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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
[Conservative management of retained central venous catheters]
N Albertos Mira-Marcelí1, N Gallego Mellado, J Mira Navarro
1Servicio de Cirugía Pediátrica del Hospital General Universitario de Alicante. nurialbertos@hotmail.com
Insights
Central venous catheters (CVCs) can be difficult to remove, especially after prolonged use in ALL B patients. Conservative management may be a safe option for retained CVC fragments, avoiding complications.
Area of Science:
- Vascular Surgery
- Oncology
- Medical Devices
Context:
- Central venous catheters (CVCs) are essential for long-term vascular access in patients undergoing chemotherapy.
- Catheter removal can be complicated by adherence to the vessel wall, necessitating advanced interventions.
- Retained CVC fragments pose potential risks including infection, thrombosis, and migration.
Purpose:
- To investigate factors associated with difficult central venous catheter removal.
- To evaluate outcomes in patients with retained CVC fragments.
- To assess the safety and efficacy of conservative management for retained CVC fragments.
Summary:
- A retrospective study analyzed 174 CVC removals between 2003 and 2011.
- Five cases (3.4%) experienced CVC removal failure, all in ALL B patients with catheters in situ for over 2 years.
- No complications were observed in patients with retained CVC fragments during a mean 36-month follow-up.
Impact:
- Identifies prolonged CVC dwell time and specific chemotherapy regimens (ALL B) as risk factors for removal difficulty.
- Suggests that conservative management of retained CVC fragments is a viable option, potentially reducing the need for invasive procedures.
- Contributes to evidence-based guidelines for managing complex CVC removal scenarios in oncology patients.
Background:
Withdrawal of central venous catheters (CVCs) is usually a simple surgical procedure. However, in some cases, the catheter is stuck in the vessel wall and its removal is not possible if more invasive interventions are not performed.
Material And Methods:
We performed a retrospective study from 2003 to 2011 of patients who were clearing a CVC and the factors that could have intervened in the removal impossibility. We compared the type of catheter, the insertion site, the time between its insertion and removal, the primary diagnosis and the treatment. In addition, a monitoring by clinical and imaging tests has been made in patients with retained CVCs.
Results:
An amount of 174 interventions were carried out. In 5 cases the CVC could not been removed. These 5 cases were patients diagnosed with ALL B and were treated with identical chemotherapy treatment. In addition, at the time of its retirement, all the patients had the CVC for a period longer than 2 years -29 to 84 months-. In patients with retained fragments, no complication arose from this condition. The mean follow-up period was 36 months -maximum 48 months-.
Conclusions:
The potential complications arising from the presence of the retained CVCs fragments include infection, venous thrombosis and catheter migration. Based on our results, we propose that a conservative management might be considered as an option in these patients.
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