Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis

Rinat, Choni; Ben-Shalom, Efrat; Becker-Cohen, Rachel; Feinstein, Sofia; Frishberg, Yaacov

doi:10.1007/s00467-014-2896-2

Cited by 20 publications

(18 citation statements)

References 13 publications

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“…Mechanically it is similar to airway obstruction developing due to an infection or allergic reaction (local oedema formation). Infants are more susceptible than adults to airway complications because of the smaller diameter of their airway [3]. SVC syndrome should be considered in acute airway obstruction where there is a history of IJV cannulation.…”

Section: Discussionmentioning

confidence: 99%

Difficult airway in an infant with acute Superior Vena Cava Syndrome following central venous catheterisation

2016

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We present the case of a 40 day old term female infant with rapidly increasing swelling of the face and neck due to undiagnosed Superior Vena Cava (SVC) syndrome. We successfully intubated the trachea using a videolaryngoscope after a failed fibreoptic intubation attempt. The possibility of thrombus and inflammation resulting in SVC obstruction should be considered following previous Internal Jugular Vein (IJV) cannulation. Videolaryngoscopes, such as the paediatric C-MAC® D-Blade, can be a valuable adjunct for a difficult airway algorithm in infants.

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Section: Discussionmentioning

confidence: 99%

Difficult airway in an infant with acute Superior Vena Cava Syndrome following central venous catheterisation

2016

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“…Peripheral vascular access is limited by the nature of the operation as well as by the history of bilateral lower extremity amputations. 17 Prior to the transplantation date, he had undergone insertion of a single-lumen port for longterm vascular access. In addition to this, we planned to insert an IJ central venous catheter for venous access during the procedure as well as for the immediate postoperative care in the PICU.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of the first pediatric bilateral hand transplant

Gurnaney

Fiadjoe

Levin

et al. 2016

Can J Anesth/J Can Anesth

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Purpose The purpose of this case report is to describe the anesthetic and case management of the first vascularized composite allograft pediatric bilateral hand transplant. Clinical details Our patient was an eight-year-old male with a medical history of Staphylococcus aureus sepsis at one year of age that resulted in end-stage renal disease as well as bilateral upper and lower extremity amputations. After referral for bilateral hand transplantation, the transplantation team, with expertise in all aspects of perioperative care (surgery, anesthesiology, nephrology, renal transplantation, pediatric intensive care, and therapeutic pharmacy), was consulted to help develop anesthetic and other perioperative protocols for surgery. Prior to activation of the transplantation team, the lead surgeon evaluated potential donors by comparing a threedimensional printed model of the recipient's forearm with the donor's upper extremities to ensure an adequate match. The anesthesia team inserted bilateral ultrasound-guided infraclavicular catheters to provide a sympathetic block to facilitate blood flow to the upper extremities and to provide both intraoperative and postoperative pain control. The patient remained in the operating room for 13 hr 37 min for a surgical time of ten hours 39 min. He remained in the hospital for 34 days after the procedure and was then transferred to an inpatient rehabilitation facility for a further 15 days. The patient is currently doing well in a postoperative rehabilitation program. He has demonstrated motor power to the hands using the forearm muscles but is not expected to reach his maximum sensory function for at least one to two years. Conclusion This report describes the anesthetic management of the first pediatric bilateral hand transplant. This procedure required considerable preoperative planning and communication between various teams to ensure all resources needed to deliver the care for this complex and novel transplant surgery were readily available. RésuméObjectif L'objectif de cette présentation de cas est de décrire la prise en charge anesthésique et la gestion du cas de la première greffe bilatérale des mains chez un enfant à partir d'une allogreffe de tissu composite. Détails cliniques Notre patient était un garçon de huit ans présentant des antécédents médicaux de sepsis dû à un staphylocoque doré contracté à l'âge d'un an, qui a entraîné une insuffisance rénale terminale ainsi que l'amputation bilatérale des membres supérieurs et inférieurs. Après son aiguillage pour une greffe bilatérale des mains, l'équipe de transplantation, forte d'une vaste expertise en soins périopératoires (chirurgie, anesthésiologie, néphrologie, transplantation rénale, soins intensifs pédiatriques et pharmacie thérapeutique), a été consultée afin de mettre au point des protocoles

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“…However, catheter‐related complications such as infection, breakage; blockage and dislodgement are not uncommon . Removal or revision of CVCs will lead to the loss of central venous access and hence jeopardizes the survival of these patients . We herein reported our experience in using the fibrous sheath for the revision of tunnelled CVCs in children.…”

Section: Introductionmentioning

confidence: 99%

The fibrous sheath of tunnelled central venous catheters: A simple and reliable access for revision

et al. 2020

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Purpose Children may require the long‐term use of a central venous catheter (CVC) for treatment. Multiple revisions may be required when these catheters malfunction. We herein reported our experience of utilizing the fibrous sheath in tunnelled CVCs for the revision. Methods A retrospective review was conducted from July 2008 to June 2018 on all children with the revision of tunnelled CVCs using the fibrous sheath. Results Sixteen children underwent 31 revisions of a tunnelled CVC (16 Broviac/Hickman catheters, 15 Permcath for haemodialysis). The age ranged from 6 months to 16 years old (mean 3.8 years old). The indications for CVC revision included blockage (n = 14), breakage (n = 9) and dislodgement (n = 6). The mean time interval between CVC insertion and revision was 10.1 months (range: 20 days to 39 months). The fibrous sheath could be used for re‐insertion in 27 revisions (success rate: 87%). The failure was associated with the upsizing of the CVC (P = .003). In three of the four failed cases, a new CVC could be inserted by the cut‐down technique through the same venous access site. The overall success rate of CVC revision using the same venous access was 97%. There was no 30‐day postoperative infective complication. Conclusions The fibrous sheath of tunnelled CVCs is a reliable access for CVC re‐insertion. This helps to preserve the same venous access site for repeated revision of CVCs. This is extremely important in those children who depend on long‐term CVC usage.

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Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis

Abstract: In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.

Cited by 20 publications

References 13 publications

Difficult airway in an infant with acute Superior Vena Cava Syndrome following central venous catheterisation

Difficult airway in an infant with acute Superior Vena Cava Syndrome following central venous catheterisation

Anesthetic management of the first pediatric bilateral hand transplant

The fibrous sheath of tunnelled central venous catheters: A simple and reliable access for revision

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