Venous Catheter Research Articles

Ultrasound-guided radial vein cannulation for general anesthesia in cases with difficult peripheral venous access: a report of two cases

BackgroundDespite advancements in ultrasonography, locating peripheral veins for catheter placement remains a challenge in patients with altered anatomy owing to multiple surgeries. Herein, we highlight the potential of using the radial vein as an alternative site for ultrasound-guided peripheral venous catheterization.Case presentationWe present two cases of patients with extensive surgical histories, including multiple abdominal surgeries, leading to difficult peripheral venous access. Traditional sites for peripheral venous catheterization were unsuitable due to vein narrowing or lack of visibility. In both cases, ultrasonography helped identify the radial vein as the only viable site for catheter placement. The patients underwent successful ultrasonography-guided catheterization of the radial vein without complications, facilitating medical management, including anesthesia induction and intraoperative monitoring.ConclusionsThe radial vein is a feasible and safe alternative for ultrasound-guided peripheral venous access in patients where traditional venous access sites are compromised.

Residual flow of the radial artery in the presence of an arterial catheter: A single-centre retrospective observational study

Background: Arterial catheterisation is a common procedure used to manage critically ill patients. The radial artery, both for its favourable anatomical position and the presence of ulnar collateral circulation, is the most used. While there is a consensus for a catheter/vein ratio of ⩽33% for venous catheterisation, there are no strong indications for arterial catheterisation. Some authors have hypothesised that a catheter/artery ratio of less than 45% is advisable. This study aimed to explore the relationship between residual flow in the Radial Artery, the catheter/artery ratio, and ulnar compensation. Methods: This retrospective observational study included patients with radial artery catheters in general wards and intensive care units of a tertiary hospital in Italy. Residual flow in the radial artery was calculated by measuring the Peak Systolic Velocity and diameter of the artery at the midpoint of the arm. The reverse Barbeau test was used to assess the residual perfusion. The sample was stratified and analysed to the catheter/artery ratio being greater or less than 33% and 45% and to the score obtained during the reverse Barbeau test. Results: The data obtained showed a significant statistical correlation between residual flow, catheter/artery ratio, and the reverse Barbeau test ( p < 0.0001 and p = 0.0074 respectively). Almost 80% of the sample had a catheter with an exit site less than 4 cm from the wrist crease. Conclusion: Adhering to the current guidelines, especially using ultrasound to ensure a catheter/artery ratio of at least 45%, can help maintain preserved perfusion through the cannulated radial artery. Ulnar compensation appears to be crucial for maintaining good tissue perfusion and should always be evaluated before catheterisation. Therefore, further studies are warranted.

Current Practice in Central Venous Catheterization

Current Practice in Central Venous Catheterization

A Bundle of Best Practices for Short Peripheral Venous Catheterization in Hospitalized Patients: A Scoping Review

A Bundle of Best Practices for Short Peripheral Venous Catheterization in Hospitalized Patients: A Scoping Review

The effectiveness of antimicrobial photodynamic therapy on catheter infection model

Background/AimThis experimental study aimed to examine the effectiveness of transdermal antimicrobial photodynamic therapy (APDT) with and without antimicrobial lock therapy (ALT), on catheter biofilms. MethodsS. epidermidis and C. orthopsilosis biofilms were formed within peripheral venous catheters positioned in the marginal ear veins of New Zealand white rabbits. Biofilm formation was confirmed with scanning electron microscopy in two catheters. 24 catheters with staphylococcal biofilms and 24 with fungal biofilms were treated with APDT, ALT or “APDT plus ALT” for five days. Six catheters were separated as controls. APDT was applied with a red colored LED lamp and methylene blue as the photosensitizer. Vancomycin lock solutions were used as ALT for staphylococcal biofilms and amphotericin B for fungal biofilms. The effect of treatment procedures was evaluated by intraluminal biofilm viability testing based on spectrophotometric evaluation, and a quantitative (OD) value was obtained for each catheter. ResultsThe mean OD values obtained by 600 nm spectrophotometric reading at 24 h (biofilm viability) after “ALT”, “APDT” and “ALT plus APDT” procedures were 0.363, 0.151 and 0.128 for S. epidermidis and 0.092, 0.104 and 0.227 for C. orthopsilosis, respectively. All these OD values obtained after treatment procedures were lower than controls for both S. epidermidis (OD: 0,802) and C. orthopsilosis (OD: 0,315), although there were large fluctuations in our results. ConclusionsOur results suggest that transdermal APDT may be an effective method for treating staphylococcal and candida biofilms formed within intravenous catheters in our rabbit ear model. The combined use of APDT and ALT might be beneficial in these staphylococcal biofilms.

The Role of POCUS and Monitoring Systems during Emergency Pericardial Effusion in the NICU.

Central venous catheterization is, now, one of the most routinely used procedures in the NICUs, helping during the care of very sick infants. Pericardial effusion is a very rare but severe complication, with a high mortality. The cases described are part of an ongoing retrospective study where the use of central catheters inserted in our surgical NICU, and its complications is being analyzed. 16 cases over 13 years are presented in this article, varying in severity from mild, self-resolving cases that were discovered during routine cardiac POCUS to cases with important hemodynamic impact associated with cardiac tamponade and cardiac arrest. Due to immediate intervention, only one of the cases led to catheter-related mortality and that was under particular conditions. Our aim is to highlight the severity of this complication, the importance of early intervention, and the impact of a highly technologized unit and widely available cardiac POCUS.

Comparison of Analgesic Effect of Local Anesthetic Injection for Pain Relief During Peripheral Venous Insertion in Adult Surgical Patients: A Prospective Observational Study

PurposeIntradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients. DesignA prospective observational study. MethodsAfter institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure. FindingsThe patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001). ConclusionsWe found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

Promising New Targets for the Treatment of Infections Caused by Acinetobacter baumannii: A Review.

Acinetobacter baumannii is a globally disseminated Gram-negative bacterium that causes several types of serious nosocomial infections, the most worrisome being ventilator-associated pneumonia and bacteremia related to using venous catheters. Due to its great ability to form biofilms, combined with its survival for prolonged periods on abiotic surfaces and its potential to acquire and control the genes that determine antibiotic resistance, A. baumannii is at the top of the World Health Organization's priority list of pathogens in urgent need of new therapies. In this sense, this review aimed to present and discuss new molecular targets present in A. baumannii with potential for promising treatment approaches. This review highlights crucial molecular targets, including cell division proteins, membrane synthesis enzymes, and biofilm-associated components, offering promising targets for novel antimicrobial drug development against A. baumannii infections.

Prehospital central venous catheters.

The use of whole blood in the prehospital setting is increasing. Currently available intraosseous and peripheral venous catheters limit the flow of blood products and fluid during resuscitation. Central venous catheters can be effectively placed in the prehospital environment. Rapid, high-volume infusion of blood products can be lifesaving.

An unilateral double fenestration of the right external jugular vein: a rare variant.

This report presents a rare anatomical variation, double fenestration of the External jugular vein on the right side. During the routine dissection of a male cadaver aged 60 years, we observed a unilateral large double fenestration of the External jugular vein on the right side. After its formation from the posterior division of the retromandibular and posterior auricular veins, External jugular vein descended in the posterior triangle of neck. Here, it divided into medial, intermediate, and lateral veins that united again before draining into the subclavian vein. Lateral vein was the largest (7.2cm) and intermediate and medial veins were measuring 6.4cm each. Two large fenestrations, measuring 5.8cm each, arranged like a "double bubble" were seen in the External jugular vein extending from fourth to sixth cervical (C4 to C6) vertebrae. The medial branch of supraclavicular nerve was seen passing superficial to the distal part of External jugular vein. On the left side, the course of External jugular vein showed a standard pattern. Surgeons must be acquainted with the varied anatomy of the superficial neck veins to prevent major bleeding during operative procedures, including carotid endarterectomy, flap operations, & central venous catheterisation.

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

Competence over confidence: uncovering lower self-efficacy for women residents during central venous catheterization training

BackgroundWhile women make up over 50% of students enrolled in medical school, disparities in self-efficacy of medical skills between men and women have been observed throughout medical education. This difference is significant because low self-efficacy can impact learning, achievement, and performance, and thus create gender-confidence gaps. Simulation-based training (SBT) employs assessments of self-efficacy, however, the Dunning-Kruger effect in self-assessment posits that trainees often struggle to recognize their skill level. Additionally, the impact of gender on self-efficacy during SBT has not been as widely studied. The objective of this study was to identify if the gender-confidence gap and the Dunning-Kruger effect exist in SBT for central venous catheterization (CVC) on the dynamic haptic robotic trainer (DHRT) utilizing comparisons of self-efficacy and performance.Methods173 surgical residents (Nwomen=61, Nmen=112) underwent training on the DHRT system over two years. Before and after using the DHRT, residents completed a 14-item Central Line Self-Efficacy survey (CLSE). During training on the DHRT, CVC performance metrics of the number of insertion attempts, backwall puncture, and successful venipuncture were also collected. The pre- and post-CLSE, DHRT performance and their relationship were compared between men and women.ResultsGeneral estimating equation results indicated that women residents were significantly more likely to report lower self-efficacy for 9 of the 14 CLSE items (p < .0035). Mann-Whitney U and Fisher’s exact tests showed there were no performance differences between men and women for successfully accessing the vein on the DHRT. Regression models relating performance and self-efficacy found no correlation for either gender.ConclusionsThese results indicate that despite receiving the same SBT and performing at the same level, the gender-confidence gap exists in CVC SBT, and the Dunning-Kruger effect may also be evident.

A new wireless device for bedside assessment of tip location of central venous access devices using intracavitary ECG: A retrospective study.

Intracavitary electrocardiography (IC-ECG) is a non-invasive method for intraprocedural tip location during central venous catheterization. Over the last 20 years, the IC-ECG method has been thoroughly investigated and many studies have confirmed its wide applicability and feasibility, as well as its great accuracy and safety in different populations of patients and in different types of central venous access devices (CVADs). This retrospective study presents a two-center experience with tip location of central venous catheters using IC-ECG, by means of a new wireless portable device. Tip location was performed during 983 insertions of CVADs at bedside, using this new device. Clinical conditions with limited or no applicability of IC-ECG were excluded. The feasibility of IC-ECG, as performed using the novel device, was 92.2%. This wireless device may play an important role in central venous catheterization at bedside, since it is pocket-sized, particularly easy to use, and easy to sanify after use.

Enhanced safety in central venous catheterization performed by Japanese board-certified pediatric surgeons: a retrospective single-center study.

Board certification by the Japanese Society of Pediatric Surgeons is awarded to pediatric surgeons with substantial surgical experience and academic achievement. However, to date, the surgical performance or outcomes of certified surgeons have not been reported. This study examined the relationship between board certification and surgical outcomes of central venous catheterization. This retrospective single-center study was conducted between April 2017 and May 2024. Patients were classified based on whether their procedures were performed by board-certified or non-certified surgeons, and their backgrounds and surgical outcomes were compared. In addition, multivariate analysis was performed to identify the factors associated with prolonged operative time. This study included 112 procedures: 26 performed by board-certified surgeons and 86 performed by non-certified surgeons. There were no significant differences in the age, sex, weight, or primary diagnosis between the groups; however, surgery-associated complications were significantly more common in the non-certified surgeon group than in the board-certified surgeon group (15.1% vs. 0%, P = 0.036). In addition, factors independently associated with a prolonged operative time included weight < 10kg, left-sided approach, implantable port device use, and < 7years of postgraduate experience for the surgeon. Board certification was associated with a significant reduction in surgery-associated complications during central venous catheterization.

Device associated healthcare associated infection (DA-HAI): a detailed analysis of risk factors and outcomes in a university hospital in Rome, Italy

This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies. A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression. Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR= 1.81, P < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR= 22.69, P <0.001), central venous pressure monitoring (AOR= 6.74, P <0.001) prolonged invasive mechanical ventilation (AOR= 4.44, P <0.001), and venous catheterisation (AOR= 1.58, P <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR= 2.51, P < 0.001). High-risk departments were also notably associated with HAI (OR= 6.13, P < 0.001). This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.

Anesthesia management for percutaneous mitral valve repair in a patient with mitochondrial cardiomyopathy and low cardiac function: a case report

BackgroundMitochondrial cardiomyopathy occurs when impaired mitochondrial energy production leads to myocardial dysfunction. Anesthetic management in such cases is challenging due to risks of circulatory depression associated with anesthesia and mitochondrial dysfunction induced by anesthetics. Although there are reports of anesthetic management for patients with mitochondrial diseases, there are few reports specifically addressing cardiac anesthesia for patients with mitochondrial cardiomyopathy. We present a case where percutaneous mitral valve repair with MitraClip™ was successfully performed under remimazolam anesthesia in a patient with mitochondrial cardiomyopathy who developed functional mitral valve regurgitation due to low cardiac function and cardiomegaly.Case presentationA 57-year-old woman was diagnosed with chronic cardiac failure, with a 10-year history of dilated cardiomyopathy. She was diagnosed with mitochondrial cardiomyopathy 8 years ago. Over the past 2 years, her cardiac failure worsened, and mitral valve regurgitation gradually developed. Surgical intervention was considered but deemed too risky due to her low cardiac function, with an ejection fraction of 26%. Therefore, percutaneous MitraClip™ implantation was selected. After securing radial artery and central venous catheterization under sedation with dexmedetomidine, anesthesia was induced with a low dose of remimazolam 4 mg/kg/h. Anesthesia was maintained with remimazolam 0.35–1.0 mg/kg/h and remifentanil 0.1 μg/kg/min. Noradrenaline and dobutamine were administered intraoperatively, and the procedure was completed successfully without circulatory collapse. The patient recovered smoothly from anesthesia and experienced no complications. She was discharged on the eighth day after surgery.ConclusionAnesthesia management with remimazolam appears to be a safe and effective for MitraClip™ implantation in patients with mitochondrial cardiomyopathy.

Ultrasound Guided Internal Jugular Vein Acesss: Comparison Between Short Axis And Long Axis Technique

Abstract Background: Percutaneous techniques have transformed vascular cannulation. It has reduced the need for open procedures and the associatedwoundcomplications, but percutaneous techniques have made physicians dependent on relationships between surface anatomic landmarks and deep anatomic structures. Now, percutaneous central venous catheter insertion by physicians has a lesser complication rate. During central venous catheterization, the complications include infection, occlusion, thrombosis and mechanical complications. Aims and Objective: To relate the inner course of cannulating needle, familiarity of surface anatomic landmarks excludes the complication. Deep anatomic relationships visualization does not only improves the efficacy and safety of the procedure but also supplements the operator’s ability to identify difficult cannulations. The safety of internal jugular cannulations increases with ultrasound visualization. Central venous cathetrization (CVC) is done for hemodynamic monitoring (such as central venous pressure) long-term administration of fluids, antibiotics, total parental nutrition, and hemodialysis. Material and Methods: Most commonly, the internal jugular vein (IJV) is cannulated because of its relatively less complications and easy accessibility. Seldinger technique is used for IJV cannulation. Landmark-guided IJV cannulation is associated with a more number of complications compared to ultrasound-guided cannulation. Ultrasound-guided cannulation improves success rate, reduces the number of needle passes, and decreases complications. Two different real-time ultrasound-guided cannulations of IJV using a short axis/out-of-plane (SA) approach and a long axis/in plane (LA) approach are compared in the study. Hence, the present study was done at our tertiary care center to compare ultrasound-guided IJV access between SA and LA technique method with the number of attempts and complications. Results: It was observed in the present study that 4 (10%) patients in Long axis group had posterior wall puncture while 9 (22.5%) patients in short axis group had posterior wall puncture. Conclusion: Posterior wall puncture incidence is lesser in long axis group than short axis group.

Non-Adherence to Peripheral Venous Catheter Care Protocols Significantly Decreases Patient Safety and Impacts Costs: A Retrospective Observational Study.

In the healthcare field, the effective implementation of clinical protocols is crucial to ensuring patient safety and well-being. In this context, this study evaluates nurses' adherence to the maintenance and replacement protocol of peripheral venous catheters (PVCs) in a university hospital in Spain, examining the impact of compliance with the protocol on the loss of PVCs and on patient safety in addition to analyzing the related costs. A retrospective observational study was conducted with 590 patients who were admitted in 2018 and 2019. The chi-square test or Fisher's exact test, as appropriate, was used to see the association between the study variables; with the dependent variable being the loss of PVCs (including, as a dependent variable, the loss of PVCs before 48 h). The patients' electronic and physical medical records were reviewed to analyze nursing interventions related to the management of PVCs. A total of 24% of patients experienced PVC loss within the first 24 h after insertion. Failure to comply with the protocol resulted in 80% more catheter loss and increased the cost of cannulation by 46.84%. Low compliance with PVC care protocols significantly increases the risk of catheter loss, suggesting the need for increased training and strict protocol implementation. The findings emphasize the critical role of nursing in ensuring patient safety through adherence to evidence-based protocols. Continuing education and diligent protocol implementation are essential to reducing healthcare costs and improving patient outcomes.

The endoscopy department can alert to complications associated with peripheral venous catheters in patients admitted to a tertiary teaching hospital

BackgroundThe more widespread use of peripheral venous catheters (PVC) has led to more frequent complications, not only in PVC-associated bacteremia, but also in phlebitis. This requires the catheter to be removed and increases healthcare costs. Our aim was to assess the PVC-associated complications in an endoscopy department. MethodsWe performed a cross‐sectional, descriptive study on patients admitted to our center and undergoing a procedure in the endoscopy department. We analyzed the appearance of the following PVC-associated complications: obstruction, phlebitis, redness, extravasation, pain, and infection on the day of the study. All catheter tips were sent to the microbiology laboratory for culture using the roll-plate semiquantitative technique. Clinical and microbiological data were collected. ResultsWe included a total of 46 patients with 50 PVCs. The median (IQR) age was 70.0 (55.0–81.5) years, and 58.7% were female. The median (IQR) hospital stay was 9.00 (6.00–14.25) days. Of the 50 PVCs, most were inserted in the emergency room (74.0%), and the median (IQR) indwelling time was 5.00 (3.00–7.00) days. The phlebitis rate was 78.0%, which occurred mainly in PVCs inserted in the emergency room (74.3%). The tip was colonized in 9 PVCs (18.0%). ConclusionThe endoscopy department can alert clinicians to PVC-associated complications. PVCs inserted in the emergency room were subject to a higher risk of phlebitis and/or colonization. Therefore, we recommend systematically replacing PVCs inserted in the emergency room within 48 h if preventive measures during insertion cannot be guaranteed.

Comparison of Intermediate and Superficial Cervical Plexus Blocks for Central Venous Catheterisation.

To compare the effectiveness of the superficial cervical plexus (SCP) and ultrasonography (USG)-guided intermediate cervical plexus (ICP) blocks for patient and operator satisfaction during central venous catheterisation (CVC). Experimental study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Konya City Hospital, Konya, Turkiye, between May and July 2022. Eighty patients were randomly assigned to the ICP and SCP block groups before CVC. Patients received 10ml of a local anaesthesia. Pain levels were assessed during needle insertion, dilation, catheter insertion, and suturing, and 5 minutes after the procedure using a 10-point numeric rating scale (NRS). Thirty minutes post-procedure, patient and operator satisfaction were evaluated using a 5-point Likert-type scale. The ICP block group had lower mean pain scores than the SCP block group during needle entry, dilation, and 5 minutes after CVC (p = 0.022, p <0.001, and p = 0.005, respectively). However, no significant differences were found in pain scores after the block application, during catheter insertion, and suturing (p = 0.279, p = 0.052, and p = 0.072, respectively). Patient and operator satisfaction scores did not significantly differ between the two groups (p = 0.189 and p = 0.329, respectively). The study demonstrated that the ICP and SCP blocks resulted in comparable patient and operator satisfaction levels during CVC. Given that the ICP block resulted in lower pain scores at various stages of the procedure, it is a recommended method to enhance overall patient comfort and minimise the pain during CVC. Central venous catheterisation, Intermediate cervical plexus block, Superficial cervical plexus block, Patient satisfaction.