scholarly journals Ultrahangvezérelt centrálisvéna-biztosítás korrigálatlan coagulopathiában

2015 ◽  
Vol 156 (27) ◽  
pp. 1085-1090
Author(s):  
Géza Reusz ◽  
Csilla Langer ◽  
Tibor Hevessy ◽  
Ákos Csomós
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Catheterization ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Venous Catheterization ◽  
Clopidogrel Therapy

Introduction: Correction of coagulopathy prior to central venous catheterization is a standard practice. Before ultrasound-guided procedures, routine correction of coagulopathy is controversial as mechanical complications are rare. Aim: To evaluate the safety of ultrasound-guided central venous access in critically ill patients with coagulopathy. Method: In this retrospective study the authors included all ultrasound-guided central venous catheterizations performed in their Intensive Care Unit between February 2011 and January 2013. They defined coagulopathy as INR or APTT ratio above 1.5, platelet count below 100 G/l, and anticoagulation or clopidogrel therapy. Data obtained from ultrasound register and patient records were used. Results: 310 ultrasound-guided central venous catheterizations were performed. Coagulopathy was observed in 134 cases (43.2%) and corrected in 10 cases prior to catheterization. There were no bleeding complications (complication rate in uncorrected coagulopathy: 0%, 95% confidence interval: 0-3.0%). Conclusions: Coagulopathy is common in critically ill patients, but its routine correction prior to ultrasound-guided central venous catheterization seems unnecessary. Orv. Hetil., 2015, 156(27), 1085–1090.

scholarly journals Bleeding Complications in Ultrasound-Guided Central Venous Access in Patients with Severe Thrombocytopenia: A Propensity Score-Based Analysis

2021 ◽  
Author(s):  
Virginia Zarama ◽  
Jorge A. Revelo-Noguera ◽  
Jaime A. Quintero ◽  
Ramiro Manzano ◽  
Francisco L. Uribe-Buriticá ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Platelet Count ◽  
Platelet Transfusion ◽  
Central Venous Access ◽  
Venous Access ◽  
Catheter Placement ◽  
Bleeding Complications ◽  
Severe Thrombocytopenia ◽  
Ultrasound Guided ◽  
Central Venous

Abstract Purpose: To study the occurrence of bleeding complications in patients with severe thrombocytopenia (platelet count <20x103/µL) subjected to ultrasound-guided central venous access (UG-CVA) while receiving or not routine prophylactic platelet transfusion (PPLT).Research Question: What is the frequency of bleeding complications related to the placement of ultrasound-guided central venous access in patients with severe thrombocytopenia between 2011 and 2019 at high complexity hospital?Methods: A total of 221 patients with severe thrombocytopenia subjected to UG-CVA from January 2.011 to November 2.019 were selected. They were classified as positive (P-PPLT) or negative (N-PPLT) recipients of PPLT. Then, P-PPLT (n=72) were 1:1 propensity matched to N-PPLT based on catheter diameter, anatomical insertion site, presence of hematologic malignancy, absolute platelet count and whether the health care provider performing the procedure was an attending or a trainee. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) score and adapted to central venous catheter placement. A logistic regression analysis was then performed using “bleeding complications” as a binary compound outcome of major (Grades 3-4) and minor bleeding (Grades 1-2) vs. no bleeding.Results: Seventy-two patients were classified as P-PPLT, while 149 as N-PPLT. No grades 3-4 of bleeding events were identified in the entire population. No significant differences were observed between N-PPLT and P-PPLT for bleeding Grades 1-2 in both pre-matched (53[35.5%] vs. 26[36.1%], p=0.90) and propensity-matched populations (27[37.5%] vs. 26[36.1%], p=0.80). Logistic regression demonstrated that PPLT did not influence any bleeding complication (OR 0.9, 95%CI 0.42-1.92, p=0.791)Conclusions: Bleeding complications related to central venous catheterization in acutely ill patients with severe thrombocytopenia are not influenced by routine prophylactic platelet transfusion when catheter placement is performed under ultrasound guidance.

A step-by-step guide to placing a central venous jugular catheter

2020 ◽  
Vol 25 (7) ◽  
pp. 1-4
Author(s):  
Delphine Le Chevallier
Keyword(s):  
Veterinary Medicine ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Sampling ◽  
Seldinger Technique ◽  
Peripheral Vein ◽  
Central Venous

Placing a central venous jugular catheter is a valuable technique. The method used is the modified Seldinger technique (over the wire), which is also used to place chest drains. While intravenous catheterisation of a peripheral vein is common practice in veterinary medicine, critically ill patients may require central venous access if peripheral access is not possible. This is also useful when large volumes of fluid are required, for example for administration of irritant drugs or for parenteral nutrition, or for regular blood sampling.

A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study

2019 ◽  
Vol 20 (6) ◽  
pp. 630-635
Author(s):  
Minmin Yao ◽  
Wanxia Xiong ◽  
Liying Xu ◽  
Feng Ge
Keyword(s):  
Observational Study ◽  
Success Rate ◽  
Central Venous Access ◽  
Demographic Data ◽  
Venous Access ◽  
Axillary Vein ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Venous Catheterization ◽  
Out Of Plane

Background: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. Methods: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients’ demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. Results: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. Conclusion: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.

scholarly journals The provision of central venous access, transfer of critically ill patients and advanced airway management.: Are advanced critical care practitioners safe and effective?

2018 ◽  
Vol 20 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Gavin Denton ◽  
Lindsay Green ◽  
Marion Palmer ◽  
Anita Jones ◽  
Sarah Quinton ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Catheterisation ◽  
The United Kingdom ◽  
Advanced Airway ◽  
Critical Care Patients

Advanced critical care practitioners are a new and growing component of the critical care multidisciplinary team in the United Kingdom. This audit considers the safety profile of advanced critical care practitioners in the provision of central venous catheterisation and transfer of ventilated critical care patients without direct supervision and supervised drug assisted intubation of critically ill patients. The audit showed that advanced critical care practitioners can perform central venous cannulation, transfer of critically ill ventilated patients and intubation with parity to published UK literature.

Intracavitary electrocardiography for tip location during central venous catheterization: A narrative review of 70 years of clinical studies

2020 ◽  
pp. 112972982092983
Author(s):  
Mauro Pittiruti ◽  
Filippo Pelagatti ◽  
Fulvio Pinelli
Keyword(s):  
Central Venous Catheterization ◽  
Central Venous Access ◽  
Venous Access ◽  
P Wave ◽  
Central Venous ◽  
Non Invasive ◽  
Venous Catheterization ◽  
Electrophysiological Studies ◽  
Invasive Method ◽  
Different Populations

Intracavitary electrocardiography is an accurate and non-invasive method for central venous access tip location. Using the catheter as a traveling intracavitary electrode, intracavitary electrocardiography is based on the increase in the detected amplitude of the P wave while approaching the cavoatrial junction. Despite having been adopted diffusely in clinical practice only in the last years, this method is not novel. In fact, it has first been described in the late 40s, during electrophysiological studies. After a long period of quiescence, it is in the last two decades of the XX century that intracavitary electrocardiography became popular as an effective mean of central venous catheters tip location. But the golden age of this technique began with the new millennium, as documented by high-quality studies in this period. In fact, in those years, intracavitary electrocardiography has been studied broadly, and important achievements in terms of comprehension of the technique, accuracy, and feasibility of the method in different populations and conditions (i.e. pediatrics, renal patients, atrial fibrillation) have been gained. In this review, we describe the technique, its history, and its current perspectives.

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

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
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.

Ultrasound-guided central venous access: what’s new?

2015 ◽  
Vol 41 (4) ◽  
pp. 705-707 ◽  
Author(s):  
Gregory A. Schmidt ◽  
Julien Maizel ◽  
Michel Slama
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Ultrasound Guided ◽  
Central Venous
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