Central Venous Catheters In Patients Research Articles

#1678 The relationship between national dialysis catheter rates and kidney transplantations

Abstract Background and Aims Vascular access for chronic hemodialysis is either achieved by an arteriovenous fistula or graft (AVF/G) or central venous catheter (CVC) and AVF/Gs have been repeatedly reported to be superior to CVCs and guidelines usually recommend it as the preferred vascular access. AVF/Gs are associated with better quality of dialysis, less complications, and a lower mortality than CVCs. This has led to initiatives such as Fistula First that aimed at maximizing AVF/Gs rates and national healthcare systems now frequently evaluate their efficiency of care for end-stage renal disease (ESRD) patients based on this metric. However, transplant activity might be a significant confounding factor since high transplant rates and therefore limited transition phases might contribute to a higher acceptance of CVCs in patients awaiting kidney transplantation. I aimed at investigating the relationship between CVC rates and transplant activity in different countries by analyzing data from national dialysis and transplant registries. Method Data was obtained from national transplant and dialysis registries including Argentina (2012-2021), Australia (2004-2022), Austria (2005-2022), New Zealand (2005-2022), Sweden (2011-2022), Turkey (2004-2022), and the USA (2012-2021). Population estimates were obtained from the World Bank. The conducted analyses included unadjusted correlation analysis as well as multivariate regression analysis. Results The study sample included data from 7 different countries spanning from North and South America, over Europe and Asia to Oceania covering data from 107 annual reports. CVC rates and transplant activity per million showed a weak positive correlation (0.283, 95% CI: 0.093–0.454) within the same year (Fig. 1). When correlating catheter rates with transplant activity of the previous year, the association increased slightly (0.357, 95% CI: 0.173–0.517). The change of incidence of ESRD or hemodialysis patients (depending on data availability) showed a moderate correlation with the change of catheter rates (0.507, 95% CI: 0.272-0.685). A regression model including the incidence of ESRD improved model fit compared to a model that uses only transplant activity to estimate catheter rates. Conclusion Even though most healthcare systems, clinicians, and epidemiologists recommend low CVC rates, a thorough evaluation of the care of ESRD patients requires the adjustment of several contributing factors, primarily kidney transplantation activity. Higher kidney transplantation rates are associated with higher CVC rates which might be due to reduced waiting times until transplantation. An increase in kidney transplantations might especially increase CVC-based dialysis in the subsequent year. There is some evidence that the incidence of ESRD in general or hemodialysis in specific additionally affects CVC rates. Increasing incidence of ESRD is associated with increasing catheter rates, indicating that healthcare systems might struggle to adapt to short-term changes regarding access demands.

Incidence and clinical progression of asymptomatic peripherally inserted central catheter–related thrombosis in solid neoplasm patients: ultrasound insights from a prospective cohort study

BackgroundManaging central venous catheters in patients with neoplasms is challenging, and peripherally inserted central catheter PORT (PICC-PORT) has emerged as a promising option for safety and efficacy. However, understanding the clinical progression of catheter-related thrombosis (CRT) in cancer patients with central venous catheters remains limited, especially in certain neoplasm types associated with a higher risk of venous thrombosis. ObjectivesThis study aims to assess the effectiveness of ultrasound-guided management in detecting and treating asymptomatic CRT in cancer patients with PICC. MethodsIn this prospective cohort study of 120 patients with solid neoplasms receiving chemotherapy, we investigated the incidence of isolated upper-extremity superficial vein thrombosis, upper-extremity deep vein thrombosis, and fibrin sheath formation through ultrasound follow-up at 30 and 90 days after catheter insertion. We analyzed risk factors associated with CRT and compared incidence rates between PICC-PORT and traditional PICC. ResultsAmong the cohort, 69 patients (57.5%) had high-risk thromboembolic neoplasm, and 31 cases (25.8%) of CRT were observed, mostly within 30 days, with only 7 cases (22.6%) showing symptoms. Traditional PICC use (odds ratio, 5.86; 95% CI, 1.14-30) and high-risk thromboembolic neoplasm (odds ratio, 4.46; 95% CI, 1.26-15.81) were identified as independent risk factors for CRT. ConclusionThe majority of CRT present asymptomatically within the first 30 days of venous catheter insertion in patients with solid neoplasms. Ultrasound follow-up is valuable for detecting asymptomatic CRT. The risk of CRT was lower with PICC-PORT than with PICC. Additionally, the risk of CRT was found to be higher in patients with high-risk thromboembolic neoplasms. It is crucial for larger studies to confirm the utility of treating asymptomatic thromboses and isolated superficial thrombosis.

Impact of the insertion site of central venous catheters on central venous catheter-related bloodstream infections in patients with cancer: results from a large prospective registry.

Overall, insertion of central venous catheter (CVC) into femoral veins (FV) has been shown to be associated with a higher risk of infection compared with subclavian and internal jugular (IJV/SCV) CVC, but no data are available on the impact of the FV insertion site on the CVC-related bloodstream infections (CRBSI) risk in patients with cancer. The objective of the study is to compare CRBSI rates and incidences of FV with those of internal jugular and subclavian vein (IJV/SCV CVC) as observed in the prospective SECRECY registry. SECRECY is an ongoing observational, prospective, clinical CRBSI registry active in six departments of hematology/oncology in Germany. Each case of FV CVC was matched at a ratio of 1:1 to a case with IJV/SCV CVC. The propensity score was estimated using a multivariable logistic regression model adjusting for age, sex, cancer type, and duration of indwelling catheter. Of 4268 CVCs included in this analysis, 52 (1.2%) were inserted into the FV and 4216 (98.8%) into the IJV/SCV. 52 cases of FV CVC were matched with 52 IJV/SCV CVC. There was no significant difference in the CRBSI rate (3.8% vs. 9.6%), the CRBSI incidence (5.7 vs. 14.2/1000 CVC days), and the median CVC time (5.5 vs. 5days) between the FV and the IJV/SCV group. Based on this data, inserting FV CVCs in patients with cancer does, at least in the short-term, not appear to be associated with an increased risk of CRBSI as compared to IJV/SCV CVC.

Significance of ultrasound navigation during central venous catheterization in children with scoliotic spinal deformity: a prospective observational single-centre study

BACKGROUND: Surgeries to correct scoliotic spinal deformity (posterior corrective transpediculocorporal fusion) are classified as highly traumatic, are accompanied by significant blood loss, and require reliable venous access. Central vein catheterization is an important part of patient management and is a successful and safe procedure.
 AIM: To evaluate the effectiveness of ultrasound navigation during central venous catheterization in patients with severe and super-severe scoliotic spinal deformity.
 MATERIALS AND METHODS: A single-center prospective study included 52 patients aged 6 to 18 (median age 13.2) years undergoing surgical treatment to correct grade IV scoliotic spinal deformity. Patients underwent catheterization of the internal jugular vein under ultrasound navigation using an ultrasound scanner with a linear sensor and a frequency of 713 MHz. The procedures were performed by one operator. The following were assessed: anatomy of the neurovascular bundle, relative position of the vessels relative to each other, size of the internal jugular vein in a horizontal and Trendelenburg positions, frequency and time of the procedure, and complications during puncture and catheterization.
 RESULTS: In patients with severe scoliotic deformity of the spine, an atypical location of neck vessels was noted in every fifth patient (13.46%). The peculiarity of the location of the vessels was associated with congenital developmental anomalies. The most common anomaly in the location of the vessels relative to each other was the medial location of the internal jugular vein relative to the carotid artery. In one patient, the passage of the internal jugular vein at a considerable distance from the carotid artery was revealed, which made it impossible to puncture according to anatomical landmarks. The average diameter of the internal jugular vein in the horizontal position was 6.20.9 mm. In the Trendelenburg position, the diameter was 9.081.5 mm. The average duration of the procedure was 92 seconds (70). Taking into account the use of ultrasound navigation during catheterization of the internal jugular vein, no early and late complications occurred.
 CONCLUSION: The use of ultrasound navigation for central venous catheterization during surgical treatment of severe and super-severe scoliotic deformities of the spine is a safe and essential method. The Trendelenburg position allows for better visualization of the jugular vein and facilitates its puncture and catheterization. The use of ultrasonography during invasive vascular manipulations allows for minimizing the number of failed catheterizations and avoiding complications, which improves the efficiency of medical care and increases the level of comfort and safety for the patient.

Comparison of Complications in Patients with Central Venous Catheter Placement Via Internal Jugular, Subclavian and Femoral Route at Intensive Care Unit

Central venous lines are passed in almost all patients admitted in intensive care unit and a need still exist to look for best route for this purpose. Objective: To compare the complications in patients with central venous catheter passed via internal jugular, subclavian and femoral route at intensive care unit. Methods: A comparative cross-sectional study was conducted on 380 patients admitted in intensive care unit of Bahria International Hospital RWP from January 2022 to June 2022. Central venous catheters were passed by consultant critical care specialist on call at the time of reception of patient in unit. All the patients were observed for one week for presence of any local or systemic complications. Results: Out of 380 patients, 240 (63.2%) were male while 140 (36.8%) were female. Central venous catheter was passed via internal jugular vein in 220 (57.8%) patients, via subclavian route in 60 (15.8%) patients and via femoral route in 100 (26.3%) patients. Failed attempts were seen statistically significantly more in internal jugular route (p-value-0.041) while local cellulitis was seen more in femoral route (p-value-0.012). Conclusions: Internal Jugular vein was the route most commonly used for insertion of central venous catheter in patients admitted in our intensive care unit. Complications were seen more not very common in our setting. Failed attempts were more seen in internal jugular route while local cellulitis was seen more in femoral route.

A Prospective Study of Apixaban for Central Venous Catheter Associated Upper Extremity Deep Vein Thrombosis in Cancer Patients: Catheter 3

Introduction Upper extremity deep vein thrombosis (UEDVT) represents up to 10% of cases of venous thromboembolism (VTE) and is frequently associated with central venous catheter (CVC) placement in patients receiving chemotherapy for cancer. UEDVT may be treated with low molecular weight heparin (LMWH) either as monotherapy or subsequently transitioned to warfarin as we have previously shown (Kovacs 2007). In the Catheter 2 Study (Davies 2018) we showed that Rivaroxaban had efficacy but in the 70 patients that were included there were 6 major bleeds (8.6%) and 1 death due to pulmonary embolism (PE). Given these findings we decided to evaluate the safety and efficacy of Apixaban in the treatment of UEDVT secondary to CVC in patients with cancer. Methods We conducted a prospective cohort study at 3 centres in Canada between May 2017 and December 2021. We enrolled patients ≥18 years of age with active malignancy and symptomatic proximal UEDVT (axillary or more proximal) with or without PE, associated with a CVC. Exclusion criteria included dialysis catheters, active bleeding, platelet count <75 x 109/L, creatinine clearance <30 mL/min, PE with hemodynamic instability, inability to infuse through the catheter after a trial of intraluminal thrombolytic therapy (tissue plasminogen activator, tPa), patients with acute leukemia, patients with multiple myeloma awaiting bone marrow transplant within 3 months, thrombosis involving the brachial, basilic or cephalic veins only, treatment for >7 days with other anticoagulants, need for dual antiplatelet therapy (recent stent), or concomitant use of P-glycoprotein and CYP3A4 inhibitors. The primary objective was to estimate catheter survival at 3 months (defined as a catheter that did not develop infusion failure not responding to 2 mg of tPa). Secondary outcomes included recurrence of DVT, PE, major bleeding, clinically relevant non-major bleeding (CRNMB) and death. All events were independently adjudicated. Due to the fact that in the Catheter 2 Study most bleeds occurred while taking 15 mg bid of Rivaroxaban, for this study, patients were treated with dalteparin, 200 IU/kg x 7days followed by Apixaban 5 mg po bid to complete 12 weeks. tPa for management of blocked lines was allowed. Patients were followed clinically for 12 weeks to assess for clinical events including recurrent symptomatic VTE, major bleeding and CRNMB. Results We included 70 patients (41, 59% women) with a mean age of 62 years. DVTs were diagnosed by ultrasound and 2 patients (3%) also had PE at baseline. The most common veins involved were axillary (n=53, 76%) and subclavian (n=52, 74%), followed by the brachial, internal jugular, brachiocephalic and external jugular. Peripherally inserted central catheters (PICC) were the most common (n=56, 80%), followed by port-a-cath lines (n=14, 20%). Types of active malignancy included breast (n=22, 31%), colon (n=12, 17%), colorectal (n=7, 10%), lung (n=4, 6%), bladder (n=3, 4%), pancreatic (n=3, 4%) and other (n=19, 27%). Catheter survival was 57% at 12 weeks with no catheters removed due to thrombosis and all catheters were functional until removal or end of study. Reasons for CVC removal prior to the end of the study included end of therapeutic need (n=21), infection (n=3), accidentally fell out (n=3), patient preference (n=1), and death (n=2). One patient (1.4%) had a recurrent DVT in the same arm during the 3-month follow-up period. The 2 patient deaths were both due to underlying cancer. There were 7 bleeding events in 6 patients, 3 major (2.9%) and 4 CRNMB (5.7%). (1 patient had 2 major bleeds). Discussion In this study, Apixaban showed promise in treating CVC-associated UEDVT in cancer patients, resulting in high preserved CVC function.

The effect of an intermediate dose of Heparin solution in the Prevention of Central Venous Catheter occlusion on ICU admitted patients: A randomized Controlled Trial

Background and aim: Central venous catheters (CVC) are widely used in critical care units. Due to the high prevalence of central venous catheter dysfunction, the cost, and the complications of their replacement, finding the right way to prevent catheter occlusion becomes important. The current study aimed to evaluate the effect of an intermediate dose of heparin solution in the prevention of central venous catheter occlusion in ICU-admitted patients.Method: This randomized controlled trial was performed in the Adult Intensive Care Unit (AICU) of Imam Reza Hospital from 2019 to 2020. In each patient (153 patients), the lines were divided into two categories: active or inactive. Inactive lines in the intervention group (76 patients) were washed every 8 hours with 10 ml of saline solution and then filled with 1.5 ml of heparin solution (at a concentration of 100 units per ml). In the control group (77 patients) only washing with 10 ml of saline solution was performed. The active lines in the intervention group were first washed with 10 ml of saline solution after each use and filled with 1.5 ml of heparin solution if not used immediately. In the control group, only saline washing was performed. Each line was examined once daily during the morning shift to determine whether it was open or closed.Result: In the studied lines in 153 patients admitted to the intensive care unit who were divided into two groups of intervention (heparin) and control (saline), no significant difference was observed in the occlusion of the catheter lines (p&gt;0.05).Conclusion: After 14 days of examination of central venous catheters in patients, the effectiveness of an intermediate dose of heparin in preventing catheter obstruction was not more than the saline solution.

Scheduled removal of central venous catheters (CVC) to prevent CVC-related bloodstream infections in patients with hematological disease or autologous stem cell transplantation: a registry-based randomized simulation-study

Although not generally recommended, scheduled central venous catheter (CVC) removal is sometimes carried out in order to reduce the CVC-related bloodstream infection (CRBSI) incidence. We conducted a simulation for scheduled CVC removal within the multicenter CRBSI registry (SECRECY). Non-tunneled jugular and subclavian CVC in patients with hematological disease or with germ cell tumors (including patients receiving autologous stem cell transplantation [SCT]) were included. Cases were randomized in a 1:1:1:1 ratio to either a simulated, scheduled CVC removal after 7, 14, and 21 days, or to non-simulated, unscheduled CVC removal (control group). The primary endpoint was definitive CRBSI incidence for a scheduled CVC removal after 14 days (dCRBSI-D14rmv). Among other, secondary endpoints were definite CRBSI incidence for a scheduled removal after 7 days (dCRBSI-D7rmv) and 21 days (dCRBSI-D21rmv). Data on 2984 CVC were included. Patients’ median age was 59 (range 16–95) years, 58.8% being male. The vast majority (98.4%) were patients with hematological malignancies. Jugular veins were the main insertion site (93.2%). dCRBSI-D14rmv was 3.10/1000 CVC days as compared to 4.15/1000 CVC days in the control group (p = 0.23). There was a significant difference between dCRBSI-D7rmv (0.86/1000 CVC days) and controls (p < 0.001), but not between dCRBSI-D21rmv (4.10/1000 CVC days) and controls (p = 0.96). Our data suggest that in patients with hematological diseases or autologous SCT recipients scheduled CVC removal after 14 days does not result in a lower CRBSI incidence compared to unscheduled removal.Trial registration: DRKS00006551, 2014/09/29, retrospectively registered.

Arteriovenous fistula: an interesting alternative to central venous catheters in patients not undergoing dialysis

Native arteriovenous fistula (AVF) is the recommended first line vascular access in patients undergoing hemodialysis. For other chronic pathologies requiring a long-term vascular access, central venous catheters are used the most. The aim of this study was to evaluate the mid-term results of arteriovenous fistulas used as chronic vascular accesses in patients not undergoing dialysis.

Effectiveness and cost-efficacy of diuretics home administration via peripherally inserted central venous catheter in patients with end-stage heart failure

BackgroundEnd-stage heart failure (ESHF) is characterized by severe cardiac dysfunction with persistent disabling symptoms and recurrent acute decompensated heart failure (ADHF), despite guideline-directed medical therapy. The aim of this study was to evaluate the efficacy and safety of intravenous diuretics administration at home through a peripherally inserted central venous catheter (PICC) in ESHF patients. Methods and resultsForty-one ESHF patients received PICC implantation for intravenous diuretic administration at home. The primary efficacy endpoint was the patient-level number of HF hospitalizations in the short (1–3 months), medium (six months), and long term (1 year), before and after PICC implantation. Pre- and post-PICC ADHF-free days were also evaluated as co-primary endpoint. Secondary endpoints comprised changes in clinical, laboratory and echocardiographic parameters, and device safety. A cost-effectiveness analysis was performed to estimate the economic impact of using PICC. For each time frame analyzed, a significant reduction in the number of hospitalizations due to ADHF was observed, resulting in a significant increase in ADHF-free days (71 ± 44 vs. 163 ± 136, p = 0.003). In matched patients' analysis, significant decrease in body weight (68 ± 16 kg vs. 63 ± 10 kg, p = 0.041) and mitral regurgitation grade 3/4 (55% vs. 18%, p < 0.001) were also observed. Freedom from PICC-related complications was observed in 61% of patients. A significant reduction in overall ADHF-hospitalizations cost was observed. ConclusionsThis proof-of-concept study demonstrates the effectiveness and safety of home administration of intravenous diuretic therapy via PICC in ESHF patients. This palliative cost-effective strategy can be taken in consideration for selected end-stage patients no longer responsive to conventional therapies.

Infections and colonisation of central venous catheters in patients admitted to intensive care units at two tertiary care hospitals

Introduction: Central venous catheters (CVC) are frequently used in modern health care systems. However, CVCs are likely to get colonised with microorganisms, resulting in catheter-related blood stream infections (CRBSI). This study investigated microorganisms causing CRBSI and CVC colonisation, their antibiotic resistance, and factors associated with CRBSI in patients in the intensive care units (ICU) at the Colombo North Teaching Hospital (CNTH) and Apeksha hospital, Sri Lanka. Methods: The study included 300 adult patients in ICUs with a CVC in-situ for &gt;48 hours. Blood taken through the CVC, peripheral blood and CVC tips were cultured. Microorganisms were identified and tested for antibiotic susceptibility. Demographic factors were recorded. Results: Seventeen patients (13.1%) developed CRBSI. The CRBSI rate was 13.3 per 1,000 catheter days in CNTH while it was 10 (5.9%) cases and 5.2 per 1,000 catheter days in Apeksha hospital. In CNTH, CVC colonisation was detected in 35 (26.9%). Coagulase negative staphylococci (CoNS) were the leading cause of both CRBSI (41%) and colonisation (58%). In Apeksha hospital, Klebsiella sp. (5/10) were the predominant pathogens that caused CRBSI. Eighty-nine CVCs (52.3%) were colonised by CoNS (58%). In CNTH, CRBSI was detected more in males (14/17) (p&lt;0.05). The majority of microorganisms that caused CRBSI and CVC colonisation in both hospitals showed resistance to commonly used antibiotics. Conclusion: The CRBSI rates and the incidences were higher in CNTH. CoNS was the most common cause of CRBSI in CNTH and Gram negative bacteria in Apeksha hospital. CVC colonisation with CoNS was common in both hospitals. Antibiotic resistance was high among bacteria causing CRBSI and colonisation.

Травма центральных сосудов, приведшая к профузному кровотечению, после имплантации туннельных диализных катетеров у больных, находящихся на лечении гемодиализом

The need for central venous catheters in patients on hemodialysis is very high. Even though complications of catheter implantation are rare (on average about 0.5% of cases, according to own data - 0.37%), their treatment is extremely difficult and, in most cases, requires a large surgery. We present four clinical observations. In the first case, during the puncture was damaged the left subclavian vein in the area of its fixation to the first rib and confluence with the internal jugular vein. The resulting heavy bleeding required a thoracotomy, the bleeding was stopped. The patient was discharged. In the second case, there was damage to the left common carotid artery. The defect was eliminated during the operation. The patient was discharged. In the third case, the right common carotid artery was damaged. During the first hours after the injury, the local hematoma did not grow, the condition remained stable. Four hours after physical exertion (stool), there was a rapid increase in hematoma, compression of the trachea, and suffocation. Attempts to intubate were unsuccessful. An emergency tracheostomy was performed. Despite this, the patient died. In the fourth case, the upper vena cava was damaged. In this case, the catheter was located in the projection of the right atrium on the frontal x-ray. The pleural cavity was drained. In connection with the ongoing bleeding on the pleural drainage, an emergency computer tomography was performed, where it was found that the catheter perforates the vein and was located in the pleural cavity. An emergency thoracotomy was performed, the vein defect was eliminated. The patient was discharged after long-term treatment. Thus, a series of clinical observations demonstrate that the diagnosis of severe complications of large vessel damage during the dialysis catheters implantation is difficult due to several factors: the patient's condition, anatomical features, comorbid background, and many localizations of possible damage to vessels. Complicated catheter implantation requires mandatory ultrasound control, observation in the intensive care unit, mandatory x-ray examination, and, if necessary, computer tomography for early detection of life-threatening conditions.

The need for multiple vascular access or preemptive central venous catheterization in patients requiring planned interhospital helicopter transport: a flight doctor’s suggestion

Hemorrhagic shock can develop due to severe bleeding, such as after major trauma, postpartum or gastrointestinal bleeding. At least two peripheral intravenous routes with large-bore catheters are recommended to reverse hemorrhagic shock, and such functional intravenous routes are essential for the proper management of other concurrent diseases as well. Conditions during helicopter transportation are different from those seen in-hospital, and the primary concerns are to maintain aseptic conditions, protect patient’s privacy, and prevent infection risk, especially during pandemics, such as the ongoing COVID-19. Herein, I describe two recent experiences of improper management during helicopter transport due to intravenous line malfunction. Subsequently, based on my experience, I suggest the use of multiple intravenous routes or preemptive central catheterization in patients requiring helicopter transportation.

A prospective study of the use of central venous catheters in patients newly diagnosed with acute myeloid leukemia treated with induction chemotherapy.

Central venous catheters (CVCs) are widely used in acute myeloid leukemia (AML) patients. Complications associated with CVCs are frequently encountered and contribute to morbidity and mortality. Prospective studies investigating and comparing complications of different types of CVCs in AML patients and their effects on the quality of life are limited. We conducted a prospective observational study and evaluated the complications associated with the use of CVCs in adult AML patients during induction chemotherapy and evaluated quality of life outcomes as reported by the patients during and after their hospitalization. Fifty newly diagnosed patients with AML (median age, 59years) who received intensive induction chemotherapy were enrolled in the study. Twenty-nine patients (58%) had a peripherally inserted central catheters (PICCs) placed and 21 (42%) patients received a Hickmann tunneled central catheter (TCC). Three percent of cases developed catheter-related thrombosis in PICCs and no thrombosis in TCCs. Catheter-related bloodstream infection was diagnosed in 8% of patients. CVC occlusion occurred in 44 patients (88%). The total number of occlusion events was 128; 97% of patients with PICCs and 76% of patients with TCCs (p = 0.003). All patients reported that the use of CVC simplified their course of treatment. Most patients reported similar restrictions in activity associated with TCCs and PICCs. The present study demonstrates that thrombosis and catheter-related bloodstream infections remain important complications of CVCs in AML patients. Occlusion rates were higher with the use of PICCs and the use of CVCs impacted the quality of life.

ТРОМБОЗ ГЛУБОКИХ ВЕН ВЕРХНИХ КОНЕЧНОСТЕЙ

Upper extremity deep vein thrombosis (UEDVT) constitutes around 10% of all DVT, and can cause both pul-monary embolism (PE) and post-thrombotic syndrome (PTS) in the arm. The incidence of secondary UED-VT is increasing due to widespread use of central venous catheters in patients with cancer and other chronic diseases. We report a case of 51-year-old female diagnosed with upper extremity deep venous thrombosis in emergency department with no co-morbidities and its successful treatment.

Mindful organizing as a healthcare strategy to decrease catheter-associated infections in neonatal and pediatric intensive care units. A systematic review and grading recommendations (GRADE) system.

To explore the clinical evidence available on mindful organizing (MO) that will improve teamwork for positioning and managing central venous catheters in patients admitted to neonatal intensive care and other pediatric intensive care units to decrease central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). We searched several databases (PubMed, Embase, CINAHL, CENTRAL, SCOPUS, and Web of Science) up to June 2018. We included studies investigating the effectiveness of MO teamwork in reducing CLABSI and CRBSI. The systematic review followed the PRISMA guidelines. We used validated appraisal checklists to assess quality. Seven studies were included: only one was a non-randomized case-controlled trial (CCT). All the others had a pre-post intervention design, one a time-series design and one an interrupted time-series design. The methodological heterogeneity precluded a meta-analysis. Despite the low certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, three studies including thousands of participants provided numerical data for calculating risk ratios (RR) and 95% confidence intervals (CI) comparing MO with no intervention for decreasing the CLABSI rate in neonatal and pediatric ICUs. The one CCT disclosed no significant difference in the CLABSI rate decrease between groups (RR = 0.96; 95%CI 0.47-1.97). Nor did the pre- and post-intervention interrupted time-series design disclose a significant decrease (RR = 0.80; 95%CI 0.36 1.77). In the study using a before-after study design, the GRADE system found that the CLABSI rate decrease differed significantly in favor of post-intervention (RR = 0.13; 95%CI 0.03 0.57; p = 0.007). Despite the decreased CLABSI rate, the available evidence is low in quality. To reduce the unduly high CLABSI rates in neonatal and pediatric intensive care settings, custom-designed clinical trials should further define the clinical efficacy of MO to include it in care bundles as a new international standard.

Prevention of Central Venous Catheter Associated Infections Using Boron Carbon Nitride (BCN) Thin Films

Central line-associated blood stream infections (CLABSIs) are the infections caused due to use of central venous catheters in patients. Implanted catheters are susceptible to bacterial colonization, biofilm formation and consequently resulting in infection. CLABSIs continue being important and preventable health-care related infection. Of all the healthcare associated infections, CLABSIs make up to 250,000 cases per year in the US with mortality of up to 35% [1]. Additionally, these infections are associated with high hospital stay durations leading to extremely high cost burden accounting to ~$46,000 per case [2]. However, central venous catheters are imperative in delivery of fluids and medications and to monitor the patient health. Current approach to mitigate this problem heavily focusses on deposition of coatings, inhibiting bacterial adhesion and reducing biofilm formation.In this study, boron carbon nitride (BCN) coatings will be incorporated on central venous catheters for the first time. Boron carbon nitride (BCN) films have achieved attention owing to their crystal structure and unique properties. BCN compounds are expected to combine excellent properties of diamond, boron carbide and boron nitride with their properties adjustable depending on their composition and structure[3]. B-C-N ternary compounds have been reported previously for biological applications [4-7]. Influence of BCN coating on bacterial colonization of gram-positive and gram-negative bacteria will be investigated. BCN films will be deposited using RF sputtering technique.

Infectious complications after insertion of peripheral or central venous catheters in patients on parenteral nutrition

Rationale: Parenteral Nutrition (PN) is an independent risk factor for bloodstream infections (BI). Guidelines do not agree when to start PN in the critical illness and there is sometimes unfounded fear on the part of assistant physicians and surgeons regarding the safety of PN.

Effects of a Quality Improvement Program to Reduce Central Venous Catheter-Related Infections in Hemodialysis Patients

BackgroundCentral catheter infections are of concern in patients on hemodialysis because of the high risk of catheter-related bloodstream infections, sepsis, and death. Adequate nursing is critical for the prevention of such infections. This study aimed to use the PDCA (plan-do-check-act) method to reduce the incidence of central venous catheter infection using management in the maintenance of central venous catheter in patients on hemodialysis, compared with routine care. MethodsThis pilot study recruited patients on hemodialysis via central venous catheterization at the Blood Purification Center of Ruijin Hospital between November 2017 and November 2018. The patients were randomized to the routine and PDCA groups. All participants received routine nursing. The PDCA group received central venous catheter management by PDCA. The incidence of central venous catheterization-related infections, nursing satisfaction, and quality of life were compared between the two groups. ResultsA total of 122 participants were enrolled in each group. The incidence of central catheter-related bloodstream infection, as the primary outcome, was 0.8 and 8.8 cases per 1000 catheter days in the PDCA and routine groups, respectively (P < 0.001). In addition, as the secondary outcomes, the scores of nursing satisfaction (health guidance, nursing technology, and therapeutic effects) score and quality of life (physiological, psychological, social, and environmental status) were better in the PDCA group than in the routine group (all P < 0.01). ConclusionsThis pilot study suggests that the PDCA cycle model can effectively reduce the incidence of central venous catheter-related infections and improve satisfaction and quality of life in patients on hemodialysis.

Comparison of outcomes of central venous catheters in patients with solid and hematologic neoplasms: an Italian real-world analysis.

Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other. We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs). A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; p = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs (p = 0.013). No significant differences in terms of catheter-related thromboses (p = 0.676) or catheter-related infections (p = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort (p = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128-0.536; p < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018-0.372; p < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135-0.553; p < 0.0001). This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk-benefit assessment, patient preferences, and compliance.