Expert consensus on the clinical application of totally implantable venous access devices in the upper arm (2022 Edition).

With the widespread adoption of ultrasound guidance, Seldinger puncture techniques, and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years, an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices (TIVADs) in the upper arm. This approach has the advantage of completely avoiding the risks of hemothorax, pneumothorax, and neck and chest scarring. Medical specialties presently engaged in this study in China include internal medicine, surgery, anesthesiology, and interventional departments. However, command over implantation techniques, treatment of complications, and proper use and maintenance of TIVAD remain uneven among different medical units. Moreover, currently, there are no established quality control standards for implantation techniques or specifications for handling complications. Thus, this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach, reduce complication rates, and ensure patient safety. This consensus elaborates on the technical indications and contraindications, procedures and technical points, treatment of complications, and the use and maintenance of upper-arm TIVAD, thus providing a practical reference for medical staff.

Catheterization of PICC through a superficial femoral vein for patients with superior vena cava syndrome using ECG positioning and ultrasound-guided technologies.

OBJECTIVE: We herein demonstrate the efficacy of PICC placement through a superficial femoral vein in patients with superior vena cava syndrome using ultrasound guidance and electrocardiographic localization. The treatment of PICC disconnection was also discussed. METHODS: The study enrolled 51 patients with superior vena cava syndrome. Ultrasound-guided technology and ECG positioning technology are employed to help these patients in catheterization. The puncture time, the number of punctures, and catheter tip position were recorded. The patient was followed up for at least 2 years. The complications and treatment during follow-up were recorded. RESULT: The average puncture time was 32.13 ± 3.91 min. A total of 49 patients were successfully punctured once, while 2 patients failed in the first puncture. The main reason for puncture failure is that the inability of a guide wire to pass through. After the nurse removed the needle and pressed the puncture point until no rebleeding occurred, the puncture above the original puncture point was successful. X-ray examination revealed that the catheter tip was located in the inferior vena cava, above the diaphragm, near the right atrium. The success rate of catheterization was 100%. The visual analog scale (VAS) score was (2.44 ± 0.73) at the time of puncture, which was tolerable during the operation, and the patient did not complain of obvious pain following the operation. One patient developed complications of broken tube half a year after the puncture. Interventional physicians utilized angiography to locate the broken catheter. CONCLUSION: It is safe and feasible to place PICC through a superficial femoral vein under ultrasound combined with ECG positioning technology in patients with superior vena cava syndrome.

The curative effect analysis of peripherally inserted central venous catheter catheterization for tumor patients under the guidance of new medical guide wire.

OBJECTIVE: To report a method of PICC catheterization with the aid of a new medical guide wire, and to discuss the curative effect. METHODS: Five hundred and thirteen patients who visited our hospital from January 2013 to December 2019 for PICC catheterization were selected as study subjects. Random number method was used to group patients. General information was recorded for both groups. Patients in the observation group received catheterization with the aid of a new medical guide wire. The control group received catheterization via conventional guide wire. The success rate of the first catheterization, the success rate of the catheterization, the timing of the catheterization, the complications and the position of the catheter end were compared between the two groups. RESULTS: There was no significant difference in general information between the two groups. After analyzing the puncture situation of the two groups, it was found that the average catheterization time of the observation group was shorter than that of the control group, and the difference was statistically significant. Patients in the observation group had higher success rate of one-time catheterization and catheterization success rate, and the difference was statistically significant. The incidences of occult thrombosis, phlebitis and catheter blockage in the observation group were lower than those in the control group, and the difference was statistically significant. The incidence of dominant thrombosis and bleeding at puncture point in the observation group was also lower than that in the control group, but the difference was not statistically significant. CONCLUSION: The new type of medical guide wire component is effective for PICC catheterization and worthy of further promotion.

Panniculitis caused by progesterone injection can be treated by physical therapy.

A method for the treatment of panniculitis caused by progesterone injection is introduced. Sixteen patients achieved good results. This is a 9-year single center retrospective study. Of all the 5633 patients who received progesterone injection, 16 developed panniculitis at the injection site. Pathological examination confirmed the occurrence of panniculitis. The patient received physical therapy. These treatments are determined by the course of the patient. Compared with patients without panniculitis, patients with panniculitis received more than one injection of progesterone. In 16 patients, symptoms and local signs disappeared completely in 15 patients. One patient did not take physical therapy according to the doctor's advice after the treatment improved. However, 1 month later, the patient went to see the doctor again and received the relevant physical therapy, and still achieved good results. Progesterone injection may lead to panniculitis, which is rare but may cause serious consequences. Physical therapy can be effective.