Repositioning of Central Venous Access Devices using a High-Flow Flush Technique - a Clinical Practice and Cost Review

Background Malpositioned central venous access device (CVAD) tip locations can cause significant mechanical and chemical vessel-related injuries and complications if left in inappropriate positions. The aim of this study is to determine the use of a high-flow flush technique (HFFT) in successful correction of malpositioned catheters into the lower superior vena cava or cavoatrial junction and provide a cost comparison to interventional/fluoroscopic-based repositioning. Methods This is a retrospective chart and radiographic review of all inserted CVADs found malpositioned between 1996-2014 in a multi-specialty 1000-bed tertiary trauma center in Sydney, Australia. 7450 CVADs placed by a nurse-led vascular access service were reviewed. Catheters repositioned pre-2010 were excluded owing to radiology repositioning interventions. Results There were 3996 peripherally inserted central catheters (PICCs) and 3454 centrally inserted central catheters (CICCs) placed. Seventy-four were malpositioned post-2010. Of these, 53 devices were repositioned using the studied technique; 86% (46/53) of catheters were successfully repositioned on the first HFFT attempt. There was supportive evidence that device insertion side is important in potential catheter malposition. Conclusions Clinical outcomes suggest that CICCs and PICCs may be successfully repositioned utilizing this technique, with no adverse events associated and a prospective cost saving benefit when compared to interventional-based repositioning procedures.

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Sharp Recanalization of a Chronically Occluded Superior Vena Cava in a Patient with Multiple Prior Peripherally Inserted Central Catheters

Journal of the Association for Vascular Access ◽

10.2309/j.java.2019.002.001 ◽

2019 ◽

Vol 24 (2) ◽

pp. 21-26

Author(s):

Omar Shwaiki ◽

Sarah Khoncarly ◽

James J. Buchino ◽

Janice McDaniel

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Collateral Flow ◽

Central Venous ◽

Peripherally Inserted Central Catheters ◽

Sharp Recanalization ◽

Central Catheters

Highlights Recurrent central venous access can lead to central venous occlusions. Collateral flow can be used adventitiously for PICC tip placement. Sharp recanalization can be used to reconstitute patency of an occluded SVC.

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Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients

World Journal of Surgical Oncology ◽

10.1186/1477-7819-9-173 ◽

2011 ◽

Vol 9 (1) ◽

Cited By ~ 65

Author(s):

Stephen P. Povoski ◽

Hooman Khabiri

Keyword(s):

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Venous Anatomy ◽

Central Venous ◽

Central Venous Access Device ◽

Left Superior Vena Cava ◽

Device Placement ◽

Venous Access Device

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How I treat central venous access device–related upper extremity deep vein thrombosis

Blood ◽

10.1182/blood-2016-08-693671 ◽

2017 ◽

Vol 129 (20) ◽

pp. 2727-2736 ◽

Cited By ~ 20

Author(s):

Anita Rajasekhar ◽

Michael B. Streiff

Keyword(s):

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Postthrombotic Syndrome ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Persistent Symptoms ◽

Vena Cava Filters ◽

Venous Access Device

AbstractCentral venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.

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Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram

The Journal of Vascular Access ◽

10.1177/11297298211045576 ◽

2021 ◽

pp. 112972982110455

Author(s):

Xinpeng Wang ◽

Yong Yang ◽

Jing Dong ◽

Xiaozheng Wang ◽

Yuanyuan Zheng ◽

...

Keyword(s):

Body Surface ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

The Body ◽

P Wave ◽

P Waves ◽

Venous Access Device ◽

Surface Electrocardiogram

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.

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Avoiding harm: central venous access in Kartagener syndrome and other vascular anomalies

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v9i41.939 ◽

2021 ◽

Vol 9 (41) ◽

pp. 40-43

Author(s):

Brad Snodgrass ◽

Victoria Chu

Keyword(s):

Patient Outcomes ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Central Venous ◽

Kartagener Syndrome ◽

Internal Jugular Vein Catheterization ◽

The Right ◽

Landmark Technique

Placement of internal jugular catheters is more likely to be complicated if a left-sided approach is used, assuming normal anatomy. Kartagener syndrome is the sine qua non of sidedness confusion and results in cognitive challenges that increase the risk of adverse patient outcomes. The altered anatomy can cause profound disorientation from our usual processes. In normal circumstances the right-sided approach is used for placement of internal jugular catheters, but in Kartagener syndrome the left-sided approach should be preferred. Surgical volume and use of ultrasound guided techniques are positively correlated with better outcomes. Clinical experience may be a detriment to performance. Knowledge of these issues will help clinicians maintain vigilance and avoid error. Keywords: Kartagener syndrome, central venous access, superior vena cava, landmark technique, internal jugular vein catheterization cognitive bias

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Thrombogenic superior vena cava syndrome from long-standing central venous access in a 5-year-old patient treated with balloon-expandable stents

Journal of Radiology Case Reports ◽

10.3941/jrcr.v12i4.3339 ◽

2018 ◽

Vol 12 (4) ◽

Author(s):

Clifford Matthew Hawkins ◽

Dabin Ji ◽

Anne Elizabeth Gill ◽

Robert Mitchell Ermentrout

Keyword(s):

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Central Venous ◽

Vena Cava Syndrome

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Superior Vena Cava Duplication: The Red Herring of Central Line Placement

Case Reports in Surgery ◽

10.1155/2019/6401236 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Karin Gunther ◽

Carmen Lam ◽

David Siegel

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Catheter ◽

Venous Access ◽

The United States ◽

Central Line ◽

Central Venous ◽

Central Venous Access Lines

5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We present a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena cava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical implications, superior vena cava duplication must be recognized when it occurs.

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In defense of the use of peripherally inserted central catheters in pediatric patients

The Journal of Vascular Access ◽

10.1177/1129729820936411 ◽

2020 ◽

pp. 112972982093641

Author(s):

Alessandro Crocoli ◽

Simone Cesaro ◽

Monica Cellini ◽

Francesca Rossetti ◽

Luca Sidro ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Late Complications ◽

Central Venous ◽

Central Venous Access Device ◽

Peripherally Inserted Central Catheters ◽

Non Invasive ◽

Venous Access Device ◽

Central Catheters ◽

Venous Access Devices

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

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Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit

The Journal of Vascular Access ◽

10.1177/112972981001100208 ◽

2010 ◽

Vol 11 (2) ◽

pp. 128-131

Author(s):

Vasileios Zochios ◽

Michael Gilhooly ◽

Simon Fenner

Keyword(s):

Central Venous Catheter ◽

Superior Vena Cava ◽

Superior Vena ◽

Central Venous Access ◽

Maxillofacial Surgery ◽

Vena Cava ◽

Venous Catheter ◽

Venous Access ◽

Central Venous Catheters ◽

Central Venous

Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall. Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long. Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards. Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.

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