Pseudo-tunneling procedure for PICC-ports catheters insertion in patients with small veins at the middle third of the arm.

BACKGROUND: Axillary vein in the brachial tract or Basilic vein in the proximal third of the arm usually present a diameter wide enough to receive a catheter of 5 Fr. Therefore, a peripherally inserted central catheters with port (PICC-Ports) cannot be positioned in these areas. Pseudo-tunneling procedure allows the positioning of the Port in the middle part of the arm without using tunnelers during insertion of PICC with Port in patients who present deep veins of the arm too small to receive a PICC-Port catheter. The aim of this study was to present our experience with pseudo-tunneling procedure during the positioning of the PICC-Port, while using a particular variation of the technique already described for PICCs and midline. METHODS: From January to December 2023, 103 PICC-Ports were placed in adult patients. Ninety catheters were tunneled from the puncture of the axillary vein at the proximal arm point, while we used this new technique in 42 patients by the same trained team of Vascular Access Unit at ASST Spedali Civili Hospital of Brescia. RESULTS: All procedures were successfully performed at the first attempt. No insertion related complications were observed. CONCLUSIONS: Our data suggest pseudo-tunnelling is a safe and effective technique for PICC-Ports insertion avoiding central venous catheterization, even in patient with small vein at the arms.

Guidewire replacement of valved tunneled-cuffed silicone catheters with power injectable polyurethane tunneled-cuffed catheters or with ports.

BACKGROUND: Silicone Cuffed Centrally Inserted Central venous catheters (CICCs) were a type of catheters that have been used for a long time especially in cancer patients. Recently, thanks to biomedic research progresses, polyurethane catheters have resulted in higher surgical performances compared to classical silicone ones. Indeed, the inferior calibers of these new catheters lead to an extremely faster infusion rate. The presence of a valve at the tip of the catheter could suggest an impossible replacement procedure over a Seldinger guidewire. METHOD: The aim of this article is to explain our replacement technique over guidewire of silicone cuffed and valved tunneled CICCs with a power injectable polyurethane cuffed tunneled CICC. The casistic presented was evaluated at the Vascular Access Unit of ASST Spedali Civili in Brescia, Italy. The study involved 35 successful catheter replacement over guidewire, meanwhile cases where patients presented sepsis, exit site infection, or catheter damage were premeditatedly excluded. RESULTS: The maneuver was always conducted following the same procedure without noticing particular complications associated with CICC insertion. Indeed, the operation was quick, feasible, and safe. Septic, thromboembolic, or hemorrhagic complications also related to patients presenting dysfunctional coagulation cascade were not encountered. CONCLUSIONS: Our experience regarding the replacement technique of silicone cuffed and valved catheters over guidewire was considered feasible, accurate, and efficient for all patients treated, even in those presenting thrombocytopenia or a dysfunctional coagulation cascade.

Guidewire replacement of tunneled central venous catheters in children reusing the same subcutaneous route.

BACKGROUND: Tunneled centrally inserted central venous catheters (CICCs) are a type of catheters used especially in cancer pediatric patients or affected from short bowel disease and malabsorption. Recently, thanks to biomedical research progresses, polyurethane catheters have resulted in high surgical performances with a low caliber but extremely fast infusion rate. Sometimes the replacement procedure over a Seldinger guidewire could be an appreciable technique especially reusing the same vein and the same tunnel of the previous catheter, with local anesthesia. The aim of this article was to explain our replacement technique over guidewire of tunneled CICCs on pediatric patients. METHODS: The casuistry presented was evaluated at the Unit of Vascular Access of ASST Spedali Civili in Brescia, Italy. The study involved 7 successful catheter replacement over guidewire, meanwhile cases where patients presented sepsis, exit site infection or catheter damage were premeditatedly excluded. Three of them were tunneled and cuffed. Five catheters were in brachiocephalic vein and 2 in internal jugular vein. RESULTS: Every procedure was ended without complications. Of seven patients, five of them underwent to the procedure only with local anesthesia and 2 patients require premedication with Midazolam. No one required general anesthesia. The maneuver was always conducted following the same procedure without noticing particular complications associated with CICC insertion. Indeed, the operation was quick, feasible and safe. Septic, thromboembolic, or hemorrhagic complications also related to patients presenting dysfunctional coagulation cascade were not encountered. CONCLUSIONS: Our experience regarding the replacement technique of tunneled catheters over guidewire was considered feasible, accurate and efficient for all patients treated, even in those presenting thrombocytopenia or dysfunctional coagulation cascade.

How to remove a tunneled and cuffed central venous catheter quickly and safely? A little trick useful in children.

BACKGROUND: The aim of this study was to present our experience with a use of own variation of the traditional technique for tunneled and cuffed catheters removal. METHODS: From July 2021 to March 2023, 110 tunneled cuffed centrally inserted central catheters (CICCs) were removed at the Vascular Access Unit of ASST Spedali Civili of Brescia using our particular technique; pediatric patients were 15 admitted to "Children Hospital" of Brescia. The catheter is cut with its adhesions above the cuff and then pulled out. The cuff is then removed with all adhesions attached. RESULTS: Each procedure was successfully performed to the end with local anesthesia, also in younger children. The maneuver was very short and well tolerated. No related complications were observed. The maneuver has always been considered easy even by less experienced surgeons. The scars were aesthetically good and well accepted by the patients. CONCLUSIONS: The technique described has the advantage of not requiring the careful lysis of the adherence from the cuff. If the procedure is quick it can be performed without general anesthesia and without significant psychological trauma also in less compliant children. The skin cut very short leaves an almost invisible scar. It is another notable advantage especially for young girls.

Pseudo-tunneling procedure: An easy technique for insertion of PICCs and Midline catheters in patients with small veins of the arm.

BACKGROUND: Axillary vein in the brachial tract or Basilic vein in the proximal third of the arm has got usually an enough diameter to receive a catheter of 4 or 5 Fr. In this case the exit site should be too proximal to the axilla with an higher risk of infection. Pseudo-tunneling procedure can create an exit site at the middle of the arm without using tunnelers during insertion of Peripherally Inserted Central Catheters and Midlines in patients who present deep veins of the arm too small to receive a catheter to consent infusion and blood samples. AIM: The aim of this study is to present our experience with pseudo-tunneling procedure, also using a particular variation of the technique. METHODS: From January 2014 to August 2022 150 Peripherally Inserted Central Catheters and 221 Midlines were insert in pediatric and adults patients with too small deep veins at the middle third of the arm with this technique by the same trained team of Vascular Access Unit at ASST Spedali Civili Hospital of Brescia. RESULTS: All procedures were successfully performed at the first or at the second attempt. No insertion related complications were observed. CONCLUSIONS: Our data suggest pseudo-tunneling technique is a safe and effective procedure for of Peripherally Inserted Central Catheters and Midline insertion avoiding central venous catheterization even in patient with small vein at the arms.

Pseudo-tunneling procedure: an advantageous and safe technique for brachial catheters in younger children.

BACKGROUND: The aim of this study is to present our experience with the use of a particular tunneling technique called pseudo-tunnelling, during insertion of peripherally inserted central catheters (PICCs) and Midlines in younger patients. The children's brachial veins at the middle third of the arm are usually too small for cannulation. So the veins in the axilla are the best option for implantation of a four or five French catheter. A pseudo-tunneling procedure can create an exit site at the middle of the arm without using other procedural sets. METHODS: From January 2014 to August 2022, 60 PICCs and 113 midlines were inserted in children admitted to Children Hospital of Brescia. RESULTS: Every procedure was successfully performed during the first or the second time at latest. The time of procedure was not significantly different from non tunnelized procedures. No insertion related complications were observed. CONCLUSIONS: Our data suggests that pseudo-tunneling is a safe and effective procedure for brachial device implants to avoid central venous catheterization even in pediatric patients.