Application of Ultrasound Guidance in Anesthesia Deep Vein Puncture Technique

2021 ◽  
Keyword(s):  
Ultrasound Guidance ◽  
Deep Vein ◽  
Puncture Technique

Catheter-Associated Deep Vein Thrombosis (CADVT) in a Pediatric ICU: A Retrospective Case-Control Study

2020 ◽  
Vol 25 (3) ◽  
pp. 45-55
Author(s):  
Sandeep Tripathi ◽  
Kimberly Burkiewicz ◽  
Jonathan A. Gehlbach ◽  
Yanzhi Wang ◽  
Michele Astle
Keyword(s):  
Deep Vein Thrombosis ◽  
Central Venous Catheter ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Retrospective Case ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Control Study

Highlights Abstract Introduction: Catheter-associated deep vein thrombosis (CADVT) in children has been recognized as a significant hospital-acquired condition. This study was undertaken to retrospectively analyze the impact of CADVT on outcomes and to identify risk factors for the development of deep vein thrombosis in children with central venous catheters. Methods: This was a single-center retrospective case-control study of patients with central venous catheters in a pediatric intensive care unit (ICU) from January 2014 to December 2018. Forty-one patients with central venous catheters who developed CADVT were compared with 100 random controls. Central venous catheter type, along with patient and disease-specific characteristics, were compared between the two groups by univariate and multivariate regression. Outcome comparison was made after adjusting for confounding variables. Results: Median time from insertion to the development of CADVT was 4 days (interquartile range, 2–9). Forty percent (16/40) of patients had a blood urea nitrogen greater than 20 mg/dL, and 86.6% (13/15) had a C-reactive protein greater than 1 mg/dL within 48 hours of development of CADVT. Central venous catheter duration (odds ratio [OR], 1.05), mechanical ventilation (OR, 7.49), and upper versus lower extremity site of the central venous catheter (OR, 0.324) were associated with the development of CADVT. Ultrasound guidance occurred significantly less in patients who developed CADVT (39.3% vs 70.7%); however, it was not independently associated with increased risk. Age, body mass index, mechanical ventilation, and severity of illness–adjusted hospital and ICU length of stay were significantly higher in patients who developed CADVT. Conclusions: CADVT is independently associated with worse outcomes. Ultrasound guidance and site selection are potential modifiable risk factors in the development of CADVT in pediatric patients. Future studies should target an effective chemoprophylaxis regimen.

Managing Peripherally Inserted Central Catheter Thrombosis Risk: A Guide for Clinical Best Practice

2011 ◽  
Vol 16 (3) ◽  
pp. 144-147 ◽  
Author(s):  
Britt M. Meyer
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Practice ◽  
Ultrasound Guidance ◽  
Vena Cava ◽  
Outer Diameter ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Vein Thrombosis ◽  
Thrombosis Risk ◽  
Deep Vein

Abstract Purpose: The purpose of this study was to evaluate the effectiveness of clinical practice changes in an effort to reduce peripherally inserted central catheter thrombosis risk. Patients and Method: A retrospective analysis of adult patients in the acute care setting. Results: A total number of 1307 charts of patients who received PICCs were reviewed encompassing the months of January 2008, October 2008 and August 2010. During the period from January 2008 to October 2008, clinical practice changes were made to include the use of ultrasound guidance. Ensuring catheter tip termination in the superior vena cava with the addition of ultrasound technology as an insertion practice combined to decrease symptomatic PICC related deep vein thrombosis rates from 4.8 % to 2.9%. During the period from October 2008 to August 2010, an additional practice was introduced that involved measurement and documentation of vein diameters(without the use of a tourniquet) prior to all PICC insertion procedures. Deep vein thrombosis (DVT) rates dropped further from 2.9 % to 1.4 % during this period. Conclusion: Obtaining central tip location and using ultrasound guidance for PICC placement are effective in reducing PICC related DVT. Additionally, routine measurement of vein diameters in their native state and use of that information to ensure that the vessel diameter is at least twice the outer diameter of the catheter is an effective practice to reduce DVT rates and reduce thrombosis risk.

Combining Ultrasound-Guided Vascular Access With Ultrasound-Guided Analgesia for Single Skin and Vessel Puncture

2018 ◽  
Vol 25 (3) ◽  
pp. 355-357 ◽  
Author(s):  
Timothy E. Murray ◽  
Damien C. O’Neill ◽  
Michael J. Lee
Keyword(s):  
Vascular Access ◽  
Local Anesthetic ◽  
Subcutaneous Injection ◽  
Vessel Wall ◽  
Ultrasound Guidance ◽  
Ultrasound Guided ◽  
Skin Puncture ◽  
Needle Tract ◽  
Puncture Technique

Purpose: To describe a single skin puncture technique combining subcutaneous injection of anesthetic to the depth of the vessel wall with venipuncture in the same movement. Technique: Using ultrasound guidance, controlled anesthetic instillation along the needle tract and outer vessel wall with a 21-G vascular access needle can be combined with vessel puncture. This technique reduces the number of skin punctures and ensures accurate anesthetic instillation. The maximum inadvertent intravascular dose of commercial local anesthetic preparations that can be delivered with a small syringe is far below toxicity thresholds. Conclusion: A technique for combining anesthetic administration and vascular access with a 21-G needle and ultrasound guidance is feasible.

Phlegmasia cerulea dolens – an uncommon but alarming manifestation of deep vein thrombosis

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 422-426
Author(s):  
Manuela Nickler ◽  
Sebastian Haubitz ◽  
Adriana Méndez ◽  
Martin Gissler ◽  
Peter Stierli ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Bleeding Risk ◽  
Venous Intervention ◽  
Aggressive Treatment ◽  
Vein Thrombosis ◽  
Prompt Treatment ◽  
Surgical Thrombectomy ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

Summary: In phlegmasia cerulea dolens (PCD), immediate diagnosis and prompt treatment is crucial for limb salvage. Aggressive treatment options including venous intervention, thrombolysis and/or surgical thrombectomy should be considered. Due to the lack of data, the most appropriate intervention depends upon etiology of PCD, clinical presentation and patient’s bleeding risk.

Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Continuous Infusion ◽  
High Speed ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Follow Up ◽  
Valve Function ◽  
Rotating Impeller ◽  
Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

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