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Chakroun-Walha O, Karray R, Jerbi M, Affes H, Nasri A, Salem I, Issaoui F, Ben Dhaou M, Rekik N. Catheterized chicken for training on ultrasound-guided vascular access: A simple, cost-effective, and effective model. Afr J Emerg Med 2024; 14:91-95. [PMID: 38660415 PMCID: PMC11039968 DOI: 10.1016/j.afjem.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/17/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Ultrasound-guided vascular access is a medical procedure that is becoming increasingly common in daily practice and is recommended to avoid iatrogenic complications. One of the procedures with a high-risk rate of complications is the vascular puncture. However, training on this technique can be challenging due to the limited availability of simulation models. We propose a simple, cost-effective, and effective ultrasound-guided vascular access simulation model that utilizes chicken breast and a urine catheter to address this need.
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Affiliation(s)
- Olfa Chakroun-Walha
- Emergency department, Habib Bourguiba university hospital, Sfax Medical School Simulation Center, Faculty of Medicine, Sfax university, Tunisia
| | - Rim Karray
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Mouna Jerbi
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Houcem Affes
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Abdennour Nasri
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Imen Salem
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Fadhila Issaoui
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
| | - Mahdi Ben Dhaou
- Sfax Medical School Simulation Center, Faculty of Medicine, Sfax University, Tunisia
| | - Noureddine Rekik
- Emergency Department, Habib Bourguiba University Hospital, Faculty of Medicine, Sfax University, Tunisia
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Elli S, Cannizzo L, Giannini L, Romanato F, Trimarco C, Pessina M, Lucchini A, Foti G, Rondelli E. Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization. J Vasc Access 2024; 25:808-812. [PMID: 36324227 DOI: 10.1177/11297298221132073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Femorally inserted central catheters are increasingly used, especially after the COVID-19 pandemic, also thanks to widespread of tunneling techniques that allow the exit site to be moved away from the groin. METHODS In this retrospective observational study, femorally inserted catheters, with exit site at mid-thigh and the tip in Inferior vena cava or in Inferior vena cava at the junction with right atrium, have been observed and complications have been analyzed. All catheters were inserted by trained Nurses of a tertiary hospital Vascular Access Team. RESULTS In 142 catheters (126 inserted via common femoral vein and 16 inserted via superficial femoral vein) and 3060 catheter days, we observed an infection rate of 1.3 events/1000 catheter days (all of them in oncologic patients and up to 30 days of catheterization), 2 cases of thrombotic events (1.41%) and 17 cases of accidental removal (11.97%). Other rare complications, as primary malposition, tip migration, arterial pseudoaneurysm, have been recorded. The average length of catheters inserted, from the exit site to the tip, was 47.6 ± 2.4 cm. CONCLUSION The attention to the correct position of the tip, the exit site at mid-thigh and the new techniques during insertion make these femoral catheters as safe as other central vascular access devices. For this kind of central access device, a catheter at least 50 cm long is needed.
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Affiliation(s)
- Stefano Elli
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | - Alberto Lucchini
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Rueckel J, Huemmer C, Shahidi C, Buizza G, Hoppe BF, Liebig T, Ricke J, Rudolph J, Sabel BO. Artificial Intelligence to Assess Tracheal Tubes and Central Venous Catheters in Chest Radiographs Using an Algorithmic Approach With Adjustable Positioning Definitions. Invest Radiol 2024; 59:306-313. [PMID: 37682731 DOI: 10.1097/rli.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
PURPOSE To develop and validate an artificial intelligence algorithm for the positioning assessment of tracheal tubes (TTs) and central venous catheters (CVCs) in supine chest radiographs (SCXRs) by using an algorithm approach allowing for adjustable definitions of intended device positioning. MATERIALS AND METHODS Positioning quality of CVCs and TTs is evaluated by spatially correlating the respective tip positions with anatomical structures. For CVC analysis, a configurable region of interest is defined to approximate the expected region of well-positioned CVC tips from segmentations of anatomical landmarks. The CVC/TT information is estimated by introducing a new multitask neural network architecture for jointly performing type/existence classification, course segmentation, and tip detection. Validation data consisted of 589 SCXRs that have been radiologically annotated for inserted TTs/CVCs, including an experts' categorical positioning assessment (reading 1). In-image positions of algorithm-detected TT/CVC tips could be corrected using a validation software tool (reading 2) that finally allowed for localization accuracy quantification. Algorithmic detection of images with misplaced devices (reading 1 as reference standard) was quantified by receiver operating characteristics. RESULTS Supine chest radiographs were correctly classified according to inserted TTs/CVCs in 100%/98% of the cases, thereby with high accuracy in also spatially localizing the medical device tips: corrections less than 3 mm in >86% (TTs) and 77% (CVCs) of the cases. Chest radiographs with malpositioned devices were detected with area under the curves of >0.98 (TTs), >0.96 (CVCs with accidental vessel turnover), and >0.93 (also suboptimal CVC insertion length considered). The receiver operating characteristics limitations regarding CVC assessment were mainly caused by limitations of the applied CXR position definitions (region of interest derived from anatomical landmarks), not by algorithmic spatial detection inaccuracies. CONCLUSIONS The TT and CVC tips were accurately localized in SCXRs by the presented algorithms, but triaging applications for CVC positioning assessment still suffer from the vague definition of optimal CXR positioning. Our algorithm, however, allows for an adjustment of these criteria, theoretically enabling them to meet user-specific or patient subgroups requirements. Besides CVC tip analysis, future work should also include specific course analysis for accidental vessel turnover detection.
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Affiliation(s)
- Johannes Rueckel
- From the Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.Rueckel, C.S., B.F.H., J.Ricke, J.Rudolph, B.O.S.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (J.Rueckel, T.L.); and XP Technology and Innovation, Siemens Healthcare GmbH, Forchheim, Germany (C.H., G.B.)
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Annetta MG, Elli S, Marche B, Pinelli F, Pittiruti M. Femoral venous access: State of the art and future perspectives. J Vasc Access 2023:11297298231209253. [PMID: 37953601 DOI: 10.1177/11297298231209253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
In the past 5 years, non-dialysis femoral venous access has changed in terms of indications, techniques of insertion, and expected incidence of complications. To the traditional non-emergency indication for femoral catheters-obstruction of the superior vena cava-many other indications have been added, both in intensive and non-intensive care. The insertion technique has evolved, thanks to ultrasound guided venipuncture, tunneling, and ultrasound based intraprocedural tip location. Insertion of femorally inserted central catheters may be today regarded as a procedure with an extremely low intraprocedural and post-procedural risk. The risk of infection is reduced by the possibility of the exit site at mid-thigh, by the use of cyanoacrylate glue for sealing the exit site, and by appropriate intraprocedural strategies of infection prevention. The risk of catheter-related thrombosis is low, due to several concomitant strategies: a proper match between vein diameter and catheter caliber; an accurate intraprocedural assessment of tip location by ultrasound and/or intracavitary ECG; the consistent use of ultrasound guided venipuncture and micro-introducer kits; an adequate stabilization of the catheter at the exit site. The risk of mechanical complications and the risk of lumen occlusion are minimized when using polyurethane, power injectable catheters. All these novelties have brought a revolution in the field of femoral venous access, so that this route may be considered as safe and effective as other approaches to central venous catheterization.
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Affiliation(s)
| | - Stefano Elli
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Bruno Marche
- Vascular Access Team, Fondazione Policlinico Universitario "A Gemelli," Roma, Italy
| | - Fulvio Pinelli
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- Vascular Access Team, Fondazione Policlinico Universitario "A Gemelli," Roma, Italy
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Amini AA, Alzuabi A, Baniyassen M, Gharbi M, Aziz MA, Abbas MM. A 47-Year-Old Woman with a Retained Central Venous Catheter Line Guidewire Presenting with a Right Atrial Thrombus Requiring Removal During Open Heart Surgery: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939908. [PMID: 37700515 PMCID: PMC10505040 DOI: 10.12659/ajcr.939908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/02/2023] [Accepted: 07/25/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND A central venous catheter (CVC) is an indwelling catheter that is inserted into a large central vein for different purposes, including hemodynamic monitoring and administration of fluids and medications. This report is of a 47-year-old woman with a retained CVC line guidewire presenting with a large right atrial thrombus requiring removal during open heart surgery. CVC insertion is one of the most frequently attempted procedures in intensive care units, emergency departments, and operation rooms, especially for critically ill patients. Possible complications range from failure to place the catheter to cardiac arrest. One of the rarest complications is missing the guidewire after insertion, which is usually discovered early after inserting it. CASE REPORT We report the case of a 47-year-old woman who had a CVC line inserted following complicated open cholecystectomy. A few years later, she developed shortness of breath, with an incidental finding of a huge right atrial thrombus and a wire shown on transthoracic echocardiography. The right atrial thrombus required open heart surgery to excise the thrombus and the wire, which was done successfully. The thrombus was histopathologically and clinically proven to be an organized right atrial thrombus formed around the CVC guidewire. CONCLUSIONS This case report presents a rare complication of CVC insertion. Because this procedure is increasingly used, clinicians should be aware of the potential complications of retained CVC lines. Moreover, this report outlines different techniques to prevent such fatal complications and emphasizes the significance of radiography after insertion.
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Affiliation(s)
- Ahmad Alsaka Amini
- Department of Anesthesia and Critical Care, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Abeer Alzuabi
- Department of Anesthesia and Critical Care, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Mohannad Baniyassen
- Department of Anesthesia and Critical Care, Sharjah Kuwait Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Maro Gharbi
- Department of Anesthesia and Critical Care, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Mohamed Abdel Aziz
- Department of Cardiac Surgery, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Mohamed Magdy Abbas
- Department of Cardiac Electrophysiology, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
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Liu Z, Li D, Ma J, Liu X, Zhang B, Qi Z, Zhang W, Yuan H, Niu Y, Shen C. A Potential Resuscitation Route on Battlefield: Immediate Intraperitoneal Fluid Administration Post-burn Shows Satisfactory Fluid Absorption and Anti-shock Effects. Mil Med 2023; 188:e3000-e3009. [PMID: 37208309 DOI: 10.1093/milmed/usad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/03/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Timely fluid resuscitation remains the key to the early treatment of severe burns. Intraperitoneal (IP) fluid administration is a simple, rapid resuscitation strategy via a puncture in the abdominal wall. This study aimed to evaluate the fluid absorption and anti-shock effects of IP delivery in the early stage after severe burns. MATERIALS AND METHODS A 30% total body surface area full-thickness burn model was established using male C57BL/6 mice. A total of 126 mice were randomly assigned into six groups (n = 21): the sham injury group (SHAM), the burn group without fluid resuscitation (NR), and the four IP resuscitation groups (IP-A/B/C/D, each being intraperitoneally administered with 60, 80, 100, and 120 mL/kg of sodium lactate Ringer's solution post-injury). Three-hour post-burn, six mice in each group were randomly selected and sacrificed for blood and tissue sampling to detect the IP fluid absorption rate and evaluate organ damage because of low perfusion. The remaining 15 mice in each group were observed for the vital signs within 48-h post-injury, and their survival rate was calculated. RESULTS The 48-h survival rate increased in the IP-A (40.0%), IP-B (66.7%), IP-C (60.0%), and IP-D (13.3%) groups, compared with the NR group (0%). The mean arterial pressure, body temperature, and heart rate of mice were significantly stabilized in the IP groups. For the first 3-h post-injury, the absorption rates of groups IP-A (74.3% ± 9.5%) and IP-B (73.3% ± 6.9%) were significantly higher than those of groups IP-C (59.7% ± 7.1%) and IP-D (48.7% ± 5.7%). The levels of arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, lactate, and hematocrit were better maintained in the IP groups. Intraperitoneal resuscitation remarkably reduced the injury scores in burn-induced histopathology of the liver, kidneys, lungs, and intestines, accompanied by decreased alanine transaminase, creatinine, interleukin-1, and tumor necrosis factor-α in plasma, and augmented superoxide dismutase 2 and inhibited malondialdehyde in tissues. Group IP-B has the best performance for these indices. CONCLUSIONS Intraperitoneal administration of isotonic saline post-burn can be adequately and rapidly absorbed, thereby boosting circulation and perfusion, precluding shock, alleviating organ damage caused by ischemia and hypoxia, and significantly increasing the survival rate. This technique, with a potential to be a supplement to existing resuscitation methods on the battlefield, is worth further investigation.
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Affiliation(s)
- Zhaoxing Liu
- Medical School of Chinese PLA, Beijing 100048, China
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Dawei Li
- Medical School of Chinese PLA, Beijing 100048, China
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Jinglong Ma
- Medical School of Chinese PLA, Beijing 100048, China
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Xinzhu Liu
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Bohan Zhang
- Medical School of Chinese PLA, Beijing 100048, China
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Zhaolai Qi
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Wen Zhang
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Huageng Yuan
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Yuezeng Niu
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
| | - Chuanan Shen
- Department of Burns and Plastic Surgery, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing 100048, China
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Govender I, Okonta HI, Adeleke O, Rangiah S. Central venous pressure line insertion for the primary health care physician. S Afr Fam Pract (2004) 2023; 65:e1-e8. [PMID: 37427779 DOI: 10.4102/safp.v65i1.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 07/11/2023] Open
Abstract
Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.
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Affiliation(s)
- Indiran Govender
- Department of Family Medicine and Primary Health Care, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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Hanaki N, Miyata J, Yamada Y, Shiga T. Choosing Wisely® in Japanese Emergency Medicine: Nine Recommendations to Improve The Value of Health Care. J Emerg Med 2023; 64:371-379. [PMID: 37019499 DOI: 10.1016/j.jemermed.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/09/2022] [Accepted: 01/06/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The overuse of diagnostic and therapeutic modalities has become an issue in the field of emergency medicine. The health care system of Japan aims to provide the most appropriate quality and quantity of care at the right price, while focusing on patient value. The Choosing Wisely® campaign was launched in Japan and other countries. OBJECTIVE In this article, recommendations were discussed to improve the field of emergency medicine based on the state of the Japanese health care system. METHODS The modified Delphi method, a consensus-building method, was used in this study. The final recommendations were developed by a working group of 20 medical professionals, students, and patients, consisting of members of the emergency physician electronic mailing list. RESULTS From the 80 candidates recommended and excessive actions gathered, nine recommendations were formulated after two Delphi rounds. The recommendations included the suppression of excessive behavior and the implementation of appropriate medical treatment, like rapid pain relief and the application of ultrasonography during central venous catheter placement. CONCLUSIONS This study formulated recommendations to improve the field of Japanese emergency medicine, based on the feedback of patients and health care professionals. The nine recommendations will be helpful for all people involved in emergency care in Japan because they have the potential to prevent the overuse of diagnostic and therapeutic modalities, while maintaining the appropriate quality of patient care.
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Affiliation(s)
- Nao Hanaki
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Miyata
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto-shi, Nagasaki, Japan
| | - Yoshie Yamada
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare, Tokyo, Otawara, Japan
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Tullo G, Candelli M, Gasparrini I, Micci S, Franceschi F. Ultrasound in Sepsis and Septic Shock-From Diagnosis to Treatment. J Clin Med 2023; 12:jcm12031185. [PMID: 36769833 PMCID: PMC9918257 DOI: 10.3390/jcm12031185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, appropriate source control as well as adequate hemodynamic resuscitation. For years now, both emergency department (ED) doctors and intensivists have used ultrasound as an adjunctive tool for the correct diagnosis and treatment of these patients. Our aim was to better understand the state-of-the art role of ultrasound in the diagnosis and treatment of sepsis and septic shock. METHODS We conducted an extensive literature search about the topic and reported on the data from the most significant papers over the last 20 years. RESULTS We divided each article by topic and exposed the results accordingly, identifying four main aspects: sepsis diagnosis, source control and procedure, fluid resuscitation and hemodynamic optimization, and echocardiography in septic cardiomyopathy. CONCLUSION The use of ultrasound throughout the process of the diagnosis and treatment of sepsis and septic shock provides the clinician with an adjunctive tool to better characterize patients and ensure early, aggressive, as well as individualized therapy, when needed. More data are needed to conclude that the use of ultrasound might improve survival in this subset of patients.
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Vijayananthan A, Bhurani D, Sapra H, Yasuda H, Kim JY, Hoerauf K, Mifflin N, Hong SK, Sheng WH, Terasaka Y. Asia-Pacific guidelines for standardization of appropriate selection, placement, and management of vascular access devices. J Vasc Access 2023:11297298221150664. [PMID: 36688479 DOI: 10.1177/11297298221150664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Vascular access devices (VADs) are common and essential in the healthcare setting. However, several factors influence VAD selection and management. Wide variations in VAD practices and the degree of VAD awareness are noted across Asia-Pacific (APAC) countries. An international panel was convened that applied the ASA 2020 method to develop standard criteria for use of VADs in the APAC region. After a literature search, scenarios related to VAD use, care, and maintenance were developed according to the patient population, indication for insertion, and duration of use. These scenarios were rated on a scale of 1-5 (1 being strongly disagreed and 5 strongly agreed) by 11 expert members. A total of 48 clinical scenarios were developed: 23 in hospitalized patients, 3 in critical patients, 4 in cancer settings, 7 pertinent to VAD placement, and 11 for VAD maintenance. The multidisciplinary panel generated several recommendations for the use, care, and management of VADs across general hospitalized patients with or without difficult venous access, critically ill patients, patients with malignancy, patients with different stages of chronic kidney disease (CKD) with or without dialysis, and in other special populations through evidence-based standards. These recommendations may help in achieving uniformity in practice patterns and improving the quality of VAD care and quality of life of patients in APAC region.
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Affiliation(s)
| | - Dinesh Bhurani
- Rajiv Gandhi Cancer Institute & Research Centre Sector 5, West Delhi, New Delhi, DL, India
| | - Harsh Sapra
- The Medicity Hospital, Gurgaon, Haryana, India
| | - Hideto Yasuda
- Department of Emergency and Critical care Medicine, Jichi Medical University Saitama Medical Center, Kyoto, Japan
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Klaus Hoerauf
- VP Global Medical Affairs, Becton, Dickinson and Company, New York City Metropolitan Area, USA
| | - Nicholas Mifflin
- Clinical Nurse Consultant Central Venous Access & Parenteral Nutrition Liverpool Hospital, Liverpool, NSW, Australia, Adjunct Fellow School of Nursing & Midwifery Western Sydney University, Blacktown, NSW, Australia
| | - Suk Kyung Hong
- University of Ulsan College of Medicine: Songpa-gu, Seoul, Korea
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City
| | - Yusuke Terasaka
- Director of Emergency Department, Kyoto Katsura Hospital, Kyoto City, Kyoto Prefecture, Japan
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Du S, Zhang Y, Wang H, Fan Y, Jiao BJ, Wang DN, Qi MM, Sun XW. More advantages of trocar compared than steel needle in deep venipuncture catheterization. Medicine (Baltimore) 2022; 101:e31216. [PMID: 36401416 PMCID: PMC9678495 DOI: 10.1097/md.0000000000031216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Deep venipuncture catheterization is widely used in clinical anesthesia. However, it is worth thinking about how to improve the rate of successful catheter insertion, and relieve patients' discomfort. This paper aimed to compare the clinical advantages between trocar and steel needle. METHODS Total 503 adult patients were recruited and randomly assigned. The control group was punctured with steel needle, and the experimental group was punctured with trocar needle. Clinical and followed-up information was recorded. Pearson's chi-squared and spearman test were performed to analyze the correlation between intervention and relative parameters. Univariate logistic regression was performed to verify the odds ratio of trocar needle compared with steel needle. RESULTS Pearson's chi-square test and Spearman's correlation test showed a significant correlation between puncture success, puncture comfort, successful catheter insertion, puncture time, thrombosis, catheter fever, bleeding, infection and interventions (P < .05). Univariate logistic regression showed that there existed better puncture comfort (odds ratio [OR] = 6.548, 95% confidence interval [CI]: 4.320-9.925, P < .001), higher successful catheter insertion (OR = 6.060, 95% CI: 3.278-11.204, P < .001), shorter puncture time (OR = 0.147, 95% CI: 0.093-0.233, P < .001), lesser thrombosis (OR = 0.194, 95% CI: 0.121-0.312, P < .001), lesser catheter fever (OR = 0.263, 95% CI: 0.158-0.438, P < .001), lesser bleeding (OR = 0.082, 95% CI: 0.045-0.150, P < .001) and lesser infection (OR = 0.340, 95% CI: 0.202-0.571, P < .001) in trocar group compared with steel needle group. CONCLUSION Trocar application in deep venipuncture catheterization can improve successful catheter insertion, relieve pain and discomfort of patients, reduce incidence of complications, and provide better security for patients.
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Affiliation(s)
- Suzhen Du
- Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
- * Correspondence: Suzhen Du, Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, NO.3, Zhen Gang Nan Li, Yun Gang, Feng Tai District, 100074, Beijing, China (e-mail: )
| | - Yanbo Zhang
- Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Hui Wang
- Department of anesthesiology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Yan Fan
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Bao-Jie Jiao
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Dong-Ni Wang
- Nursing Department, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Man-Man Qi
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
| | - Xiu-Wei Sun
- Department of anesthesiology, Cangzhou Central Hospital, Cangzhou, P.R. China
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Mastrandrea G, Giuliani R, Graps EA. International good practices on central venous catheters' placement and daily management in adults and on educational interventions addressed to healthcare professionals or awake/outpatients. Results of a scoping review compared with the existent Italian good practices. Front Med (Lausanne) 2022; 9:943164. [PMID: 36275789 PMCID: PMC9584299 DOI: 10.3389/fmed.2022.943164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/08/2022] [Indexed: 11/14/2022] Open
Abstract
This scoping review aims to check the existing international literature related to the placement and management of central venous catheters (CVCs) in adults and compare them with the Good Practices published by the Italian Society of anesthesiology intensive care (hereafter “SIAARTI Good Practices”) and the protocols written by the Italian Expert group on long-term central venous accesses (hereafter “GAVeCeLT Protocols”) and verify the existence of experiences focused on the daily assessment of the implantation site and on educational interventions on awake patients or caregivers to enhance their empowerment. A systematic search approach has been applied. Our composite research question has been primarily defined by the PICO: only patients over 18 years of age with CVC for any clinical reason except for kidney replacement therapy; placement and management of CVCs with procedures recommended by the recent international guidelines/bundles and specific educational interventions are the interventions to be compared with standard CVC placement and management without any educational interventions. In total, two different types of outcomes have been taken into consideration: catheter-related complications rate (A) and patient/caregiver involvement (B). Eligible articles have been limited to Systematic Review OR Meta-analysis OR Guidelines in Human field, focusing on adults, English language only, from January 2015 to December 2020. Searched Medical Subject Headings (MeSHs) Terms were “venous” AND “catheters,” and the correspondence with the designed PICO framework was then checked directly by the authors. A comprehensive search was conducted by two reviewers on 15 February 2021 in four databases, and 32 full-text articles were finally included and qualitatively assessed. The included articles appear to be in line with the indications provided by the available Italian Good Practices and explain the complexity of this procedure. The need to promote the use of bundles and checklists related to CVC placement and dressing procedures comes to light. These organizational technologies can be implemented following the creation of teams dedicated to venous access that are subjected to continuous training. As regards the impact of educational initiatives, implementing paths of health education and proper hospital discharge preparation for both healthcare workers and families increases safety for the patient with CVC.
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Affiliation(s)
- Giovanni Mastrandrea
- Centro Regionale Health Technology Assessment (CReHTA) – Agenzia Regionale Strategica per la Salute e il Sociale (AReSS) Puglia, Bari, Italy,Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II – BARI, Bari, Italy,*Correspondence: Giovanni Mastrandrea
| | - Rachele Giuliani
- Centro Regionale Health Technology Assessment (CReHTA) – Agenzia Regionale Strategica per la Salute e il Sociale (AReSS) Puglia, Bari, Italy
| | - Elisabetta A. Graps
- Centro Regionale Health Technology Assessment (CReHTA) – Agenzia Regionale Strategica per la Salute e il Sociale (AReSS) Puglia, Bari, Italy
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13
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Li X, Liu J, Cui S, Jian T, Ma S, Shi L, Lin Y, Zhang J, Zheng Y, Zhang Y, Jian X, Luan X, Kan B. Development and validation of a prediction model of deep venous thrombosis for patients with acute poisoning following hemoperfusion: a retrospective analysis. J Int Med Res 2022; 50:3000605221089779. [PMID: 35437041 PMCID: PMC9021492 DOI: 10.1177/03000605221089779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To develop and confirm an individualized predictive model to ascertain the probability of deep venous thrombosis in patients with acute poisoning after undergoing hemoperfusion. Methods Three hundred eleven patients with acute poisoning who were admitted to a hospital in China between October 2017 and February 2019 were included in the development group. Eighty patients with acute poisoning who were admitted between February and May 2019 were included in the validation group. The independent risk factors for deep venous thrombosis were examined. An individualized predictive model was developed using regression coefficients. Results The number of catheter indwelling days, having a catheter while being transported, elevated serum homocysteine concentrations, and dyslipidemia were independent risk factors for deep venous thrombosis following hemoperfusion in patients with acute poisoning. The areas under the receiver operating characteristic curve of the development and validation groups were 0.713 and 0.702, respectively, which suggested that the prediction model had good discrimination capacity. The calibration belts of the two groups were ideal. Conclusions Our prediction model has a moderate predictive effect for the occurrence of deep venous thrombosis in patients with acute poisoning. In clinical practice, this model could be combined with a common thrombosis risk assessment model.
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Affiliation(s)
- Xiuqin Li
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
| | - Jing Liu
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
| | - Siqi Cui
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Department of Digestive Internal Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Shuang Ma
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Longke Shi
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Ying Lin
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
| | - Juan Zhang
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Yingying Zheng
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Yanxia Zhang
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Xiaorong Luan
- Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China.,Department of Nursing, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Baotian Kan
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.,Nursing Theory & Practice Innovation Research Center of Shandong University, Jinan, Shandong 250012, China
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Corrêa Carvalho G, Miguel Sábio R, Spósito L, de Jesus Andreoli Pinto T, Chorilli M. An overview of the use of central venous catheters impregnated with drugs or with inorganic nanoparticles as a strategy in preventing infections. Int J Pharm 2022; 615:121518. [DOI: 10.1016/j.ijpharm.2022.121518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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15
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Modi HN, Goel SA, Sharma A, Patel U. Brachial Plexus Injury due to Central-line Insertion during Kypho-scoliosis Deformity Correction. J Orthop Case Rep 2021; 11:41-44. [PMID: 34790601 PMCID: PMC8576778 DOI: 10.13107/jocr.2021.v11.i07.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Internal Jugular Venous (IJV) cannulation or central-line insertion is frequently performed during kyphoscoliosis deformity correction surgery or spine surgery with high risk. This helps monitor central venous pressure and administer medicines when required. Although many complications of IJV cannulation have been reported in the literature, its effect on brachial plexus is not known. The objective of this paper was to report a rare complication of IJV during scoliosis surgery. Case Presentation: We reported a case of 27-year-old male who was operated for severe kyphoscoliosis correction where preoperatively IJV cannulation was done. Repeated attempts were done during IJV cannula insertion due to altered anatomy. Eventually, cannula insertion was done using ultrasound modality and surgery for correction was done. Postoperatively patient developed right upper extremity weakness and sensory loss although the clinical result of kyphoscoliosis correction was acceptable. EMG-NCV study proved it brachial plexus injury. The patient was treated with intravenous steroid and physiotherapy. The patient recovered completely within 6 months of surgery. Conclusion: We reported a case of kyphoscoliosis deformity corrective surgery where IJV cannulation led to brachial plexus injury and was eventually recovered with medications and physiotherapy.
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Affiliation(s)
- Hitesh N Modi
- Department of Orthopaedics and Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India
| | - Shakti A Goel
- Department of Orthopaedics and Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India
| | - Arvind Sharma
- Department of Neurology, Zydus Hospitals and Healthcare Research Pvt. Ltd., Ahmedabad, Gujarat, India
| | - Udit Patel
- Department of Orthopaedics and Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India
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16
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Static Ultrasound Guidance VS. Anatomical Landmarks for Subclavian Vein Puncture in the Intensive Care Unit: A Pilot Randomized Controlled Study. J Emerg Med 2020; 59:918-926. [PMID: 32978029 DOI: 10.1016/j.jemermed.2020.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Subclavian vein puncture is commonly used in the intensive care unit (ICU) but is associated with complications. OBJECTIVE Our aim was to compare the efficacy and safety of static ultrasound-guided subclavian vein puncture with traditional anatomical landmark-guided subclavian vein puncture in critically ill patients in the ICU. METHODS This pilot randomized controlled trial enrolled patients admitted to the ICU and requiring subclavian vein puncture between November 2017 and September 2018. The patients were randomized to ultrasound-guided puncture or anatomical landmark-guided puncture. The primary outcome measure was the puncture success rate. The secondary outcome measures included the number of punctures, rate of success at the first attempt, puncture time (i.e., procedure duration) and incidence of complications. RESULTS A total of 194 patients were included in the analyses. Compared with the anatomical landmarks group, the ultrasound group had a higher puncture success rate (91.7% vs. 77.6%; p = 0.007), lower rate of complications (7.3% vs. 20.4%; p = 0.008), and lower incidence of mispuncture of an artery (2.1% vs. 14.3%; p = 0.002). There were no significant differences in the number of punctures and puncture time between the two groups (both, p > 0.05). CONCLUSIONS Static ultrasound-guided subclavian vein puncture is superior to the traditional landmark-guided approach for critically ill patients in the ICU. It is suggested that static ultrasound-guided puncture techniques should be considered for subclavian vein puncture in the ICU. TRIAL REGISTRATION ChiCTR1900024051.
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Sethi SK, Chakraborty R, Joshi H, Raina R. Renal Replacement Therapy in Pediatric Acute Kidney Injury. Indian J Pediatr 2020; 87:608-617. [PMID: 31925716 DOI: 10.1007/s12098-019-03150-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/27/2019] [Indexed: 01/19/2023]
Abstract
Acute kidney injury (AKI) is common in critically ill children and affects nearly 30-40% of patients admitted to the pediatric intensive care unit (ICU). Even with technological advances in critical care and dialysis, there is a high mortality rate of 66.8% to 90% in ICU patients. Renal replacement therapy (RRT) is often performed to treat patients with AKI. However, for optimal RRT treatment, it is crucial to consider the indications, modes of access, and prescription of each RRT method. Therefore, this review aims to discuss the various modalities of RRT in pediatric patients, which include peritoneal dialysis (PD), hemodialysis (HD), continuous RRT (CRRT), and sustained low-efficiency dialysis (SLED).
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Affiliation(s)
- Sidharth Kumar Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Ronith Chakraborty
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, OH, USA
| | - Hirva Joshi
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, OH, USA. .,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA.
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18
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Thonon H, Espeel F, Frederic F, Thys F. Overlooked guide wire: a multicomplicated Swiss Cheese Model example. Analysis of a case and review of the literature. Acta Clin Belg 2020; 75:193-199. [PMID: 30931817 DOI: 10.1080/17843286.2019.1592738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Central venous catheter (CVC) implementation is now usual in emergency department. The most common complications are misplacement, bleeding, pleural perforation, thrombosis and sepsis. Forgetting a guide wire in the patient's body after catheterization is an underestimated complication of this procedure; only 76 cases are described. Even if the majority of patients remained asymptomatic, severe complications can happened even years later. This article's aim is to identify the sequence of elements that led to the event occurrence and to suggest recommendations of good practice to minimize complications related to central catheter placement.Method: After reviewing all the complications related to central venous catheterization and their frequencies, we analyse from a case report and a review of the literature the sequence of elements that led to the medical error. We use an Ishikawa diagram to show our results and the links between them.Results: Our Ishikawa diagram shows that material, human resources, procedural and radiological involvement factors are the main elements on which we can act to reduce the complications rate after central venous catheterization. We advocate for the establishment of standardized procedures before, during and after the technical gesture.Conclusions: Because of human nature, errors will always be possible when taking care of a patient. However, we propose good practice recommendations to avoid the repetition of a forgetting guide wire after central venous catheterization.
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Affiliation(s)
- Henri Thonon
- Emergency department, CHU UCL Namur, Yvoir, Belgium
| | - Florence Espeel
- Emergency Department, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Ficart Frederic
- Patient safety manager, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium
| | - Frédéric Thys
- Emergency department, CHU UCL Namur, Yvoir, Belgium
- Université Catholique de Louvain (UCL), Belgium
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19
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Tran QK, Foster M, Bowler J, Lancaster M, Tchai J, Andersen K, Matta A, Haase DJ. Emergency and critical care providers' perception about the use of bedside ultrasound for confirmation of above-diaphragm central venous catheter placement. Heliyon 2020; 6:e03113. [PMID: 32042935 PMCID: PMC7002808 DOI: 10.1016/j.heliyon.2019.e03113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/21/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Chest radiography (CXR) is commonly used to confirm the proper placement of above-diaphragm central venous catheters (CVCs) and to detect associated complications. Recent studies have shown that point-of-care ultrasound (POCUS) has better sensitivity and is faster than CXR for these purposes. We were interested in documenting how often emergency medicine and critical care practitioners perform POCUS to confirm proper CVC positioning as well as their confidence in performing it. Methods We surveyed members of our state's chapters of the College of Emergency Physicians and the Society of Critical Care Medicine between April and December 2018. Our primary outcome was the percentage of providers who would agree to perform only POCUS, forgoing CXR, for confirmation of CVC position. We performed multivariable logistic regressions to measure associations between demographic, clinical information, and outcomes. Results One hundred thirty-six providers participated (a 25% participation rate). Their specialties were as follows: emergency medicine, 75%; critical care, 13%; and emergency medicine/critical care, 11%. Thirty-one percent would use POCUS only for CVC confirmation, while 42% were confident in performing POCUS for this purpose. Multivariable logistic regressions showed that performing more non-procedural ultrasound examinations was associated with a higher likelihood of agreeing to perform POCUS only (OR, 2.9; 95% CI: 1.3-6.3). Forty-six percent of relevant comments suggested more training to increase the use of POCUS. Conclusion Participants in this study did not frequently use POCUS for CVC confirmation. Designers of training curricula should consider including more instruction in the use of POCUS to confirm proper CVC placement and to detect complications.
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Affiliation(s)
- Quincy K Tran
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.,University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mark Foster
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Justin Bowler
- University of Maryland at College Park, College Park, MD, USA
| | - Mia Lancaster
- University of Maryland at College Park, College Park, MD, USA
| | - Jennifer Tchai
- University of Maryland at College Park, College Park, MD, USA
| | - Katie Andersen
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| | - Ann Matta
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.,University of Maryland Medical Center, Baltimore, MD, USA
| | - Daniel J Haase
- University of Maryland School of Medicine, The R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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20
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Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24:S6-S30. [PMID: 32205954 PMCID: PMC7085816 DOI: 10.5005/jp-journals-10071-g23183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. Methods This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper. Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. Results This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. Conclusion In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. Abbreviations list ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization How to cite this article Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30.
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Affiliation(s)
- Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Ganshyam Jagathkar
- Department of Critical Care Medicine, Medicover Hospital, Hyderabad, Telangana, India, e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, e-mail:
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, , e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Rahul Anil Pandit
- Department of Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Raymond Dominic Savio
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India, e-mail:
| | - Anuj M Clerk
- Department of Intensive Care, Services Sunshine Global Hospital, Surat, Gujarat, India, e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, , e-mail:
| | - Deven Juneja
- Department of Critical Care Medicine, Max Superspecialty Hospital, New Delhi, India, , e-mail:
| | - Sumit Ray
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India, e-mail:
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India, , e-mail:
| | - Srinivas Jakkinaboina
- Department of Critical Care Medicine, Citizens Specialty Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Nandhakishore Jampala
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Ravi Jain
- Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central Line Catheters and Associated Complications: A Review. Cureus 2019; 11:e4717. [PMID: 31355077 PMCID: PMC6650175 DOI: 10.7759/cureus.4717] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 01/29/2023] Open
Abstract
The use of a central line or central venous catheterization was brought to attention in 1929 when Dr. Werner Forssmann self-inserted a ureteric catheter through his cubital vein and into the right side of his heart. Since that time the central line technique has developed further and has become essential for the treatment of decompensating patients. Central lines are widely used for anything from rapid fluid resuscitation, to drug administration, to parenteral nutrition, and even for administering hemodialysis. Central lines come in different sizes, types, and sites of administration. Sometimes their use can be associated with complications as well. The following review article addresses these parameters of central lines and goes into detail regarding their complications.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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Mohebbi S, Nezhad MN, Zarrintaj P, Jafari SH, Gholizadeh SS, Saeb MR, Mozafari M. Chitosan in Biomedical Engineering: A Critical Review. Curr Stem Cell Res Ther 2019; 14:93-116. [DOI: 10.2174/1574888x13666180912142028] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/29/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
Biomedical engineering seeks to enhance the quality of life by developing advanced materials and technologies. Chitosan-based biomaterials have attracted significant attention because of having unique chemical structures with desired biocompatibility and biodegradability, which play different roles in membranes, sponges and scaffolds, along with promising biological properties such as biocompatibility, biodegradability and non-toxicity. Therefore, chitosan derivatives have been widely used in a vast variety of uses, chiefly pharmaceuticals and biomedical engineering. It is attempted here to draw a comprehensive overview of chitosan emerging applications in medicine, tissue engineering, drug delivery, gene therapy, cancer therapy, ophthalmology, dentistry, bio-imaging, bio-sensing and diagnosis. The use of Stem Cells (SCs) has given an interesting feature to the use of chitosan so that regenerative medicine and therapeutic methods have benefited from chitosan-based platforms. Plenty of the most recent discussions with stimulating ideas in this field are covered that could hopefully serve as hints for more developed works in biomedical engineering.
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Affiliation(s)
- Shabnam Mohebbi
- Department of Chemical Engineering, Tabriz University, Tabriz, Iran
| | | | - Payam Zarrintaj
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Seyed Hassan Jafari
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Saman Seyed Gholizadeh
- Department of Microbiology, College of Basic Science, Islamic Azad University, Shiraz Branch, Shiraz, Iran
| | - Mohammad Reza Saeb
- Departments of Resin and Additives, Institute for Color Science and Technology, P.O. Box 16765-654, Tehran, Iran
| | - Masoud Mozafari
- Bioengineering Research Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), Tehran, Iran
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Moriwaki Y, Otani J, Okuda J, Zotani H, Kasuga S. Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs. Nutrition 2018; 54:100-104. [PMID: 29778906 DOI: 10.1016/j.nut.2018.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/17/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. METHODS The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. RESULTS Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. CONCLUSION PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach.
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Affiliation(s)
| | - Jun Otani
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| | - Junzo Okuda
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| | - Hitomi Zotani
- Department of Surgery, Unnan City Hospital, Shimane, Japan
| | - So Kasuga
- Department of Surgery, Unnan City Hospital, Shimane, Japan
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Tonolini M, Ierardi AM, Carrafiello G, Laganà D. Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin. Insights Imaging 2018; 9:631-642. [PMID: 29675625 PMCID: PMC6108968 DOI: 10.1007/s13244-018-0613-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022] Open
Abstract
Abstract The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries. Teaching Points • Complications may develop after femoral arterial or venous access for interventional procedures. • Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection. • Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication. • Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis. • CT angiography reliably triages vascular access site complications and groin infections.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Domenico Laganà
- Department of Radiology, "Magna Grecia" University, Viale Europa, 88100, Catanzaro, Italy
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