Special CommunicationReporting Standards for Central Venous Access
Section snippets
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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2009, European Journal of RadiologyCitation Excerpt :Satisfaction was measured with a scale from 0 (extremely dissatisfied/unhappy) to 10 (extremely satisfied/happy) analogue to the perceived Quality of Life Scale (PQoL) [9]. Peri- and post-procedual complications were defined according to the reporting standards of the Society of Interventional Radiology and stratified in minor and major complications [10–12]. A peri-procedural complication is defined as a complication occurring during the implantation procedure or within the first 24 h after implantation.