Radiologically placed tunneled internal jugular catheters in the management of chronic hemodialysis and long-term infusion therapies in the pediatric population

PURPOSE: To evaluate the long-term outcomes of radiologically inserted dual-lumen hemodialysis and infusion catheters in pediatric patients. MATERIALS AND METHODS: The authors retrospectively reviewed the outcomes of 114 tunneled internal jugular catheters in 71 consecutive pediatric patients between March 2003 and May 2006. Forty hemodialysis catheters were placed in 23 patients (11 girls, 12 boys), and 74 infusion catheters were placed in 48 patients (14 girls, 34 boys). The mean patient age was 11.2 years (range, 1-16 years) in the hemodialysis group and 7.86 years (range, 4 months to 16 years) in the infusion group. RESULTS: The technical success rate was 100%. The mean duration of catheter use was 84 days (range, 5-730 days) in the hemodialysis group and 58 days (range, 3-206 days) in the infusion group. Nine hemodialysis (22%) and 29 infusion (39%) catheters were electively removed. The most common reasons for catheter removal were malfunction (22%) in the hemodialysis group and completion of therapy (39%) in the infusion group. Revisions were performed at a rate of 0.6 and 0.4 per 100 catheters days in the hemodialysis and infusion groups, respectively. Total infection rates were 0.15 and 0.38 episodes per 100 catheter days in hemodialysis and infusion catheters, respectively. Mean primary device service intervals were 86 and 60 days for hemodialysis and infusion catheters, respectively, with total access site service intervals of 140 and 71 days. CONCLUSION: Radiologically placed tunneled internal jugular catheters appear to be safe and effective, with very low complication rates for both hemodialysis and long-term infusion therapies. Higher infection rates were seen in patients with cancer.     

颈内静脉置管在血液透析临时性血管通路中的临床应用

目的观察双腔颈内静脉置管作为临时性血液透析血管通路的临床应用,总结临床应用经验。方法回顾分析我科2005—2008年154例终末期肾脏病患者采用局麻下selding技术行颈内静脉置管术建立临时血透血管通路的临床资料,观察置管相关并发症。结果实施临时性颈内静脉置管术154例,其中149例患者穿刺插管成功。穿刺成功率为96.75%;静脉置管留置时间为1～1.5个月,应用良好;感染发生率为4%,感染发生时间多在颈内静脉置管术后3周,常见病原菌依次为:金黄色葡萄球菌(4例)、枯草杆菌(1例)、鲍氏不动杆菌(1例),其中1例患者并发真菌感染,给予拔管。血栓形成5例,发生率为3.36%。局部渗血、血肿形成7例,发生率为4.7%。结论颈内静脉穿刺插管术是一项安全、有效、方便的深静脉置管技术,对于需要临时留置导管者,是一项很好的选择。     

Use of the brachiocephalic vein for placement of tunneled hemodialysis catheters

OBJECTIVE: The purpose of this study was to evaluate the use of the brachiocephalic vein as an alternative access site for the insertion of tunneled hemodialysis catheters in patients with occluded jugular veins. CONCLUSION: Placement of brachiocephalic catheters for central venous access is safe and provides an alternative access in patients with internal and external jugular vein occlusion.     

Internal jugular vein thrombosis associated with hemodialysis catheters

PURPOSE: To determine the prevalence of internal jugular vein thrombosis among patients undergoing hemodialysis in whom tunneled dialysis catheters were placed by interventional radiologists and to evaluate potential risk factors for thrombosis, such as the number of catheters inserted per patient through the right internal jugular vein, catheter type and material, total catheter days, and catheter-associated infection. MATERIALS AND METHODS: Ultrasonographic (US) evaluation of the right internal jugular vein was performed by interventional radiologists in 143 patients with a history of dialysis catheter placement. The examination focused on the detection of right internal jugular vein thrombosis, with or without occlusion. Total catheter days, catheter type, and catheter-related complications, most notably infection, were evaluated with database analysis for possible association with subsequent development of thrombosis. Statistical analysis of potential risk factors was performed with logistic regression models and chi2 tests. RESULTS: Evidence of right internal jugular vein thrombosis was present in 25.9% of the patients enrolled in the study. Among the veins with thrombosis, 62% were occluded. Only the mean number of catheters placed in the right internal jugular vein per patient was significant below the level of P =.20; therefore, a multivariate logistic regression model was not used. CONCLUSION: Prevalence of internal jugular thrombosis, both complete and incomplete, was higher in the study population than previously reported. The risk factors that were analyzed demonstrated no statistically significant association with development of thrombosis.     

Use of the femoral vein as insertion site for tunneled hemodialysis catheters

PURPOSE: To determine the outcome of tunneled hemodialysis catheters inserted through the common femoral vein. MATERIALS AND METHODS: From April 2000 to June 2003, 33 consecutive patients had 86 tunneled hemodialysis catheters inserted through the femoral vein. There were 14 male and 19 female patients with a mean age of 56 years. Seventeen patients had bilateral central venous and/or superior vena cava (SVC) occlusions, 12 patients had unilateral central venous occlusions and were to receive contralateral arteriovenous fistulas or arteriovenous polytetrafluoroethylene grafts, and 4 patients received femoral catheters for other reasons. The technical success, complications, and clinical outcomes of these procedures were retrospectively evaluated. RESULTS: All procedures were technically successful. Fifty-seven catheters were inserted into the right femoral vein and 29 into the left femoral vein. This included 25 catheter exchanges in 13 patients. Two patients developed thigh hematomas. Follow-up data were available for 68 catheters; mean follow-up period was 51 days with a total of 3,484 catheter days. The catheter-related infection rate was 6.3 per 1,000 catheter days; 22 catheters were removed for infection. Eighteen catheters were removed because of poor blood flows (<200 mL/min). Thirteen catheters were removed because they had become retracted. Primary catheter patency was 44% at 1 month. CONCLUSIONS: The femoral vein provides an alternative access site for insertion of tunneled hemodialysis catheters when conventional sites are not available. However, tunneled femoral hemodialysis catheters have low primary patency rates and significant complications. Catheter retraction is a unique and common problem.     

颈内静脉置管建立临时性血液透析通路

血液透析是抢救和治疗各种急慢性肾功能衰竭、中毒、急性左心衰的重要手段,临床上各种急诊和短时血液透析非常常见。建立良好的临时性血管通路是进行急诊和短时血液透析的关键步骤。我们自     

Use of the right external jugular vein as the preferred access site when the right internal jugular vein is not usable

PURPOSE: The present study describes the authors' experience with central venous access through the right external jugular vein (EJV) when the right internal jugular vein (IJV) is not available. MATERIALS AND METHODS: A retrospective study of 23 patients in whom a central venous catheter placement was attempted via the right EJV was conducted. The reasons for catheterization via the right EJV included clinically silent occlusion of the right IJV (n = 17), localized skin infection overlying the right IJV related to a previous catheterization (n = 3), presence of an existing Hickman catheter in the right IJV (n = 1), and concern regarding the risk of catheter-related infection secondary to right IJV catheterization in patients with a tracheostomy tube device adjacent to the presumed site of right IJV catheterization (n = 2). Technical success, procedural complications, and follow-up results including catheter dwell time and delayed or late complications (eg, symptomatic venous thrombosis, catheter-related infection, and catheter malfunction) were assessed. Adverse events were expressed as events per 100 catheter-days of use. RESULTS: Technical success was achieved in 22 of 23 patients (96%). There were no procedural complications. The catheter dwell time ranged from 2 to 182 days, with a mean dwell time of 62.7 days. There were four delayed or late complications (three catheter-related infections, 0.22 per 100 catheter-days; one catheter malfunction, 0.07 per 100 catheter-days). No cases of symptomatic venous thrombosis were noted. CONCLUSION: The right EJV is an acceptable and preferred access site when the right IJV is not available for central venous catheterization.     

Analysis of early failure of tunneled hemodialysis catheters

OBJECTIVE: Tunneled hemodialysis catheters are often placed by the interventional radiology service using sonographic guidance and fluoroscopy for safe and optimal placement. The aim of this study was to determine the causes of early failure (相似文献   

Transjugular liver biopsy via the left internal jugular vein

PURPOSE: To retrospectively review the indications and outcomes of transjugular liver biopsy (TJLB) with the left internal jugular vein (IJV) approach. MATERIALS AND METHODS: A retrospective review of all TJLBs performed at one institution was performed. From August 1995 to October 2004, 293 liver biopsies were performed. Nineteen of the 293 procedures (6.5%) were performed from the left IJV in 17 patients. There were 11 men and six women aged 36-59 years (mean, 49.3 years). All patients were suspected of having diffuse hepatic parenchymal disease and had contraindications to conventional percutaneous liver biopsy. The stiff metal biopsy cannula was advanced across the mediastinum and through the heart over a stiff guide wire. Biopsy was performed from the right hepatic vein in 15 procedures, the middle hepatic vein in two, and the intrahepatic IVC in two. RESULTS: The indications for using the left IJV approach were nonusable right IJV in 12 procedures, difficult previous catheterization of the hepatic veins from the right IJV due to distorted hepatic anatomy in six procedures, and the operator's predilection for this approach in one procedure (the patient had previously undergone liver transplantation). All biopsies were successful, with diagnostic tissue obtained in 100% of cases. Two patients had chest pain during the procedure associated with placement of the rigid cannula through the mediastinal veins. One patient had a vaso-vagal episode that necessitated the use of intravenous atropine but subsequently underwent successful biopsy. All episodes of chest pain resolved after the cannula was removed. There were no recorded hemorrhagic or cardiac complications. CONCLUSION: TJLB can be safely and repeatedly performed from the left IJV when the right IJV is not available or the hepatic anatomy prevents catheterization of the hepatic veins from the right IJV.     

Tunneled internal jugular catheters in adult patients: comparison of outcomes in hemodialysis versus infusion catheters

Background: Tunneled central venous catheters placed by interventional radiologists are now widely used for hemodialysis and infusion therapies throughout the world. However, complications such as infections and malfunctions still remain a major concern in oncology and hemodialysis patients.

Purpose: To evaluate the long-term follow-up results of tunneled central venous catheters in an adult population in terms of infectious complications and malfunction rates in dialysis and oncology patients.

Material and Methods: We retrospectively reviewed the hospital charts and our electronic database for 434 tunneled internal jugular catheters in 335 consecutive patients between December 2002 and March 2006. Mean patient age was 57 years (range 23-86 years) in the hemodialysis group and 45 years (range 18-83 years) in the infusion group. A total of 224 hemodialysis catheters were placed in 168 patients (68 females, 100 males) and 210 infusion catheters in 167 patients (48 females, 119 males).

Results: Technical success rate was 100%. Mean duration of catheter use was 86 days (1-652 days) and 60 days (2-686 days) for hemodialysis and infusion catheters, respectively. A total of 107 hemodialysis (47%) and 95 infusion catheters (45%) were electively removed due to completion of therapy and resolution of need for dialysis. Revisions were performed 0.22 and 0.11 per 100 catheters days in the hemodialysis and infusion groups, respectively. Our total infection rate was 0.10 episodes per 100 catheter days, and the rate of infections necessitating catheter removal was 0.05 episodes per 100 catheter days in the hemodialysis group, which is lower than that reported in other big series. However, in the infusion group, the rate of infections necessitating catheter removal was 0.28 episodes per 100 catheter days.

Conclusion: Long-term central venous accesses using tunneled internal jugular catheters appeared to be safe and effective for both hemodialysis and long-term infusion therapies, with relatively higher infection rates in oncologic patients.     

Exchange of poorly functioning tunneled permanent hemodialysis catheters.

OBJECTIVE: The usefulness of exchanging poorly functioning tunneled permanent hemodialysis catheters in patients with end-stage renal disease was evaluated. MATERIALS AND METHODS: We retrospectively reviewed case histories of 51 consecutive patients who underwent 88 catheter exchanges because of poor flow rates. All hemodialysis catheters were initially placed by the radiology service using image guidance. Catheter exchanges were performed through the existing subcutaneous tract over two stiff hydrophilic guidewires and without additional interventions such as fibrin sheath stripping or venoplasty. Life table analysis was performed to evaluate catheter patency rates after initial placement (primary patency) and after multiple exchanges (secondary patency). RESULTS: The technical success rate for hemodialysis catheter exchange was 100%. Primary catheter patency was 42% at 60 days and 16% at 120 days. Secondary patency was 92% at 60 days and 82% at 120 days. The cumulative infection rate was 1.1 per 1000 catheter days. No complications from the procedure occurred. CONCLUSION: Catheter exchange is an effective means of prolonging catheter patency in patients with end-stage renal disease and limited central venous access.     

Placement of port-a-cath through the right internal jugular vein under ultrasound guidance

Purpose

This study was undertaken to demonstrate the effectiveness of ultrasound (US)-guided placement of porta-cath (PC) through the right internal jugular vein (RIJV) by evaluating the onset of early and late complications.

Materials and methods

From 30 June 2008 to 30 June 2011, we placed 695 port-a-caths in 694 patients with a mean age of 58 years. Exclusion criteria were active infection, bleeding disorders and life expectancy <6 months. The procedures were performed in the angiography suite under local anaesthesia. After US-guided puncture of the RIJV, the subcutaneous pocket was prepared, followed by tunnelling of the vein and closure of the surgical wound. In order to evaluate pneumothorax (PNX), all patients underwent chest X-ray a few hours after the end of the procedure unless there were clinical indications. We evaluated the technical success of the procedure and the rate of complications.

Results

Technical success was achieved in all cases. The device was kept in place for an average of 168 days. There was one case of PNX (0.14%) as shown on chest X-ray and five cases of late complications (0.70%): one case of intracatheter thrombosis (0.14%), two cases of disconnection between the reservoir and catheter (0.28%) and two cases of PC infection (0.28%).

Conclusions

This procedure incurs very small number of complications compared with other positioning techniques using accesses such as the subclavian vein. Complications recorded in our study are comparable, in type and incidence, to those found by other authors, with the most frequent being device infection.     

Impact of tip culture on the management of infected tunneled hemodialysis catheters

PURPOSE: It is common practice to perform culture of the tip of a catheter when a previously indwelling vascular catheter is removed for presumed infection. This study was conducted to determine the effect of hemodialysis catheter tip cultures (CTCs) on patient management. MATERIALS AND METHODS: Patients whose tunneled hemodialysis catheter (TDC) was removed for infection and who had a CTC between July 2001 and June 2006 were identified. The study sample included 242 patients with 330 catheters (109 men, 133 women). Patients' mean age was 58 years (range, 22-94 y). Catheter tip and blood culture (BC) results obtained during the event leading to catheter removal were recorded. Antimicrobial therapy before and after cultures was recorded. Medical records were reviewed for any indication that the treatment plan was influenced by tip culture results. RESULTS: Of 330 catheters, 134 had positive CTC findings; of these, complete records were available for 52 catheters. The treatment plan for patients with suspected catheter-related bloodstream infection (CRBSI) leading to TDC removal did not change in response to semiquantitative CTC results (51 of 52 patients; 98%). In a single case in which CTC results impacted management, this was because of a delay in processing BCs. Negative CTC findings (n = 108) never changed management (ie, resulted in cessation of antibiotic therapy). Seventy-three percent of patients (n = 38) received empiric antibiotics before any culture results. In these cases, the BC susceptibility profiles confirmed the appropriateness of the initial treatment (n = 10) or led to a change (n = 28). CONCLUSIONS: CTC did not alter management in the treatment of TDC infection. Because CTCs increase costs, their routine use should be abandoned in this population.     

Management of visceral interventional radiology catheters: a troubleshooting guide for interventional radiologists.

Visceral interventional radiology catheters can be difficult to exchange or remove for a variety of reasons. These reasons include exit of the guide wire through the side holes of the catheter, blockage of the catheter, difficulty unlocking the pigtail, retention of the string after catheter removal, migration of the string ahead of the guide wire, catheter fracture, and snaring of an adjacent stent by the pigtail. Secure fixation of the catheter to the skin is important. A technique that allows secure fixation without direct puncture and suturing of the catheter to the skin is recommended. If a catheter falls out or is inadvertently removed, access can occasionally be regained and the catheter can be replaced without repuncture. The timing of catheter removal is based on the clinical condition of the patient and the daily output from the catheter. "Tractography" is a useful study before removal of any catheter that requires a mature tract for removal, particularly cholecystostomy catheters and transpleural catheters. In biliary catheter exchange, the most vital issue is the position of the side holes of the catheter. If an abscess cavity remains large after catheter drainage, the catheter can be repositioned or a second catheter can be placed.