Multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominalradiographs because it overlaps with the inferior vena cava on anteroposteriorradiographs.Intensive observation by medical providers may be a cue fordiagnosis.However,knowledge of catheter misplacement of the right ascendinglumbar vein is also necessary,because misplacement cannot be suspected withoutthat awareness.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report

BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.

Viabahn Stent Graft for Inadvertent Insertion of a Central Venous Catheter in the Subclavian Artery

Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.

Peripheral Central Venous Catheter Induced Supraventricular Tachycardia in a Patient of Acute Lymphoblastic Leukemia

Central venous catheters (CVCs) are used in intensive care units (and, increasingly, in other locations) to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor haemodynamic status. The risk of complication during the insertion or exchange of central venous catheters has been well documented. The majority of complications involve mechanical problems, although rarely it may induce arrhythmias as well [1]. Herein we present a case of peripheral central venous catheter induced supraventricular tachycardia in a young patient of acute lymphoblastic leukemia.

Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients

Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Patient Satisfaction with and Acceptance of Their Totally-Implanted Central Venous Catheter: Construction and First Validation of a Questionnaire

Rationale: Most cancer patients require a totally-implanted Central Venous Catheter (CVC) for their treatment. We develop and validate a French-language questionnaire dubbed QASICC (Questionnaire for Acceptance of and Satisfaction with Implanted Central Venous Catheter) assessing patient satisfaction with and acceptance of their CVC.?Method: The construction and first validation of the questionnaire was made using validated methodology consisting in four phases. Phase 1 aimed at collecting a comprehensive list of relevant items. Phase 2 consisted in converting items into questions followed by a first item selection procedure. Phase 3 tested the acceptance of the provisional module to a small number of patients. Phase 4 involved a first validation on patients to determine its psychometric characteristics.?Results: Responses to the questionnaire were collected from 215 patients. The final tool included 27 questions assessing seven dimensions: pain, contribution to the comfort of the treatment, esthetics and privacy, impact on professional activities, social and sports, impact on daily activities, local discomfort and overall satisfaction.Conclusions: This first statistical validation seems very promising and allows us to confirm the structure and the psychometric properties of the tool. Further validation studies are required on standard and specific populations in order to confirm these first results.

A Fatal Complication of A Peripheral Venous Catheter

Peripheral venous catheters (PVC) are widely used in the hospital and seem to be innocent. However, complications can be devastating. We present a case of a fatal septic shock due to vertebral osteomyelitis after PVC-related Staphylococcus aureus bacteremia (SAB). Staphylococcus aureus is a leading cause of bacteraemia in both the community and the hospital with a significantly increased incidence over the last several decades. Intravascular catheters are the most common cause of SAB. Morbidity and mortality are high, even with appropriate therapy. Although complications are known and common, they may be difficult to recognize. Vertebral osteomyelitis is one of these known severe complications.

Study progress on relevant infection in central venous catheter led by parenteral nutrition of patients with tumor

With the wide application of parental nutrition(PN) and central venous catheter(CVC) to tumor patients, the relative infection led by CVC has become a common and troublesome hospital infection in clinics. During infusion, PN fluid forms a high-sugar and high-fat micro-environment around CVC, facilitating the adhesion, growth, and diffusion of pathogenic bacteria. This condition forms a bacterial biofilm(BF) consisting of one or several kinds of pathogenic bacteria. Upon formation of the film, pathogens in the BF can resist anti-bacterial drugs and immune cells, causing repeated infections of bacteria or fungi and endangering the lives of patients. In this paper, we summarize the applications of PN, characteristics of CVC infection in tumor patients, mixed BF, and related research methods to provide reference for studies of mixed BF infection of CVC.

Emergency service results of central venous catheters:Single center,1042 patients,10-year experience

BACKGROUND Central venous catheterization is currently an important procedure in critical care.Central catheterization has important advantages in many clinical situations.It can also lead to different complications such as infection,hemorrhage,and thrombosis.It is important to investigate critically ill patients undergoing catheterization.AIM To evaluate the characteristics,such as hospitalization,demographic characteristics,post-catheterization complications,and mortality relationships,of patients in whom a central venous catheter was placed in the emergency room.METHODS A total of 1042 patients over the age of 18 who presented to the emergency department between January 2005 and December 2015 were analyzed retrospectively.The patients were divided into three groups,jugular,subclavian,and femoral,according to the area where the catheter was inserted.Complications related to catheterization were determined as pneumothorax,guidewire problems,bleeding,catheter site infection,arterial intervention,and sepsis.Considering the treatment follow-up of the patients,three groups were formed as outpatient treatment,hospitalization,and death.RESULTS The mean age of the patients was 60.99±19.85 years;423(40.6%)of them were women.Hospitalization time was 11.89±16.38 d.There was a significant correlation between the inserted catheters with gender(P=0.009)and hospitalization time(P=0.040).Also,blood glucose,blood urea nitrogen,creatinine,and serum potassium values among the biochemical values of the patients who were catheterized were significant.A significant association was observed in the analysis of patients with complications that develop according to the catheter region(P=0.001)and the outcome stage(P=0.001).In receiver operating characteristic curve analysis of hospitalization time and mortality area under curve was 0.575,the 95%confidence interval was 0.496-0.653,the sensitivity was 71%,and the specificity was 89%(P=0.040).CONCLUSION Catheter location and length of stay are important risk factors for catheter-borne infections.Because the risk of infection was lower than other catheters,jugular catheters should be preferred at entry points,and preventive measures should be taken by monitoring patients closely to reduce hospitalization infections.

Influence of tissue pressure on central venous pressure/peripheral venous pressure correlation： An experimental report

BACKGROUND： Peripheral venous pressure （PVP） has been shown to correlate with central venous pressure （CVP） in a number of reports. Few studies, however, have explored the relationship between tissue pressure （TP） and PVP/CVP correlation. METHODS： PVP and CVP were simultaneously recorded in a bench-top model of the venous circulation of the upper limb and in a single human volunteer after undergoing graded manipulation of tissue pressure surrounding the intervening venous conduit. Measures of correlation were determined below and above a point wherein absolute CVP exceeded TP. RESULTS： Greater correlation was observed between PVP and CVP when CVP exceeded TP in both models. Linear regression slope was 0.975 （95% CI： 0.959-0.990）; r2 0.998 above tissue pressure 10 cmH20 vs. 0.393 （95% CI： 0.360-0.426）; and r2 0.972 below 10 cmH2O at a flow rate of 2000 mL/h in the in vitro model. Linear regression slope was 0.839 （95% CI： 0.754-0.925）; r2 0.933 above tissue pressure 10 mmHg vs. slope 0.238 （95% CI： -0.052-0.528）; and r20.276 in the en vivo model. CONCLUSIONS： PVP more accurately reflects CVP when absolute CVP values exceed tissue pressure.

Sonographic guidance for tunneled central venous catheters insertion in pediatric oncologic patients: guided punctures and guide wire localization

Objective Totally implantable devices (TIDs) and external tunneled catheters (ETCs) became a basic requirement in the treatment of pediatric oncologic patients. Techniques for implantation and confirmation of proper position vary among different centers. The article presented different techniques for sonographic guided puncture of the target central vein and confirmation of the proper position of tunneled catheters.

Incidence and Predictors of Peripheral Venous Catheter-Related Complications in Hospitals in Burkina Faso

Introduction: Peripheral venous catheters (PVCs) are the most commonly used medical devices in hospitals for the administration of medications. Their use can lead to complications of varying severity. Objective: Determine the incidence and factors associated with the occurrence of PVC-related complications. Methods: This was a two-month prospective observational study conducted in the Medical Emergency Department (MED) of Yalgado Ouedraogo Teaching Hospital in Ouagadougou. All patients admitted during the study period who had a PVC inserted and removed were included in the study. Logistic regression analysis was used to identify the factors associated with the occurrence of complications. Results: In total, 459 PVCs were inserted and removed in 415 patients hospitalized at the Medical Emergency Department during the study period. The placement of 37.7% (n = 173) of PVCs resulted in complications in 131 patients (31.6%). For 644.3 days of catheterization, the incidence density was estimated at 6.5 complications per 1000 patient days. Phlebitis (24.0%), infection (5.7%), and accidental removal (2.8%) were the most frequently identified complications. The average age of the patients was 46.8 ± 18.9 years with a sex ratio of 1.22. The average patient hospitalization duration was 2.5 ± 2.6 days. In multivariate analysis, the factors significantly associated with the occurrence of complications after PVC insertion were patient’s state of agitation during the procedure (aOR = 12.59;95% CI = 4.12 - 38.49), placement of the PVC at the elbow bend (aOR = 2.17;95% CI = 1.86 - 5.52), multiple attempts (aOR = 3.18;95% CI = 1.49 - 6.75), administration of 10% hypertonic glucose solution (aOR = 3.67;95% CI = 1.62 - 8.33), and duration of catheterization beyond 72 hours without being changed (aOR = 33.00;95% CI = 14.19 - 76.75). Conclusion: The incidence of PVC-related complications was relatively high. The identification of the factors that can lead to these complications is relevant to the delivery of quality healthcare to patients.

Ultrasound-Guided Central Venous Catheterization: A Protocol to Be Followed in Pediatrics?

Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period from February to October 2016 involving 144 inpatients at PICU of Irmandade da Santa Casa de Sao Paulo Hospital, undergoing central venous catheterization. The patients were matched in pairs of identical patients according to the levels of potentially intervening variables (age, nutritional status, puncture site, professional experience), differing only as to the CVC technique: ultrasound-guided (USG-CVC) or conventional (C-CVC). Discarding data from non-paired patients, the remaining did forming 47 pairs, matched as two related samples: USG-CVC and C-CVC groups. Success parameters: number of puncture attempts;time spent at CVC;success rate and complications. Results: In the USG-CVC group, the number of attempts (mean = 2.04) and the time spent at catheterization (mean = 11.89 minutes) were lower (t = 2.34, df = 46, t 0.95 = 2.02, p t = 3.07, df = 46, t 0.95 = 2.02, p < 0.05), respectively, when compared to the results obtained for the control group (C-GVC), (mean = 3.21) and (mean = 28.26 minutes), respectively. As to success, there was observed a significant difference (F (1, 46) = 16.6;Q (1) = 12.5, p < 005) when considering only one trial (USG -CVC = 27/47;C-CVC = 9/47), but no significant difference (F (1, 46) = 3.76;Q (1) = 3.56, p > 0.05) when considering several attempts. Complications were found less frequently in the USG-CVC group (3/47) than in the CVC-C (13/47), (F (1, 46) = 8.24;Q (1) = 7.14, p < 0.05). Conclusion: USG-CVC was found to be more effective than the conventional technique, especially regarding success at the first puncture attempt.

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm(2022 Edition)

With the widespread adoption of ultrasound guidance,Seldinger puncture techniques,and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years,an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices(TIVADs)in the upper arm.This approach has the advantage of completely avoiding the risks of hemothorax,pneumothorax,and neck and chest scarring.Medical specialties presently engaged in this study in China include internal medicine,surgery,anesthesiology,and interventional departments.However,command over implantation techniques,treatment of complications,and proper use and maintenance of TIVAD remain uneven among different medical units.Moreover,currently,there are no established quality control standards for implantation techniques or specifications for handling complications.Thus,this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach,reduce complication rates,and ensure patient safety.This consensus elaborates on the technical indications and contraindications,procedures and technical points,treatment of complications,and the use and maintenance of upper-arm TIVAD,thus providing a practical reference for medical staff.

Focus on peripherally inserted central catheters in critically ill patients

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.

Upper body peripherally inserted central catheter in pediatric single ventricle patients

BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement.This complication is more serious among patients with single ventricle physiology,as it might preclude them from undergoing further life-sustaining palliative surgery.AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters(PICCs)in children with single ventricle physiology.METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure.Clinical data including ultrasonography,cardiac catheterization,echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels.Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter(CVC),and use of anticoagulation were recorded.RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses,of which 56(73%)had an upper extremity PICC at some point prior to this procedure.Median duration of PICC usage was 24 d(25%,75%:12,39).Seventeen patients(30%)with PICCs also had internal jugular or subclavian central venous catheters(CVCs)in place at some point prior to their superior cavopulmonary anastomoses,median duration 10 d(25%,75%:8,14).Thrombus was detected in association with 2 of the 56 PICCs(4%)and 3 of the 17 CVCs(18%).All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients.No patients developed clinically significant venous stenosis.CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheterassociated thrombosis.

Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients

Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.