Complications Associated With Totally Implanted Venous Access Devices in the Arm Versus the Chest: A Short-Term Retrospective Study

2021 ◽  
pp. 084653712110408
Author(s):  
Samuel Pike ◽  
Kiat Tan ◽  
Brent Burbridge
Keyword(s):  
Venous Thrombosis ◽  
Pulmonary Thromboembolism ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Venous Access ◽  
P Value ◽  
Complication Rates ◽  
Infection Rates ◽  
Short Term ◽  
Venous Access Devices

Purpose: To retrospectively compare complications for totally implanted venous access devices (TIVADs or ports) in the arm vs. the chest. One participating institution implanted all TIVADs in the arm, whereas the other institution implanted them in the chest. Methods: Subjects were consecutive patients > 18 years with a device inserted between July 2017 and January 2019 at either Hospital A, where all devices were implanted in the arm, or at Hospital B, where all devices were implanted in the chest. Complications (rates/1,000 catheter-days and frequencies) were compared between the arm and chest locations. Results: 201 arm devices (71% female, mean age 59.4 years) and 203 chest devices (66% female, mean age 61.5 years) were assessed. Overall complication rates did not differ between the arm and chest [arm: 30 complications per 56,938 catheter-days (0.530/1,000 catheter-days) vs. chest: 47 complications per 63,324 catheter-days (0.742/1,000 catheter-days), p-value 0.173]. Periprocedural complications and mechanical malfunction also did not differ. Although prophylactic antibiotic use was higher in the chest (79.3% vs. 1.50%, p-value < 0.0001), infection rates did not differ. Arm venous thrombosis was significantly higher in the arm cohort (0.205 vs. 0.017/1,000 catheter-days, p-value 0.003) and pulmonary thromboembolism in the chest cohort (0.269 vs 0.056/1,000 catheter-days, p-value 0.002). Conclusions: While arm venous thrombosis was higher in the arm and pulmonary thromboembolism in the chest cohort, other complications were similar. Antibiotic use was more frequent in the chest cohort, while infection rates remained similar in both cohorts.

An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion

2021 ◽  
pp. 112972982110232
Author(s):  
Sonia D’Arrigo ◽  
Maria Giuseppina Annetta ◽  
Mauro Pittiruti
Keyword(s):  
Venous Thrombosis ◽  
Real Time ◽  
Venous Access ◽  
Central Venous ◽  
Safe Method ◽  
Central Venous Port ◽  
Catheter Malfunction ◽  
Bubble Test ◽  
Current Guidelines ◽  
Venous Access Devices

Persistent withdrawal occlusion is a specific catheter malfunction characterized by inability to withdraw blood through the device while infusion is maintained. The main causes are fibroblastic sleeve and tip malposition (associated or not to venous thrombosis around the tip). All current guidelines recommend infusing vesicant/antiblastic drugs through a central venous port only after assessment of blood return. In PWO, blood return is impossible. We have recently started to assess the intravascular position of the tip and the delivery of the infusion in the proximity of the cavo-atrial junction utilizing transthoracic/subxiphoid ultrasound with the ‘bubble test’. We found that this is an easy, real-time, accurate and safe method for verifying the possibility of using a port for chemotherapy even in the absence of blood return, as it occurs with persistent withdrawal occlusion.

Advanced vascular access

2019 ◽  
pp. 177-190
Author(s):  
Richard Craig
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Short Term ◽  
Central Lines ◽  
Venous Access Devices

In this chapter, the use of ultrasound to facilitate cannulation of a vessel is described in detail, including commentaries on equipment, preparation, scanning, and needling technique. Equipment and techniques for the insertion of short-term non-tunnelled central lines, long-term central venous access devices, arterial lines, and intraosseous needles are presented.

scholarly journals Comparison of Complication Rates of Implantable Venous Access Devices: Percutaneous Versus Cephalic Vein Cut-down Techniques

2013 ◽  
Vol 57 (5) ◽  
pp. 62S
Author(s):  
Farah Karipineni ◽  
Nadia Awad ◽  
Lisa Jablon ◽  
Nyali Taylor ◽  
Rashad G. Choudry
Keyword(s):  
Venous Access ◽  
Cephalic Vein ◽  
Complication Rates ◽  
Venous Access Devices

scholarly journals The Expansion of Cholangioscopy: Established and Investigational Uses of SpyGlass in Biliary and Pancreatic Disorders

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 132
Author(s):  
Michael Yodice ◽  
Joseph Choma ◽  
Micheal Tadros
Keyword(s):  
Guide Wire ◽  
Prophylactic Antibiotic ◽  
Cost Effective ◽  
Antibiotic Use ◽  
Complication Rates ◽  
Visually Guided ◽  
Endoscopic Retrograde ◽  
Pancreatic Disorders ◽  
Selective Cannulation ◽  
Repeat Procedures

Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques.

Power-injectable totally implantable venous access devices – analysis of success and complication rates of ultrasound-guided implantation and a patient satisfaction survey

VASA ◽  
2019 ◽  
Vol 48 (6) ◽  
pp. 524-530
Author(s):  
Julia Kunz-Virk ◽  
Karsten Krüger
Keyword(s):  
Patient Satisfaction ◽  
Venous Access ◽  
Late Complications ◽  
Subjective Rating ◽  
Complication Rates ◽  
Safe Procedure ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Port Implantation ◽  
Venous Access Devices

Summary. Background: To retrospectively evaluate the success rates, peri-interventional, early and late complications and patient satisfaction associated with power-injectable totally implantable venous access devices (TIVAPs). Patients and methods: Between April 2011 and March 2016, a total of 1,203 TIVAPs were implanted in 1,169 patients. Ultrasound-guided, fluoroscopically controlled implantation was performed through the subclavian or internal jugular vein. The systematic analysis focused on the rate of successful port implantations, the frequency of peri-interventional, early and late complications and on how the experience of the implanting radiologist impacts these parameters. Additionally, a standardized questionnaire was administered to the 102 study patients in a telephone interview to survey their subjective rating of the port implantation. Results: 99.5 % of TIVAPs were implanted successfully. In 4 out of 6 patients, the implantation was repeated successfully at a later time. Complication rates were 1.4 % (0.0512/1.000 catheter days) for peri-interventional, 2.9 % (0.081 per 1,000 catheter days) for early and 8.3 % (0.2288 per 1,000 catheter days) for late complications. The radiologist’s experience level and vein selection did not have a significant impact. Most peri-interventional complications (82.4 %) were of minor severity. The early (61.5 %) and late (65.6 %) complications were more frequently of major severity. Interventions to manage complications comprised port explanation in 46.9 %, conservative therapy in 17.4 % and interventional therapy in 12.2 %. At 1 and 3 months after port placement, the majority were satisfied or very satisfied with the interventional port implantation. Conclusions: Ultrasound-guided, fluoroscopically controlled implantation of TIVAPs is a safe procedure with low complication rates, high success rates and high patient satisfaction.

scholarly journals Subtle Microbiome Manipulation Using Probiotics Reduces Antibiotic-Associated Mortality in Fish

mSystems ◽  
2017 ◽  
Vol 2 (6) ◽  
Author(s):  
Victor Schmidt ◽  
Marta Gomez-Chiarri ◽  
Chelsea Roy ◽  
Katherine Smith ◽  
Linda Amaral-Zettler
Keyword(s):  
Disease Susceptibility ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Ornamental Fish ◽  
Prophylactic Antibiotics ◽  
Fish Farms ◽  
Short Term ◽  
Content Type ◽  
Pathogen Control ◽  
Negative Impacts

ABSTRACT Prophylactic antibiotics are widespread in the aquaculture industry and are used where vaccination is impossible or overly expensive. If antibiotics impact fish as they do mice and humans, prophylactic administrations in aquaculture and ornamental fish farms may increase downstream disease susceptibility in target hosts, despite short-term pathogen control benefits. Recent research has suggested that their use exacerbates bacterial outbreaks by creating sterile, nutrient-rich environments for invading pathogens to colonize and could help to explain rising economic costs of bacterial outbreaks in aquaculture. Our findings suggest a long-term cost of prophylactic antibiotic use and demonstrate a probiotic-based solution that does not rely on full microbiome community transplantation. Prophylactic antibiotics in the aquaculture and ornamental fish industry are intended to prevent the negative impacts of disease outbreaks. Research in mice and humans suggests that antibiotics may disturb microbiome communities and decrease microbiome-mediated disease resistance, also known as “colonization resistance.” If antibiotics impact fish as they do mice and humans, prophylactic administrations on aquaculture farms may increase downstream disease susceptibility in target hosts, despite short-term pathogen control benefits. We tested the effects of antibiotics on mortality after a pathogen challenge in the Poecilia sphenops black molly and subsequently tested if probiotic inoculations could reverse any antibiotic-induced losses of disease resistance. We found that antibiotic treatment significantly increased fish mortality. We further found that our two candidate probiotic bacterial species, Phaeobacter inhibens S4Sm and Bacillus pumilus RI06-95Sm, were able to colonize black molly microbiomes and reverse the negative impacts of antibiotics. Despite the positive impact on survival, probiotic treatment did not influence overall microbiome community structure or diversity. Our results suggest that subtle manipulations of microbiome composition can have dramatic impacts on host phenotype. The results of this study have implications for how antibiotic-treated microbiomes can be restored and suggest that small-scale additions may be as effective as wholesale transplants. IMPORTANCE Prophylactic antibiotics are widespread in the aquaculture industry and are used where vaccination is impossible or overly expensive. If antibiotics impact fish as they do mice and humans, prophylactic administrations in aquaculture and ornamental fish farms may increase downstream disease susceptibility in target hosts, despite short-term pathogen control benefits. Recent research has suggested that their use exacerbates bacterial outbreaks by creating sterile, nutrient-rich environments for invading pathogens to colonize and could help to explain rising economic costs of bacterial outbreaks in aquaculture. Our findings suggest a long-term cost of prophylactic antibiotic use and demonstrate a probiotic-based solution that does not rely on full microbiome community transplantation.

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