Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

Download Full-text

Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

The Journal of Vascular Access ◽

10.1177/1129729820944066 ◽

2020 ◽

pp. 112972982094406

Author(s):

Lucio Brugioni ◽

Elisabetta Bertellini ◽

Mirco Ravazzini ◽

Marco Barchetti ◽

Andrea Borsatti ◽

...

Keyword(s):

Central Venous Catheter ◽

Guide Wire ◽

Case Series ◽

Venous Catheter ◽

Venous Access ◽

Late Complications ◽

Central Catheter ◽

Central Venous ◽

Single Lumen ◽

Thrombotic Complications

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

Download Full-text

Risk factor identification and predictive models for central line requirements for patients on vasopressors

Anaesthesia and Intensive Care ◽

10.1177/0310057x211024258 ◽

2021 ◽

pp. 0310057X2110242

Author(s):

Adrian D Haimovich ◽

Ruoyi Jiang ◽

Richard A Taylor ◽

Justin B Belsky

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Central Venous Catheter ◽

Single Agent ◽

Composite Endpoint ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

Download Full-text

Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

QJM ◽

10.1093/qjmed/hcab113.022 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Marwa W Nasef ◽

Maha M El-gaffary ◽

Mervet G Mansour ◽

Esraa S Abd El Aty

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Meta Analysis ◽

Venous Catheter ◽

Controlled Trials ◽

Central Venous ◽

Thrombotic Occlusion ◽

Thrombotic Complications

Abstract Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.

Download Full-text

Risk factors for central venous catheter-related infections in pediatric intensive care

Clinics ◽

10.1590/s1807-59322007000500002 ◽

2007 ◽

Vol 62 (5) ◽

Cited By ~ 12

Author(s):

Ricardo Vilela ◽

Andréa D N Jácomo ◽

Antonia Teresinha Tresoldi

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Central Venous Catheter ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Venous

Download Full-text

Venous anomalies as potentially lethal risk factors during ordinary catheterization

Veins and Lymphatics ◽

10.4081/vl.2015.5098 ◽

2015 ◽

Vol 4 (2) ◽

Author(s):

Savino Occhionorelli ◽

Sergio Gianesini ◽

Lorenzo Marinelli ◽

Marianna Daniele ◽

Sara Chierici ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Central Venous Catheter ◽

Literature Review ◽

Venous Catheter ◽

Clinical Implications ◽

Venous Malformations ◽

Central Venous ◽

Venous Anomalies ◽

Technology Advancement

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.

Download Full-text