scholarly journals Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates

2021 ◽  
pp. 112972982110077
Author(s):  
Giovanni Barone ◽  
Mauro Pittiruti ◽  
Daniele G Biasucci ◽  
Daniele Elisei ◽  
Emanuele Iacobone ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Promising Tool ◽  
Device Placement ◽  
The Cost ◽  
Central Catheters ◽  
Venous Access Devices ◽  
Neonatal Population

Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence.

scholarly journals Peripherally Inserted Central Catheters in Pediatric Patients Performed by Radiologists Using Fluoroscopy

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Amanda Shane ◽  
Zahra Premji
Keyword(s):  
Ultrasound Guidance ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Central Venous Access ◽  
Pediatric Intensive Care ◽  
Venous Access ◽  
Central Catheter ◽  
Central Venous ◽  
Central Catheters ◽  
Venous Access Devices

Evidence from 2 clinical studies showed that there was no difference in the rates of infection and complications between peripherally inserted central catheter (PICC) insertion at the bedside and insertion in Interventional Radiology (IR) suites. However, each of these studies focused on small subgroups of the larger pediatric population and had other methodological limitations. Evidence from 1 clinical study in a single quaternary, non-cardiac, pediatric intensive care unit suggested that the median time from PICC line order to successful insertion was longer for lines placed in the IR compared to at the bedside. Two guidelines were identified that recommend ultrasound guidance for insertion of central venous access devices (CVAD), including PICCs: 1 was aimed at all pediatric patients and 1 was aimed at onco-hematological pediatric patients who had numerous quality limitations.

In defense of the use of peripherally inserted central catheters in pediatric patients

2020 ◽  
pp. 112972982093641
Author(s):  
Alessandro Crocoli ◽  
Simone Cesaro ◽  
Monica Cellini ◽  
Francesca Rossetti ◽  
Luca Sidro ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Late Complications ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Peripherally Inserted Central Catheters ◽  
Non Invasive ◽  
Venous Access Device ◽  
Central Catheters ◽  
Venous Access Devices

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

scholarly journals Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Aya Amer ◽  
Roland S. Broadbent ◽  
Liza Edmonds ◽  
Benjamin J. Wheeler
Keyword(s):  
Literature Review ◽  
Neonatal Intensive Care ◽  
Case Reports ◽  
Central Venous Access ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous ◽  
Catheter Position ◽  
Catheter Migration ◽  
Neonatal Population

Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

scholarly journals Epicutaneo-caval catheters in neonates: New insights and new suggestions from the recent literature

2019 ◽  
Vol 21 (6) ◽  
pp. 805-809 ◽  
Author(s):  
Giovanni Barone ◽  
Mauro Pittiruti
Keyword(s):  
Neonatal Intensive Care ◽  
Recent Literature ◽  
Central Venous Access ◽  
Daily Practice ◽  
Venous Access ◽  
Neonatal Intensive Care Units ◽  
Evidence Based ◽  
Central Venous ◽  
Vascular Access Devices ◽  
Venous Access Devices

Epicutaneo-caval catheters have been widely used in neonatal intensive care units since Shaw has described them in 1973. These central venous access devices are usually placed at bedside and they have the purpose of delivering parenteral nutrition and/or drugs that are not compatible with the peripheral route. Even though in the last decade there was a fast advancement in the world of vascular access devices, such changes have only marginally affected the field of neonatal venous access. The aim of this editorial is to give 10 recommendations that correspond to 10 novelties in the field of epicutaneo-caval catheter: some are already evidence-based and should be introduced in our daily practice now, while others are particularly interesting and deserve further clinical studies.

An observational study of the securement of central venous access devices with a subcutaneous anchor device in a paediatric population at a tertiary level hospital

2020 ◽  
Vol 21 (6) ◽  
pp. 959-962
Author(s):  
Kathryn Marie Fitzsimons ◽  
Joseph Speekman ◽  
Temora Senior ◽  
Kerrie Curtis ◽  
Alex Cochrane-Davis ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Population Data ◽  
Paediatric Population ◽  
Venous Access ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Venous Access Device ◽  
Level Hospital ◽  
Central Catheters ◽  
Venous Access Devices

Paediatric central venous access devices are associated with significant complications. Failure rates have been estimated to be as high as 25%, with securement failure a significant contributing factor. In this study, we evaluate the use of a subcutaneous securement device, securAcathTM, in minimising rates of central venous access device dislodgement and unintended early removal within a paediatric population. Data were collected on 52 consecutive paediatric patients, aged less than 18 years old, who required peripherally inserted central catheters and non-cuffed tunnelled centrally inserted central catheters. We found that the rate of securement failure with securAcathTM was 2.01 per 1000 catheter days. This compared to 2.58 in our previous practice without securAcathTM. With the use of securAcathTM, no securement failures were observed in our patients with non-cuffed tunnelled centrally inserted central catheters. There were three instances of securement failure in patients with peripherally inserted central catheters. We conclude that the use of a securAcathTM fixation device in central venous access devices is an effective method of securement, especially in use with non-cuffed tunneled centrally inserted central catheters. However, when significant tension is applied to the central venous access devices migration is still possible.

Evaluation of Alteplase 1 mg for the Restoration of Occluded Central Venous Access Devices in a Tertiary Care Hospital

2018 ◽  
Vol 23 (1) ◽  
pp. 51-55
Author(s):  
Nellie Jafari ◽  
Edward Seidl ◽  
Karly Dancsecs
Keyword(s):  
Central Venous Access ◽  
Tertiary Care ◽  
Cost Savings ◽  
Recombinant Tissue Plasminogen Activator ◽  
Venous Access ◽  
Time Frame ◽  
Care Hospital ◽  
Central Venous ◽  
The Cost ◽  
Venous Access Devices

Abstract Background: Alteplase is a recombinant tissue plasminogen activator that is approved for the treatment of occluded central venous access devices (CVADs) and is commercially available as a 2 mg/2 mL dose. Due to the increasing price of 2 mg/2 mL alteplase vials, our institution switched to using a 1 mg/1 mL dose for certain CVADs. The purpose of this study was to evaluate the use, effectiveness, and cost of a maximum of 2 doses of 1 mg/1 mL alteplase for the restoration of an occluded catheter. Methods: A report was generated to identify patients who were administered 1 mg alteplase during the period May 2016 through July 2016. A chart review was performed on each patient identified to collect the data needed, such as documentation of a dysfunctional lumen and documentation of patency after alteplase 1 mg was given. To determine the cost of waste, expired 1-mg syringes returned to the pharmacy were collected. Results: In total, there were 524 1-mg alteplase doses administered during the 3-month time frame. The effectiveness after the first and second dose was 88% and 80%, respectively. Thirty-four doses were wasted, resulting in a cost of around $2,200. It is estimated that the 1-mg syringes provided the institution with $136,000 in annualized savings. Conclusions: It is beneficial to use 1 mg alteplase for occluded CVADs. The cost of waste is nominal compared with the cost savings for the institution. The next step is to analyze other doses of alteplase to find additional areas of cost savings.

scholarly journals ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

2021 ◽  
pp. 112972982110443
Author(s):  
Antonio La Greca ◽  
Emanuele Iacobone ◽  
Daniele Elisei ◽  
Daniele Guerino Biasucci ◽  
Vito D’Andrea ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Central Venous Access ◽  
Venous Access ◽  
Adult Patients ◽  
Central Venous ◽  
Promising Tool ◽  
Standardized Protocol ◽  
Venous Catheterization ◽  
Procedural Evaluation ◽  
Venous Access Devices

Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice.

scholarly journals ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients

2021 ◽  
pp. 112972982110313
Author(s):  
Geremia Zito Marinosci ◽  
Daniele Guerino Biasucci ◽  
Giovanni Barone ◽  
Vito D’Andrea ◽  
Daniele Elisei ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Bedside Ultrasound ◽  
Pediatric Care ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Blood Samples ◽  
Promising Tool ◽  
Venous Access Devices

Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

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