Extravasal guide wire entrapment due to fraying during central venous catheter placement using the Seldinger technique is a rare complication, which should be resolved as soon as possible. A 68-year-old male was scheduled for open right-side decortication. After the induction of general anesthesia, an attempt was made to place a central venous line in the right subclavian vein. However, the guide wire was entrapped extravasally between the right clavicle and the first rib. The exact site was located by palpating the bend of the guide wire in the subclavian triangle and the thoracic surgeon was available. Therefore, it was decided not to try to visualize the guide wire any further and to immediately proceed with surgical removal of the guide wire. The platysma muscle was dissected allowing access to the subclavian triangle. Venotomy of the external jugular vein was performed and the entrapped guide wire was removed via the venotomy. The whole complication was resolved within 30 minutes and the primary procedure was then performed. Managing rare complications of central venous line placement requires skill, ingenuity and, sometimes, interdisciplinary cooperation, either with a radiologist or a surgeon. The decision to proceed with immediate surgical removal of the guide wire proved a right one, and, to the best of our knowledge, such a strategy has not been described in the relevant literature to date.

• Klíčová slova
• Central venous line, Guide wire entrapment, Thoracic surgery, Venous angle,
• MeSH
• centrální žilní katétry * škodlivé účinky   MeSH
• katetrizace centrálních vén * MeSH
• lidé MeSH
• odstranění implantátu * MeSH
• senioři MeSH
• vena subclavia MeSH
• venae jugulares MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The most commonly used permanent venous access devices in cancer patients are the port, PICC port and PICC catheter (peripherally inserted central catheter). It is always necessary to consider the type of venous access needed for each individual cancer patient. Implantation should be performed using modern instruments to minimize the risk of early and late complications and thereby a delay in oncological treatment. The use of ultrasound is recommended at all stages of introduction. Precise tip placement of the central catheter in the sinoatrial junction region further reduces the number of thromboses arising in the catheter. A trend towards the treatment of catheter infections is certainly to maintain the venous access without compromising the patients health. Permanent venous access devices allow the application of chemotherapy and repeated blood sample collections with minimal impact on the quality of life in cancer patients.

• Klíčová slova
• port, PICC, cancer patient, complication, tip position,
• MeSH
• katetrizace centrálních vén * MeSH
• katétrové infekce * MeSH
• kvalita života MeSH
• lidé MeSH
• nádory * MeSH
• periferní katetrizace * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The authors present a case review of a 30-year old patient, who developed central pleural effusion, a complication related to central venous catheterization and the consequent use of the central venous line. The authors aim to highlight potential complications of the method. The interesting feature of this case is the fact, that no apparent mistakes in the venous line introduction or its later use have been recorded.

• MeSH
• dospělí MeSH
• katetrizace centrálních vén škodlivé účinky   MeSH
• lidé MeSH
• pleurální výpotek etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The current guidelines for prevention of infections in hematopoietic stem cell transplantation (HSCT) do not specify which central venous catheter (CVC) insertion site should be preferred in allogeneic HSCT recipients-internal jugular vein (IJV) or subclavian vein (SCV). We designed a multicenter prospective observational study comparing the risk of infectious and non-infectious complications between the two most common sites of CVC insertion (IJV and SCV) in allogeneic HSCT. There were in total 232 consecutive patients (86 IJV and 146 SCV) who underwent adult allogeneic HSCT reported from 11 centers in 8 countries. The center independent analysis of central line associated/related blood stream infections with ECDC criteria has shown statistically significant difference favoring SCV (23% IJV vs 13% SCV (OR 2.03 (1.01-4.06), p = 0.047)). The differences in CLABSI per 1000 days of CVC use favored SCV over IJV (7.93/1000 days IJV vs 2.79/1000 days SCV, p = 0.002). The frequency of all non-infectious complications was similar in both arms-13% IJV and 12% SCV (OR 1.1 (0.5-2.5), p = 0.8). This multicenter prospective study showed statistically significant lower confirmed number of CLABSI per 1000 days of CVC use without higher risk of noninfectious complications related to the subclavian insertion site in allogeneic HSCT recipients.

• MeSH
• centrální žilní katétry * škodlivé účinky   MeSH
• katetrizace centrálních vén * škodlivé účinky   MeSH
• lidé MeSH
• prospektivní studie MeSH
• transplantace hematopoetických kmenových buněk * škodlivé účinky   MeSH
• vena subclavia MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

The authors evaluate the prevalence of central venous catheter sepsis and possible catheter sepsis in granulocytopenic patients with acute leukaemia after intensive treatment with cytostatics. The group comprises 42 patients subjected to 57 catheterizations of a central vein. The period of catheterizations was 18-89 days, the average period 43 days. Catheter sepsis was revealed in 15 patients, i.e. 26.3% of all performed catheterizations, possible catheter sepsis was recorded in four patients, i. e. 7.0%. In almost half of the catheter sepses (42.1%) the same microbiological finding was recorded in the haemoculture and skin smear at the site of insertion of the catheter. Twelve patients were cured (21.0%), seven patients (16.7%) from the group of 42 died. To reduce the incidence of catheter sepsis it is important in the authors' opinion to make available high quality protective materials (Tegaderm plasters) and the entire infusion line should be changed daily.

• MeSH
• akutní nemoc MeSH
• infekce etiologie   MeSH
• katetrizace centrálních vén škodlivé účinky   MeSH
• leukemie terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Specific anti-cancer therapy is administered mainly via the parenteral route, Adequate venous access is, therefore, a topical issue in oncology In some patients on long-term therapy, the peripheral venous system is extensively burdened We present an overview of risk factors associated with parenteral application of medicins We provide a comparison of different types of venous access devices and discuss recommendations on general indications for permanent venous access devices We suggest an approach to the choice of the most appropriate venous access device for an oncology patient available to date We present our experience with PICC (peripherally implanted central catheters) implantations used in 30 oncology patients in our centre In addition to venous ports, PICCs represent another safe method of permanent venous access with low rate of complications Indications for the use of a specific permanent venous access device (PICC or port) partly overlap and evidenced-based recommendations are lacking However, we discuss the few suggestions that have been formulated on this issue.

• MeSH
• katetrizace centrálních vén přístrojové vybavení   metody   MeSH
• lidé MeSH
• periferní katetrizace přístrojové vybavení   metody   MeSH
• protinádorové látky aplikace a dávkování   MeSH
• zaváděcí katétry * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• protinádorové látky MeSH

INTRODUCTION: Besides their obvious advantages for the patient, central venous catheters (CVC) also carry the risk of possible infectious complications. The purpose of our investigation was to carry out a microbiological evaluation of a 5-year set of paediatric patients with indwelling CVCs. PATIENTS AND METHODS: In the group were 218 CVCs inserted to 165 children over a period of 5 years. There were 26 multi-lumen catheters (11.927 %) and 192 single-lumen catheters (88.073 %). The mean indwelling period was 10.1 days per 1 CVC. Blood for microbiology was removed by a physician from the CVC after disinfecting its opening under standard sterile conditions into a commercial sampling vessel HEMOD (Imuna, Sarisske Michalany, Slovak Republic) or into a vessel of an automated haemoculture system BactecPeds PLUS/F (Becton Dickinson and Comp., Spark,MA, USA). When removing the tip of the CVC we disinfected, before removing the CVC, the area around the insertion with isopropyl or ethyl alcohol. We released the fixed CVC and 1 minute after disinfection we pulled out the CVC and cut off the end or rather the tip of the catheter (approx. 1-3 cm of the tip) into a sterile test tube. To establish the diagnosis of infectious complications we used the 1995 Sirges-Serra classification and the CDC criteria. RESULTS: In 5 years (1995-1999) we had 71 infectious complications. There were 31 contaminated catheters, 27 cases of catheter sepsis and 11 cases of catheter bacteraemia. With 147 catheters (67.43%) there were no infectious complications. Dominant microbes were Staphylococcus epidermidis (32 cases - 11 from haemocultures and 21 from CVCs) and Candida spp. (30 cases, 17 from haemocultures and 13 from CVCs). Among the microbiological agents of catheter sepsis predominated Gram-negative bacteria. Out of the whole analysed group 41 children (24.8 %) died. CVC as the cause of death was demonstrated in 6 children (3.636 % of patients with CVC). CONCLUSIONS: Microbiological findings in our group are in line with literary data. To reduce the incidence of infectious complications it is important to limit sampling from CVC to a minimum. Insertion of CVCs under strict sterile conditions and aseptic handling of all entries into the central bloodstream reduces to a minimum the risk of infectious complications.

• MeSH
• Bacteria izolace a purifikace   MeSH
• bakteriální infekce etiologie   mikrobiologie   MeSH
• bakteriemie etiologie   MeSH
• Candida izolace a purifikace   MeSH
• dítě MeSH
• katetrizace centrálních vén škodlivé účinky   MeSH
• lidé MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: This paper deals with the psyche of patients during intravenous therapy. Since any intervention in the physical integrity of individuals are necessarily reflected in their mental level, we decided to conduct a survey dealing with tolerance of intravenous therapy in cancer patients. Especially, we focused on long-term venous access devices tolerance. PATIENTS AND METHODS: The aim of this study was to evaluate descriptively patients´ awareness of the administration of parenteral drugs, risks in the application and the differences between the administration of drugs to the central and peripheral venous system. To collect data, own questionnaire containing 21 questions was compiled. It was distributed to patients in the oncology department and outpatient oncology ward at the hospital Novy Jicin. Patients signed an informed consent for data collection. One hundred valid questionnaires were evaluated in the analysis of the data. RESULTS: The results of the study generally indicate that patients do not tolerate venous sampling and intravenous therapy optimally. Patients who have some form of venous access device are mostly satisfied, as it fulfills its mandate of maximum patient comfort. CONCLUSION: The results indicate that most patients know alternatives to peripheral drugs application. However, awareness of this issue is inadequate. The vast majority of patients would recommend the introduction of long-term venous access device to other patients.

• MeSH
• intravenózní podání přístrojové vybavení   metody   MeSH
• katetrizace centrálních vén přístrojové vybavení   psychologie   MeSH
• lidé MeSH
• nádory farmakoterapie   MeSH
• periferní katetrizace přístrojové vybavení   psychologie   MeSH
• protinádorové látky aplikace a dávkování   MeSH
• průzkumy a dotazníky MeSH
• zaváděcí katétry MeSH
• zdraví - znalosti, postoje, praxe * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• protinádorové látky MeSH

The first specialist nursing team placing peripherally inserted central catheters (PICCs) in the Czech Republic was established in September 2012. During 2013 the team placed 167 PICCs and 162 midline catheters. In another 6 patients the insertion was not successful. PICCs were inserted mainly for oncology patients; while midline catheters were inserted for patients admitted to general wards. Average duration of catheter insertion was 91 days (range 7-285 days) for PICCs and 14 days (range 2-40 days) for midline catheters. During follow up of PICCs, catheter infection rate was 0.3/1000 days, vein thrombosis rate 0.4/1000 days, catheter occlusion 0.4/1000 days, and catheter displacement 0.33/1000 days. For midline catheters infection rate was 1.4/1000 days, vein thrombosis 5.2/1000 days, catheter occlusion 2.6/1000 days, and catheter displacement 2.2/1000 days. The authors hope that these results will motivate other hospitals in the Czech republic to establish PICC teams, as in other European countries.

• Klíčová slova
• Midline catheter, PICC team, Peripherally inserted central catheter, Specialist nursing teams, Venous access complications,
• MeSH
• cévní přístupy MeSH
• katetrizace centrálních vén škodlivé účinky   metody   MeSH
• katétrové infekce epidemiologie   MeSH
• klinické kompetence MeSH
• lidé MeSH
• neprůchodnost katétru statistika a číselné údaje   MeSH
• personál sesterský nemocniční * organizace a řízení   MeSH
• rozvoj plánování MeSH
• žilní trombóza epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: This study aimed to evaluate the safety and performance of PowerPICC catheters in a real-world setting. DESIGN: Prospective, observational, multicentre study. SETTING: Nine European countries, involving 14 centres. PARTICIPANTS: General patient population. INTERVENTION: PowerPICC catheter inserted by the clinician as standard of care with routinely collected outcomes followed through device removal or 180 days postinsertion. PRIMARY AND SECONDARY OUTCOMES MEASURES: Safety and performance outcomes were assessed for PowerPICC, PowerPICC SOLO 2 and PowerGroshong PICC. The primary safety endpoint was the incidence of symptomatic venous thrombosis (VT), and secondary safety endpoints included phlebitis, extravasation, vessel laceration, vessel perforation local infection, accidental dislodgment and catheter-related bloodstream infection (CRBSI). The primary performance endpoint was the percentage of patients whose PowerPICC device remained in place through the completion of therapy. The secondary performance endpoints included catheter patency, placement success in a single attempt and usability. RESULTS: The enrolled patients (N=451) received either PowerPICC, PowerPICC SOLO 2 or PowerGroshong PICC catheters. Across all devices, 1.6% of patients developed symptomatic VT, and CRBSI occurred in 1.6% of patients. There were no cases of phlebitis or extravasation and only three cases of vein laceration or vein perforation. The catheters showed high success rates in completing therapy (81.8%), maintaining patency (93.9%) and achieving successful placement in a single attempt (90.4%). Clinicians overwhelmingly agreed that both the guidewire and stylet (93.3% and 94.4%, respectively) were easy or very easy to use. CONCLUSIONS: This study demonstrates the safety and performance of PowerPICC catheters across diverse settings and patient cohorts in real-world hospital settings across Europe. The findings indicate that these catheters are safe and can be effectively used in the general patient setting and when inserted by a variety of clinicians. The low incidence of complications and high success rates further support the clinical utility of these catheters. TRIAL REGISTRATION NUMBER: NCT04263649.

• Klíčová slova
• CARDIOLOGY, Health & safety, Nurses, Observational Study, Safety, VASCULAR MEDICINE,
• MeSH
• centrální žilní katétry škodlivé účinky   MeSH
• dospělí MeSH
• flebitida etiologie   epidemiologie   MeSH
• katetrizace centrálních vén škodlivé účinky   přístrojové vybavení   metody   MeSH
• katétrové infekce * epidemiologie   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• periferní katetrizace škodlivé účinky   přístrojové vybavení   MeSH
• prospektivní studie MeSH
• senioři MeSH
• zaváděcí katétry škodlivé účinky   MeSH
• žilní trombóza epidemiologie   etiologie   prevence a kontrola   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH