Peripheral venous access using the Seldinger wire technique and short cannulas in patients with difficult venous access: a case series

Abstract Nurses commonly face challenges placing peripheral intravenous (IV) lines in adults and children, a situation described as difficult venous access (DVA). Multiple venipuncture attempts can heighten patient anxiety and suffering, delay vital treatment, and increase costs. Numerous factors such as small, fragile or hidden veins can predispose patients to DVA, and collapsed veins due to dehydration are especially problematic. Several techniques can improve venous prominence, but when IV access cannot be achieved promptly, other routes of administration can be valuable. For rehydration fluids and certain drugs, subcutaneous administration may be a safe and effective alternative, providing cost and ease-of-use advantages.

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Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists

The Journal of Vascular Access ◽

10.1177/1129729820966226 ◽

2020 ◽

pp. 112972982096622 ◽

Cited By ~ 1

Author(s):

Kirby R Qin ◽

Mauro Pittiruti ◽

Ramesh M Nataraja ◽

Maurizio Pacilli

Keyword(s):

Vascular Access ◽

Venous Access ◽

Common Indication ◽

Electronic Survey ◽

Peripheral Venous Access ◽

General Recommendation ◽

Peripheral Intravenous Access ◽

Intravenous Catheters ◽

Difficult Venous Access

Background: Peripheral intravenous access is no longer limited to the standard intravenous catheter (cannula). Devices varying in length, material and insertion technique, are increasingly accessible. There is substantial variability surrounding the nomenclature and use of these devices in the literature. We wished to understand the attitude of vascular access specialists towards the nomenclature and use of peripheral intravenous catheters (PIVCs), long peripheral catheters (LPCs) and midline catheters (MCs). Methods: A 15-question electronic survey was sent to members of the Association of Vascular Access (AVA) regarding the nomenclature and use of PIVCs, LPCs and MCs. Results: A total of 228 participants completed the survey. Approximately two-thirds of respondents use LPCs (65.8%) and MCs (71.9%) in their clinical practice. The most common indication for LPCs was difficult venous access (56.5%), while the most common indication for MCs was medium-term (1–4 weeks) intravenous therapy (62.7%). The majority of participants (57.9%) agreed with the following classification of peripheral intravenous devices: PIVCs: 2 to 6 cm in length, terminating distal to the axilla; LPCs: 6 to 15 cm in length, terminating distal to the axilla; MCs: 15–25 cm in length, terminating in the axilla. Participants suggested that the length of the catheter should be considered a general recommendation, as LPCs and MCs should be primarily differentiated by tip location. Conclusions: The majority of vascular access specialists from AVA have incorporated LPCs and MCs into their repertoire of peripheral venous access tools. We envisage that their use will increase as the clinical community becomes more familiar with these devices.

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Intramuscular ketamine to facilitate pediatric central vascular access

CJEM ◽

10.1017/s1481803500009222 ◽

2004 ◽

Vol 6 (04) ◽

pp. 259-262 ◽

Cited By ~ 3

Author(s):

T. Kent Denmark ◽

Jenny R. Hargrove ◽

Lance Brown

Keyword(s):

Vascular Access ◽

Central Venous Access ◽

Tertiary Care ◽

Case Series ◽

Venous Catheter ◽

Venous Access ◽

Central Venous Catheters ◽

Emergency Physicians ◽

Central Venous ◽

Peripheral Venous Access

ABSTRACT Objectives: Obtaining prompt vascular access in young children presenting to the emergency department (ED) is frequently both necessary and technically challenging. The objective of our study was to describe our experience using intramuscular (IM) ketamine to facilitate the placement of central venous catheters in children presenting to our ED needing vascular access in a timely fashion. Methods: We performed a retrospective medical record review of all pediatric patients <18 years of age who presented to our tertiary care pediatric ED between May 1, 1998, and August 7, 2003, and underwent the placement of a central venous catheter facilitated by the use of IM ketamine. Results: Eleven children met our inclusion criteria. Most of the children were young and medically complicated. The children ranged in age from 6 months to 8 years. The only complication identified was vomiting experienced by an 8-year-old boy. Emergency physicians successfully obtained central venous access in all subjects in the case series. Conclusions: The use of IM ketamine to facilitate the placement of central venous catheters in children who do not have peripheral venous access appears to be helpful. Emergency physicians may find it useful to be familiar with this use of IM ketamine.

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Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180817125036 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-49

Author(s):

Basant K. Puri ◽

Anne Derham ◽

Jean A. Monro

Keyword(s):

Bloodstream Infection ◽

Antibiotic Treatment ◽

Central Venous Access ◽

Case Series ◽

Bloodstream Infections ◽

Venous Access ◽

Host Cells ◽

Central Venous ◽

Intravenous Antibiotic ◽

Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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Ultrasound‐based criteria for adequate peripheral venous access in therapeutic apheresis procedures

Journal of Clinical Apheresis ◽

10.1002/jca.21930 ◽

2021 ◽

Author(s):

Eric Salazar ◽

Faaria Gowani ◽

Francisco Segura ◽

Heather Passe ◽

Lamesha Seamster ◽

...

Keyword(s):

Venous Access ◽

Peripheral Venous Access

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Peripheral Inotropes in Critically Ill Children: Is It Safe?

Global Pediatric Health ◽

10.1177/2333794x211022250 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110222

Author(s):

Ravi K. Mooli ◽

Kalaimaran Sadasivam

Keyword(s):

Central Venous Access ◽

Pediatric Intensive Care ◽

Venous Access ◽

Critically Ill Children ◽

Middle Income ◽

Central Lines ◽

Middle Income Countries ◽

Peripheral Venous Access ◽

Vasoactive Medications

Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.

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Totally implantable catheter embolism: two related cases

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600011 ◽

2008 ◽

Vol 126 (6) ◽

pp. 347-349 ◽

Cited By ~ 3

Author(s):

Rodrigo Chaves Ribeiro ◽

Áurea Cristina Ferreira Monteiro ◽

Quirino Cavalcante Menezes ◽

Sérgio Tomaz Schettini ◽

Sonia Maria Rossi Vianna

Keyword(s):

Wilms Tumor ◽

Rare Complication ◽

Case Series ◽

Stage Iv ◽

Venous Access ◽

Endovascular Procedure ◽

Asymptomatic Patients ◽

Case Series Study ◽

Series Study

CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath®) are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

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Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

The Journal of Vascular Access ◽

10.1177/1129729820944066 ◽

2020 ◽

pp. 112972982094406

Author(s):

Lucio Brugioni ◽

Elisabetta Bertellini ◽

Mirco Ravazzini ◽

Marco Barchetti ◽

Andrea Borsatti ◽

...

Keyword(s):

Central Venous Catheter ◽

Guide Wire ◽

Case Series ◽

Venous Catheter ◽

Venous Access ◽

Late Complications ◽

Central Catheter ◽

Central Venous ◽

Single Lumen ◽

Thrombotic Complications

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

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