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Venous Access and Feeding

 

Venous Access and Feeding

 

Types


Tunneled small-bore catheters, which are often referred to as Hohn, Hickman, or Broviac catheters, are frequently used for infusion of antibiotics or other medications, nutritional supplements, and chemotherapy treatments. Depending on the expected duration of use, these catheters may have retention cuffs to reduce infection risk and prevent accidental removal, or they may simply have an antibiotic-impregnated cuff, which reduces infection risk but allows for easy catheter removal. Some of our tunneled small-bore catheters can be used with a power injector for a CT scan or MRI, avoiding a separate intravenous catheter placement.

Peripherally inserted central catheters (also called PICC lines) are placed in the veins of the upper arms. They are easily removed and are used when venous access is required for weeks up to a few months. Some of our PICC lines can also be used with a power injector for a CT scan or MRI.

Tunneled dual-lumen catheters are placed in patients requiring stem cell transplant or for other indications that require larger flow volumes than can be provided by a small-bore catheter.

Tunneled dialysis catheters are placed in patients who require hemodialysis. These catheters are specially designed for rapid flow of blood to and from the dialysis machine. These are most frequently placed in the veins of the neck, although other sites can be used if necessary. Tunneled dialysis catheters are placed in patients who require hemodialysis but do not have a functioning fistula or graft. If a previously functional hemodialysis fistula or graft is experiencing poor flows or thromboses, interventional radiologists can also use procedures such as angioplasty, stent placement, and thrombolytic therapy to salvage function.

Implantable ports are most frequently used for cancer chemotherapy or for patients with diseases, such as cystic fibrosis, for which there will be a long-term need for frequent venous access. These ports can be maintained for longer periods (months to years). They are placed and removed by a small surgical incision and lie entirely under the skin. They are accessed with a special needle. These are available with a single lumen (most commonly used) or two lumens. Most of the ports we implant can be used with a power injector for a CT scan or MRI.

Which patients require central venous access catheters?

Doctors often recommend CVAC's for patients who regularly undergo:

    * Chemotherapy treatments

    * Infusions of antibiotics or other medications

    * Nutritional supplement infusions

    * Hemodialysis

When and how are central venous access catheters removed?

When the central venous access catheter is no longer necessary, or if a catheter-related infection arises, interventional radiologists can assist in removing the catheter. Certain catheters — such as PICC lines and Hohn catheters — can be easily removed at the bedside or in clinic. Other catheters may require dissection of the cuff from the subcutaneous tissues, which requires sterile technique, local anesthetic and possibly sedation. Port catheters require a small incision for removal.

 

Gastrostomy (Feeding) Tube


Doctors often recommend placing a gastrostomy tube in the stomach for a variety of conditions in which a patient is unable to take sufficient food by mouth for a prolonged period of time. In the procedure, the feeding tube is inserted through a small nick in the skin and into the stomach under X-ray guidance.

In patients with gastroesophageal reflux, in whom feeding into the stomach is not safe, a gastrojejunal feeding catheter can be placed, which allows liquid feeds to enter directly into the small intestines.

 

Dialysis Access Management


Interventional radiologists work closely with patients, their nephrologists and their vascular surgeons to help maintain functional hemodialysis access in hemodialysis patients.

In patients with arteriovenous fistulas or grafts, hemodialysis may fail if narrowings, called stenoses, develop in the vascular circuit. Those narrowing cause poor flow, which affects the ability to efficiently dialyze the blood. In some cases, the narrowings can cause additional symptoms, such as swelling of the head and arms. When poor flow is left untreated, it can result in clot formation, which prevents the ability to dialyze and, if not treated promptly, can lead to permanent fistula or graft failure. Interventional radiologists are skilled at treating clots with special devices and by administering clot-dissolving drugs directly into the clot. They are also skilled at treating sites of narrowing with angioplasty and, if appropriate, stent placement.

Another service that interventional radiologists provide for hemodialysis patients is placement of tunneled hemodialysis catheters. Patients with long-standing use of tunneled hemodialysis catheters can eventually develop blockages in the commonly used veins of the neck and chest. Those blockages may make placement of a new catheter challenging. In those cases, interventional radiologists can often open a channel through the blockage to allow placement of a new catheter. If that is not possible, alternative sites — such as through the veins draining the legs, through the liver, or through the back — can be used for placement of a hemodialysis catheter.

* Peripheral vascular disease (extremities, carotids, renals, mesenterics, abdominal and thoracic aneurysms)

    * Deep venous thrombosis (catheter-directed thrombolysis, temporary IVC filters)

    * Interventional oncology (yttrium radioembolization, RF ablation, chemoembolization)

    * Varicose veins (laser endovenous ablation)

    * Uterine fibroid embolization

    * Arteriovenous malformations

    * Portal hypertension (TIPS, varix embolization)

    * Varicocele embolization

    * Pelvic congestion syndrome treatment

 

Please have the following at the visit:

    * Insurance card

    * Name, address and telephone number of your referring physician, primary care provider, and any other doctors you would like us to stay in contact with regarding you care from Tulane Interventional Radiology. Please also bring these with to you appointment.

    * If you have had imaging studies (CT, MRI, ultrasound, PET scan) at another facility, please have available what imaging study was done, where, and their contact information. We will help instruct you or that facility how to send us the actual images (usually a CD) as well as the radiologist's report. It is important that we get the images in advance so we have an opportunity to review them and give you as much time in your clinic visit as we can.

    * If you have had lab tests at another hospital, please ask them to fax us a copy of the results.

 

Radiology Department SL-54, 1430 Tulane, LA 70112 504-988-7627 website@tulane.edu