Recurrent Hemorrhage from Intermittent Pneumatic Compression Device Use After the Removal of a Femoral Venous Catheter—A Case Review

2021 ◽  
Vol 26 (1) ◽  
pp. 54-56
Author(s):  
Masafumi Fukuda ◽  
Masakazu Nabeta ◽  
Toshio Morita ◽  
Osamu Takasu
Keyword(s):  
Anticoagulant Therapy ◽  
Burn Injury ◽  
Femoral Vein ◽  
Insertion Site ◽  
Venous Catheter ◽  
Intermittent Pneumatic Compression ◽  
Upper Body ◽  
Case Review ◽  
Manual Compression ◽  
Secondary Hemorrhage

Highlights Abstract Intermittent pneumatic compression (IPC) is an effective method for preventing deep vein thrombosis (DVT) and is comparatively low risk for hemorrhaging compared with anticoagulant therapy. IPC is easily administered, and severe complications are rare. The patient was a 69-year-old male with no underlying diseases related to hemorrhaging of hemostasis. He was hospitalized for treatment of a third-degree burn injury to the upper body. Because the treatment included surgical debridement and skin grafting, there was substantial concern regarding the potential of hemorrhagic complications; hence, IPC was initiated to prevent DVT rather than standard anticoagulant therapy. On the ninth day of hospitalization, a femoral venous catheter initially placed to manage hydration was removed. Manual compression was performed for 15 minutes, and after confirming hemostasis at the insertion site, a hemostasis band was applied for an additional hour. At 90 minutes after confirming hemostasis, there was a secondary hemorrhage at the site of catheter removal. The secondary hemorrhage was stopped with manual compression, and IPC was discontinued. It was concluded that IPC might result in increased blood flow in the femoral vein. This may have contributed to the secondary hemorrhage after the removal of the catheter. Clinicians need to be aware of the fact that IPC may promote secondary hemorrhage after removal of a femoral venous catheter.

A Multicenter Intervention to Prevent Catheter-Associated Bloodstream Infections

2006 ◽  
Vol 27 (7) ◽  
pp. 662-669 ◽  
Author(s):  
David K. Warren ◽  
Sara E. Cosgrove ◽  
Daniel J. Diekema ◽  
Gianna Zuccotti ◽  
Michael W. Climo ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Relative Rate ◽  
Femoral Vein ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Evidence Based ◽  
Process Of Care ◽  
Standard Data ◽  
Relative Ratio

Background.Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.Objective.To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.Design.An observational study with a planned intervention.Setting.Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers.Patients.Patients admitted during the study period.Intervention.Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care.Measurements.Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of non-tunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection.Results.Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units.Conclusions.An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.

scholarly journals Successful removal of a central venous catheter misplaced in the right subclavian artery using an intravascular stent: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Haruka Yoshida ◽  
Shinichiro Ikemoto ◽  
Yasuyuki Tokinaga ◽  
Kanako Ejiri ◽  
Tomoyuki Kawamata
Keyword(s):  
Central Venous Catheter ◽  
Subclavian Artery ◽  
Axillary Artery ◽  
Insertion Site ◽  
Venous Catheter ◽  
Central Venous ◽  
Thrombotic Complications ◽  
Successful Removal ◽  
Intravascular Stent ◽  
The Right

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

scholarly journals Effects of intermittent pneumatic compression on femoral vein peak venous velocity during active ankle exercise

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199810
Author(s):  
Kenta Sakai ◽  
Naonobu Takahira ◽  
Kouji Tsuda ◽  
Akihiko Akamine
Keyword(s):  
Femoral Vein ◽  
Bed Rest ◽  
Intermittent Pneumatic Compression ◽  
Postoperative Rehabilitation ◽  
Venous Flow ◽  
Compression Phase ◽  
Superficial Femoral Vein ◽  
Inpatient Ward ◽  
Vein Thrombosis ◽  
Strong Compression

Introduction: The risk of developing deep vein thrombosis (DVT) is high even after the period of bed rest following major general surgery including total joint arthroplasty (TJA). Mobile intermittent pneumatic compression (IPC) devices allow the application of IPC during postoperative exercise. Although ambulation included ankle movement, no reports have been made regarding the effects of IPC during exercise, including active ankle exercise (AAE), on venous flow. This study was performed to examine whether using a mobile IPC device can effectively augment the AAE-induced increase in peak velocity (PV). Methods: PV was measured by Doppler ultrasonography in the superficial femoral vein at rest, during AAE alone, during IPC alone, and during AAE with IPC in 20 healthy subjects in the sitting position. PV in AAE with IPC was measured with a mobile IPC device during AAE in the strong compression phase. AAE was interrupted from the end of the strong compression phase to minimize lower limb fatigue. Results: AAE with IPC (76.2 cm/s [95%CI, 69.0–83.4]) resulted in a significant increase in PV compared to either AAE or IPC alone (47.1 cm/s [95%CI, 38.7–55.6], p < 0.001 and 48.1 cm/s [95%CI, 43.7–52.4], p < 0.001, respectively). Discussion: Reduced calf muscle pump activity due to the decline in ambulation ability reduced venous flow. Therefore, use of a mobile IPC device during postoperative rehabilitation in hospital and activity including self-training in an inpatient ward may promote venous flow compared to postoperative exercise without IPC. Conclusion: Use of a mobile IPC device significantly increased the PV during AAE, and simultaneous AAE with IPC could be useful evidence for the prevention of DVT in clinical settings, including after TJA.

scholarly journals Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Goodness Of Fit ◽  
Insertion Site ◽  
Healthcare Providers ◽  
Venous Catheter ◽  
Goodness Of Fit Test ◽  
Peripheral Venous Catheter ◽  
Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

scholarly journals Central venous catheters in hemodialysis: To accept recommendations or to stick to own experience

2008 ◽  
Vol 65 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Radojica Stolic ◽  
Goran Trajkovic ◽  
Vladan Peric ◽  
Aleksandar Jovanovic ◽  
Dragica Stolic ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Jugular Vein ◽  
Average Rate ◽  
Statistical Significance ◽  
Femoral Vein ◽  
Insertion Site ◽  
Central Vein ◽  
Positive Finding ◽  
Increased Risk ◽  
Significant Difference

Backgraund/Aim. Hemodialysis catheter, as an integral part of hemodialysis, is a catheter placed into the jugular, subclavian and femoral vein. The most common catheter-related complications are infections and thrombosis. The aim of the study was to analyze the prevalence of complications associated with differently inserted central-vein catheters for hemodialysis. Methods. The study was organized as a prospective examination during the period from December 2003 to November 2006, and included all patients who needed an active depuration by hemodialysis, hospitalized at the Clinical Center Kragujevac. The subject of the study were 464 centralvein catheters inserted during the mentioned period and there were recorded all complications related to the placement and usage of catheters. Results. The largest percent of inserted catheters was into the femoral vein ? 403 (86.8%), significantly less into the jugular vein ? 42 (9.2%), while into the subclavian vein there were placed only 19 catheters (4%). The average of femoral catheter functioning was 17 catheter days, in jugular catheters it was 17.3 days while the subclavian catheters had an average rate of functioning of 25.9 catheter days; there was found a statistically significant difference regarding the duration of functioning (p = 0.03). By microbe colonization of smear culture of the skin at the catheter insertion site, in clinically present suspicion of catheter infection, there was obtained a positive finding in 5.5% of catheters placed into the femoral vein and 7.1% of catheters instilled into the jugular vein, of which Staphylococcus aureus was the most important bacterial type, without statistically significant difference (p = 0.51). Haemoculture, done when there was a suspicion of bacteriemia, was positive in 3.7% of the patients with femoral and 4.8% with jugular catheters; Staphylococcus aureus was the most common bacteria type, but there was no statistically significant difference (p = 0.65). Colonizing the smears of the cut catheter tops, there was found a positive finding in 8.9% of femoral and 4.7% of jugular catheters in which the mentioned type of staphylococcal bacteria was prevalent, without statistically significant difference (p = 0.82). In 77% of femoral, 71.4% of jugular and 68.4% of subclavian catheters, there were no complications associated with insertion and manipulation of catheters for hemodialysis and the difference was at the limits of statistical significance (p = 0.06). Conclusion. Unconvincing rate of infections and a smaller percent of serious complications associated with the placement and use of central vein catheters instilled into the femoral vein, indicate that personal experience is sufficient recommendation to convince us that femoral vein does not represent a region with an increased risk for insertion of hemodialysis catheters.

Central Venous Catheter Complications

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 865-866
Author(s):  
JACK L. DOLCOURT ◽  
CARL L. BOSE
Keyword(s):  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Clinical Signs ◽  
Venous Catheter ◽  
Upper Body ◽  
Right Atrial ◽  
Catheter Complications ◽  
Vena Cava Syndrome ◽  
Central Venous Catheter Complications

In Reply.— We thank Hoelzer and L'Hommedieu for their comments and for pointing out that subclavian catheters are capable of lasting as long as the percutaneously placed central Silastic catheter (PCSC).1,2 The median duration for PCSC usage in our series3 was 21 days. For us, the diagnosis of superior vena cava syndrome is only suspected in the presence of differential upper body edema. The diagnosis of right atrial thrombosis is not likely to be made by us without clinical signs of venous obstruction as echocardiograms are not routinely performed.

"REFLEX" ANURIA IN THE DOG

1956 ◽  
Vol 34 (2) ◽  
pp. 158-169 ◽  
Author(s):  
Sydney M. Friedman ◽  
Roland W. Radcliffe ◽  
J. E. H. Turpin ◽  
Constance L. Friedman
Keyword(s):  
Renal Artery ◽  
Renal Vein ◽  
Femoral Vein ◽  
Venous Catheter ◽  
Renal Vasoconstriction ◽  
Contralateral Kidney ◽  
Renal Pedicle ◽  
Ureteral Catheters ◽  
Surgical Manipulations ◽  
Reflex Anuria

The effects of various surgical manipulations on the function of the separate kidneys was studied in the dog. The application of a clamp to one renal artery produced vasoconstriction of varying severity in the contralateral kidney. The introduction of a venous catheter into the renal vein by passage upward from the femoral vein similarly caused renal vasoconstriction. The combination of manipulations involved in preparing the renal pedicle for later renal artery clamping with the passing of renal venous and ureteral catheters frequently produced oliguria or complete anuria. Since such nociceptive stimuli can cause renal vasoconstriction and, if sufficiently severe, antidiuresis, it is inferred that these mechanisms bear directly on the problem of traumatic anuria.

scholarly journals Comparison of mechanical complications of central venous catheter according to the insertion site in an intensive care unit of Bangladesh

2020 ◽  
Vol 10 (2) ◽  
pp. 115-119
Author(s):  
Debasish Kumar Saha ◽  
Suraiya Nazneen ◽  
ASM Areef Ahsan ◽  
Madhurima Saha ◽  
Kaniz Fatema ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Insertion Site ◽  
Venous Catheter ◽  
Arterial Puncture ◽  
Central Venous ◽  
Femoral Site ◽  
Mechanical Complications ◽  
Catheter Tip

Background: Central venous catheter (CVC) insertion is very common in intensive care unit (ICU). CVC is usually inserted in subclavian, internal jugular and femoral veins. However, CVC insertion may lead to significant mechanical complications. Our aim was to detect the occurrence of CVC related mechanical complications according to different insertion site. Methods: This prospective observational study was carried out during the period of May 2016 to July 2019 in Department of Critical Care Medicine, BIRDEM General Hospital, Dhaka, enrolling 349 adult patients requiring new CVC insertion in ICU. Results: Among 349 study subjects, 167 CVC were inserted through subclavian vein, 88 through internal jugular and 94 through femoral vein. There was no significant difference among three groups (subclavian / internal jugular / femoral) in terms of age, gender distribution, presence of co-morbid illness.Total mechanical complicationsin study population was 43 (12.3 %) including pneumothorax (14, 4.0%), arterial puncture (10, 2.9%), hemorrhage (11, 3.2%), catheter tip malposition (6, 1.7%), hemothorax (1, 0.3%) and lost guidewire (1, 0.3%). Pneumothorax was more with internal jugular (9.1%) than subclavian (3.6 %) route, which was statistically significant (p=0.007). Although hemorrhage and arterial puncture events were higher with femoral site than subclavian or internal jugular, which were not significant. Catheter tip malposition occurred in 4 (2.4%) patients with subclavian insertion and 2 (2.3%) patients with internal jugular site, no such event in femoral site. Hemothorax and lost guidewire occurred in only 1 patient with subclavian and internal jugular site respectively. Site-wise total mechanical complications were higher in internal jugular (17.0%) followed bysubclavian (10.8%) site and femoral site (10.6%). Conclusion: In this study, though not statistically significant, CVC related mechanical complications occurred more in subclavian site than in internal jugular or femoral insertion site. Birdem Med J 2020; 10(2): 115-119

scholarly journals Air Embolism after Central Venous Catheter Removal: Fibrin Sheath as the Portal of Persistent Air Entry

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Meggiolaro Marco ◽  
Erik Roman-Pognuz ◽  
Baritussio Anna ◽  
Scatto Alessio
Keyword(s):  
Central Venous Catheter ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Insertion Site ◽  
Venous Catheter ◽  
Air Bubbles ◽  
Left Internal Jugular Vein ◽  
Central Venous ◽  
Occlusive Dressing ◽  
Vascular Ultrasonography

Central venous catheterization is of common practice in intensive care units; despite representing an essential device in various clinical circumstances, it represents a source of complications, sometimes even fatal, related to its management. We report the removal of a central venous catheter (CVC) that had been wrongly positioned through left internal jugular vein. The vein presented complete thrombosis at vascular ultrasonography. An echocardiogram performed 24 hours after CVC removal showed the presence, apparently unjustified, of microbubbles in right chambers of the heart. A neck-thorax CT scan showed the presence of air bubbles within the left internal jugular vein, left innominate vein, and left subclavian vein. A vascular ultrasonography, focused on venous catheter insertion site, disclosed the presence of a vein-to-dermis fistula, as portal of air entry. Only after air occlusive dressing, we documented echographic disappearance of air bubbles within the right cardiac cavity. This report emphasizes possible air entry even many hours after CVC removal, making it mandatory to perform 24–72-hour air occlusive dressing or, when inadequate, to perform a purse string.

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