Central Line Research Articles

Preventive effect of probiotics on infections following colorectal cancer surgery: An umbrella meta-analysis

BACKGROUND Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer (CRC) surgery. While probiotics have been proposed as a potential strategy to mitigate the risk of these infections, contemporary meta-analyses have produced conflicting findings. AIM To synthesize the available evidence regarding the prophylactic efficacy of probiotics in preventing infections following CRC surgery. METHODS A comprehensive search of PubMed and Scopus was conducted to identify relevant meta-analyses published up to February 2024. To assess the efficacy of probiotics on outcomes, relative risks (RR) and their corresponding 95%CI were pooled using a random effects model. RESULTS This comprehensive umbrella meta-analysis integrated eleven meta-analyses encompassing 11518 participants who fulfilled the inclusion criteria. Probiotics administration resulted in a statistically significant reduction in the incidence of total infections (RR: 0.40, 95%CI: 0.31-0.51; moderate certainty), surgical site infections (RR: 0.56, 95%CI: 0.49-0.63; high certainty), pneumonia (RR: 0.38, 95%CI: 0.30-0.48; high certainty), urinary tract infections (RR: 0.44, 95%CI: 0.31-0.61; moderate certainty), bacteremia (RR: 0.41, 95%CI: 0.30-0.56; high certainty), and sepsis (RR: 0.35, 95%CI: 0.25-0.44; high certainty). However, probiotics did not significantly affect intra-abdominal, central line, or peritoneal infections. CONCLUSION Probiotics have demonstrated potential in mitigating postoperative infectious complications among patients undergoing CRC surgery.

T-Bar Angular Offset: A Novel Angle for Predicting Postoperative Coronal Balance Using Intraoperative Stitched Radiographs

BACKGROUND AND OBJECTIVES: Accurate intraoperative assessment of coronal alignment is critical to achieving favorable clinical outcomes in adult spinal deformity surgery. However, surgical positioning creates challenges in predicting standing coronal alignment. Gravity-based plumblines require an upright posture and are not possible intraoperatively. Intraoperative stitched radiography (ISR) is increasingly being used to evaluate coronal balance as an alternative to 36-inch films, which can be cumbersome. However, ISR does not allow for the measurement of absolute distances, which limits the intraoperative assessment of the coronal plane. We propose a novel angle to assess coronal balance on ISR: the T-bar angular offset (TAO). We evaluate TAO as a measure of coronal balance and assess the degree to which TAO measured on ISR can predict postoperative coronal balance. METHODS: Patients undergoing spinal fusion surgery with ISR were identified retrospectively. A virtual T-bar was created by drawing a line bisecting the S1 endplate perpendicular to a line connecting the acetabula. A second line was drawn from the origin of the first to the midpoint of the superior endplate of the upper instrumented vertebra (UIV) or C7. The angles subtended by these lines were defined as the UIV TAO and C7 TAO, respectively. RESULTS: Sixty-eight patients were identified, with a median (range) of 8 (3-21) levels fused. Intraoperative UIV TAO correlated with both postoperative UIV TAO (R = 0.695, P < .001) and postoperative UIV central sacral vertical line (R = 0.435, P = .002). Intraoperative C7 TAO did not correlate with either postoperative C7 TAO (R = 0.213, P = .22) or C7 central sacral vertical line (R = 0.063, P = .72). CONCLUSION: TAO is a useful angular measure that can be used on noncalibrated ISR to predict the positioning of the UIV relative to the sacrum during spinal fusion surgery. However, it does not appear to be predictive of the coronal alignment of C7.

Ordering Effect of Charge-Charge Repulsion in Doped Antiferromagnetic Lattices: A Coupled Cluster Study.

In quantum chemistry, single-reference Coupled Cluster theory, and its refinements introduced by Bartlett, has become a "gold-standard" predictive method for taking into account electronic correlations in molecules. In this article, we introduce a new formalism based on a Coupled Cluster expansion of the wave function that is suited to describe model periodic systems and apply this methodology to the case of hole-doped antiferromagnetic two-dimensional (2D)-square spin-lattices as a proof of concept. More precisely, we focus our study on 1/5 and 1/7 doping ratios and discuss the possible ordering effect due to large hole-hole repulsion. Starting from one of the equivalent single determinants exhibiting a full spin alternation and the most remote location of the holes as a single reference, the method incorporates some corrections to the traditional Coupled Cluster formalism to take into account the nonadditivity of excitation energies to multiply excited determinants. The amplitudes of the excitations, which are possible on the excited determinants but impossible on the reference, are evaluated perturbatively, while their effect is treated as a dressing in the basic equations. The expansion does not show any sign of divergence of the wave operator. Finally, the probabilities of holes moving toward the first- and second-neighboring sites are reported, which confirms the importance of the hole-hole repulsion and offers a picture of how stripes expand around its central line in the "stripe phases" observed in cuprates.

Perceptions of distinctions between patient and healthcare zones among intensive care unit nurses at a Korean tertiary hospital: A cross-sectional study.

Intensive care unit (ICU) patients face higher infection risks from invasive procedures, highlighting the critical role of ICU nurses in infection prevention. Clear differentiation between the patient and healthcare zones is essential for effective hand hygiene and disinfection, yet research on this topic is limited. To assess ICU nurses' perception of the concept of patient and healthcare zones and evaluate their similarity and accuracy in identifying the zones. A descriptive survey was conducted at a 2,732-bed tertiary hospital in Korea from 28 July to 27 August 2022. Participants were recruited from various ICUs through flyers. 225 questionnaires-with illustrations 27 item locations for three ICU scenarios-were made available at nursing stations for voluntary completion. Participants were asked to classify items into the patient zone or the healthcare zone. Similarity scores reflected participant agreement, while accuracy scores measured the proportion of correct answers. Participants' free-text opinions regarding zone classification were analysed thematically. 104 nurses participated voluntarily. Average similarity and accuracy were 84.7% and 82.7%, respectively. The top 8 items, with over 97% similarity and accuracy, were all frequently in contact with ICU patients (e.g., pulse oximeter, Levin tube, central line, urine bag, and patient bed). The bottom 7 items, with less than 80%, included the glucometer, flashlight, trolley, and sink. Participants with higher education levels had significantly higher similarity (p = .044) and accuracy (p = .033), whereas those already familiar with the patient-zone concept had significantly higher accuracy (p = .009). From the free-text analysis, participants considered factors beyond proximity to the patient, such as patient contact, room type, and distance. To address zone classification challenges, clear criteria for patient and healthcare zones, space redesign, and educational programs are recommended. Further research is necessary to improve greater clarity and consensus regarding patient and healthcare zones to enhance infection control practices.

Design of a CPW-based SSPP band-pass filter with reflectionless notch

Abstract This work proposes a band-pass filter (BPF) with a reflectionless notch based on spoof surface plasmon polaritons (SSPPs), utilizing interdigital coupling structures and novel transmission line unit cells. This filter efficiently transmits signals within the 0.67 GHz −4.06 GHz frequency range. By analyzing the equivalent LC circuit of the novel transmission line unit cell, its dispersion relation is derived using microwave network theory, with a cutoff frequency of 4.11 GHz. By comparing its dispersion relation with that of the conventional transmission line unit cell, the miniaturization capability of the proposed unit cell can be verified. In the BPF, loading a zigzag groove onto the central transmission line can be equivalently represented as an interdigital coupling structure, generating a stopband in the low-frequency range near 0 GHz. By deriving and analyzing its S-parameters, it is shown that the bandwidth of the low-frequency stopband can be flexibly adjusted by modifying the geometric dimensions of the zigzag groove. Additionally, loading another set of interdigital coupling structures onto the transmission line generates a notch at its resonant frequency of 3.4 GHz. It is noteworthy that in this configuration, the interdigital coupling structures along with the central transmission line can be represented equivalently as a set of CPW antennas. At the resonant frequency, the atructure radiates signals into free space, forming a reflectionless notch. Based on the simulations, a physical filter was fabricated and tested, showing excellent agreement between simulations and measurements.

Virtual Chest Radiographs Developed From Computed Tomography Images for Differentiating Central Venous Versus Misplaced Arterial Lines and for Training Radiologists

Objective Radiographic findings to identify central venous catheter misplacement in the arteries, which can cause lethal complications, have not been fully evaluated, and its training is difficult because it is rare. The purpose of this study is to clarify radiographic findings for differentiating central venous and misplaced arterial lines using virtual chest radiographs and elucidate their usefulness in training radiologists. Methods This retrospective study included 150 patients (mean age, 67 [SD, ±12] years; 97 men) who underwent colon cancer surgery between January 2018 and December 2020. Virtual chest radiographs, including 6 oblique projections at 5° intervals, were developed from the computed tomography images using ray-sum reconstruction. Virtual venous and arterial lines were drawn from the right neck to the superior vena cava and aorta, respectively. Diagnostic abilities, including area under the curve (AUC) analysis of the 7 proposed radiographic findings for differentiating these lines in 100 patients, were evaluated. The diagnostic performance, including AUC analysis by 5 radiologists in the other 50 patients, was compared before and after disclosing these results to the radiologists. Results The findings of crossing over the right paratracheal stripe and running along the paracaval line showed the highest AUC for indicating arterial and venous lines in the frontal, right anterior oblique 15°, and left anterior oblique 15° projections (AUC = 0.992, 0.991, and 0.979, and 1.000, 0.994, and 0.998, respectively). The diagnostic performance of the radiologists improved after informing them of these results (AUC, 0.982–0.999 to 0.993–1.000 [P = 0.145–1.000] for the frontal projections and 0.932–0.970 to 0.967–0.995 [P = 0.075–0.150] for the oblique projections). Conclusions Virtual chest radiographs created from computed tomography images were useful for clarifying radiographic findings for differentiating central venous and misplaced arterial lines and for training radiologists.

An event-related potential study of P300 in preschool children with attention deficit hyperactivity disorder

ObjectiveTo study the characteristics of event related potential P300 in preschool children with attention deficit hyperactivity disorder (ADHD) aged 4–6 years (4≤ age <6), and to explore the differences in cognitive function compared with healthy children. To explore a new method for the study of cognitive function in preschool children with ADHD.MethodsA total of 73 preschool children aged 4–6 years were selected from the outpatient clinic of Neurology Department, the ADHD-specialized Clinic and Health Care Department of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from March 2021 to May 2024. They were divided into the ADHD group (45 cases) and healthy children group (28 cases). Event related potential P300 was measured in all children and the amplitude and latency of the wave were compared between the two groups separately.ResultsThe latency of P300 at all the recording electrodes (Fz, Cz, Pz, Oz, C3, C4) in the ADHD group was significantly longer than controls (p < 0.05). The wave amplitudes of children with ADHD were significantly higher than controls at Pz and Oz points.ConclusionThe differences between two groups in P300 test show that preschool children with ADHD present longer latency at central line of the brain and bilateral central lobes compared with healthy children, and higher amplitude at the central parietal lobe and central occipital lobe. It may suggest that attention cognition has already impaired in preschool children with ADHD.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p<0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.

Eliminating Error in Central Line Scheduling and Placement Using Quality Improvement Methods.

The Joint Commission defines a sentinel event as "surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome." At our institution, we observed a low but consistent rate of incorrect surgical line placement for pediatric patients with cancer. Following quality improvement methodology and using the resources available on a large academic medical campus we designed and implemented a new multi-factorial process to schedule and place surgical central lines for pediatric patients with cancer. Changes included re-defining responsibilities, adding staff, and redesigning the process with workflows supported by modifications to the electronic medical record. Our primary outcome measures were incorrect central line placement or near miss event per quarter and days between these events. After implementation the rate of incorrect line placement and near miss events was reduced to zero with 1018 days since the last incorrect line placement. As a result of our multi-factorial quality improvement initiative in the scheduling and placement of central lines, we were able to eliminate surgical line placement sentinel events and improve care for pediatric patients with cancer.

102. Surgical Treatment of Brachial Artery Aneurysm Associated qith Arteriovenous Shunt for Hemodialysis: Case Report

Introduction: A brachial artery aneurysm is a rare complication of an arteriovenous fistula (AVF) created for hemodialysis access. This report details the case of a patient with a brachial artery aneurysm associated with an AVF for hemodialysis, who underwent successful surgical treatment. Case: A 64-year-old female with CKD undergoing regular hemodialysis presented with a painful lump in her right arm one-week AVF installation. Her medical history included a left nephrectomy in 2022, previous failed AV fistula placement, and central dialysis line (CDL) insertion. The patient had a medical history significant for CKD requiring routine HD twice a week. Local examination of the patient's right arm revealed a mobile, painful lump, diagnosed as a brachial artery aneurysm, limiting arm movement. A chest X-ray showed cardiomegaly, thoracic spondylosis, and proper CDL positioning. Laboratory results were normal. The patient underwent surgical repair of the aneurysm and was hospitalized for three days postoperatively. Post-surgery treatment included analgesics, antibiotics, anticoagulation therapy, and outpatient clopidogrel. Conclusions: A brachial artery aneurysm is a rare complication of an AVF, posing risks of peripheral embolism and hand ischemia, and therefore requires surgical correction.

Numerical determination of the threshold magnetic field in superconducting strips and coils triggering dynamic resistance

Abstract The threshold magnetic field is a key parameter for evaluating the current decay caused by dynamic resistance in superconducting windings and magnets. For a DC-carrying superconducting slab under an AC parallel magnetic field, the analytical theory clearly shows that there is only one electric central line (ECL) across the slab width at the onset of dynamic-resistance. However, threshold magnetic fields in superconducting strips and coils have not been fully investigated. Based onthe one-ECL criterion, this paper first presents a method for numerically determining the threshold magnetic field via the evolving internal magnetic field in superconducting strips and coils. By probing transient electromagnetic behaviours, interestingly, we found a distinctive feature of superconducting strips in which a wide region of zero electrical field is observed when dynamic resistance/loss initially occurs. With increasing magnetic fields, this region gradually shrinks and eventually become the ECL. More importantly, this numerical method can analyse the local threshold magnetic field in a targeted coil turn. The ability to quantify threshold magnetic field provides a clear guidance on the acceptable level of ripple and harmonic magnetic fields for coil windings in superconducting maglev trains and field windings of superconducting machines operating at persistent current mode.

Quality improvement initiative to achieve early enteral feeds in preterm infants at a level IV neonatal intensive care unit.

We report the results of a quality improvement initiative to reduce the time to full enteral feeds and number of central line and parenteral nutrition days in premature infants in a level IV neonatal intensive care unit (NICU) by 20%. In 2020, a multidisciplinary team at our NICU initiated a quality improvement project to improve enteral feeding in infants with a birthweight <1800 g. The key drivers were early donor human milk consent, trophic feeds initiation, and modification of the enteral feeding guidelines. The interventions included prenatal donor human milk consents, mandatory staff education, and NICU newsletter reminders. Retrospective baseline data were collected May 1, 2020, to November 23, 2020, and prospective data were collected November 24, 2020, to September 30, 2022. Special cause variation was detected for time to achieve full enteral feeds, central line days, and parenteral nutrition days with 30%, 44%, and 42% improvements, respectively. There was no increase in feeding intolerance or necrotizing enterocolitis. Small changes in feeding guideline processes improved enteral feedings in preterm infants without increase in morbidities. Our process measures are practical and easy to implement in most NICU settings.

Identifying high-risk central lines in critically ill children: a novel nurse-driven screening and mitigation intervention to reduce CLABSI

BackgroundDespite strong adherence to central line associated bloodstream infection (CLABSI) infection prevention bundles, the CLABSI rate in our academic pediatric intensive care unit (PICU) and pediatric cardiac intensive unit (PCICU) remained high. MethodsWe developed a novel screening tool that stratified patients' risk for CLABSI and considered risk-mitigation strategies. ResultsOf 1583 screenings, 30% were classified as high-risk, 27% as moderate-risk, and 43% as low-risk. With accurate screening, the tool was 100% sensitive to patients who developed CLABSI, with a negative predictive value of 100% for low-risk screens. The CLABSI rate declined from 1.83 per 1000 catheter-days to 0.98 and 1.02 in 2021 and 2022, respectively, with unprecedented consecutive months CLABSI free. Device utilization was stable across both units, declining by 22% in the PICU and rising in the PCICU with increased cardiac surgeries. Clinicians expressed increased awareness of patient CLABSI risk factors and mitigation strategies in surveys. DiscussionsThis novel screening tool effectively identified high-risk patients to target resources and promoted improvements in CLABSI-prevention processes in the PICU and PCICU. ConclusionsA novel nurse-driven CLABSI risk factor screening tool identified and focused resources on patients at high-risk for CLABSI, and increased awareness and proactive risk mitigation by clinicians.

A Data-driven Magnetohydrodynamic Simulation of the 2011 February 15 Coronal Mass Ejection from Active Region NOAA 11158

We present a boundary data-driven magnetohydrodynamic (MHD) simulation of the 2011 February 15 coronal mass ejection (CME) event of Active Region NOAA 11158. The simulation is driven at the lower boundary with an electric field derived from the normal magnetic field and the vertical electric current measured from the Solar Dynamics Observatory (SDO) Helioseismic Magnetic Imager vector magnetograms. The simulation shows the buildup of a pre-eruption coronal magnetic field that is close to the nonlinear force-free field extrapolation, and it subsequently develops multiple eruptions. The sheared/twisted field lines of the pre-eruption magnetic field show qualitative agreement with the brightening loops in the SDO Atmospheric Imaging Assembly (AIA) hot passband images. We find that the eruption is initiated by the tether-cutting reconnection in a highly sheared field above the central polarity inversion line and a magnetic flux rope with dipped field lines forms during the eruption. The modeled erupting magnetic field evolves to develop a complex structure containing two distinct flux ropes and produces an outgoing double-shell feature consistent with the Solar Terrestrial Relations Observatory B/Extreme UltraViolet Imager observation of the CME. The foot points of the erupting field lines are found to correspond well with the dimming regions seen in the SDO/AIA observation of the event. These agreements suggest that the derived electric field is a promising way to drive MHD simulations to establish the realistic pre-eruption coronal field based on the observed vertical electric current and model its subsequent dynamic eruption.

Catheter-Related Thrombosis in Adults with Cancer: A Secondary Analysis of a Prospective Randomised Controlled Trial.

Catheter-related thrombosis (CRT) is a complication of central venous access devices (CVADs). Evidence is variable regarding the significance of the side of catheter insertion. The role of the patient's hand dominance in predisposition to CRT remains uncertain. In a prospective randomised controlled trial, adult cancer patients were randomly allocated to either dominant or non-dominant side CVAD insertion. The primary endpoint of this trial examined the incidence of catheter-associated blood stream infection. Here, we report the secondary endpoint of the incidence of CRT. 640 CVADs were randomised to the dominant (n=322) or non-dominant (n=318) side of insertion. Only symptomatic patients underwent ultrasound imaging to evaluate for CRT. The median patient age was 58, 60% of patients had haematological malignancies and 40% had solid tumours. CVADs used were peripherally-inserted central catheter line (PICC)(67%), tunnelled CVAD (23%) or non-tunnelled CVAD (10%). The CRT incidence rate was 0.65 vs 0.82 per 1000 line days in the dominant vs non-dominant group (HR 1.2; 95% CI 0.58-2.48, P=0.63). There was no significant difference in CRT incidence rate between left and right sided insertions (HR 0.63; 95% CI 0.30-1.32, P=0.22). The CRT incidence rate was lower in right-handed versus left-handed line inserters (HR 0.29; 95% CI 0.12-0.71, P=0.007). The rate of CRT was not associated with whether CVAD insertion was on the patient's dominant or non-dominant side or the side of insertion. The role of inserter hand dominance requires further investigation.

Prevention of Central Line Associated Bloodstream Infections by Leadership Focus on Process Measures

Prevention of Central Line Associated Bloodstream Infections by Leadership Focus on Process Measures

Improving Maintenance of Central Line Dressing to Reduce Risk of Central Line-Associated Bloodstream Infections in an Acute-Care Setting.

Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings. With pre- and post-CVAD dressing data, utilizing rapid Plan-Do-Study-Act methodology to drive improvement, this quality improvement initiative was conducted in a 603-bed, tertiary level I trauma center. A multidisciplinary team was formed consisting of infection prevention, quality, nursing, and vascular access personnel, with the goal of improving central line dressing integrity and increasing dressing life. In-depth training included standardized CLABSI prevention bundles and central line dressing change guidelines to include the application of gum mastic adhesive and topical hemostatic product, and was tested on pilot units before implementation. Bleeding at the central line insertion site reduced by 23.6% with the use of a hemostatic powder. Central line dressing integrity was improved by 33.5% with the use of a liquid gum mastic adhesive and dressing life improved by 140.7%. Additionally, there was only 1 CLASBI and no medical adhesive-related skin injuries reported since the implementation of the bundle (October 2023). Topical hemostatic powder and liquid gum mastic adhesive paired with the adhesive remover for safe removal were shown to be effective in improving integrity in central line dressings for the prevention of CLABSIs. In October 2023, the dressing change integrity bundle was scaled to all units within the facility.

&lt;i&gt;Ochrobactrum anthropi&lt;/i&gt;: a rare case of endocarditis

Ochrobactrum anthropi is an aerobic Gram-negative bacillus, formerly known as “Achromobacter group Vd”. It is increasingly recognized as a potentially problematic, opportunistic, and nosocomial pathogen. Most cases of human diseases due to O. anthropi are associated with central venous catheter line infection; few case reports about infective endocarditis, pancreatic abscess, puncture wound osteochondritis, endophthalmitis, urinary tract infection, meningitis, pelvic abscess, and osteomyelitis are present in the literature. Among the previously stated infections it can cause, infective endocarditis is very rare; only four cases have been described in the literature. Here, we report the case of an immunocompromised man who developed native valve endocarditis with septic cerebral embolization due to O. anthropi.

Penumbra Indigo® system to safely remove intracardiac thrombus in a 7-month-old infant with severe immunodeficiency disorder.

We report on a 7-month-old boy (4.2 kg/60 cm) with severe immunodeficiency disorder and bacterial septicaemia who was referred for an infected atrial thrombus secondary to a jugular central line. The echocardiogram showed a teardrop-shaped thrombus with a wide base adherent to the interatrial wall and a flimsy tail moving freely in the right atrium. Chest CT scan showed multiple lesions in both lungs consistent with infected micro-thrombi. The thrombus increased in size despite 2 weeks of antibiotics and anticoagulation. We applied the Indigo® Lightning® 7 aspiration system from Penumbra® (Alameda, USA) and removed percutaneously the thrombus under transoesophageal ultrasound and biplane fluoroscopic guidance. At 6 weeks of follow-up, the patient is alive, under enoxaparin with no procedure-related complication.