Central Vein Catheter Research Articles

Ultrasonografi ile Deneyimsiz Ellerde Pediyatrik Santral Ven Kateterizasyonu: Ön Rapor

Ultrasonografi ile Deneyimsiz Ellerde Pediyatrik Santral Ven Kateterizasyonu: Ön Rapor

Safety evaluation of ultrasound location in axillary venipuncture

Objective To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney). Method A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded. Results Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method. Conclusion Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method. Key words: Axillary vein; Central vein catheterization; Ultrasound; Complications; Magney method

Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis.

Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the hemodialysis setting has been the focus of the Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Coalition and, more recently, the CDC's partnership with the American Society of Nephrology's Nephrologists Transforming Dialysis Safety Initiative. The majority of vascular access-associated bloodstream infections occur in patients dialyzing with central vein catheters. The CDC's core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection. However, in the United States hemodialysis catheter-associated bloodstream infections continue to occur at unacceptable rates, possibly because of lapses in adherence to strict aseptic technique, or additional factors not addressed by the CDC's core interventions. There is a clear need for novel prophylactic therapies. This review highlights the recent advances and includes a discussion about the potential limitations and adverse effects associated with each option.

Cubital vein transposition for a distal radiocephalic fistula complicated by outflow obstruction.

Outflow stenosis is a frequent complication of vascular access for hemodialysis. It may cause increased pressure within the angioaccess along with reduced blood flow. Elective treatment is percutaneous transluminal angioplasty; however, when a long occlusion (>2 cm) occurs, success and mid-term patency of endovascular treatment are uncertain. We describe a case series of patients with long occlusion of elbow outflow complicating an otherwise excellent forearm arteriovenous fistula, treated by a bypass across the elbow through cubital vein transposition. Six consecutive patients have been treated between 2015 and 2017; all were referred because of either low flow, increased venous pressure, excessive bleeding time, or recirculation and were examined by duplex ultrasound. A total of 83% of patients showed associated thrombosis within the access. All procedures were performed under loco-regional anesthesia and preventive hemostasis. Surgical thrombectomy was also performed when needed. Immediate success was obtained in all but two patients converted in veno-venous polytetrafluoroethylene bypass. Post-operative blood flow increased from 316 to 878 mL/min. All patients were dialyzed through the forearm access immediately the day after surgery, without the need for central vein catheter. Overall, 75% of patients needed a percutaneous transluminal angioplasty of the veno-venous anastomosis within 6 months. Primary and secondary patency at 12 and 24 months were 25%-0% and 100%-100%, respectively. Outflow reconstruction through the elbow bypass by cubital vein transposition is a valuable resource to rescue radiocephalic arteriovenous fistula complicated by outflow obstruction, avoiding the use of an interim central vein catheter. Endovascular treatment is vital to maintain functional patency in the mid- and long term.

Central venous catheter-associated bloodstream infections in children diagnosed with intestinal failure in Southern Israel.

To study the clinical, epidemiological, and microbiological associations between intestinal failure (IF) and central line-associated infections (CLABSI) in patients with central vein catheters (CVCs) during 2005-2016. We compared retrospectively CLABSI rates according to background disease, type of line access, pathogen distribution, and antibiotic susceptibilities. One hundred and fourteen children (64.1% < 4 years) were enrolled. Main diagnoses were persistent diarrhea (20, 17.5%), short bowel syndrome (13, 11.4%), continuous-TPN w/o diarrhea (11, 9.7%), very early-onset inflammatory bowel disease (VEO-IBD, 8, 7%), Hirschsprung's disease (3, 2.6%), non-oncologic hematologic conditions (13, 11.4%), and other diseases (46, 40.4%). 152.749 catheter days were recorded; 71.1% had Hickman's catheters. Two hundred and nine CLABSI episodes were recorded in 58 patients (82% with IF, 13.7 and 8.2/1000 catheter days in IF, and non-gastrointestinal conditions, P = 0.09). More CLABSI were recorded in continuous TPN vs. VEO-IBD or persistent diarrhea (38.8 vs.15.8 and 12.8/1000 catheter days, P < 0.004). Among patients with Hickman in jugular vein, highest CLBSI incidence was in continuous TPN, VEO-IBD, and persistent diarrhea (29.9, 15.84, and 12.49 episodes/1000 catheter days, respectively). CVCs were removed in 38.8% CLABSI. Two hundred and thirty-five pathogens were isolated (Enterobacteriaceae spp. in 39% of IF patients, mostly in persistent diarrhea and short bowel syndrome patients, 47.6% and 34.8%, respectively). Coagulase-negative Staphylococcus was the commonest pathogen in continuous TPN, VEO-IBD, and Hirschsprung's (71.4%, 55.6% and 46.1%, respectively). CLABSI rates in IF patients were among the highest reported. We reported a "hierarchy" in CLABSI incidence among patients with IF and showed that CLABSI incidence and etiology were different as function of background diseases and CVC insertion site.

Reduced patency in left-sided arteriovenous grafts in a porcine model

ObjectiveThe porcine arteriovenous graft model is commonly used to study hemodialysis vascular access failure, with most studies using a bilateral, paired-site approach in either the neck or femoral vessels. In humans, left- and right-sided central veins have different anatomy and diameters, and left-sided central vein catheters have worse outcomes. We assessed the effect of laterality on arteriovenous prosthetic graft patency and hypothesized that left-sided carotid-jugular arteriovenous prosthetic grafts have reduced patency in the porcine model. MethodsArteriovenous polytetrafluoroethylene grafts were placed ipsilaterally or bilaterally in 10 Yorkshire male pigs from the common carotid artery to the internal jugular vein. Ultrasound measurements of blood flow velocities and diameters were assessed before graft placement. Animals were sacrificed at 1 week, 2 weeks, or 3 weeks. Patency was determined clinically; grafts and perianastomotic vessels were excised and analyzed with histology and immunostaining. ResultsAt baseline, left- and right-sided veins and arteries had similar blood flow velocities. Although internal jugular veins had similar diameters at baseline, left-sided carotid arteries had 11% smaller outer diameters (P = .0354). There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; only 4 of 10 (40%) grafts were patent on the left compared with 7 of 8 (88%) grafts patent on the right (P = .04). Left-sided grafts had increased macrophages at the arterial anastomosis (P = .0007). Left-sided perianastomotic arteries had thicker walls (0.74 vs 0.60 mm; P = .0211) with increased intima-media area (1.14 vs 0.77 mm2; P = .0169) as well as a trend toward 38% smaller luminal diameter (1.6 vs 2.5 mm; P = .0668) and 20% smaller outer diameter (3.0 vs 3.7 mm; P = .0861). Left- and right-sided perianastomotic veins were similar histologically, but left-sided veins had decreased expression of phosphorylated endothelial nitric oxide synthase (P = .0032) and increased numbers of α-actin-positive smooth muscle cells (P = .0022). ConclusionsLeft-sided arteriovenous grafts are associated with reduced short-term patency compared with right-sided grafts in the Yorkshire pig preclinical model of arteriovenous prosthetic grafts. Laterality must be considered in planning and interpreting surgical preclinical models.

Evaluation of the safety and efficacy of the central venous administration of potassium chloride including the measurement of intracardiac potassium concentrations

This study examined the safety and efficacy of the intravenous administration of 20 mEq potassium chloride (KCl) dissolved in a 100 cc 5% dextrose in sterile water bolus over 1 hour through a subclavian central vein catheter in critical care unit patients for the treatment of low and low to normal serum potassium concentrations. We studied seven patients with morning serum potassium between 2.4 and 3.6 mEq/L who had intravenous KCl boluses ordered by their treating physician. Intracardiac and peripheral venous potassium levels were obtained before, during, and after infusion. Holter and electrocardiogram assessment of rhythm, supraventricular and ventricular ectopy, and electrical intervals were recorded before, during, and after the intravenous KCl bolus. The cardiac rhythm, heart rates, and electrocardiographic intervals remained unchanged throughout the infusion and postinfusion phases. In six of the seven patients, there was no new or worsening supraventricular or ventricular ectopy temporally related to the infusion. Postinfusion potassium levels increased in all patients, with an average peripheral vein serum potassium increase of 0.4 mEq/L. In conclusion, within the limitations of our sample size, our study demonstrated the safety and efficacy of the central venous infusion of 20 mEq KCl in 100 cc 5% dextrose in sterile water administered over 1 hour.

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients

Purpose To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05). Conclusions The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC. Keywords: Catheterization; peripheral; Central venous catheters; Catheter related infections; Trauma centers

Single needle hemodialysis: is the past the future?

Whereas the usual way to gain access to the vascular bed for hemodialysis is by inserting two needles, an alternative option based on the introduction of only one needle has been available for several decades. Although single needle hemodialysis gradually lost popularity in the early nineties of last century, this option now seems to make a come-back, with the current change in patient mix towards more elderly and cardio-vascular disease and the appearance of more flexible hardware. Single needle hemodialysis offers several advantages, such as the possibility to puncture small or maturing access systems, a decrease in number of punctures with less potential access damage and subsequent complications, the avoidance of central vein catheter use, and an improved quality of life by reducing puncture-related pain, stress and complications. The main drawback is recirculation which however can be overcome (if considered necessary) by making dialysis somewhat longer and in addition has more impact on removal of small water soluble compounds than on clearance of the more toxic difficult to remove solutes (middle molecules and protein bound compounds). Effective dialyzer blood flow with single needle dialysis cannot be much higher than 300mL/min, which however also offers advantages by making short dialysis sessions less feasible and thus reducing the likelihood of intradialytic blood pressure falls, organ stunning and other negative outcomes of shorter dialysis. Direct outcome comparisons between single and double needle dialysis are not available but indirect data suggest no differences, in as far as efficient enough access perfusion can keep dialyzer blood flow adequate. The single needle method seems especially suited for the elderly and for home hemodialysis. Recent technological improvements have made the system more accessible and adequate, but further studies are needed to assess with modern methodologies the clearance kinetics of these systems, which could emanate in further technological fine-tuning.

Clinical Outcomes and Economic Impact of Starting Hemodialysis with a Catheter after Predialysis Arteriovenous Fistula Creation

Background: Patients with advanced chronic kidney disease frequently undergo arteriovenous fistula creation prior to reaching end-stage renal disease (ESRD), but some initiate hemodialysis with a central vein catheter, if their fistula is not yet usable. The clinical consequences of the delay in fistula use have not been quantified in such patients. We compared patients with pre-ESRD fistula surgery who initiated dialysis with a catheter versus a fistula in terms of the frequency of post-dialysis vascular access procedures and complications and their economic impact. Methods: We identified 205 patients with predialysis fistula creation from 2006 to 2012 at a large dialysis center who started hemodialysis within the ensuing 2 years. Of these, 91 (44%) initiated dialysis with a catheter and 114 (56%) with a fistula. We compared these 2 groups in terms of their annual frequency of percutaneous vascular access procedures, surgical access procedures, total access procedures, hospitalizations due to catheter-related bacteremia, and overall cost of vascular access management. Results: The 2 groups were similar in demographics, comorbidities, and fistula type. As compared to patients initiating dialysis with a fistula, those initiating with a catheter had a significantly greater annual frequency of percutaneous access procedures (1.29 [1.19–1.40] vs. 0.75 [0.68–0.82]), surgical access procedures (0.69 [0.61–0.76] vs. 0.59 [0.53–0.66]), total access procedures (1.98 [1.86–2.11] vs. 1.34 [1.26–1.44]), and hospitalizations due to catheter-related bacteremia (0.09 [0.07–0.12] vs. 0.02 [0.01–0.03]). Patients initiating dialysis with a catheter incurred a median overall annual cost of access management that was USD 2,669 higher (USD 6,372 [3,121–12,242) vs. USD 3,703 [1,867–6,953], p = 0.0001). Conclusion: Among patients with predialysis fistula creation, those initiating dialysis with a catheter versus a fistula had substantially more frequent percutaneous, surgical, and total vascular access procedures, as well as hospitalizations due to catheter-related bacteremia. The annual cost of access management was substantially higher in those initiating dialysis with a catheter.

Febrile Neutropenia in the Emergency Department: Improving Timely Antibiotic Administration - A Quality Improvement Initiative

Background An indwelling port and central vein catheter is commonly placed in children with cancer undergoing chemotherapy. These children often present to the ED with febrile neutropenia due to chemotherapy-induced immunosuppression. It has been demonstrated that antibiotic administration in <60 minutes reduces mortality in patients with septic shock.2 Administration of antibiotics within <60 minutes of arrival is a quality-of-care measure for pediatric oncology patients with febrile neutropenia in the ED.1 In our ED, we initiated a QI project to determine barriers to timely administration and to improve time-to-antibiotics in this population to within the quality-of-care benchmark over 1 year. Methods …

Ultrasonographic guidance should be the first option during central vein catheterization.

Ultrasonographic guidance should be the first option during central vein catheterization.

The effect of applying normal saline as sealing solution for umbilical venous catheter in VLBW premature infant

Objective To explore the effect of applying normal saline as sealing solution for umbilical venous catheter in very low birth weight (VLBW) premature infant. Methods Premature infants with VLBW were selected for umbilical vein catheterization, including 76 cases with central umbilical vein catheterization (UICC), 26 cases with simple umbilical vein catheterization (UVC), and 51 cases with central peripheral vein catheterization (PICC). All children were sealed with positive pressure pulse of 0.9% normal saline after infusion.The rate of catheter patency, incidence of thrombosis, infection rate, unplanned extubation rate and blood return rate within 7 days were observed. Results Catheter patency rate of UICC group、UVC group and PICC group was 100%, 96.15%、98.04%, thrombus incidence was 2.63%, 3.85%, 1.96%, infection rate was 3.95%, 0%, 3.92%, unplanned extubation rate was 10.53%, 38.46%, 7.84%, and blood return rate within 7 days was 61.84%, 3.85%, 88.24%.There was no statistical difference in the rate of catheter patency, thrombosis and infection rate among the three groups.There was no statistically significant difference in unplanned extubation rate between the UICC group and the PICC group, and there was statistically significant difference in blood return rate within 7 days (P<0.001). Conclusions As a catheter entrapment and sealing solution for very low birth weight premature infants, 0.9%normal saline can effectively maintain the pipeline patency and prevent catheter-related complications, especially in the UICC, which is more in line with the physiological characteristics of very low birth weight premature infants, and is worthy of clinical application. Key words: Premature infant; VLBWI; Umbilical vein; Central vein; Sealing solution; 0.9% normal saline

Endovascular Intervention with a Mobile C-Arm in the Operating Room.

Mobile C-arm fluoroscopic X-ray systems are used for various diagnostic imaging and minimally invasive endovascular procedures. One of the greatest advantages of a mobile C-arm is its ability to move around the patient. The purpose of this study was to address the optimal setting of the mobile C-arm and the operating table, as well as the proper position of the operator and assistants for each procedure. In addition, methods to minimize radiation exposure to the operator and medical staff are described. Both the optimal setting and the proper position were classified by 5 types. These include the setting for aortic and inferior vena caval procedures (type I); left lower extremity (LE) intervention with an up-and-over technique (type II); right LE intervention with up-and-over technique, or bilateral LE vascular intervention with antegrade access (type III); arteriovenous fistula/graft intervention (type IV); and central vein catheterization (type V).

Whole body ultrasound in the operating room and intensive care unit.

Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.

PS1590 CENTRAL VEIN CATHETERIZATION IN ONCOHEMATOLOGICAL PRACTICE: RISK OF COMPLICATIONS

Background:The insertion of the central venous catheter (CVC) is a vascular access method used in resuscitation and oncohematology and it is required during intensive infusion and chemotherapy. However, due to the invasiveness of the procedure, complications are possible due to the procedure and course of the underlying disease.Aims:Assess the frequency of complications related to central vein catheterization in patients with hematology malignancies (HM).Methods:We have analyzed 2506 cases of CVC performed to patients with HM for the period from 2003 to 2018. All patients underwent catheterization of the right (82%), left (17.6%) subclavian vein or v. Jugularis externa (0.4%). Bacteriology tests were performed if a catheter‐related infection was suspected (n = 353).Results:Out of 2506 catheterizations bloodstream infections in the form of sepsis or bacteremia were documented in 2.5% of patients (n = 63), phlebitis, thrombophlebitis and infiltrate at CVC area were revealed in 2.6% (n = 66), lymphorrhea – in 1.3% (n = 33), catheter bleeding – in 3.9% (n = 73), haematoma – in 4.3% (n = 109), artery puncture (a. Subclavia dextra or sinistra) – in 3.0% (n = 76), pain, numbness, paresthesia of the upper limb – in 1.6% (n = 41), weakness, collapse – in 1.1% (n = 27), pneumothorax – in 0.2% of patients(n = 4). Positive bacterial cultures from venous blood were detected in 63 patients, with mixed infection in 8 cases (2 or 3 microorganisms). Detailed analysis of the infectious pathogens have demonstrated the prevalence of coagulase‐negative staphylococcus (Staph. epidermidis) – 56.3% (n = 40), At the same time, a relatively large percentage was represented by Staphylococcus aureus – 5.7% (n = 4), Micrococcus spp. – 1.4% (n = 1), Enterococcus spp. – 1.4% (n = 1). Gram‐negative microorganisms were detected in 26.7% (n = 19) of cases: Escherichia coli – 14.1% (n = 10) patients, Enterobacter spp. – 5.6% (n = 4), Enterobacter aerogenes – 1.4% (n = 1), Acinetobacter spp. – 1.4% (n = 1), Pseudomonas aeruginosa – 1.4% (n = 1), Neisseria spp. – 2.8% (n = 2). Causative agents of fungal infections were found for 8.5% of patients (n = 6), including fungi of the genus Candida – 7.1% (C. albicans (n = 4), C. crusei (n = 1), Rhodotorula spp. – 1.4% (n = 1).Summary/Conclusion:In patients with HM among catheter‐associated infections, coagulase‐negative staphylococcal infection (Staph. epidermidis) is most prevalent, which is most likely due to contact route of infection.

Duration and frequency of catheterization in central vein stenosis: A case control study

Background. Central vein catheterization (CVC) is a major risk factor for central vein stenosis (CVS). Repetitive contacts of the CVC to the blood vessel wall results in inflammation, microthrombi, hyperplasia of the intima, fibrosis and thus development of CVS. This article reports the correlation of duration and frequency of CVC in patients with CVS. Method. A matched case control study was conducted in Cipto Mangunkusumo Hospital. Samples were gathered from the medical record. Multivariate statistical comparisons were done using Chi-square tests. Results. Fifty four out of 717 patients underwent CVC for HD had CVS. 32 patients with CVS included in the study with 128 non-CVS patients included as control. Duration of CVC >6 weeks does not increase the risk of CVS (p= 0.207), whilst the odds ratio of CVS on the frequency of CVC >2 times is 30 times compared to those underwent 2 times increased the risk of CVS. Longer duration of CVC for HD did not increase CVS rate. Keywords: Catheter, central vein, hemodialysis, stenosis

ANESTEZIOLOGINĖ DARBO ZONA OPERACINĖJE – INFEKCIJŲ PREVENCIJOS REKOMENDACIJOS

2019 m. Amerikos sveikatos priežiūros epidemiologijos draugija (SHEA) kartu su Amerikos anesteziologų draugija (ASA), Anestezijos ligonių saugos fondu (APSF) ir Amerikos slaugytojų anesteziologų asociacija (AANA) publikavo infekcijų prevencijos operacinėje rekomendacijas anesteziologinėje darbo zonoje. Siekiant palaikyti optimalią infekcijų kontrolę svarbu gerinti rankų higieną: rekomenduoti minimalūs rankų higienos reikalavimai, antiseptiko dozatorių lokalizacijos, pirštinių mūvėjimas intubacijos metu. Taip pat išskirti pagrindiniai aplinkos dezinfekcijos reikalavimai, tokie kaip laringoskopų, anestezijos aparatų, vežimėlio priežiūra tarp operacijų, sterilumo priemonių laikymasis centrinės venos kateterizacijos metu ir kiti. Infekcijų prevencijos gerinimui rekomenduojama nuolat tobulinti higienos planus bei suteikti galimybę praktikams naudotis standartais.

The Polish Prevalence of Infection in Intensive Care (PPIC): A one-day point prevalence multicenter study.

Infections in critically ill patients are the main reasons for a lack of therapeutic success and increased mortality in intensive care units (ICUs). There have been many analyses of the incidence of infections in ICUs; however, no large studies of this kind have been conducted either in Poland or in Eastern and Central Europe. The aim of the research was to undertake a one-day study of the prevalence of infections in ICUs in Warszawa and the Mazovian region of Poland. A prospective questionnaire survey analysis - a one-day prevalence study of infections - was carried out on June 25, 2014, in 28 ICUs in Poland. Among 205 ICU patients (193 adults and 12 children), 134 infections were found in 101 patients (99/193 adults (51.30%) and 2/12 children (16.70%)), and bacterial colonization in 19/205 (9.3%) patients. In 66.42% of the cases, more than 1 site of infection was diagnosed. On the day of the study, 75.40% of the diagnosed infections had positive microbiological results. The most frequent were respiratory tract infections (53.73%), wound infections (18.65%) and bloodstream infections (14.92%). Most of the infections (64.10%) were caused by Gram-negative bacteria (GN), followed by Gram-positive bacteria (GP; 31.80%) and fungi (4.10%). The most frequently reported GN microorganisms were Enterobacteriaceae (44.7%). Methicillin-resistant Staphylococcus aureus (MRSA) infections were found in 8.80% of the patients. Antibiotics were administered to 75.60% of the adult patients, in 69.20% as targeted treatment. Mechanical ventilation, central vein catheterization and urinary bladder catheterization were used in 67.80%, 85.85% and 94.63% of the patients, respectively. On the day of the study, more than half of the patients had infections, mostly from GN bacteria. Respiratory tract infections were the main type found. In about 2/3 of the patients, antibiotics were administered, mainly as targeted therapy.

Optimal proportion between peripherally inserted central catheter vein and catheter among hematologic tumor patients

Objective To explore the proportion between peripherally inserted central catheter (PICC) vein and catheter on hemorrhage and plugging among hematologic tumor patients. Methods From February 2016 to February 2018, we selected 105 patients of department of hematology in Wuxi Second People's Hospital of Nanjing Medical University as subjects. Before PICC, vein diameter was measured with the portable color doppler ultrasound system to obtain the proportion between catheterization vein and catheter diameter. Among 105 PICC catheterization cases of hematologic tumor patients, proportions between catheterization vein and catheter diameter were divided into three groups including 3, 35 cases in each group. We observed the incidences of hemorrhage and plugging at different proportions of catheterization. Results There was no statistical difference in the amount of bleeding of hematologic tumor patients among three groups after catheter (P>0.05) . There was a statistical difference in the incidence of plugging (P<0.05) . Conclusions The incidence of hemorrhage and plugging of hematologic tumor patients after PICC cannot be ignored. The proportion between catheterization vein and catheter diameter has no obvious effect on hemorrhage after catheter, but it can affect the incidence of catheter plugging. Therefore, we should apply visual assessment instrument to exactly measure the internal diameter of vein and select appropriate catheter to reduce the complications after catheterization. Key words: Hematologic neoplasms; Hemorrhage; PICC; Proportion between vein and catheter; Catheter obstruction