Catheter Insertion Research Articles

YouTube as a source of education on tunneled catheter insertion: content and quality analysis.

Tunneled catheters can be inserted for many reasons, and in most centers, and in most centers it is not clear who should insert these catheters. Some anesthesiologists may not have seen first-hand the insertion of a tunneled catheter during their residency, depending on the policies of the institution. YouTube is one of the most commonly used online platforms for accessing medical information. The aim of this study was to investigate the reliability of YouTube videos, for tunneled central venous catheter (Hickman and tunneled hemodialysis catheters) insertion for education. The keywords "Tunneled catheter insertion" and "Tunneled central venous catheter insertion" were searched for on YouTube. The first 100 videos ranked by the YouTube algorithm were analysed. Animation and theoretical content videos, as well as videos that included only a part of the catheter insertion, were excluded. The sources of the videos were categorized as medical doctors or professional organizations. medical device advertisement and hospital. Two authors evaluated all videos via the Journal of the American Medical Association (JAMA) benchmark criteria, modified DISCERN scores and the Global Quality Scale (GQS). Twenty-three videos were analysed in the study. The video quality scores were similar across the video sources. The number of views and the number of likes were significantly positively correlated. Furthermore, a significant correlation was found between the JAMA, Modified DISCERN, and GQS scores. Notably, none of the analysed videos achieved full points in all three scoring systems. Relying on a single criterion, such as the video source or number of likes, is not sufficient to determine a video's quality. Therefore, what is learned from videos needs to be double-checked. These platforms should be used as an additional tool, not as the primary source of education.

Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study.

Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting. We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs. We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline. We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33-903) compared to pleurodesis group (81 days, IQR:10-737; p < 0.0001). Unadjusted median time from index procedure to death was significantly longer in the pleurodesis group (165[IQR:48-457] days vs. 81[IQR:29-256] days, p < 0.0001), however the difference between groups became insignificant after the IPTW was applied (HR 1.27, 95%CI 0.95-1.69). 35% of IPCs were removed prior to death or end of follow-up. After adjusting for differences in baseline characteristics there was no difference in post-procedure mortality between IPC and chemical pleurodesis groups. In the real world, there are significant differences in the characteristics of patients who receive these two procedures and notable regional practice variation between procedure use. Future research should evaluate these variations in care and their effect on patient outcomes.

Abstract 4148085: Transfer to ‘Hub’ Hospitals and Outcomes in Cardiogenic Shock

Introduction: Patients with cardiogenic shock (CS) have high mortality. Many CS patients present to non-tertiary care centers. Limited data exist on outcomes for patients transferred to “hub” CS centers for both acute myocardial infarction (AMI) and non-AMI etiologies. This study sought to compare the characteristics and outcomes of transferred CS patients compared to patients presenting to a hub center. Methodology: Adults (≥18 years) with a primary or secondary diagnosis of CS were identified from the National Readmissions Database (2016-2020) and stratified by transfer status. Overlap propensity score (PS) weighting was performed to assess the association between in-hospital mortality, length of stay (LOS) and transfer status. Results: Of 314,098 CS patients (AMICS 27%, non-AMICS 73%), 30,630 (9.8%) were transferred. Compared to non-transferred patients, transferred patients were on average younger (65 [interquartile range {IQR} 55-73] vs. 68 [IQR 58-77] years), more likely to be female (34% vs. 37%), less frequently with Medicare as primary payor (55% vs. 62%), and with higher comorbidity (Elixhauser index 8 [IQR 6-9] vs. 6 [IQR 5-8]) (all p &lt;0.001). Transferred patients had higher rates of respiratory failure (70% vs. 64%), renal failure (71% vs. 60%), hepatic failure (25% vs. 17%), bleeding complications (28% vs. 17%), and arrhythmias (59% vs. 52%) (all p &lt;0.001). Transferred patients were also more likely to undergo percutaneous coronary intervention (22% vs. 19%), coronary artery bypass grafting (13% vs. 8%), pulmonary artery catheter insertion (36% vs.16%), placement of intra-aortic balloon pump (25% vs.13%), percutaneous left ventricular assist device (13% vs. 7%), and extracorporeal membrane oxygenation (7% vs. 2%), receive invasive mechanical ventilation (3% vs. 2%), and undergo hemodialysis (17% vs. 11%) (all p &lt;0.001). In-hospital mortality was significantly lower in transferred patients – 39% vs. 47.1%; unadjusted odds ratio 0.71 (95% confidence interval 0.70-0.73); adjusted PS weighting odds ratio 0.73 (95% confidence interval 0.71-0.76), p &lt;0.001. Transferred patients had a longer median LOS (13 [IQR 7-22] vs. 6 [IQR 3-11] days, p &lt;0.001). Conclusion: Transferred CS patients had higher use of cardiovascular procedures and organ support therapies and lower in-hospital mortality suggesting patients were appropriately selected for transfer.

Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy.

Little is known about the safety of midline catheters vs peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT). To compare outcomes from midline catheters vs PICCs for OPAT. This retrospective cohort study included patients who received antimicrobial therapy through a midline catheter or PICC between January 2017 and November 2023 across 69 Michigan hospitals. Because peripherally compatible OPAT was the indication of interest, vancomycin therapy was excluded. Data were analyzed from April to June 2024. Insertion of a midline catheter or PICC for OPAT following hospitalization. The primary outcome was major device complications (ie, catheter-related bloodstream infection or catheter-related venous thromboembolism). Secondary outcomes included minor device complications (eg, catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, or exit site concerns) and device failure, defined as catheter removal following device complication. Cox proportional hazards regression models were fit to device type and outcomes, adjusting for patient and device confounders and device dwell. Of 2824 included patients, 1487 (53.5%) were male, and the median (IQR) age was 66.8 (55.9-77.1) years. Of 2824 devices placed for OPAT, 1999 (70.8%) were midline catheters and 825 (29.2%) were PICCs. The median (IQR) dwell time was 12 (8-17) days for midline catheters and 19 (12-27) days for PICCs (P < .001). A major device complication occurred in 44 patients (1.6%) overall, including 16 (0.8%) with midline catheters and 28 (3.4%) with PICCs (P < .001). OPAT delivered via midline catheters was associated with a lower risk of major complications vs PICCs (adjusted hazard ratio [aHR], 0.46; 95% CI, 0.23-0.91). Risks of minor complications and device failure were similar across device types (minor complications: 206 of 1999 [10.3%] vs 114 of 825 [13.8%]; aHR, 1.07; 95% CI, 0.83-1.38; device failure: 191 of 1999 [9.6%] vs 100 of 825 [12.1%]; aHR, 1.26; 95% CI, 0.96-1.65). For device dwell of 14 or fewer days, midline catheters were associated with a lower risk of major complications (12 of 1324 [0.9%] vs 16 of 304 [5.3%]; aHR, 0.29; 95% CI, 0.12-0.68) and similar risk of failure (151 of 1324 [11.4%] vs 52 of 304 [17.1%]; aHR, 0.79; 95% CI, 0.56-1.12) vs PICCs. For dwell longer than 14 days, no significant difference in rates of major complications (4 of 675 [0.6%] vs 12 of 521 [2.3%]; aHR, 0.42; 95% CI, 0.13-1.40) or device failure (40 of 675 [5.9%] vs 48 of 521 [9.2%]; aHR, 1.02; 95% CI, 0.64-1.61) were observed. In this study, midline catheters appeared to be safe alternatives to PICCs for OPAT, particularly if infusions were planned for 14 or fewer days.

Pigtail Catheter Compared to Formal Intercostal Catheter for the Management of Isolated Traumatic Pneumothorax: A Systematic Review and Meta-Analysis

(1) Background: The optimal management approach for adults with traumatic pneumothorax without haemothorax remains an area of debate. Specifically, there is lack of consensus as to whether insertion of a pigtail catheter is superior to a formal intercostal catheter in improving complication rates. (2) Methods: Medline, EMBASE, Cochrane Central, and the World Health Organisation International Clinical Trials Registry Platform databases were systematically searched for studies evaluating pigtail catheters compared to formal intercostal catheters for the management of traumatic pneumothorax. Investigative outcomes of interest included pain, duration management, failure, need for formal thoracoscopic surgery, need for supplemental oxygen, length of stay, infection and overall total complications. (3) Results: Three studies evaluating 280 patients were included in this analysis. There was no significant difference in total complications, rates of failure, length of stay or duration of management between pigtail catheters and formal intercostal catheters. This evidence was based on studies of low to moderate risk of bias with poor control for confounding factors. (4) Conclusions: This systematic review and meta-analysis demonstrates lack of evidence to suggest pigtail catheters are superior to formal intercostal catheter for traumatic pneumothorax. These findings may reflect a true absence of effect between either approach for this patient cohort or non-committal findings in light of limitations of the underlying evidence. Further prospective trials with larger sample sizes and control for confounders are required to validate the outcomes between these two modalities of treatment.

Comparison of outcomes of labor induction with dinoprostone vaginal insert (PROPESS) and double balloon cook catheter in term nulliparous pregnancies.

This retrospective study aimed to compare the outcomes of dinoprostone vaginal insert (PROPESS) and double balloon cook catheter (DBC) in term nulliparous pregnancies. A total of 1682 cases were enrolled, all of which were divided into two groups: PROPESS and DBC. The primary outcomes were rate of vaginal delivery (VD) and cesarean section (CS) and successful VD within 24 h and CS indications; the secondary outcomes were labor duration, oxytocin augmentation, complications during labor, maternal/neonatal outcomes, and predictors of successful VD within 24 h. There was no statistical difference in the rates of VD between the PROPESS group (73.74%) and the DBC group (77.73%) (p = 0.36). The VD rate within 24 h was significantly higher in PROPESS group than in the DBC group (55.45% vs. 38.43%, p < 0.001). The occurrence of nonreassuring fetal heart rate (NRFHR) patterns was higher in the CS indications of the PROPESS group than in the DBC group (56.86% vs. 37.81%, p < 0.001). The oxytocin augmentation was significantly lower in the PROPESS group than in the DBC group (52.79% vs. 94.9%, p < 0.001). The incidence of chorioamnionitis was significantly higher in the DBC group as compared with PROPESS group (4.36% vs. 1.34%, p < 0.001), while neonatal outcomes were comparable between the two groups. PROPESS (p < 0.001, odds ratio [OR] 2.478, 95% confidence interval [CI] 1.718-3.574), oxytocin augmentation (p < 0.001, OR 32.759, 95% CI 20.654-51.958), and amniotomy (p = 0.016, OR 1.897, 95% CI 1.331-2.704) were predictors of VD within 24 h. The effectiveness of delivery was comparable between the two groups. The PROPESS group resulted in a high successful VD rate within 24 h, although accompanied by NRFHR occurrence. Two cases with fetal presentation change (cephalic to breech) and four cases with umbilical cord prolapse were observed in the DBC group. PROPESS, oxytocin augmentation, and amniotomy were associated with VD interval within 24 h.

Viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và một số yếu tố liên quan tại Trung tâm Thần kinh, Bệnh viện Bạch Mai

Introduction: Peripheral venous catheter-related phlebitis is a common complication in healthcare facilities, causing pain, disrupting treatment, and potentially leading to severe complications.Objective: This study investigates the incidence and risk factors associated with peripheral intravenous catheter-related phlebitis. Method: A prospective cross-sectional descriptive study was conducted using a self-designed questionnaire and the Visual Infusion Phlebitis (VIP) Scale to assess the degree of phlebitis. The study included 347 inpatients treated in the Emergency and Intensive Care Unit, Neurology Center, at Bach Mai Hospital. Data were collected from medical records and clinical observation. Results: Among the studied patients, the incidence of phlebitis was 17.6%, and 4.3% of catheter insertion sites exhibited signs of inflammation. Grade 1 and 2 were the most common phlebitis (43.1% and 54.2%), with a small number of grade 3 cases (2.8%) and no cases of grade 4 or 5. Factors such as catheter insertion sites in the forearm, elbow, or ankle; underlying conditions like hypertension, cerebral hemorrhage, pneumonia; paralysis; continuous fluid infusion; and certain intravenous medications were identified as being associated with an increased risk of phlebitis. Conclusion: Phlebitis at the PVC site is a significant concern during treatment in ICU and Neurology centers. Proper catheter site selection and effective management of underlying conditions can help reduce the risk of phlebitis. These findings may assist in developing clinical guidelines to improve patient care quality.

Effectiveness and sustainability of a multidisciplinary care model for patients with hemodialysis access dysfunction.

A multidisciplinary care model involving the interventional radiologist, vascular surgeon, interventional nephrologist, renal advanced nurse practitioner, and renal coordinators was implemented to improve the care for the patient admitted with dysfunctional hemodialysis access. This study aims to evaluate the effectiveness and sustainability of this multidisciplinary care model. A dedicated interventional nephrology suite was established to perform endovascular procedures for patients admitted with hemodialysis access dysfunction via the emergency department of the hospital. We retrospectively collected data from electronic medical records 1-year before and after the implementation (April 2015). Outcome measures include waiting time for intervention, length of stays (LOS), number of dialysis catheter insertions before the intervention, number of inpatient dialysis required, and success rates of the interventions. The waiting time for intervention and LOS was tracked over the next 3 years to determine the sustainability of the care model. Eight hundred eighty-one endovascular interventions (314 angioplasties, 567 thrombolysis) were performed on 554 patients. Post-implementation, a greater proportion of intervention was performed within 24 h (238 (50.2%) vs 70 (17.2%), p < 0.001) with lesser proportion of patients requiring bridging hemodialysis via temporary catheter, 156 (32.9%) versus 215 (52.8%), p < 0.001. A shorter median LOS and days-to-intervention were reported, 3 (IQR 2-6) versus 5 days (IQR 3-8), p < 0.001 and 1 (IQR 1-2) versus 3 days (IQR 2-4), p < 0.001 respectively. Less hemodialysis session/patient required, 2 (IQR 1-3) versus 3 (IQR 2-4), p < 0.001. The procedural success rate was greater, 440 (92.8%) versus 355 (87.2%), p = 0.020. Three years following implementation, the proportion of patients who received intervention within 24 h and were discharged within 48 h was reported to be persistently greater, 43% versus 13%, p < 0.001, and 27% versus 6%, p < 0.001 respectively. This multi-disciplinary collaboration demonstrated a sustainable care model in improving the delivery of healthcare services for patients with dysfunctional hemodialysis access.

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

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

Percutaneous Sclerotherapy of Cystic Lesions at Kenyatta National Hospital: Indications, Outcomes, Efficacy, and Complications

Background: Percutaneous sclerotherapy is a minimally invasive treatment for cystic lesions and has emerged as a preferred alternative to traditional surgical methods due to its faster recovery times and lower complication rates. A sclerosing agent is instilled into the lesion causing cyst wall inflammation and lesion shrinkage. It has a significant role in managing cystic lesions, with better health outcomes. Objectives: To evaluate the indications, outcomes, efficacy, and complications of percutaneous sclerotherapy in the management of cystic lesions. Methodology: The study was a prospective cross-sectional study involving patients with cystic lesions referred for percutaneous sclerotherapy. Data was collected, analyzed, and presented in percentages, graphs, tables. Technical and clinical success rates were calculated. Efficacy was analyzed using chi-square test. Results: 27 patients with cystic lesions were treated. Most were females (77.8%), and males (22.2%), with a male-to-female ratio of 1:3.5. The commonest indication was pain (26.1%), followed by pressure symptoms (22.7%) and abnormal swelling (20.5%). Most lesions were located in the liver (25.9%), followed by the kidney (18.5%). Majority had significant improvement in clinical symptoms and size reduction with p-values &lt; 0.05. The technical success rate was 100% and the clinical success rate was 96.3%. Minor complications were encountered including mild pain (7.4%), catheter blockage, cyst abscess formation, catheter insertion site infection, and inflammatory cyst septations (each 3.7%). Conclusion: Percutaneous sclerotherapy is a safe, efficacious treatment of cystic lesions with a high technical and clinical success rate. It should be considered as a first line of treatment for cystic lesions.

Factors Associated With Mortality in Patients With Catheter-related Bloodstream Infection: A Multicenter Retrospective Study.

Catheter-related bloodstream infections (CRBSI) are frequently life-threatening. Several factors have been reported to be related to CRBSI development; however, the factors associated with CRBSI mortality are unclear as they have rarely been studied. This study investigated the factors associated with mortality in patients with CRBSI, specifically focusing on nutritional factors. This retrospective, multicenter study included in-patients with acute conditions and convalescent patients diagnosed with a CRBSI between January 2019 and December 2021 at 33 hospitals (23 general hospitals, two mixed-care hospitals, and eight convalescent hospitals). The primary outcome was death. Unadjusted and multivariable logistic regression analysis was performed to identify factors associated with mortality. A total of 453 patients with CRBSI were enrolled. The causes of death were analyzed for 382 (84.3%) who survived CRBSI and 71 (15.7%) who died. Multivariable analysis revealed that Candida detected in blood culture [adjusted odds ratio (aOR)=2.72, 95% confidence interval (CI)=1.15-6.41; p=0.025)], CRBSI onset within 30 days of catheter insertion (aOR=2.28, 95% CI=1.27-4.09; p=0.005), concurrent infection (aOR=2.07, 95% CI=1.19-3.60; p=0.009), low serum albumin level (aOR=1.64, 95% CI=1.02-2.63; p=0.044), and elevated C-reactive protein level (aOR=1.05, 95% CI=1.01-1.10; p=0.028) were risk factors for mortality, whereas the use of a peripherally inserted central catheter was associated with a reduced risk of CRBSI mortality (aOR=0.30, 95% CI=0.13-0.69; p=0.004). Enhanced monitoring of factors, such as candida detected in blood culture, CRBSI onset within 30 days of catheter insertion, concurrent infection, low serum albumin level, elevated C-reactive protein (CRP) level and the use of a peripherally inserted central catheter (PICC), is crucial for mitigating CRBSI severity and risk of death.

Safety and Prognostic Factor for Survival in Patients with PleurX Drain for Malignant Ascites: AscitX Study.

Background: Malignant ascites (MA) represents 10% of all causes of ascites and is associated with a poor prognosis. The PleurX tunneled peritoneal catheter is a device that allows the management of MA at home in a palliative care context (renamed AscitX catheter for this work). The objective of this study was to analyze real-world data of AscitX use for cancer patients with MA, to describe complications associated with the insertion of this device, and to identify factors influencing patient outcomes. Methods: Fifty-six patients with AscitX catheter insertion between October 2018 and October 2022 in our comprehensive cancer center were retrospectively analyzed. Computed tomography (CT) scans were reviewed by two radiologists to determine the presence of liver and peritoneal metastases and to identify portal hypertension. Results: The majority of patients were followed for pancreatic cancer (39%), followed by ovarian cancer (18%). We identified four cases of severe infections post-insertion and two moderate infections. The median survival time after AscitX insertion was 18 days. A Kaplan-Meier analysis did not identify differences in survival time between patients with peritoneal metastases and those with liver metastases. In contrast, CT-diagnosed portal hypertension and the absence of diuretic treatment were independently associated with a better prognosis. Regarding post-catheter end-of-life management, 41% of the patients died at home. Conclusions: AscitX catheter safety appears to be acceptable and most of the palliative care patients included in our study died at home. We identified CT-diagnosed portal hypertension as associated with better prognosis, as well as the absence of diuretic treatment.

Incidence of peripheral intravenous cannula induced phlebitis and its determinants among admitted patients in Ethiopia: systematic review and meta analysis, 2024

BackgroundPeripheral venous catheters (PVCs) are frequently used in clinical practice. Nonetheless, individuals who receive intravenous injections frequently have varying degrees of phlebitis. According to pertinent research, the catheter gauge, insertion site, and length of catheterization are strongly correlated with the incidence of phlebitis. However, no meta-analysis on the combined incidence of phlebitis and its contributing factors has been conducted. Thus, the purpose of this meta-analysis was to close the previously identified gaps.MethodA literature survey was conducted using electronic databases (CINAHL, Embassy, Google Scholar, and PubMed), and 4 studies were included they used peripheral intravenous catheters for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain the overall and subgroup phlebitis incidence rates and odds ratio for phlebitis incidence.ResultsThe incidence of phlebitis was 41 per 100 catheters (95% CI 0.22–0.60). There were 1584 patients in the included studies to know the incidence of phlebitis. In the subgroup analysis, the incidence of phlebitis in neonatal and infant patients was 30% (95% CI 0.25–0.34), in pediatrics patients was 34% (95% CI 0.29–0.38), and in adult patients was 50% (95% CI 0.11–0.89) respectively. Joint involvement in the PIVC (AOR: 2.44, 95% CI 1.67, 3.2), longer catheter dwell time (AOR = 3.96, 95% CI 1.59–7.33), and drug and blood administration in one vein (AOR = 1.91, 95% CI 1.67–2.15) were the most common factors associated with the incidence of phlebitis in Ethiopia.ConclusionThis meta-analysis indicates that PIVC-induced phlebitis is highly prevalent in Ethiopia. This meta-analysis identified significant risk factors for the development of phlebitis including medications and blood administered in a single vein, longer cannula dwelling times, and joint involvement in peripheral intravenous cannula insertion. Using the right interventions can lower the chance of developing phlebitis.

Multifaceted Control Interventions for Healthcare-associated Infections in a Kidney Transplant Intensive Care Unit: Clinical Outcome Improvement and Bundle Adherence.

Healthcare-associated infections (HAIs) are preventable complications that overwhelm the healthcare system. The implementation of multifaceted control intervention actions in the intensive care setting modifies clinical outcomes, but its effectiveness has not been specifically investigated for high-risk patients, such as kidney transplant recipients (KTRs). This observational retrospective natural experiment evaluated the effectiveness of multifaceted control interventions (bundles) in reducing HAIs in a KTR intensive care unit. We also measured the bundle adherence rate during 16 mo in the after era. We included 1257 KTRs, 684 before and 573 in the postintervention period. After the bundle implementation, the incidence density of device-associated HAIs decreased from 8.5 to 3.9 per 1000 patient-days (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.25-0.85; P = 0.01), primarily because of the reduction in central line-associated bloodstream infection from 8.0 to 3.4 events per 1000 catheter-days (RR = 0.43; 95% CI, 0.22-0.83; P = 0.012). Reductions in catheter-associated urinary tract infection (2.5 versus 0.6 per 1000 catheter-days; RR = 0.22; 95% CI, 0.03-1.92; P = 0.17) and ventilator-associated pneumonia (3.4 versus 1.0 per 1000 ventilator-days; RR = 0.29; 95% CI, 0.03-2.63; P = 0.27) were not significant. Central venous (P = 0.53) and urinary catheter (P = 0.47) insertion adherence were stable during 16 mo, whereas central venous (P < 0.001) and urinary catheter (P = 0.004) maintenance gradually increased. Finally, ventilator-associated pneumonia prevention bundle adherence slightly decreased over time (P = 0.06). The implementation of comprehensive multifaceted control intervention actions in an intensive care unit dedicated to KTR care was effective in significantly reducing device-associated infections. The impact was in line with the reductions observed in populations that have not undergone transplantation, underscoring the effectiveness of these interventions across different patient groups.

Are variations in ventricular catheter placement related to design of the catheter? A single-center cohort study.

The use of intracranial catheters is a common procedure used for neurosurgical patients with a variety of pathologies. Despite its frequency of use, shunt failure and revision have been reported to be a common problem. Given that depth of insertion can significantly affect the catheter tip position, a single institution retrospective chart review was performed to examine the accuracy of shunt and external ventricular drain (EVD) placement. Computed tomography (CT) images of the head following shunt or ventriculostomy insertion were analyzed to determine the delta between the final length of the intracranial catheter and the intended depth described in the operative notes. We found that there was a statistically significant difference in the accuracy of placement when comparing EVDs to shunts. The most used EVDs at our institution are marked with a solid black line in increments spaced 2 cm apart. The most used ventricular shunt catheter has a marking at 5 cm and 10 cm from the tip of the catheter. We believe that the visual confirmation that is afforded by metric unit markings on the EVD allows for better final placement of the catheter at the outer table of the calvarium. The addition of regular millimeter metric unit markings by the manufacturer is imperative in decreasing the chances of error in the insertion of ventricular catheters and preventing potential neurovascular injury to the surrounding structures.

An early economic evaluation of WireSafe™ to prevent guidewire retention in central venous catheter procedures

Background Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a ‘Never Event’ by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective. Methods We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50). Results NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398). Conclusions The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness.

Self-control study of multi-omics in identification of microenvironment characteristics in urine of uric acid stone

AbstractThe aim of this study is to perform proteomic and metabolomic analyses in bilateral renal pelvis urine of patients with unilateral uric acid kidney stones to identify the specific urinary environment associated with uric acid stone formation. Using cystoscopy-guided insertion of ureteral catheters, bilateral renal pelvis urine samples are collected. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is employed to identify differentially expressed proteins and metabolites in the urine environment. Differentially expressed proteins and metabolites are further analyzed for their biological functions and potential metabolic pathways through Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. In the urine from the stone-affected side, eight differential proteins were significantly upregulated, and six metabolites were dysregulated. The uric acid stone urinary environment showed an excess of α-ketoisovaleric acid and 3-methyl-2-oxovaleric acid, which may contribute to the acidification of the urine. Functional and pathway analyses indicate that the dysregulated metabolites are mainly associated with insulin resistance and branched chain amino acid metabolism.

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.

Total tubeless percutaneous nephrolithotomy without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis: a randomized controlled trial.

To evaluate the safety and efficacy of total tubeless percutaneous nephrolithotomy (PCNL) without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis. This prospective randomized controlled study at a tertiary care medical center was conducted from August 2019 to April 2023. Kidney stone patients diagnosed by computed tomography (CT) without significant hydronephrosis were randomly assigned to two groups: total tubeless PCNL without retrograde insertion of a ureteral catheter (group 1) and traditional PCNL (group 2). The primary endpoint was postoperative complications, while the secondary endpoints included the stone-free rate (SFR), operative time, length of postoperative hospital stay, and medical costs. A total of 99 patients were recruited, including 50 patients in group 1 and 49 patients in group 2. There were no significant differences in postoperative complications and SFR between the two groups (P > 0.05). However, relative to group 2, patients in group 1 had significantly shorter operative time (58.5 ± 25.39min vs. 82.98 ± 26.02min, P < 0.001) and length of postoperative hospital stay (1.98 ± 1.72days vs. 4.39 ± 2.95days, P < 0.001), as well as significantly lower medical costs (3190.30 ± 590.58 dollars vs. 3552.78 ± 967.79 dollars, P = 0.03). Total tubeless PCNL without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis is safe and effective for urologists with extensive experience in PCNL. chictr.org.cn identifier, ChiCTR2000040884, date of registration: 13/12/2020, retrospectively registered.

Ultrasound-Guided Percutaneous Peritoneal Dialysis Catheter Insertion for Urgent-Start Dialysis: Technique Description and Experience of a Single Center in Mexico City

Ultrasound-Guided Percutaneous Peritoneal Dialysis Catheter Insertion for Urgent-Start Dialysis: Technique Description and Experience of a Single Center in Mexico City