Hemodialysis Reliable Outflow (HeRO) graft creation in upper extremities abandoned due to stent obstruction via recanalization and HeRO outflow component insertion across stent interstices

2021 ◽  
pp. 112972982110480
Author(s):  
Brendan C Cline ◽  
Adam Zuchowski ◽  
Shawn M Gage ◽  
Jonathan G Martin ◽  
James Ronald ◽  
...  
Keyword(s):  
Venous Catheter ◽  
Graft Patency ◽  
Upper Extremities ◽  
Success Rates ◽  
Technical Success ◽  
Central Venous ◽  
Kaplan Meier ◽  
Venous Recanalization ◽  
Brachiocephalic Veins ◽  
Graft Implantation

Background: The purpose of this study was to assess the feasibility and outcomes of recanalization and subsequent HeRO graft outflow component insertion across stent interstices in patients with an otherwise abandoned upper extremity. Methods: Over a 10-year period, 15 patients underwent central venous recanalization by interventional radiology across the interstices of one or more occluded stents for the purpose of subsequent HeRO graft creation. A tunneled central venous catheter was left across the stent and occlusions with tip in right atrium. On a later date, the catheter was used for rapid guidewire access for HeRO graft implantation in the OR by vascular surgery. Procedural and clinical outcomes were determined by retrospective review. Primary and secondary HeRO graft patency rates were estimated with the Kaplan-Meier technique. Results: The technical success rates of recanalization across stent interstices was 100% (15/15). Between one and four overlapping stent walls were traversed. The technical success of the patients who underwent attempted HeRO graft implantation with outflow component traversing across stent interstices was 91% (11/12). No major complications were encountered with either recanalization or HeRO graft implantation. The primary and secondary HeRO patency rates at 12 months were 64% and 80%, respectively. Conclusion: HeRO graft insertion across stent interstices is feasible and can provide effective permanent AV access; thus, the presence of stents across the subclavian and brachiocephalic veins should not be considered a contraindication.

Peripherally Inserted Central Venous Catheter in Upper Extremities Could be a Risk for Deep Vein Thrombosis in Lower Extremities and D-Dimer in Neurology Department

2020 ◽  
Author(s):  
Wanli Liu ◽  
Lianxiang He ◽  
Wenjing Zeng ◽  
Liqing Yue ◽  
Jie Wei ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Predictive Value ◽  
Color Doppler ◽  
Venous Catheter ◽  
Upper Extremities ◽  
Central Venous ◽  
Related Factors ◽  
D Dimer

Abstract Background: With the in-depth study of Peripherally Inserted Central venous Catheter (PICC) related venous thrombosis, it is found that the incidence of lower extremity deep venous thrombosis (LEDVT) in patients with PICC in upper extremities is higher than that in patients without PICC . However, there is no explanation for this clinical phenomenon that PICC related venous thrombosis seems to have exceeded the range of PICC travel . The purpose of this study is to elucidate this association between PICC in upper extremities and LEDVT by observing the changes of D-dimer . Methods: This was a retrospective cohort study of adults in Neurology department who underwent Color Doppler ultrasound and D-dimer test between 1 April 2017 to 1 April 2020. We analyzed the related factors of LEDVT and the change of D-dimer value, compared the changes of D-dimer before and after PICC insertion, and evaluated the predictive value of D-dimer in patients with and without PICC. Results: ① It was found that the presence of PICC increased the risk of lower extremity venous thrombosis by 7 times (OR = 7.048 [95% CI: 4.486-11.074]; ②It was found that the presence of PICC promoted the increase of D-dimer value (OR = 5.133 [95% CI: 3.072-8.575]). ③ For patients without LEDVT, the level of D-dimer in patients with PICC was higher than that in patients without PICC (P < 0.05). ④ The level of D-dimer after PICC insertion was significantly higher than that before PICC insertion(P < 0.05). ⑤ In patients with PICC, the AUC value of D-dimer in the diagnosis of LEDVT was 0.657 (95% CI: 0.549-0.765), and the negative predictive value was 82.35%.Conclusion:PICC insertion may increase the level of D-dimer and become an important risk factor of LEDVT; For patients with PICC , D-dimer value is not suitable to rule out LEDVT.

Use of Ultrasound Guidance Improves Central Venous Catheter Insertion Success Rates Among Junior Residents

2012 ◽  
Vol 31 (10) ◽  
pp. 1519-1526 ◽  
Author(s):  
Kelly L. Dodge ◽  
Catherine A. Lynch ◽  
Christopher L. Moore ◽  
Brian J. Biroscak ◽  
Leigh V. Evans
Keyword(s):  
Central Venous Catheter ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Success Rates ◽  
Central Venous ◽  
Junior Residents

scholarly journals The Effect of Esmolol on Tissue Perfusion and Clinical Prognosis of Patients with Severe Sepsis: A Prospective Cohort Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Xiuling Shang ◽  
Kaiyu Wang ◽  
Jingqing Xu ◽  
Shurong Gong ◽  
Yong Ye ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Treatment Time ◽  
Venous Catheter ◽  
Tissue Perfusion ◽  
Control Group ◽  
Target Level ◽  
Central Venous ◽  
Clinical Prognosis ◽  
Kaplan Meier

Purpose. This study was aimed at investigating the effect of esmolol on tissue perfusion and the clinical prognosis of patients with severe sepsis.Materials and Methods. One hundred fifty-one patients with severe sepsis were selected and divided into the esmolol group (n=75) or the control group (n=76), who received conventional antiseptic shock treatment. The esmolol group received a continuous infusion of esmolol via a central venous catheter, and their heart rate (HR) was maintained at 70–100 bpm over 72 hours.Results. The HR of all patients reached the target level within 72 hours of treatment for both groups. The effect of esmolol on PvaCO2was only significant at 48 hours (P<0.05). ScvO2increased in the esmolol group and decreased in the control group (P<0.01). Lac showed a linear downward trend over the treatment time, but the reduction was more significant in the control group at 48 hours (P<0.05) between the two groups. Kaplan-Meier analysis showed a significantly shorter duration of mechanical ventilation in the esmolol group than in the control group (P<0.05).Conclusions. Esmolol reduced the duration of mechanical ventilation in patients with severe sepsis, with no significant effect on circulatory function or tissue perfusion.

scholarly journals HeRO (Hemodialysis Reliable Outflow) graft alkalmazása tartós hemodialíziskezelés során

2019 ◽  
Vol 160 (31) ◽  
pp. 1231-1234
Author(s):  
Péter Legeza ◽  
Dávid Garbaisz ◽  
Zoltán Szeberin ◽  
Péter Sótonyi
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Good Alternative ◽  
Venous Occlusion ◽  
Medical Documentation ◽  
Central Venous ◽  
Venous Grafts ◽  
Central Venous Occlusion ◽  
Graft Implantation ◽  
Outflow Graft

Abstract: Creating durable vascular access has become more complicated with the improvement of the management and with the increasing survival of patients with end-stage renal disease. HeRO (Hemodialysis Reliable Outflow) graft allows to maintain vascular access on the upper limb in patients with the presence of bilateral central venous occlusion. Our institute was the first in Hungary to perform a HeRO graft implantation in a patient receiving regular hemodialysis. Our objective was to present our findings with this recent innovation. Case report, medical documentation and imaging studies were reviewed. The patient (73-year-old, female) has been receiving hemodialysis since 12 years with the history of several arteriovenous fistula (AVF) creations, thrombectomies, use of central venous catheter in both sides. Following the occlusion of a left cubital arterio-venous fistula, none of the conventional vascular access types could have been performed due to bilateral subclavian vein occlusion. Successful HeRO graft implantation was performed. The patient underwent graft thrombectomy and endovascular intervention 7 and 12 months after the original procedure. After both reoperations, the graft functioned well for hemodialysis. HeRO graft can be a good alternative to central venous catheters and lower limb arterio-venous grafts in cases of bilateral central venous occlusion. Orv Hetil. 2019; 160(31): 1231–1234.

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

Vascular ◽  
2017 ◽  
Vol 26 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Robert Shahverdyan ◽  
Spyridon Mylonas ◽  
Michael Gawenda ◽  
Jan Brunkwall
Keyword(s):  
Graft Patency ◽  
Type I ◽  
Cerebrovascular Event ◽  
Technical Success ◽  
Descending Aorta ◽  
Kaplan Meier ◽  
Type Ia ◽  
Hybrid Repair ◽  
Vessel Patency ◽  
Chimney Graft

Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0–56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan–Meier curve, the estimated survival at one year was 66 ± 9%. Conclusions The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.

scholarly journals Early complications of ultrasound guided central vein catheterization in children

2018 ◽  
Vol 5 (6) ◽  
pp. 2018
Author(s):  
Mehmet Surhan Arda
Keyword(s):  
Great Influence ◽  
Venous Catheter ◽  
Central Line ◽  
Central Vein ◽  
Success Rates ◽  
Early Complications ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Lower Complication ◽  
Vein Catheterization

Background: Since mid-20th century Central Venous Catheter (CVC) has been in use. Cut-down was the initial approach that was followed by Seldinger method. Thereafter, anatomic land-mark has been recommended and finally it was switched to ultrasound (USG) guidance. In adults the lower complication and higher success rates of USG guided catheterization has been reported. However, in children, although it was accepted that USG guidance lowers puncture rates, increased success and decreased complication by USG was controversial.  Methods: Between 01/07/2014 and 31/12/2017 records of patients that were younger than five years old and that were undergone USG guided CVC placing have been extracted. The early complications due to catheterization was evaluated.Results: A total 259 patients met our criteria. All of them have placed catheter successfully whereas mean puncture rate was 1.32. The 18.9% of them necessitated repetitive procedures of whom 44.9% (n= 22) of them have been catheterized from the previous central line. Thrombosis was detected in only 2.7% (n= 7) of them. Arterial puncture was noticed in four.Conclusions: USG guided central vein catheterization is safe and reliable with lower complication. It could be speculated that lower puncture rates might have great influence on patency of vessels.

scholarly journals Management of Enterococcal Catheter-associated Bloodstream Infections in Patients with Cancer

2021 ◽  
Author(s):  
Hesham Awadh ◽  
Anne-Marie Chaftari ◽  
Melissa Khalil ◽  
Johnny Fares ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Venous Catheter ◽  
Catheter Removal ◽  
Mucosal Barrier ◽  
Successful Outcome ◽  
Success Rates ◽  
Central Venous ◽  
Group 3 ◽  
Group 2 ◽  
The Impact

Abstract Objective Enterococcus species are the third most common organisms causing central line-associated bloodstream infections (CLABSIs). The management of enterococcal CLABSI, including the need for and timing of catheter removal, is not well defined. We therefore conducted this study to determine the optimal management of enterococcal CLABSI in cancer patients. Methods We reviewed data for 542 patients diagnosed with Enterococcus bacteremia between September 2011 to December 2018. After excluding patients without an indwelling central venous catheter, we classified the remaining 397 patients into 3 groups: Group 1 consisted of patients with CLABSI with mucosal barrier injury (MBI), Group 2 included patients with either CRBSI or CLABSI without MBI, and Group 3 consisted of patients who did not meet the CDC criteria for CLABSI. The impact of early (< 3 days after bacteremia onset and late (3–7 days) catheter removal was compared. The composite primary outcome included absence of microbiologic recurrence, 90-day infection-related mortality, and 90-day infection-related complications. Results Among patients in Group 2, those whose catheters were removed within 3 days of bacteremia onset was associated a better overall outcome than those whose catheters were removed later between days 3 to 7 (success rate 88% vs 63%). However, those who had catheters retained beyond 7 days had a similar successful outcome than those who had early catheter removal. Early CVC removal in in non-CLABSI cases (group-3) was not associated with higher success rates. Conclusion If removal of central venous catheters is clinically indicated in patients with enterococcal CLABSI earlier removal in less than 3 days may be associated with better outcomes.

scholarly journals Association of Immediate Reinsertion of New Catheters With Subsequent Mortality Among Patients With Suspected Catheter Infection: a Cohort Study

2021 ◽  
Author(s):  
Yiyue Zhong ◽  
Liehua Deng ◽  
Limin Zhou ◽  
Shaoling Liao ◽  
Liqun Yue ◽  
...  
Keyword(s):  
Propensity Score ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Cox Proportional Hazards ◽  
University Hospital ◽  
Matched Cohort ◽  
Central Venous ◽  
Kaplan Meier ◽  
Increased Risk

Abstract BackgroundCentral venous catheter (CVC) insertion complications are a prevalent and significant problem in the intensive care unit (ICU), but optimal strategy for management in patients with suspected catheter-related bloodstream infection (CRBSI) remains unclear. We sought to determine the effect of immediate reinsertion of new catheter (IRINC) on 30-day mortality among patients after central venous catheter (CVC) removal for suspected CRBSI.MethodsWe conducted a propensity-score-matched cohort of suspected CRBSI who underwent IRINC or not in a 32-bed ICU of university hospital in China during the period from January 2009 through April 2021. We used the results of catheter tip culture to identify patients with suspected CRBSI by index for institutional electronic laboratory databases. The inclusion criteria were age ≥ 18 years, CVC and suspected CRBSI. The exclusion criteria were dialysis catheters, peripheral catheterization, length of stay less than 48 hours, and patients with no access to medical records. Kaplan-Meier method was used to analyze 30-day mortality before and after propensity-score-matching, and adjusted hazard ratio (HR) and 95% confidence interval (CI) for mortality in matched cohort were estimated with Cox proportional hazards models.ResultsIn total, 1238 patients with CVC removal due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. In 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan-Meier analysis found that IRINC showed a similar risk of mortality before matching (P=0.00096) and after matching (P=0.018). The competing risks analysis confirmed the results of the propensity score-matched analysis. The attributable risk for bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) but that for pneumonia was significantly different (HR, 1.128; 95% CI 1.031 to 1.233) in patients with suspected CRBSI in terms of 30-day mortality.ConclusionsIRINC during suspected CRBSI was associated with an increased 30-day mortality risk. These data suggest that it is necessary to focus more on other insertion-related complications along with preventing CRBSI in critically ill patients.Trial RegistrationThis study was registered with the China Clinical Trials Registry (ChiCTR1900022175), URL: http://www.chictr.org.cn/index.aspx.

scholarly journals Performing central venous catheters in neonates and small infants undergoing cardiac surgery using a wireless transducer for ultrasound guidance: a prospective, observational pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Judith Schiefer ◽  
Paul Lichtenegger ◽  
Daniel Zimpfer ◽  
Doris Hutschala ◽  
Lorenz Kuessel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Venous Catheter ◽  
Needle Insertion ◽  
Catheter Insertion ◽  
Success Rates ◽  
Central Venous ◽  
Clear Trend ◽  
Congenital Cardiac Disease ◽  
Survey Results ◽  
Cannulation Success

Abstract Background Neonates and small infants with congenital cardiac disease undergoing cardiac surgery represent major challenges facing paediatric anaesthesia and perioperative medicine. Aims. We here aimed to investigate the success rates in performing ultrasound (US) guided central venous catheter insertion (CVC) in neonates and small infants undergoing cardiac surgery, and to evaluate the practicability and feasibility of thereby using a novel wireless US transducer (WUST). Methods Thirty neonates and small infants with a maximum body weight of 10 kg and need for CVC before cardiac surgery were included in this observational trial and were subdivided into two groups according to their weight: < 5 kg and ≥ 5 kg. Cannulation success, failure rate, essential procedure related time periods, and complications were recorded and the clinical utility of the WUST was assessed by a 5-point Likert scale. Results In total, CVC-insertion was successful in 27 (90%) of the patients and the first attempt was successful in 24 (78%) of patients. Success rates of CVC were 80% < 5 kg and 100% ≥5 kg. Comparing the two groups we found a clear trend towards longer needle insertion time in patients weighing < 5 kg (33 [28–69] vs. 24 [15–37]s, P = .07), whereas, the total time for catheter insertion and the duration of the whole procedure were similar in both groups (199 [167–228] vs. 178 [138–234] and 720[538–818] vs. 660 [562–833]s. In total, we report 3 (10%) cases of local hematoma as procedure-related complications. Assessments of the WUST revealed very good survey results for all parameters of practicability and handling (all ratings between 4.5 and 5.0). Conclusion Although difficulties in CVC-placement seem to relate to vessel size and patient’s weight, US guided CVC-insertion represents a valuable, fast, and safe intervention in neonates and small children undergoing cardiac surgery. Using the WUST is feasible for this clinical application and may aid in efforts aiming to optimize perioperative care. Trial registration Wireless US-guided CVC placement in infants; Clinicaltrials.gov: NCT04597021; Date of Registration: 21October, 2020; retrospectively registered.

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