scholarly journals An Inexpensive Cardiovascular Flow Simulator for Cardiac Catheterization Procedure Using a Pulmonary Artery Catheter

2021 ◽  
Vol 3 ◽  
Author(s):  
Annika Johnson ◽  
Grace Cupp ◽  
Nicholas Armour ◽  
Kyle Warren ◽  
Christopher Stone ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Medical Devices ◽  
Central Venous Access ◽  
Cost Effective ◽  
Venous Access ◽  
Infectious Complications ◽  
Central Vein ◽  
Femoral Access ◽  
Cardiovascular Flow ◽  
Flow Simulator

Cardiac catheterization associated with central vein cannulation can involve potential thrombotic and infectious complications due to multiple cannulation trials or improper placement. To minimize the risks, medical simulators are used for training. Simulators are also employed to test medical devices such as catheters before performing animal tests because they are more cost-effective and still reveal necessary improvements. However, commercial simulators are expensive, simplified for their purpose, and provide limited access sites. Inexpensive and anatomical cardiovascular simulators with central venous access for cannulation are sparse. Here, we developed an anatomically and physiologically accurate cardiovascular flow simulator to help train medical professionals and test medical devices. Our simulator includes an anatomical right atrium/ventricle, femoral and radial access sites, and considers the variability of arm position. It simulates physiological pulsatile blood flow with a setting for constant flow from 3 to 6 L/min and mimics physiological temperature (37°C). We demonstrated simulation by inserting a catheter into the system at radial/femoral access sites, passing it through the vasculature, and advancing it into the heart. We expect that our simulator can be used as an educational tool for cardiac catheterization as well as a testing tool that will allow for design iteration before moving to animal trials.

scholarly journals Use of totally implantable venous port systems in children hematology clinic

2020 ◽  
Vol 7 (2) ◽  
pp. 35-41
Author(s):  
A. V. Lyanguzov ◽  
S. L. Kalinina ◽  
O. Yu. Sergunina ◽  
S. V. Ignatyev ◽  
O. M. Tselousova ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Central Venous Access ◽  
Venous Access ◽  
Infectious Complications ◽  
Central Vein ◽  
Pediatric Hematology ◽  
Retrospective Assessment ◽  
Venous Port ◽  
Peripheral Venous Access ◽  
Port Systems

Relevance. Reliable and long-term venous access is one of the most important condition for a successful leukemia therapy in children. Safe and convenient access to a central vein allows to provide chemotherapy, adjuvant treatment, parenteral nutrition and blood transfusion. It decreases the likelihood of phlebitis development and reduction of the peripheral venous network in comparison with peripheral venous access. The use of totally implantable venous port systems reduces risks of severe complications associated with re-catheterization of the central vein thus it improves patient’s quality of life.The purpose of the study is a retrospective assessment of the experience of use and analysis of the complications of totally implantable venous port systems in children with diseases of the blood system.Materials and methods. The data of 61 patients of the pediatric hematology clinic with venous port systems have been analyzed.Results. Perioperative complications developed in 3 (4.9 %) patients Median time of using of port systems was 679 catheter-days. Delayed complications requiring removal of the device developed in 8 (13.1 %) patients. Infectious complications were the reason for device removal in 3 (2.9 %) patients, mechanical complications in 5 (8.2 %) patients. No thrombotic complications were found.Conclusions. The use of venous port systems in children with hematologic diseases for a long period of time is an effective and safe way for central venous access providing.

Deployment of Direct Intrahepatic Portocaval Shunt (DIPS) from a Femoral Access

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Portal Vein ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Hepatic Veins ◽  
Portocaval Shunt ◽  
Femoral Access ◽  
Direct Puncture ◽  
The Right ◽  
Brachiocephalic Veins

The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in management of esophageal varices bleeding in patients with liver cirrhosis when endoscopic manuvers fail to control it. Ascites refractory to optimal medical therapy is another indication for TIPS procedure. Occasionally, TIPS cannot be performed due to vascular anatomical difficulties such as occluded central venous access, small hepatic veins, or portal vein occlusion. Direct intrahepatic portocaval shunt (DIPS) can be considered as an alternative option in such circumstances. DIPS is typically performed utilizing jugular access with direct puncture from the inferior vena cava (IVC) to the right portal vein. However, the interventionalist may be challenged by jugular or brachiocephalic veins occlusion. This chapter discusses perfroming DIPS procedure utilizing femoral access in a patient with bilateral occluded brachiocephalic veins and thrombosed right portal vein.

scholarly journals New organizational model to foster good practice. Central venous access management in cancer patients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Mastrandrea ◽  
F Cangialosi ◽  
P Notarangelo ◽  
G Chetta ◽  
E A Graps
Keyword(s):  
Integrated Care ◽  
Cancer Patients ◽  
Medical Devices ◽  
Remote Monitoring ◽  
Central Venous Access ◽  
Venous Access ◽  
Access Management ◽  
Central Venous ◽  
Management Procedures ◽  
Health And Social Care

Abstract Issue Central Venous Access positioning is a common practice in cancer patients, however improper devices' management lead to complications and multiple accesses to hospital services, increasing costs. Assessment and certification of Central Venous Access insertion site at hospital so as proper dressing at home, are required; patient empowerment in management of complex technologies is desirable to improve outcomes. Problem Description To tackle the abovementioned issues, PICC project was drawn up in joint action between the Strategic Health and Social care Agency and the Research Institute on Cancer in Puglia. The aim is to pilot an organisational model for central venous access positioning and remote monitoring barely technology driven and based on safe storage of outcomes pictures, patient/care-givers empowerment, integrated care approach. A sistematic review of good practices for Central Venous Access management was conducted in june 2019; besides an analysis of medical devices public procurement procedures was performed at national scale; a survey was edited to probe the existence of diverse organisational models to insert and manage Central Venous Access. Results Very preliminary data are avalaible. Procurement analysis showed: around 15 companies of Central Venous Access and related medical devices' producers; a spread of Central Venous Access location medical devices/supply of services based on few firms (including consumables). The analysis helps to identify the “least common multiple” in technologic equipment to support Central Venous Access management to develop a standard and applicable model, not driven by a conditioning “starting choice” (catheter selection, tip location, dressings). Lessons A standard Central Venous Access management certification procedure can be realized regardless of potential technology driven approach. A Central Venous Access remote monitoring model based on images and empowered patients can allow daily review fostering integrated care. Key messages Patients’ proper training, even in complex technologies usage, can increase self awareness and empowerment and promote compliance to innovative organizational models. Collaboration among patients – caregivers and professionals, set up of a dynamic pictures store to record Central Venous Access management procedures can improve oucomes avoiding added costs.

Increased Risk of PICC Line Thrombosis in Acute Promyelocytic Leukemia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4499-4499
Author(s):  
Moshe E. Gatt ◽  
Moshe Levin
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Central Venous Access ◽  
Venous Access ◽  
Infectious Complications ◽  
Promyelocytic Leukemia ◽  
Myelogenous Leukemia ◽  
Complication Rates ◽  
Central Venous ◽  
Picc Line ◽  
Heparin Prophylaxis

Abstract Introduction: Central venous access catheters are being used at increasing rates in the practice of hematology. Although significant complication rates in patients with solid tumors exist, studies have shown a lower incidence of complications in hematology patients. Recently, we noted an increased incidence of percutaneously inserted central catheters (PICC line) thrombosis in patients with acute promyelocytic leukemia (APL). Methods: We undertook an evaluation of the medical records of all adult patients with acute leukemia (AL) from the year 1995 to 2005 at our two hematology centers. All indwelling catheters (of which most are PICC lines) at our institutions are inserted by interventional radiologists under fluoroscopic visualization. The catheters are flushed with saline and heparin prophylaxis was not routinely used during this evaluation period. All thrombotic episodes were diagnosed based on clinical and ultrasound duplex studies. Data was collected in reference to catheters, thrombotic and infectious complications, and relationship to diagnosis and treatment. Results: Of 368 evaluated patients with a central venous catheter and AL, there were 23 incidents of clinically apparent catheter thrombosis (6.2%). The subgroup incidence of catheter thrombosis was nine of 237 (3.8%) patients with acute myelogenous leukemia not including APL (AML), seven of 104 patients (6.7%) with acute lymphoblastic leukemia (ALL), half of the ALL episodes were associated with catheter sepsis, and seven of 25 (28%) with APL. Comparison of the APL group with the AML group is significant at p < 0.03. Conclusion: There appears to be an increased incidence of PICC line thrombosis in APL patients. This may be secondary to the institution of all trans retinoic acid (ATRA) treatment and the thrombophillia of APL. In ALL patients the slightly raised incidence may be due to the thrombophillia of asparaginase or the increased infectious complications of high dose steroids associated with ALL treatment. Based on these findings we would recommend heparin prophylaxis for APL patients with central venous access lines. Following this evaluation we instituted heparin prophylaxis for newly diagnosed APL patients and found no evidence of clinically apparent thrombosis in 8 consecutive patients. There were no episodes of increased bleeding in these 8 APL patients. Further analysis of the data will be presented.

Safe and Cost Effective Use of Alteplase for the Clearance of Occluded Central Venous Access Devices

2002 ◽  
Vol 20 (7) ◽  
pp. 1918-1922 ◽  
Author(s):  
J. P. Timoney ◽  
M. G. Malkin ◽  
D. M. Leone ◽  
J. S. Groeger ◽  
M. L. Heaney ◽  
...  
Keyword(s):  
Thrombolytic Agent ◽  
Central Venous Access ◽  
Cost Effective ◽  
Venous Access ◽  
Central Venous ◽  
Safety And Efficacy ◽  
Reasonable Alternative ◽  
Effective Use ◽  
Assessment Initiative ◽  
Venous Access Devices

PURPOSE: To determine whether cryopreserved solutions of the thrombolytic agent alteplase could be used as a safe, effective, and economically reasonable alternative to urokinase in patients presenting with occluded central venous access devices (CVADs). MATERIALS AND METHODS: Alteplase has been reported as an efficacious alternative to urokinase for treatment of occluded CVADs. However, the practicality of using alteplase as the thrombolytic of choice for this indication remained conjectural. To make this approach economically feasible, alteplase was diluted to 1 mg/mL and 2.5-mL aliquots were stored at −20°C until use. A need to confirm that the cryopreserving and thawing of the reconstituted solution did not compromise the safety and efficacy reported from prior trials was recognized. A quality assessment initiative was undertaken to concurrently monitor the safety and efficacy of this approach. Patients presenting with occluded CVADs received a sufficient volume of the thawed alteplase solution to fill the occluded catheter(s). Data, including efficacy, adverse reactions, dwell time, and catheter type, were collected over a 5-month period. RESULTS: One hundred twenty-one patients accounting for 168 attempted clearances were assessable for safety and efficacy. One hundred thirty-six (81%) of the 168 catheter clearance attempts resulted in successful catheter clearance (95% confidence interval, 74% to 86%). No adverse events were reported. CONCLUSION: Cryopreserved 1-mg/mL aliquots of alteplase are safe and effective in the clearance of occluded CVADs when stored at −20°C for 30 days. The ability to cryopreserve alteplase aliquots makes it an economically reasonable alternative to urokinase in the setting of CVAD occlusion.

Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients

2021 ◽  
pp. 112972982110343
Author(s):  
Matthew D Ostroff ◽  
Nancy Moureau ◽  
Mauro Pittiruti
Keyword(s):  
Vascular Access ◽  
Femoral Vein ◽  
Central Venous Access ◽  
Rapid Assessment ◽  
Venous Access ◽  
Central Vein ◽  
Exit Site ◽  
Central Venous ◽  
Venous Catheterization ◽  
Subcutaneous Tunneling

In the last decade, different standardized protocols have been developed for a systematic ultrasound venous assessment before central venous catheterization: RaCeVA (Rapid Central Vein Assessment), RaPeVA (Rapid Peripheral Vein Assessment), and RaFeVA (Rapid Femoral Vein Assessment). Such protocols were designed to locate the ideal puncture site to minimize insertion-related complications. Recently, subcutaneous tunneling of non-cuffed central venous access devices at bedside has also grown in acceptance. The main rationale for tunneling is to relocate the exit site based on patient factors and concerns for dislodgement. The tool we describe (RAVESTO—Rapid Assessment of Vascular Exit Site and Tunneling Options) defines the different options of subcutaneous tunneling and their indications in different clinical situations in patients with complex vascular access.

Transdiaphragmatic tunneled Broviac catheters: Cost-effective perioperative central venous access in infants undergoing cardiac surgery

2020 ◽  
Vol 160 (6) ◽  
pp. 1559-1566 ◽  
Author(s):  
Muhammad Owais Abdul Ghani ◽  
Muhammad Aanish Raees ◽  
Alan Ruigang Tang ◽  
Dhivyaa Anandan ◽  
Chevis N. Shannon ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Central Venous Access ◽  
Cost Effective ◽  
Venous Access ◽  
Central Venous

School Nurses on the Front Lines of Healthcare: Children With Medical Devices—Central Venous Access Device Malfunctions and Infections

2020 ◽  
pp. 1942602X2094039
Author(s):  
Noa Farou ◽  
Christy Lucas ◽  
Robert P. Olympia
Keyword(s):  
Medical Devices ◽  
Central Venous Access ◽  
Healthcare Providers ◽  
Venous Access ◽  
School Nurses ◽  
Central Venous ◽  
Medical Needs ◽  
Healthcare Needs ◽  
Healthcare Interventions ◽  
Venous Access Device

An important subgroup of children with special healthcare needs are children with medical complexities that require long-term intensive healthcare interventions and treatments. As medical technology continues to advance and children with complex medical needs survive the neonatal period and progress into school-age, it is essential for school nurses to be able to recognize and acutely manage complications and malfunctions of devices in children requiring assistance from medical devices. An example of a common medical device includes central venous access devices that allow for access to the bloodstream to obtain blood for laboratory testing or to infuse medications or nutrition. These devices put children at serious medical or surgical risk when they malfunction or become infected, so it is important for healthcare providers, especially school nurses who are the first responders in schools, to recognize malfunctions and initiate appropriate care management.

scholarly journals Mastering the Central Line Placement Techniques Through Effective Resident Training Environment

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
V V Protas
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Central Line ◽  
Resident Training ◽  
Central Vein ◽  
Training Environment ◽  
Initial Stage ◽  
The Right ◽  
Conscious Patient ◽  
Medial Access

Catheterization of the central vein is one of the fundamental procedures in anesthesiology. Mastering different methods of central venous access is an important part of resident training. At the initial stage residents should master the way of high medial access to the right internal jugular vein that is one of the simplest techniques with the lowest risk of complications for a patient. The operating room can be an optimal training environment where first independent puncture attempts are performed in a stable patient undergoing surgical intervention under general anesthesia. The next stage of training should involve access to other central veins as well performing the procedure in a conscious patient.

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