECTIVE: In our study we compare landmark guided technique ( Brinkman's technique ) ( 1 ) with ultrasound guided technique. STUDY DESIGN: outcome was evaluated in terms of 1 ) Number of attempts 2 ) ...

  5. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Se Jin; Kimn, Hyo Cheol; Chung, Jin Wook; Yin, Yong Hu; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of); An, Sang Bu [National Cancer Center, Goyang (Korea, Republic of)

    2012-06-15

    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.

  7. EARLY AND LATE COMPLICATIONS RELATED TO CENTRAL VENOUS CATHETERS IN HAEMATOLOGICAL MALIGNANCIES: A RETROSPECTIVE ANALYSIS OF 1102 PATIENTS

    Directory of Open Access Journals (Sweden)

    Salvatore Giacomo Morano

    2014-02-01

    Full Text Available Several severe complications may be associated with the use of central venous catheters (CVC. We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with haematological malignancies (142,202 total day number of implanted CVC. Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC. Thirty-nine episodes of early infective complications (<1 week from CVC implant occurred (3.5% - 0.3/1000 days/CVC: furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC were recorded. There were 29 episodes (2.6% of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 – 395. The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature, notwithstanding cytopenia often coexisting in haematological patients.

  8. Rupture of totally implantable central venous access devices (Intraports in patients with cancer: report of four cases

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    Filippou Georgios K

    2004-10-01

    Full Text Available Abstract Background Totally implantable central venous access devices (intraports are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. Rupture of intraport is a rare complication. Patients and methods During 3 years period, a total of 245 intraports were placed in cancer patients for chemotherapy. Four of these cases (two colon cancer and one each of pancreas and breast cancer had rupture of the intraport catheter, these forms the basis of present report. Results Mean time insitu for intraports was 164∀35 days. Median follow-up time was 290 days and total port time in situ was 40180 days. The incidence of port rupture was 1 per 10,000 port days. Three of the 4 cases were managed by successful removal of catheters. In two of these the catheter was removed under fluoroscopic control using femoral route, while in the third patient the catheter (partial rupture was removed surgically. One of the catheters could not be removed and migrated to right ventricle on manipulations. Conclusion Port catheter rupture is a rare but dreaded complication associated with subcutaneous port catheter device placement for chemotherapy. In case of such an event the patient should be managed by an experienced vascular surgeon and interventional radiologist, as in most cases the ruptured catheter can be retrieved by non operative interventional measures.

  9. 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

  10. Central venous access device insertion and perioperative management of patients with severe haemophilia A: a local experience.

    Science.gov (United States)

    Fonseca, Adriana; Nagel, Kim; Decker, Kay; Pukulakatt, Mimitha; Pai, Mohan; Walton, Mark; Chan, Anthony K C

    2016-03-01

    Central venous access device (CVAD) insertion is one of the most common procedures performed on paediatric haemophilia patients. There are no clear guidelines outlining the optimal dosing schedule of factor VIII (FVIII) and duration of treatment required to achieve adequate haemostasis during and after surgery. In this article, we describe the experience at McMaster Children's Hospital using FVIII replacement therapy in 15 children with severe haemophilia A during the course of 7 years. This is a retrospective institutional chart review. Patients between 0 and 18 years of age with severe haemophilia A that underwent CVAD insertion at McMaster Children's Hospital in Hamilton, Ontario, from 2004 to 2010, were identified and charts were reviewed. A total of 15 CVAD insertion surgeries were reviewed. The total average preoperative dose of FVIII was 93.5 IU/kg (range: 53.7-145.4 IU/kg). The total average postoperative dose was 818.7 IU/kg (range: 441-1258 IU/kg). The total perioperative dose was 912.2 IU/kg (range: 495.2-1349 IU/kg). The current study attempts to describe the experience at McMaster Children's Hospital for CVAD insertion surgeries, the average factor dose administered has decreased during the years. These results may be of help in the development of optimal treatment schedules.

  11. 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.

  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. Mechanic and surface properties of central-venous port catheters after removal: A comparison of polyurethane and silicon rubber materials.

    Science.gov (United States)

    Braun, Ulrike; Lorenz, Edelgard; Weimann, Christiane; Sturm, Heinz; Karimov, Ilham; Ettl, Johannes; Meier, Reinhard; Wohlgemuth, Walter A; Berger, Hermann; Wildgruber, Moritz

    2016-12-01

    Central venous port devices made of two different polymeric materials, thermoplastic polyurethane (TPU) and silicone rubber (SiR), were compared due their material properties. Both naïve catheters as well as catheters after removal from patients were investigated. In lab experiments the influence of various chemo-therapeutic solutions on material properties was investigated, whereas the samples after removal were compared according to the implanted time in patient. The macroscopic, mechanical performance was assessed with dynamic, specially adapted tests for elasticity. The degradation status of the materials was determined with common tools of polymer characterisation, such as infrared spectroscopy, molecular weight measurements and various methods of thermal analysis. The surface morphology was analysed using scanning electron microscopy. A correlation between material properties and clinical performance was proposed. The surface morphology and chemical composition of the polyurethane catheter materials can potentially result in increased susceptibility of the catheter to bloodstream infections and thrombotic complications. The higher mechanic failure, especially with increasing implantation time of the silicone catheters is related to the lower mechanical performance compared to the polyurethane material as well as loss of barium sulphate filler particles near the surface of the catheter. This results in preformed microscopic notches, which act as predetermined sites of fracture. PMID:27552159

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

    Science.gov (United States)

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

    2013-01-01

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

  15. INCIDENCE OF INFECTION ASSOCIATED TO CENTRAL VENOUS CATHETERS IN A NEONATAL INTENSIVE CARE UNIT

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    Adriana Teixeira Reis

    2011-07-01

    Full Text Available Trata-se de um estudo transversal e retrospectivo que objetivou  identificar o tipo de cateter venoso central (CVC mais utilizado na Unidade de Terapia Intensiva Neonatal (UTIN de um hospital público universitário do estado do Rio de Janeiro, estratificado por peso de nascimento e apresentar as densidades de incidência de infecção associadas aos dispositivos.  Os dados foram coletados através de análise documental nos meses de junho e julho de 2008, referentes ao período de julho a dezembro de 2007, totalizando um registro de 712 cateteres-dia. Foi verificado o cateter central de inserção periférica (CCIP/PICC como o dispositivo mais utilizado na unidade, seguido do cateter venoso umbilical e da dissecção venosa. A densidade de incidência das infecções primárias da corrente sanguínea foi cerca de oito vezes maior nos recém-nascidos com peso ≤ 1.500g, sendo o cateter umbilical o dispositivo mais associado a essas infecções.

  16. 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

  17. Self-cannulation: enabling patients’ independence

    OpenAIRE

    Brouwer, Deborah

    2011-01-01

    Home hemodialysis was a modality of necessity in the early days of chronic renal replacement therapies. Patients had to be independent for all aspects of their care including self-cannulation of the hemodialysis needles. As the number of in-center staff provided hemodialysis centers has grown, the level of independence for hemodialysis patients has drastically decreased. Recent changes by the United States Centers for Medicare and Medicaid Services in the ‘Conditions of Coverage for ESRD’ enc...

  18. Entrapment of J-tip guidewires by Venatech and stainless-steel Greenfield vena cava filters during central venous catheter placement: percutaneous management in four patients.

    Science.gov (United States)

    Andrews, R T; Geschwind, J F; Savader, S J; Venbrux, A C

    1998-01-01

    We present four patients in whom bedside placement of a central venous catheter was complicated by entrapment of a J-tip guidewire by a previously placed vena cava (VC) filter. Two Venatech filters were fragmented and displaced into the superior VC or brachiocephalic vein during attempted withdrawal of the entrapped wire. Two stainless-steel Greenfield filters remained in place and intact. Fluoroscopically guided extraction of both wires entrapped by Greenfield filters was successfully performed in the angiography suite.

  19. Prevention of central venous catheter-associated bloodstream infections: A questionnaire evaluating the knowledge of the selected 11 evidence-based guidelines by Polish nurses.

    Science.gov (United States)

    Dedunska, Karina; Dyk, Danuta

    2015-12-01

    This study evaluated the questionnaire testing nurses' knowledge about the maintenance of a central venous catheter (CVC) and assessed it with regard to age, work experience, type of ward, frequency of trainings, and postgraduate education. There were 1,180 questionnaires (N = 784; 66.4% of the total sample) distributed in several regions of Poland for a period of 7 months. The difficulty level for each question ranged from 0.22-0.88.

  20. Improving our ability to diagnose infections associated with central venous catheters: value of Gram's staining and culture of entry site swabs.

    OpenAIRE

    McGeer, A.; Righter, J

    1987-01-01

    We prospectively studied 45 central venous catheters to determine whether Gram's staining and culture of skin swabs from the entry site could be used to predict catheter-related infection. Data were collected from insertion site swabs, intracutaneous and intravascular catheter segments, and blood cultures. Surveillance site cultures at the time of dressing changes showed that bacterial growth, once established, persisted until removal of the catheter but that the time of onset of infection wa...

  1. Transesophageal echocardiography guided cannulation for peripheral cardiopulmonary bypass during robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; GAO Chang-qing; WANG Gang; WANG Jia-li

    2012-01-01

    Background Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve.Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery.However,few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery.The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.Methods We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011,which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp.TEE was used to guide cannulation of the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO).The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.Results One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB.There were 67 female (51.9%) and 62 male (48.1%) patients,ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m2 (mean (1.71 ± 0.20) m2).Some 61 (47.3%) patients underwent mitral valve repair,27 (20.9%) mitral valve replacement,27 (20.9%) left atrial myxoma removal,and 14(10.9%) ventricular septal defect repair.Of the 129 patients,TEE guided cannulation of the IVC or SVC was successful in all patients (100%),and no puncture related complications occurred in all patients.Of the 129 patients,successful cannulation of the AAO was achieved in all patients (100%),and aortic

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

    Directory of Open Access Journals (Sweden)

    Geraldo Sadoyma

    2006-04-01

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

  3. Implantable central venous chemoport: camparision of results according to approach routes and methods

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Byung Suck; Ahn, Moon Sang [Chungnam National University Hospital, Taejon (Korea, Republic of)

    2003-09-01

    To evaluate the results and complications of placement of implantable port according to approach routes and methods. Between April 2001 and October 2002, a total of 103 implantable chemoport was placed in 95 patients for chemotherapy using preconnected type (n=39) and attachable type (n=64). Puncture sites were left subclavian vein (n=35), right subclavian vein (n=5), left internal jugular vein (n=9), right internal jugular vein (n=54). We evaluated duration of catheterization days, complications according to approach routes and methods. Implantable chemoport was placed successfully in all cases. Duration of catheterization ranged from 8 to 554 days(mean 159, total 17,872 catheter days). Procedure related complications occurred transient pulmonary air embolism (n=1), small hematoma (n=1) and malposition in using preconnected type (n=2). Late complications occurred catheter migration (n=5), catheter malfunction (n=3), occlusion (n=1) and infection (n=11). Among them 15 chemoport was removed (14.5%). Catheter migration was occured via subclavian vein in all cases (13%, p=.008). Infection developed in 10.7% of patients(0.61 per 1000 catheter days). There were no catheter-related central vein thrombosis. Implantation of chemoport is a safe procedure. Choice of right internal jugular vein than subclavian vain vein for puncture site has less complications. And selection of attachable type of chemoport is convenient than preconnected type. Adequate care of chemoport is essential for long patency.

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

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    Stolić Radojica

    2008-01-01

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

  5. Different techniques of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders

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    Ghoraba HH

    2013-09-01

    Full Text Available Hammouda H Ghoraba,1,2 Sameh M Elgouhary,3 Amin F Ellakwa3 1Department of Ophthalmology, Tanta University, Tanta, Egypt; 2Vitreoretinal Unit, Magrabi Eye Hospital, Tanta, Egypt; 3Department of Ophthalmology, Menoufiya University, Menufia, Egypt Purpose: To evaluate the safety and efficacy of different methods of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders. Methods: A prospective randomized study was done from August 2009 to February 2011. The study included 129 eyes of 122 patients, randomly divided into four groups. Group 1 comprised 34 eyes operated on using transconjunctival 20-gauge cannula Claes system. Group 2 comprised 32 eyes operated on using transconjunctival cannulated 23 gauge system. Group 3 comprised 27 eyes operated on using combined 20-gauge non-cannulated and 23-gauge transconjunctival cannulated system. Group 4 comprised 36 eyes operated on using conventional non-cannulated 20-gauge system. Results: The four groups were demographically similar. Anatomical outcome was achieved in all cases. Vision was improved in 29 eyes (85.3% in group 1, 23 eyes (71.9% in group 2, 19 eyes (70.4% in group 3, and 26 eyes (72.2% in group 4. There was no statistical difference between the four groups 1-day postoperative (P=0.405 and 1-week postoperative intraocular pressure (P=0.254. The number of sutureless sclerotomies was 68 (66.6% in group 1, 78 (81.3% in group 2, 50 (61.8% in group 3, and 0 in group 4. Hypotony occurred in one eye (2.9% in group 1, three eyes (9.4% in group 2, two eyes (7.4% in group 3, and no eyes in group 4. Operative endophthalmitis did not occur in any one of the four groups. Conclusion: Final anatomical and functional outcomes were not related to the type of sclerotomy used (cannulated or non-cannulated, the gauge used (20 or 23, the route (transconjunctival or transscleral, or type of suture used. The advantages of small-gauge transconjunctival

  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. Combined precut in difficult biliary cannulation

    Directory of Open Access Journals (Sweden)

    Jesús Espinel-Díez

    2013-06-01

    Full Text Available Aim: precut sphincterotomy refers to a variety of endoscopic techniques that are used in order to access the bile duct when conventional methods of cannulation have failed. There are not significant data (such as efficacy, safety about the use of different techniques of precutting at the same session. We have described our experience with combined precut sphincterotomy (CPS and we have compared our results to the use of an isolated precut. Patients and methods: we have performed 247 precuts of a total of 2.390 ERCPs. Patients were distributed according to the type of precut practiced: Needle-knife, transpancreatic and combined precut sphincterotomies. "Combined precut" consisted in performing first a transpancreatic sphincterotomy and, if the access was not achieved, then performing a needle-knife sphincterotomy in the same session. The data about safety and efficacy were prospectively collected. The complications were defined according to the consensus criteria. Results: we performed precutting techniques in 247 patients. Needle-knife, transpancreatic, and combined precuts were performed in 125 (6.9%, 74 (4.1% and 48 (2.6% patients, respectively. Bile duct cannulation was successful in 48 patients (100% in the group of combined precut, 121 patients (96.8% in the transpancreatic group, and 67 patients (90.5% in the needle-knife group (p = 0.03. There were not differences in complications rates between the three groups. There was no pancreatitis in the combined precut group. The complications were successfully managed with conservative treatment. Conclusions: combined precut sphincterotomy seems to be a safe and successful technique in those cases of difficult bile duct cannulation.

  8. 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 ...

  9. Assessment effect of central venous pressure in fluid resuscitation in the patients with shock: a multi-center retrospective research

    Institute of Scientific and Technical Information of China (English)

    HU Bo; XIANG Hu; LIANG Hui; YU Li; XU Tao; YANG Jun-hui; DU Zhao-hui

    2013-01-01

    Background Central venous pressure (CVP) and intrathoracic blood volume index (ITBVI) were used to assess the fluid status.It has previously been shown that CVP is not as accurate as ITBVI for all the shock patients.We therefore hypothesized that the change of CVP has the ability to predict fluid responsiveness in some clinical cases of shock.Methods From September 1st 2009 to September 1st 2011,sixty-three patients with shock from different Intensive Care Unit (ICU) were collected into this retrospective study.All the patients received fluid challenge strategy (infusing 300 ml hydroxyethyl starch in 20 minutes),were monitored with CVP and pulse-indicated continuous cardiac output (PICCO).The correlation between changes in cardiac index (△CI),CVP (△CVP) and ITBVI (△ITBVI) were analyzed.Fluid responsiveness was defined as an increase in CI≥10%.Receiver operating characteristic (ROC) curves were generated for △CVP and △ITBVI.Results For all the patients,there was no correlation between △CI and △CVP (P=0.073),but in the subgroup analysis,the correlation between △CI and △CVP was significant in those younger than 60 years old (P=-0.018) and those with hypovolemic shock (P=0.001).The difference of areas under the ROC curves of △CVP and △ITBVI were not statistically significant in the group younger than 60 years old or hypovolemic shock group (P >0.05,respectively).However,no similar results can be found in the group older than 60 years old and the other two shock type groups from ROC curves of △CVP and △ITBVI.Conclusions △CVP is not suitable for evaluating the volume status of the shock patients with fluid resuscitation regardless of their condition.However,in some ways,△CVP have the ability to predict fluid responsiveness in the younger shock patients or in the hypovolemic shock patients.

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

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    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.

  11. 血液透析患者中心静脉置管感染预防%Prevention analysis of central venous catheter infection in hemodialysis

    Institute of Scientific and Technical Information of China (English)

    王虹; 叶桦; 熊杰林

    2014-01-01

    目的:研究探讨血液透析患者在进行中心静脉置管以后的护理措施和预防措施,为降低血液透析患者中心静脉置管感染率提供理论指导。方法调查2012年2月-2013年5月在医院治疗的150例血液透析患者临床资料,随机分为试验组和对照组,每组各75例;将感染发生情况根据发病原因、置管部位、留置时间以及导管的通畅程度等因素进行分析对比,数据采用χ2检验。结果150例血液透析患者发生感染共44例,总感染率为29.33%,试验组患者发生感染15例,感染率为20.0%;对照组患者发生感染29例,感染率为38.67%,两组差异有统计学意义(χ2=5.6380,P<0.05)。结论确定导管感染发生原因,加强中心静脉置管的护理以及规范血液透析管理,并且采取有效的防治措施,提高血液透析患者的生存率和生活质量;延长中心静脉置管使用期限的关键就是预防中心静脉置管感染和阻塞。%OBJECTIVE To investigate and discuss nursing strategy for central venous catheterization and preventive measures for hemodialysis patients to provide theoretical guidance for reducing central venous catheter infection rates .METHODS Data of 150 hemodialysis patients admitted in the hospital from Feb .2012 to May 2013 were investigated .The 150 hemodialysis patients were randomly divided into two groups ,ie ,the experimental group and the control group ,75 patients in each group .Factors including causes of infections ,catheter sites ,retention time and obstruction situation were analyzed and compared ,data were processed with χ2 test .RESULTS There were 44 cases of infections in the 150 hemodialysis patients ,with the total infection rate of 29 .33% ,including 15 cases in the experimental group ( the infection rate 20 .0% ) and 29 in the control group (38 .67% ) ,with signifi-cant differences (χ2 =5 .6380 ,P<0 .05) .CONCLUSION To determine the causes of

  12. A comparative study of two techniques (electrocardiogram- and landmark-guided for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery

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    Neeraj Kumar Barnwal

    2016-01-01

    Full Text Available Background and Aims: The complications of central venous catheterisation can be minimized by ensuring catheter tip placement just above the superior vena cava-right atrium junction. We aimed to compare two methods, using an electrocardiogram (ECG or landmark as guides, for assessing correct depth of central venous catheter (CVC placement. Methods: In a prospective randomised study of sixty patients of <12 years of age, thirty patients each were allotted randomly to two groups (ECG and landmark. After induction, central venous catheterisation was performed by either of the two techniques and position of CVC tip was compared in post-operative chest X-ray with respect to carina. Unpaired t-test was used for quantitative data and Chi-square test was used for qualitative data. Results: In ECG group, positions of CVC tip were above carina in 12, at carina in 9 and below carina in 9 patients. In landmark group, the positions of CVC tips were above carina in 10, at carina in 4 and below carina in 16 patients. Mean distance of CVC tip in ECG group was 0.34 ± 0.23 cm and 0.66 ± 0.35 cm in landmark group (P = 0.0001. Complications occurred in one patient in ECG group and in nine patients in landmark group (P = 0.0056. Conclusion: Overall, landmark-guided technique was comparable with ECG technique. ECG-guided technique was more precise for CVC tip placement closer to carina. The incidence of complications was more in the landmark group.

  13. CONFIABILIDAD DE LOS CÁLCULOS ESPECIALES DE LA OXIGENACIÓN DE MUESTRAS VENOSAS CENTRALES EN CIRUGÍA CARDÍACA / Reliability of the special calculations of oxygenation from central venous samples in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Pedro A. Hidalgo Menéndez

    2010-09-01

    Full Text Available Resumen Introducción y objetivos: Diferentes mecanismos se implican en la captación, transporte, entrega y utilización del oxígeno en los organismos vivos, y cada uno de ellos puede afectarse en el enfermo grave. El propósito de este trabajo fue conocer la confiabilidad de los cálculos especiales de la oxigenación, procedentes de muestras venosas centrales. Método: Se realizó un estudio prospectivo con 22 pacientes a los que se les practicó cirugía cardíaca, en los que se compararon los cálculos especiales obtenidos de muestras venosas centrales con los venosos-mixtos. Resultados: Se encontró correlación estadística significativa entre la diferencia arteriovenosa de oxígeno, el cortocircuito y la saturación venosa de hemoglobina oxigenada. Sin embargo, se halló un bajo por ciento de fiabilidad al aplicarles los criterios protocolizados; pero fue factible mediante ecuaciones de regresión, lograr una corrección altamente significativa (p < 0,01, que elevó la fiabilidad a más del 90 %. Conclusiones: Las muestras venosas centrales constituyen una alternativa recomendable para obtener cálculos especiales de la oxigenación durante la cirugía cardíaca. / Abstract Introduction and Objectives: Different mechanisms are involved in the uptake, transportation, delivery and utilization of oxygen in living organisms, and each of them may be affected in the severely ill patient. The purpose of this study was to determine the reliability of the special calculations of oxygenation, from central venous samples. Methods: A prospective study was performed on 22 patients who underwent cardiac surgery, and in which special calculations obtained from central venous samples were compared to mixed-venous samples calculations. Results: A statistically significant correlation among the arteriovenous oxygen difference, the shunt and the venous hemoglobin oxygen saturation was found. However, a small percentage of reliability was found when

  14. Technical note: Ruminal cannulation technique in young Holstein calves:

    DEFF Research Database (Denmark)

    Kristensen, Niels Bastian; Engbæk, Marie; Vestergaard, Mogens;

    2010-01-01

    grass silage and sodium hydroxide-treated wheat. Ruminal fluid was collected from cannulated calves once weekly for 3 consecutive weeks. All calves were euthanized at 43 ± 3 d of age. No apparent adverse effects of cannulation were observed. Feed intake, BW gain, and gross anatomy...

  15. Suprapapillary choledochus cannulation of periampullary tumors with ERCP

    OpenAIRE

    ODABAŞI, Hacı Mehmet; YEŞİL, Atakan; Arslan, Cem; Gönen, Can; ERİŞ, Cengiz; Yildiz, Mehmet Kamil; Abuoğlu, Hacı Hasan; Günay, Emre; Özkan, Erkan; MÜFTÜOĞLU, Tolga

    2013-01-01

    Background and Aims: Endoscopic retrograde cholangiopancreatography is the gold standard for the diagnosis and treatment of biliary diseases. Direct access into the common bile duct is the most important step for successful therapeutic biliary endoscopy. Although transpapillary biliary cannulation is the preferred technique, it is not always possible. Therefore, suprapapillary cannulation has been developed as an alternative technique. Materials and Methods:Suprapapillary cannulat...

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

    Institute of Scientific and Technical Information of China (English)

    罗蕾; 秦英; 向亚娟

    2011-01-01

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

  17. Tamponamento cardíaco em dois recém-nascidos causado por cateter umbilical Cardiac tamponade caused by central venous catheter in two newborns

    Directory of Open Access Journals (Sweden)

    Andrey José Monteiro

    2008-09-01

    Full Text Available Tamponamento cardíaco secundário ao uso de cateter venoso central é uma complicação rara, porém potencialmente tratável, quando identificada a tempo. Nós relatamos dois casos de tamponamento cardíaco, diagnosticados por ecocardiograma transtorácico, seguido de pericardiocentese de urgência e drenagem pericárdica cirúrgica como complicação de cateterização venosa umbilical. Em um caso, a ponta do cateter estava adequadamente localizada e, no outro caso, não. Em ambos os casos, solução hiperosmolar estava sendo infundida. Apesar de situação incomum, esta deve ser sempre considerada em neonato, evoluindo com choque cardiogênico sem causa aparente.Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

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

    Science.gov (United States)

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

    2014-12-01

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

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

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    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.

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

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    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

  1. Portal vein cannulation: An uncommon complication of endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Evangelos Kalaitzakis; Nicholas Stern; Richard Sturgess

    2011-01-01

    Portal vein cannulation is a rare complication of endoscopic retrograde cholangiopancreatography (ERCP). It has been reported that it usually occurs after endoscopic sphincterotomy, whereas in cases without prior sphincterotomy, the presence of portobiliary fistulas has been shown. Here, we present a case in which cannulation of the portal vein occurred despite careful wire-guided cannulation and the absence of sphincterotomy. Although fatal cases of cerebral and pulmonary air and/or bile embolism have been reported in patients with combined portal and hepatic vein trauma after ERCP and sphincterotomy, isolated portal vein cannulation, as in the current case, does not usually result in mortality or serious morbidity. However, awareness of this rare complication is important so that no further intervention is performed.

  2. 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

    Energy Technology Data Exchange (ETDEWEB)

    Schummer, C.; Sakr, Y.; Reinhart, K. [Jena Univ. (Germany). Klinik fuer Anaestesiologie und Intensivtherapie; Steenbeck, J. [Jena Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Gugel, M. [Zentralklinik Bad Berka (Germany). Klinik fuer Anaesthesiologie und Intensivtherapie; Schummer, W. [SRH Zentralklinikum Suhl (Germany). Dept. of Anaesthesiology and Intensive Care Medicine

    2010-01-15

    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.)

  3. Biofilm formation in long-term central venous catheters in children with cancer: a randomized controlled open-labelled trial of taurolidine versus heparin

    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 (n...... = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi......-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream...

  4. 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

  5. Catheter related bloodstream infection (CR-BSI in ICU patients: making the decision to remove or not to remove the central venous catheter.

    Directory of Open Access Journals (Sweden)

    Rodrigo Octávio Deliberato

    Full Text Available BACKGROUND: Approximately 150 million central venous catheters (CVC are used each year in the United States. Catheter-related bloodstream infections (CR-BSI are one of the most important complications of the central venous catheters (CVCs. Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. METHODS: We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1 differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2 simultaneous quantitative blood culture with ≥ 5:1 ratio (CVC versus peripheral. RESULTS: 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208 in ICU patients. CONCLUSION: In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality.

  6. Evaluation of arterial and jugular bulb venous blood gase differences during neurosurgical procedures

    OpenAIRE

    Küçük, Dr. Nergiz; Gökmen, Dr. Gökhan; Uslu, Dr. Sebahattin

    1997-01-01

    Retrograde catheterization of the internal jugular venous bulb is a useful technique which is becoming more widespread as it enables monitoring of cerebral blood flow and cerebral metabolism. In this study, we aimed to determine our neuroanaesthesia as an objective technique. After Ethic Committee approval, 10 patients with head trauma were included in this study. Radial arter and jugular venous cannulation were performed in operating room. Blood gases, Hb, osmolality, BUN, Na, and K were ana...

  7. 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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Teichgraeber, Ulf K.M. [Charite University Hospital, Department of Radiology, Berlin (Germany); Charite Universitaetsmedizin Berlin, Institut fuer Diagnostische und Interventionelle Radiologie, Berlin (Germany); Kausche, Stephan; Nagel, Sebastian N.; Gebauer, Bernhard [Charite University Hospital, Department of Radiology, Berlin (Germany)

    2011-06-15

    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.)

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

    Science.gov (United States)

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

    2015-01-01

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

  10. 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.

  11. Radial artery cannulation. Potential hazard in patients with acromegaly.

    Science.gov (United States)

    Campkin, T V

    1980-10-01

    Using Allen's test, impaired ulnar artery circulation to one or both hands was detected pre-operatively in five out of ten acromegalic patients scheduled for transphenoidal hypophysectomy. Three of these patients also had symptoms of compression of the median nerve at the wrist (carpal tunnel syndrome). If ulnar flow is considered to be inadequate cannulation of a dorsalis pedis artery provides one possible alternative route for continuous measurement of the blood pressure during induced hypotension. In the three patients in this report in whom this vessel was cannulated no ischaemic complications in the foot were seen.

  12. 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

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    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.

  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. Long-term closed chest partial and total cardiopulmonary bypass by peripheral cannulation for severe right and/or left ventricular failure, including ventricular fibrillation. The use of a percutaneous spring in the pulmonary artery position to decompress the left heart.

    Science.gov (United States)

    Kolobow, T; Rossi, F; Borelli, M; Foti, G

    1988-01-01

    The authors report that total cardiopulmonary bypass (CPBP) for severe heart failure can be safely maintained for several days through peripheral cannulation alone. In two healthy sheep under general anesthesia, the authors cannulated the right external jugular vein and the right subclavian artery. A special spring was attached to a 7F Swan-Ganz catheter and positioned at the level of the pulmonary artery (PA) valve, rendering it partially incompetent. The extracorporeal circuit included a venous reservoir, a roller pump, a membrane lung, and a blood pulsator set at 25 beats/min. Ventricular fibrillation was induced with 110 VAC. Extracorporeal blood flow was raised to 100-120 ml/kg min. Mechanical pulmonary ventilation was changed to 5% CO2 in room air. During bypass, the wedge pressure (WP) averaged 9-13 mmHg, PA pressure 7-13 mmHg, and central venous pressure 1-9 mmHg. After 38 and 48 hr respectively the hearts were defibrillated with DC shock. There was total heart failure with no ejection from right or left. We continued with TCPBP. The right heart recovered after 1 and 3 hr respectively. After 7 and 5 hr, respectively, there was some aortic ejection. By 11 and 4 hr, respectively, the sheep were off bypass and on room air, with return to baseline cardiac function. Throughout the recovery the WP averaged 4-8 mmHg. At autopsy, all hearts were soft and normal in appearance. Histologic examination of the lungs and the heart was unremarkable. The authors conclude that the PA spring readily decompressed the LV. Ventilating lungs with 5% CO2 in air during CPBP sustained excellent lung function.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3196550

  15. Upper-extremity deep venous thrombosis: a review.

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    Mai, Cuc; Hunt, Daniel

    2011-05-01

    Upper-extremity deep venous thrombosis is less common than lower-extremity deep venous thrombosis. However, upper-extremity deep venous thrombosis is associated with similar adverse consequences and is becoming more common in patients with complex medical conditions requiring central venous catheters or wires. Although guidelines suggest that this disorder be managed using approaches similar to those for lower-extremity deep venous thrombosis, studies are refining the prognosis and management of upper-extremity deep venous thrombosis. Physicians should be familiar with the diagnostic and treatment considerations for this disease. This review will differentiate between primary and secondary upper-extremity deep venous thromboses; assess the risk factors and clinical sequelae associated with upper-extremity deep venous thrombosis, comparing these with lower-extremity deep venous thrombosis; and describe an approach to treatment and prevention of secondary upper-extremity deep venous thrombosis based on clinical evidence.

  16. Contrast media power injection using central venous port catheters - results of an in vitro study; Kontrastmitteldruckinjektion in Portkathetersysteme - Ergebnisse einer In-vitro-Studie

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B. [Klinik fuer Strahlenheilkunde, Charite, Universitaetsmedizin Berlin, Campus Buch, Berlin (Germany); Teichgraeber, U.K.M.; Hothan, T. [Klinik fuer Strahlenheilkunde, Charite, Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin (Germany); Felix, R. [Klinik fuer Strahlenheilkunde, Charite, Universitaetsmedizin Berlin, Campus Buch, Berlin (Germany); Klinik fuer Strahlenheilkunde, Charite, Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin (Germany); Wagner, H.J. [Klinik fuer Strahlendiagnostik, Medizinisches Zentrum fuer Radiologie, Klinikum der Philipps-Univ., Marburg (Germany)

    2005-10-01

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-06-01

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

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

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    Amit Singh

    2014-01-01

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

  19. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  1. 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

  2. Eliminating guidewire retention during ultrasound guided central venous catheter insertion via an educational program, a modified CVC set, and a drape with reminder stickers.

    Science.gov (United States)

    Peh, Wee Ming; Loh, Wann Jia; Phua, Ghee Chee; Loo, Chian Min

    2016-01-01

    Guidewire retention is a severe but preventable complication from central venous catheter (CVC) insertion. There were three cases of guidewire retention during CVC insertion in the medical intensive care unit (MICU) in Singapore General Hospital, in the period between December 2011 and February 2012. The primary objective of this quality improvement project was to eliminate future incidences of guidewire retention during CVC insertion in the MICU and medical intermediate care area (MICA) via a structured educational program and a cost effective modified CVC set. The secondary objective was to perform a cost analysis and comparison between the use of the conventional hospital CVC set and drape with our newly modified CVC dressing kit. Root cause analysis of the three cases identified major factors leading to guidewire retention. Interventions were planned and tested using PDSA cycles. Internal medicine trainees rotating through MICU and MICA during the period between February 2012 and June 2013 underwent a multi-modal structured CVC insertion training program with hands on simulation. They also used a newly modified CVC dressing kit and drape. The CVC dressing kit was modified (CVC PLUS) to include a sterile drape with reminder stickers stating "REMOVE the GUIDEWIRE," as well as a sterile ultrasound sleeve. The total number of CVC insertions performed and guidewire retentions were monitored. During the period of study there were 320 CVC insertions in the MICU and MICA. Since this quality improvement project was initiated, and up to the submission of this article, there have not been any further cases of guidewire retention in the MICU and MICA. The total cost reduction per use of CVC PLUS was S$29.26 (Singaporean Dollars). A multi-modal structured training program, integrated with a modified, pre-packed CVC set, and drapes with reminder stickers (all included in CVC PLUS) were cost effective, and improved patient safety by eliminating guidewire retention during CVC

  3. The comparison of stroke volume variation with central venous pressure in predicting fluid responsiveness in septic patients with acute circulatory failure

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    Santhalakshmi Angappan

    2015-01-01

    Full Text Available Purpose: The present study was designed to investigate the efficacy of stroke volume variation (SVV in predicting fluid responsiveness and compare it to traditional measures of volume status assessment like central venous pressure (CVP. Methods: Forty-five mechanically ventilated patients in sepsis with acute circulatory failure. Patients were not included when they had atrial fibrillation, other severe arrhythmias, permanent pacemaker, or needed mechanical cardiac support. Furthermore, excluded were patients with hypoxemia and a CVP >12. Patients received volume expansion in the form of 500 ml of 6% hydroxyethyl starch. Results: The volume expansion-induced increase in  cardiac index (CI was >15% in 29 patients (labeled responders and <15% in 16 patients (labeled nonresponders. Before volume expansion, SVV was higher in responders than in nonresponders. Receiver operating characteristic curves analysis showed that SVV was a more accurate indicator of fluid responsiveness than CVP. Before volume expansion, an SVV value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 78% and a specificity of 89%. Volume expansion-induced changes in CI weakly and positively correlated with SVV before volume expansion. Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI. Conclusions: When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP. Nevertheless, the overall correlation of baseline SVV with increases in CI remains poor. Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.

  4. Efficacy and safety of using L-cysteine as a catheter-clearing agent for nonthrombotic occlusions of central venous catheters in children.

    Science.gov (United States)

    Pai, Vinita B; Plogsted, Steven

    2014-10-01

    Critically ill pediatric patients, especially in the intensive care unit, receive multiple medications and have a higher risk of central venous catheter (CVC) occlusion. If an occlusion occurs immediately after the administration of multiple medications or incompatible medications, either an acidic solution such as 0.1 N hydrochloric acid (HCl) or a basic solution of 1 mEq/mL sodium bicarbonate or 0.1 N sodium hydroxide can be used. However, compounding and storing of 0.1 N HCl has become more complex due to USP guidelines for sterile compounding, and an alternative is needed. We report a series of cases in which L-cysteine was used instead of HCl to clear CVCs occluded due to administration of multiple medications. L-cysteine is a commercially available, sterile solution with a pH of 1–2.5. CVC occlusion was resolved in 10 of the 16 episodes in 13 patients. Two of the 16 occlusions were phenytoin related and would not have responded. An L-cysteine dose of 50 mg was used during 10 of the 16 episodes, 100 mg during 5 episodes, and 25 mg during 1 episode. A correlation between catheter clearance and dose was not observed. Occlusion resolution due to L-cysteine was not correlated to the prior use of tissue plasminogen activator. Metabolic acidosis, adverse effects, or damage to the catheters due to L-cysteine were not observed. On the basis of this limited experience, we propose L-cysteine as an effective alternative to 0.1 N HCl for clearing CVC occlusions caused by drugs with an acidic pKa.

  5. 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.

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

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    Rana S. Hamid

    2015-11-01

    Full Text Available Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters (TVCs at the Sultan Qaboos University Hospital (SQUH, Muscat, Oman. Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications (such as catheter-related infections or thrombosis were collected. Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female (42.2% and 93 were male (57.8%. The mean age of the patients was 54.4 ± 17.3 years. The most common reason for catheter placement was the initiation of dialysis (63.4%. A total of 203 procedures were technically successful (99.5%. The right internal jugular vein was the most common site of catheter placement (74.9%. Mild haemorrhage which resolved spontaneously occurred in 11 cases (5.4%. No other complications were observed. Subsequent follow-up data was available for 132 catheters (65.0%; of these, thrombosis-related catheter malfunction was observed in 22 cases (16.7% and catheter-related infection in 29 cases (22.0%. Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature.

  7. Risk factors for central venous catheter-related infections in NICU%NICU患者中心静脉导管相关性感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    王法欣

    2013-01-01

    目的 控制神经重症监护病房(NICU)患者中心静脉导管相关性感染的危险因素.方法 收集自2007-2011年入住NICU并进行中心静脉导管置管的患者资料,按照是否发生中心静脉导管感染进行分组,使用logistic回归分析方法明确NICU患者发生中心静脉导管相关性感染的危险因素.结果 自2007-2011年NICU进行中心静脉置管778例次,发生中心静脉导管感染175例次,发生率为22.4%,发生中心静脉导管相关性感染的平均时间9.1d;送检导管中病原菌检出阳性率为40.2%,导管血送检病原菌检出率为42.5%;logistic回归分析结果显示,糖尿病史及置入三腔导管进入最终的回归模型,OR值分别为3.777、9.094和7.342.结论 NICU患者中心静脉导管相关性感染的发病率高,中重度昏迷、糖尿病史及置入三腔导管是发生中心导管相关性感染的危险因素,建议临床对该类患者进行重点防护.%OBJECTIVE To identify the risk factors of central venous catheter-related infections in neurosurgery intensive care unit (NICU). METHODS We recruited the patients with central venous catheter-related infections in NICU from 2007 to 2011. The patients were divided according to the status of the infections, the logistic regression analysis method was employed to define the risk factors for the central venous catheter-related infections. RESULTS Of 778 case-time of patients who underwent central venous catheterization during 2007 - 2011, the centralvenous catheter-related infections occurred in 175 case-times of patients with the incidence rate of 22. 4% , the median time to onset of central venous catheters related infections was 9. 1 days. The positive rate of the pathogens isolated from submitted catheters was 40. 2%, 42. 5% of the submitted catheter blood. Logistic regression analysis showed that three factors including the history of diabetes mellitus and use of three-cavity catheter entered the final regression

  8. A novel cannulation technique for difficult urethral catheterization

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    Mehmet Kaynar

    2016-03-01

    Full Text Available Introduction: To propose a novel cannulation technique for difficult urethral catheterization procedures. Technique: The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. Results: The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. Conclusions: This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.

  9. A Rare Venous Port Complication: Supraventriculer Tachycardia

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    Tamer Yoldaş

    2016-04-01

    Full Text Available Implantable central venous port catheters are widely used in the management of children with cancer undergoing long term chemotherapy. These catheters can manifest a number of complications such as arrhythmia. Central venous port catheter was placed on a ten years old boy for chemotherapy. Before insertion of port catheter his physical examination, laboratory parameters, electrocardiography and echocardiography were normal. The patient felt palpitations shortly after the insertion of the port catheter. At that time the heart rate was 200 beats/minute but immediately normal sinus rhythm was restored. A chest roentgenogram revealed that the distal fragment of the port catheter was inside the right atrium. The port catheter was pulled back somewhat and then tachycardia attacks stopped. To our knowledge there are a few reports of supraventricular tachycardia (SVT in children associated with central venous port catheter. Here we aimed to present a pediatric case with SVT after placement of central venous port catheter and his management.

  10. Pressão venosa central em cateter femoral: correlação com acesso superior após cirurgia cardíaca Central venous pressure in femoral catheter: correlation with superior approach after heart surgery

    Directory of Open Access Journals (Sweden)

    Sirley da Silva Pacheco

    2008-12-01

    Full Text Available OBJETIVO: É comum a obtenção de acesso venoso femoral em pacientes submetidos a cirurgia cardíaca em associação ou como alternativa ao acesso superior (veia jugular interna ou veia subclávia. O objetivo deste estudo foi comparar as medidas de pressão venosa central (PVC em dois sítios diferentes (superior vs. femoral. MÉTODOS: Estudo prospectivo e aberto com 60 pacientes submetidos a cirurgia cardíaca no período de julho a novembro de 2006. Foram obtidas três medidas de cada paciente em cada sítio (admissão, 6 e 12 horas após a cirurgia em duas inclinações diferentes da cabeceira do leito (zero e 30 graus, totalizando 720 medidas. RESULTADOS: Cinqüenta e cinco por cento dos pacientes foram submetidos a revascularização do miocárdio, 38% a cirurgia valvar e 7% a outras cirurgias. A média de PVC ± desvio padrão (DP medida no acesso superior foi de 13,0 ± 5,5 mmHg (zero grau e 13,3 ± 6,1 mmHg (30 graus, enquanto que as medidas no acesso inferior foram 11,1 ± 4,9 mmHg (zero grau e 13,7 ± 4,6 mmHg (30 graus. A correlação linear (r entre as medidas nos dois sítios foi de 0,66 (zero grau e 0,53 (30 graus, ambas com p OBJECTIVE: It is common to obtain femoral venous approach in patients undergoing combined heart surgery or as an alternative to superior approach (internal jugular vein or subclavian vein. The aim of this study was to compare the measures of central venous pressure (CVP at two different sites (superior versus femoral. METHODS: We prospectively and openly allocated 60 patients who underwent heart surgery between July from November 2006. Three measures were obtained from each patient at each site (admission, 6 and 12 hours after surgery in two different inclinations of the headboard (zero and 30 degrees totaling 720 measures. RESULTS: Fifty five percent of patients who underwent coronary artery bypass grafting, 38% heart valve surgery and 7% other surgeries. The mean of CVP ± standard deviation (SD measured

  11. 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.

  12. 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

  13. 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...

  14. Clinical investigation of catheter-related infections in two central venous cathers%两种中心静脉导管相关性感染的临床观察

    Institute of Scientific and Technical Information of China (English)

    高立平

    2012-01-01

    目的 评价抗感染中心静脉导管在减少重症监护病房(ICU)患者导管相关性感染(CRI)中的作用.方法 将248例在ICU留置中心静脉导管的患者随机分成普通中心静脉导管组(对照组120例)和抗感染中心静脉导管组(抗感染组128例),观察两组CRI的发生率和病原菌分布情况.结果 抗感染组的CRI发生率明显低于对照组(6.3%vs14.2%),差异有统计学意义(P<0.05).CRI的病原菌为金黄色葡萄球菌、鲍曼不动杆菌、阴沟肠杆菌、肠球菌、肺炎克雷伯菌和白色念珠菌,但两组患者CRI病原菌分布比较,差异无统计学意义(P>0.05).结论 抗感染中心静脉导管可明显降低ICU患者CRI的发生率.%Objective To evaluate the effect of reducing intravenous catheter-ralated infection (CRT) using antiseptic impregnated central venous catheter in patients in intensive care unit (ICU). Methods 248 patients treated in ICU who needed intravascular catheterization were randomly divided into the control group (120 cases, treated with ordinary central venous catheter) and the antiseptic group (128 cases, treated with antiseptic impregnated central venous catheter). The incidence of CRI and pathogenic distribution were observed. Results The incidence of CRI in the antiseptic group was significantly lower than that of the control group (6.3% vs 14.2%, P<0.05). The pathogens of CRI were Staphytococcus aureus, Acmetabactor baumarwiii, E. Cloacae, entemcoccus, Klebsiella pneumonias and Candida albicans. Pathogenic distribution between the two groups showed no statistically significant difference (PX).O5). Conclusion Antiseptic impregnated central venous catheter can obviously reduce the incidence of CRI in patients in ICU.

  15. Topical amethocaine (Ametop) is superior to EMLA for intravenous cannulation. Eutectic mixture of local anesthetics.

    LENUS (Irish Health Repository)

    Browne, J

    2012-02-03

    PURPOSE: A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (i.v.) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel formulation of amethocaine (Ametop) is now commercially available. The aim of this study was to compare EMLA and Ametop with regard to the degree of topical anesthesia afforded, the incidence of vasoconstriction and the ease of i.v. cannulation. METHODS: Thirty two ASA I adult volunteers had a #16 gauge i.v. cannula inserted on two separate occasions using EMLA and Ametop applied in a double blind fashion for topical anesthesia. Parameters that were recorded after each cannulation included visual analogue pain scores (VAPS), the presence of vasoconstriction and the ease of cannulation, graded as: 1 = easy, 2 = moderately difficult, 3 = difficult and 4 = failed. RESULTS: The mean VAPS +\\/- SD after cannulation with Ametop M was 12+\\/-9.9 and with EMLA was 25.3+\\/-16.6 (P = 0.002). Vasoconstriction occurred after EMLA application on 17 occasions and twice after Ametop (P = 0.001). The grade of difficulty of cannulation was 1.44+\\/-0.88 following EMLA and 1.06+\\/-0.25 with Ametop (P = 0.023). CONCLUSIONS: Intravenous cannulation was less painful following application of Ametop than EMLA. In addition, Ametop caused less vasoconstriction and facilitated easier cannulation. Its use as a topical anesthetic agent is recommended, especially when i.v. access may be problematic.

  16. 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.

  17. 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

  18. Chronic intrathecal cannulation enhances nociceptive responses in rats

    Directory of Open Access Journals (Sweden)

    Almeida F.R.C.

    2000-01-01

    Full Text Available The influence of a chronically implanted spinal cannula on the nociceptive response induced by mechanical, chemical or thermal stimuli was evaluated. The hyperalgesia in response to mechanical stimulation induced by carrageenin or prostaglandin E2 (PGE2 was significantly increased in cannulated (Cn rats, compared with naive (Nv or sham-operated (Sh rats. Only Cn animals presented an enhanced nociceptive response in the first phase of the formalin test when low doses were used (0.3 and 1%. The withdrawal latency to thermal stimulation of a paw inflamed by carrageenin was significantly reduced in Cn rats but not in Nv or Sh rats. In contrast to Nv and Sh rats, injection in Cn animals of a standard non-steroid anti-inflammatory drug, indomethacin, either intraperitoneally or into the spinal cord via an implanted cannula or by direct puncture of the intrathecal space significantly blocked the intensity of the hyperalgesia induced by PGE2. Cannulated animals treated with indomethacin also showed a significant inhibition of second phase formalin-induced paw flinches. Histopathological analysis of the spinal cord showed an increased frequency of mononuclear inflammatory cells in the Cn groups. Thus, the presence of a chronically implanted cannula seems to cause nociceptive spinal sensitization to mechanical, chemical and thermal stimulation, which can be blocked by indomethacin, thus suggesting that it may result from the spinal release of prostaglandins due to an ongoing mild inflammation.

  19. 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.)

  20. 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

  1. Current use of ultrasound for central vascular access in children and infants in the Nordic countries--a cross-sectional study

    DEFF Research Database (Denmark)

    Olsen, Thomas C Risom; Rimstad, Ivan Jonassen; Tarpgaard, Mona;

    2015-01-01

    widespread across the Nordic countries. Close to 80% of respondents were using it "almost always" or "frequently" across all paediatric age groups for internal jugular vein cannulation. US was least frequently used when catheterizing the subclavian vein. The two most common reasons given when not using US....... METHODS: A cross-sectional survey using an online questionnaire was distributed to one anaesthesiologist at every hospital in the Nordic countries; a total of 177 anaesthesiologists were contacted from July till August 2012. RESULTS: The use of US for placing central venous catheters (CVCs) seems......PURPOSE: The use of ultrasound (US) guidance for central vascular access in children has been advocated as a safer approach compared to traditional landmark techniques. We therefore collected data on the current use of US for central vascular access in children and infants in the Nordic countries...

  2. 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) ...

  3. 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.

  4. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

    DEFF Research Database (Denmark)

    Halttunen, Jorma; Meisner, Søren; Aabakken, Lars;

    2014-01-01

    BACKGROUND: The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). AIMS: To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. PATIENTS AND METHODS: Prospective consecutive reco...

  5. Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

    Directory of Open Access Journals (Sweden)

    Juliana Deh Carvalho Machado

    2009-12-01

    Full Text Available OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68% estavam infectados, sendo 72% do Grupo 1 e 28% do Grupo 2 (assintomáticos. No Grupo 1, houve infecção sistêmica em 70% dos casos, já no Grupo 2 a hemocultura foi positiva em 17% dos casos. A colonização por Staphylococcus sp. ocorreu em 48% dos casos, seguida de Candida sp. (21%, Enterococcus faecalis (16%, Pseudomonas aerurginosa (10% e Proteus sp.(5%. CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed

  6. Impact of Cluster of Intervention Strategies on CRRT Central Venous Catheter-related Bloodstream Infections%集束化干预策略对CRRT中心静脉导管相关性血行感染的影响

    Institute of Scientific and Technical Information of China (English)

    陈刚; 黄晓铭; 陈鑫鑫

    2014-01-01

    Objective To explore the cluster intervention strategies for CRRT central venous catheter related bloodstream infections (hereinafter referred to as CRBIS). Methods Retrospective analysis of our department in August 2012-February 2013 lines of central venous catheter and conventional CRRT infection intervention measures of patients 150 cases (control group) and March 2013-September 2013 lines of central venous catheter and CRRT in 196 patients with cluster intervention strategies (observation group), compared two groups of patients the incidence of CRBIS, ICU hospitalization days and hospitalization expenses, etc. Results Cluster intervention strategies significantly reduce the rate of catheter-related bloodstream infection, which reduces the patients in ICU time, reduced the cost of patients. Conclusion Cluster intervention strategy can decrease the CRRT CRBIS rate of femoral vein, but need to improve the clinical compliance.%目的:探讨集束化干预策略对CRRT中心静脉导管相关性血流感染(以下简称 CRBIS)的影响。方法回顾性对比分析我科2012年8月~2013年2月行CRRT中心静脉导管并按常规实施感染干预措施的患者150例(对照组)与2013年3月~9月行CRRT中心静脉导管并按集束化干预策略患者196例(观察组),比较两组患者的CRBIS发生率、ICU 住院天数、住院费用等。结果集束化干预策略明显降低导管相关性血行感染,从而降低了患者入住 ICU时间,减少了患者费用。结论集束化干预策略可降低CRRT股静脉的CRBIS率,但需提高临床的依从性。

  7. 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.

  8. 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.

  9. Effect of positive end-expiratory pressure on central venous pressure of the patients undergoing mechanical ventilation%呼气末正压通气对机械通气患者中心静脉压的影响

    Institute of Scientific and Technical Information of China (English)

    刘丽

    2008-01-01

    目的:观察机械通气时不同水平的呼气末正压通气(postive end-expiratory pressure,PEEP)对中心静脉压(central venous pressure,CVP)的影响.方法:监测10例实施机械通气的呼吸衰竭患者在不同水平PEEP(0~14 cmH2O)时的CVP,分析CVP与PEEP的相关性.结果:不同水平PEEP时CVP有统计学意义(P<0.01);CVP与PEEP呈显著正相关(r=0.989).结论:CVP随PEEP的上调而增加.

  10. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    Science.gov (United States)

    Testoni, Pier Alberto; Mariani, Alberto; Aabakken, Lars; Arvanitakis, Marianna; Bories, Erwan; Costamagna, Guido; Devière, Jacques; Dinis-Ribeiro, Mario; Dumonceau, Jean-Marc; Giovannini, Marc; Gyokeres, Tibor; Hafner, Michael; Halttunen, Jorma; Hassan, Cesare; Lopes, Luis; Papanikolaou, Ioannis S; Tham, Tony C; Tringali, Andrea; van Hooft, Jeanin; Williams, Earl J

    2016-07-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE suggests that difficult biliary cannulation is defined by the presence of one or more of the following: more than 5 contacts with the papilla whilst attempting to cannulate; more than 5 minutes spent attempting to cannulate following visualization of the papilla; more than one unintended pancreatic duct cannulation or opacification (low quality evidence, weak recommendation). 2 ESGE recommends the guidewire-assisted technique for primary biliary cannulation, since it reduces the risk of post-ERCP pancreatitis (moderate quality evidence, strong recommendation). 3 ESGE recommends using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation is difficult and repeated unintentional access to the main pancreatic duct occurs (moderate quality evidence, strong recommendation). ESGE recommends attempting prophylactic pancreatic stenting in all patients with PGW-assisted attempts at biliary cannulation (moderate quality evidence, strong recommendation). 4 ESGE recommends needle-knife fistulotomy as the preferred technique for precutting (moderate quality evidence, strong recommendation). ESGE suggests that precutting should be used only by endoscopists who achieve selective biliary cannulation in more than 80 % of cases using standard cannulation techniques (low quality evidence, weak recommendation). When access to the pancreatic duct is easy to obtain, ESGE suggests placement of a pancreatic stent prior to precutting (moderate quality evidence, weak recommendation). 5 ESGE recommends that in patients with a small papilla

  11. 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.)

  12. 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.)

  13. Enteral fluid therapy through nasogastric tube in rumen cannulated goats

    Directory of Open Access Journals (Sweden)

    Katia Atoji-Henrique

    2012-12-01

    Full Text Available This paper reports the effects of fluid therapy in goats through nasogastric route with an electrolyte solution composed by concentrations of sodium, potassium and chloride similar to goat plasma (140mmol/L of Na+, 4.5mmol/L of K+, 110mmol/L of Cl-. Four Alpine Chamoisee goats, two of them with evident leakage of the rumen cannulas, were used in a crossover experimental design of two periods and two groups. In one group the two goats were submitted to a treatment protocol to induce dehydration before the fluid therapy, whereas the other group was not. Fluid therapy consisted supplying 10mL/kg/h of the electrolyte solution during 8 hours. No signs of discomfort or stress were observed. The dehydration model employed caused a mild dehydration indicated by decrease in feces humidity, body weight and abdominal circumference, and increase in plasma total solids concentration. During fluid therapy globular volume and plasma total solids decreased, whereas % body weight and abdominal circumference increased. No signs of hyperhydration were observed and serum electrolytes (Na+, Cl-, K+ presented no significant alterations in both groups. Fluid therapy proposed in this study was efficient to treat dehydration, even for rumen cannulated animals with evident leakage, and can be administrated safely with no electrolyte imbalance.

  14. Do double gloves protect against contamination during cannulation of blood vessels? A prospective randomized study

    OpenAIRE

    Łukasz Szarpak; Andrzej Kurowski

    2014-01-01

    Background: Undamaged medical gloves protect medical personnel from contact with physiological fluids of the patient. Thus they protect the assistance provider from hand skin contamination with potentially infectious biological material. The aim of the study was to evaluate the occurrence of pierce, perforations or damage of medical gloves during cannulation of blood vessels. Materials and Methods: In the prospective randomized study 303 pairs of gloves, used during cannulation of blood vesse...

  15. Intraoperative cooperation and nursing for successful performance of DSA-guided trachea cannulation

    International Nuclear Information System (INIS)

    Objective: To investigate the effective intraoperative cooperation and nursing in performing DSA-guided trachea cannulation for severe airway stenosis. Methods: DSA-guided trachea cannulation with interventional technique was carried out in 15 patients with severe airway stenosis in sober condition. During the procedure close intraoperative and proper nursing care were carefully adopted. Results: During the interventional procedure close cooperation, careful observation of the vital signs and keeping the airway open were effectively and carried out until the trachea cannulation was successfully accomplished in all the 15 patients. After the procedure the shortness of breath was immediately improved. No complications occurred. Conclusion: DSA-guided trachea cannulation can solve complicated tracheal stenosis. Clinically, this technique is especially is especially useful when the conventional trachea cannulation manipulation fails. The operation time of the procedure is short, the technical success rate is higher and the occurrence of complications is lower. Moreover, successful trachea cannulation can provide the patients with valuable opportunities for receiving further treatment. (authors)

  16. Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Michael P Swan; Michael J Bourke; Stephen J Williams; Sina Alexander; Alan Moss; Rick Hope; David Ruppin

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center.METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP.RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 na?ve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017).CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

  17. Ultrasonic Technology Improves Radial Artery Puncture and Cannulation in Intensive Care Unit (ICU) Shock Patients.

    Science.gov (United States)

    Li, Xiuyan; Fang, Guizhen; Yang, Danhua; Wang, Lanfang; Zheng, Chunmei; Ruan, Longjuan; Wang, Lingcong

    2016-01-01

    BACKGROUND This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. MATERIAL AND METHODS A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. RESULTS (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (Pstoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). CONCLUSIONS Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics. PMID:27397118

  18. 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

  19. Microbial biofilms on needleless connectors for central venous catheters: comparison of standard and silver-coated devices collected from patients in an acute care hospital.

    Science.gov (United States)

    Perez, Elizabeth; Williams, Margaret; Jacob, Jesse T; Reyes, Mary Dent; Chernetsky Tejedor, Sheri; Steinberg, James P; Rowe, Lori; Ganakammal, Satishkumar Ranganathan; Changayil, Shankar; Weil, M Ryan; Donlan, Rodney M

    2014-03-01

    Microorganisms may colonize needleless connectors (NCs) on intravascular catheters, forming biofilms and predisposing patients to catheter-associated infection (CAI). Standard and silver-coated NCs were collected from catheterized intensive care unit patients to characterize biofilm formation using culture-dependent and culture-independent methods and to investigate the associations between NC usage and biofilm characteristics. Viable microorganisms were detected by plate counts from 46% of standard NCs and 59% of silver-coated NCs (P=0.11). There were no significant associations (P>0.05, chi-square test) between catheter type, side of catheter placement, number of catheter lumens, site of catheter placement, or NC placement duration and positive NC findings. There was an association (P=0.04, chi-square test) between infusion type and positive findings for standard NCs. Viable microorganisms exhibiting intracellular esterase activity were detected on >90% of both NC types (P=0.751), suggesting that a large percentage of organisms were not culturable using the conditions provided in this study. Amplification of the 16S rRNA gene from selected NCs provided a substantially larger number of operational taxonomic units per NC than did plate counts (26 to 43 versus 1 to 4 operational taxonomic units/NC, respectively), suggesting that culture-dependent methods may substantially underestimate microbial diversity on NCs. NC bacterial communities were clustered by patient and venous access type and may reflect the composition of the patient's local microbiome but also may contain organisms from the health care environment. NCs provide a portal of entry for a wide diversity of opportunistic pathogens to colonize the catheter lumen, forming a biofilm and increasing the potential for CAI, highlighting the importance of catheter maintenance practices to reduce microbial contamination.

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

    OpenAIRE

    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...

  1. Warfarin for improvement the cuffed central venous catheter dysfunction and clinical analysis%华法令对于带涤纶套中央静脉导管功能不良的改善及临床分析

    Institute of Scientific and Technical Information of China (English)

    汤小芳; 严连喜; 李康峰; 石平; 王成双; 孔若曦; 严宁; 周玉坤

    2016-01-01

    目的 观察口服华法令对于因血栓及纤维蛋白鞘而至涤纶套中央静脉导管置入后功能不良的改善并行临床分析.方法 59例带卡夫隧道导管患者,分为A组(28例)口服华法令1.5~3mg/d抗凝,对照组B组(31例)口服阿司匹林100mg/d抗凝,两组常规普通肝素封管.记录导管透析中血流量、回血静脉压,记录透析前后尿素氮、肌酐、超滤等,计算透析尿素清除指数,评估透析效果,定期检测非透析状态下国际标准化比值.比较导管留存时间、导管中位留存时间,并观察两组出血、导管相关性血流感染等并发症.观察一年时间.结果 A、B两组透析前后肌酐、尿素氮水平变化存在统计学差异,A组尿素清除指数均达标,A、B两组透析中血流量、回血静脉压比较存在统计学差异.A、B两组透析后比较肌酐、尿素氮水平、尿素清除指数以及国际标准化比值也存在统计学差异,且两组导管留存时间亦存在统计学差异.A组国际标准化比值维持在(2.00±0.93)之间,A、B两组未见出血、导管相关性血流感染并发症.结论 带卡夫中央静脉导管置后常规口服中等剂量华法令抗凝配合肝素封管较口服阿司匹林更能改善因血栓及纤维蛋白鞘而至导管功能不良,延长导管留存时间,且并发症少.但本研究样本量偏少,观察时间偏短,仍需进一步临床验证以证实口服华法令在带卡夫隧道导管置入后临床安全性及有效性.%Objectives To observe the improvement of warfarin for cuffed central venous catheter dysfunction due to thrombus and fibrin sheath and to carry on the clinical analysis.Methods 59 patients with cuffed central venous catheter were divided into group A (28 cases) and control group B (31 cases),patients in the group A were given warfarin 1.5 ~3mg/d,and patients in the control group B were given aspirin 100mg/d.The heparin was used to sealed tube in two groups.Catheter hemodialysis

  2. 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

  3. 血液净化中心静脉导管感染病原菌检测结果分析%Analysis of pathogen test results for infections of central venous catheter for blood purification

    Institute of Scientific and Technical Information of China (English)

    吕春晓; 崔涛; 于少杰; 柴翠萍

    2015-01-01

    目的:对血液净化中心静脉导管感染病原菌检测结果进行回顾性分析,以期能为临床诊治提供参考。方法收集2011年6月-2013年6月321例血液净化中心静脉导管下血液透析患者临床资料,分析送检标本进行细菌培养及药物敏感试验结果,采用SPSS 17.0软件进行统计分析。结果共培养出病原菌132株,其中13例患者为混合感染,感染病原菌中革兰阳性菌、革兰阴性菌、真菌分别占50.76%、31.06%、18.18%;检出革兰阳性菌中金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌对青霉素耐药率为100.00%,革兰阴性菌中鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌对哌拉西林、头孢曲松、庆大霉素、妥布霉素耐药率菌>50.00%,真菌中光滑假丝酵母菌对两性霉素B耐药率为0。结论血液净化中心静脉导管感染病原菌以革兰阳性菌所占比例最高,其次为革兰阴性菌及真菌,病原菌对临床常用抗菌药物耐药率普遍较高。%OBJECTIVE To retrospectively analyze pathogen test results for infections of central venous catheter for blood purification ,in order to provide reference for clinical diagnosis and treatment .METHODS Clinical data of 321 cases undergoing hemodialysis by central venous catheters for blood purification during Jun .2011 to Jun .2013 were collected ,the results from specimens of bacterial culture and drug sensitivity test were analyzed .The soft‐ware SPSS17 .0 was used for statistical analysis .RESULTS Totally 132 pathogenic strains were cultured ,including gram‐positive bacteria (50 .76% ) ,gram‐negative bacteria (31 .06% ) ,and fungi (18 .18% ) ,and 13 patients had mixed infections . Among gram‐positive bacteria , Staphylococcus aureus , Staphylococcus haemolyticus , and Staphylococcus epidermidis had resistant rate of 100 .00% to penicillin ;among gram‐positive bacteria ,Acineto

  4. Central venous catheter related Infection and risk factors after cardiovascular surgery%心脏外科术后中心静脉导管相关感染致病菌及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    唐闽; 崔岭; 时东彦; 梁宜武; 马千里; 王宪德

    2008-01-01

    目的 研究心脏外科术后中心静脉导管相关感染(CRI)、导管相关性菌血症(CRB)的发生率和菌群分布状况,以及CRI的危险因素,为临床科学管理中心静脉导管,降低CRI、CRB的发病率提供有益的参考.方法 自2005年1月至2005年12月共随机选取在心脏外科手术治疗的300例患者留置的中心静脉导管进行尖端细菌培养,同时进行血培养.结果 300例中35例(11.7%)发生CBI,CBB 5例(1.7%).病原菌菌群分布:革兰阳性球菌占54.3%,革兰阴性杆菌占34.3%.真菌占11.4%.前5位致病菌分别为:表皮葡萄球茵、金黄色葡萄球菌、肺炎克雷白杆菌、铜绿假单胞杆茵、白色念珠菌.CRl、CRB的危险因素包括:原发疾病种类、穿刺置管部位、中心静脉导管留置时间等.中心静脉导管留置时间>6d,感染率明显增加.结论 CBI、CBB是留置中心静脉导管最严重的并发症,旱期诊断、及时合理应用抗生素对降低病死率具有重要的意义.%Objective To investigate the pathogen culturing of the catheter related infection(CRI),cathe-ter related bloodstram infection(CRB)and risk factors after central venous catheter(CVC)of cardiovascular surgery in order to provide the beneficial reference.Methods From Jan 2005 to Dec 2005,a total of 300 cases central ve-nous cathers were determined,and the cusp of the catheters was determined by bacteria cultivation,and blood bacte-ria cultivation.Results The infection happened in 35 of 300 patients with inserted central venous catheter.The cusps of CRI rate was 11.7%.CRB rate was 1.7%.54.3%pathogens were gram-positive cocci,34.3% were gram-negative bacilli,11.4% were fungi.The most common strain were Staphylococcus epidermis,Staphylococcus aureus,Klebsiella pneumoniae,Pseudomonas aeruginose,and Candiadia albicans.The infection rate increased obviously when the dwelling time>6 d.Conclusion CRI and CRB are the most severe complication of CVC,and it is important to cut down the death

  5. Alternative Techniques for Cannulation of Biliary Strictures Resistant to the 0.035 System Following Living Donor Liver Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hee Mang; Kim, Jin Hyoung; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique. Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches. Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision. Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.

  6. Correlation of pleth variability index with central venous pressure%脑肿瘤手术围手术期灌注变异指数和中心静脉压的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王娟丽; 罗中兵; 杨俊哲

    2015-01-01

    Objective To observe the changes of pleth variability index ( PVI) and central venous pressure ( CVP) in patients undergo-ing resection operation of brain neoplasms,and the correlation of PVI with CVP was investigated. Methods Forty-two patients ( ASA Ⅱ~Ⅲ grade) undergoing elective resection operation of brain neoplasms were included in the study. PVI was monitored continously with Masio Radical-7 pulse oximeter after patient entering operative room. CVP was monitored after central venous catheterization placed with regional an-esthesia. Total intravenous anesthesia was chosen. CVP and PVI were recorded at the time of entering operative room,operation began,and 30 minutes,60 minutes,90 minutes,120 minutes after the beginning of operation. Results The correlation coefficient of PVI with CVP was 0. 201 under spontaneously breathing ( at patient entering operative room before anesthesia) and was 0. 237 under mechanical ventilation. Conclusion Correlation of PVI and CVP is lower. The value of PVI might need further research for guiding volume management.%目的 观察灌注变异指数( PVI)和中心静脉压( CVP)持续监测用于脑肿瘤手术患者时的变化,探讨PVI和CVP的相关性. 方法 42例选择ASA分级为Ⅱ~Ⅲ级择期行脑肿瘤切除术患者,入室后持续监测PVI,局部麻醉下行中心静脉穿刺监测CVP. 麻醉方式采用全凭静脉麻醉. 记录入室时、手术开始时、手术开始后30 min、60 min、90 min和120 min时间点的CVP和PVI.结果 PVI和CVP在自主呼吸下(入室时)的相关系数r=0. 201,机械通气下的相关系数r=0. 237. 结论 PVI和CVP的相关性差,联合指导容量管理的应用价值可能还需要进一步的评估.

  7. A meta-analysis for the effect of prophylactic GTN on the incidence of post-ERCP pancreatitis and on the successful rate of cannulation of bile ducts

    Directory of Open Access Journals (Sweden)

    Wang Chun-hui

    2010-07-01

    Full Text Available Abstract Background Glyceryl trinitrate (GTN has been shown to be able to relax the sphincter of Oddi (SO both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD during the procedure, or minimizing potential pancreatic outflow obstruction after the procedure. However, clinical trials evaluating the protective effect of GTN on the post-endoscopic retrograde cholangiopancreatgraphy pancreatitis (PEP have yielded inconclusive results. This meta-analysis is to systematically assess the effect of prophylactic administration of glyceryl trinitrate (GTN on the prevention of PEP and the effect on the cannulation of bile ducts. Methods By searching PubMed (1966 to September 2009, CENTRAL (Cochrane Controlled trials Register; issue 3, 2009 and EMBASE.com (1984 to September 2009, two independent reviewers systematically identified prospective randomized controlled trials (RCTs detecting the effect of prophylactic GTN on the incidence of PEP and on the cannulation of bile ducts. A meta-analysis of these clinical trials was then performed. Results There are 55/899(6.1% patients suffering PEP in the treatment group versus 95/915(10.4% patients in the placebo group. The overall pooled risk of PEP was significantly lower in the GTN group than in the placebo group (OR 0.56, 95% CI: 0.40 to 0.79, p = 0.001. Subgroup analyses suggested that GTN administered by the sublingual form (OR 0.34,95% CI:0.16 to 0.75, p = 0.007 is more effective than transdermal route(OR 0.64,95% CI:0.40 to 1.01, p = 0.05, and the protective effect of GTN was far more obvious in the centers with high incidence of PEP (OR 0.40, 95% CI:0.24 to 0.67, p = 0.0006 than those centers with a low incidence of PEP (OR 0.75, 95% CI: 0.47 to 1.20, p = 0.22. Additionally, the meta-analysis suggests that GTN was not

  8. [Veno-venous extracorporeal oxygenation and veno-arterial extracorporeal oxygenation. Questions, answers].

    Science.gov (United States)

    Isetta, C; Lebreton, G; Janot, N; Prommenschenkel, M; Rilos, Z; Roques, F; Longrois, D

    2014-04-01

    A round table, organized by the French Society of Perfusion (Sofraperf) at the French national congress on extracorporeal circulations (Perfusion 2013), was attended by perfusionists, anaesthesiologists, intensivists and surgeons around the theme of respiratory veno-venous support and veno-arterial circulatory support with extracorporeal oxygenation in intensive care units. The debate was conducted in a participatory manner by bi-directional questions-answers session between moderators and assistance. The authors report management of this type of therapy that is not perfectly homogeneous, supported on literature data. Cannulae, cannulation, circuit, oxygenator, anticoagulation, control, surveillance, weaning are subject to paragraphs with defined entry whose contents are mutually enriching.

  9. [Veno-venous extracorporeal oxygenation and veno-arterial extracorporeal oxygenation. Questions, answers].

    Science.gov (United States)

    Isetta, C; Lebreton, G; Janot, N; Prommenschenkel, M; Rilos, Z; Roques, F; Longrois, D

    2014-04-01

    A round table, organized by the French Society of Perfusion (Sofraperf) at the French national congress on extracorporeal circulations (Perfusion 2013), was attended by perfusionists, anaesthesiologists, intensivists and surgeons around the theme of respiratory veno-venous support and veno-arterial circulatory support with extracorporeal oxygenation in intensive care units. The debate was conducted in a participatory manner by bi-directional questions-answers session between moderators and assistance. The authors report management of this type of therapy that is not perfectly homogeneous, supported on literature data. Cannulae, cannulation, circuit, oxygenator, anticoagulation, control, surveillance, weaning are subject to paragraphs with defined entry whose contents are mutually enriching. PMID:24630169

  10. 血液透析患者中心静脉留置导管堵塞的护理%Nursing Care of the Blockage of the Catheter in Hemodialysis Patients with Central Venous Catheter

    Institute of Scientific and Technical Information of China (English)

    丁洁; 曹玲芳

    2014-01-01

    Long-term indwel ing central venous catheter from January March to 2014 2013 in our hospital, 44 patients with renal failure hemodialysis therapy for example, strict aseptic operation, through ef ective nursing to prolong tube service life, reduce the incidence of infection, reduce the suffering and economic burden of patients, improve the dialysis patients quality of life.%2013年1月~2014年3月来本院就诊的留置长期中心静脉导管,进行规律血液透析治疗的肾功能衰竭患者44例,严格无菌操作,通过有效的护理来延长导管的使用寿命,减少感染的发生,减轻患者的痛苦和经济负担,提高透析患者的生活质量。

  11. Effect of controlled low central venous pressure on renal function in major liver resection%控制性低中心静脉压对肝切除术患者肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective:To investigate the effects of low central venous pressure (LVCP) on blood loss and evaluate its influence on renal function in patients undergoing hepatectomy. Methods: Forty-six patients, ASA classification Ⅰ-Ⅲ, undergoing liver resection were randomized into LCVP group (n = 23) and control group (n = 23). In LCVP group, CVP was maintained at 2-4 mmHg and MBP above 60 mmHg during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. Volume of blood loss during hepatectomy, volume of blood transfusion, and changes of renal functions were compared between the two groups. Results: There were no significant differences in demographics, ASA score, type of hepatectomy, duration of inflow occlusion, operation time, weight of resected liver tissues, and renal functions between the two groups. LCVP group had a significantly lower volume of total intraoperative blood loss (P < 0.01) and RBC transfusion (P < 0.05). Conclusion: Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss and blood infusion during liver resection, and has no detrimental effects on renal functions.

  12. Finding on a chest radiograph: A dangerous complication of subclavian vein cannulation

    Directory of Open Access Journals (Sweden)

    Srinivasan Nataraj

    2010-01-01

    Full Text Available Cannulation of the subclavian vein has its inherent risks. Post procedure chest radiograph is one of the investigations done to rule out immediate complications. Unless the clinician is aware as to what to look for in the radiograph, some of the dangerous complications can be overlooked. Accidental subclavian artery cannulation is identified immediately by color and jet of the blood. Also the position of the catheter tip has to be confirmed by obtaining the arterial pressure tracing using a pressure transducer. Non availability of Doppler ultrasound and pressure transducer are limiting factors for immediate confirmation of proper catheter placement. Also, in patients with severe hypotension and reduced oxygen content of blood, accidental arterial puncture may not show the characteristic bright red pulsatile back flow of arterial blood. In these situations radiography can be used as a diagnostic tool to rule out subclavian artery cannulation.

  13. Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

    Institute of Scientific and Technical Information of China (English)

    Dimitrios Xinopoulos; Stefanos P Bassioukas; Dimitrios Kypreos; Dimitrios Korkolis; Andreas Scorilas; Konstantinos Mavridis; Dimitrios Dimitroulopoulos; Emmanouil Paraskevas

    2011-01-01

    AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access.METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannu-lation success and post-endoscopic retrograde cholan-giopancreatography (ERCP) complication rate.RESULTS: SGT (92.3% success rate) was character-ized by statistically significant enhanced patient out-come compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favor-able outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients' gender. CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is con-sidered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is neces-sary in difficult-to-cannulate cases.

  14. 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...

  15. Ileofemoral venous thrombectomy.

    Science.gov (United States)

    Lindhagen, J; Haglund, M; Haglund, U; Holm, J; Scherstén, T

    1978-01-01

    Twentyeight patients with ileofemoral venous thrombosis were treated surgically. Five of the patients had moderate degree of venous congestion, 18 patients had phlegmasia alba dolens and five patients had phlegmasia coerulea dolens. The mean age was 54 years, range 15-80 years, and 15 were men and 13 were women. In all cases the thrombosis was verified by phlebography. Thrombectomy was performed with a Fogarty venous thrombectomy catheter. Peroperative phlebography was used in most cases to guarantee complete extraction of thrombotic material. No operative pulmonary embolism or mortality was encountered. Postoperative continuous heparin infusion in the thrombectomized segment was used for the first week followed by dicumarol treatment. The patients were followed from 6 months to 4 years postoperatively. In two patients thrombectomy was not possible to perform. One of these patients developed a pronounced postthrombotic syndrome, the other developed venous congestion of more moderate degree. Excellent long-term time results were obtained in 82% of the patients and satisfactory in 14%. Thrombectomy is an efficient treatment of ileofemoral venous thrombosis.

  16. Central venous catheter drainage and injection of thymalfasin combined with cisplatin in treatment of malignant pleural effusion: clinical observation of 86 cases%中心静脉导管引流及注入胸腺法新联合顺铂治疗恶性胸腔积液86例疗效观察

    Institute of Scientific and Technical Information of China (English)

    吴兆成; 钟福强

    2012-01-01

    目的 观察中心静脉导管注入胸腺法新联合顺铂治疗恶性胸腔积液的疗效及不良反应.方法 选择恶性胸腔积液患者86例,胸腔中心静脉置管行闭式引流并腔内注入胸腺法新联合顺铂,每周1次.结果 总有效率为83.7%,生活质量评分提高10~20分,不良反应少.结论 中心静脉导管注入胸腺法新联合顺铂治疗恶性胸腔积液,疗效肯定,不良反应轻.%Objective To observe central venous catheter and injecting thymalfasin combined with cisplatin in treatment of malignant pleural effusion curative effect and adverse reaction. Methods 86 patients with malignant pleural effusion, pleural cavity central venous catheter closed drainage and intraperi-cardial injection of thymalfasin combined with cisplatin, 1 times a week. Results the total effective rate was 83. 72% , the score of life quality to improve 10-20, fewer adverse reactions. Conclusions central venous catheter and injecting thymalfasin combined with cisplatin in treatment of malignant pleural effusion has definite curative effect, and adverse reaction to light.

  17. Detection of mixed microbial biofilms on central venous catheters removed from Intensive care Unit Patients Detecção de biofilmes microbianos mistos em cateters venosos de pacientes de Unidades de Terapia Intensiva

    Directory of Open Access Journals (Sweden)

    Anisio Storti

    2005-09-01

    Full Text Available Central venous catheters from intensive care unit patients were subjected to microbiological methods (semiquantitative culture and scanning electron microscopy in order to assess microbial attachment and correlate it with blood cultures. During the period of the survey, 59 patients with inserted central venous catheters were studied. The type of catheter used was nontunneled, noncuffed, single lumen, made of polyurethane. Blood samples for cultures were collected at the moment of catheter removal. Data on the patient's age, gender, catheter insertion site, and duration of catheterization were also obtained. From 63 catheters tips analysed, 30 (47.6% showed microbial colonization. Infection proved to be more prevalent in 26 (41.3% patients with catheters inserted via subclavia vein than in 2 (3.2% inserted via the jugular vein. Infection was observed more frequently in catheters which were kept in place more than seven days. A. baumannii, Citrobacter freundii, E. aerogenes, P. aeruginosa and S. saprohyticus were isolated as causal agents of catheter-related bloodstream infections. The antimicrobial agent with greater in vitro activity against Gram-negative bacteria was imipenen and against Gram-positive were vancomycin, cefepime, penicillin, rifampin and tetracycline. The SEM analyses revealed biofilms on surfaces of all the catheters examined.Cateteres venosos centrais inseridos em pacientes internados em unidade de terapia intensiva foram avaliados por métodos microbiológicos (cultura semi-quantitativa e microscopia eletrônica de varredura a fim de detectar adesão microbiana e correlacionar com a cultura de sangue. Durante o período de estudo, foram avaliados 59 pacientes com cateter venoso central. A idade dos pacientes, sexo, sítio de inserção e tempo de permanência do cateter foram anotados. O cateter era de poliuretano não tunelizado e de único lúmen. O sangue para cultura foi coletado no momento da remoção do cateter. De 63

  18. Near-infrared light to aid peripheral intravenous cannulation in children : a cluster randomised clinical trial of three devices

    NARCIS (Netherlands)

    de Graaff, J. C.; Cuper, N. J.; Mungra, R. A. A.; Vlaardingerbroek, K.; Numan, S. C.; Kalkman, C. J.

    2013-01-01

    Intravenous cannulation can be difficult in children. Recently, new devices using near-infrared light to make blood vessels visible have become available. We aimed to evaluate the effectiveness of three such devices in facilitating peripheral intravenous cannulation in children. In this cluster rand

  19. 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....

  20. Venous anomalies as potentially lethal risk factors during ordinary catheterization

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2015-06-01

    Full Text Available Venous malformations are rare but possible findings too, constituting a further risk factor for central venous catheter procedures. Herein we describe a case of death because of an innominate vein perforation by a catheter that incidentally was tucked into a sacciform malformation. Even if the technology advancement is constantly offering us new investigation tools, up to now diagnostic options are limited in the detection of those malformations that could potentially lead to dramatic complications as the described one. The present work raises the awareness about rare venous anomalies and their potential clinical implications. A proper literature review and diagnostic implementation proposal are reported.

  1. 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...

  2. A rapid and simple cannulation technique for repeated sampling of cerebrospinal fluid in freely moving rats

    NARCIS (Netherlands)

    Bouman, H.J.; Wimersma Greidanus, T.B. van

    1979-01-01

    A cannulation technique for frequent sampling of cerebrospinal fluid (CSF) in unanaesthetized freely moving rats is described. A permanent stainless steel cannula, constructed in such a way that no loss of CSF occurs, is placed into the rat's cisterna magna and fixed to the skull by anchoring screws

  3. How I do it: transapical cannulation for acute type-A aortic dissection

    Directory of Open Access Journals (Sweden)

    Alexiou Christos

    2008-01-01

    Full Text Available Abstract Aortic dissection is the most frequently diagnosed lethal disease of the aorta. Half of all patients with acute type-A aortic dissection die within 48 hours of presentation. There is still debate as to the optimal site of arterial cannulation for establishing cardiopulmonary bypass in patients with type-A aortic dissection. Femoral artery cannulation with retrograde perfusion is the most common method but because of the risk of malperfusion of vital organs and atheroembolism related to it different sites such as the axillary artery, the innominate artery and the aortic arch are used. Cannulation of these sites is not without risks of atheroembolism, neurovascular complications and can be time consuming. Another yet to be popularised option is the transapical aortic cannulation (TAC described in this article. TAC consists of the insertion of the arterial cannula through the apex of the left ventricle and the aortic valve to lie in the sinus of Valsalva. Trans-oesophageal guidance is necessary to ensure correct placement of the cannula. TAC is an excellent method of establishing cardiopulmonary bypass as it is quick, provides a more physiological method of delivering antegrade arterial flow and is the only method to assure perfusion of the true lumen.

  4. Central venous catheter-related bloodstream infections in blood purification department%血液净化中心静脉导管相关性血流感染调查分析

    Institute of Scientific and Technical Information of China (English)

    张祥文; 贾中尉; 滕廷波; 李丽华

    2012-01-01

    目的 了解血液净化患者中心静脉导管相关性血流感染(CRBSI)的病原菌分布特点及药敏,分析CRBSI的相关因素.方法 对三峡大学第一临床医学院肾病科血液净化室,2008年1月-2010年12月所有新增留置中心静脉导管的患者进行回顾性分析.结果 医院32例半永久留置、105例临时留置CRBSI患者发生率分别为1.09次/1000导管日、5.19次/1000导管日,两者比较差异有统计学意义(P<0.01);临时导管留置时间>45、<45 d患者的CRBSI发生率分别为6.73次/1000导管日、2.28次/1000导管日;颈内静脉、股静脉置管患者的CRBSI发生率分别为2.43次/1000导管日、6.95次/1000导管日,两者比较差异均有统计学意义(P<0.05);表面葡萄球菌、金黄色葡萄球菌、溶血性葡萄球菌、肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌是常见病原菌.结论 置管方式、部位、留置时间是CRBSI的危险因素,留置导管的CRBSI应根据本中心的经验及药敏选择抗菌药物.%OBJECTIVE To investigate the isolated pathogens and their drug susceptibility of the pathogens causing central venous catheter-related blood stream infections (CRBSI) in patients in blood purification department, and analyze the risk factors for CRBSI. METHODS A retrospective analysis of central venous catheter-related bloodstream infection (CRBSI) in all the patients who were newly placed with CVCs in our hospital s hemodialysis room from Jan 2008 to Dec 2010 was performed. RESULTS The incidence of CRBSI were 1. 09 episodes per 1,000 catheter-days in 32 permanent CVC cases and 5. 19 episodes per 1,000 catheter-days in 105 temporary CVC cases, and there was statistically difference between them (P<0. 05). The incidence of CRBSI were 6. 73 episodes per 1, 000 catheter-days in cases with temporary catheter time more than 45 days, and 2. 28 in cases with temporary catheter time less than 45 days. There was statistical difference between them (P

  5. Inhibition of oestradiol-induced prolactin release in a dual-cannulated ovariectomized rat model by carmoxirole, a peripherally restricted dopamine agonist.

    Science.gov (United States)

    Brott, David A; Werkheiser, Jennifer L; Campbell, Pam; Bentley, Patricia; Andersson, Håkan H A S; Stewart, Jane; Huby, Russell; Altekar, Maneesha; Kinter, Lewis B

    2012-12-01

    Centrally acting dopamine agonists (e.g. bromocriptine) and dopamine transport inhibitors (e.g. GBR12909) are known to inhibit oestradiol-induced prolactin release. The capacity of peripherally restricted compounds to do likewise, however, is unknown. Here, the effects of the peripherally restricted dopamine receptor agonist carmoxirole on oestradiol-induced prolactin release were investigated. Dual-cannulated ovariectomized rats were used, so that a robust, reproducible response to exogenous oestrogen could be induced and sequential blood samples were taken with minimal stress. Carmoxirole (15 mg/kg) inhibited oestradiol-induced prolactin release, similar to bromocriptine and GBR12909. However, carmoxirole also induced a rapid, transient, oestradiol-independent release of prolactin. These data show that peripherally restricted dopamine receptor agonists are sufficient to inhibit oestradiol-induced prolactin release. Like centrally acting compounds, they may therefore be expected to affect the incidence of prolactin-dependent tumours in rat carcinogenesis studies without inducing central-mediated side effects.

  6. Venous Thromboembolism in China

    Institute of Scientific and Technical Information of China (English)

    赵永强

    2005-01-01

    @@ Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are two manifesttions of venous thromboembolism (VTE) . Although the controversy remained,it has been widely accepted for many years that Chinese people have lower incidence of VTE than Caucasians with the different etiology and clinical features.

  7. 心内心电图下三种路径置入中心静脉导管的应用研究%Applied Research of Central Venous Catheter Via Three Pathways under the Intravenous Electrocardiogram

    Institute of Scientific and Technical Information of China (English)

    翟美琴; 逯豫霞; 赵砚丽; 吕从改

    2012-01-01

    Objective To discuss the use of central venous catheter under the intravenous electrocardiogram (IVECC). Methods 150 adult patients who would undergo selective operation of central venous catheterizations in general anesthesia were randomly divided into three groups, group A, B and C (n =50). Patients in group A received dexter internal jugular vein catheter-ization, patients in group B received dexter subclavian vein catheterization and in group C the dexter subclavian vein punctured and catheterization were performed. IVECC monitoring technology was applied in the three groups. We recorded the data of Lmax, Lact, Lpre and the value of Lmax - Lact and Lpre - Lmax respectively. The anteroposterior position of the X-ray examination after operation was taken to judge whether the catheter was in the right place or not. The standard of over-deep or ectopic for atrium dextrum was Lpre - Lmax ≥0.5 cm. Results 146 patients underwent paracentesis successfully, and 4 patients including one from group A, one from group B and two from group C failed in paracentesis. The average indexes of Lmax - Lact and Lpre - Lact were (2.4 ± 0.3) cm and(2.1 ±0.8)cm respectively in the 146 patients. There were 22 patients with Lpre -Lmax≥0. 5 cm (15.07% ) , including 7 patients in group A, 8 patients in group B and 7 patients in group C. The typical change was catheter tip being located at superior vena cava according to chest X-ray film postoperative. According to the results of IVECG and chest X-ray film, the patients with Lpre -Lmax≥0.5 cm canal were located in atrium dextrum and catheter placement coincidence rate was 100%. Conclusion IVECC assisted central venous catheter is easy to perform, does not have radio-active contamination and can replace X-ray examination.%目的 探讨在心内心电图(IVECG)辅助下置入中心静脉导管的可行性.方法 选择拟在全麻下行择期手术需放置中心静脉导管的成年患者150例,随机分为A、B、C3组,每组50例,

  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. 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

  10. 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

  11. OPEN REDUCTION AND CANNULATED SCREW INTERNAL FIXATION OF TALUS FRACTURE-DISLOCATION THROUGH MEDIAL-ANTERIOR APPROACH

    Institute of Scientific and Technical Information of China (English)

    董宇启; 董英海; 周健; 曹聪

    2004-01-01

    Objective To evaluate the role of open reduction through anterior-medial malleolar approach with cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ displaced talus fractures were treated by open reduction through single anterior medial malleofar approach with cannulated screw internal fixation. Results All the 16 cases of displaced talus fractures achieved bony heal in which 5 cases suffered talus aseptic necrosis. The whole excellence-good ratio reached 62.5%.Conclusion Open reduction through anterior-medial malleolar approach with cannulated screw internal fixation is a less trauma, easy manipulation, effective method of treatment for displaced talus fractures.

  12. 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

  13. Doppler ultrasound study and venous mapping in chronic venous insufficiency.

    Science.gov (United States)

    García Carriazo, M; Gómez de las Heras, C; Mármol Vázquez, P; Ramos Solís, M F

    2016-01-01

    Chronic venous insufficiency of the lower limbs is very prevalent. In recent decades, Doppler ultrasound has become the method of choice to study this condition, and it is considered essential when surgery is indicated. This article aims to establish a method for the examination, including venous mapping and preoperative marking. To this end, we review the venous anatomy of the lower limbs and the pathophysiology of chronic venous insufficiency and explain the basic hemodynamic concepts and the terminology required to elaborate a radiological report that will enable appropriate treatment planning and communication with other specialists. We briefly explain the CHIVA (the acronym for the French term "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire"=conservative hemodynamic treatment for chronic venous insufficiency) strategy, a minimally invasive surgical strategy that aims to restore correct venous hemodynamics without resecting the saphenous vein.

  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. Iliofemoral venous thrombosis following fascial excision of a deep burn of the lower extremity: case report.

    Science.gov (United States)

    Gibran, N S; Heimbach, D M; Nicholls, S C

    1992-12-01

    Burned patients with deep venous thrombosis present a particularly perplexing challenge. They frequently require central venous catheters. Their altered skin integrity does not permit correlation with the typical changes described by the classic terminology for thrombophlebitis or its most severe forms, phlegmasia cerulea dolens or phlegmasia alba dolens. They are at risk of exsanguination or massive graft loss with lytic therapy or anticoagulation. Venous thrombectomy may be a necessary limb-saving surgical option.

  17. Venous access: options, approaches and issues

    Energy Technology Data Exchange (ETDEWEB)

    Asch, M.R. [Univ. of Toronto, Mount Sinai Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada)

    2001-06-01

    Venous access is an essential part of medical practice. It is needed to obtain blood samples to make the diagnosis and to administer fluids or medicines as part of treatment. Although relatively new in the history of medicine, the placement and maintenance of the various venous access devices now occupies a significant portion of many vascular and interventional radiology practices. Thus, it is important to have a thorough understanding of these devices and their uses. The first long-term venous access devices were used in 1973. These were placed via a surgical cut-down on the subclavian vein. In 1982, the first subcutaneous implantable ports were described. These procedures were initially performed by surgeons, but over the last 5-10 years, both the insertion and management of these devices has shifted to interventional radiologists. Peripherally inserted central catheter (PICC) lines have almost completely supplanted the use of standard central lines (Fig. 1). A number of factors have facilitated this - namely, ready and less expensive room access, outpatient procedure and radiologists' accessibility and familiarity with image-guidance procedures and catheters and guide wires. (author)

  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. 中心静脉压与BNP在糖尿病酸中毒合并心衰治疗中的意义%The Significance of Central Venous Pressure and BNP in Diabetic Ketoacidosis with Heart Failure

    Institute of Scientific and Technical Information of China (English)

    陈志

    2012-01-01

      目的:分析中心静脉压(CVP)与B型脑钠肽(BNP)在糖尿病酸中毒中的变化及相关性,为临床合理补液提供依据.方法:回顾分析132例糖尿病酮症酸中毒患者的病历资料,依据是否合并心衰分为:心衰组73例和非心衰组59例;采用酶联免疫吸附法(ELISA)测定患者血浆BNP,有创心电监护测量CVP.结果:心衰组CVP及BNP较非心衰组明显增高,差异有统计学意义(P<0.01),不同心功能分级CVP与BNP呈正相关(r=0.087、0.092、0.97).结论:(1)CVP与BNP在糖尿病酮症酸中毒合并急性心衰中均增高;(2)CVP与BNP在糖尿病酮症酸中毒急性心衰中呈正相关性;(3)CVP与BNP的监测可作为临床补液的参考依据.%  Objective:To analyze the change and correlation of central venous pressure (CVP) and B-type natriuretic peptide (BNP) in diabetic ketoacidosis with heart failure ,to provide a basis for clinical rehydration.Method:A retrospective analysis of 132 cases of diabetic ketoacidosis, who were divided into tow group:heart failure group (73 cases),non-heart failure group (59 cases) that based on the records,by enzyme-linked immunosorbent assay (ELISA) to determine plasma BNP,and measure CVP by invasive ECG. Result:CVP and BNP of heart failure group were obviously higher than non-heart failure group,the difference of tow group were Statistically significant(P<0.01).Statistical significant difference,CVP and cardiac function in different BNP was positively correlated (r=0.087,0.092,0.97).Conclusion:⑴CVP and BNP in acute heart failure in diabetic ketoacidosis were increased.⑵CVP and BNP were positively correlated.⑶Monitoring of CVP and BNP can be used as a reference for clinical infusion.

  20. Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis.

    Science.gov (United States)

    Paglialonga, Fabio; Consolo, Silvia; Biasuzzi, Antonietta; Assomou, Jolanda; Gattarello, Elisabetta; Patricelli, Maria Grazia; Giannini, Alberto; Chidini, Giovanna; Napolitano, Luisa; Edefonti, Alberto

    2014-10-01

    Only a few studies have investigated the optimal exit site management of tunneled central venous catheters (CVCs) in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the efficacy of chlorhexidine solutions and a 5% povidone-iodine solution on the incidence of CVC-related infections in children on HD. The incidence of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) was assessed in two groups of tunneled CVCs. The iodopovidone group consisted of 14 CVCs used between 1 January 2011 and 30 June 2012 in 10 children, whose median age at the time of CVC placement was 11.8 years (range 1.2-19.2): 5% povidone-iodine was used for CVC exit-site care. From 1 August 2012 to 31 January 2014, 0.5% chlorhexidine gluconate/70% isopropyl alcohol was used for the exit site, and 2% chlorhexidine gluconate/70% isopropyl alcohol spray for the hub in 13 CVCs was used in 10 patients (chlorhexidine group), whose median age at the time of CVC placement was 10 years (range 1.2-19.2). Ten episodes of ESI were diagnosed in the iodopovidone group (incidence 3.4/1000 CVC days), and only one in the chlorhexidine group (incidence 0.36/1000 CVC days, P = 0.008). One TI was observed in the iodopovidone group (0.34/1000 CVC days), and none in the chlorhexidine group. The incidence of BSIs decreased from 1.7/1000 CVC days (5 cases) to 0.36/1000 CVC days (1 case, P = 0.06) after switching to chlorhexidine. Two CVCs were lost due to CVC-related infections in the iodopovidone group, whereas no CVC was lost due to infections in the chlorhexidine group. In comparison with 5% povidone-iodine, the use of chlorhexidine gluconate was associated with a reduction in the incidence of ESI, TI, and BSI in children on HD.

  1. Fibular grafting with cannulated hip screw fixation in late femoral neck fracture in young adults

    Directory of Open Access Journals (Sweden)

    Goyal R

    2006-01-01

    Full Text Available Background: We reviewed the operative results of fibular bone graft with cannulated hip screw fixation in femoral neck fracture in young adults. Method: Sixteen young adults with femoral neck fracture were treated by fibular bone graft with cannulated hip screw fixation. All the fractures were more than 3 weeks old. Results: Results were assessed in 15 patients while one patient died due to complications not related to surgery. Union occurred in all 15 patients. One patient had intra-operative complication in the form of screw cut out with graft in the joint space. The average fallow up was 24.4 months. Out of 15 patients assessed clinico-radiologically 11 showed good results, 3 had fair while 1 had poor result. Conclusion: We conclude that this is a simple and cost effective procedure for late femoral fleck fracture in young adults with good results.

  2. Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

    Science.gov (United States)

    Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

    2009-03-01

    An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds.

  3. Fixation of femoral capital physeal fractures with 7.0 mm cannulated screws in five bulls

    International Nuclear Information System (INIS)

    Salter-Harris type I fractures of the femoral capital physis were repaired in five Holstein bulls with three 7.0 mm cannulated screws placed in lag fashion. Radiographically at months 7 to 10, the fractures were healed and there was periarticular bone production on the femoral necks and the dorsal acetabular rims. Four bulls had normal gaits, and one bull had muscle atrophy and barely detectable lameness

  4. Brachiocephalic Artery Cannulation in Proximal Aortic Surgery that Requires Circulatory Arrest

    Science.gov (United States)

    Unal, Mehmet; Akar, Ilker; Ince, Ilker; Aslan, Cemal; Koc, Fatih; Kafali, Haluk

    2014-01-01

    The brachiocephalic artery is an alternative cannulation site in the repair of ascending aortic lesions that require circulatory arrest. We evaluate the effectiveness and safety of this technique. Proximal aortic surgery was performed in 32 patients from 2006 through 2012 via brachiocephalic artery cannulation and circulatory arrest. Twenty-four (75%) of the patients were men. The mean age was 48.69 ± 9.43 years (range, 30–68 yr). Twelve had type I dissection, 2 had type II dissection, and 18 had true aneurysms of the ascending aorta. All operations were performed through a median sternotomy. The arterial cannula was inserted through an 8-mm vascular graft anastomosed to the brachiocephalic artery in an end-to-side fashion. In dissections, the distal anastomosis was performed without clamping the aorta. The patients were cooled to 24 °C, and circulatory arrest was established. The brachiocephalic and left carotid arteries were clamped, and antegrade cerebral perfusion was started at a rate of 10 mL/kg/min. Cardiopulmonary bypass was resumed after completion of the distal anastomosis and the initiation of rewarming. The proximal anastomosis was then performed. None of the patients sustained a major neurologic deficit, but 5 patients experienced transient postoperative agitation (<24 hr). There were 2 early deaths (6.25%), on the 3rd and the 11th postoperative days, both unrelated to the cannulation technique. Brachiocephalic artery cannulation through a graft can be a safe and effective technique in proximal aortic surgical procedures that require circulatory arrest. PMID:25593522

  5. Osler's nodes, pseudoaneurysm formation, and sepsis complicating percutaneous radial artery cannulation.

    Science.gov (United States)

    Cohen, A; Reyes, R; Kirk, M; Fulks, R M

    1984-12-01

    Percutaneous arterial cannulation is useful for hemodynamic monitoring and frequent arterial blood gas determinations in selected intensive care patients. However, this procedure is not without risk. We report a case of localized Osler node formation, distal to a radial artery catheter, associated with sepsis, pseudoaneurysm formation, and thrombosis at the site of catheterization. Complications of this technique require aggressive medical and, in selected cases, surgical intervention.

  6. 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...

  7. 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

  8. Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture.

    Science.gov (United States)

    Riaz, O; Arshad, R; Nisar, S; Vanker, R

    2016-07-01

    Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%-19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60-101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality. PMID:27055409

  9. Effect of different radial hole designs on pullout and structural strength of cannulated pedicle screws.

    Science.gov (United States)

    Chen, Hsin-Chang; Lai, Yu-Shu; Chen, Wen-Chuan; Chen, Jou-Wen; Chang, Chia-Ming; Chen, Yi-Long; Wang, Shih-Tien; Cheng, Cheng-Kung

    2015-08-01

    Cannulated pedicle screws are designed for bone cement injection to enhance fixation strength in severely osteoporotic spines. However, the screws commonly fracture during insertion. This study aims to evaluate how different positions/designs of radial holes may affect the pullout and structural strength of cannulated pedicle screws using finite element analysis. Three different screw hole designs were evaluated under torsion and bending conditions. The pullout strength for each screw was determined by axial pullout failure testing. The results showed that when the Von Mises stress reached the yield stress of titanium alloy the screw with four radial holes required a greater torque or bending moment than the nine and twelve hole screws. In the pullout test, the strength and stiffness of each screw with cement augmentation showed no significant differences, but the screw with four radial holes had a greater average pullout strength, which probably resulted from the significantly greater mean maximum lengths of cement augmentation. Superior biomechanical responses, with lower stress around the radial holes and greater pullout strength, represented by cannulated pedicle screw with four radial holes may worth recommending for clinical application. PMID:26054806

  10. Do double gloves protect against contamination during cannulation of blood vessels? A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Łukasz Szarpak

    2014-04-01

    Full Text Available Background: Undamaged medical gloves protect medical personnel from contact with physiological fluids of the patient. Thus they protect the assistance provider from hand skin contamination with potentially infectious biological material. The aim of the study was to evaluate the occurrence of pierce, perforations or damage of medical gloves during cannulation of blood vessels. Materials and Methods: In the prospective randomized study 303 pairs of gloves, used during cannulation of blood vessels under simulated resuscitation, were analyzed. Gloves were tested by the water leak test. Results: The water test revealed 44 cases of damage to the gloves used during cannulation of blood vessels. Significant differences were noted in the frequency of damage to both the outer and single pairs of gloves and the inner pair of gloves. Conclusions: The study showed that the use of double gloves provides a higher level of security for a paramedic than the use of a single pair of gloves, however, double gloves reduce the manual dexterity of a paramedic. A large number of damages to gloves are not noticed by medical personnel during surgery. Med Pr 2014;65(2:271–278

  11. Perforation of the Papilla of Vater in Wire-Guided Cannulation

    Directory of Open Access Journals (Sweden)

    Yuichi Takano

    2016-01-01

    Full Text Available Background. WGC in ERCP is considered a safe technique, although rare complications can occur. One unique complication of WGC is the perforation of the papilla of Vater by the guidewire. Subjects and Methods. Of 2032 patients who underwent ERCP at our department between January 2010 and December 2014, we selected 208 patients who underwent WGC for naïve papilla as subjects. A detailed examination of patients in whom a perforation occurred was conducted, and risk factors for perforations were investigated. Results. The perforation was observed in 7 of 208 patients (3.4%. All patients recovered with conservative treatment without the need for surgery. The perforation rate was significantly higher in the patients with juxtapapillary duodenal diverticula than those without diverticula (12.5% versus 0.6%, p<0.001. Cannulation of the bile duct was ultimately achieved in 5 of 7 patients; PSP was performed for 4 of these patients. Conclusion. Caution must be exercised when dealing with patients who have a juxtapapillary duodenal diverticula because they are at higher risk of perforations. Because these are small perforations made by a wire, most of them heal with conservative treatment. However, perforations can make cannulation difficult, and PSP may be useful for deep cannulation.

  12. Technical note: a 2-stage cecal cannulation technique in standing horses.

    Science.gov (United States)

    Beard, W L; Slough, T L; Gunkel, C D

    2011-08-01

    Cecal cannulation is necessary for sampling of intestinal contents for a variety of nutritional or digestive physiology studies. This report describes a 2-stage technique for permanent cecal cannulation in standing horses. For the first procedure, a right flank laparotomy is performed and a small pouch of the cecal base exteriorized and sutured to the body wall. The second procedure is performed approximately 1 wk later. During the second procedure, the exposed cecal pouch is removed and the cannula inserted. Ten horses were cannulated using this technique. After the first procedure, 1 horse developed a cecal impaction unresponsive to medical therapy and ruptured its cecum, whereas 2 other horses developed mild transient colic that responded to medical management. Insertion of the cecal cannula after creation of the stoma in the second procedure resulted in transient colic in 4 of 9 horses, but they responded to analgesic therapy in less than 24 h in all instances. The time to complete healing of the cannula site was approximately 30 d. The technique described in this report decreases the risk of peritonitis due to intestinal leakage and is technically easier to perform than previously described techniques.

  13. Tissue reaction to implants of different metals: A study using guide wires in cannulated screws

    Directory of Open Access Journals (Sweden)

    DM Devine

    2009-10-01

    Full Text Available Cannulated screws, along with guide wires, are typically used for surgical fracture treatment in cancellous bone. Breakage or bending deformation of the guide wire is a clinical concern. Mechanically superior guide wires made of Co-Cr alloys such as MP35N and L605 may reduce the occurrence of mechanical failures when used in combination with conventional (316L stainless steel cannulated screws. However the possibility of galvanic or crevice corrosion and adverse tissue reaction, exists when using dissimilar materials, particularly in the event that a guide wire breaks, and remains in situ. Therefore, we designed an experiment to determine the tissue reaction to such an in vivo environment. Implant devices were designed to replicate a clinical situation where dissimilar metals can form a galvanic couple. Histological and SEM analyses were used to evaluate tissue response and corrosion of the implants. In this experiment, no adverse in vivo effects were detected from the use of dissimilar materials in a model of a broken guide wire in a cannulated screw.

  14. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To retrospectively investigate the effect and safety of various new type precut sphincterotomy techniques (VNTPST) in endoscopic retrograde cholangiopancreatography (ERCP) due to difficult biliary duct cannulation (DBC).METHODS: A plough-like pull-type sphincterotome (PLPTS) or improved short nose sphincterotome or improved needle knife was applied. VNTPST was carried out in 30 of 280 patients, whose biliary tract could not be exposed well or deep cannulation was difficult to perform during ERCP with traditional methods. Patients were followed up for short-term complications and the therapeutic effect of VNTPS was observed and compared with that of traditional endoscopic sphincterotomy (EST).RESULTS: A total 280 patients underwent ERCP, of which 3 failed in operation because of pathological features in stomch or duodenum, 247 successfully underwent traditional ERCP (89.1%, 247/277), 30 failed (10.8%, 30/277). VNTPS technique succeeded in 24(80%, 24/30) of 30 cases. The successful rate of deep biliary duct cannulation increased 8.6% (24/277), the total cannulation successful rate following precut was 97.7%. There was a significant difference between the two groups (97.7% vs 89.1%, χ2= 17.1, P < 0.01).The incidence of complications was 9.3% (26/277) for traditional ERCP group and 13.3% (4/30) for VNTPS technique group. Guideline tip was broken in pancreatic duct (KPDGP) of one patient, and there was no pancreatitis, slight or moderate bleeding postoperatively occurred in 2 patients, 1 patient had bleeding during operation (PDWN). There were no differences between VNTPS technique group and traditional ERCP(TRERCP)group (13.3% vs 9.3%,χ2 = 0.478, P > 0.05).CONCLUSION: VNTPS procedure and Deng's precut are highly effective methods to get biliary access during ERCP with DBC. With skillful techniques, it can increase the successful rate for deep cannulation of biliary duct and decrease complications. VNTPS technique, especially Deng's precut is as effective and

  15. Avaliação da mortalidade de neonatos e crianças relacionada ao uso do cateter venoso central: revisão sistemática Evaluación de la mortalidad de neonatos y niños relacionada al uso del cateter venoso central: revisión sistemática Evaluation of the mortality of neonates and children related to the use of central venous catheters: a systematic review

    Directory of Open Access Journals (Sweden)

    Janislei Giseli Dorociaki Stocco

    2012-01-01

    significativo para la mortalidad en neonatos y niños. CONCLUSIÓN: Se observó en esta revisión que la sepsis primaria fue la complicación más prevalente relacionada al cateter central.OBJECTIVE: To analyze mortality related to infections in the use of central venous catheters in newborns and hospitalized children. METHODS: This was a systematic review, using studies that were identified in the databases of MEDLINE, EMBASE, Lilacs, CINAHL, SciELO and Cochrane, in bibliographical references of articles, and other reviews. Two reviewers independently identified relevant studies, analyzed the methodological quality, and subsequently, extracted data. RESULTS: We encountered 1,000 articles, of which 16 were related to catheter infection and only two mentioned mortality. Findings of these two studies verified that sepsis was the principal complication related to the use of central venous catheters, and the most prevalent microorganisms in these infections were Candida sp. and Enterococcus sp., with significant impact on neonatal and child mortality. CONCLUSION: It was observed in this review that sepsis was most prevalent complication related to central catheters.

  16. Deep Venous Thrombosis in Teen With Crouzon Syndrome Post-Le Fort III Osteotomy With Rigid External Distraction.

    Science.gov (United States)

    Roussel, Lauren O; Myers, Rene P; Girotto, John A

    2015-11-01

    Venous thromboembolic events are rare in pediatric patients. Risk factors associated with the development of venous thromboembolic events in pediatric patients include the use of central venous catheters, hospitalization, cancer, sepsis, trauma, surgery, and congenital prothrombotic disorders.The authors present the case of a 14-year-old man with Crouzon syndrome who required Le Fort III osteotomy with rigid external distraction for significant midface hypoplasia who presented postoperatively with an extensive deep venous thrombosis. This is the first reported case of symptomatic venous thrombosis post-Le Fort III osteotomy and rigid external distraction. Although rare, surgeons should be aware of this potential complication. PMID:26595005

  17. Deep Venous Thrombosis in Teen With Crouzon Syndrome Post-Le Fort III Osteotomy With Rigid External Distraction.

    Science.gov (United States)

    Roussel, Lauren O; Myers, Rene P; Girotto, John A

    2015-11-01

    Venous thromboembolic events are rare in pediatric patients. Risk factors associated with the development of venous thromboembolic events in pediatric patients include the use of central venous catheters, hospitalization, cancer, sepsis, trauma, surgery, and congenital prothrombotic disorders.The authors present the case of a 14-year-old man with Crouzon syndrome who required Le Fort III osteotomy with rigid external distraction for significant midface hypoplasia who presented postoperatively with an extensive deep venous thrombosis. This is the first reported case of symptomatic venous thrombosis post-Le Fort III osteotomy and rigid external distraction. Although rare, surgeons should be aware of this potential complication.

  18. Cerebral sinus venous thrombosis

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    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.

  19. Venous thrombosis in athletes.

    Science.gov (United States)

    Grabowski, Gregory; Whiteside, William K; Kanwisher, Michael

    2013-02-01

    Because deep vein thrombosis (DVT) can occur following orthopaedic procedures, knowledge of hereditary and acquired risk factors for DVT is essential. Hereditary forms of thrombophilia include factor V Leiden and prothrombin G20210A mutations, and deficiencies of antithrombin III, protein C, and protein S. Acquired risk factors include but are not limited to trauma, immobilization, and surgical procedures. In general, athletes have a low risk of venous thrombosis; however, this population is exposed to many acquired thrombogenic risk factors, including hemoconcentration, trauma, immobilization, long-distance travel, and the use of oral contraceptives. Thus, orthopaedic surgeons should consider screening athletes for thrombogenic risk factors, including history of venous thrombosis, hypercoagulable disorders, or high altitude exercise, during preparticipation physicals and preoperative examinations. If a patient is determined to be at high risk of DVT, preventive measures such as physical antithrombotic measures and/or low-molecular-weight heparin should be instituted. If an athlete develops a DVT, a risk factor assessment should be conducted along with anticoagulation treatment in accordance with the American College of Chest Physicians guidelines. PMID:23378374

  20. 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

  1. 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

    Full Text Available 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 de inclusão, amostra de quinze artigos. Este trabalho evidenciou cinco intervenções como as mais frequentemente empregadas na construção dos bundles: higienização das mãos, gluconato de clorexidina como antisséptico para pele, uso de barreira máxima de precaução durante a inserção cateter, evitar acessar veia femoral e verificar necessidade diária de permanência do cateter, com sua remoção imediata quando não mais indicado. A maioria dos estudos demonstrou resultados estatisticamente significantes na redução de infecção de corrente sanguínea relacionada ou associada a cateter intravenoso central.Esta es una revisión integradora tuvo como objetivo identificar intervenciones basadas en evidencias que componen método bundle de reducción de infección sanguínea relacionadas o asociadas con catéter intravenoso central. Para recopilar los datos en las bases brasileñas e internacionales, utilizando la palabra clave bundle y los descriptores infecciones relacionadas con catéteres, control de infecciones y cateterización venosa central, identificando, con los criterios de inclusión, muestra de quince artículo. Este estudio muestra cinco intervenciones como comúnmente empleadas en los métodos bundles: higiene de las manos, clorhexidina como antiséptico para la piel, uso de precaución de barrera máxima durante la inserción del catéter, evitar el acceso de la vena femoral y comprobar la necesidad diaria del cat

  2. 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.

  3. 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

  4. Practice of quality control circle on improving qualified rate of central venous catheter maintenance%品管圈在提高中心静脉导管维护合格率中的实践

    Institute of Scientific and Technical Information of China (English)

    梁丽贞; 燕嫦

    2015-01-01

    目的:提高ICU患者中心静脉导管( CVC)维护的合格率,减少CVC留置后不良事件的发生。方法通过品管圈( Quality Control Circle,QCC)的建立,确定以“提高ICU患者中心静脉导管维护合格率”为活动主题,把握现状,设定目标,分析原因、制定及实施对策,比较QCC活动前后ICU患者CVC维护的合格率和CVC留置后不良事件的发生率。结果 QCC活动后的实验组CVC维护合格率为91.00%,与QCC活动前的对照组维护合格率78.00%比较,χ2=6.45,P<0.05,差异具有统计学意义;CVC留置后不良事件:QCC活动后的实验组5例(5.00%),与QCC活动前的对照组19例(19.00%)相比,χ2=9.28, P<0.05,差异具有统计学意义。结论运用QCC活动能明显提高CVC维护的合格率、降低CVC留置后不良事件的发生率,值得临床推广应用。%Objective To improve the qualified rate of central venous catheter ( CVC) maintenance, and to reduce the occurrence of adverse events after CVC catheter in ICU patients.Methods Setting up a quality control circle ( QCC ) activity group and designing an activity theme: 'to improving the qualified rate of CVC maintenance in ICU patients'.It is responsible for grasping situation, setting goals, analyzing reasons, creating and implementing countermeasures.Afterwards, the qualified rate of CVC maintenance and the occurrence of adverse events in the activities before and after were compared.Results After activities, the CVC maintain qualified rate of experimental group is 91%, and its rate was 78%before activities.In statistics,χ2 =6.45, P<0.05, the difference was statistically significant.In the adverse reaction, the experimental group had 5 cases (5%) after QCC, while it had 19 cases (19%) before.The contrast was stark, χ2 =9.28; P<0.05, the difference was statistically significant.Conclusions The QCC activity can significantly improve the qualified

  5. 肿瘤患者中心静脉置管相关性感染研究%A Study on Catheter Related Infection in Cancer Patient Treated with Central Venous Catheterization

    Institute of Scientific and Technical Information of China (English)

    张晓霞; 陈惠蓉; 付岚; 陈旭霞; 张智; 许辉琼; 李俊英

    2011-01-01

    目的 了解肿瘤患者中心静脉置管相关性感染情况.方法 对四川大学华西医院196例肿瘤患者进行前瞻性研究,分析导管相关性感染类型和病原菌类型,以及导管相关性感染与置管部位、性别、年龄、置管时间和骨髓抑制程度的关系.结果 196例患者中发生导管相关性感染16例,感染率8.2%,其中病原菌定植5例、出口部位感染4例、导管相关性血流感染7例.共送检标本244份,其中20份病原菌培养阳性,培养出革兰氏阳性和革兰氏阴性两类共7种病原菌,病原菌以金葡菌、表葡菌、鲍曼不动杆菌和肺炎克雷伯杆菌为主.相关性分析显示,导管相关性感染与置管部位和年龄有关,两者均为独立危险因素.结论 应树立预防为主的观念,采取综合措施降低导管相关性感染,如选择合适的置管部位和严格导管植入患者的纳入标准等.%Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylo-coccus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive

  6. 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

  7. Central venous catheter-related infection and catheter retention time after heart surgery%心脏术后中心静脉导管相关性感染与置管时间的探讨

    Institute of Scientific and Technical Information of China (English)

    芮炳峰; 安淑芬; 李宝祥

    2012-01-01

    目的 探讨心脏术后中心静脉导管相关性感染(CRI)的发生率与中心静脉导管留置时间的关系及CRI感染的途径.方法 选取242例心脏直视术后留置深静脉导管的病例,依据拔管时间将患者分为1~5 d组、6~8 d组及9~11 d组,对拔除导管的尖端进行细菌培养,并统计三组病原菌菌株数及相关构成比.结果 共38例患出现CRI,培养出病原菌48株,留置时间1~5 d、6~8 d、9~11 d时患者CRI发生率分别为8.26%、18.18%和36.36%,三组间CRI感染率有统计学差异(P<0.01).48株病原菌中革兰阳性菌占54.16%,革兰阴性菌占37.5%,真菌占8.33%.结论 随中心静脉导管留置时间延长CRI呈显著增加趋势,以革兰阳性菌感染为主,CRI以局部细菌侵入途径为主.%Objective To investigate the relationship between the incidence of central venous catheter related infections ( CRI ) and catheter retention time after heart surgery, and the pathway of CRI. Methods The patients ( n = 242 ) with deep vein catheter retention after open-heart surgery were selected and divided into 1 ~ 5 day group, 6 ~ 8 day group and 9 ~ 11 day group according to the time of extubation. The bacteria on the tip of catheter were cultured, and strains and relevant constituent ratio of pathogenic bacteria were counted in three groups. Results There were totally 38 patients suffering from CRI and 48 stains of pathogenic bacteria cultured. The incidence of CRI was, respective1y,8.26% ,18. 18% and 36. 36% in three groups ( P <0. 01 ). Among 48 stains of pathogenic bacteria,Gram-positive bacteria accounted for 54. 16% ,Gram-negative bacteria,37. 5% ,and fungus,8. 33% . Conclusion The incidence of CRI has a significant increasing tendency as the prolong of catheter retention time. The infections are mainly Gram-positive bacteria infection and the pathway of CRI is focal invasion.

  8. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    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...... is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together...... 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 should be avoided. CONCLUSIONS...

  9. Overview of venous thromboembolism.

    Science.gov (United States)

    Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Rocha, Eduardo

    2010-12-14

    Thrombosis occurs at sites of injury to the vessel wall, by inflammatory processes leading to activation of platelets, platelet adherence to the vessel wall and the formation of a fibrin network. A thrombus that goes on to occlude a blood vessel is known as a thromboembolism. Venous thromboembolism begins with deep vein thrombosis (DVT), which forms in the deep veins of the leg (calf) or pelvis. In some cases, the DVT becomes detached from the vein and is transported to the right-hand side of the heart, and from there to the pulmonary arteries, giving rise to a pulmonary embolism (PE). Certain factors predispose patients toward the development of venous thromboembolism (VTE), including surgery, trauma, hospitalization, immobilization, cancer, long-haul travel, increased age, obesity, major medical illness and previous VTE; in addition, there may also be a genetic component to VTE. VTE is responsible for a substantial number of deaths per annum in Europe. Anticoagulants are the mainstay of both VTE treatment and VTE prevention, and many professional organizations have published guidelines on the appropriate use of anticoagulant therapies for VTE. Treatment of VTE aims to prevent morbidity and mortality associated with the disease, and any long-term complications such as VTE recurrence or post-thrombotic syndrome. Generally, guidelines recommend the use of low molecular weight heparins (LMWH), unfractionated heparin (UFH) or fondaparinux for the pharmacological prevention and treatment of VTE, with the duration of therapy varying according to the baseline characteristics and risk profile of the individual. Despite evidence showing that the use of anticoagulation prevents VTE, the availability of several convenient, effective anticoagulant therapies and the existence of clear guideline recommendations, thromboprophylaxis is underused, particularly in patients not undergoing surgery. Greater adherence to guideline-recommended therapies, such as LMWH, which can be

  10. Outcome of 20-gauge transconjunctival cannulated sutureless vitrectomy using silicone oil or air tamponade

    Directory of Open Access Journals (Sweden)

    Mohamed AA

    2013-02-01

    Full Text Available Ahmed Abdel Alim Mohamed,1 Mohamed Abdrabbo21Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo; 2Faculty of Medicine, Ophthalmology Department, Benha University, Benha, EgyptBackground: The purpose of this study was to assess the outcome of pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system with air or silicone oil tamponade in cases of retinal detachment of different etiologies.Methods: A prospective study was performed in 60 eyes from consecutive 60 patients who underwent 20-gauge transconjunctival cannulated sutureless vitrectomy (30 eyes with air tamponade and 30 eyes with silicone oil tamponade, with the inclusion of a further 30 patients who underwent conventional 20-gauge vitrectomy and served as a control group. The main outcome measures were intraocular pressure, wound leakage, and comfort score.Results: Preoperative intraocular pressure increased from 17.67 ± 5.6 mmHg preoperatively to 18.78 ± 6.1 mmHg on the first postoperative day in group A and decreased from 16.97 ± 4.9 mmHg to 15.88 ± 5.3 mmHg in group B. These changes were not statistically significant (P > 0.05. The comfort score ranged from 1 to 5 (1 = very bad, 2 = bad, 3 = good, 4 = very good, and 5 = excellent, with a mean of 4.4 ± 0.94 in group A and 4.35 ± 0.99 in group B on the first postoperative day, and no significant difference in scores between the groups at any follow-up visit. There was intraoperative wound leakage in two cases (6.7% in group A which required suturing and one case (3.3% in group B, but the difference was not statistically significant (P > 0.05. There was no wound leakage at follow-up in either group. No cases of hypotony, endophthalmitis, or unsealed sclerotomies were noted.Conclusion: Pars plana vitrectomy using a 20-gauge transconjunctival cannulated sutureless system combines the advantages of smaller-gauge vitrectomy systems with the economic advantage of not needing to purchase

  11. Comparison of the bending performance of solid and cannulated spinal pedicle screws using finite element analyses and biomechanical tests.

    Science.gov (United States)

    Shih, Kao-Shang; Hsu, Ching-Chi; Hou, Sheng-Mou; Yu, Shan-Chuen; Liaw, Chen-Kun

    2015-09-01

    Spinal pedicle screw fixations have been used extensively to treat fracture, tumor, infection, or degeneration of the spine. Cannulated spinal pedicle screws with bone cement augmentation might be a useful method to ameliorate screw loosening. However, cannulated spinal pedicle screws might also increase the risk of screw breakage. Thus, the purpose of this study was to investigate the bending performance of different spinal pedicle screws with either solid design or cannulated design. Three-dimensional finite element models, which consisted of the spinal pedicle screw and the screw's hosting material, were first constructed. Next, monotonic and cyclic cantilever bending tests were both applied to validate the results of the finite element analyses. Finally, both the numerical and experimental approaches were evaluated and compared. The results indicated that the cylindrical spinal pedicle screws with a cannulated design had significantly poorer bending performance. In addition, conical spinal pedicle screws maintained the original bending performance, whether they were solid or of cannulated design. This study may provide useful recommendations to orthopedic surgeons before surgery, and it may also provide design rationales to biomechanical engineers during the development of spinal pedicle screws. PMID:26208430

  12. 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.

  13. 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...... aim was to assess the prevalence of CCSVI in Danish MS patients using sonography and compare these findings with MRI measures of venous flow and morphology....

  14. A rare cause of cerebral venous thrombosis: cryptococcal meningoencephalitis.

    Science.gov (United States)

    Senadim, Songul; Alpaydin Baslo, Sezin; Tekin Güveli, Betül; Dedei Daryan, Metin; Kantaroglu, Elif; Ozturk, Oya; Atakli, Dilek

    2016-07-01

    Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a non-endemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis. PMID:27025504

  15. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Marc A. Lazzaro

    2011-07-01

    Full Text Available Recent reports have emerged suggesting that multiple sclerosis (MS may be due to abnormal venous outflow from the central nervous system, termed Chronic Cerebrospinal Venous Insufficiency (CCSVI. These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.

  16. Venous Thromboembolism and Atherosclerosis link

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2011-01-01

    @@ Past always venous thrombosis and arterial thrombo-sis as a separate system to be discussed, the main reason is because there is between the anatomical and pathologi-cal physiological differences, the clinical manifestations are very different.

  17. Venous ulcers - self-care

    Science.gov (United States)

    Risk factors for venous ulcers include: Varicose veins History of blood clots in the legs ( deep vein thrombosis ) Blockage of the lymph vessels , which causes fluid to build up in the legs Older age, being female, or ...

  18. Infecções em cateteres venosos centrais de longa permanência: revisão da literatura Infection of long-term central venous catheters: review of the literature

    Directory of Open Access Journals (Sweden)

    Milton Alves das Neves Junior

    2010-01-01

    Full Text Available Cateteres venosos de longa permanência são amplamente utilizados em pacientes com necessidade de acesso venoso por período prolongado. A infecção relacionada a esses cateteres permanece um desafio na prática clínica. Revisamos a literatura acerca da epidemiologia e tratamento das infecções relacionadas a cateteres. Staphylococcus aureus é a bactéria mais comumente isolada. Os cateteres semi-implantáveis apresentam taxas de infecção maiores que os totalmente implantáveis. O tratamento pode ser feito com locks, antibioticoterapia sistêmica e até mesmo com retirada do cateter, dependendo do tipo de infecção, do microrganismo isolado e das condições clínicas do paciente. O salvamento do cateter deve ser tentado sempre que possível.Long-term venous catheters are widely used in patients with needs of venous access for prolonged periods. The infection related to these catheters remains a challenge in clinical practice. We reviewed the literature about infection epidemiology and treatment related to catheters. Staphylococcus aureus is the most common isolated bacteria. Tunneled catheters present higher infection rates than implanted ports. Treatment may consist in the use of locks, systemic antibiotics, and even catheter removal, depending on the kind of infection, the isolated microorganism, and the patient's clinical conditions. Catheter salvation should be tried whenever possible.

  19. Incidence of bloodstream infection among patients on hemodialysis by central venous catheter Incidencia de infección de la corriente sanguínea em los pacientes sometidos a hemodiálisis por catéter venoso central Incidência de infecção da corrente sanguínea nos pacientes submetidos à hemodiálise por cateter venoso central

    Directory of Open Access Journals (Sweden)

    Cibele Grothe

    2010-02-01

    Full Text Available This study evaluated the incidence and risk factors of bloodstream infection (BSI among patients with a double-lumen central venous catheter (CVC for hemodialysis (HD and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156 who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.El objetivo de este estudio fue evaluar la incidencia y los factores de riesgo de infección de la corriente sanguínea (ICS en pacientes con catéter venoso central (CVC doble lumen, para hemodiálisis (HD e identificar los microorganismos aislados en la corriente sanguínea. Como método, se uso el acompañamiento, realizado en el período de un año, incluyendo todos los 156 pacientes que estaban en tratamiento de HD por CVC doble lumen, en la Universidad Federal de Sao Paulo - UNIFESP. Los resultados mostraron que de los 156 pacientes estudiados, 94 presentaron ICS, de estos, 39 tuvieron culturas positivas en el local de inserción del catéter. De los 128 microorganismos aislados de la corriente sanguínea, 53 eran S.aureus, de los cuales 30 eran sensibles a la metilcilina y 23 resistentes. Entre las complicaciones relacionadas a la ICS, hubo 35 casos de septicemia y 27 casos de endocarditis, de los cuales 15 resultaron en muerte. La incidencia de ICS en este grupo de pacientes se mostr

  20. 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 ...

  1. Observation Curative Effect of Central Venous Catheter Pleural Closed Drainage in Treatment of Tuberculous Pleurisy%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

    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.

  2. 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.

  3. Development of competencies for the use of bedside ultrasound for assessment and cannulation of hemodialysis vascular access.

    Science.gov (United States)

    Marticorena, Rosa M; Mills, Linda; Sutherland, Kelly; McBride, Norma; Kumar, Latha; Bachynski, Jovina Concepcion; Rivers, Carol; Petershofer, Elizabeth J; Hunter, Joyce; Luscombe, Rick; Donnelly, Sandra

    2015-01-01

    Use of ultrasound for hemodialysis vascular access assessment and real-time cannulation requires specialized training. In order to obtain basic hand-eye coordination, theoretical sessions on ultrasound use, as well as practical sessions using phantom models are recommended prior to its use in the clinical setting with patients. New users of this technology need to consider that all competencies can be achieved with daily use of ultrasound at the bedside. It takes approximately 500 guided cannulations to achieve the highest level of competency described above. PMID:26964424

  4. Complications and Nursing of Central Venous Catheters Undergoing Hematopoietic Stem Cell Transplantation%中心静脉导管在骨髓造血干细胞移植应用中的并发症及其护理

    Institute of Scientific and Technical Information of China (English)

    刘瑞青

    2014-01-01

    Objective To explore the types , incidence and risk factors of the complications related to CVC used in children undergoing HSCT,and to explore how nurses should have a greater awareness of the prevention of complications .Methods Medical records were analyzed on 100 patients with CVC between October 2007 and October 2013.Results Overall , 186 complications were documented.The overall complication rate was 14.6/1000 CVC -days.Catheter complications were higher in nonmalignant disorders than hematological malignancies (χ2 =5.2, P=0.02).CVC malfunction rates were 1.7/1000 CVC-days (11.8%, n=22) and 0.07/1000 CVC-days for mechanical complications ( 0.5%, n=1 ).The overall CRI rate was 11.9/1000 CVC-days ( 81.2%, n=151 ).CRI episodes were higher in male than female children (χ2 =6.42, P=0.01).Nine CVC (7.9%) were removed due to infection, 70(61.4%) were removed at the end of therapy.In children who had nonhematological diseases , the rate of complications of CVC were higher than in those with hematological diseases ( odds ratio [ OR]=2.66 , concidence interval [ CI]=1.1~6.2.The risk for CRI in male children was nearly 2.5 times more compared with female children ( P =0.01 , OR =2.68 , CI =1.2 ~5.8 ).Conclusion Nurses must be aware of CVC complications and must follow guidelines and practice standards continuously.Rigorous attention should be paid to the aseptic technique . These are essential in all aspects of appropriate management of CVC.%目的:探讨中心静脉导管在骨髓造血干细胞移植(hematopoietic stem cell transplantation ,HSCT)应用中的并发症类型、发病率、危险因素,进一步探讨护理人员如何防止中心静脉导管( Central venous catheters ,CVC)并发症。方法收集本院2007-10~2013-10间100例患儿在HSCT中使用CVC的临床资料。结果共出现186次导管并发症,并发症发生率为14.6次/1000 CVC-days。良性血液病导管并发症高于恶性血液病导管并发症(χ2=5.2

  5. 中心静脉导管留置时间与血行性感染的相关性分析%The Correlation Analysis of Central Venous Catheter Retention Time and Catheter Related Bloodstream Infection

    Institute of Scientific and Technical Information of China (English)

    徐艳; 常勇杰; 徐红炜; 张振; 胡波

    2015-01-01

    目的:探讨中心静脉导管(CVC)留置时间与导管相关性血行感染(CRBSI)的相关性。方法:收集2010年2月-2014年2月本院1086例使用过CVC的患者资料,分析CVC留置1~7 d、7~14 d、14~21 d、21~28 d和≥28 d几个不同时间段CRBSI的发病率,并对CRBSI患者不同年龄段、性别、CVC留置时间和CVC置管处皮肤细菌数做统计学分析。结果:1086例使用过CVC的患者中共发生了352例CRBSI,CVC留置1~7 d、7~14 d、14~21 d、21~28 d和≥28 d CRBSI的发病数分别为65例(5.98%)、69例(8.84%)、143例(13.17%)、198例(18.23%)和352例(32.41%)。CVC留置≤3 d比3~7 d CRBSI发病率有显著性升高,差异有统计学意义(P<0.01),≥28 d比3~28 d CRBSI发病率也有显著性升高,差异有统计学意义(P=0.04)。另外患者年龄≥60岁、CVC经皮穿刺置管和CVC置管处皮肤细菌数≥100 CFU/10 cm2也是导致CRBSI的重要因素。结论:CVC留置的前3天和后28天是CRBSI发生的高峰时间,CRBSI的发生与患者年龄大和置管处皮肤细菌数多有关。%Objective: To investigate the correlation of central venous catheter (CVC) retention time and catheter related b1oodstream infection (CRBSI).Method: A total of 1086 patients who were treated with CVC in our hospital were selected from February 2010 to February 2014,the CRBSI incidence of 1086 patients in different time periods of indwelling CVC 1-7 d, 7-14 d, 14-21 d, 21-28 d and ≥28 d were analysed,the CRBSI of different ages,gender, CVC retention time and the number of skin bacteria of indwelling CVC were statistical analysed.Result: There were 352 cases of CRBSI in 1086 patients who used CVC, CRBSI incidence were respectively 65 cases (5.98%), 69 cases (8.84%), 143 cases (13.17%), 198 cases (18.23%) and 352 cases (32.41%) in indwelling CVC 1-7 d, 7-14 d, 14-21 d, 21-28 d and≥28 d.The CRBSI incidence of indwelling CVC ≤3 days has increased significantly than 3 to

  6. 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

  7. 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.

  8. Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP).

    Science.gov (United States)

    Giordano, Paola; Saracco, Paola; Grassi, Massimo; Luciani, Matteo; Banov, Laura; Carraro, Francesca; Crocoli, Alessandro; Cesaro, Simone; Zanazzo, Giulio Andrea; Molinari, Angelo Claudio

    2015-11-01

    Central venous catheters (CVC), used for the management of children with hemato-oncological disorders, are burdened by a significant incidence of mechanical, infective, or thrombotic complications. These complications favor an increasing risk in prolongation of hospitalization, extra costs of care, and sometimes severe life-threatening events. No guidelines for the management of CVC-related occlusion and CVC-related thrombosis are available for children. To this aim, members of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) reviewed the pediatric and adult literature to propose the first recommendations for the management of CVC-related occlusion and CVC-related thrombosis in children with hemato-oncological disorders.

  9. 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.

  10. An analysis of catheter-related bloodstream infections in old hemodialysis patients with tunneled central venous catheterization%老年透析患者隧道式中心静脉置管相关血流感染临床分析

    Institute of Scientific and Technical Information of China (English)

    郑洁; 黄雯; 姜立萍

    2012-01-01

    Objective To study catheter-related bloodstream infections (CRBSI) in old hemodialysis patients with tunneled central venous catheterization. Methods Twenty-six old hemodialysis patients with tunneled central venous catheterization were observed and analyzed. Results The incidence of CRBSI in old hemodialysis patients with tunneled central venous catheterization was 1.36 times/1000 catheterization days. Nine strains bacteria were isolated. The bacteria included Staphylococcus epidermidis(33.3%), Staphylococcus aureus (22.2%), Staphylococcus hominis(ll.l%), extended spectrum beta -lactamases type Escherichia coli (11.1%), pseudomonas aeruginosa (11.1%), Klebsiella pneumoniae procalcitonin of patients with CRBSI were remarkablely increased. Catheter indwelling time was an independent risk factor for CRBSI (OR = 11.09, P < 0.05). Low albumin level was associated with CRBSI. The level of procalcitonin of patients with CRBSI was increased obviously. Conclusion Prolonged catheter indwelling time is an independent risk factor of CRBSI in old hemodialysis patients with tunneled central venous catheterization.%目的 探讨老年血液透析患者隧道式中心静脉置管所致导管相关血流感染(catheter-related bloodstream infections,CRBSI)的病原菌及相关因素.方法 选择北京同仁医院使用隧道式中心静脉置管的老年维持性血液透析患者26例,根据血培养结果分为感染组和非感染组,分析CRBSI患者血培养分离出的病原菌及相关因素.结果 老年血液透析患者隧道式中心静脉置管CRBSI的发生率为1.36次/1000导管日.CRBSI患者血培养阳性8例,分离出病原菌9株,包括表皮葡萄球菌3株(33.3%)、金黄色葡萄球菌2株(22.2%)、人葡萄球菌1株(11.1%)、超广谱β内酰胺酶阳性大肠埃希菌1株(11.1%)、绿脓杆菌1株(11.1%)、肺炎克雷伯杆菌1株(11.1%).导管留置时间是CRBSI的独立危险因素(OR值为11.09,P< 0.05).低白蛋白水平与CRBSI的

  11. 两种换药方法用于老年患者中心静脉置管处皮肤过敏的效果观察%Observation of effect of two dressing change methods for skin allergy in central venous catheterization area in elderly patients

    Institute of Scientific and Technical Information of China (English)

    高杰; 张艳君; 冯丽芳; 梁锡铭; 侯惠如

    2013-01-01

    Objective To observe the treatment effect of the Compound Dexamethasone Acetate Cream coating combined with gauze fixation and the Meipikang method for the skin allergy in the central venous catheterization area in elderly patients. Methods 38 patients with skin allergy in the central venous catheterization area were divided into the Dexamethasone group and the Meipikang group with 19 patients in each group according to the occurrence time. The Dexamethasone group was given Dexamethasone acetate cream coating and gauze fixation after the local disinfection using conventional compound iodine. The Meipikang group was given Meipikang fixation after the local disinfection using conventional compound iodine. Results In the Dexamethasone group, 5 patients (26.3%) were cured, 14 patients (73.7%) relieved and none was ineffective, with the total effective rate of 100.0%. In the Meipikang group, 17 patients (89.5%) were cured, 1 patient (5.3%) relieved and 1 patient was ineffective, with the total effective rate of 94.7%. The effective rates of the two groups were not significantly different (P > 0.05), but the cure rate of the Meipikang group was significantly superior to that of the control group (P 0.05),但美皮康组的治愈率明显优于对照组(P < 0.05).结论复方醋酸地塞米松乳膏对皮肤过敏的有效率高,但起效时间较长;美皮康的治愈率显著且简便易行,但有过敏现象发生,且价格昂贵,需掌握应用对象和应用时机.

  12. Effect of semi-permanent double-lumen central venous catheter on micro-inflammatory state in maintenance hemodialysis patients%半永久双腔中心静脉导管维持性血液透析患者的微炎症状态*★

    Institute of Scientific and Technical Information of China (English)

    张晓东; 李小萍; 宋洁; 李瑛; 李辉

    2013-01-01

    BACKGROUND: Semi-permanent double-lumen central venous catheter as an important supplement of autogenous arteriovenous fistula has been widely used in maintenance hemodialysis patients. But the studies have found that the mortality rate of semi-permanent double-lumen central venous catheters used for hemodialysis vascular access is higher than that of autogenous arteriovenous fistula. The reason is not clear. At present, the effect of different types of vascular access on the micro-inflammatory state is rarely reported. OBJECTIVE: To compare the different levels of inflammation factors in maintenance hemodialysis patients with semi-permanent double-lumen central venous catheter and arteriovenous fistula, and to explore the effect of the hemodialysis vascular access types on the micro-inflammation in maintenance hemodialysis patients. METHODS: Eighty patients with uremia underwent maintenance hemodialysis were selected, and divided into autologous arteriovenous fistula group (n=48) and semi-permanent double-lumen central venous catheter group (n=32) according to different vascular access types. Sixty healthy people were selected as normal control group. The serum high sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α of the maintenance hemodialysi group and the normal control group were detected. RESULTS AND CONCLUSION: The serum high sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α of the maintenance hemodialysis patients were significantly higher than those of the normal control group (P < 0.01). The serum high sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α in the semi-permanent double-lumen central venous catheter group were higher than those in the autologous arteriovenous fistula group (P < 0.05). Micro-inflammatory state exists in maintenance hemodialysis patients, and the utilization of semi-permanent double-lumen central venous catheter as hemodialysis vascular access can

  13. Postoperative peri-axillary seroma following axillary artery cannulation for surgical treatment of acute type A aortic dissection

    Directory of Open Access Journals (Sweden)

    Katsanos Konstantinos

    2010-05-01

    Full Text Available Abstract The arterial cannulation site for optimal tissue perfusion and cerebral protection during cardiopulmonary bypass (CPB for surgical treatment of acute type A aortic dissection remains controversial. Right axillary artery cannulation confers significant advantages, because it provides antegrade arterial perfusion during cardiopulmonary bypass, and allows continuous antegrade cerebral perfusion during hypothermic circulatory arrest, thereby minimizing global cerebral ischemia. However, right axillary artery cannulation has been associated with serious complications, including problems with systemic perfusion during cardiopulmonary bypass, problems with postoperative patency of the artery due to stenosis, thrombosis or dissection, and brachial plexus injury. We herein present the case of a 36-year-old Caucasian man with known Marfan syndrome and acute type A aortic dissection, who had direct right axillary artery cannulation for surgery of the ascending aorta. Postoperatively, the patient developed an axillary perigraft seroma. As this complication has, not, to our knowledge, been reported before in cardiothoracic surgery, we describe this unusual complication and discuss conservative and surgical treatment options.

  14. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire

    Directory of Open Access Journals (Sweden)

    Sreenivasulu Metikala

    2011-01-01

    Full Text Available Background: Extracting broken segments of intramedullay nails from long bones can be an operative challenge, particularly from the distal end. We report a case series where a simple and reproducible technique of extracting broken femoral cannulated nails using a ball-tipped guide wire is described. This closed technique involves no additional equipment or instruments. Materials and Methods: Eight patients who underwent the described method were included in the study. The technique involves using a standard plain guide wire passed through the cannulated distal broken nail segment after extraction of the proximal nail fragment. The plain guide wire is then advanced distally into the knee joint carefully under fluoroscopy imaging. Over this wire, a 5-millimeter (mm cannulated large drill bit is used to create a track up to the distal broken nail segment. Through the small knee wound, a ball-tipped guide wire is passed, smooth end first, till the ball engages the end of the nail. The guide wire is then extracted along with the broken nail through the proximal wound. Results: The method was successfully used in all eight patients for removal of broken cannulated intramedullary nail from the femoral canal without any complications. All patients underwent exchange nailing with successful bone union in six months. None of the patients had any problems at the knee joint at the final follow-up. Conclusion: We report a technique for successful extraction of the distal fragment of broken femoral intramedullary nails without additional surgical approaches.

  15. A new technique for long term, stress free, cannulation of the lateral ventricle in postpubertal, freely moving, pigs

    NARCIS (Netherlands)

    Eerdenburg, van F.; Dierx, J.A.J.

    2002-01-01

    Intracerebroventricular (ICV) cannulation in adolescent and adult pigs has some unique problems. Placement of the cannula is very difficult due to large individual variability in size and structure of the skull and frontal sinus. Furthermore, the rough behavior of the animals makes it necessary to r

  16. Interpretation of peripheral venous duplex testing.

    Science.gov (United States)

    Barleben, Andrew; Bandyk, Dennis F

    2013-01-01

    Venous duplex ultrasound and plethysmography are used to evaluate patients for suspected deep venous thrombosis (DVT) or venous insufficiency symptoms. Testing can provide clinicians with detailed information on location, extent, and severity of venous conditions before and after treatment. Duplex ultrasound can image the venous system from the vena cava to the peripheral veins, including veins of the calf musculature, and is the recommended technique to diagnose DVT. Accurate interpretation of venous testing requires an understanding of venous hemodynamics, including normal flow phasicity with cardiac and respiratory motion and the changes produced by acute DVT. Duplex scanning provides a roadmap of vein anatomy similar to contrast venography and essential hemodynamic information about the presence of proximal obstruction, vein valve function, and perforator vein reflux. Indications for testing include the diagnosis of acute/chronic DVT and evaluation of patients with venous insufficiency manifested as edema, varicose veins, or ambulatory venous hypertension. Venous plethysmography, an indirect physiologic test, can be used to estimate severity of obstructive or reflux venous pathophysiology and document improvement in venous hemodynamics after intervention. Using criteria based on ultrasound imaging and physiologic testing, venous conditions producing a swollen or painful limb can be accurately determined and aid in appropriate treatment selection. PMID:24636608

  17. Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system

    Directory of Open Access Journals (Sweden)

    Lutz Weise

    2008-10-01

    Full Text Available Lutz Weise, Olaf Suess, Thomas Picht, Theodoros KombosNeurochirurgische Klinik, Charité – Universitätsmedizin Berlin, Berlin, GermanyObjective: Transpedicular screws are commonly and successfully used for posterior fixation in spinal instability, but their insertion remains challenging. Even using navigation techniques, there is a misplacement rate of up to 11%. The aim of this study was to assess the accuracy of a novel pedicle screw system.Methods: Thoracic and lumbar fusions were performed on 67 consecutive patients for tumor, trauma, degenerative disease or infection. A total of 326 pedicular screws were placed using a novel wire-guided, cannulated, polyaxial screw system (XIA Precision®, Stryker. The accuracy of placement was assessed post operatively by CT scan, and the patients were followed-up clinically for a mean of 16 months.Results: The total medio-caudal pedicle wall perforation rate was 9.2% (30/326. In 19 of these 30 cases a cortical breakthrough of less than 2 mm occurred. The misplacement rate (defined as a perforation of 2 mm or more was 3.37% (11/326. Three of these 11 screws needed surgical revision due to neurological symptoms or CSF leakage. There have been no screw breakages or dislocations over the follow up-period.Conclusion: We conclude that the use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is accurate and safe. The advantages of this technique include easy handling without a time-consuming set up. Considering the incidence of long-term screw breakage, further investigation with a longer follow-up period is necessary.Keywords: spinal instrumentation, pedicle screws, misplacement, pedicle wall perforation

  18. 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.)

  19. 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.)

  20. 肝素与抗菌药物封管预防中心静脉导管感染的临床对比研究%Comparative study of clinical effects of heparin and antibiotics sealed tubes on prevention of central venous catheter-associated infections

    Institute of Scientific and Technical Information of China (English)

    王红; 邓孝陵; 李小杰; 童峥慧

    2015-01-01

    OBJECTIVE To explore the clinical effects of heparin and antibiotics sealed tubes on prevention of cen‐tral venous catheter‐associated infections in the patients undergoing hemodialysis so as to seek the optimal method and improve the clinical treatment .METHODS A total of 70 patients who underwent central venous catheterization from Feb 2010 to Jan 2014 were recruited as the study objects and divided into the control group with 35 cases and the observation group with 35 cases .The control group was treated with single heparin sealed tube ,while the ob‐servation group was treated with antibiotics sealed tube ,and other treatments were the same .The clinical effects were observed after the treatments ,and the statistical analysis was performed with the use of SPSS 16 .0 software . RESULTS The incidence of central venous catheter‐associated infections was 22 .85% in the control group ,5 .72%in the observation group ;the total incidence of complications was 20 .00% in the control group ,2 .86% in the ob‐servation group ;the catheter indwelling time was (58 .9 ± 17 .8)days in the control group ,(50 .3 ± 15 .3)days in the observation group ,and there was statistically significant difference between the two groups (P<0 .05) .The Staphylococcus aureus ,Streptococcus spp ,and Klebsiella pneumoniae were the predominant pathogens isolated from the patient with infections in the two groups .CONCLUSION The antibiotics sealed tube can reduce the inci‐dence of central venous catheter‐associated infections in the patients undergoing hemodialysis ,with the incidence of complications lower .%目的:探讨肝素与抗菌药物封管预防血液透析患者中心静脉导管感染不同临床效果,以寻找最佳的方法,提高临床诊治水平。方法选取2010年2月-2014年1月70例中心静脉导管患者为研究对象,分为对照组35例,予单纯肝素封管;观察组35例,给予肝素与抗菌药物混合液封管,其余治疗相同,

  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. A young man with nonhealing venous ulcers

    NARCIS (Netherlands)

    Vloedbeld, M. G.; Venema, A. W.; Smit, A. J.

    2006-01-01

    A 35-year-old man presented with nonhealing ulcers at an atypical location on his left foot, caused by a combination of venous insufficiency (after deep venous thrombosis) and arterial insufficiency. The underlying cause was Buerger's disease.

  3. [Automatic regulator of venous pressure and venous outflow in the perfusion system].

    Science.gov (United States)

    Smirnov, L M; Levinskiĭ, M M; Kharnas, S Sh; Cherniak, V A

    1976-01-01

    A scheme for automatic regulation of the venous pressure and venous blood outflow during extracorporeal circulation is proposed. The system consists of a photoelectric sensor placed on a tube led out of the major venous trunkline, a converter and an electromechanical eccentric clamp that compresses the venous trunkline, all of which secures stabilization of the controlled values.

  4. 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

  5. First experiences with a combined usage of veno-arterial and veno-venous ECMO in therapy-refractory cardiogenic shock patients with cerebral hypoxemia.

    Science.gov (United States)

    Moravec, R; Neitzel, T; Stiller, M; Hofmann, B; Metz, D; Bucher, M; Silber, R; Bushnaq, H; Raspé, C

    2014-05-01

    The use of extracorporeal membrane oxygenation (ECMO) is becoming a popular tool in the treatment of cardiogenic shock. We present two case reports where classical veno-arterial peripherally cannulated ECMO therapy proved insufficient with profuse cerebral hypoxemia. After augmenting the setting into veno-veno-arterial ECMO, we achieved a remarkable improvement of all oxygenation parameters. The simultaneous use of veno-venous and veno-arterial ECMO might display as a novel strategy to counteract the coronary and cerebral hypoxemia in veno-arterial ECMO therapy in patients with therapy-refractory cardiogenic shock or in combined cardiopulmonary failure. In this manuscript, the veno-veno-arterial ECMO setup is described in full detail and different venous cannulas are discussed.

  6. 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.

  7. 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.)

  8. 早产儿经下肢浅静脉置入中心静脉导管成功率的影响因素分析%The Retrospective Analysis on Success Rate of Lower Extremity Superficial Vein in Premature Infants with Central Venous Catheter

    Institute of Scientific and Technical Information of China (English)

    文锦香

    2015-01-01

    Objective To study the factors that influenced the success rate of premature by superficial vein in central ve‐nous catheter ,And do preliminary research for building the future premature usm clinical operating standards .Methods A retrospective analysis in February 2012‐February 2014 during the records of 108 patients with lower limb in our new pediat‐ric superficial vein in central venous catheter in the treatment of the critically ill premature infants ,and success rate of cathe‐ter multi‐factor ,statistical analysis of gestational age ,weight ,puncture and catheter after phlebitis ,blocking pipe ,inci‐dence of complications such as infection ,pipe ,and so on and so forth the impact on the success rate of catheter ,double‐blind recorded 108 cases of clinical treatment and the result of catheter .Results 108 cases of children with 99 cases of placement success ,the success rate was 91 .67% ;With Multinomial Logistic regression analysis ,the main effect model of premature gestational age ,weight and phlebitis after catheter ,blocking pipe ,complications such as infection ,take off the tube were the key factors influencing the success .Conclusion Critically ill premature by central venous catheter as superficial vein of lower limb in peripheral vein in the alternative way to central venous catheter ,can effectively solve the poor upper limb vein condition of central venous catheter placement problem ,critically ill premature premature gestational age、weight and phlebi‐tis after catheter ,blocking pipe ,incidence of complications such as infection ,take off the tube of the lower extremity super‐ficial vein in central venous catheter plays a role of influence the success of the operation .%目的对影响早产儿经下肢浅静脉置入中心静脉导管成功率的因素进行分析,为建立早产儿PICC的临床操作标准提供依据。方法分析2012年2月~2014年2月我科收治的108例行下肢浅静脉置入中心静脉导管治

  9. 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

  10. Venous thromboembolic disease. CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Goodman, L. R. [Medical College of Wisconsin, Pulmonary Medicine and Intensive Care, Dept. of Diagnostic Radiology, Milwaukee, WI (United States)

    2001-12-01

    Helical and multidetector CT has proven to be a valuable imaging modality for both pulmonary embolism and deep venous thrombosis. This paper will review the sensitivity and specificity of CT and discuss diagnostic algorithms utilizing CT and more established imaging technologies.

  11. Venous thrombosis : a patient's view

    NARCIS (Netherlands)

    Korlaar, Inez van

    2006-01-01

    The studies described in this thesis had two main aims: 1) To study the quality of life of patients with venous thrombosis and to examine the role of illness perceptions in explaining the quality of life of these patients. 2) To assess the psychological consequences of genetic testing for thrombop

  12. The veno-venous bypass in liver transplantation: an unfinished product.

    Science.gov (United States)

    Salloum, Chady; Lim, Chetana; Lahat, Eylon; Compagnon, Philippe; Azoulay, Daniel

    2016-06-01

    Veno-venous bypass (VVB) using a patent para-umbilical vein during liver transplantation (LT) has not been reported previously. Here, we report the decompression of the porto-mesenteric compartment via a patent para-umbilical vein in a patient needing a VVB during LT. Pre-transplant CT-scan showed a large patent para-umbilical vein. A femoro-axillary percutaneous VVB was installed prior to abdominal opening to decompress massive collateral veins in the abdominal wall. The para-umbilical vein was stapled and its proximal end was cannulated and connected to the VVB. The severe atrophy of the native liver allowed to place the whole liver graft in the "liver fossa" while maintaining the native liver pulled toward the left side and connected to the VVB. This maneuver maintained splanchnic venous decompression during latero-lateral cavo-caval anastomosis. The "portal" cannula was clamped and removed. The native portal vein was clamped and divided. Standard portal, arterial, and biliary reconstructions were then performed. A patent para-umbilical vein, present in one third of patients with portal hypertension could be used whenever VVB is indicated during LT in this setting. PMID:27275471

  13. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspective

    Directory of Open Access Journals (Sweden)

    Neelam Aggarwal

    2016-01-01

    Full Text Available Objective: Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair. Design: A retrospective observational case series. Methodolgy: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages and mean ΁ SD respectively. Results: A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period. Conclusion: The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction.

  14. 中心静脉导管胸腔置管引流的应用及护理%Application and Nursing of Thoracic Cavity Drainage with Central Venous Catheter

    Institute of Scientific and Technical Information of China (English)

    周兰兰; 周本芝

    2011-01-01

    Objective To observe the efficacy of thoracic cavity drainage with center venous catheter(CVC) and explore the appropriate care measures.Methods The clinical date of 38 hospitalized patients with pleural effusion treated by thoracic cavity drainage in our department from April 2007 to December 2009 were collected and analyzed retrospectively.Before operation, we fuRRy understand the condition, vital signs and mental status of patients, and provide necessary psychological and humane care.In the operation,we established a venous access to patients and assisted doctors to complete operation, paid close attention to the conditions of patients and comfort them, and avoided the occurrence of adverse reactions.After surgery, the transparent sterile foil and Ke Lai Fu infusion connector were regularly replaced.The patient' s vital signs and graft patency of drainage were also closely observed.Results All patients were able to actively cooperate with the preoperative preparation and treatment of primary disease.During operation,puncture was smooth and the placement of drainage tube was very successful.The patients did not feel and discomfort, and there was no accident and serious complications such as infection.Conclusion To strengthen the medical care for patients with thoracic cavity drainage with CVC is very important to prevent the intraoperative accidents, reduce the postoperative complications and improve the rehabilitation of patients.%目的 观察中心静脉导管胸腔置管引流的疗效,并探讨应采取的护理措施.方法 收集38例胸腔积液患者资料.术前充分了解患者的病情、生命体征及精神状态,给予必要的心理护理及人文关怀;术中建立静脉通道协助置管并密切观察患者病情变化,安慰关心患者,避免不良反应的发生;术后定期更换透明无菌贴膜及可来福输液接头,密切观察患者生命体征及引流是否通畅.结果 所有患者能积极配合术前准备和原发病的治

  15. Clinical aspects of venous thrombophilia.

    Science.gov (United States)

    Girolami, Antonio; Fabris, Fabrizio; Girolami, Bruno

    2002-01-01

    Venous thrombophilia is the result of clotting changes namely of a hypercoagulable state together with blood flow and vessel wall changes. There is no need for all these components to be present in order for thrombosis to occur. As the matter of fact, thrombosis may occur even if only one of these conditions is present. In clinical practice a combination of factors is usualy seen. In comparison with arterial thrombophilia, clotting changes and blood flow seen to play a major role in venous thrombosis. Venous thrombophilia may remain asynptomatic or may result in a series of clinical syndromes. The commonest of these are: 1. Superficial vein thrombosis, 2. Deep vein thrombosis of legs, 3. Deep vein thrombosis of arms, 4. Caval veins thrombosis, 5. Portal vein thrombosis, 6. Hepatic veins thrombosis, 7. Renal vein thrombosis, 8. Cerebral sinuses thrombosis, 9. Right heart thrombosis, 10. Miscellaneous (ovarian, adrenal veins thrombosis, etc.). Since the first two are widely and easily recognized, these is no need for an extensive discussion. Deep vein thromboses of upper limbs are not as frequent as those of lower limbs or of superficial phlebitis but they can still be recognized on clinical grounds and non invasive techniques. The remaining 7 syndromes are less common and therefore less frequently suspected and recognized. Of particular interest, among these less common manifestations of venous thrombophilia are hepatic vein and renal vein thrombosis. Hepatic veins thrombosis, sometimes part of inferior vena cava thrombosis is most frequently due to an isolated occlusion of hepatic veins thereby causing a form of venocclusive disease. Occasionally diagnosis may be difficult because of slow onset of symptoms (hepatomegaly, right flank pain, fever, ascites etc.). The same is true for renal vein thrombosis which may also be of difficult diagnosis since it causes proteinuria and flank pain. The proteinuria is often interpreted as due to a nephrotic syndrome which

  16. 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.

  17. 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

  18. 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

  19. 经纤支镜气囊导管注药介入治疗耐多药空洞性肺结核的疗效观察%Clinical study of interventional treatment under CT-guided percutaneous lung centesis indwelling central venous catheter administration in treatment of cavitary multi-drug resistant pulmonary tuberculosis

    Institute of Scientific and Technical Information of China (English)

    刘小燕; 郑正; 杨坤云; 王永利

    2013-01-01

    目的:探讨经纤维支气管镜气囊导管灌洗注药介入治疗耐多药空洞性肺结核的临床价值。方法:将56例耐多药空洞性肺结核患者随机分为介入治疗组(28例)和单纯化疗组(28例),均用3KmHPThZV/18PaVThZ化疗方案治疗,介入治疗组采用经纤维支气管镜气囊导管灌洗注药介入治疗,单纯化疗组单用抗结核药物治疗,观察疗效。结果:疗程结束时,介入治疗组痰菌阴转率(82.1%)、病灶吸收率(85.7%)、空洞闭合率(57.1%)明显高于单纯化疗组的46.4%、46.4%和21.4%(P0.05)。介入治疗组无严重不良反应。结论:CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核具有加速痰细菌学阴转、病灶吸收和空洞闭合的作用,可促进症状改善,提高患者的生活质量。是一种有效安全的介入方法,且无明显的并发症及毒副反应,值得临床推广应用。%Objective:To evaluate the clinical treatment value of CT-guided percutaneous lung centesis indwel ing central venous catheter administration in treatment of cavitary multi-drug resistant pulmonary. Methods:56 patients with cavitary multi-drug resistant pulmonary tuberculosis were randomized 1:1 to experimental group and control group. Al patients received chemotherapy with 3KmHPThZV/18PaVThZ Meanwhile. 28 patients in experimental group received CT-guided percutaneous lung centesis indwel ing central venous catheter administration combined with antituberculosis treatment, and 28 patients in control group received antituberculosis treatment alone. Clinical study of interventional treatment were observed. Results:At the end of the treatment, the sputum negative conversion rate was 82.1%, lesion absorption rate was 85.7%,and cavity closure rate was 57.1%in the experimental group, al of which were higher than those of the controls (46.4%,46.4%and21.4%)(P0.05). There were not severe adverse reactions observed in the experimental

  20. 林可霉素联合肝素钠封管在预防ICU中心静脉导管感染中的作用%Effects of Lincomycin Combined with Heparin Sodium against Infection of Central Venous Catheter in ICU

    Institute of Scientific and Technical Information of China (English)

    廖益萍; 宋于康

    2013-01-01

    OBJECTIVE: To explore the effect of lincomycin combined with heparin sodium on prevention of infection of central venous catheter in ICU. METHODS: A total of 172 patients underwent central venous catheters were randomized into trial group and control group with 86 cases in each group. Trial group received lincomycin and heparin sodium, and control group received normal saline and heparin sodium to seal up the tube. The rate of catheter infection, results of blood culture for infection cases and adverse drug reaction were compared between 2 groups. RESULTS: The incidences of infection in trial group were 2.33% in 1-2 weeks after cathe-terization and 5.81% in 2-3 weeks after catheterization, and total incidence of infection was 9.30%. They were significantly lower than those of control group (10.47%, 15.12%, 30.23%); there was statistical significance (P0.05). CONCLUSIONS: Lincomycin combined with heparin sodium can prevent the infection of central venous catheter in ICU effectively and safely.%目的:探讨林可霉素联合肝素钠封管在预防ICU中心静脉导管感染中的作用.方法:将我院ICU就诊行中心静脉置管患者随机分成试验组与对照组,各86例,试验组给予林可霉素和肝素钠封管,对照组给予生理盐水和肝素钠封管.比较两组导管感染发生率、感染病例血培养结果及药品不良反应的差异.结果:试验组置管后1~2周、置管后2~3周及总感染发生率分别为2.33%、5.81%、9.30%,显著低于对照组的10.47%、15.12%、30.23%,差异均有统计学意义(P<0.05);试验组感染导管血培养阳性率(12.50%)显著低于对照组(53.85%),差异有统计学意义(P<0.05);试验组与对照组药品不良反应发生率分别为9.30%、6.98%,差异无统计学意义(P>0.05).结论:林可霉素联合肝素钠封管可有效预防ICU中心静脉导管感染,安全性好.

  1. 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

  2. The unstimulated pancreatic secretion obtained by endoscopic cannulation, and the plasma secretin levels in man.

    Science.gov (United States)

    Osnes, M; Hanssen, L E; Larsen, S

    1979-01-01

    The technique of collecting juice from the main pancreatic duct by siphonage is described. The juice was collected in 5-min fractions under basal conditions for 20 min (32 subjects) and extended to 60 min (6 subjects). Flow rate and bicarbonate concentration were significantly higher during the first collected samples, whereas concentrations of amylase and protein rose during the first 20 min of the study. All variables remained nearly constant after this period. Immunoreactive secretin (IRS) in peripheral plasma was significantly higher immediately after cannulation of the main pancreatic duct, as compared to the pre-endoscopic level. When the catheter was left in the duct and pancreatic juice drained, the IRS stabilized at a level not significantly different from the pre-endoscopic level. Positive correlations were found between flow rate and plasma level of IRS and between flow rate and bicarbonate concentrations. A negative correlation was found between the flow rate and concentrations of amylase and protein. The higher flow rate, plasma level of IRS, and bicarbonate concentration at the beginning of the examination may be due to the presence of acid and/or bile in the duodenal contents shortly after the endoscope enters the duodenum. Later in the procedure the levels have stabilized, which indicates that little or no acid or bile is passing into the duodenum. It is also concluded that secretin may be one factor responsible for the basal pancreatic secretion in man.

  3. Preliminary experimental results of radiofrequency-cement-augmented and cannulated pedicle screws

    Directory of Open Access Journals (Sweden)

    Goost H

    2011-01-01

    Full Text Available The risk of cut-out of a pedicle screw is high in the presence of osteoporotic bone. In cadaver studies it was found that cement augmentation of pedicle screws markedly increases pullout forces. However, the use of conventional low viscosity vertebroplasty or kyphoplasty cement is associated with the risk of cement extravasation. The risk might be reduced by using high viscosity, radiofrequency-activated bone cement. After performing DEXA scans, six fresh-frozen vertebral bodies of different bone densities were obtained from cadavers. Two pedicle screws (WSI Expertise-Inject, Peter Brehm, Germany were placed in the pedicles. About 3 ml of radiofrequency-activated, ultra-high viscosity cement (ER2 Bone Cement, DFine Europe GmbH, Germany was injected through the right pedicle. The left pedicle screw was left uncemented and served as control. Axial pullout tests were performed using a material testing device (Zwick/Roell Zmartpro, Ulm, Germany. The tests revealed that cementaugmented pedicle screws were able to withstand markedly higher pullout forces. Extravasation of cement did not occur. The value of the study is limited by the fact that only six samples were investigated. Further cadaver studies and clinical evaluation will be needed in the future. However, this pilot study showed that combining cannulated pedicle screws with ultra-high viscosity bone cement is a successful approach. Revision due to cut-out and complications secondary to cement extravasation can be reduced by this method.

  4. 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

  5. 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.

  6. The mechanisms of medial pedicle wall violation: insertion method is as important as correct cannulation of the pedicle.

    Science.gov (United States)

    Isik, Cengiz; Kose, Kamil Cagri; Inanmaz, Mustafa Erkan; Tagil, Suleyman Murat; Sarman, Hakan

    2014-01-01

    A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct cannulation of the pedicle. The study presents finding out the effect of insertion angle and insertion force on medial wall violation. We used 100 lumbar pedicles of cadavers. Special wooden blocks were produced to simulate a fixed angle fault after a correct pedicle cannulation. Pedicles were divided into 4 groups: 10-degree free drive (group 10), 15-degree free drive (group 15), 10-degree push drive (group 10P), and 15-degree push drive (group 15P). After insertion of pedicle screws, laminectomies were done and the pedicles were evaluated from the inside. Pedicle complications were more in group 10P than group 10 (P = 0.009). Medial wall fracture (P = 0.002) and canal penetration were more in group 15P than group 15 (P = 0.001). Groups 10P and 15P were similar regarding medial wall fractures but canal penetration was significantly higher in group 15P (P = 0.001). Medial wall breaches can happen after correct cannulation of pedicles. Change in insertion angle is one factor but the most important factor is the use of a pushing force while inserting a screw. The pedicle seems to be extremely tolerant to insertion angulation mistakes up to 10 degrees and tends to lead the screw into the correct path spontaneously. PMID:25400951

  7. The Mechanisms of Medial Pedicle Wall Violation: Insertion Method Is as Important as Correct Cannulation of the Pedicle

    Directory of Open Access Journals (Sweden)

    Cengiz Isik

    2014-01-01

    Full Text Available A cadaver study aims to determine the mechanisms of medial pedicle wall violation after a correct cannulation of the pedicle. The study presents finding out the effect of insertion angle and insertion force on medial wall violation. We used 100 lumbar pedicles of cadavers. Special wooden blocks were produced to simulate a fixed angle fault after a correct pedicle cannulation. Pedicles were divided into 4 groups: 10-degree free drive (group 10, 15-degree free drive (group 15, 10-degree push drive (group 10P, and 15-degree push drive (group 15P. After insertion of pedicle screws, laminectomies were done and the pedicles were evaluated from the inside. Pedicle complications were more in group 10P than group 10 (P=0.009. Medial wall fracture (P=0.002 and canal penetration were more in group 15P than group 15 (P=0.001. Groups 10P and 15P were similar regarding medial wall fractures but canal penetration was significantly higher in group 15P (P=0.001. Medial wall breaches can happen after correct cannulation of pedicles. Change in insertion angle is one factor but the most important factor is the use of a pushing force while inserting a screw. The pedicle seems to be extremely tolerant to insertion angulation mistakes up to 10 degrees and tends to lead the screw into the correct path spontaneously.

  8. Hydrocephalus in cerebral venous thrombosis.

    Science.gov (United States)

    Zuurbier, Susanna M; van den Berg, René; Troost, Dirk; Majoie, Charles B; Stam, Jan; Coutinho, Jonathan M

    2015-01-01

    Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and 2010 (prospectively since July 2006). Hydrocephalus was defined as a bicaudate index larger than the 95th percentile for age, and/or a radial width of the temporal horn of ≥ 5 mm. We excluded patients in whom hydrocephalus was caused by a disease other than CVT or if it was iatrogenic. 20 out of 99 patients with CVT had hydrocephalus. 6 patients with hydrocephalus were excluded from the analysis. Patients with hydrocephalus more often had focal neurological deficits (86 vs. 49%, p = 0.02) and were more frequently comatose (43 vs. 16%, p = 0.06), as compared to patients without hydrocephalus. Deep cerebral venous thrombosis (64 vs. 9%, p hydrocephalus. Intraventricular hemorrhage was present in 1 patient with hydrocephalus, compared to none among patients without hydrocephalus (7 vs. 0%, p = 0.15). Outcome at follow-up was worse in patients with hydrocephalus (mRS 0-1, 36 vs. 68%, p = 0.02; mortality 29 vs. 9%, p = 0.07). Hydrocephalus occurs more frequently in cerebral venous thrombosis than previously believed, especially in patients with deep cerebral venous thrombosis and edema of the basal ganglia. The presence of hydrocephalus is associated with a worse clinical outcome, but a direct causal relation is unlikely. Routine shunting procedures are not advisable.

  9. 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...

  10. 探讨ICU患者中心静脉导管相关性血流感染的集束化预防策略%Increase the bundle prevention strategies of central venous catheter-related bloodstream infection in patients of ICU

    Institute of Scientific and Technical Information of China (English)

    王艳菊; 陈奕文; 姜爱丽

    2014-01-01

    ICU收治急危重症患者,大多数患者需要使用中心静脉导管测压、输液等,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高等。选择最优的穿刺途径、严格的手卫生、消毒皮肤、最大消毒屏障以及定期更换辅料等,应用集束化预防措施进行置管及日常护理是预防导管相关性血流感染发生的重要措施。%In ICU,there are critically ill patients,and most patients require the use of central venous catheter manometer,infusion and so on.But at the same time,the occurrence of catheter-related bloodstream infection(CRBSI) risk,result in patients with prolonged hospitalization and mortality rate higher.The application of bundle preventive measures of catheter and daily care, including the selection of optimal puncture,strict hand hygiene,disinfection, the biggest disinfection and barrier regular replacement of accessories and so on,is an important measure to prevent occurrence of catheter-related bloodstream infection,.

  11. 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

    目的:探讨 ICU 中应用中心静脉导管行胸腔闭式引流治疗气胸的疗效。方法将90例于 ICU 突发气胸患者随机平均分为两组,回顾性分析其临床治疗结果。结果两组治愈效果对比无显著差异(P>0.05);但与对照组相比,观察组预后效果优于后者,两者差异显著(P0.05)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(P<0.05). Conclusion The treatment of pneumothorax by chest closed drainage with central venous catheter in the ICU has curative effect and low complication rate.

  12. The impact of obesity on venous insufficiency.

    Science.gov (United States)

    Seidel, A C; Belczak, C E Q; Campos, M B; Campos, R B; Harada, D S

    2015-08-01

    Association between chronic venous disease and obesity has recently been studied, with indications that it may worsen in obese patients. The aim of study was to correlate clinical classes of chronic venous disease according to Clinical Etiology Anatomy Pathophysiology (CEAP) classification and body mass index, as well as to compare the severity of chronic venous disease in obese and nonobese patients. This retrospective cross-sectional prevalence study was conducted at the Maringá State University and Belczak Vascular Center along a period of 2 years, consisting of a random sample of 482 patients with complaints compatible with chronic venous disease. Data obtained from patient's files included gender, age, weight and height (for calculating body mass index), and clinical class (C) of chronic venous disease according to CEAP classification. Statistical analysis included Spearman's correlation coefficient, Chi-square test (for comparing frequencies), and Student's t-test (for comparing means). Significant positive correlation between body mass index and clinical classes was established for women (0.43), but not for men (0.07). Obesity (body mass index  : ≥  : 30.0) was significantly more frequent in patients with chronic venous disease in clinical classes 3 (p venous disease in clinical class 1 (p venous disease in women, but not in men. It also corroborated the negative impact of obesity on the clinical severity of chronic venous disease.

  13. 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 ...

  14. 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.

  15. 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

  16. 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.

  17. Venous Thromboembolism in Patients With Thrombocytopenia

    DEFF Research Database (Denmark)

    Baelum, Jens Kristian; Moe, Espen Ellingsen; Nybo, Mads;

    2016-01-01

    BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. O...

  18. Risk factors for venous thromboembolism during pregnancy

    DEFF Research Database (Denmark)

    Jensen, Thomas Bo; Gerds, Thomas Alexander; Grøn, Randi;

    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....

  19. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis.

    Science.gov (United States)

    Minet, Clémence; Potton, Leila; Bonadona, Agnès; Hamidfar-Roy, Rébecca; Somohano, Claire Ara; Lugosi, Maxime; Cartier, Jean-Charles; Ferretti, Gilbert; Schwebel, Carole; Timsit, Jean-François

    2015-08-18

    Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication of critical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis.

  20. Increased rheumatoid factor and deep venous thrombosis

    DEFF Research Database (Denmark)

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

    2015-01-01

    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 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...... was incident deep venous thrombosis. There were no losses to follow-up. RESULTS: During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration ≥ vs

  1. 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......In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...

  2. 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.)

  3. 重症医学科中心静脉导管相关性血行感染患者病原菌分布及耐药性分析%Pathogenic Bacteria and Its Drug Resistance of Central Venous Catheter-related Bloodstream Infection in ICU

    Institute of Scientific and Technical Information of China (English)

    王晶; 崔朝勃; 魏秋菊; 亢宏山; 吉金芳; 杨腾; 王金荣

    2015-01-01

    Objective To analyze the pathogenic bacteria and its drug resistance of central venous catheter-related bloodstream infection(CRBSI)in ICU. Methods From 2011 to 2013,a total of 1 821 patients hospitalized and indwelling central venous catheters in ICU of Harrison International Peace Hospital Affiliated to Hebei Medical University were enrolled in this study,82 cases out of the 1 821 patients occurred CRBSI,and the pathogenic bacteria and its drug resistance were analyzed. Results A total of 82 stains of pathogenic bacteria was found,including Gram-negative bacilli(56. 1%),Gram-positive coccus(31. 7%)and fungus(12. 2%). Drug sensitive test results showed that,the drug resistance rate of Gram-negative bacilli is high, mainly including Baumanii, Escherichia coli and Klebsiella pneumoniae, and the drug resistance rate of Baumanii was 7. 7% to Cefperazone-Sulbactam,that of Escherichia coli and Klebsiella pneumoniae both was 0 to Meropenem;drug resistance rate of Gram-positive coccus is 0 to Teicoplanin and Linezolid,including Enterococcus faecium,Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus haemolyticus. Conclusion The main pathogenic bacteria of CRBSI in ICU includes Gram-negative bacilli and Gram-positive coccus,and Gram-negative bacilli is usually sensitive to Cefperazone-Sulbactam and Meropenem,Gram-positive coccus is usually sensitive to Teicoplanin and Linezolid.%目的:分析重症医学科中心静脉导管相关性血行感染( CRBSI)患者病原菌分布及其耐药性。方法选择2011—2013年入住河北医科大学附属哈励逊国际和平医院重症医学科并留置中心静脉导管的患者1821例,其中82例患者发生CRBSI,分析其病原菌分布及其耐药性。结果82例CRBSI患者共培养出病原菌82株,主要为革兰阴性杆菌(占56.1%),其次为革兰阳性球菌(占31.7%)、真菌(占12.2%)。药敏试验结果显示,革兰阴性杆菌耐药率高,最常见的病原菌为鲍

  4. 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

  5. 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

  6. 综合ICU导管相关性血流感染的危险因素分析%Research on risk factors for central venous catheter-related bloodstream infections in general ICU

    Institute of Scientific and Technical Information of China (English)

    许燕卿; 周立新; 罗盛鸿; 李杏崧; 李轶男; 莫韶妹; 吕春梅; 邵劲松

    2012-01-01

    目的 探讨ICU导管相关性血流感染(CRBSI)的感染率及危险因素.方法 采用前瞻性监测,对2009年7月-2010年11月入住ICU> 24 h、年龄>1月龄的置管患者进行监测,并对发生CRBSI的病例进行危险因素分析.结果 监测患者共1145例,其中接受血管内置管的患者890例,血管内导管使用率为77.7%,置管日为9189 d,发生CRBSI 26例,CRBSI感染率为2.9%,平均日感染率为2.8/千日;CRBSI感染率与置管时间、置管次数均呈正相关(x2=40.71,P=0.000;x2=28.6,P=0.000);留置天数(OR=2.415)与置管次数(OR=1.531)是综合ICU的CRBSI独立危险因素.结论 严格执行手卫生、无菌技术置管和维护、尽早拔除导管是预防CRBSI发生的关键.%OBJECTIVE To determine the incidence rate and risk factors for catheter-related bloodstream infections (CRBSI ) in general ICU. METHODS Prospective monitoring was carried out on patients aged over one month whose ICU length of stay was over 24 hours from Jul 2009 to Nov 2010. The risk factors for CRBSI were analyzed. RESULTS Among the 1145 cases surveyed,890 cases were under intravenous catheterization. The rate of intravenous catheterization was 77. 7% while the overall duration was 9189 days. A total of 26 cases of CRBSI were observed with the incidence rate of 2. 9% and the mean daily incidence rate of 2. 8 per 1,000 catheter-day; the incidence rate of CRBSI was positively correlated with the duration of catheterization (x2 =40. 71,P = 0. 000) and frequency of catheterization (x2 =28. 6, P=0. 000), respectively. The duration (OR=2. 415) and frequency (OR=l. 531) of the catheterization were the independent risk factors for CRBSI in general ICU patients with central intravenous catheter. CONCLUSION The incidence rate of CRBSI can be reduced by performing strict hand hygiene procedures, aseptic technique for insertion, care for intravascular catheters and the removal of catheters in a timely manner.

  7. Biomechanical and finite element analyses of bone cement-Injectable cannulated pedicle screw fixation in osteoporotic bone.

    Science.gov (United States)

    Liu, Yaoyao; Xu, Jianzhong; Sun, Dong; Luo, Fei; Zhang, Zehua; Dai, Fei

    2016-07-01

    The objectives of this study were to investigate the safety and biomechanical stability of a polymethylmethacrylate (PMMA)-augmented bone cement-injectable cannulated pedicle screw (CICPS) in cancellous bone model, and to analyze the stress distribution at the screw-cement-bone interface. The OMEGA cannulated pedicle screw (OPS) and conventional pedicle screw (CPS) were used as control groups. Safety of the CICPS was evaluated by the static bending and bending fatigue tests. Biomechanical stability was analyzed by the maximum axial pullout strength and maximum torque tests. Stress distribution at the screw-cement-bone interface was analyzed by the finite element (FE) method. The CICPS and CPS produced statistically similar values for bending stiffness, bending structural stiffness, and bending yield moment. The maximum pullout force was 53.47 ± 8.65 N in CPS group, compared to 130.82 ± 7.32 N and 175.45 ± 43.01 N in the PMMA-augmented OPS and CICPS groups, respectively (p screw-cement-bone interface in the CICPS group. In conclusion, PMMA-augmentation with CICPS may be a potentially useful method to increase the stability of pedicle screws in patients with osteoporosis. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 960-967, 2016. PMID:25976272

  8. Safety and efficacy of distal perfusion catheterization to prevent limb ischemia after common femoral artery cannulation for extracorporeal membrane oxygenation

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Chang Ho; Seong, Nak Jong; Yoon, Chang Jin [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2016-06-15

    The extracorporeal membrane oxygenation (ECMO) cannula has the potential for obstructing flow to the lower limb, thus causing severe ischemia and possible limb loss. We evaluated the safety and clinical efficacy of percutaneous distal perfusion catheterization in preventing limb ischemia. Between March 2013 and February 2015, 28 patients with distal perfusion catheterization after ECMO were included in this retrospective study. The technical success was evaluated by Doppler ultrasound at the popliteal level after saline injection via distal perfusion catheter. Clinical success was assessed when at least one of the following conditions was met: restoration of continuous peripheral limb oximetry value or presence of distal arterial pulse on Doppler ultrasound evaluation or resolution of early ischemic sign after connecting the catheter with ECMO. Twenty-six patients with early ischemia were successfully cannulated with a distal perfusion catheter (92.8%). Clinical success was achieved in 12/28 (42.8%) patients; 8/10 (80.0%) patients with survival duration exceeding 7 days and 4/18 (22.2%) patients with survival duration less than 7 days, respectively. A percutaneous distal perfusion catheter placement was a feasible tool with safety and efficacy in preventing lower limb ischemia for patients with prolonged common femoral arterial cannulation for ECMO.

  9. Cerebral venous outflow and cerebrospinal fluid dynamics

    Directory of Open Access Journals (Sweden)

    Clive B. Beggs

    2014-12-01

    Full Text Available In this review, the impact of restricted cerebral venous outflow on the biomechanics of the intracranial fluid system is investigated. The cerebral venous drainage system is often viewed simply as a series of collecting vessels channeling blood back to the heart. However there is growing evidence that it plays an important role in regulating the intracranial fluid system. In particular, there appears to be a link between increased cerebrospinal fluid (CSF pulsatility in the Aqueduct of Sylvius and constricted venous outflow. Constricted venous outflow also appears to inhibit absorption of CSF into the superior sagittal sinus. The compliance of the cortical bridging veins appears to be critical to the behaviour of the intracranial fluid system, with abnormalities at this location implicated in normal pressure hydrocephalus. The compliance associated with these vessels appears to be functional in nature and dependent on the free egress of blood out of the cranium via the extracranial venous drainage pathways. Because constricted venous outflow appears to be linked with increased aqueductal CSF pulsatility, it suggests that inhibited venous blood outflow may be altering the compliance of the cortical bridging veins.

  10. Current opinion on iliofemoral venous thrombectomy.

    Science.gov (United States)

    Stephens, G L

    1976-02-01

    Iliofemoral venous thrombosis is discussed and a technique of iliofemoral venous thrombectomy is presented. Operative phlebography is recommended. The personal recommendations of leading American vascular surgeons in treating the patient with acute iliofemoral venous thrombosis are presented. I recommend thrombectomy for phlegmasia cerulea dolens, and in previously healthy, young ambulatory patients with phlegmasia alba dolens who are seen within 48 hours following thrombosis and have failed to show clinical improvement after a trial of bed rest, elevation of the lower extremities, and intravenous heparin. The majority of patients seen with phlegmasia alba dolens will best be served with nonoperative treatment.

  11. 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.

  12. 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...

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. Imaging of head and neck venous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Flis, Christine M.; Connor, Stephen E. [King' s College Hospital, Neuroradiology Department, London (United Kingdom)

    2005-10-01

    Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. (orig.)

  20. 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.

  1. The chronic cerebrospinal venous insufficiency syndrome.

    Science.gov (United States)

    Zamboni, P; Galeotti, R

    2010-12-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.

  2. Central venous oxygen saturation during hypovolaemic shock in humans

    DEFF Research Database (Denmark)

    Madsen, P; Iversen, H; Secher, N H;

    1993-01-01

    (28-36) (median and range) to 34 (30-40) Ohm, mean arterial pressure (MAP) from 79 (70-88) to 86 (80-99) mmHg, heart rate (HR) from 67 (56-71) to 99 (78-119) beats min-1 (p TPR) from 20 (16-32) to 36 (15-52) mmHg min l-1 (p ... from 4.3 (3.0-4.8) to 2.7 (1.8-4.8) l min-1 (p TPR to 22 (13-33) mmHg min l-1 (p

  3. 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.

  4. Nanostructuring carbon fibre probes for use in central venous catheters.

    Science.gov (United States)

    Li, Meixian; Phair, Jolene; Cardosi, Marco F; Davis, James

    2014-02-17

    A carbon fibre probe is described which utilises the oxidation of an endogenous biomarker to provide diagnostic information on the condition of intravascular access lines. The probe surface was modified through anodic oxidation to provide a high selectivity towards urate which was used as a redox probe through which the pH could be determined. A Nernstian response (-60 mV/pH) was obtained which was free from the interference of other redox species common to biofluids. The electroanalytical performance of the probe has been optimised and the applicability of the approach demonstrated through testing the responses in whole blood.

  5. 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

  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

    - and 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...... lactate dehydrogenase were associated with VTE risk. Central venous catheter use increased the transient odds of VTE (aOR=6.7 (1.2, 28.1)). CONCLUSIONS: We report a lower VTE incidence among lymphoma patients compared with prior studies. Lymphoma aggressiveness was the main driver of baseline VTE risk......, whereas central venous catheter use increased transient risks. These accurate estimates may improve the identification of lymphoma subgroups at highest VTE risk, for whom future targeted prevention interventions may be beneficial....

  7. 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.

  8. Real time three-dimensional transesophageal echocardiography guided coronary sinus cannulation during CARILLON mitral annuloplasty device therapy for a patient with chronic severe mitral regurgitation.

    Science.gov (United States)

    Mahmoud, Hani M; Al-Ghamdi, Mohammed A; Ghabashi, Abdullah E

    2015-01-01

    The coronary sinus (CS) has become a clinically important structure especially through its role in providing access for different cardiac procedures such as arrhythmia ablation, biventricular pacing and recently, percutaneous valvular interventions. Fluoroscopy with or without two-dimensional transesophageal echocardiography is the widely used method for guidance. A 78-year-old female patient undergoing percutaneous CARILLON mitral annuloplasty device therapy for chronic severe symptomatic mitral regurgitation. After insertion of the CS catheter through the right internal jugular vein, multiple trials for CS cannulation guided by fluoroscopy and two-dimensional transesophageal echocardiography were unsuccessful. So, real time three-dimensional zoom mode was used. Then, the volume was rotated to have the anatomically oriented enface view of the interatrial septum from the right atrial perspective. The CS ostium was identified adjacent to the eustachian valve. Then the catheter was reintroduced through the superior vena cava into the right atrium then easily navigated to cannulate the CS ostium. The position was confirmed by the fluoroscopically known course of the CS plus the pattern of the invasive pressure wave form. CS cannulation is not always feasible using fluoroscopy and/or two-dimensional Echocardiography guidance. Real time three-dimensional transesophageal echocardiography can be used to guide CS cannulation as it provides an anatomically oriented and informative enface view of the CS ostium. It can help reducing fluoroscopic radiation time. PMID:25231878

  9. A retrospective comparison of the modified tension band technique and the parallel titanium cannulated lag screw technique in transverse patella fracture

    Directory of Open Access Journals (Sweden)

    Wang Chengxue

    2014-07-01

    Full Text Available 【Abstract】Objective: To compare efficacy between the modified tension band technique and the parallel titanium cannulated lag screw technique for the transverse patella fracture. Methods:Seventy-two patients were retrospectively analyzed aged 22 to 79 years (mean, 55.6 years with transverse patella fractures, among whom 37 patients underwent the modified tension band and 35 patients received the titanium cannulated lag screw. Patients were followed up for 1-3 years. We analyzed the difference of operation time, complications, fracture reduction, fracture healing time, and the Iowa score for knee function between both groups. Results:In modified tension band group, five patients had skin irritation and seven suffered wire migration, two of whom required a second operation. In comparison, there were no complications in the titanium cannulated lag screw group, which also had a higher fracture reduction rate and less operation time. Conclusion:The parallel titanium cannulated lag screw technique has superior results and should be considered as an alternative method to treat transverse patella fracture. Key words: Fractures, bone; Patella; Titanium; Bone screws

  10. Recommendation to Exclude Bile-Duct-Cannulated Rats with Hyperbilirubinemia for Proper Conduct of Biliary Drug Excretion Studies.

    Science.gov (United States)

    Kato, Koji; Hasegawa, Yoshitaka; Iwata, Katsuya; Ichikawa, Takuya; Yahara, Tohru; Tsuji, Satoshi; Sugiura, Masayuki; Yamaguchi, Jun-Ichi

    2016-08-01

    Hyperbilirubinemia (HB) is sometimes encountered following bile-duct cannulation in rats. It possibly originates from the reduced functioning of multidrug resistance-associated protein 2 (Mrp2) and subsequent adaptive alterations in the expression of Mrp3 and the organic anion transporting polypeptides (Oatps). Our aim was to clarify the importance of excluding bile-duct-cannulated (BDC) rats with HB for proper conduct of drug excretion studies. We detected HB [serum total bilirubin concentration (TBIL) ≥0.20 mg/dl] in 16% of all BDC rats prepared. The serum activities of aspartate aminotransferase, alanine aminotransferase, leucine aminopeptidase, and alkaline phosphatase were within the respective normal ranges in the BDC rats with mild HB (TBIL, 0.20-0.79 mg/dl), indicating the absence of hepatic failure. In the pharmacokinetics of pravastatin, an Oatps/Mrp2 probe drug in the BDC rats, the apparent volume of distribution and the clearance were smaller in the mild HB group as compared with the normal group, suggesting the reduction of apparent hepatic uptake and hepatobiliary elimination. The biliary excretion (percentage of dose) was significantly reduced by 54%, suggesting that the biliary efflux activity via Mrp2 was reduced to a greater extent relative to metabolic activity in hepatocytes. The serum γ-glutamyltransferase (GGT) activity correlated with TBIL and inversely correlated with biliary excretion of pravastatin, a finding which could serve as a clue to uncover the regulatory system involving cooperation between GGT and Mrp2. In conclusion, BDC rats with HB, however mild, should be excluded from drug excretion studies to avoid the risk of underestimation of the biliary excretion of drugs. PMID:27208382

  11. 动静脉血二氧化碳分压差测定在小儿脓毒性休克中的意义%Central venous-to-arterial carbon dioxide difference in critically ill pediatric patients with septic shock

    Institute of Scientific and Technical Information of China (English)

    陈容欣; 张育才; 崔云; 缪惠洁; 徐梁; 戎群芳

    2014-01-01

    Objective To assess the value of central venous-to-arterial carbon dioxide difference [P(cv-a) CO2] in evaluation of disease severity and prognosis in children with septic shock who already had central venous oxygen saturation (ScvO2) higher than 70% after early resuscitation.Method In this prospective study,48 septic shock children seen in Shanghai Children's Hospital,Shanghai Jiao Tong University were enrolled from Jun 2012 to May 2014.36(75.0%)were male,12(25.0%) were female,the average age was(31.9 ± 24.5)months.The critically ill patients with septic shock were treated to achieve ScvO2 greater than 70% depending on early goal-directed therapy(EGDT).All patients were divided into two groups,based on P (cv-a) CO2,low P (cv-a) CO2 group with P (cv-a) CO2 < 6 mmHg (1 mmHg =0.133 kPa) and high P(cv-a) CO2 group with P(cv-a) CO2 ≥6 mmHg.The parameters of hemodynamics including mean blood pressure (MAP),heart rate (HR),central venous pressure (CVP),perfusionrelated parameters [ScvO2,P (cv-a) CO2,serum lactate (Lac),Lac clearance rate],pediatric critical illness score,PRISM Ⅲ score,and 28 days in-hospital mortality were recorded for all patients.Result Of the 48 cases with septic shock whose ScvO2 was higher than 70%,17 patients (35.4%) had high P(cv-a) CO2(≥6 mmHg) and 31 (65.6%) had lower P(cv-a)CO2 (< 6 mmHg).There were no significant differences between the 2 groups of patients in age,PRISM Ⅲ score and PCIS (P > 0.05),but Lac and P(cv-a) CO2 values were significantly different (P <0.05).Low P(cv-a) CO2 group patients had lower 28 days mortality than high P (cv-a) CO2 group [11/17 vs.32.3% (10/31),P < 0.05]; 24 h after resuscitation,compared with high P(cv-a) CO2 group,low P (cv-a) CO2 group patients had lower Lac values [(2.0 ± 1.3) vs.(2.7 ± 1.2) mmol/L,P <0.05].Low P(cv-a) CO2 group patients had shorter duration of vasoactive drugs use [(16 ± 14) vs.(44 ± 21) h,P < 0.05],24 h Lac clearance rate was significantly higher

  12. Quality of life in venous disease.

    Science.gov (United States)

    van Korlaar, Inez; Vossen, Carla; Rosendaal, Frits; Cameron, Linda; Bovill, Edwin; Kaptein, Adrian

    2003-07-01

    Quality of life (QOL) can be defined as the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient. Studies on the impact of chronic venous disease on quality of life are scarce compared to quality of life research in other diseases. The purpose of this paper was to describe instruments that assess the quality of life in patients with chronic venous disease and to review the literature on this topic. A computer search of the MedLine database was performed to identify papers; the bibliographies of relevant articles were reviewed to obtain additional papers. Papers were included if they described the development or use of a quality of life instrument for patients with chronic venous disease. A total of 25 papers were identified that fit the inclusion criteria. The studies described in the papers used six different generic instruments and ten disease-specific instruments. Quality of life in chronic venous disease was assessed in 12 studies. Six studies compared different types of treatment for chronic venous disease where QOL was an outcome measure. Despite the wide variety of measures used, results indicate that the quality of life of patients with chronic venous disease is affected in the physical domain mostly with regard to pain, physical functioning and mobility, and that they suffer from negative emotional reactions and social isolation. We feel that QOL should be a standard measure in future studies in patients with chronic venous disease, preferably with a combination of generic and disease-specific measures. PMID:12876622

  13. Wound care in venous ulcers.

    Science.gov (United States)

    Mosti, G

    2013-03-01

    -to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing. PMID:23482540

  14. 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

  15. Pathogenic bacteria and drug sensitivity in central venous catheter related infections after heart surgery%心脏术后中心静脉导管相关性感染的病原菌及药物敏感性分析

    Institute of Scientific and Technical Information of China (English)

    安淑芬; 芮晨; 田坤; 张楠

    2012-01-01

    Objective To investigate the distribution of pathogenic bacteria group and drug sensitivity in central venous catheter related infections ( CVC-RI ) after heart surgery. Methods The clinical records of 526 patients were screened after open heart surgery and central vein catheterization from Jan. 2009 to June 2011. The clinical materials of CVC-RI patients,and results of bacteria culture and drug sensitivity test were analyzed retrospectively. Results There were 38 patients suffered from CVC-IR and the total occurrence rate was 7. 22% ( 38/526 ). There were 48 stains of pathogenic bacteria cultured, among which there were 26 strains of Gram-positive bacteria ( 54. 16% ), 18 stains of Gram-negative bacteria ( 37. 50% ) and 4 stains of fungus ( 8. 33% ). Common pathogenic bacteria included Staphylococcus aureus ( 29. 16% ),Staphylococcus epidermidis ( 13. 67% ) and Pseudomonas aeruginosa ( 12. 50% ). The analysis on drug sensitivity showed that the sensitivity of Gram-positive bacteria to vancomycin was 100% and followed by chloromycetin,levofoxacin and piperacillin. The drug resistance of Gram-negative bacteria was high with a higher sensitivity to imipenem and followed by levofoxacin,ceftazidime and piperacillin/tazobactam. Conclusion The pathogenic bacteria inducing CVC-IR are commonly Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa after heart surgery,so antibiotics should be chosen reasonably according to drug sensitivity of pathogenic bacteria in anti-infection treatment.%目的 探讨心脏术后中心静脉导管相关性感染(CVC-RI)的致病菌群分布及药敏情况.方法 对我院2009年1月至2011年6月间,进行心脏直视手术并行中心静脉置管术的526例患者临床病历进行筛查,对发生CVC-RI患者的临床资料及细菌培养、药物敏感性试验结果进行回顾性分析.结果 38例患者发生了CVC-RI,总发生率为7.22%(38/526),培养出病原菌48株,其中革兰氏阳性菌有26株(54.16%)

  16. Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management

    Directory of Open Access Journals (Sweden)

    Leys Didier

    2008-01-01

    Full Text Available Cerebral venous thrombosis (CVT has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnoses. Headache is the most common symptom and may be associated with other symptoms or remain isolated. The other frequent manifestations are focal neurological deficits and diffuse encephalopathies with seizures. The key to the diagnosis is the imaging of the occluded vessel or of the intravascular thrombus, by a combination of magnetic resonance imaging (MRI and magnetic resonance venography (MRV. Causes and risk factors include medical, surgical and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections and local infections. The breakdown of causes differs in different parts of the world. A meta-analysis of the most recent prospectively collected series showed an overall 15% case-fatality or dependency rate. Heparin therapy is the standard therapy at the acute stage, followed by 3-6 months of oral anticoagulation. Patients with isolated intracranial hypertension may require a lumbar puncture to remove cerebrospinal fluid before starting heparin when they develop a papilloedema that may threaten the visual acuity or decompressive hemicraniectomy. Patients who develop seizures should receive antiepileptic drugs. Cerebral venous thrombosis - even pregnancy-related - should not contraindicate future pregnancies. The efficacy and safety of local thrombolysis and decompressive hemicraniectomy should be tested

  17. Prevalence of detectable venous pressure drops expected with venous needle dislodgement.

    Science.gov (United States)

    Ribitsch, Werner; Schilcher, Gernot; Hafner-Giessauf, Hildegard; Krisper, Peter; Horina, Jörg H; Rosenkranz, Alexander R; Schneditz, Daniel

    2014-01-01

    Venous needle dislodgement (VND) is a potentially fatal complication during hemodialysis (HD) treatment and the venous pressure monitor is the most widely used device for its detection. VND can only be detected by the venous sensor if the resulting pressure drop exceeds the difference between the actual venous pressure and the lower alarm limit. In clinical practice, the lower alarm limit is usually set 30-40 mmHg below the actual venous pressure to avoid a disproportionate high number of nuisance alarms. The aim of this study was to quantify the number of fistulas and grafts in a group of HD patients where venous pressure monitoring can be expected to detect VND. We determined intra-access pressures in 99 chronic HD patients. Sixty-five (65.7%) had a fistula and 34 (34.3%) had a prosthetic graft as a vascular access. Mean intra-access pressure (Pa ) in fistulas was 32.6 ± 23.5 mmHg, whereas in grafts mean Pa was 60.9 ± 19.5 mmHg. Nineteen (29.2%) of the fistulas and 32 (94.1%) of the grafts exhibited an intra-access pressure above 40 mmHg. Therefore, in our study nearly all grafts but only 29% of fistulas would fulfill the requirement for venous pressure monitoring to detect VND. PMID:24341865

  18. Assessment of Venous Thrombosis in Animal Models.

    Science.gov (United States)

    Grover, Steven P; Evans, Colin E; Patel, Ashish S; Modarai, Bijan; Saha, Prakash; Smith, Alberto

    2016-02-01

    Deep vein thrombosis and common complications, including pulmonary embolism and post-thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here, we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro-computed tomography, and high-frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition.

  19. 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...... to the 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...

  20. Lay Stress on Study of Venous Thromboembolism

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2002-01-01

    @@ Venous thromboembolism (VTE) including deep vein thrombosis(DVT) and pulmonary embolism(PE).Its occurs in about 1 per 1 000 individuals per years.Thrombosis is a serious disorder. It may be fatal by PE (case fatality rate of venous thrombosis is estimated at 1% to 2%)(Figure 1 ). A substantial proportion of these deaths occur in the postoperative period, and many events are fatal before diagnosis can be made and therapy initiated. Just as well, the prophylactic treatment of thrombosis is focused on preventing first events and recurrences through adequate knowledge about risks and risk factors.

  1. 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.

  2. Imaging characteristics of two patients with isolated cortical venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    Shunchang Han; Hui Zhang; Guoguang Fan; Baohai Sun

    2008-01-01

    BACKGROUND:Over the past twenty years, improvements in neuroimaging have greatly improved the ability to diagnose cerebral venous sinus thrombosis, as well as isolated cortical venous thrombosis. Neuroimaging allows for variations to be detected in the cortical vein and venous sinus. Diagnosis of thromboses in the venous system should not depend entirely on angiography of undeveloped veins or venous sinus. Currently, the combination of magnetic resonance imaging and magnetic resonance venography is the gold standard for diagnosing cerebral venous sinus thrombosis, rather than digital subtraction angiography. This article summarizes clinical manifestations, results from computed tomography and magnetic resonance imaging in two cases of isolated cortical venous thrombosis, analyzed relevant literature, and discussed the clinical and imaging characteristics of isolated cortical venous thromboses.

  3. Taponamiento cardíaco tras cambio de catéter venoso central, sobre guía, para nutrición parenteral total: ¿Lo podemos evitar? Cardiac blockade after changing central venous catheter, on a guide, for total parenteral nutrition: Can it be avoided?

    Directory of Open Access Journals (Sweden)

    C. González Fernández

    2003-02-01

    Full Text Available La cateterización de venas centrales es un proceso rutinario, sobre todo en enfermos graves. Es una técnica en la que están descritas múltiples complicaciones, afortunadamente no muy frecuentes, y en relación con la pericia del que la realiza. El taponamiento cardíaco es una de estas infrecuentes complicaciones, con muy elevada mortalidad. Describimos un caso en el que por sospecha, diagnóstico precoz y tratamiento inmediato se siguió de éxito en las maniobras de recuperación del enfermo. Asimismo, se revisa la literatura y se analizan los posibles mecanismos de estos episodios.Catheterization of central veins is a routine process, especially in severely-ill patients. It is a technique associated with multiple potential complications, fortunately infrequent, depending on the skill with which it is performed. Cardiac blockade is one of these infrequent complications with a high mortality. We describe a case in which suspicion, early diagnosis, and immediate manipulative treatment allowed a successful recovery of the patient. In addition, the literature is reviewed and possible mechanisms involved in these episodes are discussed.

  4. The recalcitrant venous leg ulcer - A never ending story?

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan); M.B. Maessen-Visch (Birgitte); S.I. Langendoen; K.P. de Roos; H.A.M. Neumann (Martino)

    2013-01-01

    textabstractIntroduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is lipodermat

  5. 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...

  6. 中心静脉-动脉血二氧化碳分压差评估肿瘤危重患者的血流动力学状态%Evaluation of the hemodynamic state of critically ill cancer patients with central venous-to-arterial carbon dioxide difference

    Institute of Scientific and Technical Information of China (English)

    王东浩; 吕扬; 夏睿; 杨洋; 刘坤彬; 韩涛

    2011-01-01

    目的 应用中心静脉-动脉血二氧化碳分压差(Pcv-aCO2)评估危重患者血流动力学状态并指导治疗.方法 回顾性选取本院重症监护病房(ICU)收治的47例血流动力学异常的肿瘤危重患者,按照指南规范治疗24 h,以早期目标导向治疗(EGDT)的标准作为治疗终点.按治疗前后序贯器官衰竭评分(SOFA评分)差值(△SOFA)分为△SOFA≤1组(27例)与△SOFA>1组(20例),比较两组患者治疗前后平均动脉压(MAP)、每小时尿量、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2)、乳酸清除率、Pcv-aCO2等指标的差异及与△SOFA的相关性.结果 在接受治疗前,△SOFA≤1组与△SOFA>1组MAP[mm Hg(1 mm Hg=0.133 kPa):54.48±4.95比54.45±4.30]、每小时尿量(ml:19.33±4.53比20.55±5.54)、CVP (mm Hg:3.48±1-81比3.25±1.16)、ScvO2 (0.571±0.042比0.578±0.047)比较差异均无统计学意义(均P>0.05);与△SOFA>1组比较,△SOFA≤1组Pcv-aCO2 (mm Hg:7.80±2.20比9.39±0.97)、SOFA评分(分:6.33±2.11比9.50±1.24)显著降低(均P<0.01).在容量复苏后24 h,△SOFA≤1组与△SOFA>1组MAP(mm Hg:73.48±6.12比71.30±7.30)、CVP(mm Hg:6.85±1.26比6.50±1.28)、ScvO2(0.693±0.032比0.684±0.039)等指标均较治疗前有所改善,但两组间比较差异无统计学意义(均P>0.05),而Pcv-aCO2(mm Hg:3.02±1.59比8.21±2.23)、每小时尿量(ml:71.41±6.74比51.70±7.50)、SOFA评分(分:6.03±2.56比10.05±1.61)、乳酸清除率[(27.71±11.46)%比-(0.78±13.29)%]差异均有统计学意义(均P<0.01).两组患者每小时尿量及Pcv-aCO2、乳酸清除率与△SOFA均存在显著相关性(r值分别为-0.712、0.745、-0.631,均P<0.05).结论 Pcv-aCO2可作为评估患者血流动力学状态的指标,也可作为评估治疗效果和预后的一项指标.%Objective To evaluate the hemodynamic state of critically ill cancer patients using central venous-to-arterial carbon dioxide difference (Pcv-aCO2) and to direct the treatment

  7. Treatment of Cancer-Associated Venous Thrombosis

    NARCIS (Netherlands)

    G.L. van Sluis; H.R. Buller

    2009-01-01

    Venous thromboembolism (VTE) is an important complication in cancer patients, which is associated with bad outcome. Increased recurrence rates and bleeding complications as compared to non-cancer patients during the treatment of VTE, require special attention. This review aims to summarize the avail

  8. The aetiology of deep venous thrombosis.

    Science.gov (United States)

    Malone, P C; Agutter, P S

    2006-09-01

    Most ideas about the pathogenesis of deep venous thrombosis (DVT) are dominated by a 'consensus model' first articulated around 1962. This model invokes 'Virchow's triad' and attributes thrombogenesis in veins to some combination of 'hypercoagulability', 'stasis' and 'intimal injury'. This arose as a by-product of studies on the mechanisms of haemostasis and bleeding diatheses that were at best only indirectly relevant to thrombosis, and there are reasons for doubting the causal significance of 'hypercoagulability' and 'stasis' in the aetiology of DVT. Proponents of the consensus model make little reference to a substantial literature, mostly historical, that: (a) emphasizes the significance of the venous valve pockets (VVP) and blood rheology in DVT pathogenesis; and (b) describes morphological features specific to venous thrombi that a valid aetiological model must explain. This literature provides the basis for an alternative hypothesis of DVT aetiology, published some 30 years ago, which has been experimentally corroborated and is compatible with recent cell and molecular biological studies of the venous endothelium. We review this alternative hypothesis, considering its potential value for future research on DVT and embolism, and its significance for clinical practice.

  9. Microalbuminuria and Risk of Venous Thromboembolism

    NARCIS (Netherlands)

    Mahmoodi, Bakhtawar K.; Gansevoort, Ron T.; Veeger, Nic J. G. M.; Matthews, Abigail G.; Navis, Gerjan; Hillege, Hans L.; van der Meer, Jan

    2009-01-01

    Context Microalbuminuria (albuminuria 30-300 mg per 24-hour urine collection) is a well-known risk marker for arterial thromboembolism. It is assumed that microalbuminuria reflects generalized endothelial dysfunction. Hence, microalbuminuria may also predispose for venous thromboembolism (VTE). Obje

  10. 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.

  11. 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.

  12. 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

  13. 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...

  14. To what extent might deep venous thrombosis and chronic venous insufficiency share a common etiology?

    Science.gov (United States)

    Malone, P Colm; Agutter, P S

    2009-08-01

    According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration.

  15. 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

    Directory of Open Access Journals (Sweden)

    Jacinta Sanchez Pelayo

    2006-10-01

    Full Text Available 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 tests and an automated system. For the study, 198 CVC tips were evaluated and 105 (53% were considered positive, that is, showed microbial growth ³ 15 CFU. The microorganisms found were the following: 63.8% Grampositive bacteria, 30.5% Gram-negative bacteria, and 5.7% yeast. The most isolated were: coagulasenegative Staphylococci (35.2%, Staphylococcus aureus (25.7%, Klebsiella pneumoniae (8.5%, Pseudomonas aeruginosa (7.6%, Acinetobacter baumannii (7.6% and Candida albicans (4.7%. The increase of infection cases related to catheter has been observed worldwide reflecting the increase of invasive medical procedures used to treat patients. This work allowed the identification of the microorganisms most frequently isolated from CVC tips at a teaching hospital in the region of Londrina- PR. The identification of these microorganisms is extremely important in order to optimize the treatment of the infections and to establish methods of prevention. Cateteres venosos centrais (CVC são utilizados na terapia intravenosa com a finalidade de facilitar o diagnóstico e o tratamento do paciente, pois permitem a administração de medicamentos, nutrição parenteral, além de serem usados como acesso vascular para hemodiálise. Entretanto, o uso desses cateteres oferece riscos de infecção local e sistêmica, incluindo endocardite e bacteremia. O presente estudo teve por objetivo isolar microrganismos de CVC, utilizando a técnica de cultura semi-quantitativa, e

  16. 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。

  17. 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

  18. 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

  19. Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein

    International Nuclear Information System (INIS)

    We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres. (orig.)

  20. Surgical treatment of the osteoporotic spine with bone cement-injectable cannulated pedicle screw fixation: technical description and preliminary application in 43 patients

    Directory of Open Access Journals (Sweden)

    Fei Dai

    2015-02-01

    Full Text Available OBJECTIVES: To describe a new approach for the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws. METHODS: Between June 2010 and February 2013, 43 patients with degenerative spinal disease and osteoporosis (T-score <-2.5 underwent lumbar fusion using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. Patients were given radiographic follow-up examinations after 3, 6, and 12 months and once per year thereafter. RESULTS: All patients were followed for a mean of 15.7±5.6 months (range, 6 to 35 months. The Visual Analog Scale and Oswestry Disability Index scores showed a significant reduction in back pain (p = 0.018 and an improvement in lower extremity function (p = 0.025 in patients who underwent lumbar fusion using the novel screw. Intraoperative cement leakage occurred in four patients, but no neurological complications were observed. Radiological observation indicated no loosening or pulling out of the novel screw, and bone fusion was excellent. CONCLUSIONS: The described polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws can reduce pain and improve spinal dysfunction in osteoporotic patients undergoing osteoporotic spine surgery.