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Dominikus H, Veronika W, Mair Maximilian J, Martina S, Pavla K, Christoph K, Christian K, Christian L, Rupert B, Christoph M. Complication Rates of Peripherally Inserted Central Catheters in Oncologic Versus Non-Oncologic Patients. Semin Oncol Nurs 2024; 40:151681. [PMID: 38945733 DOI: 10.1016/j.soncn.2024.151681] [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: 02/07/2024] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Peripherally inserted central catheters are commonly used in cancer patients and provide vascular access for the administration of chemotherapy, antibiotics, or parenteral nutrition. Besides many advantages, they represent a source of possible complications such as catheter related blood stream infection, catheter occlusion, or thrombosis. In this study, the catheter-related complication rate between oncologic and non-oncologic patients was compared. METHODS This retrospective cohort-study included 411 patients who underwent their first catheter placement at the Vienna General Hospital-Medical University of Vienna from January 2013 to June 2018. Patient demographics and catheter-related parameters were collected and statistically analyzed using a competing risk model. RESULTS Mean catheter dwell time was 27.75 days. The overall complication rate was 7.54% (2.72 per 1000 catheter days). Underlying malignant disease (hazard ratio: 0.351, 95% confidence interval [CI]: 0.133-0.929, P = .035) and chemotherapy administration (hazard ratio: 2.837, 95% CI: 1.088-7.394, P = .033) were significantly associated with the occurrence of any kind of complication. Catheter related blood stream infection was observed among 11 (2.68%) patients and again significantly associated with chemotherapy administration (hazard ratio: 4.545, 95% CI: 1.178-17.539; P = .028). Thrombosis was found in 7 (1.70%) patients and occlusion in 13 (3.16%) cases. CONCLUSIONS AND IMPLICATIONS FOR NURSING PRACTICE Choice of venous access is an interdisciplinary decision with emphasis on patient participation. In oncologic patients, our data suggests that the benefits of peripherally inserted central catheters regarding costs, invasiveness, and accessibility might be outweighed by the higher rate of complications associated with the device. This becomes even more important in a community care setting, where standardized handling procedures and patient education play a pivotal role in device safety.
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Affiliation(s)
- Huber Dominikus
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Weiler Veronika
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - J Mair Maximilian
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Spalt Martina
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Krotka Pavla
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Krall Christoph
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Kinstner Christian
- Division of Cardiovascular and Interventional Radiology, Department of Radiology and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Loewe Christian
- Division of Cardiovascular and Interventional Radiology, Department of Radiology and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bartsch Rupert
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Minichsdorfer Christoph
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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McManus C, Mifflin N, Rivera R, Vause S, Tran T, Ostroff M, Harrowell L, Frost S, Alexandrou E. Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study. BMJ Open 2024; 14:e081749. [PMID: 38760049 PMCID: PMC11103188 DOI: 10.1136/bmjopen-2023-081749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities. DESIGN A propensity-score matched cohort study. SETTING A 980-bed tertiary referral hospital in South West Sydney, Australia. PARTICIPANTS In-patients referred to the hospital central venous access service for the insertion of a central venous access device. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT). RESULTS The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00). CONCLUSION There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.
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Affiliation(s)
- Craig McManus
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Nicholas Mifflin
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Renz Rivera
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Sophie Vause
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ton Tran
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew Ostroff
- St Joseph's Health and Medical Centre, Emerson, New Jersey, USA
| | - Lorenza Harrowell
- Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Steven Frost
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Evan Alexandrou
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
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Salinaro G, Pirrone M, Cardone C, Cova M, Abbruzzese C, Galazzi A. Effects of positive airway pressure on basilic vein diameter and venous flow velocity in healthy volunteers. J Vasc Access 2024; 25:928-934. [PMID: 36527186 PMCID: PMC11075407 DOI: 10.1177/11297298221124405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/07/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The placement of vascular catheters of adequate size in accordance to catheter-to-vein ratio (CVR) recommendations represents one of the cornerstones of catheter-related upper vein thrombosis prevention. However there is scarcity of data on its effect on the venous dynamics of the basilic vein, a common site for long-term catheter placement. This study investigates the effects of the application of positive airway pressure on the diameter and blood flow velocity of basilic vein. We also measured the effects of under-armpit straps, a device commonly used to keep continuous positive airway pressure (CPAP) helmets in place. METHODS We enrolled 28 healthy volunteers. Basilic vein diameter and minimum/maximum blood flow velocity, according to respiratory venous flow oscillation, were measured by ultrasound on the midpoint of their dominant arm during spontaneous breathing and during breathing in a CPAP helmet with 10 cm H2O of airway pressure applied, with the helmet kept in place either through armpit straps or by tying the helmet to the bed. RESULTS The application of 10 cm H2O of positive airway pressure significantly increased basilic vein diameter by 0.9 ± 0.2 mm, while reducing minimum blood flow velocity by 1.8 ± 0.4 cm/s. These effects were amplified by the application of under armpit straps. CONCLUSIONS Breathing with positive airway pressure increases basilic vein diameter while reducing blood flow-velocity. This phenomenon might lead to an incorrect assessment of CVR, misleading the operator into choosing improperly large catheters.
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Affiliation(s)
- Gianluca Salinaro
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Pirrone
- Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Cardone
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Cova
- Division of Vascular Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Abbruzzese
- Anesthesia, Intensive Care and Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Galazzi
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Barton A. Extravasation and infiltration: under-recognised complications of intravenous therapy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S18-S26. [PMID: 38578942 DOI: 10.12968/bjon.2024.33.7.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Occasionally, the administration of intravenous (IV) therapies can go wrong. Infiltration or extravasation is a complication when a drug or IV therapy leaks into the tissues surrounding the vascular access device. Extravasation can cause serious and often life-changing injuries. Extravasation is often associated with systemic anti-cancer therapy but non-chemotherapy drugs have been reported as having a greater risk of serious complications. This study outlines the first UK Infusion unit evaluation of the ivWatch infusion monitoring device which was undertaken from August 2023 to January 2024. Out of 2254 infusions monitored with ivWatch, the device prevented 122 cases of infiltration and extravasation from causing any harm to the patient, corresponding to a 5.4% 'check IV' notification rate.
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Affiliation(s)
- Andrew Barton
- Nurse Consultant IV Therapy and Vascular Access, IVAS Lead Nurse, FHFT Product Selection Group Chair, National Infusion and Vascular Access Society (NIVAS) Chair, WoCoVA Global Committee Member
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Cominacini M, De Marchi S, Tosi F, Piccinno E, Dal Corso A, Dalla Grana E, Stefani F, Dalle Carbonare L. Incidence and clinical progression of asymptomatic peripherally inserted central catheter -related thrombosis in solid neoplasm patients: ultrasound insights from a prospective cohort study. Res Pract Thromb Haemost 2024; 8:102391. [PMID: 38660454 PMCID: PMC11039392 DOI: 10.1016/j.rpth.2024.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background Managing central venous catheters in patients with neoplasms is challenging, and peripherally inserted central catheter PORT (PICC-PORT) has emerged as a promising option for safety and efficacy. However, understanding the clinical progression of catheter-related thrombosis (CRT) in cancer patients with central venous catheters remains limited, especially in certain neoplasm types associated with a higher risk of venous thrombosis. Objectives This study aims to assess the effectiveness of ultrasound-guided management in detecting and treating asymptomatic CRT in cancer patients with PICC. Methods In this prospective cohort study of 120 patients with solid neoplasms receiving chemotherapy, we investigated the incidence of isolated upper-extremity superficial vein thrombosis, upper-extremity deep vein thrombosis, and fibrin sheath formation through ultrasound follow-up at 30 and 90 days after catheter insertion. We analyzed risk factors associated with CRT and compared incidence rates between PICC-PORT and traditional PICC. Results Among the cohort, 69 patients (57.5%) had high-risk thromboembolic neoplasm, and 31 cases (25.8%) of CRT were observed, mostly within 30 days, with only 7 cases (22.6%) showing symptoms. Traditional PICC use (odds ratio, 5.86; 95% CI, 1.14-30) and high-risk thromboembolic neoplasm (odds ratio, 4.46; 95% CI, 1.26-15.81) were identified as independent risk factors for CRT. Conclusion The majority of CRT present asymptomatically within the first 30 days of venous catheter insertion in patients with solid neoplasms. Ultrasound follow-up is valuable for detecting asymptomatic CRT. The risk of CRT was lower with PICC-PORT than with PICC. Additionally, the risk of CRT was found to be higher in patients with high-risk thromboembolic neoplasms. It is crucial for larger studies to confirm the utility of treating asymptomatic thromboses and isolated superficial thrombosis.
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Affiliation(s)
- Mattia Cominacini
- Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - Sergio De Marchi
- Department of Angiology, Integrated University Hospital of Verona, Verona, Italy
| | - Federica Tosi
- Department of Emergency Medicine, Integrated University Hospital of Verona, Verona, Italy
| | - Elia Piccinno
- Department of Emergency Medicine, Integrated University Hospital of Verona, Verona, Italy
| | - Alessandro Dal Corso
- Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - Elisa Dalla Grana
- Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
| | - Francesca Stefani
- Department of Emergency Medicine, Integrated University Hospital of Verona, Verona, Italy
| | - Luca Dalle Carbonare
- Department of Engineering for Innovative Medicine, University of Verona, Verona, Italy
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Sharp R, Xu Q, Pumpa R, Elliott L, Corsini N, Marker J, Altschwager J, Ortmann A, Turner L, Jin L, Ullman A, Esterman A. Supportive care needs of adults living with a peripherally inserted central catheter (PICC) at home: a qualitative content analysis. BMC Nurs 2024; 23:4. [PMID: 38163877 PMCID: PMC10759691 DOI: 10.1186/s12912-023-01614-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are common vascular access devices inserted for adults undergoing intravenous treatment in the community setting. Individuals with a PICC report challenges understanding information and adapting to the device both practically and psychologically at home. There is a lack of research investigating the supportive care needs of individuals with a PICC to inform nursing assessment and the provision of additional supports they may require to successfully adapt to life with a PICC. The aim of this study was to identify the supportive care needs of adults with cancer or infection living with a PICC at home. METHOD Qualitative, semi-structured interviews were used to identify supportive care needs of adults living with a PICC at home. Participants were recruited from cancer and infectious diseases outpatient units. Two researchers independently analysed transcripts using content analysis. RESULTS A total of 15 participants were interviewed (30-87 years old). There were 5 males and 10 females interviewed, 9 participants had a cancer diagnosis and most lived in a metropolitan area. Many participants lived with a partner/spouse at home and three participants had young children. Participants identified supportive care needs in the following eight categories (i (i) Adapting daily life (ii) Physical comfort (iii) Self-management (iv) Emotional impact (v) Information content (vi) Understanding information (vii) Healthcare resources and (viii) Social supports. CONCLUSIONS Adults living with a PICC at home report a broad range of supportive care needs. In addition to practical and information needs, health consumers may also require support to accept living with a device inside their body and to assume responsibility for the PICC. These findings may provide nurses with a greater understanding of individual needs and guide the provision of appropriate supports.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia.
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Robyn Pumpa
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Lisa Elliott
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | | | - Alanna Ortmann
- Metropolitan Referral Unit, SA Health, Adelaide, Australia
| | | | - Lili Jin
- South Australia Medical Imaging (SAMI)/ Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Adrian Esterman
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Chen L, Lu Y, Wang L, Pan Y, Zhou X. Construction of a nomogram risk prediction model for PICC-related venous thrombosis and its application. Asian J Surg 2024; 47:107-111. [PMID: 37302889 DOI: 10.1016/j.asjsur.2023.05.043] [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: 02/01/2023] [Revised: 03/07/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To explore the risk factors of the peripherally inserted central catheter (PICC)-related venous thrombosis and correspondingly construct a nomogram risk prediction model. METHODS The clinical data of 401 patients receiving PICC catheterization in our hospital from June 2019 to June 2022 were retrospectively analyzed. The independent influencing factors for venous thrombosis were predicted using logistic regression analysis, and significant indicators were screened to construct a nomogram for predicting PICC-related venous thrombosis. The difference in predictive efficacy between simple clinical data and nomogram was analyzed using a receiver operating characteristic (ROC) curve, and the nomogram was internally validated. RESULTS Single-factor analysis showed that catheter tip position, plasma D-dimer concentration, venous compression, malignant tumor, diabetes, history of thrombosis, history of chemotherapy, and history of PICC/CVC catheterization were correlated with PICC-related venous thrombosis. Further multi-factor analysis revealed that catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization were the risk factors for PICC-related venous thrombosis. Based on binary logistic regression analysis, a nomogram prediction model for PICC-related venous thrombosis was constructed. The area under the curve (AUC) was 0.876 (95%CI: 0.818-0.925), with a statistically significant difference (P < 0.01). CONCLUSION The independent risk factors for PICC-related venous thrombosis are screened out, including catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization, and a nomogram prediction model with good effect is constructed to predict the risk of PICC-related venous thrombosis.
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Affiliation(s)
- Lili Chen
- Department of Traditional Chinese Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yanyan Lu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Lei Wang
- Department of PICC Catheter Maintenance Clinic, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yihong Pan
- Department of Traditional Chinese Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaoyan Zhou
- Department of Traditional Chinese Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China.
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Zhao QY, Li Q, Cui TL. Risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome. J Vasc Surg Venous Lymphat Disord 2024; 12:101682. [PMID: 37708936 DOI: 10.1016/j.jvsv.2023.08.021] [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: 03/08/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We analyzed the risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome (SVCS) and effectiveness of endovascular intervention in hypotension related to SVCS. METHODS This was a retrospective cohort study. A total of 194 maintenance hemodialysis patients diagnosed with SVCS who were admitted to the Department of Nephrology, West China Hospital of Sichuan University from January 2019 to December 2021 were selected and divided into a hypotension group and a nonhypotension group. Demographic and clinical data were compared. Hypotension simply refers to blood pressure levels of <90/60 mm Hg on a nondialysis day. All patients received endovascular intervention. RESULTS Hypotension was found in 85 of the 194 patients. The following factors were significantly different between the hypotension and nonhypotension groups: body mass index, history of hypertension, tunneled-cuffed catheter as the means of dialysis access, azygos ectasis, SVC stenosis of >70% or occlusion, occlusion at the cavitary junction, serum calcium, diastolic left ventricular (LV) posterior wall thickness, LV end-diastolic volume, stroke output, and LV ejection fraction. Multivariate logistic regression analysis showed that hypertension history (OR, 0.314; P = .027), tunneled-cuffed catheter as vascular access (OR, 3.997; P < .001), SVC stenosis of >70% or occlusion (OR, 5.243; P < .001), LV posterior wall thickness (OR, 0.772; P = .044), and serum calcium (OR, 0.146; P = .005) were independent risk factors for hypotension. The mean values of systolic and diastolic blood pressure after intravascular treatment were significantly elevated from those before intervention (P < .001). The primary patency rates of SVC were 66.8%, 58.7%, and 50.0% at 3, 6, and 12 months after the procedure. CONCLUSIONS The incidence of hypotension in patients with hemodialysis-associated SVCS is high. The identification of risk factors of hemodialysis-related hypotension provides insight into potential treatment strategies. Endovascular treatment is expected to improve hypotension related to SVCS in hemodialysis patients.
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Affiliation(s)
- Qiu-Yan Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qiu Li
- Department of Nephrology, The First People's Hospital of Shuangliu District, Chengdu, China
| | - Tian-Lei Cui
- Department of Nephrology, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
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Weber MD, Conlon T, Connelly J, Himebauch AS. Bedside placement of tunneled femorally inserted central catheters in pediatric patients on extracorporeal life support: A case series and discussion. J Vasc Access 2023:11297298231199117. [PMID: 37731355 DOI: 10.1177/11297298231199117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Pediatric patients requiring extracorporeal life support (ECLS) often need central venous access for extended periods of time. In this population, the placement of an upper extremity peripherally inserted central catheter (PICC) can be challenging due to the location and size of the venous ECLS cannula. Bedside placement of a tunneled femorally inserted central catheters (T-FICC) can be a viable alternative to a traditional PICC. METHODS In this case series we present five children who were on ECLS and had a T-FICC placed at the bedside. RESULTS In this series of five patients we successfully placed T-FICCs while the patients were on ECLS. The T-FICCs dwelled from 15 to 182 days. There were no events of central line associated blood stream infections or deep vein thrombosis. There was only one unintentional line dislodgement noted. CONCLUSION The use of T-FICCs placed at the bedside is a safe and reliable alternative for secure long-term venous access in children who are on ECLS.
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Affiliation(s)
- Mark D Weber
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James Connelly
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bahl A, Johnson S, Mielke N, Chen NW. Risk Factors for Coated Midline Catheter-Related Thrombosis: A Secondary Analysis of Existing Trial Data. JOURNAL OF INFUSION NURSING 2023; 46:259-265. [PMID: 37611283 DOI: 10.1097/nan.0000000000000518] [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: 08/25/2023]
Abstract
Midline catheter-related thrombosis (MCRT) is a high-stakes complication. The authors aimed to explore risk factors for the development of symptomatic MCRT, including patient, procedure, catheter, and vein characteristics. This study performed an analysis of existing trial data that compared MCRT in 2 MCs with differing antithrombotic properties. Cox regression was used for univariable and multivariable analyses to evaluate the primary outcome of MCRT. Among 191 patients in this analysis, the average age was 60.2 years (standard deviation = 16.7 years), and 59.7% were female (114/191). Clinical indications for MC placement included antibiotics (60.7%), difficult venous access (32.5%), or both (6.8%). Body temperature ≥38°C (adjusted hazard ratio [aHR] = 6.26; 95% CI, 1.24-20.29; P = .03), catheter-to-vein ratio >0.40 (aHR = 2.65; 95% CI, 0.99-6.74; P = .05), and MC distance from antecubital fossa >7.0 cm (aHR = 2.82; 95% CI, 1.10-7.90; P = .03), were each significantly associated with the higher risk of the occurrence of symptomatic MCRT. This study found that catheter-to-vein ratio >0.40, distance from the antecubital fossa >7 cm, and body temperature ≥38°C were each associated with higher risk of MCRT. Current practices should be modified to include a minimum vein size to avoid MC insertions that occupy >40% of a given vein. Further research is needed to explain the impact of the catheter tip position and fever in relation to MCRT.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan (Drs Bahl and Johnson); Oakland University William Beaumont School of Medicine, Rochester, Michigan (Mr Mielke); Beaumont Research Institute, Royal Oak, Michigan (Dr Chen)
- Amit Bahl, MD, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. He is the recipient of several foundation and industry grants for research and has authored numerous peer-reviewed manuscripts in high-impact medical journals. Dr Bahl is a passionate speaker who presents internationally on the complications of vascular access devices and strategies to improve patient outcomes
- Steven Johnson, DO, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. Dr Johnson is well regarded for his expertise, clinical care, and research contributions in the fields of point-of-care ultrasound and vascular access
- Nicholas Mielke, BS, is a senior medical student pursuing a career in internal medicine. Mr Mielke has published several manuscripts in the field of vascular access and has supported the study team in multiple capacities, ranging from study design to manuscript preparation
- Nai-Wei Chen, PhD, is a senior biostatistician with extensive experience in design, creation, and management of datasets for primary and secondary analyses. Dr Chen has coauthored numerous publications with the study team within the discipline of vascular access
| | - Steven Johnson
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan (Drs Bahl and Johnson); Oakland University William Beaumont School of Medicine, Rochester, Michigan (Mr Mielke); Beaumont Research Institute, Royal Oak, Michigan (Dr Chen)
- Amit Bahl, MD, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. He is the recipient of several foundation and industry grants for research and has authored numerous peer-reviewed manuscripts in high-impact medical journals. Dr Bahl is a passionate speaker who presents internationally on the complications of vascular access devices and strategies to improve patient outcomes
- Steven Johnson, DO, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. Dr Johnson is well regarded for his expertise, clinical care, and research contributions in the fields of point-of-care ultrasound and vascular access
- Nicholas Mielke, BS, is a senior medical student pursuing a career in internal medicine. Mr Mielke has published several manuscripts in the field of vascular access and has supported the study team in multiple capacities, ranging from study design to manuscript preparation
- Nai-Wei Chen, PhD, is a senior biostatistician with extensive experience in design, creation, and management of datasets for primary and secondary analyses. Dr Chen has coauthored numerous publications with the study team within the discipline of vascular access
| | - Nicholas Mielke
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan (Drs Bahl and Johnson); Oakland University William Beaumont School of Medicine, Rochester, Michigan (Mr Mielke); Beaumont Research Institute, Royal Oak, Michigan (Dr Chen)
- Amit Bahl, MD, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. He is the recipient of several foundation and industry grants for research and has authored numerous peer-reviewed manuscripts in high-impact medical journals. Dr Bahl is a passionate speaker who presents internationally on the complications of vascular access devices and strategies to improve patient outcomes
- Steven Johnson, DO, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. Dr Johnson is well regarded for his expertise, clinical care, and research contributions in the fields of point-of-care ultrasound and vascular access
- Nicholas Mielke, BS, is a senior medical student pursuing a career in internal medicine. Mr Mielke has published several manuscripts in the field of vascular access and has supported the study team in multiple capacities, ranging from study design to manuscript preparation
- Nai-Wei Chen, PhD, is a senior biostatistician with extensive experience in design, creation, and management of datasets for primary and secondary analyses. Dr Chen has coauthored numerous publications with the study team within the discipline of vascular access
| | - Nai-Wei Chen
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan (Drs Bahl and Johnson); Oakland University William Beaumont School of Medicine, Rochester, Michigan (Mr Mielke); Beaumont Research Institute, Royal Oak, Michigan (Dr Chen)
- Amit Bahl, MD, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. He is the recipient of several foundation and industry grants for research and has authored numerous peer-reviewed manuscripts in high-impact medical journals. Dr Bahl is a passionate speaker who presents internationally on the complications of vascular access devices and strategies to improve patient outcomes
- Steven Johnson, DO, is a physician-scientist with board certification in emergency medicine and subspeciality expertise in point-of-care ultrasound. Dr Johnson is well regarded for his expertise, clinical care, and research contributions in the fields of point-of-care ultrasound and vascular access
- Nicholas Mielke, BS, is a senior medical student pursuing a career in internal medicine. Mr Mielke has published several manuscripts in the field of vascular access and has supported the study team in multiple capacities, ranging from study design to manuscript preparation
- Nai-Wei Chen, PhD, is a senior biostatistician with extensive experience in design, creation, and management of datasets for primary and secondary analyses. Dr Chen has coauthored numerous publications with the study team within the discipline of vascular access
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11
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Bahl A, Mielke N, Xing Y. Risk of midline catheter-related thrombosis due to catheter diameter: An observational cohort study. Thromb Res 2023; 228:172-180. [PMID: 37331120 DOI: 10.1016/j.thromres.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Deep vein thrombosis is a common and serious complication associated with midline catheters (MC). The aim of this investigation was to determine if catheter diameter is related to development of thrombosis. METHODS This was an observational cohort study conducted at a tertiary care academic center in Southeastern Michigan. Hospitalized adults that required a MC were eligible participants. Primary outcome was symptomatic MC associated upper extremity deep vein thrombosis (DVT) comparing three catheter diameters. Secondary outcomes included complications based on size and DVT comparing catheter to vein ratio. RESULTS Between January 1, 2017, and December 31, 2021, 3088 MCs met inclusion criteria; the distribution of 3 French (Fr), 4 Fr, and 5 Fr MCs was 35.1 %, 57.0 %, and 7.9 %, respectively. The majority of the population was female (61.2 %) and the average age was 64.2 years old. DVT occurred in 4.4 %, 3.9 %, and 11.9 % of 3 Fr, 4 Fr, and 5 Fr MCs, respectively (p < 0.001). In multivariable regression analysis, there was no difference in the odds of developing DVT for the 4 Fr MC compared to the 3 Fr (aOR 0.88; 95 % CI 0.59-1.31; p = 0.5243), however, there was significantly higher odds for the 5 Fr (aOR 2.72; 95 % CI 1.62-4.51; p = 0.001). Additionally, for every additional day the MC was in place, the odds of DVT increased by 3 % (aOR 1.03; 95 % CI 1.01-1.05; p = 0.0039). When comparing accuracy of the size model versus catheter to vein ratio model for predicting DVT, receiver operating characteristic curve analysis demonstrated the area under the curve for size was 73.70 % (95 % CI 68.04 %-79.36 %) compared to 73.01 % (95 % CI: 66.88 %-79.10 %) for catheter-to-vein ratio. CONCLUSIONS Smaller diameter catheters should be preferentially chosen to mitigate the risk of thrombosis when therapy via midline catheters is required. Choosing a catheter based on reduced size or 1:3 catheter to vein ratio threshold has similar accuracy in predicting DVT.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States of America.
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, United States of America
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12
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Huang C, Wu Z, Huang W, Zhang X, Lin X, Luo J, Li L, Li J. Identifying the impact of the Zone Insertion Method TM (ZIM TM): A randomized controlled trial. J Vasc Access 2023; 24:729-738. [PMID: 34711086 DOI: 10.1177/11297298211052528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In 2011, Dawson proposed the Zone Insertion MethodTM (ZIMTM) to identify the optimal peripherally inserted central catheters (PICCs) insertion site in the upper arm. However, data on the effectiveness and safety of the ZIMTM in guiding PICC placement in Chinese population is limited. METHODS In this randomized controlled trial, 120 cancer patients were randomly assigned to the upper portion of the red zone (RZ), the green zone (GZ) and the lower portion of the yellow zone (YZ) groups (at a 1:1:1 ratio). The aim was to compare the degree of patient comfort and the incidence of major PICC complications among the three insertion zones based on the ZIMTM in a Chinese Cancer Center. (Clinical Trials. Gov number, ChiCTR1900024111). RESULTS A total of 118 catheters were inserted in 118 patients (2 patients were lost to follow-up). After the 1-month follow-up, patients randomly assigned to the YZ group had a higher degree of comfort with a lower score than those assigned to the other two zone groups: 30.21±3.16 in the YZ group versus 31.65±2.51 in the RZ group and 31.59±2.92 in the GZ group (P=.046). The incidence of thrombosis (10/40, 25%) and occlusion (4/40, 10%) in the RZ, which were significantly higher than those in the other two zone groups (χ2 =7.368, P=.02; χ2 =5.778, P =.03), whereas the risk in the GZ group was similar to that in the YZ group. The incidence of contact dermatitis in the GZ group was significantly higher than that of the other two zone groups (χ2=12.873, P=.001). CONCLUSIONS This study found that the lower portion of YZ seems to be another suitable PICC insertion site for a higher degree of comfort and a lower risk of occlusion and thrombosis, which broadens the choice of PICC insertion sites in the upper arm for clinical practice.
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Affiliation(s)
- Chunli Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhenming Wu
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Weihua Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xinghong Zhang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xiling Lin
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jielin Luo
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Lihua Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jia Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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13
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Pinelli F, Little A, Kokotis K, Alsbrooks K, Pittiruti M. Assessment of the MAGIC recommendations in context of evolving evidence based on the use of PICC in ICU. J Vasc Access 2023; 24:836-847. [PMID: 34689644 DOI: 10.1177/11297298211048019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data.
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | | | - Kathy Kokotis
- Becton Dickinson and Company, Franklin Lakes, NJ, USA
| | - Kim Alsbrooks
- Becton Dickinson and Company, Franklin Lakes, NJ, USA
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
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14
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Fabiani A, Santoro M, Sanson G. The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters. Heart Lung 2023; 60:39-44. [PMID: 36898280 DOI: 10.1016/j.hrtlng.2023.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In patients requiring a peripheral venous access for more than seven days, long peripheral catheters (LPCs) or midline catheters (MCs) are recommended. Since MCs and LPCs share many characteristics, studies comparing devices made of the same biomaterial are needed. Moreover, a catheter-to-vein ratio >45% at the insertion point has been recognized as a risk factor for catheter related complications, but no study investigated the effect of the catheter-to-vein ratio at the catheter tip level in peripheral venous devices. OBJECTIVES To compare the catheter failure risk between polyurethane MCs and LPCs, considering the effect of the catheter-to-vein ratio at the tip location. METHODS Retrospective cohort study. Adult patients having an expected need for a vascular access of more than 7 days and receiving either a polyurethane LPC or MC were included. The catheter uncomplicated indwelling time within 30 days was considered in survival analysis. RESULTS In a sample of 240 patients, the relative incidences of catheter failure were 5.13 and 3.40 cases for 1,000 catheter days for LPCs and MCs, respectively. In univariate Cox regression, MCs were associated to a statistically significant lower risk of catheter failure (HR 0.330; p = 0.048). After adjusting for other relevant conditions, a catheter-to-vein ratio >45% at the catheter tip location - not the catheter itself - was an independent predictor of a catheter failure (HR 6.762; p = 0.023). CONCLUSIONS The risk of catheter failure was strongly associated with a catheter-to-vein ratio > 45% at the catheter tip level, irrespective for having used a polyurethane LPC or MC.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste 34148, Italy.
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15
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Gidaro A, Casella F, Lugli F, Cogliati C, Calloni M, Samartin F, Brena N, Pace G. Contrast enhanced ultrasound as a new tool to estimate the performance of midline catheters in the single patient. J Vasc Access 2023; 24:284-288. [PMID: 34289731 DOI: 10.1177/11297298211034629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Contrast enhanced ultrasound (CEUS) through MicroBubbles Time (MBT) (time from infusion of saline with addition of micro-bubbles of air to visualization of first bubbles in right atrium (RA), visualized by subxiphoid or apical echocardiography) is an alternative to Intracavitary ECG and chest X-ray in evaluation of tip location in central venous catheters. OBJECTIVE To evaluate feasibility and variability of CEUS in peripheral catheters (Midline-MC) in a cohort of patients and in a subgroup where tip location was also performed through chest X-ray. Secondary outcomes were verifying the correlation between MBT and distance between tip of MC and RA (anthropometric and radiological measures), body mass index (BMI), vein diameter at point of insertion. METHODS Patients with insertion of MC were enrolled in this prospective cohort. After catheter insertion, CEUS was performed recording MBT. RESULTS One hundred thirty-two MCs were inserted, 45 performed Chest X-ray. MBT wasn't feasible in 7 (5%) because of low quality echocardiographic images. Subcostal view was available in 114 patients (91.2%), while 11 patients (8.8%) were examined through apical four-chamber view. Mean MBT in the whole population was 2.3 ± 0.8 s. Significant correlation between anthropometric and radiological measures, BMI and MBT was found. 32.8% of MC had a MBT ⩽2 s. CONCLUSIONS CEUS could be useful to estimate tip position. Our study showed how 2 s is not a suitable cutoff to confirm central catheter's tip.
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Affiliation(s)
- Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesca Lugli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Calloni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Federica Samartin
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Nicola Brena
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Guido Pace
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
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16
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Different diagnostic strategies using D-dimer for peripherally inserted central catheter-related upper extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2023; 11:565-572. [PMID: 36681296 DOI: 10.1016/j.jvsv.2022.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Deep vein thrombosis (DVT) in the upper extremities caused by a peripherally inserted central venous catheter (PICC) is distinct from the typical DVT. This specific type of mural thrombus might have an effect on the D-dimer levels. In the present study, we aimed to ascertain whether the D-dimer level might be considered an independent diagnostic marker to rule out upper extremity DVT caused by PICCs. METHODS We performed a retrospective case-cohort study of 205 patients who had undergone D-dimer measurement and color Doppler ultrasound within 14 days after placement of a PICC to December 31, 2020, from January 1, 2018. The participants were followed up for 3 months to evaluate for upper extremity DVT. In addition, different D-dimer diagnostic strategies were analyzed. RESULTS Of the 205 included patients, 53 (25.9%) had had a negative D-dimer level. Of the 53 patients, 10 had had upper extremity DVT attributable to a PICC using color Doppler ultrasound. Of these 10 patients, 3 had developed upper extremity DVT during the 3-month follow-up. Using the various D-dimer diagnostic techniques, the negative predictive value for the D-dimer levels was 81.1%. CONCLUSIONS The present study has shown that the different D-dimer diagnostic strategies are not effective for safely excluding the diagnosis of suspected PICC-related upper extremity DVT. Adding PICC placement as a special factor in the modified Wells score, in addition to the D-dimer level, could securely rule out PICC-related upper extremity DVT; however, the diagnostic efficacy was low.
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17
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Bahl A, Alsbrooks K, Gala S, Hoerauf K. Symptomatic Deep Vein Thrombosis Associated With Peripherally Inserted Central Catheters of Different Diameters: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2023; 29:10760296221144041. [PMID: 37366542 PMCID: PMC10328005 DOI: 10.1177/10760296221144041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 06/28/2023] Open
Abstract
We assessed the relationship between peripherally inserted central catheter (PICC) diameters and symptomatic deep vein thrombosis (DVT) rates. We conducted a systematic search for articles published between 2010 and 2021 reporting DVT incidence by catheter diameter in patients who had a PICC, followed by meta-analyses for DVT risk in each diameter group. Pooled DVT rates were incorporated into an economic model. Of 1627 abstracts screened, 47 studies were included. The primary meta-analysis of 40 studies demonstrated the incidence of DVT was 0.89%, 3.26%, 5.46%, and 10.66% for 3, 4, 5, and 6 French (Fr) PICCs (P = .01 between 4 and 5 Fr). Rates of DVT were not significantly different between oncology and nononcology patients (P = .065 for 4 Fr and P = .99 for 5 Fr). The DVT rate was 5.08% for ICU patients and 4.58% for non-ICU patients (P = .65). The economic model demonstrated an annual, incremental cost savings of US$114 053 for every 5% absolute reduction in 6 Fr PICCs use. Using the smallest PICC that meets the patients' clinical needs may help to mitigate risks and confer savings.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine,
Beaumont Hospital, Royal Oak, MI, USA
| | | | - Smeet Gala
- Medical Affairs, Becton Dickinson and
Company, Franklin Lakes, NJ, USA
| | - Klaus Hoerauf
- Medical Affairs, Becton Dickinson and
Company, Franklin Lakes, NJ, USA
- Department of Anesthesiology and
Intensive Care, Medical University of
Vienna, Wien, Austria
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18
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Asymptomatic pulmonary thromboembolism due to hemodialisys catheter thrombosis: case series and literature review. CEN Case Rep 2022. [PMID: 36574198 PMCID: PMC10393924 DOI: 10.1007/s13730-022-00757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Right atrial thrombus is commonly associated to catheters. Catheter-related right atrial thrombus (CRAT) in hemodialysis patients frequently presents as pulmonary embolism. Although CRAT is sometimes asymptomatic, even in these cases it is associated with worse prognosis. The management strategy for CRAT is not well established, however, along with catheter removal, anticoagulation, thrombolysis, and surgical thrombectomy may be performed. Suspicion of asymptomatic pulmonary embolism associated to CRAT is important in order to perform proper treatment. The authors of this article report two cases of asymptomatic pulmonary thromboembolism due to CRAT in hemodialysis patients and perform a review of the literature.
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19
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Wang L, Jia L, Jiang A. Pathology of catheter-related complications: what we need to know and what should be discovered. J Int Med Res 2022; 50:3000605221127890. [PMID: 36268763 PMCID: PMC9597033 DOI: 10.1177/03000605221127890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the considerable efforts made to increase the prevalence of autogenous fistula in patients on hemodialysis, tunneled cuffed catheters are still an important access modality and used in a high percentage of the hemodialysis population. However, because of the conundrum posed by tunneled cuffed catheters, patients can develop a multitude of complications, including thrombosis, infections, formation of a fibrin sheath, and central vein stenosis, resulting in increased morbidity and mortality as well as placing a heavy burden on the healthcare system. However, with an increasing number of studies now focusing on how to manage these catheter-related complications, there has been less translational research on the pathology of these complications. This review of the most recent literature provides an update on the pathological aspects of catheter-related complications, highlighting what we need to know and what is yet to be discovered. The future research strategies and innovations needed to prevent these complications are also addressed.
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Affiliation(s)
- Lihua Wang
- Lihua Wang, Department of Kidney Disease
and Blood Purification Centre, 2nd Hospital of Tianjin Medical University, 23rd
Pingjiang Road, Hexi District, Tianjin 300211, PR China.
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20
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Zhou RN, Ma XB, Wang L, Kang HF. Accidental venous port placement via the persistent left superior vena cava: Two case reports. World J Clin Cases 2022; 10:9879-9885. [PMID: 36186175 PMCID: PMC9516935 DOI: 10.12998/wjcc.v10.i27.9879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/27/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Breast cancer poses a great threat to females worldwide. There are various therapies available to cure this common disease, such as surgery, chemotherapy, radiotherapy, and immunotherapy. Implantable venous access ports (IVAP, referred to as PORT) have been widely used for breast cancer chemotherapy. Venous malformations are possible conditions encountered during PORT implantation. Persistent left superior vena cava (PLSVC) is a common superior vena cava malformation. Most patients have normal right superior vena cava without affecting hemodynamics, so patients often have no obvious symptoms.
CASE SUMMARY We incidentally found that two patients had PLSVC while a PORT was implanted via the internal jugular vein. Due to chemotherapy for breast cancer, PORT was successfully implanted under the guidance of ultrasound into these 2 patients. Positive chest X-ray examination after the operation showed that the catheter ran beside the left mediastinum and the end was located in the seventh thoracic vertebra. The patients had no catheter-related complications and successfully completed the course of chemotherapy. Ultrasonography found that the ratio of PORT outer diameter to PLSVC inner diameter was less than 0.45, which was in line with the recommendations of relevant literature and operating guidelines. The purpose of this article is to introduce two rare cases and review the relevant literature.
CONCLUSION Correct assessment of PLSVC status and ultrasound-guided PORT placement generally does not affect breast cancer patients chemotherapy.
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Affiliation(s)
- Rui-Na Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
| | - Xiao-Bin Ma
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
| | - Li Wang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
| | - Hua-Feng Kang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
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Bhasin N, Roe DJ, Saboda K, Journeycake J, Moreno V, Lentz SR. Association of low serum albumin with venous thrombosis in pediatric patients. Thromb Res 2022; 218:48-51. [PMID: 35988444 DOI: 10.1016/j.thromres.2022.08.008] [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: 04/29/2022] [Revised: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The incidence of venous thromboembolism (VTE) in children is increasing, attributed in part to increased utilization of central venous catheters (CVCs). Children with protein losing disorders (PLDs) and low serum albumin may have an increased incidence of thrombosis. We sought to determine the prevalence of PLDs and hypoalbuminemia at the time of diagnosis of VTE in pediatric patients and its relationship to central venous catheters. METHODS We performed a single institution retrospective study of 65 consecutive hospitalized pediatric patients with an acute VTE. Data collected included clinical diagnoses, type of thrombosis, presence or absence of a CVC, and serum albumin level, if available. RESULTS Of 65 patients with acute VTE, 51 % (33/65) had catheter-related thrombosis (CRT), including 71 % (19/27) of patients <12 years of age and 37 % (14/38) of patients aged 12 to 23 (P = 0.008). Eleven VTEs occurred in patients with a diagnosis of a PLD; of these, ten (91 %) were CRT and one (9 %) was a non-CRT (P = 0.003). Serum albumin levels obtained within four days of diagnosis of VTE were available for 38 patients. An albumin level below the lower limit of the age-adjusted normal reference range was documented in 27/38 (71 %) patients with VTE compared to 1011/3028 (33 %) of all pediatric patients admitted to the hospital during a two-year period (P < 0.0001). Albumin levels were low in 19/22 (86 %) patients with CRT compared with 8/16 (50 %) patients with non-CRT (P = 0.019). CONCLUSION Low serum albumin levels are highly prevalent among pediatric patients with VTE, especially in those patients with CRT.
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Affiliation(s)
- Neha Bhasin
- Department of Pediatrics, University of Arizona, 1625 N. Campbell Ave, Tucson, AZ 85719, USA.
| | - Denise J Roe
- Department of Epidemiology and Biostatistics, University of Arizona, 1625 N. Campbell Ave, Tucson, AZ 85719, USA; The University of Arizona Cancer Center, University of Arizona, 1625 N. Campbell Ave, Tucson, AZ 85719, USA
| | - Kathylynn Saboda
- The University of Arizona Cancer Center, University of Arizona, 1625 N. Campbell Ave, Tucson, AZ 85719, USA
| | - Janna Journeycake
- Department of Pediatrics, University of Oklahoma, 700 NE 13(th) St., Oklahoma City, OK 73104, USA
| | - Vivian Moreno
- Department of Pediatrics, University of Arizona, 1625 N. Campbell Ave, Tucson, AZ 85719, USA
| | - Steven R Lentz
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242, USA
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Puri A, Dai H, Giri M, Wu C, Huang H, Zhao Q. The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:917572. [PMID: 35958406 PMCID: PMC9360324 DOI: 10.3389/fcvm.2022.917572] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Venous thromboembolism (VTE) can be fatal if not treated promptly, and individual studies have reported wide variability in rates of VTE associated with peripherally inserted central catheters (PICC). We thus conducted this meta-analysis to investigate the overall incidence and risk of developing PICC-related VTE in hospitalized patients. Methods We searched PubMed, Embase, Scopus, and Web of Science databases from inception until January 26, 2022. In studies with a non-comparison arm, the pooled incidence of PICC-related VTE was calculated. The pooled odds ratio (OR) was calculated to assess the risk of VTE in the studies that compared PICC to the central venous catheter (CVC). The Newcastle-Ottawa Scale was used to assess methodological quality. Results A total of 75 articles (58 without a comparison arm and 17 with), including 109292 patients, were included in the meta-analysis. The overall pooled incidence of symptomatic VTE was 3.7% (95% CI: 3.1–4.4) in non-comparative studies. In the subgroup meta-analysis, the incidence of VTE was highest in patients who were in a critical care setting (10.6%; 95% CI: 5.0–17.7). Meta-analysis of comparative studies revealed that PICC was associated with a statistically significant increase in the odds of VTE events compared with CVC (OR, 2.48; 95% CI, 1.83–3.37; P < 0.01). However, in subgroup analysis stratified by the study design, there was no significant difference in VTE events between the PICC and CVC in randomized controlled trials (OR, 2.28; 95% CI, 0.77–6.74; P = 0.13). Conclusion Best practice standards such as PICC tip verification and VTE prophylaxis can help reduce the incidence and risk of PICC-related VTE. The risk-benefit of inserting PICC should be carefully weighed, especially in critically ill patients. Cautious interpretation of our results is important owing to substantial heterogeneity among the studies included in this study.
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Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengfei Wu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qinghua Zhao,
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Risk factors assessment for radiographically guided port implantations with forearm access. PLoS One 2021; 16:e0259127. [PMID: 34699565 PMCID: PMC8547706 DOI: 10.1371/journal.pone.0259127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Port implantations at the forearm are associated with an increased risk of relevant vein thrombosis. Therefore, with this study we sought to identify the responsible risk factors to improve technical quality of the method. Methods This is a retrospective analysis of 313 patients with port implantation at the forearm in 2019. Then, exploratory statistics were conducted comprising Cox-Regression and Kaplan-Meier-Analyses. Results Mean age was 60 ± 14 years. 232 (74%) of the patients were female. No early infection was observed. 29 late infections and 57 cases of thrombosis occurred. In only 9% of the patients with thrombosis hospital admission was necessary for treatment. Median interval to the diagnosis of thrombosis was 23 days; inter-quartile-range: 16–75. Mean interval to elective port explantation was 227 ± 128 days. There was no effect of occurrence of thrombosis of the interventionalist, the assistance nor of several technical aspects. However, there was a significantly lower risk of thrombosis for primary implanted port system compared to replacement ports, Hazard-ratio: 0.34 [Confidence interval: 0.172, 0.674], p = 0.002. Age was a significant risk factor for late infections, Hazard-ratio: 3.35 [Confidence interval:1.84, 6.07], p < 0.0001. Conclusion The main risk factor for adverse outcome after radiographically guided port implantation at the forearm is the type of the implanted port system. The reason for that might not be the material itself but the experience of a team with a certain port system. Age is a risk factor for late complications.
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24
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Peng SY, Wei T, Li XY, Yuan Z, Lin Q. A model to assess the risk of peripherally inserted central venous catheter-related thrombosis in patients with breast cancer: a retrospective cohort study. Support Care Cancer 2021; 30:1127-1137. [PMID: 34432170 DOI: 10.1007/s00520-021-06511-3] [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: 03/17/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Limited risk assessment tool to stratify the risk of PICC-related thrombosis (PICC-RVT) in breast cancer patients. This study developed a model to assess the risk of PICC-RVT in breast cancer patients. METHODS We conducted a retrospective cohort study of 1284 breast cancer patients receiving PICC insertion from January 1, 2015, to August 31, 2019, at a cancer specialized hospital in Hunan province, China. The entire population was divided into two groups at a ratio of 3:1 which included a derivation sample (n = 978), and a validation sample (n = 284). PICC-RVT was confirmed by ultrasonography in the presence of clinical symptoms and signs. RESULTS PICC-RVT occurred in 40 (4.09%) of the derivation sample patients. Multivariable analysis identified 9 variables: chronic obstructive pulmonary disease, prior central venous catheter placement, higher level of platelets, higher level of D-dimer, lower level of activated partial thromboplastin time, menopause, no prior breast surgery, upper extremity lymphedema, and endocrine therapy. Points were assigned to each variable according to regression coefficient. The model had an area under the receiver operating characteristics curve (AUC) of 0.850 (95% CI 0.776 to 0.924), The Hosmer-Lemeshow goodness-of-fit was 5.780 (p = 0.328). At a cutoff value of 3.5, the sensitivity and specificity were 75% and 83%, respectively. CONCLUSION Several disease-specific factors of breast cancer (e.g., menopause, endocrine therapy, and upper extremity lymphedema) play important roles in the development of PICC-RVT. Patients at higher PICC-RVT risk could be candidates for close post-insertion monitoring and interventions to prevent PICC-RVT.
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Affiliation(s)
- Si-Yi Peng
- The Early Clinical Trial Center in The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan Province, China
| | - Tao Wei
- Anesthesiology Department, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, 283 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan Province, China
| | - Xu-Ying Li
- Anesthesiology Department, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, 283 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan Province, China.
| | - Zhong Yuan
- Vascular Access Clinic, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan Province, China
| | - Qin Lin
- Vascular Access Clinic, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan Province, China
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25
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Large-Sized Vascular Access in Continuous Renal Replacement Therapy: Balancing Filter Life With Risk of Vascular Thrombosis. Pediatr Crit Care Med 2021; 22:766-767. [PMID: 34397995 DOI: 10.1097/pcc.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Kaganovskaya M, Wuerz L. Development of an educational program using ultrasonography in vascular access for nurse practitioner students. ACTA ACUST UNITED AC 2021; 30:S34-S42. [PMID: 33529109 DOI: 10.12968/bjon.2021.30.2.s34] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HIGHLIGHTS Ultrasonography is an important tool for vascular access practice. Ultrasound should be used for vascular access assessment and insertion. Ultrasonography should be incorporated into formal nursing education curriculum and simulation training. BACKGROUND This study analyzed nurse practitioner students' knowledge of ultrasound-guided vascular access after the implementation of an educational and simulation course. METHODS Nurses' knowledge of ultrasound-guided peripheral intravenous catheter placement was analyzed using a ten-item questionnaire both before and after course. A sample of bachelor's degree-prepared nurses voluntarily participated in this study. Ultrasonography simulation was carried out with two handheld ultrasound devices and two ultrasound blocks. RESULTS The findings demonstrated that there is a statistically significant increased comprehension of ultrasoundguided vascular access after simulation courses. CONCLUSION This study illuminates the need for formal education both in academic curriculum and through simulation to improve ultrasound-guided vascular access knowledge for patient care.
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Affiliation(s)
- Marcel Kaganovskaya
- Department of Surgery, Bronx, NY, and Wagner College-Evelyn Spiro School of Nursing, Staten Island, NY
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27
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Sharp R, Carr P, Childs J, Scullion A, Young M, Flynn T, Kirker C, Jackson G, Esterman A. Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study. BMJ Open 2021; 11:e045895. [PMID: 34226216 PMCID: PMC8258560 DOI: 10.1136/bmjopen-2020-045895] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group. DESIGN Retrospective cohort study. SETTING 4 tertiary hospitals in Australia and New Zealand. PARTICIPANTS Adults who had undergone PICC insertion. PRIMARY OUTCOME MEASURE Symptomatic thrombus of the limb in which the PICC was inserted. RESULTS 2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions. CONCLUSIONS Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.
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Affiliation(s)
- Rebecca Sharp
- Clinical and Health Sciences/Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Nathan, Queensland, Australia
| | - Jessie Childs
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew Scullion
- Vascular Access Team, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Mark Young
- Peri-Operative Services, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Tanya Flynn
- Cancer Services, St George Hospital, Sydney, New South Wales, Australia
| | - Carolyn Kirker
- Department of Anaesthesia and Pain Management, Capital and Coast District Health Board, Wellington, New Zealand
| | - Gavin Jackson
- Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adrian Esterman
- Clinical and Health Sciences/Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
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28
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The effect of systemic and local risk factors on triggering peripherally inserted central catheter-related thrombosis in cancer patients: A prospective cohort study based on ultrasound examination and structural equation modeling. Int J Nurs Stud 2021; 121:104003. [PMID: 34273807 DOI: 10.1016/j.ijnurstu.2021.104003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The negative synergistic effect of cancer and a peripherally inserted central catheter could significantly increase the incidence of thrombosis. Rather than identifying risk factors for peripherally inserted central catheter-related thrombosis, exploring the effect of these risk factors might be a promising method to improve the outcomes of thrombosis. OBJECTIVES To analyze the effect of systemic and local risk factors on triggering peripherally inserted central catheter-related thrombosis in the first two weeks post-insertion in cancer patients. DESIGN A prospective cohort study. SETTING The study was conducted at a 4500-bed university-affiliated medical center in China. PARTICIPANTS One hundred seventy-three cancer patients with peripherally inserted central catheters were included. METHODS Peripherally inserted central catheter-related thrombosis was assessed using ultrasound at a series of timepoints, once every two days post-insertion. Data on age, body mass index, blood hypercoagulation, insertion attempts, catheter-to-vein ratio, and blood flow velocity were collected as risk factors. Descriptive statistics and structural equation modeling were used to describe the study samples and analyze the effects of systemic and local risk factors. RESULTS Among the 173 cancer patients included, 126 (72.8%) patients were diagnosed with peripherally inserted central catheter-related thrombosis. Most thromboses (n = 118, 93.7%) were detected within five days, and 100% were detected within nine days post-insertion. Structural equation modeling analysis showed that local risk factors [catheter-to-vein ratio (standardized path coefficient = 0.32, p < 0.05) and blood flow velocity (standardized path coefficient = -0.35, p < 0.05)] had a greater effect than systemic factors [age (standardized path coefficient = 0.13, p < 0.05) and blood hypercoagulation (standardized path coefficient = 0.17, p < 0.05)] on triggering peripherally inserted central catheter-related thrombosis. CONCLUSION Peripherally inserted central catheter-related thrombosis is quite common and can occur very early post-insertion in cancer patients. Among the common risk factors, local risk factors reflecting peripherally inserted central catheter technology itself had a greater effect than systemic risk factors reflecting predisposition to thrombosis. Clinical Registration: Clinical Trials ChiCTR1900024890.
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29
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Iatrogenic superior vena cava syndrome with concomitant deep vein thrombosis of azygos and hemiazygos veins. Radiol Case Rep 2021; 16:1895-1898. [PMID: 34113414 PMCID: PMC8170043 DOI: 10.1016/j.radcr.2021.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022] Open
Abstract
Iatrogenic superior vena cava syndrome (SVCs) represents an emergent diagnostic entity and its correlation with deep vein thrombosis is extremely rare. Recently, the increased use of indwelling lines, pacemakers and intracardiac devices has led to more cases of SVC syndrome also associated with a higher frequency of DVT. We report an unusual complication in a 74-year-old female, who has been undergoing hemodialysis via CVC for 14 years, who referred at our Emergency Department complaining of shortness of breath, headache, face and neck swelling. She underwent chest Computed Tomography Angiography (CTA), that showed a thrombus extending from the superior vena cava to the azygos and hemiazygos veins. Acute SVCs should be suspected in emergency settings in symptomatic patients with indwelling central lines, catheters and pacemakers. CTA represents an accurate and quick imaging modality for the diagnosis and the assessment of the extension of the thrombus.
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30
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van Loon FHJ, Korsten HHM, Dierick-van Daele ATM, Bouwman ARA. The impact of the catheter to vein ratio on peripheral intravenous cannulation success, a post-hoc analyses. PLoS One 2021; 16:e0252166. [PMID: 34029356 PMCID: PMC8143382 DOI: 10.1371/journal.pone.0252166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Intravenous cannulation is usually the first procedure performed in modern healthcare, although establishing peripheral intravenous access is challenging in some patients. The impact of the ratio between venous diameter and the size of the inserted catheter (catheter to vein ratio, CVR) on the first attempt success rate can be of added value in clinical. This study tries to give insight into the consideration that must be made when selecting the target vein and the type of catheter, and proved the null hypothesis that an optimal CVR would not be associated with increased first attempt cannulation success. Methods This was a post-hoc analyses on adult patients admitted for peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines, by applying the traditional landmark approach. The CVR was calculated afterwards for each individual patient by dividing the external diameter of the inserted catheter by the diameter of the target vein, which was multiplied by 100%. Results In total, 610 patients were included. The median CVR was 0.39 (0.15) in patients with a successful first attempt, whereas patients with an unsuccessful first attempt had a median CVR of 0.55 (0.20) (P<0.001). The optimal cut-off point of the CVR was 0.41. First attempt cannulation was successful in 92% of patients with a CVR<0.41, whereas as those with a CVR>0.41 had a first attempt success rate of 65% (P<0.001). Conclusion This first introduction of the CVR in relation to cannulation success should be further investigated. Although, measuring the venous diameter or detection of a vein with a specific diameter prior to cannulation may increase first attempt cannulation success.
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Affiliation(s)
- Fredericus H J van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands.,Department of Science and Technology in Anesthesia Nursing Practice, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Hendrikus H M Korsten
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
| | - Angelique T M Dierick-van Daele
- Department of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Research and Education, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R A Bouwman
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands.,Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
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31
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Xiao MF, Xiao CQ, Li J, Dai C, Fan YY, Cao HJ, Qin HY. Subcutaneous tunneling technique to improve outcomes for patients undergoing chemotherapy with peripherally inserted central catheters: a randomized controlled trial. J Int Med Res 2021; 49:3000605211004517. [PMID: 33840246 PMCID: PMC8044577 DOI: 10.1177/03000605211004517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the value of the subcutaneous tunneling technique versus the normal technique in improving the outcomes of patients undergoing chemotherapy with peripherally inserted central catheters (PICCs). METHODS One hundred thirty patients were randomly divided into an experimental group (subcutaneous tunneling technique) and control group (normal technique) according to the PICC placement technique, and clinical data were compared between the groups. RESULTS In total, 129 PICCs were successfully inserted. Compared with the control group, the experimental group had a lower occurrence of complications after placement (especially catheter dislodgement: 3.1% vs. 15.4%, venous thrombosis: 3.1% vs. 15.4%, and wound oozing: 14.1% vs. 27.7%), lower occurrence of unscheduled PICC removal (3.1% vs. 13.8%), greater comfort during placement (14.16 ± 2.21 vs. 15.09 ± 2.49 on a scale ranging from 6 to 30 points, with higher scores indicating lower degrees of comfort), and lower costs of PICC maintenance (median (interquartile range) per-day maintenance cost: 13.90 (10.99-32.83) vs. 15.69 (10.51-57.46) Yuan). The occurrence of complications and amount of bleeding during placement were not significantly different between the two groups. CONCLUSIONS The subcutaneous tunneling technique can improve PICC placement by reducing complications and costs of maintenance with better patient comfort during placement.
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Affiliation(s)
- Mao-Fang Xiao
- School of Nursing, Sun Yat-sen University, Yuexiu District, Guangzhou, Guangdong, China
| | - Cai-Qiong Xiao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jia Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Can Dai
- Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yu-Ying Fan
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Hui-Jiao Cao
- General Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Hui-Ying Qin
- Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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Mielke N, Johnson S, Karabon P, Bahl A. A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis. J Vasc Access 2021; 23:754-763. [PMID: 33860710 DOI: 10.1177/11297298211009019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. METHODS We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than 2 days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. RESULTS A total of 62 PIVCs were included between July and August 2020. About 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR = 5.41 (1.91, 15.4) p = 0.0015] and angle of distal tip of catheter against vein wall ⩾5° [AHR = 4.39 (1.39, 13.8) p = 0.0116] were associated with increased likelihood of thrombophlebitis. CONCLUSIONS Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs.
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Affiliation(s)
- Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Amit Bahl
- Beaumont Hospital, Royal Oak, MI, USA
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33
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Bertoglio S. Reverse tapered versus non-tapered peripherally inserted central catheters: A narrative review. J Vasc Access 2021; 23:689-691. [PMID: 33845675 DOI: 10.1177/11297298211009998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduced over 20 years ago, the reverse tapering design for PICC catheters is supposed to have some benefits in terms of both efficacy and safety. In particular, it would ensure less postoperative bleeding at the exit site and greater effectiveness in preventing kinking or twisting of the same. Since its introduction, these hypothesized advantages have never been demonstrated in clinical studies, however very scarce, which have highlighted neither advantages nor disadvantages of reverse tapered catheters when compared to non-reverse tapered ones. This narrative review analyzes some aspects of the use of reverse tapered PICCs, also paying attention to some possible undesirable effects that have arisen from the introduction into clinical practice of new subcutaneous systems of securement of PICCs to the skin. Clinicians should be aware of the fact that reverse tapering design does not represents a sure improvement in terms of safety and efficacy of PICCs and its adoption should be weighed against possible clinical disadvantages.
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Affiliation(s)
- Sergio Bertoglio
- Department of Surgical Sciences, University of Genova, Genova, Italy
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34
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Gupta N, Gandhi D, Sharma S, Goyal P, Choudhary G, Li S. Tunneled and routine peripherally inserted central catheters placement in adult and pediatric population: review, technical feasibility, and troubleshooting. Quant Imaging Med Surg 2021; 11:1619-1627. [PMID: 33816196 DOI: 10.21037/qims-20-694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vascular access procedures are crucial for the management of various critically ill pediatric and adult patients. Venous access is commonly performed in the form routine as well as tunneled peripherally inserted central catheters (PICC). These venous accesses are commonly used in emergency, surgical as well as ICU settings, for various infusions, total parenteral nutrition, long term intravenous antibiotics, frequent blood draws, etc. PICC insertion is guided using ultrasound and fluoroscopic guidance, which decreases the risk of complications that are otherwise seen with central venous accesses like triple lumen catheters, etc. PICC insertion and care is very simple and can be performed by specially trained PICC nurses and that helps in decreasing the overall cost of healthcare. This review article is written with educational intent for the readers to discuss indications, contraindications, procedure techniques, imaging, care of routine as well as tunneled PICC.
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Affiliation(s)
- Nishant Gupta
- Department of Radiology, Bassett Healthcare, Cooperstown, NY, USA
| | - Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Salil Sharma
- Department of Radiology, Bassett Healthcare, Cooperstown, NY, USA
| | - Pradeep Goyal
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gagandeep Choudhary
- Department of Radiology; Division of Molecular Imaging & Therapeutics and Neuroradiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shuo Li
- Department of Radiology, KU School of Medicine-Wichita, University in Wichita, Wichita, KS, USA
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35
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Yin YX, Gao W, Feng SY, Wang DX, Wan M, Liu CH, Wang LN, Cao MK, Zhang HJ. ECG-guided PICC insertion using a new silicon catheter with a conductive tip: A retrospective clinical study. J Vasc Access 2021; 23:567-573. [PMID: 33769118 DOI: 10.1177/11297298211002572] [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: 11/16/2022] Open
Abstract
OBJECTIVE Safety and efficacy of ECG-guided PICC insertion using a new silicon catheter with a conductive tip was evaluated in daily practice. METHODS A retrospective study was conducted on 1659 patients who accepted successful tip-conductive PICC placement and clinically followed-up until the catheter removal between January 2018 and April 2019. Baseline of patient characteristics, catheter placement characteristics, date of dressing changes as well as records of catheter-related complications were extracted from a special designed mobile APP. RESULTS The first-attempt success (success of placing catheter tip to the ideal position by primary indwelling operation) rate of PICC placement was 99.3%. The average duration of PICC placement was 128.7 ± 39.5 days and 1535 patients (92.5%) reached the therapy end-point without any complications and removed the catheter normally. The cumulative rates of total complications were 7.5%, including exit site infection (2.5%), phlebitis (0.9%), DVT (1.0%), catheter malposition (1.1%), catheter breakage (0.1%), and liquid extravasation (1.8%). In multivariable logistic regression analyses, hyperlipidemia, diabetes mellitus, lung cancer, stomach cancer, and lymphoma were significantly associated with increased risk of complications, as the independent risk factors. CONCLUSIONS This retrospective clinical study demonstrates that ECG-guided insertion of a new tip-conductive PICC is associated with a high rate of first-attempt success and low rate of catheter related complications.
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Affiliation(s)
- Yu-Xia Yin
- Department of Vascular and Intervention, Tenth Peoples' Hospital of Tongji University, Shanghai, China.,School of Materials Science and Engineering, University of Science and Technology, Beijing, China
| | - Wei Gao
- PICC Clinic, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Sheng-Yu Feng
- National Engineering Research Center for Colloidal Materials & Key Laboratory of Special Functional Aggregated Materials, Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, China
| | - Deng-Xu Wang
- National Engineering Research Center for Colloidal Materials & Key Laboratory of Special Functional Aggregated Materials, Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, China
| | - Min Wan
- Shandong Quality Inspection Center For Medical Devices, Jinan, Shandong, China.,Shandong Provincial Key Laboratory of Biological Evaluation of Medical Devices, Jinan, Shandong, China
| | - Cheng-Hu Liu
- Shandong Quality Inspection Center For Medical Devices, Jinan, Shandong, China.,Shandong Provincial Key Laboratory of Biological Evaluation of Medical Devices, Jinan, Shandong, China
| | - Lu-Ning Wang
- School of Materials Science and Engineering, University of Science and Technology, Beijing, China
| | - Ming-Kun Cao
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong, China
| | - Hai-Jun Zhang
- Department of Vascular and Intervention, Tenth Peoples' Hospital of Tongji University, Shanghai, China.,National United Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong, China
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Gu L, Xu L, Meng A, Shi R, Jiang D, Liu C, Mao J. Guidewire‐guided electrocardiogram for positioning the catheter tip of upper arm port in breast cancer patients. PRECISION MEDICAL SCIENCES 2021. [DOI: 10.1002/prm2.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lili Gu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Liyong Xu
- Department of General Surgery Nanjing Agriculture University Hospital Nanjing China
| | - Aifeng Meng
- Department of Nursing Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Ruchun Shi
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Dingbiao Jiang
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Chunli Liu
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Jing Mao
- Department of Vascular Access Center Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods. Am J Med 2021; 134:e79-e88. [PMID: 32673624 DOI: 10.1016/j.amjmed.2020.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. METHODS Prospectively collected data from patients that received peripherally inserted central catheters at 52 Michigan hospitals were analyzed. The method used to confirm tip confirmation at insertion and deep vein thrombosis outcomes were extracted from medical records. Multivariate models (accounting for the clustered nature of the data) were fitted to assess the association between peripherally inserted central catheter-related deep vein thrombosis and method of tip confirmation (electrocardiographic vs radiographic imaging). RESULTS A total of 42,687 peripherally inserted central catheters (21,098 radiology vs 21,589 electrocardiographic) were included. Patients receiving electrocardiographic-confirmed peripherally inserted central catheters had fewer comorbidities compared with those that underwent placement via radiology. Overall, deep vein thrombosis occurred in 594 (1.3%) of all peripherally inserted central catheters. Larger catheter size (odds radio [OR] 1.32; 95% confidence interval [CI], 0.93-1.90 per unit increase in gauge), history of deep vein thrombosis, and cancer were associated with increased risk of deep vein thrombosis (OR 2.00; 95% CI, 1.65-2.43 and OR 1.62; 95% CI, 1.16-2.26, respectively) using logistic regression. Following adjustment, electrocardiographic guidance was associated with a significant reduction in peripherally inserted central catheter-related deep vein thrombosis compared with radiographic imaging (OR 0.74; 95% CI, 0.58-0.93; P = .0098). CONCLUSION The use of electrocardiography to confirm peripherally inserted central catheter tip placement at the cavoatrial junction was associated with significantly fewer deep vein thrombosis events than radiographic imaging. Use of this approach for peripherally inserted central catheter insertion may help improve patient safety, particularly in high-risk patients.
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Corcuera Martínez MI, Aldonza Torres M, Díez Revilla AM, Maali Centeno S, Mañeru Oria A, Elizari Roncal I, Ibarra Marín B, Casado Del Olmo MI, Escobedo Romero R, Ferraz Torres M. Impact assessment following implementation of a vascular access team. J Vasc Access 2020; 23:135-144. [PMID: 33356810 DOI: 10.1177/1129729820984284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A vascular access team (VAT) was created in 2018 with the aim of improving vascular access and reducing complications associated with catheters. The impact of the introduction of a VAT in the insertion and maintenance of peripheral insertion central catheters (PICCs) was assessed. The cost-benefit associated with the use of a VAT was evaluated and the satisfaction of patients and professionals interacting with the VAT was measured. METHODS In a prospective study, 275 PICCs inserted by the VAT were assessed for their impact on complications. PICCs were implanted with maximum barrier measures using an ultrasound with IC-ECG. Also, patient and professional satisfaction have been analysed thought a questionnaire over the phone or online, and hospital financial data was used to assess the cost impact of the insertion methodology followed by the VAT versus Anaesthesia Service. RESULTS The thrombosis rate was 2.5% (7) and the bacteraemia rate was 1.1% (3). The use of the IC-ECG was correlated with a lower complication than the RX + IC-ECG (OR = 3.28, p = 0.021). In addition, there was a high level of perceived satisfaction for the patients surveyed and for the healthcare professionals involved in the care and management of these devices. The calculated saving for the implementation of the VAT was 61.81% compared with PICCs implanted in Anaesthesia Service. CONCLUSION Low complication rates and high overall satisfaction scores in patients and professionals were observed, showing that a specialist VAT can have a positive impact in the insertion of PICCs and which also has a clear economic benefit.
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Affiliation(s)
- Mª Inés Corcuera Martínez
- Head of the Information Systems and Computerized Clinical Record Department, Complejo Hospitalario de Navarra (CHN), Chair of the intravenous therapy expert committee in (CHN), Mutilva, Navarra, Spain
| | - Marco Aldonza Torres
- Specialist Surgery Unit, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain
| | | | | | - Amaya Mañeru Oria
- Head of Continuing Education, Teaching and Research Unit, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain
| | | | - Beatriz Ibarra Marín
- Head of Hematology Unit and VAT Coordinator, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain
| | | | | | - Marta Ferraz Torres
- Coordinator of computerized Clinical Records, Associate Professor at UPNA (Navarra University), Research member at IDISNA, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain
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Abstract
OBJECTIVES Perform a needs assessment by evaluating accuracy of PICU provider bedside ultrasound measurement of femoral vein diameter prior to utilization of the catheter-to-vein ratio for central venous catheter size selection. DESIGN Prospective observational cohort study. SETTING PICU within a quaternary care children's hospital. PATIENTS PICU patients greater than 30 days and less than 6 years without a femoral central venous catheter. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Gold-standard femoral vein diameter measurements were made by a radiologist, sonographer, or bedside ultrasound expert. PICU providers then repeated the femoral vein diameter measurements, and results were compared by Bland-Altman analysis with a priori accuracy goal of limits of agreement ± 15%. Among recruited patients (n = 27), the median age was 1.1 years (interquartile range 0.5-2.3 yr), weight was 9.0 kg (interquartile range 7.0-11.5 kg), and reference femoral vein diameter was 0.36 cm (interquartile range 0.28-0.45 cm). Providers performed 148 femoral vein diameter measurements and did not meet goal accuracy when compared with the reference measurement with a bias of 4% (95% of limits of agreement -62% to 70%). A majority of patients would have a catheter-to-vein ratio greater than 0.5 using either age-based central venous catheter size selection criterion (14/27) or the provider bedside ultrasound femoral vein diameter measurement (18/27). CONCLUSIONS PICU provider measurement of femoral vein diameter by bedside ultrasound is inaccurate when compared with expert reference measurement. Central venous catheter size selection based on age or PICU provider femoral vein diameter measurement can lead to a catheter-to-vein ratio greater than 0.5 and potentially increase the risk of catheter-associated venous thromboembolism. Structured bedside ultrasound training with assessment of accuracy is necessary prior to implementation of venous thromboembolism reduction efforts based on catheter-to-vein ratio recommendations.
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Ultrasound of Venous Diameters for Central Line Selection: Can We "Measure Up" to Expectations? Pediatr Crit Care Med 2020; 21:1105-1106. [PMID: 33278225 DOI: 10.1097/pcc.0000000000002501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Ponsoye M, Espinasse F, Coutte L, Lepeule R, Gnamien S, Hanslik T. [The use of venous catheter : Which ones to choose, how to prevent their complications?]. Rev Med Interne 2020; 42:411-420. [PMID: 33234320 DOI: 10.1016/j.revmed.2020.10.385] [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: 07/25/2019] [Revised: 09/08/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022]
Abstract
Intravenous catheters are multiple and essential for daily practice. They are also responsible for high morbidity and mortality. Simple or echo-guided peripheral venous catheters, midlines, PICCline, tunneled or non-tunneled central venous catheters, and implantable venous access device are currently at our disposal. Thus, catheter selection, duration and indications for use, and prevention and treatment of complications vary according to the situation. The objective of this update is to provide the clinician with an overview of knowledge and rules of good practice on the use of catheters.
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Affiliation(s)
- M Ponsoye
- Hôpital Foch, 40 rue Worth, 92150 Suresnes, France.
| | - F Espinasse
- AP-HP, hôpital Ambroise Paré, Equipe Opérationnelle Hygiène, 92100 Boulogne-Billancourt, France
| | - L Coutte
- AP-HP, hôpital Ambroise Paré, service de médecine interne, 92100 Boulogne-Billancourt, France
| | - R Lepeule
- Unité transversale de traitement des infections, département de virologie, bactériologie-hygiène, parasitologie-mycologie, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Gnamien
- AP-HP, hôpital Ambroise Paré, unité des dispositifs médicaux stériles, Pharmacie, 92100 Boulogne-Billancourt, France
| | - T Hanslik
- AP-HP, hôpital Ambroise Paré, service de médecine interne, 92100 Boulogne-Billancourt, France; Université Versailles Saint Quentin en Yvelines, UFR des sciences de la santé Simone Veil, 78000 Versailles, France
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Slaughter E, Kynoch K, Brodribb M, Keogh SJ. Evaluating the Impact of Central Venous Catheter Materials and Design on Thrombosis: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs 2020; 17:376-384. [PMID: 33098628 DOI: 10.1111/wvn.12472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thrombosis is a common complication associated with central venous catheter (CVC) insertion. Several antithrombogenic materials and alterations to catheter design have been developed to lower thrombosis rates. AIM To systematically evaluate the effectiveness and safety of antithrombogenic materials and alterations to CVC design on thrombosis rates. METHODS A systematic search was completed of main databases (CINAHL, EMBASE, MEDLINE, and PubMed) as well as trial registries and gray literature. Randomized controlled trials conducted in any age group, published in English language since 2008 reporting impact of different CVC designs or materials on thrombosis were included, to capture studies that reflect contemporary products and practice. Cochrane systematic review methodology was followed, including independent study selection and data extraction. Quality appraisal was conducted using the Cochrane risk of bias tool. A narrative synthesis and meta-analysis in RevMan were conducted. RESULTS From a possible 232 studies, nine studies met the inclusion criteria. Four studies (n = 1,320) assessed different catheter materials; four studies (n = 591) compared different CVC designs, and one study (n = 150) evaluated impact of combined design and material on outcomes. Meta-analysis demonstrated that neither catheter material nor design alone or in combination had a significant impact on thrombosis (RR: 0.98 [95% CI 0.87, 1.11]). Different catheter materials and design also had no significant impact on occlusion or CRBSI. Studies were of mixed quality overall. LINKING EVIDENCE TO ACTION Different CVC materials and designs were not associated with a reduction in the risk of either catheter-related thrombosis or infection. Overall reporting and small sample sizes make it difficult to draw firm conclusions. Larger, quality randomized trials are required to provide evidence about the possible merits of innovative catheter design and materials on patient outcomes.
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Affiliation(s)
- Eugene Slaughter
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia.,Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | | | - Megan Brodribb
- Library Services, Queensland University of Technology, Brisbane, Qld, Australia
| | - Samantha J Keogh
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia.,Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
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Fabiani A, Eletto V, Dreas L, Beltrame D, Sanson G. Midline or long peripheral catheters in difficult venous access conditions? A comparative study in patients with acute cardiovascular diseases. Am J Infect Control 2020; 48:1158-1165. [PMID: 31973988 DOI: 10.1016/j.ajic.2019.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Midline catheters (MCs) are commonly inserted in patients with difficult venous access (DVA) needing peripheral access. Recently, the alternative placement of ultrasound-guided long peripheral catheters (LPCs) has spread. However, no study has compared the reliability of the 2 devices. This study aims to compare the safety and reliability of MCs and LPCs in DVA patients. METHODS A retrospective cohort study was conducted, enrolling 184 DVA patients. Polyurethane MCs and 2 lengths of polyethylene LPCs (8/10 cm and 18 cm) were compared. The independent effect of catheter type on uncomplicated catheter survival was determined through a Cox regression analysis. RESULTS The relative incidences of overall catheter-related complications (CRCs) were 15.84 of 1,000, 10.64 of 1,000, and 6.27 of 1,000 catheter-days for 8/10 cm-LPCs, 18 cm-LPCs, and MCs, respectively. The relative incidences of catheter-related bloodstream infections were 0.72 of 1,000 for both length LPCs and 0.48 of 1,000 catheter-days for MCs. Compared to MCs, a significant increase in CRC risk for 8/10 cm LPCs (hazard ratio [HR] 5.328; 95% confidence interval [CI] 2.118-13.404; P < 0.001) was found, along with a nonsignificant trend toward an increased risk for 18 cm-LCPs (HR 2.489; 95% CI 0.961-6.448; P = 0.060). CONCLUSION MCs allow for longer uncomplicated indwelling times than LPCs. The decision regarding which catheter to use should consider the planned duration of intravenous therapy, the patient's clinical condition, and the cost of the device.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Valentina Eletto
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Lorella Dreas
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Daria Beltrame
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
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Venous Thromboembolism After Peripherally Inserted Central Catheters Placement in Children With Acute Leukemia: A Single-center Retrospective Cohort Study. J Pediatr Hematol Oncol 2020; 42:e407-e409. [PMID: 32427704 DOI: 10.1097/mph.0000000000001832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore the incidence rate and characteristics of symptomatic venous thromboembolism (VTE) after peripherally inserted central catheters (PICC) placement in children with acute leukemia (AL). METHODS The authors performed a retrospective study aiming at children admitted to Pediatric Blood Diseases Center with a new diagnosis of AL and received a PICC insertion, collected the clinical materials of all venous thrombosis cases, and analyzed the incidence rate and characteristics in various types of AL. RESULTS From September 2007 to December 2018, a total of 2423 patients got PICCs at least once, of whom 29 patients experienced thrombosis events and the overall incidence rate of symptomatic VTE after PICC insertion was 1.2%. Deep venous thrombosis accounted for the majority with 75.9%. Seven cases of cerebral venous sinus thrombosis were documented and they all developed in patients with acute lymphoblastic leukemia (ALL). No pulmonary embolism was detected. Patients with acute myeloid leukemia (AML) had an identical risk of thrombosis to patients with acute lymphoblastic leukemia (ALL) (1.7% vs. 1.09%, P>0.05). All thrombi in patients with AML were located on the upper extremity, whereas in the ALL group about half of the thromboembolism developed in other locations. There were no statistical differences between patients in different clinical trials of the ALL group (0.7% vs. 1.6%, P>0.05). CONCLUSIONS The incidence rates of symptomatic VTE after PICC placement in children with AL in our center were relatively low and acceptable. For patients with AML, PICC placement plays the most important role in venous thrombosis. However, in patients with ALL, the potential risk factors were more complex.
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McDiarmid S, Larocque G. Time to rethink vascular access in patients with breast cancer. ACTA ACUST UNITED AC 2020; 29:S32-S38. [DOI: 10.12968/bjon.2020.29.14.s32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breast cancer management is a rapidly evolving field. Diagnosis and treatment options have changed dramatically over the years, as have options for vascular access devices used to administer therapies. We now need to critically rethink vascular access device options for our breast cancer patients.Breast cancer (BC) is the most commonly diagnosed cancer among Canadian women. Although BC incidence continues to rise, the overall mortality rate in Canada is the lowest it has been for 70 years. The five-year net survival is 87%, and 83% of women are alive at 10 years. New oral therapies, shorter dose-dense treatments, and decreased use of anthracycline-base regimens are reducing the need for central venous access devices during acute treatment phases. However, these survivors go on to develop other health issues requiring routine venipuncture and insertion of vascular access devices.Breast cancer-related lymphedema (BCRL) is a chronic complication that has no cure and no proven prevention strategies. Approximately 21% of breast cancer survivors are at risk of developing BCRL. Of those patients who do develop BCRL, 70% do so within two years of surgery, 90% within three years, and another one percent per year thereafter. The literature supports axillary lymph node dissection, mastectomy, administration of chemotherapy or radiotherapy, and obesity, as risk factors for the development of BCRL. However, 40% of patients who develop BCRL have no identifiable risk factors. Broader risk reduction strategies developed are not evidence based, the most commonly cited being avoidance of needle sticks. Large cohort studies have found no significant association between blood draws and intravenous infusion in the surgical arm with the development of BCRL. Recommendations that effectively eliminate vascular access on the surgical side for the patient's entire lifetime are neither necessary nor realistic.Vascular access specialists can provide leadership by developing standardized, evidence-informed recommendations for safe vascular access and infusion practices for this patient population.
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Affiliation(s)
- Sheryl McDiarmid
- Advanced Practice Nurse in the Corporate Vascular Access, Apheresis and Blood and Marrow Transplant Programs at The Ottawa Hospital. She has presented and published extensively on all areas of her clinical expertise. Sheryl is the past President of the Canadian Vascular Access Association
| | - Gail Larocque
- Nurse Practitioner (NP) in the Wellness Beyond Cancer Program, at the Ottawa Regional Cancer Centre. She completed her Nurse Practitioner's program at the University of Ottawa, and her Masters of Nursing at Charles Sturt University, New South Wales, Australia
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Yoshimaru K, Matsuura T, Uchida Y, Kajihara K, Toriigahara Y, Kawano Y, Kondo T, Takahashi Y, Matsuoka W, Kaku N, Maki J, Taguchi T. Ultrasound-guided double central venous access for azygos vein via the ninth and tenth intercostal veins. J Vasc Access 2020; 22:304-309. [PMID: 32605473 DOI: 10.1177/1129729820937133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Some patients with intestinal failure, who are dependent on total parenteral nutrition for long periods, suffer from a lack of suitable conventional venous access points, including axillary, external jugular, internal jugular, subclavian, saphenous, and the brachio-cephalic and femoral veins, due to their occlusion. Furthermore, extensive central venous stenosis and/or thrombosis of the superior and inferior vena cava may preclude further catheterization, so uncommon routes must be used, which can be challenging. In such patients, the azygos vein via the intercostal vein is a viable candidate. Thoracotomy-assisted, thoracoscopy-assisted, and cut-down procedures are currently suggested such access. We found that ultrasound-guided percutaneous puncture method was a safe and minimally invasive approach and successfully placed two central venous lines in preparation for small bowel transplantation via two different intercostal veins (ninth and tenth). Although the lung was actually located just below the target veins, an ultrasound provided augmented and clear vision, which contributed to the safe performance of the procedure without the need for invasive surgical intervention, such as thoracotomy, thoracoscopy, or rib resection using the cut-down technique. Furthermore, constant positive-pressure ventilation during vein puncture under general anesthesia also helps avoid venous collapse. Despite carrying a slight risk of light injury to the lung, artery, and nerve along with the vein compared to other procedures, we believe that ultrasound-guided puncture under general anesthesia is feasible as a minimally invasive method.
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Affiliation(s)
- Koichiro Yoshimaru
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yasuyuki Uchida
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Keisuke Kajihara
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yukihiro Toriigahara
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yuki Kawano
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Takuya Kondo
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yoshiaki Takahashi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.,Pediatric Emergency and Critical Care Medicine, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
| | - Wakato Matsuoka
- Pediatric Emergency and Critical Care Medicine, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
| | - Noriyuki Kaku
- Pediatric Emergency and Critical Care Medicine, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
| | - Jun Maki
- Emergency and Critical Care Center, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.,Pediatric Emergency and Critical Care Medicine, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
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Song X, Lu H, Chen F, Bao Z, Li S, Li S, Peng Y, Liu Q, Chen X, Li J, Zhang W. A longitudinal observational retrospective study on risk factors and predictive model of PICC associated thrombosis in cancer patients. Sci Rep 2020; 10:10090. [PMID: 32572092 PMCID: PMC7308336 DOI: 10.1038/s41598-020-67038-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
To analyze the incidence of PICC associated venous thrombosis. To predict the risk factors of thrombosis. To validate the best predictive model in predicting PICC associated thrombosis. Consecutive oncology cases in 341 who initially naive intended to be inserted central catheter for chemotherapy, were recruited to our dedicated intravenous lab. All patients used the same gauge catheter, Primary endpoint was thrombosis formation, the secondary endpoint was infusion termination without thrombosis. Two patients were excluded. 339 patients were divided into thrombosis group in 59 (17.4%) and non-thrombosis Group in 280 (82.6%), retrospectively. Tumor, Sex, Age, Weight, Height, BMI, BSA, PS, WBC, BPC, PT, D-dimer, APTT, FIB, Smoking history, Location, Catheter length, Ratio and Number as independent variables were analyzed by Fisher's scoring, then Logistic risk regression, ROC analysis and nomogram was introduced. Total incidence was 17.4%. Venous mural thrombosis in 2 (3.4%), "fibrin sleeves" in 55 (93.2%), mixed thrombus in 2 (3.4%), symptomatic thrombosis in 2 (3.4%), asymptomatic thrombosis in 57 (96.6%), respectively. Height (χ² = 4.48, P = 0.03), D-dimer (χ² = 37.81, P < 0.001), Location (χ² = 7.56, P = 0.006), Number (χ² = 43.64, P < 0.001), Ratio (χ² = 4.38, P = 0.04), and PS (χ² = 58.78, P < 0.001), were statistical differences between the two groups analyzed by Fisher's scoring. Logistic risk regression revealed that Height (β = -0.05, HR = 0.95, 95%CI: 0.911-0.997, P = 0.038), PS (β = 1.07, HR = 2.91, 95%CI: 1.98-4.27, P < 0.001), D-dimer (β0.11, HR = 1.12, 95%CI: 1.045-1.200, P < 0.001), Number (β = 0.87, HR = 2.38, 95% CI: 1.619-3.512, P < 0.001) was independently associated with PICC associated thrombosis. The best prediction model, D-dimer + Number as a novel co-variable was validated in diagnosing PICC associated thrombosis before PICC. Our research revealed that variables PS, Number, D-dimer and Height were risk factors for PICC associated thrombosis, which were slightly associated with PICC related thrombosis, in which, PS was the relatively strongest independent risk factor of PICC related thrombosis.
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Affiliation(s)
- Xiaomin Song
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Hong Lu
- Administrative Department of Nurse, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Fang Chen
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Zuowei Bao
- Department of Ultrasound, The third people's Hospital of ChangZhou, JiangSu Province, 213001, China
| | - Shanquan Li
- Department of Intravenous lab, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Siqin Li
- Department of Intravenous lab, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Yinghua Peng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Qiao Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Xiaohui Chen
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Jingzhen Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China
| | - Weimin Zhang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ShenZhen, 518116, China.
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48
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Bhargava M, Broccard S, Bai Y, Wu B, Dincer EH, Broccard A. Risk factors for peripherally inserted central catheter line-related deep venous thrombosis in critically ill intensive care unit patients. SAGE Open Med 2020; 8:2050312120929238. [PMID: 32551112 PMCID: PMC7278290 DOI: 10.1177/2050312120929238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/30/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction: Central venous access using peripherally inserted central catheters is frequently used for patients receiving intravenous medications in the hospital or outpatients. Although there are several benefits of peripherally inserted central catheters, such as ease of insertion, low procedure-related risk and higher patient satisfaction, there are complications associated with peripherally inserted central catheter use. Despite some studies evaluating peripherally inserted central catheter line–related complications, the factors associated with peripherally inserted central catheter–related deep venous thrombosis in critically ill medical-surgical patients are poorly described. The objective of this case-control study was to identify the risk factors associated with peripherally inserted central catheter line–related deep venous thrombosis in critically ill medical-surgical intensive care unit patients in a community hospital. Methods: We abstracted relevant clinical data from 21 cases with symptomatic peripherally inserted central catheter–related deep venous thrombosis and 42 controls with peripherally inserted central catheters but no deep venous thrombosis. Results: Of the factors evaluated, female gender, the use of triple lumen peripherally inserted central catheters, larger outer diameter, and open (vs valve) peripherally inserted central catheters were associated with venous thrombosis. In this retrospective study, we did not identify any association of peripherally inserted central catheter–related deep venous thrombosis with a prior history of deep venous thrombosis, use of alteplase, antiplatelet therapy, prophylactic or therapeutic anticoagulation, international normalized ratio, platelet count and the use of peripherally inserted central catheters for total parenteral nutrition. Conclusion: Our study indicates that the catheter size relative to the diameter of the vein could be an important risk factor for the development of peripherally inserted central catheter–related deep venous thrombosis. The study findings should be confirmed in a larger study designed to identify risk factors of peripherally inserted central catheter–related deep venous thrombosis. In the meantime, the peripherally inserted central catheter lines should be used judiciously in critically ill patients.
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Affiliation(s)
- M Bhargava
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Y Bai
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - B Wu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - E H Dincer
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - A Broccard
- Division of General Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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49
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Ullman AJ, Bernstein SJ, Brown E, Aiyagari R, Doellman D, Faustino EVS, Gore B, Jacobs JP, Jaffray J, Kleidon T, Mahajan PV, McBride CA, Morton K, Pitts S, Prentice E, Rivard DC, Shaughnessy E, Stranz M, Wolf J, Cooper DS, Cooke M, Rickard CM, Chopra V. The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC. Pediatrics 2020; 145:S269-S284. [PMID: 32482739 DOI: 10.1542/peds.2019-3474i] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. RESULTS The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. CONCLUSIONS In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of General Medicine and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ranjit Aiyagari
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - Darcy Doellman
- Division of Pediatric Cardiology, Department of Pediatrics, and
| | - E Vincent S Faustino
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Section of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Beth Gore
- Association for Vascular Access, Herriman, Utah
| | | | - Julie Jaffray
- Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Prashant V Mahajan
- Department of Emergency Medicine and Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Craig A McBride
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kayce Morton
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Stephanie Pitts
- St Joseph's Children's Hospital, Tampa, Florida.,B. Braun Medical, Bethlehem, Pennsylvania
| | - Elizabeth Prentice
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Victoria, Australia
| | - Douglas C Rivard
- Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Erin Shaughnessy
- College of Medicine, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Marc Stranz
- Stranz Crossley Inc, Philadelphia, Pennsylvania
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David S Cooper
- Department of Pediatrics, College of Medicine, University of Cincinnati and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Division of Hospital Medicine, Department of Internal Medicine
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50
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Ullman AJ, Chopra V, Brown E, Kleidon T, Cooke M, Rickard CM, Bernstein SJ. Developing Appropriateness Criteria for Pediatric Vascular Access. Pediatrics 2020; 145:S233-S242. [PMID: 32482737 DOI: 10.1542/peds.2019-3474g] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the methodology undertaken to provide guidance on the appropriateness, as well as inappropriateness, of vascular access device selection, characteristics, and insertion technique for pediatric patients. METHODS The RAND Corporation-University of California, Los Angeles Appropriateness Method was used. After definition of key terms and scope, a systematic review of the pediatric vascular access literature was undertaken. Clinical scenarios were developed to reflect the common indications for vascular access across pediatric health care. These were sectioned according to (1) device selection, (2) device characteristics, and (3) insertion technique. An interdisciplinary panel of experts (N = 14) consisting of leading experts representing diverse pediatric clinical disciplines including anesthesiology, cardiology and cardiac surgery, critical care and emergency, general surgery, hematology and oncology, hospital medicine, infectious disease, interventional radiology, pharmacology, regional pediatric hospitalist, and vascular access nursing specialties was convened. The scenarios were rated for appropriateness by the panel over 2 rounds (1 [highly inappropriate] to 9 [highly appropriate]). Round 1 ratings were completed anonymously and independently by panel members and classified into 3 levels of appropriateness: appropriate, uncertain, and inappropriate, or disagreement. For round 2, panelists met in-person to discuss the round 1 ratings and independently rerated the indications. All indications were reclassified into 3 levels of appropriateness or disagreement. CONCLUSIONS The RAND Corporation-University of California, Los Angeles Appropriateness Method provides a rigorous, in-depth and transparent methodology to develop the first appropriateness criteria for the selection of pediatric vascular access devices in a range of patient groups.
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Affiliation(s)
- Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Divisions of Hospital Medicine and.,Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan; and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
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