Novel experience of laser-assisted ‘inside-out’ central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation

Abstract In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonography during the supraclavicular approach to the subclavian vein is also described which may improve its safety profile. This technique could be more appropriate in scenarios when central venous access is preferred over intraosseous access for patients being transported to another location for further care.

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Obesity Hinders Ultrasound Visualization of the Subclavian Vein: Implications for Central Venous Access

The Journal of Vascular Access ◽

10.5301/jva.5000051 ◽

2012 ◽

Vol 13 (2) ◽

pp. 246-250 ◽

Cited By ~ 4

Author(s):

Todd M. McGrath ◽

Eric A. Farabaugh ◽

Michael J. Pickett ◽

David K. Wagner ◽

Sharon Griswold-Theodorson

Keyword(s):

Subclavian Vein ◽

Central Venous Access ◽

Venous Access ◽

Central Venous

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Use of the Surfacer® Inside-Out® Catheter Access System to Obtain Central Venous Access in Dialysis Patients With Thoracic Venous Obstructions: Single-Center Series

Vascular and Endovascular Surgery ◽

10.1177/1538574420980604 ◽

2020 ◽

pp. 153857442098060

Author(s):

Noemi Galas ◽

Robert Shahverdyan

Keyword(s):

Central Venous Access ◽

Kidney Injury ◽

Venous Access ◽

Iliac Vein ◽

Dialysis Patients ◽

Central Venous ◽

Access System ◽

Cardiac Decompensation ◽

History Of ◽

Inside Out

Background: Thoracic central venous obstruction (TCVO) is a common condition which can impact the ability to achieve central venous access (CVA) in patients on hemodialysis. The Surfacer® Inside-Out® Catheter Access System is designed to enable repeated right-side central venous access in patients with TCVO. Methods: We retrospectively analyzed medical records of 10 dialysis patients who presented with TCVO and underwent the Inside-Out procedure with the Surfacer System to obtain CVA between 2017 and 2020. Patient demographics, hemodialysis vascular access history, and procedural data were identified and analyzed. The mean patient age was 62.4 ± 19.6 years (25.9-89.1 years) with 7 of the 10 patients being male. Eight patients (80.0%) were diagnosed with chronic kidney disease with time on hemodialysis ranging from 3 to 13 years. The remaining 2 required CVA to treat acute-on-chronic kidney injury due to septic shock. Patients in our series had a mean of 2.8 ± 1.6 previous catheters placed prior to the Surfacer procedure. Results: CVA was achieved in all 10 patients with 1 patient requiring a second attempt to achieve access due to the inability to initially traverse the iliac vein with the device, possibly due to a history of kidney transplantation. One multimorbid patient died shortly after the successful procedure, possibly due to cardiac decompensation. Mean total procedure time for the 7 patients having only dialysis catheter placement using the Surfacer device was 67.2 ± 19.1 minutes (49-103 minutes). The remaining 3 patients received a Hemodialysis Reliable Outflow (HeRO) graft in conjunction with the Inside-Out procedure. All vascular accesses functioned properly during the immediate time period following placement. No adverse events associated with the use of Surfacer device were encountered. Conclusions: Data presented from our patient series confirms the effectiveness of the Surfacer System to safely achieve CVA in dialysis patients with TCVOs with a history of multiple catheter placements.

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