Figure 2 - uploaded by Ahmad Razali Md Ralib
Content may be subject to copyright.
Lateral radiograph showing the translumbar chemoport. The tip of the catheter is near the cavaatrial junction (black arrow), and the subcutaneous port is seen anterolaterally (white arrowhead).
Source publication
Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of...
Citations
... Among the alternatives, the radiology team decided to cannulate the inferior vena cava through the middle hepatic vein as it is relatively easier, and the team was well experienced with this approach. [1][2][3][4] However, the catheters used routinely for central venous access in children are typically shorter in length than needed for such an approach. The radiologists generally use a catheter with peel-off sheath with sequential dilatation method (Seldinger technique) in these situations. ...
... Under direct visualization the HD catheter is then passed in such a manner that the catheter tip is positioned at the junction of the IVC and the right atrium. For this approach preliminary data suggests that the rate of catheter thrombosis, fibrin sheath formation and infection parallel those of more traditional access sites [44][45][46][47][48]. The cumulative patency rate for this approach reported was 52% at 6 months and 17% at 12 months [43]. ...
Purpose:
This review aims to examine the reported complications associated with IVC catheterization and investigate the reasons for discrepancies between reports.
Materials and methods:
The Cochrane Library trials register, PubMed, EMBASE, and Scopus databases were systematically searched for studies that included any terms for IVC and phrases related to catheters or central access. Of 5075 searched studies, 137 were included in the full-text evaluation. Of these, 37 studies were included in the systematic review, and the adverse events reported by 16 of these 37 identified studies were analyzed. An inverse-variance random-effects model was used to conduct the meta-analysis. Outcomes were summarized by the incidence rate (IR) and 95% confidence interval (CI).
Results:
Compared with catheters < 10 Fr (IR 0.08; %95 CI 0.03, 0.12), the incidence of catheter-related infections per 100 catheter days was 0.2 more for catheters ≥ 10 Fr (IR 0.28; %95 CI 0.25, 0.31). Also, dual-lumen catheters showed 0.13 more malfunction per 100 catheter-days (IR 0.27; %95 CI 0.16, 0.37) than single-lumen catheters (IR 0.14; %95 CI 0.09, 0.19). Both differences were statistically significant. Other complications were malposition 0.04 (95% CI; 0.04, 0.05), fracture 0.01 (95% CI; 0.00, 0.02), kink 0.01 (95% CI; 0.00, 0.01), replaced catheter 0.2 (95% CI; 0.1, 0.31), removal 0.13 (95% CI; 0.1, 0.16), IVC thrombosis 0.01 (95% CI; 0.00, 0.03), and retroperitoneal hematoma 0.01 (95% CI; 0.00, 0.01), all per 100 catheter-days.
Conclusion:
Translumbar IVC access is an option for patients with exhausted central veins. Small-caliber catheters cause fewer catheter-related infections, and single-lumen catheters function longer.
Introduction: The complex, long-term hospitalized patient that is unable to be discharged with multiple comorbidities (pressure ulcers, ventilator dependent, renal failure) and on total parenteral nutrition (TPN) is often the most challenging to provide prolonged central venous access. Implementation of the ultrasound assessment protocols of the rapid peripheral vein assessment (RaPeVA), rapid central vein assessment (RaCeVA), rapid femoral vein assessment (RaFeVA), and the decision tool for vascular exit site and tunneling options (RAVESTO) provides clinicians with a clear map of viable insertion and exit site options. Patient safety and procedural success are ensured following the protocols for the Safe Insertion of Peripheral central catheters (SIP), the Safe Insertion of Central catheters (SIC), and the Safe Insertion of Femoral catheters (SIF). In challenging patients with tracheostomy secretions, anasarca, implantable cardiac devices, and morbid obesity, advanced knowledge and training are essential for complex ultrasound-guided approaches, and the application of multiple insertion and tunneling techniques. Case Report: This is a 26-year-old male with a past medical history significant for tuberculosis, hyperthyroidism, ventricular disease, anemia, and autism who presented to the ED 2 years and 3 months ago with fever, tachycardia, diarrhea, and weight loss for a duration of 4 months. During the course of this patient’s hospitalization the patient has had multiple episodes of sepsis, thyrotoxicosis, cardiac arrest with anoxic brain injury currently in a vegetative state, intubation followed by tracheostomy, now ventilator-dependent, acute renal injury evolving into chronic renal disease stage 4, seizure disorder, compartment syndrome with fasciotomy to the left forearm, DIC syndrome, pneumopericardium, pneumoperitoneum, right-sided pleural effusion, pneumonia, multiple areas of perforated bowel from military tuberculosis (TB) and on total parenteral nutrition (TPN). The palliative care team continues to follow the patient due to poor prognosis, but the family insists on full code status. This case was referred to the ethics committee. The vascular access service has been consulted 23 times for central access, with 9 additional central line catheters placed by the medical and surgical services over the past 27 months. Conclusion: Successful ultrasound-guided bedside central venous access options in the long-term complex hospitalized patient requires thorough assessment skills combined with the knowledge of and the ability to perform a multitude of approaches and techniques.
Purpose:
To evaluate the rate and types of complications after minimally invasive radiological central vein port implantation without ultrasound guidance.
Materials and methods:
We retrospectively evaluated 8654 patients who underwent port implantations in the subclavian vein without ultrasound guidance in our institution from 1998 to 2014 with regard to types and rates of peri-, early and late post-interventional complications according to the common classification for complications published by the Society of Interventional Radiology (SIR). Additionally, the impact of the training level of the operators on the rate of complications was analyzed.
Results:
Successful port implantations were performed in 99.8% (8636/8654 procedures). From 1998 to 2014, a total of 565 (6.52%) complications were recorded. The overall percentage of the peri-, early and late post-interventional complications according to the SIR criteria was 1.69, 0.15 and 4.68, respectively. Significant differences due to the training level of the performing physician could be seen for the rates of pneumothorax, arterial puncture and hematoma.
Conclusion:
Minimally invasive radiological interventional port implantation is a safe treatment option with a low rate of complications even without ultrasound guidance.
Intestinal failure is associated with the inability to maintain protein, energy, electrolyte, fluid, or micronutrients balance while receiving a conventional diet. Subsets of inflammatory bowel disease (IBD) patients require total parenteral nutrition (TPN) as a result of extensive small bowel damage, obstruction, or resection that prevents adequate enteral nutrition. In these patients, TPN represents an essential modality to hasten further nutritional deficiency, restore nutritional homeostasis, and prevent long term complications of nutritional deficiency. Specific indications for TPN in IBD include supportive therapy, life sustaining therapy, volume and calorie replacement, perioperative nutritional support, and gut rest. Patients being treated with TPN have been shown to benefit the most from a home parenteral nutrition treatment plan due to its success in avoiding hospitalization and associated costs.
Given the changing climate of health care and the imperative to add value, radiologists must join forces with the rest of medicine to deliver better patient care in a more cost-effective, evidence-based manner. For several decades, interventional radiology has added value to the health care system through innovation and the provision of alternative and effective minimally invasive treatments, which have decreased morbidity, mortality, and overall cost. The clinical practice of interventional radiology embodies many of the features of Imaging 3.0, the program recently launched by the ACR. We provide a review of some of the major contributions made by interventional radiology and offer general principles from that experience, which are applicable to all radiologists.
Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.
