scholarly journals Femoral placement of a totally implantable venous access port with spontaneous catheter fracture: case report

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Tomohiro Kondo ◽  
Shigemi Matsumoto ◽  
Keitaro Doi ◽  
Motoo Nomura ◽  
Manabu Muto
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Venous Access ◽  
Brachiocephalic Vein ◽  
Access Port ◽  
Femoral Site ◽  
First Case ◽  
Venous Access Port ◽  
The Right ◽  
Catheter Fracture

Abstract Background The incidence of catheter fracture after standard positioning of a totally implantable venous access port (TIVAP) is reported to be 1.1%–5.0%; however, the incidence of catheter fracture after TIVAP implantation at a femoral site remains unclear. Case presentation In a 30-year-old man with angiosarcoma of the right atrium, tumor embolism was observed from the left brachiocephalic vein to the superior vena cava. A TIVAP was implanted in the right femur. A catheter fracture was spontaneously observed after 7 months. Conclusions To the best of our knowledge, this is the first case of catheter fracture in a TIVAP implantation at a femoral site.

scholarly journals Migration of catheter of a totally implantable venous access port to right thoracic cavity in a child - a case report

2021 ◽  
Author(s):  
Qiteng Xu ◽  
Yueyi Ren ◽  
Yifei Hu ◽  
Shuhua Duan ◽  
Rui Chen ◽  
...  
Keyword(s):  
Venous Access ◽  
Thoracic Cavity ◽  
Severe Condition ◽  
Access Port ◽  
Intravenous Antibiotics ◽  
Catheter Tip ◽  
Life Threatening ◽  
Venous Access Port ◽  
And Migration ◽  
The Right

Abstract BackgroundThe totally implantable venous access port (TIVAP) is a secure and practical choice for children undergoing long-term chemotherapy. Nevertheless, various complications still need to be treated cautiously. Among the complications, the migration of catheters to the thoracic cavity is a very rare (but potentially severe) condition that may necessitate device reimplantation. Furthermore, this migration may even be life-threatening if it is not detected in time.Case presentationA 1-year-old girl undergoing palliative chemotherapy underwent TIVAP placement via the right internal jugular vein. During the operating procedure, the catheter tip was located in the right atrium, which was confirmed by the use of C-arm. Prophylactic intravenous antibiotics were then adopted with routine aspiration and with flushing being conducted each time before administration. Massive right pleural effusion and migration of the catheter tip to the right thoracic cavity were detected on the 2nd day after implantation, which resulted in the removal and reimplantation of the TIVAP device.ConclusionsThe migration of the catheter into the thoracic cavity should be considered a possible complication of TIVAP implantation in children. Early detection and reimplantation may provide opportunities for the prevention of further severe complications.

scholarly journals P238 Chemotherapy venous access port endocarditis in a patient with breast cancer

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Siama ◽  
M Iliopoulou ◽  
A Kalogeris ◽  
A Tsoukas ◽  
A J Manolis
Keyword(s):  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Venous Access ◽  
Left Ventricular ◽  
Breast Adenocarcinoma ◽  
Access Port ◽  
Maximal Diameter ◽  
Fungal Endocarditis ◽  
Venous Access Port ◽  
The Right

Abstract Funding Acknowledgements No funding Background/Introduction Right sided infective endocarditis (IE) accounts for less than 10% of all IE cases. Predisposing factors include portal of entry, implanted foreign material and unrepaired congenital heart disease with conduit. Fungal endocarditis (FE) constitutes the most severe form of IE and is etiologically connected predominantly to Candida and Aspergillus species. Among these two agents, Candida species is a common nosocomial infection with increasing prevalence and mortality rates up to 40% in cases of systemic candidiasis. Individuals with different forms of solid or hematological malignancies, under chemotherapy regimens or bone marrow transplantation comprise a particularly susceptible patient population. Case presentation A 58 year old woman with personal history of triple negative breast adenocarcinoma stage IV under palliative chemotherapy, administered for metastatic mass riknosis in the gastrointestinal tract, was admitted to the Emergency Department of our Hospital due to persistent fever, malaise and dyspnea on effort. Chemotherapy was infused via an implantable venous access port (intraport catheter). Methods/Results: Her heart auscultation revealed a holosystolic ejection type murmur of 3/6 located in the third intercostal space of changing quality. Candida tropicalis was isolated in three separate blood cultures. Transthoracic echocardiography demonstrated a good overall left ventricular systolic function. The right cavities were moderately dilated with moderate tricuspid regurgitation and a pulmonary pressure estimated at 45 mmHg. A large vegetation (approximately 2 cm maximal diameter) at the atrial surface of the posterior and diaphragmatic leaflets of the tricuspid valve with parts of the vegetation periodically apparent in the right ventricle was observed. Transesophageal echocardiography confirmed the findings of the transthoracic study and elucidated in the bicaval view the connection of the vegetation in the tricuspid valve with the edge of the intraport catheter. Moreover computed tomography scan revealed multiple pulmonary emboli in the segmental branches of the bronchial tree and a circumscribed peripheral pulmonary infarct of the left inferior lobe. A multidisciplinary team concluded that the best treatment strategy would require aggressive intravenous combined antifungal therapy until eradication followed by removal of the implantable venous access port, which was uncomplicated. Conclusions The majority of fungal endocarditis episodes represented healthcare-associated infections in vulnerable subsets of patients. Treatment of Candida endocarditis can prove challenging because of the formation of biofilms on prosthetic devices often requiring combination therapy. Septic pulmonary embolism with multiple loci is a frequent complication in right sided infective endocarditis. Removal of the prosthetic device if feasible in addition to antifungal treatment is linked to a more favorable prognosis. Abstract P238 Figure. Chemotherapy intraport endocarditis

scholarly journals Avoiding harm: central venous access in Kartagener syndrome and other vascular anomalies

2021 ◽  
Vol 9 (41) ◽  
pp. 40-43
Author(s):  
Brad Snodgrass ◽  
Victoria Chu
Keyword(s):  
Patient Outcomes ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Central Venous ◽  
Kartagener Syndrome ◽  
Internal Jugular Vein Catheterization ◽  
The Right ◽  
Landmark Technique

Placement of internal jugular catheters is more likely to be complicated if a left-sided approach is used, assuming normal anatomy. Kartagener syndrome is the sine qua non of sidedness confusion and results in cognitive challenges that increase the risk of adverse patient outcomes. The altered anatomy can cause profound disorientation from our usual processes.  In normal circumstances the right-sided approach is used for placement of internal jugular catheters, but in Kartagener syndrome the left-sided approach should be preferred.  Surgical volume and use of ultrasound guided techniques are positively correlated with better outcomes.  Clinical experience may be a detriment to performance. Knowledge of these issues will help clinicians maintain vigilance and avoid error.    Keywords: Kartagener syndrome, central venous access, superior vena cava, landmark technique, internal jugular vein catheterization cognitive bias

scholarly journals Atypical Presentation of Central Venous Occlusion (CVO) Disease

2019 ◽  
Vol 9 (1) ◽  
pp. 268-270
Author(s):  
Rosnelifaizur R*,Aizat Sabri I, Krishna K,Lenny SS,Azim I, H Harunarashid
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Lymphatic Vessels ◽  
Venous Access ◽  
Venous Occlusion ◽  
Intermittent Fever ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
End Stage

We reported a case of 58 years old gentleman who known case of end stage renal failure and had history of Right IJC cannulation of venous access on 2012, presented with recurrent shortness of breath, chesty cough and intermittent fever. Otherwise he got no hemoptysis, no recent contact with PTB patients and no joint pain. The same presentation occurred last month with a pleural tapping was done and claimed it was a milky content. No further investigation was done at that moment. This current presentation noted a dullness in percussion up to midzone of right lung and reduce air entry on auscultation as well. The pigtail catheter was inserted over the right pleural space and it was confirmed as a chylothorax with a present of cholesterol in a pleural fluid analysis. Computed tomography of the thorax showed complete occlusion of the superior vena cava with an established collateral circulation. Lymphangiogram revealed lipiodol seen opacified lymph node and lymphatic vessels until the level of T3 on the right and T5 on the left. There was no obvious lipiodol opacification seen at the region of the right thorax. Effusion was improved after the instillation of fibrinolytic agent and the the chest radiograph shows improvement.

The role of venography in the evaluation of malfunctioning central venous access ports (CVAPs)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18535-18535 ◽  
Author(s):  
E. Atallah ◽  
M. Salomon ◽  
C. A. Schiffer ◽  
B. El-Rayes
Keyword(s):  
Cancer Patients ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Common Finding ◽  
Fibrin Sheath ◽  
Catheter Tip ◽  
Catheter Fracture

18535 Background: Malfunction of CVAPs is common in cancer patients receiving chemotherapy. We evaluated the role of venography as a means of assessing the cause of malfunction. Methods: We reviewed and analyzed data available from cancer patients who had a venogram for a malfunctioning CVAP between 1/03 to 3/05. All patients in our institution who have a malfunctioning CVAP receive a trial of intracatheter thrombolytics. If the malfunction persists, then a venogram is performed through the catheter. Results: Seventy-seven patients were studied. The indication for evaluation was inability to aspirate blood (54%), pain (18%), swelling at site of injection (10%), difficult aspiration and infusion (6.5%) and others (11.5%). Forty-four patients had chest ports (31% left and 26% right side), while 33 patients had the CVAP placed in the upper extremity (24% right and 18% left arm). Fibrin sheath or thrombus was the most common finding in 44% of patients, and 41% of venograms were normal. Only two patients had soft tissue extravasation of contrast. Sites of extravasation were in the chest at the catheter/port junction and in the supraclavicular area secondary to a catheter fracture. In patients with aspiration failure, 68% had either a fibrin sheath or thrombus at the catheter tip, 14% had CVAP malposition as the only abnormality, 14% were normal and one patient had extravasation. The CVAP tips were optimally positioned in 70% of patients (distal superior vena cava (SVC), venocava-atrial junction or atrium), while 30% were in a suboptimal position (proximal SVC, brachiocephalic, azygous, or internal jugular vein). Suboptimally positioned CVAPs had a higher incidence of an associated abnormality compared to optimally positioned CVAPs (58% vs. 4% P = 0.001). Only five CVAPs were removed, for extravasation (1), cellulitis (2), and malposition (2). Conclusion: Although the incidence of extravasation was low, venography evaluation could be considered in patients with malfunctioning catheters receiving a vesicant drug to help prevent a potentially significant complication. CVAPs with suboptimally positioned tips had a higher rate of associated abnormalities, emphasizing the importance of proper tip position. No significant financial relationships to disclose.

Challenges in the Accurate Identification of the Ideal Catheter Tip Location

2011 ◽  
Vol 15 (4) ◽  
pp. 196-201 ◽  
Author(s):  
Nadine Nakazawa
Keyword(s):  
Chest Radiograph ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Accurate Identification ◽  
Landing Zone ◽  
Catheter Tip ◽  
The Right ◽  
The Ideal

Abstract The chest radiograph has been the primary tool to identify the catheter tip location after bedside placement of central venous access devices (CVADs), especially with peripherally inserted central catheters. The targeted ideal landing zone for a CVAD has evolved over time to the lower third of the superior vena cava, near the juncture of the right atrium. This article will discuss the evolution in the narrowing of the ideal targeted zone for landing the CVAD tip, and the issues around perception of “seeing” the catheter tip in the chest radiograph that can be imprecise and inaccurate. A brief overview of emerging technologies that capitalize on individual patient's internal physiologic characteristics to better identify this ideal landing zone will be presented.

scholarly journals Endovascular retrieval of two migrated stents from pulmonary artery by means of balloon catheter

2021 ◽  
Vol 5 ◽  
pp. 21
Author(s):  
Saad Saeed Alqahtani ◽  
Ahmed Kandeel Elhadad ◽  
Rusha Abdulmohsen Sarhan ◽  
Saleh Mohamed Alwaleedi
Keyword(s):  
Pulmonary Artery ◽  
Superior Vena ◽  
Balloon Catheter ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Venous Stenting ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
The Right

Long-term central venous catheters can be associated with central venous stenosis in up to 50% of cases. Central venous stenosis can be managed with central venous stenting which was demonstrated to restore patency and improve suboptimal results after percutaneous transluminal angioplasty. Dislodgment of venous stents into the right side of the heart or the pulmonary artery during stent deployment is one of the most feared complications of this procedure. Percutaneous removal of these migrated stents is the preferred alternative for the more invasive operative intervention, which may be very hazardous in these patients. We report an unusual case of a 52-year-old man on hemodialysis who underwent endovascular stenting to treat a tight stenosis of the right brachiocephalic vein and superior vena cava and suffered from stent migration to the left pulmonary artery, requiring removal by interventional radiologist.

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