Radiation burden of pediatric ultrasound-guided percutaneous central venous access devices: A prospective cohort study

2018 ◽  
Vol 53 (4) ◽  
pp. 802-807 ◽  
Author(s):  
Mohit Bajaj ◽  
Jon Wells ◽  
Anuja Liyanage ◽  
Stephen Evans ◽  
James Hamill
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Central Venous Access ◽  
Venous Access ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Radiation Burden ◽  
Venous Access Devices

Effect of a Nurse-Led Protocol on Time to Treatment of Partial Occlusions in Central Venous Access Devices in Pediatric Oncology

2020 ◽  
Vol 37 (5) ◽  
pp. 305-312
Author(s):  
Allison Hunter ◽  
K. Shantel Cunningham ◽  
Carol Yuen ◽  
Kristen Jensen ◽  
Arfan Afzal ◽  
...  
Keyword(s):  
Life Span ◽  
Pediatric Oncology ◽  
Prospective Cohort ◽  
Retrospective Cohort ◽  
Dwell Time ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Time To Treatment ◽  
Venous Access Devices

Central venous access devices (CVADs) are the standard of care in pediatric oncology. Occlusion is a common complication that can lead to delays in therapy, readmission, and CVAD removal and reinsertion. Early treatment of partial occlusions using a standardized protocol may restore patency and increase life span of CVADs. The objective of this study was to develop and evaluate a nurse-led protocol to manage partial CVAD occlusions in pediatric oncology and autologous bone marrow transplant patients. The protocol enabled nurses to manage partially occluded CVADs by administering thrombolytic therapy following an algorithm and patient-specific standing order. The primary outcome was time from recognition of the partial occlusion to instillation of a thrombolytic. Secondary outcomes were thrombolytic dwell time, number of complete occlusions, and CVAD life span. We used a quasi-experimental, after-only, nonequivalent control group design to compare patients not exposed (retrospective cohort, n = 137) and patients exposed (prospective cohort, n = 101) to the nurse-led protocol. Mann–Whitney U tests were used to compare time to treatment, dwell time, and CVAD life span between cohorts, and χ2 was used to compare the proportion of occlusions classified as complete. Time to treatment was significantly lower in the prospective cohort ( M = 99.9 minutes) versus the retrospective cohort ( M = 483.7 minutes), U = 1366.50, p < .01, as was thrombolytic dwell time, U = 282.50, p < .01. Proportion of complete occlusions and CVAD life span did not differ between cohorts. The nurse-led protocol was effective to manage partial CVAD occlusions in pediatric oncology patients.

Midline catheters for extracorporeal photopheresis in hematological patients

2021 ◽  
pp. 112972982110414
Author(s):  
Bruno Marche ◽  
Sonia D’Arrigo ◽  
Maria Giuseppina Annetta ◽  
Andrea Musarò ◽  
Alessandro Emoli ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Extracorporeal Photopheresis ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Graft Versus Host ◽  
Single Lumen ◽  
Peripheral Venous Access ◽  
Preliminary Study ◽  
Venous Access Devices

Introduction: Peripheral venous access for extracorporeal photopheresis (ECP) may be difficult in graft versus host disease (GVHD) patients, because of previous intravenous therapies and multiple peripheral cannulations; in this population of patients, ultrasound guided midline catheters may be an alternative option to central venous access. Methods: In this single-center, prospective preliminary study, we enrolled all consecutive patients with a diagnosis of GVHD and candidate to ECP, over a period of 10 months. We used inserted power injectable, non-valved, polyurethane, 20–25 cm single lumen midline catheters (MC). Results: Sixty-nine ECP procedures were carried out in six patients, using single-lumen MCs for outflow (5Fr in 74% and 4Fr in 26% of cases). For inflow, we used 5Fr or 4Fr MCs, or central venous access devices previously placed for other clinical reasons. There were no catheter-related complications during the entire period of ECP treatment. Mean outflow was significantly higher for 5Fr than for 4Fr MCs (35.8 ± 7.3 vs 29.2 ± 7.8 ml/min; p = 0.0008) and the procedure time was significantly shorter (92.9 ± 9.2 vs 108 ± 13.2 min; p < 0.0001). Conclusion: In GVHD patients, ECP can be performed efficiently and safely using single lumen polyurethane power injectable MCs. The best results are obtained with 5Fr rather than with 4Fr catheters. This strategy of venous access should be implemented in DIVA patients requiring ECP treatments, and probably also in other types of apheresis.

scholarly journals ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients

2021 ◽  
pp. 112972982110313
Author(s):  
Geremia Zito Marinosci ◽  
Daniele Guerino Biasucci ◽  
Giovanni Barone ◽  
Vito D’Andrea ◽  
Daniele Elisei ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Bedside Ultrasound ◽  
Pediatric Care ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Blood Samples ◽  
Promising Tool ◽  
Venous Access Devices

Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.

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