A comparison of tunnelled and nontunnelled subclavian vein catheters: a prospective study of complications during parenteral feeding

Forty-four silastic catheters in 38 surgical patients, nursed in general surgical wards, were inserted under aseptic conditions by the infraclavicular subclavian route. The catheters were randomly allocated to non-tunnelled (NT) (n = 24) or tunnelled (T) (n = 20) groups. Catheters were removed on completion of intravenous feeding or clinical suspicion of catheter infection, and the catheter tip and blood samples taken through the catheter and from the peripheral vein were cultured. There was no significant difference between the two groups in terms of bacteriological infection (defined as two or more cultures of the same organism), clinical infection (defined by elevated temperature returning to normal after catheter removal) and combined infection (when both bacteriological and clinical infection co-existed). When the number of infected catheters was related to the duration of catheter insertion, the incidence of combined catheter related sepsis was reduced with tunnelling (NT: one infected catheter per 35 catheter days, T: one infected catheter per 89 catheter days). This study highlights the risks of subclavian vein catheterisation and emphasises the difficulties in defining catheter sepsis but suggests that its incidence may be reduced if skin tunnelling is employed.     

A modified method of vascular access system implantation using the subclavian vein

A new method of implanting vascular access systems using the Arrow Percutaneous Sheath Introducer Kit is described. The surgeon who frequently inserts these systems may find this technique to be a useful alternative in those patients in whom cutdowns were unsuccessful or in whom the percutaneous technique with a peel-away sheath is found to be difficult.     

Effort thrombosis of the subclavian vein

Three patients, 2 women aged 42 and 20 years and a 21-year-old man, presented with painful swelling of the upper extremity. The symptoms developed after activities involving repetitive, excessive use of the upper extremity. Duplex examination and venography showed thrombosis of the subclavian vein. This specific type of thrombosis is known as effort thrombosis or Paget-von Schroetter syndrome. It results from a narrowed thoracic outlet combined with repetitive strenuous use of the upper extremity. All three patients were first treated with thrombolytic therapy using urokinase delivered locally in the thrombus with a catheter. After the thrombus had resolved, a first rib resection was performed to decompress the thoracic outlet. Due to the remaining substantial stenosis and vessel wall irregularity, additional percutaneous transluminal angioplasty was performed. It is important to treat effort thrombosis immediately and adequately. Otherwise, it may lead to a postthrombotic syndrome, which can be severely disabling.     

Chylothorax--a complication of subclavian vein catheterization

Insertion complications of subclavian vein catheter placement are well documented. Thoracic duct injury is a potential problem which has rarely been reported. A patient with duct injury and resultant chylothorax is presented. The management of this problem is discussed with emphasis placed on chyle leakage from both the nutritional and mechanical aspect. The anatomy and function of the thoracic duct as well as the pathophysiology and treatment of chylothorax are detailed.     

Delayed pneumothorax: a complication of subclavian vein catheterization

Subclavian catheterization is a reliable, well-described technique of central venous access for a variety of indications. Significant complications are associated with the procedure. Detection of the majority of complications is afforded by the postinsertion chest x-ray. Delayed pneumothorax, a relatively unrecognized complication of subclavian catheterization, is caused by a slow pleural air leak which appears to be associated with the "difficult" insertion as illustrated by three case reports. A repeat or "delayed" chest roentgenogram should be considered in the following situations: Difficult subclavian insertions requiring multiple attempts. Suspicion of pleural injury such as aspiration of air during insertion or subcutaneous emphysema with a normal postinsertion chest x-ray. The presence of another major complication. If the patient complains of persistent pleuritic or back pain after insertion. Preoperatively after previous difficult insertion of a central venous line. Postoperatively when a subclavian catheter is inserted intraoperatively.     

减少锁骨下静脉穿刺并发症方法探讨(附1 480例分析)

目的:结合行锁骨下静脉穿刺经验,探讨减少穿刺术中并发症的措施.方法:回顾性分析2018年1月1日至2020年1月1日在北京大学肿瘤医院静脉通路中心进行中心静脉置管的1 480例病人.结果:所有病人中196例首先尝试行左侧锁骨下静脉穿刺,1 284例首先尝试行右侧锁骨下静脉穿刺,其中左侧锁骨下静脉穿刺3针及以内成功172...     

Contamination of central venous catheters in immunocompromised patients: a comparison between two different types of central venous catheters

Catheters impregnated with silver have been proposed as a means of reducing catheter-related infection. We therefore performed a prospective randomized study to compare a new silver-impregnated central venous catheter (CVC) with a commercially available CVC in a cohort of immunocompromised patients. We studied 157 patients of whom 97 could be analysed. The median indwelling time in the study group (SC) was 10.5 days and 11 days in the control group (CC). The incidence of contamination in the SC group was 15.6 vs 24.6 in the CC group referring to 1000 catheter days. In both groups, we found 6% of catheter-related infections according to the definitions of a published scoring system. The differences between the two groups were not significant. We conclude that the SC decrease the incidence of catheter contamination and may have a positive effect on the reduction of CVC-related infections.     

Use of triple-lumen subclavian catheters for administration of total parenteral nutrition.

This study evaluated the safety of triple vs single-lumen catheters in intravenous nutrition. Patients who were judged likely to benefit from a triple-lumen catheter were randomized to receive either a single-lumen catheter, with additional peripheral or central venous access as needed, or a triple-lumen catheter. All patients were at increased risk of catheter-related infection because of one or more of the following conditions: > 60 years of age, breakdown of skin integrity, severe underlying illness, diagnosis of acute pancreatitis, recent head or neck surgery, or presence of a preexisting infection. Patients were excluded who had neutropenia, were immunosuppressed, had body burns > 40%, or had contaminated wounds in the subclavicular area. Of 204 patients entered between June 1989 and November 1991, 177 completed the required > or = 7 days of therapy. Seventy-eight of these patients were randomized to a single-lumen catheter and 99 to a triple-lumen catheter. Catheters were inserted and maintained by the Nutrition Support Team. Dressings were monitored daily and changed weekly using a bio-occlusive dressing. When parameters were met for a possible septic episode, simultaneous peripheral and central catheter blood cultures were obtained using the Isolator method. Catheter-related sepsis was considered present if the colony count from a central catheter lumen was > or = 5 times that of the peripheral blood. The incidence of catheter-related sepsis for single-lumen catheters was 2.6% (2 of 78) compared with 13.1% for triple-lumen catheters (13 of 99) (p < .01). No correlation was found with the number of insertion attempts, catheter days, or patient's age.(ABSTRACT TRUNCATED AT 250 WORDS)     

锁骨下静脉穿刺置管误入同侧颈内静脉的简易判断法

经锁骨下途径作锁骨下静脉穿刺置管时 ,若患者头部用力偏向并转向对侧 ,很容易使插入的导管逆行进入同侧颈内静脉。近 2年经锁骨下途径用右锁骨下静脉穿刺置管近百例 ,其中 10余例误将导管送入同侧颈内静脉 ,进行肠外营养治疗一周患者出现局部静脉炎 ,使输液发生困难。既往我们用血管造影在放射线科做导管调整 ,有许多不便。现在我们均在病房穿刺 ,同时能确定导管尖端的位置 ,使穿刺置管一次成功 ,现将方法介绍如下。方法　先按常规步骤穿刺锁骨下静脉 ,穿刺成功后 ,将导管送入血管 3～ 5ｃｍ时 ,嘱患者头部取正位并耸肩 ,使同侧锁骨下静脉…     

导丝塑型在锁骨下静脉置管中的应用

目的　探讨导丝塑型法在锁骨下静脉置管中的临床应用价值。方法　2015年1月至2016年1月400例经右侧锁骨下穿刺行中心静脉置管的患者按就诊单双日分为两组：对照组200例、研究组200例。置管由同一位操作者实施。对比分析两组患者置管过程中导丝异位的发生率。结果　393例成功置管,总体置管成功率98.25%,其中研究组置管成功率98.5%（197/200）,对照组置管成功率98.0%（196/200）,差异无统计学意义（P=0.500）。研究组置管过程中导丝异位发生率1.02%(2/197),明显低于对照组的7.14%(14/196)（P=0.002）,差异有统计学意义。结论　导丝塑型法能够有效预防置管过程中导丝异位的发生,该方法简单、实用、成功率高,是预防置管异位的有效措施。     

超声引导锁骨下静脉置管对导管相关性血流感染控制研究

目的采用高频彩色多普勒超声实时引导锁骨下静脉精确置管对导管相关性血流感染发生率影响的临床研究,降低导管血流感染发生率。方法将实施锁骨下静脉精确置管的48例患者随机分为观察组和对照组,每组各24例,其中观察组采用高频彩色多普勒超声显像进行锁骨下静脉精确置管;而对照组则采用常规的方法进行置管,对所得的相关数据均采用SPSS13.0软件进行分析处理。结果两组患者临床资料比较差异无统计学意义;观察组锁骨下静脉精确置管一次成功23例占95.83%,对照组一次成功18例占75.00%;置管操作时间<2min者观察组21例、对照组9例;出现并发症观察组2例占8.33%、对照组7例占29.17%;置管一段时间后进行血液细菌检查,结果显示观察组感染1例占4.17%、对照组感染3例占12.50%;4个指标观察组与对照组对比差异均有统计学意义(P<0.05)。结论采用高频彩色多普勒超声引导锁骨下静脉精确置管和常规置管相比操作简便安全、异常成功率较高、并发症和感染率比较低,在临床上对于锁骨下静脉精确置管有一定的临床指导意义。     

Risk of infection accompanying the use of single-lumen vs double-lumen subclavian catheters: a prospective randomized study

A prospective study was undertaken to compare the risks of a multiple-lumen catheter to bilateral subclavian catheters in patients receiving total parenteral nutrition (TPN). All patients had one preexisting subclavian catheter. Patients were randomized into two groups: one group received a double-lumen catheter via a guidewire change of the preexisting single-lumen subclavian catheter. In the second group, a second single-lumen subclavian catheter was inserted and the preexisting single-lumen catheter was changed over a guidewire. Patients were followed by the Nutrition Support Service and were managed identically with regard to solutions given, catheter care, dressing changes, monitoring of mechanical complications, and evaluation of fever. Total infection rates in both groups were identical (22.7%). The difference in mechanical complication rates in the double-lumen catheter group (9%) and the group with bilateral single-lumen catheters (22.7%) was not significant by Fischer's exact test. The multiple-lumen catheter is superior in convenience and as safe as bilateral single-lumen catheters.     

Complications in hemodialysis performed by catheterization of the subclavian vein

Hemodialysis was performed in 349 cases on 35 patients with 50 special subclavian catheters. The catheters were inserted infraclavicularly with Seldinger's technique. The cannulation period was 26.6 (1-148) days and on the average 7 hemodialyses (1-63) were performed through 1 catheter. The aspects of subclavian catheterization, indication and complications are described. In 3 patients suffering from chronic uremia the end of the catheter (3-5 cm) in the subclavian vein was found broken after 1-5-6 weeks long "single-needle" dialysis. The broken end became fixed into the segmental artery of the lung and did not cause any complication during the long (6-14-33 months) observation period, thus its open or transluminal removal was not considered necessary. In the opinion of the authors the "single-needle" hemodialysis should be avoided to prevent similar complications. The use of the "two-needle" treatment or a catheter with double lumen is advisable.     

Ultrasound guidance versus anatomical landmarks for subclavian vein catheterization: a prospective study

Background: Several clinical practice guidelines strongly support the use of ultrasound guidance (USG) for internal jugular vein catheterization. The level of evidence concerning the use of USG for subclavian vein (SCV) cannulation remains low. Aim: To compare the effectiveness and safety of USG and anatomical landmarks approaches for cannulation of SCV. Methods: This was a prospective randomized study. Patients aged over 18 years old who requiring elective central venous catheterization were included. Non-inclusion criteria were thrombosis of the vein or major coagulopathy. All catheterizations were performed by two anaesthesiology residents. Patients were randomized into two groups: ultrasound guidance group (US group) and anatomical landmarks (LM group). The main outcome was the success rate. The secondary outcomes were the first attempt success rate and the incidence of complications. Results: Seventy patients were included (35 in each group). The success rate was higher in US group compared to LM group without statistical significance (100% vs 85.7%; p=0.054). The first attempt success rate was significantly higher in the US group (82.9% vs. 40%; p<10^-3). The incidence of mechanical complications was significantly lower in the US group compared to LM group (5.7% vs. 37.1%; p=0,001). Conclusion: according to our study, US guidance for SCV catheterization seems to be an interesting alternative to anatomical landmarks approaches