The totally implantable venous port device is used in patients undergoing chemotherapy. The complications associated with this device include venous thrombosis, infection, catheter fracture, extravasation, and intravascular dislodgement. The incidence of port catheter dislodgement is low. The treatment of choice for port dislocation involves immediate retrieval of the distal migrated part, and percutaneous transcatheter retrieval is regarded as the standard method. A 40-year-old female presented with intermittent palpitation. She was referred from the Department of General Surgery after detection of a fractured and dislocated implantable venous port system into the main pulmonary artery. We successfully retrieved the dislocated fractured device using a 5-Fr pigtail catheter and snare catheter. We herein report this case with a literature review.
Cardiac Complexes, Premature ; Catheterization, Central Venous ; Catheters ; Catheters, Indwelling ; Dislocations ; Female ; Humans ; Incidence ; Pulmonary Artery ; SNARE Proteins ; Vascular Access Devices ; Venous Thrombosis

No abstract available.
Vascular Access Devices*

No abstract available.
Child ; Humans ; Vascular Access Devices

Introduction: Accurate and reliable glucose level measurements are essential for ensuring safe and effective glycemic control among diabetic patients undergoing hemodialysis (HD). Capillary blood glucose (CBG) monitoring is the standard of care of glycemic control assessment in patients with diabetes on maintenance HD. In the Philippines, glucose monitoring during HD involves either standard finger stick (CBG) or blood sample from the arterial line (AL) of extracorporeal circuit of HD machine. However, anecdotal observations noted over the years have shown discrepancies in the glucose values from the two sites. This study aimed to determine the accuracy of blood glucose measurements of capillary and AL of extracorporeal circuit of HD machine using point-of-care (POC) glucose meter in comparison to central laboratory venous plasma among diabetic patients undergoing outpatient HD in a private tertiary hospital in the Philippines. Determining the most accurate and reliable method of glucose level measurement is vital in helping patients attain glycemic control. To date, there is limited published data regarding the accuracy of blood glucose values obtained through CBG and AL of extracorporeal circuit of HD machine while patients are undergoing dialysis. Methods: This is a prospective, cross-sectional, analytical study involving thirty patients. Forty blood samples from 30 patients obtained through CBG, AL and the peripheral venous plasma of the opposite arm were simultaneously analyzed. Specifically, StatStrip was utilized as the POC glucose meter. Accuracy of AL of extracorporeal circuit and CBG were determined and assessed in accordance with International Organization for Standardization (ISO) 15197:2013 minimum accuracy criteria for glucose meters. Regression analysis was used to determine whether AL and CBG significantly predict peripheral venous blood glucose levels. Results: Analysis showed that there is a statistically significant difference in the glucose values obtained from AL and CBG (p-values 0.005 and <0.0001) when compared to venous plasma glucose. However, this may not pose clinical significance in routine practice. It is noteworthy that both AL (concordance rate (CR)=100%) and CBG (CR=96.5%) satisfied the revised ISO 15197:2013 accuracy criteria for glucose value greater than or equal to 100mg/dL. Conclusion Both CBG and AL blood glucose measurement significantly predict venous plasma blood glucose level. POC blood glucose value from both AL of extracorporeal circuit during HD and CBG satisfied the accuracy criteria set by ISO 15197: 2013 for glucose value greater than or equal to 100mg/dL. Thus, confirming the glucose level by CBG monitoring is not necessary in patients with arterial glucose value of greater than or equal to 100 mg/dL during HD.
Vascular Access Devices ; Renal Dialysis

PURPOSE: Long-term venous access is cumbersome in children because of their thin caliber veins, less cooperative nature, and easy compromise of venous integrity. Hence, a study was conducted to evaluate the indication, efficacy, and safety of chemoport in children who require chronic venous access. MATERIALS AND METHODS: Children who underwent chemoport insertion between January 2008 and December 2017 were retrospectively evaluated. RESULTS: A total of 159 children (169 chemoports) were included in the study. The most common indication for chemoport insertion was acute lymphoblastic leukemia (51.5%). The mean chemoport days were 832±666 days. Among the 169 chemoports, 55.0% were removed after treatment completion. The chemoport was not removed in 35.5% of the patients, as 28.4% of the patients were still under treatment and 7.1% died during the treatment. Sixteen patients (0.1 per 1,000 chemoport days) had a premature chemoport removal. The indications were port-related bloodstream infection (12 patients), port pocket infection (1 patient), exposed chemoport (1 patient), and blocked chemoport catheter (2 patients). Twenty-two patients (0.15 per 1,000 chemoport days) had complications of port-related bloodstream infection (0.09 per 1,000 chemoport days), making it the most common. Other complications include block, fracture, arrhythmias, avulsion, bleeding, decubitus-over-port, and port pocket infection. CONCLUSION: Owing to the safe, reliable, and low complication rate of chemoports, more children can be saved from deadly illnesses. Chemoport is the best option for children who require chronic venous access.
Arrhythmias, Cardiac ; Catheters ; Child ; Hemorrhage ; Humans ; Leukemia ; Observational Study ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Vascular Access Devices ; Veins

BACKGROUND: Carefully using a totally implanted vascular access device and regular check-up of its condition in children who suffer with malignancy is very important. This study was performed to determine the complications related to using this device, according to the patient's age, gender and diagnosis, and the time from port insertion. METHODS: We retrospectively studied 77 patients with malignancy (46 males and 31 females, age: 0.1~18 years, mean age: 7.8 years) and they were treated with a totally implanted vascular access device (chemoport) from January 1996 to May 2007 in Kyungpook National University Hospital, Korea. We assessed the symptoms and radiologic findings, conducted blood tests and doppler USG; we found several complications and compared them according the patients' age, gender and diagnosis. RESULTS: Among the 77 cases with a totally implanted vascular access device (chemoport), 14 cases had complications related to the chemoport. Infections were detected in 8 cases. 6 of them had infections related to the chemoport after 4~7 months from the port-insertion. After port removal and treatment with broad spectrum antibiotics, their symptoms such as fever and swelling were improved. Disconnection of the port was detected in 2 cases after 2 months and 22 months from port-insertion, respectively. These ports were successfully removed by cardiac catheterization. Rotation of the port was detected in one case after 9 months from port-insertion: the rotated port was removed. Obstruction with thrombus was detected in 3 cases, after 7~16 months from port-insertion: this condition was treated with thrombolytic agents such urokinase and t-PA (tissue plasminogen activator), or surgical removal of the blood clot in the port site. CONCLUSION: To reduce the complications related to the totally implanted vascular access (device), such as infection, thrombosis and disconnection, we should carefully use this device and also regularly check its function and position. After completion of chemotherapy, removal of the port as soon as possible should be considered. If a complication is detected, then we should manage it immediately.
Anti-Bacterial Agents ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Female ; Fever ; Fibrinolytic Agents ; Hematologic Tests ; Humans ; Korea ; Male ; Plasminogen ; Retrospective Studies ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vascular Access Devices

BACKGROUND: Despite the importance of burn-induced encephalopathy, cerebral hemodynamics after burn injury and during resuscitation remains undefined. The aim of our study was to evaluate the effects of a large cutaneous burn injury on the cerebral circulation. METHODS: Anesthetized sheep(n=8) were prepared with vascular catheters, a urinary catheter and a Richmond bolt for intracranial pressure monitoring. A scald injury was inflicted on 70% of total body surface area with hot water. Resuscitation was started 30 minutes after scald with Ringer's lactate to restore and then maintain baseline oxygen delivery. Resuscitation maintained blood pressure, cardiac output and urine output at normal levels. Brain blood flow was measured with colored microspheres. RESULTS: During resuscitation intracranial pressure rose slowly from 10.6+/-1.5 to 17.0+/- 4.0 mmHg(P<0.05) and cerebral perfusion pressure was reduced from 86.4+/- 6.8 to 64.1+/- 2.8 mmHg(P<0.05). During early resuscitation cerebrovascular resistance declined to maintain brain blood flow and oxygen delivery at baseline or better. After 6 hours, cerebrovascular resistance was inappropriately increased during a period of reduced cerebral perfusion pressure which resulted in brain blood flow being half the baseline levels. CONCLUSIONS: These data suggest that autoregulation maintains brain blood flow immediately after burn shock and early resuscitation, but autoregulation may be less effective as burn resuscitation proceeds.
Blood Pressure ; Body Surface Area ; Brain ; Burns* ; Cardiac Output ; Hemodynamics ; Homeostasis ; Intracranial Pressure ; Lactic Acid ; Microspheres ; Oxygen ; Perfusion ; Resuscitation* ; Shock ; Skin ; Urinary Catheters ; Vascular Access Devices ; Water

PURPOSE: The aim of this study is to evaluate the results for the insertion of totally implantable central venous access devices (TICVADs) by surgeons. METHODS: Total 397 patients, in whom TICVADs had been inserted for intravenous chemotherapy between September 2008 and June 2014, were pooled. This procedure was performed under local anesthesia in an operation room. The insertion site for the TICVAD was mainly in the right-side subclavian vein. In the case of breast cancer patients, the subclavian vein opposite the surgical site was used for insertion. RESULTS: The 397 patients included 73 males and 324 females. Primary malignant tumors were mainly colorectal and breast cancer. The mean operation time was 54 minutes (18-276 minutes). Operation-related complications occurred in 33 cases (8.3%). Early complications developed in 15 cases with catheter malposition and puncture failure. Late complications, which developed after 24 hours, included inflammation in 6 cases, skin necrosis in 6 cases, hematoma in 3 cases, port malfunction in 1 case, port migration in 1 case, and intractable pain at the port site in 1 case. CONCLUSION: Insertion of a TICVAD under local anesthesia by a surgeon is a relatively safe procedure. Meticulous undermining of the skin and carefully managing the TICVAD could minimize complications.
Anesthesia, Local ; Breast Neoplasms ; Catheterization, Central Venous ; Catheters ; Drug Therapy ; Female ; Hematoma ; Humans ; Inflammation ; Maintenance Chemotherapy ; Male ; Necrosis ; Pain, Intractable ; Punctures ; Skin ; Subclavian Vein ; Vascular Access Devices

A central venous port catheter is widely used to administer fluids, chemotherapeutic agents, and parenteral nutrition; however, similar to other invasive procedures, it has numerous potential complications. Among them, distal migration of a fractured central venous port catheter is a rare complication. A 66-year-old man had a central venous port catheter implanted into the right subclavian vein for adjuvant stomach cancer chemotherapy and presented with an ulceration at the chemoport insertion site. While removing the port catheter, it fractured and the distal tip and migrated and impacted the annulus of the right atrium. The impacted port catheter was successfully removed through a femoral vein approach using a radiofrequency ablation catheter and a multi snare.
Aged ; Catheterization, Central Venous ; Catheters ; Femoral Vein ; Fractures, Spontaneous ; Heart Atria ; Humans ; SNARE Proteins ; Stomach ; Stomach Neoplasms ; Subclavian Vein ; Ulcer ; Vascular Access Devices

BACKGROUND/AIMS: Fragmented care in nephrology can cause treatment delays. Nephrologists are qualified to perform vascular access-related procedures because they understand the pathophysiology of renal disease and perform physical examination for vascular access. We compared treatment delays associated with tunneled hemodialysis catheter (TDC) placement between interventional radiologists and nephrologists. METHODS: We collected data by radiologists from January 1, 2011 through December 31, 2011 and by nephrologists from since July 1, 2012 through June 30, 2013. We compared the duration from the hemodialysis decision to TDC placement (D-P duration) and hemodialysis initiation (D-H duration), catheter success and the complication rate, and the frequency and the usage time of non-tunneled hemodialysis catheters (NDCs) before TDC placement. RESULTS: The study analyzed 483 placed TDCs: 280 TDCs placed by radiologists and 203 by nephrologists. The D-P durations were 319 minutes (interquartile range [IQR], 180 to 1,057) in the radiologist group and 140 minutes (IQR, 0 to 792) in the nephrologist group. Additionally, the D-H durations were 415 minutes (IQR,260 to 1,091) and 275 minutes (IQR, 123 to 598), respectively. These differences were statistically significant (p = 0.00). The TDC success rate (95.3% vs. 94.5%, respectively; p = 0.32) and complication rate (16.2% vs. 11%, respectively; p = 0.11) did not differ between the groups. The frequency (24.5 vs. 26%, respectively; p = 0.72) and the usage time of NDC (8,451 vs. 8,416 minutes, respectively; p = 0.91) before TDC placement were not statistically significant. CONCLUSIONS: Trained interventional nephrologists could perform TDC placement safely, minimizing treatment delays.
Catheters* ; Nephrology ; Physical Examination ; Renal Dialysis* ; Vascular Access Devices