Статті в журналах: "Central venous lines"

1

Henderson, Nigel. "Central venous lines." Nursing Standard 11, no. 42 (July 7, 1997): 49–56. http://dx.doi.org/10.7748/ns.11.42.49.s50.

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2

Prabhu, M., and S. Abdy. "Latex-free central venous lines." Anaesthesia 55, no. 7 (July 2000): 723. http://dx.doi.org/10.1046/j.1365-2044.2000.01557-45.x.

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3

Prabhu, M., and S. Abdy. "Latex-free central venous lines." Anaesthesia 55, no. 7 (July 2000): 723. http://dx.doi.org/10.1046/j.1365-2044.2000.01557-45x./.

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4

Dickinson, EdwardJ, and P. Y. Gueugniaud. "SPEED AND CENTRAL VENOUS LINES." Lancet 330, no. 8565 (October 1987): 973. http://dx.doi.org/10.1016/s0140-6736(87)91458-9.

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5

Ljung, R. "Central venous lines in haemophilia." Haemophilia 9 (April 22, 2003): 88–93. http://dx.doi.org/10.1046/j.1365-2516.9.s1.7.x.

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6

Burdett, Ed, and Monty Mythen. "Putting in central venous lines." British Journal of Hospital Medicine 66, Sup2 (September 2005): M36—M38. http://dx.doi.org/10.12968/hmed.2005.66.sup2.19719.

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7

Lamperti, M., N. Moureau, L. J. Kelly, R. Dawson, M. Elbarbary, A. J. H. van Boxtel, and M. Pittiruti. "Competence in paediatric central venous lines placement." British Journal of Anaesthesia 112, no. 2 (February 2014): 383. http://dx.doi.org/10.1093/bja/aet557.

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8

Robinson, D. L., and R. G. W. Stacey. "Maintaining patency of central venous pressure lines." Anaesthesia 53, no. 2 (February 1998): 208–9. http://dx.doi.org/10.1111/j.1365-2044.1998.tb00016.x.

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9

Pippus, Kenneth G., J. Michael Giacomantonio, D. Alexander Gillis, and Elihu P. Rees. "Thrombotic complications of saphenous central venous lines." Journal of Pediatric Surgery 29, no. 9 (September 1994): 1218–19. http://dx.doi.org/10.1016/0022-3468(94)90805-2.

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10

Ragavan, M., S. Gazula, D. K. Yadav, Sandeep Agarwala, M. Srinivas, M. Bajpai, V. Bhatnagar, and D. K. Gupta. "Peripherally inserted central venous lines versus central lines in surgical newborns — A comparison." Indian Journal of Pediatrics 77, no. 2 (January 20, 2010): 171–74. http://dx.doi.org/10.1007/s12098-009-0291-y.

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11

Wilson, D., M. T. Verklan, and K. A. Kennedy. "Randomized trial of percutaneous central venous lines versus peripheral intravenous lines." Journal of Perinatology 27, no. 2 (January 24, 2007): 92–96. http://dx.doi.org/10.1038/sj.jp.7211650.

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12

Stolfi, Ilaria, Francesca Boccanera, Castellano Chiara, Alessandra Ticchiarelli, Carla Fassi, Luigi Giannini, Corrado Moretti, and Patrizia Colarizi. "Central venous lines and how to manage them." Early Human Development 85, no. 10 (October 2009): S83—S84. http://dx.doi.org/10.1016/j.earlhumdev.2009.08.023.

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13

Smirk, C., T. Soosay Raj, A.-L. Smith, and S. Morris. "Neonatal percutaneous central venous lines: fit to burst." Archives of Disease in Childhood - Fetal and Neonatal Edition 94, no. 4 (February 3, 2009): F298—F300. http://dx.doi.org/10.1136/adc.2008.147900.

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14

Kotinatot, Suresh, Shiva Shankar, Muhammad Eyad Ba'Ath, and Munira Mahmoud Almaazmi. "Unexplained abdominal distention in a neonate: culprit femoral central venous line extravasation." BMJ Case Reports 12, no. 12 (December 2019): e232537. http://dx.doi.org/10.1136/bcr-2019-232537.

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Central venous lines are an essential part of neonatal intensive care and are used for infusion of medications and parenteral nutrition (PN). PN is usually given via either peripherally inserted central lines or umbilical venous lines. Occasionally, central venous catheters (CVCs) are inserted in the femoral veins. Extravasation of femoral venous catheter leading to ascites is a rare entity. This report describes the case of a neonate with a femoral CVC, who developed ascites as a result of extravasation of PN. Ascites resolved following the removal of the catheter.

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15

Fusaro, F., M. G. Scarpa, R. Lo Piccolo, and G. F. Zanon. "Central Venous Access in Pediatric Patients." Journal of Vascular Access 2, no. 3 (July 2001): 125–28. http://dx.doi.org/10.1177/112972980100200308.

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Occlusion of traditional sites for central venous cannulation is a challenging problem in patients that require a permanent central venous line for chronic administration of nutrients or drugs. In rare cases, extensive central venous thrombosis of the superior and inferior vena cava may preclude catheterization, and uncommon routes should be used. We describe our approach for placement of chronic central venous lines in two pediatric patients with short bowel syndrome and extensive caval occlusion.

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16

Mushtaq, Ammara, Bhagyashri Navalkele, Maninder Kaur, Amar Krishna, Aleena Saleem, Natasha Rana, Sonia Gera, Suganya Chandramohan, Malini Surapaneni, and Teena Chopra. "Comparison of complications in midlines versus central venous catheters: Are midlines safer than central venous lines?" American Journal of Infection Control 46, no. 7 (July 2018): 788–92. http://dx.doi.org/10.1016/j.ajic.2018.01.006.

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17

Burrell, Anthony R., Mary‐Louise McLaws, Margherita Murgo, Eda Calabria, Annette C. Pantle, and Robert Herkes. "Aseptic insertion of central venous lines to reduce bacteraemia." Medical Journal of Australia 194, no. 11 (June 2011): 583–87. http://dx.doi.org/10.5694/j.1326-5377.2011.tb03109.x.

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18

Ferguson, Chantal S., Victoria C. D'Abrera, Helen J. Van Gessel, and Dorothy Jones. "Aseptic insertion of central venous lines to reduce bacteraemia." Medical Journal of Australia 195, no. 8 (October 2011): 448–49. http://dx.doi.org/10.5694/mja11.10775.

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19

Busca, A., R. Miniero, E. Vassallo, L. Leone, O. Oddenino, and E. Madon. "Monitoring of Cyclosporine Blood Levels From Central Venous Lines." Therapeutic Drug Monitoring 16, no. 1 (February 1994): 71–74. http://dx.doi.org/10.1097/00007691-199402000-00012.

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20

Mushtaq, Ammara, Bhagyashri Navalkele, Maninder Kaur, Aleena Saleem, Natasha Rana, Sonia Gera, Suganya Chandramohan, Malini Surapaneni, and Teena Chopra. "Comparison of Midline vs. Central Venous Catheter-Related Bloodstream Infections: Are Midlines Safer Than Central Venous Lines?" Open Forum Infectious Diseases 4, suppl_1 (2017): S637. http://dx.doi.org/10.1093/ofid/ofx163.1691.

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21

Watkin, S. L., and T. J. Stephenson. "Embolization of a Percutaneous Central Venous Catheter." Clinical Pediatrics 33, no. 2 (February 1994): 126–27. http://dx.doi.org/10.1177/000992289403300215.

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Percutaneous central venous catheters are widely used in both pediatric and neonatal practice. Complications previously reported with these lines include sepsis, occlusion, limb swelling, catheter retention, and rupture on attempted removal. 1-4 We describe a case in which the catheter ruptured during routine use, with embolization of the distal part into the child's central venous system.

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22

Camilleri, A. E., and F. W. Davies. "Aberrant central venous catheter complicating radical neck dissection." Journal of Laryngology & Otology 105, no. 6 (June 1991): 491–92. http://dx.doi.org/10.1017/s0022215100116408.

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AbstractAbnormal migration of central venous catheters is especially common in the case of long lines inserted via the antecubital fossa. A case is described of internal jugular vein migration of a central venous catheter complicating an ipsilateral radical neck dissection.

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23

Wong, Adrian VK, Nitin Arora, Olusegun Olusanya, Ben Sharif, Robert M. Lundin, A. Dhadda, S. Clarke, et al. "Insertion rates and complications of central lines in the UK population: A pilot study." Journal of the Intensive Care Society 19, no. 1 (August 21, 2017): 19–25. http://dx.doi.org/10.1177/1751143717722914.

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Background Central venous catheters are inserted ubiquitously in critical care and have roles in drug administration, fluid management and renal replacement therapy. They are also associated with numerous complications. The true number of central venous catheters inserted per year and the proportion of them associated with complications are unknown in the UK. Methods We performed a prospective audit at five hospitals, as a feasibility pilot for a larger, nationwide audit. Using a novel secure online data collection platform, developed earlier and adapted for this project, all central venous catheters inserted for patients admitted to the Intensive Care Units were documented at five pilot sites across the UK. Results A total of 117 data collection forms were submitted. Users found the electronic data collection system easy to use. All data fields were ready for analysis immediately after data input. Out of the 117 central venous catheters, 17 were haemodialysis catheters and five pulmonary artery introducers. Experienced practitioners (at least three years’ experience) inserted 85% of the central venous catheters. The site of insertion was the internal jugular vein for 80%, femoral for 12% and subclavian for 8% of central venous catheters. Most central venous catheters were inserted in ICU (49%) or theatres (42%). Ultrasound was used for 109 (93%) of central venous catheter insertions and its use was not associated with fewer complications. In 15 cases venopuncture was attempted more than once (all with ultrasound) and this was associated with significantly increased risk of complications. There were eight immediate complications (6.8%): five related to venopuncture and inability to pass a guidewire, two carotid artery punctures and one associated with significant arrhythmia. Conclusion This study demonstrates the ease and feasibility of collecting detailed descriptive data on central line insertion and its immediate complications in the UK over two weeks. In our proposed nationwide audit, organisation-level data on local policies and standard operating procedures is required to complete the picture on this important aspect of intensive care practice.

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24

Manian, Farrin A., Lynn Meyer, and Joan Jenne. "Puncture Injuries Due to Needles Removed From Intravenous Lines: Should the Source Patient Routinely be Tested for Bloodborne Infections?" Infection Control & Hospital Epidemiology 14, no. 6 (June 1993): 325–30. http://dx.doi.org/10.1086/646751.

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AbstractObjective:To better assess the risk of exposure to bloodborne pathogens following puncture injuries due to needles removed from intravenous(IV) lines.Setting:Tertiary care community medical center.Patients:A convenience sample of hospitalized patients requiring IV piggy-back medications.Methods:Examination of 501 IV ports of peripheral lines, heparin-locks, and central venous lines for visible blood and testing the residual fluid in the needles removed from these ports for the presence of occult blood by using guaiac-impregnated paper.Results:The proximal ports of central venous lines and heparin-locks were statistically more likely to contain visible blood than proximal and distal ports of peripheral lines (17% and 20% versus 1% and 3% respectively, P<0.05). Similarly, needles removed from proximal ports of central venous lines and heparin-locks were statistically more likely to contain occult blood than those from peripheral lines ( 11% and 14% versus 2%, respectively, P<0.05). Only two needles removed from IV lines without visible blood contained occult blood: one from the proximal port of a central line and another from a heparin-lock. None of the needles from peripheral lines without visible blood contained occult blood.Estimation of the risk of transmission of hepatitis B and C and human immunodeficiency virus (HIV) following injury by needles from various IV lines revealed that injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood was associated with “near zero” risk of transmission of these bloodborne infections at our medical center.Conclusions:Routine serological testing of source patients involving injury due to needles removed from peripheral IV lines and distal ports of central lines without visible blood is not necessary at our medical center. Conversely, due to the relatively high rate of occult blood in the needles removed from proximal ports of central venous lines and heparin-locks, puncture injuries due to these needles are considered significant and managed accordingly.

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25

TONG, TIMOTHY K. "Caveats on Abdominal Central Venous Pressure Measurement." Pediatrics 90, no. 3 (September 1, 1992): 479. http://dx.doi.org/10.1542/peds.90.3.479.

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To the Editor.— I applaud the important study done by Lloyd et al on the "Accuracy of Central Venous Pressure Measurement From the Abdominal Inferior Vena Cava"1 Those of us who help take care of critically ill children know too well the risks and technical difficulties of establishing internal jugular and central venous lines in children. The authors report that the intra-abdominal venous pressure closely reflects that of the intrathoracic venous pressure. They offer the caveat that this may not be accurate in patients with an obstruction to the inferior vena cava by a thrombus or extrinsically by a tumor.

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26

Asokkumar, A., and J. Dorling. "1371 Complications Associated with Insertion of Percutaneous Central Venous Lines." Pediatric Research 68 (November 2010): 679. http://dx.doi.org/10.1203/00006450-201011001-01371.

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27

Brock-Utne, John G. "Central Venous Lines in Low-birth-weight Newborns: Watch Out." Anesthesiology 129, no. 2 (August 1, 2018): 387. http://dx.doi.org/10.1097/aln.0000000000002285.

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28

Cartwright, D. W. "Central venous lines in neonates: a study of 2186 catheters." Archives of Disease in Childhood - Fetal and Neonatal Edition 89, no. 6 (November 1, 2004): F504—F508. http://dx.doi.org/10.1136/adc.2004.049189.

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29

Arredondo, Olivia, Tina L. Palmieri, Soman Sen, David G. Greenhalgh, and Kathleen S. Romanowski. "521 Maintaining Central Line Patency in Burned Children." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S96. http://dx.doi.org/10.1093/jbcr/irac012.152.

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Abstract Introduction Children with major burn injury frequently require prolonged central venous access to assure appropriate fluid management and pain control. Central venous catheters in children frequently develop clots that prevent drug administration, requiring administration of tissue plasminogen activator (TPA). The purpose of this study was to identify the frequency and efficacy of TPA use in burned children with central venous catheters (CVC). Methods This retrospective chart review evaluated all children requiring CVC admitted to our tertiary pediatric burn center from 2018-2019. Data collected included patient demographics (age, burn size, hospital length of stay (LOS)), catheter-related data (number of central lines, lines replaced due to clotting), TPA administration (number of times administered, successful TPA administrations, how often repeated), and line clotting data (time from insertion to clot, interval between TPA order and administration). Results In 2018, 116 lines were place in 49 children with mean age of 8.4 years and mean burn size of 29%, intensive care unit LOS was 24 days. TPA was infused in 20% of lines to relieve obstruction and was successful in relieving the clot in 21% (5/23). The interval between identification of the obstructed line to TPA order was 191 minutes, with the administration of TPA 83 minutes after order placement. The average time from identification of obstruction to TPA administration was 257 minutes. In 2019, 150 lines were place in 65 children with mean age of 5.2 years and mean burn size of 25%, LOS was 13 days in the PICU. TPA was infused in 5% of lines to relieve obstruction and was successful in relieving the clot in 0 % (0/8). The interval between identification of the obstructed line to TPA order was 117 minutes, with the administration of TPA 49 minutes after order placement. The average time from identification of obstruction to TPA administration was 158 minutes. Conclusions The incidence of obstruction in pediatric central venous catheters in our unit decreased from 26% in 2018 to 3% in 2019. TPA was successful in clot resolution in only 5% (2018), and 0% (2019) . Based on our results, we targeted areas for improvement including: Standing order for TPA; staff education on TPA use; decreasing our average time to identify, order, and administer TPA; and standardizing the frequency of flushing unused central venous catheter lumens with heparinized saline flush.

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30

Rachapalli, Vamsidhar, Pankaj Sharma, Sheo Kumar, and Mangerira Uthappa. "Do You Know Your Lines?" Journal of Clinical Interventional Radiology ISVIR 01, no. 03 (September 1, 2017): 161–67. http://dx.doi.org/10.1055/s-0037-1604415.

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AbstractThe use of central venous catheters has become ubiquitous in the clinical practice. While a majority of them are easy to insert, many consider it a mundane interventional procedure. However, it is important to ensure that the right catheter is selected for the right patient. In addition, due diligence should be observed during site selection and catheter securement. This article briefly but concisely covers various aspects of venous catheter insertion ranging from catheter selection, patient preparation, choice of skin antisepsis to catheter tip position. This article, however, does not deal with the actual steps involved in the insertion of various catheters.

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31

Raees, Muhammad Aanish, Paul V. Dubar, and David P. Bichell. "A Medium-Term Venous Access Alternative for Infants Undergoing Congenital Heart Surgery." World Journal for Pediatric and Congenital Heart Surgery 9, no. 1 (January 2018): 91–94. http://dx.doi.org/10.1177/2150135117738008.

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We describe a strategy aimed at maximizing the safety and minimizing the thrombogenicity of central venous lines for neonates with congenital heart defects. Our method involves the use of a tunneled technique to place a 4.2 Fr single-lumen (Broviac) catheter in the subpericardial space, with minimal intravascular course and a tip placed in the lower right atrium. Using this technique, we potentially eliminated the requirement for percutaneous placement of central venous lines postoperatively as well as potentially decreased the risk of intrapericardial bleeding associated with transthoracic lines.

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32

Ratchagame, Vicknesh, and Vetriselvi Prabakaran. "Comparison of Risks from Central Venous Catheters and Peripheral Intravenous Lines among Term Neonates in a Tertiary Care Hospital, India." Journal of Caring Sciences 10, no. 2 (May 23, 2021): 57–61. http://dx.doi.org/10.34172/jcs.2021.012.

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Abstract Introduction: Venous access in neonates is a basic yet critical component in neonatal intensive care unit (NICU). Central venous access and peripheral intravenous access are mostly preferred for delivering medications and intravenous fluids. This study aimed to compare the risks involved in central venous catheters and peripheral intravenous lines among term neonates. Methods: A prospective cohort study was carried out among 78 term neonates in the NICU of a tertiary care center in puducherry in India. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to demographic and clinical characteristics, cannulation details, indwelling time, and incidence of thrombosis, phlebitis, occlusion, extravasation, and sepsis were collected by direct observation and from case record. Data were analyzed using SPSS software version 21. To analyze the data, descriptive statistics including frequency, percentage, mean, and standard deviation and inferential statistics including Fisher’s exact test were utilized. Results: Our findings indicated that the risks of thrombosis and phlebitis were significantly higher in peripheral intravenous line group than the central venous group. There was no statistically significant association between the risks and demographic and clinical characteristics in both of the venous access system. Conclusion: According to our results, the use of central venous catheter among neonates showed lower risks than peripheral intravenous lines. Hence, using central venous catheter may be given priority in the NICUs.

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33

Sattinger, E., S. Diedrichs, J. Brickwedel, C. Detter, H. Reichenspurner, A. E. Goetz, and J. Kubitz. "Arterial blood gases from central venous lines: a sign for malformation." British Journal of Anaesthesia 113, no. 2 (August 2014): 301–3. http://dx.doi.org/10.1093/bja/aeu249.

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34

Hammerli, Mark, and Richard A. Meyer. "Doppler evaluation of central venous lines in the superior vena cava." Journal of Pediatrics 122, no. 6 (June 1993): S104—S108. http://dx.doi.org/10.1016/s0022-3476(09)90053-1.

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35

Farhat, Rania, Jennifer Minoff, Shannon Burke, and Setu Patolia. "Options to Minimize the Use of Central Lines: Midodrine, Peripheral Venous Lines, and Midline Catheters." American Journal of Respiratory and Critical Care Medicine 204, no. 12 (December 15, 2021): 1473–75. http://dx.doi.org/10.1164/rccm.202103-0685rr.

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36

Busack, Bethany, Vy Tran, Christopher Busack, and Christine Butts. "Ultrasonography of a Helical Left Common Carotid Artery." Clinical Practice and Cases in Emergency Medicine 4, no. 2 (April 23, 2020): 230–31. http://dx.doi.org/10.5811/cpcem.2020.2.46272.

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Case Presentation: An 83-year-old woman was admitted to the intensive care unit for septic shock at which point an internal jugular central venous line was placed. The patient’s common carotid artery was visualized in an atypical location, lateral to the internal jugular vein. Further inspection revealed the common carotid artery travelling in a rotational trajectory around the internal jugular vein. Discussion: For at least two decades, point-of-care ultrasound has become the standard of care for placing central venous lines. This surprising anatomical orientation is rare and cautions physicians to fully explore a patient’s anatomy prior to placing central lines.

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Ruud, Ellen, Henrik Holmstrøm, Einar Hopp, and Finn Wesenberg. "Central Line-Associated Venous Late Effects in Children without Any Prior History of Thrombosis - A Cross-Sectional Study of Children Previously Treated for Malignant or Hematological Diseases." Blood 106, no. 11 (November 16, 2005): 4118. http://dx.doi.org/10.1182/blood.v106.11.4118.4118.

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Abstract Background: The frequency of asymptomatic central line-associated thromboses is high and well recognised among children with cancer, while the long-term consequences are mainly unknown. In a cross-sectional study, we have evaluated clinical and radiological venous outcome in children with previous long-standing intravascular catheters. Methods: The study enrolled 71 children previously treated for malignant or haematological diseases, 4–180 (median 37) months after removal of their central lines. The central lines had been placed in a jugular vein for a minimum of six months, and none had a previously identified event of thrombosis. The children were clinically examined for post-thrombotic syndrome (PTS) and had Doppler ultrasonography of their central neck veins. In a subgroup of twelve children, venous magnetic resonance imaging (MRI) of the same area of interest was performed. Results: We observed mild PTS with increased superficial collaterals in four children (6 %), but no cases of more severe PTS. None complained of symptoms related to venous late effects. By ultrasonography, post-thrombotic venous alterations were detected in 17 children (24 %), and five of these had complete occlusion of veins. The sensitivity for pathologically increased collaterals to identify occlusive thrombosis was 0.6, while the specificity was 0.98. Occlusive thrombosis was associated with previous central line-associated infections (p = 0.001) and duration of central lines in place (p = 0.042). MRI did not give any extra information, and only occlusive thromboses were confirmed at MRI. Conclusions: In spite of no prior history of thrombosis, children with previous long-term jugular lines had often local thrombotic sequelae, while clinical symptoms of PTS were rare.

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Cook, Rebecca, and Roger Berkow. "Infectious Central Venous Line Complications During Induction Therapy for Newly Diagnosed Acute Leukemia." Blood 116, no. 21 (November 19, 2010): 4322. http://dx.doi.org/10.1182/blood.v116.21.4322.4322.

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Abstract Abstract 4322 Introduction: Childhood acute leukemia treatment requires central venous lines (CVL) for instillation of chemotherapy and blood products. Ideally, a proper white cell count (WBC) and absolute neutrophil count (ANC) ensure proper healing of CVLs, but this is challenging in children with acute leukemia. We sought to investigate the CVL complication rate in newly diagnosed children with acute leukemia during their induction therapy, and determine if the degree of neutropenia at the time of CVL placement correlated with the number of CVLs lost due to infection, wound dehiscence, or thrombosis. Methods: We conducted a retrospective chart review of children diagnosed with leukemia between January 2007 and December 2009 and recorded leukemia type, WBC and ANC at diagnosis and at the time of CVL placement, the type of CVL placed (external line, subcutaneous port) or placement of peripherally inserted central (PICC) line. We recorded complications, including infection, line malfunction, wound dehiscence, and thrombosis within their induction therapy phase. Results: Ninety-five children were evaluable, including 68 children with precursor B acute lymphoblastic leukemia (pre B ALL), 19 with acute myelogenous leukemia (AML), and 8 with T-cell acute lymphoblastic leukemia (T cell ALL). Ninety-eight CVLs were placed in 94 children (1 child died of complications of APML before initiation of therapy). There were 77 subcutaneous ports and 21 external lines placed. Eleven patients received PICC lines for various reasons (ex – sedation risk due to large mediastinal mass or altered mental status due to leukocytosis, coagulopathy, refractory thrombocytopenia, previously placed PICC line at outside hospital). ANC at the time of CVL insertion was reviewed: ANC<500 in 39 central lines, 500–1000 in 29 central lines, and >1000 in 30 central lines. Only 1 central line was removed due to wound dehiscence in a child with T cell ALL, and 2 central lines were removed for cellulitis in children with pre B ALL, and all these patients had ANC<500 at the time of line insertion. Two of the 98 central lines developed an associated thrombosis (1 CVL associated extensive arm venous thrombus and 1 external line with small atrial thrombus at tip of catheter), as opposed to 2 of the 11 PICC lines placed (both extensive arm venous thrombi). Seventeen positive blood cultures occurred during the first month of induction (15 from central lines and 2 from PICC lines), and all infections cleared with antibiotics except for 1 patient with PICC-associated venous thrombosis and persistent MRSA bacteremia. One subcutaneous port had to be revised after 3 days due to deep insertion and difficultly accessing; this child had ANCs<500 during each surgery and healed without complications. Three external lines were removed due to malfunction (2 with ANC<500, 1 with ANC 500–1000 at time of insertion). Conclusions: Nearly 40% of CVLs were placed in times of severe neutropenia (ANC<500), and only 3 were lost due to cellulitis or wound dehiscence. No CVL was lost due to persistent bacteremia compared to 1 PICC line. There was an increased incidence of thrombosis in PICC lines (2 of 11 placed) compared to external lines or ports (2 of 98 lines placed). We failed to see an increased risk of infection due to degree of neutropenia at the time of CVL insertion. Disclosures: No relevant conflicts of interest to declare.

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Male, Christoph, Peter Chait, Maureen Andrew, Kim Hanna, Jim Julian, and Lesley Mitchell. "Central venous line–related thrombosis in children: association with central venous line location and insertion technique." Blood 101, no. 11 (June 1, 2003): 4273–78. http://dx.doi.org/10.1182/blood-2002-09-2731.

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Abstract Venous thromboembolic events (VTEs) in children are associated with central venous lines (CVLs). The study objective was to assess whether CVL location and insertion technique are associated with the incidence of VTE in children. We hypothesized that VTE would be more frequent with (1) CVL location on the left body side, (2) CVL location in the subclavian vein rather than the jugular vein, and (3) CVL insertion by percutaneous technique rather than venous cut-down. This was a prospective, multicenter cohort study in children with acute lymphoblastic leukemia who had a CVL placed in the upper venous system during induction chemotherapy. Characteristics of CVL were documented prospectively. All children had outcome assessment for VTE by objective radiographic tests, including bilateral venography, ultrasound, echocardiography, and cranial magnetic resonance imaging. Among 85 children, 29 (34%) had VTE; 28 VTEs appeared in the upper venous system, and 1 was sinovenous thrombosis. Left-sided CVL (odds ratio [OR], 2.5; 95% confidence interval, 1.0-6.4; P = .048), subclavian CVL (OR, 3.1; 95% CI, 1.2-8.5; P = .025), and percutaneous CVL insertion (OR, 3.5; 95% CI, 1.3-9.2; P = .011) were associated with an increased incidence of VTE. Interaction occurred between CVL vein location and insertion technique. Subclavian vein CVL inserted percutaneously had an increased incidence (54%) of VTE compared with any other combination (P = .07). For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk for CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cut-down appears preferable over percutaneous insertion.

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Nossair, Fadi, Arash Mahajerin, Janet Hoang, Daniel Diaz, and Diane J. Nugent. "Thrombin Generation and Microparticles As Promising Biomarkers for Venous Thromboembolism in Children with Central Venous Lines." Blood 128, no. 22 (December 2, 2016): 3810. http://dx.doi.org/10.1182/blood.v128.22.3810.3810.

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Abstract Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) has increased over the past ten years (Raffini et al. Pediatrics 2009; 124; 1001-1008), with an associated increase in both VTE-associated complications and treatment-related adverse events. Children with VTE have a four-fold increase in length of admission compared to children without VTE. There are many known clinical risk factors but the presence of central venous lines (CVLs) has been shown to be among the strongest risk factors in children (Mahajerin et al. Haematologica 2015 Aug; 100(8): 1045-50). Current tools, including clinical risk-prediction scoring systems as well as genetic risk factors, are not sufficient to predict VTE risk at this time. Identification of dependable, rapid and cost-effective biomarkers for the prediction of VTE in children with CVLs is essential in guiding anti-coagulation prophylaxis, thus reducing VTE occurrence among hospitalized children with CVLs. Objectives: Determine the ability of thrombin generation (TG) and microparticle-based phospholipid-dependent procoagulant potential (MP-PPL) to predict VTE occurrence in hospitalized children with CVLs. Methods: Plasma sample were collected from 34 hospitalized acutely ill children between the age of 1 month and 21 years, who are at risk for VTE due to multiple known clinical risk factors, including a newly placed non-tunneled CVL. Children that had undergone a recent cardiac catheterization or on dialysis, plasmapheresis or ECMO were excluded. Samples from 16 age matched healthy controls were also collected. Venous samples were collected prior to CVL placement. Platelet poor plasma (PPP) was obtained according to a strict protocol to minimize pre-analytical variable. All pertinent clinical and laboratory information was extracted, including CVL-related variables and details of VTE in affected subjects. TG was measured by means of the calibrated automated thrombogram (CAT). MP-PPL was measured using two methods: 1) Functional assay that detects the ability of circulating MPs to indirectly facilitate thrombin generation (Zymuphen MP-Activity kit, Hyphen BioMed, France), 2) Clot-based assay that measures phospholipid-dependent, factor Xa initiated clotting time in relation to normal controls (STA-Procoag-PPL, Diagnostica Stago). Results: The median age of our cohort was 10 yrs (IQR 12, range 0 - 19), with a slight male predominance (53%) and increased representation of adolescents (41%). CVLs were placed in an intensive care setting in 38% of subjects and 39% of subjects had an underlying condition associated with chronic inflammation. The median duration of CVL placement from admission was 2 days (IQR 5, range 1 - 19) and the median total duration of CVLs were 14 days (IQR 20, range 5 - 84). Line-associated VTE occurred in 9% (3/34) of children with CVL and one subject had a VTE unrelated to CVL. There was no observed significant difference between children with or without line-related VTE in terms of age, gender, lag of CVL placement from admission, duration of CVLs, caliber of initial vessel of insertion, number of lumens, size of CVL and internal length of the CVL. However, all subjects with line-associated VTE were admitted for acute infection to an intensive care setting, with the majority of VTE occurring within 48 hours from line placement (2/3). Correlation analysis of the two MP-PPL assays was significant (r = -0.659). Even though the MP-PPL functional assay did not show a significant difference between subjects with and without line-associated VTE (p-value 0.189), the MP-PPL clot-based assay showed measurable difference between the two groups, both as an absolute value and as a ratio (p-value: 0.04 and 0.038 respectively, Table 1). Peak thrombin generation (p-value 0.001), estimated thrombin potential (ETP) - (p-value 0.02) and velocity index (p-value 0.001) were significantly higher in subjects with line-associated VTE (see Figure 1). Subject recruitment and sample analyses, involving these assays and other potential biomarker candidates, are ongoing. Conclusion: Given the rising incidence of pediatric VTE, the ability to use biomarkers to stratify patients according to their VTE risk will provide a vital tool to guide preventative efforts, and minimizing unnecessary expense and toxicities. TGA and MP-PPL have shown great potential for differentiating children with CVLs that may develop a line-related VTE as a HA-VTE. Disclosures No relevant conflicts of interest to declare.

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Pye, Sherry, Xinyu Tang, Jeffrey Gossett, Parthak Prodhan, Adnan Bhutta, and Xiomara Garcia. "Catheter-Associated Blood Stream Infections in Intracardiac Lines." Journal of Pediatric Intensive Care 06, no. 03 (December 5, 2016): 159–64. http://dx.doi.org/10.1055/s-0036-1596064.

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Purpose Right atrial (RA) or intracardiac lines are commonly used for hemodynamic monitoring in children undergoing cardiac surgery. In some institutions, these lines are used as the preferred long-term access line due to concerns for catheter-associated blood stream infections (CABSI) and catheter-related venous thrombosis with central lines in other locations. However, the rates and risk factors for CABSI and other complications are not known for RA lines. We undertook this study to estimate CABSI rates for RA lines in comparison with central catheters of various types and locations and to evaluate the incidence of other complications associated with the use of RA lines. Methods After approval from the Institutional Review Board, a retrospective review of all patients undergoing cardiac surgery at Arkansas Children's Hospital between the dates of January 1, 2006 and December 31, 2011 was performed. Demographic data, clinical features, and outcomes were summarized on a per-patient level. Type, location of placement, and duration of all centrally placed catheters as well as associated complications were recorded. Central venous lines (CVL) used in our unit include peripherally inserted central catheters (PICC) lines, and antibiotic and heparin coated double or triple lumen lines placed in internal jugular (IJ), femoral (Fem), or RA positions. The data were analyzed using statistical software STATA/MP. Results A total of 2,736 central lines were used in 1,537 patients. Data on line duration, alteplase use, and percentage of lines developing CABSI are described in the study. Disease severity as assessed by risk-adjusted classification for congenital heart surgery (RACHS) score (p < 0.046), year of placement (p < 0.001), and line type adjusted for thrombolytic (alteplase) use are significantly associated with risk of any CABSI. Overall, IJ and RA lines had least risk of CABSI while PICC lines had the highest CABSI rates. RA lines are also associated with other medically significant complications. Conclusion The CABSI rates associated with RA lines are lower than those seen with PICC lines. However, RA line use is associated with other, potentially significant complications. RA lines may be used cautiously as long-term access lines in cardiac patients in whom it is important to preserve venous patency for future interventions.

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Trotter, Carol. "Why Are We Trimming Peripherally Inserted Central Venous Catheters?" Neonatal Network 23, no. 3 (May 2004): 82–83. http://dx.doi.org/10.1891/0730-0832.23.3.82.

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PERIPHERALLY INSERTED CENTRAL venous catheters (PICCs) are used as the standard of care for longterm intravenous access in neonates treated in neonatal intensive care units. Little evidence supports many of the practices associated with PICC lines, however. Some practices needing more evidence include catheter tip placement in very low birth weight neonates, the catheter insertion site, the catheter material, insertion site dressings, and mechanisms to prevent catheter-related sepsis. Of particular concern is the practice of trimming the excess length off the distal end of the catheter prior to insertion.

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Molgaard, O., M. S. Nielsen, B. B. Handberg, J. M. Jensen, J. Kjaergaard, and N. Juul. "Routine X-ray control of upper central venous lines: Is it necessary?" Acta Anaesthesiologica Scandinavica 48, no. 6 (July 2004): 685–89. http://dx.doi.org/10.1111/j.0001-5172.2004.00400.x.

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Odd, D. E. "Does radio-opaque contrast improve radiographic localisation of percutaneous central venous lines?" Archives of Disease in Childhood - Fetal and Neonatal Edition 89, no. 1 (January 1, 2004): 41F—43. http://dx.doi.org/10.1136/fn.89.1.f41.

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Robertson, Jeanette. "Changing Central Venous Catheter Lines: Evaluation of a Modification to Clinical Practice." Journal of Pediatric Oncology Nursing 8, no. 4 (January 1991): 173–79. http://dx.doi.org/10.1177/104345429100800405.

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46

Gow, Kenneth W., David Tapper, and Robert O. Hickman. "Between the Lines: The 50th Anniversary of Long-Term Central Venous Catheters." Journal of the Association for Vascular Access 22, no. 4 (December 1, 2017): 165–77. http://dx.doi.org/10.1016/j.java.2017.10.004.

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Abstract Background: Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. Data source: A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used. Conclusions: CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion.

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Pollard, A. J., N. Sreeram, J. G. Wright, S. V. Beath, I. W. Booth, and D. A. Kelly. "ECG and echocardiographic diagnosis of pulmonary thromboembolism associated with central venous lines." Archives of Disease in Childhood 73, no. 2 (August 1, 1995): 147–50. http://dx.doi.org/10.1136/adc.73.2.147.

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Dollery, C., I. Sullivan, K. Bull, and P. Milla. "ECG and echocardiographic diagnosis of pulmonary thromboembolism associated with central venous lines." Archives of Disease in Childhood 75, no. 2 (August 1, 1996): 169. http://dx.doi.org/10.1136/adc.75.2.169.

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Copacia, Jessica Ann, Kimberly Taylor, Melissa Laudick, Hemalatha G. Rangarajan, Rolla Abu-Arja, Jeffery J. Auletta, Amy Pyle-Eilola, Joseph Stanek, Vinita B. Pai, and Rajinder Bajwa. "70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors." Annals of Pharmacotherapy 52, no. 1 (August 24, 2017): 32–39. http://dx.doi.org/10.1177/1060028017709289.

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Background: Tacrolimus, commonly used for graft versus host disease prophylaxis is usually administered via a dedicated central venous line (CVL) and trough levels drawn from the unexposed lumen. Being an oil-based medication, it may be adsorbed to the inner lumen of the CVL and result in falsely high levels drawn from an inadvertently exposed lumen. There is no treatment for decontamination of such CVLs, and natural decay occurs over months before the CVL can be used to draw reliable trough levels. Objective: The primary objective of the study was to estimate the effectiveness of 70% ethanol locks for decontaminating CVLs exposed to tacrolimus. Methods: We studied the efficacy of 70% ethanol lock in decontaminating CVLs exposed to tacrolimus in patients during transplant. Trough tacrolimus levels were drawn from the exposed and unexposed (control) lumens at 8:00 am, followed by a 2-mL 70% ethanol lock instilled for a 2-hour dwell into the exposed (intervention) lumen. Trough tacrolimus levels were again drawn from both lumens at 8:00 pm and levels compared for efficacy. Results: All 20 sets showed a high 8 am trough level in the exposed intervention arm (median = 30 ng/mL), significantly greater ( P < 0.0001) than that in the control arm (median = 9.05 ng/mL), and were contaminated. After the 2-hour ethanol lock, 65% of the lumens were decontaminated. The difference between the control and intervention arms was no longer found to be statistically significant ( P = 0.0826). Conclusion: A 2-hour 70% ethanol lock is effective for decontamination of CVLs exposed to tacrolimus.

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Davenport, Mark. "ECG and echocardiographic diagnosis of pulmonary thromboembolism associated with central venous lines." Journal of Pediatric Surgery 31, no. 3 (March 1996): 449. http://dx.doi.org/10.1016/s0022-3468(96)90767-8.

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