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Yu H, Xin Q, Wang X, Jia L, Wang J, Meng X, Li B, Wei F, Jiang A. Effects of different catheter replacement methods on catheter service time and complications in hemodialysis patients: A cohort study. J Vasc Access 2019; 21:497-503. [PMID: 31820667 DOI: 10.1177/1129729819891336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Central venous catheter insertion for long-term vascular access is not recommended in clinical practice. However, since arteriovenous fistula creation is difficult to perform in some patients, central venous catheter insertion for long-term vascular access is performed. This study aimed to assess the complications and service time of central venous catheters replaced using different methods and to determine the influencing factors of service time. METHODS Study design: A retrospective observational cohort study. Setting and participants: Patients who underwent tunneled dialysis catheter malfunction (2009-2019) and had to undergo another dialysis catheter insertion were enrolled. Exposures: Ectopic replacement and in situ replacement. Outcomes: Factors such as age, sex, primary patency rate, secondary patency rate, early complications, and late complications were considered. Analytical approach: This study used a Cox proportional hazards regression model. RESULTS The first and the newly replaced catheter service time were 37.779 ± 24.563 months and 32.468 ± 26.638 (25) months in the ectopic group and 37.075 ± 20.550 months and 26.349 ± 22.672 months in the in situ group, respectively. In the early service time, the newly replaced catheter resulted in significant bleeding from the tunnel. The first catheter had the least complications, most adequate blood flow, and longest service time. Ectopic catheter replacement and the tip shape of the catheter were the independent factors for catheter service time. Catheter service time increased with age. CONCLUSION Ectopic catheter replacement can improve the primary patency rate and auxiliary primary patency rate of catheters. Ectopic catheter replacement may require sufficient surgical skills with digital subtraction angiography, resulting in a better prognosis.
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Affiliation(s)
- Haibo Yu
- Kidney Disease and Blood Purification Treatment Department, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qi Xin
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin, China
| | - Xuewen Wang
- Department of Cardiology, Key Laboratory of Ion and Molecular Function of Cardiovascular Diseases and Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lan Jia
- Kidney Disease and Blood Purification Treatment Department, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | | | - Xianhai Meng
- Infectious Diseases Department, Heping District Center for Disease Control and Prevention, Tianjin, China
| | - Bo Li
- Kidney Disease and Blood Purification Treatment Department, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fang Wei
- Kidney Disease and Blood Purification Treatment Department, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Aili Jiang
- Kidney Disease and Blood Purification Treatment Department, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Reply to Letter to the Editor by Crocoli A, et al. J Pediatr Surg 2017. [PMID: 28648879 DOI: 10.1016/j.jpedsurg.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kaji T, Kawano T, Yamada W, Yamada K, Onishi S, Nakame K, Mukai M, Ieiri S, Takamatsu H. The changing profile of safe techniques for the insertion of a central venous catheter in pediatric patients - improvement in the outcome with the experiences of 500 insertions in a single institution. J Pediatr Surg 2016; 51:2044-2047. [PMID: 27829522 DOI: 10.1016/j.jpedsurg.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The ability to safely insert a central venous catheter (CVC) is critical to avoid associated complications. The aim of this study was to explore appropriate technique to maintain the safety of pediatric patients during CVC. METHODS We reviewed the surgical records of CVC insertion techniques and associated complications of 503 tunneled CVC insertions performed from 2000 to 2015. RESULTS Two hundred thirty CVCs (45.7%) were inserted into the subclavian vein using the landmark technique for 10years (first period). Only two pneumothoraxes (0.9%) were experienced. In 2009, we adopted ultrasound-guided venous catheterization from the internal jugular vein, and 103 CVCs (20.5%) were inserted (second period). This procedure led to penetration into the innominate vein (1.0%) by dilater sheath. Patient underwent repair of the penetrated vessel. After this serious complication, 170 CVCs (33.8%) were inserted using the venous cutdown procedure except two catheters. We had two cases whose accessible veins were occluded because of frequent catheterization using venous cutdown technique. No mechanical complications were experienced. CONCLUSIONS The venous cutdown method is the safest technique for inserting a tunneled CVC in pediatric patients. However, multiple vein occlusions because of repeated catheterizaion by venous cutdown lead to the exhaustion of accessible vessels. LEVEL OF EVIDENCE Treatment Study - Level IV.
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Affiliation(s)
- Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University.
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Over-catheter tract suture to prevent bleeding and air embolism after tunnelled catheter removal. J Vasc Access 2016; 18:170-172. [DOI: 10.5301/jva.5000620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 01/05/2023] Open
Abstract
Introduction Severe, life-threating, complications might occur on dialysis catheter removal. Methods We present a useful technique that may prevent vascular air embolism and severe bleeding. Results The suture is placed around the catheter and tied over previous tract just after device removal. Conclusions Applying a compressing suture to the tract left after removal of a tunnelled haemodialysis catheter is a simple manoeuvre that could prevent severe complication.
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Abstract
Central venous catheters (CVCs) are essential in the management of hemodialysis patients, but they also carry unintended negative consequences and in particular thrombosis and infection, adversely affecting patient morbidity and mortality. This review will focus on the etiology, prevention, and management of CVC-related dysfunction, which is mainly associated with inadequate blood flow. CVC dysfunction is a major cause of inadequate depuration. Thrombus, intraluminal and extrinsic, as well as fibrous connective tissue sheath (traditionally indicated as fibrin sheath) formation play a central role in establishing CVC dysfunction. Thrombolysis with urokinase or recombinant tissue plasminogen activator (rTPA) can be undertaken in the dialysis unit, restoring adequate blood flow in most patients, preserving the existing catheter, and avoiding an interventional procedure. If thrombolytics fail, mainly because of the presence of fibrous connective tissue sheath, catheter exchange with fibrin sheath disruption may be successful and preserve the venous access site. Prevention of CVC dysfunction is important for containing costly pharmacologic and interventional treatments, which also affect patients’ quality of life. Prevention is based on the use of anticoagulant and/or thrombolytic CVC locks, which are only partially effective. Chronic oral anticoagulation with warfarin has also been proposed, but its use for this indication is controversial and its overall risk-benefit profile has not been clearly established.
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Kim S, Kim Y, Moon SB. Histological changes of the unligated vein wall adjacent to the central venous catheter after open cutdown in rats. J Pediatr Surg 2015; 50:1928-32. [PMID: 26012741 DOI: 10.1016/j.jpedsurg.2015.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/26/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The sequelae of a central venous cutdown usually include venous deformity causing venous stenosis or stricture. However, the cellular mechanisms causing these deformities have not been elucidated. METHODS Silicone 2.7-Fr catheters were placed via the right external jugular vein of 16 rats with the cutdown method. After fixation with formalin at scheduled intervals (1week, 2weeks, 4weeks, and 8weeks; 4 rats in each group), the vein segment with the catheter in situ was harvested. Histological changes in the vein wall were studied and serially compared with light microscopy; standard hematoxylin-eosin staining, Masson's trichrome staining, van Gieson's elastin stain, and immunohistochemical stain against α-actin. RESULTS Pericatheter sleeve formation, circumferential smooth muscle cell proliferation and infiltration into the pericatheter sleeve by direct contact were noted in all 4 rats of 1-week model; this indicated the initiation of neointimal hyperplasia. The neointimal hyperplasia was located inside the elastin layer. At 2weeks, the SMCs stained faintly but the components of the vein wall were largely replaced by collagen. The proliferation and infiltration of SMCs stabilized at 4weeks and no SMCs were stained around the catheter. At 8weeks, luminal narrowing was noted and the venous wall was composed mainly of collagen. CONCLUSIONS Circumferential neointimal hyperplasia occurred after surgical cutdown of the external jugular vein in a rat model and was caused by SMC activation, proliferation, and infiltration into the pericatheter sleeve.
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Affiliation(s)
- Seongyup Kim
- Department of General Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Younglim Kim
- Department of Surgery, Kangwon National University, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Suk-Bae Moon
- Department of Surgery, Kangwon National University, Kangwon National University School of Medicine, Chuncheon, South Korea.
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Jung KH, Moon SB. Cephalic vein cutdown for totally implantable central venous port in children: a retrospective analysis of prospectively collected data. Can J Surg 2014; 57:21-5. [PMID: 24461222 DOI: 10.1503/cjs.025512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The jugular vein cutdown for a totally implantable central venous port (TICVP) has 2 disadvantages: 2 separate incisions are needed and the risk for multiple vein occlusions. We sought to evaluate the feasibility of a cephalic vein (CV) cutdown in children. METHODS We prospectively followed patients who underwent a venous cutdown for implantation of a TICVP between Jan. 1, 2002, and Dec. 31, 2006. For patients younger than 8 months, an external jugular vein cutdown was initially tried without attempting a CV cutdown. For patients older than 8 months, a CV cutdown was tried initially. We recorded information on age, weight, outcome of the CV cutdown and complications. RESULTS During the study period, 143 patients underwent a venous cutdown for implantation of a TICVP: 25 younger and 118 older than 8 months. The CV cutdown was successful in 73 of 118 trials. The 25th percentile and median body weight for 73 successful cases were 15.4 kg and 28.3 kg, respectively. There was a significant difference in the success rate using the criterion of 15 kg as the cutoff. The overall complication rate was 8.2%. CONCLUSION The CV cutdown was an acceptable procedure for TICVP in children. It could be preferentially considered for patients weighing more than 15 kg who require TICVP.
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Affiliation(s)
- Kyu-Hwan Jung
- The Department of Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Suk-Bae Moon
- The Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
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Safe and simple reinsertion technique for occluded central venous catheter in premature infants. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Masumoto K, Esumi G, Teshiba R, Nagata K, Taguchi T. Usefulness of exchanging a tunneled central venous catheter using a subcutaneous fibrous sheath. Nutrition 2010; 27:526-9. [PMID: 20705429 DOI: 10.1016/j.nut.2010.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Revised: 05/03/2010] [Accepted: 05/03/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The reserve of the venous route to the central veins is important for long-term parenteral nutrition (PN). Frequent catheter-related bloodstream infection (CRBSI) induces occlusion of the venous routes. Therefore, a modified exchange procedure using a tunneled central venous catheter (CVC) with a fibrous sheath was developed to preserve the route to the central veins. METHODS Seven patients who required long-term PN received the modified exchange procedure and the outcome of exchanged CVC was retrospectively reviewed. RESULTS The procedure was performed 10 times in seven patients. The venous routes were either the subclavicular or the internal jugular vein in all patients. The exchange of the catheter was due to CRBSI or occlusion in almost all patients. The mean duration of new catheter use was 296.2 days following the exchange. Four catheters continued to be used, and the remaining ones were removed. The reasons for removal were severe CRBSI and occlusion, each of which occurred in two catheterized patients, while the reason for removing the remaining catheters was because the patients no longer needed the catheters. CONCLUSION The modified catheter exchange using fibrous sheath, even in patients with CRBSI, appears to be an effective procedure for reserving the venous route to the central veins in patients who require either long-term PN or other treatments.
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Affiliation(s)
- Kouji Masumoto
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Reinsertion of Accidentally Dislodged Catheters through the Original Track: What is the Likelihood of Success? J Vasc Interv Radiol 2010; 21:861-4. [DOI: 10.1016/j.jvir.2010.02.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/09/2009] [Accepted: 02/22/2010] [Indexed: 11/22/2022] Open
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Lai CH, Kan CD, Wu HY, Luo CY, Chao CM, Wen JS. Modified Exchange Technique for Management of Dysfunctional Tunneled Hemodialysis Catheters in the Presence of Exit-Site Infection: A Quality Improvement Report. Am J Kidney Dis 2009; 53:112-20. [DOI: 10.1053/j.ajkd.2008.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Accepted: 08/15/2008] [Indexed: 11/11/2022]
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