scholarly journals The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

2021 ◽  
pp. 112972982110414
Author(s):  
Fabrizio Brescia ◽  
Mauro Pittiruti ◽  
Matthew Ostroff ◽  
Timothy R Spencer ◽  
Robert B Dawson
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Late Complications ◽  
Exit Site ◽  
Central Venous ◽  
Standardized Protocol ◽  
Tip Position ◽  
Correct Application ◽  
Ultrasound Guided Puncture ◽  
Central Catheters

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.

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 The SIC protocol: A seven-step strategy to minimize complications potentially related to the insertion of centrally inserted central catheters

2021 ◽  
pp. 112972982110360
Author(s):  
Fabrizio Brescia ◽  
Mauro Pittiruti ◽  
Matthew Ostroff ◽  
Timothy R Spencer ◽  
Robert B Dawson
Keyword(s):  
Central Venous Catheters ◽  
Immediate Early ◽  
Thoracic Region ◽  
Exit Site ◽  
Central Venous ◽  
Standardized Protocol ◽  
Adequate Coverage ◽  
Tip Position ◽  
Central Catheters ◽  
Late Insertion

Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.I.C.: Safe Insertion of Centrally Inserted Central Catheters) for the systematic application of seven basic beneficial strategies to be adopted during insertion of central venous catheters in the cervico-thoracic region, aiming to minimize immediate, early, or late insertion-related complications. These strategies include: preprocedural evaluation, appropriate aseptic technique, ultrasound guided insertion, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and adequate coverage of the exit site.

Tip Position of Long-Term Central Venous Access Devices Used for Parenteral Nutrition

2007 ◽  
Vol 31 (5) ◽  
pp. 382-387 ◽  
Author(s):  
Robert DeChicco ◽  
Douglas L. Seidner ◽  
Carlos Brun ◽  
Ezra Steiger ◽  
Judy Stafford ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Tip Position ◽  
Venous Access Devices

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.

Sharp Recanalization of a Chronically Occluded Superior Vena Cava in a Patient with Multiple Prior Peripherally Inserted Central Catheters

2019 ◽  
Vol 24 (2) ◽  
pp. 21-26
Author(s):  
Omar Shwaiki ◽  
Sarah Khoncarly ◽  
James J. Buchino ◽  
Janice McDaniel
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Collateral Flow ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Sharp Recanalization ◽  
Central Catheters

Highlights Recurrent central venous access can lead to central venous occlusions. Collateral flow can be used adventitiously for PICC tip placement. Sharp recanalization can be used to reconstitute patency of an occluded SVC.

Cavoatrial Junction and Central Venous Anatomy: Implications for Central Venous Access Tip Position

2008 ◽  
Vol 19 (3) ◽  
pp. 359-365 ◽  
Author(s):  
Kevin M. Baskin ◽  
Rafael M. Jimenez ◽  
Anne Marie Cahill ◽  
Abass F. Jawad ◽  
Richard B. Towbin
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Venous Anatomy ◽  
Central Venous ◽  
Tip Position

The intracavitary electrocardiography method for tip location of jugular internal vein access device in infants of less than 5 kg: A pilot study

2018 ◽  
Vol 19 (6) ◽  
pp. 639-643 ◽  
Author(s):  
Rossella Mastroianni ◽  
Antonella Capasso ◽  
Gaetano Ausanio
Keyword(s):  
Neonatal Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
P Wave ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Access Device ◽  
Vein Access ◽  
Tip Position ◽  
Venous Access Device

Purpose: This is a prospective observational study conducted by neonatologists in neonatal intensive care unit from Sant’Anna and San Sebastiano Hospital, Caserta, Italy. The objective of the study is to verify the feasibility of intracavitary electrocardiography method for tip location of central venous access device in infants of less than 5 kg and evaluate the accuracy of the method in comparison with post-procedural echocardiographical verification of the tip position. Patients and methods: We enrolled 27 patients weighted between 0.660 and 5 kg, requiring central vascular access. Ultrasound-guided jugular internal vein access was used and after cannulation, we applied the intracavitary electrocardiography for tip location as well as post-procedural echocardiography. Results: No significant complication related to intracavitary electrocardiography occurred in the studied infants. The increase in P wave on intracavitary electrocardiography was detected in all cases (27/27). In only one case (false positive), the catheter had the tip out of cavoatrial junction–target zone (to post-procedural echocardiography). Conclusion: The intracavitary electrocardiography method for tip location of central venous access device is safe and accurate in infants, as demonstrated by post-procedural comparative echocardiographic controls. As an alternative to echocardiography, not always achievable, the diffusion of intracavitary electrocardiography method could reduce X-ray exposition and complications of a malpositioned tip.

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