Special Communication
Reporting Standards for Central Venous Access

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Discussion

Documentation of demographic information allows for comparison of study populations from different reports. Basic demographic information includes age, sex, and underlying disease. Additional information that characterizes the study population includes history of previous CVAD insertion, presence of coagulopathy, potential risk factors for CVAD infection (eg, fever, sepsis, known infection, or immunodeficiency), mental competence, nutritional status/weight, hospitalization at the time of the

Discussion

A tunneled catheter is defined as a central venous catheter that travels through a subcutaneous tract before entering the access vein. A subcutaneous infusion port consists of a tunneled central venous catheter that terminates in a subcutaneous pocket where a self-sealing reservoir is implanted (1). The tunneled catheter exit site or implanted port pocket is usually placed over the upper chest or the upper extremity near the antecubital fossa (11, 12, 13, 14, 15, 16). Reports have described

Recommendations for Reporting Standards

The CVAD insertion technique description should be sufficiently detailed to allow the procedure to be consistently reproduced by others. The description of a novel technique should specify the differences from standard techniques.

Discussion

Studies comparing the outcomes of CVADs placed in surgical operating rooms and interventional radiology suites have shown comparable results (22, 23, 24).

Patient skin preparation routines vary. Some routines involve the use of iodophor scrub, iodophor paint, isopropyl alcohol, chlorhexidine, or a combination of agents (25). There is currently no consensus as to the routine use of prophylactic antibiotics (26, 27, 28).

Recommendations for Reporting Standards

Indicate the type of procedure room used, such as interventional radiology

Discussion

Studies have been performed comparing outcomes of CVAD placement, using operators with variable experience. Some series have encountered lower complication rates for procedures performed by experienced operators (29, 30).

Recommendations for Reporting Standards

Indicate operator and institutional experience with the device used in the study.

Recommendations for Reporting Standards

Report the types and routes of administration of anesthetic or sedative agents. Report the number of procedures performed with the assistance of an anesthesiologist.

DEVICE INSERTION

The device insertion procedure is divided into initial venous access, device insertion and positioning, wound closure and wound dressing, and postprocedure imaging.

Discussion

Several centers have established an expert infusiontherapy team for the insertion and maintenance of catheters. One study has shown that such a team can decrease the infection rate (65).

In a prospective randomized study, low-dose oral anticoagulation significantly decreased the incidence of thrombotic complications of CVADs (66).

Recommendations for Reporting Standards

Document the postprocedure catheter maintenance protocol. Describe the catheter flush and dressing routine. Report the timing of initial device access and/or use after

Discussion

Technical success is defined as catheter introduction into the venous system with the tip positioned in the desired location, and with adequate catheter function (1). Withdrawal of blood for sampling and infusion of saline into the device without significant resistance are indicators of successful catheter function. For tunneled hemodialysis catheters in adult patients, 300 mL/min is considered an adequate rate of blood flow (67).

Device failure is defined as any limitation in catheter function

Discussion

Grading of complications quantifies the morbidity caused by a procedure (2). Early complications (Table 2a, Table 2b) occur within 30 days of the procedure and late complications (Table 3) occur after 30 days of the procedure. Most of the early complications are related to the technique of placing the CVAD and are more likely to be encountered within 24 hours of the procedure. However, some procedure-related complications may not be recognized until days or weeks after the procedure. For

Discussion

Cost analysis provides an evaluation of resource utilization (85). Factors that contribute to the total cost for CVAD insertion include direct material costs such as the venous access device, catheters, guide wires, needles, syringes, drapes, surgical instruments, dressings, contrast material, anesthetic agents, and antibiotics. After the CVAD insertion procedure, follow-up costs include catheter maintenance, reinterventions, and episodes of infection that require antibiotics or

CONCLUSION

CVAD insertion has become a common procedure performed by interventional radiologists (86, 88, 89, 90, 91, 92). Many variables are involved in CVAD selection, insertion, management, and follow-up. The purpose of this document is to provide standardized definitions and uniform reporting requirements to assist in study design and outcomes reporting. This document attempts to guide future studies toward a consistency of reporting that will allow comparisons among studies from different

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References (92)

  • R McKee et al.

    Does antibiotic prophylaxis at the time of catheter insertion reduce the incidence of catheter-related sepsis in intravenous nutrition?

    J Hosp Infect

    (1985)
  • PF Jaques et al.

    The first rib as a fluoroscopic marker for subclavian vein access

    JVIR

    (1995)
  • JE Silberzweig et al.

    Venography in the lordotic projection to facilitate central venous access

    JVIR

    (1996)
  • DL Mallory et al.

    Ultrasound guidance improves the success rate of internal jugular vein cannulation

    Chest

    (1990)
  • DL Mallory et al.

    Ultrasound guidance improves the success rate of internal jugular vein cannulation

    Chest

    (1990)
  • H Ferral et al.

    Recanalization of occluded veins to provide access for central catheter placement

    JVIR

    (1996)
  • RL Brandt et al.

    Mechanism of perforation of the heart with production of hydropericardium by a venous catheter and its prevention

    Am J Surg

    (1970)
  • AR Borja

    Current status of infraclavicular subclavian vein catheterization

    Ann Thoracic Surg

    (1972)
  • GK Nazarian et al.

    Changes in tunneled catheter tip position when a patient is upright

    JVIR

    (1997)
  • CM Kowalski et al.

    Migration of central venous catheters: implications for initial catheter tip positioning

    JVIR

    (1997)
  • DG Maki et al.

    A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection

    Am J Med

    (1981)
  • A Levin et al.

    Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine

    Kidney Int

    (1991)
  • D Shaffer

    Catheter-related sepsis complicating long-term, tunneled central venous dialysis catheters: management by guidewire exchange

    Am J Kidney Dis

    (1995)
  • ZJ Haskal et al.

    Transvenous removal of fibrin sheaths from tunneled hemodialysis catheters

    JVIR

    (1996)
  • RJ Duszak et al.

    Replacement of failing hemodialysis catheters using pre-existing subcutaneous tunnels: a comparison of catheter function and infection rates for de novo placements and over-the-wire exchanges

    JVIR

    (1998)
  • MH Knelson et al.

    Functional restoration of occluded central venous catheters: new interventional techniques

    JVIR

    (1995)
  • TKP Egglin et al.

    Replacement of accidentally removed tunneled venous catheters through existing subcutaneous tracts

    JVIR

    (1997)
  • DE Clarke et al.

    Infectious complications of indwelling long-term central venous catheters

    Chest

    (1990)
  • HS Raucher et al.

    Quantitative blood cultures in the evaluation of septicemia in children with Broviac catheters

    J Pediatr

    (1984)
  • MA Mauro et al.

    Radiologic placement of long-term central venous catheters: a review

    JVIR

    (1993)
  • KL Openshaw et al.

    Interventional radiologic placement of Hohn central venous catheters: results and complications in 100 consecutive patients

    JVIR

    (1994)
  • CE Ray et al.

    Patients with thrombocytopenia: outcome of radiologic placement of central venous access devices

    Radiology

    (1997)
  • JF Cockburn et al.

    Insertion of Hickman central venous catheters by using angiographic techniques in patients with hematologic disorders

    AJR

    (1992)
  • B Damascelli et al.

    Placement of long-term central venous catheters in outpatients: study of 134 patients over 24,596 catheter days

    AJR

    (1997)
  • RS Surratt et al.

    The importance of perioperative evaluation of the subclavian vein in dialysis access planning

    AJR

    (1991)
  • GE Cimochowski et al.

    Superiority of the internal jugular over the subclavian access for temporary dialysis

    Nephron

    (1990)
  • F Schillinger et al.

    Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses

    Nephrol Dial Transplant

    (1991)
  • JA Kaufman et al.

    Long-term outcomes of radiologically placed arm ports

    Radiology

    (1996)
  • JM Pearl et al.

    Improved methods in long term venous access using the P.A.S. Port

    Surg Gynecol Obstet

    (1991)
  • MV Beheshti et al.

    Long-term results of radiologic placement of a central vein access device

    AJR

    (1998)
  • B Funaki et al.

    Radiologic placement of subcutaneous infusion chest ports for long-term central venous access

    AJR

    (1997)
  • GB Lund et al.

    Translumbar inferior vena cava catheters for long-term venous access

    Radiology

    (1990)
  • DF Denny et al.

    Inferior vena cava: translumbar catheterization for central venous access

    Radiology

    (1989)
  • GX Zaleski et al.

    Experience with tunneled femoral hemodialysis catheters

    Am J Roentgenol

    (1999)
  • GM McGann

    Long-term venous access service based in the barium room

    Br J Radiol

    (1995)
  • LJ Robertson et al.

    Radiologic placement of Hickman catheters

    Radiology

    (1989)
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