Catheter Complications Research Articles

Safety and complications associated with tunneling and pseudotunneling techniques during PICC and Midline insertion.

Peripherally Inserted Central Catheters and Midline Catheters are particularly attractive because of their favorable risk/benefit ratio. If the ideal venipuncture site is in an area inappropriate for catheter emergence, a valid alternative is the tunneling technique, which allows the exit site to be moved to reach the optimal position. There are two main types of tunneling techniques: standard tunnel, using a tunneling device (metal tunneler or peel-away tunneler), and pseudo-tunnel. As much as both are recognized as appropriate and safe, there are still few literature data indicating the criteria for choosing and using the two techniques and the possible related complications. This retrospective observational investigation analyzed data regarding intra- and post-procedural complications of tunneled catheters inserted using two different techniques. The sample was stratified into three subgroups: (1) Standard Tunnel (patients with no PLT or INR disorders), (2) Pseudotunnel (patients with no PLT or INR disorders), and (3) Pseudotunnel (patients with any PLT or INR disorder). Data regarding the procedure, at 24 h and 7 days were collected and analyzed. A total of 143 patients who underwent tunneled catheter insertion were included in the study. Among these, 113 patients were divided into subgroups 1 and 2 and 30 were assigned to subgroup 3. No significant differences were found among the three subgroups regarding immediate, short, and medium-term tunnel complications. The findings of this study suggest that both standard and pseudo-tunnels provide comparable levels of safety and comfort for patients. It was noted that Pseudotunnel offers an equivalent level of safety for patients with coagulation disorders related to PLT and INR, rendering it comparable to a "minimally invasive procedure," which necessitates the same precautions as a non-tunneled PICC.

Decreased Incidence of Radial Artery Vasospasm Using a Distal Transradial Approach in Diagnostic Cerebral Angiography: A Comparison of 200 Consecutive Cases.

Radial artery vasospasm is a common complication of radial artery catheterization. During the implementation of distal transradial approach (dTRA), we observed a decreased incidence of radial artery vasospasm on radial artery angiography following access that was not well detailed in the literature. The purpose of this study was to characterize the phenomenon of radial artery vasospasm in the context of different radial artery access points for diagnostic cerebral angiography. We retrospectively reviewed consecutive patients undergoing diagnostic cerebral angiography from September 2023 to March 2024. Hundred conventional transradial approach (cTRA) and 100 dTRA diagnostic cerebral angiograms were performed. Following sheath insertion, all angiographic runs were reviewed, and a classification scheme was used to detail radial artery vasospasm occurrence. Radial artery vasospasm was lower in the dTRA approach compared with the cTRA approach (P = .019). A change in radial artery diameter was noted in 47 (47%) patients in the cTRA group vs 28 (28%) patients in the dTRA group. Radial artery diameter distal to the sheath was smaller in the cTRA group (2.30 ± 0.41) compared with the dTRA group (2.42 ± 0.48) (P = .021). Patients with Grade II/III spasm were younger (58 years vs 62 years; P = .029) and had a higher percentage of females (77.3% vs 62.4%; P = .030). Grade II/III spasm patients had a higher percentage of the cTRA approach compared with the dTRA approach (62.7% vs 42.4%; P = .008). These procedures were significantly longer with Grade II/III procedure time of 18:00 minutes vs 15.59 minutes in the Grade I group. Number of vessels catheterized was not significantly different between groups (P = .262). dTRA for diagnostic cerebral angiography is associated with a lower incidence of radial artery vasospasm compared with cTRA. Operators seeking to obviate radial artery vasospasm may consider using the dTRA approach for diagnostic cerebral angiography.

Fatal Superior Vena Cava Obstruction With High-Output Chylothorax in a Preterm Infant: A Complication of Central Venous Catheterization

Fatal Superior Vena Cava Obstruction With High-Output Chylothorax in a Preterm Infant: A Complication of Central Venous Catheterization

Knowledge and Practices Regarding Prevention of Central Venous Catheter Removal-Associated Air Embolism: A Survey of Nonintensive Care Unit Medical and Nursing Staff.

Air embolism is a potentially serious complication of central venous catheter (CVC) use. While CVC insertion is usually performed by a trained specialist, extraction is frequently the responsibility of junior staff members. This complication can be easily prevented by following several simple measures described in common guidelines. We conducted a single-center survey to assess knowledge and practices concerning the prevention of air embolism associated with CVC removal among healthcare workers from nonintensive care units. The correct answers to the questionnaire were determined according to best-practice recommendations for CVC removal. Based on a comparison of the total sum of correct answers between the categories of groups, factors that predicted the level of knowledge were identified using an independent sample t test. Of the 156 respondents, one-third were unfamiliar with air embolism as a complication of CVC extraction. Almost 80% were unaware of the existence of a CVC removal protocol. Almost half of respondents did not follow guidelines regarding patient position when removing a CVC, 72% did not ask the patient to perform the Valsalva maneuver during the procedure, and 54% did not ask the patient to remain supine after the procedure. Adherence to the protocol was correlated with professional experience, with a lower level among those with experience of less than 1 year and, particularly, among interns. Our survey revealed inappropriately low awareness of CVC removal-associated air embolism risk and low familiarity with CVC removal best-practice recommendations among nonintensive care unit healthcare workers. Staff members with experience of less than 1 year, including interns, were found to have a lower level of knowledge. These findings emphasize the importance of development and distribution an internal hospital protocol and the integration of educational intervention into a preliminary internship program.

Machine learning for adverse event prediction in outpatient parenteral antimicrobial therapy: a scoping review.

This study aimed to conduct a scoping review of machine learning (ML) techniques in outpatient parenteral antimicrobial therapy (OPAT) for predicting adverse outcomes and to evaluate their validation, implementation and potential barriers to adoption. This scoping review included studies applying ML algorithms to adult OPAT patients, covering techniques from logistic regression to neural networks. Outcomes considered were medication intolerance, toxicity, catheter complications, hospital readmission and patient deterioration. A comprehensive search was conducted across databases including Cochrane Central, Cochrane Reviews, Embase, Ovid MEDLINE and Scopus, from 1 January 2000 to 1 January 2024. Thirty-two studies met the inclusion criteria, with the majority being single-centre experiences primarily from North America. Most studies focused on developing new ML models to predict outcomes such as hospital readmissions and medication-related complications. However, there was very little reporting on the performance characteristics of these models, such as specificity, sensitivity and C-statistics. There was a lack of multi-centre or cross-centre validation, limiting generalizability. Few studies advanced beyond traditional logistic regression models, and integration into clinical practice remains limited. ML shows promise for enhancing OPAT outcomes by predicting adverse events and enabling pre-emptive interventions. Despite this potential, significant gaps exist in development, validation and practical implementation. Barriers include the need for representative data sets and broadly applicable, validated models. Future research should address these barriers to fully leverage ML's potential in optimizing OPAT care and patient safety. Models must deliver timely, accurate and actionable insights to improve adverse event prediction and prevention in OPAT settings.

Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge.

Managing acute abdomen in very low birth weight (VLBW) and premature infants presents a diagnostic challenge, often necessitating a thorough assessment to discern underlying causes. Umbilical venous catheters (UVCs), commonly used in neonatal intensive care, are essential but not without risks. A 29-week premature male infant, born to a 23-year-old mother, was referred to our clinic on the 16th day of life with a suspected diagnosis of necrotizing enterocolitis (NEC). The infant had spent the first day intubated and received non-invasive respiratory support for 15 days. A 5 French UVC was inserted at the 2nd hour of life, and by the 3rd day of life, the infant transitioned to minimal enteral feeding. Between the 12th and 16th days of life, the infant initially diagnosed with NEC due to symptoms such as decreased stool passage and abdominal distension. The patient had been on a continuous course of antibiotic treatment throughout the entirety of his life, commencing on the very first day due to suspected early neonatal sepsis, followed by nosocomial sepsis during the hospitalization, and persisting with antibiotic therapy for suspected NEC. The case took a unique turn upon further evaluation after being referred to our unit. Despite a preliminary NEC diagnosis, further evaluation revealed umbilical catheter complications, leading to total parenteral nutrition extravasation. Removal of the catheter, drainage, and antibiotic adjustment resulted in improved clinical outcomes. In neonatal care, cautious management is vital when dealing with infants exhibiting abdominal symptoms. A nuanced approach, including differential diagnosis and careful antibiotic use, is essential.

Complications of intrathecal baclofen therapy in children and young adults

OBJECTIVE The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. METHODS The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children’s hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). RESULTS One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. CONCLUSIONS Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

Prevention and treatment of coronary catheter kinking.

Coronary catheter kinking is an uncommon but potentially catastrophic complication of cardiac catheterization. Although simple maneuvers can often result in resolution of a kink, tighter knots may not respond to such measures. We provide a systematic, stepwise approach to the prevention and treatment of catheter kinking.

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

Two Unusual Cases of Spontaneous Thrombosis in Neonates: Management and Outcome

Neonatal thrombosis usually occur as a complication of an indwelling central vascular catheter. Here we report two unusual cases of spontaneous thrombosis in neonates. In case 1, baby had a left atrial thrombus diagnosed soon after birth serendipitously by echocardiography. Since the thrombus was highly mobile with risk of embolization, he was given thrombolytic therapy. Thrombolysis resulted in prompt resolution of the thrombus without any complication. In case 2, baby had a chronic left axillary artery thrombosis that had occurred in utero. He presented at birth with features of limb ischemia. He was given anticoagulant therapy for three months. Though the limb perfusion and movements normalized, he developed shortening of the limb due to chronic ischemia. To conclude, due to non-availability of standard guidelines and scarcity of existing literature, management of these neonates is arbitrary. Owing to the rapidly expanding neonatal intensive care that contemplates more such cases, it is time to formulate separate guidelines for the management of thrombosis in neonates.

Lethal septic pulmonary thromboembolism in a repatriated body - a rare complication of prolonged urinary catheterization.

A case of septic pulmonary thromboembolism arising from thrombophlebitis of the prostatic venous plexus associated with long-term urinary catheterisation in a 51-year-old man is reported. Despite a previous autopsy having been conducted in the country where he had been resident overseas, a re-examination showed histological evidence of mild patchy chronic prostatitis with a florid, focally purulent, thrombophlebitis of the periprostatic venous plexus with abscess formation and evidence of bacterial overgrowth. Corresponding microscopy of the lungs showed septic microthromboemboli within small pulmonary arteries with variable degrees of necrotising acute inflammation and thrombosis. Death was not due to 'acute pulmonary oedema' as had been originally certified but to septic thromboembolism. This case demonstrates the need to carefully evaluate the prostatic venous plexus at autopsy, and also the type of problems that may arise at the time of the re-examination of repatriated remains.

Relation of Pre-operative Ureteral Catheter Use and Complications of Intraoperative Ureteral and Bladder Trauma in Gynecologic Oncology Patients Undergoing Major Surgical Procedures

Iatrogenic injury to the urinary tract is a potential complication of all surgical procedures performed in or retroperitoneum and pelvis. Gynecological surgery in particular has a risk of urinary tract injury due to the close anatomy of the urinary tract and the reproductive system in women. This study aimed to evaluate the relation between pre-operative ureteral catheter use and complications of intraoperative ureteral and bladder trauma in gynaecologic oncology patients undergoing major surgical procedures. This study used cohort data of patients undergoing major surgical procedures at Prof. Dr. R. D. Kandou Hospital, Manado, recorded in medical records from January 1, 2023 to June 30, 2023. The bivariate test showed that patients who received pre-operative ureteral catheter insertion had fewer urological trauma events (4.5%) compared to patients who did not get pre-operative ureteral catheter (95.5%). The relations between pre-operative ureteral catheters and the incidence of urological trauma was found to be statistically significant with a p-value of 0.019 and the history of chemotherapy had a p-value of 0.036, meanwhile the relations with other variables showed p-values of &gt;0.05. Therefore, the use of pre-operative catheters could not significantly eliminate the occurrence of ureteral trauma because many of the confounding factors were accompanied by several other conditions that were also studied in the multivariate analysis. In conclusion, there is no association between the use of pre-operative ureteral catheters and complications of intraoperative ureteral trauma in gynecologic oncology patients undergoing major surgical procedures. Future studies using samples from more sources are expected to assess the relation between pre-operative ureteral catheter use and the incidence of urological trauma more accurately, and to assess the ease of use of pre-operative ureteral catheter. Keywords: ureteral catheter; ureteral trauma; gynaecologic oncology patients

Involvement of veterinary students in the placement of intravenous catheters in adult horses in a teaching hospital does not significantly increase the rate of catheter complications.

To determine whether student involvement in intravenous catheter (IVC) placement increases the risk for complications and to report the rate and types of complications associated with IVCs in adult horses in a university teaching hospital. 455 IVCs placed in 394 horses. Data relevant to IVC placement and removal were retrieved from an electronic medical record search including records of adult horses from January 1 to December 31, 2022. Data retrieved from records included the role of the individual who prepared the site and placed the IVC, site of IVC placement, and type of IVC. The reason for removal of the IVC and presence or absence of detectable changes within the vein at the time of removal were documented in addition to clinical data, allowing for classification of each case. Data were reviewed retrospectively, and statistical analyses were performed using mixed-effects logistic regression models. Significance was set at P ≤ .05. The overall rate of complications was 15.6%, and the most common type of complication was swelling of the vein. Students were involved in 87 of 455 IVC site preparations and placements, and there were no statistically significant differences in complication rates between IVC sites prepared or placed by veterinary students versus nonstudent personnel. Veterinary personnel and clients may be hesitant to allow student involvement in IVC placement in horses, but these data suggest that student involvement does not increase the risk of IVC complications.

Comparing the Complications in Central Venous Catheterization by Ultrasound Guidance vs Anatomical Landmark Technique in Critical Ill ICU Patients

Objective: To compare the complication rates during central venous catheterization using ultrasound guidance versus the anatomical landmark technique in critical ill ICU patients. Methodology: A prospective comparative study was conducted in intensive care unit (ICU) of Farooq Teaching Hospital, Rawalpindi from December 2023 to June 2024. Total 127 critically ill ICU patients with acute surgical or medical conditions requiring central venous catheterization (CVC), such as hypotension, dehydration, or required blood resuscitation, where periphery approach was not feasible, underwent CVC insertion. Patients were randomly divided into two groups: one group underwent ultrasound-guided CVC insertion, while the other group used anatomical landmark technique. The rate of complications was measured between the groups. Results: Mean age of the patients was 46.5±11.2 years. The mean time from skin puncture to blood flashback was 104±172 sec in ultrasound group compared to 401±587 sec in landmark group. Among 127 patients, 61 underwent catheterization using ultrasound guidance, while 66 underwent catheterization using the anatomical landmark technique. The complication rates between the two groups were compared. The complications experienced by patients included multiple attempts (&gt;1 puncture), pneumothorax, improper cannulation, hematoma, arterial punctures, incisional bleeding, and ecchymosis. In ultrasound group, 11.5% of patients experienced complications, compared to 28.8% in anatomical landmark group (p = 0.016). Conclusion: Ultrasound-guided central venous catheterization was associated with fewer complications and a higher success rate (correct placement of the CVC), making it easier to perform. This procedure simplicity is linked to enhanced safety and patient comfort.

Intraperitoneal Nivolumab after Debulking Surgery and Hyperthermic Intraperitoneal Chemotherapy in Advanced Ovarian Cancer: A Phase I Study with Expansion Cohort.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are expected to be synergistic with intraperitoneal (IP) immunotherapy by increasing tumor antigen expression and mutational load. We assessed the feasibility and safety of IP nivolumab following complete CRS and HIPEC in pretreated patients with recurrent ovarian cancer (ClinicalTrials.gov identifier: NCT03959761). Patients received IP nivolumab (0.5, 1, or 3 mg/kg) using a 3 + 3 dose-escalation design, starting 5 to 7 days after CRS and HIPEC. Four IP Q2W (once every 2 weeks) nivolumab infusions were planned. The primary objective was to demonstrate the feasibility of IP nivolumab based on dose-limiting toxicity. Secondary objectives were to assess changes in tolerance of CRS and HIPEC. A total of 17 patients were enrolled including 10 patients in the dose escalation and 7 patients in the expansion phase. No dose-limiting toxicity was observed at any dose level in the 9 evaluable patients. Six of the 17 patients (35%) did not complete all planned infusions: 4 (23.5%) due to peritoneal catheter complications and 2 (11.8%) due to early progression. No procedure-related deaths occurred. Eleven patients (65%) experienced serious adverse events (SAE), mainly transitory grade 3 to 4 transaminase elevations (6/11) and surgery-related (9/11). Four SAEs were related to the peritoneal catheter and two to HIPEC. No SAEs/grade 3 to 4 adverse events related to IP nivolumab occurred. This is the first study demonstrating the feasibility of IP nivolumab in patients with relapsed advanced ovarian cancer. Further investigation at 3 mg/kg is warranted.

Ultrasound-guided vs. Standard Coronary Access in Coronary Angiography: A Systematic Review and Meta-analysis.

Coronary angiography is a procedure performed during cardiac catheterization to define the coronary anatomy and determine the extent of coronary artery disease (CAD). The use of a cheap, relatively available tool like an ultrasound machine to assist in vascular access might reduce the risks associated with blind access. This study aimed to explore the efficacy and associated complications of ultrasound-guided coronary artery catheterization. This systematic review of randomized controlled trials (RCTs) was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analysis (PRISMA) and was registered in PROSPERO (CRD42022365518). A systematic search was performed for all published studies without language or country restrictions and all study variables were extracted into prefilled sheets by two independent reviewers. This meta-analysis identified 10 RCTs. The results confirmed statistically significantly reductions of total complications (RR = 0.53, 95% CI 0.39-0.72, P < .001), and hematoma >5 cm formation (RR = 0.43, 95% CI 0.25-0.75, P = 0.003) in patients who underwent ultrasound-guided coronary artery catheterization. Ultrasound with catheterization, as opposed to landmark-based catheterization, significantly improved the peri-catheterization operative outcomes, providing evidence for further research to be conducted and consideration for its implementation within the medical setting.

Tunneled Dialysis Catheter Insertion in External Jugular Vein by Nephrologists

Background External jugular vein (EJV) is used to insert tunneled dialysis catheter (TDC) in patients with no AVF and exhausted right internal jugular veins (IJV). There is scarce data on TDC insertion in EJV by nephrologists with fluoroscopy guidance. Materials and Methods This was a prospective observational study that included hemodialysis patients with exhausted right IJV access who underwent EJV TDC insertion, and excluded occluded ipsilateral brachiocephalic vein or superior vena cava, EJV &lt; 5 mm diameter, or patients with existing EJV TDC. All patients underwent evaluation of central veins. TDC insertions were performed by a nephrologist using ultrasound and fluoroscopic guidance. The primary outcome was the successful insertion of EJV TDC and catheter removal within 6 months due to major catheter dysfunction or complications. Results EJV TDC was successfully inserted in 23/23 cases (100% success), of which 17 (73.9%) were in right side, and 21 (91.3%) were denovo insertions. Catheter dysfunction needing removal occurred in seven cases (30.4%) with subclavian vein thrombosis in five cases (21.7%) and infectious complications in two cases (8.6%). The censored catheter survival was 23/23 (100%) at 1 month, 22/23 (95.6%) at 3 months, and 13/20 (65%) at 6 months. Cases of EJV catheter removal had a significant association with drainage of EJV into subclavian vein as compared to other anatomical variants (p = 0.005). Conclusion EJV TDC insertion has a good technical success rate when performed under fluoroscopy. It is associated with an acceptable rate of catheter dysfunction, especially thrombosis, which is more common in EJV opening into subclavian veins.

Extended-Infusion β-Lactam Therapy, Mortality, and Subsequent Antibiotic Resistance Among Hospitalized Adults With Gram-Negative Bloodstream Infections

Current evidence is conflicting for associations of extended-infusion β-lactam (EI-BL) therapy with clinical outcomes. To investigate the association of EI-BL therapy with survival, adverse events, and emergence of antibiotic resistance in adults with gram-negative bloodstream infections (GN-BSI). This cohort study of consecutive adults with GN-BSI admitted to 24 United States hospitals between January 1, 2019, and December 31, 2019, receiving EI-BL were compared with adults with GN-BSI receiving the same agents as intermittent infusion β-lactam (II-BL; ≤1-hour infusions). Statistical analysis was performed from January to October 2023. EI-BL (ie, ≥3-hour infusion). EI-BL and II-BL groups underwent 1:3 nearest-neighbor propensity score matching (PSM) without replacement. Multivariable regression was applied to the PSM cohort to investigate outcomes, all censored at day 90. The primary outcome was mortality; secondary outcomes included antibiotic adverse events and emergence of resistance (≥4-fold increase in the minimum inhibitory concentration of the β-lactam used to treat the index GN-BSI). Among the 4861 patients included, 2547 (52.4%) were male; and the median (IQR) age was 67 (55-77) years. There were 352 patients in the EI-BL 1:3 PSM group, and 1056 patients in the II-BL 1:3 PSM group. Among 1408 PSM patients, 373 (26.5%) died by day 90. The odds of mortality were lower in the EI-BL group (adjusted odds ratio [aOR], 0.71 [95% CI, 0.52-0.97]). In a stratified analysis, a survival benefit was only identified in patients with severe illness or elevated minimum inhibitory concentrations (ie, in the intermediate range for the antibiotic administered). There were increased odds of catheter complications (aOR, 3.14 [95% CI, 1.66-5.96]) and antibiotic discontinuation because of adverse events (eg, acute kidney injury, cytopenias, seizures) in the EI-BL group (aOR, 3.66 [95% CI, 1.68-7.95]). Emergence of resistance was similar in the EI-BL and II-BL groups at 2.9% vs 7.2%, respectively (P = .35). In this cohort study of patients with GN-BSI, EI-BL therapy was associated with reduced mortality for patients with severe illness or those infected with nonsusceptible organisms; potential advantages in other groups remain unclear and need to be balanced with potential adverse events. The subsequent emergence of resistance warrants investigation in a larger cohort.

Smaller-gauge catheters and greater body weights are associated with increased risk of peripheral intravenous catheter complications in cats hospitalized in the critical care unit.

To identify risk factors associated with peripheral intravenous catheter (PIVC) complications in cats hospitalized in the critical care unit (CCU). 120 cats admitted to the CCU between October 2022 and September 2023. This prospective, observational study was performed at a single veterinary teaching hospital. Cats hospitalized in the CCU for ≥ 24 hours were evaluated for enrollment. Peripheral intravenous catheters were placed by trained personnel following a standardized protocol and monitored for complications. PIVC complications were classified as extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal. Median PIVC dwell time was 42.25 hours (range, 24.25 to 164.25 hours). Overall PIVC complication rate was 18.3% (22/120), with extravasation (7/120 [5.8%]) and dislodgement (7/120 [5.8%]) being the most frequently recorded complications. Multivariable analysis identified that for each kilogram increase in body weight there is a higher likelihood of a PIVC complication (OR, 1.46; 95% CI, 1.03 to 2.05; P = .03). Additionally, use of a larger-gauge (20-gauge vs 22-gauge) PIVC is associated with a significantly lower likelihood of a PIVC complication (OR, 0.13; 95% CI, 0.03 to 0.56; P = .006). These results suggest that smaller-gauge (22-gauge) PIVCs and greater body weights are associated with an increased risk of complications in cats hospitalized in the CCU. When possible, a larger-gauge (20-gauge) PIVC should be placed in cats admitted to the CCU.

Peripherally inserted central catheter design and material for reducing catheter failure and complications.

Peripherally inserted central catheter design and material for reducing catheter failure and complications.