The journal of vascular access
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Comparative Study Observational Study
A comparison of infections and complications in central venous catheters in adults with solid tumours.
The aim of this study is to compare the complication rates of three vascular access devices in patients with solid tumours having infusion chemotherapy. ⋯ In our study, we demonstrated that central venous ports and PICC lines in patients undergoing infusional chemotherapy had lower line infection rates than tunnelled catheters, and only ports have been shown to be almost complication-free. In addition, we found infection rates higher in CVCs s cared for by patient/carers rather than hospital only care, and higher in colorectal patients with stomas. Therefore, we recommend that central venous ports are a safe, acceptable CVC option for infusional chemotherapy for adults with solid tumours.
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An interventional vascular access unit is usually part of an interdisciplinary centre, including departments of nephrology, vascular surgery, angiology and interventional radiology. We present recommendations on quality control, equipment and diagnostic and interventional techniques for the treatment of vascular access insufficiency.
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Central venous catheterization is a commonly used procedure to gain access to the central circulation. Although ultrasound guidance decreases the complication rates, arterial puncture may still occur. Failure to recognize this early may lead to devastating complications such as thrombosis and embolic stroke. We discuss the factors associated with increased risk of arterial puncture, techniques to detect them early and the management of established carotid artery cannulation. ⋯ Even with ultrasound-guided central venous catheterization, it is essential to remain vigilant for the early detection of vascular complications. Clinical suspicion combined with diagnostic modalities such as chest radiograph, transduction and manometry can increase the detection rates.
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Almost all central venous catheters are placed using the Seldinger technique. Despite the introduction of ISO 11070 in 1998, we continue to see mechanical wire failures and their associated complications. ⋯ The mechanical properties of different types of guidewires show considerable differences, not detected with current ISO 11070 based testing. Uncovering those may allow set up of clinical trials to examine whether regular use of wires with high-end mechanical properties could reduce CVC insertion-related complication rates.
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Peripherally inserted central venous catheters (PICCs) are being increasingly placed at the bedside by trained vascular access professional such as nurses. This is to increase the availability of the service, for cost containment, and to reduce the workload on the interventional radiologist. We describe a single institution experience with over 700 PICC lines placed by trained nurses at the bedside and determine the success rate, malposition rate of the PICC line , degree of support needed from the Interventional radiologist, and factors affecting a successful placement of a PICC line by the nurses. ⋯ Bedside placement of PICC line by trained vascular nurses is an effective method with a high success rate, low malposition rate and requires minimal support from interventional radiology.