Abstract

Background: Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told.

Data source: A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used.

Conclusions: CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion.

Abstract

Background: Successful placement of peripherally inserted central catheters (PICCs) has increased with the use of a modified Seldinger technique (MST). However, differences exist between MST kits related to the transition between the introducer and dilator. When blunt, a skin nick (dermatotomy) is necessary to allow the dilator/sheath combination to pass through the skin. However, this does not reduce the trauma on the vein. Upper extremity deep vein thrombosis (UEDVT) is a PICC-related complication. It is unclear what effect the MST kit has on this complication. Our previous study found a rate of 0.76% UEDVT ≤ 2 weeks postinsertion using a MST kit without dermatotomy.

Methods: We performed a retrospective analysis on a cohort of patients at The Ottawa Hospital undergoing a PICC insertion using a MST kit requiring a dermatotomy between November 1, 2016, and January 1, 2017. We obtained a complete dataset for 701 patients and determined the incidence of UEDVT ≤ 2 weeks postinsertion.

Results: Of 701 patients included in the study, 8 patients developed symptomatic UEDVT ≤ 2 weeks postinsertion, for a rate of 1.14%. The odds ratio comparing the group that received a dermatotomy to the previous group who did not was 1.50% (95% confidence interval 0.40-4.62).

Conclusions: The odds ratio of UEDVT ≤ 2 weeks post-PICC insertion with a dermatotomy compared with those without was not significantly different. We conclude that a MST kit requiring a dermatotomy does not increase the risk of early UEDVT.

Abstract

Background: Peripherally inserted central catheters (PICCs) are ubiquitous in modern hospitals, but are associated with venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE). We retrospectively examined this association in hospitalized patients, highlighting anatomically associated VTEs (those with DVT in the PICC extremity).

Methods: Charts with an International Classification of Diseases, Ninth Revision (ICD9) code for VTE were collected from a discharge database of PICC-managed patients at a tertiary hospital. A sample (52.3%) of the VTE charts was manually reviewed to verify PICC-associated VTE (unverified charts were excluded), and determine such data as the extremity in which each DVT was diagnosed (using ultrasound reports). VTE rates were calculated using an uncorrected method (from charts with VTE ICD9 code) and a corrected method (from charts with manually verified PICC-associated VTE).

Results: Our uncorrected VTE rate was 3.9% (P < .0001), whereas the corrected rate was 1.5%. Among 125 charts with manually verified PICC-associated VTE, 69 (60.5%) out of 114 patients with a DVT had their DVT occur in the PICC extremity, yielding an anatomically associated VTE rate of 0.84%. The most common reason for a chart being excluded (60.2%) was a VTE occurring before PICC placement.

Conclusions: We found clinically significant rates of PICC-associated VTE. The majority of patients' DVT occurred in the same extremity as their PICC, lending further evidence that PICCs are an independent risk factor for VTE and require judicious use. There was also a discrepancy in VTE rate derived from ICD codes alone vs. manual chart review.

Abstract

Background: We aimed to describe characteristics of acute pain related to port-a-cath implantation (PACI) in an oncology department.

Methodology: We prospectively followed 145 patients who received PACI under local anesthesia. Our study asked patients to rate their pain according to a numerical scale immediately after implantation and within 72 hours. Patient and disease characteristics, PACI data, pain peak, and need for analgesic agents were collected. Patients already taking painkillers were excluded.

Results: Median age was 55 years (range = 28–83 years) and 71% were women. Pain after PACI was rated mild by 52.4%, moderate by 35.9%, and severe by 11.7% of patients. Pain peaks were described during introducer insertion (40.7%), venous puncture (23.4%), anesthesia (18.6%), tunneling (5.9%), and suturing (1.4%). Patients with severe pain were significantly more frequently women and had a fast heart rate (≥120 bpm) before PACI (94.1% vs. 68% [P = .018] and 11.8% vs. 3.9% [P = .021], respectively). Within 72 hours of PACI, 56% of patients experienced no pain, 24.1% had mild pain, 6.2% had moderate pain, and 10.3% had severe pain. All patients who needed to use painkillers (39%) used acetaminophen.

Conclusions: Women and patients with heart rate ≥ 120 bpm before PACI should probably be considered for systematic painkillers after the implantation.

Abstract

Aim: Implantable ports are typically inserted by interventional radiologists or surgeons; however, daily maintenance, access, and de-access are often performed by members of nursing staff in accordance with manufacturers' guidelines and local policy. An audit of port access using retrospective computed tomography (CT) scanning was proposed.

Methodology: Across a 4-year period, all CT scans performed for any reason while a port was accessed were reviewed.

Results: Fifty-four CT scans of accessed ports were included. Mean depth of tissue between skin and port was 3.74 mm, and between port and pectoralis major was 5.91 mm. Port tilt in side-to-side and up-down axes measured 6.9° and 10.6°, respectively. Mean distance from needle to center of the septum was 1.96 mm. Mean distance from center of the chamber to the needle tip was 2.73 mm. In 2 cases (3.7%), the needle bevel was malpositioned, with the bevel still within the silicone-rubber septum. Mean angulation of the access needle from perpendicular was 11.5°. Angulation of the needle correlated with port tilt (r = 0.37; P = .006). Angle of the needle bevel relative to the port exit channel was 140.8°. No significant correlation between needle bevel directionality and needle angle, depth of port, or tilt of port was detected (all P values > .21).

Conclusions: Variability in accessing of implantable ports is described relative to research- and manufacturer-recommended needle bevel angle, needle puncture angle, and central puncture position. The extent to which such deviation influences port function deserves focused clinical research.

Abstract

Establishing venous access can be an important and often complex aspect of care for pediatric patients. When stable central venous access is required for long-term intravenous infusions, several options are available including peripherally inserted central catheters (PICC), tunneled catheters and ports. Both PICC placement and tunneled catheter placement include an exposed external segment of catheter, either in an extremity or on the chest. We present a pediatric patient with complex behavioral history who required long-term intravenous therapy. After careful review, the best option for the patient was determined to be a tunneled catheter that exited the skin in the right upper back, making it difficult to grab and pull out. The catheter was successfully placed and the patient appropriately completed his intravenous antibiotic course. Upon completion, the catheter was removed without complications. This tunneling technique to the scapular region may be useful for patients with psychiatric or neurodegenerative disorders where purposeful dislodgement may be a problem.

Abstract

The threat of catheter-associated bloodstream infections (CABSIs) among hemodialysis patients is present beyond health care settings. With the rise of antimicrobial-resistant infections, the benefits of partnering with patients in preventing CABSIs cannot be overemphasized. Patient education is the cornerstone of patient engagement, and a prerequisite for other involvement strategies. The responsibility for educating patients is multidisciplinary and must be accentuated at all stages of hemodialysis care. Enhancing patient self-efficacy in preventing CABSIs requires them to have an adequate level of knowledge on infection prevention and the skills and confidence to self-care in the community. Providing patient education is the first step to empower patients, facilitating their ownership of their journey in care and safeguarding them from infections.