Document Detail

Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement.
MedLine Citation:
PMID:  12616419     Owner:  NLM     Status:  MEDLINE    
The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters (PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwell time and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. 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. Patients with longer catheter dwell time were more likely to develop central vein abnormalities. In order to preserve vascular access for dialysis fistulae and grafts and adhere to Dialysis Outcomes Quality Initiative guidelines, alternative venous access sites should be considered for patients with chronic renal insufficiency and end-stage renal disease.
Carin F Gonsalves; David J Eschelman; Kevin L Sullivan; Nancy DuBois; Joseph Bonn
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Publication Detail:
Type:  Journal Article     Date:  2003-03-06
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  26     ISSN:  0174-1551     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:    2003 Mar-Apr
Date Detail:
Created Date:  2003-06-18     Completed Date:  2003-12-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  123-7     Citation Subset:  IM    
Department of Radiology, Jefferson Medical College/Thomas Jefferson University Hospital, Suite 4200 Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA.
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MeSH Terms
Aged, 80 and over
Azygos Vein / pathology,  physiopathology,  radiography
Brachiocephalic Veins / pathology,  physiopathology,  radiography
Catheterization, Central Venous / instrumentation*
Catheters, Indwelling / adverse effects
Equipment Safety
Follow-Up Studies
Middle Aged
Peripheral Vascular Diseases / diagnosis,  epidemiology,  etiology
Retrospective Studies
Subclavian Vein / pathology,  physiopathology,  radiography
Time Factors
Treatment Failure
Upper Extremity / blood supply*,  radiography
Vascular Patency / physiology
Vena Cava, Superior / pathology,  physiopathology,  radiography
Venous Thrombosis / diagnosis,  epidemiology,  etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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