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Barth D, Sanchez A, Thomsen AM, Garcia A, Malachowski R, Weldon R, Mayhew M, Mudie K, Faller D, Schwartz J. Peripheral vascular access for therapeutic plasma exchange: A practical approach to increased utilization and selecting the most appropriate vascular access. J Clin Apher 2020; 35:178-187. [PMID: 32191358 DOI: 10.1002/jca.21778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is used in the treatment of many diseases. At present, peripheral vascular access (PVA) is an underutilized method of vascular access in TPE. It should be considered more frequently due its relatively low risk for adverse events, particularly infections. METHODS The Advancing Vascular Access in Apheresis Working Group met in December 2017 for an extensive review and discussion of vascular access for TPE and developed a "road map" providing detailed information regarding clinical situations in which PVA-based TPE would and would not be appropriate. RESULTS The road map is consistent with current recommendations that PVA should be used in combination with TPE whenever possible. PVA should be considered for patients who do not have existing central lines and who are stable. The patient should have peripheral veins that will allow for adequate treatment and must be able to comply with the process of achieving and maintaining peripheral access. There should be expert clinical assessment of veins, and this evaluation may include ultrasound and/or near infrared evaluation. Conditions that would prompt a switch from PVA to an alternate method of venous access include loss of venous access, patient preference, or development of a requirement for very frequent treatment over a long period of time. CONCLUSIONS While PVA is not suitable for all patients requiring TPE, it has significant safety advantages over other approaches and should be employed whenever possible.
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Affiliation(s)
- David Barth
- Department of Laboratory Medicine and Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Amber Sanchez
- Department of Medicine, University of California, San Diego, California, USA
| | - Anna-Marie Thomsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Alicia Garcia
- USCF Children's Hospitals, Oakland and San Francisco, California, USA
| | - Roman Malachowski
- Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland
| | - Rebecca Weldon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Kari Mudie
- Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | | | - Joseph Schwartz
- Colombia University Medical Centre, New York City, New York, USA
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Use of and patient-reported complications related to midline catheters and peripherally inserted central catheters. Infect Control Hosp Epidemiol 2020; 41:608-610. [PMID: 32127066 DOI: 10.1017/ice.2020.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central catheters.
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104
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Levy ER, Hutchins KA, Schears GJ, Rodriguez V, Huskins WC. How We Approach Central Venous Catheter Safety: A Multidisciplinary Perspective. J Pediatric Infect Dis Soc 2020; 9:87-91. [PMID: 31886510 DOI: 10.1093/jpids/piz096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Emily R Levy
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn A Hutchins
- Quality Management Services, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory J Schears
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - W Charles Huskins
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Silva JT, Lagares-Velasco A, Fernández-Ruiz M, González-Monterrubio G, Pérez-Cárdenas MD, Aguado JM, López-Medrano F. Peripherally inserted central venous catheter placed and maintained by a dedicated nursing team for the administration of antimicrobial therapy vs. another type of catheter: a retrospective case-control study. Enferm Infecc Microbiol Clin 2020; 38:425-430. [PMID: 32057552 DOI: 10.1016/j.eimc.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Data concerning the use of peripherally inserted central catheters (PICC) for the administration of intravenous (IV) antimicrobials in the acute care setting is scarce. METHODS We performed a single-center retrospective case-control study (1:1). Case subjects were defined as patients who received IV antimicrobial treatment through a PICC line placed and maintained by specifically trained nurses (PICC group). Control subjects were defined as patients who received antimicrobial therapy by a peripheral or a central venous catheter (CVC) (control group). Control subjects were matched by type of antimicrobial, causative microorganism of the infection that was being treated and duration of treatment. An event leading to undesired catheter removal (ELUCR) was defined as any circumstance which lead to the removal of the indwelling catheter other than the completion of the scheduled course of antimicrobial therapy. RESULTS The study included 50 patients in each group. The total follow-up time was 1376 catheter-days for the PICC group and 1362 catheter-days for the control group. We observed a significantly lower incidence of ELUCR in the PICC group (0.2 versus 7.7 events per 100 catheter-days; P<0.001). When the incidence of ELUCR was analyzed according to the duration of indwelling catheterisation for each type of catheter (divided into one-week intervals), differences between both groups were also significant (P-values≤0.001 for the first three weeks of treatment). During the second week of IV treatment, only one patient in the PICC group (2.1%) developed an ELUCR compared to 19 (38.8%) in the control group (P<0.001). CONCLUSIONS A PICC placed and maintained by a dedicated nursing team is an excellent alternative to peripheral venous catheters or CVCs for administrating antimicrobial therapy for both short and long periods of treatment.
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Affiliation(s)
- Jose Tiago Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Almudena Lagares-Velasco
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Gema González-Monterrubio
- Nursing Management, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Dolores Pérez-Cárdenas
- Nursing Management, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.
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Lee JH, Kim MU, Kim ET, Shim DJ, Kim IJ, Byeon JH, Kim HB. Prevalence and predictors of peripherally inserted central venous catheter associated bloodstream infections in cancer patients: A multicentre cohort study. Medicine (Baltimore) 2020; 99:e19056. [PMID: 32028425 PMCID: PMC7015558 DOI: 10.1097/md.0000000000019056] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434-53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257-23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082-7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care.
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Affiliation(s)
- Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Min Uk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul
| | - Eung Tae Kim
- Department of Radiology, Hanyang University Guri Hospital, Guri-si
- Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Gangwon-do
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital
| | - Il Jung Kim
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Hyun Beom Kim
- Center for Liver Cancer
- National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
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107
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Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer 2020; 28:4753-4760. [PMID: 31970514 PMCID: PMC7447660 DOI: 10.1007/s00520-019-05276-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022]
Abstract
Purpose So far there is little evidence on peripherally inserted central venous catheter (PICC) in radiation oncology patients maintaining the access during the periods of ambulatory and hospital treatment. Methods A total of 522 PICC placements in 484 patients were performed between 11/2011 and 07/2016 at the Department of Radiation Oncology and analysed retrospectively for complications and treatment- and patient-related factors during ambulatory and hospital inpatient use. On initial hospitalization, all patients received a multimodal radio-oncological treatment consisting of radiation and intravenous therapy administered via the PICC. Results A total of 18,292 catheter days were documented. Median follow-up from catheter insertion to their removal was 37 days (1–97). The overall complication rate was 4.1 per 1000 catheter days (n = 75, 14.4%). Complications were similar between the cohort of outpatient 3.6 per 1000 catheter days and the cohort of inpatient 4.8 per 1000 catheter days (OR 0.976; 95% CI [0.598; 1.619]; p = 0.924). Severe bloodstream infections occurred at a rate of 0.60 per 1000 catheter days (n = 11, 2.1%), deep vein thrombosis at a rate of 0.82 per 1.000 catheter days (n = 15, 2.9%) and local inflammation at a rate of 1.26 per 1.000 catheter days (n = 23, 4.4%). Only immunotherapy could be identified as an independent risk factor for complications (OR 5.6; 95% CI [2.4; 13.1]; p < 0.001). Conclusion Using PICC in outpatients is not associated with an elevated risk of complications. Particular attention should be payed to early identification of PICC associated bloodstream infections. Immunotherapy is an independent risk factor for local skin complication. Electronic supplementary material The online version of this article (10.1007/s00520-019-05276-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothea Mielke
- Department of Radiation Oncology, Universitätsklinikum Jena, Bachstr.18, 07743 Jena, Germany and SRH Wald-Klinikum Gera GmbH Straße des Friedens 122, 07548, Gera, Germany
| | - Andrea Wittig
- Department of Radiation Oncology, Universitätsklinikum Jena, Bachstr.18, 07743, Jena, Germany
| | - Ulf Teichgräber
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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108
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Martincich I, Cini K, Lapkin S, Lord H, Fernandez R. Central Venous Access Device Complications in Patients Receiving Parenteral Nutrition in General Ward Settings: A Retrospective Analysis. JPEN J Parenter Enteral Nutr 2019; 44:1104-1111. [PMID: 31785017 DOI: 10.1002/jpen.1743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Central venous access devices (CVADs) are used widely in acute clinical settings for the infusion of parenteral nutrition (PN) in patients who are unable to meet their nutrition requirements via the oral or enteral routes. The aim of this study was to characterize the frequency and nature of CVAD complications in patients receiving PN in general ward settings. METHODS A retrospective analysis of CVAD-related outcomes for adult patients who received PN from January 2014 to December 2016 was conducted. RESULTS A total of 629 CVADs were placed in 475 patients for parenteral administration in general ward settings during the 3-year study period. A total 104 (16.53%) episodes of CVAD-associated complications were reported during this period, including suspected line infection, leak at site, catheter blockage, and generalized patient sepsis. Overall, 13 CVAD catheter-related bloodstream infections (CRBSIs) were diagnosed in the patient cohort over 8695 PN feeding days, giving an incidence of 1.49 CVAD infections per 1000 PN feeding days. CONCLUSION The results showed that patients receiving PN through CVADs within general ward settings experience CRBSI at rates no different from those reported within critical care settings. These findings demonstrate that with appropriate nursing care, CVADs appear safe when used for the administration of PN in general ward settings.
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Affiliation(s)
- Irena Martincich
- Nutritional Support Special Nursing Services, St George Hospital, Sydney, Australia
| | - Krystle Cini
- Nutritional Support Special Nursing Services, St George Hospital, Sydney, Australia
| | - Samuel Lapkin
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, Australia
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, Sydney, Australia
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, Australia
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109
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Simonetti G, Sommariva A, Lusignani M, Anghileri E, Ricci CB, Eoli M, Fittipaldo AV, Gaviani P, Moreschi C, Togni S, Tramacere I, Silvani A. Prospective observational study on the complications and tolerability of a peripherally inserted central catheter (PICC) in neuro-oncological patients. Support Care Cancer 2019; 28:2789-2795. [PMID: 31724074 DOI: 10.1007/s00520-019-05128-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/09/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE The use of central venous catheters with peripheral insertion (PICC) has increased rapidly in recent years, particularly in cancer patients. The benefits provided may occasionally be affected by relevant complications, such as infections and thrombotic events, especially in neuro-oncological patients. To date, the risk of PICC-related complications in this subset of patients is unknown, as is tolerability. As a primary objective, this study aimed to collect complications related to PICCs in primary neuro-oncological patients. As a secondary objective, the study aimed to evaluate PICC tolerability. METHODS Neuro-oncological patients with PICCs that were placed as part of normal clinical practice at IRCCS Neurologico C. Besta were consecutively enrolled in the study. PICC-related complications were recorded immediately (during the procedure), early (within 1 week after PICC insertion), and late (1-3-5 months after PICC placement). At the same time points, all patients were also evaluated for tolerability through interviews with semi-structured, open-ended questions. RESULTS Sixty patients were enrolled (41 males and 19 females, with a median age of 56.2 years). Excluding loss to follow-up, 33/49 patients developed at least one complication related to the PICC. Immediate complications mainly included hematoma (8), accidental arterial puncture (4), and primary malpositioning (3). Regarding early and late complications, 3 device-related infections, 8 thrombotic events, and 20 mechanical complications were registered. Semi-structured interviews revealed an overall positive experience with the device. The most negative impact was on hygiene habits, with 34 patients becoming caregiver-dependent. Over time, almost all patients became used to the device and perceived greater security during chemotherapy. A strongly negative issue was the difficulty of relying on competently trained healthcare personnel in outpatient setting. CONCLUSION The results showed a nonnegligible increased thromboembolic risk in neuro-oncological patients with PICCs, almost double that in historical oncological populations. It is essential to extend the study to a greater number of patients to achieve reliable results and to identify patients at high risk. The device seems to be positively accepted by the majority of patients, without affecting activities of daily living.
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Affiliation(s)
- G Simonetti
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - A Sommariva
- Department of Neuro-anesthesia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - M Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - E Anghileri
- Neurology VIII-Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - C Basso Ricci
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - M Eoli
- Neurology VIII-Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - A V Fittipaldo
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - P Gaviani
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - C Moreschi
- S.I.T.R.A, Fondazione IRCCS Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - S Togni
- S.I.T.R.A, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - I Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - A Silvani
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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110
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Aminzadeh Z, Simpson P, Athan E. Central venous catheter associated blood stream infections (CVC-BSIs) in the non-intensive care settings: Epidemiology, microbiology and outcomes. Infect Dis Health 2019; 24:222-228. [DOI: 10.1016/j.idh.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/23/2022]
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111
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Galen B, Baron S, Young S, Hall A, Berger-Spivack L, Southern W. Reducing peripherally inserted central catheters and midline catheters by training nurses in ultrasound-guided peripheral intravenous catheter placement. BMJ Qual Saf 2019; 29:245-249. [PMID: 31582569 DOI: 10.1136/bmjqs-2019-009923] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Training nurses in ultrasound-guided peripheral intravenous catheter placement might reduce the use of more invasive venous access devices (peripherally inserted central catheters (PICC) and midline catheters). METHODS We implemented an abbreviated training in ultrasound-guided peripheral intravenous catheter placement for nurses on an inpatient medical unit and provided a portable ultrasound device for 10 months. RESULTS Nurses on this unit placed 99 ultrasound-guided peripheral intravenous catheters with a high level of success. During the implementation period, PICC and midline catheter placement decreased from a mean 4.8 to 2.5 per month, meeting criteria for special cause variation. In the postimplementation period, the average catheter use reverted to 4.3 per month on the intervention unit. A comparison inpatient medical unit without training or access to a portable ultrasound device experienced no significant change in PICC and midline catheter use throughout the study period (mean of 6.0 per month). CONCLUSIONS These results suggest that an abbreviated training in ultrasound-guided peripheral intravenous catheter placement for nurses on an inpatient medical unit is sufficient to reduce PICC and midline catheters.
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Affiliation(s)
- Benjamin Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Sarah Baron
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
| | - Sandra Young
- Deparment of Nursing, Montefiore Medical Center, Bronx, New York, United States
| | - Alleyne Hall
- Deparment of Nursing, Montefiore Medical Center, Bronx, New York, United States
| | | | - William Southern
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States
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Patel PK, Olmsted RN, Hung L, Popovich KJ, Meddings J, Jones K, Calfee DP, Fowler KE, Saint S, Chopra V. A Tiered Approach for Preventing Central Line-Associated Bloodstream Infection. Ann Intern Med 2019; 171:S16-S22. [PMID: 31569225 DOI: 10.7326/m18-3469] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
| | - Louella Hung
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (L.H.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Karen Jones
- University of Michigan Medical School, Ann Arbor, Michigan (K.J.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
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113
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Ryu DY, Lee SB, Kim GW, Kim JH. A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2019.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dong Yeon Ryu
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Busan, Korea
| | - Sang Bong Lee
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Busan, Korea
| | - Gil Whan Kim
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Busan, Korea
| | - Jae Hun Kim
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Busan, Korea
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114
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Campagna S, Gonella S, Berchialla P, Morano G, Rigo C, Zerla PA, Fuzzi R, Corona G, Storto S, Dimonte V, Mussa B. Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days. Oncologist 2019; 24:e953-e959. [PMID: 30755503 PMCID: PMC6738314 DOI: 10.1634/theoncologist.2018-0281] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are central venous catheters (CVCs) that are commonly used in onco-hematologic settings for chemotherapy administration. As there is insufficient evidence to recommend a specific CVC for chemotherapy administration, we aimed to ascertain PICC-related adverse events (AEs) and identify independent predictors of PICC removal in patients with cancer receiving chemotherapy. MATERIALS AND METHODS Information on adult patients with cancer with a PICC inserted for chemotherapy administration between September 2007 and December 2014 was extracted from six hospital databases. The primary outcome was PICC removal due to PICC-related AEs (occlusion, infection, or symptomatic thrombosis). Independent predictors of PICC removal were identified using a multivariate Cox regression model. RESULTS Among the 2,477 included patients, 419 PICC-related AEs (16.9%; 1.09 AEs per 1,000 PICC-days) were reported. AEs increased when PICC was inserted at the brachial site (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.02-1.84) and with open systems (HR, 1.89; 95% CI, 1.24-2.88) and decreased in older men (HR, 0.63; 95% CI, 0.49-0.81). CONCLUSION Use of PICC for chemotherapy administration was associated with a low all-AEs rate. The basilic vein was the safer site, and valved systems had fewer AEs than open systems. More research is needed to explore the interaction between AEs, sex, and age. IMPLICATIONS FOR PRACTICE These findings provide clinicians with evidence that peripherally inserted central catheters (PICCs) are safe for chemotherapy administration. They also suggest that clinicians should limit the use of open systems when long chemotherapy regimens are scheduled. Moreover, alternatives to PICCs should be considered when administering chemotherapy to young men.
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Affiliation(s)
- Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Silvia Gonella
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | | | - Carla Rigo
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Pietro Antonio Zerla
- Azienda Socio Sanitaria Territoriale Melegnano e della Martesana, Vizzolo Predabissi, Italy
| | - Raffaella Fuzzi
- Azienda Unità Sanitaria Locale Romagna sede di Forlì, Forlì, Italy
| | | | | | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Baudolino Mussa
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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115
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Scrivens N, Sabri E, Bredeson C, McDiarmid S. Comparison of complication rates and incidences associated with different peripherally inserted central catheters (PICC) in patients with hematological malignancies: a retrospective cohort study. Leuk Lymphoma 2019; 61:156-164. [PMID: 31387422 DOI: 10.1080/10428194.2019.1646908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with hematological malignancies (HM) or undergoing hematopoietic cell transplantation (HCT) require reliable vascular access. Peripherally inserted central catheters (PICC) meet this need, however, studies suggest these patients have higher rates of PICC-associated complications. This retrospective cohort study evaluates the influence of PICC type on the rates and incidences of complications. Four hundred and eighty-five dual lumen PICCs were inserted into 469 complex patients with HM or undergoing HCT: 161 Groshong®, 60 PowerPICC® Solo, 165 BioFlo®, and 99 Arrow®. The rates and incidences of complications differed significantly across the PICC types. The overall rate of complication ranged from 7.40 to 26.4/1000 catheter days (CDs). The rate of deep vein thrombosis (0.31-1.48/1000 CDs) and occlusion differed across the PICC types, while the rate of central line-associated bloodstream infection (0.53-0.74/1000 CDs) did not. Following multivariate adjustment, PICC type was associated with complication rate. This highlights that PICC type should be considered in clinical decisions.
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Affiliation(s)
| | - Elham Sabri
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher Bredeson
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.,The University of Ottawa, Ottawa, ON, Canada
| | - Sheryl McDiarmid
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
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116
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Flynn JM, Larsen EN, Keogh S, Ullman AJ, Rickard CM. Methods for microbial needleless connector decontamination: A systematic review and meta-analysis. Am J Infect Control 2019; 47:956-962. [PMID: 30824388 DOI: 10.1016/j.ajic.2019.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The objective of this review was to compare the effectiveness of connector decontamination with 70% alcohol wipes, alcoholic chlorhexidine gluconate wipes, or alcohol impregnated caps to prevent catheter-associated bloodstream infection (CABSI). METHODS A systematic search was conducted in CINAHL, Cochrane Central Register of Controlled Trials, Medline, and PubMed. The primary outcome was CABSI, with randomized and observational studies included. The inclusion criteria were: English language, any age group, no date limitations, and reporting connector decontamination interventions to prevent CABSI. The exclusion criteria were: multimodal interventions, letters, and conference abstracts. Quality assessment with the Newcastle-Ottawa Scale, a narrative synthesis, and meta-analysis were conducted. Pooled data used a random effects model for pair-wise comparisons, due to clinical heterogeneity. Statistical heterogeneity was investigated by visual model inspection, χ², and I² statistics. RESULTS Ten studies compared 70% alcohol wipes with 70% alcohol-impregnated caps, and 2 studies (n = 1,216) tested an alcoholic chlorhexidine gluconate wipe. Alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.28; 95% confidence interval, 0.20-0.39). Alcohol-impregnated caps were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.43; 95% confidence interval, 0.28-0.65). Studies were of low to moderate quality. CONCLUSIONS Alcohol impregnated caps and alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes. This requires confirmation in randomized controlled trials.
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117
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Larsen E, Keogh S, Marsh N, Rickard C. Experiences of peripheral IV insertion in hospital: a qualitative study. ACTA ACUST UNITED AC 2019; 26:S18-S25. [PMID: 29068742 DOI: 10.12968/bjon.2017.26.19.s18] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adult medical and surgical patients admitted to tertiary hospitals regularly have peripheral venous catheters (PVCs) inserted for their treatment. Anecdotally, patients report varying levels of pain and anxiety during the insertion procedure; however, lived experiences of patients are not well documented in the literature. The aim of this study was to gain an understanding of patients' experiences of PVC insertion. Some 10 participants were purposively sampled for semi-structured interviews, from the medical and surgical wards at a tertiary hospital in Queensland, Australia. Four key themes developed from the interview data: communication between the patient and the inserter; technique of device insertion; competence of the inserter; and location of the device. These themes informed practical ways that nurses might improve the patient experience, including: consultation with patients regarding device insertion preferences; siting the PVC in locations other than the antecubital fossa and hand; ensuring experienced and confident inserters are available to insert PVCs.
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Affiliation(s)
- Emily Larsen
- Senior Research Assistant, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland (MHIQ), Griffith University, Nathan Campus, Brisbane, Australia
| | - Samantha Keogh
- Professor, School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia
| | - Nicole Marsh
- Research Fellow in Vascular Access, Menzies Health Institute Queensland (MHIQ), Griffith University, Australia
| | - Claire Rickard
- Professor, School of Nursing and Midwifery, Griffith University, Australia
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118
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Lima AFC, Saba A, Berger S, Bianchini SS, Berssaneti FT. Preventive risk analysis in the maintenance of patency of the peripherally inserted central catheter. Rev Esc Enferm USP 2019; 53:e03462. [PMID: 31291392 DOI: 10.1590/s1980-220x2018011803462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/21/2018] [Indexed: 11/22/2022] Open
Abstract
This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient's health, the nursing professional and the health institution.
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Affiliation(s)
| | - Amanda Saba
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Simone Berger
- Universidade de São Paulo, Escola Politécnica, Departamento de Engenharia de Produção, São Paulo, SP, Brazil
| | - Silvia Sauaia Bianchini
- Universidade de São Paulo, Escola Politécnica, Departamento de Engenharia de Produção, São Paulo, SP, Brazil
| | - Fernando Tobal Berssaneti
- Universidade de São Paulo, Escola Politécnica, Departamento de Engenharia de Produção, São Paulo, SP, Brazil
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119
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Schults JA, Kleidon T, Petsky HL, Stone R, Schoutrop J, Ullman AJ. Peripherally inserted central catheter design and material for reducing catheter failure and complications. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Jessica A Schults
- Lady Cilento Children’s Hospital; Department of Anaesthesia and Pain Management; Level 7, Centre for Children’s Health Research 62 Graham Street South Brisbane Queensland Australia 4101
| | - Tricia Kleidon
- Lady Cilento Children's Hospital; Vascular Access and Management Service; 501 Stanley Street South Brisbane QLD Australia 4101
| | - Helen L Petsky
- Griffith University; School of Nursing and Midwifery, Griffith University and Menzies Health Institute Queensland; Brisbane Queensland Australia
| | | | - Jason Schoutrop
- Lady Cilento Children’s Hospital; Department of Anaesthesia and Pain Management; Level 7, Centre for Children’s Health Research 62 Graham Street South Brisbane Queensland Australia 4101
| | - Amanda J Ullman
- Griffith University; Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland; 170 Kessels Road Brisbane Queensland Australia 4111
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120
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Paje D, Rogers MAM, Conlon A, Flanders SA, Bernstein SJ, Chopra V. Use of Peripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney Disease: A Prospective Cohort Study. Ann Intern Med 2019; 171:10-18. [PMID: 31158846 DOI: 10.7326/m18-2937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD). OBJECTIVE To describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD (glomerular filtration rate [GFR] <45 mL/min/1.73 m2). DESIGN Prospective cohort study. SETTING 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium. PARTICIPANTS Hospitalized medical patients who received a PICC between November 2013 and September 2016. MEASUREMENTS Percentage of patients receiving PICCs who had CKD, frequency of PICC-related complications, and variation in the proportion of PICCs placed in patients with CKD. RESULTS Of 20 545 patients who had PICCs placed, 4743 (23.1% [95% CI, 20.9% to 25.3%]) had an estimated GFR (eGFR) less than 45 mL/min/1.73 m2 and 699 (3.4%) were receiving hemodialysis. In the intensive care unit (ICU), 30.9% (CI, 29.7% to 32.2%) of patients receiving PICCs had an eGFR less than 45 mL/min/1.73 m2; the corresponding percentage in wards was 19.3% (CI, 18.8% to 19.9%). Among patients with an eGFR less than 45 mL/min/1.73 m2, multilumen PICCs were placed more frequently than single-lumen PICCs. In wards, PICC-related complications occurred in 15.3% of patients with an eGFR less than 45 mL/min/1.73 m2 and in 15.2% of those with an eGFR of 45 mL/min/1.73 m2 or higher. The corresponding percentages in ICU settings were 22.4% and 23.9%. In patients with an eGFR less than 45 mL/min/1.73 m2, PICC placement varied widely across hospitals (interquartile range, 23.7% to 37.8% in ICUs and 12.8% to 23.7% in wards). LIMITATION Nephrologist approval for placement could not be determined, and 2.7% of eGFR values were unknown and excluded. CONCLUSION In this sample of hospitalized patients who received PICCs, placement in those with CKD was common and not concordant with clinical guidelines. PRIMARY FUNDING SOURCE Blue Cross Blue Shield of Michigan and Blue Care Network.
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Affiliation(s)
- David Paje
- University of Michigan Medical School, The Patient Safety Enhancement Program, and Center for Clinical Management Research at VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.P., M.A.R.)
| | - Mary A M Rogers
- University of Michigan Medical School, The Patient Safety Enhancement Program, and Center for Clinical Management Research at VA Ann Arbor Healthcare System, Ann Arbor, Michigan (D.P., M.A.R.)
| | - Anna Conlon
- University of Michigan Medical School, The Patient Safety Enhancement Program, Center for Clinical Management Research at VA Ann Arbor Healthcare System, and Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan (A.C., S.A.F., V.C.)
| | - Scott A Flanders
- University of Michigan Medical School, The Patient Safety Enhancement Program, Center for Clinical Management Research at VA Ann Arbor Healthcare System, and Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan (A.C., S.A.F., V.C.)
| | - Steven J Bernstein
- University of Michigan Medical School, The Center for Clinical Management Research at VA Ann Arbor Healthcare System, and Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan (S.J.B.)
| | - Vineet Chopra
- University of Michigan Medical School, The Patient Safety Enhancement Program, Center for Clinical Management Research at VA Ann Arbor Healthcare System, and Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan (A.C., S.A.F., V.C.)
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121
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Abstract
Uses of central venous access devices (CVADs) include the administration of vital fluids and medications. Implanted ports are a type of CVAD that is used when long-term vascular access is required. The device is discreet and associated with a low risk of catheter-related bloodstream infection. This article describes the different types and components of ports and how to select them. It explains how to insert ports, and provides guidance on accessing and de-accessing them
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Affiliation(s)
- Jane Hodson
- Lead IV Practitioner, Guy's and St Thomas' NHS Foundation Trust, London, UK
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122
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Taxbro K, Hammarskjöld F, Thelin B, Lewin F, Hagman H, Hanberger H, Berg S. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth 2019; 122:734-741. [PMID: 31005243 DOI: 10.1016/j.bja.2019.01.038] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Centrally inserted totally implanted vascular access ports (PORTs) and peripherally inserted central catheters (PICCs) are widely used for the administration of chemotherapy. Our aim was to study the incidence of catheter-related deep venous thrombosis in patients with cancer receiving chemotherapy through either a PICC or a PORT. METHODS Adults with non-haematological cancer (mainly breast and colorectal) from two Swedish oncology centres were included and followed for up to 1 yr. Patients were randomly assigned to receive a single-lumen PICC or PORT. The primary end point was the occurrence of a clinically significant catheter-related deep venous thrombosis, and the secondary end point was a composite of adverse events related to the catheter: insertion complication, thrombosis, occlusion, infection, and mechanical problems. RESULTS The trial recruited 399 participants (PICC, n=201; PORT, n=198) between March 2013 and February 2017. The PICCs were associated with 16 (8%) deep venous thromboses compared with two (1%) in the PORT group (HR=10.2; 95% confidence interval, 2.3-44.6; P=0.002). The overall incidence of composite adverse events was higher for patients with a PICC compared with those with a PORT (HR=2.7; 95% confidence interval, 1.6-4.6; P<0.001). CONCLUSIONS PICCs are associated with higher risk for catheter-related deep venous thrombosis and other adverse events when compared with PORTs. This increased risk should be considered when choosing a vascular access device for chemotherapy, especially in patients with solid malignancy. CLINICAL TRIAL REGISTRATION NCT01971021.
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Affiliation(s)
- Knut Taxbro
- University of Linköping, Linköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
| | - Fredrik Hammarskjöld
- University of Linköping, Linköping, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Bo Thelin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Helga Hagman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Håkan Hanberger
- University of Linköping, Linköping, Sweden; Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
| | - Sören Berg
- University of Linköping, Linköping, Sweden; Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Linköping University Hospital, Linköping, Sweden
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123
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Xiong ZY, Luo Z, Chen HY. Prevalence of idle peripherally inserted central catheters in adult patients: A multicenter cross-sectional study. J Vasc Access 2019; 20:677-682. [PMID: 30983490 DOI: 10.1177/1129729819840917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Increasing studies concern about idle vascular access devices, but still scant data on idle peripherally inserted central catheters. We aimed to assess the prevalence and risks of idle peripherally inserted central catheters in adult patients. Methods: A multicenter cross-sectional observational study was performed between April 2018 and July 2018. Patient demographics and peripherally inserted central catheters–related information were abstracted using a site questionnaire by directly inquiring and medical records reviewing right after their peripherally inserted central catheters were removed. Results: Three hundred and fifty-eight patients with peripherally inserted central catheter episodes who met the inclusion criteria were studied. Of the 58,000 total catheter-days recorded, 5311 (9.2%) were considered as idle based on our study criteria. Two hundred and fifty-five (71.2%) patients had at least 1 idle catheter-day with a mean duration of 14.84 (19.31) idle days. The incidence of catheter-related complications in patients with idle peripherally inserted central catheters was lower than that in patients without idle peripherally inserted central catheters, though the difference did not reach statistical significance (odds ratio = 0.635, 95% confidence interval = 0.367–1.099, p = 0.103). Conclusion: In conclusion, idle peripherally inserted central catheters were common in adult patients, but the low risks of catheter-related complications may justify maintaining a peripherally inserted central catheter for further observation when necessary.
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Affiliation(s)
- Zhao-Yu Xiong
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Luo
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Hai-Yan Chen
- Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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124
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Velissaris D, Karamouzos V, Lagadinou M, Pierrakos C, Marangos M. Peripheral Inserted Central Catheter Use and Related Infections in Clinical Practice: A Literature Update. J Clin Med Res 2019; 11:237-246. [PMID: 30937113 PMCID: PMC6436570 DOI: 10.14740/jocmr3757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/18/2019] [Indexed: 12/16/2022] Open
Abstract
Peripherally inserted central catheter (PICC) lines are commonly used by clinicians in daily practice. This strategy has been established the latest years as a common approach in many clinical conditions. Apart from their usefulness, PICC use is related to some complications. Aim of this review is to summarize all relevant publications regarding the PICC-related infection, as sepsis remains a high mortality syndrome. We conducted a PubMed search to identify all relevant publications referring to infective complications after insertion and use of PICC lines in hospitalized adult patients. A great number of publications suggest that PICC lines are widely used in the management of patients. The use of peripheral inserted central lines is related with a few complications, including bloodstream infections. Existing data mainly support their use in specific clinical conditions because of the low infectious rates. Some conflicting data also exist regarding PICC use, due to an unclear benefit from their use compared to other commonly used strategies. Although a number of complications, including bloodstream infections are related with insertion of PICC lines, their use has a promising role and can be used when indicated in a wide variety of clinical conditions, especially in specific categories of patients and prolonged periods.
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Affiliation(s)
- Dimitrios Velissaris
- Internal Medicine Department, University of Patras, University Hospital of Patras, Greece
| | | | | | | | - Markos Marangos
- Department of Infectious Diseases, University of Patras, Greece, University Hospital of Patras, Greece
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125
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Lee JH, Kim ET, Shim DJ, Kim IJ, Byeon JH, Lee IJ, Kim HB, Choi YJ, Lee JH. Prevalence and predictors of peripherally inserted central catheter-associated bloodstream infections in adults: A multicenter cohort study. PLoS One 2019; 14:e0213555. [PMID: 30845210 PMCID: PMC6405206 DOI: 10.1371/journal.pone.0213555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/22/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PBSI) and PBSI-related death in hospitalized adult patients. Materials and methods A retrospective multicenter cohort of consecutive patients who underwent PICC placement from October 2016 to September 2017 at four institutes was assembled. Using multivariable logistic and Cox-proportional hazards regression models, all risk factors were analyzed for their association with PBSI. Multivariable logistic models were used to evaluate predictors of PBSI-related death. Results During the study period, a total of 929 PICCs were inserted in 746 patients for a total of 17,913 catheter days. PBSI occurred in 58 patients (6.2%), with an infection rate of 3.23 per 1,000 catheter days. Number of catheter lumens [double lumen, odds ratio (OR) 5.295; 95% confidence interval (CI), 2.220–12.627; hazard ration (HR) 3.569; 95% CI, 1.461–8.717], PICC for chemotherapy (OR 4.94; 95% CI, 1.686–14.458; HR 7.635; 95% CI, 2.775–21.007), and hospital length of stay (OR 2.23; 95% CI, 1.234–4.049; HR 1.249; 95% CI, 0.659–2.368) were associated with PBSI. Risk factors, such as receiving chemotherapy (OR 54.911; 95% CI, 2.755–1094.326), presence of diabetes (OR 11.712; 95% CI, 1.513–90.665), and advanced age (OR 1.116; 95% CI 1.007–1.238), were correlated with PBSI-related death. Conclusion Our results indicated that risk factors associated with PBSI included the number of catheter lumens, the use of PICCs for chemotherapy, and the hospital length of stay. Furthermore, PBSI-related death was common in patients undergoing chemotherapy, diabetics, and elderly patients.
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Affiliation(s)
- Jae Hwan Lee
- Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
- National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Eung Tae Kim
- Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, College of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
- * E-mail:
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il Jung Kim
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hyun Byeon
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Joon Lee
- Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
- National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Hyun Beom Kim
- Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
- National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Young Ju Choi
- National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Hong Lee
- National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
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Zohourian H, Schaubschlager T, Phan L, Polsinelli E, Hunter K, Timis A, Sanchez D, Maini A, Hardigan P, Carreon A, Jani V. Comparing Incidence of Thrombosis in PICC and Midlines and Evaluating the Role of Anticoagulation, Site of Insertion, and Risk Factors. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.java.2018.29.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Highlights
New practice models are in demand for prevention and reduction in rates of catheter thrombosis that can be devastating to the health care system and patients Risk factors for catheter thrombosis were analyzed retrospectively for their impact Site of insertion and overall use of anticoagulation at the time of catheter placement did not show any significant impact on incidence of thrombosis Several variables (i.e., triple lumen, critically ill) were used to create a clinical prediction score model
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Affiliation(s)
| | | | - Lee Phan
- Broward Health Medical Center, Fort Lauderdale, FL
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127
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Halvey AK, Macdonald B, Dhyani A, Tuteja A. Design of surfaces for controlling hard and soft fouling. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2019; 377:20180266. [PMID: 30967072 PMCID: PMC6335287 DOI: 10.1098/rsta.2018.0266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 05/29/2023]
Abstract
In this review, we present a framework to guide the design of surfaces which are resistant to solid fouling, based on the modulus and length scale of the fouling material. Solid fouling is defined as the undesired attachment of solid contaminants including ice, clathrates, waxes, inorganic scale, polymers, proteins, dust and biological materials. We first provide an overview of the surface design approaches typically applied across the scope of solid fouling and explain how these disparate research efforts can be united to an extent under a single framework. We discuss how the elastic modulus and the operating length scale of a foulant determine its ability or inability to elastically deform surfaces. When surface deformation occurs, minimization of the substrate elastic modulus is critical for the facile de-bonding of a solid contaminant. Foulants with low modulus or small deposition sizes cannot deform an elastic bulk material and instead de-bond more readily from surfaces with chemistries that minimize their interfacial free energy or induce a particular repellant interaction with the foulant. Overall, we review reported surface design strategies for the reduction in solid fouling, and provide perspective regarding how our framework, together with the modulus and length scale of a foulant, can guide future antifouling surface designs. This article is part of the theme issue 'Bioinspired materials and surfaces for green science and technology'.
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Affiliation(s)
- Alex Kate Halvey
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brian Macdonald
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Abhishek Dhyani
- BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anish Tuteja
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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128
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Kagan E, Salgado CD, Banks AL, Marculescu CE, Cantey JR. Peripherally inserted central catheter-associated bloodstream infection: Risk factors and the role of antibiotic-impregnated catheters for prevention. Am J Infect Control 2019; 47:191-195. [PMID: 30180989 DOI: 10.1016/j.ajic.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/08/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antimicrobial-impregnated (AIP) peripherally inserted central catheters (PICCs) may lower risk of central line-associated bloodstream infection (CLABSI) compared with nonantimicrobial-impregnated (NAIP) catheters. We sought to assess risk factors for CLABSI with a focus on the effect of AIP PICCs. METHODS CLABSI rate was determined among patients who received PICCs from July 2009 through June 2012 using a retrospective study design. A nested case-control study matched for operators (interventional radiology [IR], infectious diseases [IDs], and the nurse venous access team [VAT]) was conducted to assess risks for PICC CLABSI. RESULTS Eighty-nine PICC CLABSIs (1.66%) occurred among 5,372 PICC placements a mean of 32 days after placement. Higher infection risk (1.75) was observed for IR-placed PICCs compared with ID-placed PICCs (P = .02). In addition, higher infection risk (4.22) was observed for IR-placed PICCS compared with VAT-placed PICCs (P = .0008). IR-placed NAIP catheters, as indicated by multivariate analysis, revealed a 5.45-fold greater CLABSI risk compared with AIP catheters (P < .0005). Other risk factors included chemotherapy, placement of a tunneled catheter, leukemia, and AIDS. CONCLUSIONS PICC CLABSIs were highest among patients receiving NAIP catheters in this large study. Highest risk occurred with placement of a tunneled catheter, AIDS, leukemia, and if the indication for PICC was chemotherapy. Our study suggests that the AIP PICC should be considered in all patients receiving PICCs.
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Krein SL, Saint S, Trautner BW, Kuhn L, Colozzi J, Ratz D, Lescinskas E, Chopra V. Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study. BMJ Qual Saf 2019; 28:574-581. [PMID: 30683751 PMCID: PMC6593651 DOI: 10.1136/bmjqs-2018-008726] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/06/2018] [Accepted: 11/11/2018] [Indexed: 01/07/2023]
Abstract
Objective Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation. Design Prospective cohort study. Setting Inpatient medical units at four US hospitals in two states. Participants Consecutive sample of patients who had a new PICC placed during a hospital stay between August 2015 and May 2017. Main outcome(s) Patient-reported signs and symptoms of a possible PICC-related complication or functional issues. Results Of the 438 patients in the analytic cohort (91.4% of those consented), two-thirds were male with a mean age of 56 years. The most common reason for PICC placement was long-term antibiotic therapy (43.4%). During the 70-day follow-up period, 61.4% of patients reported signs of at least one complication, including potentially serious complications, such as bloodstream infection (17.6%) and deep vein thrombosis (30.6%). Correspondence of these reported events with medical record documentation of the complication was generally low. More than one-quarter (27.9%) of patients reported minor complications, such as insertion site redness, discomfort or difficult removal. While the PICC was in place, 26.0% reported restrictions in activities of daily living, 14.4% social activity restrictions and 19.2% had difficulty with flushing or operating the PICC. Conclusion Over 60% of patients report signs or symptoms of a possible complication or adverse effect after PICC placement. Bothersome complications from the patient perspective are clearly more common than those that typically rise to the level of healthcare provider attention or concern. Understanding the patient experience is critical for providing safe and effective care.
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Affiliation(s)
- Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Latoya Kuhn
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - John Colozzi
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Erica Lescinskas
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Vineet Chopra
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Badger J. Long peripheral catheters for deep arm vein venous access: A systematic review of complications. Heart Lung 2019; 48:222-225. [PMID: 30660325 DOI: 10.1016/j.hrtlng.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Long peripheral catheters (LPCs) offer a quick, simple and cost-effective alternative for venous access in intensive care patients with difficult venous access, but the decision to use them must be balanced against an assessment of harm. The aim of this systematic review was to synthesise reports of complications associated with LPCs. METHODS The electronic databases MEDLINE, EMBASE and CINAHL were searched systematically for randomised controlled trials, cohort studies and case control studies published in the period 1966 to 24th July 2018 reporting LPC associated occlusion, catheter related blood stream infections, phlebitis and infiltration. Study quality was assessed using the Methodological Index for Non-Randomised Studies. The studies were described and participant characteristics; type of catheter; setting; average dwell time; and rates of occlusion, catheter related blood stream infection, phlebitis and infiltration were extracted as summary measures. RESULTS Five cohort studies and one randomised controlled study, comprising a total of 350 participants, fulfilled the inclusion criteria. Dwell time ranged from 1 to 15days and the reported complication rate was 3-14%. The most common complication was catheter occlusion (4%), followed by phlebitis (1%), infiltration (0.9%), and catheter related blood stream infection (0.3%). Significant heterogeneity, particularly in identification and reporting of complications, means results should be interpreted with caution. CONCLUSION There is a lack of intervention specific and adequately powered randomised controlled trials investigating LPCs in an intensive care setting. Until the results of such studies are available, LPCs should be used as an alternative to ultrasound-guided PVCs in well monitored acute care environments.
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Affiliation(s)
- James Badger
- Honorary Academic Research Trainee, University of Southampton NHS Trust, University of Southampton, University Road, Southampton, SO171BJ, United Kingdom.
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131
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Abstract
OBJECTIVES To create a bedside peripherally inserted central catheter service to increase placement of bedside peripherally inserted central catheter in PICU patients. DESIGN Two-phase observational, pre-post design. SETTING Single-center quaternary noncardiac PICU. PATIENTS All patients admitted to the PICU. INTERVENTIONS From June 1, 2015, to May 31, 2017, a bedside peripherally inserted central catheter service team was created (phase I) and expanded (phase II) as part of a quality improvement initiative. A multidisciplinary team developed a PICU peripherally inserted central catheter evaluation tool to identify amenable patients and to suggest location and provider for procedure performance. Outcome, process, and balancing metrics were evaluated. MEASUREMENTS AND MAIN RESULTS Bedside peripherally inserted central catheter service placed 130 of 493 peripherally inserted central catheter (26%) resulting in 2,447 hospital central catheter days. A shift in bedside peripherally inserted central catheter centerline proportion occurred during both phases. Median time from order to catheter placement was reduced for peripherally inserted central catheters placed by bedside peripherally inserted central catheter service compared with placement in interventional radiology (6 hr [interquartile range, 2-23 hr] vs 34 hr [interquartile range, 19-61 hr]; p < 0.001). Successful access was achieved by bedside peripherally inserted central catheter service providers in 96% of patients with central tip position in 97%. Bedside peripherally inserted central catheter service central line-associated bloodstream infection and venous thromboembolism rates were similar to rates for peripherally inserted central catheters placed in interventional radiology (all central line-associated bloodstream infection, 1.23 vs 2.18; p = 0.37 and venous thromboembolism, 1.63 vs 1.57; p = 0.91). Peripherally inserted central catheters in PICU patients had reduced in-hospital venous thromboembolism rate compared with PICU temporary catheter in PICU rate (1.59 vs 5.36; p < 0.001). CONCLUSIONS Bedside peripherally inserted central catheter service implementation increased bedside peripherally inserted central catheter placement and employed a patient-centered and timely process. Balancing metrics including central line-associated bloodstream infection and venous thromboembolism rates were not significantly different between peripherally inserted central catheters placed by bedside peripherally inserted central catheter service and those placed in interventional radiology.
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Pathak R, Bierman SF, d'Arnaud P. Inhibition of bacterial attachment and biofilm formation by a novel intravenous catheter material using an in vitro percutaneous catheter insertion model. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:427-432. [PMID: 30588133 PMCID: PMC6305250 DOI: 10.2147/mder.s183409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Despite sterile barrier precautions and vigorous skin antisepsis, percutaneous insertion of intravenous catheters has been shown to result in attachment to the catheter surface of bacteria residing in the deep structures of the skin. Such attachment poses the risk of biofilm formation and eventual catheter-related bloodstream infection (CRBSI). This study was undertaken to assess whether the non-coated surface treatment of a unique catheter material (ChronoFlex C® with BioGUARD™) could inhibit bacterial attachment and biofilm formation. Methods A novel in vitro model and fluorescence microscopy were used to compare two intravascular catheter materials with respect to bacterial attachment and biofilm formation. The control material was a commonly used polyurethane. The study material was a unique copolymer, treated so as to remove surface additives, alter hydrophobicity and create surface micro-patterning. Outcomes were assessed using both a membrane potential indicator and a cell death reporter with appropriate fluorescent channels. Thus, bacterial cells attached to the catheter surface (living and dead) were imaged without mechanical disruption. Results Both bacterial attachment and biofilm formation are significantly inhibited by the study catheter material. In fact, over 5 times more bacteria were able to attach and grow on the control polyurethane material than on the study material (P=0.0020). Moreover, those few bacteria that were able to attach to the study material had a 1.5 times greater likelihood of dying. Conclusion Using a novel in vitro percutaneous catheter insertion model, ChronoFlex C with BioGUARD is proven to significantly inhibit bacterial attachment and biofilm formation as compared with a commonly used polyurethane catheter material.
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Affiliation(s)
- Rahul Pathak
- University of Central Florida College of Medicine, Lakeland, FL 33813, USA,
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Kim IJ, Shim DJ, Lee JH, Kim ET, Byeon JH, Lee HJ, Cho SG. Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study. Eur Radiol 2018; 29:2716-2723. [PMID: 30560363 DOI: 10.1007/s00330-018-5917-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line-associated bloodstream infections (CLABSIs). METHODS Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models. RESULTS Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149-0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI. CONCLUSIONS Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI. KEY POINTS • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.
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Affiliation(s)
- Il Jung Kim
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyung-gu, Incheon, 21431, Republic of Korea.
| | - Jae Hwan Lee
- Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Eung Tae Kim
- Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, South Korea
| | - Jong Hyun Byeon
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyung-gu, Incheon, 21431, Republic of Korea
| | - Hun Jae Lee
- Department of Social and Preventive Medicine, College of Medicine, Inha University, Michuhol-Gu, Incheon, 22212, Republic of Korea
| | - Soon Gu Cho
- Department of Radiology, College of Medicine, Inha University, Incheon, Republic of Korea
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Kostner R, Mairvongrasspeinten H, De Martin Polo A, Vittadello F, Ausserhofer D, Mantovan F. [Types and frequencies of complications associated with midline catheters and PICCs in a South Tyrolean district hospital: a retrospective cohort study]. Pflege 2018; 32:1-8. [PMID: 30526314 DOI: 10.1024/1012-5302/a000654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Types and frequencies of complications associated with midline catheters and PICCs in a South Tyrolean district hospital: a retrospective cohort study Abstract. BACKGROUND Specialized registered nurses play a key role in the insertion and management of peripherally inserted central catheters (PICCs) and midline catheters in Anglo-Saxon countries. From the German-speaking area no data on the use of PICCs and midline catheters are available. AIM The aim of this study was to describe the types and frequencies of complications of PICCs and midline catheters which were inserted by specialized registered nurses in a South Tyrolean district hospital. METHODS We performed a retrospective cohort study of PICCs and midline catheters inserted between 2013 and 2015 in one surgical unit in the district hospital Bruneck (South Tyrol / Italy). RESULTS Data from 900 catheters (421 midline catheters and 479 PICCs) inserted in 686 adult patients (404 women, 282 men) were analysed. The cumulative incidence was 29.2 % complications for midline catheters (incidence rate: 13 complications / 1000 catheter days) and 16.0 % for PICCs (incidence rate: 3 complications / 1000 catheter days). The most frequent complication was the removal of the catheter by the patients (PICCs: 6.7 %, midline catheters: 15.7 %). Other less frequent complications were mechanical complications, occlusions, infections and thromboses. CONCLUSIONS This study in one district hospital revealed similar types and frequencies of complications as previous international studies. Specialized and clinically competent nurses in German-speaking countries could develop advanced roles in the insertion and management of PICCs and midline catheters.
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Affiliation(s)
- Roman Kostner
- 1 Sanitätsbetrieb Südtirol, Bezirkskrankenhaus Bruneck, Italien.,* geteilte Erstautorenschaft
| | | | | | | | | | - Franco Mantovan
- 3 Landesfachhochschule für Gesundheitsberufe Claudiana, Bozen, Italien.,4 Scuola di Medicina e Chirurgia Universität Verona, Italien
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Ullman AJ, Bulmer AC, Dargaville TR, Rickard CM, Chopra V. Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety. Expert Rev Med Devices 2018; 16:25-33. [PMID: 30513003 DOI: 10.1080/17434440.2019.1555466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Thrombotic complications associated with peripherally inserted central catheters (PICCs) are common, as most synthetic materials when placed in the presence of serum often result in platelet activation, fibrin deposition, thrombotic occlusion, and potentially embolization. A current innovation focus has been the development of antithrombogenic catheter materials, including hydrophilic and hydrophobic surfaces. These are being incorporated into PICCs in an attempt to prevent the normal thrombotic cascade leading to patient harm. AREAS COVERED This review focuses on the laboratory efficacy and clinical effectiveness of antithrombogenic PICCs to prevent PICC-associated thrombosis, as well as their efficiency and safety. This synthesis was informed by a systematic identification of published and unpublished laboratory and clinical studies evaluating these technologies. EXPERT COMMENTARY A range of PICCs have been developed with antithrombogenic claims, using varying technologies. However, to date, there is no peer-reviewed laboratory research describing the individual PICCs' effectiveness. Despite promising early clinical trials, adequately powered trials to establish efficacy, effectiveness, efficiency, and safety of all of the individual products have not yet been undertaken.
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Affiliation(s)
- Amanda J Ullman
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,b School of Nursing and Midwifery , Griffith University , Nathan , Australia.,c Centre for Clinical Nursing , Royal Brisbane and Women's Hospital , Herston , Australia.,d Paediatric Critical Care Research Group , Queensland Children's Hospital , South Brisbane , Australia
| | - AndreW C Bulmer
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,e School of Medical Science , Griffith University , Gold Coast , Australia
| | - Tim R Dargaville
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,f Institute of Health and Biomedical Innovation, Science and Engineering Faculty , Queensland University of Technology , Brisbane , Australia
| | - Claire M Rickard
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,b School of Nursing and Midwifery , Griffith University , Nathan , Australia.,c Centre for Clinical Nursing , Royal Brisbane and Women's Hospital , Herston , Australia.,d Paediatric Critical Care Research Group , Queensland Children's Hospital , South Brisbane , Australia
| | - Vineet Chopra
- a Alliance for Vascular Access Teaching and Research , Menzies Health Institute Queensland , Nathan , Australia.,g Division of Hospital Medicine , University of Michigan Health System , Ann Arbor , MI , USA
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Comparison of Complication Rates of Central Venous Catheters Versus Peripherally Inserted Central Venous Catheters in Pediatric Patients. Pediatr Crit Care Med 2018; 19:1097-1105. [PMID: 30142121 DOI: 10.1097/pcc.0000000000001707] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The purpose of our study is to compare the rate of central line-associated blood stream infections and venous thromboembolism in central venous catheters versus peripherally inserted central catheters in hospitalized children. There is a growing body of literature in adults describing an increased rate of venous thromboembolisms and similar rates of central line-associated blood stream infection associated with peripherally inserted central catheters versus central venous catheters. It is not known if the rate of central line-associated blood stream infection and venous thromboembolism differs between peripherally inserted central catheters and central venous catheters in children. Based on current adult literature, we hypothesize that central line-associated blood stream infection rates for peripherally inserted central catheters and central venous catheters will be similar, and the rate of venous thromboembolism will be higher for peripherally inserted central catheters versus central venous catheters. DESIGN This is a cohort study using retrospective review of medical records and prospectively collected hospital quality improvement databases. SETTING Quaternary-care pediatric hospital from October 2012 to March 2016. PATIENTS All patients age 1 day to 18 years old with central venous catheters and peripherally inserted central catheters placed during hospital admission over the study dates were included. Central venous catheters that were present upon hospital admission were excluded. The primary outcomes were rate of central line-associated blood stream infection and rate of venous thromboembolism. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 2,709 catheters included in the study, 1,126 were peripherally inserted central catheters and 1,583 were central venous catheters. Peripherally inserted central catheters demonstrated a higher rate of both infection and venous thromboembolism than central venous catheters in all reported measures. In multivariable analysis, peripherally inserted central catheters had increased association with central line-associated blood stream infection (odds ratio of 3.15; 95% CI, 1.74-5.71; p = 0.0002) and increased association with venous thromboembolism (odds ratio of 2.71; 95% CI, 1.65-4.45; p < 0.0001) compared with central venous catheters. CONCLUSIONS Rates of central line-associated blood stream infection and venous thromboembolism were higher in hospitalized pediatric patients with peripherally inserted central catheters as compared to central venous catheters. Our study confirms the need for further investigation into the safety of central access devices to assist in proper catheter selection.
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137
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Govindan S, Snyder A, Flanders SA, Chopra V. Peripherally Inserted Central Catheters in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals. Crit Care Med 2018; 46:e1136-e1144. [PMID: 30247241 PMCID: PMC6317857 DOI: 10.1097/ccm.0000000000003423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward. DESIGN Retrospective cohort study. SETTING Fifty-two hospital Michigan quality collaborative. PATIENTS Twenty-seven-thousand two-hundred eighty-nine patients with peripherally inserted central catheters placed during hospitalization. MEASUREMENTS AND MAIN RESULTS Descriptive statistics were used to summarize patient, provider, and device characteristics. Bivariate tests were used to assess differences between peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the ward. Multilevel mixed-effects generalized linear models adjusting for patient and device factors with a logit link clustered by hospital were used to examine the association between peripherally inserted central catheter complications and location of peripherally inserted central catheter placement. Variation in ICU peripherally inserted central catheter use, rates of complications, and appropriateness of use across hospitals was also examined. Eight-thousand two-hundred eighty patients (30.3%) received peripherally inserted central catheters in the ICU versus 19,009 (69.7%) on the general ward. The commonest indication for peripherally inserted central catheter use in the ICU was difficult IV access (35.1%) versus antibiotic therapy (53.3%) on wards. Compared with peripherally inserted central catheters placed in wards, peripherally inserted central catheters placed in the ICU were more often multilumen (59.5% vs 39.3; p < 0.001) and more often associated with a complication (odds ratio, 1.30; 95% CI, 1.18-1.43; p < 0.001). Substantial variation in ICU peripherally inserted central catheter use and outcomes across hospitals was observed, with median peripherally inserted central catheter dwell time ranging from 3 to 38.5 days (p < 0.001) and complications from 0% to 40.2% (p < 0.001). Importantly, 87% (n = 45) of ICUs reported median peripherally inserted central catheter dwell times less than or equal to 14 days, a duration where traditional central venous catheters, not peripherally inserted central catheters, are considered appropriate by published criteria. CONCLUSIONS Peripherally inserted central catheter use in the ICU is highly variable, associated with complications and often not appropriate. Further study of vascular access decision-making in the ICU appears necessary.
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Affiliation(s)
- Sushant Govindan
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan Health System
- Patient Safety Enhancement Program, Ann Arbor VA Medical Center all in Ann Arbor, MI
| | - Ashley Snyder
- Division of Hospital Medicine, Department of Medicine, University of Michigan Health System
| | - Scott A. Flanders
- Division of Hospital Medicine, Department of Medicine, University of Michigan Health System
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Michigan Health System
- Center for Clinical Management Research, Ann Arbor VA Healthcare System
- Patient Safety Enhancement Program, Ann Arbor VA Medical Center all in Ann Arbor, MI
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Tetrasodium EDTA Is Effective at Eradicating Biofilms Formed by Clinically Relevant Microorganisms from Patients' Central Venous Catheters. mSphere 2018; 3:3/6/e00525-18. [PMID: 30487154 PMCID: PMC6262258 DOI: 10.1128/msphere.00525-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The colonization of catheters by microorganisms often precludes their long-term use, which can be a problem for human patients that have few body sites available for new catheters. The colonizing organisms often form biofilms, and increasingly these organisms are resistant to multiple antibiotics, making them difficult to treat. In this article, we have taken microorganisms that are associated with biofilm formation in catheters from two Canadian hospitals and tested them with tetrasodium EDTA, a new antimicrobial catheter lock solution. Tetrasodium EDTA was effective at eliminating Gram-positive, Gram-negative, and fungal species and represents a promising alternative to antibiotic treatment with less chance of the organisms developing resistance. We expect that our results will be of interest to researchers and clinicians and will lead to improved patient care. Central venous access devices (CVADs) are an essential component of modern health care. However, their prolonged use commonly results in microbial colonization, which carries the potential risk of hospital-acquired bloodstream infections. These infections complicate the treatment of already sick individuals and cost the existing health care systems around the world millions of dollars. The microbes that colonize CVADs typically form multicellular biofilms that are difficult to dislodge and are resistant to antimicrobial treatments. Clinicians are searching for better ways to extend the working life span of implanted CVADs, by preventing colonization and reducing the risk of bloodstream infections. In this study, we analyzed 210 bacterial and fungal isolates from colonized CVADs or human bloodstream infections from two hospitals geographically separated in the east and west of Canada and screened the isolates for biofilm formation in vitro. Twenty isolates, representing 12 common, biofilm-forming species, were exposed to 4% tetrasodium EDTA, an antimicrobial lock solution that was recently approved in Canada for use as a medical device. The EDTA solution was effective at eradicating surface-attached biofilms from each microbial species, indicating that it could likely be used to prevent biofilm growth within CVADs and to eliminate established biofilms. This new lock solution fits with antibiotic stewardship programs worldwide by sparing the use of important antibiotic agents, targeting prevention rather than the expensive treatment of hospital-acquired infections. IMPORTANCE The colonization of catheters by microorganisms often precludes their long-term use, which can be a problem for human patients that have few body sites available for new catheters. The colonizing organisms often form biofilms, and increasingly these organisms are resistant to multiple antibiotics, making them difficult to treat. In this article, we have taken microorganisms that are associated with biofilm formation in catheters from two Canadian hospitals and tested them with tetrasodium EDTA, a new antimicrobial catheter lock solution. Tetrasodium EDTA was effective at eliminating Gram-positive, Gram-negative, and fungal species and represents a promising alternative to antibiotic treatment with less chance of the organisms developing resistance. We expect that our results will be of interest to researchers and clinicians and will lead to improved patient care.
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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140
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Abstract
Neurointensive care (NICU) patients experience complex infectious disease challenges. Central nervous system (CNS) infections are difficult to diagnose and treat, and post-neurosurgical patients are vulnerable to a unique set of healthcare-acquired infections (HAI) in addition to those typical of critically ill patients. The purpose of this review is to summarize the approach to suspected infection in the NICU and discuss management of several infectious syndromes in the NICU setting.
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Affiliation(s)
- John C O'Horo
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Priya Sampathkumar
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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141
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LeVasseur N, Stober C, Ibrahim M, Gertler S, Hilton J, Robinson A, McDiarmid S, Fergusson D, Mazzarello S, Hutton B, Joy AA, McInnes M, Clemons M. Perceptions of vascular access for intravenous systemic therapy and risk factors for lymphedema in early-stage breast cancer-a patient survey. ACTA ACUST UNITED AC 2018; 25:e305-e310. [PMID: 30111976 DOI: 10.3747/co.25.3911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The choice of vascular access for systemic therapy administration in breast cancer remains an area of clinical equipoise, and patient preference is not consistently acknowledged. Using a patient survey, we evaluated the patient experience with vascular access during treatment for early-stage breast cancer and explored perceived risk factors for lymphedema. Methods Patients who had received systemic therapy for early-stage breast cancer were surveyed at 2 Canadian cancer centres. Results Responses were received from 187 patients (94%). The route of vascular access was peripheral intravenous line (IV) in 24%, a peripherally inserted central catheter (picc) in 42%, and a surgically inserted central catheter (port) in 34%. Anthracycline-based regimens were associated with a greater use of central vascular access devices (cvads- that is, a picc or port; 86/97, 89%). Trastuzumab use was associated with greater use of ports (49/64, 77%). Although few patients (7%) reported being involved in the decisions about vascular access, most were satisfied or very satisfied (88%) with their access type. Patient preference centred mainly on avoiding delays in the initiation of chemotherapy. Self-reported rates of complications (183 evaluable responses) were infiltration with peripheral IVs (9/44, 20%), local skin infections with piccs (7/77, 9%), and thrombosis with ports (4/62, 6%). Perceived risk factors for lymphedema included use of the surgical arm for blood draws (117/156, 75%) and blood pressure measurement (115/156, 74%). Conclusions Most patients reported being satisfied with the vascular access used for their treatment. Improved education and understanding about the evidence-based requirements for vascular access are needed. Perceived risk factors for lymphedema remain variable and are not evidence-based.
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Affiliation(s)
- N LeVasseur
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - C Stober
- The Ottawa Hospital Research Institute, Ottawa
| | - M Ibrahim
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - S Gertler
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - J Hilton
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa.,The Ottawa Hospital Research Institute, Ottawa
| | - A Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston
| | - S McDiarmid
- Department of Nursing, The Ottawa Hospital, Ottawa; and
| | - D Fergusson
- The Ottawa Hospital Research Institute, Ottawa.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | | | - B Hutton
- The Ottawa Hospital Research Institute, Ottawa.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A A Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - M McInnes
- The Ottawa Hospital Research Institute, Ottawa.,Department of Radiology, University of Ottawa, Ottawa, ON
| | - M Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa.,The Ottawa Hospital Research Institute, Ottawa.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
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142
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Smismans A, Vantrappen A, Verbiest F, Indevuyst C, Van den Poel B, von Winckelmann S, Peeters A, Ombelet S, Lybeert P, Heremans A, Frans E, Ho E, Frans J. OPAT: proof of concept in a peripheral Belgian hospital after review of the literature. Acta Clin Belg 2018; 73:257-267. [PMID: 29385901 DOI: 10.1080/17843286.2018.1424503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Since its introduction in the 1970s in the United States, outpatient parenteral antibiotic/antimicrobial therapy (OPAT) has been adopted internationally for long-term intravenous (IV) treatment of stable infectious diseases. The aim is to provide a safe and successful completion of IV antimicrobial treatment at the ambulatory care center or at home without complications and costs associated with hospitalization. OPAT implementation has been accelerated by progress in vascular access devices, newly available antibiotics, the emphasis on cost-savings, as well as an improved patient comfort and a reduced incidence of health care associated infections with a similar outcome. OPAT utilization is supported by an extensive published experience and guidelines of the British Society of Antimicrobial Chemotherapy and the Infectious Diseases Society of America for adults as well as for children. Despite these recommendations and its widespread adoption, in Belgium OPAT is only fully reimbursed and established for cystic fibrosis patients. Possible explanations for this unpopularity include physician unfamiliarity and a lack of uniform funding arrangements with higher costs for the patient. This article aims to briefly review benefits, risks, indications, financial impact for supporting OPAT in a non-university hospital as standard of care. Our experience with OPAT at the ambulatory care center of our hospital and its subsequent recent introduction in the home setting is discussed.
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Affiliation(s)
- Annick Smismans
- Laboratory of Clinical Biology, Imelda Hospital, Bonheiden, Belgium
| | | | | | | | - Bea Van den Poel
- Laboratory of Clinical Biology, Imelda Hospital, Bonheiden, Belgium
| | | | | | - Sara Ombelet
- Internal Medicine, Imelda Hospital, Bonheiden, Belgium
| | - Peter Lybeert
- Internal Medicine, Imelda Hospital, Bonheiden, Belgium
| | | | - Eric Frans
- Internal Medicine, Imelda Hospital, Bonheiden, Belgium
| | - Erwin Ho
- Laboratory of Clinical Biology, Imelda Hospital, Bonheiden, Belgium
| | - Johan Frans
- Laboratory of Clinical Biology, Imelda Hospital, Bonheiden, Belgium
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143
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LeVasseur N, Stober C, Daigle K, Robinson A, McDiarmid S, Mazzarello S, Hutton B, Joy A, Fergusson D, Hilton J, McInnes M, Clemons M. Optimizing vascular access for patients receiving intravenous systemic therapy for early-stage breast cancer-a survey of oncology nurses and physicians. Curr Oncol 2018; 25:e298-e304. [PMID: 30111975 PMCID: PMC6092058 DOI: 10.3747/co.25.3903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Despite advances in systemic therapy choices for patients with early-stage breast cancer, optimal practices for intravenous (IV) access remain unknown. That lack of knowledge holds particularly true for the use of central venous access devices (cvads) such as peripherally inserted central catheters (piccs) and implanted vascular access devices (ports). Methods Using a survey of Canadian oncologists and oncology nurses responsible for the care of breast cancer patients, we evaluated current access practices, perceptions of complications, and perceptions of risk, and we estimated complication rates and evaluated perceived risk factors for lymphedema. Results Survey responses were received from 25 physicians and 57 oncology nurses. Administration of trastuzumab or an anthracycline was associated with a higher likelihood of a cvad being recommended. Other factors associated with recommendation of a cvad included prior difficult IV access and a recommendation from the chemotherapy nurse. Although the complication rates perceived to be associated with the use of piccs and ports remained high, respondents felt that cvads might improve patient quality of life. Risk factors perceived to be associated with the risk of lymphedema were axillary lymph node dissection, radiation to the axilla, and line-associated infection. Factors known to be unrelated to lymphedema risk (specifically, blood draws and blood pressure measurement) continue to be perceived as posing a higher risk. Conclusions Despite widespread use of chemotherapy for patients with breast cancer, the type of venous access used for treatment varies significantly, as do perceptions about the risks of cvad use and the risk for lymphedema development. Further prospective studies are needed to identify best-practice strategies.
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Affiliation(s)
- N. LeVasseur
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
| | - C. Stober
- The Ottawa Hospital Research Institute, Ottawa
| | - K. Daigle
- Department of Nursing, The Ottawa Hospital, Ottawa
| | - A. Robinson
- Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston; and
| | - S. McDiarmid
- Department of Nursing, The Ottawa Hospital, Ottawa
| | | | - B. Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A. Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - D. Fergusson
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - J. Hilton
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
| | - M. McInnes
- Department of Radiology, The Ottawa Hospital, Ottawa, ON
| | - M. Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa
- The Ottawa Hospital Research Institute, Ottawa
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
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144
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Hon K, Bihari S, Holt A, Bersten A, Kulkarni H. Rate of Catheter-Related Bloodstream Infections Between Tunneled Central Venous Catheters Versus Peripherally Inserted Central Catheters in Adult Home Parenteral Nutrition: A Meta-analysis. JPEN J Parenter Enteral Nutr 2018; 43:41-53. [PMID: 30035806 DOI: 10.1002/jpen.1421] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Tunneled central venous catheters (TCVCs) and peripherally inserted central catheters (PICC) are often used for the provision of home parenteral nutrition (HPN). There is no formal comparison being made to study the rate of catheter-related bloodstream infection (CRBSI) between TCVCs and PICC in HPN to recommend the use of 1 over the other. METHODS An online MEDLINE, PubMed, and Scopus search was conducted. Studies reporting the rate of CRBSI in HPN patients were included. DerSimonian and Laird random effects meta-analyses were used to analyze comparative studies, whereas Begg and Pilote's random effects meta-analysis was used to pool and analyze single-arm studies. RESULTS Seventeen studies (12 single-arm studies and 5 comparative studies) were included for analysis. Meta-analysis of comparative studies showed that PICC use was associated with a significantly lower rate of CRBSI (relative risk (RR) 0.40, 95% CI 0.19-0.83), whereas meta-analysis of single-arm studies revealed that the relative risk for CRBSI was not statistically significantly different from unity. CONCLUSION TCVC is more commonly used in long-term HPN. Our analysis of comparative studies showed a lower rate of CRBSI in HPN patients using PICC compared with TCVC; however, analysis of single-arm studies showed that the rate of CRBSI was comparable in PICC and TCVC use. The decision to which type of catheter is most suited for HPN patients should hence be based on the duration of treatment, level of care, patients' dexterity, as well patients' underlying comorbidities that may potentially contribute to other catheter-related complications.
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Affiliation(s)
- Kay Hon
- College of Medicine, Flinders University, South Australia, Australia
| | - Shailesh Bihari
- College of Medicine, Flinders University, South Australia, Australia.,Department of Intensive and Critical Care Unit, Flinders Medical Centre, South Australia, Australia
| | - Andrew Holt
- College of Medicine, Flinders University, South Australia, Australia.,Department of Intensive and Critical Care Unit, Flinders Medical Centre, South Australia, Australia.,South Australia Home Parenteral Nutrition Unit, Flinders Medical Centre, South Australia, Australia
| | - Andrew Bersten
- College of Medicine, Flinders University, South Australia, Australia.,Department of Intensive and Critical Care Unit, Flinders Medical Centre, South Australia, Australia
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145
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Patel SA, Bhattacharjee P, Roman L. Bedside Peripherally Inserted Central Catheter Tip Confirmation: A Direct Savings Analysis. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.java.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Peripherally inserted central catheter use has increased dramatically over the past decade, parallel to health care costs. Traditional bedside peripherally inserted central catheter placement requires anthropometric measurements of estimated catheter length and confirmation of appropriate tip positioning via chest radiograph. Newer bedside technology, using magnet and electrocardiogram capabilities, seeks to replace the traditional method with equal efficacy but less overall cost. The need for follow-up chest radiograph can been removed, a significant cost savings in direct patient care. In this retrospective case control study, we examine costs related to these 2 tip confirmation methods while assessing overall cost savings to the health care industry.
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Affiliation(s)
- Sanjay A. Patel
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Poushali Bhattacharjee
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Latoyia Roman
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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146
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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 2018; 44:742-759. [PMID: 29754308 DOI: 10.1007/s00134-018-5212-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022]
Abstract
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.
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147
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Assis DB, Madalosso G, Padoveze MC, Lobo RD, Oliveira MS, Boszczowski Í, Singer JM, Levin AS. Implementation of tailored interventions in a statewide programme to reduce central line-associated bloodstream infections. J Hosp Infect 2018; 100:e163-e168. [PMID: 29730142 DOI: 10.1016/j.jhin.2018.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND There have been few studies exploring implementation strategies to central line-associated bloodstream infections (CLABSIs) in low- or middle-income countries. AIM To implement tailored interventions to reduce CLABSI rates in adult intensive care units. METHODS The implementation strategy of the State Health Department was performed in São Paulo State, Brazil, over two cycles. Cycle 1 (56 hospitals) was exploratory and cycle 2 (77 hospitals) was designed to confirm the hypothesis generated by the first cycle, with three phases each (pre-intervention, intervention, post-intervention). Cycles included: evaluation of healthcare workers' knowledge, observation of practices, and CLABSI rates monthly report. In cycle 1, a log-normal mixed model was used to select variables significantly associated with the reduction of CLABSI. In cycle 2, CLABSI rates were evaluated. FINDINGS Healthcare workers' practices improved after intervention. In cycle 1, reduction of CLABSI rates was more pronounced in hospitals with initial CLABSI rates >7.4 per 1000 catheter-days (P < 0.001) and those that introduced the use of peripherally inserted central catheters (P = 0.01). For hospitals with high CLABSI initial rates, simulation demonstrated that the rates were expected to decrease by 36% (95% CI: 9-63), no matter the type of intervention. In cycle 2, there was an overall decrease in CLABSI rates during the intervention period; whereas the mean rate fell further post-intervention, rates at the 90th percentile increased. CONCLUSION The implementation strategy may have had an effect on infection rates independently of the specific interventions implemented; however, the sustainability of reduction in the post-intervention period remains a challenge.
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Affiliation(s)
- D B Assis
- Division of Nosocomial Infections, Center for Epidemiologic Surveillance 'Prof. Alexandre Vranjac', Center of Disease Control, São Paulo State Health Department, São Paulo, Brazil.
| | - G Madalosso
- Division of Nosocomial Infections, Center for Epidemiologic Surveillance 'Prof. Alexandre Vranjac', Center of Disease Control, São Paulo State Health Department, São Paulo, Brazil
| | - M C Padoveze
- Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | - R D Lobo
- Department of Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M S Oliveira
- Department of Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Í Boszczowski
- Department of Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - J M Singer
- Department of Statistics, University of São Paulo, São Paulo, Brazil
| | - A S Levin
- Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil; Department of Infectious Diseases and LIM54, University of São Paulo, São Paulo, Brazil; Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
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148
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Central line-associated bloodstream infections and catheter dwell-time: A theoretical foundation for a rule of thumb. J Theor Biol 2018; 445:31-32. [DOI: 10.1016/j.jtbi.2018.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/21/2018] [Indexed: 11/21/2022]
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149
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SANTOLIM THAISQUEIROZ, BAPTISTA ANDRÉMATHIAS, GIOVANI ARLETEMAZZINIMIRANDA, ZUMÁRRAGA JUANPABLO, CAMARGO OLAVOPIRESDE. PERIPHERALLY INSERTED CENTRAL CATHETERS IN ORTHOPEDIC PATIENTS: EXPERIENCE FROM 1023 PROCEDURES. ACTA ORTOPEDICA BRASILEIRA 2018; 26:206-210. [PMID: 30038549 PMCID: PMC6053963 DOI: 10.1590/1413-785220182603189368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives The advantages of using a peripherally inserted central catheter (PICC) in hospitalized patients make this device very important for intravenous therapy. This study describes the use of PICCs at the Institute of Orthopedics and Traumatology at the Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo over the last 10 years. Methods This retrospective study analyzed 1,057 medical records and included 1,023 medical files with complete information on the punctured vein, diagnosis, duration of catheterization, complications, and catheter tip positioning. Results Seven hundred and twenty PICCs (70.4%) were considered successfully positioned, and mean duration of catheterization was 34.3 days. The basilic vein was used in 528 (51.6%) patients, while 157 (15.4%) catheters were removed due to complications. No cases of catheter-related thrombosis or infection were found. Eight hundred and sixty-six (84.6%) patients completed their treatment with PICC in place. Conclusion PICC is a safe intravenous device that can be successfully utilized for medium- and long-course intravenous therapy in hospitalized and discharged orthopedic patients. Level of Evidence IV; Case series.
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150
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Sylvia CJ, Wagel MA, Giare-Patel K, Spangler TA, Breznock EM, Gupta N. Chlorhexidine-coated peripherally inserted central catheters reduce fibroblastic sleeve formation in an in vivo ovine model. J Vasc Access 2018; 19:644-650. [DOI: 10.1177/1129729818769033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study compared an antimicrobial and anti-thrombogenic peripherally inserted central catheter treated with a chlorhexidine-based technology, a peripherally inserted central catheter with bulk distributed fluoro-oligomers, and a poly 2-methoxyethyl acrylate–based peripherally inserted central catheter to an untreated peripherally inserted central catheter (control) in an ovine model at 14 and 30 days post-implant. Methods: One of four types of peripherally inserted central catheters was surgically implanted into the left jugular vein of each of 18 sheep for 14 or 30 days. Blood analysis consisted of complete blood counts, serum chemistries, and coagulation (fibrinogen, prothrombin time, and partial thromboplastin time) profiles. Sheep were sacrificed to examine the vein and thorax. Histological analysis was performed on serial catheter sections using standard microscopy on hematoxylin and eosin–stained tissues. Results: All catheters developed fibroblastic sleeves at both 14 and 30 days. The chlorhexidine-peripherally inserted central catheter showed a 64% lower mean fibroblastic sleeve weight and a 66% shorter mean fibroblastic sleeve length compared to the untreated control at 14 days. By 30 days, compared to untreated control, the chlorhexidine-peripherally inserted central catheter showed 81% lower mean fibroblastic sleeve weight with 75% shorter mean fibroblastic sleeve length, the fluoro-oligomer-peripherally inserted central catheter showed 54% lower mean sheath weight with 40% shorter mean fibroblastic sleeve length, and the poly 2-methoxyethyl acrylate-peripherally inserted central catheter had 41% lower mean fibroblastic sleeve weight with 57% lower fibroblastic sleeve length. Conclusion: Among the three anti-thrombogenic peripherally inserted central catheter technologies, the chlorhexidine-peripherally inserted central catheter had the smallest fibroblastic sleeves, followed by the fluoro-oligomer-peripherally inserted central catheter, poly 2-methoxyethyl acrylate-peripherally inserted central catheter, and control peripherally inserted central catheter.
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Affiliation(s)
| | | | | | - Taylor A Spangler
- VDx Veterinary Diagnostics and Preclinical Research Services, Davis, CA, USA
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