Catheter Removal Research Articles

Stensen's Duct Dynamic Anatomy Assessed with Sialography.

Objectives: The presence of a catheter required for contrast infusion during sialography obscures imaging of the distal duct. Static imaging via cone beam computed tomography and magnetic resonance sialography fails to address changes that occur dynamically to the anatomy of the flexible salivary ductal system. We aim to identify dynamic changes to the parotid gland by introducing a novel approach to analyze the full extent of Stensen's duct based on dynamic infusion digital sialography. Methods: Retrospective chart review of a single-center consecutive series of 409 parotid sialograms performed between April 2008 and June 2023 permitted selection of a contemporary series including seven normal sialograms and seven sialograms with stricture(s). Dynamic (fluoroscopic) infusion (iopamidol/gadolinium) sialograms were assessed through blinded review by two radiologists employing the institution's picture archiving and communication (PACS) system (©2023 Koninklijke Philips N.V., Amsterdam, Netherlands). Measurements determined changes, in two dimensions, to the angle of the masseteric bend and duct length while the catheter was in place (repose), during catheter withdrawal (stretch), and during recoil after withdrawal. Differences in median lengths and angles of Stensen's duct between the three time points were compared using Wilcoxon matched-pairs signed rank and Mann-Whitney tests. Results: Fourteen patients [median age (IQR), 55 years (24.7); 10 women] were evaluated. The median angle of the masseteric bend was 117.7° in repose versus 155.4° during catheter withdrawal (P < .001, n = 14). The median distance measured from the Stensen's duct orifice to the first major ductal bifurcation was 81.5 mm (IQR = 12.3) in repose. The median percent increase in length from repose to stretch was 6.3% (P < .001, n = 14). Conclusions: Dynamic infusion digital sialography with fluoroscopic recording during catheter removal permits assessment of the distal duct unobstructed by the presence of a catheter. The technique also identifies the dynamic nature and varying length and angulation of Stensen's duct.

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

Male Foley Catheter Placement and Removal for Surgery

Male Foley Catheter Placement and Removal for Surgery

Surgical removal of a knotted Swan-Ganz catheter inadvertently placed in the common carotid artery

A Swan-Ganz catheter is an intravenous device used for the invasive measurement of pulmonary capillary wedge pressure and other cardiovascular measurements often utilized in major surgical procedures and critical care units. Several device-related complications were reported in literature - arterial puncture, pneumothorax, inadvertent arterial catheter insertion due to non-ultrasound-guided placement, and formation of knots. This paper presents a case of inadvertent left carotid artery insertion of a Swan-Ganz catheter, complicated by a knot formation requiring surgical intervention to successfully remove the catheter.

Checking vesicourethral anastomosis for urinary extravasation during radical prostatectomy: is it still necessary in the robotic era? A prospective, randomized case-control study

PurposeThis study aims to evaluate the role of intraoperative control of the watertightness of vesicourethral anastomosis extravasation control (VUAEC) in predicting vesicourethral anastomosis (VUA) healing and early postoperative outcomes in patients undergoing robot-assisted radical prostatectomy (RARP).Methods100 patients who underwent RARP between October 2020 and May 2023 were consecutively included in the study. Preoperatively, the patients were randomized to undergo VUAEC (Group-A) or not (Group-B). Patients in Group-A were evaluated in 2 subgroups: those with no extravasation observed during VUAEC (Group-A1; n = 31 (62%)) and those with extravasation (Group-A2; n = 19 (38%)). On the 8th post-operative day, a gravity cystogram (GC) was performed on all patients to assess VUA healing.ResultsThere was no statistically significant difference between the groups in terms of clinical features, drain removal time, length of hospital stay, extravasation on GC, catheter removal time and postoperative complications (p > 0.05, for each). There was also no statistically significant difference between the subgroups in terms of drain removal time, length of hospital stays, catheter removal time (p > 0.05, for each). In Group-A2, urinary extravasation on GC was found in a greater percentage, but the difference remained statistically insignificant (p = 0.082).ConclusionsPerforming intraoperative VUAEC did not have a significant role in the prediction of VUA healing and early postoperative outcomes in patients undergoing RARP. The current study did not identify a substantial clinical benefit of routine intraoperative VUAEC.

Clinical Features of Candida Catheter-related Bloodstream Infections and Persistent Infections Associated with Early Catheter Reinsertion: A 6-year Retrospective Study

Abstract Introduction: Catheter-related persistent Candida infections (CRPCI) may develop after Candida catheter-related bloodstream infections (CRBSI) due to colonization of the newly inserted catheter. However, the optimal timing for new catheter insertion remains controversial. The aim of this study was to determine the clinical features of CRBSI due to Candida species and CRPCI. This was a retrospective study conducted in a teaching hospital in Japan. Methods: We retrospectively collected clinical information on hospitalized patients diagnosed with Candida CRBSIs by catheter tip culture from 2015 to 2020. CRPCI was defined as the growth of the same Candida species from the tip culture of a newly inserted catheter after the onset of a Candida CRBSI. The Chi-squared and Fisher’s exact tests were used to compare differences between the case and control groups. Results: Sixty-three cases of Candida CRBSI were collected. Fifty-four (85.7%) received total parenteral nutrition. CRPCI developed in 12 (48%) patients of the 25 in whom cultures of newly inserted catheters were performed. Despite antifungal therapy in these patients, persistent fungemia incidence was significantly higher (50.0% vs. 9.1%, odds ratio = 10.0, P = 0.033). The mean number of days from removal of infected catheter to reinsertion was significantly shorter for patients with CRPCI (0.27 days vs. 3.08 days, P = 0.038). Conclusions: Total parenteral nutrition may be a major risk factor in the development of Candida CRBSI. CRPCI often leads to persistent fungemia. Early insertion of a new catheter after removal of an infected catheter may be a risk factor for CRPCI.

Peritoneal dialysis-associated peritonitis caused by Tsukamurella inchonensis: a case report and literature review

BackgroundPeritoneal dialysis (PD)-associated peritonitis is a serious complication that can lead to PD discontinuation and mortality. Tsukamurella species are uncommon opportunistic pathogens that can cause peritonitis, often necessitating catheter removal.Case presentationA 46-year-old woman with a 1.5-year history of PD presented with fever and lower abdominal pain, along with cloudy peritoneal effluent showing an elevated cell count. Empiric antibiotic therapy with ciprofloxacin, cefazolin, and ceftazidime was started for PD-associated peritonitis. The peritoneal effluent culture yielded a gram-positive rod with weak acid-fast staining. A rebound in the cell count necessitated a switch of antibiotics to meropenem and vancomycin. This led to improvement, and the treatment was switched to oral levofloxacin on day 30 and the patient was discharged on day 35. Subsequently, 16S rRNA gene sequencing confirmed the isolate as Tsukamurella inchonensis.ConclusionThis case highlights the challenges in identifying and treating Tsukamurella peritonitis. Successful treatment without catheter removal in this case suggests that early detection and appropriate antibiotics may enable catheter salvage in this rare infection. However, further research is needed to establish optimal treatment strategies.

Uncommon threads: pneumopericardium complexity following liver catheter removal in pancreatic cancer

Pneumopericardium, the presence of air within the pericardial sac, is a rare but critical condition that can lead to severe complications such as tension pneumopericardium and cardiac tamponade, causing hemodynamic instability and necessitating immediate intervention. Various etiologies include congenital defects, post-surgical complications, infections, and trauma. Malignancies, such as advanced esophageal cancer or lung carcinoma, can also cause pneumopericardium via fistula formation. Multimodal imaging, including chest X-ray, echocardiography, and computed tomography (CT), is essential for diagnosis. This case report discusses a 65-year-old male with advanced pancreatic adenocarcinoma who developed pneumopericardium following the removal of a left lobe liver drainage catheter. Initial CT imaging revealed liver lesions suspicious for metastatic disease or abscess, leading to drainage procedures. Following the removal of the drainage tube, the patient experienced respiratory distress and hypotension, and computed tomography pulmonary angiogram (CTPA) revealed pneumopericardium, likely due to a fistula formed between the abscess and pericardium. Despite no echocardiographic signs of tamponade, the patient’s persistent hypotension warranted CT-guided pericardiocentesis, resulting in gradual blood pressure improvement. This case highlights the intricate interplay between malignancy, infection, and procedural complications in developing pneumopericardium. It emphasizes the need for a multidisciplinary approach and the importance of considering both the quantity and rate of air accumulation when assessing the risk of hemodynamic compromise. The patient’s hemodynamic instability and subsequent improvement following pericardiocentesis underscore the critical role of timely intervention in managing this condition.

Nurse-Driven Process for the Successful Removal of Urinary Catheters Among Elderly Patients After Hip Fracture Surgery: A Quality Improvement Project.

Hip fracture is a major health concern and the use of an indwelling urinary catheter (IUC) constitutes a significant burden on elderly patients undergoing hip fracture surgery. The institution had a high rate of urinary tract infection (UTI) and IUC reinsertion after hip fracture surgery. A pre/post-implementation design was used for this quality improvement initiative. A nurse-driven process was developed and implemented to improve the successful removal of IUC among patients after hip fracture surgery. There was a significant reduction in post-operative urinary retention (P =.042), UTI rate (P =.047), and IUC reinsertion (P =.042) in the post-implementation group. IUC duration decreased by 1.1days, however this was not significant (P =.206). Nurse compliance with following the new process was 93.3%. The nurse-driven process designed for elderly patients following hip fracture surgery presents a promising approach to reducing IUC reinsertion rates and UTI.

A qualitative approach on long-term indwelling catheter use in an outpatient setting.

A long-term indwelling catheter may be indicated in clinical situations, such as chronic diseases of the genitourinary or neurological systems. In addition to the risks of infection, trauma, and bleeding, a catheter's permanence can affect psycho-emotional and socioeconomic dimensions. We aimed to understand how the need to use a long-term indwelling catheter affects this patient's self-perception, interrelationships, and self-care. We carried out a qualitative, descriptive study based on interviews with 17 patients, and applied thematic analysis and complex thinking. The different prognoses and expectations regarding the catheter influenced self-perception, adaptation, acceptance, or denial. The presence of a catheter, whether as a curative measure or for comfort, can affect self-image and sexuality, and generate insecurities and uncertainties, which require understanding the multidimensionality of situations that suffer interference from the personal, family, and social environment, as well as health systems' capacity to deal with it. Despite the challenges, the majority of participants reported a favorable disposition towards self-care, whether to enable catheter removal or to prevent injuries in lifelong indications.

To Hold or Continue Blood Thinners? A Retrospective Analysis on Outcomes of Holmium Laser Enucleation of the Prostate in Patients Who Either Held or Continued Antiplatelet/Anticoagulation Therapy

ObjectivesTo compare the outcomes between those who held or continued APAC (antiplatelet or anticoagulation therapy) for HoLEP (holmium laser enucleation of the prostate). MethodsWe retrospectively reviewed patients on APAC who underwent HoLEP between January 2021 and August 2023 by a single surgeon at a high-volume center. APAC was further categorized to the specific medication: clopidogrel, apixaban, warfarin, rivaroxaban. Preoperative, intraoperative, and postoperative characteristics and outcomes were then compared. SPSS was used for statistical analysis with significance defined as p<0.05. Results139 patients were on APAC, of which 82 held and 57 continued APAC: 38 on clopidogrel (21 held), 20 on warfarin (11 held), 57 on apixaban (34 held), 24 on rivaroxaban (16 held). Overall, there were no significant differences between those who held versus those who continued APAC. On sub-analysis, controlling for age and prostate size, patients who held clopidogrel had shorter length of stays (11.3hr vs 27.3hr, p=0.016), higher likelihood for same-day catheter removal (90.5% vs 47.1%, p=0.002) and same-day discharge (90.5% vs 35.3%, p=0.002). Patients who held warfarin had shorter procedure (61.3 min vs 92.2min, p = 0.025) and morcellation time (7.36min v 18min, p=0.048). ConclusionsHoLEP is safe and efficacious in patients whether APAC is held or continued through surgery. Holding APAC in those on clopidogrel may decrease length of stay and improve rates of same-day foley removal and discharge. Patients who held warfarin had shorter morcellation and procedure times.

Trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy: A case series.

To detail a novel technique of robotic-assisted simple prostatectomy that makes handling the gland protruding into the bladder neck easier and can preserve the urethra and retain ejaculation function as much as possible. This is a prospective case series. Clinical data of 17 male patients who had large volume (>80 mL) benign prostatic hyperplasia (BPH) were enrolled to undergo trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy (usRASP). We adopted the approach through the space between the bladder neck and seminal vesicle to perform a usRASP that can avoid the detrusor skirt and fibrous matrix area of the retropubic prostate. Between the transitional zone and the peripheral zone of the large prostate, the hyperplastic prostatic gland tissue can be enucleated under direct vision while preserving the prostatic urethra and retaining the ejaculatory duct and bladder neck intact. All preoperative, perioperative and postoperative clinical data were collected, and descriptive analysis was performed. The median intravesical prostatic protrusion was 19.3 mm (8.5-32.2). The median operative time was 100 min (75-140), and the median estimated blood loss was 100 mL (10-500). The median time to catheter removal was 7 days (5-7), with a median postoperative hospital stay of 2 days (2-4). After at least 6-month follow-up, the median maximum urine flow rate and postvoid residual volume were 40.1 mL/s (12.7-52.4) and 15 mL (5-23), respectively; the median International Prostate Symptom Score and Quality of Life score were 0 (0-6.3) and 1 (0-3), respectively; and the median total prostate-specific antigen was 0.84 ng/mL (0.15-1.01). All patients successfully underwent usRASP. Fifty-eight percent of patients with normal ejaculation function before surgery can still retain normal ejaculation function. We described a new approach to performing usRASP. This new method remarkably improved the voiding function, maintained antegrade ejaculation and did not increase the post-operative complications.

Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation

BackgroundExtremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications.MethodsWe performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding.ResultsThe KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants.ConclusionKangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.

Study on the recovery of bladder function in patients with cervical cancer after operation by portable ultrasound combined.

Postoperative urination dysfunction is a common complication after surgery in patients with cervical cancer. Portable bladder ultrasound are commonly utilized in clinical practice for measuring residual urine volume. This study aimed to the effect of bladder function training combined with portable ultrasound monitoring on bladder function recovery in patients with cervical cancer after training. A total of 40 postoperative patients with cervical cancer were randomly divided into a control group (A) and an experimental group (B) of 20 cases each. Group A was given routine postoperative care, while group B was given bladder function training. Urgent urine bladder volume were taken twice daily after removal of the urinary catheter and monitored for five consecutive days. The difference of urgent urine bladder volume and bladder filling rate were compared by t-test and chi-square test respectively. The 36-item Short Form Health Survey (SF-36) was used to evaluate the quality of life of patients before and after intervention, and compared by Mann-Whitney U test. There was no significant difference in preoperative urgent urine volume between the two groups. After catheter removal, the bladder volume of patients in the B increased, while the bladder volume of patients in the A increased less and fluctuated greatly. The bladder filling rate in the A was significantly lower than that in the B (5/15 vs 17/18, p < 0.05). After intervention, the quality of life of the experimental group was better than that of the control group, including scores of general health, mental health, vitality, and physical role (p < 0.05). Postoperative cervical cancer patients trained to hold urine by portable ultrasound monitoring are able to recover bladder function.

Different modes of ankle pump exercise to prevent PICC-related thrombosis through femoral vein.

To explore the preventive effect of different modes of ankle pump exercise on femoral vein PICC catheter-related thrombosis. Convenient sampling method was used to select 172 patients with lung cancer with PICC catheterization through femoral vein admitted to West China Hospital of Sichuan University as the observation group and control group. Comfort angle ankle pump exercise mode and maximum angle ankle pump exercise mode were adopted. We have compared the differences in the incidence of catheter-related thrombosis, unplanned catheter removal, fatigue score, and catheter retention time between two groups of patients. The incidence of catheter-related thrombosis, unplanned catheter removal, fatigue score, and catheter retention time were statistically significant (p < .05) in both groups of patients. The maximum angle ankle pump exercise mode can reduce the incidence of catheter-related thrombosis and unplanned catheter removal in patients with lung cancer with PICC catheterization through femoral vein, increase catheter retention time, but it can easily cause patient fatigue. In clinical practice, patient tolerance should be considered.

Transperineal Laser Ablation for Focal Therapy of Localized Prostate Cancer: 12-Month Follow-up Outcomes from a Single Prospective Cohort Study.

To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson's Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.

Comparison of early and late removal of the urinary catheter after rectal cancer surgery

Comparison of early and late removal of the urinary catheter after rectal cancer surgery

Practical techniques for safely removing long-term implanted ventricular catheters to minimize bleeding.

Removing ventricular catheters, particularly those implanted for extended periods, poses significant challenges for neurosurgeons due to potential complications such as bleeding from adhesions to the ependyma or choroid plexus. This study aimed to review various techniques for safely removing ventricular catheters, emphasizing methods that minimize the risk of hemorrhagic complications. A comprehensive narrative review focused on techniques developed and documented in the literature for safely detaching ventricular catheters adhered to brain structures. Various techniques have been identified that enhance the safety of catheter removal. Notably, the use of monopolar diathermy to coagulate and release adhesions has proven effective. Innovations such as insulated suction devices and the strategic use of flexible endoscopes have also contributed to safer removal procedures, minimizing the risk of damaging surrounding cerebral tissue and preventing catastrophic hemorrhage. The removal of ventricular catheters, especially those with long-term implantation, requires precise and cautious techniques to avoid severe complications. The study underscores the importance of adopting advanced surgical techniques and the continuous evolution of safer practices in neurosurgery. These methods not only ensure patient safety but also facilitate the handling of potentially complex and life-threatening situations during catheter removal.

Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study.

This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan. A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion. Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20-40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day 1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis. This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended.

Which individual components of a colorectal surgery enhanced recovery program are associated with improved surgical outcomes?

BackgroundEnhanced recovery programs improve surgical outcomes. However, the association of adherence to individual components and outcomes in a comprehensive enhanced recovery program remains unclear. MethodsWe performed a retrospective study of all elective colorectal surgery patients at our institution from 2019 to 2022 (n = 1,175). Data were acquired from our institution’s enhanced recovery program dashboard and American College of Surgeons National Surgical Quality Improvement Program database. Traditional analyses and machine-learning classification trees were used to identify enhanced recovery program components associated with length of stay, readmissions, and complication rates. ResultsThe average length of stay was 5.0 days, readmission rate was 12.3%, and complication rate was 32.6%. On linear regression analysis, adherence to preoperative education, regional analgesia, pre- and postoperative multimodal analgesia, no nasogastric tube, early mobilization, early regular diet, early discontinuation of maintenance intravenous fluids, postoperative venous thromboembolism prophylaxis, and early Foley catheter removal were associated with an decrease in length of stay by 0.7–7.1 days (P < .05). Patients who adhered to no prolonged fasting had a 4.1% decrease in readmission rate (P = .04). Patients who adhered to no nasogastric tube, early mobilization, early regular diet, postoperative multimodal analgesia, and discontinuation of maintenance intravenous fluids had decreases in complication rates ranging from 7.0 to 28.2% (P < .001). Machine learning demonstrated that no nasogastric tube and discontinuation of maintenance intravenous fluids were significant predictors of shorter length of stay and no nasogastric tube and early mobilization were significant predictors of reduced complication rates. ConclusionsAlthough multiple components were associated outcomes, no nasogastric tube, early mobilization, early regular diet, postoperative multimodal analgesia, and early discontinuation of maintenance intravenous fluids were associated with more than 1 outcome. Focusing on these components may make enhanced recovery program implementation more feasible for resource-limited hospitals.