The journal of vascular access
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Peripherally inserted central catheters are venous devices intended for short to medium periods of intravenous treatment. Positioning of the catheter tip at the cavoatrial junction is necessary for optimum performance of a peripherally inserted central catheter. In this study, safety, effectiveness and cost-effectiveness of electrocardiographic-guided peripherally inserted central catheter positioning in a Dutch teaching hospital were evaluated. ⋯ Implementation of electrocardiographic-guided tip positioning for peripherally inserted central catheter was safe and effective in this study and led to an improved high value and cost-conscious care.
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Observational Study
Electrocardiography-controlled central venous catheter tip positioning in patients with atrial fibrillation.
A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. ⋯ Electrocardiography-guided central venous catheter tip positioning is a feasible real-time method for patients with atrial fibrillation. Combined with ultrasound, the electrocardiography-controlled central venous catheter placement may eliminate the need for postinterventional radiation exposure.
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For arrhythmia treatment or sudden cardiac death prevention in hemodialysis patients, there is a frequent need for placement of a cardiac implantable electronic device (pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization device). Leads from a cardiac implantable electronic device can cause central vein stenosis and carry the risk of tricuspid regurgitation or contribute to infective endocarditis. ⋯ Whenever feasible, one should avoid transvenous leads and choose alternative options such as subcutaneous implantable cardioverter defibrillator, epicardial leads, and leadless pacemaker. Based on recent reports on the leadless pacemaker/implantable cardioverter defibrillator effectiveness, in patients with rapid progression of chronic kidney disease (high risk of renal failure) or glomerular filtration rate <20 mL/min/1.73 m2, this option should be considered by the implanting cardiologist for future access protection.
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Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. ⋯ Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.
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Comparative Study
Comparison of two types of catheters through femoral vein catheterization in patients with lung cancer undergoing chemotherapy: A retrospective study.
This study aimed to investigate the effects and complications of different types of peripherally inserted central catheters through femoral vein catheterization in patients with lung cancer undergoing chemotherapy. ⋯ Single-lumen power-injectable peripherally inserted central catheters with no valve had a high gravity flow rate, were strong and not prone to rupture, tolerant to high-pressure injection, and were more suitable for femorally inserted central venous catheterization in patients with lung cancer undergoing chemotherapy.