Mechanical complications of central venous catheters in children: A cohort study

2021 ◽  
pp. 1-7
Author(s):  
Kieran J. Moore ◽  
David Greencorn ◽  
Nadine Smith ◽  
Joanne M. Langley ◽  
Ketan Kulkarni
Keyword(s):  
Superior Vena ◽  
Tertiary Care ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Mechanical Complication ◽  
Complication Rates ◽  
Care Hospital ◽  
Central Venous ◽  
True Incidence ◽  
Mechanical Complications

Abstract Background: Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear. Setting and methods: Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described. Results: In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications. Conclusions: Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.

scholarly journals 10 Mechanical Complications Associated with Central Venous Catheters at a Canadian Tertiary Care Centre

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e4-e4
Author(s):  
Kieran Moore ◽  
Ketan Kulkarni ◽  
David Greencorn ◽  
Stefan Kuhle ◽  
Joanne Langley
Keyword(s):  
Tertiary Care ◽  
Central Venous Catheters ◽  
Mechanical Complication ◽  
Complication Rates ◽  
Central Venous ◽  
Term Care ◽  
Indwelling Catheters ◽  
Health Care Center ◽  
Mechanical Complications ◽  
Paediatric Patients

Abstract Background The administration of life-saving treatment through central venous catheters (CVC) has significantly improved the quality of life and outcomes for patients, especially for those requiring long-term care. While CVC-associated bacteremia is a standard patient outcome measure, little is known about the incidence of mechanical complications in children. Although common, large data on mechanical complications are scarce and generally limited to specific paediatric populations from modest single center series. Objectives To determine the incidence of mechanical complications among paediatric patients with CVCs. Design/Methods In this retrospective study we analyzed data from all paediatric patients (0-19 years) who required a CVC between 2001 and 2016 at our health care center, which services patients from regional hospitals in a shared care model. Details on CVC insertions and daily records of catheter function while in hospital have been collected prospectively and stored in a dedicated database. Patient demographics, catheter characteristics, and complications were abstracted from the database. Complications were defined through clinician documentation of CVC mechanical failures such as disconnect, leakage, fracture, and blockage. Complication rates were expressed per 1,000 line days. Results A total of 8,747 CVCs were placed in 5,743 patients during the study period for a total of 780,448 line days. Neonatal patients required the most CVC insertions and made up 41% of the cohort studied. Total mechanical complication rates were the highest over the 15-year period in 2001 (12 per 1,000 line days) and lowest in 2013 (3.8 per 1,000 line days). Peripherally inserted central catheters were used in the majority of patients (56%), while port-a-caths made up the vast majority of line days (78%). Mechanical complications occurred more frequently in non-tunneled catheters and were least likely to occur in port-a-caths (43 and 3.1 per 1,000 line days, respectively). Tunneled catheters failed mechanically at a rate of 8.0 per 1,000 line days and the peripherally inserted central catheter complication rate was 17 per 1,000 line days. Conclusion We provide a novel description of the incidence of mechanical complications in the setting of commonly used CVCs in a large paediatric cohort. Our findings help convey the true frequency of mechanical failures and create a benchmark for mechanical CVC complications in children. Recognizing the mechanical limitations of indwelling catheters will assist clinicians in optimizing catheter choice. Future study is planned to identify risk factors associated with CVC complications.

Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

2021 ◽  
pp. 152660282198933
Author(s):  
Pablo V. Uceda ◽  
Julio Peralta Rodriguez ◽  
Hernán Vela ◽  
Adelina Lozano Miranda ◽  
Luis Vega Salvatierra ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Esophageal Varices ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Dialysis Patients ◽  
Central Venous ◽  
Endovascular Recanalization ◽  
Flow Through ◽  
The Right

The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

Central venous catheters in the left-sided superior vena cava: Clinical implications

2013 ◽  
Vol 48 (2) ◽  
pp. 400-403 ◽  
Author(s):  
Mohammad Bader ◽  
Peter Bromley ◽  
Ingo Jester ◽  
James Bennett ◽  
G. Suren Arul
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Clinical Implications ◽  
Central Venous

Safe Placement of Central Venous Catheters

2011 ◽  
Vol 26 (6) ◽  
pp. 392-396 ◽  
Author(s):  
William T. McGee ◽  
Patrick T. Mailloux ◽  
Richard T. Martin
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Prospective Trial ◽  
Vena Cava ◽  
Pericardial Tamponade ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Insertion Depth ◽  
Simple Method

Introduction. To develop a simple method for safely placing central venous catheters (CVCs) outside the heart from the subclavian or internal jugular vein in compliance with Food and Drug Administration (FDA) and manufacturer guidelines. Methods. Patients requiring CVCs were enrolled into this prospective trial. Central venous catheters were inserted into the subclavian or internal jugular vein from either the right or left side to a depth of 15 cm. Chest radiographs were obtained immediately after insertion of the catheter to check tip placement and to evaluate for mechanical complications. Results. Operators successfully placed 201 of 210 (96%) CVCs outside the heart. Six of these required repositioning. Nine catheter tips were located in an intracardiac position. No cases of pneumothorax, hemothorax, or pericardial tamponade occurred. One case of delayed hydrothorax due to superior vena cava injury occurred. Conclusions. Using a 15-cm insertion depth via the internal jugular or subclavian vein results in safe catheter tip location in the majority of procedures consistent with FDA and manufacturer guidelines.

Long-Term Silicone Central Venous Catheters Impregnated With Minocycline and Rifampin Decrease Rates of Catheter-Related Bloodstream Infection in Cancer Patients: A Prospective Randomized Clinical Trial

2004 ◽  
Vol 22 (15) ◽  
pp. 3163-3171 ◽  
Author(s):  
Hend Hanna ◽  
Robert Benjamin ◽  
Ioannis Chatzinikolaou ◽  
Badie Alakech ◽  
Deborah Richardson ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cancer Patients ◽  
Bloodstream Infection ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Care Hospital ◽  
Central Venous ◽  
Catheter Related Bloodstream Infection

PurposeTo evaluate the efficacy of long-term nontunneled silicone catheters impregnated with minocycline and rifampin (M-R) in reducing catheter-related bloodstream infections.Patients and MethodsThis prospective, randomized, double-blind clinical trial was conducted at M.D. Anderson Cancer Center, a tertiary care hospital in Houston, TX. All patients in the trial had a malignancy.ResultsBetween September 1999 and May 2002, 356 assessable catheters were used: 182 M-R and 174 nonimpregnated. The patients' characteristics were comparable between the two study groups. The mean (± standard deviation) duration of catheterization with M-R catheters was comparable to that of nonimpregnated catheters (66.21 ± 30.88 v 63.01 ± 30.80 days). A total of 17 catheter-related bloodstream infections occurred during the course of the study. Three were associated with the use of M-R catheters and 14 were associated with the nonimpregnated catheters, with a rate of catheter-related bloodstream infection of 0.25 and 1.28/1,000 catheter-days, respectively (P = .003). Gram-positive cocci accounted for the majority of the organisms causing the infections. There were no allergic reactions associated with M-R catheters.ConclusionLong-term nontunneled central venous catheters impregnated with minocycline and rifampin are efficacious and safe in reducing catheter-related bloodstream infections in cancer patients.

Placement of Permanent Central Venous Catheters in Thrombosis of the Superior Vena Cava

2014 ◽  
Vol 26 (1) ◽  
pp. 33-36
Author(s):  
Marina Cornacchiari ◽  
Roberto Ferraresi ◽  
Barbara Gidaro ◽  
Antonia Stasi ◽  
Maria Giuseppina Ponticelli ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Central Venous

Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit

2010 ◽  
Vol 11 (2) ◽  
pp. 128-131
Author(s):  
Vasileios Zochios ◽  
Michael Gilhooly ◽  
Simon Fenner
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Maxillofacial Surgery ◽  
Vena Cava ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Central Venous

Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall. Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long. Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards. Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.

Sign in / Sign up

Export Citation Format

Share Document