Risk Of Catheter-related Complications Research Articles

Midline and Extended Dwell Catheters for IV Antibiotics


 Midline catheters may be associated with longer uncomplicated indwelling time and a lower overall risk of catheter-related complications than extended dwell catheters.
 The rates of catheter-related complications were low across different peripheral catheter types.
 Midline catheters may have a lower proportion of catheter-related bloodstream infections, drug leakage from the exit site, and complete catheter occlusion, but a higher proportion of catheter-related thrombosis events compared with extended dwell catheters.
 The findings were derived from 1 retrospective cohort study with imbalanced baseline characteristics of patients, and the limitations of the study may have favoured midline catheters; future studies are needed to confirm our findings.
 We did not find any systematic reviews, health technology assessments, randomized controlled trials, or evidence-based guidelines that met our inclusion criteria.

History and descriptions of vascular access devices

This article aims to provide an overview of the range of long- and short-term vascular access devices (VADs) used in most healthcare settings for the administration of intravenous therapies or to deliver medical interventions. This article will describe the devices in use and the rationale for correct device selection; and how to reduce the risk of catheter related complications. Within the article, there is a discussion on the optimal care and maintenance procedures necessary to help ensure that VAD dwell complications free and until treatment is complete. This ensures patient safety, satisfaction, and an improved patient experience.

SPONTANEOUS BACTERIAL EMPYEMA: HOW IS IT ACTUALLY DEFINED?

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Hepatic hydrothorax refers to a pleural effusion in a cirrhotic without another identifiable cause. When this pleural fluid becomes infected, it is called a spontaneous bacterial empyema (SBE). SBE needs to be distinguished from an effusion secondary to a primary lung infection because chest tube drainage is avoided in SBE. We present a case of a cirrhotic patient with an infected pleural space where the diagnosis is not clear based on existing diagnostic criteria for SBE. CASE PRESENTATION: A 64 year old male with alcoholic cirrhosis presented to the Emergency Department for shortness of breath. He had a history of refractory ascites requiring paracentesis every two weeks and a small, right-sided pleural effusion that had been present for two years. Upon presentation, he was tachycardic and hypoxic requiring three liters of oxygen. Initial workup was significant for a white blood cell (WBC) count of 14,000/uL, chest x-ray showed a moderate right-sided pleural effusion, thoracic ultrasound showed a loculated pleural space, and abdominal ultrasound revealed no ascites. A thoracentesis was performed with serosanguinous fluid appearance, WBC of 6,000/uL with 98% neutrophils, pH of 6.50, and a glucose of 172 mg/dL. A chest tube was placed soon after admission. After four days of drainage and intravenous antibiotics, the patient was weaned off supplemental oxygen and his leukocytosis resolved. The chest tube was removed, and he was discharged to complete six weeks of antibiotics. DISCUSSION: Chest tube drainage has been associated with increased incidence of protein loss, kidney injury, and infection in cirrhotic patients [1], and most guidelines recommend against tube drainage for SBE [1, 2, 3]. To our knowledge, there is no consensus definition of SBE (Table 1), and none incorporate the presence of loculations on chest imaging. This patient met some definitions of SBE while not meeting others (Table 1). Because of the low pleural fluid pH and complex appearing pleural space, we proceeded with chest tube drainage despite recommendations to avoid catheter placement in SBE because of concern for inadequate source control with antibiotics alone. The patient’s clinical improvement after chest tube drainage confirmed our suspicion that he likely had a parapneumonic effusion instead of SBE. Integrating pleural loculations and standardizing the definition for SBE may help stratify patients that require chest tube drainage from those that will improve with antibiotics alone. CONCLUSIONS: The diagnostic criteria for SBE is not clear. The lack of a consensus definition can lead to treatment uncertainty and inappropriate delays in chest drainage. Standardizing the diagnostic criteria will allow for more judicious use of chest tube drainage in cirrhotic patients that are at increased risk of catheter related complications. Reference #1: 1. Xiol X, Casais L. Spontaneous Bacterial Empyema in Cirrhotic Patients: Analysis of Eleven Cases. Hepatology. 1990 Mar; 11(3): 365-7 Reference #2: 2. Tu CY, Chen CH. Spontaneous Bacterial Empyema. Curr Opin Pulm Med. 2012 Jul; 18(4): 355-8 Reference #3: 3. Cardenas A, Kelleher B, Chopra S. Hepatic Hydrothorax. UptoDate. Retrieved January 25, 2019 from https://www.uptodate.com/contents/hepatic-hydrothorax DISCLOSURES: No relevant relationships by Kevin Ho, source=Web Response No relevant relationships by Jennifer McCallister, source=Web Response

Local Anesthetic Additives for Regional Anesthesia: a Review of Current Literature and Clinical Application

Improving perioperative pain management with regional anesthesia has become prevalent and extremely important, due in part to the opioid epidemic and increased emphasis on enhanced recovery after surgery (ERAS) protocols. Perineural catheters offer extended duration of nerve blockade as compared with single dose of local anesthetic at the cost of increased risk of catheter-related complications like displacement and higher infection rate. Also, many practices lack the infrastructure to manage catheters. We are continuously exploring options to extend block duration without catheters, and local anesthetic additives offer a viable option to prolong the benefits of plain local anesthetics. A recent randomized cross-over study has suggested that the efficacy of local anesthetic additives like dexamethasone on the duration of nerve block remains uncertain despite several supporting systematic reviews and meta-analysis data. This article reviews current literature to provide clinically relevant information about common nerve block additives, describing rationale for their use, effect on block onset, extension of block duration, and safety profiles of the additives.

<p>Japanese patient preferences regarding intermediate to advanced hepatocellular carcinoma treatments</p>

Purpose: This study aimed to evaluate Japanese patient preferences regarding features of intermediate or advanced (Progressed) hepatocellular carcinoma (HCC) treatments: transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), and oral anti-cancer therapy.Methods: Patients with HCC, recruited from clinical sites and a patient panel in Japan, completed a cross-sectional web-based survey. Preferences were quantified using best–worst scaling, where patients identified the best and worst among 13 treatment features. Direct elicitation was used to identify preference for TACE, HAIC, or oral therapy, including the likelihood of trying each. Additional items asked for the willingness to try an oral medication that delays progression by six months but has an 8% or 21% risk of severe hand-foot skin reaction (HFSR).Results: The sample (N=119; 29 early stage; 90 Progressed) most preferred “oral medication”, “artery branches plugged”, and “prevents formation of new blood vessels”, and least preferred “risk of liver damage” and “risk of catheter-related complications”. Overall, 51%, 40%, and 8% preferred oral therapy, TACE, and HAIC, respectively (p<0.05), and the mean likelihood of trying each were 59%, 52%, and 35%, respectively (p<0.001). Patients with sorafenib or TACE experience most preferred what they had received; however, both groups were equally willing to try the other treatment. Patients preferring oral therapy favored “oral medication” over “artery branches plugged”, “surgery is repeated as required when the cancer grows again”, and “risk of liver damage”, compared to those preferring TACE (p<0.05). Sixty-eight percent would probably try therapy with an 8% risk of severe HFSR, compared to 50% with a 21% risk.Conclusion: Treatment type, mode of action, and risks may drive HCC patient preferences. Such features likely should be incorporated into physician–patient interactions regarding treatment decision-making.

Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis

BackgroundCentral venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement.MethodsPatients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association’s Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter–related complications (MCRCs).ResultsThirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter–related complications were most frequently seen in patients 16 years or younger.ConclusionsThe risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters. Data provided in this study can be applied toward improving patient care.

Early Mobility and Walking for Patients with Femoral Arterial Catheters in Intensive Care Unit: a Case Series

ABSTRACT Patients with femoral arterial catheters for hemodynamic monitoring are sometimes placed on bed rest because of the anatomical location and perceived risk of catheter-related complications associated with mobility. This practice subjects these patients to the well known adverse effects of inactivity on functional mobility and functional outcomes. Because of limited evidence to link mobility with femoral artery displacement or damage, this practice may be unwarranted and may add to the treatment burden of the patient in the intensive care unit. The purpose of this study was to explore whether physical therapy-directed mobilization of patients with femoral arterial catheters resulted in adverse events. A retrospective case series was undertaken on patients in a 40-bed cardiovascular and thoracic intensive care unit. The list of potential catheter-related adverse events investigated included bleeding at the femoral arterial catheter site, accidental catheter dislodgement and/or removal, non-functioning catheter after activity event, and acute limb ischemia within 24 hours. The 30 patients identified for the study underwent 47 physical therapy sessions with a total of 156 activity events including sitting on the side of the bed, standing at bedside, transfers to a regular chair or a stretcher chair, and walking. No femoral arterial catheter-related adverse events that could be attributed to participation in physical therapy were documented in either the nursing or physical therapy notes. The data from this single center retrospective case series suggest that early mobility and walking activities do not affect femoral arterial catheters used for hemodynamic monitoring and orders for bed rest may unnecessarily add to symptom burden faced by these patients.

Pulmonary Arterial Hypertension – Future Directions

Pulmonary arterial hypertension (PAH) is a rare but life-threatening condition that has traditionally required treatment with continuous intravenous epoprostenol via an indwelling central catheter.1–3 Such therapy improves outcome, but is fraught with side effects, expense, and risk of catheter-related complications.

Is oral treatment of CMV-infections with valganciclovir after heart transplantation sufficient?

Background: CMV-infection and CMV-disease is a common adverse event after heart transplantation (HTx). Todate oral formulations of virostatics had a limited bioavailability. Therefore state of the art therapy of CMV-infections used to be intravenous application of ganciclovir. Patients had to be hosptalized and intravenous application was associated with the risk of catheter-related complications. Methods: In this study 12 patients after HTx with manifest CMVinfections were treated with the new oral formulation of ganciclovir (Valcyte), a valylester prodrug of ganciclovir, achieving similar plasma concentrations when compared to intravenous treatment. CMVinfection was defined as positive CMV-Clonab(pp65) or positive CMV-PCR. Valcyte was adminstered according to creatinine clearance until PCR or Clonab proved to be negative (at least for two weeks). During treatment patients were screened every second day, using venous blood sampling and measurement of PCR and Clonab(pp65). Results: Survival during follow up was 100%. All patients tolerated the medication well, only one patient showed leucopenia and medication had to be stopped. Mean duration of administration was 50,3 days with a mean dosis of 231,7 712 mg/d; in all patients the infections were treated effectively. Creatinine levels, glutamate-oxalacetate-transaminase, glutamat-pyruvate-transaminase did not increase significantly during follow up. Conclusion: The findings of these study indicate that the oral formulation of ganciclovir is an effective alternative for treating CMV-infections after HTx. It is well tolerated and avoids the risk of catheter-related complications, associated with long term daily intravenous therapy administration as well as the costs for hospitalization.

Effects of long-term parenteral nutrition on the course of pancreatic pseudocyst

The benefit of total parenteral nutrition (TPN) for the non-operative treatment of acute pancreatic pseudocyst remains hypothetical benefit. We reviewed results for 40 patients with pancreatic pseudocyst treated with TPN who had had serial imaging studies. On presentation, mean cyst size was 7.4 cm and after non-operative treatment with TPN (mean 32.5 days) the cyst had decreased to 5.6 cm. After the non-operative period, 68% of the pseudocysts had regressed, completely in 14% and partially in 54% of the patients. Except for 1 patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) of the patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complications, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), during the course of hospitalization. Most of the patients treated with TPN showed both clinical and radiographic regression of their pseudocysts. However, the risk of catheter-related complications in this group suggests that this therapy should be limited to those patients who are unable to sustain enteral nutrition.