Figure 4 - uploaded by Maria Dzierzega
Content may be subject to copyright.
Chest X-ray presented a "strange" shape of the port's catheter in the right atrium due to the clot in right atrium (arrow).
Source publication
Background
Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutrition...
Similar publications
Objectives. To examine narrative writing in cochlear implant (CI) children and understand the factors associated with unfavorable outcomes. Materials and Methods. Forty-five CI children in grades 2-6 participated in this study. They received CIs at 4.1 ± 2.1 years of age and had used them for 6.5 ± 2.7 years. A story-writing test was conducted and...
Introduction:
Increasing the femoral offset when performing total hip arthroplasty (THA) theoretically increases the stresses and risks of the stem not integrating itself into bone. But this concept has not been validated for cementless stems; this led us to conduct a retrospective study to determine: (1) the risk factors for the occurrence of sym...
Introduction:
Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures.
Materials and Methods:...
Objective: To evaluate the short-term radiographic results of cementless hemiarthroplasty using a tapered wedge-shaped femoral component in elderly patients with displaced femoral neck fracture. Specifically, the authors assessed the prevalence of intraoperative crack and rate of subsidence associated with tapered wedge-shaped femoral component in...
Purpose: The purpose of this study is to compare the effect of implant-abutment connections, abutment angulations, and screw lengths on screw loosening (SL) of preloaded abutment using three dimensional (3D) finite element analysis.
Materials and Methods: 3D models of implants (conical connection with hex/trilobed connections), abutments (straight/...
Citations
... To the best of our knowledge, there are only three published studies that attempted a comparison between the open surgical and the transcutaneous technique for the insertion of central venous lines in the pediatric population. However, they share in common several methodological disadvantages· all of them are retrospective in nature, they are not well-organized, and due to methodological errors, they present conflicting results [4][5][6]. ...
Background: The purpose of this study was to compare the immediate and long-term complications that are associated with the utilized techniques for the insertion of indwelling central venous catheters, that is the open surgical technique, the ultrasound-guided technique, and the transcutaneous technique based on external anatomical landmarks in the right internal jugular vein, to a pediatric population. Methods: This was a prospective randomized trial based on a pediatric patient population under 16 years of age of a tertiary pediatric-oncological hospital. The procedure was performed by a medical team with varying experience regarding the percutaneous and open insertion methods. We studied the outcome of our procedure, based on the immediate and delayed complication rate, as well as the needed time in order to complete the procedure and mean duration of line use. Results: The patients that were inserted in our protocol were divided into three subgroups based on the selected technique for the insertion of the central venous catheter. A total number of 88 insertions (25.4%) (out of 346) were based on the technique that was using external anatomical landmarks, 121 insertions were based on the ultrasound-guided transcutaneous technique (34.9%), whereas in 137 cases (39.5%) the open surgical technique was preferred. All cases that were related to catheter re-insertion were excluded from our study. We performed a statistical analysis regarding the catheter dwell time between the three subgroups of patients and no significant difference was recorded. Moreover, the development of thrombosis was investigated, and we noted that a higher percentage of this complication was related to the transcutaneous external landmark and open surgical technique. Also, the incidence of infection was taken into consideration, which manifested an increased incidence when the transcutaneous technique based on external landmarks was used. Conclusions: Ultrasound-guided percutaneous insertion was considered to be a safe and effective technique for the insertion of central venous catheters. Our study also demonstrated a decrease in operating times when performed by operators with increasing expertise, increased preservation of the diameter of the venous lumen, and no increase in complication rates when the ultrasound-guided technique was selected.
... However, they share in common several methodological disadvantages· all of them are retrospective in nature, they are not well organized and due to methodological errors, they present conflicting results. [4][5][6]. ...
... As we have already mentioned, inappropriate position of the tip of the central venous catheter was a relatively common complication to our patient series. The most common erroneous position of 6 the distal end of the catheter was within the right subclavian vein (6 out of 14 cases, 42.85%). This was followed by the short length of the inserted central venous catheter (4/14, 28.57%). ...
Background: The purpose of this study was to compare the immediate and long-term complications that are associated with the utilized techniques for the insertion of indwelling central venous catheters, that is the open surgical technique, the ultrasound-guided technique and the transcutaneous technique based on external anatomical landmarks in the right internal jugular vein, to a pediatric population. Methods: This was a prospective randomized trial based on a pediatric patient population, under 16 years of age, of a tertiary pediatric-oncological hospital. Procedure was performed by a medical team with varying experience regarding the percutaneous and open insertion methods. We studied the outcome of our procedure, based on the immediate and delayed complication rate, as well as the needed time in order to complete the procedure and mean duration of line use. Results: The patients that were inserted in our protocol were divided into three subgroups, based on the selected technique for the insertion of the central venous catheter. A total number of 88 insertions (25.4%) (out of 346) were based on the technique that was using external anatomical landmarks, 121 insertions were based on the ultrasound-guided transcutaneous technique (34,9%), whereas in 137 cases (39.5%) the open surgical technique was preferred. All cases that were related to catheter re-insertion were excluded from our study. We performed a statistical analysis regarding the catheter dwell time between the three subgroups of patients and no significant difference was recorded. Moreover, the development of thrombosis was investigated, and we mentioned that the higher percentage of this complication was related with the transcutaneous external landmark and open surgical technique. Also, the incidence of infection was taken into consideration, which manifested an increased incidence when the transcutaneous technique based on external landmarks was used. Conclusions: Ultrasound guided percutaneous insertion was considered to be a safe and effective technique for the insertion of central venous catheters. Our study also demonstrated a decrease in operating times, when performed by operators with increasing expertise, increased preservation of the diameter of the venous lumen, and no increase in complication rates when the ultrasound-guided technique was selected.
... This technique is associated with several complications (infective and mechanical), so it must be strongly discouraged. [28][29][30][31] It also requires specialist surgical skills 31,32 and has higher performance costs. 33 Last but not least, in the event of repeated insertions, venous cutdown is inevitably associated with a progressive depletion of the vascular patrimony due to venous thrombosis and/or stenosis. ...
Introduction
Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment.
Methods
The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP.
Results and Conclusions
Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
Central Venous Catheters insertion is a very common procedure performed at the operation room and the Intensive Care Unit. In the paediatric population they are frequently used to administer fluids, blood products, resuscitation drugs, parenteral nutrition and chemotherapy. One of the reported complications, though a less commonly described one, is the inappropriate position of the tip of the CVC in a vessel other than the superior vena cava. In this study, we initially present the anatomy of the superior vena cava system and that of the internal jugular vein, the optimal catheter tip position as well as the possible suboptimal catheter tip locations. Subsequently, paediatric chest X-rays of our hospital with catheter tip malpositioning are illustrated, after internal jugular vein catheterization. Following, we discuss possible mechanisms of central venous catheters malpositioning, signs and symptoms which could help us identify a wrong placement and also how to prevent as well as how to fix one. Finally, an interrelation between malpositioning, malfunction and the existence of infection or thrombosis is investigated. Our study concluded that the right internal jugular vein should be the first choice in all cases of vessel implantation, mainly based on our statistical analysis results, which suggested that this vessel was associated with the least possibility of erroneous catheter placement. Another important clue of our study is based on the fact that the inappropriate positioning of a central venous catheter over the long term could be a significant predisposing factor of malfunction, along with infection and thrombosis.
CONTEXT: The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources.
OBJECTIVE: To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics.
DATA SOURCES: Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing
and Allied Health databases were systematically searched up to January 2015.
STUDY SELECTION: Included studies were of cohort design and examined the incidence of CVAD
failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure
was defined as CVAD loss of function before the completion of necessary treatment, and
complications were defined as CVAD-associated bloodstream infection, CVAD local infection,
dislodgement, occlusion, thrombosis, and breakage.
DATA EXTRACTION: Data were independently extracted and critiqued for quality by 2 authors.
RESULTS: Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and
methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI]
20.9%–29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71–2.23). The failure per CVAD
device was highest proportionally in hemodialysis catheters (46.4% [95%CI 29.6%–63.6%]) and per
1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4–39.8]). Totally
implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09–0.20]).
LIMITATIONS: The inclusion of nonrandomized and noncomparator studies may have affected the
robustness of the research.
CONCLUSIONS: CVAD failure and complications in pediatrics are a significant burden on the health
care system internationally.
