Catheter fracture and embolization in a totally implanted venous access catheter

A totally implanted venous access system was placed in a 24-year-old male patient with Hodgkins disease for chemotherapy. Twelve months after implantation it was noted on chest x-ray that the catheter had fractured and the distal fragment embolized to the right ventricle. Catheter separation and embolization is a recognized but uncommon complication of Hickman catheters. It is an even rarer complication of implanted central venous catheters. With the increasing use of these new venous access systems this complication may become a more prevalent, but an avoidable complication.     

消化系统恶性肿瘤患者经数字减影血管造影引导植入静脉输液港的应用

目的　探讨消化系统恶性肿瘤患者经数字减影血管造影（DSA）引导下植入静脉输液港的安全性、可行性及临床应用价值。方法　回顾性分析2013年4月至2016年1月在DSA引导下植入静脉输液港的15例消化系统恶性肿瘤患者的病例资料,记录输液港并发症、输液港留置时间,调查患者对输液港使用的满意度,用配对秩和检验比较输液港植入前后患者生活质量的差异。结果　15例消化系统恶性肿瘤患者完成静脉输液港植入术,手术成功率100%,一次性静脉穿刺成功率为100%。并发症的发生率为6.67％ (1/15),发生在植入术后第8个月,表现为颈部牵拉感。输液港留置时间2～28个月,中位留置时间9个月。对输液港的满意度为86.67%（13/15）。输液港植入前后患者生活质量好的比例分别为46.67%（7/15）、100%(15/15),差异有统计学意义（Z=-3.416,P=0.000）。结论　DSA引导下在消化系统恶性肿瘤患者中植入静脉输液港操作安全、可行,并发症少,提高患者生活质量和满意度,值得在临床上推广。     

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.     

IVPA与PICC在宫颈癌化疗患者中的应用研究

目的 探讨植入式静脉输液港(LVPA)与外周静脉穿刺中心静脉置管(PICC)在宫颈癌化疗患者中的应用效果,为临床置管应用提供参考.方法 选择2015年1月到2016年12月在西安交通大学第一附属医院和陕西省咸阳市中心医院收治的725例宫颈癌化疗患者为研究对象,依照家庭经济情况及患者、患者家属的意愿,分为IVPA组(305例)和PICC组(420例).比较两组的置管成功率、导管留置时间、导管维护操作时间、导管相关并发症的发生率、患者的置管舒适度及置管的费用等.结果 IVPA与PICC相比,置管成功率显著增高(χ2=4.508,P<0.05)、导管留置时间显著增加(t=52.745,P<0.05)、导管维护操作时间显著减少(t=13.110,P<0.05)、导管相关并发症的发生率显著降低(χ2=26.36,P<0.05)、患者带管期间的置管舒适度显著增加(t=21.399,P<0.05)及置管费用显著减少(t=66.868,P<0.05).结论 对于宫颈癌化疗患者,推荐使用IVPA法,该方式可降低并发症发生率,减少护士工作量及工作强度,提高患者的置管舒适度,降低医疗成本.     

AbioCor totally implantable artificial heart. How will it impact hospitals?

Although heart transplantation remains the most effective treatment for severe heart failure, there are far fewer donor hearts available than there are patients who could benefit from them. One approach to addressing this shortfall is the total artificial heart, or TAH. To date, however, no TAH design has been able to achieve one of the ultimate goals of heart replacement: to allow a patient to live a reasonably normal life without being connected to external machinery. A new design, the AbioCor TAH developed by Abiomed Inc., may make this goal achievable. Thanks to a power system that transfers energy through the skin without the aid of wires, the AbioCor--currently undergoing clinical trials in the United States--allows the patient to be completely mobile. The lack of transcutaneous wires also eliminates the primary source of the infections that have plagued TAH patients in the past. Though it is not without drawbacks, the AbioCor could represent a crucial advance in TAH technology. In this Technology Overview, we describe the operation of the AbioCor and discuss its likely impact on hospitals if it is approved for marketing in the United States. We also discuss a related cardiac-support technology: ventricular assist devices (VADs), which may also be used for permanent cardiac support someday.     

Effects of different rinsing regimen on totally implantable vascular access after 70 days infusion of total parenteral nutrition in vitro

Totally implantable vascular access catheters with injection ports (IP) have been used for total parenteral nutrition (TPN). It is well known that thrombosis may cause occlusion of catheters. Recently we have experienced occlusion of the vascular access chambers in TPN-patients because of precipitation from the solutions. Three different IPs were tested in vitro: Port-A-Cath (PAC), Vascular-Access-Port (VAP), and Implantofix (IMP). Each received a daily infusion of a 2.5-liter solution consisting of fat emulsion, amino acids, glucose, and additives from a "3-liter bag." After infusions, the IPs were washed with three different rinsing methods, one including 45% v/v alcohol. After 70 days the ports were opened and examined for precipitation. Ports washed with alcohol showed no signs of precipitation, while four of six ports which were washed with conventional rinsing methods had precipitates.     

Applications of totally implantable telemetry systems to chronic medical research

The motivation for the development of advanced totally implantable telemetry systems is to improve the quality of medical care through a more detailed understanding of basic physiological processes. Three research protocols in electrophysiology, hepatic hemodynamics, and cardiac pharmacology are described which rely on new implantable instrumentation; these devices allow chronic measurements in the conscious animal of such diverse parameters as aortic and ventricular pressures; atrial, ventricular, and bundle of HIS electrograms; aortic and coronary blood flow, and total hepatic blood flow by measuring velocity profiles in the portal vein and the hepatic artery. The compact size and high reliability now achievable with these telemetry systems provides new tools to the researcher for the study of the body in health and disease.     

Internal fracture of a pediatric broviac catheter

Indwelling central venous catheters have become an integral part of the care of bone marrow transplant patients. Current technology provides the physician with repeated, reliable accesses to the central venous system via centrally placed silastic (Broviac) catheters. This report describes an unusual mechanical complication and a method for catheter salvage.     

Intraperitoneal infusion as a complication of needle catheter feeding jejunostomy

The needle catheter feeding jejunostomy is being increasingly utilized for postoperative nutritional support. We report a case of catheter dislodgement with intraperitoneal infusion of an elemental diet with subsequent peritonitis and death. A review of the literature reveals this complication to occur in 1.5% of patients, even when the serosa of the small bowel has been attached to the anterior abdominal wall. Recommendations are made regarding the prevention and management of such complications.     

Usefulness of exchanging a tunneled central venous catheter using a subcutaneous fibrous sheath

Objectives

The reserve of the venous route to the central veins is important for long-term parenteral nutrition (PN). Frequent catheter-related bloodstream infection (CRBSI) induces occlusion of the venous routes. Therefore, a modified exchange procedure using a tunneled central venous catheter (CVC) with a fibrous sheath was developed to preserve the route to the central veins.

Methods

Seven patients who required long-term PN received the modified exchange procedure and the outcome of exchanged CVC was retrospectively reviewed.

Results

The procedure was performed 10 times in seven patients. The venous routes were either the subclavicular or the internal jugular vein in all patients. The exchange of the catheter was due to CRBSI or occlusion in almost all patients. The mean duration of new catheter use was 296.2 days following the exchange. Four catheters continued to be used, and the remaining ones were removed. The reasons for removal were severe CRBSI and occlusion, each of which occurred in two catheterized patients, while the reason for removing the remaining catheters was because the patients no longer needed the catheters.

Conclusion

The modified catheter exchange using fibrous sheath, even in patients with CRBSI, appears to be an effective procedure for reserving the venous route to the central veins in patients who require either long-term PN or other treatments.     

完全植入式静脉输液港三种不同植入方法的首次成功率比较

目的比较完全植入式静脉输液港不同植入方法的首次成功率。方法2002年4月至2012年5月在我院外科连续植入351例静脉输液港,其中头静脉切开植入234例,锁骨下静脉穿刺植入41例,B超引导颈内静脉植入76例,对不同植入方法的首次手术成功率进行比较。结果头静脉切开植入静脉输液港首次成功率为78.6%（184/234）,锁骨下静脉穿刺植入首次成功率为90.2%（37/41）,B超引导经颈内静脉植入首次成功率为100%（76/76）,头静脉切开组与锁骨下静脉穿刺组比较,差异无统计学意义（χ2=2.981,P=0.059）,B超引导颈内静脉穿刺组首次植入成功率高于头静脉切开组（χ2=19.362,P=0.000）和锁骨下静脉穿刺组（χ2=7.677,P=0.014）。头静脉切开组手术并发症发生率为2.2%(4/234),导管植入颈内静脉2例（1.1%）,术后伤口积液2例（1.1%）,另两组均未发生手术并发症。结论完全植入式静脉输液港不同植入方法手术并发症发生率均较低,首选B超引导颈内静脉穿刺植入法。     

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。