Tunneled internal jugular catheters in adult patients: comparison of outcomes in hemodialysis versus infusion catheters

Background: Tunneled central venous catheters placed by interventional radiologists are now widely used for hemodialysis and infusion therapies throughout the world. However, complications such as infections and malfunctions still remain a major concern in oncology and hemodialysis patients. Purpose: To evaluate the long-term follow-up results of tunneled central venous catheters in an adult population in terms of infectious complications and malfunction rates in dialysis and oncology patients. Material and Methods: We retrospectively reviewed the hospital charts and our electronic database for 434 tunneled internal jugular catheters in 335 consecutive patients between December 2002 and March 2006. Mean patient age was 57 years (range 23–86 years) in the hemodialysis group and 45 years (range 18–83 years) in the infusion group. A total of 224 hemodialysis catheters were placed in 168 patients (68 females, 100 males) and 210 infusion catheters in 167 patients (48 females, 119 males). Results: Technical success rate was 100%. Mean duration of catheter use was 86 days (1–652 days) and 60 days (2–686 days) for hemodialysis and infusion catheters, respectively. A total of 107 hemodialysis (47%) and 95 infusion catheters (45%) were electively removed due to completion of therapy and resolution of need for dialysis. Revisions were performed 0.22 and 0.11 per 100 catheters days in the hemodialysis and infusion groups, respectively. Our total infection rate was 0.10 episodes per 100 catheter days, and the rate of infections necessitating catheter removal was 0.05 episodes per 100 catheter days in the hemodialysis group, which is lower than that reported in other big series. However, in the infusion group, the rate of infections necessitating catheter removal was 0.28 episodes per 100 catheter days. Conclusion: Long-term central venous accesses using tunneled internal jugular catheters appeared to be safe and effective for both hemodialysis and long-term infusion therapies, with relatively higher infection rates in oncologic patients.

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Endovascular extraction of entrapped long-term central feeding catheter: Case series

The Journal of Vascular Access ◽

10.1177/1129729818792822 ◽

2018 ◽

Vol 20 (3) ◽

pp. 329-332

Author(s):

Marcin Michalak ◽

Łukasz Januszkiewicz ◽

Franciszek Majstrak ◽

Monika Gawałko ◽

Grzegorz Opolski ◽

...

Keyword(s):

Vessel Wall ◽

Balloon Dilatation ◽

Case Series ◽

High Volume ◽

Central Venous Catheters ◽

Catheter Removal ◽

Central Venous ◽

High Volume Center ◽

Manual Traction

Long-term tunneled central venous catheters are widely used in several clinical indications, that is, hemodialysis, chemotherapy, and total parenteral nutrition. However, central venous catheters are associated with a number of complications, including catheter occlusion and sepsis, which may necessitate earlier catheter removal. In most cases manual traction is sufficient to remove the catheter. Nevertheless, in some cases severe adhesions, formed between the catheter and the vessel wall, complicate simple catheter removal. We present four cases of entrapped long-term central venous catheters and describe methods (e.g. endoluminal balloon dilatation and wire snare) performed by experienced cardiologists at high-volume center to remove them. We claim that permanent central venous catheters removal procedures may be unpredictable and hazardous. Therefore, entrapped central venous catheters should be extracted by experienced operators in specialized high-volume centers.

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Comparison of outcomes of central venous catheters in patients with solid and hematologic neoplasms: an Italian real-world analysis

Tumori Journal ◽

10.1177/0300891620931172 ◽

2020 ◽

pp. 030089162093117

Author(s):

Francesca Corti ◽

Marta Brambilla ◽

Sara Manglaviti ◽

Laura Di Vico ◽

Maria Neve Pisanu ◽

...

Keyword(s):

Real World ◽

Multivariable Analysis ◽

Central Venous Catheters ◽

Cancer Center ◽

Central Venous ◽

Free Survival ◽

Treatment Type ◽

Risk Benefit Assessment ◽

Oncologic Patients

Introduction: Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other. Methods: We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs). Results: A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; p = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs ( p = 0.013). No significant differences in terms of catheter-related thromboses ( p = 0.676) or catheter-related infections ( p = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort ( p = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128–0.536; p < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018–0.372; p < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135–0.553; p < 0.0001). Conclusions: This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk–benefit assessment, patient preferences, and compliance.

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Infectious Complications of Indwelling Long-term Central Venous Catheters

CHEST Journal ◽

10.1378/chest.97.4.966 ◽

1990 ◽

Vol 97 (4) ◽

pp. 966-972 ◽

Cited By ~ 109

Author(s):

David E. Clarke ◽

Thomas A. Raffin

Keyword(s):

Infectious Complications ◽

Central Venous Catheters ◽

Central Venous

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IMPROVED PERCUTANEOUS INSERTION OF LONG‐TERM CENTRAL VENOUS CATHETERS IN CHILDREN: THE ‘SHRUG’ MANOEUVRE

Australian and New Zealand Journal of Surgery ◽

10.1046/j.1440-1622.1999.01530.x ◽

1999 ◽

Vol 69 (3) ◽

pp. 231-233 ◽

Cited By ~ 3

Author(s):

A. J. A. Holland ◽

W. D. A. Ford

Keyword(s):

Central Venous Catheters ◽

Central Venous ◽

Percutaneous Insertion

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The retrograde tunnel: a method for the fixation of central venous catheters in the military environment

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-77-75 ◽

1991 ◽

Vol 77 (2) ◽

pp. 75-77

Author(s):

R. A. Wheeler ◽

T. J. W. Spalding ◽

J. A. Thomas ◽

G. A. Carss

Keyword(s):

Central Venous Line ◽

Central Venous Catheters ◽

Patient Transfer ◽

Central Venous ◽

Medical Facilities ◽

Subcutaneous Tunnel ◽

Paediatric Practice ◽

The Military

AbstractCentral venous catheters (CVCs) are prone to accidental removal during patient transportation. Of the casualties who require transfer between medical facilities, those with CVC in situ require additional vigilance to prevent loss of the CVC, which continues to occur despite various methods of fixation. The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters. Several methods have been described, but the long-term CVCs in paediatric practice pose special problems, particularly that of the patients continually testing the CVCs fixation. Using a new polyurethane CVC, a retrograde tunnelling technique has been developed which affords immediate and secure fixation. We propose that this CVC, together with the technique of retrograde tunnelling, is the solution to inadvertent central venous line removal during patient transfer.

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Infections associated with the central venous catheters

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1404261d ◽

2014 ◽

Vol 142 (3-4) ◽

pp. 261-266

Author(s):

Biljana Draskovic ◽

Izabella Fabri ◽

Anna Uram-Benka ◽

Goran Rakic

Keyword(s):

Intensive Care ◽

Critically Ill Patients ◽

Venous Access ◽

Health Condition ◽

Central Venous Catheters ◽

Maintenance Period ◽

Central Venous ◽

Prevention Of Infection ◽

Catheter Infections

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.

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Incidence rates of bloodstream infections in children with long-term central venous catheters at Instituto Nacional do Câncer, Brazil (1995 to 2001)

International Journal of Infectious Diseases ◽

10.1016/s1201-9712(02)90235-3 ◽

2002 ◽

Vol 6 ◽

pp. S29

Author(s):

Marcelo Schirmer ◽

Eduardo Velasco ◽

Carlos A.S. Martins ◽

Leda M. Dias ◽

Vânia M.S.C. Gonçalves ◽

...

Keyword(s):

Bloodstream Infections ◽

Incidence Rates ◽

Central Venous Catheters ◽

Central Venous

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Catheter-related deep venous thrombosis in children with hemophilia

Blood ◽

10.1182/blood.v98.6.1727 ◽

2001 ◽

Vol 98 (6) ◽

pp. 1727-1731 ◽

Cited By ~ 91

Author(s):

Janna M. Journeycake ◽

Charles T. Quinn ◽

Kim L. Miller ◽

Joy L. Zajac ◽

George R. Buchanan

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Central Venous Catheters ◽

Catheter Placement ◽

Central Venous ◽

Radiographic Evidence ◽

Catheter Dysfunction ◽

The Mean ◽

Clinical Problems

Abstract Central venous catheters (CVCs) are a common adjunct to hemophilia therapy, but the risk of CVC-related deep venous thrombosis (DVT) in hemophiliacs is not well defined. In a previous study, 13 patients with CVCs had no radiographic evidence of DVT. However, recent abstracts and case studies demonstrate that DVT does occur. Therefore, this study sought to determine the frequency of DVT in children with hemophilia and long-term CVCs and to correlate venographic findings with clinical features. All hemophilia patients with tunneled subclavian CVCs in place for 12 months or more were candidates for evaluation. Patients were examined for physical signs of DVT and questioned about catheter dysfunction. Contrast venograms were obtained to identify DVT. Fifteen boys with severe hemophilia were evaluated, including 9 from the initially studied group of 13. Eight patients had evidence of DVT, 5 of whom previously had normal venograms. Five of 15 patients had clinical problems related to the CVC, all of whom had DVT. Four of 15 patients had suggestive physical signs; 3 had DVT. The mean duration of catheter placement for all patients was 57.5 months (range, 12-102 months). For patients with DVT, the mean duration was 66.6 ± 7.5 months, compared to 49.5 ± 7.2 months for patients without DVT (P = .06). No patient whose CVC was in place fewer than 48 months had an abnormal venogram. Many hemophilia patients with CVCs develop DVT of the upper venous system, and the risk increases with duration of catheter placement.

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