Tunneled internal jugular catheters in adult patients: comparison of outcomes in hemodialysis versus infusion catheters

Background: Tunneled central venous catheters placed by interventional radiologists are now widely used for hemodialysis and infusion therapies throughout the world. However, complications such as infections and malfunctions still remain a major concern in oncology and hemodialysis patients.

Purpose: To evaluate the long-term follow-up results of tunneled central venous catheters in an adult population in terms of infectious complications and malfunction rates in dialysis and oncology patients.

Material and Methods: We retrospectively reviewed the hospital charts and our electronic database for 434 tunneled internal jugular catheters in 335 consecutive patients between December 2002 and March 2006. Mean patient age was 57 years (range 23-86 years) in the hemodialysis group and 45 years (range 18-83 years) in the infusion group. A total of 224 hemodialysis catheters were placed in 168 patients (68 females, 100 males) and 210 infusion catheters in 167 patients (48 females, 119 males).

Results: Technical success rate was 100%. Mean duration of catheter use was 86 days (1-652 days) and 60 days (2-686 days) for hemodialysis and infusion catheters, respectively. A total of 107 hemodialysis (47%) and 95 infusion catheters (45%) were electively removed due to completion of therapy and resolution of need for dialysis. Revisions were performed 0.22 and 0.11 per 100 catheters days in the hemodialysis and infusion groups, respectively. Our total infection rate was 0.10 episodes per 100 catheter days, and the rate of infections necessitating catheter removal was 0.05 episodes per 100 catheter days in the hemodialysis group, which is lower than that reported in other big series. However, in the infusion group, the rate of infections necessitating catheter removal was 0.28 episodes per 100 catheter days.

Conclusion: Long-term central venous accesses using tunneled internal jugular catheters appeared to be safe and effective for both hemodialysis and long-term infusion therapies, with relatively higher infection rates in oncologic patients.     

Comparison of complications between transjugular and axillosubclavian approach for placement of tunneled, central venous catheters in patients with hematological malignancy: a prospective study

This study was designed to compare the incidence of mechanical, thrombotic and infective complications in transjugular (IJV) and axillosubclavian (SCV) central venous catheters (CVC) in patients with hematological malignancy. In a prospective observational trial, 131 consecutive patients were classified into two groups: Group A included those with IJV catheter insertions under sonography guidance (n=61) and group B included those with SCV insertions under venography guidance (n=70). After catheter placement, patients were prospectively acquired and recorded to obtain the following data: success rates, total catheter days, and complication episodes per 100 catheter days. All procedures were technically successful. Total catheter days were 7800 (group A) versus 8391(group B). Mechanical complications were observed in three cases from group A and 11 from group B, with an incidence rate of 0.04 per 100 catheter days versus 0.13 (P=0.043), respectively. Two symptomatic thrombotic complications were observed in group B. The number of infective complications was not significantly different between the two groups (P=0.312). There was no difference in infective complication incidence between the two groups. To minimize catheter-related mechanical and thrombotic complications, however, the IJV approach is superior to the SCV approach.     

婴幼儿超声辅助下颈内静脉穿刺植入完全植入式静脉输液港评价

目的 探讨超声辅助下颈内静脉穿刺在婴幼儿完全植入式静脉输液港(TIVAP)植入术中的效果.方法 回顾性分析2009年1月至2016年7月在上海交通大学医学院附属儿童医学中心(单中心)治疗的446例TIVAP植入术患儿临床资料,患儿平均年龄1.3岁(4个月～2.8岁).比较传统颈内静脉盲穿刺和超声辅助下颈内静脉穿刺耗时、一次穿刺成功率、穿刺并发症发生率,并作统计学分析.结果 446例患儿中颈内静脉盲穿刺265例,平均需时7.6 min,一次穿刺成功201例(75.85％),发生穿刺并发症15例(5.66％);超声辅助下颈内静脉穿刺181例,平均需时4.2 min,一次穿刺成功176例(97.24％),发生穿刺并发症3例(1.70％).结论 婴幼儿TIVAP植入术时采用超声辅助下颈内静脉穿刺,可缩短手术时间,提高一次穿刺成功率并减少穿刺并发症发生,是一种安全有效、简单可行的技术,值得临床推广.     

Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

Objective

To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein.

Materials and Methods

We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records.

Results

A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively).

Conclusion

Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.     

右侧头臂静脉入路植入静脉输液港临床应用

目的 探讨右侧头臂静脉入路行完全植入式静脉输液港(TIVAP)植入的可行性及安全性.方法 回顾性分析2013年3月至2015年12月采用BCV入路植入TIVAP共493例患者临床资料,其中男137例,女356例;年龄29～78岁,平均(47.3±13.2)岁.总结穿刺成功率及留置过程相关并发症.结果 手术成功率为100％,首次穿刺成功率为99％ (488/493).手术时间18～35 min,平均(22.5±8.3) min.术中误穿动脉3例(0.61％,3/493),未见血胸、气胸等严重并发症.术后患者携TIVAP时间为124～986 d,平均(271.1±53.8)d;并发症发生率为2.25％(11/488),包括港穴出血2例,导管相关感染1例,部分血栓形成2例,纤维蛋白鞘形成6例,未见导管异位、断裂、置管相关夹闭综合征(POS)等严重并发症.结论 经右侧BCV入路行TIVAP植入,穿刺成功率高,安全可靠,可为临床植入TIVAP提供另一入路选择.     

中心静脉通道的建立及其在临床中的应用

目的 倡导建立中心静脉通道的重要性,比较经右锁骨下静脉（TSCV）和右颈内静脉（TIJV）两种途径建立中心静脉通道的技术特点。方法 自1999年3月至2001年6月间共完成中心静脉通道植入术348例次,其中经右锁骨下静脉270例次,经右侧颈内静脉78例次;导管留置时间13－75d,平均23d。结果 TSCV组270次,268次成功,成功率99％。操作中和留置期间11例出现严重并发症,包括气胸2例,误留入锁骨下动脉1例,留置管阻塞3例,留置管进入右颈内静脉引起输液异常3例。穿刺口感染2例。TIJV组78次75次成功,成功率96％,严重并发症1次。结论 中心静脉通道在临床上具有很大的实用价值,其成功率与操作者解剖知识及技术熟练程度有关。     

Central venous catheter placement in the inferior vena cava via the direct translumbar approach

The aim of this study was to evaluate the technical aspects and efficacy of placing tunneled central venous access catheters (CVA) in the inferior vena cava (IVC) via a direct translumbar approach. Between August 1994 and July 1998, 50 CVA (Hickman 13.5 F) were placed in the IVC via a direct translumbar approach in 46 patients (10 males, 36 females) with a mean age of 39.9 years (age range 10–87 years). The indications were chemotherapy administration plus leukoaphoresis (n = 39), bone marrow transplantation (n = 2) and hemodialysis (n = 5). The reasons for placing the CVA in the IVC were cosmetic (n = 34), supradiaphragmatic venous thrombosis (n = 8), previous catheter infection (n = 2), and non-functioning arteriovenous fistula (n = 2). There were no immediate complications. The mean period of time the CVA was in place was 3 months (15 days to 15 months), during which the function was excellent. The commonest late complication was infection (4 local, 6 bacteremia). Others included: pain (n = 2), ureteric fistula (n = 1), pericatheter fibrin sheath formation (n = 6) and catheter-tip impaction (n = 2). Two catheters were damaged due to postprocedural inappropriate manipulations and two others fell off due to incorrect fixation. Due to these complications, it was necessary to remove ten catheters, replace an additional four and reposition two. Direct translumbar catheterization of the IVC is a safe and effective way of placing a long-term CVA with a moderate complication rate. Received: 20 November 1998; Revision received: 5 March 1999; Accepted: 17 May 1999     

X线辅助经外周至中心静脉置管与传统中心静脉置管的对比研究

目的 比较在Ｘ线辅助下经外周静脉至中心静脉置管（ＰＩＣＣ）与传统的经锁骨下静脉至中心静脉置管（ＣＶＣ）两种方法的优越性及并发症。方法 自１９９７年１月至１９９８年１２月期间，在Ｘ线监视下，对ＰＩＣＣ和ＣＶＣ各６０例病人进行临床研究，观察指标包括置管成功率、导管尖端的位置、并发症发生率。两组结果经显著性检验比较。结果 经Ｘ线影像证实，ＰＩＣＣ与ＣＶＣ组一次穿刺置管成功率分别为９５．０％（５７／６０例     

Central venous access: techniques and indications in oncology

Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient's performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.     

严重多发伤患者颈内静脉的粗细及其影响因素

目的 了解严重多发伤患者颈内静脉粗细和影响因素，为提高颈内静脉置管成功率提供指导。方法 超声检测50例多发伤患者和27例正常人吸气末、呼气末的颈内静脉截面积，比较2组颈内静脉粗细、影响因素及优势静脉分布情况。结果 多发伤患者颈内静脉较对照组增粗，每侧有3例截面积〈0．40cm^2，优势静脉位于右、左侧分别为37例和13例，与对照组比较，差异无统计学意义。正常组颈内静脉粗细与年龄、身高、体重有关，多发伤患者则与中心静脉压、机械通气相关。结论 多发伤患者双侧颈内静脉不对称，较正常人增粗，穿刺前超声探查和穿刺时使用呼吸机吸气暂停功能有助于提高颈内静脉置管成功率。     

Subcutaneous chest ports via the internal jugular vein. A retrospective study of 117 oncology patients

Purpose:
To review image-guided chest port insertion using the right internal jugular vein as the access site of choice. Material and Methods:
One hundred and eighteen subcutaneous chest ports were placed via the internal jugular vein in 117 patients with malignancies using both fluoroscopic and US guidance in interventional radiology suites. Results:
The technical success rate was 100% with no procedural complications. Follow-up was obtained in all patients with total access days of 40,450 days (mean, 342.8 days). Premature catheter removal was required in 8 patients (6.8%, 0.20 per 1,000 access days) due to non-treatable complications: 2 catheter occlusions/malfunctions (1.7%, 0.05 per 1,000 access days), 1 catheter-related skin erosion (0.85%, 0.024 per 1,000 access days), and 5 infections (4.2%, 0.15 per 1,000 access days). Two symptomatic right upper extremity venous thromboses also occurred (1.7%, 0.05 per 1,000 access days) that were treated successfully with anticoagulation. Conclusion:
Image-guided placement of internal jugular vein chest ports has a high success rate and low complication rate compared with reported series of unguided subclavian vein port insertion. The internal jugular vein should be used as the preferred venous access site compared to the subclavian vein.     

Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

Purpose

To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication.

Materials and methods

A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port.

Results

Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction.

Conclusion

FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required.     

Hemopericardium resulting from attempted internal jugular vein catheterization: A case report and review of complications of central venous catheterization

An unusual case of hemopericardium and presumed fatal cardiac tamponade complicating attempted right internal jugular vein catheterization by the posterior approach is reported. Reports of complications in a series of internal jugular vein catheterizations using various approaches (posterior, central, anterior, supraclavicular) and subclavian vein catheterizations are reviewed. Internal jugular vein catheterization is not necessarily safer than subclavian vein catheterization: numerous factors determine success rate and complication rate in central venous catheterizations.     

Comparison of Ultrasonography-Guided Central Venous Catheterization Between Adult and Pediatric Populations

The purpose of this study was to compare the technical success and complication rates of ultrasonography-guided central venous catheterization between adult and pediatric patients which have not been reported previously. In a 4-year period, 859 ultrasonography-guided central vein catheterizations in 688 adult patients and 247 catheterizations in 156 pediatric patients were retrospectively evaluated. Mean age was 56.3 years (range, 18 to 95 years) for adults and 3.3 years (range, 0.1 to 16.3 years) for children. The preferred catheterization site was internal jugular vein in 97% of adults and 85% of children. The technical success rate, mean number of punctures, and rate of single wall puncture were 99.4%, 1.04 (range, 1–3), and 83% for adults and 90.3%, 1.25 (range, 1–5), and 49% for children, respectively. All the differences were statistically significant (p < 0.05). Complication rates were 2.3% and 2.4% for adults and children, respectively (p > 0.05). Major complications such as pneumothorax and hemothorax were not seen in any group. In conclusion, ultrasonography-guided central venous catheterization has a high technical success rate, lower puncture attempt rate, and higher single wall puncture rate in adults compared to children. Complication rates are comparable in the two groups.     

锁骨下静脉输液港的并发症及临床处理

目的：探讨锁骨下静脉输液港的并发症,分析临床处理方法及疗效。方法：回顾性分析150例行锁骨下静脉输液港置入术的患者病例资料,记录并发症的发生及临床处理方法及疗效。结果：147例患者完成锁骨下静脉输液港系统置入术,操作成功率为98%;操作时间为25-60 min,平均43 min;3例手术失败,其中1例气胸,2例穿刺锁骨下动脉;近期并发症的发生率为6.67%;远期并发症发生率为14%。结论：锁骨下静脉输液港置入术操作简单、使用安全,临床操作及护理程序的提高有利于减少并发症的发生。     

低剂量尿激酶较长时间经导管直接溶栓术治疗急性髂-股静脉血栓形成的安全性和临床疗效

目的 探讨低剂量尿激酶较长时间经导管直接溶栓术(CDT)治疗急性髂-股静脉血栓形成的安全性及临床疗效.方法 搜集2005年1月至2011年3月间,采用CDT治疗且至少有12个月临床随访资料的,单侧急性髂-股静脉血栓形成的63例患者的临床资料.对CDT期间患者出现的并发症、血栓清除率、置管灌注持续溶栓时间、尿激酶用量、患肢消肿程度以及临床随访资料进行回顾性分析.计数资料用Fisher精确概率法检验.计量资料多组间比较采用方差分析,两两比较用LSD检验.对不同时间点的血栓清除率比较用重复测量资料的方差分析.结果 CDT期间没有肺栓塞和大出血发生,小的出血并发症10例(15.9％),其中沿血管鞘边缘渗血3例、穿刺点周围皮下瘀斑或血肿3例、血尿3例、牙龈出血1例.因置管引起并发症4例(6.3％),其中穿刺点周围软组织炎症表现3例、血管鞘周围继发血栓1例.53例(84.1％)患者CDT第4～8天血栓溶解程度达到Ⅲ级和Ⅱ级.CDT中,尿激酶50万U/d和75 U/d灌注溶栓获得的血栓清除率分别为(91.2±10.1)％和(91.3±12.2)％,明显优于25万U/d的(75.9 ±20.1)％(P＜0.05),但尿激酶50万U/d和75万U/d二者间的血栓清除率差异无统计学意义(P＞0.05);尿激酶50万U/d和75万U/d灌注溶栓达到Ⅲ级时的平均置管时间[分别为(7.1±0.9)d和(6.2±1.3)d]与Ⅱ级时的平均置管时间[分别为(6.4±1.0)d和(6.0±0.8)d],差异均无统计学意义(P＞0.05).随置管灌注时间的延长,平均血栓清除率有增加的趋势(P＜0.05).CDT 24 h后58例(92.1％)患肢软组织张力减轻,48 h后患肢周径[大腿中部为(54.25±5.79) cm,小腿中部为(44.05 ±5.18)cm]缩小,同术前[大腿中部为(56.46±5.91)cm,小腿中部为(45.68 ±5.16)cm]比较差异有统计学意义(P＜0.05),出院时患肢周径[大腿中部为(49.00±4.67)cm,小腿中部为(38.41±4.15)cm]同健侧[大腿中部为(48.38±4.68)cm,小腿中部为(37.73±3.92) cm]比较差异无统计学意义(P＞0.05).术后6个月时髂静脉支架通畅率91.1％(41/45).12个月时多普勒超声显示11例开通的股静脉瓣膜功能有反流征象.结论 采用低剂量尿激酶、较长时间经导管直接溶栓术治疗急性髂-股静脉血栓形成具有较高的安全性和满意的临床治疗效果.     

经皮球囊血管成形术和经皮支架植入术治疗透析通路中心静脉狭窄的临床效果比较

目的：观察透析通路中心静脉狭窄（CVS）经皮球囊血管成形术（PTA）和经皮支架植入术（PTS）治疗的近中期疗效。 方法：选取2014年10月—2016年10月收治的发生CVS的血液透析患者40例,按治疗方式的不同分为PTA治疗组26例和PTA+PTS治疗组14例。观察两组患者术后疗效及通路管径变化情况;随访术后1、3、6个月透析通路的开放情况及开放时间。 结果：术后相关症状均在1周内改善,治疗后通路直径较治疗前均增宽;PTA治疗组的初级开放时间为（5.17±1.54）个月,高于PTA+PTS治疗组的初级开放时间（3.57±1.71）个月;PTA+PTS治疗组的腔内干预次数为（1.93±0.47）次,高于PTA治疗组的（1.35±0.56）次,差异均有统计学意义。PTA治疗组1、3、6个月的初级开放率分别为96.2%、80.7%、69.2%,辅助初级开放率分别为100%、92.3%、92.3%;PTA+PTS治疗组1、3、6个月的初级开放率分别为92.9%、64.3%、14.3%,辅助初级开放率分别为100%、100%、85.7%。两组的初级开放率和辅助初级开放率差异无统计学意义。 结论：透析通路CVS的治疗首选单纯PTA,当出现PTA抵抗或频繁复发时,可以考虑植入支架。     

完全植入式静脉输液港术后港体翻转临床分析

目的探讨完全植入式静脉输液港(TIVAP)术后港体翻转的发生原因、确诊方法、处理措施及预防策略。方法回顾性分析2015年12月至2018年10月428例接受TIVAP植入术患者临床资料。记录术后港体翻转率、发生时间、原因分析和处理措施。结果428例患者术中港体均未缝合固定,术后6例发生港体翻转,均经影像学检查证实,港体翻转率为1.4%(6/428)。其中男2例,女4例;年龄55~71岁,平均(65.0±6.3)岁。术后23~451 d出现港体翻转,2例考虑与皮下组织过剩/疏松相关,1例考虑为囊袋尺寸过大,其余3例原因不明。处理措施:单纯手法复位3例,囊袋内注射0.9%氯化钠溶液后手法复位1例,囊袋内注射0.9%氯化钠溶液手法复位失败后切开复位1例,直接切开复位1例。结论TIVAP植入术后港体翻转发生率低,易于确诊和复位,因此没有必要常规缝合固定港体。建议选择宽基底、凸缘设计港体。港体翻转原因尚需进一步研究探讨。     

喉罩通气对颈内静脉与颈总动脉解剖关系的影响

 目的 研究喉罩置入对颈内静脉与颈总动脉解剖关系的影响, 寻找喉罩全身麻醉下, 颈内静脉穿刺适合的入路, 提高穿刺成功率。方法 选择喉罩全身麻醉择期手术患者30例, 应用超声波扫描术, 在胸锁乳突肌三角顶点和锁骨上窝2 cm位置, 头部偏转0°、30°、60°和最大角度, 在喉罩置入前后分别测定双侧颈内静脉与颈总动脉的夹角和动脉重叠率。结果 胸锁乳突肌三角顶点和锁骨上窝2 cm位置, 随患者转头角度的增加, 双侧颈内静脉与颈总动脉的夹角逐渐减小(P<0.05), 动脉重叠率逐渐增高(P<0.05)。胸锁乳突肌三角顶点位置, 喉罩置入后, 与相同转头角度喉罩置入前比较, 动静脉夹角明显减小(P<0.05), 而动脉重叠率明显增高(P<0.05)。锁骨上窝2 cm位置, 喉罩置入对动静脉夹角和动脉重叠率均无明显影响(P>0.05)。结论 转头与喉罩置入充气可改变颈内静脉与颈总动脉解剖关系, 增加穿刺难度, 了解这一变化规律有助于选择适宜的穿刺路径, 降低颈内静脉穿刺时误伤颈总动脉的发生率。
     

植入式静脉输液港导管断裂预防与处理

目的 探讨植入式静脉输液港(IVAP)导管断裂及其预防处理.方法 回顾性分析2012年1月至12月单中心878例IVAP植入患者中发生导管断裂7例患者临床资料,结合相关文献对导管断裂原因和预防措施进行讨论.结果 截至2016年11月31日,经颈内静脉植入IVAP术后导管断裂发生率为0.8％(7/878);断裂时间为术后855～1 412 d,平均1 133 d;断裂部位为导管进入颈内静脉交界处、导管与底座接头处和皮下隧道部位.结论 导管断裂是IVAP植入后长期使用过程中严重并发症之一.规范手术操作流程、加强维护和护理宣教、适时取出等措施,有助于降低IVAP导管断裂发生率,保障患者生命安全.