Erschienen in:
01.04.2003 | Clinical Investigations
Incidence of Central Vein Stenosis and Occlusion Following Upper
Extremity PICC and Port Placement
verfasst von:
Carin F. Gonsalves, David J. Eschelman, Kevin L. Sullivan, Nancy DuBois, Joseph Bonn
Erschienen in:
CardioVascular and Interventional Radiology
|
Ausgabe 2/2003
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Abstract
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.