The fibroblastic sleeve, the neglected complication of venous access devices: A narrative review

2020 ◽  
pp. 112972982095103
Author(s):  
Giovanna Passaro ◽  
Mauro Pittiruti ◽  
Antonio La Greca
Keyword(s):  
Venous Thrombosis ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
Venous Access ◽  
Narrative Review ◽  
Access Device ◽  
Physiological Phenomenon ◽  
Intravascular Foreign Body ◽  
Vascular Access Device ◽  
Venous Access Devices

The presence of a vascular access device (or of any intravascular foreign body) inside the bloodstream is often associated with the formation of a connective tissue sleeve around the catheter (often named—erroneously—“fibrin sleeve”). Such sleeve is usually a physiological phenomenon with little or no clinical relevance, but its pathogenesis is still unclear, so that it is frequently confused with venous thrombosis; also, its relationship with other major catheter-related complications, such as venous thrombosis and bloodstream infection, is uncertain. This narrative review tries to convey in a systematic form the current knowledge about pathogenesis, incidence, clinical manifestations, diagnosis, and management of this phenomenon.

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.

Late fracture of Groshong ports: A report of the three cases

2019 ◽  
Vol 20 (5) ◽  
pp. 563-566 ◽  
Author(s):  
Fumito Saijo ◽  
Mitsuhisa Mutoh ◽  
Joho Tokumine ◽  
Odaka Yoshinobu ◽  
Hikaru Hama ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Venous Access ◽  
Access Device ◽  
Device Implantation ◽  
Catheter Fracture ◽  
Venous Access Device ◽  
Enhanced Computed Tomography ◽  
Venous Access Devices

Background: Totally implantable venous access devices are valuable tools for total parenteral nutrition, chemotherapy, and long-term intravenous therapy. However, late catheter fracture is a well-known complication of totally implantable venous access device, particularly in Groshong silicone catheter. Recently, a specific type of totally implantable venous access device made with Groshong silicone has been introduced to facilitate power injection of contrast medium for enhanced computed tomography. Cases description: We reported three cases of catheter fracture in power-injectable Groshong silicone totally implantable venous access device. From May 2012 to August 2014, 66 patients underwent power-injectable Groshong silicone totally implantable venous access device implantation at our institution, with a median follow-up of 20.1 (range 0.2–58.1) months. The catheters in all patients were inserted into the internal jugular vein under ultrasound guidance and were connected to the port implanted in the upper chest through the subcutaneous tunnel. Chemotherapy was administered using these routes. Fractures of all three cases specifically showed a torn catheter section: smooth surface on one side, and a rough edge on the other side of the catheter, suggesting that long-term repeated stretch force may be related with the mechanism of fracture. Conclusion: Totally implantable venous access devices with Groshong silicone catheters, if inserted via the internal jugular vein, have a potential risk for late catheter fracture.

scholarly journals Cerebral venous thrombosis: a practical guide

2020 ◽  
Vol 20 (5) ◽  
pp. 356-367 ◽  
Author(s):  
Leonardo Ulivi ◽  
Martina Squitieri ◽  
Hannah Cohen ◽  
Peter Cowley ◽  
David J Werring
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
Stroke Care ◽  
Future Research ◽  
Supporting Evidence ◽  
Permanent Disability ◽  
Decompressive Craniotomy ◽  
Relative Rarity

All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from ‘conventional’ stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research.

Optimizing vascular-access device decision-making in the era of midline catheters

2019 ◽  
Vol 40 (6) ◽  
pp. 674-680 ◽  
Author(s):  
Kelly A. Cawcutt ◽  
Richard J. Hankins ◽  
Teresa A. Micheels ◽  
Mark E. Rupp
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Vascular Access ◽  
Central Venous Catheters ◽  
Narrative Review ◽  
Central Venous ◽  
Access Device ◽  
Vascular Access Device ◽  
Intravenous Catheters

AbstractThis narrative review addresses vascular access device choice from peripheral intravenous catheters through central venous catheters, including the evolving use of midline catheters. The review incorporates best practices, published algorithms, and complications extending beyond CLABSI and phlebitis to assist clinicians in navigating complex vascular access decisions.

Infection of totally implantable venous access devices: A review of the literature

2018 ◽  
Vol 19 (3) ◽  
pp. 230-242 ◽  
Author(s):  
Fulvio Pinelli ◽  
Elena Cecero ◽  
Dario Degl’Innocenti ◽  
Valentina Selmi ◽  
Rosa Giua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Access ◽  
Outpatient Setting ◽  
Intravenous Therapy ◽  
Access Device ◽  
Venous Access Device ◽  
Treatment Of Infection ◽  
Venous Access Devices

Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient’s quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients’ morbidity and mortality—both in the hospital or outpatient setting—and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device–related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device–related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device–related infections.

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.

Type II Heparin-Induced Thrombocytopenia: Toward Developing a Strategy to Determine the Role of Routine Vascular Access Device Heparinization

2004 ◽  
Vol 9 (4) ◽  
pp. 221-225
Author(s):  
Kelli Rosenthal
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Venous Access ◽  
Type Ii ◽  
Heparin Induced Thrombocytopenia ◽  
Access Device ◽  
Clinical Literature ◽  
Vascular Access Device ◽  
Venous Access Device

Abstract Immunologic Heparin-induced Thrombocytopenia (HIT Type II) results from heparin exposure in any form, and can result in major intravascular thrombotic events, ischemia, and death. Type II HIT occurs in approximately 1 to 3% of patients receiving heparin and can occur at any dose or via any route of administration, making it a potentially serious complication of routine central venous access device (CVAD) maintenance with heparin flush locking techniques. A review of the clinical literature reveals largely anecdotal information implicating the role of heparin flush solutions in its development. Further study is needed to more specifically identify the likelihood of developing HIT from vascular access device related causes.

Utilizing a Sedation Decision Aid in Ambulatory Venous Access Device Placement: Effects on Patient Choice, Workup, and Recovery Time

2018 ◽  
Vol 23 (2) ◽  
pp. 79-85
Author(s):  
Melissa D. Chittle ◽  
Erin McIntyre ◽  
Judy Borsody Lotti ◽  
Catherine Saltalamacchia ◽  
Robert M. Sheridan ◽  
...  
Keyword(s):  
Vascular Access ◽  
Recovery Time ◽  
Decision Aid ◽  
Venous Access ◽  
Patient Choice ◽  
Radiology Department ◽  
Moderate Sedation ◽  
Access Device ◽  
Device Placement ◽  
Vascular Access Device

Abstract This study was undertaken to determine the influence of using a sedation decision aid when selecting a sedation option for totally implantable vascular access device placement on patient choice, workup, and recovery time. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of 76 patients (aged 23–89 years, 58% female) presenting to a vascular interventional radiology department between January 2, 2017, and May 5, 2017. Patients were given a decision aid that inquired about personal values and goals, and provided information about expectations; benefits; and risks of the options, including undergoing the procedure with no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine), or moderate sedation (benzodiazepine and opiate). No sedation was selected by 15 out of 76 patients (19.7%), minimal sedation was selected by 26 out of 76 patients (34.2%), and moderate sedation was selected by 34 out of 76 patients (44.7%). Postprocedure recovery time differences were significant (P &lt; .001) with a mean of 17.4 minutes for no sedation, 49.3 minutes for minimal sedation, and 70.8 minutes for moderate sedation. The use of a decision aid did not slow down the process because workup times were not significantly different: 15.9 minutes for no sedation, 22.1 minutes for minimal sedation, and 18.4 minutes for moderate sedation. Patient sedation preference for totally implantable vascular access device is variable, signifying there is a role for utilizing a decision aid because it empowers a patient to select the option most aligned with his or her goals. Influence on departmental flow is notable because this does not slow down the workup and a majority of patients choose no or minimal sedation, resulting in a decreased postprocedure recovery time burden.

The “Arm-to-Chest Tunneling” technique: A modified technique for arm placement of implantable ports or central catheters

2019 ◽  
Vol 20 (6) ◽  
pp. 771-777 ◽  
Author(s):  
Elias Kehagias ◽  
Dimitrios Tsetis
Keyword(s):  
Vascular Access ◽  
Standard Of Care ◽  
Venous Access ◽  
Implantation Technique ◽  
Modified Technique ◽  
Access Device ◽  
Device Placement ◽  
Venous Access Device ◽  
Central Catheters ◽  
Venous Access Devices

Purpose: Central venous catheters or “venous access devices” include totally implantable venous access devices or “ports,” peripherally inserted central catheters, and tunneled lines. Venous access devices are now the standard of care in patients requiring long-term intravenous drug administration. Arm venous access device placement is a valuable option for vascular access yet often complicated or rendered practically impossible by the condition and size of peripheral veins. We describe a modification of the arm venous access device implantation technique that we use in our department in order to offer this option to our patients, regardless of their peripheral veins condition. Methods: After ultrasound guided venous access of a suitable neck vein, we create a port pouch—in case of a totally implantable vascular access device—or a skin nick—in case of a venous access device—in the inner aspect of the mid-arm. Using a straight metal tunneler, we tunnel the line from the neck to the arm in two stages, externalizing and re-inserting the line into a skin nick made on the deltopectoral groove. We call this technique “Arm-to-Chest Tunneling” and use it to place venous access devices in the arm using a neck venous access. Results: The Arm-to-Chest Tunneling technique allows us to use larger arm venous access device catheters irrespective of the arm veins condition. Thus, this technique has the advantages of arm venous access device placement, with the added benefit of saving the arm veins. Conclusion: The “Arm-to-Chest Tunneling” method offers the alternative to place a venous access device in a more discreet site in the arm, even in cases in which arm veins are inadequate.

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