How long should peripherally inserted central catheterization be delayed in the context o…

[Read more →]

Percutaneous Cholecystostomy for Acute Cholecystitis: Ten-Year Experience.
J Vasc…

[Read more →]

Related Articles

Short-term infection in cuffed versus noncuffed small bore central catheters: a randomized trial.

J Vasc Interv Radiol. 2010 Feb;21(2):203-11

Authors: Trerotola SO, Patel AA, Shlansky-Goldberg RD, Solomon JA, Mondschein JI, Stavropoulos SW, Soulen MC, Itkin M, Chittams J

PURPOSE: To determine if a polyester cuff offered benefit in jugular small-bore central catheters (SBCCs). MATERIALS AND METHODS: Eighty-four patients were randomly assigned to receive a 5-F single- or 6-F dual-lumen SBCC with (n = 42) or without (n = 42) a polyester cuff. Follow-up was performed at 2 weeks, 1 month, and 3 months or at catheter removal, whichever came first. At scheduled follow-up, catheter function, patient satisfaction, and infection were determined. At catheter removal, tip culture was performed to determine colonization and jugular vein patency was determined with ultrasonography (US). RESULTS: The overall infection rate was 0.4 per 1,000 catheter days. There was one clinical infection (noncuffed catheter). Colonization occurred in two noncuffed catheters and one cuffed catheter. There was one catheter dislodgment in the noncuffed group and none in the cuffed group. Cuffed catheters were no more difficult to insert but took slightly longer to remove (6 minutes +/- 4.7 vs 5 minutes +/- 3, P = .39) and often required local anesthesia for removal, whereas noncuffed catheters did not (41% vs 0%, P = .001). Partial (two cuffed, 0 noncuffed) or complete (two cuffed, one noncuffed) jugular thrombosis was seen on five of 58 completion US studies (8.6%). CONCLUSIONS: A polyester cuff on a SBCC confers no significant benefit in short-term colonization rates. Infection in SBCCs is uncommon. Despite their small diameters, SBCCs can result in jugular thrombosis, an important consideration in any patient requiring long-term venous access.

PMID: 20036147 [PubMed - indexed for MEDLINE]

[Read more →]

Related Articles

Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions.

J Vasc Interv Radiol. 2009 Aug;20(8):1066-9

Authors: Zuckerman DA, Reed MF, Howington JA, Moulton JS

PURPOSE: To assess the feasibility and effectiveness of intrapleural recombinant tissue-type plasminogen activator (r-tPA) in the treatment of loculated parapneumonic effusions (PPEs). MATERIALS AND METHODS: A single-arm prospective study of 25 consecutive patients with loculated PPEs was analyzed. All patients received 6-mg doses of intrapleural r-tPA on a defined schedule via a thoracostomy tube. The volume of output from the tubes was recorded and analysis of the fluid composition performed. Follow-up was both clinical and radiographic, with all patients undergoing pre- and postprocedural computed tomography. RESULTS: Eighteen of the 25 patients (72%) required no additional intervention and had a complete clinical and radiographic response with the fibrinolytic therapy. Seven patients (28%) were treated with video-assisted thoracoscopic surgery, but no patient required thoracotomy for total decortication. There were no hemorrhagic complications. CONCLUSIONS: Intrapleural r-tPA is effective in the treatment of loculated PPEs. It can be performed safely and in some patients may avoid the need for additional surgical intervention.

PMID: 19560940 [PubMed - indexed for MEDLINE]

[Read more →]

Related Articles

Single-incision technique for tunneled central venous access.

J Vasc Interv Radiol. 2009 Aug;20(8):1052-8

Authors: Contractor SG, Phatak TD, Klyde D, Gonzales S, Sadowski S, Bhagat N

PURPOSE: To describe the authors’ experience in using a single-incision technique for placing implantable chest ports and tunneled dialysis catheters. MATERIALS AND METHODS: Implantable chest ports and tunneled dialysis catheters were placed in 130 consecutive unselected patients aged 18 to 81 years over a 6-month period. A micropuncture needle bent into a C shape was used to access the internal jugular vein (IJV) from an infraclavicular access under real-time ultrasonographic (US) guidance. A microwire and sheath were then passed into the superior vena cava; this was followed by placement of the tunneled catheter either through a peel-away sheath (implantable chest port) or de novo over the wire (tunneled dialysis catheter). Technical success of procedure performance, total US and procedure times, and adverse procedural outcomes were documented for each case. Follow-up for infections and catheter outcomes was performed, with an average follow-up of 2 months. RESULTS: One hundred thirty of the 131 placements were successful. Fifty-eight implantable chest ports and 72 tunneled dialysis catheters were placed. Four implantable chest ports and 16 tunneled dialysis catheters were placed via the left IJV; the remainder were placed via the right IJV. There were no procedure-related complications. The average US and total procedure times were the same as those for a conventional technique. The lack of a second incision in the lower neck improved the cosmetic result. CONCLUSIONS: The single-incision technique for tunneled central venous access is feasible and safe. Total US and procedure times are within the range of those with a conventional technique. Cosmetically, this technique is superior to the conventional technique.

PMID: 19647183 [PubMed - indexed for MEDLINE]

[Read more →]

Related Articles

Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy.

J Vasc Interv Radiol. 2008 Dec;19(12):1723-31

Authors: Courtney A, Nemcek AA, Rosenberg S, Tutton S, Darcy M, Gordon G

PURPOSE: To prospectively assess the safety of the PleurX catheter in the management of recurrent ascites in patients with advanced abdominal malignancy and the consequent quality of life among these patients. MATERIALS AND METHODS: This was a multicenter, prospective study of PleurX catheters implanted between March 2004 and April 2005 for control of nonhepatic abdominal ascites associated with malignancy. A total of 34 subjects were included (age range, 40-81 years; mean age, 64.3 y) who underwent 440 drainage sessions. Subjects kept records of volume and frequency of ascites drainage and recorded any difficulties encountered with use of the device. Subjects assessed symptoms before device insertion and weekly for as long as 12 weeks. Serum laboratory values reflecting overall volume status were tracked. RESULTS: All catheter insertions were successful without major procedural complications. Twenty-nine (85%) required no catheter intervention or separate therapeutic paracentesis during 12 weeks observation or until the patient's death. Three needed a total of 13 interventions to restore catheter function. Before 12 weeks, 26 subjects died. Five discontinued catheter use as a result of catheter function despite the presence of ascites. Ascites resolved in five patients. Bloating and abdominal discomfort were significantly reduced at 2 and 8 weeks (P < .05). At weekly follow-up, 83%-100% of subjects reported their ascites to be well controlled. There were no significant changes in blood chemistry results between baseline and 12 weeks. One case of peritonitis at 10 weeks resolved with antibiotic treatment. CONCLUSIONS: In terminally ill patients, PleurX catheter use resulted in improvement of ascites-related discomfort and was associated with low rates of serious adverse clinical events and catheter failure.

PMID: 18951041 [PubMed - indexed for MEDLINE]

[Read more →]

Related Articles

Acute lower gastrointestinal hemorrhage: minimally invasive management with microcatheter embolization.

J Vasc Interv Radiol. 2008 Sep;19(9):1289-96.e2

Authors: Kickuth R, Rattunde H, Gschossmann J, Inderbitzin D, Ludwig K, Triller J

PURPOSE: To evaluate the efficacy of superselective embolization therapy in the management of acute lower gastrointestinal (LGI) hemorrhage, including any bleeding distal to the ligament of Treitz. MATERIALS AND METHODS: Between June and August 2007, 20 patients with acute LGI bleeding underwent superselective transcatheter arterial embolization (TAE) at the authors’ institution. The bleeding had different causes. All patients were treated with use of microcatheters. The following embolic agents were used: microcoils (n = 16), polyvinyl alcohol (PVA) particles (n = 2), and a combination of microcoils and PVA particles (n = 2). Outcome measures included technical success (complete cessation of bleeding as documented at completion angiography), clinical success (resolution of signs or symptoms of LGI bleeding within 30 days after TAE), and the rate of major and minor complications. RESULTS: The identified bleeding sources were as follows: jejunal branch, branch of middle colic artery, branch of ileocolic artery, ileal branch, branch of left colic artery, branch of sigmoid artery, branch of the superior rectal artery, and branch of the middle rectal artery. Technical success with effective control of active bleeding was achieved in all patients (100%). Clinical success attributed to TAE was documented in 18 of the 20 patients (90%). Major complications included death due to pulmonary embolism, heart infarction, and multiorgan failure in the 3rd week after TAE; a procedure-related colonic infarction occurred in one patient. A minor complication occurred in one patient who developed a groin hematoma. CONCLUSIONS: Superselective embolization may be used for effective, minimally invasive control of acute LGI bleeding.

PMID: 18725091 [PubMed - indexed for MEDLINE]

[Read more →]

Related Articles

Cavoatrial junction and central venous anatomy: implications for central venous access tip position.

J Vasc Interv Radiol. 2008 Mar;19(3):359-65

Authors: Baskin KM, Jimenez RM, Cahill AM, Jawad AF, Towbin RB

PURPOSE: To quantify the anatomic relationships of the cavoatrial junction and propose a system for describing central venous access device tip location on the basis of structures visible on chest radiographs. MATERIALS AND METHODS: The authors performed a retrospective study of 100 consecutive computed tomographic (CT) studies from a predominantly pediatric population consisting of 52 male and 48 female patients aged 12-28 years (mean age, 16 years). With use of multiplanar and scout images, relevant mediastinal structures were marked, vertebral levels were noted, and measurements were made electronically. Catheter tip positions were recorded in the 26 children who had central catheters. RESULTS: A vertebral body unit was defined as the distance between the inferior endplate of one vertebra to the inferior endplate of the next, with the upper intervertebral disk included. The most reliable estimate of cavoatrial junction position is a point two vertebral body units below the carina; there was no association with patient age or other parameters. CONCLUSIONS: A more accurate understanding of the superior vena cava anatomy is essential for the correct interpretation of central venous access device position. The true cavoatrial junction is located more inferiorly than commonly believed and is not accurately estimated with commonly used imaging landmarks. A point two vertebral body units below the carina enables the reliable estimate of the position of the cavoatrial junction. Catheter tip position can be most reliably described in vertebral body units below the carina, with use of the thoracic spine as an internal ruler.

PMID: 18295694 [PubMed - indexed for MEDLINE]

[Read more →]