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*14 Source: "Central Venous Catheter Tip Position: A Continuing Controversy",
Journal of Vascular and Interventional Radiology (JVIR) May 2003, Volume 14, Issue 5, pages 527-534 http://www.jvir.org |
Notice: This page is no longer being kept up to date.
Please refer to our new Medical
Journal Articles Index,
a searchable database of over 500 article references from leading medical journals
that deal with Medcomp® products and/or their uses. Each article reference links
directly to PubMed.
Central Venous Catheter Tip Position: A Continuing Controversy
*14Abstract: "There is continuing debate among physicians, nurses, and federal regulatory agencies regarding the correct position for the tip of a central venous catheter. The traditional approach has been to place the catheter tip within the superior vena cava. However, many interventionalists believe that the performance and durability of the catheter will be improved by positioning the catheter tip within the upper right atrium. Recently, this variability in clinical practice has become an increasingly divisive issue among physicians who insert these catheters and nurses who use them. This article is intended to elucidate the controversial issues and provide a brief review of the extensive literature on this important topic."
See the full text article from JVIR|
*13 Source: "Catheter Securement:
Trends in Performance and Complications Associated with the Use of Either Traditional
Methods or Adhesive Anchor Devices",
Journal of Vascular Access Devices (JVAD) Spring 2003, pages 29-33 http://www.navannet.org |
Catheter Securement: Trends in Performance and Complications
Associated with the Use of Either Traditional Methods or Adhesive Anchor Devices
*13"Summary Description: Although tape and/or sutures are still widely used for catheter securement, a newer alternative is an adhesive anchor pad with a molded plastic area that grasps the catheter (StatLock). Seven studies, spanning a variety of health care settings and types of catheters, were reviewed in order to compare complication rates, catheter dwell times, and rates of unscheduled restarts for adhesive anchor securement with that of traditional securement methods. The results consistently showed that adhesive anchor devices had fewer complications and fewer unscheduled restarts than did traditional securement methods, with relative reductions in dislodgment of 67%, in total complications of 50%, and in unscheduled restarts of 78% and an increased in dwell time of 48% with the use adhesive anchor devices. These results, together with the cost data summarized from the studies examined, suggest that adhesive anchors have great advantages over traditional catheter securement techniques."
This article is available for purchase from NAVAN (also
see *11 & *12)|
*12 Source: "Guidelines for
the Prevention of Intravascular Catheter-Related Infections, 2002.",
Centers for Disease Control (CDC) MMWR Recommendations and Reports, Volume 51, Number RR-10 http://www.cdc.gov |
Skin Antisepsis. *12In response to the many customers asking about Choloraprep: In August 2002, the Centers for Disease Control published its "Guidelines for the Prevention of Intravascular Catheter-Related Infections." (see article citation below). These guidelines recommended "using a 2% chlorhexidine gluconate preparation for skin antisepsis." One such preparation is available under the tradename Chloraprep.
"Skin Antisepsis: In the United States, povidone iodine has been the most widely used antiseptic for cleansing arterial catheter and CVC- insertion sites (72). However, in one study, preparation of central venous and arterial sites with a 2% aqueous chlorhexidine gluconate lowered BSI rates compared with site preparation with 10% povidone-iodine or 70% alcohol (73). Commercially available products containing chlorhexidine have not been available until recently; in July 2000, the U.S. Food and Drug Administration (FDA) approved a 2% tincture of chlorhexidine preparation for skin antisepsis. Other preparations of chlorhexidine might not be as effective. Tincture of chlorhexidine gluconate 0.5% is no more effective in preventing CRBSI or CVC colonization than 10% povidone iodine, as demonstrated by a prospective, randomized study of adults (74). However, in a study involving neonates, 0.5% chlorhexidine reduced peripheral IV colonization compared with povidone iodine (20/418 versus 38/408 catheters; p = 0.01) (75). This study, which did not include CVCs, had an insufficient number of participants to assess differences in BSI rates. A 1% tincture of chlorhexidine preparation is available in Canada and Australia, but not yet in the United States. No published trials have compared a 1% chlorhexidine preparation to povidone-iodine."
See the full report on the Centers for Disease Control (CDC) Web site.|
*12 Source: "Guidelines for
the Prevention of Intravascular Catheter-Related Infections, 2002.",
Centers for Disease Control (CDC) MMWR Recommendations and Reports, Volume 51, Number RR-10 http://www.cdc.gov |
Guidelines for the Prevention of Intravascular Catheter-Related
Infections, 2002. *12"Summary: These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. ..."
"Catheter Securement Devices: Sutureless securement devices can be advantageous over suture in preventing catheter-related BSIs. One study, which involved only a limited number of patients and was underpowered, compared a sutureless device with suture for the securement of PICCS; in this study, CRBSI was reduced in the group of patients that received the sutureless device (78)."
See the full report on the Centers for Disease Control (CDC) Web site.
An excellent related article from Medical DeviceLink
An article from JVIR cited in the CDC report (also see
*11 below)Other articles that cite the above from JVIR:
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*11 Source: "Sutureless Securement
Device Reduces Complications of Peripherally Inserted Central Venous Catheters",
Journal of Vascular and Interventional Radiology (JVIR) Vol. 13, Number 2, Pages 77-81, January, 2002 http://www.jvir.org |
Sutureless Securement Device Reduces Complications of Peripherally
Inserted Central Venous Catheters *11"Purpose: This study was conducted to evaluate the performance of a sutureless adhesive-backed device, StatLock, for securement of peripherally inserted central venous catheters (PICCs). Earlier studies have demonstrated that StatLock significantly reduces catheter-related complications when compared to tape. The purpose of this study was to determine whether a sutureless securement device offers an advantage over suture in preventing catheter-related complications."
"Conclusion: The sutureless anchor pad was beneficial for both patients and health care providers. Further investigation to determine how StatLock helps reduce catheter-related blood stream infections is necessary."
View the abstract/full article on JVIR's Web site (also
see *12 & *13 above)This article has also been cited in the following articles:
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*10 Source: "The Atriocutaneous
Fistula: A New Surgical Technique for Hemodialysis Access.",
Journal of the American Society of Nephrology Vol. 11, Program and Abstracts Issue, Pg. 186A, September 2000 http://www.asn-online.org |
The Atriocutaneous Fistula: A New Surgical Technique for
Hemodialysis Access. *10"Introduction. The widespread use of hemodialysis in patients with renal failure has led to an increasing need for long-term venous access. Within this population of patients there exists a subset of patients who have exhausted conventional routes of central and peripheral venous access because of obstruction or thrombosis. For these patients a new surgical technique of atriocutaneous vascular access was developed."
"Methods. ... Patients were considered for this procedure it they required long-term hemodialysis, had exhausted conventional access sites and no other medical option was available. The procedure consists of creating a pedicled skin and subcutaneous tissue tunnel that is anastomosed to a right atriotomy thereby creating a permanent central venous access which is immediately ready for use."
"Results. The mean duration of surgery was 156 minutes (range = 105 to 210 minutes). No intraoperative complications were reported. Traumatic disrution of the fistula occurred perioperatively in one patient and 1 perioperative death and 2 late deaths were reported. Late complications included those associated with central venous catheters such as sepsis and catheter thrombosis. The six-month actuarial survival was 85.7%."
"Conclusions. The atriocutaneous fistula surgical technique is a new option for patients with end-stage renal disease who have exhausted traditional central venous access for hemodialysis. This procedure is performed in patients with no other medical alternatives and is not intended as a primary means of central access."
Email Dr. Enrique Marquez & Dr. Fernando L. Joglar for more first-hand information.|
*9 Source: "Randomized comparison
of split tip versus step tip high-flow hemodialysis catheters",
Kidney International Vol. 62, Issue 1, Pg. 282, July 2002 http://www.blackwell-synergy.com |
Randomized comparison of split tip versus step tip high-flow
hemodialysis catheters *9
"Background. Our purpose was to compare the function and complications
of two high-flow polyurethane hemodialysis catheters."
"Methods. This prospective, randomized trial compared the Ash-Split
(MedComp) and Opti-Flow (Bard Access Systems) catheters. All patients referred
for tunneled hemodialysis catheter placement were offered entry in the study,
provided they met inclusion criteria. Catheters were placed by interventional
radiologists using ultrasound and fluoroscopic guidance. Procedure time and initial
complications were recorded. Effective (QbEff) catheter flow rates and recirculation
were studied at baseline, one month, three and six months using ultrasonic dilution
(Transonic) at various pump speeds (Qb). Episodes of catheter malfunction and
infection were recorded. Catheter removal or six months was the study endpoint."
"Conclusions. Both catheters can deliver flow rates well beyond those
recommended by the Dialysis Outcomes Quality Initiative. While Optiflow delivered
higher flow rates at some measurement points, this was offset by higher recirculation.
The Ash catheter showed a long-term survival advantage and fewer late complications."
*9
Link to the Kidney International web site
|
*8 Source: "The role of guidewire
exchange in the treatment of hemodialysis catheter related bloodstream infection",
The International Journal of Artificial Organs Vol. 24, No. 4, 2001 http://www.artificial-organs.com |
The role of guidewire exchange in the treatment of hemodialysis
catheter related bloodstream infection *8
"The two primary mechanisms of catheter related bloodstream infection (CR-BSI)
are 1) migration of organisms down the subcutaneous tract at the insertion site,
2) introduction of organisms into the lumen of the catheter, usually from colonized
catheter hubs (19). ... Both these conditions are relevant to tunneled cuffed
hemodialysis catheters; Almiral (14) and Cheesrough (9) both demonstrated that
over 50% of infections were related at least in part to interluminal colonization."
"... If the primary route of colonization and eventual CR-BSI is intraluminal
it follows that guidewire exchange is a reasonable management option. Guidewire
exchange is likely to remove the primary source of the infection even if some
contamination should occur at the time of exchange as the wire is inserted into
a lumen that is colonized. In contrast if the catheter were insered into a contaminated
tunnel (not grossly infected), infection would be likely to return as it tracts
down the outside of the new catheter." *8
Link to The International Journal of Artificial Organs web site
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*7 Source: "Cuff-tunneled
femoral catheter for long-term hemodialysis",
The International Journal of Artificial Organs Vol. 24, No. 7, 2001 http://www.artificial-organs.com |
Cuff-tunneled femoral catheter for long-term hemodialysis
*7
"Methods: We inserted 14 cuffed-tunneled femoral catheters in 11 hemodialysis
patients with exhausted dialysis access sites of their upper extremities. Access
survival and risk of infection were compared with the 11 femoral PTFE grafts in
10 patients of our center during the same period. The choice of dialysis access
was determined by the individual nephrologist. Access survival was defined as
the achievement of a blood flow rate of at least 180 ml/min."
"... Recently, the cuffed-tunneled femoral catheter has been tried for hemodialysis
(10-15). However, most of the reported series restricted the used of cuffed-tunneled
femoral catheter for an average of 6 weeks (10-14). In this series, we examinied
the role of the cuffed-tunneled femoral catheter as an alternative to femoral
PTFE graft for long-term hemodialysis access in patients with exhausted vascular
access sites in their upper extremities." *7
Link to The International Journal of Artificial Organs web site
|
*6 Source: "Radiological placement
of the AshSplit haemodialysis catheter: a prospective analysis of outcome and
complications",
Nephrology Dialysis Transplantation Vol. 17, No. 4, April 2002 http://ndt.oupjournals.org |
Radiological placement of the AshSplit haemodialysis catheter:
a prospective analysis of outcome and complications *6
"The arteriovenous (AV) fistula remains the reliable access route of choice
for haemodialysis, but may patients require alternative access..."
"... Dual lumen single catheters have been used widely but performance can
be affected by poor flow and high access recirculation rates [3]. More recently
the twin single lumen catheter was introduced in an attempt to overcome these
problems but the need for dual venous punctures and tunnels prolongs the procedure
time and increases the risk of complications [4]. The AshSplit haemodialysis catheter
(Medcomp, Harleysville, PA) combines the advantages of the single puncture insertion
technique with the benefits of improved flow and reduced recirculation associated
with two free-floating i.v. lumens [5]. The purpose of our study was to assess
the radiological insertion and ongoing function of this new catheter. The Dialysis
Outcomes and Quality Initiative (DOQI) guidelines [6], first published in 1997,
were taken as the gold standard with which to compare performance."
*6
Link to the Nephrology Dialysis Transplantation web site
Please
see our disclaimer
regarding all medical news
posted on this site.
|
*5 Source: "Complications of
central venous catheters: Internal jugular versus subclavian access - a systematic
review",
Critical Care Medicine Vol. 30, No. 2, February 2002 http://www.ccmjournal.com |
Complications of central venous catheters: Internal jugular
versus subclavian access - a systematic review*5
"Discussion: In many situations, the anatomical site of CVC insertion
is chosen on the grounds of personal experience or local policies rather than
on evidence-based guidelines. The aim of this quantitative systematic review was
to clarify some of the controversies that exist on the relative risk of internal
jugular compared with subclavian access. If there was evidence for an increased
risk of specific complications with one approach, then clinicians may take advantage
of that knowledge for insertion of a CVC in an individual patient." *5
"Conclusion: There are more arterial punctures but less catheter malpositions
with the internal jugular compared with the subclavian access. There is no evidence
of any difference in the incidence of hemato- or pneumothorax and vessel occlusion.
Data on bloodstream infection are scarce. These data are from nonrandomized studies;
selection bias cannot be ruled out. In terms of risk, the data most likely represent
a best case scenario. For rational decision-making, randomized trials are needed."
*5
Get the full article from Critical Care Medicine
|
*4 Source: "Peritoneal Dialysis
Catheters: the beauty of simplicity or the glamour of technicality? Percutaneous
vs surgical placement",
Nephrology Dialysis Transplantation Vol. 17, No. 2, February 2002 http://ndt.oupjournals.org |
Peritoneal Dialysis Catheters: the beauty of simplicity or
the glamour of technicality? Percutaneous vs surgical placement*4
"Uncomplicated access to the peritoneal cavity using a permanent in-dwelling
catheter is a key factor for successful peritoneal dialysis (PD).
"The Question 'what defines a good peritoneal access?' has many potential
answers. Some clinicians will argue that the long-term reliability regarding flow
is most important, others will point to the prevention of exit-site infection
and peritonitis, and still others will look at the price or the simplicity and
safety of the insertion. Taking into account all these different factors, it becomes
clear that 'the' preferred access method does not exist, but that each modality
has its pros and cons, and its specific indications." *4
Link to the Nephrology Dialysis Transplantation web site
|
*3 Source: "Indication for the
use of central venous catheters as vascular access for hemodialysis",
The Journal of Vascular Access Vol. 2, No. 1, January-March 2001 http://www.wichtig-publisher.com/jva |
Indication for the use of central venous catheters as vascular
access for hemodialysis*3
"Adequate treatment for uremic patients on hemodialysis requires valid and
lasting access to central vessels.
"The Central
Venous Catheter (CVC) as a mean of immediate access is indispensable in all
acute cases where it has not been possible to prepare an AVF in time and when
the peripheral vascularization is highly compromised. We present our investigation
on the best access route to central vessels and the selection of the type of catheters
to adopt in different conditions.
"On the basis of complications arising during the catheter life especially
as permanent access, it seems to us that the right internal jugular catheterization
with the
2 Tesio® catheters kit is the more useful and less dangerous catheterization."
*3
Link to the Complete Article
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*2 Source: "Femoral positioning
of Tesio® catheters for hemodialysis",
The Journal of Vascular Access Vol. 2, No. 2, April-June 2001 http://www.wichtig-publisher.com/jva |
"The original Tesio®
technique for twin catheter insertion into the internal jugular vein was based
on the opportunity, given by the clavicula to support the devices (2). Using this
method, it is possible to perform parasternal subcutaneous tunnelling and so patient
discomfort is minimal and catheter kinking unlikely. Theoretically, a similar
anatomic support is missed if another central vein is employed and the exit site,
working on femoral vein, is placed at the anteromedial side of the thigh (7).
Therefore, we have focused on a new method of femoral catheter positioning with
two advantages:
1. Abdominal exit site, without any obstacles from the lower limb.
2. 'Soft' catheters curvature, to avoid kinking and obtain maximum blood flow."
"Our data indicate that the 'high' catheter exit does not affect the lower
limb motility. Furthermore another advantage, provided by the antigravitational
positioning, is the increased resistance to tractions and dislocations.
"Our experience with this new method is still preliminary; presently we have
only a 26-month observation period and a too small number of cases for statistical
analysis.
"Using this technique we easily obtain high blood flow (250 ml/min or more)
and, as indicated above another advantage consists in low recirculation (<5-10%).
In conclusion, it is not difficult to obtain satisfactory KT/V. Until now we have
observed no infection (both of the tunnel site and systemic), and so far no catheter
had to be removed due to this complication. Moreover, no venous lumen stenosis,
no iliac vein or inferior vena cava thrombosis, no stasis at the lower limb were
observed in our series after prolonged use." *2
Link to the Complete Article
|
*1 Source: "The
Ash Split Cath® in 7 Uremic Patients with Slow Maturation of the Arteriovenous
Fistula", Nephron
Vol. 86, No. 4, December 2000 http://www.online.karger.com |
with Slow Maturation of the Arteriovenous Fistula *1
".. Due to the slow maturing of the AVF, in our department the Ash Split
Cath has been used in 7 uremic patients (3 males and 4 females) who required hemodialysis:
3 patients with diabetes (74, 44, and 46 years old, respectively), 3 patients
over 75 years old, and 1 51-year-old patient with polycystic disease. The clinical
setting and the patient age justified the slow maturation of the AVF. Informed
consent was obtained from all patients.
The cannulation of the internal jugular vein was performed by an ultrasound-assisted
technique [4, 5], and the correct catheter position was verified by standard chest
X-ray (fig.1). ..." *1
Link to the Complete Article
| Please
see our disclaimer regarding all medical news posted on this site. |
Useful Links (Not affiliated with
Medcomp®)
Journal of Nephrology - Italy
Journal of the American Medical Association
National Kidney Foundation
Nephrology Dialysis Transplantation
American Journal of Kidney Diseases
American Nephrology Nurses' Association
Journal of Vascular and Interventional Radiology (JVIR)
Journal of Vascular Access Devices (JVAD) (a NAVAN publication)
The International Journal of Artificial Organs
Kidney International