Ultrasound-guided Central Venous Catheterization for Home Parenteral Nutrition and Hydratation in Advanced Incurable Cancer Patients: Results of A Prospective Observational Study

Abstract

BackgroundMost patients with advanced cancer are frequently malnourished and frequently they develop decreased oral fluid intake and dehidratation. Home parenteral nutrition (HPN) is an increasingly used therapy for patients with advanced cancer. A central venous access device is often an essential component allowing parenteral nutrition and hidratation. However central venous catheter (CVC) insertion represents a risk for pneumothorax or other mechanical complications. This study aimed to determine the reduction of risks related to central venous catheter positionement in the setting of cancer patients with palliative programm.MethodsConsecutive patients with a variety of cancer in advanced phase requiring palliative care who were undergoing placement of central venous catheter for parenteral nutrition or hydratation have been prospectively studied in a program of ultrasound-guided CVC placement. Four types of possible complications were defined:mechanical, thrombotic, infection and malfunctioning. After sterilization, local anesthesia is applied and a 7.5 MHZ puncturing US probe is placed in the supraclavicular site and a 16-gauge needle is advanced under real-time US guidance, into the last portion of internal jugular vein by experienced physicians. The Seldinger tecnique is used to place the catheter that is advanced into the superior vena cava until insertion to right atrium. Two hours after each procedure a chest X-ray and US scanning are carried out to confirm CVC position and rule out a pneumotorax.ResultsFrom 30 October 2000 to 31 October 2008: 209 CVC insertional procedure were applied in 207 patients with cancer in the palliative phase only. There were 101 women and 106 men with a mean age of 67.68 year (range 22-86). A single needle puncture of the vein was performed on 206 of 209 procedures (98.6%), the technique was efficacious at the first attempt in 98.6% of cases, in 2 patients (0.96%) the CVC was positioned at the second attempt. The procedure failed only one case (0.44%). No cases of pneumothorax, of major bleeding or nerve punctured were reported. Symptomatic vein thrombosis developed in one patient (0.44%). Infection episodes were reported in two cases. Mean time for CVC permanence was 92.5±9.1 days (range 8-158).ConclusionThis study indicates that US-guided CVC insertion is a safe, cheap procedure for cancer patients in advanced phase and with palliative program, allowing parenteral nutrition and hydratation.

Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

“…A paper studying PORTs was excluded due to the administration of chemotherapy in a palliative care setting [19]. Hence, a total of five publications were included with four studies on PICCs [20][21][22][23] and one study on central lines [24]. The inter-rater reliability of publication screening by the authors was 97.6%, which was related to the doubtful eligibility of one publication, resolved by consensus.…”

“…The characteristics of 327 patients analyzed in this meta-analysis are shown in Table 2. Regarding the type of CVAD, 207 patients who received central line insertion were contributed by a single study, and the remaining 120 patients who had PICCs inserted were from the remaining four publications [20][21][22][23][24]. There was a total of 209 central line insertions in 207 patients due to 2 failed insertions [24].…”

Central venous catheterization in cancer patients with severe thrombocytopenia: Ultrasound‑guide improves safety avoiding prophylactic platelet transfusion

“…The procedure was performed using Esaote SpA equipped with two transducers between 3.5 to 7.5 MHZ, with a needle guide. The method that we commonly use is 'the three-handed method', as previously reported (17,18); this method requires an assistant to hold the probe, while the operator controls the needle and performs the procedure under real-time guidance, and the nurse helps the two physicians during the maneuver. The central vein was identified along its greater longitudinal axis and its relationship with other anatomical structures using Valsalva's maneuver which determines an increase of the diameter of the veins.…”

“…Mechanical complications of CVC insertion without ultrasound (US) guidance, such as arterial puncture and pneumothorax, are seen in up to 21% of attempts, and up to 35% of insertion attempts are not successful (3)(4)(5). Prior researches show that the use of US-guide CVC has been associated with a reduction in complication rate and an improved first-pass success when placing CVC in the internal jugular vein (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). We sought to investigate within US-guidance CVC in a subset of cancer patients with severe thrombocytopenia also effects the safety, reducing bleeding complications and avoid prophylactic platelet transfusion.…”

Bedside Peripheral Ultrasound-Guided Vascular Access in 253 Patients Hospitalized With COVID-19 Pneumonia: A Retrospective Italian Study

“…Hospitalized COVID-19 patients often need vascular devices for the delivery of fluids, parenteral nutrition, medication, phlebotomy, and to avoid multiple venipuncture attempts [ 5 , 6 ]. A previous study by the authors reported the results of 1,978 ultrasound-guided central venous catheter (CVC) insertional procedures [ 7 ], and the authors previously published the results of a study on ultrasound-guided central venous catheterization for home parenteral nutrition and hydration in 207 advanced-stage cancer patients [ 8 ].…”