Percutaneous Central Venous Catheters Research Articles

2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: the ARCTIC randomised controlled feasibility trial

ObjectiveCatheter-related sepsis (CRS) is a major complication with significant morbidity and mortality. Evidence is lacking regarding the most appropriate antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion...

Proper Depth of Percutaneous Central Venous Catheter via the Great Saphenous Vein for Very Low Birth Weight Infants: A Single-Center, Prospective Cohort Study.

A proper depth of percutaneous central venous catheter (PCVC) is very important to reduce procedural time and prevent various complications in very low birth weight (VLBW) infants who require minimal handling or have a sensitive skin. The objective of this study was to suggest a formula for faster and proper insertion of PCVC in VLBWIs to prevent unintended consequences of patients' conditions. Prospective data of VLBW infants admitted from June 2015 to January 2018 who had PCVC inserted via the great saphenous vein within seven days after birth were analyzed. Correlations of length of inserted PCVC with body weight, body length, and postmenstrual age at the date of PCVC insertion were determined with a linear regression analysis. Using results of this analysis, a formula to determine the optimal insertion length of PCVC was derived. Coefficient of determination was used to assess how well outcomes were replicated by the formula. The formula to predict the proper insertion length of PCVC via the great saphenous vein at popliteal crease level was obtained as follows: Optimal Length (cm) = 3.8 × Body Weight (kg) + 11.1. With everyday movements such as flexion and extension of the lower extremities, the mean difference in catheter tip position was 7.0 ± 3.9 mm, which was not significant enough to escalate the risk of catheter tip displacement. The rate of catheter-related complications was as low as 4.9% in this study. The formula derived from this study to predict the optimal PCVC insertion length could benefit VLBW infants by reducing procedural time and lowering the risk of complications.

Management of Inadvertent Arterial Catheterization during Central Venous Catheter Placement: A Case Series.

Percutaneous central venous catheterization, although a widely used technique in ICU patients worldwide, is not devoid of complications even under real-time ultrasound guidance. Arterial puncture is a well-recognized complication, while unintended subclavian or carotid artery cannulations during attempted central venous catheterization are infrequent, but documented complications with potentially deleterious consequences. Recently, endovascular balloon tamponade has emerged as the preferred initial approach to repair inadvertent arterial cannulations. Herein, we present a case series of inadvertent arterial catheterization during an attempted ultrasound-guided access of the right internal jugular and the left subclavian vein that were successfully managed with endovascular balloon tamponade.

Dose-Related Analysis in Percutaneous Central Venous Catheters Insertion: Experience of a Pediatric Interventional Radiology Center.

Background: There are many techniques for long-term central venous catheter (CVC) placement, but none of them are specific for pediatric patients or focused on the delivered dose of ionizing radiation. Materials and Methods: This retrospective study examined a sample of pediatric patients who received percutaneous long-term CVC positioning in a tertiary care pediatric hospital. Effective dose, dose-area product (DAP) and length of time of exposition during the procedure were determined, using an appropriate technical procedure, exam and program set of the angiograph, and compared with an unpaired t-test analysis. Results: The study included 1410 enrolled patients, with a median age of 10 years (range 0.2–18 years), between 2016 and 2019. In 2016 (318 pts), the mean effective dose was 0.13 mSv and the mean DAP dose was 18.95 µGy/m2 In 2017 (353 pts), the mean effective dose was 0.11 mSv and the mean DAP dose was 17.26 µGy/m2. In 2018 (351 pts), the mean effective dose was 0.05 mSv and the mean DAP dose was 7.23 µGy/m2. In 2019 (388 pts), the mean effective dose was 0.02 mSv and the mean DAP dose was 3.10 µGy/m2. Conclusions: Medical and technical expertise led to a remarkable reduction in the radiation dose. Therefore, the authors’ hypothesis is that US- and fluoroscopy-guided percutaneous long-term CVC insertion technique is safer, more cost-effective and lower in terms of radiation exposure if correctly applied, compared to surgical or percutaneous by direct puncture techniques.

Echocardiographic Determination of Percutaneous Central Venous Catheters in the Superior Vena Cava: A Prospective Cohort Study.

Malposition of percutaneous central venous catheters (PCVCs) in the superior vena cava (SVC) is common. We previously showed that real-time sonography was safer and faster than radiography in identifying PCVC tip location in the inferior vena cava (IVC). However, in preterm infants, determining PCVC tip location in the SVC is complicated by endotracheal or nasogastric tubes in situ and emphysematous lung conditions. We aimed to find an appropriate sonographic view by which to assess PCVC tip location in the SVC compared to the sonographic examination of PCVC in the IVC. Neonates (n = 50) with PCVCs in the SVC were enrolled and their data (gestational age, gender, birth weight, body weight at intervention, repositioning rate, and duration of tip assessment) were compared with retrospective data of 50 neonates with PCVCs in the IVC. The mean gestational age in the groups of IVC and SVC was 31.43 weeks and 32.16 weeks, respectively. The mean birth weight in the groups of IVC and SVC was 1642.18 g and 1792.00 g, respectively. Placement of an S12-4 ultrasound sector transducer to obtain clear parasternal views of the aorta allows visualization of PCVC tips in the SVC and near the cavoatrial junction. PCVC repositioning rates were not significantly different between the two groups (p = 0.092). Sonography examinations in the SVC had a longer duration than those in the IVC (p < 0.001). Sonography provides an accurate method for determining PCVC tip location in the SVC.

Contralateral pneumothorax after central line placement in COVID-19 positive patients.

Contralateral pneumothorax after percutaneous central venous catheter placement has not been previously reported. Three patients who required intubation and mechanical ventilation for acute respiratory failure due to COVID-19 were identified with a new pneumothorax on routine post-placement chest roentgenogram on the side opposite the catheter placement. Retrospective review of charts, radiographs, and laboratory studies. No causative relationship was identified between the percutaneous placement of the central venous catheters and the subsequent pneumothoraces identified on the contralateral side, other than the presence of active COVID-19 viral pneumonia. The timing of the contralateral pneumothoraces were coincidental the placement of the central venous catheters. We believe these pneumothoraces were a consequence of the pulmonary pathology of the COVID-19 virus.

Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia

BackgroundPediatric sepsis remains a significant cause of morbidity and mortality worldwide. This study aimed to identify the incidence of sepsis and septic shock among patients admitted to the pediatric intensive care unit (PICU) of a tertiary center in Saudi Arabia. Patients' demographics and risk factors associated with sepsis-related mortality were also investigated.MethodsA retrospective cohort study was conducted in the PICU of King Abdulaziz Medical City, Jeddah (KAMC-J). KAMC-J is a tertiary care hospital in the western region of Saudi Arabia. A total of 2389 patients admitted to the PICU of KAMC-J between January 1, 2013 and December 31, 2017 were screened and evaluated for sepsis using The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).ResultsOf the 2389 total admissions to the PICU, 113 patients (4.9%) met the definition of Sepsis-3; 50.4% of the 113 patients met the definition of septic shock. Most patients (66.3%) were less than 6 years old, and 52.2% were male. Eight-five patients (75.2%) had underlying comorbidities. The respiratory system was the most common primary site of infection (57.5%). Bacterial and viral infections were the most common infectious etiology with reported rates of 29.2 and 21.2%, respectively. The median duration of PICU stay was 8 days and the 28-day PICU mortality rate was 23.9%. A Pediatric Sequential Organ Failure Assessment (pSOFA) Score greater than four and a pre-existing percutaneous central venous catheter were associated with a significant increase in mortality, with adjusted odds ratios of 3.6 (95% confidence interval: 1.30–9.93) and 9.27 (95% confidence interval: 1.28–67.29), respectively.ConclusionsThe incidence of sepsis in our institution is comparable to that reported internationally; however, the mortality rate is higher than that of developed countries. Nationwide studies identifying sepsis epidemiology are needed to improve the outcome of pediatric sepsis. Following international guidelines for central-line insertion and maintenance is of paramount importance.

P0529 / #554: IMPACT OF PERCUTANEOUS CENTRAL VENOUS CANNULATION UNDER ULTRASOUND - GUIDED IN A PEDIATRIC INTENSIVE CARE UNIT

Aims & Objectives: Percutaneous vein cannulation in pediatric group, can be technically challenging, especially in young children. The purpose was to determine if ultrasound guided placement of percutaneous central venous catheters (CVC) would decrease the number of attempts, to achieve successful catheterization in the internal yugular vein (IYV), and femoral (FV). Methods: Design: Descriptive, prospective and analytical study between May 2018 and May 2019. Setting and participants: All patients from 1 month to 18 year- old admitted to the PICU of Garrahan Hospital, who required CVC. The insertion site was chosen by the attending physician Secondary outcome: incidence of complications Results: IYV was chosen in 66 patients (43.5%), while FV was the choice in 86 patients (56.5%). Eighty-six (56.5%) CVC, were inserted in the first attempt and 66 (43.5%), required one or more. IYV insertions were successful on the first attempt in 46 patients (53.5%) and twenty children required more than one puncture for correct catheter placement (30.3%) p 0.004 OR 0.37 (95% CI 0.18-0.78).In children under 6 months CVC placed in IYV had less risk of requiring more than one attempt, compared to those in the FV, p 0.0026 OR 0.31 (95% CI 0.12 -0.75).There were 3% complications (pneumothorax that required drainage), and there was no mortality related to the insertion method. Conclusions: Ultrasound-guided CVC insertion was safe in most cases, and significantly successful on the first attempt when the YIV was the insertion choice, especially for those under 6 months of age.

The appropriate frequency of dressing for percutaneous central venous catheters in preventing catheter-related blood stream infection in NICU – A randomized controlled trial

Complications of percutaneous central venous catheters (PCVCs) include catheter-related blood stream infection (CRBSI), occlusion, leakage, and phlebitis, which may lead to sepsis or prolonged hospitalization. The primary objective of this randomized controlled trial was to determine the appropriate frequency of dressing for percutaneous central venous catheters in preventing CRBSI, every week regularly vs. non-regularly, in premature neonates in NICU. Patients in NICU requiring PCVCs from March 2019-May 2020 were enrolled. Enrolled patients were randomly assigned into 2 groups: regular dressing group (RD), for which dressings were changed every week regularly, or additionally when oozing was noticed; and non-regular dressing group (ND), for which dressings were changed only when oozing was visible. The incidence of CRBSI, occlusion, leakage, and phlebitis were compared between the two groups using the Chi-squared test. The incidence of catheter-related complications was defined as numbers of episodes per 1000 catheter-days. A total of 197 PCVCs were enrolled. The ND and RD groups had 99 and 98 PCVCs, respectively. The average CD interval was 9.3 days in ND group and 5.8 days in RD group. The incidence of CRBSI in RD group was 0‰, which was significantly lower than that of ND group, which was 2.0‰ (p=0.048), but no significant differences were found between groups in the incidence of occlusion, leakage, and phlebitis of PCVCs. Regular dressing changes every week and when oozing occurs while maintaining the protocol of maximum sterile barrier precautions is the best method and frequency of dressings of PCVCs.

The role of ultrasonography for detecting tip location of percutaneous central venous catheters in neonates—a single-center, prospective cohort study

Percutaneous central venous catheters (PCVCs) are used commonly and widely in the neonatal intensive care unit (NICU). Malposition of PCVCs may cause life-threatening complications and prolong hospitalization. In Taiwan, conventional chest-abdomen radiography (CXR) has been used widely and routinely for assessing tip location of PCVCs. Compared to ultrasonography (US), CXR cannot provide real-time assessment, and patients are exposed to radiation. Therefore, this study aimed to analyze the role of US in detecting PCVC tip location in the lower extremities. Neonates who received PCVC insertion in the lower extremities in NICU from March 2019to April 2020 were enrolled in this prospective cohort study. PCVC tip location was confirmed finally by conventional CXR after US examination and patients were included in the sono group; those not assessed by US formed the non-sono group. In addition, PCVCs inserted in 2018 for whichtip location was evaluated only by CXR, were reviewed retrospectively and these cases were included in the non-sono group. Withdrawal rates between the two groups were analyzed using Chi-square test. The sono group included 166 neonates with PCVCs and 141 were in the non-sono group. Median gestational age at date of PCVC insertion was 33.21 and 32.71 weeks in sono and non-sono groups, respectively (p=0.37). Withdrawal rates were 10.84% and 65.95% (p<0.001) and duration for catheter location confirmation were 2-4.75min and 75-247.25min (p<0.001), respectively. US provides more reliable images than conventional radiography alone for identifyingPCVC tip locations in the lower extremities. It can effectively reduce catheter insertion duration, and was associated with fewer manipulations.

Central Venous Access in Neonates: Comparison of Ultrasound-Guided Percutaneous Access and Minimal Surgical Open Methods.

Background:In neonates, percutaneous central venous catheter (CVC) insertion is often a challenging technique. Recent reports have reported the efficacy of ultrasound (US) guidance when performing such an intervention. We conducted this study to compare US-guided and minimal surgical CVC insertion regarding time and ease of insertion, reliability, and complications.Patients and Methods:This prospective randomized study included 92 neonates scheduled for CVC insertion. They were divided into two groups: Group A (46 neonates) underwent the US-guided approach and Group B (46 neonates) underwent the surgical approach. The number of attempts and the duration of the procedure were documented in both groups. In addition, intraoperative and postoperative complications were recorded.Results:Each of patient's age, gender, weight, and the indication of catheter insertion were statistically comparable between the two groups. The number of trials showed a significant increase in Group A (1.52 vs. 1.07 in Group Bp <0.001). Nevertheless, the time of the procedure was significantly decreased in the same group (3.68 vs. 10.21 in Group Bp <0.001). Table 2 summarizes the previous findings. Failure was encountered only in one case in Group A (2.2%), which was converted to the open surgical technique. In general, the incidence of complications showed no significant difference between the two approaches.Conclusion:Although US-guided CVC insertion is associated with an increased number of trials, the duration of the procedure is significantly diminished with its use. Furthermore, it has a high success rate in addition to a comparable complication profile with the traditional surgical method.

Pericardial effusion complicated by percutaneous central venous catheterization treated with pericardial window in a very low birth weight infant

Pericardial effusion complicated by percutaneous central venous catheterization treated with pericardial window in a very low birth weight infant

Hickman Central Venous Catheters in Children: Open Versus Percutaneous Technique

The ideal technique for insertion of tunneled central venous catheters (CVCs) in children is still debatable. This study aimed to compare the outcomes of open versus percutaneous technique for the insertion of tunneled CVCs. The study included 279 patients who had CVCs insertions from 2010 to 2020. Patients were divided into two groups according to the technique of insertion: group 1 (n=90) included patients who had the open cutdown method and group 2 (n=189) included patients who had the percutaneous technique. There was no difference in age and gender distribution between groups (P=0.152 and 0.102, respectively). Chemotherapy was the most common indication of insertion (77 [85.56%] vs. 165 [87.30%]); in group 1 vs. 2, P=0.688). The left external jugular was the most common site of insertion in group 1 (n=66; 73.33%), and the left subclavian was the most common site in group 2 (n=77; 40.74%). Complications of insertion were nonsignificantly higher in group 2 (P=0.170). Nine patients in group 2 required conversion to cutdown technique (4.76%). Complications during removal were nonsignificantly higher in group 2 (P=0.182), and the most common was bleeding (n=4; 2.12%). The most common indication for catheter removal was the completion of the treatment (36 [40%] vs. 85 [44.97%] in groups 1 and 2, respectively). Percutaneous and open tunneled central venous catheter insertion are safe in pediatric patients who require long-term venous access. Both techniques have a low complication rate. The choice of each method should be tailored to the condition of each patient.

Paediatric Central Venous Access: Experience in the Largest South African Paediatric Surgical Centre

ABSTRACT Background: Percutaneous central venous catheterization (CVC) in the paediatric population is a relatively common procedure but local data in South Africa are extremely limited. Objective: To describe percutaneous CVC in the local setting with regard to patient population demographics, health care professionals performing the procedure, techniques, and immediate complications of the procedure. Methods: A prospective descriptive study of CVC was performed at Chris Hani Baragwanath Academic Hospital from 1 May 2017 to 31 July 2017. Results: A total of 129 CVCs were inserted. Complete data were collected on 95 placements. Median patient age was 60 days (range: 1–5760). The majority of CVCs occurred in surgical patients (78/95, 82%). Irritant drugs (31/95, 33%), fluid administration (27/95, 28%), and failure to establish peripheral intravenous access (16/95, 17%) were the most common indications for CVC. The immediate mechanical complication rate was 13% (12/95). No statistical difference was found in complication rates between line placement by junior and senior staff, between the subclavian and internal jugular routes, between patients with previous CVC access and those without, and between intubated and awake patients. The majority of CVC were placed in the neonatal unit (55%, 52/95), without the use of ultrasound guidance (100%, 95/95), and outside of the operating theatre (74%, 70/95). Conclusions: Immediate mechanical complication rates are comparable to international figures. The high number of CVCs necessitates the establishment of a vascular access service that identifies those patients at high risk of requiring CVC early, relieves the paediatric surgical service of the high burden of CVC, and actively pursues safer and less resource intensive alternatives to CVC.

Study of Central Venous Cut-Down Versus Percutaneous Central Venous Catheterization in Neonates and Infants

Background: Several more access routes of have been described. Umbilical artery catheters (UACs), and umbilical vein catheters (UVCs). CVCs can be placed in numerous sites, including the internal jugular vein (IJV), the subclavian vein, the femoral vein, peripheral veins leading to central access, and other surgical access sites. Objective: To compare central venous cut-down catheterization versus percutaneous central venous catheterization in neonates and infants regarding technical feasibility, indications, operative time and complications. Patients and Methods: This is a prospective study on two different methods for central line insertion in neonates and infants. This study was done at Al-Azhar University Hospitals, in Pediatric Surgery Department, Neonatal Intensive Care Unit and Pediatric Intensive Care Unit. One hundred patients who required central venous catheterization were included in this study, during period between December 2018 and October 2019. Results: The present study reported that the ultrasound guided CVC was more useful in placement of CVC in infants and neonates, and decreasing complications. The ultrasound technique not only clarified the relative position of the vein and its surrounding structures but also helped in identifying the course of the central vein and its caliber and provide confidence to the operator Conclusion: The present study reported that the ultrasound guided CVC was more useful in placement of CVC in infants and neonates, and decreasing complications. Cost is one of the limiting factors in the availability of ultrasound device in many clinical applications.

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.

Safety and efficacy of 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheter insertion in preterm neonates: the ARCTIC randomised-controlled feasibility trial protocol

IntroductionCatheter-related sepsis is one of the most dangerous complications of neonatal intensive care and is associated with significant morbidity and mortality. Use of catheter-care ‘bundles’ has reduced the incidence of...

The comparison of anatomical description and ultrasound-guided percutaneous central venous catheter insertion methods single center experience

The comparison of anatomical description and ultrasound-guided percutaneous central venous catheter insertion methods single center experience

Differences in The Number of Germs in The Insertion Area of Central Venous Catheter (CVC) Done by Polyurethane Transparent and Plaster Gauze Dressing

A central venous catheter is a catheter that is placed directly on a large vein in the body and its tip lies in one of the central veins that is often used on critical care patients. Colonization of bacteria (germ) around the insertion area of the CVC is an area that is very likely to cause infection even though it has been closed by dressing. The factor that should always be considered is that the state of moisture retention occurs beneath the dressing. Moisture will cause an increase in colonization of the insertion area and increase the risk of catheter-related infection. As is known the humidity level of Indonesia with other countries is higher and the results of positive swabs in the insertion area are associated with Percutaneous Central Venous Catheter (PCVC) colonization and Catheter-related Sepsis (CRS). Transparent polyurethane and plaster gauze are two types of dressings that are different and often used. The transparent polyurethane is widely used in invasive procedures, there are still many medical staff who use plaster gauze dressings. The purpose of this study is to determine the difference in the number of germs in the CVC insertion area that are dressed using transparent polyurethane and plaster gauze. The design of this study is a quasi-experimental pretest-posttest control group with positive sampling. The number of samples is 12 for the intervention group and 11 for the control group. The intervention group performed transparent polyurethane dressings and a control group with plaster gauze. Calculation in the number of germs is with the cup count method. Wilcoxon and Mann-Whitney tests are for te data analysis. Based on the results of the study, it can be concluded that there is no difference in the number of CVC insertion germs between the use of dressings transparent polyurethane and plaster gauze so that both types of dressings can be used for CVC dressings in critical patient care settings.

Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial

BackgroundIn patients with short-term percutaneous central venous catheter (CVC), it is recommended that a dressing be applied to the catheter insertion site to prevent catheter-related infections. ObjectivesThe objective of this study was to assess the feasibility of a randomised controlled trial to compare the efficacy of chlorhexidine-impregnated dressing with that of polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients with short-term percutaneous CVC. MethodsOne hundred fifteen patients with a CVC were randomised to chlorhexidine-impregnated gel dressing (chlorhexidine gel group) or transparent polyurethane dressing (polyurethane group) between April and December 2014. Feasibility outcomes included data on eligibility, recruitment, missing data, and protocol violation. The primary outcome measure of efficacy was the presence of colonisation with the same microorganism in both the skin swab around catheter insertion site and the catheter tip. ResultsOf 526 patients assessed for eligibility, 411 (78%) did not meet inclusion criteria, and 115 (22%) were randomised. Among participants of both groups, there were 14 missing primary outcomes of which 10 were due to failure to collect the catheter tip (a protocol violation). The final sample had 47 and 54 individuals in the chlorhexidine and polyurethane groups, respectively. Skin and catheter tip were colonised by the same microorganism for 13% of the participants in the chlorhexidine group and 8% in the polyurethane group, although the difference was not statistically significant (p = 0.51). There were no differences between the two groups for catheter tip colonisation, skin site colonisation, catheter insertion site infection, catheter-related bloodstream infection, skin irritation, and the number of unplanned dressing changes. ConclusionsOur preliminary results found that a large randomised controlled trial would be feasible. This study provides valuable information that can be used to design more robust studies to prevent infection among patients with short-term percutaneous CVC when using either chlorhexidine or polyurethane dressing.