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1.
J Vasc Access ; 20(1_suppl): 15-19, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032727

RESUMO

The prevalence rate and the incidence rate of hemodialysis and functioning kidney transplant recipients have continuously increased; on the contrary, those of peritoneal dialysis have continuously decreased since 2006. Dialysis patients have been getting older and have been maintained on dialysis longer. Diabetic nephropathy was the leading cause of end stage renal disease. The type of hemodialysis vascular access has been stable during the last 5 years (arteriovenous fistulas 76%, arteriovenous grafts 16%, central venous catheters 8% at 2016). Peritoneal dialysis catheter was mostly inserted surgically (67%), and swan neck straight tip peritoneal dialysis catheter was the most commonly used (48%). Vascular access was managed by radiologists and surgeons, and the management was fragmented among them in the past. However, since the nephrologists became interested in and knowledgeable about the vascular access, they began to play roles in vascular access management. Vascular access has been mostly created by vascular surgeons (≈60%); tunneled central venous hemodialysis catheter insertion and endovascular intervention such as percutaneous transluminal angioplasty (PTA) and thrombectomy have been mostly performed by radiologists (≈70%). Tunneled hemodialysis catheter insertion and endovascular intervention by nephrologists have slowly but consistently increased. Recently, the number of central venous hemodialysis catheter insertion has decreased, and tunneled hemodialysis catheter has been inserted more than non-tunneled hemodialysis catheter, indicating that vascular access has been created timely and the vascular access team has been educated about and following international guidelines.


Assuntos
Derivação Arteriovenosa Cirúrgica/tendências , Implante de Prótese Vascular/tendências , Cateterismo Venoso Central/tendências , Nefropatias/terapia , Avaliação de Processos e Resultados (Cuidados de Saúde)/tendências , Diálise Peritoneal/tendências , Padrões de Prática Médica/tendências , Diálise Renal/tendências , Idoso , Angioplastia/tendências , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Obstrução do Cateter , Cateterismo Venoso Central/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Nefrologistas/tendências , Radiologistas/tendências , República da Coreia/epidemiologia , Cirurgiões/tendências , Trombectomia/tendências , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
2.
Ren Fail ; 41(1): 113-117, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30909767

RESUMO

BACKGROUND: Prophylactic laparoscopic omentopexy is a safe technique to prevent catheter obstruction during peritoneal dialysis (PD). Here we described a technique through which the omentopexy was accomplished by Hem-o-loks before PD catheter insertion. METHODS: The procedures of omentopexy were described. To evaluate the efficiency of this surgical method, a retrospective review of PD catheter insertion cases and their follow-ups were performed, covering 10 consecutive patients with end-stage renal disease. RESULTS: All patients showed no intraoperative events. No catheter flow obstruction, migration, exit-site infection appeared during the follow-up. CONCLUSION: Laparoscopic PD catheter insertion using omentopexy can decrease catheter obstruction and migration.


Assuntos
Cateterismo/métodos , Falência Renal Crônica/terapia , Laparoscopia/métodos , Omento/cirurgia , Diálise Peritoneal/efeitos adversos , Adulto , Idoso , Obstrução do Cateter , Cateteres/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/instrumentação , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento
3.
J Pediatr Surg ; 54(5): 1069-1075, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30803792

RESUMO

BACKGROUND: Peritoneal dialysis (PD) catheter obstruction often leads to surgical revision and may require transition to hemodialysis. The purpose of this study was to evaluate risk factors (including omentectomy) associated with early PD catheter obstruction (<6 months from insertion). METHODS: A retrospective review of all PD catheters inserted at a single high-volume referral center (2005-2018) was performed. 185 PD catheters were placed in 123 patients (45 female). Potential risk factors for early catheter obstruction were analyzed using Chi-square analysis (p < 0.05 considered statistically significant). RESULTS: Median age at catheter insertion was 3.42 years (3 days-39 years). Early catheter obstruction occurred in 42 cases (22.7%). Median time to early obstruction was 24 days (3-118 days). Previous PD catheter placement (p = 0.9) or prior abdominal surgery (p = 0.89) was not associated with obstruction. Weight ≥ 10 kg (p = 0.011) and age ≥ 1 year (p = 0.048) were associated with a significantly higher incidence of obstruction. Overall, omentectomy was associated with a trend in reduction of early obstruction in patients with weight ≥ 10 kg (p = 0.08) and significantly in patients ≥1 year (p = 0.028). CONCLUSION: Early PD catheter obstruction appears to occur more often in older patients with a higher weight. Concomitant omentectomy seems beneficial at reducing early catheter obstruction events in those patients. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: III.


Assuntos
Obstrução do Cateter/estatística & dados numéricos , Cateterismo , Diálise Peritoneal , Adolescente , Adulto , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/instrumentação , Diálise Peritoneal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
Nutr Clin Pract ; 34(2): 210-215, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30729597

RESUMO

For patients receiving home parenteral nutrition (HPN), vascular access with a central venous catheter (CVC) is essential to safely administer parenteral nutrition (PN) to meet their nutrition and hydration needs. Unfortunately, despite rigorous training and prevention strategies, CVCs are susceptible to complications such as infection, occlusion, thrombosis, and mechanical failure. Much of the published research on CVC complications focuses on infections; however, catheter occlusions and mechanical failures also contribute significantly to catheter dysfunction and loss. Frequent CVC exchanges put HPN patients at risk of loss of vascular access, making it essential that any strategies that can salvage the CVC be implemented prior to removal. CVC repair is 1 technique that can be utilized to avoid CVC exchanges in certain situations. CVC repairs can be performed in the office or on the ward and are cost effective when compared with CVC replacement. When performed by trained clinical staff, the procedures are highly successful and associated with low risk.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais/efeitos adversos , Nutrição Parenteral no Domicílio , Obstrução do Cateter , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Falha de Equipamento , Humanos , Nutrição Parenteral no Domicílio/instrumentação , Nutrição Parenteral no Domicílio/métodos
6.
J. bras. econ. saúde (Impr.) ; 10(3): 239-245, dez. 2018.
Artigo em Português | LILACS, ECOS | ID: biblio-980933

RESUMO

Objetivo: O avanço da tecnologia no setor da saúde vem provocando, principalmente às Operadoras de Saúde, uma discussão sobre qual o melhor caminho para a incorporação de novos produtos médico-hospitalares. O objetivo deste estudo é fazer uma análise de custo comparando uma nova tecnologia (seringa pré-enchida) com uma tecnologia usual (seringa preenchida manualmente) em pacientes em uso de cateter venoso central (CVC). Métodos: Uma avaliação econômica baseada em modelo de Árvore de decisão foi desenvolvida para avaliar a seringa pré-enchida comercialmente em comparação com a seringa preenchida manualmente com solução salina para flushing em pacientes com CVC, considerando-se a perspectiva das operadoras de saúde. O horizonte de tempo considerado foi de um ano. Como desfechos clínicos, foram adotadas a ocorrência de infecção da corrente sanguínea associada a cateter (ICSAC) e a de oclusões. Para os desfechos econômicos, foram considerados os custos com flush, redução de ocorrência de ICSAC e da oclusão. Todos os custos foram extraídos de base de dados locais de custo para o Brasil. Resultados: A avaliação econômica mostrou que o uso da seringa pré-enchida promove redução de 77% (1,17 vs. 5,10) e 62% (3,26 vs. 8,57) nas ocorrências de ICSAC e oclusão, respectivamente, comparada à seringa de preenchimento manual. O custo por flushing é de R$ 32,88 e R$ 98,48 para seringa pré-enchida e seringa preenchida manualmente, respectivamente, redução absoluta de R$ 65,60 e percentual de 67%. Conclusão: A utilização da seringa pré-enchida comercialmente demonstrou ser uma opção dominante econômica e clinicamente para o flushing em pacientes com CVC, quando comparada à seringa preenchida manualmente.


Objective: The advancement of technology in the health sector has brought, mainly to the Health Insurances, a discussion on what is the best path for the incorporation of new medical and hospital products. The objective of this study is to do a cost analysis comparing a new technology (pre-filled syringe) with a usual technology (manually filled syringe) in patients in use of central venous catheter (CVC). Methods: An economic assessment based on a Decision Tree model was developed to evaluate the commercially pre-filled syringe in comparison to the manually filled syringe with saline solution for flushing in patients with CVC, considering the perspective of private health care providers. The time horizon considered was 1 year. As clinical outcomes, the occurrence of central line-associated blood stream (CLABSI) and occlusions were adopted. For economic outcomes, we considered flush costs, reduction of CLABSI and occlusion. All costs were extracted from local cost database for Brazil. Results: The economic evaluation indicated that the use of the pre-filled syringe presented a reduction of 77% (1.17 vs. 5.10) and 62% (3.26 vs. 8.57) in the occurrences of CLABSI and occlusion, respectively, compared to the manually filled syringe. The cost per flushing is R$ 32.88 and R$ 98.48 for pre-filled syringe and manually filled syringe, respectively, representing an absolute reduction of R$ 65.60 and percentual of 67%. Conclusion: The use of the commercially pre-filled syringe has been shown to be an economically and clinically dominant option for flushing in patients with CVC when compared to the manually filled syringe.


Assuntos
Humanos , Seringas , Cateterismo Venoso Central , Custos e Análise de Custo , Infecções Relacionadas a Cateter , Obstrução do Cateter
7.
Medicine (Baltimore) ; 97(38): e12427, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30235721

RESUMO

The aim of this study was to assess the incidence rate and the risk factors for late complications associated with use of central totally implanted venous access devices (TIVAPs) in patients with cancer, and to devise nursing strategies to minimize late complications.This retrospective study included 500 patients with TIVAPs from 2012 to 2015. Multivariable logistic regression analysis was performed to assess the effect of sex, age, primary diagnosis, duration of surgery, and the length of hospital stay on the incidence of late complications of TIVAP.The cumulative maintenance period of TIVAP was 159,605 days. Late complications included catheter-related obstruction (n = 14; 2.8%), infection (n = 3; 0.6%), drug extravasation (n = 1; 0.2%), and catheter exposure (n = 1; 0.2%). Multivariate analyses revealed that age, breast cancer, lung cancer, and gastric cancer were risk factors for the late complications associated with TIVAP.There was a low incidence of late complications with TIVAP use. Catheter-related obstruction is the most frequent late complication of TIVAP. Risk factors for TIVAP-associated late complications include age and certain cancers, such as breast cancer, lung cancer, and gastric cancer.


Assuntos
Obstrução do Cateter/estatística & dados numéricos , Infecções Relacionadas a Cateter/complicações , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Neoplasias/complicações , Adulto , China/epidemiologia , Tratamento Farmacológico/instrumentação , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco
8.
Rev. esp. anestesiol. reanim ; 65(7): 398-402, ago.-sept. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177136

RESUMO

Los catéteres venosos centrales se utilizan de manera generalizada en pacientes críticos; sin embargo, también se asocian a una elevada morbimortalidad. La literatura puede subestimar la incidencia de los trombos auriculares derechos asociados a catéter venoso, que son asintomáticos, pero potencialmente de riesgo. Los factores de riesgo reconocidos para su desarrollo incluyen infecciones relativas al catéter y lesiones endoteliales secundarias al daño mecánico y químico inducido por ciertos fármacos y líquidos infundidos. También desempeñan un papel añadido las características del paciente y del catéter, tales como tamaño, material, tipo, localización y facilidad de inserción, y duración de la misma. Reportamos el caso de un varón de 38 años que desarrolló trombos auriculares derechos asintomáticos asociados a catéter venoso y precisó cirugía a corazón abierto tras cateterización venosa central durante 35días. El presente caso destaca las limitaciones existentes a la hora de realizar un diagnóstico correcto y rápido, que debería anticiparse en pacientes con factores de riesgo múltiples de trombosis. Dadas las recomendaciones disponibles limitadas, consideramos que debería individualizarse la estrategia más adecuada


Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role. We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized


Assuntos
Humanos , Masculino , Adulto , Cateterismo Venoso Central/efeitos adversos , Trombose/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Átrios do Coração/cirurgia , Obstrução do Cateter/etiologia , Terapia Trombolítica/métodos , Diagnóstico Diferencial
9.
An. sist. sanit. Navar ; 41(2): 269-272, mayo-ago. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-173607

RESUMO

La canulación venosa central es un procedimiento habitual en el medio hospitalario, siendo la vena yugular interna uno de los vasos más frecuentemente escogido para realizar el acceso venoso central. La presencia de válvulas venosas en dicha vena es un hecho conocido al que habitualmente no se concede importancia durante la canulación venosa central. No obstante, las válvulas venosas pueden llegar a dificultar este procedimiento, incrementando la probabilidad de que ocurran complicaciones. Presentamos el caso de un paciente en el cual la presencia de una válvula venosa yugular interna impidió obtener un acceso vascular a través de este vaso


Central venous cannulation is a commonly performed procedure in the hospital setting, while the internal jugular vein is one of the most frequently used to perform central venous access. The presence of venous valves in the jugular veins is a well-known fact, albeit often neglected during central venous cannulation. However, venous valves can make this procedure difficult, increasing the chance of developing complications. We report the case of a patient in whom the presence of a valve in the internal jugular vein did not permit a vascular access to be obtained through this vessel


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Válvulas Venosas/anormalidades , Obstrução do Cateter/etiologia , Dispositivos de Acesso Vascular/efeitos adversos , Perfuração Intestinal/complicações , Norepinefrina/administração & dosagem
10.
Cochrane Database Syst Rev ; 7: CD008462, 2018 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-30058070

RESUMO

BACKGROUND: Intermittent locking of central venous catheters (CVCs) is undertaken to help maintain their patency. There are systematic variations in care: some practitioners use heparin (at different concentrations), whilst others use 0.9% NaCl (normal saline). This review looks at the effectiveness and safety of intermittent locking with heparin compared to 0.9% NaCl to see if the evidence establishes whether one is better than the other. This work is an update of a review first published in 2014. OBJECTIVES: To assess the effectiveness and safety of intermittent locking of CVCs with heparin versus normal saline (NS) in adults to prevent occlusion. SEARCH METHODS: The Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (last searched 11 June 2018) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5). Searches were also carried out in MEDLINE, Embase, CINAHL, and clinical trials databases (11 June 2018). SELECTION CRITERIA: We included randomised controlled trials in adults ≥ 18 years of age with a CVC that compared intermittent locking with heparin at any concentration versus NS. We applied no restriction on language. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed quality, and extracted data. We contacted trial authors to retrieve additional information, when necessary. We carried out statistical analysis using Review Manager 5 and assessed the overall quality of the evidence supporting assessed outcomes using GRADE. We carried out prespecified subgroup analysis. MAIN RESULTS: We identified five new studies for this update (six prior studies were included in the original review), bringing the number of eligible studies to 11, with a total of 2392 participants. We noted differences in methods used by the included studies and variation in heparin concentrations (10 to 5000 IU/mL), time to follow-up (1 to 251.8 days), and the unit of analysis used (participant, catheter, line access).Combined results from these studies showed fewer occlusions with heparin than with NS (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.51 to 0.95; P = 0.02; 1672 participants; 1025 catheters from 10 studies; I² = 14%) and provided very low-quality evidence.We carried out subgroup analysis by unit of analysis (testing for subgroup differences (P = 0.23; I² = 30.3%). When the unit of analysis was the participant, results show no clear differences in all occlusions between heparin and NS (RR 0.79, 95% CI 0.58 to 1.08; P = 0.15; 1672 participants; seven studies). Subgroup analysis using the catheter as the unit of analysis shows fewer occlusions with heparin use (RR 0.53, 95% CI 0.29 to 0.95; P = 0.03; 1025 catheters; three studies). When the unit of analysis was line access, results show no clear differences in occlusions between heparin and NS (RR 1.08, 95% CI 0.84 to 1.40; 770 line accesses; one study).We found no clear differences in the duration of catheter patency (mean difference (MD) 0.44 days, 95% CI -0.10 to 0.99; P = 0.11; 1036 participants; 752 catheters; six studies; low-quality evidence).We found no clear evidence of a difference in the following: CVC-related sepsis (RR 0.74, 95% CI 0.03 to 19.54; P = 0.86; 1097 participants; two studies; low-quality evidence); mortality (RR 0.76, 95% CI 0.44 to 1.31; P = 0.33; 1100 participants; three studies; low-quality evidence); haemorrhage at any site (RR 1.32, 95% CI 0.57 to 3.07; P = 0.52; 1245 participants; four studies; moderate-quality evidence); or heparin-induced thrombocytopaenia (RR 0.21, 95% CI 0.01 to 4.27; P = 0.31; 443 participants; three studies; low-quality evidence).The main reasons for downgrading the quality of evidence were unclear allocation concealment, imprecision, and suspicion of publication bias. AUTHORS' CONCLUSIONS: Given the very low quality of the evidence, we are uncertain whether intermittent locking with heparin results in fewer occlusions than intermittent locking with NS. Low-quality evidence suggests that heparin may have little or no effect on catheter patency. Although we found no evidence of differences in safety (sepsis, mortality, or haemorrhage), the combined trials are not powered to detect rare adverse events such as heparin-induced thrombocytopaenia.


Assuntos
Anticoagulantes/administração & dosagem , Obstrução do Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Heparina/administração & dosagem , Cloreto de Sódio/administração & dosagem , Adulto , Anticoagulantes/efeitos adversos , Obstrução do Cateter/estatística & dados numéricos , Infecções Relacionadas a Cateter/epidemiologia , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Heparina/efeitos adversos , Humanos , Irrigação Terapêutica/métodos , Trombocitopenia/induzido quimicamente , Trombocitopenia/epidemiologia
11.
Medicine (Baltimore) ; 97(30): e11622, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30045303

RESUMO

RATIONALE: A multilumen access catheter (MAC) is a large-bore catheter that prevents kinking or collapsing. Misplacement is a frequently reported complication. PATIENT CONCERNS: A 59-year-old man who was diagnosed with a hemoperitoneum due to a liver laceration after a fall. DIAGNOSIS: After catheterization, we were able to aspirate blood through the 9 Fr, but not the 12-gauge line. Thus, we assumed that the catheter was misplaced. Nevertheless, ultrasonographic findings did not reveal the reason for the malfunction. We found kinking in the distal part of the catheter after removing it. INTERVENTION: The MAC was removed soon after stopping the active bleeding. OUTCOMES: A hemihepatectomy was successfully performed, and the patient was transferred to the intensive care unit. LESSONS: Anesthesiologists should consider kinking of large-bore catheters, including MACs.


Assuntos
Obstrução do Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Humanos , Masculino , Pessoa de Meia-Idade
12.
Eur J Gastroenterol Hepatol ; 30(9): 1082-1089, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29738325

RESUMO

BACKGROUND AND AIMS: The aim of this study was to investigate the Alfapump, an automated low-flow pump system for the treatment of refractory ascites (RA) as an alternative for repeated large-volume paracentesis in patients with contraindication for placement of a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation. MATERIALS AND METHODS: In 21 consecutive patients with RA and contraindication for a placement of a TIPS, the Alfapump was implanted at Hannover Medical School between December 2012 and May 2016. Repeated laboratory, clinical, and microbiology data were collected and analyzed to assess the outcome of patients with an Alfapump. Half of the patients received a modified peritoneal catheter. RESULTS: Twenty-one patients with RA in end-stage liver disease and with a contraindication to TIPS placement received the Alfapump. Diuretic dosages were significantly reduced, and the number of paracentesis declined from 2.3±2.7 to 0 per week. Using the Alfapump, kidney function and serum sodium remained stable. Likewise, serum albumin remained stable in the absence of albumin infusions. Thirty-three complications (dislocation and/or blockade of the catheter, infection, pump dysfunction) related to the Alfapump were observed in 15 of 21 patients (71.4%), and 21 surgical interventions were needed in 15 patients (71.4%, 1-3 interventions per patient). A new peritoneal catheter system could significantly reduce blockage of the peritoneal catheter. CONCLUSION: The Alfapump is an effective treatment in patients with RA. However, a high rate of complications were observed, which could be reduced with a modified peritoneal catheter.


Assuntos
Ascite/terapia , Cateteres de Demora , Drenagem/instrumentação , Cirrose Hepática/terapia , Idoso , Ascite/diagnóstico , Ascite/etiologia , Ascite/mortalidade , Automação , Obstrução do Cateter/etiologia , Remoção de Dispositivo , Diuréticos/uso terapêutico , Drenagem/efeitos adversos , Drenagem/mortalidade , Contaminação de Equipamentos , Desenho de Equipamento , Feminino , Alemanha , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Paracentese , Diálise Peritoneal/instrumentação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Asian Cardiovasc Thorac Ann ; 26(5): 387-389, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29734836

RESUMO

Thrombus formation is not uncommon in longstanding intracardiac catheters, but formation of a thrombus at the tip of a Peritnoeo-venous-atrial shunt, causing obstruction of the tricuspid valve, is a rare complication and frequently unrecognized. A large intracardiac thrombus causing valve obstruction requires surgical removal with the support of cardiopulmonary bypass which is associated with significant morbidity. We successfully removed a thrombus attached to the tip of peritoneovenous shunt without cardiopulmonary bypass in a 25-year-old man.


Assuntos
Ascite/terapia , Cardiopatias/cirurgia , Linfangiectasia Intestinal/complicações , Derivação Peritoneovenosa/efeitos adversos , Trombectomia , Trombose/cirurgia , Adulto , Ascite/diagnóstico , Ascite/etiologia , Ponte Cardiopulmonar , Obstrução do Cateter/etiologia , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Linfangiectasia Intestinal/diagnóstico , Masculino , Derivação Peritoneovenosa/instrumentação , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento
14.
BMJ Case Rep ; 20182018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769186

RESUMO

Two patients with ventriculoperitoneal shunts presented with symptoms of raised intracranial pressure indicative of possible shunt malfunction. During investigation, to eliminate this possibility, cerebral spinal fluid infusion studies were performed, which indicated proximal occlusion of the shunts in both cases. Retrograde flush of the ventricular catheter was performed during temporary compression of the siphon-control device, a manoeuvre which blocks distal flow. After the use of this technique, both patients' symptoms improved and they have remained symptom-free for over 2 years. This case report validates the role that infusion studies can play in clearing a blocked ventricular catheter shunt.


Assuntos
Obstrução do Cateter , Hidrocefalia/terapia , Hipertensão Intracraniana/etiologia , Soluções Isotônicas/administração & dosagem , Derivação Ventriculoperitoneal/instrumentação , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Hipertensão Intracraniana/terapia , Masculino , Lactato de Ringer , Tomografia Computadorizada por Raios X
15.
Ann Vasc Surg ; 51: 298-305, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29772317

RESUMO

Central venous catheter (CVC) use is common among patients undergoing hemodialysis. Catheter-related vascular thrombosis is a frequent complication, which results in catheter dysfunction. This may eliminate the affected vein as a potential route of vascular access and leads to significant morbidity of the limbs involved. Despite increasing prevalence, there is a dearth of evidence-based guidelines for managing such catheter-related thrombi, often leading to treatment dilemmas in clinical practice. Minimizing the use of CVCs for hemodialysis remains the best approach in preventing such adverse complications. Furthermore, meticulous planning and care when using such catheters in unavoidable circumstances along with vigilant surveillance to identify complications early will allow to avoid associated morbidity.


Assuntos
Anticoagulantes/administração & dosagem , Obstrução do Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Remoção de Dispositivo/métodos , Procedimentos Endovasculares/métodos , Diálise Renal , Irrigação Terapêutica , Terapia Trombolítica/métodos , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/terapia , Anticoagulantes/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Remoção de Dispositivo/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Fatores de Risco , Irrigação Terapêutica/efeitos adversos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/etiologia , Trombose Venosa Profunda de Membros Superiores/fisiopatologia
16.
J Coll Physicians Surg Pak ; 28(4): 284-287, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29615168

RESUMO

OBJECTIVE: To evaluate the reasons of removal of non-tunneled double lumen catheters (NTDLC) in incident hemodialysis (HD) patients in a tertiary renal care hospital. STUDY DESIGN: Observational retrospective study. PLACE AND DURATION OF STUDY: Department of Nephrology, The Kidney Centre Postgraduate Training Institute (TKC PGTI), Karachi, from June 2015 to May 2016. METHODOLOGY: All patients were selected who had naive NTDLC placement at TKC PGTI either in Emergency Room (ER) or Intensive Care Unit (ICU) during the study period. The reason for removal were observed. Data was analysed by SPSS 21 and mean, percentages and frequencies were calculated. Cross tabulation between variables was done to find significance. RESULTS: A total of 429 NTDLCs were inserted in the study period, out of which 296 catheters were inserted for incident HD. One hundred and twenty-seven (42.9%) catheters were removed prematurely due to malfunction, and 50 (17%) due to catheter-related blood stream infection (CRBSI). Methicillin resistant Staphylococcus aureus was the commonest organism responsible for CRBSI. One hundred and five (35.47%) catheters were removed because the permanent vascular access (PVA) became usable. CONCLUSION: Catheter malfunctions and infections frequently occurred in NTDLC used for HD, which culminated early removal of catheter. Early creation of PVA should be encouraged to reduce the complications in already immunocompromised patients.


Assuntos
Lesão Renal Aguda/terapia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/instrumentação , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Diálise Renal/métodos , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Diálise Renal/efeitos adversos , Estudos Retrospectivos
17.
J Vasc Access ; 19(5): 467-472, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29529916

RESUMO

PURPOSE: Real-time ultrasound is indicated for hemodialysis catheters' insertion in internal jugular veins. We evaluated unsuccessful implantation of short-term hemodialysis catheters in internal jugular veins using real-time ultrasound between patients with and without previous short-term catheters. METHODS: Observational open-label study of unsuccessful implantation of short-term hemodialysis catheters in internal jugular veins using real-time ultrasound from July 2013 to August 2014. RESULTS: A total of 185 procedures were compared in 122 individuals; 120 (64.86%) had previously used short-term catheters. There were 5 (8%) unsuccessful implantation among 62 catheterizations without previous short-term catheter and 41 (33.6%) among 122 with previous short-term catheter (p = 0.001 Pearson's chi-squared, odds ratio = 5.77, 95% confidence interval = 2.15-15.50, p = 0.001). Non-progressing guidewire occurred in 2 (3.2%) of 62 patients without previous short-term catheter and in 18 (14.8%) of 122 with previous short-term catheter (p = 0.018 Pearson's chi-squared, odds ratio = 5.19, 95% confidence interval = 1.16-23.15, p = 0.031). No difference was observed between size of the veins with or without non-progressing guidewire. All 11 cases of venous thrombosis occurred in patients who had previous short-term catheter removed due to infection. CONCLUSION: Previous use of short-term catheter is pivotal in the occurrence of unsuccessful implantation of short-term catheter in internal jugular veins using real-time ultrasound.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Veias Jugulares/diagnóstico por imagem , Diálise Renal , Ultrassonografia de Intervenção , Idoso , Brasil , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose Venosa/etiologia
18.
J Vasc Access ; 19(3): 252-257, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29529930

RESUMO

PURPOSE: The exchange from a non-tunneled hemodialysis catheter to a tunneled one over a guidewire using a previous venotomy has been reported to be safe. However, some concerns that it may increase infection risk prevent its clinical application. This approach seems particularly useful for acute kidney injury patients requiring initial renal replacement therapy, in whom we frequently worry about the choice of non-tunneled versus tunneled catheters. MATERIALS AND METHODS: From March 2012 to February 2016, 88 cases to receive the over-the-guidewire exchange method from a non-tunneled to a tunneled catheter and 521 cases to receive de novo tunneled catheter placement from the hemodialysis vascular access cohort were compared retrospectively. RESULTS: The immediate complication, later catheter dysfunction requiring replacement, and infection rates were comparable between the two groups. Newly placed tunneled catheter survival in the over-the-guidewire exchange group was comparable with survival in the de novo tunneled catheter group (p = 0.24). In addition, when we compared the same two methods among only intensive care unit patients; they remained similar (p = 0.19). CONCLUSION: An exchange with the over-the-guidewire method from a non-tunneled to a tunneled catheter was comparable to a de novo catheter placement technique. Therefore, this method should be viewed more favorably and should especially be considered for acute kidney injury patients.


Assuntos
Lesão Renal Aguda/terapia , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Remoção de Dispositivo/métodos , Diálise Renal , Grau de Desobstrução Vascular , Lesão Renal Aguda/diagnóstico , Idoso , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Tomada de Decisão Clínica , Remoção de Dispositivo/efeitos adversos , Desenho de Equipamento , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
J Vasc Access ; 19(5): 484-491, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29587560

RESUMO

BACKGROUND AND OBJECTIVES: We evaluated the location and structure of the fibrous sheath formed after the placement of tunneled, cuffed hemodialysis catheters in large animals, 70 kg pigs. We focused on describing the location of the fibrous sheath in relation to the catheter. Its location explains the fibrous sheath's ability to cause catheter dysfunction by covering the catheter exit ports located at the catheter's tip. DESIGN: We used three animals. Each animal had a tunneled, cuffed, 15-French diameter hemodialysis catheter placed in the external jugular vein, with the tip at the junction of the superior vena cava and the right atrium. Two animals were sacrificed at 5 weeks and one animal at 17 weeks after catheter placement. The catheter and surrounding tissues were removed in one block. The fibrous sheath was dissected and longitudinally cut along the catheter to evaluate its extension in relation to the catheter. Relevant portions of the fibrous sheath were sent for pathology examination. RESULTS: The fibrous sheath covered the catheter in its entire length and circumference. It started at the entry site and continued without any interruption along the entire length of the catheter, including the tip. Its average thickness is 1 mm and has an inner cellular/inflammatory layer comprising lymphocytes, plasma cells, neutrophils, macrophages, multinucleated giant cells, and spindled cells and an outer layer comprising a mixture of collagen and fibroblasts. CONCLUSION: Our model showed that the fibrous sheath forms around all catheters and covers them in their entire length and circumference without any gaps.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Reação a Corpo Estranho/etiologia , Veias Jugulares/patologia , Diálise Renal , Animais , Obstrução do Cateter/etiologia , Desenho de Equipamento , Fibrose , Reação a Corpo Estranho/patologia , Modelos Animais , Fatores de Risco , Sus scrofa , Fatores de Tempo
20.
J Vasc Access ; 19(4): 378-381, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29546772

RESUMO

PURPOSE: To review our experience with peripherally inserted central catheters in pediatric cancer patients. METHODS: The analysis included 353 patients (3 months up to 17 years, mean age 11.2 years) with a variety of cancers diseases, which in 2011-2016, 354 peripherally inserted central catheters were placed. All settings are carried out using ultrasound guidance. In 138 (39%) patients, external anatomical landmarks were used and in 216 (61%) intraoperative fluoroscopy. RESULTS: Maximal duration of the line was 1.3 years, the lowest 1.5 months, and average 6.3 months. Among the technical difficulties during placement, most frequently have been the migration of the distal end of the catheter into the internal jugular vein against blood flow-32 (9%) patients. In one (0.3%) case, we were unable to catheterize the patient's vein. Among the most common complications of operation were marked peripherally inserted central catheter clot occlusion of the lumen-26 (7.3%) cases. Symptomatic catheter-related thrombosis was observed in 16 (4.5%) cases. Catheter-related blood stream infections were not reported. Removal of peripherally inserted central catheters related to the complications was performed in 30 (8.5%) patients who were later implanted venous ports. CONCLUSION: Peripherally inserted central catheters are recommend to use in the treatment of children with cancer. There should be trained nursing staff to minimize the risk of complications.


Assuntos
Antineoplásicos/administração & dosagem , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Neoplasias/tratamento farmacológico , Administração Intravenosa , Adolescente , Fatores Etários , Pontos de Referência Anatômicos , Obstrução do Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Criança , Pré-Escolar , Remoção de Dispositivo , Feminino , Humanos , Lactente , Masculino , Radiografia Intervencionista , Fatores de Risco , Federação Russa , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Trombose Venosa Profunda de Membros Superiores/etiologia , Trombose Venosa Profunda de Membros Superiores/cirurgia
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