Catheter Indwelling Time Research Articles

Increase of recurrent central line-associated bloodstream infections in children with home parenteral nutrition in a rehabilitation care facility compared to home

Central line-associated bloodstream infections (CLABSIs) are the main complication in children with home parenteral nutrition (HPN) and some patients develop recurrent CLABSIs (REC-CLABSIs), defined as two or more infections within six months. Our aims were to assess the incidence and to characterize the risk factors of REC-CLABSIs in children with HPN. We characterized 79 HPN children from 2014 to 2019 and calculated the incidence of CLABSIs. To minimize the risk of bias related to the exposure time of the septic risk, we paired the patients according to their central venous catheter (CVC) dwell time. After analyzing the whole cohort, a univariate and multivariate unconditional logistic regression was performed on the paired cohort. We included 75 (94.9%) children with a mean age of 7.11 years. The rate of septicemia was 1.55/1000 CVC days, mainly with Staphyloccocus sp. The patients with recurrent CLABSIs (REC group) represented 25% of the cohort, with an incidence of 2.99/1000 CVC days. In the whole cohort, a higher risk of recurrent infections was significantly associated with a longer CVC dwell time (OR=1.04, IC 95% [1.01-1.06], p=0.004), and with care located in rehabilitation care facilities (RCF) compared to home (OR=6, IC 95% [1.5-26.6], p=0.012). When children were paired according to their CVC dwell time, only in univariate analysis did the care in RCF remain significant (OR=6.27, IC 95% [1.21-32.5], p=0.03). Recurrent CLABSIs incidence was 2.99/1000 CVC days. Our study suggests that preventive measures should be implemented especially in RCFs to reduce the proportion of children with recurrent infections. A multicenter study is needed to confirm our results in a larger cohort with several RCFs.

Retrospective Study of the Application Value Analysis of Ultrasound-Guided Technology in Peripheral Deep Venous Catheterization of Neonates.

Objective To investigate the application value analysis of ultrasound-guided technology in peripheral deep venous catheterization of neonates. Method A total of 94 neonates who underwent peripheral deep venous catheterization treatment from March 2020 to August 2021 in our hospital were selected and divided into the study group and the control group according to the simple randomized method, and each group had 47 cases. The control group was performed peripheral deep venous catheterization through X-ray examination, while the study group was performed peripheral deep venous catheterization through ultrasound-guided technology. The catheter placement, catheter retention time and adjustment times, the incidence of complications (limb swelling, pain, fluid leakage, and phlebitis), and the intervention satisfaction of family members were counted. Results The success rate of one-time catheterization in the study group was higher than that in the control group, the operation time was shorter than that in the control group, and the amount of bleeding was less than that in the control group. The indwelling time of catheter in the study group was longer than that in the control group, and the number of adjustments was less than that in the control group. The incidence of complications in the study group was lower than that in the control group. The intervention satisfaction of family members in the study group was higher than that in the control group. Conclusion Peripheral deep venous catheterization in neonates through ultrasound-guided technology can reduce operation time and blood loss and ensure the success rate of one-time catheterization, resulting in a long indwelling time of catheter, low number of adjustments, and low incidence of complications, which has safety and high intervention satisfaction of family members.

Urinary and sexual function changes in benign prostatic hyperplasia patients before and after transurethral columnar balloon dilatation of the prostate.

BACKGROUNDTransurethral columnar balloon dilatation of the prostate (TUCBDP) is a new surgical treatment, but its efficacy remains controversial because of limited clinical application.AIMTo investigate the clinical effect of TUCBDP for benign prostatic hyperplasia (BPH).METHODSOverall, 140 patients with BPH who underwent surgical treatment were included in the study. A random number table was used to divide the participants into study and control groups (n = 70 per group). The study group underwent TUCBDP. The prostate resection surgical time, intraoperative blood loss, bladder irrigation time, catheter indwelling time, length of hospital stay, International Prostate Symptom Score (IPSS), maximum urine flow rate (Qmax), residual urine volume (RUV), changes in the International Erectile Function Score (IIEF-5) score, serum prostate-specific antigen (PSA), quality of life (QOL) score, and surgical complications were compared in both groups.RESULTSThe operation time, intraoperative blood loss volume, bladder flushing time, urinary catheter indwelling time, and length of hospital stay were significantly lower in the study group than in the control group (P < 0.05). There were no significant differences in the IPSS, Qmax, and RUV measurements between the study and control groups (P > 0.05). However, at 3 mo post-surgery, the IPSS and RUV measurements were both lower (P < 0.05) and Qmax values were higher (P < 0.05) compared to the pre-surgery results in both groups. The IIEF-5 scores before and 3 mo after surgery were not significantly different between the study and control groups (P > 0.05). At 1 mo after surgery, the IIEF-5 score was higher in the study group than in the control group (P < 0.05). The serum PSA levels and QOL scores before treatment and at 1 and 3 mo after treatment were not significantly different between the study and control groups (P > 0.05). However, lower serum PSA levels and QOL scores were observed after 1 and 3 mo of treatment compared to pre-treatment levels in the study group (P < 0.05). The surgical complication rate of the study group (4.29%) was lower than that of the control group (12.86%; P < 0.05).CONCLUSIONTUCBDP for BPH and transurethral resection of the prostate can achieve better results, but the former method is associated with less surgical trauma.

Definition of catheter jamming: A mechanical analysis of catheter fracture tension and fracture strain.

BACKGROUND: Catheter jamming is an emerging and possibly underrated complication.OBJECTIVE: To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain (f) of Peripheral Inserted Central Catheters (PICC).METHOD: We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted.RESULTS: The fracture tension of catheter in sections A and B were 5.8917 1.0095 and 6.0670 0.8066 Newtons respectively ( 0.393) and the fracture strain of catheter in sections A and B were 6.0611 1.0810 and 6.2543 0.7187 Newtons respectively ( 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 0.9414 and 5.9192 0.8972 Newtons respectively ( 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 0.7227 and 6.2584 1.0212 respectively ( 0.301).CONCLUSION: It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.

Decongestion Models and Metrics in Acute Heart Failure: ESCAPE Data in the Age of the Implantable Cardiac Pressure Monitor.

The United States Food and Drug Administration restricts the use of implantable cardiac pressure monitors to patients with New York Heart Association (NYHA) class III heart failure (HF). We investigated whether single-pressure monitoring could predict survival in HF patients as part of a model constructed using data from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial. We validated survival models in 204 patients, using all-cause 180-day mortality. Two levels of model complexity were tested: 1) a simplified 1-pressure model based on pulmonary artery mean pressure ([PAM]1P) (information obtainable from an implanted intracardiac monitor alone), and 2) a pair of 5-variable risk score models based on right atrial pressure (RAP) + pulmonary capillary wedge pressure (PCWP) ([RAP+PCWP]5V) and on RAP + PAM ([RAP+PAM]5V). The more complex models used 5 dichotomous variables: a congestion index above a certain threshold value, baseline systolic blood pressure of <100 mmHg, baseline blood urea nitrogen level of ≥ 34 mg/dL, need for cardiopulmonary resuscitation or mechanical ventilation, and posttreatment NYHA class IV status. The congestion index was defined as posttreatment RAP+PCWP or posttreatment RAP+PAM, with congestion thresholds of 34 and 42 mmHg, respectively (median pulmonary catheter indwelling time, 1.9 d). The 5-variable models predicted survival with areas under the curve of 0.868 for the (RAP+PCWP)5V model and 0.827 for the (RAP+PAM)5V model, whereas the 1-pressure model predicted survival with an area under the curve of 0.718. We conclude that decongestion as determined by hemodynamic assessment predicts survival in HF patients and that it may be the final pathway for treatment benefit despite improvements in pharmacologic intervention since the ESCAPE trial.

Central line-associated bloodstream infection (CLABSI) with three different vascular access in neonatal intensive care unit

BackgroundCentral venous catheters (CVCs) are a mandatory aspect in the neonatal intensive care units. Unfortunately, bloodstream infection is a frequent complication of CVCs. A needleless connector is attached to the end of CVC to allow infusion of fluids. We aimed to assess the effect of needleless connectors on central line-associated blood stream infection, and to assess rate of occurrence of bloodstream infection with the use of three different types of venous access in neonates.MethodsThis study is a prospective, randomized, comparative study which was held at the Neonatal Intensive Care, Faculty of Medicine, Ain Shams University. The study recruited 120 neonates who were categorized into three groups according to the type of inserted CVC: group A with umbilical venous catheter, group B with peripherally inserted central catheter, and group C with non-tunneled central venous catheter, and each group was further subdivided into two groups according to the use of needleless connector. Criteria of central line-associated bloodstream infection (CLABSI) and central line-related bloodstream infection (CLRBSI) were applied.ResultsThe study included 120 neonates, a multivariable logistic regression analysis was held for two predictors (type of CVC and use of needleless connector) of CLABSI/CLRBSI, it revealed that the use of needleless connector was associated with significant lower incidence of CLABSI/CLRBSI (P value < 0.05, adjusted odds ratio [aOR] = 0.303), the use of peripheral inserted central catheter (PICC) was also associated with the lowest incidence of CLABSI/CLRBSI (P value = 0.015, aOR = 0.284). Another multivariable logistic regression analysis was done for four predictors (type of CVC, use of needleless connector, gestational age, and catheter dwell time) which revealed that the gestational age (P value = 0.001, aOR = 0.691) and catheter dwell time (P value = 0.004, aOR = 1.313) were the only independent predictors for the occurrence of CLABSI/CLRBSI.ConclusionThe use of needleless connector can lower the incidence of CLABSI/CLRBSI, PICC line was associated with the lowest incidence of CLABSI/CLRBSI among the three types of CVCs. Low gestational age and long catheter dwell time were found to be the main risk factors for increasing the incidence of CLABSI/CLRBSI.

Intra-abdominal hypertension in cardiac surgery patients: a multicenter observational sub-study of the Accuryn registry

Intra-abdominal hypertension (IAH) is frequently present in the critically ill and is associated with increased morbidity and mortality. Conventionally, intermittent ‘spot-check’ manual measurements of bladder pressure in those perceived as high risk are used as surrogates for intra-abdominal pressure (IAP). True patterns of IAH remain unknown. We explored the incidence of IAH in cardiac surgery patients and describe the intra-and postoperative course of IAP using a novel, high frequency, automated bladder pressure measurement system. Sub-analysis of a prospective, multicenter, observational study (NCT04669548) conducted in three large academic medical centers. Continuous urinary output (CUO) and IAP measurements were observed using the Accuryn Monitoring System (Potrero Medical, Hayward, CA). Data collected included demographics, hemodynamic support, and high-frequency IAP and CUO. One Hundred Thirty-Seven cardiac surgery patients were analyzed intraoperatively and followed 48 h postoperatively in the intensive care unit. Median age was 66.4 [58.3, 72.0] years, and 61% were men. Median Foley catheter dwell time was 56.0 [46.8, 77.5] hours, and median baseline IAP was 6.3 [4.0, 8.1] mmHg. 93% (128/137) of patients were in IAH grade I, 82% (113/137) in grade II, 39% (53/137) in grade III, and 5% (7/137) in grade IV for at least 12 cumulative hours. For maximum consecutive duration of IAH, 84% (115/137) of patients spent at least 12 h in grade I, 62% (85/137) in grade II, 18% (25/137) in grade III, and 2% (3/137) in grade IV IAH. During the first 48 h after cardiac surgery, IAH is common and persistent. Improved and automated monitoring of IAP will increase the detection of IAH—which normally would remain undetected using traditional intermittent monitoring methods.

Robot-assisted pericystectomy using Da Vinci Xi surgical system with indocyanine green fluorescence imaging for hepatic cystic echinococcosis

The clinical efficacy of robot-assisted laparoscopic pericystectomy using the Da Vinci Xi surgical system plus indocyanine green（ICG） fluorescence imaging and the conventional laparotomy for en bloc pericystectomy was compared. The clinical data of 7 patients treated by robot-assisted laparoscopic pericystectomy using the Da Vinci Xi surgical system plus ICG fluorescence imaging at our hospital between October 2019 and July 2021 and 15 patients treated by conventional laparotomy for en bloc pericystectomy were retrospectively analyzed. Compared with the conventional laparotomy group, the intraoperative blood loss was reduced using the Da Vinci surgical system [(225.43±44.75)ml: (521.33±246.34) ml, P=0.015]. The indwelling time of the urinary catheter was also shorter [2.86±0.75)d: (3.87±0.81)d, P=0.012]. However, the total expense was increased significantly [(49.9±3.7) thousand RMB: (28.7±5.0) thousand RMB, P<0.001]. The two groups of patients were not significantly different in operation time, time to flatulence after surgery, time to eat a liquid diet after surgery, length of hospital stay after surgery, time to drainage tube removal, and the incidence of postoperative complications (P=0.899). Both two groups were followed up for 3-12 months after surgery. The patients were generally good without recurrence or intra-abdominal implantation. The Da Vinci Xi surgical system could be feasibly and safely applied to the robot-assisted laparoscopic pericystectomy plus ICG fluorescence imaging for Hepatic cystic echinococcosis(HCE). This procedure could effectively remove the hepatic hydatid cysts under the ICG fluorescence imaging with a higher resection rate, causing less trauma and fewer complications.

A prospective randomized controlled trial comparing the effect and safety of Piranha and VersaCut morcellation devices in transurethral holmium laser enucleation of the prostate.

Holmium laser enucleation of the prostate (HoLEP) is reported to be widely used in the surgical treatment of benign prostatic hyperplasia (BPH), which consists of two procedures: enucleation and morcellation. This study is to examine the efficiency and safety of two different morcellator systems within a cohort of men undergoing HoLEP for BPH. A total of 210 consecutive patients undergoing HoLEP and morcellation procedures were enrolled. Individuals were randomly divided into 2 separated groups: the first group (105 patients) was performed with a nephroscope using a mechanical Versacut morcellator and the second (105 patients) was performed with the new morcellation system, nephroscopes and Piranha morcellator. Perioperative characteristics were studied and analyzed. The morcellation time and the morcellation rate was similar when the prostate volume (PV) ≤ 60mL while the morcellation time was significantly shorter and the morcellation rate was higher in the Piranha group with PV > 60mL. No significant difference was observed according to the bladder irrigation time, indwelling catheter time, and discharge time. Piranha morcellator presents a higher efficiency for the prostate over 60mL.

Impact of very wide antral pulmonary vein isolation on esophageal temperature changes during pulsed field ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Esophageal thermal injury (ETI) is a serious drawback of available energy sources for atrial fibrillation (AF) ablation, especially on the posterior left atrial (LA) wall. Pulsed field ablation (PFA) is a novel non-thermal energy source with promising safety advantages over existing methods due to its unique myocardial tissue specificity sparing the esophagus. Objective To evaluate esophageal temperature changes during very wide antral pulmonary vein isolation (PVI) using the PFA system. Methods Thirteen consecutive AF patients (62% with paroxysmal AF; age: 61 years; 70% male) underwent first-time PFA under deep sedation. Eight pulse trains (2kV/2.5 sec, bipolar, biphasic, 4x basket/flower configuration each) were delivered to each pulmonary vein (PV). Extra pulse trains in the flower configuration were added for very wide antral circumferential ablation (vWACA). Continuous intraluminal esophageal temperature (TESO) was monitored with an S-shaped esophageal temperature probe. Results A median of 32 (IQR 32;32) and 8 (IQR 8;9) pulse trains for PVI and vWACA with a procedural time and catheter dwell time of 67 min (IQR 61-69) and 17 min (IQR 16-18) were applied. PFA with vWACA resulted in consecutive posterior LA wall isolation in 11/13 patients. Fluoroscopically, the esophagus coursed near the right PVs in 2/13, left PVs in 8/13 and mid-posterior wall position in 3/13 patients. Maximum TESO increase from baseline was 0.8 ±0.9 °C. However, no clinically relevant TESO changes occurred (Table 1). On short-term, all patients remained asymptomatic for sore throat, cough, or other symptoms potentially related to ETI. No esophago-duodenoscopy was necessary. Conclusion PFA of the PVs and lesion extension to the posterior LA wall demonstrated clinically non-significant TESO changes and has the potential to eliminate the risk of a thermal damage to the esophagus.

Additional left atrial posterior wall ablation using pulsed field ablation as a safe and feasible treatment option for persistent atrial fibrillation patients

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Center Split Background Catheter ablation in persistent (PeAF), and especially long-standing persistent AF (ls-PeAF) patients often requires ablation beyond pulmonary vein isolation (PVI) (1). Adjunctive ablation of the left atrial posterior wall (LAPW) may improve outcomes of PeAF patients but has been limited by the difficulty of achieving lesion durability and concerns of thermal damage of nearby structures. Pulsed field ablation (PFA) is a new, nonthermal ablative modality, with proven myocardial ablative efficacy, quick energy delivery, and a favorable safety profile, which makes PFA suitable for the LAPW ablation (2). Purpose We aimed to report the safety profile, intraprocedural parameters, and acute success rate of LAPW ablation in a regular clinical setting with the CE-marked PFA platform. Methods This was a prospective observational study on the safety and feasibility aspects of LAPW ablation with the PFA in PeAF and ls-PeAF patients. The safety endpoints included the percentage of clinically relevant complications, including stroke/TIA, atrioesophageal fistula, cardiac tamponade, myocardial infarction, diaphragmatic paralysis, and death in the first 30-days post-procedure. Acute ablation success was confirmed with electroanatomical mapping (EAM). Ablation was performed using 2.0 kV biphasic waveforms, 2 deliveries for each application site. The lesion set depended on the patient’s AF ablation history, LA size, and anatomy. After LA mapping and PVI or PVI touch-up (index or re-do procedure), 2 anchor lesions per vein extending to the LAPW were deployed. A lesion set was then performed between the anchor lesions on the LAPW (upper and lower row) with the catheter in a flower configuration and the intention of 75% overlap for the neighbouring application sites at 3D EAM. Results Twenty-three patients (87% men) received PFA LAPW ablation. The age median was 64 (Q1-Q3: 56.5-71) years. 52% had ls-PeAF and 65% had previous ablation. The median LA diameter was 47 mm (Q1-Q3: 46-52 mm). The safety endpoints did not occur in any of the patients. The LA ablation catheter dwell time median for the index and re-do procedure was 39.5 (Q1-Q3: 31-42.25) and 18 (Q1-Q3: 16-21) minutes. The median time for LAPW ablation was 10 (Q1-Q3: 8-12) minutes. The median number of application sites on the upper and lower posterior wall was 6 (Q1-Q3: 5-7) and 6 (Q1-Q3: 5-7), respectively. Acute ablation success was 100% in terms of completed box lesion, and LAPW electrical activity loss. In a single case, first-pass ablation was not achieved, but additional delivery under intracardiac echocardiography guidance resulted in the electrical silence of the targeted segment. Conclusion LAPW ablation with PFA is safe, quick and results in excellent acute isolation rates in PeAF patients. Posterior wall ablation with PFA is not a time-consuming procedure which is an important aspect for real-world PeAF and ls-PeAF patients who are often fragile.

PO-623-08 FIRST-IN-HUMAN CLINICAL EXPERIENCE OF A NOVEL CONFORMABLE "SINGLE-SHOT" PULSED FIELD ABLATION CATHETER FOR PULMONARY VEIN ISOLATION

Pulsed field ablation (PFA) has safety and procedural workflow advantages over conventional thermal ablation. Most “single-shot” PFA catheters are either not linked to mapping systems, require serial re-positioning or cannot easily accommodate varying PV anatomies. Recently, a novel 8-Fr single-shot large lattice PFA catheter that can conform to anatomies has been developed. In a first-in-human single-arm trial (NCT05144503, NCT05115214) of PAF ablation, we assessed the acute safety and efficacy of PVI using this single-shot PFA catheter. The 8Fr PFA catheter (SpherePVI; Affera Inc) has a large compressible/conformable lattice framework (expandable up to 34 mm diameter), and consists of 6 sections that are independently and sequentially energized for ablation. Under general anesthesia and after ICE-guided transseptal puncture, an 8.5 Fr deflectable sheath (Agilis, Abbott Inc) was used in concert with the PFA catheter and custom mapping system (Prism-1, Affera Inc) to quickly render the PV anatomy. Then the catheter was serially positioned at the ostium of each PV, and a PFA generator (HexaPULSE; Affera Inc) delivered biphasic pulse trains (5 sec per application; 1.3-2.0 kV [±]); goal of 1-3 lesions per PV. Post-procedure endoscopy (EGD) and brain MRI occurred within 24-72 hours. At 3 centers (5 operators), a total of 30 pts (age 57.6 ± 9.3 yrs; M / F = 15 / 15) underwent PVI. Mapping time to render the LA-PV anatomy was 5.7±3.2 min (range 1.3 - 13.1). PVI was acutely successful in all 30 pts: 122 of 122 (100%) PVs were acutely isolated using 2.4±0.4 applications/vein (10.0±1.6 applications/pt). The PVI duration time (transpired from 1st to last lesion) was 8.2±5.5 min (range 3.3 - 29.8). The total LA catheter dwell time for the PFA catheter was 12.9±7.6 min (range 5.0 - 36.0). Fluoroscopy time was 4.8±4.1 min. There were no serious adverse events - including no esophageal fistula, stroke/TIA, phrenic injury or tamponade. EGD in 18 pts revealed no thermal lesions, and brain MRI revealed acute lesions in 2 of 21 (9.5%) pts. PVI using the conformable “single-shot” PFA catheter was acutely successful and safe. Further studies should assess lesion durability and large multicenter clinical outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Central line-associated bloodstream infections at the multidisciplinary intensive care unit of Universitas Academic Hospital, Bloemfontein, South Africa.

Background Central line-associated bloodstream infections (CLABSIs) are frequently encountered device-related healthcare-associated infections in critically ill patients, causing substantial morbidity, mortality and prolonged hospitalisation. Objectives To determine the incidence of CLABSI, median catheter dwell-time prior to developing CLABSI, as well as the causative microorganisms of CLABSI among patients admitted to the multidisciplinary intensive care unit (MICU) at Universitas Academic Hospital, Bloemfontein. Methods We conducted a retrospective review of medical and laboratory records of all MICU patients who had a central line placed between January and December 2018. Results A total of 377 patients were admitted to the MICU in 2018, of which 182 met the inclusion criteria for the present study. From the cohort of 182 patients, 16.5% (n=30) of patients presented with 32 CLABSI episodes, with two patients having had two independent episodes each. A total of 1 215 central line days were recorded, yielding a CLABSI rate of 26.3/1 000-line days. Laboratory analysis identified microorganisms in 38 blood cultures, with Gram-negative organisms (55.3%; n=21) being predominant over Gram-positive organisms (39.5%; n=15) and fungi (5.3%; n=2). Conclusion The incidence of CLABSI at the MICU at Universitas Academic Hospital is high. Urgent intervention with strict compliance to prevention bundles is required to reduce the high incidence of CLABSI.

Transurethral plasmakinetic resection versus enucleation for benign prostatic hyperplasia: comparison of intraoperative safety profiles based on endoscopic surgical monitoring system

ObjectiveTo compare the intraoperative safety profiles of transurethral plasmakinetic resection of the prostate (PK-TURP) with transurethral plasmakinetic endoscopic enucleation of the prostate (PK-EEP) in the treatment of benign prostatic hyperplasia (BPH) based on endoscopic surgical monitoring system (ESMS).MethodsA total of 128 patients who were diagnosed with BPH were stratified based on prostate volume (PV) and accepted PK-EEP or PK-TURP treatment at 1:1 ratio. The ESMS as a novel method was used to monitor blood loss and fluid absorption during the operation. Clinical parameters such as intraoperative blood loss volume, fluid absorption volume, operation time, tissue weight of resection, preoperative and postoperative red blood cell count (RBC), hemoglobin concentration (HB), hematocrit (HCT), electrolyte, postoperative bladder irrigation time, indwelling catheter time, hospital stay time and other associated complications were documented and compared between two groups.ResultsNo significant differences in majority of baseline characteristics were observed among patients with different prostate volumes between two surgical methods. For patients with prostate volume < 40 ml, the average operation time of patients who received PK-EEP treatment was much more than those who received PK-TURP (P = 0.003). On the other hand, for patients with prostate volume > 40 ml, the PK-TURP surgery was associated with a significant increase in intraoperative blood loss (P = 0.021, in PV 40–80 ml group; P = 0.014, in PV > 80 ml group), fluid absorption (P = 0.011, in PV 40–80 ml group; P = 0.006, in PV > 80 ml group) and postoperative bladder irrigation time as well as indwelling catheter time but decrease in resected tissue weight compared to the PK-EEP treatment.ConclusionThe ESMS plays an important role in comparison of intraoperative safety profiles between PK-TURP and PK-EEP. Our data suggest that PK-TURP treatment is associated with a decreased operation time in patients with prostate volume < 40 ml and the PK-EEP treatment is associated with decreased intraoperative blood loss, fluid absorption and increased tissue resection for patients with prostate volume > 40 ml. Our results indicate that the size of prostate should be considered when choosing the right operation method.

Duplex Ultrasound Assessment of Radial Artery Access Site: Complications and Clinical Outcomes

Introduction: The radial artery is often utilized for invasive hemodynamic monitoring as well as an access site for arterial and cardiac catheterization. Complications requiring intervention, although uncommon, may have implications for future utilization of this site and harvesting for coronary bypass. We aimed to better define the occurrence and the risk factors associated with radial artery access (RAA). Methods: Patients referred for upper extremity arterial duplex (UEAD) examinations with clinical findings suspicious for complications after RAA between 2008 and 2016 were reviewed. Electronic medical records and vascular laboratory records were reviewed for demographics and peri-procedural data. Results: The radial artery was used for 19,253 arterial lines, and 13,402 cardiac catheterizations during the study period at our institution. During this time, a total of 131 patients were referred to our vascular laboratory for UEAD based on abnormal clinical findings after RAA. Sixty-two (47%) patients had undergone radial artery catheter (A-line) placement for hemodynamic monitoring, and 69 (53%) had left heart catheterization (LHC). Six patients required surgical intervention: 5 after A-line and 1 after LHC. A-line was more frequently associated with a positive UEAD finding compared with LHC (79% vs 57%, P = .007). Among patients with A-lines, there was no significant relationship between presence of a positive UEAD finding and the specialty or level of training of the operator, the number of attempts, the usage of ultrasound guidance, or catheter indwelling time. There was also no significant relationship between a positive UEAD finding and the size of sheath (5Fr vs 6Fr) among patients who underwent LHC. Conclusions: A positive UEAD finding in patients with clinically apparent complications after RAA is uncommon, and the need for surgical intervention is similarly infrequent. Follow-up UEAD studies may be useful to determine long-term patency of the radial artery and usability for future access or for coronary artery bypass grafting.

Peripherally Inserted Central Catheter Dwell Time as a Risk Factor of Central Line-Associated Bloodstream Infection in Neonates

Peripherally Inserted Central Catheter Dwell Time as a Risk Factor of Central Line-Associated Bloodstream Infection in Neonates

Effect of Cluster Nursing in Preventing Urinary Tract Infection in Postoperative Patients with Indwelling Urinary Catheter

Objective: This paper expounds and analyzes the effect of cluster nursing in preventing urinary tract infection in postoperative patients with indwelling urinary catheter. Methods: A total of 400 postoperative patients with indwelling urinary catheter, treated in Yancheng No. 1 People’s Hospital in recent two years, were recruited as research subjects. The patients were equally divided into group A and group B, with 200 patients in each group, and all received routine anti-infectives. The patients in group A (200 cases) received routine nursing. On the basis of group A, cluster nursing was implemented for patients in group B (200 cases). Results: The indwelling time of urinary catheter, the disappearance time of bladder irritation symptoms, and the probability of urinary tract infection were compared between both groups, which showed that the nursing effect of group B was better than that of group A (P &lt; 0.05). Conclusion: The implementation of cluster nursing in postoperative patients with indwelling urinary catheter can improve the deficiency of routine nursing, consolidate the treatment effect, and reduce the complication rate of urinary tract infection.

Efficacy and Safety of Midline Catheters with Integrated Wire Accelerated Seldinger Technique.

PurposeThe midline catheter (MC) is a peripheral venous access device with the catheter tip located in the axilla and available for mid-term intravenous (IV) therapy. This study evaluated the efficacy and clinical outcomes associated with the placement of MCs with an integrated wire-accelerated Seldinger technique for IV access.MethodsMaterials and A retrospective review was conducted at a single center in South Korea between March 2020 and July 2020. Consecutive patients in whom MC insertions were performed by vascular surgeons were enrolled. The outcomes included catheter indwelling time and incidence of catheter-related adverse events.ResultsNinety-five patients (117 catheters) were included in the study. The total indwelling time was 1,964 days, with a median of 16.7 days (range, 0-76). The complication-free catheter rates at 5 and 28 days were 92.9% and 65.5%, respectively. Overall, 32 (27.4%) catheters were removed due to complications; however, major complications, such as symptomatic deep venous thrombosis and catheter-induced bloodstream infections, were confirmed in only 3 (2.6%) catheters. A common reason for premature catheter removal is inadvertent removal owing to patient inattention. A high body mass index and female sex were identified as risk factors for short indwelling times and complicated premature catheter removal.ConclusionMC insertion is a simple and operator-friendly procedure with a low rate of major complication. It enables mid-term IV treatment through a single procedure if there are no specific complications, thereby improving quality of life of patients during hospital stay.

The Efficacy and Safety of Transurethral 2 μm Laser Bladder Lesion Mucosal En Bloc Resection in the Treatment of Cystitis Glandularis.

ObjectiveTo study the safety and feasibility of transurethral bladder lesion mucosal en bloc resection with 2 μm laser for cystitis glandularis.MethodsFrom July 2018 to July 2019, 58 patients with cystitis glandularis received surgical treatment were selected. All patients in this study were randomly divided into experimental group (transurethral 2 μm laser bladder lesion mucosal en bloc resection) and control group (traditional transurethral resection of bladder lesion mucosal). By analyzing the perioperative and follow-up clinical data of these two operation procedures, we discuss the efficacy and safety of transurethral 2 μm laser bladder lesion mucosal en bloc resection in the treatment of cystitis glandularis.ResultsPatients of two groups received operation successfully without serious complications such as bladder perforation. Compared with the experimental group, the laser treated group hadless bleeding in operation, shorter post-operative catheter indwelling time. These differences were statistically significant. No significant difference existed between two groups in terms of operative time, Bladder flushing time, irritation symptoms of bladder.ConclusionTransurethral 2 μm laser bladder lesion mucosal en bloc resection is safe and effective for the treatment of cystitis glandularis, and it is worthy of further clinical application.

Relationship between central line-associated bloodstream infection and catheter dwell time in neonates

The central line-associated bloodstream infection (CLABSI) is a common and serious complication of central venous catheterization, which can lead to various short-term and long-term adverse outcomes. Neonatal CLABSI did not increase linearly with the prolongation of peripherally inserted central catheter (PICC). When the umbilical venous catheter (UVC) is retained for more than 1-2 weeks, the incidence of neonatal CLABSI may increase significantly; PICC replacement at 7-10 days after UVC indwelling may reduce the incidence of CLABSI, but it has not been supported by evidence-based medicine. This article reviews the related studies between neonatal CLABSI and catheter dwell time, in order to plan the indwelling time more reasonably and prevent CLABSI better.