Radiological Interventions for Correction of Central Venous Port Catheter Migrations

Purpose The purpose of this study was to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Materials and Methods Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5-F angiographic catheters (pigtail; Sos Omni), gooseneck snares, or combinations thereof. Results One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients port catheter malposition correction was not possible, because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. Conclusions We conclude that in migrated catheter tips radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis port catheter correction is often more challenging.     

Radiological Interventions for Correction of Central Venous Port Catheter Migrations

The purpose of the study is to evaluate radiological–interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency, a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5F angiographic catheters (pigtail, Sos Omni), goose-neck snare, or combinations thereof. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological–interventional port catheter correction was successful. In two patients, port catheter malposition correction was not possible because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. In migrated catheter tips, radiological–interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis, port catheter correction is often more challenging.     

Management of visceral interventional radiology catheters: a troubleshooting guide for interventional radiologists.

Visceral interventional radiology catheters can be difficult to exchange or remove for a variety of reasons. These reasons include exit of the guide wire through the side holes of the catheter, blockage of the catheter, difficulty unlocking the pigtail, retention of the string after catheter removal, migration of the string ahead of the guide wire, catheter fracture, and snaring of an adjacent stent by the pigtail. Secure fixation of the catheter to the skin is important. A technique that allows secure fixation without direct puncture and suturing of the catheter to the skin is recommended. If a catheter falls out or is inadvertently removed, access can occasionally be regained and the catheter can be replaced without repuncture. The timing of catheter removal is based on the clinical condition of the patient and the daily output from the catheter. "Tractography" is a useful study before removal of any catheter that requires a mature tract for removal, particularly cholecystostomy catheters and transpleural catheters. In biliary catheter exchange, the most vital issue is the position of the side holes of the catheter. If an abscess cavity remains large after catheter drainage, the catheter can be repositioned or a second catheter can be placed.     

脑损伤昏迷患者术后PICC与锁骨下静脉置管的疗效观察

目的：探讨PICC与锁骨下静脉置管在脑损伤昏迷患者术后置管输液治疗的疗效。方法回顾性分析79例行PICC及63例行锁骨下静脉置管输液治疗的脑损伤昏迷患者的临床资料,比较2种治疗方法的一次性置管成功率及导管置入相关并发症的发生率。结果 PICC一次穿刺成功率94.9％（75／79）,锁骨下静脉置管一次穿刺成功率为74.5％（47／63）,差异有统计学意义（P＜0.05）;PICC组发生机械性静脉炎、堵管高于锁骨下静脉组（P＜0.05）,而导管脱落、非计划性拔管的机率小于锁骨下静脉组（P＜0.05）,两组在导管位、导管相关性感染的发生率上差异无统计学意义（ P＞0.05）。结论 PICC与锁骨下静脉置管在脑损伤昏迷患者术后输流治疗中有简单易行、护理方便,留置时长等优点,相比较而言,PICC更具有优势。     

Central venous catheter motion: a pitfall in catheter localization on pediatric chest radiography

OBJECTIVE: We evaluated central venous catheter motion causing misinterpretation of catheter tip location in pediatric patients and in an experimental model. MATERIALS AND METHODS: After the recognition of clinically significant catheter motion in 12 randomly selected patients, we conducted a prospective 2-month study of chest radiographs in our pediatric care unit and neonatal emergency department. Serial radiographs were examined for change in catheter tip position ascribed to motion artifact. An in vitro model was developed to replicate clinical parameters. Experimentally, catheter movement and exposure time were analyzed and their impact on catheter localization was recorded. RESULTS: In the 12 randomly selected patients, radiographic assessment of central venous catheter tip localization on sequential radiographs caused minor to major misinterpretation of the position of the catheter tip and even total nonvisualization of the catheter. Ten (3.5%) of 352 prospectively interpreted pediatric emergency department radiographs showed similar findings. Catheter motion that caused blurring was reproduced in vitro using radiographic parameters typically used in a clinical setting. CONCLUSION: Catheter motion can cause problems in assessing catheter tip position on pediatric emergency department chest radiographs. We reproduced this phenomenon in an in vitro model. Catheter removal or change in position may be mimicked by this artifact, and patient management may be affected. In our study, catheter localization was affected by catheter motion and exposure time.     

Spontaneous intrajugular migration of long-term central venous access catheters.

Two patients with long-term central venous access catheters introduced via the right subclavian vein demonstrated catheter migration into the right internal jugular vein several months after satisfactory catheter placement. One patient developed internal jugular vein thrombosis, which was treated with direct infusion of urokinase before catheter removal. In the other patient, the catheter was repositioned by using an intravascular snare loop, which was introduced via the femoral vein. In the first patient, an interim chest radiograph suggested the mechanism by which the catheter had migrated and provided a clue for early detection of catheter migration.     

Design and testing of a high-flow autoperfusion catheter: an experimental study.

An autoperfusion catheter is similar to an angioplasty balloon catheter with side holes in the guide-wire lumen proximal to the balloon. When the balloon of the autoperfusion catheter is deployed and inflated in an artery, the guide wire is removed, and the hub of the guide-wire lumen is capped. The catheter then allows passive distal perfusion by using ambient pressure to drive blood into the guide-wire lumen, through the balloon, and out the end hole. This article discusses the requirements and constraints of a high-flow autoperfusion catheter, summarizes attempts to modify standard angioplasty catheters for use as an autoperfusion catheter, and describes the design and testing of a custom autoperfusion catheter capable of delivering approximately 3 mL/sec at physiologic pressures. In a model of canine acute renal artery occlusion lasting 90 minutes, the custom autoperfusion catheter provided marked protection from acute tubular necrosis compared with conventional percutaneous transluminal angioplasty catheters. The authors conclude that the high-flow autoperfusion catheter may be useful as a temporary stent in cases of rupture, dissection, or penetrating wounds involving large arteries.     

荧光静脉留置针的整体设计与研发

 目的 利用荧光粉光致发光的原理,研制一种适合在暗环境下穿刺的荧光静脉留置针。方法 选择发光效率高、无毒、无放射性及组织相容性好的荧光材料及临床应用的留置针,进行整体建模设计,研发荧光静脉留置针的实物产品。结果 完成荧光静脉留置针整体设计,制作了荧光静脉留置针的模型和实物产品。结论 荧光静脉留置针的成功研发为野战环境下的静脉穿刺提供了保障。
     

Experience with a modified Gray-St. Louis catheter for percutaneous gastrojejunostomy.

PURPOSE: To determine if design modifications to the Gray-St. Louis gastrojejunostomy catheter would improve its deployment and utilization characteristics. METHODS: A modified catheter and the Gray-St. Louis catheter were alternately inserted in consecutive patients requiring gastrojejunostomy. At the time of insertion, the anatomic locations of the fenestrated end of the catheter and the Cope retention loop were recorded. At the time of removal or exchange, catheters were assessed for the position of the fenestrated end and the retention loop, the presence of catheter tears, leakage of injected contrast medium and evidence of catheter blockage. RESULTS: Of the 250 catheters we assessed in a 3-year period, 141 (56%) were modified catheters and 109 (44%) were Gray-St. Louis catheters. At insertion, the retention loop of the modified catheter was in the duodenum in 132 (94%) patients, whereas the retention loop of the Gray-St. Louis Catheter reached the duodenum in 29 (27%) (p < 0.05). At the time of catheter removal or exchange, the retention loop of the modified catheter was in the duodenum in 72 (60%) patients, whereas the retention loop of the Gray-St. Louis catheter was in the duodenum in 13 (14%) (p < 0.05). CONCLUSION: The design modifications to the Gray-St. Louis catheter improved the likelihood of the retention loop residing in the duodenum, while continuing to allow the fenestrated portion of the catheter to reside in the jejunum.     

Femoral-to-port through-and-through wire access to reestablish subcutaneous port function

OBJECTIVE: Central venous catheter malfunction often results from fibrin sheath formation and is routinely addressed with thrombolytic therapy or mechanical stripping. Mechanical stripping from a distant access site such as a femoral vein is the only option for a subcutaneous port that has failed thrombolytic therapy. When a fibrin sheath has rendered the catheter tip inaccessible to snaring, catheter salvage cannot be achieved, requiring port exchange. We report two cases in which an inaccessible catheter tip was mobilized via advancing a wire through the port and through the catheter, allowing for successful snaring, mechanical stripping, and return of normal port function. CONCLUSION: Passage of a hydrophilic wire through a subcutaneous port and beyond the catheter tip is technically possible. The wire can be snared from a femoral access to achieve successful catheter stripping when direct catheter snaring is not possible.     

MR coil design for simultaneous tip tracking and curvature delineation of a catheter.

In active catheter tracking, small RF coils are attached to the catheter for localization. For interactive catheter steering at vessel branchings, it is necessary to visualize not only a single point near the catheter tip but also the entire shape and orientation of the catheter's distal end. Therefore, a 35-mm-long twisted-pair RF coil was added to a 5 French intravascular catheter with a single tip-tracking coil. With the use of small nonmagnetic electronic components at the catheter tip, and a special switching circuitry outside the catheter, the coil assembly could be operated in two different modes. During MRI, the tip-tracking coil was detuned so that the MR signal was received by the visualization coil only. During tracking, detuning was switched off and the MR signal was predominantly received by the more sensitive tracking coil. The catheter was used in combination with a MR pulse sequence with automatic slice positioning so that the current imaging slice was always placed at the position of the catheter tip. Phantom and animal experiments showed that the catheter tip is better visualized with the combined approach than with a tracking coil alone.     

A novel technique in selective venous sampling in the localization of parathyroid tumours utilizing a micro-wire and standardized catheter

Selective venous sampling (SVS) is a useful technique to localize a number of hormone-producing tumours, such as parathyroid tumours, when other imaging techniques are inconclusive. Typically, a 5 French selective single end-hole catheter and standard hydrophilic wire are utilized to access the required vessels and an attempt made to withdraw blood. However, most interventional radiologists are familiar with the difficulty and limited success in withdrawing venous blood through an end-hole catheter. We describe a simple, cheap and novel technique utilizing a micro-wire that we have developed in our interventional suite to overcome this common problem. Having reached the target site with the selective end-hole catheter, a Tuohy Borst adapter is attached to the catheter end. A 0.018-inch micro-wire is then inserted through the selective end-hole catheter such that the distal wire tip exits the distal catheter tip. The purpose of the micro-wire exiting the catheter is to both straighten the catheter tip to a position parallel to the vessel, allowing easier aspiration as well as physically preventing blockage of the catheter by the vein intimal wall collapse on suction. The 5-ml sample required for PTH assay is then successfully obtained via the Tuohy Borst adapter.     

Posteriorly Tunneled Dialysis Catheters for Permanent Use in Cognitively Impaired Patients Undergoing Hemodialysis

Cognitively impaired patients often pull at their dialysis catheters when the catheters are tunneled over the anterior chest. To potentially circumvent this, a technique was developed that tunnels the catheter posteriorly, over the patient’s shoulder. A total of 32 posteriorly tunneled catheters were placed in 12 patients. The mean catheter use interval was 164 days, with a total of 5,248 catheter use days. Indications for nonelective catheter removals were catheter dysfunction (n = 7; 23.3%), removal by the patient (n = 7; 23.3%), infection (n = 5; 16.7%), and inadvertent dislodgment (n = 1; 3.3%). Only six of the 12 patients were able to dislodge their catheters. The procedure described here reduced catheter manipulation and extended catheter viability in these patients.     

长期颈内静脉留置导管对透析充分性的影响

目的 观察长期颈内静脉留置导管对透析充分性的影响。探讨定期尿激酶治疗对改善导管功能和透析充分性的作用。方法颈内静脉插管时间小于3个月及大于3个月的维持性血液透析患者各12例，记录透析前后体重、脱水量、透析血流速，检测透析前后、透析结束后1h血尿素氮，计算尿素清除指数（Kt／V）、溶质清除指数（SRI）。每2周重复尿激酶封管，3个月后复查上述指标。结果颈内静脉导管留置时间超过3个月者，透析血流速下降、Kt／V、SRI降低；经过定期尿激酶治疗，透析血流速、Kt／V、SRI与近期插管透析者无差异。结论颈内静脉导管留置3个月以上，会出现导管功能不良，透析充分性下降;定期尿激酶治疗，可以有效保持导管功能，提高透析效率。     

Complications Encountered with a Transfemorally Placed Port-Catheter System for Hepatic Artery Chemotherapy Infusion

A port-catheter system was implanted via femoral artery access for hepatic artery chemotherapy infusion. Implantation was attempted in 90 patients and was successful in 88. Blood flow redistribution was performed using embolization coils. In the first ten patients a soft heparin-coated infusion catheter was used. For the following 78 patients we used a stiffer catheter coated with fluorine-acryl-styrene-urethane-silicone (FASUS) copolymer. The catheter was connected to a port implanted subcutaneously below the level of the inguinal ligament. Complications during the procedure and after placement were observed in 7 of 90 patients and 24 of 88 patients, respectively. These included catheter obstruction (11%), dislocation of the catheter tip (10%), drug toxicity (5.7%), and catheter infection (3.4%). In 6 of 10 patients with catheter obstruction, recanalization of the port system was achieved. In 7 of 9 patients with dislocation of the indwelling catheter tip, replacement of the port system was successful. Our complications appear to be comparable with those encountered with the subclavian/brachial approach when the new catheter coating is used. Notable is the avoidance of cerebral infarcts.     

Percutaneous retrieval of 20 centrally dislodged Port-A catheter fragments

A total of 20 patients with centrally embolized Port-A catheter fragments underwent the percutaneous retrieval procedures at our hospital. The causes of the dislodgement of these catheters included bad connection between the port and catheter, angulation or distortion at the anastomosis site, severing the catheter during insertion and removal of the catheter, improper catheter position and fatigue of the catheter. Consequently, improper procedure handling by the inexperienced surgeons could be considered as the most frequent cause of embolization. The percutaneous retrieval procedures were successful in all centrally embolized fragments. Of 20 successful retrievals, 16 were performed will loop snare catheters and 4 with Dormia basket retrievers.     

Development of a New Coaxial Balloon Catheter System for Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO)

Purpose To develop a new coaxial balloon catheter system and evaluate its clinical feasibility for balloon-occluded retrograde transvenous obliteration (B-RTO). Methods A coaxial balloon catheter system was constructed with 9 Fr guiding balloon catheter and 5 Fr balloon catheter. A 5 Fr catheter has a high flexibility and can be coaxially inserted into the guiding catheter in advance. The catheter balloons are made of natural rubber and can be inflated to 2 cm (guiding) and 1 cm (5 Fr) maximum diameter. Between July 2003 and April 2005, 8 consecutive patients (6 men, 2 women; age range 33–72 years, mean age 55.5 years) underwent B-RTO using the balloon catheter system. Five percent ethanolamine oleate iopamidol (EOI) was used as sclerosing agent. The procedures, including maneuverability of the catheter, amount of injected sclerosing agent, necessity for coil embolization of collateral draining veins, and initial clinical results, were evaluated retrospectively. The occlusion rate was assessed by postcontrast CT within 2 weeks after B-RTO. Results The balloon catheter could be advanced into the proximal potion of the gastrorenal shunt beyond the collateral draining vein in all cases. The amount of injected EOI ranged from 3 to 34 ml. Coil embolization of the collateral draining vein was required in 2 cases. Complete obliteration of gastric varices on initial follow-up CT was obtained in 7 cases. The remaining case required re-treatment that resulted in complete obstruction of the varices after the second B-RTO. No procedure-related complications were observed. Conclusion B-RTO using the new coaxial balloon catheter is feasible. Gastric varices can be treated more simply by using this catheter system.     

Intravascular magnetic resonance imaging using a loopless catheter antenna

Recently, intravascular catheter probes have been developed to increase signal-to-noise ratio (SNR) for MR imaging of blood vessels. Miniaturization of these catheter probes without degrading their performances is very critical in imaging small vessels such as coronary arteries. Catheter coils have a loop incorporated in their structure and have limitations in physical dimensions and electromagnetic properties. The use of a loopless intravascular catheter antenna is proposed to overcome these problems. The catheter antenna is essentially a dipole, which makes a very thin diameter possible, and its electronic circuitry can be placed outside the blood vessels without performance degradation. The theoretical foundation for the design and operation of the catheter antenna is presented. Several catheter antennae, as small as 1.5 French, were constructed and tested on phantoms and rabbits with great success. The catheter antenna has a simple structure and is easy to design, implement, and operate.     

Emergency percutaneous retrieval of a silicone port catheter fragment in pinch-off syndrome by means of an Amplatz gooseneck snare

Rupture of a silicone Port-a-Cath catheter may occur, especially with costoclavicular pinch-off syndrome (POS), which is a typical consequence of fatigue when the catheter is introduced in the subclavian vein too medially. This case report describes the percutaneous retrieval of a fractured silicone port catheter fragment, which had migrated into the internal jugular vein. Extraction was complicated by the presence of an internal jugular vein stenosis and the fact that the catheter fragment was looped upon itself. Several retrieval devices failed before an Amplatz gooseneck snare finally allowed retrieval of the fragment. We recommend this device for extraction of silicone port catheter fragments. Rerupture of the port catheter occurred 7 months after surgical reinsertion at the same infraclavicular site, as a consequence of constant compression by POS. Alternative approaches should be used after catheter failure due to POS. Electronic Publication     

自制选择性输卵管再通导管的临床应用研究

目的 探讨自制选择性输卵管再通导管的临床应用效果。方法 ５０４例经证实有一例或双侧输卵管不通的不孕症患者,采用自制选择性卵管再通导管进行再通。该导管由导向导管、锥头导管、微导管和导丝４部分组成,导管头端据子宫形态分别弯曲成不同角度的３种形态。对操作技术也进行了改进。结果 ５０４例中经子宫输卵管造影共发现７９２支输卵管支通,共疏通７３１,总疏通率９２．３％。插管总成功率为９７．４％。发生输卵管穿破２