Perianal fistulas often require multiple surgical interventions because of their chronic nature. Various sphincter-sparing techniques achieve clinical closure rates of up to 70%, yet recurrence remains a major challenge. Vacuum-assisted closure (VAC) therapy has shown promise in wound healing, but its application in perianal fistulas remains largely unexplored. The Semiflex catheter was developed to facilitate outpatient vacuum therapy without the need for general anesthesia during catheter exchanges. This pilot study aimed to evaluate the feasibility and clinical applicability of the Semiflex catheter in perianal fistula management. The Semiflex pilot study was a two-part feasibility trial. The first part assessed proof of principle in ten patients, while the second part, a multicentre study, aimed to confirm feasibility in 20 patients. Feasibility included smoothness of insertion and changing of the Semiflex catheters, capability of proper fixation of the Semiflex catheter, maintaining vacuum for more than 48h, and compliance to the therapy in terms of pain and discomfort. The protocol was scored feasible if at least 50% of the exchanges met all these criteria in at least 70% of patients. Secondary outcomes included clinical fistula closure, radiological healing, and treatment-related adverse events. Twenty patients were included (median age 39.5years; 70% Crohn's disease). Thirteen Semiflex treatments were scored as feasible, below the predefined threshold. Clinical fistula closure was observed in 50% of patients, but none showed radiological healing at 3months. One serious adverse event occurred, requiring early treatment discontinuation, while minor complications, including local skin reactions and pressure sores, were managed conservatively. Semiflex therapy was feasible in a subset of patients and allowed outpatient treatment. However, maintaining vacuum and achieving long-term fistula closure remains challenging. While Semiflex may have a role in perianal fistula management, further research is needed to refine patient selection and optimize its application.

Beyond body mass index: how vascular morphology influences the risk of thrombosis associated with peripherally inserted central catheters in patients with cancer.

Two billion vascular access devices (VADs) are used each year worldwide for the administration of intravenous therapy. Among the most serious complications are catheter-related bloodstream infections (CRBSIs), which increase morbidity and mortality and reduce patients' quality of life. The aim of this study was to evaluate the impact of implementing a multimodal intervention through a mobile application (CUIDAVEN, Nursing-led Vascular Access Care) on reducing catheter failure and the healthcare costs associated with CRBSIs, while improving nurses' adherence to best practice recommendations for vascular access care. We conducted a quasi-experimental pre-post intervention study without a control group, from April 2019 to August 2022, at the Hospital Regional University of Málaga (Spain). Adult patients requiring VADs (short peripheral intravenous catheters, midlines, peripherally inserted central catheter, and centrally inserted central catheters) for intravenous therapy and capable of using a mobile application were included. Patients with cognitive impairment or in a terminal condition were excluded. The intervention involved the use of the CUIDAVEN mobile application, which provided educational resources, reminders, and monitoring tools. Data were collected during the pre- and post-intervention phases. Variables analysed included sociodemographic characteristics, adherence to good practices, health outcomes, and resource consumption. A total of 378 patients and 968 VADs were analysed. Catheter failure rate decreased by 19.42% in the post-intervention phase (from 16.95% to 12.24%), with an 80% reduction in CRBSIs (from 2.30% to 0.61%). Mean cost per complication fell from €310.66 to €118.79 (p=0.007). Significant improvements were observed in adherence to best practices. Patients also reported increased knowledge and satisfaction with the use of CUIDAVEN. The implementation of the CUIDAVEN mobile application was associated with a reduction in both infectious and non-infectious complications and improved adherence to recommended practices. Patients perceived greater knowledge and satisfaction, highlighting the potential of digital health tools to empower individuals and improve health outcomes.

Objective: Children undergoing surgery for congenital heart disease (CHD) are at risk for catheter-associated deep vein thrombosis (CA-DVT). We sought to understand the practice variations which may impact the risk for CA-DVT by conducting a comprehensive survey. Methods: Analysis of electronic survey of Pediatric Cardiac Critical Care Consortium (PC4) hospitals caring for children undergoing surgery for CHD. Results: Responses from 45 respondent PC4 centers was analyzed; 71% of centers (n = 32) had a prophylactic anticoagulation protocol. Two of the 45 respondent centers utilized a protocol for proactive screening for CA-DVT; 64% of centers (29/45) treated CA-DVT for a duration of 6 to 12 weeks. Internal jugular central vein catheters (CVC) were the most common primary access in children who were 1 to 18 years of age undergoing surgery (89% [40/45] of centers) and in infants 1 to 12 months of age (73% [33/45] of centers). Significant variability CVC-type selection was reported in neonates (<30 days of age). More than half of centers reported avoiding upper extremity peripherally inserted central catheter placement in patients both prior to and after stage 2 palliation for single ventricle CHD (58% [26/45] and 53% [24/45], respectively). Conclusions: Significant variability in prevention and management of CA-DVT is reported among PC4 centers. Only half of respondent PC4 centers reported having an established treatment protocol for CA-DVT. Consensus and evidence-based guidelines for the treatment of CA-DVT are not consistently followed with only 62% (28/45) of centers reported treating for the recommended 6 to 12 weeks with anticoagulation. There is high variability in CVC-type and location selection in neonates undergoing CHD surgery.

We aimed to determine whether central line-associated bloodstream infection (CLABSI) rates differ between tunneled and conventionally inserted PICCs (tPICCs and cPICCs). This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42024616470) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were comprehensively searched from inception to November 27, 2024, to identify randomized controlled trials that compared CLABSI rates between tPICCs and cPICCs. Risk ratios along with the 95% confidence intervals (CI) were calculated for outcomes using a random-effects meta-analysis model following the Hartung-Knapp-Sidik-Jonkman method. Statistical heterogeneity was assessed using the I2 statistic. Methodological quality and risk of bias were assessed using the Cochrane risk of bias tool. A meta-analysis of four relevant studies, comprising 2,659 participants (pooled mean age ± standard deviation, 59.3 ± 15.5years; 1,481 women) and 177,879 catheter days, revealed overall CLABSI rates of 0.31 per 1,000 catheter-days in the tPICC group and 0.68 per 1,000 catheter-days in the cPICC group. The risk ratio (0.48; 95% CI, 0.28-0.81; p = 0.02) indicated a 52% reduction in the tPICC group compared with the cPICC group, with low heterogeneity (I2 = 0%). Subcutaneous tunneling for PICC placement is associated with a significant reduction in CLABSI rate among hospitalized adult patients.

Effects of three peripherally inserted central catheters insertion techniques on catheterization outcomes: A randomized controlled trial.

Exploring experiences and needs among children with cancer undergoing peripherally inserted central catheter insertion: A qualitative study.

BACKGROUNDPeripherally inserted central catheter (PICC) is the preferred intravenous route for chemotherapy in patients with cancer, but its complications, especially deep vein thrombosis (DVT), are becoming increasingly prevalent. Medical staff proficient in intubation and maintenance techniques can reduce complications. The multivariate integration teaching model applies the integration of “teaching learning application” to medical training, which helps shift the prevention of complications from “passive management of complications” to “active construction of risk immunity”, thereby ensuring foundational competency for PICC in patients with cancer.AIMTo investigate the efficacy of the multivariate integration teaching model in patients with gastric cancer and concurrent DVT after PICC intubation and analyze its effect on patients’ quality of life index (QLI) and satisfaction.METHODSA retrospective analysis of medical records of 100 patients with gastric cancer and PICC treated at Zhejiang Provincial People’s Hospital from May 2019 to November 2020 was conducted. According to the different treatment methods and teaching modes received by medical staff, they were divided into a control group and an experimental group, with 50 cases in each group. The routine clinical teaching model and the multivariate integration teaching model were administered to the medical staff for the control group and the experimental group, respectively, to compare the incidence rates of DVT and other adverse reactions, QLI scores, Karnofsky Performance Scale scores, Mental Status Scale in Non-Psychiatric Settings scores, patient satisfaction, medical staff’s test marks, and satisfaction evaluation of the teaching model.RESULTSCompared with the control group, the experimental group exhibited significantly lower incidence rates of DVT and other adverse reactions and MSSNS scores but significantly higher QLI scores, KPS scores, patient satisfaction, medical staff’s test marks, and their satisfaction evaluations of the teaching model (P < 0.05).CONCLUSIONIn a single-center practice, performing the multivariate integration teaching model for medical staff may effectively improve the patients’ QLI and satisfaction and may have certain application value in preventing DVT in patients with gastric cancer and PICC.

BackgroundAdherence to evidence-based care processes and patient outcomes in intensive care units (ICUs) can be influenced by staffing and resource availability. We aimed to evaluate if there is a weekend effect on adherence to evidence-based care processes, and hospitalization outcomes and whether a checklist implementation could mitigate potential differences.MethodsPost hoc analysis of the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) study dataset collected before and after checklist implementation in 34 ICUs across 15 countries (2013-2017). Admission days were classified as 'weekend/holidays' or 'weekdays' according to local work schedules and public holidays. The primary outcome was the omission of 10 evidence-based care processes addressed in the checklist. Mortality and length of stay differences between weekend/holiday and weekday admissions were evaluated as secondary outcomes.Results4256 patients contributed 1141 weekend versus 3501 weekday observation days pre-intervention, and 2014 versus 6507 post-intervention. Pre-intervention, peptic ulcer prophylaxis was omitted more frequently on weekends/holidays than weekdays (adjusted rate ratio [aRR], 0.58 [95%-confidence interval [CI] 0.38-0.88), whereas head-of-bed elevation was omitted more often on weekdays than on weekends/holidays (aRR, 3.17 [1.14-8.86]). Post-intervention, peptic ulcer prophylaxis omission rates became similar (aRR, 1.03 [0.68-1.56], but head-of-bed elevation became omitted more often on weekends than on weekdays (aRR, 0.63 [0.45-0.88]). Post-intervention, oral care was omitted more frequently on weekends/holidays than in weekdays (aRR, 0.63 [0.45-0.9]), and central catheter removal was more frequent on weekdays than in weekends/holidays (aRR, 1.11 [1.02-1.21]). No significant differences in mortality or length of stay were found.ConclusionA weekend effect influenced adherence to some care processes. While checklist implementation improved overall adherence, some disparities diminished, while new ones emerged. Organizational, cultural, and temporal factors should be further studied to optimize care delivery across all times and settings.Clinical Trial Registration NumberNCT01973829.

Risk factors for complications associated with peripherally inserted central venous catheters for parenteral nutrition: Machine learning and survival analysis based on deep learning.

Effective nursing interventions for infection prevention and control in acute and critically ill patients with a peripherally inserted venous catheter: an umbrella review.

To compare the peripherally inserted central catheter (PICC) and a new type of arm-port, the PICC-port, in patients with nasopharyngeal cancer in terms of complications and cost-effectiveness. A randomized controlled trial was conducted with a total of 126 patients. The patients were randomly assigned to the experimental group or the control group. The outcomes were observed from the day of placement until extubation. Demographic data, data related to catheter placement, and the placement effects were collected and analyzed using SPSS 29.0. Catheters were successfully inserted in 123 out of the 126 patients (61 in the experimental group and 62 in the control group). Compared with the control group, the experimental group had a lower incidence of complications after placement (21.3% vs 54.8%, p < 0.001). This included lower incidences of catheter dislodgement (0% vs 21.0%, p < 0.001), catheter occlusion (1.6% vs 12.9%, p = 0.032), wound oozing (4.9% vs 33.9%, p < 0.001), and medical adhesive-related skin injury (4.9% vs 14.9%, p = 0.025). Additionally, the severity of both wound oozing (p < 0.001) and medical adhesive-related skin injury (p = 0.014) was lower in the experimental group. Although the surgical cost was higher in the experimental group, the PICC-ports required less maintenance and the patients' quality of life coefficient was higher. When considering overall healthcare costs and health outcomes, the net benefits became equal between the two groups after 2.8 months. Beyond this point, the net benefits of the experimental group surpassed those of the control group, with the difference increasing as the dwelling time of the catheter increased. For patients with nasopharyngeal carcinoma requiring long-term treatment (duration >3 months), PICC-ports may be the preferred option compared to PICCs, particularly for those unable to undergo regular catheter maintenance or prioritizing quality of life.

Background: The primary objective was to assess the effectiveness and safety of combined bFGF and light therapy for Peripherally Inserted Central Catheters (PICC) phlebitis, measuring improvements in phlebitis grading and Visual Analogue Scale (VAS) scores; evaluating inflammatory regulation through C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6); and determining quality of life changes using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), to establish whether combined therapy demonstrates statistically significant advantages over standard care. Methods: This retrospective study included leukemia patients aged 18-75 years with PICC-associated phlebitis at Huai'an Second People's Hospital between January 2019 and December 2024. Patients were divided into an intervention group (n=33) receiving combined bFGF and light therapy, and a control group (n=32) receiving standard care. Assessment metrics included phlebitis scores and VAS pain scores evaluated on days 3 and 7; inflammatory markers (CRP, PCT, ESR, IL-6) and QLQ-C30 scores assessed on day 7. Data were analyzed using SPSS 26.0, with t-tests for between-group comparisons (P&lt;0.05 considered statistically significant). The study received ethics committee approval, and all participants provided informed consent. Results: Baseline characteristics were similar between groups. In the intervention group, phlebitis scores decreased from 2.22 (±1.08) at baseline to 0.18 (±0.46), and VAS scores from 5.4 (±2.8) to 0.55 (±1.37), significantly outperforming the control group (p&lt;0.001). Regarding inflammatory markers, by day 7, the intervention group showed reductions in CRP to 4.32 mg/L (±4.20), PCT to 0.15 ng/ml (±0.24), ESR to 8.45 mm/h (±9.25), and IL-6 to 4.79 pg/ml (±6.37), all significantly superior to the control group (P&lt;0.001). In QLQ-C30 scores, the intervention group demonstrated significant improvements in physical, role, cognitive, and social functioning, as well as overall health, with marked reductions in fatigue, pain, insomnia, and appetite loss (P&lt;0.05). No adverse events were reported in the intervention group, while 18.8% of control group patients experienced complications requiring additional intervention. Conclusion: This study confirms that combined basic fibroblast growth factor and light therapy significantly improves outcomes in managing PICC-associated phlebitis in leukemia patients. This combined approach effectively relieves pain, reduces inflammatory response, and significantly enhances overall comfort and quality of life with excellent safety profiles, offering a promising new strategy for clinical management of PICC phlebitis. Larger prospective studies with longer follow-up periods are needed to further validate the long-term efficacy and optimize clinical applications of this combined treatment regimen.

Intensive care units (ICUs) frequently host patients who often need to be infused with all kinds of drugs. Currently, modified midlines and peripherally inserted central catheters (PICCs) are used frequently. The present retrospective research aims to assess the use, efficacy, and complications due to modified midlines and PICCs in the treatment of patients in a medical ICU. One hundred forty-two patients hospitalized were inserted with a modified midline or PICC. The choice of catheters for different underlying diseases, actual clinical application, the number of days of dwell time, and complications were compared. Risk factors for complications and puncture-site bleeding were investigated. Compared to PICCs, modified midlines were used far more frequently in patients suffering from acute respiratory distress syndrome, chronic obstructive pulmonary disease, cardiovascular diseases, and coronavirus-19 infections; however, this is not the case in malignancy patients. Moreover, modified midlines were more frequently used for the infusion of vasoactive drugs rather than chemotherapeutic drugs. As for overall complications associated with catheter placement, it was significantly different between the 2 groups. Stratified analysis revealed that in the modified midline group, the incidence of partial or complete catheter removal and puncture-site infection was less than the incidence among PICC group; however, modified midline group developed puncture-site bleeding more frequently than PICC group. Multivariate analyses indicated that a catheter indwelling duration of ≥12 days was the only risk factor for complications, rather than PICC. Meanwhile, it also showed that the 2 risk factors for puncture-site bleeding were an age of ≥60 years and ICU stay ≥14 days. In the medical ICU, modified midlines offer a safe alternative to PICCs for medium-term access in non-chemotherapy patients, reducing rates of unplanned removal and puncture-site infection while simplifying clinical workflow.

To quantify inter-center variation (ICV) in non-elective removal (NER) of central venous catheters (CVCs) in level 4 Neonatal Intensive Care Units (NICUs). Using the Children's Hospitals Neonatal Database (CHND), we identified CVCs in infants admitted 2017-2023. The primary outcome was CVC NER, and the primary exposure was CHND center. We quantified unadjusted and adjusted ICV in NER. We analyzed 71,865 patients and 135,671 CVCs. Median gestational age was 36 weeks and birth weight 2450 g. Over 50% infants (28,077) received >1 CVC. Centers placed 196-7120 catheters with a median dwell time of 7 (IQR 4-14) days. The overall NER rate was 11.7%, with significant ICV (unadjusted ICV: 3-19%, p < 0.001; adjusted center-level odds of NER: 0.26-2.03, p < 0.001). There is significant ICV in NER between level IV NICUs. Reducing modifiable NER may increase safety for patients with CVCs. Center-specific NER metrics may serve as clinical benchmarks.

To examine the performance of tunnelled, noncuffed central venous catheters and small-gauge peripherally inserted central catheters for infants. Single-center, retrospective cohort study analyzing patient records for all patients younger than 12 months who had a tunnelled, noncuffed central venous catheter or small-gauge (≤3Fr) peripherally inserted central catheter inserted at an Australian pediatric hospital over 4years (2019-2022). A total of 267 catheters (107 tunnelled, noncuffed central venous catheters and 160 peripherally inserted central catheters) were examined, from device insertion to removal. Median age of infants was 58days (IQR 86). A change in inserting clinicians' preferences for device selection over the study period was demonstrated, with increasing use of tunnelled, noncuffed central venous catheters. Of all devices, 65.2% (n = 174) were used until the end of prescribed treatment (104 peripherally inserted central catheters [65.0%] vs 70 tunnelled, noncuffed central venous catheters [65.4%]). Rates of central line-associated bloodstream infection (n = 7; 2.6%) and venous thrombosis (n = 5; 1.9%) were low. High rates of occlusion (overall [n = 115; 43.1%]; 76 peripherally inserted central catheters [47.5%] vs 39 tunnelled, noncuffed central venous catheters [36.4%]) and dislodgement (overall [n = 53; 19.8%]; 32 peripherally inserted central catheters [20.1%] vs 21 tunnelled, noncuffed central venous catheters [19.6%]) were evident. However, there is no indication of increased odds of occlusion between the device types. There was a change in clinician preference from peripherally inserted central catheters to tunnelled, noncuffed central venous catheters, and the removal rate due to complications was similar between devices.

Umbilical venous catheter and peripherally inserted central catheter malposition and tip migration in neonates: A mixed methods cost analysis

Hemodialysis (HD) remains the primary renal replacement therapy for over 80% of global end-stage kidney disease (ESKD) patients, underscoring the critical need for safe and effective vascular access. Despite the high complication rates and associated morbidity/mortality of tunneled cuffed catheters (TCCs), their use remains prevalent, particularly in aging populations. We present a case where a fractured TCC fragment migrated into the superior vena cava (SVC) during catheter exchange. The fragment was successfully retrieved using a snare device with single-sheath traction wire technique, followed by in situ TCC replacement.

BackgroundLong-term venous access devices, including PICCs and implantable ports, increase the risk of catheter-related thrombosis (CRT) in cancer patients. The role of prophylactic rivaroxaban in this setting remains uncertain.MethodsWe retrospectively analyzed adult cancer patients who underwent peripherally inserted central catheter (PICC) or implantable port (PORT) placement between January 2019 and May 2023. CRT was diagnosed via B-ultrasound. To reduce surveillance bias, only patients who underwent ≥4 ultrasound examinations were included. Kaplan–Meier and Cox regression were used to assess the effect of rivaroxaban prophylaxis and to explore subgroup differences.ResultsAmong 1,585 patients with upper-limb catheters, 822 met inclusion criteria, with 135 CRT events. The median time to CRT was 55 days (IQR: 29.5–121.5), and 66.2% occurred within 90 days post-catheterization. Prophylactic rivaroxaban significantly reduced CRT risk (HR = 0.47, 95% CI: 0.33–0.67; p < 0.001), particularly in high-risk groups such as those with PICC lines or active tumors. No significant benefit was observed in patients with no-evidence-of-disease (NED) or those with cardiac stents, atrial fibrillation, or prior cerebral infarction. In the PORT subgroup, risk reduction was not statistically significant overall (HR = 0.66, p = 0.07), but became significant after excluding NED and cardiovascular conditions (HR = 0.52, p = 0.0195).ConclusionRivaroxaban prophylaxis reduces CRT in cancer patients with long term central venous catheters, particularly those with PICCs or active disease. Routine use appears unnecessary in NED or patients on antiplatelet therapy, highlighting the importance of individualized prophylaxis strategies.

Safe and reliable venous access is critical for high-quality cancer care. Patients with both solid and hematologic cancers require vascular access devices (VADs) for systemic chemotherapies and for supportive treatments, including blood products, antimicrobials, antiemetics, and fluids. However, VADs are associated with serious complications, including bloodstream infection and venous thromboembolism. Evidence-based guidance could maximize benefits and reduce risks in the selection and management of VADs in patients with cancer. The authors convened a 9-member international multidisciplinary panel and used the RAND/UCLA Appropriateness Method to develop recommendations for VAD selection, insertion, and management in patients with cancer. A literature review informed the development of clinical scenarios, which were rated by the panel for appropriateness based on cancer type, treatment indication, urgency, comorbidities, and anticipated duration of use. Of 1422 scenarios, 502 (35%) were rated as appropriate, 400 (28%) were rated as neutral/uncertain, and 520 (37%) were rated as inappropriate. Appropriateness of VAD selection varied by type of cancer, treatment urgency, and planned dwell time. For patients with acute hematologic cancers requiring urgent chemotherapy, placement of a double-lumen peripherally inserted central catheter (PICC) or a tunneled central venous catheter (CVC) was rated as appropriate, regardless of treatment intensity or infusate characteristics. For patients with malignant solid tumors, a single-lumen tunneled CVC or implanted port was rated as appropriate for delivering chemotherapy, regardless of treatment intensity, urgency, or duration. In patients with advanced chronic kidney disease, coordination of care with a nephrologist to ensure vein preservation in the context of cancer prognosis was recommended. By developing comprehensive, evidence-informed expert recommendations, the Michigan Appropriateness Guide for Intravenous Catheters in Adult Patients With Cancer (MAGIC-ONC) aims to improve clinical care, reduce complications, support quality improvement efforts, and advance the safety of vascular access for patients with cancer.