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.

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.

Midline catheters for extracorporeal photopheresis in hematological patients

2021 ◽  
pp. 112972982110414
Author(s):  
Bruno Marche ◽  
Sonia D’Arrigo ◽  
Maria Giuseppina Annetta ◽  
Andrea Musarò ◽  
Alessandro Emoli ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Extracorporeal Photopheresis ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Graft Versus Host ◽  
Single Lumen ◽  
Peripheral Venous Access ◽  
Preliminary Study ◽  
Venous Access Devices

Introduction: Peripheral venous access for extracorporeal photopheresis (ECP) may be difficult in graft versus host disease (GVHD) patients, because of previous intravenous therapies and multiple peripheral cannulations; in this population of patients, ultrasound guided midline catheters may be an alternative option to central venous access. Methods: In this single-center, prospective preliminary study, we enrolled all consecutive patients with a diagnosis of GVHD and candidate to ECP, over a period of 10 months. We used inserted power injectable, non-valved, polyurethane, 20–25 cm single lumen midline catheters (MC). Results: Sixty-nine ECP procedures were carried out in six patients, using single-lumen MCs for outflow (5Fr in 74% and 4Fr in 26% of cases). For inflow, we used 5Fr or 4Fr MCs, or central venous access devices previously placed for other clinical reasons. There were no catheter-related complications during the entire period of ECP treatment. Mean outflow was significantly higher for 5Fr than for 4Fr MCs (35.8 ± 7.3 vs 29.2 ± 7.8 ml/min; p = 0.0008) and the procedure time was significantly shorter (92.9 ± 9.2 vs 108 ± 13.2 min; p < 0.0001). Conclusion: In GVHD patients, ECP can be performed efficiently and safely using single lumen polyurethane power injectable MCs. The best results are obtained with 5Fr rather than with 4Fr catheters. This strategy of venous access should be implemented in DIVA patients requiring ECP treatments, and probably also in other types of apheresis.

Comparison of the Single-Syringe Push-Pull Technique With the Discard Technique for Obtaining Blood Samples From Pediatric Central Venous Access Devices

2017 ◽  
Vol 34 (6) ◽  
pp. 381-386
Author(s):  
Sarah Hess ◽  
Mary Decker
Keyword(s):  
Central Venous Access ◽  
Intraclass Correlation ◽  
Hospital Setting ◽  
Venous Access ◽  
Central Venous ◽  
Blood Samples ◽  
Laboratory Results ◽  
Clinically Significant ◽  
Blood Specimens ◽  
Venous Access Devices

The discard technique is the most widely used method of obtaining blood samples from patients with central venous access devices (CVADs), but risks removing more blood than is necessary for laboratory testing and may increase a patient’s risk of anemia. We hypothesized that laboratory results from pediatric blood specimens obtained via CVAD using the single-syringe push-pull (formerly called the mixing) method and the discard method would be similar. Blood samples were obtained from pediatric oncology patients in a hospital setting using both collection methods and laboratory values were analyzed for concordance using the pairwise t-test, intraclass correlation coefficient, and Bland-Altman analysis methods. Statistical analysis revealed significant differences for sodium, potassium, chloride, bicarbonate, creatinine, calcium, white blood cell count, hemoglobin, hematocrit, and platelet count, but these differences were not clinically significant and within the standard error of measurement for the instrument. Given the similarity in laboratory results, the push-pull method should be considered for obtaining blood samples from CVADs in pediatric patients to avoid unnecessary blood loss.

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 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.

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