ACR logo

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Dariushnia SR, Wallace MJ, Siddiqi NH, et al. Quality improvement guidelines for central venous access. J Vasc Interv Radiol 2010;21:976-81. Review/Other-Tx N/A To provide quality improvement guidelines for central venous access. No abstract available. 4
2. Basford TJ, Poenaru D, Silva M. Comparison of delayed complications of central venous catheters placed surgically or radiologically in pediatric oncology patients. J Pediatr Surg 2003;38:788-92. Observational-Tx 98 CVCs, 52 external tunneled catheters, 46 subcutaneous ports, in 67 patients To compare the frequency of delayed complications in CVCs placed surgically or radiologically in a pediatric oncology population. Median patient age was 6.1 years for children with external catheters and 7.8 years for those with ports. Both infectious and mechanical complications were significantly more common among surgically placed ETCs than those placed radiologically (P <.05). Complications per 1,000 catheter days and premature removal showed a trend toward greater frequency among surgical ETCs, although this did not reach statistical significance. No consistent trends were seen in complications among ports. 2
3. Busch JD, Herrmann J, Heller F, et al. Follow-up of radiologically totally implanted central venous access ports of the upper arm: long-term complications in 127,750 catheter-days. AJR Am J Roentgenol 2012;199:447-52. Review/Other-Tx 512 complete datasets of procedures To retrospectively evaluate radiologically totally implanted central venous access ports (VAPs) of the upper arm in terms of safety, technical feasibility, and device-related complications. In 507 patients, a total of 523 devices were implanted. Of these 523 procedures, 512 complete datasets were available during follow-up. The primary technical success rate was 99.04%. All procedures were completed without major complications. During follow-up and with a total number of 127,750 days of totally implanted central VAP implantation (248 +/- 279 days/patient; range, 1-1687 days/patient), 50 devices had to be revised because of complications (9.8%). Complications occurred at a mean of 114 +/- 183 days (range, 1-1113 days) after placement. Early complications were noted in 21 of 512 cases (4.1%), and late complications were noted in 29 of 512 cases (5.7%). Complications were as follows: local infections, 4.9% (25/512); systemic infections, 0.4% (2/512); venous thrombosis, 1.6% (8/512); paralysis of the median nerve, 0.6% (3/512); skin dehiscence at the port site, 0.2% (1/512); and mechanical problems including catheter line displacement, port hub rotation, and catheter fracture, 2.1% (11/512). 4
4. Koroglu M, Demir M, Koroglu BK, et al. Percutaneous placement of central venous catheters: comparing the anatomical landmark method with the radiologically guided technique for central venous catheterization through the internal jugular vein in emergent hemodialysis patients. Acta Radiol 2006;47:43-7. Experimental-Tx 40 anatomical landmark method; 40 radiologically guided technique To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. 1
5. McBride KD, Fisher R, Warnock N, Winfield DA, Reed MW, Gaines PA. A comparative analysis of radiological and surgical placement of central venous catheters. Cardiovasc Intervent Radiol 1997;20:17-22. Observational-Tx 253 Hickman catheters in 209 patients To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution. There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p < 0.001). Average catheter life-span was similar for the two placement methods (100 +/- 23 days). 2
6. Reeves AR, Seshadri R, Trerotola SO. Recent trends in central venous catheter placement: a comparison of interventional radiology with other specialties. J Vasc Interv Radiol 2001;12:1211-4. Review/Other-Tx N/A To determine the percentage of venous access procedures performed by each specialty in the last 5 years and to evaluate trends in venous access. A secondary goal was to track overall growth of venous access procedures in IR. The authors determined changing trends and growth in tunneled and nontunneled central venous catheter placement procedures. With use of Medicare billing data for tunneled and nontunneled catheter placement, a comparison was made among interventional radiology (IR), surgery, anesthesia, and internal medicine. There has been substantial growth in the placement of central venous catheters. Currently, a minority of these procedures are performed in IR departments. However, there has been significant growth in the radiologic placement of both types of catheters. 4
7. Teichgraber UK, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011;21:1224-32. Review/Other-Tx 3,160 port catheter systems To evaluate the success and complication rates after radiologically guided port catheter implantation. 922,599 catheter days (mean, 292 days; range, 0-2,704 days) were documented. The implantation was successful in 3,153 (99.8%) cases. A total of 374 (11.8%; 0.41/1,000 catheter days) adverse events were recorded. Of these, 42 (1.33%) were periprocedural complications. 86 (3.3%; 0.09/1,000 catheter days) early and 246 (9.4%; 0.27/1,000 catheter days) late onset complications occurred after port implantation. The most common complications were blood stream infection (n = 134; 5.1%; 0.15/1,000 catheter days), catheter-induced venous thrombosis (n = 97; 3.7%; 0.11/1,000 catheter days) and catheter migration (n = 34; 1.3%; 0.04/1,000 catheter days). A total of 193 (6.1%) port explantations were required. 4
8. Freire MP, Pierrotti LC, Zerati AE, et al. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors. Infect Control Hosp Epidemiol 2013;34:671-7. Observational-Tx 966 CVADs (mostly venous ports) in 933 patients To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days ([Formula: see text]). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. 2
9. Caparas JV, Hu JP. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. J. vasc. access. 15(4):251-6, 2014 Jul-Aug. Experimental-Tx 29 patients = Midline Group; 25 patients = PICC Group To determine if intravenous vancomycin could be safely administered through a novel midline catheter (POWERWAND®, Access Scientific, San Diego, CA). The two groups did not differ significantly with respect to total complications (17.9% with PICCs vs. 19.9% with the midline), phlebitis (0% vs. 0%) or thrombosis (0% vs. 0%). One suspected catheter-associated bloodstream infection did occur in the PICC group. Insertion costs were $90.00 less per insertion in the midline group. 1
10. Tomas-Lopez MA, Cristobal-Dominguez E, Baez-Gurruchaga O, et al. Experience in the use of midclavicular catheters: An inception cohort study. J Clin Nurs 2021. Observational-Tx 1,841 participants To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal. Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age =70 years and home therapy were associated with a lower likelihood of catheter failure. 2
11. Takashima M, Schults J, Mihala G, Corley A, Ullman A. Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings. Crit Care Med. 46(12):1998-2009, 2018 12. Meta-analysis 63 studies To examine the proportion and rate of central venous access device failure and complications across central venous access device types in adult intensive care. A total of 63 studies involving 50,000 central venous access devices (396,951 catheter days) were included. Central venous access device failure was 5% (95% CI, 3-6%), with the highest rates and proportion of failure in hemodialysis catheters. Overall central line-associated bloodstream infection rate was 4.59 per 1,000 catheter days (95% CI, 2.31-6.86), with the highest rate in nontunneled central venous access devices. Removal of central venous access device due to suspected infection was high (17%; 20.4 per 1,000 catheter days; 95% CI, 15.7-25.2). Good
12. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71. Meta-analysis 200 studies To better understand the absolute and relative risks of bloodstream Infection (BSI) associated with the various types of intravascular devices (IVDs) by analyzing 200 published studies of adults in which every device in the study population was prospectively evaluated for evidence of associated infection and microbiologically based criteria were used to define IVD-related BSI. Point incidence rates of IVD-related BSI were lowest with peripheral Intravenous catheters (0.1%, 0.5 per 1000 IVD-days) and midline catheters (0.4%, 0.2 per 1000 catheter-days). Far higher rates were seen with short-term noncuffed and nonmedicated central venous catheters (CVCs) (4.4%, 2.7 per 1000 catheter-days). Arterial catheters used for hemodynamic monitoring (0.8%, 1.7 per 1000 catheter-days) and peripherally inserted central catheters used in hospitalized patients (2.4%, 2.1 per 1000 catheter-days) posed risks approaching those seen with short-term conventional CVCs used in the Intensive care unit. Surgically implanted long-term central venous devices--cuffed and tunneled catheters (22.5%, 1.6 per 1000 IVD-days) and central venous ports (3.6%, 0.1 per 1000 IVD-days)--appear to have high rates of Infection when risk Is expressed as BSIs per 100 IVDs but actually pose much lower risk when rates are expressed per 1000 IVD-days. The use of cuffed and tunneled dual lumen CVCs rather than noncuffed, nontunneled catheters for temporary hemodlalysis and novel preventive technologies, such as CVCs with anti-infective surfaces, was associated with considerably lower rates of catheter-related BSI. M
13. Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489-95. Meta-analysis 115 patients in study population plus 33 studies To determine the risk of PICC-related BSI in hospitalized patients. Overall, 115 patients had 251 PICCs placed. Mean duration of catheterization was 11.3 days (total, 2,832 PICC-days); 42% of the patients were in an ICU at some time, 62% had urinary catheters, and 49% had received mechanical ventilation. Six PICC-related BSIs were identified (2.4%), four with coagulase-negative staphylococcus, one with Staphylococcus aureus, and one with Klebsiella pneumoniae, a rate of 2.1 per 1,000 catheter-days. M
14. Turcotte S, Dube S, Beauchamp G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 2006;30:1605-19. Review/Other-Tx 48 studies To compare the associated infectious, thrombotic, phlebitic, and other common complications, as well as PICC and CVC durability. Our results show that infectious complications do not significantly differ between PICC and CVC. Thrombotic complications appear to be more significant with PICC and to occur early after catheterization. Phlebitic complications accounted for premature catheter removal in approximately 6% of PICC. Finally, prospective data suggest that approximately 40% of PICC will have to be removed before completion of therapy, possibly more often and earlier than CVC. 4
15. Bonizzoli M, Batacchi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011;37:284-9. Observational-Tx 239 patients To determine the thrombosis rate in relation to PICC placement in patients discharged from the intensive care unit (ICU). Data of 239 patients were analyzed (125 of CVC group, 114 of PICC group). A total of 2,747 CVC-days and 4,024 PICC-days of observation were included. Patient characteristics were comparable between groups. Patients with PICC had a significantly higher incidence rate of deep venous thrombosis (DVT) than patients with CVC (27.2 vs. 9.6%, P = 0.0012). The rate of DVT/1,000 catheter days was 4.4 for CVCs and 7.7 for PICCs. Eighty percent of DVTs occurred within 2 weeks after insertion. Binary logistic analysis showed a two-fold increased risk for women and a three-fold increased risk when using the left basilic vein in the PICC group. 1
16. Trerotola SO, Stavropoulos SW, Mondschein JI, et al. Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010;256:312-20. Experimental-Tx 50 patients To prospectively evaluate outcomes associated with use of a triple-lumen (TL) peripherally inserted central catheter (PICC) in the intensive care unit (ICU) setting. The study was stopped prematurely after 50 of a planned 167 patients were enrolled when a scheduled interim analysis detected a venous thrombosis rate that was considered unacceptably high by the study oversight committee (thrombosis was symptomatic in 20% of patients [10 of 50]). Venous thrombosis (symptomatic or asymptomatic) was detected in 26 of 45 patients (58%; 95% confidence interval [CI]: 43%, 72%) examined with US. Documented catheter-related bloodstream infection did not occur (0%; 95% CI: 0%, 7%); colonization was detected in three of 29 catheter tips sent for culture (10%; 95% CI: 2%, 27%). Catheter malfunction and dislodgment occurred in one patient each. 1
17. Sanfilippo F, Noto A, Martucci G, Farbo M, Burgio G, Biasucci DG. Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis. [Review]. J. vasc. access. 18(4):273-278, 2017 Jul 14. Review/Other-Tx 3 studies To investigate whether the difference between PICC- and CICC-measured CVP is not significant. Four studies matched the inclusion criteria, but only three of them provided data for the meta-analyses. Both analyses showed non-significant differences between PICC-measured and CICC-measured CVP: 1489 paired simultaneous CVP assessments (MD 0.16, 95%CI -0.14, 0.45, p = 0.30) on a total of 57 patients (MD 0.22, 95%CI -1.46, 1.91, p = 0.80). Both analyses showed no heterogeneity (I2 = 0%). 4
18. Mendu ML, May MF, Kaze AD, et al. Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study. BMC Nephrol. 18(1):351, 2017 Dec 04. Observational-Tx 154 patients To compare differences in renal replacement delivery and mechanical and infectious outcomes between NTDCs and TDCs. Patients who received TDCs had significantly better RRT delivery, both with continuous venovenous hemofiltration (CVVH) and intermittent hemodialysis (IHD), compared to patients who received NTDCs; these findings were confirmed after multivariable adjustment for AKI-specific disease severity score, history of chronic kidney disease, renal consult team, and AKI cause. In CVVH and IHD, the median venous and arterial blood flow pressures were significantly higher with TDCs compared to NTDCs (p < 0.001). Additionally for CVVH, the median number of interruptions per catheter was higher with NTDCs compared to TDCs (Rate Ratio (RR) 2.7; p < 0.001), and for IHD, a higher median blood flow was seen with TDCs (p < 0.001). There were a significantly higher number of mechanical complications with NTDCs (RR 13.6 p = 0.001). No significant difference was observed between TDCs and NTDCs for positive blood cultures per catheter. 2
19. van Oevelen M, Abrahams AC, Weijmer MC, et al. Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study. J. vasc. access. 20(3):307-312, 2019 May. Observational-Tx 1603 patients To assess whether precurved non-tunnelled central venous catheters are comparable to tunnelled central venous catheters in terms of infection and catheter malfunction and to assess whether precurved non-tunnelled catheters are superior to straight catheters. A total of 1603 patients were included. No difference in reaching the primary endpoint was seen between tunnelled catheters, compared to precurved non-tunnelled catheters (hazard ratio, 0.91; 95% confidence interval, 0.70-1.19, p = 0.48). Tunnelled catheters were removed less often, compared to precurved non-tunnelled catheters (hazard ratio, 0.65; 95% confidence interval, 0.46-0.93; p = 0.02). A trend for less infections and catheter malfunctions was seen in precurved jugular non-tunnelled catheters compared to straight non-tunnelled catheters (hazard ratio, 0.60; 95% confidence interval, 0.24-1.50; p = 0.28) and were removed less often (hazard ratio, 0.41; 95% confidence interval, 0.18-0.93; p = 0.03). 3
20. Patel GS, Jain K, Kumar R, et al. Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies. Support Care Cancer 2014;22:121-8. Experimental-Tx 70 patients To compare the safety and cost of two commonly used CVCs, peripherally inserted central venous catheter (PICCs) and ports, in the delivery of chemotherapy in patients with non-haematological malignancies. Port devices were associated with fewer complications compared with PICC lines (hazard ratio of 0.25, CI, 0.09-0.86, P = 0.038). Major complication rate was lower in the port arm compared to the PICC arm (0.047 versus 0.193 major complications/100 catheter days, P = 0.034) with 6 versus 20 % of patients experiencing major complications, respectively. Thrombosis, the most common complication, was significantly higher in the PICC arm compared to the port arm (25 versus 0 %, P = 0.013). Quality of life and cost estimates did not differ significantly between the two arms. 1
21. Pu YL, Li ZS, Zhi XX, et al. Complications and Costs of Peripherally Inserted Central Venous Catheters Compared With Implantable Port Catheters for Cancer Patients: A Meta-analysis. Cancer Nurs. 43(6):455-467, 2020 Nov/Dec. Meta-analysis 15 studies To compare the differences of complications and costs of PICC and IPC in the treatment of cancer patients with chemotherapy and to provide a basis for better clinical decision making. A total of 761 articles were retrieved, with 15 articles meeting eligibility criteria. Outcome analysis showed no difference in 1-puncture success rate. Peripherally inserted central catheter use was associated with higher complication rates than IPC, including occlusion, infection, malposition, catheter-related thrombosis, extravasation, phlebitis, and accidental removal rate. The life span of IPC was longer than that of PICC, and the costs of IPC were lower. Not Assessed
22. Taxbro K, Hammarskjold F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth. 122(6):734-741, 2019 Jun. Experimental-Tx 399 participants (PICC, n=201; PORT, n=198) To study the incidence of catheter-related deep venous thrombosis in patients with cancer receiving chemotherapy through either a PICC or a PORT. The trial recruited 399 participants (PICC, n=201; PORT, n=198) between March 2013 and February 2017. The PICCs were associated with 16 (8%) deep venous thromboses compared with two (1%) in the PORT group (HR=10.2; 95% confidence interval, 2.3-44.6; P=0.002). The overall incidence of composite adverse events was higher for patients with a PICC compared with those with a PORT (HR=2.7; 95% confidence interval, 1.6-4.6; P<0.001). 1
23. Biffi R, Orsi F, Pozzi S, et al. Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial. Ann Oncol 2009;20:935-40. Experimental-Tx 401 patients To compare two different percutaneous routes of access to superior vena cava (subclavian and internal jugular) with a surgical cut-down access through the cephalicvein, evaluating early and late complications, including pneumothorax, clinically relevant bleeding, primary malposition, port-related bacteremia, pocket infections, late dislocation, fibrin sleeve formation, malfunction of the device, extravasation, clinically evident and silent venous thrombosis at anytime. Four hundred and one patients (99.9%) were assessable: 132 with the internal jugular, 136 with the subclavian and 133 with the cephalic vein access. The median follow-up was 356.5 days (range 0-1087). No differences were found for early complication rate in the three groups {internal jugular: 0% [95% confidence interval (CI) 0.0% to 2.7%], subclavian: 0% (95% CI 0.0% to 2.7%), cephalic: 1.5% (95% CI 0.1% to 5.3%)}. US-guided subclavian insertion site had significantly lower failures (e.g. failed attempts to place the catheter in agreement with the original arm of randomization, P = 0.001). Infections occurred in one, three and one patients (internal jugular, subclavian and cephalic access, respectively, P = 0.464), whereas venous thrombosis was observed in 15, 8 and 11 patients (P = 0.272). 1
24. Furuhashi S, Morita Y, Ida S, et al. Risk Factors for Totally Implantable Central Venous Access Port-related Infection in Patients With Malignancy. Anticancer Res. 41(3):1547-1553, 2021 Mar. Observational-Tx 324 patients To identify the risk factors of totally implantable central venous access port (TICVAP)-related infections in patients with malignant disease. With a median TICVAP duration of 268 days (range=1-1,859 days), TICVAP-related complications were observed in 36 cases and infectious complications in late phase were the most common, seen in 19 cases (9.26%). A multivariate analysis showed that patients with head and neck malignancy (p<0.001) and patients who received TICVAP insertion in the upper arm (p<0.001) were independently at a higher risk for TICVAP-related infections. 3
25. Jiang M, Li CL, Pan CQ, Cui XW, Dietrich CF. Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta-analysis. J Thromb Haemost. 18(9):2253-2273, 2020 09. Meta-analysis 80 studies (39,148 patients) To quantify the incidence of TIVAP-associated VTE and compare it with external central venous catheters (CVCs) in cancer patients through a meta-analysis. In total, 80 studies (11 with a comparison group and 69 without) including 39 148 patients were retrieved. In the noncomparison studies, the overall symptomatic VTE incidence was 2.76% (95% confidence interval [CI]: 2.24-3.28), and 0.08 (95 CI: 0.06-0.10) per 1000 catheter-days. This risk was highest when TIVAPs were inserted via the upper-extremity vein (3.54%, 95% CI: 2.94-4.76). Our meta-analysis of the case-control studies showed that TIVAPs were associated with a decreased risk of VTE compared with peripherally inserted central catheters (OR = 0.20, 95% CI: 0.09-0.43), and a trend for lower VTE risk compared with Hickman catheters (OR = 0.75, 95% CI: 0.37-1.50). Meta-regression models suggested that regional difference may significantly impact on the incidence of VTE associated with TIVAPs. Inadequate
26. Jiang M, Li CL, Pan CQ, Yu L. The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis. Support Care Cancer. 28(1):361-372, 2020 Jan. Meta-analysis 26 studies To provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs). In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31-0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22-0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38-0.79]). Good
27. Kulkarni S, Wu O, Kasthuri R, Moss JG. Centrally inserted external catheters and totally implantable ports for the delivery of chemotherapy: a systematic review and meta-analysis of device-related complications. Cardiovasc Intervent Radiol 2014;37:990-1008. Meta-analysis 5 RCTs and 25 observational studies To evaluate the risks of complications (infectious and non-infectious) including the need for device removal associated with centrally inserted external catheters compared with totally implantable ports in patients undergoing chemotherapy. Overall, five RCTs and 25 observational studies were included in the study. The studies were heterogeneous, and included adults and children, with different types of cancer, undergoing chemotherapy. Based on the pooled estimates from included studies, external catheters were associated with approximately a three to four-fold increase in the risks of infections, non-infectious complications and device removal compared implantable ports. M
28. Yoshida J, Ishimaru T, Kikuchi T, Matsubara N, Asano I. Association between risk of bloodstream infection and duration of use of totally implantable access ports and central lines: a 24-month study. Am J Infect Control 2011;39:e39-43. Observational-Tx 977 patients To evaluate over a 24-month period the association between risk of BSI and duration of AP use in comparison with the use of a central venous line (CL). BSIs occurred in 81 patients with an AP, for a BSI rate of 2.81 cases per 1,000 days of use. Among the 896 patients with a CL, the BSI rate was 5.60 cases per 1,000 days of use. The ROC analysis found a cutoff time of 33 days for APs (median days of use, 48) and 10 days for CLs (median days of use, 20.5). For the total 22,481 days of use, the odds ratio between APs and CLs with respect to BSI was 0.556 (95% confidence interval [CI], 0.256-1.208; P = .138). Days of use beyond the cutoff had an odds ratio of 2.867 (95% CI, 1.823-4.507; P < .001). Among the risk factors, preexisting sepsis had an odds ratio of 7.843 (95% CI, 4.666-13.184; P < .001). 3
29. Sriskandarajah P, Webb K, Chisholm D, et al. Retrospective cohort analysis comparing the incidence of deep vein thromboses between peripherally-inserted and long-term skin tunneled venous catheters in hemato-oncology patients. Thromb J 2015;13:21. Observational-Tx 346 PICC and 237 LTSTC patients To compare the cumulative incidence of thrombotic events between peripherally-inserted and long term skin tunneled venous catheters. 346 patients had a PICC inserted with cumulative incidence of symptomatic thrombosis of 5.8%, while 237 patients had a LTSTC inserted with a cumulative incidence of 1.7% (p = 0.003). Post-thrombotic complication rates, particularly infection, were higher in the PICC group compared to the LTSTC group (p = 0.597). 2
30. Carde P, Cosset-Delaigue MF, Laplanche A, Chareau I. Classical external indwelling central venous catheter versus totally implanted venous access systems for chemotherapy administration: a randomized trial in 100 patients with solid tumors. Eur J Cancer Clin Oncol 1989;25:939-44. Experimental-Tx 96 total patients (CE Group = 46 patients, TI Group = 50 patients) To assess the reliability of classical external catheters (CE) versus totally implanted access systems (TI) for delivering intravenous chemotherapy for a duration of at least 6 months. The analysis was performed on the 96 patients whose implantation succeeded (CE 46, TI 50). Failure was defined as loss of ability to function (followed by removal) within the 6-month period of the survey. Patients dying with functional catheters were considered as censored (15 cases) at the time of death. Twenty-four access systems were removed. The removal-free curves differ significantly (P less than 0.001), favoring the TI access systems. The main reasons for removal were: catheter fall (CE6, (TI 0), migration (CE 1, TI 1), infection (CE 5, TI 1), thrombotic occlusion (CE 1, TI 0) and venous complications (CE 1 thrombosis plus 1 pulmonary embolism, TI 1 thrombosis). In addition, a survey by questionnaire demonstrated a significantly better patient activity rate (P = 0.02) and hygiene (P less than 0.001) in the TI group. 1
31. Cotogni P, Mussa B, Degiorgis C, De Francesco A, Pittiruti M. Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days. JPEN J Parenter Enteral Nutr 2021;45:768-76. Observational-Tx 761 patients To compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. 2
32. Vashi PG, Virginkar N, Popiel B, Edwin P, Gupta D. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis. 17(1):372, 2017 05 30. Observational-Tx 335 patients To evaluate the incidence of and factors associated with CRBSIs in cancer patients undergoing HPN managed using a standardized catheter care protocol. Of 335 patients, 193 were females and 142 were males. The most common cancer types were colorectal, pancreatic, ovarian and stomach. A total of 408 VADs in 335 patients were studied, covering a total of 29,403 HPN days. Of 408 VADs, 206 (50.5%) were ports, 191 (46.8%) were PICCs, and 7 (2.7%) were TCCs. The median duration of HPN was 54 days. A total of 16 CRBSI episodes were recorded (8 in ports, 7 in PICCs and 1 in TCCs). The median duration from the start of HPN to the development of CRBSI episodes was 43.5 days. The overall incidence of CRBSI per 1000 HPN days was 0.54 (95% confidence interval: 0.32-0.86). Upon univariate analysis, no variables were found to be statistically significantly associated with CRBSI incidence. 3
33. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M, Espen. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009;28:365-77. Review/Other-Tx N/A To provide general recommendations about the indications for and the use of the different types of venous access devices available for parenteral nutrition. The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion and maintenance. These too depend on appropriate choice of device, skilled implantation and correct positioning of the catheter, adequate stabilization of the device (preferably avoiding stitches), and the use of infusion pumps, as well as adequate policies for flushing and locking lines which are not in use. 4
34. Gavin NC, Button E, Castillo MI, et al. Does a Dedicated Lumen for Parenteral Nutrition Administration Reduce the Risk of Catheter-Related Bloodstream Infections? A Systematic Literature Review. [Review]. J Infus Nurs. 41(2):122-130, 2018 Mar/Apr. Review/Other-Tx N/A To report comparative rates of catheter-related bloodstream infection (CR-BSI) in patients with CVADs who received PN through a dedicated lumen compared with those who had PN administered through multilumen CVADs. Two studies included 650 patients with 1349 CVADs. CR-BSIs were equally distributed between the 2 groups. Both studies were poorly reported and had significant risk of bias. These results should be interpreted with caution. 4
35. Cho CH, Schlattmann P, Nagel S, Schmittbuttner N, Hartung F, Teichgraber UK. Cephalad dislocation of PICCs under different upper limb positions: influence of age, gender, BMI, number of lumens. J. vasc. access. 19(2):141-145, 2018 Mar. Observational-Tx 162 patients To evaluate parameters that influence the amount of movement of peripherally inserted central catheter (PICC) tips regarding upper limb movement. Up to 88% of the PICCs dislocated in a mean of 19 mm cephalad when the patient was positioned from a supine in an upright position. The greatest influence upon dislocation was the position change from supine to upright. The side of the implanted PICC (left vs. right) had no influence. 2
36. Gonsalves CF, Eschelman DJ, Sullivan KL, DuBois N, Bonn J. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 2003;26:123-7. Observational-Tx 150 patients To determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters (PICCs) and venous ports. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n = 154) at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p = 0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access devices. 2
37. Aljarrah Q, Allouh M, Hallak AH, et al. Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease. Vasc Health Risk Manag. 16:419-427, 2020. Observational-Tx 66 hemodialysis patients To assess several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis. The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p<0.001), followed by type 2 diabetes mellitus (47.0 %, p<0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p<0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p<0.01). 3
38. Cimochowski GE, Worley E, Rutherford WE, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis. Nephron 1990;54:154-61. Observational-Tx 52 patients with 85 catheters To ascertain the occurrence and severity of this potential complication, i.e. late strictures of the subclavian vein following temporary catheter dialysis via the subclavian or internal jugular route. The two groups were statistically similar with respect to age, sex and race. The subclavian catheters were left in for a mean of 11.5 days (2-22) while the internal jugular ones were inserted for 15.8 days (5-25; p = 0.0015). One hundred percent of the internal jugular patients were free of any venogram abnormalities in their venous access return. In marked contrast, 50% of the subclavian sites had mild to severe stricutures with 90% having 70-100% occlusion of the subclavian vein. Six patients had bilateral severe strictures. 2
39. Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991;6:722-4. Experimental-Tx 100 total patients (50 patients = First Group; 50 patients = Second Group) To study angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subclavian catheter for 50 (first group) and by internal jugular catheter for the 50 others (second group). These two groups were not statistically different as regards age (61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second), sex (48% and 56% were women), duration of catheter insertion (31 +/- 21.8 and 31.7 +/- 16 days), and the number of dialysis sessions (13.5 +/- 9.1 and 13.6 +/- 7.1). The type of catheters, the frequency of removal for poor flow (16% in both groups) or infections (6% in both groups), and the local nursing were similar in the two groups. The only difference was the side of cannulation: the right side in 58% of cases in group 1 and 78% in group 2. The angiographic study revealed a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority over the subclavian route is asserted in respect of venous access of dialysed patients. 2
40. Abdullah BJ, Mohammad N, Sangkar JV, et al. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol. 2005;78(931):596-600. Review/Other-Dx 26 patients To prospectively determine the incidence of venous thrombosis in the upper limbs in patients with PICC. No statistical correlation between the site of insertion of the PICC and the location of venous thrombosis. No observed correlation between the occurrence of venous thrombosis with the patient’s history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. No statistical correlation with the size of the catheter. PICC are associated with a significant risk of UEDVT. 4
41. Allen AW, Megargell JL, Brown DB, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 2000;11:1309-14. Observational-Tx 119 patients To evaluate the true rate of thrombosis of upper extremity veins after the placement of PICCs and the potential impact on future access in hemodialysis patients. Three hundred fifty-four PICCs were placed in 119 patients. Of the 144 extremities, 137 had normal findings during initial venography. Of the 137 extremities, 32 developed thrombosis of the cannulated vein (or central veins) after initial PICC placement (23.3%). When all extremities with multiple PICC lines placed were considered, 52 developed thrombosis, for an overall thrombosis rate of 38%. The incidence of thrombosis by site was cephalic 57%, basilic 14%, and brachial 10%. No significant differences were noted in the rates of thrombosis by age, sex, or catheter size. 3
42. Poletti F, Coccino C, Monolo D, et al. Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management. J. vasc. access. 19(5):455-460, 2018 Sep. Observational-Tx 137 PICCs To test the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care. In our cardiac intensive care unit, 137 peripherally inserted central catheters were placed: 80.3% of patients eligible for a peripherally inserted central catheter were implanted. The rate of symptomatic catheter-related peripheral venous thrombosis was 1.4%. Catheter-related blood stream infection was diagnosed in one patient (0.7%; 5.7 × 1000 peripherally inserted central catheter days). All peripherally inserted central catheters were inserted successfully without other major complications. 3
43. El Ters M, Schears GJ, Taler SJ, et al. Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas: a case-control study in hemodialysis patients. Am J Kidney Dis 2012;60:601-8. Observational-Tx 282 patients (120 cases and 162 controls) To assess the association between past peripherally inserted central catheters (PICCs) and lack of functioning arteriovenous fistulas (AVFs). On January 31, 2011, a total of 425 patients were receiving maintenance hemodialysis, of whom 282 were included in this study. Of these, 120 (42.5%; cases) were dialyzing through a tunneled dialysis catheter or synthetic arteriovenous graft and 162 (57.5%; controls) had a functioning AVF. PICC use was evaluated in both groups and identified in 30% of hemodialysis patients, with 54% of these placed after dialysis therapy initiation. Cases were more likely to be women (52.5% vs 33.3% in the control group; P = 0.001), with smaller mean vein (4.9 vs 5.8 mm; P < 0.001) and artery diameters (4.6 vs 4.9 mm; P = 0.01) than controls. A PICC was identified in 53 (44.2%) cases, but only 32 (19.7%) controls (P < 0.001). We found a strong and independent association between PICC use and lack of a functioning AVF (OR, 3.2; 95% CI, 1.9-5.5; P < 0.001). This association persisted after adjustment for confounders, including upper-extremity vein and artery diameters, sex, and history of central venous catheter (OR, 2.8; 95% CI, 1.5-5.5; P = 0.002). 2
44. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020;75:S1-S164. Review/Other-Tx N/A To assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidencebasedguidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been agreat accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQIClinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinarypractitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stagekidney disease “Life-Plan” and related concepts, guidance on vascular access choice, new targets for arteriovenousaccess (fistulas and grafts) and central venous catheters, management of specific complications, and renewedapproaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using aGrading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretationand application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement isaccompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance,implementation considerations, special discussions, and recommendations for future research. 4
45. Choosing Wisely® An initiative of the ABIM Foundation. American Society of Nephrology. Five Things Physicans and Patients Should Question.  Available at: https://www.choosingwisely.org/societies/american-society-of-nephrology/. Review/Other-Tx N/A No abstract available No abstract available 4
46. Bhutani G, El Ters M, Kremers WK, et al. Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative. Hemodial. int.. 21(2):284-293, 2017 04. Observational-Tx 92 patients To evaluate the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs. The study cohort included 92 patients with a median age of 55 (46-67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11-43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). 3
47. Stavropoulos SW, Pan JJ, Clark TW, et al. Percutaneous transhepatic venous access for hemodialysis. J Vasc Interv Radiol 2003;14:1187-90. Observational-Tx 36 catheters in 12 patients To examine our experience, including clinical follow-up with transhepatic hemodialysis catheters in patients in whom more traditional venous access sites have been exhausted. Twenty-one catheters were replaced or removed because of catheter thrombosis, yielding a catheter thrombosis rate of 2.40 per 100 catheter-days. The line sepsis rate was 0.22 per 100 catheter-days. Poor patency rates were seen because of a high rate of late thrombosis. 2
48. Kade G, Les J, Buczkowska M, Labus M, Niemczyk S, Wankowicz Z. Percutaneous translumbar catheterization of the inferior vena cava as an emergency access for hemodialysis - 5 years of experience. J Vasc Access 2014;15:306-10. Review/Other-Tx 13 patients To analyze of translumbar catheter efficiency and complications connected with its functioning. The total time of translumbar catheter observation was 4,169 days. Average time of their functioning was 261 days. The most frequent reason for termination of the use of translumbar HD catheters was spontaneous/idiopathic removal - 2 cases. Episodes of infection and thrombosis per 1,000 days of catheter observation were 2.2 and 1.2, respectively. 4
49. Lund GB, Trerotola SO, Scheel PJ, Jr. Percutaneous translumbar inferior vena cava cannulation for hemodialysis. Am J Kidney Dis 1995;25:732-7. Experimental-Tx 17 double-lumen hemodialysis catheters in 12 patients To evaluate the percutaneous translumbar approach for long-term hemodialysis catheter access. Catheter placement was successful in all patients. Adequate flow rates were obtained. Seven episodes of thrombosis-related access failure occurred (0.33 episodes/100 days at risk). Two catheters were removed and five catheters were managed with urokinase infusion. Six episodes of infection occurred (0.28 episodes/100 days at risk). Four required catheter removal. Two catheters were removed after defects developed in the catheter. Five catheters were removed electively because catheter hemodialysis was discontinued. Four catheters remained in place. Cumulative patency was 52% at 6 months and 17% at 12 months. 2
50. Moura F, Guedes FL, Dantas Y, Maia AH, Oliveira RA, Quintiliano A. Translumbar hemodialysis long-term catheters: an alternative for vascular access failure. Jornal Brasileiro de Nefrologia. 41(1):89-94, 2019 Jan-Mar. Observational-Tx 12 patients To describe placement technic, complications, and patency of 12 TLDC. All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. 3
51. Wan Y, Chu Y, Qiu Y, Chen Q, Zhou W, Song Q. The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. J. vasc. access. 19(1):34-39, 2018 Jan. Experimental-Tx 221 cancer patients (FICC Group); 2604 cancer patients (Control Group/PICC Group) To investigate the feasibility and safety of the peripherally inserted central catheters (PICCs) accessed via the superficial femoral vein in patients with superior vena cava syndrome (SVCS). In the FICC group, the mean catheterization time was 31.60 ± 0.15 minutes, one-time puncture frequency was 1.05 ± 0.08, and catheter duration was 168.95 ± 20.47 days. There was no significant difference compared with the upper extremity veins PICC group: 31.11 ± 3.86 minutes, 1.03 ± 0.30, and 173.58 ± 39.81 days, respectively. The major complications included skin allergy to chlorhexidine gluconate (CHG) dressings, exudation, catheter-related infection, catheter occlusions, unplanned catheter withdrawal, venous thrombosis, mechanical phlebitis, and catheter malposition. It is interesting that a higher rate of catheter malposition was observed in the upper extremity veins PICC group than in the FICC group (2.15% vs. 0.00%). There were no significant differences in other complications between the two groups. 2
52. Bjorkander M, Bentzer P, Schott U, Broman ME, Kander T. Mechanical complications of central venous catheter insertions: A retrospective multicenter study of incidence and risks. Acta Anaesthesiol Scand. 63(1):61-68, 2019 01. Observational-Tx 10,949 insertions To study risk factors for mechanical complications in a large, recently collected cohort of patients. We included 10 949 insertions and identified 118 (1.1%) incidents of mechanical complication, of which 85 (0.8%) were bleedings, 21 (0.2%) were pneumothoraces, 7 (0.06%) were transient nerve injuries, and 5 (0.05%) were self-limiting arrhythmias. Severe mechanical complications occurred in 23 (0.2%) cases. 3
53. Iorio O, Cavallaro G. External jugular vein approach for TIVAD implantation: first choice or only an alternative? A review of the literature. J Vasc Access 2015;16:1-4. Review/Other-Tx 1,308 TIVAD implantations To present a review of the literature about EJV approach for TIVAD implantation. A total of 1,308 TIVAD implantations through EJV have been reported, with a success rate ranging from 73.7% to 100% and a complication rate up to 13%. Only in 4 on 10 series reported (with more than 15 procedures) the EJV approach was the first choice, while in the other 6 series this approach was the alternative after failure of other approaches. 4
54. Kato K, Taniguchi M, Iwasaki Y, et al. Computed tomography (CT) venography using a multidetector CT prior to the percutaneous external jugular vein approach for an implantable venous-access port. Ann Surg Oncol 2014;21:1391-7. Observational-Tx 45 patients To determine the success rate and complications of using the percutaneous approach of the external jugular vein (EJV) for placement of a totally implantable venous-access port (TIVAP) with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V). CT-V success was achieved in 45 of 45 patients (100 %). A plexus of veins under the clavicle was most commonly responsible for the insertion of the central venous catheter. The EJV approach resulted in a successful cannulation rate of 93 %. No initial complications of pneumothorax or carotid artery puncture occurred during insertion procedures. Late complications occurred in three patients. These included one port erosion (2 %), one catheter occlusion (2 %), and one wound hematoma (2 %). Catheter-related infections were observed in one patient (2 %). 2
55. Goetz AM, Wagener MM, Miller JM, Muder RR. Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 1998;19:842-5. Observational-Tx 300 catheters in 204 patients To determine the influence of catheter site and type (single- vs triple-lumen) on infection rates associated with central venous catheterization. Three hundred catheters were inserted into 204 patients. Seventy percent were inserted into upper-body sites, and 30% were inserted into the femoral vein. Forty-five percent were triple-lumen catheters. Bacteremia occurred in 2.7% of catheter insertions; insertion-site infections developed in 1.3%, and catheter colonization developed in 12%. Catheter contamination was associated with emergent insertion (odds ratio [OR], 6.2; 95% confidence interval [CI95], 1.1-36.7; P=.04) by logistic regression and with femoral location (hazard, 4.2; CI95, 2.0-8.8; P=.0001) and history of transplantation (hazard, 2.8; CI95, 1.1-6.7; P=.024) by Cox regression. Clinical infection was not associated with any of the risk factors evaluated, although there was a trend for association with femoral location by Cox regression (hazard, 4.7; CI95, 0.82-26; P=.08). We did not identify an association between infection and use of triple-lumen catheters or parenteral nutrition. 2
56. Lorente L, Henry C, Martin MM, Jimenez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005;9:R631-5. Observational-Tx 2,018 patients To analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) with central venous catheters (CVCs) according to different access sites. The study included 2,018 patients. The number of CVCs and days of catheterization duration were: global, 2,595 and 18,999; subclavian, 917 and 8,239; jugular, 1,390 and 8,361; femoral, 288 and 2,399. CRLI incidence density was statistically higher for femoral than for jugular (15.83 versus 7.65, p < 0.001) and subclavian (15.83 versus 1.57, p < 0.001) accesses, and higher for jugular than for subclavian access (7.65 versus 1.57, p < 0.001). CRBSI incidence density was statistically higher for femoral than for jugular (8.34 versus 2.99, p = 0.002) and subclavian (8.34 versus 0.97, p < 0.001) accesses, and higher for jugular than for subclavian access (2.99 versus 0.97, p = 0.005). 2
57. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700-7. Experimental-Tx 293 patients To compare mechanical, infectious, and thrombotic complications of femoral and subclavian venous catheterization. Femoral catheterization was associated with a higher incidence rate of overall infectious complications (19.8% vs 4.5%; P<.001; incidence density of 20 vs 3.7 per 1000 catheter-days) and of major infectious complications (clinical sepsis with or without bloodstream infection, 4.4% vs 1.5%; P =.07; incidence density of 4.5 vs 1.2 per 1000 catheter-days), as well as of overall thrombotic complications (21.5% vs 1.9%; P<.001) and complete thrombosis of the vessel (6% vs 0%; P =.01); rates of overall and major mechanical complications were similar between the 2 groups (17.3% vs 18.8 %; P =.74 and 1.4% vs 2.8%; P =.44, respectively). Risk factors for mechanical complications were duration of insertion (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.08 per additional minute; P<.001); insertion in 2 of the centers (OR, 4.52; 95% CI, 1.81-11.23; P =.001); and insertion during the night (OR, 2.06; 95% CI, 1.04-4.08; P =.03). The only factor associated with infectious complications was femoral catheterization (hazard ratio [HR], 4.83; 95% CI, 1.96-11.93; P<.001); antibiotic administration via the catheter decreased risk of infectious complications (HR, 0.41; 95% CI, 0.18-0.93; P =.03). Femoral catheterization was the only risk factor for thrombotic complications (OR, 14.42; 95% CI, 3.33-62.57; P<.001). 1
58. Parienti JJ, Mongardon N, Megarbane B, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med 2015;373:1220-9. Experimental-Tx 3,471 catheters in 3,027 patients To evaluate the risk of catheter-related bloodstream infection or symptomatic catheter-related deep-vein thrombosis in adult patients who had been admitted to an intensive care unit (ICU). A total of 3471 catheters were inserted in 3027 patients. In the three-choice comparison, there were 8, 20, and 22 primary outcome events in the subclavian, jugular, and femoral groups, respectively (1.5, 3.6, and 4.6 per 1000 catheter-days; P=0.02). In pairwise comparisons, the risk of the primary outcome was significantly higher in the femoral group than in the subclavian group (hazard ratio, 3.5; 95% confidence interval [CI], 1.5 to 7.8; P=0.003) and in the jugular group than in the subclavian group (hazard ratio, 2.1; 95% CI, 1.0 to 4.3; P=0.04), whereas the risk in the femoral group was similar to that in the jugular group (hazard ratio, 1.3; 95% CI, 0.8 to 2.1; P=0.30). In the three-choice comparison, pneumothorax requiring chest-tube insertion occurred in association with 13 (1.5%) of the subclavian-vein insertions and 4 (0.5%) of the jugular-vein insertions. 1
59. Schwanke AA, Danski MTR, Pontes L, Kusma SZ, Lind J. Central venous catheter for hemodialysis: incidence of infection and risk factors. [Portuguese, English]. Rev Bras Enferm. 71(3):1115-1121, 2018 May. Observational-Tx 69 patients To measure the incidence of infection in short-term central venous catheter for hemodialysis and to identify the associated risk factors. The final sample consisted of 69 patients, who used 88 catheters. The incidence of infection was 9.1%, and the risk factors were length of hospital stay and insertion of the catheter in the left femoral vein. 2
60. Trottier SJ, Veremakis C, O'Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med 1995;23:52-9. Experimental-Tx 45 patients To determine the frequency of central venous catheter-induced deep vein thrombosis of the femoral vein. Of the 21 patients randomized to upper access sites, none developed positive or nondiagnostic duplex ultrasound examinations. Six (25%) of 24 patients randomized to the femoral access site developed lower extremity deep vein thrombosis (p = .02). In addition, seven (29%) patients randomized to the lower access site sustained non-diagnostic ultrasound examinations. A total of 13 (54%) of 24 patients from the lower access group developed abnormal ultrasound examinations (p < .001). Age, duration of catheterization, coagulation profile, deep vein thrombosis prophylaxis, and Acute Physiology and Chronic Health Evaluation II scores were similar between the upper and lower access groups. 1
61. Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012;3:CD004084. Meta-analysis 4 studies; 1,513 participants To establish whether the jugular, subclavian or femoral CVA routes resulted in a lower incidence of venous thrombosis, venous stenosis or infections related to CVA devices in adult patients, and to assess whether the jugular, subclavian or femoral CVA routes influenced the incidence of catheter-related mechanical complications in adult patients; and the reasons why patients left the studies early. We identified 5854 citations from the initial search strategy; 28 references were then identified as potentially relevant. Of these, we Included four studies with data from 1513 participants. We undertook a priori subgroup analysis according to the duration of catheterization, short-term (< one month) and long-term (> one month) defined according to the Food and Drug Administration (FDA).No randomized controlled trial (RCT) was found comparing all three CVA routes and reporting the complications of venous stenosis.Regarding internal jugular versus subclavian CVA routes, the evidence was moderate and applicable for long-term catheterization in cancer patients. Subclavian and internal jugular CVA routes had similar risks for catheter-related complications. Regarding femoral versus subclavian CVA routes, the evidence was high and applicable for short-term catheterization in critically ill patients. Subclavian CVA routes were preferable to femoral CVA routes in short-term catheterization because femoral CVA routes were associated with higher risks of catheter colonization (14.18% or 19/134 versus 2.21% or 3/136) (n = 270, one RCT, RR 6.43, 95% CI 1.95 to 21.21) and thrombotic complications (21.55% or 25/116 versus 1.87% or 2/107) (n = 223, one RCT, RR 11.53, 95% CI 2.80 to 47.52) than with subclavian CVA routes. Regarding femoral versus internal jugular routes, the evidence was moderate and applicable for short-term haemodialysis catheterization in critically ill patients. No significant differences were found between femoral and internal jugular CVA routes in catheter colonization, catheter-related bloodstream infection (CRBSI) and thrombotic complications, but fewer mechanical complications occurred in femoral CVA routes (4.86% or 18/370 versus 9.56% or 35/366) (n = 736, one RCT, RR 0.51, 95% CI 0.29 to 0.88). M
62. Bell J, Goyal M, Long S, et al. Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions. J Intensive Care Med. 35(9):869-874, 2020 Sep. Observational-Tx 801 patients To define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. 3
63. Jonszta T, Czerny D, Prochazka V, Vrtkova A, Chovanec V, Krajina A. Computed Tomography (CT)-Navigated Translumbar Hemodialysis Catheters: A 10-Year Single-Center Experience. Med Sci Monit. 26:e927723, 2020 Dec 15. Observational-Tx 37 patients = Translumbar catheters group; 196 patients = Jugular vein catheters group To present the study of a cohort of patients who had dedicated hemodialysis catheters implanted in the angiography suite of our institution over a 9-year period with a hybrid procedure consisting of CT-navigated translumbar IVC cannulation followed by fluoroscopy-controlled catheter implantation. The rates of technical success of the implantations and minor periprocedural complications were 97.4% and 10.3% in the TLC group and 98.6% and 4.2% in the JVC group, respectively. The median follow-up in the TLC and JVC groups was 673 days and 310 days, respectively. The primary-assisted patency at the 1-year and 3-year follow-up was 88.7% and 72.0% in the TLC group and 81.6% and 67.0% in the JVC group, respectively, with no statistically significant difference between the 2 groups. The incidence rate of infection-related and patency-related complications calculated for 1000 catheter-days was 0.15 and 0.11 in the TLC group and 0.33 and 0.25 in the JVC group, respectively. 2
64. Guillermo-Corpus G, Ramos-Gordillo JM, Pena-Rodriguez JC. Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients. Blood Purif. 47(1-3):132-139, 2019. Observational-Tx 673 hemodialysis patients To compare the outcomes of tunneled femoral catheters with jugular catheters, in which the literature found scarce and derived mainly from small cohorts. The survival of the tunneled catheters was 771 days 95% CI (737-805) for jugular and 660 days 95% CI (582-739) for femoral veins. Blood flow (0.292 ± 0.003 L/min) and infection rate (0.25 × 1,000 days/catheter) were similar for upper and lower extremities vascular accesses. Factors including sex, age, diabetes and previous catheters did not affect the outcome. 1
No of Rows: 64