Lumen Central Venous Catheter Research Articles

CAT Study: Pediatric Catheter-Associated Thrombosis: A Retrospective Electronic Record Review

Highlights CAT is a significant problem in pediatric patients with CVCs and other risk factors. CAT was found in 4% of the sample with estimated 0.23 events per 1,000 CVC days. Incidence of CAT was lower than anticipated but consistent with published evidence. Median LOS was substantial in the CAT group suggesting increased disease burden. Specific clinical modifiers and CVC factors were more common in the CAT group. Findings provide valuable foundation for future CAT research and risk models. Clinicians and researchers should collaborate to reduce CAT incidence. Abstract Background: Catheter-associated thrombosis (CAT) is a serious condition, especially among pediatric surgical patients. This study describes the CAT incidence rate and clinical, demographic, and central venous catheter (CVC)-specific risk factors that may be associated with CAT, for a cohort of pediatric surgical patients. Methods: An electronic record review of 124 pediatric surgical patients with indwelling CVCs receiving parenteral nutrition (PN) cared for in a single pediatric hospital between 2016 and 2018 was performed. Results: Of the 297 CVCs, 4% of patients (n = 5) developed CAT, resulting in an estimated incidence rate of 0.23 events per 1,000 CVC days (95% confidence interval 0.15–0.31). Patients diagnosed with CAT had a higher burden of anemia, blood product administration, chronic lung disease, congenital heart disease, sepsis, prolonged mechanical ventilation, extracorporeal membrane oxygenation use, increased surgical complexity, and longer hospital stays. They also had a higher frequency of peripherally inserted central catheters, small caliber size CVCs, double lumen CVCs, extended PN and lipid course, lack of ethanol prophylaxis, higher rates of intravenous antibiotics, lower rates of treatment-dose heparin, and prolonged CVC duration. Conclusion: The incidence of CAT in this study was consistent with published rates for hospitalized pediatric patients with CVCs. The study provides additional foundational evidence about clinical, demographic, and CVC-specific risk factors associated with CAT in pediatric surgical patients with CVCs. It can help guide future research and collaborative efforts to develop risk assessment and other preventative strategies to reduce CAT incidence and improve patient care outcomes.

Efficacy of Ultrasound-Guided Double Lumen Central Venous Catheter Insertion in Minimizing Mechanical Complications and Bloodstream Infections: An Empirical Evidence of Pakistan

The aim of the study was to compare the outcomes of ultrasound-guided double-lumen central venous catheter (DLC) insertion and without ultrasound guidance in reducing mechanical complications and bloodstream infections. This quasi-experimental study was conducted at Urology Department in collaboration with the Anesthesia department at GMC Teaching Hospital Gujranwala. The study had 60 insertions in each group. The insertion duration ranged from 8-50 days in Group A and 9-60 days in the B group. Placements were done at the right internal jugular and right subclavian veins. Four patients in Group A and five patients in Group B experienced catheter-related bloodstream infections (CRBSI), but the difference was not significant. The Charlson Comorbidity Index (CCI) was 0-10 in Group A and 0-8 in Group B. Group A had no mechanical complications, while three patients in Group B experienced manageable complications. In conclusion, ultrasound-guided DLC placement improves safety but does not reduce CRBSI.

#4772 DOUBLE FILTRATION PLASMAPHERESIS DURING HETEROLOGOUS FERTILIZATION PREGNANCY FOR THE TREATMENT OF HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA

Abstract Background and Aims Pregnancy in women affected by familial hypercholesterolemia is rare. Estrogen and progesterone fluctuations, featuring pregnancy, adversely influence lipid metabolism, causing considerable increase of LDL-C, triglyceride and lipoprotein A levels. These changes in fatty metabolism, essential for embryonic development, might be critical for placental circulation and for mother's health. Indeed, high lipoprotein amount can raise uteroplacental vascular resistance and it is associated with intrauterine growth restriction because of oxidative stress, whereas hypertriglyceridemia and hypercholesterolemia might cause an increased risk of cardiovascular accidents and pancreatitis. Lipid-lowering drugs, such as statins, ezetimibe or PCSK9 inhibitors are discontinued due to possible teratogen effects. Thus, LDL apheresis is the only available therapy for severe hypercholesterolemia during pregnancy. Method A 46 years old woman affected by heterozygous familial hypercholesterolemia in treatment with PCSK9 inhibitors and statins, decided to undergo an heterologous in vitro fertilization with oocyte donation. Hence, pharmacological therapy was stopped to avoid teratogen effects. We started a 10-months apheresis program with double filtration plasmapheresis (DFPP). The treatment was performed by a temporary double lumen central venous catheter. Initially, she underwent apheresis twice a month with an average exchange volume of 1.2, low blood flow (≤ 90 ml/min) and incremental plasma flow (from 5 to 30 ml/min every 10 minutes of treatment), to ensure a physiological procedure. We gradually modulated the exchange volume monitoring blood levels of LDL-C, Lp(a) and triglycerides before and after each procedure. We aimed to keep mean LDL-C level < 200 mg/dl. We did not use anti-coagulation during the procedure, monitoring TMP values and arterial-venous pressure. Results LDL-C levels remained about 227.2 ± SD 91 mg/dl, with a median of 186.8 mg/dl, complying with the target range (Figure 1). Mean triglycerides and Lp(a) values were, respectively, 180.3±94 mg/dl (median 146 mg/dl) and 77.3±36.3 mg/dl (median 55.7 mg/dl) (Figure 1). Our patient did not face any complications related to pregnancy or to the procedure, and gave birth at 38th gestational week to an healthy full-term male baby of 52 centimeters and 3.34 kilograms. Conclusion Although there is a widespread hesitation in performing extracorporeal blood purification treatment in pregnancy, this case underlines the essential role of LDL apheresis in in this setting, giving spark to standardize the procedure and to encourage its use also in pregnancy.

Is minimising waste volume for drawing blood samples in critically ill patients feasible?

IntroductionDrawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AimTo determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. MethodA quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (−.536; .012); prothrombin time (−.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.

Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible?

IntroductionDrawing blood samples through a central venous catheter is a customary practice in intensive care units. It is indicated to discard a volume of waste blood to avoid interference in the results. AimTo determine whether a lower discard volume for obtaining blood samples from temporary central venous catheters placed into the internal jugular, femoral or subclavian vein offers valid results. MethodA quasi-experimental prospective cross-sectional study for which 65 patients of over 18 years of age in intensive care units, who had been fitted with a triple lumen central venous catheter, were recruited over a period of 8 months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and haemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5ml from a total extracted volume of 10.2ml, similar to the usual waste in our ambit (10ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient were used to measure the agreement between methods. The reference change value was established as the admissible limit of variation between the pairs of samples. ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α=0.05 for chlorine (−0.536; 0.012); prothrombin time (−0.092; 0.019) and prothrombin activity (0.284; 1.375). The intraclass correlation coefficient was greater than 0.9 in all the variables and the limit determined for the reference change value was not surpassed by any value. ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5ml.

Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery.

Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HPN in AC and evaluate associated outcomes, including hospital readmissions and HPN-related complications. This was a cohort study of adults with AC requiring palliative HPN between 2010–2018 at a tertiary intestinal failure (IF) center, primarily utilizing a centralized model of HPN oversight to discharge patients remotely from an oncology center to their homes over a wide geographic area. A total of 126 patients were included, with a median distance between the patient’s home and the IF center of 17.5 km (IQR 10.9–39.1; maximum 317.4 km). A total of 28 (22%) patients experienced at least one HPN-related complication, the most common being a central venous catheter (CVC) occlusion and electrolyte abnormalities. The catheter-related bloodstream infection (CRBSI) rate was 0.49/1000 catheter days. The CVC type, administration of concomitant chemotherapy via a distinct CVC lumen separate from PN, venting gastrostomy and distance between the patient’s home and the IF center were not associated with CRBSI or mechanical CVC complications. A total of 82 (65.1%) patients were readmitted while on HPN, but only 7 (8.5%) of these readmissions were HPN-related. A total of 44 (34.9%) patients died at home, 41 (32.5%) at a hospice and 41 (32.5%) in a hospital. In conclusion, this study demonstrates that a centralized approach to IF care can provide HPN to patients over a large geographical area while maintaining low HPN-related complications that are comparable to patients requiring HPN for benign conditions and low hospital readmission rates.

Intraoperative accurate assessment of septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM)

Surgical restoration of the left ventricular outflow tract (LVOT) is necessary for patients suffering from hypertrophic obstructive cardiomyopathy (HOCM), when symptoms are present despite the administration of medical treatment. One point of great significance during the procedure is the evaluation of the LVOT gradient after completion of septal myectomy. Most physicians choose to measure this value by transesophageal echocardiography (TEE) in combination with the direct measurement with the use of needles inserted into the aorta and left ventricle. In this article, we present the implementation of a new technique to estimate the peak-to-peak pressure gradient between the left ventricle and the aorta intraoperatively using a single double lumen central venous catheter inserted through the antegrade cardioplegia cannulation site across the aortic valve into the left ventricle.

521 Maintaining Central Line Patency in Burned Children

IntroductionChildren with major burn injury frequently require prolonged central venous access to assure appropriate fluid management and pain control. Central venous catheters in children frequently develop clots that prevent drug administration, requiring administration of tissue plasminogen activator (TPA). The purpose of this study was to identify the frequency and efficacy of TPA use in burned children with central venous catheters (CVC).MethodsThis retrospective chart review evaluated all children requiring CVC admitted to our tertiary pediatric burn center from 2018-2019. Data collected included patient demographics (age, burn size, hospital length of stay (LOS)), catheter-related data (number of central lines, lines replaced due to clotting), TPA administration (number of times administered, successful TPA administrations, how often repeated), and line clotting data (time from insertion to clot, interval between TPA order and administration).ResultsIn 2018, 116 lines were place in 49 children with mean age of 8.4 years and mean burn size of 29%, intensive care unit LOS was 24 days. TPA was infused in 20% of lines to relieve obstruction and was successful in relieving the clot in 21% (5/23). The interval between identification of the obstructed line to TPA order was 191 minutes, with the administration of TPA 83 minutes after order placement. The average time from identification of obstruction to TPA administration was 257 minutes. In 2019, 150 lines were place in 65 children with mean age of 5.2 years and mean burn size of 25%, LOS was 13 days in the PICU. TPA was infused in 5% of lines to relieve obstruction and was successful in relieving the clot in 0 % (0/8). The interval between identification of the obstructed line to TPA order was 117 minutes, with the administration of TPA 49 minutes after order placement. The average time from identification of obstruction to TPA administration was 158 minutes.ConclusionsThe incidence of obstruction in pediatric central venous catheters in our unit decreased from 26% in 2018 to 3% in 2019. TPA was successful in clot resolution in only 5% (2018), and 0% (2019) . Based on our results, we targeted areas for improvement including: Standing order for TPA; staff education on TPA use; decreasing our average time to identify, order, and administer TPA; and standardizing the frequency of flushing unused central venous catheter lumens with heparinized saline flush.

Prodigious Valve: Ultrasound Will Surely Help!!!

Prodigious Valve: Ultrasound Will Surely Help!!!

Late venous air embolism following insertion of Mayfield head pins.

Dear Editor, Venous air embolism (VAE) is not an uncommon event during neurosurgical procedures. It is an iatrogenic complication that occurs when air from the atmosphere enters into the systemic circulation specifically when the surgical site is above the level of heart producing a sub-atmospheric pressure in the open veins. A 27-year-old male diagnosed as a case of fronto-temporo-parietal meningioma was posted for craniotomy and excision under general anesthesia. His Glasgow Coma Scale [GCS] was 15, and no neurological deficit was present. All laboratory investigations were within normal limits. His magnetic resonance imaging was suggestive of large well-defined lesion in left Sylvian fissure, extending into left basal cistern with mass effect. Following anesthesia induction, a Mayfield pin was used to stabilize the head of the patient in a supine position. The pin was removed and reinserted by the surgeon to improve the surgical access. Half an hour later, the surgeon repositioned the patient with head end elevated by 30 degree. We observe a sudden fall in end-tidal carbon dioxide concentration [EtCO2] from 30 to 19 mmHg with a drop of oxygen saturation from 100% to 95%. Rest of the vital parameters including heart rate and blood pressure demonstrated no change from baseline. We started the management with administration of 100% oxygen and intravenous fluids. We could aspirate 4–5 ml of air through the central venous line catheter [Arrow triple lumen central venous catheter, 7 French sizes, and 16-centimeter length]. We confirmed the central venous line position with electrocardiogram as a guide. The superior vena cava – right atrium junction positioning of the central venous line was confirmed with a tall P wave, which was equal to R wave height. The time frame between the event and air aspiration was one and half minutes. Within 1–2 min of air aspiration, oxygen saturation returned back to normal and EtCO2 rose up to 25 mmHg from 19 mmHg. No further episodes of VAE occurred during surgery. Mayfield head pin is commonly used in neurosurgical patients to keep the head stable during surgery. The literature is scarce in case reports showing an association of VAE and Mayfield head pins in adult patients.[12] Ture H et al. observed that the rate and severity of VAE were significantly lower in patients with 30-degree head elevation than in patients with 45-degree head elevation undergoing craniotomy in semi-sitting position.[3] This was a case of late VAE during repositioning of patient possibly following air entrainment through diploic veins injured at first attempt of pin insertion. In our case, we could not find any other possible explanation for this sudden decrease in EtCO2 except for the traumatized initial skull pin site being culprit for air entrainment after a change in position. At this time point, the surgery was not started and anesthetic depth was well maintained. The proper scanning of the surgical site by a surgeon before pin insertion, avoidance of sudden change in patient positioning, and proper suturing of the initial traumatized pin insertion site could avert this iatrogenic complication. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Comparison of Intra Abdominal Pressure Monitoring Techniques and the Effects of the Abdominal Compartment Syndrome

Background: Abdominal compartment syndrome (ACS) is a life-threatening condition that develops in the setting of increasing and uncontrolled intra-abdominal hypertension (IAH), leading to cardiovascular, respiratory, neurologic and/or renal dysfunction. Aims: To establish a porcine model for the evaluation of the effects of IAH on renal blood flow (RBF) and to determine if IVC pressure and/or Camino fiberoptic direct intraabdominal pressure measurements can accurately predict IAPs that have been derived using bladder pressure measurements. Methods: Abdominal laparotomy, placement of IAP and RBF measuring devices, and fascial closure were performed on six adult feeder pigs with a mean body weight of 25 +/- 5 kg. A Transonic Doppler flow probe, a suprapubic bladder catheter, a Camino fiberoptic probe, and a triple lumen central venous catheter were placed and then baseline measurements were taken of renal blood flow, bladder pressure, direct intra-peritoneal Camino pressure and IVC pressure, respectively. Normal saline was then infused into the abdomen to simulate increasing IAP. Following a 5–10-minute stabilization period, all measurements were again taken. Results: The correlation between IVC pressure and bladder pressure was 0.98, with a mean bias of -0.5 (SD 2.0; 95% CI: -0.9, -0.2). The correlation between direct IAP readings by Camino probe and bladder pressure was 0.91, with a mean bias of -3.9 (SD 4.3; 95% CI: -4.6, -3.2). There was a strong negative correlation (-0.95) between RBF and bladder pressure. At an IAP of 20 mmHg, RBF reduced by an average of 45.4% (95% CI: 40%, 50.8%). Upon abdominal decompression, RBF returned to 66.6% (95% CI: 54.3%, 78.9%) of its baseline value. Conclusions: A porcine model is effective in accurately measuring changes in real time RBF. RBF progressively declines as IAP increases, however upon decompression, it fails to achieve complete recovery. IVC pressure measurements correlate well with, and therefore may substitute, the gold standard bladder pressure measurements as representatives of IAP. Keywords: Abdominal Compartment syndrome, renal blood flow, intrabdominal hypertension, bladder pressure

Incidence rate and risk factors of central line-associated bloodstream infections among neonates and children admitted to a tertiary care university hospital

Central-line associated bloodstream infection (CLABSI) is a common healthcare-associated infection in patients indwelling central venous catheter (CVC). This study examined the incidence rates, risk factors, and clinical outcomes of CLABSI among neonates (aged < 1 month) and children (aged ≥ 1 month) admitted to a tertiary care university hospital. An overall CLABSI incidence rate was 3.2 per 1,000 catheter-days. Number of CVC lumen and place of catheter insertion were a significant risk factor among our neonates and children, respectively. CLABSI prolonged hospitalization and increased hospital costs.

Infusion Pump Flow Rates In Central Venous Catheters: Thrombus Reflux And Aspiration Clot

Aggressive infusion pump flow rates can lead to central venous catheter (CVC) occlusion resulting from thrombus reflux into the CVC lumen. &#x0D; &#x0D; Methods: A single-center prospective comparative study was performed, including all consecutive cases of occlusion events in hematology oncology patients using a CVC (Hickman® nº7) since August 2018 to September 2019 (Phase 1), and October 2019 to September 2020 (Phase 2) at the Onco-Hematology Department of the Portuguese Institute of Oncology (Porto). Two phases were described:&#x0D; Phase 1: Observational period using a platinum-based regime (DHAP) undergoing continuous infusion pump rate ≥ 200 mL/hr.&#x0D; Phase 2: Intervention period using a platinum-based regime (DHAP) undergoing continuous infusion pump rate ≤ 200 mL/hr.&#x0D; &#x0D; Results: Overall, 39 DHAP regimens were reported with a total number of 43 occlusions identified in the study period (phase 1, n=28 vs phase 2, n=15). Occlusion risk associated with the infusion pump rates between phases was higher in phase 1 (phase 1, n=11 vs phase 2, n=3, RR 3.313 [1.010 to 13.863], ≤0.05). When aspiration clot (n=5) was identified, CVC always was removed. No aspiration clot was observed in phase 2. &#x0D; &#x0D; Conclusion: Aggressive infusion pump flow rates can increase occlusion risk resulting from thrombus reflux into the CVC lumen and aspiration clot.

P0251 / #1820: PAEDIATRIC THERAPEUTIC PLASMA EXCHANGE. A MALAYSIAN TERTIARY PAEDIATRIC INTENSIVE CARE UNIT EXPERIENCE.

Aims & Objectives: To review indications, prescriptions, complications, and treatment outcomes of patient underwent therapeutic plasma exchange in Paediatric intensive Care Unit (PICU), Penang Hospital. Methods: A retrospective descriptive study. All patients from 1 month old to 18 years old who underwent therapeutic plasma exchange in our center will be included. Results: A total of 20 sessions of therapeutic plasma exchange (TPE) were performed in 4 patients from January 2016 to August 2018. All cases were due to demyelinating disorders of the nervous system. The median disease duration at time of TPE was 56.5 days. The vascular accesses for all sessions were through femoral vein using a double lumen central venous catheter. The median exchange volume was 50 ml/kg (range: 48 – 80 ml/kg), corresponding to exchange volume of 1.0 (range 1.0 –1.5). Mixture of Fresh Frozen Plasma (FFP) & 5% albumin were used as replacement fluid in 17/20 (85%). The median proportion was 69.2 % (range: 56.8% – 80%) for 5% albumin and 30.8% (range: 20% – 45%) for FFP. 5% albumin alone was used in 3/20 (15%) TPE in view of anaphylaxis towards FFP. We observed complications in 18 (90%) sessions. All patients showed favorable outcomes without mortality. Conclusions: Neurological disorders were the commonest indications for TPE in our center. TPE appeared to improve neurological outcomes in our patients.

Tryptophol Coating Reduces Catheter-Related Cerebral and Pulmonary Infections by Scedosporium apiospermum.

IntroductionCentral venous catheter (CVC) is a medical device that is used to administer medication for a long duration. Colonization by an emerging opportunistic pathogen Scedosporium apiospermum in the CVC lumen is frequently reported to cause severe complications in patients. Here, we describe the effect of fungal quorum-sensing molecule (QSM) known as tryptophol (TOH) to control S. apiospermum colonization in catheter tube lumens in both in vitro and in vivo models.MethodsAntifungal susceptibility of TOH against S. apiospermum was compared with voriconazole, and the colony diameter was determined on days 2, 4, and 6. Experimental catheterization rat model was conducted with pre-coating of TOH and voriconazole or an uncoated control and an infection with S. apiospermum. Biofilm formation on the catheter luminal surface was assessed using the scanning electron microscopy, crystal violet, and 2,3-bis(2-methoxy-4-ni-tro-5-sulfophenyl)-5-(phenylamino)-carbonyl-2H-tetra-zolium hydroxide (XTT) reduction assays. Brain and lung samples of catheterized rats were histopathologically assessed. Serum samples from catheterized rats were injected into Galleria mellonella larvae. Survival of catheterized rats and G. mellonella was determined.ResultsTOH impeded the growth of S. apiospermum by reducing the colony diameter in a dose-dependent manner. TOH coating remarkably lessened S. apiospermum biofilm formation and fungal cell viability on the catheter luminal surface. Additionally, TOH coating lessens cerebral edema that is associated with abscess and invasive pulmonary damages due to S. apiospermum catheter-related infection. Furthermore, TOH coating also lessened the virulence of S. apiospermum in sera of experimental catheterized rats and extended the survival rate of larvae Galleria mellonella infection model.ConclusionAn alternative modification of catheter by coating with TOH is effective in preventing S. apiospermum colonization in vivo. Our study gives a new strategy to control catheter contamination and prevents nosocomial diseases due to S. apiospermum infection.

Experiences from the epicenter: an observational report on converting a post anesthesia care unit to a COVID-19 intensive care unit

Experiences from the epicenter: an observational report on converting a post anesthesia care unit to a COVID-19 intensive care unit

Effect of the expression of CD62P and thrombin generation on patients using central venous catheters for hemodialysis.

The formation of thrombi in medical devices that come into contact with blood is a common cause of increased morbidity and mortality. Prolonged use of central venous catheters (CVCs) may cause high infection rates or compromise CVC patency due to thrombus development. In this study, we sought insights into possible changes in the hemostatic system during prolonged use of inserted CVCs for hemodialysis by assessing platelets by CD62P and CD41a expression and the potential for thrombin generation (TG). This study included patients with chronic renal failure who were undergoing hemodialysis three times a week using a CVC, and healthy subjects as controls. The participants were distributed into three groups: Group 1: clinically and laboratorially healthy individuals matched by sex and age to the patients (controls); Group II: patients who had completed 1month of CVC insertion; and Group III: the same patients after they had completed 4months of CVC insertion. Platelet activation analysis and TG evaluation were performed using blood samples obtained through two different accesses, that is, through a peripheral vein and directly from the CVC lumen. The data showed platelet activation and an increase in the generation of thrombin, particularly after 4months of CVC use. The results also indicated that insertion of the catheter into the blood stream stimulated the intrinsic rather than the extrinsic pathway. Taken together, the data showed a direct relationship between the use of CVCs in hemodialysis patients and a state of hypercoagulability, most likely associated with endothelial damage and the contact of the medical device with blood components such as platelets and coagulation factors.

Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters

BackgroundVenous thrombosis (VT) in children is often associated with a central venous catheter (CVC). We aimed to determine the incidence of VT associated with percutaneous non-tunnelled CVCs in a general paediatric population, and to identify risk factors for VT in this cohort. MethodsObservational, prospective study enrolling consecutive patients at a tertiary multi-disciplinary paediatric hospital. A total of 211 percutaneous, non-tunnelled CVCs were analysed. Data regarding potential risk factors for CVC-related VT were collected. Compression ultrasonography with colour Doppler was used to diagnose VT. ResultsOverall, 30.3% of children developed CVC-related VT, with an incidence rate of 29.6 (confidence interval, 22.5–36.9) cases/1000 CVC days. Upper body CVC location, multiple lumen CVCs, and male gender were independent risk factors for VT in multivariate analysis. All upper body VTs were in the internal jugular vein (IJV). The occurrence of CVC-related VT did not affect length of paediatric ICU or hospital stay. In patients with VT, femoral CVCs, young age, paediatric ICU admission, and a ratio of CVC/vein diameter >0.33 were associated with VT being symptomatic, occlusive, or both. IJV VT was often asymptomatic and non-occlusive. ConclusionsPaediatric non-tunnelled CVCs are frequently complicated by VT. Avoiding IJV CVCs and multiple lumen catheters could potentially reduce the overall risk of VT. However, IJV VT was more likely to be smaller and asymptomatic compared with femoral vein VT. More data are needed on the risk of complications from smaller, asymptomatic VT compared with the group of VT with symptoms or vein occlusion. Femoral vein CVCs and CVC/vein diameter >0.33 could be modifiable risk factors for VT with larger thrombotic mass. Clinical trial registrationACTRN12615000442505.

Comparison of semiquantitative and differential time to positivity methods for the diagnosis of central line-associated bloodstream infections in an intensive care unit

Introduction Central line-associated bloodstream infections (CLABSIs) adversely affect patients’ hospitalization.Aim We compared semiquantitative roll plate (SQRP) and differential time to positivity (DTP) culture methods in diagnosing CLABSIs.Methodology A retrospective study was conducted in an intensive care unit (ICU) from January 2013 to August 2014. All ICU patients with suspected CLABSIs were included. Blood cultures were taken, while central venous catheter (CVC) tips were cultured using the roll-tip method. DTP was considered positive if CVC lumen blood cultures became positive at least 2 h prior to concurrently drawn peripheral blood cultures with an identical micro-organism. SQRP method was considered positive when ≥15 c.f.u. of a micro-organism identical to that of blood cultures grew. Measures of diagnostic accuracy were calculated.Results SQRP displayed high sensitivity (94.7 %), while DTP showed high specificity (82.5 %). SQRP combined with DTP displayed 100 % sensitivity and negative predictive value.Conclusion SQRP and DTP methods should be evaluated in combination.

Innovations in Quality Improvement of Intravascular Catheter-Related Bloodstream Infections

Significant reductions in catheter-related bloodstream infections (CRBSI) have occurred in the United States. Reductions in CRBSIs are attributed to the widespread implementation of the practice-based measures and innovations in the diagnosis, treatment, and prevention of CRBSI. Diagnosis of CRBSI historically required removal of the central venous catheter (CVC) for catheter tip culture. Removing the CVC for CRBSI diagnosis predisposes many patients to potential life-threatening complications. Advances in diagnostic techniques such as culturing catheter hubs, catheter entry site cultures, applying differential time to positivity, molecular diagnostics, biomarkers, and innovative approaches like biosensors on the CVC lumen may provide an alternative to CVC removal. Removal of the CVC is common for the treatment of CRBSI; however, antimicrobial lock therapy is increasingly used as a CVC salvage method. Implementation of newer technology such as antimicrobial coated catheters, chlorhexidine-impregnated dressings, and antiseptic port protectors are crucial for the prevention of CRBSIs. Increasing evidence also support newer sutureless CVC securement devices prevent CRBSIs. CRBSI remains a significant clinical problem despite advances made in the diagnosis, management, and prevention. Molecular techniques are increasingly being used for pathogen identification in CRBSI, but the optimal diagnostic test remains debatable. Increasing experience is being gained with antimicrobial lock therapy for CRBSI treatment with catheter salvage. Use and adherence to practice-based measures and technological innovations has significantly reduced CRBSIs. Continued efforts are required to develop a cost-effective and targeted approach for CRBSI prevention.