Catheter Occlusion Rate Research Articles

The effect of different flushing and locking techniques on catheter occlusion rates in central venous catheters: protocol for a multicentre, randomized controlled, parallel-group, open-label, superiority clinical trial

BackgroundMaintaining venous access is of great clinical importance. Running a slow continuous infusion to keep the vein open (KVO) is often used in peripheral intravenous catheters (PIVCs). Previous studies have compared the effects of intermittent flushing and continuous infusion via peripherally inserted central catheters (PICCs). In this study, we applied KVO to central venous catheters (CVCs) and compared the occlusion rate of this technique with that of the intermittent flushing technique.MethodThis is a randomized controlled trial of 14 hospitals in China. A total of 250 patients will be recruited in this study, and they will be randomized at a 1:1 ratio. After study inclusion, patients who will undergo CVC insertion will receive intermittent flushing with prefilled saline syringes (control group) or KVO infusion with elastic pumps (test group). All the catheters will be checked for patency by scoping Catheter Injection and Aspiration (CINAS) Classification on Days 3 and 7. The primary outcome is the rate of catheter occlusion in 7 days. Patients will be followed up until 9 days after CVC insertion, catheter occlusion, or catheter removal. The secondary outcomes are the rate of catheter occlusion in 3 days, nurse satisfaction, cost-effectiveness, adverse event rate, catheter-related bloodstream infection rate, catheter-related thrombosis rate, extravasation rate, phlebitis rate, and catheter migration.DiscussionWe expect that the trial will generate findings that can provide an evidence-based basis for the improvement and optimization of clinical catheter flushing techniques.Trial registrationChinese Clinical Trial Registry, ChiCTR2200064007. Registered on 23 September 2022. https://www.chictr.org.cn/showproj.html?proj=177311.

A Study on the Effect of Lidocaine-Assisted Non-Coring Needle Placement Using Painless Encircling Puncture in Children with Totally Implantable Venous Access Device.

This study aimed to investigate the maintenance effect of two puncture methods using non-coring needles in children with totally implantable venous access device (TIVAD). The 110 children who received TIVAD implantation for short bowel syndrome and solid tumors in our department from 2021.12 to 2022.12 were selected as the study subjects. Blinded method was used and divided into experimental group and control group according to random number table The experimental group underwent painless surround puncture method to place the needles and compound lidocaine ointment for topical anesthesia, while the control group underwent traditional puncture method to complete this operation. The effects of the two puncture methods on pain, catheter seal fluid volume, and catheter occlusion rate were evaluated using the Facial Pain Scale Revised, Behavioral Assessment Scale, and in vitro digital subtraction angiography test. In the control group, the degree of puncture pain was mild in 5 patients, moderate in 19 patients, and severe in 28 patients; the amount of catheter sealing solution was 9.32 ± 1.32 mL, and the catheter occlusion rate was 25.00%. In the experimental group, the degree of puncture pain was mild in 16 patients, moderate in 22 patients, and severe in 16 patients; the amount of sealing solution was 7.66 ± 1.08 mL, and the blocking rate was 9.26%. The total pain score in the experimental group was lower than that in the control group (5.23±6.17 VS 7.89±2.38). The difference between the two groups had statistical significance (P < 0.05). The use of the painless surround puncture method can effectively reduce the pain experienced by children during puncture, decrease the volume of catheter sealing fluid, reduce the rate of catheter blockage, provide a valuable basis for enhancing the maintenance effect of TIVAD in clinical practice for children.

Flushing and locking management related to central venous catheter occlusion rate among adult patients in acute care: a best practice implementation project.

A central venous catheter (CVC)-a type of central venous access device (CVAD)-is the most common intervention for critical illnesses. Obstruction of the CVC can lead to fatal consequences. Thus, it is critical to maintain catheter lumen patency. The CVC occlusion rate in a hospital in Taiwan was 33%. This project aimed to decrease the CVC occlusion rate in acute care. This project was conceptually informed by the JBI Evidence-Based Model of Healthcare, in particular, the conceptualization of evidence implementation as inclusive of context analysis, implementation, and evaluation of outcomes using evidence-based quality indicators. As part of the seven-phase implementation process, we used audit and feedback in a pre- and post-test design to measure baseline compliance. Based on the initial audit, we developed an implementation strategy responsive to the identified gaps in compliance. We then undertook a final audit to measure changes in compliance to evaluate our implementation effects. The JBI software, PACES, and the situational analysis software, GRiP, were used for data collection and implementation planning. There were six evidence-based criteria, with a sample size of 30 nurses for each criterion. The team carried out the project from September 2022 to January 2023. Post-implementation audit compliance rates increased to 100% for the following criteria: the organization had a standardized flushing and locking solution protocol (0%), the CVAD lumen was locked upon completion of the final flush (10%), a single-dose system was used for flushing and locking the CVAD (60%), and preservative-free 0.9% sodium chloride was used to flush the CVAD (60%). Furthermore, the CVC occlusion rate decreased from 33% to 5%. The project successfully decreased the rate of CVC occlusion and increased the competence of nurses in acute care settings. The implementation of best practices in clinical care should focus on leadership, cross-department coordination, education, and innovation.

Effects of the low-speed continuous infusion catheter technique on double-lumen central venous catheters: A randomized controlled trial

BackgroundCentral venous catheters are widely used in clinical practice, and the incidence of central venous catheter occlusion is between 25 % and 38 %. The turbulence caused by the pulsatile flushing technique is harmful to the vascular endothelium and may lead to phlebitis. The low-speed continuous infusion catheter technique is a new type of continuous infusion that ensures that the catheter is always in a keep-vein-open state by continuous low-speed flushing; hence, avoiding the problem of catheter occlusion. ObjectiveTo investigate the effectiveness of the low-speed continuous infusion catheter technique and the routine care of double-lumen central venous catheters. DesignThis was a prospective, randomized, controlled, open-label trial. SettingPatients were recruited from 14 medical institutions in China between February and June 2023. ParticipantsIn total, 251 patients were recruited, with 125 in the intervention group and 126 in the control group. MethodsPatients who used double-lumen central venous catheters for infusion treatment were selected, and those who met the sampling criteria were randomly divided into intervention and control groups using the random envelope method. The intervention group used low-speed continuous infusion catheter technique to maintain catheter patency, whereas the control group used routine care with a trial period of 7 days. The primary outcome was occlusion rate. The secondary outcomes included nursing satisfaction and complication rates of the two groups. ResultsAfter 7 days, the rate of catheter occlusion was 28.0 % (35/125, 95 % confidence intervals (CI):0.203,0.367) in the intervention group and 53.97 % (68/126,95%CI:0.449 ~ 0.629) in the control group, with a statistically significant difference (χ2 = 17.488, p < 0.001); at 3 days of intervention, the rate of catheter blockage was 8.0 % (10/125，95%CI: 0.039 ~ 0.142) in the intervention group and 23.8 % (30/126，0.167 ~ 0.322) in the control group, with a statistically significant difference (χ2 = 11.707，p < 0.001). Nurse satisfaction was significantly higher in the intervention group (115/125，92.0 %，95%CI: 0.858 ~ 0.961) than in the control group (104/126, 82.54 %,95%CI: 0.748 ~ 0.887) (χ2 = 5.049, p = 0.025). There were no statistically significant complication rates in either group (p = 0.622). ConclusionThe low-speed continuous infusion catheter technique helps maintain catheter patency, improves nurse satisfaction, and provides a high level of safety. RegistrationChinese Clinical Trial Registry (ChiCTR2200064007，www.chictr.org.cn). The first recruitment was conducted in February.https://www.chictr.org.cn/showproj.html?proj=177311

Intraventricular Lavage vs External Ventricular Drainage for Intraventricular Hemorrhage

Intraventricular lavage has been proposed as a minimally invasive method to evacuate intraventricular hemorrhage. There is little evidence to support its use. To evaluate the safety and potential efficacy of intraventricular lavage treatment of intraventricular hemorrhage. This single-blinded, controlled, investigator-initiated 1:1 randomized clinical trial was conducted at Aarhus University Hospital and Odense University Hospital in Denmark from January 13, 2022, to November 24, 2022. Follow-up duration was 90 days. The trial was set to include 58 patients with intraventricular hemorrhage. Prespecified interim analysis was performed for the first 20 participants. Data were analyzed from February to April 2023. Participants were randomized to receive either intraventricular lavage or standard drainage. The main outcome was risk of catheter occlusions. Additional safety outcomes were catheter-related infections and procedure time, length of stay at the intensive care unit, duration of treatment, and 30-day mortality. The main outcome of the prespecified interim analysis was risk of severe adverse events. Efficacy outcomes were hematoma clearance, functional outcome, overall survival, and shunt dependency. A total of 21 participants (median [IQR] age, 67 [59-82] years; 14 [66%] male) were enrolled, with 11 participants randomized to intraventricular lavage and 10 participants randomized to standard drainage; 20 participants (95%) had secondary intraventricular hemorrhage. The median (IQR) Graeb score was 9 (5-11), and the median (IQR) Glasgow Coma Scale score was 6.5 (4-8). The study was terminated early due to a significantly increased risk of severe adverse events associated with intraventricular lavage at interim analysis (risk difference for control vs intervention, 0.43; 95% CI, 0.06-0.81; P = .04; incidence rate ratio for control vs intervention, 6.0; 95% CI, 1.38-26.1; P = .01). The rate of catheter occlusion was higher for intraventricular lavage compared with drainage (6 of 16 patients [38%] vs 2 of 13 patients [7%]; hazard ratio, 4.4 [95% CI, 0.6-31.2]; P = .14), which met the prespecified α = .20 level. Median (IQR) procedure time for catheter placement was 53.5 (33-75) minutes for intraventricular lavage vs 12 (4-20) minutes for control (P < .001). This randomized clinical trial of intraventricular lavage vs standard drainage found that intraventricular lavage was encumbered with a significantly increased number of severe adverse events. Caution is recommended when using the device to ensure patient safety. ClinicalTrials.gov Identifier: NCT05204849.

Substantial Variation in Peripherally Inserted Central Catheter Use and Outcomes in Patients with Hematologic Malignancies: A Multi-Center Study

Background:Use of peripherally inserted central catheters (PICCs) has grown rapidly in patients with hematologic malignancies. Studies demonstrating the safety of PICCs in hematologic malignancies, however, are largely single-center, retrospective designs focused on the outpatient setting. Little is known about inpatient PICC use in patients with hematologic malignancies and how such use varies across hospitals.Methods:Data was prospectively collected between November 2013 and December 2019 from a cohort of patients admitted at one of 42 Michigan hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). Patients had a diagnosis of a hematologic malignancy and had a PICC placed during their hospital stay. Adult medical patients admitted to a general ward or intensive care unit were eligible for data collection and data were collected from the medical record using a standardized template. The indications for PICC placement, catheter characteristics, and associated complications from 17 hospitals with more than 25 discrete patients with hematologic malignancy were included in a comparative analysis. Major complications were defined as central line associated bloodstream infection (CLABSI), catheter occlusion, and venous thromboembolism (VTE). Differences across hospitals were tested using the Kruskal-Wallis test for continuous variables and Pearson chi-square test for categorical variables.Results:A total of 2092 PICCs placed in 1798 patients were included in the analysis with a median (IQR) dwell time of 15 (6-30) days. Most patients were male (n=1242, 59.4%), white (n=1720, 82.2%), and 50 to 69 years old (n=950, 45.4%). Patients were primarily admitted to large hospitals (≥375 beds: n=1429, 68.8%) that were teaching centers (n=1600, 76.5%) in metropolitan locations (n=2000, 95.6%). Leukemia (n=752, 36.0%) and non-Hodgkin's lymphoma (n=409, 19.6%) were the most represented malignancies. The most common primary indication for PICC placement was administration of chemotherapy (n=1180, 56.4%). The majority of PICCs were double lumen (n=1457, 69.6%), most often placed by vascular access nurses (n=1520, 72.7%). A concurrent central venous catheter was present at the time of PICC placement in 12.2% (n=264) of patients. A major complication event occurred in over 1 in 4 PICCs placed (n=562, 26.9%). Catheter occlusion occurred in 17.8% (n=372), CLABSI in 8.2% (n=171), and VTE in 3.8% (n=80) of PICCs respectively.There was wide variation in PICC indications, characteristics, and outcomes across hospitals. Placement of PICCs for chemotherapy varied from 33.3% to 85.3% (p<0.001). Similarly, there was a wide range of placement for antibiotics (2.8% to 32.4%, p<0.001), transfusion of blood products (0.0% to 9.7%, p<0.001), medications requiring central access (0% to 26.7%, p<0.001), difficult access and blood draws (1.8% to 33.3%, p<0.001), and administration of total parenteral nutrition (0.0% to 14.3%, p=0.002). There was significant variation in the number of lumens used: single (5.6% to 37.9%, p<0.001), double (51.9% to 93.0%, p<0.001), or triple (0.0% to 30.8%, p<0.001). The incidence of major complications spanned from 9.7% to 40.8% (p=0.001). Rate of catheter occlusion had the widest range (0.0% to 36.7%, p<0.001). The differences between rates of VTE (0.0% to 8.7%, p=0.29) and CLABSI (1.4% to 15.9%, p< 0.20) were not statistically significant. Patient mortality ranged from 2.8% to 19.4% (p<0.001).Conclusion:Appropriate venous access is critical to the care of patients with hematologic malignancy. This study demonstrates wide variation in the practice patterns and outcomes for PICCs in patients with hematologic malignancies across hospitals in Michigan. Further work is necessary to further understand and improve decision making around choosing vascular access in this vulnerable population. [Display omitted] DisclosuresZhang: SIMR, Inc: Ended employment in the past 24 months, Research Funding; AmerisourceBergen: Current Employment. Sood: Bayer: Consultancy.

Comparison between the effects of normal saline with and without heparin for the prevention and management of arterial catheter occlusion: a triple-blinded randomized trial.

We aimed to compare the effects of saline with and without heparin on the catheter-occlusion rate and coagulation-related blood test results for the management of arterial catheters among patients admitted to a short-term intensive care unit postoperatively. This prospective, triple-blinded, randomized controlled study recruited patients aged 20-90years scheduled to undergo radial arterial catheter insertion and postoperative intensive care unit admission between February and August 2019. Patients were randomly allocated to two groups (1:1 ratio) depending on the use of heparin: study (normal saline with heparin, 3000 units to 500ml of normal saline) and control (normal saline without heparin) groups with arterial catheters. The allocated management method was employed immediately after intensive care unit admission. Occlusion assessment (every 12h), arterial blood gas tests (every 6h), and blood sample collection (every 24h) were performed. The occlusion of arterial catheter was assessed using occlusion rate, and blood test results were assessed using a linear mixed model. There were 147 patients in the arterial catheter groups. There were no significant differences in occlusion rates and changes in platelet counts and activated partial thromboplastin time between the groups with arterial (p = 0.98, 0.16, and 0.32, respectively) catheters during the first 6days after intensive care unit admission. Normal saline with and without heparin showed similar efficiency for both the prevention of occlusion and the results of coagulation.

Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis

Recently, some studies have shown that prolonging flush interval is safe and feasible for patients who complete chemotherapy. However, there is no consensus about the optimal flush interval for those patients. The purpose of this review was to evaluate whether the flush interval could be prolonged based on monthly interval for regular maintenance and to explore the optimal flush interval. We searched the following databases for articles published between 1 January 1982 and 21 February 2020: PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and Ovid. Randomized controlled trials, retrospective and prospective cohort studies of flush interval less than 4 weeks versus longer than 4 weeks for patients who completed chemotherapy, were included. Two reviewers extracted information and assessed the quality of the articles independently. In total, 389 articles were retrieved, and 4 studies including 862 cases fulfilled the inclusion criteria. There was no statistical heterogeneity (I2 = 0, p > 0.05) among the included studies. Hence, the fixed-effects model was used for the meta-analysis. The meta-analysis showed that the total complication rate associated with longer than 4-week interval was higher than that associated with less than 4-week interval. Nevertheless, there was no significant difference between the two groups (7.2% vs 7.6%, p = 0.83). Moreover, the meta-analysis showed that the total complication and catheter occlusion rates associated with the 4-week interval were higher than those associated with the 8-week interval. However, there was no significant difference between the two groups (total complications: 11.4% vs 9.5%, p = 0.68; catheter occlusions: 4.9% vs 4.1%, p = 0.89). Only four non-randomized controlled studies were included, and the outcomes of the included studies were reported incompletely. Extending the flush interval to longer than 4 weeks is safe and feasible. Based on previous studies, extending the flush interval to 8 weeks might not increase the incidence of total complications and catheter occlusions. However, there is no conclusion on whether the flush interval could be extended to 3 months or longer.

Effect of open-ended venous port with different sealing fluids to seal tube

Objective To evaluate the effect of tube sealing using pre-flushed flushing syringes (flush) and heparin saline on open-ended port for venous transfusion during continuous infusion. Methods During the period of continuous intravenous infusion, a total 90 tumor patients were randomly divided into 2 groups. They used open-ended port for venous transfusion and was sealed by using pre-flushed flushing syringes and 100 U/ml heparin saline respectively. The catheter blockage rate, dispensing time, sealing tube time and cost of single sealing tube were compared between two groups. Results During the period of continuous infusion, the catheter occlusion rate of flush group and the heparin saline group were 1.84% and 1.47% (χ2=0.2642, P>0.05); on the dispensing and seal tube time, they were (11.5±2.9) seconds and (10.5±2.6) seconds in the flash group, and (37.1±2.9) seconds and (24.6±3.3) seconds in the heparin saline group (t=41.982, 22.797; P<0.01). The cost for flush sealing is 8.33 yuan lower than that of heparin saline sealing. Conclusions During the period of continuous intravenous infusion, sealing tube by using flush on open-ended infusion port is safe and effective. The workload of the nurses and cost is reduced, it is worth to be promoted. Key words: Open-ended venous port; Pre-flushed flushing syringes; Heparin saline; Catheter occlusion rate

Observational Study of the Effect of Heparin-Containing Flush Solutions on the Incidence of Arterial Catheter Occlusion

The National Patient Safety Agency (NPSA) highlighted potential dangers associated with arterial lines in 2008, recommending the use of saline-only flush solutions. The incidence of catheter thrombosis appeared to increase following the implementation of this guidance in some units. The objective of the current study was to observe local practice regarding the use of heparin in arterial catheter flush solutions, and subsequent arterial catheter occlusion rates. This was an observational study in which data were collected prospectively from 445 catheter insertions in unselected intensive care patients in eight member hospitals of the Association of North Western Intensive Care Units (ANWICU). Catheters flushed with heparinised solutions had a significantly increased median lifespan of 102 hours versus 72 hours for saline-flushed catheters (p&lt;0.01). The likelihood of line blockage was significantly decreased in the heparin group (7.9%) compared with the saline group (41.2%, p&lt;0.0001). Our results suggest that routine use of heparinised flush solutions is associated with increased catheter lifespan and reduced catheter thrombosis. We believe that there is justification for an adequately powered, randomised controlled trial. Current NPSA guidance may need to be reviewed.

Translumbar Hemodialysis Catheters in Patients with Limited Central Venous Access: Does Patient Size Matter?

PurposeTo describe a single institutional experience with translumbar tunneled dialysis catheters (TDC) and compare outcomes between patients with normal and abnormal body mass index (BMI). Materials and MethodsTranslumbar TDCs placed between January 2002 and July 2011 were reviewed retrospectively. There were 33 patients; 18 had a normal BMI<25, and 15 had an abnormal BMI>25. Technical outcome, complications, indications for exchange or removal, and BMI were recorded. Catheter dwell time, catheter occlusion rate, frequency of malposition, and infection rates were collected. ResultsThere were 92 procedures (33 initial placements) with 7,825 catheter days. The technical success rate was 100%. Two minor (2.2%) and three major (3.3%) complications occurred. The complication rate did not differ significantly between patients with a normal BMI and patients with an abnormal BMI. Median catheter time in situ (interquartile range) for all patients was 61 (113) days, for patients with normal BMI was 66 (114) days, and for patients with abnormal BMI was 56 (105) days (P = .9). Primary device service intervals for all patients, patients with normal BMI, and patients with abnormal BMI were 47 (96) days, 63 (98) days, and 39 (55) days (P = .1). Secondary device service intervals for all patients, patients with normal BMI, and patients with abnormal BMI were 147 (386) days, 109 (124) days, and 409 (503) days (P = .23). Catheter-related central venous thrombosis rate was 0.01 per 100 catheter days (n = 1). ConclusionsTranslumbar TDC placement can provide effective hemodialysis in patients with limited venous reserve regardless of the patient’s BMI. An abnormal BMI (>25) does not significantly affect complication rate, median catheter time in situ, or primary or secondary device service interval of translumbar TDCs.

Influence of Local Skin Temperature and Choice of Insulin Analog on Catheter Occlusion Rates During Continuous Insulin Infusion: An Exploratory Study

The aim of this study was to determine whether changes in local skin temperature over which the infusion catheters pass when using insulin pump therapy and the choice of rapid-acting insulin analog influence the risk of catheter occlusion. Twenty healthy volunteers were assigned to wear insulin pumps primed with insulin glulisine and insulin aspart in a randomized order each for a duration of 5 days and a temperature probe (taped to the skin near the insulin catheter). To reproduce the effect of subcutaneous infusion, the insulin catheter was inserted into an absorbent sponge in a plastic bag strapped to the subject's abdomen. Basal infusion rates were programmed at 0.2 IU/h, and 2-IU boluses were given three times a day with meals. Average skin temperature ranged between 33.5°C and 36.68°C for insulin glulisine and 32.35°C and 35.28°C for insulin aspart, with no difference in skin temperature between treatments or between the first and second week of the study. Nine occlusions were seen in eight subjects with an overall rate of occlusion of 22.5% (95% confidence interval, 21.9-61.3%) and were more likely to occur in the second week. On an individual level the risk of occlusion was similar for insulin glulisine and insulin aspart (odds ratio, 0.87%; P=0.6). Overall, in this small study simulating subcutaneous insulin infusion, the rate of catheter occlusion was low and unaffected by local fluctuations in ambient skin temperature. There was no significant difference between the two rapid-acting insulin analogs tested. Where occlusions occurred, they were more likely to happen beyond the manufacturer's recommended 72-h limit for catheter use.

Effect of standard catheter management for prevention of PICC occlusion in premature infants

Objective To explore the effect of standard catheter management to prevent the PICC occlusion in premature infants.Methods After May 2009,PICC nursing teams were organized and trained on improving the methods of flushing and sealing the catheter and the occlusion rates before and after intervention was analyzed.Results The study outcome showed a significant reduction in the catheter occlusion rate,from 13.85％ to 2.94％,and the difference was statistically sighificant ( x2 =5.209,P ＜ 0.05 ).Conclusions Standard catheter management has remarkable effect in preventing PICC occlusion in premature infants. Key words: Infants, premature; PICC; Catheter management; Nursing intervention

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates

To evaluate the effect of low-dose heparin on duration of peripherally inserted percutaneous central venous catheter (PCVC) patency and catheter occlusion. Our research was a prospective, randomized, controlled, double-blind clinical study including 246 eligible neonates with PCVCs. It was conducted at the neonatal intensive care unit (NICU) of Diyarbakir Children's Hospital between 1 February 2007 and 31 October 2008. In the heparin group (n=118), the total parenteral nutrition (TPN) solutions contained heparin, which was infused at a rate of 0.5 IU kg⁻¹ h⁻¹ . The no-heparin group (n=121) received TPN fluids without heparin. In the heparin group, the duration of catheter patency was longer than that of the no-heparin group reaching a statistically significant difference (12.4 ± 4.5 vs 9.7 ± 4.0, P<0.0001). In the heparin group, the proportion of patients completing the TPN therapy successfully was higher than in the no-heparin group (P=0.0001; relative risk (RR): 3.32 (95% confidence interval (CI): 1.92 to 5.73)) also demonstrating a statistically significant difference. The rate of catheter occlusion among infants in the heparin group was smaller (P=0.0001; RR: 3.44 (95% CI: 1.92 to 6.44)). There were no statistically significant differences between the two groups in the incidence of other catheter-related problems. The length of the occluded catheter outside the skin, TPN infusion rate and catheter duration time were found to be the factors associated with catheter occlusion. Heparin prevented catheter occlusion with a mechanism unrelated to these factors. In neonates with PCVCs, low-dose continuous infusion of heparin (0.5 IU kg ⁻¹h⁻¹ within TPN fluids is an effective measure in terms of reducing catheter occlusion, allowing successful completion of the therapy, without increasing adverse effects. Furthermore, this effect of heparin may occur independently via occlusion-related factors that we evaluated in the study.

The comparison of two different routs for central venous catheterization in clinical analysis

Objective Both kind of cases of the different routs for central venous catheterization were analyzed to compare the feasibility complications and advantages. Methods After studying some relative literatures of the two different routs for central venous catheterization( CVC ), we reviewed 110 cases that the single lumen venous catheter were placed into superior vena cave via subclavian vein and 110 cases that the peripherally inserted central venous catheter(PICC) were placed into surperior vena cava via peripheral vein. Comparing the rate of success, complication of pneumothorax or hemothorax, rate of catheter occlusion, rate of catheter translocation and phlebitis, the time for placing the catheter, to find the differences between the two groups about the feasibility complications and advantages. Results The statistics difference of catheter translocation rate is significant in complication of pneumothorax or hemothorax rate. Other factors make no sense in statistics after analyse by the SPSS system. Conclusion PICC method has an exact same effect as CVC method dose. While it is superior in some other factors, especially when it comes to preventing hemopneumothorax. The PICC methods is a safer and more effective way for central venous catheterization. Key words: Peripherally inserted central venous catheters; Central venous catheters; Comparative studies

Safety of Insulin Glulisine when Given by Continuous Subcutaneous Infusion Using an External Pump in Patients with Type 1 Diabetes

This twelve-week, European, multicenter, controlled, open-label, randomized (1 : 1), parallel-group trial compared the safety of insulin glulisine with insulin as part used in continuous subcutaneous insulin infusion. Patients with type 1 diabetes (n=59) and continuous subcutaneous insulin infusion experience (mean values: HbA1c 6.9 % [insulin glulisine: 6.8 % VS. insulin as part: 7.1 %]; age 45.8 years; body mass index 26.0 kg/m2) were enrolled. HbA1c levels at endpoint (insulin glulisine: 7.0 % VS. insulin as part: 7.2 %), daily insulin doses, blood glucose profiles and adverse event rates were similar in both groups. The median (minimum-maximum) catheter occlusion rate was low for insulin glulisine and insulin as part (0 [0 - 0.7] VS. 0 [0 - 1.1] occlusions/month. Unexplained hyperglycemia occurred in six insulin glulisine-treated patients and twelve insulin as part-treated patients. Patients were expected to change their catheters every 2 days (15 changes/month); the catheter change rate was similar for insulin glulisine and insulin as part (14.1 VS. 14.8 changes/month). The frequency of infusion site reactions and hypoglycemia, and the time between catheter changes were similar for both insulin forms. Diabetic ketoacidosis was not reported. This study supports the safety of insulin glulisine in continuous subcutaneous insulin infusion administered via an external pump in type 1 diabetes.

The Impact of Needleless Connector Device Design on Central Venous Catheter Occlusion in Children: A Prospective, Controlled Trial

Intraluminal occlusion is common in children with central venous catheters (CVCs). Although multiple factors predispose CVCs to occlusion, reflux of blood is frequently implicated. We hypothesized that use of either a single-valve or positive-pressure-valve needleless connector device would reduce CVC occlusion rates in comparison to a standard device. We further hypothesized that saline would be as effective as heparinized saline flush in preventing occlusion and infection. CVC lumens were prospectively capped with 1 of 3 needleless connector devices in a 4-group design. Group 1 lumens were capped with a standard device, group 2 with a single-valve device, group 3 with a positive-pressure-valve device flushed with heparinized saline, and group 4 with a positive-pressure-valve device flushed with saline. Data were obtained regarding occlusion and infection rates and user satisfaction. Three hundred sixty children with 599 CVC lumens completed the study. Complete occlusion occurred in 19/150 (12.7%) lumens in group 1 in comparison to 2/150 (1.3%) in group 2, 5/149 (3.4%) in group 3, and 6/150 (4%) in group 4 (p < .05). There was a trend toward a 2-fold greater infection rate in group 4. User satisfaction was higher in groups 2, 3, and 4 than group 1 (p < .05). CVCs capped with a single-valve or positive-pressure-valve needleless connector device have lower complete catheter occlusion rates than those capped with a standard device. Heparinized saline flush affords no advantages over saline in reducing occlusion rate; however, there was a trend toward lower infection rate with the use of heparinized saline.

Peripherally Inserted Central Catheters in Children

There is little published information describing standards of practice in the placement, use, and maintenance of peripherally inserted central catheter (PICC) devices in children. A Web-based survey tool was designed to query these issues, and 72 intravenous therapy nurses from 72 hospitals provided complete responses to the survey. The respondents were predominantly (81%) from healthcare organizations inserting 40 or fewer PICC devices per month. These hospitals were equally divided in using 0.9% sodium chloride (USP) (saline) or heparinized saline flush to maintain patency, whereas 76% used catheters for blood sampling. Flushing and blood sampling practices were not related to catheter occlusion rates. From their survey, the authors conclude that the standards of practice for 3-Fr PICC devices, the most commonly used for children, are quite variable and in need of standardization for this specific population.

A Theory-based Intervention to Improve Nursesʼ Knowledge, Self-efficacy, and Skills to Reduce PICC Occlusion

The peripherally inserted central catheter (PICC) is an effective intermediate and long-term central vascular access device. Its functions are comparable with those of other percutaneously placed central venous catheters. However, its high occlusion rate and the consequent infection risk may disrupt therapy for patients. The primary investigator in this study developed an educational intervention based on Albert Bandura's social learning theory, and hypothesized that increasing nurses' knowledge and self-efficacy related to PICCs would have a positive impact on patient outcomes related to occlusion and infection rates. The study outcome showed an overall increase in nurses' knowledge and self-efficacy related to PICC care, and a significant reduction in the catheter occlusion rate, from 29% to 8.5%, over a 6-month period.

Home parenteral nutrition registry: A five-year retrospective evaluation of outcomes of patients receiving home parenteral nutrition support

Objective Few data are currently reported on home parenteral nutrition (HPN) patient outcomes, which makes evaluating comparative outcomes in HPN difficult. This study describes outcomes of consecutive HPN patients collected retrospectively over a 5-y period by one HPN support provider. Methods Retrospective data from the HPN support provider was aggregated yearly from 1997 to 2001. Length of therapy, demographics, diagnosis, rehospitalizations, catheter infection rate, catheter occlusion rate, and mechanical complication rate data were reported. Results The mean age of HPN patients ranged from 42 y to 45 y. The average length of HPN therapy was 100 d. There were more female than male HPN patients. Nutritional deficiency and malabsorption were the most common International Classification of Diseases, Ninth Revision codes for HPN use and reflects a focus on nutritional diagnosis rather than on disease state as the criterion for HPN use. Catheter infection rates ranged from 0.44 to 0.84 per 1000 catheter days, a lower than anticipated number. Mean catheter occlusion rates were lower than 7% and mean mechanical complication rates were approximately 5%. Known termination of therapy was secondary to completion of therapy (50% to 56%) or death (17.3% to 22%). Conclusions Overall, time on HPN therapy in the United States has increased. Nutritional diagnoses are currently used to justify HPN. Catheter infection and occlusion rates, in general, are low. Termination of therapy and death are the most common reasons for HPN discontinuation. Standardization of HPN data collection is necessary to obtain a historical snapshot of the efficacy and safety of patients treated outside the hospital with nutritional support.