Thromboembolic complications are common complications amongst cases of COVID-19 worldwide. This occurrence has seen a key role of endovascular treatment in managing this potentially fatal complication. Endovascular thrombectomy or catheter directed thrombolysis is a fast and effective method for treatment of pulmonary embolisms, especially in the setting of a pandemic. However, good workflow and safety measures should be strictly adhered to ensure a favorable outcome of patients and ensure safety of treating personnel.
Introduction: Persistent left superior vena cava is a rare anatomic anomaly, found only about 0.3-0.5% of the general population. On top of that, about 12% of patient has associated congenital cardiac anomaly. Typically, this anomaly is found as an incidental finding as patient is generally asymptomatic. However, it is important to recognize such anomaly in order to avoid complication during placement of central venous catheter. Case report: We herein report a case of an incidental finding of persistent left sided superior vena cava (SVC) upon insertion of peripherally inserted central catheter (PICC). Initial difficulty and perplexity during insertion of PICC with the tip of catheter keep pointing towards the left side of the heart leads us to proceed with central venogram that confirmed such anomaly.
Objective: Long term intravenous access in paediatrics is challenging in terms of ease of procedure, maintenance of catheter and complications. Small calibre of peripheral veins in children make insertion of peripheral long-term access difficult. Our centre adopted the use of tunneled adult Peripherally Inserted Central Catheter (PICC) for central venous access in paediatrics with the hope to improve these challenges. We describe a single institute 3-year experience of this technique. Material & Methods: Retrospective analysis of patients aged less than 12 years old who had tunneled PICC insertions from January 2018 till December 2020. The following data was recorded and studied: indication, reason for removal, duration of PICC, vessel inserted, device type and complications. Results: Eleven adult PICCs were inserted from this technique in 10 children. The average age was 35.7months and weight was 13.2kg. The youngest patient was 3 months old at 6.9kg. Most common indication for insertion was for long term antibiotics (82%) and the remainder were for difficult intravenous access. The procedure was done under local anaesthetic with sedation in 90% of cases. Average duration of PICC was 26.8 days. Out of 11 PICCs only 1 had line related infection that required premature removal of the catheter. 55% completed the intended duration while 27% of PICCs had dislodged. Conclusion: Tunnelled adult PICC for central venous access in paediatrics is a feasible option for long term vascular access and has a lower risk of infection. However, almost a third of the catheters inserted still suffered premature dislodgement.
Background: COVID-19 infection is associated with thrombotic events causing micro thrombosis and venous thromboembolism. Anticoagulant treatment has been shown to reduce mortality in COVID-19 cases and is routinely used. Spontaneous extraperitoneal hemorrhage (SEH), which includes retroperitoneal, iliopsoas or rectus sheath hematomas, is a known complication of anticoagulant use. Trans arterial embolization (TAE) is a safe and minimally invasive management option to control bleeding in SEH. We report 7 cases of SEH in COVID-19 patients admitted to Hospital Sungai Buloh. This case series highlights the occurrence of SEH in COVID-19 patients, its clinical and radiological manifestations and management pathways. Case presentation: All patients were on anticoagulants and presented with abdominal pain and/or swelling with sudden drop in hemoglobin. Computed tomography angiography (CTA) showed contrast extravasation indicative of active bleed. All patients proceeded with conventional transfemoral angiography with option of TAE. TAE was utilized in 6 out of 7 cases and was successful in achieving hemostasis with no procedure related complication. Conclusion: SEH should be suspected in COVID-19 patients on anticoagulants presenting with abdominal pain or drop in hemoglobin. CTA is confirmatory and TAE offers a viable and safe treatment option.
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