중심정맥포트 설치 시 포트 피하고정의 필요성에 대한 고찰

김상수,김형필,배재익,원제환 대한영상의학회 2010 대한영상의학회지 Vol.63 No.3

Purpose: The technical success and complications were especially focused on and evaluated the need for fixation of a port under fluoroscopic guidance placement of the totally implantable central venous access ports for long term central venous access. Materials and Methods: Two hundred eighty nine consecutive patients (170 men, 119 women, mean age: 52-year-old) who underwent venous port implantation for the administration of chemotherapy were followed over a 1-month period. The procedures were performed in the angiographic suite by an interventional radiologist and all access was through the right jugular vein, except for the patients who had undergone a right mastectomy. The procedures were performed in the following order: 1) venous puncture, 2) making a pocket, 3) catheter tunneling, 4) port insertion, 5) catheter sizing, and 6) insertion. A port which was connected to the tunneled catheter was inserted into the minimally sized subcutaneous pocket with the aid of a small retractor. A follow-up was performed with medical records and chest radiographs. The follow-up period for evaluating the venous port ranged from 59 to 329 days (mean: 175 days)Results: The procedures performed to gain right jugular vein access were successful without difficulty in all cases. The 18 patients that underwent procedures to gain left jugular vein access encountered some difficulty upon insertion of a catheter into the SVC due to encountering the tortuous left brachiocephalic vein. No complications occurred during and immediately after the procedure. In one case the port chamber rotated within the subcutaneous pocket; however, no catheter migration or malfunction occurred. Conclusion: If port insertion was followed by catheter insertion, the port chamber can be tightly implanted in the minimally sized pocket. This would avoid the need for fixation of the catheter to the port chamber leading into the pocket. 목적: 중심정맥포트 설치 시 포켓을 작게 만들어 특별한 고정장치 없이 포트가 꽉 끼게 설치하였을 때, 장기간 동안 위치이동이나 회전, 또는 카테터 기능부전 등의 문제점이 얼마나 발생하는지를 알아보았다. 대상과 방법: 항암치료를 위하여 정맥포트설치 후 1개월 이상 사용한 289명의 환자(남자 170, 여자 119, 평균연령 52세)를 대상으로 하였다. 시술은 혈관조영실에서 한 명의 영상의학과 의사가 시행하였다. 우측유방절제 때문에 불가피하게 좌측접근을 시행한 경우를 제외하고는 모두 우측 목정맥 접근을 통하여 포트를 설치하였다. 설치는 정맥천자-포켓만들기-카테터피하심기-포트삽입- 카테터삽입의 순서로, 피하에 심은 카테터를 연결한 다음, 포트를 최소크기의 포켓에 삽입하고, 카테터의 길이를 조정하여 정맥에 삽입하였다. 정맥포트의 문제 발생 여부는 환자의 의무기록과 흉부촬영을 통해서 후향적으로 조사하였다. 추적검사 기간은 59일에서 325일(평균 175일)이었다. 결과: 우측 목정맥을 통하여 포트를 설치한 경우(n=271)는 모두 시술상의 어려움 없이 성공적이었다. 좌측 목정맥을 통한 포트 설치(n=18) 시 카테터 삽입 도중 기정맥으로 끝이 향하는 경우가 1예(5.5%)에서 있었다. 추적기간 도중 포트 회전은 1예(0.4%)에서 발생하였는데 의도보다 포켓이 크게 만들어진 소아환자였다. 시술 후 설치부에 문제가 발생한 경우는 없었다. 추적기간 동안 카테터나 포트의 이동이 발생하거나 또는 카테터 기능부전이 생긴 경우는 없었다결론: 포트를 먼저 삽입하고 카테터를 삽입하는 방법으로 포켓의 크기를 최소화할 수 있으며, 이렇게 작은 포켓에 포트가 꽉 끼이게 설치하면 특별한 고정장치 없이도 포트의 회전이나 이동이 생기지 않는다.

Efficacy and Safety of Midline Catheters with Integrated Wire Accelerated Seldinger Technique

Mun Hee Jeon,Cheol Seung Kim,Kyu Dam Han,Mi Jin Kim 대한혈관외과학회 2022 Vascular Specialist International Vol.38 No.1

Purpose: The midline catheter (MC) is a peripheral venous access device with the catheter tip located in the axilla and available for mid-term intravenous (IV) therapy. This study evaluated the efficacy and clinical outcomes associated with the placement of MCs with an integrated wire-accelerated Seldinger technique for IV access. Materials and Methods: A retrospective review was conducted at a single center in South Korea between March 2020 and July 2020. Consecutive patients in whom MC insertions were performed by vascular surgeons were enrolled. The outcomes included catheter indwelling time and incidence of catheter-related adverse events. Results: Ninety-five patients (117 catheters) were included in the study. The total indwelling time was 1,964 days, with a median of 16.7 days (range, 0-76). The complication-free catheter rates at 5 and 28 days were 92.9% and 65.5%, respectively. Overall, 32 (27.4%) catheters were removed due to complications; however, major complications, such as symptomatic deep venous thrombosis and catheterinduced bloodstream infections, were confirmed in only 3 (2.6%) catheters. A common reason for premature catheter removal is inadvertent removal owing to patient inattention. A high body mass index and female sex were identified as risk factors for short indwelling times and complicated premature catheter removal. Conclusion: MC insertion is a simple and operator-friendly procedure with a low rate of major complication. It enables mid-term IV treatment through a single procedure if there are no specific complications, thereby improving quality of life of patients during hospital stay.

소아 환자에서의 피하 중심정맥 도관 접근술

조용훈 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21

Purpose: Central venous access is an essential component of the management for the pediatric patients requiring a temporary nutritional support, an infusion of chemotherapeutic agents and antibiotics, a frequent transfusion and drawing of blood. Recently, usually performed a subcutaneous tunneled, implantable vascular access through puncture or cut-down method. In this study, the author tried to assess an property and effectiveness of this procedure. Subject and Methods: Reviewed medical records of 37 patients who receiving percutaneous central venous access from Jan 2003 to Dec 2006. Results: There were 37 patients with a predominance of boy and 10 patients were younger than 5 years old. Medical problems that need the central venous access were 18 hematooncologic cases, 12 chronic renal failures, 4 malignant cases, 3 aplastic anemia and one lymphoma, respectively. Device for venous access was a Hickman catheter, Broviac dual-lumen catheter and Chemoport system. According to the access route of vein, intemal(24 cases) or extemal(7 cases) jugular vein, subclavian vein(6 cases) was used. Although there were some complications related to the procedure, such as bleeding at the base, catheter dislodgement, subcutaneous infection, no other serious complications such as thromboembolism, sepsis. Conclusions: In the pediatric populations, subcutaneous implantable central venous access is an essential, safe and proper method for managing medical or surgical problems.

Incidents and Complications of Permanent Venous Central Access Systems: A Series of 1,460 Cases

Massine El Hammoumi,Mohammed El Ouazni,Adil Arsalane,Fayçal El Oueriachi,Hamid Mansouri,El Hassane Kabiri 대한흉부외과학회 2014 Journal of Chest Surgery (J Chest Surg) Vol.47 No.2

Background: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. Methods: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. Results: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. Conclusion: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

A Retrospective Clinical Study: Complications of Totally Implanted Central Venous Access Ports

석준필,조현민,류한영,황완진,송태은,김영진 대한흉부외과학회 2014 Journal of Chest Surgery (J Chest Surg) Vol.47 No.1

Background: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. Methods: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. Results: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). Conclusion: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.

Septic Arthritis and Infective Endocarditis in an Adolescent Hemophilia B Patient with an Inhibitor and a Central Venous Access Device

김지수,박영실 대한소아혈액종양학회 2018 Clinical Pediatric Hematology-Oncology Vol.25 No.1

Central venous access devices (CVAD) provide hemophilic patients, particularly children, with prolonged reliable venous access to promote routine factor replacement therapy. However, one of the significant complications of CVAD use is infection. We report the case of a severe hemophilia B patient with an inhibitor who developed septic arthritis and infective endocarditis associated with methicillin-resistant Staphylococcus aureus infection originating from a CVAD. Our patient had an underlying condition of congenital heart disease, one of the risk factors for infective endocarditis. Unfortunately, the antibiotic therapy did not have a significant effect. An echocardiogram revealed vegetation on the right ventricular moderate band and surgery was determined to be the best course of action. Septic arthritis and endocarditis rarely occur in hemophilia patients, however, they must be taken into account in hemophiliacs with continuing bacteremia.

Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

안세진,김효철,정진욱,안상부,인용후,제환준,박재형 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.3

Objective: To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. Materials and Methods: We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. Results: A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). Conclusion: Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.

Pinch-Off Syndrome, a Rare Complication of Totally Implantable Venous Access Device Implantation: A Case Series and Literature Review

Burak Mehmet Ilhan,İsmail Cem Sormaz,Rüştü Türkay 대한흉부외과학회 2018 Journal of Chest Surgery (J Chest Surg) Vol.51 No.5

Background: Pinch-off syndrome (POS) is a rare complication after totally implantable venous access device (TIVAD) implantation. In cancer patients, it is important to prevent this rare complication and to recognize it early if it does occur. We present a case series of POS after TIVAD implantation and the results of a literature search about this complication. Methods: From July 2006 to December 2015, 924 permanent implantable central venous catheter implantation procedures were performed. The most common indication was vascular access for chemotherapy. Results: POS occurred in 5 patients in our clinic. Two patients experienced POS within 2 weeks, and the other 3 patients were admitted to department of surgery, Istanbul Faculty of Medicine at 6 to 14 months following implantation. The catheters were found to be occluded during medication administration, and all patients complained of serious pain. The transected fragments of the catheters had migrated to the heart. They were successfully removed under angiography with a single-loop snare. Conclusion: POS is a serious complication after TIVAD implantation. It is important to be aware of this possibility and to make an early diagnosis in order to prevent complications such as drug extravasation and occlusion events.

소아의 중심정맥로 설치술

이명덕,Lee, Myung-Duk 대한소아외과학회 1998 소아외과 Vol.4 No.1

To evaluate the effectiveness of central venous catheters(CVCs) in children, 320 CVCs placed in 255 neonate and children over a 10-year period were analyzed retrospectively. CVC was placed by one pediatric surgeon for a total of 6, 116 patients days. Catheters were placed preoperatively for TPN or chemo in 223 cases. CVC was solely for TPN in 57 cases and for chemotherapy in 40. Local anesthesia was utilized in 71 cases, and the general anesthesia was administered in the remainder of the patients. The subclavian vein was catheterized(SCV) in 202 cases(82 infants and neonates), tunneled external jugular venotomy(EJV) was utilized in 38, tunneled internal jugular venotomy(UV) in 2, the facial venotomy(FV) was used in 3, and the umbilical vein was catheterized UVC) with vein transposition in 74 infants. In neonates, 72 UVCs were placed during laparotomy. SCV was increased with ages, from 3 kg of minimal body weight. The average catheter-periods over-all were 19.1 days, SCV 17 days, EJV 40, IJV 60 and UVC 14. Technical complications were; arterial puncture(6), puncture failure(5) and abnormal location(12) in SCV; insertion failure(3) in EJV; abnormal location in the portal vein(4) and the liver parenchyma(2) cystic fluid accumulations in UVC. Twelve migrations(3.8 %) out of position occurred; SCV(2), EJV(1) and UVC(9). There were 4 cases(1.2 %) of catheter obstruction and 11(3.4 %) of catheter infection(3 SCV, 2 EJV and 6 UVC). Rescue procedures were utilized with some success. There was one mortality(0.3 %) due to deep sedation in a 1.06 kg baby during placement of an EJV. The surgeon's experience, proper catheter selection and following safety rules are the most important factors for successful CVCs.

항암 화학요법을 받는 환자들에서의 중심정맥삽관술

김욱성,김기봉,Kim, Uk-Seong,Kim, Gi-Bong 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.6

From July 1990 to August 1992,78 Hickman catheters and 22 chemoports were inserted in 98 patients for chemotherapy.We analyzed the clinical data of these patients. The results were as follows: 1]Mean age of patients was 42.8$\pm$1.6[SE] years 2]Male to female ratio was 1.09:1 3]The diseases of the cases were leukemia[66] ,lymphoma[8], stomach cancer[8],uterine cervix cancer[5],ovarian cancer[4],lung cancer[3],aplastic anemia[2],maxillary gland cancer[1],pancreas cancer[1],malignant mesothelioma[1] and multiple myeloma[1] 4]Mean values of preoperative WBC counts,platelet counts,PT and APTT were 31,500$\pm$ 8,132[SE]/mm,104,000$\pm$ 12,200 [SE]/mm,82$\pm$ 1.9[SE]% and 32$\pm$ 0.8[SE] sec,respectively. 5]The average duration of catheter uses was 121.7$\pm$ 17.3[SE]days. 6]The complications were subcutaneous tunnel bleeding or hematoma[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1]. 7]The causes of catheter removal were patient`s death or hopeless discharge[22],completion of treatment[6],subcutaneus hematoma or bleeding[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1].So,we concluded that Hickman catheter and chemoport were useful vascular access for chemotherapy in patients with malignant diseases, with low rate of complication and longterm duration.