Venous Catheter Research Articles

Retrospective Evaluation of Central Venous Catheters Applications in Pediatric Patients in Tertiary Hospital

Introduction: Central venous catheters are mainly used for safe fluid infusion, total parenteral nutrition, and evaluation of hemodynamic parameters. Complications related to central venous access can occur during insertion, after insertion or during catheter maintenance. The aim of this study was to investigate the demographic data and the presence of catheter-related complications in pediatric patients with central venous catheters in our hospital. Materials and methods: This study retrospectively reviewed demographic data and the presence of catheter-related complications in pediatric patients with central venous catheters in our hospital from June 1, 2019, to February 28, 2023. Results: Patients who underwent central venous catheterisation in our hospital between June 2020 and February 2023 were included in the study. When the demographic data of the patients were evaluated, 141 (57.8%) of our patients were male and 103 (42.2%) were female, and there was no statistically significant difference between the groups. In the femoral group, catheterisation of the right femoral vein was preferred more than the left vein (72.2%-27.7%), whereas in the jugular-subclavian group, the right internal jugular vein was preferred more than other sites. The risk of infection was statistically higher in the femoral group compared to the subclavian group. Conclusion: In clinical practice, we think that the risk of complications can be reduced in central venous catheter applications in pediatric patients by experienced personnel by complying with asepsis/antisepsis conditions and using appropriate imaging devices. Keywords: Central venous catheter, pediatric, complication

Features of surgical line managements in Baku

Aims: Central venous catheters (CVC) have become an acceptable form of permanent access in patients with limited access options. Proper management of this procedure is crucial for a successful treatment period. Therefore, we aim to demonstrate our insertion steps and discuss our findings with the literature, highlighting the successful outcomes we have achieved. Methods: After the approval of the hospital directorate, central catheters were inserted into pediatric patients at a Children’s Hospital in Baku through a retrospective review of patient notes over the last two years. Experienced or inexperienced staff, operating theatre or ward, emergent or elective insertions, catheter diameters, catheter dimensions, selected models, number of lumens, reason for insertion, insertion method, fixation methods, dressings, and locations of catheter tips are evaluated. Also, companies that produce catheters are mentioned. Results: Sixty-three CVC insertions were performed via CVC between 2021 and 2023. Forty-one catheters were inserted by senior staff. Sixty-one were inserted in the operating theatre. Fifty-four were emergent applications. Mainly, 6.5 and 7 French lines were used. Three different international companies supplied the catheters. Half of the catheters used were double-lumen. Oncology diseases were the most common reasons for insertions (n=40). Seldinger’s method was the main one chosen for insertions (n=59). Prolene sutures are mainly used to fix catheters. After insertions, iodine dressings (tegaderm®) are commonly used (n=48). The right atrium was the principal place for the lumen tip (n=39). Conclusion: Our procedures for central venous catheterizations are similar to those in the literature. Nevertheless, the catheter might be positioned at the ending area of the superior vena cava. We observed no harm in the patients with the right atrium location. Also, fixation and trademarks might be matters of evaluation about the effectiveness of procedures.

"Navigating Danger: Emergency Thoracotomy For Superior Vena Cava Injury During Dialysis Access In An Elderly Patient"

Superior vena cava (SVC) injury is a rare but life-threatening complication during the insertion of central venous catheters, especially in elderly patients with multiple comorbidities. We report a case of an 81-year-old woman with a complex medical history, including diabetes mellitus, hypertension, dyslipidemia, and end-stage renal disease (ESRD), who suffered an SVC injury during the placement of a PermCath for hemodialysis. The patient was initially admitted with fever and altered sensorium, requiring urgent dialysis. A femoral catheter was initially used, but a more permanent solution was sought. During the placement of the PermCath, the patient developed hypotension and shock, necessitating immediate transfer to the intensive care unit (ICU). Imaging revealed a severe right hemothorax and active bleeding from a perforation of the SVC. Emergency right exploratory thoracotomy was performed, revealing a 2 cm laceration at the insertion of the azygous vein into the SVC and a linear laceration of the right lower lung lobe. Both injuries were repaired, and the patient was stabilized. She recovered well postoperatively and was discharged on the fifth postoperative day. This case underscores the importance of early recognition and prompt surgical intervention in managing SVC injuries during central venous catheterization

Right Subclavian Venous Catheterization: Don't Throw the Baby Out With the Bathwater.

Right Subclavian Venous Catheterization: Don't Throw the Baby Out With the Bathwater.

Influence of Arm Abduction on Ipsilateral Internal Jugular Vein Misplacement During Ultrasound-Guided Subclavian Venous Catheterization.

Influence of Arm Abduction on Ipsilateral Internal Jugular Vein Misplacement During Ultrasound-Guided Subclavian Venous Catheterization.

Clinical evaluation of the PowerGlide Pro midline catheter– dwell time, complications and outcomes for various medications including prostaglandins

PurposeThe PowerGlide Pro™ Midline Catheter is a peripheral venous access device with a length of 8–10 cm, allowing the tip to reach far into the venous system. The aim of this study was to evaluate the dwell time of the catheter. Secondary endpoints included suitability for specific medications (e.g. prostaglandins) and assessment of complications.MethodsBetween January 2019 and November 2021, 50 patients were included in the study. Data on patient demographics, placement characteristics, complications and reasons for removal, were collected.ResultsPlacement was technically successful in 92% (n = 46) of cases. In all cases, veins of the upper extremity were punctured (34 basilic veins, 7 brachial veins, 6 cephalic veins, and 3 median cubital veins). The average dwell time was 6.1 days (1–17 days). A significant difference between duration and medication administered could not be demonstrated.ConclusionsThe longer maximum dwell time compared to a standard peripheral venous catheter makes it particularly suitable for intravenous therapy for more than 7 days or patients who have poor peripheral vein status.

Effect of infusion time on risk of Bacillus cereus bloodstream infections in patients administered with BFLUID amino acid infusions via peripheral venous catheters.

Comprehensive electrolyte infusions containing amino acids, including BFLUID, are a source of nosocomial infections caused by Bacillus cereus. It is recommended that clinicians finish the administration of BFLUID within 6 h; however, this recommendation currently lacks supporting empirical evidence. Accordingly, the present study aimed to investigate the risk of B. cereus infection associated with BFLUID infusion according to the administration time. In the present single-center retrospective observational cohort study, clinical information was extracted from the medical records of patients aged ≥18 years who received BFLUID infusions via a peripheral line between April 2017 and October 2020 at Saitama Red Cross Hospital (Saitama, Japan). A total of 96 patients were enrolled during the study period, of whom 32 developed B. cereus infection. No patients with BFLUID infusions administered within 6 h developed B. cereus infection. Compared with patients who received BFLUID infusions within 8 h, those who received BFLUID infusions after 8 h had a 7-fold higher risk of infection. The present study provided empirical evidence supporting the recommendation that amino acid infusions should be administered to patients within 6 h to minimize the risk of B. cereus infection.

Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion

BackgroundDuring central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique.MethodsA systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed.ResultsPooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53–0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49–0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41–0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48–0.87).ConclusionUS-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators.Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.

Evaluation of fetal heart size, morphology and function with fetal growth restriction using fetal HQ

BackgroundFetal growth restriction (FGR) is associated with various perinatal complications. Limited research has focused on the fetal heart in the context of FGR. This study aimed to investigate the application value of fetal heart quantification (HQ) technology in evaluating the size, morphology, and function of the heart in FGR.MethodsA total of 31 fetuses diagnosed with FGR in our hospital from April 2022 to May 2024 were included, alongside another 31 normal fetuses matched for gestational age as the control group. Ultrasound Doppler parameters of the middle cerebral artery (MCA), umbilical artery (UA), venous catheter, and fetal HQ parameters were collected for comparative analysis, and perinatal data were followed up.ResultsFetuses with FGR exhibited significant differences in various parameters of the MCA and UA compared to the control group (P < 0.05). The four-chamber view end-diastolic transverse width, end-diastolic area, left ventricular (LV) end-diastolic area, end-systolic area, end-systolic length, end-diastolic volume, end-systolic volume, and right ventricular (RV) end-systolic area in the FGR group were significantly lower than those in the control group (P < 0.05). In the 24-segment analysis, the LV fractional shortening in the FGR group was greater than in the control group at segments 12 to 14, while the end-diastolic diameter (ED) at segments 5 to 13 of the LV and segments 1 to 14 of the RV were smaller than those in the control group, with statistical significance (P < 0.05). Analysis of each subgroup indicated that fractional shortening (FS) in the early-onset group was significantly greater than in the late-onset group at RV segments 2 to 8. LV-ED at segments 1 to 15 and RV-ED at segments 1 to 16 were significantly smaller in the early-onset group than in the control group, and LV ED segments 20 to 21 were significantly smaller in the early-onset group compared to the late-onset group (P < 0.05). FS in the mild group was significantly larger than in the normal group at LV segments 10 to 16. The severe group exhibited significantly smaller LV segment 2 to 11 ED and the mild group showed smaller RV segments 1 to 13 compared to the control group (P < 0.05).ConclusionsFetal HQ is a promising technique for evaluating the cardiac function, size, and morphology in cases of FGR.

Haemorrhagic Shock in a Pregnant Patient and the Unsuspicious Subclavian Catheter.

Central venous catheterisation (CVC) is a commonly performed procedure in clinical practice. Although usually safe, complications can arise such inadvertent vascular lesion. This report is of a case of left brachiocephalic vascular lesion due to a subclavian catheter, thus raising awareness about this potential complication, which is not always immediately recognised. We report the case of a 31-year-old healthy woman, 42 weeks pregnant, who presented with complications during an elective caesarean section. The patient experienced haemorrhagic shock due to the incomplete rupture of the left ovarian pedicle, further complicated by the accidental lesion of the left brachiocephalic vein caused by the tip of a right subclavian catheter, aggravated by the late discovery only after extubation. This case highlights the importance of patient selection, proper technique and the careful monitoring pre- and post-procedure. Brachiocephalic vein lesions arising from CVC insertions are rare but significant complications that require timely recognition and intervention. Although uncommon, vascular lesions from central venous catheter insertion can occur so post-procedural monitoring and follow-up are very important.Computed tomography angiography is a useful diagnostic tool.Many vascular injuries related to central venous catheter insertion can have a delayed presentation.

Iatrogenic Carotid Injury Following Jugular Vein Cannulation: A Case Report

Central Venous Catheterization (CVC) through the internal jugular vein is a routine procedure conducted in critically ill patients for hemodynamic monitoring, medication administration, and fluid management both in preparation for and during major surgery and for possible dialysis therapy. We present a case of an 80-year-old patient who went to hospital due to a sudden increase in creatinine levels. Subjected to an attempted CVC placement procedure, she suffered damage to the right common carotid artery with perforation and hemorrhage of the carotid artery. Taken immediately to the operating room, it was decided to repair the common carotid artery endovascularly using a covered stent with an immediate stop to the bleeding.

Validating the accuracy of the Omron HBP-M4500 blood pressure measuring device according to the ISO81060-2:2018+ Amd 1:2020 protocol.

Blood pressure (BP) naturally undergoes fluctuations and variations, particularly during anesthesia administration during surgery, hemodialysis, upper and lower gastrointestinal endoscopy, exercise testing, arterial and venous catheterization, and rehabilitation. These changes in BP may lead to life-threatening events. The performance of the Omron HBP-M4500 device in monitoring blood pressure (BP) in the upper arm was validated according to the International Organization for Standardization (ISO) 81060-2:2018+amendment (Amd) 1:2020 protocol. The device was used to assess 113 participants in the inflation mode, and 107 participants in the deflation mode. All the patients fulfilled the inclusion criteria, including the arm circumference range and systolic and diastolic BP levels, outlined in the protocol. Data validation and analysis were performed according to the manufacturer's instructions. In criterion 1, the mean ± standard deviation (SD) values of the differences between the test device and reference BP were -0.6 ± 5.80/2.8 ± 6.78 mmHg (systolic/diastolic) and -1.0 ± 5.35/3.2 ± 6.52 mmHg for the inflation and deflation modes, respectively. These data fulfilled the ISO81060-2:2018+Amd1:2020 requirements of ⩽ 5 ±⁣⩽ 8 mmHg. In criterion 2, the differences were -0.6 ± 4.44/2.8 ± 6.26 and -1.0 ± 3.84/3.2 ± 6.09 mmHg for the inflation and deflation modes, respectively, fulfilling criterion 2 with SD values of ⩽ 6.91 and ⩽ 6.87 for systolic BP and ⩽ 6.34 and ⩽ 6.14 for diastolic BP in the inflation and deflation modes, respectively. These two criteria were fulfilled in both studies. The Omron HBP-M4500 device, either in inflation or deflation mode, fulfilled the criteria outlined in the ISO protocol. Therefore, this device is valuable for BP measurement in clinical and hospital settings.

‘Tabs versus Jabs’ time and motion study involving experiential learning student pharmacists: how long to prepare intravenous versus oral antibiotics?

Abstract Introduction Approximately one-third of inpatients in Scotland are prescribed antibiotics1. Patients prescribed IV antibiotics should be reviewed regularly and switched to oral therapy when clinically appropriate. Optimising IV to oral switch (IVOST) is often perceived as challenging2 and risks associated with IV access and patient comfort benefits to IVOST are well known. Workforce time required to administer IV medicines compared to oral equivalents is rarely considered in the risk-benefit assessment to IVOST2. To quantify this difference, a medicines administration time and motion study was undertaken. Aim To conduct a time and motion study to explore antibiotic administration in NHS Lanarkshire (NHSL) district general hospitals: University Hospitals Hairmyres, Wishaw, and Monklands. Objectives To measure time taken by nursing staff to prepare and administer IV/oral antibiotics. To explore potential nursing time saved if IVOST. To make recommendations to NHSL’s Antimicrobial Management Committee on inpatient antibiotic use. To involve final year Student Pharmacists in a multidisciplinary (MDT) project during placement. Methods Data were collected by Student Pharmacists on Antimicrobial/Surgical Experiential Learning (EL) placements as a novel approach to specialist EL. Data were collected during midday medication rounds in a surgical ward at each hospital. Nurses were observed administering antibiotics and the time taken recorded included medicine preparation; patient identification; assessment of peripheral venous catheter; and gathering IV equipment. The timer stopped when medication was administered to the patient. IV infusion duration was not included. Data were recorded in an Excel spreadsheet in HH:MM:SS. This study did not require review by an NHS Research Ethics Committee under the updated Governance Arrangements for Research Ethics Committees (GAfREC) 2020 Edition; although local permission was sought from service leads. Results Mean nursing time to prepare IV antibiotic administration was 11 minutes 55 seconds (n=20). Mean nursing time for oral administration was 1 minute 59 seconds (n=10). Nursing staff take 6 times longer to prepare IV compared to oral antibiotics for patient administration. Potential nursing time saved per individual IVOST is approximately 10 minutes. Discussion/Conclusion Results suggest IVOST would reduce nursing time involved in medicines administration, with IVOST for one patient taking antibiotics three times daily potentially saving 30 minutes of nursing time alone. Some antibiotics have excellent oral bioavailability and this project highlights the need to educate clinical teams on selecting oral route for high bioavailability antibiotics when safe and clinically appropriate. Student pharmacists observed that nurses managed multiple interruptions and spent time looking for IV equipment, commenting that IV antibiotics produced more waste (single use plastics, syringes, packaging). Student pharmacists had a better understanding of medicines administration and nursing roles following involvement in the study. Limitations Small sample size, time constraints, data did not include infusion durations or administrations outside drug rounds. Benefits of IVOST are well known and the results of this study are comparable to similar studies in the UK. NHSL’s Antimicrobial Team are disseminating key information from this study in line with local and national guidelines. Student Pharmacists effectively contributed to a novel EL placement project and this improved their understanding of nursing roles within the MDT.

Central Venous Catheterization in the ICU: A Comparison of Anatomical Landmark and Ultrasound-Guided Techniques

Introduction: Central venous catheterization (CVC) is frequently required in intensive care units (ICUs) for administering medications, fluids, and monitoring central venous pressure. However, CVC insertion can lead to complications such as arterial puncture, hematoma formation, and pneumothorax. Ultrasound guidance has been advocated to reduce these complications, but its effectiveness in the ICU setting remains debated. This study compared the complication rates of anatomical landmark-guided versus ultrasound-guided CVC insertion in ICU patients. Methods: A prospective cohort study was conducted in the ICU of a tertiary care hospital. Patients requiring CVC were divided into two groups: anatomical landmark-guided and ultrasound-guided insertion. The primary outcome was the incidence of complications, including arterial puncture, hematoma, and pneumothorax. Secondary outcomes included cannulation time and the number of cannulation attempts. Results: A total of 39 patients were included in the study. The incidence of complications was significantly lower in the ultrasound-guided group (2 complications) compared to the anatomical landmark group (7 complications) (p=0.017). The most common complication was arterial puncture, occurring in 7 patients in the anatomical landmark group and 2 patients in the ultrasound-guided group. Conclusion: Ultrasound guidance significantly reduces the risk of complications during CVC insertion in the ICU. This technique should be considered the standard of care for CVC insertion in this setting.

Estrogen blood profile of chickens in the studied period of the ovulatory cycle

The aim: to study the dynamics of the concentrations of estradiol, estriol and estrone, their ratios in the studied period of the ovulatory cycle and the connection with the size of egg yolk.Materials and methods. The material for the study was chickens of the Pushkin breed, in the amount of 36 birds. at 36 weeks of age. The chickens were kept in individual cages. Light mode — 14C:10T. Watering — nipple, temperature in the poultry house and feeding - in accordance with the standards adopted by the Central Collective Use Center of the All-Russian Scientific Research Institute of Growing Animals "Genetic collection of rare and endangered breeds of chickens". Over the course of 7 days, eggs from 96 chickens of 30 weeks of age were assessed by the weight of the egg, yolk, white, shell - using electronic scales Mertech M-ER 122ACF(JR) with an accuracy of 0,01 g. Eggs were counted and assessed individually: From each hen, at least 3 consecutively laid eggs were examined the next day after collection. Based on the data obtained from assessing chickens based on the quality characteristics of eggs and productivity, 36 birds with egg yolk weights M-0,5σ, M±0,45σ, M+0,5σ were selected. Blood from the studied chickens was taken in the morning and during the day on an empty stomach to simultaneously determine the concentrations of estradiol, estriol and estrone 2 hours before laying eggs and within 4 hours after laying, with an interval of 1 hour. In order to obtain serial blood samples from chickens for Dynamic studies of estrogens included the installation of peripheral venous (intravenous) catheters. The concentration of estrogen in the blood plasma of chickens was determined by ELISA.Results. The concentrations of individual estrogenic hormones change during the 6 hours of the studied period of the ovulatory cycle, periodically increasing and decreasing, while the fluctuations coincide only in two periods after the egg is laid: after 1—2 hours — a rise and 2—3 hours — a decline. Of the six studied periods of the ovulatory cycle of chickens, the time period of practical interest is 2—1 hours before egg laying, when the ratio of estradiol:estrone was 7,4:1, estriol:estrone — 7,9:1 and estradiol:estriol — 1:1. During this period, a positive significant correlation was revealed between the estradiol:estrone ratio and the yolk mass of chicken eggs — +0,55 (p &lt;0,05). Also, in the established period, the highest concentration of estradiol (1,52±0,12 nmol/l), estrone (0,29±0,04 nmol/l) was simultaneously observed compared to other periods, and the lowest concentration of estriol (1,67± 0,16 nmol/l). A positive correlation was determined between estradiol and estrone — +0,68 (p &lt;0,05) and estradiol and estriol — +0,71 (p &lt;0,05).Conclusion. In the period 2—1 hours before laying eggs, the effect on the body of chickens of estrogenic hormones in the ratio estradiol: estrone 7,4:1, estriol:estrone – 7,9:1 and estradiol:estriol — 1:1 leads to inactivation of synthetic systems, providing intensive formation of ovogenic substances by the liver (vitellogenin, lipoproteins), and the transfer of vitellogenic material into developing follicles.

Development of prediction models for carbapenem-resistant Klebsiella pneumoniae acquisition and prognosis in adult patients.

To explore the risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and establish nomograms to predict the probability of CRKP infection and mortality in adult patients. Patients infected with KP from August 2019 to April 2021 in a tertiary hospital in Shanghai were enrolled. Risk factors associated with CRKP and 30-day mortality were identified using multivariate logistic regression analysis and Cox regression analysis. Overall, 467 patients with KP infection were enrolled, wherein 210 (45.0%) patients were infected with CRKP and 257 (55.0%) patients with carbapenem-susceptible K. pneumoniae (CSKP). Five factors, namely Charlson's Comorbidity Index (CCI) ≥ 3, the use of central venous catheterization, prior hospitalization during the 3months before infection, and previous exposure to carbapenems and broad-spectrum β-lactams, were found to be independently associated with CRKP infection. Based on these parameters, the nomogram showed a better performance as indicated by C-index of 0.94 (95% confidence interval [CI]: 0.92-0.96) and well-fitted calibration curves. CRKP was independently associated with 30-day mortality. Multivariate Cox regression analysis revealed that age ≥65years, higher CCI scores, higher Sequential Organ Failure Assessment scores, the presence of respiratory failure, albumin levels ≤30g/L, and non-appropriate treatments in 3days, were associated with 30-day mortality. The predictive nomogram established in this study can facilitate the clinicians to make better clinical decisions when treating patients with KP infection.

Evaluation of use and identification of predictive factors for nonuse of peripheral venous catheters in the emergency department.

The placement of peripheral venous catheters (PVC) is a frequent procedure in the emergency department (ED), which exposes patients to complications (hematoma, fluid leakage, phlebitis, edema, infection), increases hemolysis of blood samples, is time-consuming and costly. The main aim of this study is to analyze the rate of PVC nonuse in the ED and to identify predictive factors of their nonuse. This prospective single-center observational study was conducted in the ED of the Saint-Antoine Hospital in Paris, France between February and March 2022. Adult patients receiving a PVC were included. In addition to demographic and medical data, the reason for PVC prescription and the prescribing physician's expectation of PVC use were collected. A total of 304 patients were included, with a median age of 61.5years (IQR: 43-79years), of whom 152 (50%) were men. PVC were primarily prescribed for intravenous medication administration. Seventy-two (23.7%) PVC were not used. In multivariable analysis, the predictive factors of nonuse were the prescribing physician's expectation of nonuse [OR 6.35, CI 95% (2.64-15.29), for "no" and "not sure" vs. "yes" responses] and the reason for prescribing "just in case" [OR 3.54, CI 95% (1.37-9.17)]. PVC were not used in 23.7% of cases. Predictors of nonuse were the prescribing physician's expectation of nonuse and the reason for prescribing "just in case". A PVC should probably not be prescribed if the prescribing physician thinks it will not be used or prescribes it "just in case".

Clinical Features and Risk Factors of 134 HA-PTE Patients

&amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: The objective of this study was to determine the clinical features and risk factors for hospital-associated pulmonary thromboembolism (HA-PTE) in Taizhou Hospital of Zhejiang Province. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: The clinical data of 513 pulmonary thromboembolism (PTE) patients who were admitted to Taizhou Hospital of Zhejiang Province in from January 1st, 2020, to December 31st, 2022, were retrospectively analyzed. The HA-PTE group and the community-associated PTE (CA-PTE) group were classified according to whether these disorders occurred during hospitalization or within a 90-day period of admission to the hospital (including inpatients with at least two days of hospitalization stay or a surgical procedure under or regional anesthesia). Differences in clinical features, risk factors and other indicators were also analyzed between the two groups. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: A total of 513 patients with acute PTE were analyzed in the present study. Among them, 134 patients had HA-PTE, and 379 patients had CA-PTE. Patients in the HA-PTE group had less dyspnea or hemoptysis and more fever and chest pain. The all-cause mortality rate in the HA-PTE group was greater than that in the CA-PTE group, but it was not statistically significant. In comparison to community-acquired pulmonary thromboembolism (CA-PTE), long-term bed rest, active malignancy, lung infection, acute cerebral infarction, and fracture were observed as more prevalent risk factors in the hospital-acquired pulmonary thromboembolism (HA-PTE) group. Additionally, recent surgery (within one month post-operation) and central venous catheterization were identified as independent risk factors in the HA-PTE group. According to the subgroup analysis of the HA-PTE group, the all-cause mortality rate of patients who experienced HA-PTE in the hospital was lower than that of patients who experienced HA-PTE which in 90 days after admission (1.56% versus 2.85%, respectively); however, the difference was not statistically significant. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: More than half of the HA-PTE events were associated with recent hospitalization. HA-PTE and CA-PTE have different risk factors; when combined with different clinical symptoms, they have a higher incidence of HA-PTE occurring in the hospital. More attention should be given to inpatients to reduce the incidence of HA-PTE.

Septic Thrombophlebitis of the Umbilical Vein Complicating an Intrahepatic Umbilical Venous Catheter in a Premature Newborn

Septic thrombophlebitis of the umbilical vein (SVT) is a serious pathology in neonates, characterized by inflammation of the umbilical vein due to bacterial infection, with 90% of cases linked to the use of central venous catheters (CVCs). This inflammation can lead to thrombus formation as part of the immune system's response. Premature newborn, 33 weeks gestation, delivered vaginally, with history of gestational diabetes, twin pregnancy, macrosomia and premature rupture of membranes (57 hours), initially well adapted to extrauterine life, with a birth weight of 1575 g. The infant was admitted to neonatology for respiratory distress, and an intrahepatic umbilical catheter was inserted. On the 5th day of hospitalization, the infant developed a nosocomial Klebsiella pneumoniae infection, complicated by a fulminant hemorrhagic syndrome with hematemesis and melena. The clinical course was further complicated by multivisceral failure, requiring hepatic Doppler ultrasound, which revealed umbilical vein thrombosis. The newborn was treated with curative doses of Lovenox, while targeted antibiotic therapy was maintained for three weeks after negative blood cultures, resulting in significant clinical and biological improvement. Based on this case, we conclude that it is advisable to think about umbilical vein thrombosis and to perform an abdominal ultrasound in the presence of any digestive hemorrhage in a newborn or an intrahepatic or peripheral umbilical venous catheter, or in subjects at risk (hypotrophy, polycythemia, transfusion on the catheter) in order to screen for possible umbilical or portal vein thrombosis.

Analysis of Risk Factors for Multidrug-Resistant Organism (MDRO) Infections and Construction of a Risk Prediction Model in a Cancer Specialty Hospital.

Aims/Background Patients receiving treatment in specialized cancer hospitals are particularly susceptible to multidrug-resistant organisms (MDRO) infections due to factors such as weakened immune systems caused by intensive treatments and prolonged hospital stays. This study aims to investigate the risk factors for MDRO infections in the cancer specialty hospital setting and to develop a corresponding risk prediction model. Methods Patients diagnosed with MDRO infections were selected for the MDRO infection group (n = 238), and those without for the non-MDRO infection group (n = 238). Non-parametric tests, chi-square tests, and multivariate logistic regression analysis were used to identify the primary risk factors for MDRO infections. With the aid of analysis utilizing R software 4.4.1 (R Foundation for Statistical Computing, Vienna, Austria), we developed a nomogram prediction model, which was evaluated using the receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA). Results Age, antibiotic application time, and central venous catheterization were independent risk factors for MDRO infection (p < 0.05). The constructed nomogram prediction model for patients with MDRO infection has a C-index of 0.8640. The ROC curve results showed that the prediction model has a specificity of 0.7700, a sensitivity of 0.8800, and an area under the curve (AUC) of 0.8800. Conclusion This study identifies significant risk factors for MDRO infections in a cancer specialty hospital setting and offers a clinically useful prediction model, which may aid in targeted preventive measures and optimization of antibiotics usage, thereby potentially reducing the incidence and impact of these infections.