Résumé
This study aimed to investigate the causes and managements of the fractures and migrations of the implantable venous access port catheter (IVAPC). The fracture or migration of IVAPC occurred in 4 patients who were treated between May 2012 and January 2014 in Union Hospital, Wuhan, China. The port catheter leakage was found in 2 cases during drug infusion. Catheters that dislodged to the superior vena cava and right atrium were confirmed by port angiogram. The two dislodged catheters were successfully retrieved by interventional procedures. Catheter fracture occurred in two cases during port removal. One catheter was eventually removed from the subclavian vein through right clavicle osteotomy and subclavian venotomy, and the other removed by external jugular venotomy. Flushing the port in high pressure and injury of the totally implantable venous access port (TIVP) during implantation are usually responsible for catheter displacement. Interventional retrieval procedure can be used if the catheter dislodges to the vena cava and right atrium. Catheter fracture may occur during removal if clipping syndrome occurs or the catheter is sutured very tight during implantation.
Sujets)
Enfant , Enfant d'âge préscolaire , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Angiographie , Cathéters à demeure , Voies veineuses centrales , Ablation de dispositif , Méthodes , Panne d'appareillage , Analyse de panne d'appareillage , Atrium du coeur , Imagerie diagnostique , Chirurgie générale , Ostéotomie , Méthodes , Techniques de suture , Veine cave supérieure , Imagerie diagnostique , Chirurgie généraleRésumé
BACKGROUND: A properly placed epidural catheter tip may become displaced out of the epidural space after being secured as a result of patient movement, a common cause of inadequate analgesia. This study was performed to evaluate the migration of an epidural catheter with patient movement. METHODS: Forty-six parturients planning to undergo a cesarean section under epidural anesthesia were enrolled. Patients were divided into two groups according to body mass index (BMI): 26 kg/m2. A 19-gauge single-orifice epidural catheter (Flextip Plus(TM), Arrow, USA) was inserted at the L(2-3) or L(3-4) interspace with the patient in the sitting flexed position. The distance to the epidural space and length of catheter position change was measured before the catheter was secured to the skin, as the patient moved from the sitting flexed to sitting upright and then to the lateral decubitus position with flexion and extension. RESULTS: Catheters were drawn inward with position change from the sitting flexed to lateral decubitus position, the magnitude increasing with BMI (0.73 +/- 0.40 cm vs. 0.98 +/- 0.35 cm). CONCLUSIONS: This study shows that the indrawing of the catheter with reference to the skin occurs as a patient changes position, and this indrawing can result in catheter dislodgement out of the epidural space.