• 종양간호연구
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• 제11권1호
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• pp.1-8
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• 2011

Purpose: The purpose of this study was to identify the types of venous access devices (VAD) for cancer patients and investigate the factors related to the insertions of central venous catheter (CVC) in cancer patients. Methods: The subjects were 379 cancer patients. A retrospective review of all patients who were discharged from a cancer unit from November 1st to 21st in 2008 was done using a structured questionnaire. Results: A total of 82 CVC (21.6%) was inserted among 379 patients for administering anticancer therapy. There were statistically significant differences in age, length of stay (LOS), cumulative LOS, medical department, history of CVC insertion, cancer category, and albumin level between patients using peripheral intravenous (IV) catheters and CVC. In addition, factors influencing the use of CVC were LOS (odds ratio [OR]=0.286, confidence interval [CI]=1.043-1.124), history of CVC insertion (OR=3.920, CI=0.128-0.637), albumin level (OR=1.010, CI=1.879-8.179), cumulative LOS (OR=1.010, CI=1.001-1.018), and hematological diseases (OR=4.863, CI=2.162-10.925). Conclusion: We found that central venous catheterization for anticancer therapy was minimal even though CVC was safe and effective device for IV access. It is necessary to develop a strategy to use VADs efficiently and timely for cancer patients.

• Journal of Chest Surgery
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• 제51권5호
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• pp.333-337
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• 2018

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.

• Clinical and Experimental Pediatrics
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• 제51권12호
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• pp.1359-1362
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• 2008

혈우병 환자에서 가장 효과적인 치료 방침은 응고 인자의 보충으로, 그를 위해 안전하고 오래 사용할 수 있는 정맥 확보가 필요하다. 그러나 중심 정맥으로의 port는 전신 마취와 일정한 입원이 필요하고, 혈우병 환자에서 시행할 경우 보험 삭감의 문제도 있다. 본 저자는 두 명의 중증 혈우병 항체 환자에게 말초 삽입 중심 정맥관을 삽입하였다. 환자들은 잦은 출혈 소견 때문에 응고 인자를 투여 받았으며, 그로 인하여 혈관 확보에 어려움이 있었다. 환자 나이는 7세와 11세였다. 제 8 응고 인자 활성도는 모두 1% 이하였으며, 제 8 응고 인자 항체 수치는 각각 160과 26.3 BU/mL였다. 말초 삽입 중심 정맥관은 초음파 인도 하에, 외래에서, 국소 마취로 쉽게 삽입되었다. 말초 삽입 중심 정맥관 삽입은 잦은 출혈을 보이는 혈우병 환자에게 사용해 볼 수 있는 방법이다.

• Journal of Chest Surgery
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• 제40권10호
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• pp.691-695
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• 2007

배경: 중심정맥 도관은 1979년 처음 사용된 이래로 암환자의 치료에 있어 많은 편의를 제공하였다. 이에 본원 흉부외과에서는 완전 거치형 정맥도관의 임상 양상 및 사용에 따른 합병증 등을 분석하여 향후 치료에 도움이 되고자 본 연구를 하였다. 대상 및 방법: 2004년 11월부터 2006년 2월까지 완전 거치형 정맥도관 시술을 받은 100명의 환자를 대상으로 후향적 연구를 하여 다음과 같은 결과를 얻었다. 결과: 완전 거치형 정맥 도관 시술의 삽입정맥으로는 우측 쇄골하정맥 삽입이 74예(74%)였으며 좌측쇄골하 정맥(21예, 21%), 우측 경정맥(3예, 3%), 좌측 경정맥(1예, 1%)을 사용하였으며 1예에서는 우측 대퇴정맥을 사용하였다. 초기 합병증으로는 위치 이상이 5예(5%)와 동맥천자한 경우 5예 있었다. 만기 합병증으로는 쇄골하 정맥 혈전 형성이 한 예 있어 현재 항응고제 복용중이며 pinch off 증후군이 2예 있었다. 그 외의 초기 또는 만기 합병증은 없었다. 결론: 완전 거치형 도관의 사용은 합병증의 발생률은 낮고 비교적 안전한 방법이지만 감염, 혈전 형성, 도관의 절단 등은 장기간 사용시 나타날 수 있는 합병증으로 초기에 진단 및 치료가 된다면 더 큰 합병증을 예방할 수 있다.

• Clinical and Experimental Pediatrics
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• 제59권2호
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• pp.96-99
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• 2016

Survival rates of preterm infants have improved in the past few decades, and central venous catheters play an important role in the intensive medical treatment of these neonates. Unfortunately, these indwelling catheters increase the risk of intracardiac thrombosis, and they provide a nidus for microorganisms during the course of septicemia. Herein, we report a case of persistent bacteremia due to methicillin-resistant Staphylococcus aureus in an extremely low birth weight (ELBW) infant, along with vegetation observed on an echocardiogram, the findings which are compatible with a diagnosis of endocarditis. The endocarditis was successfully treated with antibiotic therapy, and the patient recovered without major complications. We suggest a surveillance echocardiogram for ELBW infants within a few days of birth, with regular follow-up studies when clinical signs of sepsis are observed.

• Advances in pediatric surgery
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• 제12권2호
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• pp.167-174
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• 2006

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time: 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.

• Advances in pediatric surgery
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• 제4권1호
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• pp.1-15
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• 1998

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.

• Journal of Chest Surgery
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• 제41권4호
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• pp.504-507
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• 2008

피하매몰형 중심정맥도관은 근래에 항암 치료, 장기간의 정맥주사, 영양 공급 등을 위해 빈번히 사용되고 있다. 그러나 중심정맥도관을 거치했을 때 감염, 혈전, 폐색 등의 합병증이 발생할 수 있으며, 비교적 낮은 빈도에서 도관의 절단이 발생할 수 있다. 저자들은 Pinch off 증후군에 의한 도관 절단을 3예 경험하였기에 이를 보고하고, 고찰하고자 한다.

• 임상간호연구
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• 제29권1호
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• pp.42-55
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• 2023

Purpose: This study was conducted to update nursing practice guidelines for intravenous infusion published in 2017. Methods: The guideline update process was carried out using 22 steps developed by NICE and SIGN. It was agreed to update domains related to central venous infusion therapy. Contents related to peripheral infusion would be updated later. Results: Updated guidelines for central venous infusion therapy consisted of 6 domains and 195 recommendations. The number of recommendations by domain was 11 for general instruction, 14 for central vascular access devices (CVAD) and add-on devices, 13 for nursing management before insertion of CVAD, 30 for management during insertion of CVAD, 51 for management after insertion of CVAD, and 76 for complications. A grade was 29 (14.9%), B grade was 87 (44.6%), and C grade was 79 (40.5%) in the strength of recommendations. A total of 37 (19.0%) recommendations were newly developed and 23 (12.3%) previous recommendations have been modified. The newly developed recommendations were mainly related to the infection control methods. Conclusion: The updated guideline is focused on safe maintenance of central venous infusion therapy. Through this guideline, it is hoped to minimize the occurrence of complications and improve the standardization and efficiency of nursing practice.

• Advances in pediatric surgery
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• 제13권1호
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• pp.72-75
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• 2007

The use of subcutaneously tunneled, cuffed central venous catheters like Broviac's or Hickman's has increased and complications related to catheter removal has also increased. However, there are only few reports of complications that occur at the time of removal. The authors report an unusual case of catheter fracture during removal of Broviac catheter.