Retrospective review of the development and implementation of a bedside tunneled dialysis catheter program.

Background: The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.

Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study.

Objectives: To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities.

Design: A propensity-score matched cohort study.

Setting: A 980-bed tertiary referral hospital in South West Sydney, Australia.

Case report: End of life care via a mid-thigh femoral midline catheter.

Maintaining peripheral vascular access represents a major challenge for medical providers and patients leading to the emergence of ultrasound guided vascular access teams. Upper extremity peripheral vascular access options are often limited in the chronically ill patient population with end stage cancer, patients with severe contractures, tracheostomies, and feeding tubes and patients referred for palliative care are just some examples of patients who live with difficult access. The following is a case description of a mid-thigh superficial femoral vein midline catheter for comfort care medications in a patient with exhausted peripheral vasculature on hospice.

The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters.

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.

The SIC protocol: A seven-step strategy to minimize complications potentially related to the insertion of centrally inserted central catheters.

Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.

Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients.

In the last decade, different standardized protocols have been developed for a systematic ultrasound venous assessment before central venous catheterization: RaCeVA (Rapid Central Vein Assessment), RaPeVA (Rapid Peripheral Vein Assessment), and RaFeVA (Rapid Femoral Vein Assessment). Such protocols were designed to locate the ideal puncture site to minimize insertion-related complications. Recently, subcutaneous tunneling of non-cuffed central venous access devices at bedside has also grown in acceptance.

A triple tunnel from the mid-calf to the femoral vein in patient with severe dementia.

Achieving the ideal exit site is the new philosophy for complicated vascular access patients. Recent publications have described multiple venous access solutions such as tunneling to the scapular region, the chest to the arm, and from the femoral vein to the abdominal and patellar region. In the patients afflicted with delirium, dementia, or confusion even these sites may not be sufficient.

Providing the conduit for treatment: The impact of vascular access and vein preservation in a 5-year-old child with prenatally diagnosed CRIM-negative Infantile Pompe disease.

Pompe disease is an autosomal recessive glycogen storage disorder resulting in progressive glycogen accumulation expressed in infancy with cardiomyopathy and skeletal myopathy. Without treatment by enzyme replacement therapy (ERT), life expectancy is less than 2 years. The cross-reactive immunologic material (CRIM) positive or negative status is the basis for the response to ERT.

Achieving superficial femoral venous access in a critically ill COVID-19 patient in the prone position.

A 63-year-old obese male was admitted with acute respiratory failure secondary to COVID-19. Day 13 the patient decompensated, lapsing into a critical stage of severe acute respiratory distress syndrome, requiring immediate prone positioning. The Rapid Response Team managed the emergency intervention for intubation but was unable to establish central access with the patient in the prone position.

Rapid Femoral Vein Assessment (RaFeVA): A systematic protocol for ultrasound evaluation of the veins of the lower limb, so to optimize the insertion of femorally inserted central catheters.

In this paper we describe a new protocol-named RaFeVA (Rapid Femoral Vein Assessment)-for the systematic US assessment of the veins in the inguinal area and at mid-thigh, designed to evaluate patency and caliber of the common and superficial femoral veins and choose the best venipuncture site before insertion of a FICC.

Venous catheter at alternate exit site in a 2-year-old requiring long-term antibiotics for osteomyelitis: A case report.

In the pediatric population, vascular access is often challenging to secure and to maintain, especially for long-term intravenous (IV) treatment. The traditional approach for patients who require long-term IV antibiotics is placement of a peripherally inserted central catheter (PICC). The challenge in the pediatric population is the high risk of dislodgement after PICC placement, as these patients tend to pull their line out accidentally or purposefully.

Alternative exit sites for central venous access: Back tunneling to the scapular region and distal tunneling to the patellar region.

Uncooperative elderly patients with cognitive disorder are often confused and/or agitated. Risk of involuntary venous access device dislodgment is high in these patients. This is equally likely with peripherally inserted central catheters and centrally inserted central catheters but less common with femorally inserted central catheters.

Report of Modification for Peripherally Inserted Central Catheter Placement: Subcutaneous Needle Tunnel for High Upper Arm Placement.

The majority of peripherally inserted central catheters (PICCs) are currently inserted with the aid of ultrasound guidance in the middle third of the upper arm. A growing patient population is presenting with challenging vessel access requiring placement of the PICC in the high upper third of the arm. To avoid this suboptimal exit site, a subcutaneous tunneling of the PICC is established away from the axilla to a more appropriate skin exit site.