Catheter-related Complications Research Articles

Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days.

Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.

GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research.

Subcutaneously anchored securement devices (or subcutaneous engineered securement devices) have been introduced recently into the clinical practice, but the number of published studies is still scarce. The Italian Group of Long-Term Central Venous Access Devices (GAVeCeLT)-in collaboration with WoCoVA (World Congress on Vascular Access)-has developed a Consensus about the effectiveness, safety, and cost-effectiveness of such devices. After the definition of a panel of experts, a systematic collection and review of the literature on subcutaneously anchored securement devices was performed. The panel has been divided in two working groups, one focusing on adult patients and the other on children and neonates. Although the quality of evidence is generally poor, since it is based mainly on non-controlled prospective studies, the panel has concluded that subcutaneously anchored securement devices are overall effective in reducing the risk of dislodgment and they appear to be safe in all categories of patients, being associated only with rare and negligible local adverse effects; cost-effectiveness is demonstrated-or highly likely-in specific populations of patients with long-term venous access and/or at high risk of dislodgment. Subcutaneously anchored securement is a very promising strategy for avoiding dislodgment. Further studies are warranted, in particular for the purpose of defining (a) the best management of the anchoring device so to avoid local problems, (b) the patient populations in which it may be considered highly cost-effective and even mandatory, (c) the possible benefit in terms of reduction of other catheter-related complications such as venous thrombosis and/or infection, and-last but not least-(d) their impact on the workload and stress level of nurses taking care of the devices.

Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit.

Background:Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced.Methods:In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018.Results:The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates.Conclusion:A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.

Infection and Thrombotic Complications in Peripherally Inserted Central Catheters (PICCs) in Cancer Patients at Healthcare Global Hospital, Bangalore

Introduction: Peripherally inserted central catheter (PICC) is a form of vascular access device (VAD) that can be used for a prolonged period of time in cancer patients for diverse indications. Despite the many advantages, catheter related complications are common.&#x0D; Objectives: The objective of this study was to evaluate infection and thrombotic complications of PICCs in cancer patients.&#x0D; Methodology: We conducted a prospective longitudinal study, over a duration of thirty months from June 2015 to December 2017 in the Department of Haematology and Medical Oncology at our tertiary care, cancer hospital to assess, analyze and compare the infection and thrombotic complications in cancer patients with a PICC line. All patients with cancer who met the inclusion criteria were enrolled and were followed up until catheter removal. The basic information regarding PICCs insertion, weekly care and removal was maintained. The data were analyzed and compared to identify catheter related complications&#x0D; Result: Four hundred and sixty-one PICCs were monitored for a total of 57,438 catheter-days (mean of 124 days i.e. 4.15 months, range : 1 to 434 days). Out of these 461 PICCs, 29 (6.29%) had both infection and thrombotic complications, as a result of which 22 were removed in 57,438 catheter days. (ie catheter removal rate was 0.38 per 1000 PICC days). Infection complications were found more with hematological malignancies while thrombotic complication were predominant in solid tumours.&#x0D; Conclusion: Infection complications were more common in hematological cancer patients than solid cancers where thrombotic complications were more common.

Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients.

Current guidelines recommend home parenteral nutrition (HPN) for cancer patients with chronic deficiencies of dietary intake or absorption when enteral nutrition is not adequate or feasible in suitable patients. HPN has been shown to slow down progressive weight loss and improve nutritional status, but limited information is available on the monitoring practice of cancer patients on HPN. Clinical management of these patients based only on nutritional status is incomplete. Moreover, some commonly used clinical parameters to monitor patients (weight loss, body weight, body mass index, and oral food intake) do not accurately reflect patient’s body composition, while bioelectrical impedance analysis (BIA) is a validated tool to properly assess nutritional status on a regular basis. Therefore, patient’s monitoring should rely on other affordable indicators such as Karnofsky Performance Status (KPS) and modified Glasgow Prognostic Score (mGPS) to also assess patient’s functional status and prognosis. Finally, catheter-related complications and quality of life represent crucial issues to be monitored over time. The purpose of this narrative review is to describe the role and relevance of monitoring cancer patients on HPN, regardless of whether they are receiving anticancer treatments. These practical tips may be clinically useful to better guide healthcare providers in the nutritional care of these patients.

P1369ACUTE EXTRACORPOREAL DIALYSIS USING TWO-WAY PICC POWER INJECTABLE IN YOUNG CHILDREN

Abstract Background and Aims Acute extracorporeal dialysis is a short treatment, performed by a central venous catheter of large size, ensuring high flow. These devices have limitations: high caliber, excessive length, impossibility of tunneling and exit-site location in the supraclavicular region, with a subsequent high risk of dislocation and contamination. The authors report a new approach to dialytic central venous catheters selection in children. Method From January 2013 to December 2017, 16 children weighing less than 15 kg needed acute extracorporeal dialysis. Patients received an ultrasound guided percutaneous implantation of a two-way PICC power injectable catheter, in the right internal jugular vein or in the anonymous right vein. The device size always respected the ratio of 1/3; the catheters were cut to be adapted to child height, and subclavear tunnelizations and stabilizations were ensured. The hemodialysis was performed with the Prismaflex Gambro system. The effectiveness of treatment was evaluated by recirculation test and by measuring the KT/Vat the third hour, expressing the dialysis adequacy. Results Two-way power injectable central venous catheter,sized from 5 to 7 Fr and long from 8 to 15 cm were used. The recorded blood flow ranged from 4.7ml/min/kg to 7ml/min/kg; a KT/V variable from 0.5 to 1 was detected; the recycling rate was between 32% and 40%. No catheter related complications were observed. Conclusion In children weighing less than 15 kg, PICC power injectable have lower blood flow and higher recirculation rate compared to traditional dialysis catheters. However, the dialytic adequacy was suitable for an acute hemodialysis treatment. In addition, these catheters are available in a wide range of calibers and result more adaptable to the venous system of younger children.

P1353IS AGE RISK FACTOR FOR TUNNELED VASCULAR CATHETER OUTCOMES?

Abstract Background and Aims According to previous data, the prevalence of tunnelled cuffed vascular catheters (TCC) is more frequent in elderly as compared to younger HD patients. Still, it is not clear if elderly have decreased survival of TCC as compared with survival in younger. Method During the period from January 2010 to June 30, 2015, 110 permanent catheters were implanted in 64 patients (1.72 catheters per patient, 51.6% male mean age 67±12years, 20 diabetics). Out of all patients, 44 (68.7%) were older than 65 years, 12 (27.3%) were diabetic and 11 (25%) were previously treated with peritoneal dialysis. In the age-based subpopulations we compared the incidence of infections, thrombosis, chemical removal of thrombus by actilysis and TCC outcome. Results Reasons for TCC placement in elderly were inability of the second option and exhausted vascular approach and these reasons were found to be significantly more frequent compared to patients younger than 65 years (p = 0.020 ). Primary position of TCC was right jugular vein in both groups (39.1%, No = 25 vs 14.1% No = 9), more commonly in group of elderly patients, but there was no significant difference in the initial TCC position depending on the age structure of the patient (Hi square = 1.720, p = 0.886). The overall incidence of infections was 3.44 episodes per 1000 catheter days and patients' age did not affect TCC replacement, infection, thrombosis and inflammation. In the group of elderly, 27 patients had catheter infection (61.4%), 10 (22.7%) had catheter thrombosis and actilysis resolved thrombosis in 6 (13.6%) patients without significant difference as compared with younger patients. Catheter-induced bacteraemia were more common in TCC over 65 years (47 TCC vs. 12 TCC) but without statistical significance (p = 0.062). Similarly, exit site infection, was more common (14 TCC vs. 4 TCC) for those older than 65 years but also without statistical significance. Thrombosis of TCC occurred in 7 patients with TCC younger than 65 years and in 20 TCC in cohort of elderly (Hi square = 0.033, p = 0.535) (Table 1). Regarding treatment outcome, 19 (43.2%) elderly patients died while being treated with TCC, 12 patients (27.3%) changed treatment modality to peritoneal dialysis, 4 patients (9.1%) received arteriovenosus graft (AVG) and 9 patients had functional TCC at the end of follow up (20.5%) and no significant difference was found in the outcome compared to younger patients. Conclusion The reason for placement of TCC in elderly is the inability of other treatment options and exhaustion of vascular access. Concerning catheter related complication and outcome, there was no significant difference between the elderly and younger patient.

P1164INTERVENTIONAL NEPHROLOGY SERVICE ENHANCES PERITONEAL DIALYSIS UTILISATION AND UPTAKE: EXPERIENCE FROM A SINGLE CENTRE IN SINGAPORE

Abstract Background and Aims Interventional nephrology (IN) is not having a well-defined role in peritoneal dialysis (PD) service provision. Impact to PD catheter outcomes, PD utilisation and uptake on integrated care approach under IN service was not known. Here we report the experience and outcomes of IN practice in PD service from a single centre in Singapore. Method We postulated an IN-led, multidisciplinary collaborative model of care for end stage renal failure patients, who transited through a seamless care pathway from pre-dialysis counselling to insertion of PD catheter, could improve utilisation and increase uptake of PD as dialysis modality of choice. This approach was based on: 1. Interventional nephrologist-led PD catheter insertion service, 2. coordination of care (figure 1) and 3. early start of PD. Outcomes of IN involvement in PD access management and coordination of care were included in this study. Results From January 2015 to May 2019, a total of 140 PD catheter insertions were performed by interventional nephrologist (table 1). The prevalence of PD patients in our program was increased by 217% after initiation of IN service (figure 2). Annually, incident ESRF patients who chose PD as dialysis modality increased from 10% to 28% (figure 3). We had a very low PD catheter-related complication rate in reference to international standards (table 2). Catheter adjustment-free survival was 94% and 83% at 12 months and 36 months respectively (figure 4). Conclusion The multifaceted and holistic role of IN in PD translated into remarkable outcomes on PD utilisation and uptake. It also confirms the safety and efficacy of IN procedures in PD when performed by appropriately trained nephrologists.

Dialysis for Undocumented Immigrants: Challenges and Solutions.

Undocumented immigrants with ESKD have traditionally had very limited options for dialysis care. They are not eligible for Medicare, they are typically not able to afford private insurance, and they are not eligible for assistance through the Affordable Care Act (ACA). A handful of states provide coverage through Medicaid programs. For patients in the state of Texas, this is not an option. Consequently, these patients have no options for scheduled dialysis care and must present to the emergency department (ED) for evaluation for emergent dialysis. As a result of federal policy, inpatient dialysis units are not able to provide scheduled dialysis, so these patients can only receive dialysis when a life-threatening indication develops. Such practice exposes these patients to adverse health outcomes (including increased mortality) and impaired quality of life, as well as creating a great deal of stress on all levels of the healthcare system and providers, including trainees. As the primary safety-net hospital for Dallas County, Parkland Hospital has cared for the vast majority of undocumented immigrants with ESKD in North Texas, and the expected array of problems has been observed. Over the past several years we have engaged in several ongoing team-based, multidisciplinary efforts to improve quality of care for this population. Through allocation of resources, collaboration with other healthcare divisions, development of educational materials, and the creation of partnerships with organizations outside our institution, we have observed improvements in the care of our patients, including increased access to scheduled dialysis, decreased catheter-related complications, and decreased mortality. Although much work remains, we have been gratified by the improvement in patient care and hope that our story can serve as an example for others faced with similar challenges and spark discussion for needed broader policy changes. Undocumented immigrants with ESKD have limited options for dialysis care. They are …

Percutaneous insertion of peritoneal dialysis catheter is a safe and effective technique irrespective of BMI

BackgroundA large body mass index (BMI) has been considered as a relative contraindication for percutaneous catheter insertion, although this technique has many advantages. Up to now, there are few studies on peritoneal catheter placement and obesity. The aim of this study was to determine whether patients with large BMI can also choose the percutaneous technique for peritoneal dialysis catheter insertion.MethodsOne hundred eighty seven consecutive patients underwent peritoneal catheter insertions in the Chinese PLA General Hospital between January 1, 2015 and December 31, 2016, with 178 eligible cases being included in the analysis. Two groups were created based on the catheter insertion techniques, the percutaneous group (group P) and the surgical group (group S). Subgroups were created according to BMI > 28 or ≤ 28. The outcomes included catheter related complications and catheter survival.ResultsTotal infectious complication rates were significantly lower in group P than in group S. There were no significant differences in peritonitis rate between group P and group S (1.20% vs. 3.16% with P = 0.71 in early stage, and 4.82% vs. 11.58% with P = 0.11 in late stage). All other measured complications were similar between the two groups. Though the one-year infection-free catheter survival in group P was 7.5% higher than group S, the difference was not significant. The one-year dysfunction-free catheter survival, one-year dysfunction-and-infection-free catheter survival, and overall catheter survival were similar between the two groups. Subgroup analyses showed a superior one-year infection-free catheter survival of percutaneous technique in patients with BMI > 28, which was confirmed by Kaplan-Meier analysis.ConclusionsDespite the challenges that may be encountered with patients who have a large BMI, the percutaneous technique seems to be a safe and effective approach to placing a peritoneal dialysis catheter.

Overall survival (OS) and healthcare utilization results of a randomized controlled trial (RCT) assessing a patient navigation (PN) intervention to increase early access to supportive care (SC) for patients with metastatic cancer in a resource-limited setting.

12112 Background: We previously reported improvements in access to SC, advance directive completion, and pain control in a RCT comparing a patient navigator-led early SC intervention vs. usual care among patients with newly-diagnosed metastatic cancer in Mexico (NCT03293849). We now present results on healthcare utilization and OS. Methods: Patients were randomized to PN or usual oncology care. Patients in the PN arm received SC interventions by a navigator-led multidisciplinary team (palliative care, physical therapy, geriatrics, psychology) in the first 12 weeks after diagnosis. At 12-weeks, patients allocated to usual care were able to cross-over to PN and receive multidisciplinary SC. We analyzed the number (no.) of emergency room (ER) visits, their cause, and whether they were potentially avoidable (as determined by expert consensus), using descriptive statistics and X2 tests. OS was estimated using the Kaplan-Meier method and the log-rank test. Results: 133 patients (median age 60, range 23-93; 52% male) were randomized (66 PN, 67 control) from 08/17 to 04/18. Median follow-up was 22.8 months. 61% had gastrointestinal tumors, and 45% had a calculated life expectancy ≤6 months. 69% of patients randomized to usual care crossed-over to PN and received SC interventions. 80% of patients attended the ER ≥once (median no. of visits = 2). No difference was found between patients randomized to early SC or usual care in ER visits (2.4 vs. 2.3, p = 0.58). Out of a total 316 ER visits, the most common reason was infections (n = 69, 22%), followed by pain (n = 40, 13%), and indwelling catheter-related complications (n = 23, 7%). 41% of ER visits were considered as potentially avoidable, with no difference in avoidable visits found between arms (1.7 vs. 1.7, p = 0.49). No differences between arms were found in no. of hospitalizations (0.8 vs. 0.6 p = 0.82). Survival results were assessed after 64% of patients had died (n = 85), finding no statistically significant OS difference between the early SC intervention and the usual care arms (11.0 vs 13.0 months, p = 0.77) Conclusions: In the context of a limited-resource healthcare system, the early delivery of SC did not improve healthcare utilization, reduce avoidable ER visits, or prolong OS compared to the implementation of SC at a later time, which might be partially explained by the unavailability of hospice or home care, and by high rates of cross-over between arms. Clinical trial information: NCT03293849 .

Cutaneous port-site recurrence secondary to tumour seeding following implantation of an intraperitoneal chemotherapy access port for gastric cancer.

Intraperitoneal chemotherapy has shown promising results for the treatment of peritoneal carcinomatosis in gastric cancer. However, the implantation of an intraperitoneal chemotherapy port may be associated with catheter-related complications. The authors describe a case of cutaneous port-site recurrence secondary to tumour seeding from an intraperitoneal chemotherapy access port.

Is continuous catheter adductor canal block better than single-shot canal adductor canal block in primary total knee arthroplasty?: A GRADE analysis of the evidence through a systematic review and meta-analysis.

The adductor canal block (ACB) has emerged as an alternative to the femoral nerve block (FNB) after total knee arthroplasty. This meta-analysis was conducted to investigate which ACB method provides better pain relief and functional recovery after total knee arthroplasty METHODS:: We conducted a meta-analysis to identify randomized controlled trials involving single-shot adductor canal block (SACB) and continuous catheter ACB (CACB) after TKA up to December 2019 by searching databases including the PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases. Finally, we included 8 randomized controlled trials involving 702 knees in our study. We used Review Manager Software and Grading of Recommendations Assessment, Development, and Evaluation profiler to perform the meta-analysis. Compared with SACB, CACB can achieve better postoperative pain relief at 24 and 48 h both at rest and after mobilization, lower amount of opioid consumption at 72 h, a shorter length of hospital stay (LOH) and larger range of motion (ROM). In addition, the Timed Up and Go (TUG) test results; quadriceps strength; and incidence of complications, including postoperative nausea and vomiting, DVT, catheter-related infections, catheter dislodgement and neurologic deficits, showed no significant difference between the two ACB methods. The results of this study demonstrate that CACB is an effective alternative to SACB and can provide better pain relief, a shorter LOH, more degrees of maximum flexion and a lower amount of opioid consumption over time, but it provides a comparable level of recovery of quadriceps strength and mobility with a similar risk of catheter-related complications. Thus, CACB may be a better analgesia strategy than SACB after TKA at present.

A Comparable Study on the Outcomes of Urgent Initiated Peritoneal Dialysis Versus Conventional Start, A Single Centre Study from North-East India.

Introduction To avoid temporary hemodialysis, urgent initiated PD (UIPD) has been designed. In these patients, PD is initiated within 3 days after PD catheter placement. In this study, we evaluated the outcomes of UIPD in end-stage renal disease patients compared with the conventional start of PD. Methods This is a single-center observational study, comparing outcomes of UIPD to conventional initiation of PD. All patients diagnosed with ESRD from March 2013 to February 2019 and were willing for CAPD were recruited. In UIPD group treatment was initiated at day 2 of catheter insertion with a dialysate volume of 1000 mL per dwell for 2 hours gradually increased to 2000 mL per dwell volume by 8 to 10 days. Results During the study period, 98 patients were started on peritoneal dialysis in our hospital: 35 UIPD, 63 conventional PD. The mean age was 60.81 ± 13.04 years. 67% of patients were males with diabetes mellitus (32%) being the most common cause of CKD. Among the patients in UIPD, the mean age was 58.49 ± 16.1 years, while as in conventional group mean age was 62.10 ± 10.9 years. The Median follow-up time was 381 days. Technique survival was seen in 95 patients (96.9%). There was no difference in technique failure between UIPD vs conventional group. Total complications in our study occurred in 16 patients out of 98 patients during this period. There was no significant difference in the complication rates between the UIPD group and the conventional group. Conclusion Our study showed that catheter patency, technique survival, and catheter-related complications were comparable between UIPD and conventional start peritoneal dialysis.

Efficacy of Ultrasonography in the Diagnosis of Peritoneal Catheter Obstruction in Children: A Case Series

Catheter obstruction is a serious complication associated with peritoneal dialysis (PD). Diagnostic imaging techniques play a role in the management of patients undergoing PD, mainly in detecting potential catheter-related complications. Imaging can help in the treatment decision process. Visualizing the obstruction and understanding the etiology are crucial for accurate management of patients and in determining therapeutic strategies. Although a PD catheter obstruction can be diagnosed using magnetic resonance imaging (MRI), ultrasonography (US) has been reported to be equally effective. The effectiveness of US and MRI in detecting PD catheter obstructions was compared in four pediatric patients. These cases demonstrate that US was more useful in visualizing PD obstruction compared with MRI. US can be repeated more conveniently and is noninvasive, especially in children. US can be considered an effective tool for diagnosing PD catheter obstruction in children.

A Narrative Review of Early Oral Stepdown Therapy for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia: Yay or Nay?

Historically, intravenous (IV) antibiotics have been the cornerstone of treatment for uncomplicated Staphylococcus aureus bacteremia (SAB). However, IV antibiotics are expensive, increase the rates of hospital readmission, and can be associated with catheter-related complications. As a result, the potential role of oral antibiotics in the treatment of uncomplicated SAB has become a subject of interest. This narrative review article aims to summarize key arguments for and against the use of oral antibiotics to complete treatment of uncomplicated SAB and evaluates the available evidence for specific oral regimens. We conclude that evidence suggests that oral step-down therapy can be an alternative for select patients who meet the criteria for uncomplicated SAB and will comply with medical treatment and outpatient follow-up. Of the currently studied regimens discussed in this article, linezolid has the most support, followed by fluoroquinolone plus rifampin.

Ultrasound-guidance of peripheral venous catheterization in apheresis minimizes the need for central venous catheters.

Central venous catheters (CVC) can facilitate a reliable blood flow for apheresis procedures, but the placement is time-consuming and costly and the incidence of catheter-related complications is high. Ultrasound can aid nurses to insert peripheral venous catheters (PVC), which is safer for the patients. We evaluated the use of CVC vs PVC for all apheresis procedures 3 years after the implementation of structured training of apheresis nurses to perform ultrasound-guided PVC. Ultrasound can visualize the needle tip and target vessel dynamically and guide peripheral venous catheterization with an increased success rate. Time consumption for PVC insertion was measured. In 10 months, we performed 1294 apheresis procedures on 227 patients, where 97.4% were performed with PVC. Hundred percent of extracorporeal photophoresis (off-line ECP) and peripheral blood stem cell collections on adults were performed with PVC. Patients who were treated with CVC (n = 8) were either children, had poor peripheral blood flow due to dehydration or admitted to an intensive care unit and had CVC for other reasons. Time consumption for PVC placement with ultrasound was 11 minutes on average. Training of apheresis nurses in ultrasound-guided peripheral venous catheterization can enable close to 100% of apheresis procedures to be performed by PVC.

Patient characteristics and clinical outcomes in a specialised intestinal failure unit: An observational cohort study.

Intestinal failure (IF) is defined by a need for intravenous (IV) supplementation. Patients may present with multiple morbidities, and IV treatments carry a risk for catheter-related complications. Few studies described patient characteristics and clinical outcomes according to type of IF. We consecutively included patients who were admitted to a newly established inpatient IF unit (IFU) from 2013 through 2017. We evaluated patient characteristics and clinical outcomes of all patients' first admission. Outcomes included IF classification, length of stay, central line-associated blood stream infection (CLABSI), and discharge on home parenteral support (HPS). Follow-up was conducted six months after discharge for mortality and the continued need for HPS. A total of 236 patients were evaluated, including 39 (17%) with type 1 IF, 123 (52%) with type 2 IF, and 74 (31%) with type 3 IF. Of 91 who had a central venous catheter (CVC) on admission, CLABSI was present in 11 (12%). The CLABSI occurrence during admission was 2 (1%) of 173 patients with a CVC. Mean length of stay declined from mean 33 days (95% confidence interval (CI): 26.2-42.5) in 2013 to 15 days (95% CI: 12.2-17.7) in 2017 (p<0.0001). Undiagnosed comorbidity was revealed in 165 patients (70%) with unchanged frequency during the study period (p=0.8). Sixty-seven (28%) patients were discharged with HPS. Inpatients with IF present with multiple morbidities. CLABSI should be investigated on admission. A low inpatient CLABSI rate may be achieved through the implementation of a specialised IFU.

The incidence and management of complications of venous access in home parenteral nutrition (HPN): A 19 year longitudinal cohort series.

Long term central venous access for Home Parenteral Nutrition (HPN) is associated with catheter related complications. The most studied and well known of these is Catheter Related Blood Stream Infection (CRBSI). This paper looks at other venous access complications, including blocked and damaged catheters, catheter related thrombosis and CRBSI. This paper will also present treatment outcomes for each of these complications. This paper will also examine if there are any correlating patient or catheter related factors that can help predict future catheter related complications. By demonstrating the treatment outcomes for each line complication, it is hoped this will contribute to the literature that could be used for standard setting in complications related to long term central venous access. HPN data were analysed from the Greater Glasgow and Clyde (GGC) Home Parenteral Nutrition Database (HPN) which is a comprehensive, prospectively maintained electronic record of all HPN patients treated in GGC. The time period of data collection was 1998-2017. Descriptive statistics were used to report data frequency, age, and catheter days' distributions. Data were not normally distributed and so non-parametric tests were used. Spearman's Rho correlation was used to measure correlation between two numeric groups. Catheter complications were reported as a rate in count data, meaning that more than one event could be recorded per patient, with 1000 catheter days as the person-time denominator. Poisson means test and Fisher exact tests were used to compare different rates, as complications were treated as count data increasing over variable total time periods. P<0.05 with 95% confidence interval (CI) was considered significant in all tests. Comparisons between binary data sets used two sample t-tests to compare the groups. From 169 patients, 101 (59.8%) were female and 68 (40.2%) were male. The age when first starting HPN ranged from 16 to 79 years old with a median of 56 years. Total catheter days was 173,151 derived from 408 catheter insertions on 169 patients. 282 complications occurred in 85 patients over the study period. An overall catheter complication rate of 1.62/1000 days was found. 84 patients did not experience a single complication. There were 171 proven catheter infections in 66 patients over the study period. Infection rate from the entire period of report was 1.35 infections/1000 catheter days. This decreased over time. Infection was found to be correlated with length of time on HPN, catheter location, catheter diameter and use of Taurolock-Hep100. Thrombosis (n=16) was associated with total time on HPN (r2=0.187, P<0.05) and the number of infections (r2=0.207, P<0.05). Damage was strongly associated with increasing time on HPN with (r2 of 0.494 and P<0.005). Blockage was not associated with any patient or catheter factors. Overall catheter salvage rate for CRBSI by antibiotic treatment was 61.87%. Success varied according to organism cultured. Catheter salvage was less successful in other complications and overall catheter salvage rate was 41,115 catheters were salvaged from 282 complications. This study has provided a baseline for rates of less common venous access complications in HPN and their management. Catheter salvage is possible after at least 41% of complications. It is likely that experience is helpful whether that of individual patient, the team or a clinical network. Our results support the use of smaller central venous catheters, in upper body veins, and the use of Taurolock-Hep100 in patients who have recurrent infections.

Comparison of the effects of laparoscopic catheterization and surgical incision catheterization on catheter-related complications and microinflammation in uremic peritoneal dialysis patients

Objective To compare the effects of laparoscopic and surgical catheterization on catheter-related complications and microinflammation in uremic peritoneal dialysis (PD) patients. Methods According to different catheterization methods, 98 uremic patients who were scheduled to undergo peritoneal dialysis in the First People's Hospital of Jiande from January 2014 to March 2019 were divided into group A (38 cases), group B (60 cases). Laparoscopic catheterization was used in group A, and incision catheterization was used in group B. Surgical parameters, catheter complications, microinflammation and survival rate of early catheterization were observed in the two groups. Results The operation time of group A was (35.00±3.14)min, which was shorter than that of group B [(50.00±5.17)min], and the operation cost of group A was (5 800.0±318.9)CNY, which was higher than that of group B [(3 400.0±297.4)CNY], and the visual analogue score (VAS) of group A was (2.33±0.31)points, which was lower than that of group B [(3.25±0.49)points], there were statistically significant differences between the two groups (t=11.540, 9.317, 10.328, 36.578, all P 0.05). After catheterization, the levels of hs-CRP, IL-6 and TNF-alpha in group B were (12.52±3.75)mg/L, (12.02±3.76)ng/L, (15.92±5.72)ng/L, respectively, which were higher than those in group A [(9.63±2.36)mg/L, (9.11±3.54)ng/L, (13.41±5.61)ng/L] (t=4.244, 4.081, 4.510, all P<0.05). After 2 months of follow-up, the survival rate of dialysis tube technique was 89.47%(34/38) in group A and 71.67%(43/60) in group B, there was statistically significant difference between the two groups (χ2=4.382, P<0.05). Conclusion Application of laparoscopic catheterization in uremic PD patients has satisfactory effect, light pain, fewer complications, mild inflammation and high survival rate of early catheterization technology, which is worthy of clinical promotion. Key words: Uremia; Peritoneal dialysis; Laparoscopy; Catheterization; Postoperative complications; C-reactive protein; Interleukin-6; Tumor necrosis factor-alpha