A prospective study of complications in Hickman right-atrial catheters in marrow transplant patients

One hundred forty-three large bore right-atrial catheters (RACs) in 111 bone marrow transplant recipients were prospectively analyzed for the incidence of complications interfering with catheter function. Of the 143 RACs, 108 (76%) were patent on departure from Seattle or death. Infectious complications occurred in 63 (44%) of the catheters, resulting in 18 (13%) removals. Noninfectious complications occurred with 54 (38%) of the catheters, resulting in 17 (12%) removals. Successful interventions included catheter repair, dissolving precipitates with ammonium chloride solution, and declotting catheter lumens with heparin and/or urokinase. We conclude that RACs continue to be reliable and safe devices to use in marrow transplant patients. Complications interfering with catheter function are frequent; however, most can be resolved without the need to remove the catheter.     

Placing of Hickman catheters under ultrasonic guidance]

We describe a new technique using ultrasound guided puncture of the subclavian vein and fluoroscopic control of the guide wire and the catheter position. Using this technique we performed 70 catheter introductions in 54 patients at the radiological department of the University Hospital of Rotterdam. Long term administration of chemotherapy was the most frequent indication for introduction of the Hickman catheter. The puncture related complication rate was compared with the complications of the 'blind' percutaneous puncture method, as mentioned in literature. All the ultrasound guided punctures of the subclavian vein were successful and no puncture related complications, such as pneumothorax, haemothorax or arterial puncture, occurred. Since ultrasound guided puncture of the subclavian vein in combination with fluoroscopic control of the guide wire and catheter reduces the risk of complications of introduction of Hickman catheters, we consider this technique superior to other methods.     

Hickman catheter complications in marrow transplant recipients

The complications associated with the insertion and use of 95 single lumen and 312 double lumen Hickman right atrial catheters in 357 marrow transplant recipients were retrospectively analyzed. Three-hundred (84%) first inserted catheters were in place for a median of 93 days (range, 16-209) without complications and were removed electively. Thirty-nine (9.6%) of all catheters were removed for infections and 24 (5.9%) for mechanical complications. Ninety-five patients (26.6%) had 111 episodes of septicemia involving 128 separate organisms and 25 patients had 25 episodes of localized catheter infection with 26 separate organisms. The most frequently isolated organism was coagulase-negative staphylococcus. Twelve of 24 removals due to mechanical complications were caused by accidental pulling of the catheter by the patient.     

Infectious complications in 135 Turkish renal transplant patients

Infections are the emerging causes of mortality and morbidity due to lifelong immunosuppressive therapy in renal transplant patients (1, 4). Here, we report infectious complications of 135 renal allograft recipients who were followed up in the last 20 years in Gülhane Military Medical Academy, Ankara, Turkey. Of them, 83 (61.4%) had a transplant from living related donors, 18 (13.3%) from living non-related HLA matched donors and 34 (25.1%) from cadaveric matched donors. Immunosuppression was achieved in 42 (31.1%) recipients by azathioprine plus corticosteroid (AZA + CS) and in 93 (68.8%) by AZA + CS + cyclosporin A (CsA). Encountered infections were classified according to three different periods of the transplantation procedure [early (first month), intermediate (2-6th months) and late (after the 6th month)]. Bacterial infections were the leading infections in all three periods and the most affected system was the urinary tract. Each recipient had at least one episode of urinary tract infection (UTI) and E. coli was the most common urinary pathogen. On the other hand, HCV was the leading viral pathogen (14.3%). The total mortality rate was 7.4%, and septic shock was the most common cause of death (80%).     

完全植入式中心静脉输液泵的应用探讨

目的 探讨完全植入式中心静脉输液泵的应用.方法 对217例完全植入式中心静脉输液泵的应用及并发症进行回顾性分析.结果经锁骨下静脉置管胸壁皮下输液泵植入199例,经颈内静脉置管胸壁皮下输液泵植入17例,植入成功率为99.6%(216/217).中心静脉输液泵植入后长期正常使用207例(95.8%),因并发症导致输液泵取出9例(4.2%).相关并发症:锁骨下动脉误穿3例(1.4%),并形成局部血肿1例;导管置入右心室导致室性心动过速1例(0.4%),泵体周围软组织感染5例(2.3%),经抗炎治疗无效并取出2例;导管脱位2例(0.9%);导管堵塞行输液泵取出6例(2.8%),其中导管扭曲3例,导管内血栓形成3例.总体并发症发生率为7.8%.结论 完全植入式中心静脉输液泵可以提供更加长期、安全的静脉通路,植入手术简单,但有一定的并发症发生率,需要注意监测.对于需要长期静脉输液的患者,特别是接受化疗的肿瘤患者具有较高的临床应用价值.     

Outbreak of Mycobacterium mucogenicum bacteraemia due to contaminated water supply in a paediatric haematology-oncology department

We describe an outbreak of bloodstream infections due to Mycobacterium mucogenicum involving five patients in a paediatric haematology-oncology ward over a six-month period. Specimens from faucets on the floor indicated that an automatic faucet was the probable source of infection and identity between strains was confirmed using molecular techniques. Levels of chlorine in the water were intermittently low and may have contributed towards bacterial growth. A review of infection control practices revealed that the exit sites of central venous catheters (CVCs) of children were not properly covered during bathing, which may have facilitated CVC colonisation. Replacing the contaminated faucets, optimal water chlorination and proper coverage of the CVC exit site using impermeable dressings terminated the outbreak. This investigation emphasises the three major factors that should be investigated in outbreaks due to a waterborne pathogen: source of the infection, water supply and infection control practices.     

置入式中心静脉输液港常见并发症的原因分析与防治

目的:探讨置入式中心静脉输液港相关并发症的原因和防治对策。方法:将103例病人在X线透视下经右锁骨下静脉穿刺行中心静脉输液港置入术,回顾性分析相关并发症的原因,并探讨防治对策。结果:101例病人成功完成手术,成功率达98.06%,2例手术失败。发生相关并发症为19例(18.45%)。结论:完善围手术期处理,加强临床护理培训,可有效地降低中心静脉输液港置入术相关并发症的发生率。     

Percutaneous vs. totally implantable catheters in home parenteral nutrition

The technique of the implementation of Home Parenteral Nutrition (HPN) is improving continuously so carrying minimum risk of technical complications and supplying maximum comfort for the patient. For example the HPN benefits of the recent availability of Ethil-Vinil-Acetate (EVA) bags that permit the contemporary administration of all nutrients, lipids included, and of infusion pumps which are lighter, safer and more versatile and which have rechargeable batteries. Some new types of completely implantable catheters with a subcutaneous reservoir present a better rationale compared with complications and with patient's compliance in respect of traditional percutaneous catheters used in HPN. We wanted to verify these presuppositions in a retrospective study with a completely implantable catheter, Port-A-Cath (PAC) Pharmacia, with a group of six patients already under HPN for a period of 901 patient-days with a percutaneous catheter. We compared the two methods of treatment after 1114 patient-days with the PAC. Concerning complications, we have three catheter related sepsis (3.3 1000 days) with percutaneous catheter and 1 sepsis (0.9 1000 days) with the PAC. We also had one catheter obstruction in a patient with the PAC implanted in the Inferior Vena Cava. All the patients accepted the new technique and even if they did not have the same motivation, all of them particularly appreciated the possibility of the avoidance of any external device. Our experience leads us to report that the Port-A-Cath system may be useful in long-term parenteral nutrition but other research is needed to confirm its rationale.     

Sutured securement of peripherally inserted central catheters yields fewer complications in pediatric patients

BACKGROUND: Pediatric peripherally inserted central catheters (PICCs) can be secured with tape, sutures, or sutureless securement devices. Despite widespread catheter use, no standardized method of securement has been proven superior. METHODS: A prospective randomized trial of catheter securement with either tape or suture was undertaken in pediatric patients hospitalized at a tertiary children's hospital. Patient demographics, catheter dwell time, and all catheter complications were collected. All patients were followed for the entire dwell time of the catheter, including those discharged with lines still in place. RESULTS: Sixty-six patients completed the study, with 34 children in the suture group and 32 children in the tape group. Patients' ages ranged from 9 months to 19 years. Overall complication rate in our sutured group was 5.8%, and 32.4% in the tape group. CONCLUSIONS: In this study of children of varying ages, sutured PICCs were associated with significantly fewer complications than those catheters secured with tape (p=.005). The 3 most common complications included migration, occlusion, and leaking catheters.     

The use of central venous catheters in paediatric oncology--a cautionary tale

The use of indwelling central venous catheters has become widespread since their introduction by Broviac et al in 1973 and Hickman et al in 1974. They are of particular value in paediatric oncology where young children require intensive chemotherapy over a long period of time and where peripheral venous access may become a problem.     

Indications, complications and cost of internal jugular catheters in hemodialysed patients: study of 533 cases

INTRODUCTION: Central venous catheters for hemodialysis are very useful as blood accesses when arteriovenous fistulas (AVF) are not available. The aim of this study is to analyse the clinical impact of internal jugular catheters (IJC) in hemodialysed patients and to assess their economic consequences. PATIENTS AND METHODS: It is a prospective study realised from July 1998 to March 2002 including 533 hemodialysed patients without functional AVF: 280 males and 253 females aged between 17 and 87 years (mean age: 54.1 +/- 15 years). Single lumen polyurethane Vygon were used. All catheters were placed using Seldinger procedure and the posterior route of Jernigan which is more comfortable for patient. RESULTS: Indications of IJC placement were new hemodialysed patients without AVF in 73.5% cases and no functional AVF in 26.5% cases. During the period of the study. IJC was placed in 533 patients. We failed to place the IJC at the first attempt in 42 patients but we succeed in placing it on the controlateral side. During IJC placement, we observed 50 (9.4%) cases of accidental puncture of carotid artery. The median duration use of IJC was 41 days (extreme: 1 to 413 days). IJC were removed mainly because of the use of AVF in 469 (88%) cases and the catheter infection in 41 (77%) cases. Bacteriological analysis were made only for 25 patients: staphylococci were identified in 16 cases and catheter cultures were negative in the 9 other cases. All patients were treated with antibiotics. Outcome was favourable for 39 of them and we had 2 deaths by septicemia. The IJC cost was 44,287 Tunisian Dinars (DT) coresponding to 31.633 Euro including 10125 DT (7,232 Euro) for infectious treatment. CONCLUSION: The use of IJC is frequent in our center with a high rate of infectious complications which increased the hemodialysis cost. The realisation of AVF, in patients with chronic renal failure before the beginning of hemodialysis, is the best way to limit the use of catheters.     

Experience with the Hickman catheter: unusual complications and suggestions for their prevention

With the expanding clinical use of the Hickman catheter, new complications have emerged. This report describes two such complications: one in an adult with postplacement malposition and a second in a child with a ballooning double-lumen catheter. The risk of postplacement malposition can be reduced by placing the catheter's tunnel as medial as possible; the risk of material malfunction can be reduced by careful quality control and careful surgical technique.     

完全植入式静脉输液港在婴幼儿恶性肿瘤化疗中的应用

目的　总结完全植入式静脉输液港在婴幼儿恶性肿瘤化疗过程中的应用经验。方法　回顾性分析2011年12月至2015年5月安徽省儿童医院接受完全植入式静脉输液港（TIVAP）手术的50例恶性肿瘤患儿的临床资料,观察手术成功率、临床效果及并发症。结果　全部病例TIVAP均植入成功,无穿刺相关损伤等术中并发症。术后1例导管头端过深,行再次手术调整;1例使用1年后出现感染,予以拔除;15例化疗结束后拔除;5例肿瘤复发、转移后死亡;29例仍在继续安全使用中。结论　完全植入式静脉输液港可安全应用于婴幼儿,有效保障化疗的进行,提高婴幼儿的生活质量。     

Use of Hickman right atrial catheter in pediatric oncology patients

Eighteen pediatric oncology inpatients had 21 Hickman right atrial catheters placed for total venous access; 16 patients received parenteral nutrition. Mean duration of catheterization was 43 +/- 29 (SD) days. Four catheters had to be removed for infection or clotting. The catheter-related sepsis rate was 10%. Serious catheter-related complications were no more frequent in this population than in patients receiving only parenteral nutrition via Broviac or pediatric Broviac catheters.