central venous catheter

Introduction: Peripherally inserted central venous catheters (PICCs) have been increasingly used as an alternative to conventional central venous catheters for long-term administration of chemotherapy, antibiotics, parenteral nutrition, and hydration in patients with difficult venous access. Traumatic complications to arteries and nerves adjacent to veins selected for PICC placement have been rarely described. Case presentation: We report the case of a PICC placement in the brachial vein of the right upper limb of a 78-year-old woman that resulted in brachial artery pseudoaneurysm and median nerve lesion. Discussion: The pseudoaneurysm was successfully repaired with thrombin injection, but neurological deficits to the hand resulting from nerve injury persisted even four months after the procedure.

Central venous catheter fracture and migration are rare complications in patients receiving long-term infusions or chemotherapy. We present a rare case of a chest port catheter fracture that migrated into the coronary sinus. This case is likely the fourth report of a port catheter fracture with migration to the coronary sinus. Because of the difficult-to-retrieve location, multiple attempts were unsuccessful with traditional techniques using a loop snare. Finally, the fractured portion was disengaged from the coronary sinus using a navigational electrophysiology catheter guided by intracardiac echocardiography; the dislodged end was snared and eventually removed by the femoral route. This case of a chest port catheter fracture is unique because of the unusual migration to the coronary sinus and the use of a navigational electrophysiology catheter as a novel retrieval technique.

Catheter-Related Bloodstream Infections (CRBSIs) are severe healthcare-associated complication that occurs when bacteria enter the bloodstream through a catheter. The risk of CRBSIs is influenced by various factors. Prolonged catheter placement increases the risk, as each day increases the potential for bacterial colonization and bloodstream infection. Proper aseptic technique and a sterile environment during catheter insertion are essential to minimize infection risk. Stringent infection control measures during insertion, including sterile gloves, thorough hand hygiene, and appropriate skin disinfection, are crucial. Inadequate catheter site care and suboptimal catheter management can contribute to CRBSIs. Regular cleaning, disinfection, and dressing changes are necessary to reduce the risk of infection. The type of catheter used also affects infection risk. Central Venous Catheters (CVCs) and arterial catheters, especially those inserted into the jugular or subclavian vein, carry a higher risk of CRBSIs compared to peripheral venous catheters. Individuals with compromised immune systems, such as chemotherapy patients, organ transplant recipients, and those with HIV/AIDS, are more susceptible to CRBSIs. Patients with existing infections, like pneumonia or urinary tract infections, are at a heightened risk of acquiring CRBSIs due to potential cross-contamination. Healthcare professionals who fail to practice thorough hand hygiene before and after catheter-related procedures can introduce pathogens into the bloodstream. Leaving catheters in place when no longer necessary or using them unnecessarily elevates the risk of infection. To prevent CRBSIs, strict infection control protocols, including effective hand hygiene, sterile catheter insertion techniques, routine site care, and prompt catheter removal when no longer needed, are imperative. Healthcare facilities often implement specific protocols to mitigate CRBSI risk and enhance patient safety.

Introduction: Permanent vascular access (arteriovenous fistula (AVF), arteriovenous graft (AVG)) is susceptible to acute events that reduce patency. The temporary central venous catheter (CVC) constitutes bridging therapy for primary vascular access dysfunction. The impact of “residence time” on the rate of dysfunction/thrombosis or infection remains to be explored.AIM: 1) To evaluate the impact of CVC residence time on outcomes (infection or Thrombosis/dysfunction) in consecutive temporary CVCs adjusted for the insertion site (upper site vs. lower site).2) To establish a cut-off resident time.Patients and methods: Seventeen prevalent hemodialysis patients with three consecutive CVCs are followed up prospectively in an observational study for a period equivalent to the permanence of the CVCs. The data is recorded at the beginning of the CVC time. The diagnosis of catheter-related bloodstream infection and thrombosis/dysfunction is made following the K-Doqi 2019 guidelines.Statistical analysis: Seventeen hemodialysis patients (51 CVCs) were included. The ‘CVC resident time’ of each individual patient ((i.e. βcoefficient (log-transformed)*AUC)) was determined using LMM and then inserted into multivariate Cox models to assess infection and dysfunction/thrombosis outcomes (Joint Models). The AUC was calculated at various baseline levels of CVC time (10th……50th percentile). The cut-off point for thrombosis in CVC time corresponds to the mean of the CVC time at the 30th percentile of all CVCs.Results: The CVC time is different for CVC’s site insertion and sequence. From the analysis of multivariate joint models, CVC resident time appears not to be significant for infection, but heterogenicity for the insertion site (ref3-4=upper site) is significant for the outcome of thrombosis/dysfunction. From the study of survival analysis, the free survival from outcomes by CVC site insertion appears to be significant for thrombosis/dysfunction. The average time of CVCs’ calculation at the 30th percentile is 14 days (cut-off).Conclusion: No tunneled hemodialysis Catheter (NTHC) residence time is considered not to be a risk factor for infection, but it represents a risk factor for lower access thrombosis. After the cut-off time of 14 days, the advantage of the higher NTHCs is lost.