Journal articles: 'Catheter positioning'

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Kamenetsky, Eric, Rahul Reddy, Mark C. Kendall, Antoun Nader, and Jessica J. Weeks. "Effect of Arm Positioning on Entrapment of Infraclavicular Nerve Block Catheter." Case Reports in Anesthesiology 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/7196340.

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Continuous brachial plexus nerve block catheters are commonly inserted for postoperative analgesia after upper extremity surgery. Modifications of the insertion technique have been described to improve the safety of placing an infraclavicular brachial plexus catheter. Rarely, these catheters may become damaged or entrapped, complicating their removal. We describe a case of infraclavicular brachial plexus catheter entrapment related to differences in arm positioning during catheter placement and removal. Written authorization to obtain, use, and disclose information and images was obtained from the patient.

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Ramirez, Chuck, Shannon Miranda, and Erica Sager. "Hemodialysis Catheter Insertion Without Chest X-Ray: Review of a 24-Month Study." Journal of the Association for Vascular Access 23, no. 4 (December 1, 2018): 216–20. http://dx.doi.org/10.1016/j.java.2018.10.001.

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Abstract Acute care hemodialysis catheters have traditionally been validated for use through chest X-ray interpretation. This study was implemented to evaluate if hemodialysis catheters can be placed safely and accurately, utilizing an electrocardiogram plus doppler or dual vector positioning system to validate for use. Over a 24-month period hemodialysis catheters were inserted and validated by utilizing a dual vector positioning system instead of chest X-ray. During the study period, 260 hemodialysis catheters were inserted without chest X-ray and validated for use via the dual vector positioning system. An additional 74 inserted catheters required follow-up chest X-rays because of failure to obtain technological validation. During the study period, no patients had a pneumothorax or hemothorax complication subsequent to catheter placement. The use of a dual vector positioning system in this study demonstrated optimal hemodialysis catheter insertion can be done with no X-ray and no increase in mechanical complications.

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Sampson, John H., Gary Archer, Christoph Pedain, Eva Wembacher-Schröder, Manfred Westphal, Sandeep Kunwar, Michael A. Vogelbaum, et al. "Poor drug distribution as a possible explanation for the results of the PRECISE trial." Journal of Neurosurgery 113, no. 2 (August 2010): 301–9. http://dx.doi.org/10.3171/2009.11.jns091052.

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Object Convection-enhanced delivery (CED) is a novel intracerebral drug delivery technique with considerable promise for delivering therapeutic agents throughout the CNS. Despite this promise, Phase III clinical trials employing CED have failed to meet clinical end points. Although this may be due to inactive agents or a failure to rigorously validate drug targets, the authors have previously demonstrated that catheter positioning plays a major role in drug distribution using this technique. The purpose of the present work was to retrospectively analyze the expected drug distribution based on catheter positioning data available from the CED arm of the PRECISE trial. Methods Data on catheter positioning from all patients randomized to the CED arm of the PRECISE trial were available for analyses. BrainLAB iPlan Flow software was used to estimate the expected drug distribution. Results Only 49.8% of catheters met all positioning criteria. Still, catheter positioning score (hazard ratio 0.93, p = 0.043) and the number of optimally positioned catheters (hazard ratio 0.72, p = 0.038) had a significant effect on progression-free survival. Estimated coverage of relevant target volumes was low, however, with only 20.1% of the 2-cm penumbra surrounding the resection cavity covered on average. Although tumor location and resection cavity volume had no effect on coverage volume, estimations of drug delivery to relevant target volumes did correlate well with catheter score (p < 0.003), and optimally positioned catheters had larger coverage volumes (p < 0.002). Only overall survival (p = 0.006) was higher for investigators considered experienced after adjusting for patient age and Karnofsky Performance Scale score. Conclusions The potential efficacy of drugs delivered by CED may be severely constrained by ineffective delivery in many patients. Routine use of software algorithms and alternative catheter designs and infusion parameters may improve the efficacy of drugs delivered by CED.

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Theodosopoulos, Philip V., Aviva Abosch, and Michael W. McDermott. "Intraoperative Fiber-Optic Endoscopy for Ventricular Catheter Insertion." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 28, no. 1 (February 2001): 56–60. http://dx.doi.org/10.1017/s0317167100052562.

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ABSTRACT:Objective:Ventricular catheter placement is a common neurosurgical procedure often resulting in inaccurate intraventricular positioning. We conducted a comparison of the accuracy of endoscopic and conventional ventricular catheter placement in adults.Methods:A retrospective analysis of data was performed on 37 consecutive patients undergoing ventriculo-peritoneal shunt (VPS) insertion with endoscopy and 40 randomly selected, unmatched patients undergoing VPS insertion without endoscopy, for the treatment of hydrocephalus of varied etiology. A grading system for catheter tip position was developed consisting of five intraventricular zones, V1-V5, and three intraparenchymal zones, A, B, C. Zones V1 for the frontal approaches and V1 or V2 for the occipital approaches were the optimal catheter tip locations. Postoperative scans of each patient were used to grade the accuracy of ventricular catheter placement.Results:Seventy-six percent of all endoscopic ventricular catheters were in zone V1 and 100% were within zones V1-V3. No endoscopically inserted catheters were observed in zones V4, V5 or intraparenchymally. Thirty-eight percent of the conventionally placed catheters were in zone V1, 53% in zones V1-3 and 15% intraparenchymally. There was a statistically significant difference in the percentage of catheters in optimal location versus in any other location, favoring endoscopic guidance (p<0.001).Conclusion:We conclude that endoscopic ventricular catheter placement provides improved positioning accuracy than conventional techniques.

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Pettorini, Benedetta L., Gianpiero Tamburrini, Luca Massimi, Massimo Caldarelli, and Concezio Di Rocco. "Endoscopic transventricular positioning of intracystic catheter for treatment of craniopharyngioma." Journal of Neurosurgery: Pediatrics 4, no. 3 (September 2009): 245–48. http://dx.doi.org/10.3171/2009.4.peds0978.

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The intracystic injection of chemo- and radiotherapeutic agents was introduced for the treatment of craniopharyngioma to control tumor growth and to delay the potentially harmful effects of surgery or radiation therapy. The positioning of cyst catheters has been performed by means of direct vision, stereotactically guided insertion, and ultrasonographic and ventriculoscopic guidance. The insertion of a catheter into the cyst is not devoid of complications, with an incidence ranging up to 16%, independent of the surgical technique used. Eight patients (mean age 25.8 years) with symptomatic cystic craniopharyngioma were treated by means of an endoscopic transventricular approach for the insertion of an intracystic catheter for intratumoral therapy with interferon-α. A single right precoronal bur hole is made, and the frontal horn of the lateral ventricle is accessed under neuronavigation guidance. A ventricular catheter with an inserted stylet was advanced anterior to the endoscope sheath through the same cortical access as the endoscope and was guided under endoscopic view down to the cyst dome wall. The coagulated surface of the craniopharyngioma cyst was punctured and the tip of the ventricular catheter was advanced; the depth was established preoperatively on MR scans and confirmed by neuronavigation guidance. The proximal end of the cystic catheter was connected to an access chamber to be left in the subcutaneous space, and the endoscope was slowly retracted. The authors' experience favors the use of neuroendoscopic positioning of intracystic catheters as safer than open and stereotactic approaches.

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MARCELLI, E., S. PIRANI, I. CORAZZA, and L. CERCENELLI. "ELECTROLOC: A SIMPLE, FAST AND ACCURATE SYSTEM FOR LOCALIZATION OF ENDOCARDIAL CATHETERS." Journal of Mechanics in Medicine and Biology 15, no. 04 (August 2015): 1550062. http://dx.doi.org/10.1142/s0219519415500621.

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Accurate positioning of endocardial catheters inside cardiovascular structures is crucial in electrophysiology (EP) procedures. Improvements in cardiac mapping are required for a better understanding and treatment of arrhythmias. The proposed Electroloc system is a simple, fast and accurate method for endocardial catheters localization. The key features of Electroloc are the use of conventional EP catheters and the simple data processing for providing localization. Electroloc is able to locate any conventional EP mapping catheter with respect to a noncontact EP catheter used as reference, by sequentially passing a sub-threshold current between the mapping electrode (ME) of the mapping catheter and each electrode of the reference catheter. This creates different potential gradients across the reference catheter used to compute two spatial coordinates (horizontal and vertical coordinates) intended for positioning the ME in the cardiac chamber. In vitro experiments demonstrated that Electroloc is a reliable and sensitive system for localizing the ME with a spatial resolution of 2 mm in the vertical localization and of 5 mm in the horizontal localization. Further studies will be required to improve Electroloc accuracy and to extend its sensitivity range.

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Bloemen, Arthur, Anne M. Daniels, Martine G. Samyn, Roel JL Janssen, and Jan-Willem Elshof. "Electrocardiographic-guided tip positioning technique for peripherally inserted central catheters in a Dutch teaching hospital: Feasibility and cost-effectiveness analysis in a prospective cohort study." Journal of Vascular Access 19, no. 6 (March 21, 2018): 578–84. http://dx.doi.org/10.1177/1129729818764051.

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Introduction: Peripherally inserted central catheters are venous devices intended for short to medium periods of intravenous treatment. Positioning of the catheter tip at the cavoatrial junction is necessary for optimum performance of a peripherally inserted central catheter. In this study, safety, effectiveness and cost-effectiveness of electrocardiographic-guided peripherally inserted central catheter positioning in a Dutch teaching hospital were evaluated. Methods: All patients who received a peripherally inserted central catheter in 2016 using electrocardiographic guidance were compared to those where fluoroscopy guidance was used in a prospective non-randomized cohort study. Relevant data were extracted from electronic health records. Cost-effectiveness analysis was performed. Results: A total of 162 patients received a peripherally inserted central catheter using fluoroscopy guidance and 103 patients using electrocardiographic guidance in 2016. No significant difference was found in malposition, infection or other complications between these groups. Due to personnel reduction and omission of fluoroscopy costs, cost reduction for each catheter insertion was €120 in the first year and, as a result of discounted acquisition costs, €190 in subsequent years. Discussion: The positioning results and complication rate are comparable to the previously reported literature. The cost reduction may vary in different hospitals. Other benefits of the electrocardiographic-guided technique are omission of X-ray exposure and improved patient service. Conclusion: Implementation of electrocardiographic-guided tip positioning for peripherally inserted central catheter was safe and effective in this study and led to an improved high value and cost-conscious care.

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Hugenholtz, Herman, Robert F. Nelson, and Eric Dehoux. "Intrathecal Baclofen – The Importance of Catheter Position." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 20, no. 2 (May 1993): 165–67. http://dx.doi.org/10.1017/s0317167100047776.

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ABSTRACT:In a patient receiving intrathecal baclofen injections for intractable trunk and leg spasms, positioning the subarachnoid catheter tip just caudal to the spinal segments innervating the spastic muscles enhanced the spasmolytic effect of bolus injections of intrathecal baclofen on the affected muscles. Such selective positioning of subarachnoid catheters may facilitate segmental spasmolysis with lower intrathecal doses of baclofen and provide an important alternative to relying only on ascending CSF concentration gradients of baclofen from chronic lumbar intrathecal infusion.

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Yıldızeli, Bedrettin, Tunç Laçin, Feyyaz Baltacıoğlu, Hasan F. Batırel, and Mustafa Yüksel. "Approach to Fragmented Central Venous Catheters." Vascular 13, no. 2 (March 1, 2005): 120–23. http://dx.doi.org/10.1258/rsmvasc.13.2.120.

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Prolonged venous access devices are needed in cancer patients for central venous access. Catheter fragmentation leading to catheter malfunction represents a rare problem. Herein we present our experience in the management of fragmented catheters. Between 2001 and 2003, 183 catheters were placed via the subclavian vein, and five cases of fragmented catheters were observed. Fragments were removed by an Amplatz gooseneck snare (Microvena, St. Paul, MN) with angiographic intervention. The diagnosis of the breakage was made by chest radiography. The incidence of catheter rupture was 2.7%. All fragments were removed by the snare, without any complications. Catheter narrowing and breakage owing to its medial positioning in the subclavian vein were the main causes of catheter malfunction. In any case of catheter malfunction, radiologic evaluation of the catheter must be done to rule out its rupture. Removal of the fragments using the Amplatz snare is a safe and easily applied procedure.

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Yazbek, Guilherme, Antonio Eduardo Zerati, Luiz Caetano Malavolta, Kenji Nishinari, and Nelson Wolosker. "Endovascular techniques for placement of long-term chemotherapy catheters." Revista do Hospital das Clínicas 58, no. 4 (2003): 215–18. http://dx.doi.org/10.1590/s0041-87812003000400005.

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PURPOSE: To analyze the results from using endovascular techniques to place long-term chemotherapy catheters when advancing the catheter using the external jugular vein is difficult due to obstructions or kinking. METHODS: Between July 1997 and August 2000, 320 long-term chemotherapy catheters were placed, and in 220 cases the external jugular vein was used as the primary venous approach. In 18 of these patients, correct positioning was not achieved and several endovascular techniques were then utilized to overcome these obstacles, including manipulation of a J-wire with a moveable core, venography, and the exchange wire technique. RESULTS: In 94.5% of the patients with difficulties in obtaining the correct positioning, we were able to advance the long-term catheter to the desired position with the assistance of endovascular techniques. CONCLUSIONS: Venography and endovascular guidance techniques are useful for the placement of long-term catheters in the external jugular vein.

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Nakamuta, Soshi, Toshihiro Nishizawa, Shiori Matsuhashi, Arata Shimizu, Toshio Uraoka, and Masato Yamamoto. "Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy." Journal of Vascular Access 19, no. 6 (March 21, 2018): 609–14. http://dx.doi.org/10.1177/1129729818765057.

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Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

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Limpabandhu, Chayabhan, Yihua Hu, Hongliang Ren, Wenzhan Song, and Zion Tse. "Towards catheter steering using magnetic tractor beam coupling." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 236, no. 4 (February 7, 2022): 583–91. http://dx.doi.org/10.1177/09544119221075400.

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Catheters are used in various clinical applications, and the ability to direct the catheter to the desired location is critical for clinical outcomes. Steerable catheters assist clinicians to access targeted areas, notably the vascular bundles and major vessels, while causing no damage to the surrounding tissue. A novel catheter actuation technology for catheter steering is presented in this study. The technique is simple and relies on three magnetic couples interacting with one another to generate steering motions. A proof-of-concept catheter prototype demonstrated the capacity to remotely steer a catheter over 100 mm of distance and ±45° of angular positioning, showing the potential manoeuvrability for clinical applications. It is feasible to steer a catheter using this three-magnet pair approach with the great potential to be used for catheterisation procedures. The presented mechanism’s kinematics and a near-form solution for catheter steering regardless of design factors will be studied in the future.

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Desai, A., M. Bennikal, G. Bangari, M. Janaky, and R. Manjunath. "Malpositioned dialysis catheters: A case series." Ukrainian Journal of Nephrology and Dialysis, no. 4(76) (August 28, 2022): 10–15. http://dx.doi.org/10.31450/ukrjnd.4(76).2022.02.

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Hemodialysis catheters (HDC) are the commonly used vascular access for hemodialysis. Functioning access is essential for adequate dialysis. Dialysis catheter insertion under ultrasound guidance is now standard practice and has reduced the incidence of mechanical complications during catheter insertion. However, complications such as tip misplacement and puncture of the mediastinum cannot be prevented by ultrasound-guided procedures alone. We report four cases of abnormal positioning of HDC insertion and emphasize the importance of fluoroscopy or radiography after the procedure to verify the position of the catheter

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Slutsky, A. S., and A. S. Menon. "Catheter position and blood gases during constant-flow ventilation." Journal of Applied Physiology 62, no. 2 (February 1, 1987): 513–19. http://dx.doi.org/10.1152/jappl.1987.62.2.513.

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We studied the effect of catheter position and flow rate on gas exchange during constant-flow ventilation (CFV) in eight anesthetized, paralyzed dogs. The distal tips of the insufflation catheters were positioned 0.5, 2.0, 3.5, and 5.0 cm from the tracheal carina. Flow rates were varied between 10 and 55 l/min and steady-state arterial blood gases were measured. At a given flow rate, arterial CO2 pressure (PaCO2) decreased as CFV was administered further into the lung up to a distance of 3.5 cm from the carina; there were no significant differences in PaCO2 at 3.5 and 5.0 cm. For a given catheter position, PaCO2 decreased with increasing flow rate up to a flow rate of 40 l/min. Further increases in flow rate had no significant effect on PaCO2. Arterial O2 pressure (PaO2) was relatively constant at all flow rates and catheter positions. We conclude that, up to a point, CO2 elimination can be improved by positioning the catheters further into the lung; advancing the catheters further than 3.5 cm from the carina may cause over-ventilation of specific lung regions resulting in a relative plateau in CO2 elimination and relatively constant PaO2's. Positioning the catheters further into the lung permits the use of lower flow rates, thus potentially minimizing the risk of barotrauma.

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Xie, Pan, Kanfu Peng, Keqin Zhang, Hongwen Zhao, Yuxiu Sheng, Min Tao, Qian Yuan, and Claudio Ronco. "Anatomy Revisited: Hemodialysis Catheter Malposition into the Chest." Blood Purification 47, no. 1-3 (September 17, 2018): 58–61. http://dx.doi.org/10.1159/000493177.

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In most situations, central catheters are implanted in the right jugular vein as initial access for hemodialysis. However, after repeated punctures, the proximal vessels become stenosed and thrombosed and misplacement is likely to occur. Correct catheter position in the vein can be easily ascertained with X-ray or cross-sectional CT imaging. In this report, we describe the case of a 77-year-old patient on chronic hemodialysis via catheter due to arteriovenous fistula dysfunction. We placed a cuffed-tunneled hemodialysis catheter in the left internal jugular vein. Malpositioning of the catheter led to perforation of the great veins and migration of the catheter tip into the chest. It is important to be aware of the risk of potential incorrect positioning of dialysis catheters. Due to the stenosis and fragility of the vessel wall, perforation may occur. In cases of doubt, correct placement of large-bore catheters via the internal jugular vein should be verified by means of appropriate imaging before hemodialysis is performed.

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Lin, Chuan-Min, Yi-Ming Wu, Chien-Hung Chang, Ching-Chang Chen, and Alvin Yi-Chou Wang. "The ANTRACK Technique: Employing a Compliant Balloon or Stent Retriever to Advance a Large-Bore Catheter to an Occlusion During Thrombectomy Procedures in Acute Stroke Patients." Operative Neurosurgery 16, no. 6 (December 10, 2018): 692–99. http://dx.doi.org/10.1093/ons/opy202.

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Abstract BACKGROUND Stent retrievers and thrombosuction catheters have become the cornerstones of acute stroke therapy. A large-lumen catheter facilitates the passage of different instruments and the application of greater suction force to clots. However, positioning a flexible thrombosuction or intermediate catheter within a tortuous artery is difficult and time-consuming. OBJECTIVE To evaluate the efficacy and safety of the ANchor TRACKing (ANTRACK) technique in achieving distal positioning of a large-lumen catheter in a tortuous cranial artery. We summarize our experience using either a compliant balloon catheter or a stent retriever as an anchor in the distal vessels to facilitate the navigation of a large-lumen catheter into the distal circulation. METHODS Consecutive patients who underwent thrombectomy using the ANTRACK technique were identified. Patient characteristics, procedure details, and outcomes were reviewed from our database. The efficacy and safety of advancing thrombosuction or intermediate catheters to the site of an occlusion were the primary outcome measures. Secondary outcomes included the recanalization result. RESULTS Thirty-nine patients who underwent thrombectomy using the ANTRACK technique were identified; a compliant balloon was used in 32 patients and a stent-retriever was used in 7 patients. The primary outcomes were achieved in all patients. No adverse event was observed. The secondary outcome of recanalization of an occluded artery was achieved in 34 patients (87.2%). CONCLUSION The ANTRACK technique using either a compliant balloon catheter or a stent-retriever is an effective and safe way of passing a large-bore catheter through a tortuous carotid siphon, particularly in cases with atheromatous plaque or ulceration.

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Kim, Dong Hun. "Bedside peripherally inserted central catheter placement: focus on the procedure." Trauma Image and Procedure 7, no. 1 (June 30, 2022): 21–26. http://dx.doi.org/10.24184/tip.2022.7.1.21.

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A peripherally inserted central catheter (PICC) provides long-term central venous access through a peripheral vein in an upper extremity. A trained physician should insert a PICC, but any trained medical professional, such as a specially trained nurse, can perform an insertion. Appropriate PICC placement reduces complications, such as malposition and malfunction of the catheter, venous thrombosis, and infections, and overall catheter performance is better. Complications depend mainly on the adequacy of venous puncture or the positioning of the catheter tip. Better PICC performance depends on learning accurate techniques for insertion. Here, the overall procedure for bedside ultrasonography-guided PICC placement, including patient positioning, catheter preparation, venous assessment and measurement, overall technique, and catheter tip positioning, is described.

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Lovisari, Federica, Martina Favarato, Ilaria Giovannini, Riccardo Giudici, and Roberto Fumagalli. "Procedure of a peridural catheter positioning." ASVIDE 7 (January 2020): 42. http://dx.doi.org/10.21037/asvide.2020.042.

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Schellekens, Willem-Jan M., and Leo M. A. Heunks. "Appropriate positioning of the NAVA catheter." Intensive Care Medicine 42, no. 4 (February 5, 2016): 633–34. http://dx.doi.org/10.1007/s00134-016-4213-y.

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Metellus, Philippe, Wesley Hsu, Siddharth Kharkar, Sumit Kapoor, William Scott, and Daniele Rigamonti. "Accuracy of percutaneous placement of a ventriculoatrial shunt under ultrasonography guidance: a retrospective study at a single institution." Journal of Neurosurgery 110, no. 5 (May 2009): 867–70. http://dx.doi.org/10.3171/2008.10.17674.

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The authors report their experience using preoperative chest radiography and intraoperative ultrasonography for percutaneous positioning of the distal end of the catheter when placing ventriculoatrial (VA) shunts in patients with hydrocephalus. The distal portion of VA shunt catheters were percutaneously placed into the internal jugular vein with the aid of intraoperative ultrasonography in 14 consecutive adults. In all cases, the technique was easy, there were no postoperative complications, and postoperative chest radiography demonstrated good positioning of the distal catheter tip. One patient presented with a shunt infection and needed a shunt replacement. The authors therefore conclude that percutaneous placement of a VA shunt under preoperative radiographic guidance and ultrasonographic monitoring is a safe, effective, and reliable technique that is simple to learn.

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Kowalski, Christopher M., John A. Kaufman, S. Mitchell Rivitz, Stuart C. Geller, and Arthur C. Waltman. "Migration of Central Venous Catheters: Implications for Initial Catheter Tip Positioning." Journal of Vascular and Interventional Radiology 8, no. 3 (May 1997): 443–47. http://dx.doi.org/10.1016/s1051-0443(97)70586-4.

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Rossi, Luigi, Pasquale Libutti, Francesco Casucci, Piero Lisi, Annalisa Teutonico, Carlo Basile, and Carlo Lomonte. "Is the removal of a central venous catheter always necessary in the context of catheter-related right atrial thrombosis?" Journal of Vascular Access 20, no. 1 (May 11, 2018): 98–101. http://dx.doi.org/10.1177/1129729818774438.

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Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available. This complication seems to be closely associated with positioning of the catheter tip in the atrium, whereas it is unlikely with a tip located within superior vena cava. Herein, we report the case of a patient affected by catheter-related right atrial thrombosis, who showed a quick resolution of thrombosis with a new therapeutic scheme combining loco-regional thrombolytic therapy (urokinase as a locking solution) and systemic anticoagulation therapy (vitamin K antagonists), thus avoiding catheter removal. Neither complications of the combination therapy were reported, nor recurrence of catheter-related right atrial thrombosis occurred. In conclusion, the combination therapy here described was safe, quick and effective, achieving the goal of not removing the catheter.

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Jiao, Yuting, Yumei Wu, and Zhi Yang. "Application Value of Bedside Ultrasound in the Positioning of PICC Tips in Preterm Infants." E3S Web of Conferences 271 (2021): 04038. http://dx.doi.org/10.1051/e3sconf/202127104038.

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Objective To investigate the application value of bedside ultrasound in the localization of the tip of a Peripherally Inserted Central Catheter (PICC) in preterm infants. Methods 52 preterm infants underwent bedside ultrasound and bedside X-ray examination. Observing the position of the catheter tip, and using the bedside X-ray positioning as the gold standard. Statistics of the incidence of PICC tip normal position and ectopic position showed by bedside ultrasound, and comparing the difference between the results of bedside ultrasound and bedside X-ray. Calculating the accuracy, sensitivity, and specificity of ultrasound in diagnosing the tip position, and the length of the inlet and withdrawal tubes of the ectopic catheter was observed and calculated by ultrasound and down-regulated to the appropriate position under ultrasound guidance. Results The display rate of catheter tip by bedside color Doppler ultrasound was 98.0%, and the accuracy rate of tip position was 90.2%. There was no significant difference compared with bedside X-ray (P = 0.375), and the tip position of the two examination methods was highly consistent (Kappa = 0.769, P<0.001). The sensitivity of diagnosing tip ectopy was 76.5% and the specificity was 97.1%, and the success rate of ectopic catheters in ultrasound-guided downsetting was 100%. Conclusion Bedside ultrasound accurately show the position of the catheter tip and guide the entry and withdrawal of ectopic catheter, with high sensitivity and specificity, which has high value of clinical promotion.

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Payne, Drew. "Catheters at home: managing urinary catheters in the home environment." British Journal of Community Nursing 26, no. 8 (August 2, 2021): 370–76. http://dx.doi.org/10.12968/bjcn.2021.26.8.370.

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In England, there are some 90000 people with catheters in the community, and community nurses often have to manage catheter-related problems. This article looks at these common catheter problems found in the community, for example, blockage, infections and positioning problems. These problems were identified by a literature review and from the author's experience, from many years working in the community. It has been found that education, knowledge, empowerment and communication are vital factors affecting patients' ability to manager their catheters themselves. The article begins with a discussion about how patients can be involved in and manage many aspects of care for their own catheters. It goes on to talk about the common catheter-associated problems and how these can be avoided or addressed. It is hoped that better management of catheter-associated complications in the community settings can prevent unnecessary visits to the emergency department, which will save time and costs for the health service, as well as avoid the negative impact of these on patient lives.

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Balzer, Jan, Tobias Zeus, Verena Veulemans, and Malte Kelm. "Hybrid Imaging in the Catheter Laboratory: Real-time Fusion of Echocardiography and Fluoroscopy During Percutaneous Structural Heart Disease Interventions." Interventional Cardiology Review 11, no. 1 (2016): 59. http://dx.doi.org/10.15420/icr.2016.11.01.59.

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Percutaneous catheter-based techniques for the treatment of structural heart disease are becoming more complex, and current imaging techniques have limitations: while fluoroscopy gives poor visualisation of cardiac anatomical structures, echocardiography is limited in its ability to detect the position of catheters and devices. The EchoNavigator® (Philips) live image guidance tool is a novel system that integrates real-time echocardiography with fluoroscopic X-ray imaging, optimising the guidance and positioning of devices. Use of the EchoNavigator system facilitates improved understanding of anatomical structures while showing enhanced visualisation of catheter and device movements. Early clinical experience suggests that the technology is feasible and safe, and provides enhanced understanding of the relationship between soft tissue anatomy and catheter devices in structural heart disease. The use of the EchoNavigator system can improve the confidence of interventional cardiologists in the targeting and positioning of devices in percutaneous interventions in structural heart disease, and has the potential to reduce procedural time, reduce the dosage of contrast and radiation and increase safety in the performance of procedural steps.

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Balzer, Jan, Tobias Zeus, Verena Veulemans, and Malte Kelm. "Hybrid Imaging in the Catheter Laboratory: Real-time Fusion of Echocardiography and Fluoroscopy During Percutaneous Structural Heart Disease Interventions." Interventional Cardiology Review 11, no. 1 (2016): 59. http://dx.doi.org/10.15420/icr.2016.11.1.59.

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Percutaneous catheter-based techniques for the treatment of structural heart disease are becoming more complex, and current imaging techniques have limitations: while fluoroscopy gives poor visualisation of cardiac anatomical structures, echocardiography is limited in its ability to detect the position of catheters and devices. The EchoNavigator® (Philips) live image guidance tool is a novel system that integrates real-time echocardiography with fluoroscopic X-ray imaging, optimising the guidance and positioning of devices. Use of the EchoNavigator system facilitates improved understanding of anatomical structures while showing enhanced visualisation of catheter and device movements. Early clinical experience suggests that the technology is feasible and safe, and provides enhanced understanding of the relationship between soft tissue anatomy and catheter devices in structural heart disease. The use of the EchoNavigator system can improve the confidence of interventional cardiologists in the targeting and positioning of devices in percutaneous interventions in structural heart disease, and has the potential to reduce procedural time, reduce the dosage of contrast and radiation and increase safety in the performance of procedural steps.

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Magnani, Caterina, Alice Calvieri, Diana Giannarelli, Margot Espino, and Giuseppe Casale. "Peripherally inserted central catheter, midline, and “short” midline in palliative care: Patient-reported outcome measures to assess impact on quality of care." Journal of Vascular Access 20, no. 5 (December 3, 2018): 475–81. http://dx.doi.org/10.1177/1129729818814732.

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Objectives: A prospective, observational study was conducted in our palliative care unit to assess the impact of peripherally inserted central catheters (PICCs), midline, and “short” midline catheters on the quality of care in cancer and non-cancer patients. The secondary objective was to assess pain and distress during vascular access device insertion. Methods: Patients were recruited if they underwent insertion of a PICC, midline, or “short” midline catheter as part of their standard care. The Palliative care Outcome Scale was used to assess changes in quality of care after vascular access device positioning. A numerical rating scale was used to measure pain intensity during catheter insertion. Results: Of the 90 patients enrolled, 52.2% were male with a mean age of 73.0 ± 13 years. Among these patients, 64.4% patients underwent “short” midline insertion, 26.7% PICC, and 8.9% midline catheter. The patients’ mean baseline Palliative care Outcome Scale score was 15.7 ± 5.6. Three days after vascular access device positioning, the patients’ mean Palliative care Outcome Scale score was 11.5 ± 5.5 (p < 0.0001). Mean pain score during vascular access device insertion was 1.26 ± 1.63, and mean procedural distress score was 1.78 ± 1.93. Conclusion: These findings suggest that medium-term intravenous catheters can have a favorable impact on quality of care and the procedures for these vascular access device insertions are well tolerated. Further research on the performance of different vascular access devices and their appropriateness in palliative care should be encouraged.

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Szewczyk, Jérôme, Emilie Marchandise, Patrice Flaud, Laurent Royon, and Raphaël Blanc. "Active Catheters for Neuroradiology." Journal of Robotics and Mechatronics 23, no. 1 (February 20, 2011): 105–15. http://dx.doi.org/10.20965/jrm.2011.p0105.

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Surgeons performing endovascular interventions have high expectations with regard to the improvement of their operating tools and, more specifically, of their catheters. Active catheters, in which the tip moves actively using Shape Memory Alloy (SMA) actuators, constitute a promising approach. In this article, we review existing SMA-based active catheters present in the literature. We analyze their performances regarding the requirements imparted to neuroradiology. Then, we propose a new analytical model for predicting the thermo-mechanical behavior of steerable catheters actuated through SMA wires. Particularly, we give an expression for the maximal achievable bending angle of the catheter tip. These results are finally applied to the design of single-use small-diameter active catheters especially devoted to neuroradiology. In particular, we present a 3.3-Fr catheter suited for navigating into the Willis’ polygon and for accurate positioning into aneurysmal cavities.

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Pecorari, M. "Femoral Positioning of Tesio Catheters for Hemodialysis." Journal of Vascular Access 1, no. 2 (April 2000): 60–65. http://dx.doi.org/10.1177/112972980000100206.

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Vascular access may be of crucial importance in long-term dialyzed patients when traditional blood access fails. Long-term central vascular access devices are usually inserted in the internal jugular or subclavian veins but thrombosis may be the major factor limiting their long-term use. To solve this problem the Tesio caheter is one of the most commonly recommended tools for long-term use in RD patients, and is normally placed in the neck veins. In this study the femoral vein is indicated as an alternative site for positioning the Tesio catheter. The “high” exit (abdominal) reported here presents some advantages for the patient who can then walk without difficulties while maintaining a high blood flow that is similar to those achieved with catheters implanted in other sites.

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Abadi, S., O. R. Brook, E. Solomonov, and D. Fischer. "Misleading positioning of a Foley catheter balloon." British Journal of Radiology 79, no. 938 (February 2006): 175–76. http://dx.doi.org/10.1259/bjr/13576050.

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TATAR, H., S. RICEK, U. DEMIRKILIC, H. SUER, M. ASLAN, and O. OZTURK. "Exact positioning of intra-aortic balloon catheter." European Journal of Cardio-Thoracic Surgery 7, no. 1 (1993): 52–53. http://dx.doi.org/10.1016/1010-7940(93)90150-a.

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Kanter, Gary, and Neil Roy Connelly. "Unusual positioning of a central venous catheter." Journal of Clinical Anesthesia 17, no. 4 (June 2005): 293–95. http://dx.doi.org/10.1016/j.jclinane.2004.06.014.

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Liu, Guang, Wenbo Hou, Chao Zhou, Yuxia Yin, Shoutao Lu, Cuihai Duan, Maoquan Li, Egon Steen Toft, and Haijun Zhang. "Meta-analysis of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement." Journal of Vascular Access 20, no. 6 (March 6, 2019): 577–82. http://dx.doi.org/10.1177/1129729819826028.

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Background:Recently, intracavitary electrocardiogram technology has been applied to peripherally inserted central catheter placement and demonstrates many potential advantages. However, the tip positioning accuracy of intracavitary electrocardiogram technology compared to conventional X-ray method is unknown.Objective:We did a meta-analysis to compare the tip positioning accuracy between intracavitary electrocardiogram technology and conventional X-ray method.Data sources:We searched several databases, including Cochrane Library, PubMed, Web of science, and Embase. Additional studies were identified through hand searches of bibliographies and Internet searches. All human studies published in full text, abstract, or poster form were eligible for inclusion. Search terms included peripherally inserted central catheter, PICC, intracavitary electrocardiogram, IC-ECG, EKG, ECG, and catheter tip location.Study eligibility criteria:Only randomized controlled trials of using intracavitary electrocardiogram technology versus X-ray method for peripherally inserted central catheter placement were included. All studies included adult patients aged at least 18 years.Study appraisal and synthesis methods:Independent extraction of articles by two authors using predefined data fields, including study quality indicators. Of the 178 citations identified, 5 studies that included 1672 patients met the eligibility criteria. It was found that statistical heterogeneity existed among the various studies (I2 = 16%, p < 0.00001); therefore, the fixed effect model was used in the meta-analysis (p < 0.05). The meta-analysis compared the tip positioning accuracy between intracavitary electrocardiogram technology and X-ray method and showed that intracavitary electrocardiogram technology had a better positioning accuracy (odds ratio: 2.88, 95% confidence interval: 2.15–3.87, p < 0.0001).Limitations:Only five randomized trial met inclusion criteria, and the lack of an incomplete search led to the publication bias seen in these results.Conclusion:The intracavitary electrocardiogram method had a more favorable positioning accuracy versus traditional X-ray method for peripherally inserted central catheter placement in adult patients. The intracavitary electrocardiogram can be a promising technique to guide tip positioning of peripherally inserted central catheter.

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Pang, Dachling, and Paul A. Grabb. "Accurate placement of coronal ventricular catheter using stereotactic coordinate-guided free-hand passage." Journal of Neurosurgery 80, no. 4 (April 1994): 750–55. http://dx.doi.org/10.3171/jns.1994.80.4.0750.

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✓ Long-term patency of the ventricular catheter of a cerebrospinal fluid shunt depends on the positioning of the hole-bearing segment of the catheter. Placement of this segment near the choroid plexus or injured ependyma increases the probability of obstruction. Proper positioning for a coronal shunt in turn depends on the ventricular catheter length and target coordinates. The authors describe a method of calculating the catheter length based on bone landmarks on skull radiographs, and a technique for accurate ventricular catheter placement using free-hand passage guided by simple stereotactic coordinates based on visible and palpable surface anatomy. The insertion trajectory is aligned with the coronal obliquity of the lateral ventricle so that, even with slit ventricles, the entire hole-bearing segment of the catheter can be reliably situated within the anterior horn. The predetermined catheter length also fixes the tip at the foramen of Monro, away from the choroid plexus and injured ependyma. Of 160 children undergoing ventriculoperitoneal shunt insertion using this technique, only three required catheter revision during a mean follow-up period of 39 months. Radiographic grading of the ventricular catheter position in 112 children showed a satisfactory placement rate of 93.2%; all three children with occlusion showed poor catheter positioning. Thus, this method results in accurate ventricular catheter placement with a 1.9% obstruction rate, which compares favorably to the 16% to 18% incidence of proximal obstruction reported in the literature. This technique is applicable to patients of all ages but is particularly suitable for children because of the greater variability in head size.

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Knezevic, Violeta, Tatjana Djurdjevic-Mirkovic, Dusan Bozic, Gordana Strazmester-Majstorovic, Igor Mitic, and Ljiljana Gvozdenovic. "Risk factors for catheter-related infections in patients on hemodialysis." Vojnosanitetski pregled 75, no. 2 (2018): 159–66. http://dx.doi.org/10.2298/vsp160205332k.

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Background/Aim. Catheter-related infections are a significant morbidity and mortality cause in patients on hemodialysis. The objective of this study was to determine the incidence, to analyze risk factors and to identify etiological causes of catheter-related infections in these patients. Methods. The study was carried out at the Clinic for Nephrology and Clinical Immunology of the Clinical Centre of Vojvodina, from August, 2012 to May, 2015. One hundred and thirteen patients on chronic hemodialysis participated in the study. The risk factors of catheterrelated infections in the infected patients were to those in the control group, as follows: demographic and laboratory parameters, co-morbidities and the use of immunosuppressive therapy, the length of hemodialysis treatment, urgent catheter placement, the position and placement difficulties, the number of insertions and catheter maneuvering, the existence of permanent vascular access in maturation or without a vascular access in the course of catheter positioning, catheter life, surgical procedures (? 30 days from catheter placing), the length of hospitalization and isolated infection causes. Results. One hundred and ninety-seven catheters were placed in 113 patients, among which 182 of them temporary. The total number of catheter days was 17.842, the incidence of infections was 3.53/1,000 catheter days. During the monitoring period, 63 catheter-related infections were diagnosed, 54 (85.7%) with temporary and 9 (14.3%) with permanent catheters. Multivariate logistic regression analysis (with border values/ levels determined by receiver operating characteristic ? ROC analysis) determined independent predictors of catheter-related infections in the following order: hemoglobin levels < 95 g/l (p < 0.001) and albumin levels < 33 g/l (p = 0.041), catheter duration of > 90 days (p = 0.004), > 2/day catheter maneuvering (p = 0.011) and the duration of hospitalization of > 15 days (p = 0.003). The main pathogen was Staphylococcus spp. Coagulase negative. Conclusion. Intensifying of prevention measures and infection control would significantly reduce the frequency of catheter-related infections and the number of hospitalizations. The timely creation of a native arteriovenous fistula would decrease the use of hemodialysis catheters.

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Chew, Sou Chen, Zhi Yuen Beh, Vineya Rai Hakumat Rai, Mohamad Fadhil Jamaluddin, Ching Choe Ng, Karuthan Chinna, and M. Shahnaz Hasan. "Ultrasound-guided central venous vascular access—novel needle navigation technology compared with conventional method: A randomized study." Journal of Vascular Access 21, no. 1 (May 31, 2019): 26–32. http://dx.doi.org/10.1177/1129729819852057.

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Purpose: Central venous catheter insertion is a common procedure in the intensive care setting. However, complications persist despite real-time ultrasound guidance. Recent innovation in needle navigation technology using guided positioning system enables the clinician to visualize the needle’s real-time position and trajectory as it approaches the target. We hypothesized that the guided positioning system would improve performance time in central venous catheter insertion. Methods: A prospective randomized study was conducted in a single-center adult intensive care unit. In total, 100 patients were randomized into two groups. These patients underwent internal jugular vein central venous catheter cannulation with ultrasound guidance (short-axis scan, out-of-plane needling approach) in which one group adopted conventional method, while the other group was aided with the guided positioning system. Outcomes were measured by procedural efficacy (success rate, number of attempts, time to successful cannulation), complications, level of operators’ experience, and their satisfaction. Results: All patients had successful cannulation on the first attempt except for one case in the conventional group. The median performance time for the guided positioning system method was longer (25.5 vs 15.5 s; p = 0.01). And 86% of the operators had more than 3-year experience in anesthesia. One post-insertion hematoma occurred in the conventional group. Only 88% of the operators using the guided positioning system method were satisfied compared to 100% in the conventional group. Conclusion: Ultrasound-guided central venous catheter insertion via internal jugular vein was a safe procedure in both conventional and guided positioning system methods. The guided positioning system did not confer additional benefit but was associated with slower performance time and lower satisfaction level among the experienced operators.

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Bernasconi, Filippo, Clelia Zanaboni, Andrea Dato, Andrea Dolcino, Michela Bevilacqua, Luigi Montagnini, and Nicola Disma. "Atypical use of PICC in Infants and Small Children: A Unicentric Experience." Journal of Vascular Access 18, no. 6 (July 29, 2017): 535–39. http://dx.doi.org/10.5301/jva.5000773.

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Introduction The peripherally inserted central catheters (PICCs) are vascular access devices (VAD) that are increasingly being used in the pediatric population. If a small vein caliber prevents positioning the catheter in the arm, the following step is to position the same catheter in the supraclavicular area, which can be defined as an off-label use or “atypical” approach, first described by Pittiruti. Materials and methods We retrospectively reviewed PICC positioning with puncture-site in the supra-clavicular area (“atypical” PICC insertion) and then tunneled on the chest. Results Nineteen atypical PICCs were positioned in 18 patients. The median age of patients at the day of implant was 14 months (IQR 3-27 months), and weight 7.5 kg (IQR 4-12 kg). Within this population, 74% of cases scheduled for a typical PICC insertion presented vein caliber too small for this procedure. For this reason, the typical PICC insertion was changed in favor of an atypical PICC procedure. Atypical PICCs were successfully used in 100% of cases without immediate complications. Conclusions Atypical PICC positioning is a safe and useful alternative to the conventional technique when there is need for a central vascular access device (CVAD) for mid- or long-term therapy.

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Gallieni, M., P. A. Conz, E. Rizzioli, A. Butti, and D. Brancaccio. "Placement, Performance and Complications of the Ash Split Cath™ Hemodialysis Catheter." International Journal of Artificial Organs 25, no. 12 (December 2002): 1137–43. http://dx.doi.org/10.1177/039139880202501204.

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A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath™, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron® cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 ± 20 ml/min at 1 week after insertion, 306 ± 17 ml/min at 3 months, 299 ± 44 ml/min at 6 months, and 308 ± 16 ml/min at 12 months. With a mean dialysis session duration of 234 ± 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71%±8 or a mean urea kinetic modeling, or Kt/V, value of 1.51±0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement.

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Büttner, Stefan, Sammy Patyna, Sarah Rudolf, Despina Avaniadi, Moritz Kaup, Helmut Geiger, and Christoph Betz. "Anatomy Revisited: Hemodialysis Catheter Malposition in the Left Ascending Lumbar Vein." Blood Purification 44, no. 3 (2017): 206–9. http://dx.doi.org/10.1159/000477755.

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In selected cases, cuffed tunneled catheters via the iliac vein are implanted as a last resort access for hemodialysis. To monitor the correct position, sonography of the inferior vena cava (IVC) is sufficient in most cases. Position control using an X-ray of the abdomen is not routinely recommended when femoral catheters are implanted. In this report, we describe the case of a 59-year-old patient on chronic hemodialysis due to granulomatosis with polyangiitis and complex shunt history with multiple shunt occlusions and revisions. The implantation of an iliac-cuffed tunneled catheter led to complications because the catheter was malpositioned into the left ascending lumbar vein (ALV). It is important to be aware of potential incorrect positioning of dialysis catheters into the ALV. Due to the anatomical relation to the IVC, this happens more frequently on the left side than on the right side. In case of doubt, the correct placement of large-bore catheters via iliac access route should be verified by means of appropriate imaging before hemodialysis is performed.

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Weber, Mark D., Adam S. Himebauch, and Thomas Conlon. "Repositioning of malpositioned peripherally inserted central catheter lines with the use of intracavitary electrocardiogram: A pediatric case series." Journal of Vascular Access 21, no. 2 (July 31, 2019): 259–64. http://dx.doi.org/10.1177/1129729819865812.

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Introduction: Peripherally inserted central catheter tip migration is an infrequent event that occurs in neonatal, pediatric, and adult patients. We discuss a novel technique of utilizing intracavitary electrocardiogram to help confirm proper peripherally inserted central catheter tip repositioning, thereby reducing the need for serial radiographs. Case presentation: A case series of four patients will be discussed. The first three patients had peripherally inserted central catheter tips that were initially appropriately positioned but had later peripherally inserted central catheter tip migration. The use of intracavitary electrocardiogram was able to confirm the appropriate repositioning of the peripherally inserted central catheters without the need for serial radiographs. The fourth patient had several central lines in place, which led to difficulty in identifying the peripherally inserted central catheter tip location. The use of intracavitary electrocardiogram confirmed proper positioning of his peripherally inserted central catheter tip when standard radiographs could not provide clarity. Discussion: Several techniques have been published on methods to reposition a migrated peripherally inserted central catheter tip back to the superior vena cava/right atrial junction. These repositioning techniques often require fluoroscopic guidance or a confirmatory radiograph to assess the appropriate peripherally inserted central catheter tip location. At times, several radiographs may be required before the tip is successfully repositioned. This novel application of intracavitary electrocardiogram can help to minimize radiographs when peripherally inserted central catheter tip repositioning is required.

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Steinhagen, Folkert, Maximilian Kanthak, Guido Kukuk, Christian Bode, Andreas Hoeft, Stefan Weber, and Se-Chan Kim. "Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation." Journal of Vascular Access 19, no. 6 (March 7, 2018): 528–34. http://dx.doi.org/10.1177/1129729818757976.

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Introduction: A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. Methods: An observational prospective case–control cohort study was set up to study the feasibility and accuracy of the electrocardiography-controlled central venous catheter tip placement in 13 patients with atrial fibrillation versus 10 patients with sinus rhythm scheduled for elective surgery. Each intervention was crosschecked with ultrasound-guided positioning via right supraclavicular fossa view and chest radiography. Ultrasound-guided supraclavicular venipuncture of the right subclavian vein and guidewire advancement were performed. A B-mode view of the superior vena cava and the right pulmonary artery was obtained to visualize the J-tip of the guidewire. The central venous catheter was advanced over the guidewire and the electrocardiography was derived from the J-tip of the guidewire protruding from the central venous catheter tip. Electrocardiography was read for increased p- and atrial fibrillation waves, respectively, and insertion depth was compared with the ultrasound method. Results: Electrocardiography indicated significantly increasing fibrillation and p-waves, respectively, in all patients and ultrasound-guided central venous catheter positioning confirmed a tip position within the lower third of the superior vena cava. Conclusion: Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure.

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Skandalos, I., A. Hatzibaloglou, I. Evagelou, T. Ntitsias, A. Samaras, G. Visvardis, K. Mavromatidis, and K. Karamoshos. "Deviations of Placement / Function of Permanent Central Vein Catheters for Hemodialysis." International Journal of Artificial Organs 28, no. 6 (June 2005): 583–90. http://dx.doi.org/10.1177/039139880502800607.

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Fourteen cases of malposition of a permanent central vein catheter for hemodialysis or poor blood flow associated with thrombosed central veins but correct catheter positioning, in 13 patients suffering from end stage renal disease, presented from September 1991 to December 2003 among 385 permanent central vein catheters for hemodialysis (3.6%). There were 8 episodes of catheter tip malplacement in the azygos vein (1 case), hemiazygos vein (1), left internal thoracic (mammalian) vein (1), contralateral innominate vein (5) and 6 cases with correct anatomical catheter tip placement but with blood inflow from the catheter through the collateral vein system because of thrombosis of a major vein trunk (hemiazygos vein system (2), azygos vein (2), ascending lumbar veins (1), or portal vein system (1)). The malposition was diagnosed using roentgenography, with or without contrast, and computer tomography. In 3 cases the catheter was removed, in 5 cases the position was corrected. In the remaining 6 cases its function was maintained using anticoagulation or/and thrombolytic therapy. In conclusion, the placement of a permanent central vein catheter for hemodialysis must be followed by simple or contrast medium x-ray evaluation of its correct position or function. The malposition must be corrected whereas in the case where there is no alternative solution the function of the catheter may be maintained in the incorrect position using a combination of anticoagulation or/and thrombolytic therapy.

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Kim, Sun Key, Jung Hwan Ahn, Yoon Kyung Lee, Bo Young Hwang, Min Kyung Lee, and Il Seok Kim. "Accuracy of Catheter Positioning during Left Subclavian Venous Access: A Randomized Comparison between Radiological and Topographical Landmarks." Journal of Clinical Medicine 11, no. 13 (June 27, 2022): 3692. http://dx.doi.org/10.3390/jcm11133692.

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Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.

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Giese, Henrik, Karl-Titus Hoffmann, Andreas Winkelmann, Florian Stockhammer, George I. Jallo, and Ulrich-W. Thomale. "Precision of navigated stereotactic probe implantation into the brainstem." Journal of Neurosurgery: Pediatrics 5, no. 4 (April 2010): 350–59. http://dx.doi.org/10.3171/2009.10.peds09292.

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Object The indications for stereotactic biopsies or implantation of probes for local chemotherapy in diffuse brainstem tumors have recently come under debate. The quality of performing these procedures significantly depends on the precision of the probes' placement in the brainstem. The authors evaluated the precision of brainstem probe positioning using a navigated frameless stereotactic system in an experimental setting. Methods Using the VarioGuide stereotactic system, 33 probes were placed into a specially designed model filled with agarose. In a second experimental series, 8 anatomical specimens were implanted with a total of 32 catheters into the pontine brainstem using either a suboccipital or a precoronal entry point. Before intervention in both experimental settings, a thin-sliced CT scan for planning was obtained and fused to volumetric T1-weighted MR imaging data. After the probe positioning procedures, another CT scan and an MR image were obtained to compare the course of the catheters versus the planned trajectory. The deviation between the planned and the actual locations was measured to evaluate the precision of the navigated intervention. Results Using the VarioGuide system, mean total target deviations of 2.8 ± 1.2 mm on CT scanning and 3.1 ± 1.2 mm on MR imaging were detected with a mean catheter length of 151 ± 6.1 mm in the agarose model. The catheter placement in the anatomical specimens revealed mean total deviations of 1.95 ± 0.6 mm on CT scanning and 1.8 ± 0.7 mm on MR imaging for the suboccipital approach and a mean catheter length of 59.5 ± 4.1 mm. For the precoronal approach, deviations of 2.2 ± 1.2 mm on CT scanning and 2.1 ± 1.1 mm on MR imaging were measured (mean catheter length 85.9 ± 4.7 mm). Conclusions The system-based deviation of frameless stereotaxy using the VarioGuide system reveals good probe placement in deep-seated locations such as the brainstem. Therefore, the authors believe that the system can be accurately used to conduct biopsies and place probes in patients with brainstem lesions.

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Guzman, Raphael, Arjun V. Pendharkar, Michel Zerah, and Christian Sainte-Rose. "Use of the NeuroBalloon catheter for endoscopic third ventriculostomy." Journal of Neurosurgery: Pediatrics 11, no. 3 (March 2013): 302–6. http://dx.doi.org/10.3171/2012.10.peds11159.

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Endoscopic third ventriculostomy (ETV) has become the procedure of choice for treatment of obstructive hydrocephalus. While patient selection is the most critical factor in determining the success of an ETV procedure, the technical challenge lies in the proper site of fenestration and the successful creation of a patent stoma. Positioning of a single balloon catheter at the level or below the floor of the third ventricle to achieve an optimal ventriculostomy can at times be challenging. Here, the authors describe the use of a double-barrel balloon catheter (NeuroBalloon catheter), which facilitates positioning across, as well as dilation of, the floor of the third ventricle. The surgical technique and nuances of using the NeuroBalloon catheter and the experience in more than 1000 cases are described. The occurrence of vascular injury was less than 0.1%, and the risk of balloon rupture was less than 2%. The authors found that the placement and deployment of this balloon catheter facilitate the creation of an adequate ventriculostomy in a few simple steps.

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Sivasubramaniam, Subash, and Mrityunjay Hiremath. "Central Venous Catheters: Do we need to Review Practice on Positioning?" Journal of the Intensive Care Society 9, no. 3 (October 2008): 228–31. http://dx.doi.org/10.1177/175114370800900307.

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It is generally agreed that the tip of an inserted central venous catheter (CVC) should not lie within the right atrium. However, the tip of a CVC not inserted to an adequate depth could lie outside the superior vena cava, predisposing to thrombus formation and infection. A retrospective audit of the position of CVCs on chest radiographs in intensive care patients and the associated incidence of catheter-related infections was therefore undertaken. Chest radiographs of 100 patients who had central venous catheterisation were assessed using the electronic record system, measuring the distance of the CVC tip from the tracheal carina and the site of insertion. Comparisons were then made of the incidence of infection in the groups where the CVC tip was above or below the carina. In a significant proportion of patients (31%) the CVC tip lay too far below the carina. There was no significant difference in the incidence of catheter-related infections between the groups where the catheter was too far below the carina and too far above the carina. CVCs should not be placed too far below the carina as seen on the chest radiograph. Leaving a portion of CVC outside the skin does not appear to increase the incidence of infection in this small group of patients.

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Ahlsson, Anders, Espen Fengsrud, and Birger Axelsson. "Positioning of the ablation catheter in total endoscopic ablation." Interactive CardioVascular and Thoracic Surgery 18, no. 1 (October 2, 2013): 125–27. http://dx.doi.org/10.1093/icvts/ivt433.

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Hayes, Don, Kan N. Hor, Thomas J. Preston, and Patrick I. McConnell. "Computed Tomography Angiography and Bicaval Dual-Lumen Catheter Positioning." Annals of Thoracic Surgery 98, no. 4 (October 2014): 1479. http://dx.doi.org/10.1016/j.athoracsur.2014.06.076.

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Asnes, Jeremy D., and John T. Fahey. "Novel catheter positioning technique for atretic pulmonary valve perforation." Catheterization and Cardiovascular Interventions 71, no. 6 (2008): 850–52. http://dx.doi.org/10.1002/ccd.21436.

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Santarsia, G., F. G. Casino, V. Gaudiano, S. D. Mostacci, C. Bagnato, A. Latorraca, and T. Lopez. "Jugular Vein Catheterization for Hemodialysis: Correct Positioning Control using Real-Time Ultrasound Guidance." Journal of Vascular Access 1, no. 2 (April 2000): 66–69. http://dx.doi.org/10.1177/112972980000100207.

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Abstract:

The jugular vein catheterism (JVC) is adopted for blood access in patients with acute renal failure, in chronic renal failure and when patients show failure of traditional vascular access. The technique of catheter insertion in the jugular vein is quick and easy. Usually correct catheter positioning, before starting the dialytic procedure, is controlled by chest X-ray or by intra-cavitary electrocardiogram. The aim of this work is to evaluate the feasibility of the real-time ultrasound guidance to control the correct positioning of the catheter instead of the usual chest X-ray control. We have studied 158 patients with JVC insertion before the hemodialytic procedure; 54 patients have undergone both ultrasound and a chest X-ray control while 104 were only submitted to ultrasound control. The ultrasound procedure includes an under xifoid scanning, with a convex 3.5 Mhz drill to evaluate the four heart cavities. When the right atrium is identified a second operator rapidly infuses in the venous catheter 15 ml of physiological solution thus creating a blood turbolence easily observed in real time as a light jet inside the atrium. This turbolence appears to be the main evidence for good catheter positioning and we were able to show the light jet in 156 (98%) patients. All light jet positive patients were submitted to the hemodialytic procedure without any complications during and after dialysis. We concluded that the intraoperative ultrasound control technique is an alternative to the chest X-ray evaluation because it offers the possibility for safe intraoperative immediate control thus reducing the total costs of the procedure.

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Journal articles on the topic 'Catheter positioning'

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