Catheter Line Research Articles

Home alone on milrinone: a novel way to deliver home inotropes as a bridge to heart transplantation

Abstract Continuous ambulatory intravenous inotropes can be successfully used as a bridge to decision or heart transplant in patients with end-stage heart failure. The traditional model at our institute involved the Hospital in the Home (HITH) team, with daily nurse-led visits to the patients’ home, to safely maintain this treatment, which is otherwise largely restricted to the intensive care setting. In response to the COVID-19 pandemic, delivery of healthcare underwent a paradigm shift. Our model was changed to a patient led continuous intravenous inotrope program at home which obviated the need for a daily nurse visit. We describe our process and our early outcomes. Fifteen patients were deemed suitable for the Independent at Home program. All patients needed to complete ambulatory intravenous inotrope education, pass competency testing and have implantable cardioverter-defibrillators inserted prior to discharge. Competencies included proficiency for troubleshooting the inotrope ambulatory delivery pump, monitoring of vital signs and ability to report decompensated heart failure symptoms. Weekly outpatient visits to our heart failure clinic with nursing, medical and pharmacy reviews were scheduled. Emergency action plans were provided to patients. 73.3% of our cohort were male. The average age was 51 years. 46.6% had a diagnosis of dilated cardiomyopathy. 53.3% were listed for heart transplant and were bridge to transplant (BTT) and 46.7% were bridge to decision (BTD) for heart transplant. Over a study period of 35 months, seven (46.7%) patients were weaned off inotropes, three (20.0%) were escalated to durable mechanical circulatory support (one due to decompensated heart failure and two due to persistently elevated pulmonary pressures), four (26.7%) were transplanted and one (6.7%) chose to be palliated. Six patients had one admission, five patients had two admissions. Five readmissions were due to decompensated heart failure, four admissions were planned to optimize pulmonary hypertension following a right heart catheterization, three had peripherally inserted central catheter (PICC) line complications and two had non-cardiac admissions (refer to table 1). The median length of days on the Independent at Home program was 112 days with an interquartile range of 120 days. A comparative group consisting of consecutive patients treated under the previous Hospital in the Home model are presented in table 2; the Independent at Home cohort shows reduced unplanned admissions. The independent at home inotrope program is an effective and safe option to bridge to decision or bridge to cardiac transplantation.HITH vs Independent admission reasonHITH vs Independent admissions

Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study.

Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals' and students' knowledge, image interpretation skills, and clinical acumen. This study aimed to (1) establish an assessment instrument gauging nurses' competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses' PoCUS training needs and evaluate its content and appearance validity. We will conduct a methodological study of technological production guided by Rogers' diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses' competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. PRR1-10.2196/58030.

Impact of sterile gloving during proximal manipulation of central line catheter hub: the multicenter observational study CleanHandPROX

BackgroundPatients with central lines face an increased risk of developing bacteremia. Preventing late-onset catheter-related infections relies on implementing various measures during manipulations of the catheter hub of central lines (e.g., during connections, disconnections, blood withdrawals, pulsed rinses, or injections performed at the first connection after the central catheter). French guidelines include, among these measures, the requirement to put on sterile gloves immediately before proximal manipulation to help prevent contamination of the catheter hub during preparation. To our knowledge, no study has reported compliance with wearing sterile gloves during these manipulations, nor the impact of not wearing sterile gloves on the cleanliness of the fingers of healthcare workers (HCWs) just before manipulating the connectors.MethodsWe conducted a two-part study to assess compliance with sterile gloving and to provide direct microbiological evidence of bacterial contamination on HCWs’ hands immediately before the manipulation of central lines when sterile gloving is not used. First, the use of sterile gloves was observed during proximal manipulations of central lines using a standardized grid. Second, we examined the microbial flora present on the fingers of each observed HCW just before proximal manipulation.ResultsA total of 260 HCWs from 35 healthcare institutions were observed during proximal manipulation. The HCWs were distributed into three groups: 188 used sterile gloves (72%), 23 used nonsterile gloves (9%), and 49 did not wear gloves (19%). The swabbing of the fingertips revealed microbial cultures from 72 samples (28%). A total of 97 microorganisms were identified, all of which are well-recognized agents responsible for catheter-related bacteremia, predominantly coagulase-negative staphylococci (n = 36) and Bacillus sp. (n = 31). Fingertip contamination was lower for HCWs wearing sterile gloves (27/188; 14%) than for those wearing nonsterile gloves (12/23; 52%) or not wearing gloves (33/49; 67%) (p < 0.001). The contaminants were similar across the three groups.ConclusionsOur data support the positive impact of sterile gloving in ensuring clean fingertips during proximal manipulation of central lines, a key measure in preventing late-onset catheter-related bacteremia. The contamination of sterile gloves in one out of seven HCWs highlights the need for a clean care environment and minimal contact with the patient’s skin and surroundings during proximal manipulation.

The Influence of Invasive Candida Infections on Prognosis and Analysis of Their Risk Factors After Liver Transplantation

PurposeThis study aimed to investigate the incidence, timing, risk factors, and impacts of invasive Candida infections (ICIs) within 3 months after liver transplantation (LT) on LT recipients’ prognosis. MethodsPatients undergoing LT from January 2015 to December 2022 in a tertiary university hospital were investigated the incidence, onset, and risk factors of ICIs and the effects of ICIs on the outcome of LT recipients using statistical methods. FindingsThe mean age of involved 389 LT recipients was 47.3 ± 10.5 years, with 322 (82.8%) being men. The incidence of ICIs was 3.3% (13/389), and the median time between LT and onset of ICIs was 5.0 days. The univariate analysis of predictors of ICIs identified that massive blood loss, prolonged duration of central line and urethral catheter, and prophylactic antifungal therapy were related to post-LT ICI risk. Multivariate logistic regression analysis adjusted for men and age identified that intraoperative blood loss ≥5000 mL (odds ratio [OR] = 7.005, 95% CI: 2.084–23.542, P = 0.002) and central line duration >14 days (OR = 5.270, 95% CI: 1.556–17.854, P = 0.008) were independently associated with the development of post-LT ICIs. Post-LT prophylactic antifungal therapy >3 days reduced ICIs (OR = 0.103, 95% CI: 0.021–0.501, P = 0.005). Regarding clinical outcomes, patients with ICIs were more likely to stay in the intensive care unit for 7 days or longer compared with those without ICIs (OR = 6.910, 95% CI: 1.737−27.493, P = 0.006). ICIs had no impact on hospitalization stay and 1-month all-cause mortality after LT. ImplicationsICIs are frequent and occur early after LT. Predictors of post-LT ICIs were massive intraoperative blood loss and prolonged duration of the central line. However, post-LT prophylactic antifungal therapy reduced ICIs. Patients with ICIs stayed longer in the intensive care unit than those without ICIs.

Direct-to-catheter ablation versus second line catheter ablation for persistent atrial fibrillation: Effect on arrhythmia recurrence, AF burden, early left atrium remodeling and quality of life.

Catheter ablation has obtained class 1 indication in ablation of young, healthy patients with symptomatic paroxysmal atrial fibrillation (AF). Anti-arrhythmic drugs (AADs) remain first-line therapy before ablating persistent AF (PersAF). We sought to evaluate the efficacy of a direct-to-catheter ablation approach against catheter ablation post AADs in PersAF. In this DECAAF II subanalysis, patients were stratified into two subgroups: 'Direct-to-catheter' group comprising patients who had not received AADs prior to ablation, and'second-line ablation' group, comprising patients who had been on any AAD therapy at any time before ablation. Patients were followed over 18months. The primary outcome was AF recurrence. Secondary outcomes included AF burden, quality of life (QoL) that assessed by the AFSS and SF-36 scores, and changes in the left atrial volume index (LAVI) assessed by LGE-MRI scans. The analysis included 815 patients, with 279 classified as'direct-to-catheter' group and 536 classified as'Second-line ablation' group. The primary outcome was similar between both groups (44.8% vs 44.4%, p > 0.05), as was AF burden (20% vs 16%, p > 0.05). Early remodeling, reflected by LAVI reduction, was similar between the groups (9.1 [1.6-18.0] in the second-line ablation group and 9.5 [2.5-19.7] in the direct-to-catheter group, p > 0.05). QoL pre/post ablation was also similar (p > 0.05). On multivariate analysis, history of AAD was not predictive of AF recurrence(p > 0.05). Prior AAD therapy demonstrated minimal impact on atrial remodeling and QoL improvement, in addition to limited benefit on AF recurrence and burden post-ablation in patients with PersAF. Additional studies are warranted to explore the efficacy of catheter ablation as a first-line therapy in PersAF.

A multimodal interventional strategy for prevention of ventilator associated pneumonia: a study from a tertiary care hospital in South India

Ventilator associated pneumonia (VAP) is the second most commonly encountered HAI after CAUTI. A robust system in place for prevention of VAP will not only bring down nosocomial mortality significantly but also reduce the burden on the healthcare system, cut the cost of medical expenditure and reduce the length of stay in hospitals. The present interventional study was conducted in adult Medical ICUs of a tertiary care hospital and the study demonstrated a statistically significant improvement in reducing VAE rate following a multimodal educational intervention involving all types of HCWs in the adult medicine ICU of a tertiary care hospital, South India. We observed that the care bundle compliance was considerably low in ICUs. However, intervention approaches, such as the ones employed in this study effectively improved care bundle compliance in our ICUs. Through overall analysis, there was significant reduction of VAE rate in this study and hence, a continuous monitoring system and education of the staff should exist to reduce the incidence of VAP in hospitals and the same strategy can be employed in other areas of hospital as well for prevention of other nosocomial infections like Catheter associated urinary tract infections, central line associated bloodstream infections and so on. The methodology of this study can be extended to the other ICUs including developing customized care bundles for other devices such as urinary catheter and central line in our healthcare facilities and other facilities across the country to obtain a similar improvement in care bundle compliance

Cumulative Analysis of Device-associated Hospital-acquired Infection Quality Indicators in a Teaching Hospital in Telangana

Background and Aims: In the realm of healthcare, device-associated hospital-acquired infections (DA-HAIs) pose significant challenges. These infections occur due to invasive medical devices and can lead to serious complications for patients. This study intends to assess the trends in device-associated infections over time in order to improve patient safety and quality through measurements and improvements in device-associated infections. Methods: The Department of Microbiology conducted a routine surveillance using a specific infection surveillance proforma for various healthcare-associated infections, including ventilator-associated events (VAEs), central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). The data were examined at the end of each month, and the infection rate was determined using CDC guidelines. Results: The overall rate of HAI was found to be 1.69 HAI cases per 1,000 patient days. The cumulative DAI rates for the years 2021 and 2022 were CAUTI 6.14/1,000 urinary catheter days, CLABSI 4.5/1,000 central line catheter days and VAE 16.3/1,000 ventilator days. Discussion: It was observed that the CAUTI and CLABSI rates in our institution were comparable to or slightly higher than the national standard benchmark and INICC report and were significantly higher compared to the CDC/NHSN benchmark. The VAE rate was comparable to INICC report but was significantly higher compared to the NSB and the CDC/NHSN reports. Conclusion: Individual hospitals should make efforts to generate and evaluate their DAI trends and overall HAI rates and implement and improve their infection control programme to collectively achieve the target in our country in bringing down HAIs.

Iterative Health Equity Analyses of Central Line-Associated Bloodstream Infection (CLABSI) Events at a Pediatric Hospital

Background: Per the Centers for Disease Control and Prevention, health equity stipulates all have a fair, just opportunity to attain their highest level of health. Limited evidence exists for disparities in health equity and healthcare-associated infections (HAI), with no evidence on language or primary insurance payor. While reviewing quality metrics, a disparity signal in central line-associated bloodstream infections (CLABSIs) prompted a multidisciplinary deep dive, with iterative analyses to understand potential inequities to identify improvement opportunities. Methods: CLABSI data was stratified and analyzed for evidence of disparity by race/ethnicity, primary insurance payor, and preferred spoken language utilizing an internal methodology. Subsequent analyses included a root cause analysis (RCA), case mix index (CMI) analysis, analysis of CLABSI Kamishibai card (K-card) rounding to monitor maintenance bundle reliability, and comparison of distribution of central venous catheter (CVC) line days to K-card audits [Figure 1]. Chi-square tests were used to test for significant differences for categorical variables in RCA and K-card analyses. ANOVA was used to compare CMI between demographic groups. Multiple logistic regression was used to compare K-card compliance rates by demographic groups. Results: When stratifying CLABSI rate by primary payor, pairwise comparisons indicated patients with a public payor had a statistically higher rate of CLABSI compared to private (p=0.02) [Figure 2A]. RCA analysis revealed when compared to patients with private payors, those with public had significantly higher rates of overdue needless connector changes (p = 0.03) and increased number of daily CVC entries (p = 0.05), while patients speaking another language (p = 0.02) were significantly more likely to have CVC contamination events. CMI analyses on CLABSI cases did not show patient acuity to vary significantly between demographics. Bivariate analysis of K-card data revealed minor differences in reliability with 7 Core Maintenance Bundle Elements by demographics; adjusting for all demographics and accounting for unit, pairwise comparisons indicated public payors had significantly higher compliance than international [Figure 2B]. We found no major differences in demographic distribution of CVC line days compared to K-card audits, suggesting we representatively audit maintenance bundle process measures. Conclusions: Our review of health equity in CLABSI events ultimately led to subsequent questions requiring analysis of other data sets. Utilizing an exploratory approach and assembling a multidisciplinary team to identify potential drivers of identified disparities adds value to health equity analyses. This is the first description of HAI data beyond race and ethnicity and can assist other institutions in their process of evaluating healthcare disparities and HAIs.

Comparative Analysis of Healthcare-associated Bloodstream Infections &amp; CLABSI Surveillance in A Singaporean tertiary Hospital

Background: Healthcare-associated central line associated bloodstream infection (HA-CLABSI) surveillance is important for monitoring healthcare-associated infections (HAIs) and evaluating effectiveness of infection prevention (IP) measures. However, implementing it is a laborious and time-consuming approach. Exclusive focus on central lines neglects HAI risk due to peripheral vascular catheters. This study aimed to assess whether HA-CLABSI incidence could be inferred from HA-bloodstream infection (BSI) trends and explore shift to HA-BSI surveillance. Methods: The study was performed in a Singaporean tertiary care hospital. Electronic medical records review was performed to determine whether positive blood cultures met Centers for Disease Control/National Health Safety Network (CDC/NHSN) definitions for HA-CLABSI and HA-BSI. Incident episodes of HA-BSI were included (excluding positive cultures repeated within 14 days). Incident organisms were explored to identify common causative pathogens (excluding same organisms isolated from cultures repeated within 14 days). CLABSI and BSI occurring ≥72hrs after admission were considered healthcare-associated. Patients under oncology or hematology service were considered immunocompromised. Incidence rates (IR) per 10,000 patient-days, patient characteristics and causative pathogens were compared between both indicators. Results: From January 2022 to October 2023, mean IR for HA-CLABSI was 0.63 (n=68) and for HA-BSI was 10.06 (n=1094). Median age of patients with HA-CLABSI was 66 years and HA-BSI was 68 years. HA-CLABSI and HA-BSI were more common in males (60.86% &amp; 58.68%). Median duration between admission to HA-CLABSI was 20 days and to HA-BSI was 12 days. Median duration between central line insertion to HA-CLABSI was 16 days. Of 1094, 631 (57.7%) patients had vascular catheter(s) (i.e., IV cannula, port-a-cath, peripherally-inserted central catheter or central line) inserted at time of HA-BSI diagnosis, of whom 46 (7.3%) patients had CLABSI ±2days from positive blood culture. There was no significant correlation between monthly aggregate data from these indicators (Spearman’s correlation coefficient= 0.36, p-value=0.1). Predominant organisms causing HA-CLABSI and HA-BSI were gram negative bacteria (GNB, 40% &amp; 57.21%), gram positive bacteria (24.71% &amp; 22.23%), and fungi. Common GNB in CLABSI patients were Pseudomonas spp. and Stenotrophomonas maltophilia (8.24%), followed by Serratia marcescens and Klebsiella pneumoniae (5.88%). The frequent GNB in HA-BSI patients were Escherichia coli (15.4%), Klebsiella pneumonia (12.68%), and Pseudomonas spp. (6.69%). Common multi-drug resistant organisms were vancomycin-resistant Enterococcus faecium (10.59% &amp; 3.69%) and methicillin-resistant Staphylococcus aureus (10.59% &amp; 3.07%). Conclusion: HA-BSI did not correlate with HA-CLABSI. HA-BSI reflects heterogenous population outcomes. For utilization as surveillance indicator, further assessment on exclusion criteria is required to improve specificity.

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P&gt;0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P&gt;0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Peripherally Inserted Central Venous Catheter (PICC) Line Use for Conjoined Twins: Single-Center Experience

Abstract Purpose This article assesses the feasibility, safety, and efficacy of peripherally inserted central catheters (PICCs) in conjoined twins. Material and Methods A retrospective chart review of all consecutive conjoined twins who had PICC placement at a tertiary center. Seventeen conjoined twins (12 females; 71%) had 25 PICC insertions. The average age of patients at PICC insertion was 15.9 ± 19.3 months. The most common type of twin was thoraco-omphalopagus (5 patients; 29%). The most common access was the brachial vein (N = 10, 40%). Thirteen procedures (52%) were performed before separation. Results Seven long-term minor complications were identified (28%). The most common complication was malpositioning (8%). Average dwell time was 122 days while the average fluoroscopy time was 2 minutes and 3 seconds. Conclusion Image-guided PICC placement in conjoined twins is safe and feasible. It provides excellent durable vascular access.

Arrow QuickFlash Radial Artery and Radial Artery/Arterial Line Catheterization Kits

Arrow QuickFlash Radial Artery and Radial Artery/Arterial Line Catheterization Kits

Trajectory pattern of serially measured acute kidney injury biomarkers in critically ill patients: a prospective observational study

BackgroundThe clinical value of the trajectory of temporal changes in acute kidney injury (AKI) biomarkers has not been well established among intensive care unit (ICU) patients.MethodsThis is a single-center, prospective observational study, performed at a mixed ICU in a teaching medical institute in Tokyo, Japan. Adult ICU patients with an arterial line and urethral catheter were enrolled from September 2014 to March 2015. Patients who stayed in the ICU for less than 48 h and patients with known end-stage renal disease were excluded from the study. Blood and urine samples were collected for measurement of AKI biomarkers at 0, 12, 24, and 48 h after ICU admission. The primary outcome was major adverse kidney events (MAKE) at discharge, defined as a composite of death, dialysis dependency, and persistent loss of kidney function (≥ 25% decline in eGFR).ResultsThe study included 156 patients. Serum creatinine-based estimated glomerular filtration rate (eGFR), plasma neutrophil gelatinase-associated lipocalin (NGAL), and urinary liver-type fatty acid-binding protein (uL-FABP) were serially measured and each variable was classified into three groups based on group-based trajectory modeling analysis. While the trajectory curves moved parallel to each other (i.e., “low,” “middle,” and “high”) for eGFR and plasma NGAL, the uL-FABP curves showed distinct trajectory patterns and moved in different directions (“low and constant,” “high and exponential decrease,” and “high and exponential increase”). These trajectory patterns were significantly associated with MAKE. MAKE occurred in 16 (18%), 16 (40%), and 9 (100%) patients in the “low and constant,” “high and exponential decrease,” and “high and exponential increase” groups, respectively, based on uL-FABP levels (p-value < 0.001). The initial value and the 12-h change in uL-FABP were both significantly associated with MAKE, even after adjusting for eGFR [Odds ratio (95% confidence interval): 1.45 (1.17–1.83) and 1.43 (1.12–1.88) for increase of initial value and 12-h change of log-transformed uL-FABP by 1 point, respectively].ConclusionsTrajectory pattern of serially measured urinary L-FABP was significantly associated with MAKE in ICU patients.

Reducing pediatric ambulatory central line-associated bloodstream infections in patients at a single institution home health agency

We conducted a quality improvement project from 2019 to 2021 at a single home health agency to reduce rates of central line-associated bloodstream infection in our ambulatory pediatric population. Annualized central line-associated bloodstream infection rates per 1,000 catheter line days decreased by 20% during the study period, from a rate of 1.023 to 0.810. This decrease was sustained in the 10-month post-study period with a center line shift of 1.090 to 0.658.

ChatGPT may free time needed by the interventional radiologist for administration / documentation

Motive: Documentation and administration, unpleasant necessities, take a substantial part of the working time in the subspecialty of interventional radiology. With increasing future demand for clinical radiology predicted, time savings from use of text drafting technologies could be a valuable contribution towards our field. Method: Three cases of peripherally inserted central catheter (PICC) line insertion were defined for the present study. The current version of ChatGPT was tasked with drafting reports, following the Radiological Society of North America (RSNA) template. Key results: Score card evaluation by human radiologists indicates that time savings in documentation / administration can be expected without loss of quality from using ChatGPT. Further, automatically generated texts were not assessed to be clearly identifiable as AI-produced. Conclusions: Patients, doctors, and hospital administrators would welcome a reduction of the time that interventional radiologists need for documentation and administration these days. If AI-tools as tested in the present study are brought into clinical application, questions about trust into those systems eg with regard to medical complications will have to be addressed.

Central Line Repair in Pediatric Patients in the Pediatric Emergency Department by Emergency Physicians-A Single-Center Experience.

Central venous catheters are more common with advanced treatments for a variety of conditions. These catheters may need to be repaired after local damage. This has been performed by those more involved with catheter placement such as pediatric surgeons and interventional radiologists. Gastroenterologists who treat many of these patients have also been involved with catheter repair. Repair by pediatric emergency physicians has not been explored. Such repairs by the emergency physician may be time saving and avoid unnecessary admissions. This was a retrospective study of a single center's experience with catheter repair. The performers and outcomes were compared. During the study period, 52 catheter repairs were performed on 7 children. Forty of the repairs were performed by a pediatric emergency physician, 5 by pediatric surgeons, and 5 by interventional radiology. All but 1 repair was successful. Infectious complications were reported in 3 cases. None required catheter removal. The length of stay was significantly shorter for repair by emergency physician. Central line catheter repair can be performed successfully by pediatric emergency physician with minimal complications. A dedicated process of repair tutoring is required and may avoid infectious complications.

The effect of minimizing central line days for very low birth weight infants through quality improvement

Blood culture proven sepsis is associated with increased mortality and morbidity. Given the extended hospitalization of very preterm infants, catheter-related blood stream infections (CRBSIs) play a substantial role in sepsis. The reported incidence of CRBSIs in neonates varies from 3.2 to 21.8 CRBSIs per 1000 catheter line days. Moreover, discrepancies in neonatal practices and potential neglect may lead to the unwarranted prolongation of central lines. This study aims to compare two distinct periods (Pre-QI vs. Post-QI) in relation to the central line insertion rate and duration, as well as blood culture proven sepsis, duration of total parenteral nutrition (TPN), and the progression of feeding. These factors are known to be associated with prolonged hospitalization and increased morbidities. A total of 210 very low birth weight infants (VLBWIs), defined as either less than 32 weeks of gestational age (GA) or weighing less than 1500 g, were admitted to the Neonatal Intensive Care Unit (NICU) at Seoul St. Mary’s Hospital, The Catholic University of Korea, between January 2020 and June 2023. Fourteen infants were excluded from the study as they did not survive beyond 1 month of life, and one was excluded due to a congenital anomaly. Consequently, the analysis included 195 VLBWIs. The Quality Improvement (QI) initiative began in January 2022, marking the division into two distinct epochs: the Pre-QI period, encompassing the years 2020 to 2021, and the Post-QI period, spanning from 2022 to 2023. The primary outcome measures included PICC insertion rates, duration, and feeding advancement or feeding-related complications. The hospital outcome measures were also compared between the two periods. A total of 195 VLBWI were included in the analysis. The birth weight was significantly lower in the pre-QI period, with an average of 1023 g compared to 1218 g (P < 0.001). Severe BPD ≥ moderate was significantly lower in the post-QI period (36.2% vs. 53.9%) (P < 0.001) along with shorter mechanical ventilation days (12 ± 29 vs. 22 ± 27) (P = 0.046). The PICC insertion rate was significantly decreased from 95.6% in pre-QI period compared to 55.2% in post-QI period (P < 0.001) along with a notable reduction in blood culture-proven sepsis (25.6% vs. 10.5%, P = 0.008). CRBSI rate was reduced from 1.3 to 1.1 per 1000 catheter days in the post-QI period. Moreover, the time required to achieve full enteral feeding of 100 mL/kg/day was significantly shorter in the post-QI (24 ± 23 vs. 33 ± 25) (P = 0.006). Multivariable logistic regression analysis for sepsis revealed that both birth weight and pre/post QI consistently demonstrated an association with lower sepsis rates in the Post-QI period. QI has the potential to reduce the burden of unnecessary interventions and blood culture proven sepsis rate along with CRBSI rate, thereby, optimizing the better care of very preterm babies.

The Study of the Feasibility of Ultrasound-guided Catheterization of the Right Brachiocephalic Vein in Adult Patients: A Prospective Observational Study.

The brachiocephalic vein (BCV) is a feasible option for central venous access in the pediatric population and is rapidly developing as an alternative site for insertion of the central line in young children with faster insertion times, fewer attempts, and lower rates of complications. However, studies demonstrating the feasibility of BCV catheterization in adult patients are insufficient. The current study sought to assess the safety and effectiveness of ultrasound-guided supraclavicular right BCV cannulations in adults. A linear array Ultrasound (US) probe was used to obtain a longitudinal picture of the BCV beginning at the junction of the internal jugular vein and the subclavian vein in the supraclavicular region. Under US supervision, the needle was guided into the BCV using the in-plane approach. A prospective study was performed on 80 adult patients scheduled for elective and emergency operative procedures under general anesthesia requiring a central venous catheter (CVC). Success rates and complications that occurred during catheter insertion were analyzed. CVC placement was successful in all adults. The procedure was successful at the first attempt in 74 cases (92.5%) and after 2 attempts in six patients (7.5%). The time to guide wire insertion was 31.26 s (19-58 s), and catheter insertion took 88.44 s (63-145 s). The mean length of catheter insertion was 10.46 cm. No complications were noted. Ultrasound-guided supraclavicular BCV catheterization offers a new and safe method for central venous line catheterization in adults. However, larger trials and meta-analyses are needed to confirm these findings and evaluate the safety of this technique.

In vitro assessment of isopropanol leakage from antiseptic barrier caps into commonly used needleless connectors.

Needleless connectors (NCs) can be disinfected using antiseptic barrier caps (ABCs) to reduce the risk of catheter-related bloodstream infections. However, recent evidence suggests that isopropanol can leak from the ABC into the NC, posing concern about their safe use. We sought to determine in vitro which ABC and NC parameters influence the leakage of isopropanol through the infusion circuit. We assessed 13 NCs and 4 ABCs available in the European market. In vitro circuits consisting of an isopropanol cap, a NC, and an 11-cm catheter line were created. The circuits were left in place for 1 to 7 days at room temperature to assess the kinetics of isopropanol leakage. Isopropanol content in ABC and in circuit flushing solutions (5 mL NaCl 0.9%) after exposure to the cap were measured using gas chromatography with a flame ionization detector. The leakage of isopropanol from the cap to the NC was dependent on the NC, but not the cap. The NC mechanism did not predict the leakage of isopropanol. The Q-Syte NC exhibited the most isopropanol leakage (7.01±1.03 mg and 28.32±2.62 mg at 24 hours and 7 days, respectively), whereas the Caresite NC had the lowest isopropanol leakage at 7 days (1.69±0.01 mg). The use of isopropanol ABCs can cause isopropanol leakage into the catheter circuit according to NC parameters. Caution should be exercised when using these devices, especially in the pediatric and neonatal population.

A Single-Centre Experience of an Anesthesia-Led Pediatric Peripherally Inserted Central Catheter Service at a Specialized Cancer Institute

Introduction: To report our experience of establishing a pediatric peripherally inserted central catheter (PICC) line procedure led by the anesthesia department of a tertiary care cancer center. Materials / Patients and Methods: A retrospective review was conducted over a period of 28 months. Variables such as demographic data, indications, the number of days the line remained in situ, and the frequency of adverse events were considered. Results A total of 112 patients between the ages of one and fourteen years who had PICC lines inserted were included. All procedures were done under general anesthesia by two separate anesthesia teams with established protocols. Insertion was guided by ultrasonography through the basilic (n = 84, 75%), median cubital (n = 12, 10.7%), femoral (n=1, 0.9%), or cephalic (n=15, 13.39%) veins in the non-dominant arm. The insertion success rate was 97.3% while the unsuccessful in 2.7%. The 4Fr (French number) PICC line was used in 95 (84.82%) patients and 5F in 17 (15.17%) patients. The PICC line was used for an average of 85.47 days (ranging from 0 to 350 days). Chemotherapy (n = 89, 78.47%), difficult Intravenous (IV) access (n=15, 13.39%), and palliative care (n=8 7.14%) patients require long-term venous access. 38 (33.92%) patients had completed treatment with PICC line while 4 (3.57%) patients lost follow-up. Conclusion: PICC - lines are an essential element of cancer treatment in children. Anesthesia-led PICC line service is a reliable option. They maintain operating room, PICC line sterility during insertion, and complications comparable to follow the recommended precautions.