An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion

D’Arrigo, Sonia; Annetta, Maria Giuseppina; Pittiruti, Mauro

doi:10.1177/11297298211023275

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…In a very recent clinical study, 44 the bubble test has been used as a rapid bedside maneuver for verifying the intravascular position of totally implanted venous devices with persistent withdrawal occlusion.…”

Section: Tip Location By Indirect Visualization Of the Final Position Of The Tip Of The Cathetermentioning

confidence: 99%

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

et al. 2021

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Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice.

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Section: Tip Location By Indirect Visualization Of the Final Position Of The Tip Of The Cathetermentioning

confidence: 99%

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

et al. 2021

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“…According to our current policy, as described in a previous paper, 14 a bedside transthoracic ultrasound “bubble test” was performed so to verify whether the catheter tip was still in the proper location, that is, in the proximity of the cavo-atrial junction. Using the sectorial transducer of a wireless probe (Cerbero, ATL) via the subcostal view, 10 ml of shaken saline solution were rapidly injected through the device, but no turbulence was evident in the right atrium.…”

Section: Case Descriptionmentioning

confidence: 99%

Secondary malposition of a PICC-port due to heavy physical exercise: A case report

et al. 2021

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Physical exercise is often encouraged in cancer patients, mainly for the purpose of rehabilitation and for its psychological benefit. Some authors also suggest that exercise—specially in patient with peripherally inserted central venous access devices—may contribute to reduce the risk of catheter-related thrombosis. Still, the impact of physical exercise on the risk of device-related complications is not yet defined. We report a case of secondary migration of the tip of an arm port, caused by high-intensity exercise in a woman undergoing chemotherapy because of ovarian cancer. Tip migration was suspected because of malfunction (persistent withdrawal occlusion) and diagnosis established after ultrasound examination and chest x-ray. Even if exercise may yield benefit in the cancer patient on chemotherapy, the risk of mechanical complication of the venous access device—such as tip migration—should be considered in the case of high-intensity exercise.

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“… 8 – 10 Echo ‘bubble test’ (BT) is available to verify the correct tip location in the superior vena cava. 11 – 14 The drugs can be administered safely in case of PWO and the positivity of the BT, but the port cannot be used for drawing blood. The main goal of the BT is not really to establish the diagnosis of the cause of the PWO, but more generally to be reassured that the port can be safely used, especially in case of administration of vesicant drugs.…”

Section: Introductionmentioning

confidence: 99%

Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients

Maňásek,

Zapletalová,

Olosová

et al. 2024

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Introduction: Persistent withdrawal occlusion (PWO) is a specific catheter malfunction characterized by the inability to withdraw blood through the device. The most common cause of PWO in ports is the presence of a fibroblastic sleeve (FS). If malfunction occurs, medication can be applied incorrectly with the increased risk of complications. Methods: One hundred seventy-seven cases of PWO in venous ports were managed. We focused on evaluating the cause of PWO, the frequency of occurrence of FS, and the options to address the malfunction. The patients underwent fluoroscopy with a contrast agent administration. Mechanical disruption (MD) with a syringe of saline using the flush method was used; in case of its failure, subsequent administration of a lock solution with taurolidine and urokinase, or low-dose thrombolysis with alteplase was indicated. Demographic data were compared with a control group. Results: A significantly higher proportion of female patients was found in the cohort of patients with PWO (80.3% vs 66.3%, p = 0.004), dominantly patients with ovarian cancer (12.8% vs 4.8%, p = 0.022). No effect of the cannulated vein or the type of treatment on the incidence of PWO was demonstrated. The presence of FS was verified in 70% of cases. MD with a syringe was successful in 53.5% of cases. A significantly shorter time to referral (3 weeks) was demonstrated with successful management. The overall success rate of achieving desobliteration by MD alone or in combination with a thrombolytic (urokinase or alteplase) administration was 97.4%. Conclusion: We created a method for resolving PWO using MD +/- application of thrombolytics with 97.4% success rate. Current evidence showed that FS is not likely to be affected by thrombolytic drugs; however, we have ascertained an effect of these drugs, proposing a hypothesis of microthrombotic events at the tip of the catheter if fibroblastic sleeve is present.

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An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion

Cited by 5 publications

References 22 publications

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

Secondary malposition of a PICC-port due to heavy physical exercise: A case report

Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients

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