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Results for “Vascular Access Devices”

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At least 19 recordsLinked to original sources

PubMed2006

Complications associated with an implantable vascular access device.

PURPOSE: Implantable vascular access devices (ports) are well accepted in the management of many pediatric conditions. Modifications have improved port function, patient satisfaction, and enhanced compatibility with imaging studies. We reviewed our experience with a port system and identified unique mechanical complications. METHODS: From 1998 to the present, 301 patients underwent 296 port insertions and 175 port removals. We assessed medical records, radiographs, and operative findings. The 6.6F MRI Low-Profile Implanted Port (Bard Access Systems, Salt Lake City, Utah) was used almost exclusively and was assembled by the operating surgeon. Outcome measures included port reservoir leakage, catheter dislodgment, and number of device days until complication. Ports were implanted for multiple medical problems including 74.2% in hematology/oncology patients. RESULTS: For 296 port insertions, 15 complications (5.1%) were identified in 13 patients (mean age, 8.4 years). Eleven leaks (3.7%) in 9 patients were found, with 9 leaks resulting from needle perforation of the port base and 2 leaks seen at the catheter connection site. Average port duration was 425 days (range, 12-1266 days) before leakage. Four patients had catheter dislodgment (1.4%), with 3 of 4 catheters embolizing to the heart or pulmonary artery. Patients were asymptomatic, and catheters were retrieved by interventional radiology. Dislodgment at the catheter-port connection site was seen in 3 of 4 cases, and average port duration was 1075 days (range, 269-2657 days) until catheter separation. Twelve of 13 patients had successful implantation of a new port system. CONCLUSIONS: This study identifies that (1) mechanical port complications (5.1%) are not rare for this device; (2) regardless of port age, the thin plastic base may result in a risk of perforation not seen in other devices; (3) the extended period before embolization likely indicates device wear rather than faulty assembly; and (4) complications could be successfully managed including retrieval of embolized catheters.

Adolescent↗

PubMed1999

Vascular access devices: lines to live by.

Vascular access devices take many forms--all designed to maximize treatment options, reduce risks to patients and clinicians, and deliver optimal patient outcomes.

Catheterization, Central Venous↗

PubMed1984

Intravenous transcutaneous vascular access device.

The indwelling transcutaneous vascular access device is easily implantable with little more skill or time required than is typically used in placement of standard intravenous needles or catheters. With routine maintenance of the device site, the infection rate in our studies are negligible. Biocompatibilty, assessed by the lack of destruction of blood components and by the paucity of signs of initimal or systemic disease, was good. Over the period of 10 to 21 days, all but one unit maintained adequate flow rates. The device is stable. There was no blood leakage from the area around the limbs in the chronic flow studies or the hemodialysis studies. The one episode of malpositioning occurred after a sudden strong tug on the tubing. A second dacron retaining cuff will be placed on the distal limb. This will be sutured into place and should increase unit stability. There was little evidence of pain or irritation from the device. No thrombotic tendencies were noted at the access site or systemically. The dogs were on Ascriptin and also the model (canine) is not prone to thromboembolic events. Further improvements on the device will include using smoother, more compatible materials: carbon-coated steel, brushed titanium, or covering the steel with PTFE or ceramic rather than the silastic-dacron cuff. Other future changes include the improvement of the device-tubing connection to one in which no blood will be lost when the device is attached to the dialyzer.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1994

Vascular access device for treatment of cancer patients.

Vascular access devices that are completely implanted have been used for treatment of cancer patients. Vascular access devices are useful for transarterial infusion of anticancer drugs, intravenous hyperalimentation, and drainage of bile juice in obstructive jaundice. These systems have several advantages in the care of patients: they are sealed, they have no external tubes, and they may be useful for blood or biliary sample and intravenous hyperalimentation or chemotherapy. There are only minimal discomforts related to the implantation procedure and no need for routine external catheter care. Most importantly, the quality of the patient's life is dramatically improved without external tubes. For these reasons, we believe that vascular access devices should be indicated for patients with malignant tumors as much as placement of these devices is technically feasible.

Bile↗

PubMed1998

Maintaining vascular access devices: the nurse's role.

The role of the nurse in maintaining vascular access devices has altered dramatically with the advance in vascular access device technology and the greater involvement in selection of the device and its insertion, maintenance and removal. Up-to-date knowledge and the use of evidence-based practice underpinned by good scientific research is the key to vascular access device maintenance. The routine maintenance of vascular access devices is a shared responsibility between the nurse and the patient, so that the nurse has an important part to play in the adequate preparation and education of the patient. The nurse therefore has a responsibility to ensure the maintenance of vascular access devices in order to increase the benefits to the patient and decrease the risk of serious complications.

Bandages↗

PubMed2003

Totally implantable vascular access devices for cystic fibrosis.

BACKGROUND: Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Their use is associated with some complications such as thrombosis, embolism and infection. OBJECTIVES: To assess if totally implantable venous access devices are a safe and effective route for providing venous access for intermittent administration of intravenous antibiotics in people with cystic fibrosis, also to assess strategies to reduce possible complications of totally implantable venous access devices (e.g. anticoagulants to reduce the risk of thrombosis). SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Date of the most recent search: May 2003. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials which compared the use of totally implantable venous access devices in people with cystic fibrosis to other means of vascular access, trials which compared the different types of these devices against each other and trials which assessed strategies to reduce complications of these devices. DATA COLLECTION AND ANALYSIS: No relevant trials were identified. MAIN RESULTS: No trials were included in this review. REVIEWER'S CONCLUSIONS: Totally implantable vascular access devices are widely used in people with cystic fibrosis to provide intermittent venous access for therapeutic infusions. Reports of their use in people with cystic fibrosis suggest that they are safe and effective. These reports also suggest that certain interventions might reduce the risk of complications; however, it is disappointing that these reports have not been assessed by randomised controlled trials. This systematic review identifies the need for a multicentre randomised controlled trial assessing both efficacy and possible adverse effects of totally implantable venous access devices in cystic fibrosis.

Catheters, Indwelling↗

PubMed1995

Rare complications of vascular access devices.

OBJECTIVE: To provide an overview of rare complications of vascular access devices in terms of etiology, assessment, management, and follow-up. CONCLUSIONS: Rare complications of vascular access devices are serious and in some cases life-threatening. These complications include pinch-off and catheter fracture, catheter malposition and migration, cardiac perforation, extravasation, breakage, and defective devices. Knowledge and awareness of these complications can contribute to accurate identification and immediate management. Documentation and reporting of complications to the Food and Drug Administration helps to ensure the safety and efficacy of vascular access devices. IMPLICATIONS FOR NURSING PRACTICE: Developing the expertise needed to manage these types of complications is a continual challenge to the oncology nurse. Although managing rare complications is usually performed by a physician, recognizing the clinical manifestations will alert the nurse to seek medical advice immediately, thus decreasing the risk of mortality. All health care professionals are responsible for continually monitoring vascular access devices, consistently documenting findings, and communicating recommendations for care.

Catheterization, Central Venous↗

PubMed1985

Results from use of 826 vascular access devices in cancer patients.

Vascular access technology is rapidly improving. Over the last 7 years we evaluated 826 access devices in 681 patients with neoplastic disease. The devices included 103 polytetrafluoroethylene (PTFE) arteriovenous (A-V) grafts, 358 Broviac 2.2-mm and 135 Hickman 3.2-mm right atrial catheters, 161 2.2-mm and 44 4.5-mm dual-lumen right atrial catheters, 12 venous infusion ports, and 13 large-bore staggered-tip dual-lumen catheters. All devices provided satisfactory venous access. Twenty-eight percent of the PTFE A-V grafts eventually thrombosed, versus 0.7% of Silastic right atrial catheters (P less than 0.005). Because of its low long-term complication rate (only 7% removed or lost because of a complication) and its simplicity of insertion and use, the Silastic right atrial catheter is now our preferred device. Most patients receive a 2.2-mm dual-lumen catheter, the second channel of which can provide a route for parenteral nutrition or blood sampling, and is a form of "insurance" if the first lumen becomes occluded. In over 95% of patients with chemotherapy-induced neutropenia and fever or bacteremia, their right atrial catheters were not removed, rather they were used for intravenous antibiotic infusions. The new larger bore dual-lumen catheters provided effective access for acute hemodialysis or plasmapheresis, as well as for routine venous access. The infusion port was particularly suitable for administration of adjuvant chemotherapy in the outpatient department, although the complexity of its use challenged the professional staff.

Adolescent↗

PubMed1999

Epidemiology of device-associated infections related to a long-term implantable vascular access device.

OBJECTIVE: To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device. SETTING: Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia. PATIENTS: 123 consecutive patients who received a PAS-Port implantable venous access device between January 1 and June 30, 1995. DESIGN: Retrospective cohort study with follow-up > or = 1 year following device implantation. RESULTS: Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/1,000 device days). CONCLUSIONS: Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.

Adult↗

PubMed1985

The Biocarbon vascular access device (DiaTAB) for haemodialysis.

The Biocarbon vascular access device (DiaTAB) is a relatively new method in secondary access surgery. Punctures, often the cause of complications can be avoided because it is a no-needle method of dialysis. However thrombosis due to stenosis of the venous anastomosis or of the efferent vein is a continuing problem. A new experience is the fibrin flap formation under the plug of the device, which can be removed easily.

Adult↗

PubMedDate not supplied

Fibrin sheaths in vascular access devices.

Persistent withdrawal occlusion associated with vascular access devices is a common problem with most intravenous devices that are left in place for more than seven days. This paper discusses the possible causes and describes how the most usual cause, fibrin sheath formation, can be remedied.

Catheterization, Central Venous↗

PubMed1993

Vascular access devices: perspectives on designs, complications, and management.

The use of vascular access devices in hospitalized and home care patients has expanded rapidly in the past decade. New designs, materials, insertion techniques, and protocols for care related to vascular access devices have emerged. Complications associated with them, however, have remained a persistent problem. Septicemia, thrombosis, and occlusion are three of the more serious complications that can lead to the need for removal of the device. These complications are reviewed and areas for future research are identified.

Catheters, Indwelling↗

PubMedDate not supplied

Complications associated with implantable vascular access devices in the patient with cancer.

Implantable vascular access devices (IVADs), or implantable ports, have been used for patients with cancer for more than 20 years. Although these devices have greatly improved infusion access for this population of patients, complications may still occur. Nurses working with oncology patients who have IVADs must be aware of possible problems for these patients, as well as the importance of early assessment and intervention. The diagnosis of cancer and potential treatments for this disease may make these patients at higher risk for complications associated with the use of IVADS.

Bacteremia↗

PubMed2002

Potential mechanical blood trauma in vascular access devices: a comparison of case studies.

Since vascular access devices may cause disturbances in blood flow, possibly damaging red blood cells (RBCs), the correlated risk of lysis must be assessed. The monodimensional approach for the evaluation of cannulae hydrodynamic behaviour (in vitro measured flow curves) does not furnish information on the local flow field occurring in specific clinical conditions. Researchers consider the prediction of blood trauma, induced by mechanical loading, to optimize the design phase, and to furnish indications on their optimal clinical use. In this study, a model of cannula inserted in a non compliant wall vessel was used as a test bench in a Computational Fluid Dynamics (CFD) problem. By means of CFD the flow field was 3D analysed to achieve information on velocity and shear stress local values, when cannula is used for inflow and outflow cannulation. A prediction of potential blood corpuscle damage, based on a power law, quantified the potential blood damage. Several numerical simulations, with different cannula/vessel flow rate ratios were provided, to investigate the incidence of local sites in the design on blood damaging potential during cannulation. Several regions appeared to be sensitive to the flow rate not only inside the cannula but also in the space between cannula and vessel, suggesting new indications for the assessment of a quality factor based on the evaluation of induced blood cells injury.

Blood Flow Velocity↗

PubMedDate not supplied

Vascular access devices--management of common complications.

Developments in vascular access technology, along with advances in therapy, have created specific challenges for the intravenous nurse caring for patients with indwelling vascular access devices. The nurse clinician must be aware of clinical and technical complications that may occur, as well as the nursing management of those complications.

Catheterization, Central Venous↗

PubMedDate not supplied

Subcutaneous vascular access devices.

Tunneled dialysis catheters have played an important role in providing vascular access for hemodialysis for over 20 years, yet limitations associated with poor flow, thrombosis, and infections due to the transcutaneous nature of catheters have led to the development of alternative vascular access devices. This article reviews two historical devices-the Hemasite and the Bentley DiaTAP button-and provides an overview of two new fully subcutaneous vascular access devices-the LifeSite Hemodialysis Access System (Vasca, Inc., Tewksbury, MA) and the Dialock Hemodialysis System (Biolink Corp., Norwell, MA). These new subcutaneous devices differ significantly from currently available tunneled dialysis catheters in their design and method of use and may result in improved outcomes in hemodialysis patients. Indeed, initial clinical experiences with this new class of fully implanted access devices validate a subcutaneous approach to hemodialysis access and suggest that their high flow rates and low complication rates may make subcutaneous devices an attractive alternative to dialysis catheters for hemodialysis patients.

Catheterization, Central Venous↗

PubMedDate not supplied

Multidisciplinary management of vascular access devices.

Many problems associated with the use of vascular access devices (VADs) can be circumvented with an organized, systematic approach to management. This paper describes an approach that includes several key components: 1) A nurse coordinator of parenteral therapy (CPT) follows all patients with a VAD; records demographic and clinical data on an ongoing basis; monitors complications and outcomes; serves as a consultant for VAD-related questions; develops policies, procedures, and guidelines for catheter care; and oversees inservice nursing and basic patient education. 2) A data coordinator enters all data into a data base management system, compiles complication and other statistics on a periodic basis, and retrieves selected data for specific purposes. 3) A VAD Committee, composed of the above two individuals, a nurse epidemiologist, and physicians representing medical oncology, hematology, transplantation, pediatrics, and surgery, meets monthly to collectively evaluate and assign cause for complications, consider new products, and discuss policy changes regarding VADs. As a result of this multidisciplinary process, responsibility and accountability for VAD insertion and care are appropriately placed, statistics on complications are compiled, and treatment and policy decisions are made. These outcomes have resulted in a significant reduction in complications, an increase in average catheter life, enhancement of quality assurance, and overall improved patient care.

Algorithms↗

PubMedDate not supplied

A trial with a new peripheral implanted vascular access device.

In a prospective study, a new implanted vascular access device designed for peripheral placement in the arm was evaluated. Thirty-two patients requiring long-term venous access received the Port-A-Cath P.A.S. Port over a 13-month period. The access devices were used for multiple therapies including chemotherapy, antibiotics, antivirals, antifungals, and blood products. After 4,896 patient days (range 12-388), 19 complications occurred in 14 patients or 3.88/1,000 catheter days. The infection rate was 3% or 0.2/1,000 catheter days. Port pocket cellulitis was reported in 3% of patients or 0.2/1,000 catheter days. Vein phlebitis occurred at 12.5% or 0.8/1,000 catheter days. Two instances of vessel thrombosis occurred (6.2% or 0.4/1,000 catheter days). Ten incidents in six patients of inability to aspirate blood samples were noted (18.75% or 2/1,000 catheter days). No infiltrations or extravasations were reported. Nurses involved in this early trial found performance similar to the standard venous chest ports. Peripheral port placement was accepted well by patients.

Adult↗