Abstract

Background: The frequency with which vascular access specialists (VASs) are placing peripherally inserted central catheters (PICCS) has allowed for the improvement and expansion of the skill set by using advanced insertion techniques such as the modified Seldinger technique and ultrasound for real-time imaging. The use of real-time imaging has decreased complications such as arterial puncture and has improved success rates. Due to this positive influence on patient outcomes, many VASs are moving to the placement of central venous catheters (CVC).

Method: We describe the service improvement process of expanding a vascular access team (VAT) practice to include the placement of CVCs and arterial lines in a large community hospital in Illinois. We also outline the history of vascular access and the journey of a VAT.

Results: By following a methodic approach toward implementation of practice expansion, our VAT has gone from solely placing PICCS to the placement of CVCs in the internal jugular, axillary/subclavian, and femoral veins and to the placement of arterial lines.

Conclusions: VASs have the capacity to positively influence patient safety and outcomes even further by placing CVCs, rather than simply staying with the current scope of practice by placing intravenous lines, midlines, and PICCs. Patient outcomes will improve as VASs move to the placement of CVCs, and the costs associated with potential complications will improve also. Moving to the placement of CVCs is vital to the specialty of vascular access and will continue the breadth and depth of service provided by VASs.

Abstract

Purpose: A case is presented wherein hypnosis alone provided anesthesia for the ultrasound-guided placement of a device into right basilic vein. This is the first reported case of hypnoanesthesia for ultrasound-guided vascular access.

Method: Ericksonian hypnosis was employed by the operator while a second clinician performed the vascular access procedure. The general method of induction and the anesthetic suggestions are disclosed and discussed.

Results: The patient's experience was painless and, by her own repeated reports, pleasurable.

Conclusions: Hypnosis is merely a refinement of everyday communication wherein ideas are expressed to increase the likelihood of their actualization. This case illustrates how a few carefully chosen sentences can alter a vascular access patient's entire experience.

Abstract

Introduction: Placement of totally implanted venous access devices, or port systems, in the upper arm is becoming a common practice in interventional radiology. To gain a better understanding of the literature in this area, we performed a search for and analysis of previous publications related to upper arm implantation of these devices by members of interventional radiology departments.

Methods: A review of the literature pertaining to upper arm port systems implanted in human beings by members of interventional radiology departments was performed, assessing publications between the years 1992 and 2014. Only English-language publications were assessed.

Results: Eighteen publications met selection criteria during the time frame reviewed. None of the studies used a prospective, randomized design; rather, all studies consisted of case–cohort descriptions of outcomes for a single device or for multiple devices. Analysis of the available literature for interventional radiology-inserted arm ports was performed. The technical success rate ranged between 93.7% and 100%, with an average of 98.9%.

Conclusions: The high technical success rate of arm port implantation and the elimination of the potential for pneumothorax, hemothorax, catheter pinch-off syndrome, and subclavian and carotid artery injury are strengths of the arm implantation strategy. There was wide variation in the rates of complications detected, in addition to inconsistent study design and study implementation strategies.

Abstract

Chronic refractory venous hypertension is a common complication following repeated central venous cannulation performed as a temporary vascular access for dialysis in patients with chronic renal failure. The symptoms of venous hypertension may diverge from being asymptomatic to severe edema, ulceration, headaches, bloating, and blackouts, especially if the patient has a surgical arteriovenous fistula for dialysis in any of his upper limbs. Treatment options for such patients are mainly directed toward endovascular management via balloon angioplasty and possibly stenting of the stenosed vein. Resistant lesions or cases with total venous occlusion coerce surgeons to consider surgical bypass. We present a case of a 43-year-old patient with history of renal impairment and repeated bilateral central venous cannulation for dialysis. The patient experienced superior vena cava syndrome with bilateral total occlusion of the internal jugular veins and both subclavian veins (with an occluded previously inserted stent) along with the superior vena cava. An extra-anatomical bypass was done from the left internal jugular vein to the left external iliac vein using a synthetic silver Dacron ringed graft. The procedure was successful and resulted in relief of the patient's symptoms and a dramatic improvement of the patient's quality of life. Superior vena cava syndrome represents 1 of the most challenging complications for patients with chronic renal impairment and repeated central venous cannulation. The endovascular approach is currently gaining popularity as the first line of treatment for such patients. However, surgical management is sometimes the only available option when the endovascular approach is not technically feasible. Our case, along with others, shows that an extra-anatomical synthetic graft bypass can be a reliable, less invasive option for the management of superior vena cava syndrome once surgical intervention is inevitable.

Abstract

Objective: To describe the underpinning principles involved in central venous access device (CVAD) securement and dressing products to prevent CVAD failure and complications through a synthesis of research studies.

Background: Functional, dependable CVADs are a necessary part of patient care. Dressing and securement products are used to prevent CVAD failure and complications, but there is a large variety of products available for clinicians to access, with variable effectiveness.

Methods: A narrative review of studies describing the mechanisms for CVAD securement and dressing products to prevent failure and complication was undertaken. After a systematic search, 20 clinical and laboratory studies were included in the review.

Discussion: The major mechanisms by which CVAD dressing and securement products prevent failure are providing a barrier to microbial contamination and motion reduction. CVAD securement and dressing products provide these functions using coating, adhesion, antimicrobial properties, absorbency, and moisture vapor transmission without causing irritation to skin and maintaining visibility of the insertion site. The complexity of patients requiring CVAD securement and dressing means that universal recommendations across CVAD populations and broad generalization of studies from single populations (eg, intensive care) or devices (eg, peripherally inserted central catheters) are ill advised.

Conclusions: CVAD securement and dressing products provide important, multifaceted functions to prevent CVAD failure and complication.