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

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.

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Approach to Fragmented Central Venous Catheters

Vascular ◽

10.1258/rsmvasc.13.2.120 ◽

2005 ◽

Vol 13 (2) ◽

pp. 120-123 ◽

Cited By ~ 13

Author(s):

Bedrettin Yıldızeli ◽

Tunç Laçin ◽

Feyyaz Baltacıoğlu ◽

Hasan F. Batırel ◽

Mustafa Yüksel

Keyword(s):

Subclavian Vein ◽

Central Venous Access ◽

Venous Access ◽

Central Venous Catheters ◽

Central Venous ◽

Radiologic Evaluation ◽

Catheter Malfunction ◽

Venous Access Devices ◽

Gooseneck Snare ◽

Rule Out

Prolonged venous access devices are needed in cancer patients for central venous access. Catheter fragmentation leading to catheter malfunction represents a rare problem. Herein we present our experience in the management of fragmented catheters. Between 2001 and 2003, 183 catheters were placed via the subclavian vein, and five cases of fragmented catheters were observed. Fragments were removed by an Amplatz gooseneck snare (Microvena, St. Paul, MN) with angiographic intervention. The diagnosis of the breakage was made by chest radiography. The incidence of catheter rupture was 2.7%. All fragments were removed by the snare, without any complications. Catheter narrowing and breakage owing to its medial positioning in the subclavian vein were the main causes of catheter malfunction. In any case of catheter malfunction, radiologic evaluation of the catheter must be done to rule out its rupture. Removal of the fragments using the Amplatz snare is a safe and easily applied procedure.

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288 CF patients with totally implantable venous access devices (TIVAD): prospective survey of Doppler-US (DUS) central venous thrombosis (CVT) and thrombophilia (TB) assessment

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(12)60456-1 ◽

2012 ◽

Vol 11 ◽

pp. S130

Author(s):

A. Munck ◽

A. Kheniche ◽

C. Alberti ◽

D. Hubert ◽

M. Reynaud-Gaubert ◽

...

Keyword(s):

Venous Thrombosis ◽

Venous Access ◽

Central Venous ◽

Prospective Survey ◽

Doppler Us ◽

Central Venous Thrombosis ◽

Venous Access Devices

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

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650254 ◽

1996 ◽

Vol 75 (02) ◽

pp. 251-253 ◽

Cited By ~ 264

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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Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180817125036 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-49

Author(s):

Basant K. Puri ◽

Anne Derham ◽

Jean A. Monro

Keyword(s):

Bloodstream Infection ◽

Antibiotic Treatment ◽

Central Venous Access ◽

Case Series ◽

Bloodstream Infections ◽

Venous Access ◽

Host Cells ◽

Central Venous ◽

Intravenous Antibiotic ◽

Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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A Psychometric Validation of the Decisional Conflict Scale in Italian Cancer Patients Scheduled for Insertion of Central Venous Access Devices

Anticancer Research ◽

10.21873/anticanres.14571 ◽

2020 ◽

Vol 40 (10) ◽

pp. 5583-5592

Author(s):

MARIA ROSARIA ESPOSITO ◽

ASSUNTA GUILLARI ◽

FRANCESCO GIANCAMILLI ◽

TERESA REA ◽

MICHELA PIREDDA ◽

...

Keyword(s):

Cancer Patients ◽

Central Venous Access ◽

Venous Access ◽

Decisional Conflict ◽

Psychometric Validation ◽

Central Venous ◽

Decisional Conflict Scale ◽

Venous Access Devices ◽

Conflict Scale

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Use of catheter with 2-methacryloyloxyethyl phosphorylcholine polymer coating is associated with long-term availability of central venous port

Scientific Reports ◽

10.1038/s41598-021-84885-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuuki Iida ◽

Kumiko Hongo ◽

Takanobu Onoda ◽

Yusuke Kita ◽

Yukio Ishihara ◽

...

Keyword(s):

Odds Ratio ◽

Polymer Coating ◽

Venous Access ◽

Preventive Effect ◽

Central Venous ◽

Factors Associated ◽

Central Venous Port ◽

Venous Port ◽

Venous Access Device

AbstractCentral venous port (CVP) is a widely used totally implantable venous access device. Recognition of risks associated with CVP-related complications is clinically important for safe, reliable, and long-term intravenous access. We therefore investigated factors associated with CVP infection and evulsion, including the device type. A total of 308 consecutive patients with initial CVP implantation between January 2011 and December 2017 were retrospectively reviewed, and the association of clinical features with CVP-related complications were analyzed. Intraoperative and postoperative complications occurred in 11 (3.6%) and 39 (12.7%) patients, respectively. The overall rate of CVP availability at six months was 91.4%. Malignancy and 2-Methacryloyloxyethyl phosphorylcholine (MPC) polymer-coated catheter use were negatively associated with the incidence of CVP infections. Accordingly, malignancy and MPC polymer-coated catheter use were independent predictors for lower CVP evulsion rate (odds ratio, 0.23 and 0.18, respectively). Furthermore, both factors were significantly associated with longer CVP availability (hazard ratio, 0.24 and 0.27, respectively). This retrospective study identified factors associated with CVP-related complications and long-term CVP availability. Notably, MPC polymer-coated catheter use was significantly associated with a lower rate of CVP infection and longer CVP availability, suggesting the preventive effect of MPC coating on CVP infection.

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