scholarly journals Retaining venous access and eliminating radiation exposure during Hickman-Broviac catheter replacement for difficult-line insertion patients with intestinal failure

2021 ◽  
Vol 54 (1) ◽  
pp. 36
Author(s):  
Yun Chen ◽  
JustinT Chu ◽  
Chee-Chee Koh
Keyword(s):  
Radiation Exposure ◽  
Intestinal Failure ◽  
Venous Access ◽  
Line Insertion ◽  
Catheter Replacement

Review of the radiation exposure during screening of surgically implanted central venous access devices

2015 ◽  
Vol 50 (7) ◽  
pp. 1214-1219 ◽  
Author(s):  
Jikol Friend ◽  
Suzanna Lindsey-Temple ◽  
Ian Gollow ◽  
Elizabeth Whan ◽  
Parshotam Gera
Keyword(s):  
Radiation Exposure ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Venous Access Devices

Thrombosis and Thrombophilia in Children with Intestinal Failure Syndromes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4007-4007
Author(s):  
Janna M. Journeycake ◽  
Nandini Channabasappa
Keyword(s):  
Liver Disease ◽  
Intestinal Adaptation ◽  
Anticoagulation Therapy ◽  
Intestinal Failure ◽  
Venous Access ◽  
Central Venous ◽  
Vitamin Deficiencies ◽  
Imaging Results ◽  
Intestinal Transplant

Abstract Abstract 4007 Poster Board III-943 Introduction Intestinal failure (IF) results from acquired or congenital loss of small bowel affecting absorption and digestion. The most common reason for this condition is prematurity combined with surgery to treat necrotizing enterocolitis. It is defined as <200 cm of intestines (small and large) or <100 cm of jejunum. Both situations can lead to malabsorption and the need for total parenteral nutrition (TPN). The average length of time children with IF require TPN is >48 months. However, some require it indefinitely due to failure of intestinal adaptation. These children require placement of multiple central venous catheters (CVC) to administer nutrition and fluids, and CVCs are complicated by infection and occlusion. Having IF and long term TPN can also lead to complications such as liver disease and vitamin deficiencies. The indications for intestinal transplant include impaired venous access, life-threatening sepsis or progressive liver disease with coagulopathy in a child who indefinitely requires TPN. Our center performed its first intestinal transplant in 2005. Since then, multiple children have been referred for transplant evaluation. Objective To determine prevalence of catheter-related thrombosis and thrombophilia in a population of children referred for intestinal transplant. Methods Retrospective review of children being evaluated for IT between 2005 and 2008. Evaluation included review of vascular imaging results, thrombophilia testing and response to treatment with anticoagulation medications. Results Thirteen children were evaluated. Magnetic resonance venography revealed that 11/13 (85%) had evidence of catheter-related DVT, with 7 (56%) having more than one vessel involved. Results of prothrombotic evaluation are included in the table. Five children were treated with long-term (>3 months) anticoagulation therapy (warfarin in 1 and enoxaparin in 4). Prior to initiation of anticoagulation, the mean number of lines inserted per child was 4, post treatment 1.2 (p= 0.001). Before anticoagulation mean number of catheter-related bacteremia episodes per child was 3.8, after treatment 5 (p=0.55). Discussion Children with IF and chronic TPN use have very high rates of catheter-related DVT and loss of venous access. The most common thrombophilia associated with this population are persistently elevated FVIII activity and low levels of natural anticoagulant proteins. This is most likely a reflection of liver insufficiency and chronic inflammation of recurrent bacteremia. Conclusion Anticoagulant therapy appears to preserve venous access and reduce the need for CVC replacement. Though our study population is small, the results highlight the problem of acquired hypercoagulability in a subset of children who rely on long-term central venous access. Prospective studies are needed to determine if prophylactic anticoagulation initiated prior to loss of first or second catheter will benefit this growing population of children and possibly delay or even prevent the need for intestinal transplantation. Disclosures: Journeycake: Baxter Healthcare: Honoraria, Membership on an entity's Board of Directors or advisory committees. Off Label Use: anticoagulation in children.

scholarly journals The novel use of the Haemodialysis reliable outflow graft (HeRo®) in intestinal failure patients with end-stage vascular access

2020 ◽  
pp. 112972982096197
Author(s):  
Fungai Dengu ◽  
James Hunter ◽  
Georgios Vrakas ◽  
James Gilbert
Keyword(s):  
Parenteral Nutrition ◽  
Vascular Access ◽  
Intestinal Failure ◽  
Case Series ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Life Threatening ◽  
End Stage

Intestinal failure (IF) patients are dependent on central venous access to receive parenteral nutrition. Longstanding central venous catheters are associated with life-threatening complications including infections and thromboses resulting in multiple line exchanges and the development ofprogressive central venous stenosis or occlusion. The Haemodialysis Reliable Outflow (HeRO) graft is an arterio-venous device that has been successfully used in haemodialysis patients with ‘end-stage vascular access’. We describe a case series of HeRO graft use in patients with IF and end-stage vascular access. Four HeRO grafts were inserted into IF patients with end-stage vascular access to facilitate or support intestinal transplantation. In all patients the HeRO facilitated immediate vascular access, supporting different combinations of parenteral nutrition, intravenous medications, fluids or renal replacement therapy with no bloodstream infections. In a highly complex group of IF patients with central venous stenosis/occlusion limiting conventional venous access or at risk of life-threatening catheter-related complications, a HeRO® graft can be a feasible alternative.

scholarly journals IONIZING RADIATION EXPOSURE REVIEW IN CHILDREN WITH INTESTINAL FAILURE

2020 ◽  
Vol 104 (S3) ◽  
pp. S47-S47
Author(s):  
Ana Grasso ◽  
Marina Ulla ◽  
Paula Violo ◽  
Veronica Busoni ◽  
Rodrigo Sanchez Claria ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Radiation Exposure ◽  
Intestinal Failure ◽  
Ionizing Radiation Exposure

scholarly journals FP659IONIZING RADIATION EXPOSURE FROM DIALYSIS CENTRAL VENOUS ACCESS PROCEDURES

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Andreana De Mauri ◽  
Roberta Matheoud ◽  
Giuseppe Guzzardi ◽  
Valentina Vaccarone ◽  
Marco Brambilla ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous

scholarly journals Role and Responsibility of Nurses in Central Line - Insertion and Maintenance

2021 ◽  
Vol 8 (9) ◽  
pp. 252-260
Author(s):  
R. Surendra Naik ◽  
Avadhesh Kumar Yadav ◽  
Rajendra Kumar Sahu
Keyword(s):  
Central Venous Catheter ◽  
Subclavian Vein ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Line ◽  
Axillary Vein ◽  
Central Venous ◽  
Central Line Insertion ◽  
Hematoma Formation ◽  
Line Insertion

Introduction -A central venous catheter (CVC) is thin, a flexible tube (catheter) that is placed into a large vein above the Heart. It may be inserted through A vein in the Neck, (internal jugular) chest (subclavian vein. Axillary vein) groin (femoral vein), or through veins in the arms known as a PICC, or peripherally inserted central catheters. Site- Internal jugular vein, subclavian vein, axillary vein, femoral veins, the best approach or access point for Central line insertion. Indications - The indications for central venous access are broad and are often situational. Inability to obtain venous access in emergent situations, chemotherapy administration, medications administration (Vasopressors. inotropic administration Total Parental nutrition administration, Hemodynamic monitoring are common indications for CVC insertion. Contraindication- Local cellulitis, Low platelet count, Local infections, Thrombocytopenia, Congenital anomalies, Trauma are common contraindications of CVC insertion. Complications - Numerous potential complications can occur during the procedural placement of a central venous catheter, but also as a result of the indwelling equipment. Arrhythmias, Arterial puncture, Pulmonary puncture with or without resultant pneumothorax, Bleeding – hematoma formation, which can obstruct the airway, Tracheal injury, Air emboli during venous puncture or removal of the catheter, Pulmonary embolism, Local cellulitis, Catheter infection, Cardiac tamponade, Intravascular loss of guidewire, Hamo thorax, Phrenic nerve injury, Brachial plexus injury, Cerebral infarct from carotid artery cannulation, Bladder perforation, Bowel perforation, Sterile Thrombophlebitis. Post-procedural complications: Catheter-related bloodstream infections – bacterial or fungal, Central vein stenosis, Thrombosis, Delayed bleeding with multiple attempts in a coagulopathic patient Clinical Significance - Ensure that sterile products are not contaminated and that there is no evidence of damage to the packaging. Follow sterile procedures at all times. Central line infections can be a serious and life-threatening illness. Always ensure that the catheter is appropriately placed through one or several methods: radiographic evidence, measurement of CVP, or by analyzing a venous blood gas. Never use excessive force during any part of this procedure. It will lead to damage to local structures. Nursing Responsibility - After a CVC placement, nurses are responsible for maintaining, monitoring, and utilizing central venous catheters. The assigned nurse must check complications such as infections, hematoma, thrombosis of the catheter, and signs of pneumothorax and bleeding. Nurses are also responsible for ensuring that the site is maintained in a clean and sterile fashion. Daily inspection of the access site and device patency should be performed during nursing rounds. In particular, nursing officers must disinfect injection ports, catheter hubs, and needleless connectors with institutionally approved antiseptics. Intravenous administration sets should be changed regularly per hospital policy. The site should be checked for bleeding, hematoma formation, and signs of cellulitis, which include erythema, purulent drainage, and/or warmth. Dressings should be changed if visibly soiled. This must be performed with proper sterile technique. Keywords: CVC, Central Line, Central venous catheter.

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