Definition of catheter jamming: A mechanical analysis of catheter fracture tension and fracture strain

BACKGROUND: Catheter jamming is an emerging and possibly underrated complication. OBJECTIVE: To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain (εf) of Peripheral Inserted Central Catheters (PICC). METHOD: We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted. RESULTS: The fracture tension of catheter in sections A and B were 5.8917 ± 1.0095 and 6.0670 ± 0.8066 Newtons respectively (p= 0.393) and the fracture strain of catheter in sections A and B were 6.0611 ± 1.0810 and 6.2543 ± 0.7187 Newtons respectively (p= 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 ± 0.9414 and 5.9192 ± 0.8972 Newtons respectively (p= 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 ± 0.7227 and 6.2584 ± 1.0212 respectively (p= 0.301). CONCLUSION: It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.

Multislice Spiral CT Imaging Localization and Nursing Care of Catheter Fracture of Scalp Vein Indwelling Needle

In order to improve the success rate of scalp venous indwelling needles in infants, image positioning and nursing of scalp venous indwelling needle catheters broken with multislice spiral CT were discussed. In this method, three-dimensional reconstruction of multislice spiral CT was used to diagnose and locate the broken catheter according to the anatomical morphology of the indwelling needle, and the treatment and related nursing were carried out. The results showed that the body temperature was 38.7°C, the pulse was 106 times/min, the respiration was 30 times/min, and the body weight was 15 kg. Laboratory examination: the percentage of leukocytes was 10.00 × 10/L, the percentage of lymphocytes was 24.8%, and the percentage of neutrophils was 63.7%. Head CT examination: no obvious abnormalities were observed. 31.9% of children diagnosed with hyperfebrile convulsions had good image quality after treatment with MSCT for catheter fracture of scalp vein indwelling needle; good quality was 52.8%, and barely diagnosed was 12.1%. Multiple post-treatment functions of MSCT have important value in the application of three-dimensional localization of foreign bodies in soft tissues in children and play a more important role in the diagnosis and preoperative evaluation of foreign bodies. Appropriate nursing care for children in the image location examination has very important guiding significance.

Fractura de catéter implantable con reservorio por síndrome de pinch-off

Fracture and migration of totally implantable venous access devices is a rare but potentially serious complication. Pinch-off syndrome was described in subclavian venous accesses when the intermittent compression of the catheter between the first rib and the clavicle produces catheter fracture. The report the case of a patient with cancer who underwent implantation of a totally implantable venous access device through the subclavian vein under ultrasound and radioscopy guidance. After several cycles of chemotherapy, the patient started with malfunctioning of the device. The chest X-ray showed a complete fracture of the catheter at the level of the costoclavicular space with migration of a fragment of the catheter to the right cardiac chambers. The fractured catheter was percutaneously removed via the right femoral vein using nitinol gooseneck snare without complications. The incidence of the pinch-off syndrome, risk factors and prevention measures in totally implantable venous access devices are analyzed.

Long-Term Results of a Standard Algorithm for Intravenous Port Implantation

Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.

Two broken pieces make a whole: adductor canal block

Total knee arthroplasty (TKA) is expounded to intense postoperative pain with a desire for early ambulation and reduce postoperative complications. Adductor canal blockade (ACB) blocks primarily the pain sensation while preserving the quadriceps strength facilitating early rehabilitation after knee surgery. ACB has been gaining popularity over femoral nerve block (FNB), continuous epidural analgesia (CEA), and psoas compartment block (PCB). Studies show that use of ultrasound alone reduced the possibilities of vascular and multiple skin punctures. Though there's emerging evidence proving the efficacy of ACB, there's limited literature on safe use of continuous ACB catheters. We report 2 cases of catheter fracture with USG guided ACB employed in TKA.

Fracture and embolization of an implantable venous access device in patient with atrial septal defect

Totally implantable venous access devices (TIVADs) are frequently used for the administration of chemotherapy or parenteral nutrition and have proved to be safe and improve patient quality of life during treatment. Catheter-related infections are the most common complication, whereas catheter fracture and embolization is rarely seen. We present a case of a 61-year-old cancer patient in which the TIVAD fractured and embolized to the patient’s left knee 18 months after its initial placement. An endovascular procedure with intraoperative imaging revealed that the catheter had embolized to the popliteal artery and was successfully removed, the only explanation being the presence of an atrial septal defect. A bubble echocardiogram was unsuccessful in confirming the diagnosis. The catheter fracture could be related to an intravascular procedure that was performed 18 months prior to remove fibrin sheaths as a cause of port malfunction, or it could be a case of pinch-off syndrome.