Inferior vena cava implant of permanent central venous access devices

Occlusion of traditional sites for central venous cannulation is a challenging problem in patients that require a permanent central venous line for chronic administration of nutrients or drugs. In rare cases, extensive central venous thrombosis of the superior and inferior vena cava may preclude catheterization, and uncommon routes should be used. We describe our approach for placement of chronic central venous lines in two pediatric patients with short bowel syndrome and extensive caval occlusion.

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Transhepatic Snare Placement for Translumbar Inferior Vena Cava Access

10.1093/med/9780199986071.003.0044 ◽

2018 ◽

Author(s):

Mikin V. Patel ◽

Steven Zangan

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Catheter ◽

Catheter Placement ◽

Direct Access ◽

Hepatic Veins ◽

Central Venous ◽

Direct Puncture

In patients requiring long-term chemotherapy, antibiotics, hemodialysis, or parenteral nutrition, central venous access is usually possible via catheter placement in the jugular, subclavian, or femoral veins. As these routes become complicated by thrombosis, stenosis, infection, or surgical intervention, the options for central venous catheter placement become limited, and direct puncture of the inferior vena cava (IVC) may be required. This chapter reviews the technique for placement of a catheter in the IVC via translumbar approach. Because direct access using anatomic landmarks can be challenging, initial puncture of the hepatic veins can be used to guide placement of an IVC catheter.

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Deep vein thromboses induced by central venous access devices

VASA ◽

10.1024/0301-1526.28.2.71 ◽

1999 ◽

Vol 28 (2) ◽

pp. 71-78 ◽

Cited By ~ 8

Author(s):

Lersch ◽

Paschalidis ◽

Theiss

Keyword(s):

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Central Venous ◽

Zentralvenöser Katheter ◽

Onkologische Patienten ◽

Vena Cava Superior ◽

Deep Vein ◽

Venous Access Devices ◽

Deep Vein Thromboses

Häufigste Komplikationen zentralvenöser Katheter und Ports sind neben Infektionen Thrombosen. Ihre Häufigkeit hängt von der Art der verwendeten Katheter oder Portsysteme, dem Herstellungsmaterial, dem Durchmesser und der Lage ab. Hickman- und zentralvenöse Portkatheter aus Silikon mit einem oder maximal zwei Lumina, deren Spitze in der unteren Hälfte der Vena cava superior oder im rechten Vorhof liegen, sind mit den geringsten Thromboseraten verbunden. Neben einer vor Implantation von Ports gegebenen Antibiotikaprophylaxe ist auch eine Heparinprophylaxe über mindestens 90 Tage vor allem für onkologische Patienten mit hohem Thromboserisiko zu empfehlen. Bei thromboseassoziertem Verschluß von Kathetern kann eine Fibrinolyse mit Urokinase oder Streptokinase zur Erhaltung des venösen Zugangs sinnvoll sein. Im übrigen folgt die Therapie den üblichen Richtlinien für Thrombosen der oberen Körperhälfte.

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Ultrasound-guided cannulation of the superficial femoral vein for central venous access

The Journal of Vascular Access ◽

10.1177/11297298211003745 ◽

2021 ◽

pp. 112972982110037

Author(s):

Maria Giuseppina Annetta ◽

Bruno Marche ◽

Laura Dolcetti ◽

Cristina Taraschi ◽

Antonio La Greca ◽

...

Keyword(s):

Inferior Vena ◽

Femoral Vein ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Ultrasound Guided ◽

Central Venous ◽

Superficial Femoral Vein ◽

Ultrasound Guided Puncture ◽

Guided Puncture

Background: In some clinical conditions, central venous access is preferably or necessarily achieved by threading the catheter into the inferior vena cava. This can be obtained not only by puncture of the common femoral vein at the groin, but also—as suggested by few recent studies—by puncture of the superficial femoral vein at mid-thigh. Methods: We have retrospectively reviewed our experience with central catheters inserted by ultrasound-guided puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and incidence of immediate/early complications. Results: From June 2020 to December 2020, we have inserted 98 non-tunneled central venous catheters (tip in inferior vena cava or right atrium) by ultrasound-guided puncture of the superficial femoral vein at mid-thigh or in the lower third of the thigh, all of them secured by subcutaneous anchorage. The success of the maneuver was 100% and immediate/early complications were negligible. Follow-up of hospitalized patients (72.5% of all cases) showed only one episode of catheter dislodgment, no episode of infection and no episode of catheter related thrombosis. Conclusions: The ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous access. In our experience, it was not associated with any risk of severe insertion-related complications, even in patients with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if compare to the exit site in the inguinal area.

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Inferior vena cava surgical cannulation for infants needing veno-venous extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659120987089 ◽

2021 ◽

pp. 026765912098708

Author(s):

Gennaro Martucci ◽

Fabrizio di Francesco ◽

Giovanna Panarello ◽

Marcello Piazza ◽

Jean de Ville de Goyet ◽

...

Keyword(s):

Inferior Vena Cava ◽

Extracorporeal Membrane Oxygenation ◽

Inferior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Ecmo Support ◽

Common Iliac Vein ◽

Flow Profile ◽

Membrane Oxygenation

Introduction: Femoral cannulation for veno-venous extracorporeal membrane oxygenation is challenging in infants because of the diameter of the vein. Case report: Prolonged ECMO support (67 days) was necessary for an 8-month-old (8 kg) girl with acute respiratory distress syndrome that was caused by H1N1 influenza. After 30 days on ECMO support and using a single 16 Fr double-lumen cannula (internal jugular vein), a second cannula was necessary to ensure adequate flow. This second 12 Fr single-lumen cannula was surgically placed through the right common iliac vein. An excellent flow profile was then achieved and ECMO continued successfully for 37 more days. Discussion: As a lifesaving option, this double caval configuration successfully optimized the flow profile and oxygenation, outweighing the related risks. Conclusion: In small children, a surgical approach to the inferior vena cava can be considered safe, especially in those cases where there is a shortage of adequate cannulas, or when central venous access is difficult.

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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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