Time Of Catheter Insertion Research Articles

The body mass index change is associated with death or hemodialysis transfer in Japanese patients initiating peritoneal dialysis

A decreased body mass index (BMI) over time is associated with a poor prognosis for patients on hemodialysis. We aimed to examine whether this association also applies to patients with peritoneal dialysis (PD). BMI change was defined as the percentage change in the BMI between the time of PD catheter insertion and six months after its insertion. The association between the BMI change and all-cause mortality or PD discontinuation from six months after PD catheter insertion until October 2021 was investigated. This retrospective cohort study included 122 patients (aged 61.1 ± 12.1 years; 90 males) who underwent PD catheter insertion between January 2008 and March 2020. The median follow-up period was 43.1 (21.2–78.8) months. The median six-month percentage change in the BMI was −2.14 (−5.56–1.84)%, and patients were categorized into tertiles based on their BMI changes. The fully-adjusted Cox regression analysis revealed a significantly higher rate of PD discontinuation or all-cause mortality (hazard ratio (HR): 2.48; 95%; confidence interval (CI): 1.41–4.37) in patients with the lowest tertile (T1, BMI change: < −4.13%) compared to patients with the middle tertile (T2, BMI change: −4.13%–0.67%). The risk was not significantly higher in patients with the highest tertile (T3, BMI change: >0.67%) than those in the T2 group (HR: 1.18; 95% CI: 0.66–2.11). A decreased BMI over time is independently associated with HD transfer or all-cause mortality among patients initiating PD, which highlights the importance of the 6-month BMI change as a novel prognostic marker.

PS-C18-4: HIGH BODY MASS INDEX IS A RISK FACTOR FOR TRANSITION TO HEMODIALYSIS OR HYBRID THERAPY AND PERITONEAL DIALYSIS-RELATED INFECTION

Objective: Obesity may negatively impact clinical outcomes of peritoneal dialysis (PD) patients. However, obesity is defined differently in Japan, and its impact on PD-related outcomes remains unclear. In current study, we aimed to examine the association of high body mass index (BMI) with the complete hemodialysis (HD) transfer, transition to HD and PD/HD hybrid therapy, peritonitis, catheter exit-site and tunnel infection (ESI/TI), and heart failure-related hospitalization. Design and method: This retrospective cohort study included 120 patients who underwent PD catheter insertion between January 2008 and June 2018. BMI ≧ 25 kg/m2, which was calculated from the height (m) and body weight (kg) at the time of PD catheter insertion, was defined as high BMI. Patients who develop solute retention or fluid overload with PD alone could choose to transfer first to PD/HD hybrid therapy, wherein patients usually undergo PD 5–6 days a week along with once-weekly HD, instead of directly transferring to HD alone. Association between high BMI and outcomes were analyzed by the log-rank test and the Cox proportional hazards models. Results: The follow-up duration was 46.2 (23.3–75.3) months. Time until transfer to HD and hybrid therapy was significantly shorter in the high BMI group than in the low one, whereas time until transfer to HD was not significantly different between both groups (P &lt; 0.001 and 0.18, respectively). Peritonitis-free and ESI/TI-free survival were significantly shorter in the high BMI group than in the low one (P = 0.006 and 0.03, respectively). After adjusting for age, sex, diabetes mellitus, estimated glomerular filtration rate, BMI ≧ 25 kg/m2 remained as a significant risk factor for transferring to HD and PD/HD hybrid therapy, peritonitis, and ESI/TI (hazard ratio [HR] 2.60, P &lt; 0.001; HR 2.08, P = 0.01; HR 2.64, P = 0.02, respectively). Conclusions: High BMI, defined as BMI ≧ 25 kg/m2, is a risk factor for transition to HD and PD/HD hybrid therapy, peritonitis, and ESI/TI. However, high BMI is not associated with early complete HD transfer in Japan, where PD/HD hybrid therapy is commonly used.

COMBATING HEMODIALYSIS CATHETER-RELATED INFECTION USING AN ANTIBIOTIC LOCK, ACASE-CONTROL STUDY, AT KING FAHD HOSPITAL OF THE UNIVERSITY, SAUDI ARABIA

Background: Catheter-related infections (CRI) in hemodialysis patients are very common complications with devastating consequences if not managed appropriately, as most of the morbidity and mortality among these patients are caused by bacteremia related to hemodialysis. Hence, safety issues exist to restrict the spread of infections among this group of patients. A prophylactic technique that is worth of much discussion is the use of antimicrobial lock solutions (ALS). Several studies have been conducted in this area. Yet, there is no consensus recommendation in this regarding. Hence, the purpose of our study is to examine the efficacy of ALS for prevention of CRI in patients undergoing HD. Methodology: Methods:A total of 86 TCC in 69 HD patients were enrolled at the time of catheter insertion for delivering HD. Patients were randomized into two groups: Group I (36 patients-39 insertions) included TCC with antibiotic-lock therapy and Group II (33 patients-47 insertions) with routine TCC management. Infection-free catheter survi­val of both groups was evaluated and compared at the end of the 7-month study period. Results:A total of 67 TCC-related infections were detected, with an incidence rate of 8.79/1000 dialysis sessions (ds). Out of these infections, 50 belonged to patients in group II with an incidence rate of 12.88/1000 ds, and 17 in patients of group I with an incidence rate of 4.51/1000 ds (p&lt;0.001) (Table 3). The bacteremia rate was 5.14/1000 ds in patients of group II and only 0.63/1000 ds in patients of group I (p&lt;0.001). Clinical sepsis occurred in 19 (28.4%) of the 67 TCC infections. Clinical sepsis rate was significantly lower in patients of group I (0.61/1000ds) compared with 4.12/1000 ds in group II patients (p&lt;0.005). Conclusion: TCC lock with vancomycin and gentamycin appears to be highly effective strategy for the reduction of morbidity, and potentially mortality and costs, associated with TCC-related bacterial infections in HD patients. In this study, this protocol was free of side effects.

Ultrasound-guided placement of long peripheral cannula in children with cystic fibrosis.

BackgroundThe natural history of cystic fibrosis (CF) lung disease is a chronic deterioration of lung function with intermittent episodes of pulmonary infectious exacerbations (PExs). Reliable venous access is a milestone of effective management of such exacerbations, managed both in hospital and outpatient chronic therapy. The aim of our study was to analyze the feasibility of ultrasound‐guided positioning of long peripheral catheters (LPC) as reliable midterm venous access in children affected by CF.MethodsIn this single‐center prospective study, over a 60‐month period, we included paediatric CF subjects admitted with PExs and undergoing intravenous antibiotic treatment. LPCs were inserted in all participants by paediatric anaesthesiologists with ultrasound guide technique. Prospective data were collected assessing catheter positioning procedure and complications.ResultsA total of 122 LPC insertions were performed in 55 CF children. Participants had a median age of 6.75 years (interquatile range: 3.7−13.5) at the time of catheter insertion. Implantation was successful on the first attempt in 86% of cases; 2 (1%) major insertion‐related complications were reported. Eighty‐eight percent of catheters were electively removed at the end of antibiotic therapy without any complication. Seven percent of the catheters were removed electively for occlusion and 2% for local dislodgment.ConclusionsThe results of the present study suggest that ultrasound‐guided positioning of LPCs are safe alternative means of peripheral venous access in children with chronic diseases such as CF.

MO692: A Four-Year Analysis on Home Dialysis at the North Bristol NHS Trust—What to Do Next?

Abstract BACKGROUND AND AIMS Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been associated with improved patient autonomy, quality of life and overall cost effectiveness (Weinhandl et al. Propensity matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010; 21: 499–506). The 2021 Get It Right First Time (GIRFT) Renal report revealed that home dialysis patients were at a lower risk of contracting and dying of coronavirus disease 2019 (COVID-19), compared to those who received in-center hemodialysis (ICHD) (2). Despite these advantages, uptake of home dialysis is still lower than that of ICHD. The aim of our study was to analyse the numbers and reasons for home dialysis withdrawal at the North Bristol NHS Trust between 2018 and 2021. METHOD All patients on PD and HHD between 2018 and 2021 were included. Analysis of the episodes that led to home dialysis cessation was carried out. As some patients required withdrawal more than once during the 4-year period, each episode of dropout was considered separately. The prevalence rate of patients on home dialysis was calculated. RESULTS The total number of patients on home dialysis increased from 74 in 2018 to 98 in 2021. The male: female ratio of patients was 3:2 with an average age of 58.3. The number of patients on PD increased from 58 at the end of 2018 to 82 in 2021. The number of patients on HHD remained stable over the years, with an average of 16. The prevalence rate of home dialysis was 17.1% at the end of 2021. Figure 1 shows the total number of patients who started and dropped out of home dialysis every year. The number of patients initiating PD was 58 in 2018, 55 in 2019, 37 in 2020 and 59 in 2021. The number of dropouts was 57 in 2018, 41 in 2019, 29 in 2020 and 43 in 2021. The dip in number of patients initiated on PD in 2020 can be attributed to the start of the COVID-19 pandemic, when elective procedures were temporarily withheld. On the other hand, a lower number dropped out during 2020. This may be explained by the emphasis given to self-isolation rules and persistence with home dialysis during the outbreak. The overall increase in PD uptake in 2021 may be explained by the establishment of a new specialist clinic that promotes the uptake of home dialysis. The initiation of a new peer support service group in 2021 may also have contributed. The number of patients initiating and withdrawing from HHD followed the same pattern, with a significant dip in 2020. Figure 2 demonstrates the reasons for withdrawal from PD over the study period. The most prevalent reasons were PD-related infections and transplantation. The observed figures for transplantation reflect the continuous efforts involved in the maintenance of a successful transplant programme. The figure also shows that termination of PD due to failure was highest in 2021. The authors postulate that this surge might be due to the previous year's low PD dropout rate. The leading reason for stopping HHD was transplantation. Other reasons included recovery of renal function and switching to conservative management. Death led to one dropout/year in 2018–20, but none in 2021. CONCLUSION Around 17% of the NBT’s total dialysis population is currently on home dialysis. The commonest reasons for termination of home dialysis were transplantation and PD-related infections. The GIRFT report recommends that all adult renal units in the UK should reach a minimum prevalence rate of 20% of their dialysis population on home dialysis by the end of 2024 (Lipkin et al. Renal medicine: Get It Right First Time (GIRFT) Programme National Specialty Report. March 2021. NHS England and NHS Improvement). Whereas our statistic falls slightly short of this, we aim to reach this target through various strategies. These include continued audit, home dialysis campaign, continued psychological services and a reduction in waiting time for PD catheter insertion.

Establishing a Core Outcome Measure for Peritoneal Dialysis-related Peritonitis: A Standardized Outcomes in Nephrology—Peritoneal Dialysis Consensus Workshop Report

IntroductionPeritoneal dialysis (PD)-related peritonitis is one of the leading causes of discontinuation of PD and is considered a critically important outcome for patients on PD. However, there is no universally accepted method of measuring this outcome in clinical trials.MethodsWe convened an online consensus workshop to establish a core outcome measure for PD-related peritonitis in clinical trials.ResultsA total of 53 participants, including 18 patients and caregivers, from 12 countries engaged in breakout discussions in this workshop. Transcripts were analyzed thematically. We identified the following 3 themes: (i) feasibility and applicability across diverse settings, which reflected the difficulty with implementing laboratory-based measures in resource-limited environments; (ii) ensuring validity, which included minimizing false positives and considering the specificity of symptoms; and (iii) being meaningful and tangible to patients, which meant that the measure should be easy to interpret, reflect the impact that symptoms have on patients, and promote transparency by standardizing the reporting of peritonitis among dialysis units.ConclusionA core outcome measure for PD-related peritonitis should include both symptom-based and laboratory-based criteria. Thus, the International Society for Peritoneal Dialysis (ISPD) definition of peritonitis is acceptable. However, there should be consideration of reporting suspected peritonitis in cases where laboratory confirmation is not possible. The measure should include all infections from the time of catheter insertion and capture both the rate of infection and the number of patients who remain peritonitis free. A core outcome measure with these features would increase the impact of clinical trials on the care and decision-making of patients receiving PD.

Comparison of ultrasound guided dorsal radial artery cannulation and conventional radial artery cannulation at the volar aspect of wrist: A pilot randomized controlled trial.

Distal radial artery cannulation at the "anatomical snuffbox" carries several theoretical advantages over conventional radial arterial cannulation at the wrist. However, these two techniques have not been evaluated in perioperative settings. In this randomized controlled trial, n = 200 patients requiring arterial cannulation for perioperative monitoring were recruited. Patients were randomized to either ultrasound guided distal radial artery cannulation group (group D) or ultrasound guided conventional radial artery cannulation group (group W). Primary outcome of this study was first attempt cannulation success rate. First attempt cannulation success rate was significantly lower in distal radial artery cannulation (57% in group D and 77% in group W; p = 0.003). Use of alternative cannulation site was significantly higher in group D when compared to group W (p = 0.015) and number of attempts for successful cannulation was significantly higher in group D when compared to group W (p = 0.015). None of the patients in any group developed thrombosis and related complications and intraoperative catheter dislodgement. Time to puncture the artery (p < 0.0001), total cannulation time (p < 0.0001), and actual catheter insertion time (p < 0.0001) were significantly higher in group D in comparison to group W. Distal radial artery cannulation was associated with lower first attempt cannulation success rate and requires longer time to perform. As distal radial artery is a new technique, further studies are required in different clinical settings.

Omental Procedures During Peritoneal Dialysis Insertion: A Systematic Review and Meta-Analysis.

Peritoneal dialysis (PD) is an option for ultrafiltration for patients with end-stage renal disease. Once placed, PD catheters may malfunction often due to omental wrapping. Omental procedures such as omentectomy and omentopexy may reduce this risk. This investigation aims to perform a systematic review and meta-analysis of the literature on the role of omental procedures on PD catheter insertions. Following protocol registration on PROSPERO (CRD42020218950), a systematic review was performed in accordance with the Cochrane Collaboration. A literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. Records with patients who underwent PD catheter insertion with and without omental manipulation were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I and RoB2. Effect estimates were extracted as risk ratios and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random-effect model. Of 510 records identified, 15 studies were included in the meta-analysis (1 RCT, 2 prospective, 12 retrospective). With omental procedures, there was decreased the likelihood of failure requiring removal of PD catheter (RR 0.47, 95% CI 0.38, 0.58) and PD catheter obstruction (RR 0.23, 95% CI 0.14, 0.39); there was no difference in likelihood of catheter malposition or migration (RR 0.87, 95% CI 0.23, 3.29) or peritonitis (RR 0.74, 95% CI 0.40, 1.35). Based on the current low to moderate quality of evidence, omental manipulation at the time of PD catheter insertion confers benefits of decreased obstruction and failure requiring removal.

Central Subclavian Catheterization in Newborns: Single-Center Experience

AbstractOur main aim of this article was to show that central venous catheter (CVC) can be an easy-to-use, less-complicated catheter application such as peripherally inserted central catheter and umbilical catheter placement in the neonatal intensive care unit. We here described our experience with subclavian vein catheterization. Neonates who had venous access through subclavian central catheterization were assessed retrospectively. Data such as gestational age, age at the time of catheter insertion, birth weight, and gender were collected. In addition, problems related to catheterization during hospitalization were documented. This study comprised 40 newborns, 22 male and 18 female, with a mean gestational week of 29.57 ± 3.80 weeks and a mean gestational weight of 2067.50 ± 545.97 g. Due to occlusion, catheters were switched in five cases twice and in three cases once, totaling 53 catheterizations on 40 newborns. None of our patients had pneumothorax or hemothorax. On the postoperative 8th and 21st days, the catheter was withdrawn due to catheter infection in two (5%) patients, and catheter cultures revealed coagulase negative Staphylococcus aureus in both cases. Even in preterm infants, subclavian central venous catheterization is a safe and straightforward technique of gaining venous access in expert hands in the neonatal intensive care unit.

External ventricular drainage for posthemorrhagic ventricular dilatation in preterm infants: insights on efficacy and failure.

The objective of this study was to describe the clinical and neuroradiological characteristics of a cohort of preterm infants who had undergone external ventricular drain insertion as a temporary measure to treat posthemorrhagic ventricular dilatation. In addition, the authors investigated the factors predicting permanent shunt dependency. The authors retrospectively reviewed the medical records of a cohort of preterm infants who had undergone external ventricular drain insertion at Gaslini Children's Hospital (Genoa, Italy) between March 2012 and February 2018. They also analyzed clinical characteristics and magnetic resonance imaging data, including diffusion- and susceptibility-weighted imaging studies, which were obtained before both catheter insertion and removal. Twenty-eight infants were included in the study. The mean gestational age was 28.2 ± 2.7 weeks, and the mean birth weight was 1209 ± 476 g. A permanent ventriculoperitoneal shunt was inserted in 15/28 (53.6%) infants because of the failure of external ventricular drainage as a temporary treatment option. Compared with the shunt-free group, the shunt-dependent group had a significantly lower gestational age (29.3 ± 2.3 vs 27.2 ± 2.7 weeks, p = 0.035) and tended toward a lower birth weight (p = 0.056). None of the clinical and neuroradiological characteristics significantly differed between the shunt-free and shunt-dependent groups at the time of catheter insertion. As expected, ventricular parameters as well as the intraventricular extension of intracerebral hemorrhage, as assessed using the intraventricular hemorrhage score, were reportedly higher in the shunt-dependent group than in the shunt-free group before catheter removal. External ventricular drainage is a reliable first-line treatment for posthemorrhagic hydrocephalus. However, predicting its efficacy as a unique treatment remains challenging. A lower gestational age is associated with a higher risk of posthemorrhagic hydrocephalus progression, suggesting that the more undeveloped the mechanisms for the clearance of blood degradation products, the greater the risk of requiring permanent cerebrospinal fluid diversion, although sophisticated MRI investigations are currently unable to corroborate this hypothesis.

Catheter-Obtained Urine Culture Contamination Among Young Infants: A Prospective Cohort Study.

Objectives: A correct diagnosis of urinary tract infection in young infants requires an uncontaminated urine culture, commonly obtained by urethral catheterization. In the current study, we examined the rates and factors associated with contaminations of catheter-obtained urine cultures in very young infants.Methods: This prospective cohort study included 143 catheter-obtained urine cultures of infants ≤2 months of age admitted to the pediatric ward of a tertiary hospital in Israel from April 2019 to September 2020. Patient's and operator's study variables were documented at the time of catheter insertion. Positive urine cultures were reviewed by a pediatric nephrologist and a pediatric infectious disease specialist and designated as infection or contamination. The study variables were compared between those with or without contamination.Results: The contamination rate in our cohort was 29%. Females were more than twice as likely to have a contaminated urine culture (37 vs. 18%, respectively, P = 0.014). Circumcision status, official training about sterile catheterization, a sense of difficult catheterization, and the shift in which the culture was obtained did not influence the contamination rate.Conclusions: Catheter-obtained urine cultures have a high contamination rate among very young infants, especially among girls.

Evaluation of Venous-to-Arterial Carbon Dioxide Tension Difference as a Complementary Parameter During Pediatric Septic Shock Resuscitation: A Prospective Observational Study.

The aim of this study was to evaluate the venous-to-arterial carbon dioxide tension difference during early resuscitation in pediatric septic shock. A prospective observational study was conducted in the pediatric intensive care unit of a tertiary care teaching. Children having septic shock aged from 3 to 60 months were studied within the first 24 hours of admission. Central venous and peripheral arterial blood samples for blood gases analysis at time of central venous catheter insertion and after 6 hours were obtained. Central venous carbon dioxide pressure, arterial carbon dioxide pressure, and their difference (delta Pco2) were recorded. Patients were categorized, accordingly to delta Pco2 after 6 hours of resuscitation, into high delta Pco2 group (≥6 mm Hg) and low delta Pco2 group (<6 mm Hg). Oxygen extraction ratio at 6 hours of resuscitation was significantly lower among the low delta Pco2 group. Arterial lactate showed marked improvement in the low delta Pco2 group to be less than 2 mmol/L at 12 hours of resuscitation. Low delta Pco2 group showed significant higher shock reversal with shorter shock reversal time. Mortality was significantly lower among low delta Pco2 group with shorter pediatric intensive care unit stay. Delta Pco2 after 6 hours of resuscitation of <6 mm Hg indicates normalization of tissue perfusion during pediatric septic shock management. It could be used as a complementary tool to guide the resuscitation in the early phase of pediatric septic shock.

Performing central venous catheters in neonates and small infants undergoing cardiac surgery using a wireless transducer for ultrasound guidance: a prospective, observational pilot study

BackgroundNeonates and small infants with congenital cardiac disease undergoing cardiac surgery represent major challenges facing paediatric anaesthesia and perioperative medicine. Aims.We here aimed to investigate the success rates in performing ultrasound (US) guided central venous catheter insertion (CVC) in neonates and small infants undergoing cardiac surgery, and to evaluate the practicability and feasibility of thereby using a novel wireless US transducer (WUST).MethodsThirty neonates and small infants with a maximum body weight of 10 kg and need for CVC before cardiac surgery were included in this observational trial and were subdivided into two groups according to their weight: < 5 kg and ≥ 5 kg. Cannulation success, failure rate, essential procedure related time periods, and complications were recorded and the clinical utility of the WUST was assessed by a 5-point Likert scale.ResultsIn total, CVC-insertion was successful in 27 (90%) of the patients and the first attempt was successful in 24 (78%) of patients. Success rates of CVC were 80% < 5 kg and 100% ≥5 kg. Comparing the two groups we found a clear trend towards longer needle insertion time in patients weighing < 5 kg (33 [28–69] vs. 24 [15–37]s, P = .07), whereas, the total time for catheter insertion and the duration of the whole procedure were similar in both groups (199 [167–228] vs. 178 [138–234] and 720[538–818] vs. 660 [562–833]s. In total, we report 3 (10%) cases of local hematoma as procedure-related complications. Assessments of the WUST revealed very good survey results for all parameters of practicability and handling (all ratings between 4.5 and 5.0).ConclusionAlthough difficulties in CVC-placement seem to relate to vessel size and patient’s weight, US guided CVC-insertion represents a valuable, fast, and safe intervention in neonates and small children undergoing cardiac surgery. Using the WUST is feasible for this clinical application and may aid in efforts aiming to optimize perioperative care.Trial registrationWireless US-guided CVC placement in infants; Clinicaltrials.gov: NCT04597021; Date of Registration: 21October, 2020; retrospectively registered.

Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

Introduction: Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD. Methods: Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed. Results: This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8–75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, p < 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 < 1.54 than in those with E1W/E0 ≥ 1.54 (p = 0.002, <0.001, and <0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, p = 0.01; HR 2.19, p < 0.001; HR 2.15, p < 0.001, respectively). Conclusion: Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.

Omentectomy reduces the need for peritoneal dialysis catheter revision in children: a study from the Pediatric Nephrology Research Consortium.

There are no multi-center studies examining omentectomy and peritoneal dialysis (PD) catheter revision in the pediatric dialysis population. We performed a retrospective study at eight centers within the Pediatric Nephrology Research Consortium (PNRC). Data review included all incident tunneled PD catheters placed between 1/1/2011 and 12/31/2016 in pediatric stage 5 chronic kidney disease (CKD 5) patients. The primary outcome was the need for catheter revision and/or replacement. Multivariable logistic regression was performed to evaluate predictors for catheter revision/replacement. Data from 184 children (62.5% male; median age 7.4 years) were analyzed. Omentectomy was completed in 63.6% (n = 117). Revision/replacement occurred in 34.2% (n = 63); median time to revision/replacement was 38.5 days after insertion. PD catheter revision/replacement catheter occurred in 23.9% who underwent omentectomy versus 52.2% without omentectomy (p = 0.0005). Children ≥ 6 years at the time of catheter insertion experienced fewer revisions/replacements (18.2% age ≥ 6 vs. 56.5% age < 6 years, p <0.001). After adjusting for covariates, omentectomy reduced the need for revision by 63%; revision was 3.66 times more likely in those < 6 years of age. This multi-center study demonstrates that omentectomy at the time of PD catheter insertion in pediatric patients is strongly associated with reduced likelihood of PD catheter revision. Omentectomy should be considered at the time of PD catheter insertion, especially in young children who are at high risk for PD catheter malfunction. A higher resolution version of the Graphical abstract is available as Supplementary information.

Cervical Dilation at the Time of Epidural Catheter Insertion Is Not Associated With the Degree of Prolongation of the First or Second Stages of Labor, or the Rate of Instrumental Vaginal Delivery

(Acta Obstet Gynecol Scand. 2020;99:1039–1049) Although epidural analgesia (EA) is used in over 60% of deliveries in Western countries with high patient satisfaction, it has been associated with risk of prolonged second stage of labor and instrumental vaginal delivery. The optimal time to administer EA based on cervical dilation is unknown, and whether the timing of its administration affects the duration of the first and second stages of labor or maternal or fetal outcomes. The aim of this study was to determine if the cervical dilation at the time of epidural placement impacts the duration of the first and/or second stage of labor and correlates with the rate of instrumental vaginal delivery.

Comparative efficacy of supraclavicular versus infraclavicular approach of subclavian vein cannulation under ultrasound guidance: A randomised clinical trial.

Background and Aims:Subclavian vein (SCV) cannulation can be performed using either supraclavicular (SC) or infraclavicular (IC) long-axis approach under ultrasound guidance (USG). However, their relative efficacy remains debatable. The aim of this study was to compare these two approaches in terms of safety, ease, success rate, and record the incidence of complications.Methods:We studied 90 adult patients distributed into two groups of 45 each. Data regarding the time taken for first venous puncture, the time required for inserting the catheter, the total number of attempts, the incidence of guidewire misplacement, and other mechanical complications were compared using Student's t-test for quantitative data and Chi-square test for qualitative value.Results:Mean puncture time was significantly lesser in group SC than IC (P-value < 0.001). Mean catheter insertion time taken was also significantly less in group SC than IC (P-value = 0.003). The first attempt rate was higher in group SC than IC (P = 0.013). Guidewire misplacement was seen in the IC group, P = 0.001. No pneumothorax, haemothorax, or arterial puncture were noted in our study in any of the groups.Conclusion:We conclude that for right-sided SCV cannulation using USG in the long axis, the SC approach is superior to the IC approach in terms of overall ease of cannulation. It was associated with a relatively shorter procedure time, higher success rate in the first attempt, lesser incidence of guidewire misplacement, and other complications. It should be considered as an alternative approach to the IC approach in patients requiring central line insertion.

Use of a Novel Fluorescent Catheter to Locate the Ureters during Total Laparoscopic Hysterectomy

Ureteral injury can occur during total laparoscopic hysterectomy. This report documents our experience in using the near-infrared ray catheter (NIRC), a newly developed fluorescent ureteral catheter made of material that contains a fluorescent dye to improve visualization of the ureters. We have used the device in 3 patients between 40 and 50 years of age (mean, 46.3 ± 4.5 years) undergoing total laparoscopic hysterectomy and bilateral salpingectomy for uterine myomas. The time of catheter insertion ranged from 4 minutes and 9 seconds to 10 minutes and 57 seconds. A number of intraoperative procedures were performed near the ureters, namely, identification and ligation of the uterine arteries, dissection of the cardinal ligament, incision of the vaginal canal, and suturing of the vaginal stump. The abovementioned fluorescent ureteral catheter appears green on a monitor when illuminated by near-infrared light, and this facilitated real-time confirmation of the ureter positions, increasing surgical safety. The patients were followed up for 6 months postoperatively, and no urinary tract infection or injury was found. Prophylactic use of the fluorescent ureteral catheter may improve visualization of the ureters in patients considered to be at high risk of ureteral injury, such as those expected to exhibit ureteral deviation due to severe adhesions or an enlarged uterus and when the surgeon has little experience in laparoscopic surgery.

Effect of a Vein Imaging Device and of Fist Clenching on Determination of an Appropriate Vein and on Catheter Placement Time in Patients Receiving Chemotherapy

As the vein structure gets damaged in patients receiving chemotherapy treatment, placement of peripheral intravenous catheter becomes difficult. To increase the success of peripheral intravenous catheter placement, a vein imaging device and fist clenching can be used. The aim of this study was to determine the effect of using a vein imaging device or fist clenching on the determination of an appropriate vein and successful catheter placement time in adult patients receiving chemotherapy. One hundred thirty-five patients receiving chemotherapy were randomly assigned to either the vascular imaging device group (n = 45), the fist clenching group (n = 45), or the control group (n = 45). In the vascular imaging group, a vascular imaging device was used to determine the appropriate vein; in the fist clenching group, the patients were asked to open and close their palms to determine the appropriate vein; and in the control group, no interventions except for the process steps were applied and the same nurse carried out the catheter insertion. The durations of determining the appropriate vein and successful peripheral intravenous catheter insertion were shorter in the device group at a significant level (P < .05) compared with the control group. The satisfaction levels of the patients and the nurse were higher in the device group at a significant level (P < .05) compared with the control group. The vascular imaging device was effective in determining the proper vein and in successful intravenous catheter insertion time in patients who were receiving chemotherapy. The use of vein imaging device will have positive results for patients and nurses.

Ultrasound-guided infraclavicular axillary vein cannulation: - is it a good alternative to internal jugular vein in pediatric cardiac surgery?

INTRODUCTION: This study was designed to compare the rate of successful first attempt and mechanical complications between internal jugular vein (IJV) and axillary vein (AXV) cannulation. METHODS: This prospective, randomized, comparative, controlled study included 220 pediatric patients with age range 1 to 12 years admitted for cardiac surgery. Patients were allocated into 2 equal groups, IJV group and AXV group. The main collected data were the rate of successful first, second and third punctures attempts and the rate of mechanical complications (arterial puncture, pneumothorax, catheter occlusion, catheter malposition, nerve injury). RESULTS: There was no statistically significant difference (P=0.053) in the first skin puncture success rate in both groups (AXV group 80% and IJV group 68%). There were no significant differences as regard the second and third skin punctures success rates. The incidence of failed vein puncture was similar (P=1.000) in IJV (3%) and AXV (2%) groups. The vein puncture and catheter insertion times were comparable in both groups. The rates of arterial puncture, pneumothorax and catheter malposition were similar in IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). Catheter occlusion with sternal retraction was significantly higher (p=0.029) in AXV than IJV group (6% vs 0%). No patient developed postoperative phrenic (IJV group) or brachial plexus nerve injury (AXV group). DISCUSSION AND CONCLUSION: Ultrasound-guided cannulation of both infraclavicular AXV and IJV were similarly associated with high success rate and low incidence of mechanical complications.