Displaying publications 1 - 20 of 38 in total

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  1. Venkateswaran V
    Med J Malaysia, 1986 Dec;41(4):374-6.
    PMID: 3670163
    Repeatedly catheterising the internal jugular vein percutaneously through the same site, between the heads of the sternomastoid, resulted in soft tissue cleavage planes. The catheter entered the pleural cavity from the superior vena cava, a site remote from the percutaneous entry.
    The internal jugular line can be misplaced in spite of respiratory fluctuation, free flow, and reflux with the container lowered below cardiac level. Radiological confirmation is mandatory.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects; Catheterization, Central Venous/methods*
  2. Teh A, Leong KW
    Med J Malaysia, 1995 Dec;50(4):353-8.
    PMID: 8668056
    Hickman catheters have previously been conventionally placed by surgical dissection. This usually performed by experienced surgeons and is carried out under general anaesthesia. We report our preliminary experience in Hickman catheter placement by percutaneous technique in twenty patients. We outline the implantation methods and complications encountered by this technique. The procedure is relatively simple provided the operator is skilled in central venous cannulation. The chief advantages are that the procedure can be done under local anaesthesia and results in less trauma compared with surgical dissection. Such an alternative in catheter insertion would promote wider usage of Hickman catheters in cancer patients.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects; Catheterization, Central Venous/methods*
  3. Sakijan AS, Zambahari R, Annuar Z, Yahya O, Ali J
    Med J Malaysia, 1990 Dec;45(4):340-3.
    PMID: 2152057
    A successful retrieval of a detached segment of a CVP catheter by percutaneous right transfemoral venous route, using a Dotter intravascular retriever basket, is reported. The procedure was monitored under fluoroscopy. Only local anaesthesia, which was infiltrated around the puncture site, was given to the patient. No significant complication was encountered. Successful retrieval of the detached catheter fragment by percutaneous means obviates the need for thoracotomy.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*; Catheterization, Central Venous/instrumentation
  4. Sze Yong T, Vijayanathan AA, Chung E, Ng WL, Yaakup NA, Sulaiman N
    J Vasc Access, 2021 Jan 13.
    PMID: 33438482 DOI: 10.1177/1129729820987373
    OBJECTIVE: To compare catheter related blood stream infection (CRBSI) rate between cuffed tunnelled and non-cuffed tunnelled PICC.

    METHODS: We prospectively followed 100 patients (50:50 cuffed and non-cuffed PICC) and compared CRBSI rate between these groups. Daily review and similar catheter care were performed until a PICC-related complication, completion of therapy, death or defined end-of-study date necessitate removal. CRBSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of infection and from peripheral blood cultures.

    RESULTS: A total of 50 cuffed PICC were placed for 1864 catheter-days. Of these, 12 patients (24%) developed infection, for which 5 patients (10%) had a CRBSI for a rate of 2.7 per 1000 catheter-days. Another 50 tunnelled non-cuffed PICCs were placed for 2057 catheter-days. Of these, 7 patients (14%) developed infection, for which 3 patients (6%) had a CRBSI. for a rate of 1.5 per 1000 catheter-days. The mean time to development of infection is 24 days in cuffed and 19 days in non-cuffed groups. The mean duration of utilization was significantly longer in non-cuffed than in cuffed group (43 days in non-cuffed vs 37 days in cuffed group, p = 0.008).

    CONCLUSIONS: Cuffed PICC does not further reduce the rate of local or bloodstream infection. Tunnelled non-cuffed PICC is shown to be as effective if not better at reducing risk of CRBSI and providing longer catheter dwell time compared to cuffed PICC.

    Matched MeSH terms: Catheterization, Central Venous
  5. Vijaynanthan, A., Nawawi, O., Abdullah, B.J.J.
    JUMMEC, 2017;20(2):8-12.
    MyJurnal
    In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter
    (PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment
    provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was
    well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the
    infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC.
    The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled
    PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000
    catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection
    development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days).
    Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47
    days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.
    Matched MeSH terms: Catheterization, Central Venous
  6. Chan KY, Teoh CM, Sukumar N
    Med J Malaysia, 2005 Mar;60(1):94-6.
    PMID: 16250289
    This is a case report of a patient with difficult venous access following thrombosis of major superficial and deep veins of the limbs as documented by ultrasound doppler and venography. The insertion of a few central ports were infected and the vein thrombosed. Venography revealed that central venous access was no longer feasible. The previous laparotomies had resulted in dense intra-peritoneal adhesions, and rendered further laparotomy virtually impossible. The patient had occasional adhesion colics, vomiting and hypoglycemic episodes. A rarely performed retro-peritoneal approach of inserting an improved non-heparinised port proved to be effective for long-term management of this patient. The surgical approach and the selected port are discussed.
    Matched MeSH terms: Catheterization, Central Venous/methods*
  7. Leang LT
    Med J Malaysia, 1989 Jun;44(2):147-50.
    PMID: 2626123
    Percutaneous insertion of central venous catheter (CVC) is a valuable procedure in managing critically ill patients. However, placement of CVC is not without its complications. The author reports a case in which a CVC was inserted into the right pleural cavity which was not detected by the usual clinical methods of confirming catheter placement and an antero-posterior (A-P) chest x-ray.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*
  8. Fraga MV, Stoller JZ, Glau CL, De Luca D, Rempell RG, Wenger JL, et al.
    Pediatrics, 2019 11;144(5).
    PMID: 31615954 DOI: 10.1542/peds.2019-1401
    Point-of-care ultrasound is currently widely used across the landscape of pediatric care. Ultrasound machines are now smaller, are easier to use, and have much improved image quality. They have become common in emergency departments, ICUs, inpatient wards, and outpatient clinics. Recent growth of supportive evidence makes a strong case for using point-of-care ultrasound for pediatric interventions such as vascular access (in particular, central-line placement), lumbar puncture, fluid drainage (paracentesis, thoracentesis, pericardiocentesis), suprapubic aspiration, and soft tissue incision and drainage. Our review of this evidence reveals that point-of-care ultrasound has become a powerful tool for improving procedural success and patient safety. Pediatric patients and clinicians performing procedures stand to benefit greatly from point-of-care ultrasound, because seeing is believing.
    Matched MeSH terms: Catheterization, Central Venous/methods*
  9. Abdullah BJ, Mohammad N, Sangkar JV, Abd Aziz YF, Gan GG, Goh KY, et al.
    Br J Radiol, 2005 Jul;78(931):596-600.
    PMID: 15961840
    The objective of this study was to prospectively determine the incidence of venous thrombosis (VT) in the upper limbs in patients with peripherally inserted central catheters (PICC). We prospectively investigated the incidence of VT in the upper limbs of 26 patients who had PICC inserted. The inclusion criteria were all patients who had a PICC inserted, whilst the exclusion criterion was the inability to perform a venogram (allergies, previous contrast medium reaction and inability of gaining venous access). Both valved and non-valved catheters were evaluated. Prior to removal of the PICC, an upper limb venogram was performed. The number of segments involved with VT were determined. The duration of central venous catheterization was classified as; less than 6 days, between 6 days and 14 days and more than 14 days. VT was confirmed in 38.5% (10/26) of the patients. The majority 85.7% (12/14) were complete occlusive thrombi and the majority of VT only involved one segment. There was no statistical correlation between the site of insertion of the PICC and the location of VT. Neither was there any observed correlation between the occurrence of VT with the patient's history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. There was also no statistical correlation with the size of the catheter. In conclusion, PICCs are associated with a significant risk of upper extremity deep vein thrombosis (UEVT).
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*; Catheterization, Central Venous/instrumentation; Catheterization, Central Venous/methods
  10. Tan CC, Zanariah Y, Lim KI, Balan S
    Med J Malaysia, 2007 Dec;62(5):370-4.
    PMID: 18705468
    Six hundred and fifty-five central venous catheters (CVC) in 496 patients in the intensive care unit of Hospital Sultanah Aminah were studied to determine the incidence and risk factors for central venous catheter-related blood stream infection (CR-BSI). CR-BSI was diagnosed in 38 catheters, giving an incidence of 9.43 CR-BSI per 1000 catheter days. The mean duration in situ was 8.4 +/- 4.9 days for infected CVCs and 6.0 +/- 3.8 days for non infected CVCs (p = 0.001). CVCs inserted in ICU had the highest infection rate (9.4%) compared to those inserted in the operating theatre (1.4%) and ward (2.8%) (p = 0.001). The highest rate of CR-BSI occurred with 4-lumen catheters (usually inserted when patients needed total parenteral nutrition) with a percentage of 15.8%. The majority of the CVCs (97.9%) were inserted via the subclavian or the internal jugular routes and there was no statistical difference in CR-BSI between them (p = 0.83). Number of attempts more than one had a higher rate of CR-BSI compared to single attempt with percentage of 7.0% vs 4.8% (p = 0.22). The top two organisms were Klebseilla pneumoniae and Pseudomonas aeruginosa. In conclusion, the incidence of CR-BSI in our ICU was 9.43 CR-BSI per 1000 catheter days. The risk factors were duration of CVC in situ, venue of insertion and use of 4 lumen catheter for total parenteral nutrition. The site of insertion, number of lumen up to 3 lumens and the number of attempts were not risk factors.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*; Catheterization, Central Venous/instrumentation
  11. Fauzi AR, Jeyabalan V, Kong NC, Selvam T
    Saudi J Kidney Dis Transpl, 2003 Apr-Jun;14(2):194-6.
    PMID: 18209446
    Central vein stenosis is usually associated with previous cannulation or trauma to the affected vein. This pathology may present as ipsilateral arm swelling in patients in whom a recent arteriovenous fistula has been prepared for chronic hemodialysis. The presence of central vein stenosis without prior trauma or cannulation is not hitherto reported to the best of our knowledge. We herewith report a patient with end-stage renal disease who was initiated on chronic dialysis using an arteriovenous fistula, who was noted to have central vein stenosis. This was despite her never having had any central vein cannulation or previous known trauma. Venogram confirmed the presence of brachiocephalic vein stenosis. The patient underwent venographic stenting of the involved vein with good success.
    Matched MeSH terms: Catheterization, Central Venous
  12. Rickard CM, Marsh NM, Larsen EN, McGrail MR, Graves N, Runnegar N, et al.
    Lancet, 2021 04 17;397(10283):1447-1458.
    PMID: 33865494 DOI: 10.1016/S0140-6736(21)00351-2
    BACKGROUND: The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters.

    METHODS: We did a randomised, controlled, assessor-masked trial at ten Australian hospitals. Our hypothesis was CRBSI equivalence for central venous access devices and non-inferiority for peripheral arterial catheters (both 2% margin). Adults and children with expected greater than 24 h central venous access device-peripheral arterial catheter use were randomly assigned (1:1; stratified by hospital, catheter type, and intensive care unit or ward) by a centralised, web-based service (concealed before allocation) to infusion set replacement every 7 days, or 4 days. This included crystalloids, non-lipid parenteral nutrition, and medication infusions. Patients and clinicians were not masked, but the primary outcome (CRBSI) was adjudicated by masked infectious diseases physicians. The analysis was modified intention to treat (mITT). This study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12610000505000 and is complete.

    FINDINGS: Between May 30, 2011, and Dec, 9, 2016, from 6007 patients assessed, we assigned 2944 patients to 7-day (n=1463) or 4-day (n=1481) infusion set replacement, with 2941 in the mITT analysis. For central venous access devices, 20 (1·78%) of 1124 patients (7-day group) and 16 (1·46%) of 1097 patients (4-day group) had CRBSI (absolute risk difference [ARD] 0·32%, 95% CI -0·73 to 1·37). For peripheral arterial catheters, one (0·28%) of 357 patients in the 7-day group and none of 363 patients in the 4-day group had CRBSI (ARD 0·28%, -0·27% to 0·83%). There were no treatment-related adverse events.

    INTERPRETATION: Infusion set use can be safely extended to 7 days with resultant cost and workload reductions.

    FUNDING: Australian National Health and Medical Research Council.

    Matched MeSH terms: Catheterization, Central Venous/adverse effects; Catheterization, Central Venous/economics; Catheterization, Central Venous/instrumentation*
  13. Yaacob Y, Zakaria R, Mohammad Z, Ralib AR, Muda AS
    Malays J Med Sci, 2011 Oct;18(4):98-102.
    PMID: 22589680
    Central venous catheter placement is indicated in patients requiring long-term therapy. With repeated venous catheterisations, conventional venous access sites can be exhausted. This case illustrates the expanding role of radiology in managing difficult venous access. We present a case of translumbar, transhepatic, and transcollateral placement of central catheter in a woman with a difficult venous access problem who required lifelong parenteral nutrition secondary to short bowel syndrome. This case highlights the technical aspects of interventional radiology in vascular access management.
    Matched MeSH terms: Catheterization, Central Venous
  14. Alazzawi S, Hindi K, Malik A, Wee CA, Prepageran N
    Laryngoscope, 2015 Nov;125(11):2551-2.
    PMID: 26108861 DOI: 10.1002/lary.25422
    We describe extremely rare cases of vocal cord palsy following surgical insertion of a chemo port. Our cohort consisted of patients with cancer who developed hoarseness immediately after central venous line placement for the administration of chemotherapy, with vocal cord palsy confirmed with flexible laryngoscopy. Given the timing, central venous line placement appears to be the most likely cause.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*
  15. Chan L, Ngeow YF, Parasakthi N
    Med J Malaysia, 1998 Mar;53(1):10-5.
    PMID: 10968131
    Fourteen severely ill ventilated patients in an intensive care unit, requiring short-term total parenteral nutrition, were examined for catheter-related infection. Microbiological analysis using Maki's SQ technique was carried out on catheter exit site, catheter hub, proximal subcutaneous segment of catheter and catheter up. Qualitative cultures were carried out on total parenteral nutrition and peripheral blood samples. Twenty six of 29 catheters removed (90%) were culture positive but only 7 catheters were related to positive blood cultures, giving a catheter-related bacteremia (CRB) rate of 24%. Haematogenous seeding was strongly implicated in 7/29 (24%) of catheters. Patients' skin flora appeared to be the main source of catheter-related infection. The organisms isolated for patients with CRB included coagulase-negative staphylococci, Acinetobacter and Klebsiella. It is suggested that to control infective complications of central venous catheters, emphasis should be focused on specialised intravenous therapy teams and the use of strict protocols for insertion and care of central lines.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*
  16. Henry TCL, Huei TJ, Yuzaidi M, Safri LS, Krishna K, Rizal IA, et al.
    Chin J Traumatol, 2020 Feb;23(1):29-31.
    PMID: 31744657 DOI: 10.1016/j.cjtee.2019.10.001
    Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*
  17. Kurien M, Teo R, Zainuddin K, Azidin AM, Izaham A, Budiman M, et al.
    Clin Ter, 2021 Jul 05;172(4):278-283.
    PMID: 34247211 DOI: 10.7417/CT.2021.2332
    Objective: We compared sonoanatomy of the internal jugular vein (IJV) the high (HA), conventional (CA) and the medial oblique approach (MA) to identify the best approach and head position for IJV cannulation.

    Materials & Methods: Total of 45 volunteers aged 18-65 years were included in this study. The degree of overlap in percentage, depth of IJV from skin, antero-posterior (AP) and transverse diameters (TD) of IJV were measured in real time with ultrasound (US). Measurements were taken in the HA, CA and MA in neutral and 30° head rotation on both the right and left side of the neck.

    Results: The HA had lower percentage of overlap when compared to CA and MA in neutral and 30° head rotation (p= 0.002 to ≤0.001). The IJV was more shallow in the CA and MA. The AP and TD of the IJV were larger in the MA when compared to HA (p=<0.001) and CA (p =0.026 to < 0.001) and the right IJV has a larger AP and TD in all approaches.

    Discussion: The HA had the least percentage of overlap compared to CA and MA, therefore the risk of accidental ICA puncture can be reduced. The apparent overlap seen in MA may not reflect the actual scenario because of the way the US beam cuts the vessel. The AP and TD of IJV were significantly increased in the MA, which would ease CVC.

    Conclusion: We conclude and recommend the medial oblique probe position with 30° head rotation provides optimal real time sonographic parameters for US guided IJV cannulation.

    Matched MeSH terms: Catheterization, Central Venous/methods*
  18. Pau CP, Aini A
    Med J Malaysia, 2019 04;74(2):182-183.
    PMID: 31079133
    Central venous cannulation is a common procedure done for various medical indications. The use of the central venous cannula is associated with various immediate complications such as pneumothorax, vascular injury, and arrhythmia. The following is an unusual case of delayed presentation of a right vertebral artery injury due to central venous cannulation which resulted in a posterior circulation stroke. This is a condition that can be difficult to diagnose and has a significant impact on patient's quality of life. Clinicians and radiologists should be alert to this possibility to prevent further morbidity resulting from the iatrogenic injury.
    Matched MeSH terms: Catheterization, Central Venous/adverse effects*
  19. Cheong SM, Totsu S, Nakanishi H, Uchiyama A, Kusuda S
    J Neonatal Perinatal Med, 2016;9(1):99-105.
    PMID: 27002262 DOI: 10.3233/NPM-16915054
    OBJECTIVE: In order to evaluate safety and usefulness of peripherally inserted double lumen central catheter (PIDLCC) in very low birth weight (VLBW) infants, outcomes of VLBW infants who had PIDLCC was studied.

    SUBJECTIVE: Thirty-nine VLBW infants who were admitted to our NICU in 2013 were retrospectively analyzed.

    RESULTS: Mean birth weight and gestational age was 1042.7 gram and 28.5 weeks, respectively. Total duration of indwelling PIDLCC was 1121 days (mean 28.5+18.2 days) with 85 PIDLCCs used. Dressing at the insertion site was done twice weekly with 10% povidone iodine. Four (10.3% with mean of 48 days) infants had catheter-related blood stream infection (CRBSI), with a 3.57 infection per 1000 catheter-day. The mean for days of PIDLCC in 35 infants without CRBSI was 26.5 days. Organisms isolated were Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus capitis ureolytic. Our study showed significant difference in the duration of indwelling catheter (p = 0.023) and intraventricular hemorrhage (p = 0.043) between the CRBSI group and non-CRBSI group. Five (12.8%) infants had abnormal thyroid function test, in which two infants required thyroxine supplementation upon discharge. However, duration of PIDLCC and abnormal thyroid function test was not statistically significant (p = 0.218). One (2.5%) infant died (death was not related to CRBSI). There was no serious adverse effects secondary to PIDLCC.

    CONCLUSION: It is concluded that the use and maintenance of PIDLCC is safe for VLBW infants, but close monitoring should be observed to detect early signs of infection.

    Matched MeSH terms: Catheterization, Central Venous/adverse effects*; Catheterization, Central Venous/statistics & numerical data
  20. Shanmuganathan M, Goh BL, Lim CTS
    Am J Med Sci, 2018 11;356(5):476-480.
    PMID: 30384954 DOI: 10.1016/j.amjms.2018.08.004
    BACKGROUND: Noncuffed catheters (NCC) are often used for incident hemodialysis (HD) patients without a functional vascular access. This, unfortunately results in frequent catheter-related complications such as infection, malfunction, vessel stenosis, and obstruction, leading to loss of permanent central venous access with superior vena cava obstruction. It is important to preserve central vein patency by reducing the number of internal jugular catheter insertions for incident HD patients with a functional vascular access. We sought to achieve this by introducing in-patient intermittent peritoneal dialysis (IPD) as bridging therapy while awaiting establishment of long-term vascular access for HD patients.

    METHODS: Incident HD patients without permanent vascular access encountered from January to December 2014 were included in this study. Patients were divided into 2 groups: Group 1 were encountered within 6 months prior to introduction of in-patient IPD bridging therapy in substitution of noncuffed catheter (NCC) insertion while awaiting maturation of permanent vascular access. Group 2 were encountered within 6 months after the introduction of this policy. The number of NCC and peritoneal dialysiscatheter insertion, along with catheter-related infections were evaluated during this period.

    RESULTS: Approximately 450 patients were distributed in each group. We achieved 45% reduction in internal jugular catheter insertion from 322 to 180 catheters after policy change. This led to a significant drop in catheter-related blood stream infection (53%, P <0.001). On the other hand, 30% more peritoneal dialysiscatheter were inserted to accommodate our IPD bridging therapy.

    CONCLUSIONS: The introduction of IPD as bridging therapy while awaiting maturation of permanent vascular access significantly reduced the utilization of NCC in incident HD patients and catherter-related blodstream infection. With this, it is our hope that it will contribute to the preservation of central vein patency.

    Matched MeSH terms: Catheterization, Central Venous/methods*; Catheterization, Central Venous/statistics & numerical data
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