Central venous catheters in acute blood malignancies

Krog, M; Ekbom, Anders; Nyström-Rosander, Christina; Rudberg, Claes; Simonsson, N. O. B.

doi:10.1002/1097-0142(19870401)59:7<1358::aid-cncr2820590721>3.0.co;2-n

Cited by 16 publications

(4 citation statements)

References 10 publications

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“…The overall incidence of positive blood cultures of 2.1 per 1000 catheter days compares favorably with the literature. 5,6,[19][20][21] In total 30.9% of the lines were removed because of suspected or proven catheter-related infection.…”

Section: Discussionmentioning

confidence: 99%

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Apsner

Schulenburg

Sunder‐Plassmann

et al. 1998

Bone Marrow Transplant

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Summary:The purpose of this study was to evaluate the efficacy and safety in placement of Hickman catheters via the supraclavicular route without fluoroscopic guidance. We studied 81 consecutive percutaneous placements of dual lumen Hickman catheters via the supraclavicular route without the use of fluoroscopic guidance. Success rates, technical problems, complications, infections and reasons for explantation were recorded prospectively. Seventy-nine punctures were successful (97.5%). One pneumothorax (1.2%) and three accidental arterial punctures (3.7%) occurred. Difficulties in introducing the catheter through the peel away sheath or misplacement were not observed. The catheters remained in place for a total of 7657 days (mean 94.5, range 3-392 days). Sixteen blood cultures were positive (2.1/1000 catheter days). Five catheters (6.1%) were lost because of mechanical complications. Forty-two lines (52%) were removed electively, 23 (28.4%) because of suspected infection, and two (2.5%) because of tunnel infection. Nine patients died with a functioning catheter. We conclude that the supraclavicular approach to the subclavian vein is safe and efficient for introduction of Hickman catheters. Using this access, routine fluoroscopic or sonographic guidance is not required for proper placement. Implantation of the lines in an intensive care unit did not lead to higher infection rates than those reported in the literature. Keywords: Hickman; supraclavicular access; fluoroscopic guidance; infection; bone marrow transplantation Central venous access for antineoplastic treatment, supportive therapy and parenteral nutrition is required in most patients scheduled for bone marrow transplantation (BMT). In many centers a Hickman catheter is routinely inserted before BMT. [1][2][3] Usually the infraclavicular route to the subclavian vein is chosen for percutaneous implantation of the line. [4][5][6] Pneumothorax, arterial puncture and chylothorax are well known complications of this approach. 7 number of problems occur during placement of permanent catheters from the infraclavicular site: failure to pass the gap between the first rib and the clavicle, kinking of the guide wire and the introducer sheath and misplacement of the line into adjacent vessels such as the contralateral subclavian vein or both internal jugular veins. 6-10 For these reasons implantation is usually performed under fluoroscopic guidance in the operation theatre or angiogram suite, 5,6 which is expensive and causes exposure of the patient to radiation and potential nephrotoxic contrast media. Secondary migration, compression (the pinch off sign) and fragmentation of the catheter are other adverse events related to the infraclavicular approach. 6,11,12 The obvious disadvantages of the infraclavicular route prompted us to evaluate a 'new' approach for placement of Hickman catheters in patients scheduled for BMT. Supported by our previous experience, 9,13,14 our hypothesis was that routine fluoroscopic guidance could be avoided by using the supraclavicular ac...

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Section: Discussionmentioning

confidence: 99%

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Apsner

Schulenburg

Sunder‐Plassmann

et al. 1998

Bone Marrow Transplant

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“…Mit einer durchschnittlichen Implantatliegedauer von 363 Tagen wurde deutlich die Funktionsdauer vom ZVK und HK mit maximal 110 Tagen iiberschritten [3,13,22]. Mit einer durchschnittlichen Implantatliegedauer von 363 Tagen wurde deutlich die Funktionsdauer vom ZVK und HK mit maximal 110 Tagen iiberschritten [3,13,22].…”

Section: Diskussionunclassified

“…W~ihrend Studien mit geringen Fallzahlen oder kurzer Beobachtungszeit iiber keinen Fall berichten [8,10], stellten andere Arbeiten in 43% Subclavia-Thrombosen fest [15]. In unserem Krankengut mit 2 F~illen entsprechend den Erfahrungen anderer Autoren [13,18,25] konnte eine ausreichende Collateralisierung nach 7 Tagen mit Beschwerdefreiheit erzielt werden. In unserem Krankengut mit 2 F~illen entsprechend den Erfahrungen anderer Autoren [13,18,25] konnte eine ausreichende Collateralisierung nach 7 Tagen mit Beschwerdefreiheit erzielt werden.…”

Section: Diskussionunclassified

“…Trotz aller Verbesserungen sind periphere Verweilkantilen und zentralvenrse, percutan ausgeleitete Katheter (ZVK) mit einer hohen Komplikationsrate belastet, unter denen Infektion, Sepsis und Thrombose des Katheters oder der kan01ierten Vene im Vordergrund stehen [3,9,13,20]. Trotz aller Verbesserungen sind periphere Verweilkantilen und zentralvenrse, percutan ausgeleitete Katheter (ZVK) mit einer hohen Komplikationsrate belastet, unter denen Infektion, Sepsis und Thrombose des Katheters oder der kan01ierten Vene im Vordergrund stehen [3,9,13,20].…”

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Total implantierbarer dauerhafter zentralven�ser Zugang, Langzeiterfahrung mit subcutanen Infusionskammern

Lorenz

Hottenrott

Seufert

et al. 1988

Langenbecks Arch Chiv

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Subcutaneously implanted infusion chambers represent a new method of central venous access. In 57 evaluable out of 70 patients, four different models of infusion chambers with an accumulative observation time of 57 years were implanted. In 72% of the patients, up to 12 cycles of polychemotherapy were administered. Parenteral nutrition and blood drawing were also performed. After 4,970 punctions of the system and 12.2 years of use 46 complications in 38 patients were observed, however, most were minor ones, such as temporary occlusions (12) and extravasations (14). Septum luxation (1), septum perforation (1), catheter fracture (1) and catheter migration (2) as well as 7 cases of septicemia or port-pocket-infection required explanation. Infusion chambers seem to be particularly suitable for intermittent and long-term chemotherapy and emergency bolus injections with a significant advantage (10 complications per one thousand days of use) compared to externally placed venous catheters. However, follow-up and care must be performed by a skilled team.

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Catheter‐Related Thrombosis

Williams

1990

Clinical Cardiology

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The use of indwelling central catheters for administration of chemotherapy, blood products, and parenteral nutrition is becoming increasingly common. Thrombosis, manifested as formation of either a fibrin sleeve around the catheter or a thrombus adherent to the vessel wall, is a major complication of the use of such catheters. Although frequently asymptomatic, thrombosis may cause catheter occlusion, vascular obstruction, septic phlebitis, or pulmonary embolism. The pathophysiology and management of catheter thrombosis are discussed.

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Central venous catheters in acute blood malignancies

Cited by 16 publications

References 10 publications

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Routine fluoroscopic guidance is not required for placement of Hickman catheters via the supraclavicular route

Total implantierbarer dauerhafter zentralven�ser Zugang, Langzeiterfahrung mit subcutanen Infusionskammern

Catheter‐Related Thrombosis

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