Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in c...Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.展开更多
Objective To discuss the mechanism,clinical features,complications,diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Methods The diagnosis criteria and tr...Objective To discuss the mechanism,clinical features,complications,diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Methods The diagnosis criteria and treatment of 2 cases of intracardiac migration of the distal catheter of展开更多
Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is st...Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is still the thorny issue during our clinical practice. Then the reset surgery is often required to be taken again. Nowadays, laparoscopic peritoneal dialysis catheter draws our attention due to its advantages of accurate positioning, smaller incision, and less pain, and its clinical application has been limited. While laparoscopic surgery is recognized, there are few relevant studies on whether there is difference during the catheter reset process between the two surgical approaches. In this study, we mainly discussed the rate of secondary catheter migration, the incidence of complications after catheter reset for two surgical approaches and the hospital stay as well as the total clinical cost for the two surgical approaches. In this study, we retrospectively analyzed 25 cases of end-stage renal disease, who received catheterization for peritoneal dialysis and regular peritoneal dialysis in our hospital from March 2010 to December 2013, and had a medical history of catheter migration. We collected the relevant clinical data for all patients. Fifteen patients selected laparoscopic catheter reset, and 10 patients selected the traditional surgical method for catheter reset by themselves. For all patients enrolled, we analyzed the incidence of secondary catheter migration and postoperative complications, hospitalization time, and total cost for different methods of reset. Through the studies above, we found that laparoscopic peritoneal dialysis catheter surgery offered accurate catheter location and a small incision that was easy to heal. Besides, the incidence of postoperative complications for the laparoscopic surgery was lower than that for traditional surgical approach for catheter reset. The average hospitalization time for laparoscopic surgery was shorter than that for the traditional surgical approach. The total cost of laparoscopic surgery was more than that of the traditional surgery. Therefore, the rational application of a laparoscopic peritoneal dialysis catheter and reset surgery can increase the success rate of peritoneal dialysis, reduce the complications, shorten hospitalization time of patients, and thus enhance patient＇s confidence to stick it out.展开更多
BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelv...BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.AIM To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.METHODS Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study.The patients were divided into two groups based on the procedure performed:Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017.We recorded patient character istics and catheter complications over a two-year follow-up period.In addition,postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.RESULTS The no-tunnel and tunnel groups included 115 and 107 patients,respectively.Compared to the no-tunnel group,the tunnel group showed lesser catheter angle deviation toward the pelvis(15.51±11.30 vs 25.00±23.08,P=0.0002)immediately after the operation,and a smaller range of migration within 2 years postoperatively(13.48±10.71 vs 44.34±41.29,P<0.0001).Four events of catheter dysfunction due to migration were observed in the no-tunnel group,and none occurred in the tunnel group.There was no difference in the two-year catheter function survival rate between the two groups(88.90%vs 84.79%,P=0.3799).CONCLUSION The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration,thus preventing catheter dysfunction.展开更多
In the text, the authors present a successful treatment of an 8-year-old hydrocephalic girl with retained infected ventricular catheter. Altogether, there have been 56 recorded cases of intraventricular catheter migra...In the text, the authors present a successful treatment of an 8-year-old hydrocephalic girl with retained infected ventricular catheter. Altogether, there have been 56 recorded cases of intraventricular catheter migration, including only 5 of infected shunt. In the case described, the first attempt to remove the lost catheter endoscopically was unsuccessful which was the reason for an inflammation’s spread. Only by means of fluoroscopy-assisted endoscopy was it possible to remove the free-floating infected shunt drain from the lateral ventricle during another surgery. In order to prevent immediate or delayed infection complications, the authors postulate a complete removal of a retained ventricular catheter from every patient.展开更多
文摘Background: Chemotherapy in colorectal cancer is usually administered as continuous infusion of 5-fluorouracil, often in combination with oxaliplatin or irinotecan. Targeted drugs are most efficient and tolerable in conjunction with continuous infusion dosing. Implanted venous access devices (VAD) are the prerequisite for continuous infusion administration. The reported catheter migration frequency with VAD is 0% - 3.5%. The purpose of this case-control study was to evaluate the predisposing factors of catheter migration. Methods: We inserted VADs in 88 radically operated colorectal cancer patients randomized to adjuvant 48-hour-infusion chemotherapy repeated every 14 days, altogether 12 times over 24 weeks. Three out of 88 patients (3.4%) had a symptomatic catheter migration from the superior caval vein into the internal jugular vein. The fourth case had chemotherapy for osteosarcoma. These 4 cases were compared with 12 controls from the same 88 patient study population, matched for age, sex, body mass index (BMI), physical activity level and right subclavian insertion site. Tip position, port model, complications, catheter length and material was studied. The post insertion catheter tip position in the chest X-ray was numbered from 1 (in subclavia) to 8 (in atrium). Results: The four cases, all male, had a median position of 3 (range 3 - 4) and controls 6 (range 4 - 8), P = 0.004, median difference 3 (CI95% 1 - 5). At notification of migration the patients had experienced discomfort in the neck region starting 5 to15 days before at strenuous upper extremities activity with Valsalva maneuvers. Conclusion: Optimal catheter tip position when sitting is in the right atrium or low in the superior vena cava to avoid migration. Patients with VADs should avoid strenuous activity with Valsalva maneuvers.
文摘Objective To discuss the mechanism,clinical features,complications,diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Methods The diagnosis criteria and treatment of 2 cases of intracardiac migration of the distal catheter of
文摘Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is still the thorny issue during our clinical practice. Then the reset surgery is often required to be taken again. Nowadays, laparoscopic peritoneal dialysis catheter draws our attention due to its advantages of accurate positioning, smaller incision, and less pain, and its clinical application has been limited. While laparoscopic surgery is recognized, there are few relevant studies on whether there is difference during the catheter reset process between the two surgical approaches. In this study, we mainly discussed the rate of secondary catheter migration, the incidence of complications after catheter reset for two surgical approaches and the hospital stay as well as the total clinical cost for the two surgical approaches. In this study, we retrospectively analyzed 25 cases of end-stage renal disease, who received catheterization for peritoneal dialysis and regular peritoneal dialysis in our hospital from March 2010 to December 2013, and had a medical history of catheter migration. We collected the relevant clinical data for all patients. Fifteen patients selected laparoscopic catheter reset, and 10 patients selected the traditional surgical method for catheter reset by themselves. For all patients enrolled, we analyzed the incidence of secondary catheter migration and postoperative complications, hospitalization time, and total cost for different methods of reset. Through the studies above, we found that laparoscopic peritoneal dialysis catheter surgery offered accurate catheter location and a small incision that was easy to heal. Besides, the incidence of postoperative complications for the laparoscopic surgery was lower than that for traditional surgical approach for catheter reset. The average hospitalization time for laparoscopic surgery was shorter than that for the traditional surgical approach. The total cost of laparoscopic surgery was more than that of the traditional surgery. Therefore, the rational application of a laparoscopic peritoneal dialysis catheter and reset surgery can increase the success rate of peritoneal dialysis, reduce the complications, shorten hospitalization time of patients, and thus enhance patient＇s confidence to stick it out.
文摘BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.AIM To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.METHODS Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study.The patients were divided into two groups based on the procedure performed:Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017.We recorded patient character istics and catheter complications over a two-year follow-up period.In addition,postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.RESULTS The no-tunnel and tunnel groups included 115 and 107 patients,respectively.Compared to the no-tunnel group,the tunnel group showed lesser catheter angle deviation toward the pelvis(15.51±11.30 vs 25.00±23.08,P=0.0002)immediately after the operation,and a smaller range of migration within 2 years postoperatively(13.48±10.71 vs 44.34±41.29,P<0.0001).Four events of catheter dysfunction due to migration were observed in the no-tunnel group,and none occurred in the tunnel group.There was no difference in the two-year catheter function survival rate between the two groups(88.90%vs 84.79%,P=0.3799).CONCLUSION The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration,thus preventing catheter dysfunction.
文摘In the text, the authors present a successful treatment of an 8-year-old hydrocephalic girl with retained infected ventricular catheter. Altogether, there have been 56 recorded cases of intraventricular catheter migration, including only 5 of infected shunt. In the case described, the first attempt to remove the lost catheter endoscopically was unsuccessful which was the reason for an inflammation’s spread. Only by means of fluoroscopy-assisted endoscopy was it possible to remove the free-floating infected shunt drain from the lateral ventricle during another surgery. In order to prevent immediate or delayed infection complications, the authors postulate a complete removal of a retained ventricular catheter from every patient.
