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1.
J Vasc Access ; : 11297298241236816, 2024 May 06.
Article in English | MEDLINE | ID: mdl-38708819

ABSTRACT

BACKGROUND: Femoral ports are used in patients with indication to a totally implanted venous access device but with contraindication to chest-ports and brachial ports because of obstruction of the superior vena cava. In the last three decades, femoral ports have been implanted almost exclusively by cannulation of the common femoral vein at the groin, while the position of the tip has been assessed by X-ray. METHODS: We report our experience with a new approach to femoral ports, which includes recent methods and techniques developed in the last few years. These novel femoral ports, which we call "FICC-ports," are characterized by (a) long femoral 5 Fr polyurethane catheter inserted by ultrasound-guided puncture of the superficial femoral vein at mid-thigh; (b) intraprocedural location of the tip in the sub-diaphragmatic inferior vena cava, using ultrasound visualization by the transhepatic and/or the subcostal view; (c) low-profile or very low-profile reservoir implanted above the quadriceps muscle, at mid-thigh. RESULTS: In the last 3 years, we have implanted 47 FICC-ports in young adults with mediastinal lymphoma compressing the superior vena cava. We had no immediate/early complication, and only three late complications (one kinking of the catheter in the subcutaneous tissue; one tip migration with secondary venous thrombosis; one persistent withdrawal occlusion due to fibroblastic sleeve). CONCLUSION: If there is indication to a femoral port, the implantation of a "FICC-port"-as described above-is to be strongly considered in terms of safety, effectiveness, and cost-effectiveness: no immediate-early complications, minimal late complications, no X-ray exposure, low invasiveness, low cost.

2.
J Vasc Access ; 24(1): 165-182, 2023 Jan.
Article in English | MEDLINE | ID: mdl-34088239

ABSTRACT

Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.


Subject(s)
Catheterization, Central Venous , Catheterization, Peripheral , Adult , Humans , Consensus , Catheters , Cannula
3.
Med Ultrason ; 25(2): 201-207, 2023 Jun 26.
Article in English | MEDLINE | ID: mdl-36191248

ABSTRACT

The objective of this paper is to review and compare the different commercial and homemade models of ultrasound-guided vascular cannulation phantoms, as well as the methods used for the elaboration of the latter. There are a variety of simulators for ultrasound-guided puncture techniques, from simple homemade phantoms to the most sophisticated and expensive virtual reality simulators. Commercial-grade ultrasound phantoms are expensive and although they are reusable, their cost can be a barrier to simulation-based training. Homemade phantoms are a cost-effective, highly useful tool for teaching vascular access using ultrasound. For the elaboration of the homemade ones, different substances and elements are usually used to produce varied echogenicities and geometries. Specifically, animal-based ones provide more realistic tissue feedback and have a back-ground echogenicity that is closer to that of human tissue. A powerful alternative is the use of poly vinyl alcohol or modified mixtures of this material, which would be better suited to cannulation simulation with high functional fidelity.


Subject(s)
Catheterization , Ultrasonography, Interventional , Animals , Humans , Ultrasonography, Interventional/methods , Ultrasonography , Phantoms, Imaging
4.
J Vasc Access ; : 11297298221126818, 2022 Oct 06.
Article in English | MEDLINE | ID: mdl-36203365

ABSTRACT

INTRODUCTION: Current guidelines recommend intraprocedural methods-such as Intra-Cavitary ECG (IC-ECG) and echocardiography-for verifying the location of the tip of central venous catheters. Nonetheless, there are clinical conditions which may require to verify tip location by less accurate methods such as Chest X-Ray (CXR). We have compared the feasibility and accuracy of two radiological methods for tip location-the Sweet Spot Criterion (SSC) and the Carina Criterion (CC)-using IC-ECG as reference. METHODS: In this retrospective multicenter study, we reviewed the radiology databases of three hospitals, examining all CXRs performed on patients after insertion of Peripherally Inserted Central Catheters (PICCs), as long as the tip location had been successfully performed during the procedure by IC-ECG. Tip location was verified using SSC and CC, comparing the two methods in terms of feasibility and accuracy. RESULTS: We reviewed the CXR of 1116 PICCs successfully inserted by IC-ECG. CC was not feasible in 0.5% (impossible visualization of the carina) and difficult in 1.5%; in 97.7% of cases, the position of the tip was adequate (1-5 cm below the carina), in 0.6% too high (<1 cm), in 1.2% too low (6-9 cm). On the other hand, because of unclear visualization of radiological landmarks, SSC was not feasible in 0.9% and difficult in 10.5%; though, according to SSC the tip location was always acceptable (in 94.2% the tip was in the middle of the spot, in 2.5% close to the superior border, and in 2.3% close to the inferior border); no tip was visualized outside of the spot. CONCLUSION: CC and SSC were similar in terms of feasibility (99.5% vs 99.1%) and accuracy (98.1% vs 100%), though CC was subjectively perceived to be easier and more rapid to perform.

5.
Enferm. clín. (Ed. impr.) ; 23(4): 148-153, jul.-agos. 2013. tab, ima
Article in Spanish | IBECS | ID: ibc-114835

ABSTRACT

Objetivo Valorar la aplicabilidad, la factibilidad y la precisión de la técnica del IC-EKG con columna de suero en la verificación de la posición final de la punta del catéter central de inserción periférica (PICC) llevado a cabo por enfermeras especialistas. Método Se han implantado PICC en 99 pacientes consecutivamente. Se han excluido pacientes sin onda P en el EKG de superficie, pacientes con fibrilación auricular y pacientes con marcapasos. La técnica del IC-EKG se ha aplicado en 84 pacientes. Tras el implante se ha realizado placa de tórax a todos los pacientes y se ha comparado con el IC-EKG. Resultados Hemos obtenido una aplicabilidad del 84,4%, una factibilidad del 88% y una precisión del 87,8%. Conclusiones La técnica IC-EKG para la posición de la punta del PICC con columna de suero es fácil de aplicar, coste-eficaz, aplicable por enfermeras y no implica riesgos para el paciente. Supone la superación de una curva de aprendizaje y su ejecución por personal formado. La técnica se ejecuta durante el implante del PICC, por lo que la verificación se realiza in situ y con ello se disminuyen posteriores implantes por mal posicionamiento de la punta (AU)


Objective To evaluate the applicability, feasibility and accuracy of the IC-ECG with column of saline technique for verifying the final tip position of peripherally inserted central catheters (PICC) by specialist nurses. Method A total of 99 consecutive PICC were inserted. Patients with no superficial ECG P wave, atrial fibrillation, or a pacemaker were excluded. The IC-ECG technique was performed on 84 patients. A chest x-ray was performed after insertion in all cases, in order to compare images with IC-ECG. Results The technique showed an applicability of 84.4%, an feasibility of 88%, and an accuracy of 87.8%. Conclusions The IC-ECG technique for verification of catheter PICC tip locations with column of saline is easy to apply, is cost-effective, is achievable by nurses, and does not involve any risk for patients. The technique involves a learning curve, and it must be performed by qualified health care professionals. The technique is performed during the insertion of the catheter, so verification of the tip is made in situ. It reduces future re-insertions due to wrong positioning of the tip (AU)


Subject(s)
Humans , Catheterization, Peripheral/methods , Catheterization, Central Venous/methods , Electrocardiography , p Wave , Critical Care/methods
6.
Enferm Clin ; 23(4): 148-53, 2013.
Article in Spanish | MEDLINE | ID: mdl-23809166

ABSTRACT

OBJECTIVE: To evaluate the applicability, feasibility and accuracy of the IC-ECG with column of saline technique for verifying the final tip position of peripherally inserted central catheters (PICC) by specialist nurses. METHOD: A total of 99 consecutive PICC were inserted. Patients with no superficial ECG P wave, atrial fibrillation, or a pacemaker were excluded. The IC-ECG technique was performed on 84 patients. A chest x-ray was performed after insertion in all cases, in order to compare images with IC-ECG. RESULTS: The technique showed an applicability of 84.4%, an feasibility of 88%, and an accuracy of 87.8%. CONCLUSIONS: The IC-ECG technique for verification of catheter PICC tip locations with column of saline is easy to apply, is cost-effective, is achievable by nurses, and does not involve any risk for patients. The technique involves a learning curve, and it must be performed by qualified health care professionals. The technique is performed during the insertion of the catheter, so verification of the tip is made in situ. It reduces future re-insertions due to wrong positioning of the tip.


Subject(s)
Catheterization, Central Venous/methods , Central Venous Catheters , Electrocardiography , Monitoring, Intraoperative/methods , Catheterization, Peripheral , Feasibility Studies , Humans , Reproducibility of Results
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