Venous Catheter-related Complications Research Articles

Neonatal Liver Imaging: Techniques, Role of Imaging, and Indications.

The neonatal liver may be affected by a variety of congenital and acquired diseases. Imaging has an important role in the workup and management of many neonatal hepatic abnormalities. Some aspects of imaging the liver and imaging findings are specific to neonatal patients when compared with those in older children. Therefore, selecting and tailoring the imaging technique for each indication in the neonate is important for optimal care, with minimal invasiveness. Common indications for imaging include incidental focal lesions, neonatal liver failure, cholestasis, and sepsis. US is the primary imaging modality, and for most conditions it is the only imaging modality required. MRI is the next modality after US for neonatal liver assessment and is especially required for complete assessment and staging of neoplasms, vascular abnormalities, and diagnosis of neonatal hemochromatosis. CT can be used when MRI is not available and should be used sparingly and in patients with acute conditions such as intra-abdominal bleeding. The authors emphasize imaging modalities that can be used for assessment of neonatal liver abnormalities, the imaging appearances of normal and changing structures in the neonatal liver, and indications for imaging. Abnormalities that are described include neonatal liver failure, infections, hepatic calcifications, umbilical venous catheter-related complications, and vascular abnormalities. ©RSNA, 2024 Supplemental material is available for this article.

Peripherally Inserted Central Venous Catheter-Related Complications in Adult Patients with Haematological Malignancy.

Peripherally inserted central venous catheters (PICC) are widely used in patients with haematological malignancies owing to the requirement for prolonged intravenous therapy. However, the growing use of PICCs has resulted in a multitude of complications such as infections and thrombosis, leading to prolonged hospitalisation periods and increased morbidity. This study aimed to determine the incidence of and factors associated with PICC-related complications in patients with haematological malignancies. This prospective cohort study was conducted at a single academic institution. The inclusion criteria involved all adult patients with haematological malignancies who had newly inserted PICCs. The patients were observed for a minimum duration of 60 days to evaluate the incidence of PICC-related infections and thrombosis, as well as mechanical complications. A total of 119 PICCs were implanted in 85 patients. Among them, more than half of the patients were diagnosed with lymphoma (55.0%). The median dwell time was 61 days (interquartile range: 98 days). The incidence of PICC-related complications was 58.0% (6.9 per 1,000 catheter-days). Specifically, 43 PICCs (36.1%, 4.3 per 1,000 catheter-days) experienced infective complications, 25 (21.1%, 2.5 per 1,000 catheter-days) encountered mechanical complications and 1 (0.8%, 0.1 per 1,000 catheter-days) exhibited thrombotic complications. Furthermore, an underlying diagnosis of acute leukaemia was significantly associated with a higher incidence of PICC-related infections. Our study revealed higher incidence rates of PICC-related complications in adult patients with haematological malignancies compared to the finding of other studies. Notably, patients with underlying acute leukaemia displayed a higher incidence of PICC-related infections. These findings underscore the importance of implementing appropriate interventions and conducting thorough root cause analyses to effectively mitigate this complication and improve patient outcomes.

Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study.

To explore the risk factors for peripherally inserted central venous catheter (PICC)-related complications in children. This retrospective study analyzed data collected from electronic medical records. A total of 584 patients with indwelling PICC treated between January 2019 and August 2021 were included in this study. According to the occurrence of PICC-related complications, the patients without PICC-related complications were included in the control group (n = 538) and those with PICC-related complications were included the observation group (n = 46). The risk factors for PICC-related complications were analyzed. Of the 584 patients with PICCs, 46 (7.88%) had PICC-related complications. Univariate analysis revealed significant differences in venipuncture (P < .001), oozing of blood from the puncture point (P < .001), indwelling time (P < .001), intravenous nutrient solution (P < .001), and catheter type (P = .003). Complications were used as dependent variables. The independent variables were vein puncture, blood oozing at the puncture point, indwelling time, intravenous nutrient solution, and catheter type. Multivariate logistic regression analysis revealed that the vein puncture (odds ratio [OR] 10.115, 95% confidence interval [CI] 5.034-20.323, P < .001), puncture point blood oozing (OR 9.217, 95% CI 3.860-22.004, P < .001), indwelling time (OR 6.390, 95% CI 3.527-10.972, P = .005), intravenous nutrient solution (OR 2.593, 95% CI 1.675-4.015, P < .001), and catheter type (OR 8.588, 95% CI 2.048-19.095, P = .013) were all risk factors for PICC-related complications in children. Venipuncture, oozing of blood from the puncture point, indwelling time, intravenous nutrient solution, and catheter type are risk factors for PICC-related complications in children. Significant attention should be paid to whether the puncture point is bleeding, the presence or absence of an intravenous nutrient solution, duration of catheterization, type of catheterization, and venipuncture. Additionally, preventive nursing measures should be implemented as soon as possible to reduce the risk of complications related to peripheral PICC.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients: An observational study

Objective: To evaluate the complications of central venous catheterization (CVC). Methods: A prospective, observational study was conducted at a tertiary care center in India from December 2018 to September 2020. Critically ill patients (aged ≥18 years) in the intensive care unit undergoing CVC procedures were included in the study. Baseline demographics and detailed medical history were recorded. Chest X-rays and electrocardiography were performed on all the patients. Complications associated with CVC were recorded. Results: A total of 100 patients with the indication for centralvenous catheter insertion were included. The majority (81%) of the patients were inserted with CVC at the right internal jugular vein. Complications such as arterial puncture (2%), hematoma (4%), blood clot formation (4%), catheter kinking (3%), thoracic injury(1%), thrombophlebitis (6%), sepsis (9%) and nerve injury (1%)were reported. Conclusions: Though central venous access is preferred in management of critically ill patients, it has its risks. However, early recognition and prompt management of complications may reduce mortality and morbidity. Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications. Suitable site selection, operator experience, and proper catheter maintenance are associated with optimal outcomes.

Adverse events related to central venous catheters (CVC) and the influence of CVC characteristics on peripheral blood hematopoietic progenitor cell collection in children.

The use of peripheral blood progenitor cells (PBPCs) as a source for hematopoietic stem cell transplantation (HSCT) in pediatric healthy donors is still under debate. The risk of a central venous catheter (CVC) placement and catheter-related complications continue to be the main arguments to discourage its use. we present a retrospective analysis of 140 PBPC collections in pediatric patients and donors, describing adverse events (AE) related to CVCs as well as the influence of catheterrelated variables on the efficiency of the leukapheresis. 14 CVC-related AEs were recorded (10%). The most common was fever in 5 patients, 4 of which had a catheter-related bacteriemia. Thrombotic events were only observed in 3 patients with active malignancy. A healthy donor presented a moderate bleeding after catheter withdrawal that resolved with local measures, and none of the rest presented any AE. Regarding variables related to the development of AEs, the subject group (patient or donor) was the only one significantly associated (p < 0.0001). Of interest, efficiency was also related to catheter location, being worse in those located in the femoral vein than in into the jugular or the subclavian veins (p < 0.05). In a multivariate analysis, the only variable significantly associated was catheter size (beta 0.238, p < 0.01). Placing a CVC for PBPC collection in pediatric subjects is overall safe; CVC-related complications in pediatric healthy donors are very rare. Furthermore, we should try to place catheters of the largest caliber possible, since the efficiency of the collection is related to this variable.

Evaluation of non-infectious complications in children receiving parenteral nutrition.

Parenteral nutrition may lead to inevitable complications. To determine the indications, metabolic and mechanical complications of parenteral nutrition in children. One hundred fifty-eight children (91 males; 57.8%) who received 179 episodes of individualized parenteral nutrition for ≥ 5days within 2years were analyzed. Indications and duration of parenteral nutrition, effect on growth, and metabolic and central venous catheter-related non-infectious complications were evaluated. Parenteral nutrition was administered in 179 different episodes (109 males; 60.9%), and the median age during these episodes was 64.0 (14.0-129.0) months. The most common indications were hematological malignancies, gastrointestinal surgery, and hematopoietic stem cell transplantation. Most of the electrolyte imbalances occurred in the first 3days. Hypophosphatemia (44.7%), hypomagnesemia (43.0%), hypokalemia (43.0%), hyponatremia (40.8%), and hypertriglyceridemia (38.2%) were the most common metabolic complications. Liver transaminases elevated in 32/145 (22.1%) episodes and bilirubin in 30/149 (21.0%). Ursodeoxycholic acid treatment was added to 25 patients with hypertransaminasemia and/or hyperbilirubinemia. Transaminase levels improved in 16 (64%) and bilirubin levels in 15 (60%) patients receiving ursodeoxycholic acid. Catheter thrombosis was seen in 4.5% of the episodes. The targeted energy could be given more efficiently via central catheters rather than peripheral venous accesses. Patients' bodyweights increased in 39.1% of the episodes. Close monitoring of electrolyte levels, especially in the first 3days, is crucial to prevent complications of parenteral nutrition. When individualized PN preparations are used for metabolically unstable patients, it can be easier to maintain the blood glucose, lipids, and electrolyte levels within the normal range.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

ObjectiveAssessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management...

Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials

BackgroundThe anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications.MethodsWe retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization. The primary outcome was the required catheter dwell time, defined as the period between the first catheter insertion and removal of the last catheter for absence of utility. Predictors were identified in the training cohort (3SITES trial; 2336 patients) through multivariable analyses based on the subdistribution hazard function accounting for death as a competing event. Internal validation was performed in the training cohort by 500 bootstraps to derive the CVC-IN score from robust risk factors. External validation of the CVC-IN score were performed in the testing cohort (CLEAN, and DRESSING2; 2371 patients).ResultsThe analysis was restricted to patients requiring mechanical ventilation to comply with model assumptions. Immunosuppression (2 points), high creatinine > 100 micromol/L (2 points), use of vasopressor (1 point), obesity (1 point) and older age (40–59, 1 point; ≥ 60, 2 points) were independently associated with the required catheter dwell time. At day 28, area under the ROC curve for the CVC-IN score was 0.69, 95% confidence interval (CI) [0.66–0.72] in the training cohort and 0.64, 95% CI [0.61–0.66] in the testing cohort. Patients with a CVC-IN score ≥ 4 in the overall cohort had a median required catheter dwell time of 24 days (versus 11 days for CVC-IN score < 4 points). The positive predictive value of a CVC-IN score ≥ 4 was 76.9% for > 7 days required catheter dwell time in the testing cohort.ConclusionThe CVC-IN score, which can be used for the first catheter, had a modest ability to discriminate required catheter dwell time. Nevertheless, preference of the subclavian site may contribute to limit the risk of intravascular complications, in particular among ventilated patients with high CVC-IN score.Trials Registration NCT01479153, NCT01629550, NCT01189682

Imaging of Umbilical Venous Catheter-Related Hepatic Complications in Neonates.

An umbilical venous catheter (UVC) is commonly placed for central venous access in preterm or critically ill full-term neonates to provide total parenteral nutrition (TPN) and medication. However, UVCs can result in complications, including infection, portal vein thrombosis, and hepatic tissue injury. The inadvertent administration of hypertonic fluid through a malpositioned UVC can also cause hepatic parenchymal damage with mass-like fluid collection that simulates a tumorous condition during imaging. Ultrasonography and radiographic examinations play an essential role in detecting UVC-related complications. This pictorial essay aims to present the imaging findings of UVC-related hepatic complications in neonates.

The Evaluation of Central Venous Catheter-related Complications in Pediatric Acute Leukemia Patients: Single Center Experience.

Central venous catheters (CVCs) are important for maintenance of childhood leukemia treatment but CVCs may develop complications. The aim of this study was to retrospectively evaluate the CVC-related complication rate, complication types, and outcome in children with acute leukemia. Complications developing in 310 CVCs (ports n=250, Hickman catheters n=60) inserted in 262 patients were evaluated. A total of 225,296 catheter days were screened. Median (range) CVC in-dwelling time was 661.5 (1 to 2636) days. In total, 157 complications developed of which 91 (58%) were infectious complications, 35 (22.3%) were vascular, 19 (12.1%) were surgical, and 12 (7.6%) were mechanical. Hickman catheters had a higher complication rate and were more prone to mechanical complications ( P <0.01) but there was no difference for other complications. A lower absolute neutrophil count at insertion was observed in children with infectious complications ( P <0.01). Seventy-eight of 136 catheters (57.3%) had to be removed prematurely. The overall complication rate was 0.65 per 1000 catheter days. In multivariate analysis, relapse leukemia, Hickman catheter and low absolute neutrophil count increased complication risk by 4.00, 1.97, and 1.92 times, respectively. Five (1.9%) deaths occurred because of catheter complications. Safe use of CVCs can be improved by early detection of complications and an experienced catheter care team.

Central venous catheter-related complications in older haemodialysis patients: A multicentre observational cohort study.

Central venous catheters (CVC) remain a commonly used vascular access option in haemodialysis, despite guidelines advising to preferably use arteriovenous fistulae. Compared to younger patients, the risk-benefit ratio of CVC in older patients might be more beneficial, but previous studies mainly focussed on catheter-related bacteraemia and/or assessed tunnelled CVC (TCVC) only. This study's aim was to compare all catheter-related infections and malfunctions in older patients with younger patients using all CVC subtypes. We used data from DUCATHO, a multicentre observational cohort study in The Netherlands. All adult patients in whom a CVC was placed for haemodialysis between 2012 and 2016 were included. The primary endpoint was the occurrence of catheter-related infections, comparing patients aged ⩾70 years with patients aged <70 years (reference). As secondary endpoints, catheter malfunctions and catheter removal due to either infection or malfunction were assessed. Using Cox proportional hazards and recurrent events modelling, hazard ratios (HR) with 95% confidence intervals (CI) were calculated with adjustment of prespecified confounders. Additionally, endpoints were assessed for non-tunnelled CVC (NTCVC) and TCVC separately. A total of 1595 patients with 2731 CVC (66.5% NTCVC, 33.1% TCVC) were included. Of these patients, 1001 (62.8%) were aged <70 years and 594 (37.2%) ⩾70 years. No statistically significant difference was found for the occurrence of catheter-related infections (adjusted HR 0.80-95% CI 0.62-1.02), catheter malfunction (adjusted HR 0.94-95% CI 0.75-1.17) and catheter removal due to infection or malfunction (adjusted HR 0.94-95% CI 0.80-1.11). Results were comparable when assessing NTCVC and TCVC separately. Patients aged ⩾70 to <70 years have a comparable risk for the occurrence of catheter-related infections and catheter malfunction. These findings may help when discussing treatment options with older patients starting haemodialysis and may inform the current debate on the best vascular access for these patients.

Safety of prolonged outpatient courses of intravenous antibiotics: a prospective cohort study

ObjectivesThe perceived need for prolonged intravenous antibiotic courses has become a major driver behind the growth of outpatient parenteral antimicrobial therapy (OPAT) services. Several recent randomized controlled trials demonstrate noninferiority of an early switch to oral therapy and highlight the need to accurately quantify harms associated with OPAT. MethodsWe conducted a 10-year prospective cohort study in a tertiary hospital OPAT service. Adults admitted to the service between 1 June 2009 and 30 June 2019 who received an intravenous antimicrobial agent were included. Adverse events (AEs) attributable to intravenous antibiotics or intravenous access were recorded in a prospectively maintained database and analyzed. ResultsThere were 4160 admissions (median length of stay: 20 days) and a total of 88 432 patient-days of observation; 135 patients (3.3% of admissions) experienced at least one major AE (1.54 per 1000 patient-days; 95% CI, 1.29–1.82). The risk of a major AE peaked in the second week of OPAT admission, with acute kidney injury (43 of 136; 32%) and severe cytopenia (42 of 136; 31%) being the most common. At least one minor AE occurred in 38.3% of admissions (1592 of 4160; 26.4 per 1000 patient-days; 95% CI, 25.4–27.5), with central venous catheter-related complications accounting for 71% of AEs (1658 of 2338). DiscussionThe incidence of major AEs during long courses of intravenous antibiotics is low, peaking in week 2 and tailing off thereafter. These results should inform decisions concerning the choice of intravenous versus oral antimicrobials.

DELAYED COMPLICATIONS OF CENTRAL VENOUS CATHETER IN PATIENTS UNDERWENT BONE MARROW TRANSPLANTATION IN SULAIMANI CITY/IRAQ

Background: Central venous catheter is essential in the management of patients undergoing bone marrow transplants, however, insertion of it has often the potential of inducing major complications. Aim: The aim of the study was to assess central venous catheter-related complications in patients underwent bone marrow transplants. Methodology: A retrospective study was carried out at Shahid Shaswary Garmian for bone marrow transplantation in Sulaimani City on 112 adult patients who underwent bone marrow transplants from June 2016 to May 2021. The patient's medical records were used to collect data regarding; patients' and CVCs characteristics, intravenous infusions, CVC-related complications; the number and type of complication. Results: The age of 52.7% was between 40-60 years, most of them were male, primary school, and from urban. The medical diagnosis for (43.8%) was multiple myeloma, majority underwent autologous transplant, Hickman line was used for 48.2%, internal jugular vein was a most used vein, the length of stay with a catheter for almost 70% was between 2 to 3 weeks, and the majority had 2 dressing per week, most of the participants received 2 bags of Fresenius, 51.8% received blood, and 92% received platelet. The catheter-related complications occurred in 65.2% of participants, the number and type of complications were varied; 42% had one, 19.6% two, and 3.6% three complications, the proportion of fibrin was 42.9% followed by infection 32.1, occlusion 10.7%, and hematoma 7.1%. The incidence of complications was higher in leukemic patients, who had allogeneic transplants and used Hickman line 88.9%. In addition, using internal jugular vein for insertion 90%, long stay with the catheter (≥ 4 weeks) 89.3% and fewer number of dressing (1 dressing/week) 100% were more problematic. Conclusions: The incidence of central venous catheter-related complications was high, almost two-thirds had at least one complication. The most common complications were fibrin and infection. The incidence of complications affects by patients' medical diagnosis, type of transplant and catheter, vein used for insertion of the catheter, the duration of stay with a catheter, and the number of dressings for catheters sit.

Study of central venous catheter-related complications in major burn patients

Background: Routinely changing central venous catheters (CVCs) as a prevention strategy of bbloodstreaminfections in burns patients has been controversial due to the paucity of evidence for appropriate timings of line changes. This study aims to ascertain the risk factors associated with central line-associated sepsis and thrombosis and to evaluate the role of heparin lock, routine line changes, and thromboprophylaxis in reducing the risk of complications associated with central venous catheterization. Materials and Methods: A retrospective observational hospital-based study on 50 patients admitted with major burns (involving 40% or more total body surface area [TBSA] in burn intensive care unit/ward at Gandhi Medical College and Associated Hamidia Hospital from May 2021 to June 2022. Nontunneled, triple-lumen central lines were inserted usingthe Seldinger technique preferentially on healthy skin and secured with Tegaderm™ CHG Chlorhexidine Gluconate transparent dressing. The removal of central lines was done sepsis (persistent rise of fever unresponsive to antipyretics or empirical antibiotics) or when distal limb swelling edema) developed. Routine removal of the central line was also done when resuscitation was over and parenteral nutritional supplementation was no longer needed (after 12–15 days) or before shifting from HDU or on discharge. Data collection included: Demographics, co-morbidities, type and cause of burn, %TBSA, route (subclavian, femoral, and jugular line), access (healthy/burned) of line, duration of line in situ, complications (cellulitis, edema, venous thrombosis, and persistent high-grade fever), culture/sensitivity (c/s) reports, duration of hospital stay, heparin prophylaxis, or treatment. The data were processed with Chi-square test. The primary outcome of this observational study was a measure of catheter-related bloodstream infections and symptomatic deep vein thrombosis and their correlation with demographics and various comorbidities. Result: Central line duration and age were identified as independent risk factors for central line-associated bloodstream infection (CLABSI), with central line duration the most significant predictor (P &lt; 0.05). CLABSI occurred at 12.81 ± 2.967 days' postline insertion. Further research is needed to assess the role of routine line changes (every 12–15 days' postinsertion) in preventing CLABSI and heparin lock in reducing the incidence of venous thrombosis. Hospital stay was prolonged in the patients developing CVC-associated complications independently increasing morbidity in patients with severe burns, but was not found to be significant (P &lt; 0.05). Conclusion: Jugular venous route should be preferred as the site of CVC insertion (easier and associated with a lower complication rate) and the duration of line kept in situ should be reduced. The blood c/s (preferably central line tip c/s) should be sent routinely after 10 days or on the first suspicion of complications to reduce the incidence and severity of CLABSI in major burn patients.

PE-31: Single-centre Experience on Central Venous Catheter-related Complications in Children on Home Parenteral Nutrition

PE-31: Single-centre Experience on Central Venous Catheter-related Complications in Children on Home Parenteral Nutrition

Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience.

The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age ( p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5-8] days) and CRBSI (6 [5-9] days) patients ( p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization ( p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.

Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial

Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes used in combination (innovation group) over open catheters and three-way stopcocks for treatment administration (standard group) in preventing catheter failure. We did an open-label, randomised-controlled trial with a two-by-two factorial design, for which we enrolled adults (age ≥18 years) visiting the emergency department at the Poitiers University Hospital, France, and requiring one peripheral venous catheter before admission to the medical wards. Before catheter insertion, patients were randomly assigned (1:1:1:1) using a secure web-based random-number generator to one of four treatment groups based on skin preparation and type of devices (innovative devices or standard devices; 2% chlorhexidine plus alcohol or 5% povidone iodine plus alcohol). Primary outcomes were the incidence of infectious complications (local infection, catheter colonisation, or bloodstream infections) and time between catheter insertion and catheter failure (occlusion, dislodgment, infiltration, phlebitis, or infection). This study is registered with ClinicalTrials.gov, NCT03757143. 1000 patients were recruited between Jan 7, and Sept 6, 2019, of whom 500 were assigned to the chlorhexidine plus alcohol group and 500 to the povidone iodine plus alcohol group (250 with innovative solutions and 250 with standard devices in each antiseptic group). No significant interaction was found between the two study interventions. Local infections occurred less frequently with chlorhexidine plus alcohol than with povidone iodine plus alcohol (0 [0%] of 496 patients vs six [1%] of 493 patients) and the same was observed for catheter colonisation (4/431 [1%] vs 70/415 [17%] catheters among the catheters cultured; adjusted subdistribution hazard ratio 0·08 [95% CI 0·02-0·18]). Median time between catheter insertion and catheter failure was longer in the innovation group compared with the standard group (50·4 [IQR 29·6-69·4] h vs 30·0 [16·6-52·6] h; p=0·0017). Minor skin reactions occurred in nine (2%) patients in the chlorhexidine plus alcohol group and seven (1%) patients in the povidone iodine plus alcohol group. For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol. Use of innovative devices extends the catheter complication-free dwell time. Becton Dickinson.

Incidence and Predictors of Peripheral Venous Catheter-Related Complications in Hospitals in Burkina Faso

Introduction: Peripheral venous catheters (PVCs) are the most commonly used medical devices in hospitals for the administration of medications. Their use can lead to complications of varying severity. Objective: Determine the incidence and factors associated with the occurrence of PVC-related complications. Methods: This was a two-month prospective observational study conducted in the Medical Emergency Department (MED) of Yalgado Ouedraogo Teaching Hospital in Ouagadougou. All patients admitted during the study period who had a PVC inserted and removed were included in the study. Logistic regression analysis was used to identify the factors associated with the occurrence of complications. Results: In total, 459 PVCs were inserted and removed in 415 patients hospitalized at the Medical Emergency Department during the study period. The placement of 37.7% (n = 173) of PVCs resulted in complications in 131 patients (31.6%). For 644.3 days of catheterization, the incidence density was estimated at 6.5 complications per 1000 patient days. Phlebitis (24.0%), infection (5.7%), and accidental removal (2.8%) were the most frequently identified complications. The average age of the patients was 46.8 ± 18.9 years with a sex ratio of 1.22. The average patient hospitalization duration was 2.5 ± 2.6 days. In multivariate analysis, the factors significantly associated with the occurrence of complications after PVC insertion were patient’s state of agitation during the procedure (aOR = 12.59; 95% CI = 4.12 - 38.49), placement of the PVC at the elbow bend (aOR = 2.17; 95% CI = 1.86 - 5.52), multiple attempts (aOR = 3.18; 95% CI = 1.49 - 6.75), administration of 10% hypertonic glucose solution (aOR = 3.67; 95% CI = 1.62 - 8.33), and duration of catheterization beyond 72 hours without being changed (aOR = 33.00; 95% CI = 14.19 - 76.75). Conclusion: The incidence of PVC-related complications was relatively high. The identification of the factors that can lead to these complications is relevant to the delivery of quality healthcare to patients.

A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore.

Umbilical venous catheters (UVCs), commonly inserted in neonates for vascular access, are not without complications. A single-centre retrospective cohort study that reviewed complications related to UVC insertion in neonates was conducted in a tertiary neonatal unit in Singapore from January 2016 to July 2017. Ideal UVC position was defined as catheter tip within 0.5 cm above or below the diaphragm. Catheter-related sepsis was defined as clinical or biochemical abnormalities suggesting any new-onset or worsening sepsis 72 hours before or after removal of UVCs, with or without positive culture. Catheter-associated bloodstream infection (CABSI) was defined as positive microbiological growth in one or more blood cultures obtained from a symptomatic infant up to two days after UVC placement or within 48 hours of catheter removal. 108 patients had UVC insertions. Mean gestational age and birth weight were 30.4 ± 4.0 weeks and 1,536.2 g ± 788.9 g, respectively. Mean UVC duration was 6.6 days. The UVC was in an ideal position in 27 (25.0%), deep in 13 (12.0%) and short in 35 (32.4%) neonates. One-third of the UVCs (n = 33) were malpositioned. Catheter-related sepsis was observed in 16 (14.8%) neonates, with 5 (4.6%) having CABSI. The most common organism was coagulase-negative Staphylococcus. Other complications include peritoneal extravasation in 3 (2.8%) patients, with two requiring surgical intervention. Venous thrombosis occurred in 2 (1.9%) neonates and was managed conservatively. Although complication rates were in line with international norms, UVCs were associated with serious complications and should be judiciously used.

Influence of the Insertion Site on Central Venous Catheter-Related Complications in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation.

Central venous catheters (CVCs) are extensively used in patients undergoing allogeneic hematopoietic cell transplantation (HCT). In these patients CVC are placed routinely either via the internal jugular vein (IJV) or the subclavian vein (SCV). Purpose of this study was to systematically analyze complications of CVC at different insertion sites in HCT recipients. In this retrospective analysis, all consecutive patients (n=56) who received a CVC (n=101) due to allogeneic HCT at our institution between January 2011 and June 2013 were included. Three-lumen standard, nontunneled CVCs were placed via either the IJV (n=60; 59%) or the SCV (n=41; 41%). Study endpoints were time to local inflammation at the insertion site, time to fever, time to a combined endpoint of inflammation and fever, central line-associated bloodstream infection (CLABSI), duration of catheterization, catheter lumen obstruction, deep-vein thrombosis, pneumothorax, and catheter-related death. The median duration of catheterization per CVC was almost identical for the IJV and SCV sites (18 days versus 17 days; P not significant). There were no differences in the frequency of CLABSI, deep-vein thrombosis, pneumothorax, and catheter lumen obstruction between IJV and SCV CVC insertion sites. None of the patients died due to a CVC-related cause. Local inflammation occurred less frequently (48% versus 71%; P = .025) and later (median time to local inflammation, 25 days versus 12 days; P = .01) in IJV CVCs versus SCV CVCs. There was a trend toward a median longer time to the occurrence of fever for IJV CVCs compared with SCV CVCs (20 days versus 13 days; P=.07). In the multivariate analysis, diagnosis of acute leukemia (hazard ratio [HR], 1.696; P = .036), SCV CVC (HR, 1.617; P =.039), and neutropenic CVC-days (HR, 2.477; P = .01) were identified as risk factors for the occurrence of local inflammation or fever. In contrast to earlier studies in patients without hematologic malignancies, these data demonstrate that CVCs placed in the SCV are not superior over IJV CVCs. Moreover, local inflammation occurred earlier and more frequently in patients with an SCV CVC.