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Bucyk TB, Collins CR, Macuja JT, Boeck MA, Wong JK. Subclavian line infiltration causing neck compartment syndrome and bradycardic arrest: A case report. Trauma Case Rep 2024; 52:101065. [PMID: 38957175 PMCID: PMC11217749 DOI: 10.1016/j.tcr.2024.101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/04/2024] Open
Abstract
Unrecognized central venous catheter (CVC) infiltration is an uncommon but potentially life-threatening complication. For instance, a malpositioned subclavian line can infuse into the mediastinum, pleural cavity, or interstitial space of the neck. We present the case of a 30-year-old male with gunshot wounds to the right chest, resuscitated with an initially functional left subclavian CVC, which later infiltrated into the neck causing compression of the carotid sinus and consequent bradycardic arrest. Return of spontaneous circulation (ROSC) was achieved following intravenous epinephrine, cardiac massage, and emergency neck exploration and cervical fasciotomy. Our case highlights the importance of frequent reassessment of lines, especially those placed during fast-paced, high-intensity clinical situations. We recommend being mindful when using rapid transfusion devices as an interstitial catheter may not mount enough back pressure to trigger the system's alarm before significant tissue damage or compartment syndrome occurs.
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Affiliation(s)
- Taylor B. Bucyk
- University of California San Francisco, Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Caitlin R. Collins
- University of California San Francisco, Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Jeffrey T. Macuja
- University of California San Francisco, Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Marissa A. Boeck
- University of California San Francisco, Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Jenson K. Wong
- University of California San Francisco, Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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Xiao L, Chen X, Zhang D. Carotid Artery Aneurysm-Induced Mediastinal Hematoma Leading to Airway Compression-A Rare Complication of Internal Jugular Vein Puncture. Vasc Endovascular Surg 2024; 58:676-679. [PMID: 38648073 DOI: 10.1177/15385744241247535] [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] [Indexed: 04/25/2024]
Abstract
Carotid artery puncture is a common complication of internal jugular vein (IJV) catheterization. However, there are few reports about an aneurysm from the carotid artery that can develop into an occult mediastinal hematoma, leading to airway compression. In this case study, we present the case of a 71-year-old male who experienced an aneurysm and delayed mediastinal hematoma, ultimately resulting in airway compression after right jugular line insertion. Our findings highlight the importance of not only addressing local hematoma formation at the puncture site promptly, but also recognizing the potential for aneurysm extension into the mediastinum and the formation of an occult hematoma, which can lead to airway compression. Additionally, we provide a summary of landmark technique precautions that can help reduce the occurrence of such severe complications.
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Affiliation(s)
- Linlin Xiao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoying Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tamaoki Y, Kamidani R, Okada H, Miyake T, Suzuki K, Yoshida T, Kumada K, Yoshida S, Ogura S. Right subclavian artery injury during catheter insertion into the right internal jugular vein treated with endovascular stent graft placement after balloon occlusion test: A case report. Radiol Case Rep 2024; 19:2579-2584. [PMID: 38645954 PMCID: PMC11026536 DOI: 10.1016/j.radcr.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
Subclavian artery injuries during internal jugular vein puncture when attempting central venous catheter insertion are rare. A 60-year-old man undergoing treatment for neuromyelitis optica with paralysis and sensory loss developed a complication during catheter placement into his right internal jugular vein for plasmapheresis. His previous physician felt resistance and discontinued the procedure. The patient later developed mild dyspnea and dysphagia. Computed tomography scans indicated thrombus formation and tracheal deviation. Contrast-enhanced computed tomography scans showed right subclavian artery injury with extravasation and a large pseudoaneurysm. Following transferal to our hospital, he was stable and asymptomatic; however, contrast-enhanced computed tomography scans showed a pseudoaneurysm located proximal to the right subclavian artery. Considering challenges with compression hemostasis and the invasiveness of open surgery, endovascular treatment was selected using a VIABAHN stent graft. A balloon occlusion test of the right vertebral artery was performed to assess stroke risk. Prophylactic embolization of the right vertebral artery, internal thoracic artery, and thyrocervical trunk were performed to prevent a type 2 endoleak. On hospital day 5, our patient showed no postoperative complications and was transferred to the referring hospital. Follow-up imaging showed the graft was intact with no pseudoaneurysm, confirming successful treatment. Endovascular treatment with a stent graft is highly effective for peripheral artery injuries. Using a balloon occlusion test to assess collateral blood flow and stroke risk is essential pretreatment, especially when a graft might occlude the vertebral artery. Balloon occlusion tests are recommended when planning treatment for iatrogenic and other types of subclavian artery injuries.
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Affiliation(s)
- Yuto Tamaoki
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Ryo Kamidani
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Hideshi Okada
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Takahito Miyake
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Kodai Suzuki
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Takahiro Yoshida
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Keisuke Kumada
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
- Patient Safety Division, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Shozo Yoshida
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
- Abuse Prevention Center, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
| | - Shinji Ogura
- Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan
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Zhang L, Dong YF, Chen Y, Li XG, Wang YH, Wang Y, Ge ZT, Wang X, Cai S, Yang X, Zhu QL, Li JC. Impact of Microbubble Degradation and Flow Velocity on Subharmonic-aided Pressure Estimation (SHAPE): An Experimental Investigation. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1020-1027. [PMID: 38594125 DOI: 10.1016/j.ultrasmedbio.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to investigate the impact of microbubble degradation and flow velocity on Sub-Harmonic Aided Pressure Estimation (SHAPE), and to explore the correlation between subharmonic amplitude and pressure as a single factor. METHODS We develop an open-loop vascular phantom platform system and utilize a commercial ultrasound machine and microbubbles for subharmonic imaging. Subharmonic amplitude was measured continuously at constant pressure and flow velocity to assess the impact of microbubble degradation. Flow velocity was varied within a range of 4-14 cm/s at constant pressure to investigate its relationship to subharmonic amplitude. Furthermore, pressure was varied within a range of 10-110 mm Hg at constant flow velocity to assess its isolated effect on subharmonic amplitude. RESULTS Under constant pressure and flow velocity, subharmonic amplitude exhibited a continuous decrease at an average rate of 0.221 dB/min, signifying ongoing microbubble degradation during the experimental procedures. Subharmonic amplitude demonstrated a positive correlation with flow velocity, with a variation ratio of 0.423 dB/(cm/s). Under controlled conditions of microbubble degradation and flow velocity, a strong negative linear correlation was observed between pressure and subharmonic amplitude across different Mechanical Index (MI) settings (all R2 > 0.90). The sensitivity of SHAPE was determined to be 0.025 dB/mmHg at an MI of 0.04. CONCLUSION The assessment of SHAPE sensitivity is affected by microbubble degradation and flow velocity. Excluding the aforementioned influencing factors, a strong linear negative correlation between pressure and subharmonic amplitude was still evident, albeit with a sensitivity coefficient lower than previously reported values.
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Affiliation(s)
- Li Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Fan Dong
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yao Chen
- Department of Ultrasound, GE Healthcare Medical System (China), Shanghai, China
| | - Xiao-Gang Li
- Biobank Facility, National Infrastructures for Translational Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ya-Hong Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhi-Tong Ge
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Sheng Cai
- Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Quan K, Mao Z, Lu Y, Qin Y, Wang S, Yu C, Bi X, Tang H, Ren X, Chen D, Cheng Y, Wang Y, Zheng Y, Xia D. Composited silk fibroins ensured adhesion stability and magnetic controllability of Fe 3O 4-nanoparticle coating on implant for biofilm treatment. MATERIALS HORIZONS 2024; 11:3157-3165. [PMID: 38629215 DOI: 10.1039/d4mh00097h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Magnetic propulsion of nano-/micro-robots is an effective way to treat implant-associated infections by physically destroying biofilm structures to enhance antibiotic killing. However, it is hard to precisely control the propulsion in vivo. Magnetic-nanoparticle coating that can be magnetically pulled off does not need precise control, but the requirement of adhesion stability on an implant surface restricts its magnetic responsiveness. Moreover, whether the coating has been fully pulled-off or not is hard to ensure in real-time in vivo. Herein, composited silk fibroins (SFMA) are optimized to stabilize Fe3O4 nanoparticles on a titanium surface in a dry environment; while in an aqueous environment, the binding force of SFMA on titanium is significantly reduced due to hydrophilic interaction, making the coating magnetically controllable by an externally-used magnet but still stable in the absence of a magnet. The maximum working distance of the magnet can be calculated using magnetomechanical simulation in which the yielding magnetic traction force is strong enough to pull Fe3O4 nanoparticles off the surface. The pulling-off removes the biofilms that formed on the coating and enhances antibiotic killing both in vitro and in a rat sub-cutaneous implant model by up to 100 fold. This work contributes to the practical knowledge of magnetic propulsion for biofilm treatment.
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Affiliation(s)
- Kecheng Quan
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Zhinan Mao
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Yupu Lu
- Department of Dental Materials, Peking University School and Hospital of Stomatology, & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
| | - Yu Qin
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Shuren Wang
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Chunhao Yu
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Xuewei Bi
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Hao Tang
- Department of Dental Materials, Peking University School and Hospital of Stomatology, & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
| | - Xiaoxiang Ren
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China
| | - Dafu Chen
- Laboratory of Bone Tissue Engineering, Beijing Laboratory of Biomedical Materials, National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Yan Cheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Yong Wang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Dandan Xia
- Department of Dental Materials, Peking University School and Hospital of Stomatology, & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing 100081, China.
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6
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Ke Y, Meng H, Du Z, Zhang W, Ma Q, Huang Y, Cui L, Lei Y, Yang Z. Bioinspired super-hydrophilic zwitterionic polymer armor combats thrombosis and infection of vascular catheters. Bioact Mater 2024; 37:493-504. [PMID: 38698921 PMCID: PMC11063950 DOI: 10.1016/j.bioactmat.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Thrombosis and infection are two major complications associated with central venous catheters (CVCs), which significantly contribute to morbidity and mortality. Antifouling coating strategies currently represent an efficient approach for addressing such complications. However, existing antifouling coatings have limitations in terms of both duration and effectiveness. Herein, we propose a durable zwitterionic polymer armor for catheters. This armor is realized by pre-coating with a robust phenol-polyamine film inspired by insect sclerotization, followed by grafting of poly-2-methacryloyloxyethyl phosphorylcholine (pMPC) via in-situ radical polymerization. The resulting pMPC coating armor exhibits super-hydrophilicity, thereby forming a highly hydrated shell that effectively prevents bacterial adhesion and inhibits the adsorption and activation of fibrinogen and platelets in vitro. In practical applications, the armored catheters significantly reduced inflammation and prevented biofilm formation in a rat subcutaneous infection model, as well as inhibited thrombus formation in a rabbit jugular vein model. Overall, our robust zwitterionic polymer coating presents a promising solution for reducing infections and thrombosis associated with vascular catheters.
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Affiliation(s)
- You Ke
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
- School of Materials Science and Engineering, Key Lab of Advanced Technology for Materials of Education Ministry, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Haotian Meng
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
- School of Materials Science and Engineering, Key Lab of Advanced Technology for Materials of Education Ministry, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Zeyu Du
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
- School of Materials Science and Engineering, Key Lab of Advanced Technology for Materials of Education Ministry, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Wentai Zhang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - Qing Ma
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
- School of Materials Science and Engineering, Key Lab of Advanced Technology for Materials of Education Ministry, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Yuting Huang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
| | - Linxian Cui
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Cardiology, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, Sichuan, 611137, China
| | - Yifeng Lei
- The Institute of Technological Science, Wuhan University, Wuhan, 430072, China
| | - Zhilu Yang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, Guangdong, 523000, China
- School of Materials Science and Engineering, Key Lab of Advanced Technology for Materials of Education Ministry, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
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Brown DC, Nguyen K, Miller SR, Moore JZ. Identifying diversity of patient anatomy through automated image analysis of clinical ultrasounds. J Ultrasound 2024:10.1007/s40477-024-00908-6. [PMID: 38910220 DOI: 10.1007/s40477-024-00908-6] [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] [Received: 09/07/2023] [Accepted: 04/06/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Central venous catheterization (CVC) carries inherent risks which can be mitigated through the use of appropriate ultrasound-guidance during needle insertion. This study aims to comprehensively understand patient anatomy as it is visualized during CVC by employing a semi-automated image analysis method to track the internal jugular vein and carotid artery throughout recorded ultrasound videos. METHODS The ultrasound visualization of 50 CVC procedures were recorded at Penn State Health Milton S. Hershey Medical Center. The developed algorithm was used to detect the vessel edges, calculating metrics such as area, position, and eccentricity. RESULTS Results show typical anatomical variations of the vein and artery, with the artery being more circular and posterior to the vein in most cases. Notably, two cases revealed atypical artery positions, emphasizing the algorithm's precision in detecting anomalies. Additionally, dynamic vessel properties were analyzed, with the vein compressing on average to 13.4% of its original size and the artery expanding by 13.2%. CONCLUSION This study provides valuable insights which can be used to increase the accuracy of training simulations, thus enhancing medical education and procedural expertise. Furthermore, the novel approach of employing automated data analysis techniques to clinical recordings showcases the potential for continual assessment of patient anatomy, which could be useful in future advancements.
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Affiliation(s)
- Dailen C Brown
- Department of Mechanical Engineering, The Pennsylvania State University, State College, USA
| | | | - Scarlett R Miller
- Department of Engineering Design and Industrial Engineering, The Pennsylvania State University, State College, USA
| | - Jason Z Moore
- Department of Mechanical Engineering, The Pennsylvania State University, State College, USA.
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Buehler PK, Wendel-Garcia PD, Müller M, Schmidt MT, Schuepbach RA, Lohmeyer Q, Hofmaenner DA. Where do ICU trainees really look? An eye-tracking analysis of gaze patterns during central venous catheter insertion. J Vasc Access 2024:11297298241258628. [PMID: 38856000 DOI: 10.1177/11297298241258628] [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: 06/11/2024] Open
Abstract
BACKGROUND There is limited knowledge about gaze patterns of intensive care unit (ICU) trainee doctors during the insertion of a central venous catheter (CVC). The primary objective of this study was to examine visual patterns exhibited by ICU trainee doctors during CVC insertion. Additionally, the study investigated whether differences in gaze patterns could be identified between more and less experienced trainee doctors. METHODS In a real-life, prospective observational study conducted at the interdisciplinary ICU at the University Hospital Zurich, Switzerland, ICU trainee doctors underwent eye-tracking during CVC insertion in a real ICU patient. Using mixed-effects model analyses, the primary outcomes were dwell time, first fixation duration, revisits, fixation count, and average fixation time on different areas of interest (AOI). Secondary outcomes were above eye-tracking outcome measures stratified according to experience level of participants. RESULTS Eighteen participants were included, of whom 10 were inexperienced and eight more experienced. Dwell time was highest for CVC preparation table (p = 0.02), jugular vein on ultrasound image (p < 0.001) and cervical puncture location (p < 0.001). Concerning experience, dwell time and revisits on jugular vein on ultrasound image (p = 0.02 and p = 0.04, respectively) and cervical puncture location (p = 0.004 and p = 0.01, respectively) were decreased in more experienced ICU trainees. CONCLUSIONS Various AOIs have distinct significance for ICU trainee doctors during CVC insertion. Experienced participants exhibited different gaze behavior, requiring less attention for preparation and handling tasks, emphasizing the importance of hand-eye coordination.
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Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Intensive Care Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Mattia Müller
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marc T Schmidt
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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9
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Pour L, Micheva I, Usenko G, Mikala G, Masszi T, Simeonova K, Thuresson M, Huledal G, Norin S, Bakker NA, Minarik J. PORT: A Randomized, Cross-Over, Phase 2 Study of Melflufen Peripheral Versus Central Intravenous Administration in Patients With Relapsed/Refractory Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e267-e275.e2. [PMID: 38490927 DOI: 10.1016/j.clml.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Melflufen, a first-in-class alkylating peptide-drug conjugate, rapidly enters tumor cells and metabolizes to melphalan. In previous studies, melflufen was administered via central venous catheter (CVC). However, administration by peripheral venous catheter (PVC) may be preferable. PATIENTS AND METHODS PORT was a two-period, phase 2 crossover study of CVC versus PVC melflufen administration in patients with relapsed/refractory multiple myeloma. Adults with ≥ 2 prior therapies refractory to/intolerant of an immunomodulatory drug and a proteasome inhibitor were randomized 1:1 to weekly oral dexamethasone plus melflufen (40 mg) via CVC or PVC infusion on day 1 of 28-day cycle 1. In cycle 2, patients continued dexamethasone and crossed over to the other melflufen administration route. In cycle 3, all patients received melflufen until progression; PVC or CVC routes were allowed based upon investigator decision. Pharmacokinetic sampling was performed during and after melflufen infusion. Primary endpoints were melphalan pharmacokinetic parameters (Cmax, AUC(0-t), and AUC(0-∞)) and frequency and severity of PVC-related local reactions. RESULTS The 90% CIs for adjusted geometric mean ratios for pharmacokinetic parameters following CVC versus PVC administration were within the 0.8-1.25 bioequivalence range (Cmax 0.946 [90% CI: 0.849, 1.053]; AUC(0-t) 0.952 [90% CI: 0.861, 1.053]; AUC(0-∞) 0.955 [90% CI: 0.863, 1.058]). In both arms, adverse events were primarily hematological and similar; no phlebitis or local infusion-related reactions occurred. CONCLUSION Melflufen PVC and CVC administrations are bioequivalent based on melphalan pharmacokinetic parameters. Melflufen via PVC was well tolerated, with no infusion-related reactions or new safety signals and may represent an alternative route of administration.
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Affiliation(s)
- Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ilina Micheva
- Hematology Clinic, University Hospital "St. Marina," Medical University, Varna, Bulgaria
| | - Ganna Usenko
- City Clinical Hospital #4 of Dnipro, Dnipro, Ukraine
| | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, National Institute for Hematology and Infectious Diseases, South Pest Central Hospital, Budapest, Hungary
| | - Tamas Masszi
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Kameliya Simeonova
- Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | | | | | | | | | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
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10
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Koudounas G, Giannopoulos S, Volteas P, Aljobeh A, Karkos C, Virvilis D. Arteriovenous Fistula Maturation in Patients with Ipsilateral Versus Contralateral Tunneled Dialysis Catheter: A Systematic Review and Meta-analysis. Ann Vasc Surg 2024; 103:14-21. [PMID: 38307236 DOI: 10.1016/j.avsg.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Although it is evident that a prior history of tunneled dialysis catheter (TDC) affects arteriovenous fistula (AVF) function, it is unclear whether its location (contralateral versus ipsilateral to AVF) has any effect on AVF maturation and failure rates. We aimed to document this possible effect. METHODS This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing outcomes between patients with contralateral TDC (CONTRA group) and those with ipsilateral one (IPSI group) were examined for inclusion. A random effects model meta-analysis of the odds ratio (OR) was conducted. Primary outcomes were AVF functional maturation, assisted maturation, and failure rates. RESULTS Four eligible studies comprising 763 patients were included in the meta-analysis. There were no significant differences in terms of AVF functional maturation (OR: 1.49; 95% confidence interval [CI]: 0.64-3.47; I2 = 83.4%), assisted maturation (OR: 0.59; 95% CI: 0.29-1.19; I2 = 61.4%), and failure rates (OR: 0.67; 95% CI: 0.29-1.58; I2 = 83.3%) between the 2 study groups. CONCLUSIONS TDC laterality seems not to affect fistula maturation rate in patients requiring TDC placement and concurrent AVF creation, but rather, vein- and patient-related characteristics might play a more important role in choosing TDC access site. Further studies are needed to validate these results.
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Affiliation(s)
- Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Ahmad Aljobeh
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Christos Karkos
- Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Dimitrios Virvilis
- Department of Vascular and Endovascular Surgery, St Francis Hospital & Heart Center, Roslyn, NY.
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11
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Christensen J, Andersson E, Sjöberg F, Hellgren E, Harbut P, Harbut J, Sjövall F, von Bruhn Gufler C, Mårtensson J, Rubenson Wahlin R, Joelsson-Alm E, Cronhjort M. Adverse Events of Peripherally Administered Norepinephrine During Surgery: A Prospective Multicenter Study. Anesth Analg 2024; 138:1242-1248. [PMID: 38180886 DOI: 10.1213/ane.0000000000006806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Perioperative treatment of hypotension by intravenous administration of norepinephrine in a peripheral vein can lead to adverse events, for example, tissue necrosis. However, the incidence and severity of adverse events during perioperative administration are unknown. METHODS This was a prospective observational study conducted at 3 Swedish hospitals from 2019 to 2022. A total of 1004 patients undergoing surgery, who met the criteria for perioperative peripheral norepinephrine administration, were included. The infusion site was inspected regularly. If swelling or paleness of skin was detected, the infusion site was changed to a different peripheral line. Systolic blood pressure and pulse frequency were monitored during the infusion time and defined as adverse events at >220 mm Hg and <40 beats•min -1 . In case of adverse events, patients were observed for up to 48 hours. The primary outcome was prevalence of extravasation, defined as swelling around the infusion site. Secondary outcomes were all types of adverse events and associations between predefined clinical variables and risk of adverse events. RESULTS We observed 2.3% (95% confidence interval [CI], 1.4%-3.2%) extravasation of infusion and 0.9% (95% CI, 0.4%-1.7%) bradycardia. No cases of tissue necrosis or severe hypertension were detected. All adverse events had dissipated spontaneously within 48 hours. Proximal catheter placement was associated with more adverse events. CONCLUSIONS Extravasation of peripherally administrated norepinephrine in the perioperative period occurred at similar rates as in previous studies in critically ill patients. In our setting, where we regularly inspected the infusion site and shifted site in case of swelling or paleness of skin, we observed no case of severe adverse events. Given that severe adverse events were absent, the potential benefit of this preventive approach requires confirmation in a larger population.
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Affiliation(s)
- Jens Christensen
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Andersson
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Fredric Sjöberg
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Hellgren
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Piotr Harbut
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
| | - Joanna Harbut
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
| | - Fredrik Sjövall
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden
| | | | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Eva Joelsson-Alm
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Maria Cronhjort
- From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Danderyd Hospital, Stockholm, Sweden
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12
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Watts S, Apte Y, Holland T, Hatt A, Craswell A, Lin F, Tabah A, Ware R, Byrnes J, Anstey C, Keijzers G, Ramanan M. Randomised, controlled, feasibility trial comparing vasopressor infusion administered via peripheral cannula versus central venous catheter for critically ill adults: A study protocol. PLoS One 2024; 19:e0295347. [PMID: 38739611 PMCID: PMC11090297 DOI: 10.1371/journal.pone.0295347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND When clinicians need to administer a vasopressor infusion, they are faced with the choice of administration via either peripheral intravenous catheter (PIVC) or central venous catheter (CVC). Vasopressor infusions have traditionally been administered via central venous catheters (CVC) rather than Peripheral Intra Venous Catheters (PIVC), primarily due to concerns of extravasation and resultant tissue injury. This practice is not guided by contemporary randomised controlled trial (RCT) evidence. Observational data suggests safety of vasopressor infusion via PIVC. To address this evidence gap, we have designed the "Vasopressors Infused via Peripheral or Central Access" (VIPCA) RCT. METHODS The VIPCA trial is a single-centre, feasibility, parallel-group RCT. Eligible critically ill patients requiring a vasopressor infusion will be identified by emergency department (ED) or intensive care unit (ICU) staff and randomised to receive vasopressor infusion via either PIVC or CVC. Primary outcome is feasibility, a composite of recruitment rate, proportion of eligible patients randomised, protocol fidelity, retention and missing data. Primary clinical outcome is days alive and out of hospital up to day-30. Secondary outcomes will include safety and other clinical outcomes, and process and cost measures. Specific aspects of safety related to vasopressor infusions such as extravasation, leakage, device failure, tissue injury and infection will be assessed. DISCUSSION VIPCA is a feasibility RCT whose outcomes will inform the feasibility and design of a multicentre Phase-3 trial comparing routes of vasopressor delivery. The exploratory economic analysis will provide input data for the full health economic analysis which will accompany any future Phase-3 RCT.
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Affiliation(s)
| | - Yogesh Apte
- Caboolture Hospital, Caboolture, Australia
- James Mayne Academy of Critical Care, The University of Queensland, Brisbane, Australia
| | | | - April Hatt
- Caboolture Hospital, Caboolture, Australia
| | - Alison Craswell
- Caboolture Hospital, Caboolture, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Frances Lin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Sunshine Coast Health Institute, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Alexis Tabah
- James Mayne Academy of Critical Care, The University of Queensland, Brisbane, Australia
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Queensland Critical Care Research Network, Herston, Australia
| | - Robert Ware
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Christopher Anstey
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Gerben Keijzers
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Australia
- Faculty of Health Sciences and Medicine Bond University, Robina, Australia
| | - Mahesh Ramanan
- Caboolture Hospital, Caboolture, Australia
- Queensland Critical Care Research Network, Herston, Australia
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Kensington, Australia
- Faculty of Health, Queensland of Technology, Brisbane, Australia
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13
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Nguyen B, Harmon D, Krall S, Weber F, Yoo R. Adverse Events from Fluoroscopic versus Portable Placement of Peripherally Inserted Central Catheters and Central Venous Catheters in Pediatric Patients. J Vasc Interv Radiol 2024:S1051-0443(24)00325-7. [PMID: 38704139 DOI: 10.1016/j.jvir.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE To compare the outcomes of fluoroscopic versus portable placement of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) in pediatric patients. MATERIALS AND METHODS This is a single-center, retrospective review of 346 upper-extremity PICC placements (286 fluoroscopic and 60 portable; mean age, 9.83 years [SD ± 5.58]; 49.1% female) and 138 tunneled femoral CVC placements (56 fluoroscopic and 82 portable; mean age, 0.23 years [SD ± 0.36]; 57.0% female). Portable placements used mobile plain-film radiography. All lines were placed by board-certified interventional radiologists. RESULTS Fluoroscopic PICC placements had a lower procedure time (43.9 vs 57.9 minutes; P < .001), radiation dosage (342 vs 590 mGy·cm2; P < .001), incidence of technical failure (0% vs 3.3%; P = .029), and incidence of catheter malfunction (1.7% vs 12.1%; P < .001) compared with portable PICC placements. Fluoroscopic CVC placements had a lower procedure time (42.6 vs 54.8 minutes; P < .001) and radiation dosage (63.8 vs 405 mGy·cm2; P < .001) compared with portable CVC placements. No technical failures were found in either CVC groups and the difference was nonsignificant for catheter malfunction (0% vs 7.3%; P = .081). Fluoroscopic placements of PICCs and CVCs had a lower incidence rate of central line-associated bloodstream infection compared with portable placements (0.71 vs 2.22 cases per 1,000 line-days; P = .046). Overall, fluoroscopic placements of PICCs and CVCs had fewer adverse events compared with portable placements (3.2% vs 14.8%; P < .001). Portable procedure setting was the only significant factor associated with adverse events (odds ratio, 33.77; 95% CI, 4.56-757.01). CONCLUSIONS Fluoroscopic placements of PICCs and CVCs are associated with lower procedure time, radiation dose, and risk of adverse events compared with portable placements in pediatric patients.
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Affiliation(s)
- Bao Nguyen
- University of Central Florida College of Medicine, Orlando, Florida; Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida.
| | - David Harmon
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida
| | - Stefani Krall
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida
| | - Fabiola Weber
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida; University of Central Florida College of Medicine, Orlando, Florida
| | - Raphael Yoo
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida; University of Central Florida College of Medicine, Orlando, Florida
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14
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Saade EA, Lytle FT, Pronovost PJ. Enhancing Quality and Safety in Critical Care-Challenges and Strategies for Central Venous Catheters. JAMA Intern Med 2024; 184:482-483. [PMID: 38436978 DOI: 10.1001/jamainternmed.2023.8243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Elie A Saade
- University Hospitals of Cleveland, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Francis T Lytle
- University Hospitals of Cleveland, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Peter J Pronovost
- University Hospitals of Cleveland, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
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15
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Teja B, Bosch NA, Diep C, Pereira TV, Mauricio P, Sklar MC, Sankar A, Wijeysundera HC, Saskin R, Walkey A, Wijeysundera DN, Wunsch H. Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:474-482. [PMID: 38436976 DOI: 10.1001/jamainternmed.2023.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions. Objective To summarize current rates of CVC-associated complications. Data Sources MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023. Study Selection This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated. Main Outcomes and Measures Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed. Results Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters). Conclusions and Relevance Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.
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Affiliation(s)
- Bijan Teja
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicholas A Bosch
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V Pereira
- Clinical Trial Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paolo Mauricio
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashwin Sankar
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Refik Saskin
- ICES Central, University of Toronto, Toronto, Ontario, Canada
| | - Allan Walkey
- Division of Health Systems Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- ICES Central, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Wunsch
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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16
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Adnan I, Zailani NH, Varma V, Mansor MSH, Mokhtar RAR, Amir M'A. Surgical removal of an ectopic haemodialysis catheter in the brachiocephalic artery: a case report. J Surg Case Rep 2024; 2024:rjae329. [PMID: 38800502 PMCID: PMC11126339 DOI: 10.1093/jscr/rjae329] [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: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Percutaneous central vein catheterization is commonly performed to access venous circulation for various clinical indications. However, unintentional arterial puncture may occur which can result in catastrophic complications. We report a case of an inadvertent right brachiocephalic artery cannulation in a 77-year-old lady planned for haemodialysis via a percutaneous internal jugular vein vascular access performed under ultrasound guidance. As an intravascular stent is not favourable in view of the close proximity of the right common carotid artery to the site of puncture as well as the risk of massive bleeding upon simple removal of the catheter, an open surgical removal via a median sternotomy was performed. Acquiring the competency in procedural skills, an understanding of the surgical anatomy and anticipating impending complications are of paramount importance in preventing as well as in mitigating the above complication.
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Affiliation(s)
- Isqandar Adnan
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh 47000, Selangor, Malaysia
| | - Nurul Hafizah Zailani
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
| | - Vimal Varma
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh 47000, Selangor, Malaysia
| | - Mardhiah Sarah Harnani Mansor
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh 47000, Selangor, Malaysia
| | - Raja Amin Raja Mokhtar
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
| | - Muhammad 'Abid Amir
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Sungai Buloh 47000, Selangor, Malaysia
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17
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Thongdee C, Lumkul L, Wongyikul P, Spilles N, Laonapaporn B, Patumanond J, Phinyo P. Optimal volume for the draw-and-return methods to enhance activated partial thromboplastin time ratio accuracy in hemodialysis patients with central venous catheters. Heliyon 2024; 10:e28651. [PMID: 38590898 PMCID: PMC11000023 DOI: 10.1016/j.heliyon.2024.e28651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background Significant errors of activated partial thromboplastin time (aPTT) ratio were frequently observed in blood sampling from central venous dialysis catheter (CVC) of hemodialysis (HD) patients. Following the draw-and-return methods, initial blood withdrawal from the catheter before sampling can reduce the error, but the optimal withdrawal volume remains undetermined. Aim The objective of this study is to determine the optimal blood withdrawal volume for the draw-and-return methods to improve aPTT ratio accuracy in hemodialysis patients with CVC. Methods A prospective study was conducted in patients receiving HD via CVC. Four blood samples were collected from each patient, involving a peripheral venipuncture and three draw-and-return samples (10 ml, 20 ml and 25 ml groups). The aPTT ratio of a peripheral sample was used as a reference to determine the aPTT ratio accuracy for each draw-and-return group. Subsequently, the agreement was illustrated using modified Bland-Altman plot. Results A total of 1,000 samples were obtained from 250 patients. The patients had a mean age of 59.6 ± 15.4 years, with 17.2% using citrate as the CVC's locking agent. The adjusted accuracies of the aPTT ratio varied significantly among the three withdrawal volumes (p-value <0.001). The 25 ml group demonstrated the highest accuracy (43.2%; 95%CI, 38.0-48.4), followed by the 20 ml group (30.0%; 95%CI, 24.9-35.2), and the 10 ml group (18.0%; 95%CI, 12.8-23.2). Additionally, using citrate as a locking agent provided more than 80.0% aPTT ratio accuracy, whereas heparin demonstrated inferior accuracy even in the 25 ml withdrawal group. Conclusion The optimal blood withdraw volume for the draw-and-return methods concluded at 20 ml for citrate locked-CVC and 25 ml for heparin which significantly improved aPTT ratio accuracies. Applying citrate as a locking agent provides clear benefits for aPTT ratio monitoring, while peripheral venipuncture is recommended in cases of heparin-locked CVC.
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Affiliation(s)
- Chitrada Thongdee
- Dialysis Center, Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakpoom Wongyikul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nantana Spilles
- Dialysis Center, Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Boonruksa Laonapaporn
- Dialysis Center, Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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18
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Nag DS, Swain A, Sahu S, Swain BP, Sam M. Pitfalls in internal jugular vein cannulation. World J Clin Cases 2024; 12:1714-1717. [PMID: 38660082 PMCID: PMC11036472 DOI: 10.12998/wjcc.v12.i10.1714] [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: 12/24/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased use of ultrasound in healthcare settings. Despite the increased safety profile and insertion convenience, it has complications. Herein, we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Amlan Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Bhanu Pratap Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Merina Sam
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
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Long B, Bridwell RE, DeVivo A, Gottlieb M. Transvenous Pacemaker Placement: A Review for Emergency Clinicians. J Emerg Med 2024; 66:e492-e502. [PMID: 38453595 DOI: 10.1016/j.jemermed.2023.11.018] [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: 04/24/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Transvenous pacemaker placement is an integral component of therapy for severe dysrhythmias and a core skill in emergency medicine. OBJECTIVE This narrative review provides a focused evaluation of transvenous pacemaker placement in the emergency department setting. DISCUSSION Temporary cardiac pacing can be a life-saving procedure. Indications for pacemaker placement include hemodynamic instability with symptomatic bradycardia secondary to atrioventricular block and sinus node dysfunction; overdrive pacing in unstable tachydysrhythmias, such as torsades de pointes; and failure of transcutaneous pacing. Optimal placement sites include the right internal jugular vein and left subclavian vein. Insertion first includes placement of a central venous catheter. The pacing wire with balloon is then advanced until electromechanical capture is obtained with the pacer in the right ventricle. Ultrasound can be used to guide and confirm lead placement using the subxiphoid or modified subxiphoid approach. The QRS segment will demonstrate ST segment elevation once the pacing wire tip contacts the endocardial wall. If mechanical capture is not achieved with initial placement of the transvenous pacer, the clinician must consider several potential issues and use an approach to evaluating the equipment and correcting any malfunction. Although life-saving in the appropriate patient, complications may occur from central venous access, right heart catheterization, and the pacing wire. CONCLUSIONS An understanding of transvenous pacemaker placement is essential for emergency clinicians.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Anthony DeVivo
- Department of Emergency Medicine, Institute for Critical Care Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University, Chicago, Illinois
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20
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Yaxley J, Gately R, Scott T, Kurtkoti J, Mantha M. Effect of insertion site on tunnelled haemodialysis catheter outcomes: an observational study of 967 catheters. Intern Med J 2024; 54:632-638. [PMID: 37595018 DOI: 10.1111/imj.16200] [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: 06/07/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND The right internal jugular vein is the preferred approach to tunnelled haemodialysis catheter placement. However, the effect of the insertion site on long-term catheter outcomes remains uncertain. AIMS We aimed to analyse a large cohort of tunnelled haemodialysis catheter placements to compare short-term and long-term results according to central venous catheter location. METHODS A retrospective cohort study was performed on consecutive tunnelled catheter insertions at two centres over 7 years. The primary outcome was catheter survival, compared according to the central vein site. We used the Kaplan-Meier curve method and Cox proportional hazards modelling to determine the effect of the catheterisation route on primary patency, adjusted for clinical risk factors for catheter failure. RESULTS There were 967 tunnelled dialysis catheter placements in 620 patients. The median survival for right internal jugular vein catheters was 569 days. There were no differences in rates of catheter failure between right internal jugular, left internal jugular (adjusted hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.52-1.21), external jugular (HR, 0.79; CI, 0.33-3.13), subclavian (HR, 0.67; CI, 0.58-2.44) and femoral vein (HR, 1.20; CI, 0.36-1.33) catheters following multivariable analysis. There were no major differences in functionality or complications between the groups. CONCLUSIONS This study identified no statistically significant relationship between tunnelled haemodialysis catheter insertion site and catheter survival. The contemporary approach to dialysis vascular access should be tailored to specific patient circumstances.
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Affiliation(s)
- Julian Yaxley
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia
| | - Ryan Gately
- Nephrology and Transplant Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tahira Scott
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia
| | - Jagadeesh Kurtkoti
- Department of Nephrology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Murty Mantha
- Department of Nephrology, Cairns Hospital, Cairns, Queensland, Australia
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Endo T, Takayama T, Kimura M, Mochizuki Y, Taniguchi R, Hoshina K. A case of endovascular treatment for iatrogenic left vertebral artery injury due to central line catheter placement. J Vasc Surg Cases Innov Tech 2024; 10:101368. [PMID: 38566912 PMCID: PMC10985260 DOI: 10.1016/j.jvscit.2023.101368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 04/04/2024] Open
Abstract
We describe a case of endovascular treatment for an iatrogenic left vertebral artery injury after central line catheter placement in a 68-year-old male patient. The patient had a massive pulmonary embolism, and a Swan-Ganz catheter was required to monitor the patient's circulatory condition. However, the catheter was inserted into the left vertebral artery and passed through the left internal jugular vein. Endovascular treatment was indicated due to the patient's poor general health. Complete hemostasis was achieved, and the postoperative course was uneventful without neurologic deficits.
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Affiliation(s)
- Takashi Endo
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaru Kimura
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuaki Mochizuki
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Taniguchi
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ängeby E, Adrian M, Bozovic G, Borgquist O, Kander T. Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations. Acta Anaesthesiol Scand 2024; 68:520-529. [PMID: 38351546 DOI: 10.1111/aas.14380] [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: 09/14/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND There is a paucity of data on the incidence of central venous catheter tip misplacements after the implementation of ultrasound guidance during insertion. The aims of the present study were to determine the incidence of tip misplacements and to identify independent variables associated with tip misplacement. METHODS All jugular and subclavian central venous catheter insertions in patients ≥16 years with a post-procedural chest radiography at four hospitals were included. Each case was reviewed for relevant catheter data and radiologic evaluations of chest radiographies. Tip misplacements were classified as 'any tip misplacement', 'minor tip misplacement' or 'major tip misplacement'. Multivariable logistic regression analyses were used to investigate associations between predefined independent variables and tip misplacements. RESULTS A total of 8556 central venous catheter insertions in 5587 patients were included. Real-time ultrasound guidance was used in 91% of all insertions. Any tip misplacement occurred (95% confidence interval) in 3.7 (3.3-4.1)% of the catheterisations, and 2.1 (1.8-2.4)% were classified as major tip misplacements. The multivariable logistic regression analyses showed that female patient gender, subclavian vein insertions, number of skin punctures and limited operator experience were associated with a higher risk of major tip misplacement, whereas increasing age and height were associated with a lower risk. CONCLUSIONS In this large prospective multicentre cohort study, performed in the ultrasound-guided era, we demonstrated the incidence of tip misplacements to be 3.7 (3.3-4.1)%. Right internal jugular vein catheterisation had the lowest incidence of both minor and major tip misplacement.
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Affiliation(s)
- Emilia Ängeby
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - Maria Adrian
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Gracijela Bozovic
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Medical Imaging and Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Ola Borgquist
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Thomas Kander
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
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23
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Rueckel J, Huemmer C, Shahidi C, Buizza G, Hoppe BF, Liebig T, Ricke J, Rudolph J, Sabel BO. Artificial Intelligence to Assess Tracheal Tubes and Central Venous Catheters in Chest Radiographs Using an Algorithmic Approach With Adjustable Positioning Definitions. Invest Radiol 2024; 59:306-313. [PMID: 37682731 DOI: 10.1097/rli.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
PURPOSE To develop and validate an artificial intelligence algorithm for the positioning assessment of tracheal tubes (TTs) and central venous catheters (CVCs) in supine chest radiographs (SCXRs) by using an algorithm approach allowing for adjustable definitions of intended device positioning. MATERIALS AND METHODS Positioning quality of CVCs and TTs is evaluated by spatially correlating the respective tip positions with anatomical structures. For CVC analysis, a configurable region of interest is defined to approximate the expected region of well-positioned CVC tips from segmentations of anatomical landmarks. The CVC/TT information is estimated by introducing a new multitask neural network architecture for jointly performing type/existence classification, course segmentation, and tip detection. Validation data consisted of 589 SCXRs that have been radiologically annotated for inserted TTs/CVCs, including an experts' categorical positioning assessment (reading 1). In-image positions of algorithm-detected TT/CVC tips could be corrected using a validation software tool (reading 2) that finally allowed for localization accuracy quantification. Algorithmic detection of images with misplaced devices (reading 1 as reference standard) was quantified by receiver operating characteristics. RESULTS Supine chest radiographs were correctly classified according to inserted TTs/CVCs in 100%/98% of the cases, thereby with high accuracy in also spatially localizing the medical device tips: corrections less than 3 mm in >86% (TTs) and 77% (CVCs) of the cases. Chest radiographs with malpositioned devices were detected with area under the curves of >0.98 (TTs), >0.96 (CVCs with accidental vessel turnover), and >0.93 (also suboptimal CVC insertion length considered). The receiver operating characteristics limitations regarding CVC assessment were mainly caused by limitations of the applied CXR position definitions (region of interest derived from anatomical landmarks), not by algorithmic spatial detection inaccuracies. CONCLUSIONS The TT and CVC tips were accurately localized in SCXRs by the presented algorithms, but triaging applications for CVC positioning assessment still suffer from the vague definition of optimal CXR positioning. Our algorithm, however, allows for an adjustment of these criteria, theoretically enabling them to meet user-specific or patient subgroups requirements. Besides CVC tip analysis, future work should also include specific course analysis for accidental vessel turnover detection.
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Affiliation(s)
- Johannes Rueckel
- From the Department of Radiology, University Hospital, LMU Munich, Munich, Germany (J.Rueckel, C.S., B.F.H., J.Ricke, J.Rudolph, B.O.S.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (J.Rueckel, T.L.); and XP Technology and Innovation, Siemens Healthcare GmbH, Forchheim, Germany (C.H., G.B.)
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24
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Kumar M, Rustagi K. A modified technique of subclavian vein catheterisation: Remembering Sedillot. Indian J Anaesth 2024; 68:309-310. [PMID: 38476553 PMCID: PMC10926328 DOI: 10.4103/ija.ija_808_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 03/14/2024] Open
Affiliation(s)
- Meenakshi Kumar
- Department of Anaesthesia and Intensive Care VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanika Rustagi
- Department of Anaesthesia and Intensive Care VMMC and Safdarjung Hospital, New Delhi, India
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25
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Gonzalez-Vargas JM, Sinz E, Moore JZ, Miller SR. Clinical Outcomes of Standardized Central Venous Catheterization Simulation Training: A Comparative Analysis. JOURNAL OF SURGICAL EDUCATION 2024; 81:444-455. [PMID: 38278722 PMCID: PMC10922709 DOI: 10.1016/j.jsurg.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE A standardized ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) using online- and simulation-based training was first designed and then large-scale deployed at a teaching hospital institution to improve CVC surgical education. To understand the impact that the standardized training might have on patient complications, this study focuses on identifying the impact of the integration of an iteratively designed US-IJCVC training on clinical complications at a teaching hospital. DESIGN AND PARTICIPANTS A comparative study was conducted using TriNetX, a global health research network. Using Current Procedural Terminology (CPT) codes and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified the total number of patients with a CVC and mechanical, infectious, and thrombosis complications with and without billable ultrasound between July 1 to June 30 in 2016, 2017, and 2022. SETTING A teaching hospital institution in Pennsylvania. RESULTS Results showed a correlation between years and complications indicating, (1) mechanical complications billable ultrasound, (2) infectious complications billable ultrasound, and (3) thrombosis complications billable ultrasound were significantly lower with the large-scale deployment. Results also showed that (4) mechanical, infectious, and thrombosis complications with and without billable ultrasound are within the range that prior work has reported. CONCLUSION These results indicate that there has been a decrease in mechanical, infectious, and thrombosis complications, which correlates with the US-IJCVC training large-scale deployment.
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Affiliation(s)
| | - Elizabeth Sinz
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jason Z Moore
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, Pennsylvania
| | - Scarlett R Miller
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania; School of Engineering Design, Technology, and Professional Programs, Penn State, University Park, Pennsylvania
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26
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Wang TF, Kou R, Carrier M, Delluc A. Management of catheter-related upper extremity deep vein thrombosis in patients with cancer: a systematic review and meta-analysis. J Thromb Haemost 2024; 22:749-764. [PMID: 38065528 DOI: 10.1016/j.jtha.2023.11.017] [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: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Patients with cancer commonly require a central venous catheter, which is associated with an increased risk of venous thromboembolism (VTE). Despite the frequent occurrence, the optimal anticoagulation management and outcomes for patients with cancer and catheter-related upper extremity deep vein thrombosis (DVT) are unclear. OBJECTIVE We performed a systematic review and meta-analysis to evaluate the rates of recurrent VTE and bleeding in patients with cancer and catheter-related upper extremity DVT. METHODS We searched MEDLINE, Embase, Scopus, and CENTRAL from inception to June 2, 2023. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates (with 95% CI) of outcomes were pooled using random effects model. RESULTS We included 29 studies (N = 2,836), among which 5 were prospective. The duration of follow-up and anticoagulation varied considerably. The main long-term anticoagulant used was low molecular weight heparin, followed by direct oral anticoagulants. The pooled 3-month recurrent VTE rate from 14 studies (N = 1,128) was 0.56% (95% CI, 0.10%-3.01%; I2 = 0%). The pooled 3-month major bleeding rate from 10 studies (N = 834) was 2.34% (95% CI, 1.14%-4.76%; I2 = 0%). We were unable to pool event rates beyond 3 months, given high heterogeneity. All studies had serious risk of bias. CONCLUSIONS Our study demonstrated a relatively low rate of recurrent VTE and moderate rate of major bleeding events within the first 3 months in patients with cancer and catheter-related upper extremity DVT. However, there was significant heterogeneity in the management and reporting after 3 months.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Roger Kou
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada. https://twitter.com/MarcCarrier1
| | - Aurélien Delluc
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada. https://twitter.com/DellucAurelien
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27
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Ley Greaves R, Bolot R, Holgate A, Gibbs C. Safety of pre-hospital peripheral vasopressors: The SPOTLESS study (Safety of PrehOspiTaL pEripheral vaSopreSsors). Emerg Med Australas 2024. [PMID: 38423993 DOI: 10.1111/1742-6723.14396] [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: 09/14/2023] [Revised: 11/16/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To assess the safety and effectiveness of peripheral vasoactive drugs initiated during pre-hospital care and retrieval missions, in Queensland, Australia. METHODS Three years of retrospective data was gathered from two sources. Medical notes were reviewed using a search for any patient having 'inotrope' recorded on an electronic medical record. Each case was reviewed to include only peripheral infusions of adrenaline or noradrenaline. Clinical Governance records were searched for adverse events related to vasoactive drugs, alerted for review to ensure complete capture. RESULTS A total of 418 patients received peripheral infusions of adrenaline and noradrenaline over the 3-year period. No major complications were recorded either immediately or at Clinical Governance review. Minor complications were recorded in 4.7% of the cases, of which 3.5% occurred with peripheral vasoactives during the presence of the retrieval team. The frequency of use of peripheral vasoactives increased over the study period. CONCLUSIONS In this retrospective data set there were no major complications of peripheral vasoactive drugs. Minor complications were similar to in-hospital use and related to vascular access and drug delivery.
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Affiliation(s)
- Robbie Ley Greaves
- Lifeflight Retrieval Medicine, Brisbane, Queensland, Australia
- High Acuity Response Unit, Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Renee Bolot
- Lifeflight Retrieval Medicine, Brisbane, Queensland, Australia
| | - Andrew Holgate
- Lifeflight Retrieval Medicine, Brisbane, Queensland, Australia
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Clinton Gibbs
- Research and Evaluation, Retrieval Services Queensland, Brisbane, Queensland, Australia
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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28
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Naddi L, Hübinette J, Kander T, Borgquist O, Adrian M. Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study. BMC Anesthesiol 2024; 24:68. [PMID: 38383304 PMCID: PMC10880374 DOI: 10.1186/s12871-024-02455-3] [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: 08/17/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND A previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified. METHODS This was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8 586 patients ≥ 16 years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications. RESULTS Female operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P = .02), were less experienced (P < .001), had more patients with invasive positive pressure ventilation (P < .001), more often chose the internal jugular vein (P < .001) and more frequently used ultrasound guidance (P < .001). Male operators more often chose the subclavian vein (P < .001) and inserted more catheters with bore size ≥ 9 Fr (P < .001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26-5.64]) after correction for other relevant independent variables. CONCLUSIONS The hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018.
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Affiliation(s)
- Leila Naddi
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden.
- Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85, Lund, Sweden.
| | | | - Thomas Kander
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85, Lund, Sweden
| | - Ola Borgquist
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Maria Adrian
- Anaesthesiology and Intensive Care, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
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29
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Brown DC, Gonzalez-Vargas JM, Tzamaras HM, Sinz EH, Ng PK, Yang MX, Adhikary SD, Miller SR, Moore JZ. Evaluating the Impact of Assessment Metrics for Simulated Central Venous Catheterization Training. Simul Healthc 2024; 19:27-34. [PMID: 36378597 PMCID: PMC10185707 DOI: 10.1097/sih.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Performance assessment and feedback are critical factors in successful medical simulation-based training. The Dynamic Haptic Robotic Trainer (DHRT) allows residents to practice ultrasound-guided needle insertions during simulated central venous catheterization (CVC) procedures while providing detailed feedback and assessment. A study was performed to examine the effectiveness of the DHRT in training the important skills of needle tip tracking and aspiration and how these skills impact procedural complications in simulated CVC. METHODS The DHRT data were collected for 163 residents at 2 hospitals for 6 simulated needle insertions. Users were given automated feedback on 5 performance metrics, which measure aspiration rate, arterial punctures, punctures through and through the vein, loss of access to the vein, and successful access to the vein. Aspiration rates and tip tracking rates were analyzed to determine their significance in preventing CVC complications and improving performance. RESULTS Tip tracking rates higher than 40% were 2.3 times more likely to result in successful venous access than rates less than 10%. Similarly, aspiration rates higher than 80% were 2.6 times more likely to result in successful venous access than rates less than 10%. Proper tip tracking and aspiration both reduced mechanical complications. Resident performance improved for all metrics except tip tracking. CONCLUSIONS Proper tip tracking and aspiration both reduced complications and increased the likelihood of success. However, the skill of tip tracking was not effectively learned through practice without feedback. Therefore, ultrasound-guided needle-based procedures, including CVC, can be improved by providing specific feedback to users on their ultrasound usage to track needle insertions.
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Affiliation(s)
- Dailen C Brown
- From the Departments of Mechanical and Nuclear Engineering (D.C.B., J.Z.M.) and Industrial and Manufacturing Engineering (J.M.G.-V., H.M.T.), The Pennsylvania State University; The Pennsylvania State University College of Medicine (E.H.S., S.D.A.), Hershey, PA; Cedars Sinai Medical Procedure Center and Vascular Access Services (P.K.N.); Cedars Sinai Medical Center (M.X.Y.), Los Angeles, CA; and Department of Engineering Design and Industrial Engineering (S.R.M.), The Pennsylvania State University, Hershey, PA
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30
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Ingefors S, Adrian M, Heckley G, Borgquist O, Kander T. Major immediate insertion-related complications after central venous catheterisation and associations with mortality, length of hospital stay, and costs: A prospective observational study. J Vasc Access 2024:11297298231222929. [PMID: 38267828 DOI: 10.1177/11297298231222929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND It is well-known that infectious complications after central venous catheterisation are associated with increased mortality, length of hospital stay and costs. However, there are limited data regarding such associations for immediate insertion-related complications. Therefore, the aim of this study was to investigate whether major immediate insertion-related complications are associated with mortality, length of hospital stay and costs. METHODS This was a preplanned substudy to the CVC-MECH trial on immediate insertion-related complications after central venous catheterisation in the ultrasound-guided era. Patients receiving central venous catheters at Skåne University Hospital from 2 March 2019 to 31 December 2020 were prospectively included. Patient characteristics, clinical data and costs were automatically collected from medical journals and the patient administration system. Associations between major immediate insertion-related complications and mortality, length of hospital stay and costs were studied by multivariable logistic and linear regression analyses. RESULTS In total, 6671 patients were included, of whom 0.5% suffered major immediate insertion-related complications. Multivariable analyses, including surrogates for general morbidity, showed associations between major immediate insertion-related complications and 30-day (odds ratio 2.46 [95% CI 1.05-5.77]), 90-day (2.90 [1.35-6.21]) and 180-day (2.26 [1.05-4.83]) mortality. There were no associations between major immediate insertion-related complications and increased length of hospital stay or costs. CONCLUSION This study showed that major immediate insertion-related complications, although not directly responsible for any death, were associated with increased 30-day, 90-day and 180-day mortality. These findings clearly demonstrate the importance of using all possible means to prevent avoidable insertion-related complications after central venous catheterisation.
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Affiliation(s)
| | - Maria Adrian
- Anaesthesiology and Intensive Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital Lund, Sweden
| | - Gawain Heckley
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ola Borgquist
- Anaesthesiology and Intensive Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital Lund, Sweden
| | - Thomas Kander
- Anaesthesiology and Intensive Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Sweden
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Kocaşaban DÜ, Güler S. Esophageal inserted subclavian catheter: a rare complication. World J Emerg Med 2024; 15:243-245. [PMID: 38855373 PMCID: PMC11153368 DOI: 10.5847/wjem.j.1920-8642.2024.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/26/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Dilber Üçöz Kocaşaban
- Emergency Medicine Clinic, Health Sciences University Ankara Training and Research Hospital, Ankara 06930, Turkey
| | - Sertaç Güler
- Emergency Medicine Clinic, Health Sciences University Ankara Training and Research Hospital, Ankara 06930, Turkey
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Sobczak A, Kowalik A, Homa M, Turalska P, Kwinta P. Changes in umbilical catheters' microstructure in vivo: A prospective study. J Vasc Access 2024; 25:158-164. [PMID: 35674147 DOI: 10.1177/11297298221100441] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Umbilical vessels present after birth allow a unique central access for both venous and arterial catheterization, yet the catheterization complications can be misdiagnosed as the complications of prematurity per se. METHODS A prospective observational study of 41 used polyurethane umbilical catheters, both venous and arterial was conducted in a tertiary neonatal intensive care unit. The study consisted of bedside ultrasound imaging and post-removal microbiological and microstructural analysis to assess the in vivo catheters' changes and their clinical significance. RESULTS The study has shown that catheters' surface thrombosis and bacterial colonization happen more often within umbilical venous than within arterial catheters (31% vs 8% in both cases) and are inversely proportional to the patient's gestational age (thrombosis: Me: 28 weeks vs no thrombosis: 32 weeks; p = 0.05, bacterial colonization: 27 weeks vs no colonization: 30 weeks; p = 0.013), respectively. The clots formed near the catheter's tip are correlated with catheter's bacterial colonization. Chemical analysis with energy dispersive spectroscopy showed a higher calcium composition in used catheters (19.89% vs 0%, p = 0.016) and structure analysis in the scanning electron microscopy proved that within hours catheters become covered with an external coating of a constant thickness, not affected by the catheterization time. CONCLUSION The following observations give a better insight to the complex in vivo interactions and call for a more intense bedside-monitoring of the indwelling devices.
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Affiliation(s)
- Alina Sobczak
- Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Kowalik
- Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Marta Homa
- Center for High Temperature Studies, Foundry Research Institute, Kraków, Poland
| | - Patrycja Turalska
- Center for High Temperature Studies, Foundry Research Institute, Kraków, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
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O'Cearbhaill ED. A needle that softens on intravenous insertion. Nat Biomed Eng 2023:10.1038/s41551-023-01171-6. [PMID: 38129655 DOI: 10.1038/s41551-023-01171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Eoin D O'Cearbhaill
- School of Mechanical and Materials Engineering, UCD Centre for Biomedical Engineering and Conway Institute, University College Dublin, Dublin, Ireland.
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland.
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Naddi L, Borgquist O, Adrian M, Bark BP, Kander T. Ultrasound-guided subclavian vein catheterisation with a needle guide (ELUSIVE): protocol for a randomised controlled study. BMJ Open 2023; 13:e080515. [PMID: 38114277 DOI: 10.1136/bmjopen-2023-080515] [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] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Central venous catheters are indispensable in modern healthcare. Unfortunately, they are accompanied by minor as well as major complications, leading to increased morbidity, mortality and costs. Immediate insertion-related complications (mechanical complications) have decreased due to the implementation of real-time ultrasound guidance, but they still occur and additional efforts to enhance patient safety are warranted. This study aims to investigate whether the use of a needle guide mounted on the ultrasound probe in subclavian catheterisations may decrease the number of catheterisations with >1 skin puncture (primary outcome). METHODS AND ANALYSIS This is an investigator-initiated, non-commercial, randomised, controlled, parallel-group study conducted at Skåne University Hospital, Lund, Sweden. Adults (≥18 years) with a clinical indication for a subclavian central venous catheter and the ability to give written informed consent will be eligible for inclusion. Exclusion criteria include subclavian catheterisation deemed unsuitable based on the preprocedural ultrasound examination. Patients will be randomised to catheterisation by certified operators using a microconvex probe (long-axis, in-plane technique) with (n=150) or without (n=150) a needle guide. The ultrasound imaging from the procedures will be recorded and assessed by two reviewers individually. The assessors will be blinded for group affiliation. Secondary outcomes include the total number of skin punctures, mechanical complications, time to successful venous puncture, number of failed catheterisations and operator satisfaction with the needle guide at the end of the study period.Recruitment started on 8 November 2022 and will continue until the sample size is achieved. ETHICS AND DISSEMINATION This study was approved by the Swedish Ethical Review Authority (#2022-04073-01) and the Swedish Medical Products Agency (#5.1-2022-52130; CIV-21-12-038367). The findings will be submitted to an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05513378, clinicaltrials.gov.
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Affiliation(s)
- Leila Naddi
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Ola Borgquist
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Maria Adrian
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Björn P Bark
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Thomas Kander
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
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Sohail MA, Vachharajani TJ, Lane JE, Huang S, Wang X, Mucha S, Kapoor A, Dugar S, Hanane T. Thromboelastography-Guided Correction of Coagulopathy Before Tunneled Central Venous Access in Critically Ill Patients With Liver Disease: A Propensity Score-Matched Study. Crit Care Explor 2023; 5:e1023. [PMID: 38115819 PMCID: PMC10730036 DOI: 10.1097/cce.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Importance Optimal blood product transfusion strategies before tunneled central venous catheter (CVC) placement are required in critically ill coagulopathic patients with liver disease to reduce exposure to allogeneic blood products and mitigate bleeding and thrombotic complications. Objectives This study evaluated the safety and efficacy of a thromboelastography-guided transfusion strategy for the correction of coagulopathy in patients with liver disease compared with a conventional transfusion strategy (using international normalized ratio, platelet count, and fibrinogen) before tunneled CVC insertion. Design Setting and Participants A retrospective propensity score-matched single-center cohort study was conducted at a quaternary care academic medical center involving 364 patients with liver disease (cirrhosis and acute liver failure) who underwent tunneled CVC insertion in the ICU. Patients were stratified into two groups based on whether they received blood product transfusions based on a thromboelastography-guided or conventional transfusion strategy. Main Outcomes and Measures Primary outcomes that were evaluated included the volume, units and cost of blood products (fresh frozen plasma, cryoprecipitate, and platelets) when using a thromboelastography-guided or conventional approach to blood transfusions. Secondary outcomes included the frequency of procedure-related bleeding and thrombotic complications. Results The total number of units/volume/cost of fresh frozen plasma (12 U/3,000 mL/$684 vs. 32 U/7,500 mL/$1,824 [p = 0.019]), cryoprecipitate (60 U/1,500 mL/$3,240 vs. 250 U/6,250 mL/$13,500 [p < 0.001]), and platelets (5 U/1,500 mL/$2,610 vs. 13 units/3,900 mL/$6,786 [p = 0.046]) transfused were significantly lower in the thromboelastography-guided transfusion group than in the conventional transfusion group. No differences in the frequency of bleeding/thrombotic events were observed between the two groups. Conclusions and Relevance A thromboelastography-guided transfusion strategy for correction of coagulopathy in critically ill patients with liver disease before tunneled CVC insertion, compared with a conventional transfusion strategy, reduces unnecessary exposure to allogeneic blood products and associated costs without increasing the risk for peri-procedural bleeding and thrombotic complications.
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Affiliation(s)
- Mohammad A Sohail
- Department of Kidney Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Tushar J Vachharajani
- Department of Medicine, John D. Dingell Department of VA Medical Center, Detroit, MI
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI
| | - James E Lane
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Shuaiqi Huang
- Department of Quantitative Health Sciences at Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences at Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Simon Mucha
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Aanchal Kapoor
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Tarik Hanane
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
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Locatello LG, Saitta T, Maggiore G, Signorini P, Pinelli F, Adembri C. A 5-year experience with midline catheters in the management of major head and neck surgery patients. J Vasc Access 2023; 24:1412-1420. [PMID: 35441553 DOI: 10.1177/11297298221091141] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development. METHODS Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications. RESULTS A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017-3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150-5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295-5.110) were independent predictors of major complications. CONCLUSIONS MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.
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Affiliation(s)
| | - Thomas Saitta
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Patrizia Signorini
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Fulvio Pinelli
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Chiara Adembri
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
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Alexandrou E, Mifflin N, McManus C, Sou V, Frost SA, Sanghavi R, Doss D, Pillay S, Lawson K, Aneman A, Konstantinou E, Rickard CM. A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement. J Vasc Access 2023; 24:1372-1380. [PMID: 35394395 DOI: 10.1177/11297298221085228] [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: 11/17/2022] Open
Abstract
BACKGROUND Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. METHODS Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG (n = 172) or traditional (n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. RESULTS Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9-24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference-19.9 min (95% CI-14.6 to -34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. CONCLUSIONS Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. TRIAL REGISTRATION This trial is registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au). The registration number is ACTRN12620000919910.
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Affiliation(s)
- Evan Alexandrou
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Australia
| | - Nicholas Mifflin
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
| | - Craig McManus
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
| | - Vanno Sou
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
- Department of Anaesthetics, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Steven A Frost
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Australia
- Nursing and Midwifery Research Alliance, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Ritesh Sanghavi
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - David Doss
- Department of Radiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Sugendran Pillay
- Department of Radiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Anders Aneman
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Evangelos Konstantinou
- Faculty of Nursing at National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Australia
- University of Queensland, Queensland, Australia
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Zeng X, Zeng X, Zeng Q, Wu Y, Zhang S, Yang Y, Zhu X, Zhang W, Xu Y, Min X, Chen W, Zhou W, Qiu J. The external jugular vein is a feasible and safe alternative access for retrieval of inferior vena cava filter. J Vasc Access 2023; 24:1489-1494. [PMID: 35168443 DOI: 10.1177/11297298211064467] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose is to analyze whether the external jugular vein (EJV) is a feasible and safe alternative access for the retrieval IVCFs designed for the jugular approach. METHODS This study was designed as a nonrandomized, controlled study. The patients were divided into two groups: the IJV or EJV access groups. All operations were performed by the vascular surgery team. The main outcome was the technical success rate. The secondary outcomes included (1) the IVCF retrieval rate; (2) the time required to puncture the access vein (min); (3) the number of punctures required for access, and other aspects. RESULTS A total of 119 patients were recruited for IVCF retrieval. Seventeen patients refused to join this trial, leaving 58 patients in the IJV group and 44 patients in the EJV group. In the IJV group, technical success was not achieved in one patient who started in the EJV group and was transferred to the IJV group. There was no significant difference in age, comorbidities, or technical success rate between the two groups. Significant differences were observed in puncture time (min), number of punctures, and inadvertent puncture of the carotid artery. All of the patients were discharged 1 or 2 days after the operation. CONCLUSION EJV is safe and feasible alternative access for the retrieval of IVCFs that are designed for jugular approaches.
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Affiliation(s)
- Xiong Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiande Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingfu Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuewu Wu
- Department of Cardiovascular Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China
| | - Shanzhong Zhang
- Department of Vascular Surgery, First People's Hospital of Jingdezhen, Jingdezhen, Jiangxi, China
| | - Yujin Yang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xianhua Zhu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenwen Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yingqi Xu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xixi Min
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weimin Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiehua Qiu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Cardiovascular Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China
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Chan KS, Martin N, Rafeeqi T, Salimi-Jazi F, Chao S. Complications Associated with Subsequent Vascular Access in Pediatric ECMO Patients. J Pediatr Surg 2023; 58:2201-2205. [PMID: 37599195 PMCID: PMC10592097 DOI: 10.1016/j.jpedsurg.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Following ECMO decannulation, intensivists and surgeons must consider whether to reuse the cannulation site for central venous catheters (CVC) or seek remote access. This study investigates the risk of infectious complication associated with the reuse of peripheral ECMO cannulation sites for subsequent central venous access. METHODS A retrospective review was conducted for patients aged 0-18 years, who underwent peripheral ECMO cannulation between 2009 and 2021 at a single children's hospital. RESULTS Of the 227 charts reviewed, after ECMO decannulation, 53 patients received a CVC at the same location, 25 received a CVC at a different location, 62 received a peripherally inserted central catheter (PICC), and 87 had no subsequent vascular access placed within 30 days of decannulation. Patients with secondary access placed at the same site experienced 1 CLABSI, or 0.94 CLABSIs per 1000 line days. Patients with PICC lines after ECMO decannulation had 1 CLABSI, or 0.43 CLABSIs per 1000 line days. In comparison, the institution's hospital-wide CLABSI rate was 1.46 per 1000 line days during this same period. Although the rate of CLABSI among patients with secondary access at the site of decannulation was higher than the rate among patients with PICC lines (p = 0.79) it was lower than the institutional rate (p = 0.54), these differences did not rise to the level of statistical significance. CONCLUSION Compared with ECMO patients with subsequent CVCs placed at an alternative access site or via PICC after decannulation, patients with contemporaneous CVC placement at the site of decannulation do not experience a significantly higher rate of CLABSIs. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Katelyn S Chan
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, University of Washington, Seattle, WA 98195, USA.
| | - Nolan Martin
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, Valley Health System, Las Vegas, NV 89119, USA
| | - Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Ingoe HMA, Mohammed K, Malone AA, Beadle G, Sharpe T, Cockfield A, Lloyd R, Singh H, Colgan F. Traumatic posterior sternoclavicular joint dislocation - Current aspects of management. Injury 2023; 54:110983. [PMID: 37634999 DOI: 10.1016/j.injury.2023.110983] [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: 02/24/2023] [Revised: 06/19/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
The posterior sternoclavicular joint dislocation is a rare and potentially life-threatening injury, as massive haemorrhage can occur at the time of trauma, during reduction manoeuvres and drilling. These injuries are rare and a collective experience of managing them is of paramount importance. We present our multidisciplinary experience of managing several of these injuries in our centre, with learning points we have identified. Assessment should include Computerised Tomography Angiography (CTA) to assess the anatomy of the joint including the proximity to the underlying innominate vein and to identify any bleeding. Both closed reduction and open reconstruction have the potential for massive haemorrhage which can be controlled successfully with direct access to the underlying vessel. We recommend that all reductions should be performed in the presence of a cardiothoracic surgeon who can gain vascular control in the head, neck, and thorax. In specific high-risk cases, pre-emptive venous catheterisation can also be considered. We recommend that a discussion and rehearsal for intra-operative bleeding should be undertaken with the whole theatre team, with roles assigned pre-emptively and to allow identification of any deficiencies in staff expertise or equipment. Of the five recent cases managed in our centre one patient had a closed reduction and four had open reductions. Success of closed reductions within 48 h is high and these can be attempted up to 10 days after injury. Our patient undergoing closed reduction had a favourable outcome and returned to professional rugby at five months. Open reduction was performed in a physeal fracture as there was a delay to surgery and callus had begun to form and had the potential to adhere to the underlying vessel. In this case we performed open reduction and stabilised with tunnelled suture fixation. Our preferred method of reconstruction uses a palmaris graft with internal figure of eight bracing. One patient had a subsequent fracture of the medial clavicle around the drill holes that healed without further intervention. Despite good reduction and stability achieved following palmaris reconstructions, two patients are experiencing ongoing symptoms of globus and one with voice change without any objective underlying cause.
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Affiliation(s)
- Helen M A Ingoe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand.
| | - Khalid Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Alex A Malone
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Gordon Beadle
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Thomas Sharpe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Allen Cockfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Richard Lloyd
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand; Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Harsh Singh
- Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand; Dept of Cardiothoracic Surgery, Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Frances Colgan
- Christchurch Hospital, Riccarton Avenue, Christchurch, 8140, New Zealand; Department of Interventional Radiology, Christchurch Hospital, Christchurch, 8011 New Zealand
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Kehagias E, Galanakis N, Tsetis D. Central venous catheters: Which, when and how. Br J Radiol 2023; 96:20220894. [PMID: 37191031 PMCID: PMC10607393 DOI: 10.1259/bjr.20220894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Short-term or long-term CVCs are now considered the standard of practice for the administration of chemotherapy, fluid therapy, antibiotic therapy, and parenteral nutrition. Central venous access catheters are broadly divided into tunneled or non-tunneled catheters. Tunneled catheters can be further subdivided into totally implanted and totally not implanted devices. Device selection generally depends on various factors such as availability of peripheral veins, expected duration of therapy, and desired flow rate. Ultrasound-guided access is the safest technique for central venous access compared to the landmark technique and departments should strive to for a 100% ultrasound guided access. This review gives a basic overview of the differences of CVC catheters including PICCs, Hickman-catheters and port-catheters along with the criteria for CVC selection. It will also describe technical tips on placement of CVCs. Finally, it aims to highlight complications which are associated with CVC placement and options to treat or prevent them.
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Affiliation(s)
- Elias Kehagias
- Department of Medical Imaging, Heraklion University Hospital, University of Crete Medical School, Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Department of Medical Imaging, Heraklion University Hospital, University of Crete Medical School, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, Heraklion University Hospital, University of Crete Medical School, Heraklion, Crete, Greece
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Harduin LDO, Barroso TA, Guerra JB, Filippo MG, de Almeida LC, de Castro-Santos G, Oliveira FAC, Cavalcanti DET, Procopio RJ, Lima EC, Pinhati MES, dos Reis JMC, Moreira BD, Galhardo AM, Joviliano EE, de Araujo WJB, de Oliveira JCP. Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230052. [PMID: 38021275 PMCID: PMC10648056 DOI: 10.1590/1677-5449.202300522] [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: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.
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Affiliation(s)
- Leonardo de Oliveira Harduin
- Universidade Estadual do Estado do Rio de Janeiro - UERJ, Departamento de Cirurgia Vascular, Niterói, RJ, Brasil.
| | | | | | - Marcio Gomes Filippo
- Universidade Federal do Rio de Janeiro - UFRJ, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
| | | | - Guilherme de Castro-Santos
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | - Ricardo Jayme Procopio
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | | | - Barbara D’Agnoluzzo Moreira
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | | | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Departamento de Anatomia e Cirurgia, Ribeirão Preto, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Departamento de Angioradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
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Sandell M, Ericsson A, Al-Saadi J, Södervall B, Södergren E, Grass S, Sanchez J, Holmin S. A novel noble metal stent coating reduces in vitro platelet activation and acute in vivo thrombosis formation: a blinded study. Sci Rep 2023; 13:17225. [PMID: 37821529 PMCID: PMC10567768 DOI: 10.1038/s41598-023-44364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
Inherent to any stenting procedure is the prescription of dual antiplatelet therapy (DAPT) to reduce the platelet response. Clinical guidelines recommend 6-12 months of DAPT, depending on stent type, clinical picture and patient factors. Our hypothesis is that a nanostructured noble metal coating has the potential to reduce protein deposition and platelet activation. These effects would reduce subsequent thrombo-inflammatory reactions, potentially mitigating the need for an extensive DAPT in the acute phase. Here, a noble metal nanostructure coating on stents is investigated. Twelve pigs underwent endovascular implantation of coated and non-coated stents for paired comparisons in a blinded study design. The non-coated control stent was placed at the contralateral corresponding artery. Volumetric analysis of angiographic data, performed by a treatment blinded assessor, demonstrated a significant thrombus reduction for one of the coatings compared to control. This effect was already seen one hour after implantation. This finding was supported by in vitro data showing a significant reduction of coagulation activation in the coated group. This novel coating shows promise as an implant material addition and could potentially decrease the need for DAPT in the early phases of stent implementation.
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Affiliation(s)
- Mikael Sandell
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, Malvinas väg 10, 114 28, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- MedTechLabs, Stockholm, Sweden
| | - Anna Ericsson
- Bactiguard AB, Alfred Nobels allé 150, 146 48, Tullinge, Sweden
| | - Jonathan Al-Saadi
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Billy Södervall
- Bactiguard AB, Alfred Nobels allé 150, 146 48, Tullinge, Sweden
| | - Erika Södergren
- Bactiguard AB, Alfred Nobels allé 150, 146 48, Tullinge, Sweden
| | - Stefan Grass
- Bactiguard AB, Alfred Nobels allé 150, 146 48, Tullinge, Sweden
| | - Javier Sanchez
- Bactiguard AB, Alfred Nobels allé 150, 146 48, Tullinge, Sweden
- Department of Clinical Sciences, Danderyd Hospital, 182 88, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
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Garzón JAR, López GCZ, Piñeros-Hernandez LB, Martínez YFB. Internal jugular access using pocket ultrasound in a simulated model: comparison between biplane and monoplane visualization techniques. Ultrasound J 2023; 15:42. [PMID: 37815637 PMCID: PMC10564683 DOI: 10.1186/s13089-023-00335-4] [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: 06/07/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Ultrasound is the current standard for central venous access due to its advantages in efficiency and safety. In-plane and out-of-plane visualization techniques are commonly used, but there is no clear evidence showing an advantage of one technique over the other. The objective of this study was to compare the success and time required for biplane visualization vs. in-plane and out-of-plane techniques in simulated models. METHODOLOGY Ten emergency medicine specialists participated in 60 simulated events, with randomization of the visualization technique for each event. Each event required intravenous cannulation of a simulated model for jugular venous access, with a maximum of three attempts allowed. The number of attempts required for each event, success of puncture and venous cannulation, frequency of redirection and puncture of the posterior wall, time required to obtain an optimal window, visualize the needle inside the vessel, and passage of the guidewire were recorded. The success ratios and times required for each visualization technique (biplane, in-plane, and out-of-plane) were compared. RESULTS Cannulation success rate was 100% for all three techniques. Success on the first attempt was 95% for biplane visualization vs. 100% for in-plane and out-of-plane. The median total time for the procedure was higher for biplane visualization (29.9 s) compared to in-plane (25.2 s) and out-of-plane (29 s), but this difference was not statistically significant (p = 0.999). There were no significant differences in cannulation success, needle redirection, or posterior wall puncture frequency between biplane visualization and in-plane and out-of-plane techniques. CONCLUSIONS This study suggests that biplane visualization with the use of pocket ultrasound for internal jugular cannulation in simulated models did not demonstrate significant differences when compared with in-plane and out-of-plane visualization techniques. Further research with larger sample sizes may be needed to confirm these results.
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Affiliation(s)
- Jair Antonio Ruiz Garzón
- Advanced Center for Clinical Simulation and Technological Innovation, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Laura B Piñeros-Hernandez
- Advanced Center for Clinical Simulation and Technological Innovation, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Yury Forlan Bustos Martínez
- Advanced Center for Clinical Simulation and Technological Innovation, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
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Misirlioglu M, Yildizdas D, Yavas DP, Ekinci F, Horoz OO, Yontem A. Central Venous Catheter Insertion for Vascular Access: A 6-year Single-center Experience. Indian J Crit Care Med 2023; 27:748-753. [PMID: 37908424 PMCID: PMC10613870 DOI: 10.5005/jp-journals-10071-24536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 11/02/2023] Open
Abstract
Background Central venous catheterization is performed for such reasons as hemodynamic monitoring, parenteral nutrition, drug and fluid administration, and extracorporeal treatment. This study aimed to retrospectively review the indications for central venous catheter (CVC) insertion for vascular access and removal by pediatric intensive care unit (PICU) physicians, catheter types, and catheter-associated complications. Materials and methods The indications for CVC insertion and removal, catheter insertion site, types of catheters, catheter-associated complications, whether or not insertion was ultrasonographically guided, catheter-associated infections, and duration of use of 1200 catheters used by PICU physicians between 2015 and 2020 were retrospectively reviewed. Results In all, 315 (26.3%) hemodialysis catheters and 885 (73.8%) CVCs were inserted. Mean duration of catheter use was 12.33 ± 7.28 days. CVCs were inserted most commonly (28.4% [n = 341]) based on the indication of multiple drug infusions. In total, 44.8% of the CVCs were inserted under ultrasonographic guidance. The most common reason for the removal of catheters was that they were no longer needed (76.8% [n = 921]). Catheter-associated bloodstream infection occurred at the rate of 5.5 days per 1000 catheter days. Conclusion Central venous catheterization is becoming more widespread because of the benefits it provides during the follow-up and treatment of children. As central venous catheterization is a more invasive procedure than peripheral localization and is associated with severe complications, especially in pediatric patients, it should be carefully performed under sterile conditions and by experienced personnel based on appropriate indications. Central venous catheters should be removed as soon as the need disappears. How to cite this article Misirlioglu M, Yildizdas D, Yavas DP, Ekinci F, Horoz OO, Yontem A. Central Venous Catheter Insertion for Vascular Access: A 6-year Single-center Experience. Indian J Crit Care Med 2023;27(10):748-753.
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Affiliation(s)
- Merve Misirlioglu
- Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Damla Pinar Yavas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
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Kasai Y, Kasai J, Haraguchi T, Kitai T, Morita J, Okada T, Tsujimoto M, Fujita T. Lock and dock: Two-step transvenous retrieval of a fractured femoral sheath with a vascular snare via the right internal jugular vein. J Cardiol Cases 2023; 28:176-179. [PMID: 37818439 PMCID: PMC10562096 DOI: 10.1016/j.jccase.2023.06.007] [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: 03/31/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 10/12/2023] Open
Abstract
An 86-year-old male with progressive palpitations and dyspnea was referred to our hospital for heart failure treatment. Catheter ablation was performed for atrial flutter as we suspected tachycardia-induced cardiomyopathy as the cause of the patient's heart failure. Due to difficulty securing a peripheral venous route, a 6-Fr sheath was inserted via the right common femoral vein prior to administering general anesthesia. While attempting to insert a mapping catheter, the 6-Fr sheath became lodged and subsequently fractured during removal. Percutaneous transvenous retrieval using an 8-Fr sheath was unsuccessful, and a switch to a right internal jugular vein approach with a 16-Fr sheath was necessary for successful retrieval. The following two-step retrieval ("lock and dock") was then performed: 1) lock: a vascular snare was used to catch the remaining wire crossing into the fractured sheath lumen to prevent the risk of sheath migration to the right ventricle or the pulmonary artery, and 2) dock: the same snare was subsequently used to catch the fractured sheath. The planned catheter ablation was then successfully performed, without any complications. Learning objective Our case presents, "lock and dock," a novel approach for percutaneous transvenous retrieval that involves two steps: a vascular snare is used to catch the wire and subsequently the fractured sheath. This use of a vascular snare and a large-diameter sheath through the right internal jugular vein effectively reduces the possibility of fractured sheath migration.
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Affiliation(s)
- Yuhei Kasai
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Jungo Kasai
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Takuya Haraguchi
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takayuki Kitai
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Junji Morita
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takuya Okada
- Department of Clinical Engineering, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Masanaga Tsujimoto
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
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Kemp BJR, Kearns DJ, Uberoi R. ProGlide entrapment of the occlusive balloon during repair of an iatrogenic subclavian artery injury. BJR Case Rep 2023; 9:20230015. [PMID: 37780972 PMCID: PMC10513006 DOI: 10.1259/bjrcr.20230015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 10/03/2023] Open
Abstract
The insertion of any central venous catheter (CVC) is associated with a risk of damage to neurovascular structures, pneumothorax, cardiac arrhythmias, and infection1. Unintentional arterial puncture remains rare, occurring in 6.3-9.4% of attempted internal jugular vein (IJV) catheterisation and 3.1-4.9% of attempted subclavian vein catheterisation2. We present a previously undocumented complication encountered while utilising the Perclose ProGlide device in the case of a 59-year-old male who underwent right subclavian artery closure following the accidental insertion of a 14Fr Vascath into the right subclavian artery. This was performed using two ProGlide devices and one Angio-Seal device. Following deployment of the ProGlide devices, an uninflated balloon passed into the subclavian artery as a precaution, but not used, was removed. One of the ProGlide devices became dislodged having been deployed into the balloon, threatening haemostasis.
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Affiliation(s)
| | | | - Raman Uberoi
- Oxford University Hospitals, Oxford, United Kingdom
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Banana Y, Boukabous S, El malki H, Rezziki A, Belarbi A, Haddiya I, Bentata Y, Moutaouekkil EM, Benzirar A, El Mahi O. Long-term patency of bypass to the right atrium as a last resort in two hemodialysis patients: case report. Ann Med Surg (Lond) 2023; 85:5043-5046. [PMID: 37811058 PMCID: PMC10553076 DOI: 10.1097/ms9.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/10/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Central venous occlusion (CVO), which is caused by central venous catheters in haemodialysis patients , remains a challenge in vascular surgery. Case presentation The authors report data evaluating bypass graft patency and complications of two patients with CVO who have benefited from a subclavian artery to right atrium bypass using polytetrafuloroetylene. The first patient , underwent three times an angioplasty of the atrio prothetic anastomosis , finally the graft failed at 12 month. The second one, presented a steal syndrome with ischaemia of the right upper limb immediately postoperatively. Three months after the procedure , she underwent an angiographic control that showed a stenosis of the protheto atrial junction. Clinical discussion Central venous occlusion in patients with end-stage kidney disease is most often due to central venous catheters. Although the endovascular therapy is the first-line approach to the treatment of CVO, the surgical bypass to the right atrium is often the last resort to preserve adequate vascular access in haemodialysis patients, with CVO. The autologous vein and bovine arterial bypass remains better than polytetrafuloroetylene grafts in terms of long-term patency. Only few cases have been reported un the literature , besides no long-term outcome data has been previously reported. Conclusion Long-term secondary patency of bypass to the right atrium can be achieved, but requires strict follow-up, and multiple endovascular procedures to maintain the bypass access.
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Affiliation(s)
| | | | - Hicham El malki
- Cardiovascular Surgery, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Abdellah Rezziki
- Departments of Vascular Surgery
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Adam Belarbi
- Cardiovascular Surgery, Mohammed VI University Hospital of Oujda
| | - Intissar Haddiya
- Nephrology—Dialysis and Kidney Transplantation
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - Yassamine Bentata
- Nephrology—Dialysis and Kidney Transplantation
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
| | - El Mehdi Moutaouekkil
- Cardiovascular Surgery, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Oujda, Morocco
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Marsh PL, Moore EE, Moore HB, Bunch CM, Aboukhaled M, Condon SM, Al-Fadhl MD, Thomas SJ, Larson JR, Bower CW, Miller CB, Pearson ML, Twilling CL, Reser DW, Kim GS, Troyer BM, Yeager D, Thomas SG, Srikureja DP, Patel SS, Añón SL, Thomas AV, Miller JB, Van Ryn DE, Pamulapati SV, Zimmerman D, Wells B, Martin PL, Seder CW, Aversa JG, Greene RB, March RJ, Kwaan HC, Fulkerson DH, Vande Lune SA, Mollnes TE, Nielsen EW, Storm BS, Walsh MM. Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies. Front Immunol 2023; 14:1230049. [PMID: 37795086 PMCID: PMC10546929 DOI: 10.3389/fimmu.2023.1230049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/12/2023] [Indexed: 10/06/2023] Open
Abstract
Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.
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Affiliation(s)
- Phillip L. Marsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO, United States
| | - Hunter B. Moore
- University of Colorado Health Transplant Surgery - Anschutz Medical Campus, Aurora, CO, United States
| | - Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Michael Aboukhaled
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Shaun M. Condon
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | | | - Samuel J. Thomas
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - John R. Larson
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Charles W. Bower
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Craig B. Miller
- Department of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United States
| | - Michelle L. Pearson
- Department of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United States
| | | | - David W. Reser
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - George S. Kim
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Brittany M. Troyer
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Doyle Yeager
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Scott G. Thomas
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Daniel P. Srikureja
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Shivani S. Patel
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Sofía L. Añón
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine, South Bend, IN, United States
| | - Joseph B. Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - David E. Van Ryn
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
- Department of Emergency Medicine, Beacon Health System, Elkhart, IN, United States
| | - Saagar V. Pamulapati
- Department of Internal Medicine, Mercy Health Internal Medicine Residency Program, Rockford, IL, United States
| | - Devin Zimmerman
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Byars Wells
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Peter L. Martin
- Department of Emergency Medicine, Goshen Health, Goshen, IN, United States
| | - Christopher W. Seder
- Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States
| | - John G. Aversa
- Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States
| | - Ryan B. Greene
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Robert J. March
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniel H. Fulkerson
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Department of Trauma & Surgical Research Services, South Bend, IN, United States
| | - Stefani A. Vande Lune
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, United States
| | - Tom E. Mollnes
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Erik W. Nielsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Benjamin S. Storm
- Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Mark M. Walsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
- Indiana University School of Medicine, South Bend, IN, United States
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Jatczak L, Puton RC, Proença AJL, Rubin LC, Borges LB, Saleh JN, Corrêa MP. Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study. J Vasc Bras 2023; 22:e20230070. [PMID: 37790889 PMCID: PMC10545227 DOI: 10.1590/1677-5449.202300702] [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: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 10/05/2023] Open
Abstract
Background Central venous catheters are essential for management of hospitalized patients, but their insertion is subject to complications that can make them unusable and/or cause patient morbidity. There are few data on the incidence of these complications and the variables associated with these outcomes in Brazil. Objectives To determine the incidence of mechanical complications and failures of short stay central venous catheters fitted by the vascular surgery service at a teaching hospital and identify variables associated with their occurrence. Methods This was a prospective cohort of 73 attempts to fit patients with a central venous catheter performed by the vascular surgery service at a teaching hospital from July to October of 2022. Results Mechanical complications occurred in 12 cannulation attempts (16.44%) and there were 10 failures (13.70%). The factors associated with mechanical complications were less experienced operators (p < 0.001), less specialized operators (p = 0.014), a failed attempt prior to requesting help from the vascular surgery service (p = 0.008), and presence of at least two criteria for difficulty (p = 0.007). Conclusions The local incidence of mechanical complications and central venous cannulation failures was similar to rates described in the international literature, but higher than rates in other Brazilian studies. The results suggest that the degree of experience of the person fitting the catheter, history of a failed prior attempt, and presence of at least two criteria for difficulty identified before the procedure were associated with worse outcomes.
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Affiliation(s)
| | - Renan Camargo Puton
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
| | | | | | - Luiza Brum Borges
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
| | - Jaber Nashat Saleh
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
- Universidade de Passo Fundo - UPF, Passo Fundo, RS, Brasil.
| | - Mateus Picada Corrêa
- Faculdade Meridional - IMED, Passo Fundo, RS, Brasil.
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
- Universidade de Passo Fundo - UPF, Passo Fundo, RS, Brasil.
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