Transcutaneously Tunneled Central Venous Lines in Cancer Patients: An Analysis of Device-Related Morbidity Factors Based on Prospective Data Collection

Schwarz, Roderich E.; Coit, Daniel G.; Groeger, Jeffrey S.

doi:10.1007/s10434-000-0441-y

Cited by 64 publications

(27 citation statements)

References 34 publications

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“…Placement of the catheter tip high in the superior vena cava (SVC) results in a higher incidence of thrombosis than when the catheter tip is placed low in the SVC [21,30,33,64,65]. A possible explanation for this is the greater chance of damage to the blood vessel when the catheter tip is in the higher position rather than in the lower position.…”

Section: Devicementioning

confidence: 92%

“…A very common and usually underreported event is the development of clotting within the lumen of the catheter [20][21][22]. This usually is uncovered when the catheter fails to allow blood to be withdrawn or fails to allow infusion through a port.…”

Section: Intraluminal Thrombosis Of Cvcsmentioning

confidence: 99%

“…This usually is uncovered when the catheter fails to allow blood to be withdrawn or fails to allow infusion through a port. [20][21][22]. Fortunately, these intraluminal thrombi can be lysed in most situations (80%-95%) with fibrinolytic agents such as urokinase, streptokinase, and tissue plasminogen activator (TPA) [23,24].…”

Section: Intraluminal Thrombosis Of Cvcsmentioning

confidence: 99%

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Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with lowmolecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

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Section: Devicementioning

confidence: 92%

Section: Intraluminal Thrombosis Of Cvcsmentioning

confidence: 99%

Section: Intraluminal Thrombosis Of Cvcsmentioning

confidence: 99%

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Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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“…Placement of the catheter tip high in the SVC results in a higher incidence of thrombosis than low placement in the SVC or at the atriocaval junction. 50 Therefore, at least in oncology patients, the atriocaval junction appears to be the optimal position; hemodialysis could require full atrial positioning of the catheter tip, at least for cuffed devices. 51 Thrombosis also seems to be more common when catheters are inserted entering the left subclavian vein.…”

Section: Catheter Tip Positionmentioning

confidence: 99%

Vascular Access in Oncology Patients

Gallieni

Pittiruti

Biffi

2008

CA: A Cancer Journal for Clinicians

253

166

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Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date. (CA Cancer J Clin 2008;58:323-346.)

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“…Complicações existem e devem ser conhecidas para serem evitadas 7,22,23 . Didaticamente podemos dividi-las em de curto e longo prazo.…”

Section: -Complicaçõesunclassified

Cirurgia dos cateteres de longa permanência (CLP) nos centros de transplante de medula óssea

Albuquerque¹

2005

Medicina (Ribeirão Preto)

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O capítulo disserta sobre a utilização de Cateteres de Longa Permanência (CLP) num Centro de Transplante de Medula Óssea (CTMO), abordando seus aspectos cirúrgicos com o objetivo de preparar cirurgiões para o enfrentamento de pacientes hematológicos graves, seja no preparo para um TMO ou em situações complexas durante ou após o transplante. Baseado numa experiência de 2.000 cateterismos executados pelo autor no Instituto Nacional de Câncer (INCA) é intencionado, numa narrativa didática para jovens cirurgiões, a dar orientação da prática cirúrgica necessária para o sucesso da implantação destes cateteres em pacientes de CTMOs.São mostrados e discutidos aspectos inerentes ao cateter em si, como escolha de tipos e modelos, suas indicações, as técnicas cirúrgicas a serem adotadas normalmente (com a descrição detalhada do acesso jugular interno), as situações difíceis com questões relevantes à anatomia do mediastino com seus possíveis obstáculos e a forma de vence-los, e finalmente, os resultados e as complicações advindas do uso destes sistemas especificamente em pacientes de um CTMO.

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Transcutaneously Tunneled Central Venous Lines in Cancer Patients: An Analysis of Device-Related Morbidity Factors Based on Prospective Data Collection

Cited by 64 publications

References 34 publications

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Vascular Access in Oncology Patients

Cirurgia dos cateteres de longa permanência (CLP) nos centros de transplante de medula óssea

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