Shanghai expert consensus on totally implantable access ports 2019

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Abstract

Totally implantable access ports (TIAPs) are used for patients with poor peripheral vascular support requiring central venous access. In recent years, TIAPs have been gradually accepted and promoted by patients, doctors, and nurses owing to their advantages of convenient carrying, a long maintenance period, low complications, and a high quality of life for patients. Currently, medical personnel that handle TIAP implantation and management in China are from different areas of healthcare, including surgery, internal medicine, radiology, nurse anesthesia, vascular access, etc., and many only handle TIAP as a part of their duties. Therefore, the operating procedures and steps for the diagnosis and treatment of complications of TIAP vary from person to person, resulting in different incidence and treatment methods for complications in the implantation and use of TIAP in different medical units. Based on this, we have updated the Shanghai expert consensus on TIAPs from 2015 and explored the diagnosis and treatment procedures of related complications while continuing to emphasize standardized implantation and maintenance.

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Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice

Bernd Saugel, Thomas W L Scheeren, Jean-Louis Teboul (2017)

The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this review, we describe the rationale for the use of US during CVC placement, the basic principles of this technique, and the current evidence and existing guidelines for its use. In addition, we recommend a structured approach for US-guided central venous access for clinical practice. Static and real-time US can be used to visualize the anatomy and patency of the target vein in a short-axis and a long-axis view. US-guided needle advancement can be performed in an "out-of-plane" and an "in-plane" technique. There is clear evidence that US offers gains in safety and quality during CVC placement in the internal jugular vein. For the subclavian and femoral veins, US offers small gains in safety and quality. Based on the available evidence from clinical studies, several guidelines from medical societies strongly recommend the use of US for CVC placement in the internal jugular vein. Data from survey studies show that there is still a gap between the existing evidence and guidelines and the use of US in clinical practice. For clinical practice, we recommend a six-step systematic approach for US-guided central venous access that includes assessing the target vein (anatomy and vessel localization, vessel patency), using real-time US guidance for puncture of the vein, and confirming the correct needle, wire, and catheter position in the vein. To achieve the best skill level for CVC placement the knowledge from anatomic landmark techniques and the knowledge from US-guided CVC placement need to be combined and integrated.

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Venous thromboembolism associated with long-term use of central venous catheters in cancer patients.

Melina Verso, Giancarlo Agnelli (2003)

Long-term central venous catheters (CVCs) have considerably improved the management of cancer patients because they facilitate chemotherapy, transfusions, parenteral nutrition, and blood sampling. However, the use of long-term CVCs, especially for chemotherapy, has been associated with the occurrence of upper-limb deep venous thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to CVCs has been reported to vary between 0.3% and 28.3%. The incidence of CVC-related UL-DVT screened by venography reportedly varies between 27% and 66%. The incidence of clinically overt pulmonary embolism (PE) in patients with CVC-related UL-DVT ranges from 15% to 25%, but an autopsy-proven PE rate of up to 50% has been reported. Vessel injury caused by the procedure of CVC insertion, venous stasis caused by the indwelling CVC, and cancer-related hypercoagulability are the main pathogenetic factors for CVC-related venous thromboembolism (VTE). Several studies have assessed the benefit of the prophylaxis of UL-DVT after CVC insertion in cancer patients. According to the results of these studies, prophylaxis with low molecular weight heparin or a low fixed dose of warfarin has been recently proposed. However, the limitations of the experimental design of the prophylactic studies do not allow definitive recommendations. The recommended therapy for UL-DVT associated with CVC is based on anticoagulant therapy with or without catheter removal. This review focuses on the epidemiology, pathogenesis, diagnosis, prevention, and treatment of VTE in cancer patients with long-term CVC.

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Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH

A A Khorana, M Carrier, C. O'Connell … (2018)

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Author and article information

Contributors

Lichao Xu

Wentao Li

Journal

Journal ID (nlm-ta): J Interv Med

Journal ID (iso-abbrev): J Interv Med

Title: Journal of Interventional Medicine

Publisher: KeAi Publishing

ISSN (Print): 2096-3602

ISSN (Electronic): 2590-0293

Publication date PMC-release: 02 November 2019

Publication date Collection: November 2019

Publication date (Electronic): 02 November 2019

Volume: 2

Issue: 4

Pages: 141-145

Affiliations

[a ]Ruijin Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China

[b ]Sixth People's Hospital Affiliated with Shanghai Jiaotong University, Shanghai, 200233, China

[c ]Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

[d ]Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, 200080, China

[e ]Changhai Hospital Affiliated with The Second Military Medical University, Shanghai, 200433, China

[f ]Changzheng Hospital Affiliated with The Second Military Medical University, Shanghai, 200003, China

[g ]Shanghai Public Health Clinical Center Affiliated with Fudan University, Shanghai, 200083, China

[h ]Shanghai Children's Medical Center Affiliated with Shanghai Jiaotong University, Shanghai, 200025, China

[i ]Zhongshan Hospital Affiliated with Fudan University, Shanghai, 200032, China

Author notes

[∗ ]Corresponding author. lichaoxu163@ 123456163.com

[∗∗ ]Corresponding author. liwentao98@ 123456126.com

Article

Publisher Item ID: S2096-3602(19)30125-5

DOI: 10.1016/j.jimed.2019.10.008

PMC ID: 8562251

PubMed ID: 34805890

SO-VID: f7c636c7-4145-49c1-95db-f1f024fd636c

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Shanghai expert consensus on totally implantable access ports 2019

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Most cited references 43

Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice

Venous thromboembolism associated with long-term use of central venous catheters in cancer patients.

Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH

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