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Fernandez-Fernandez I, Parra-García G, Blanco-Mavillard I, Carr P, Santos-Costa P, Rodríguez-Calero MÁ. Vascular access specialist teams versus standard practice for catheter insertion and prevention of failure: a systematic review. BMJ Open 2024; 14:e082631. [PMID: 38969373 PMCID: PMC11227807 DOI: 10.1136/bmjopen-2023-082631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE Billions of vascular access devices (VADs) are inserted annually for intravenous therapy worldwide. However, their use is not without challenges. Facilitating the process and enhancing results, hospital authorities have created vascular access specialist teams (VASTs) with advanced competencies in the evaluation, insertion, care and management of VADs. The objective is to compare the effectiveness of VASTs versus standard practice regarding cannulation success and vascular access maintenance in hospitalised adults. DESIGN Systematic review, using the Mixed Methods Appraisal Tool. DATA SOURCES We conducted a structured data search on Cochrane Library, MEDLINE, Web of Science, Scopus and EBSCOhost up to 31 May 2023. We did not impose a time limit regarding the date of publication. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review if they were randomised and non-randomised trials and observational studies. DATA EXTRACTION AND SYNTHESIS We included studies that described or evaluated the activity of VASTs compared with clinical practitioners. The outcomes analysed were the success of the cannulation and the incidence of associated adverse effects. RESULTS The search strategy produced 3053 papers published between 1984 and 2020, from which 12 were selected for analysis. VASTs are heterogeneously described among these studies, which mainly focus on insertions, frequently for patients with difficult intravenous access. Some patients presented with specific needs or requirement for specific insertion technique or catheter type. Compared with usual practice, these studies indicate that the involvement of a VAST is associated with a higher effectiveness in terms of first attempt insertions and insertion success rates, and a reduction in catheter-associated adverse events. However, meta-analyses confirming this trend are not currently possible. CONCLUSIONS It seems apparent that VASTS contribute to improving the health of patients during the administration of intravenous. VASTs seem to increase the effectiveness of VAD insertion and care and reduce complications. PROSPERO REGISTRATION NUMBER CRD42021231259.
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Affiliation(s)
| | | | - Ian Blanco-Mavillard
- Healthcare Implementation and Research Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma de Mallorca, Spain
- Care, Chronicity and Evidence in Health Research Group, Health research institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing (UICISA: E), Higher School of Nursing of Coimbra, Coimbra, Portugal
- Portuguese Association for Vascular Access (APoAVa), Coimbra, Portugal
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Schults JA, Kleidon T, Charles K, Young ER, Ullman AJ. Peripherally inserted central catheter design and material for reducing catheter failure and complications. Cochrane Database Syst Rev 2024; 6:CD013366. [PMID: 38940297 PMCID: PMC11212118 DOI: 10.1002/14651858.cd013366.pub2] [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: 06/29/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) facilitate diagnostic and therapeutic interventions in health care. PICCs can fail due to infective and non-infective complications, which PICC materials and design may contribute to, leading to negative sequelae for patients and healthcare systems. OBJECTIVES To assess the effectiveness of PICC material and design in reducing catheter failure and complications. SEARCH METHODS The University of Queensland and Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the WHO ICTRP and ClinicalTrials.gov trials registers to 16 May 2023. We aimed to identify other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, as well as relevant systematic reviews, meta-analyses, and health technology assessment reports. We contacted experts in the field to ascertain additional relevant information. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating PICC design and materials. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were venous thromboembolism (VTE), PICC-associated bloodstream infection (BSI), occlusion, and all-cause mortality. Secondary outcomes were catheter failure, PICC-related BSI, catheter breakage, PICC dwell time, and safety endpoints. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 12 RCTs involving approximately 2913 participants (one multi-arm study). All studies except one had a high risk of bias in one or more risk of bias domain. Integrated valve technology compared to no valve technology for peripherally inserted central catheter design Integrated valve technology may make little or no difference to VTE risk when compared with PICCs with no valve (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.19 to 2.63; I² = 0%; 3 studies; 437 participants; low certainty evidence). We are uncertain whether integrated valve technology reduces PICC-associated BSI risk, as the certainty of the evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Integrated valve technology may make little or no difference to occlusion risk when compared with PICCs with no valve (RR 0.86, 95% CI 0.53 to 1.38; I² = 0%; 5 studies; 900 participants; low certainty evidence). We are uncertain whether use of integrated valve technology reduces all-cause mortality risk, as the certainty of evidence is very low (RR 0.85, 95% CI 0.44 to 1.64; I² = 0%; 2 studies; 473 participants). Integrated valve technology may make little or no difference to catheter failure risk when compared with PICCs with no valve (RR 0.80, 95% CI 0.62 to 1.03; I² = 0%; 4 studies; 720 participants; low certainty evidence). We are uncertain whether integrated-valve technology reduces PICC-related BSI risk (RR 0.51, 95% CI 0.19 to 1.32; I² = not applicable; 2 studies (no events in 1 study); 542 participants) or catheter breakage, as the certainty of evidence is very low (RR 1.05, 95% CI 0.22 to 5.06; I² = 20%; 4 studies; 799 participants). Anti-thrombogenic surface modification compared to no anti-thrombogenic surface modification for peripherally inserted central catheter design We are uncertain whether use of anti-thrombogenic surface modified catheters reduces risk of VTE (RR 0.67, 95% CI 0.13 to 3.54; I² = 15%; 2 studies; 257 participants) or PICC-associated BSI, as the certainty of evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces occlusion (RR 0.69, 95% CI 0.04 to 11.22; I² = 70%; 2 studies; 257 participants) or all-cause mortality risk, as the certainty of evidence is very low (RR 0.49, 95% CI 0.05 to 5.26; I² = not applicable; 1 study; 111 participants). Use of anti-thrombogenic surface modified catheters may make little or no difference to risk of catheter failure (RR 0.76, 95% CI 0.37 to 1.54; I² = 46%; 2 studies; 257 participants; low certainty evidence). No PICC-related BSIs were reported in one study (111 participants). As such, we are uncertain whether use of anti-thrombogenic surface modified catheters reduces PICC-related BSI risk (RR not estimable; I² = not applicable; very low certainty evidence). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces the risk of catheter breakage, as the certainty of evidence is very low (RR 0.15, 95% CI 0.01 to 2.79; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Antimicrobial impregnation compared to non-antimicrobial impregnation for peripherally inserted central catheter design We are uncertain whether use of antimicrobial-impregnated catheters reduces VTE risk (RR 0.54, 95% CI 0.05 to 5.88; I² = not applicable; 1 study; 167 participants) or PICC-associated BSI risk, as the certainty of evidence is very low (RR 2.17, 95% CI 0.20 to 23.53; I² = not applicable; 1 study; 167 participants). Antimicrobial-impregnated catheters probably make little or no difference to occlusion risk (RR 1.00, 95% CI 0.57 to 1.74; I² = 0%; 2 studies; 1025 participants; moderate certainty evidence) or all-cause mortality (RR 1.12, 95% CI 0.71 to 1.75; I² = 0%; 2 studies; 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter failure (RR 1.04, 95% CI 0.82 to 1.30; I² = not applicable; 1 study; 221 participants; low certainty evidence). Antimicrobial-impregnated catheters probably make little or no difference to PICC-related BSI risk (RR 1.05, 95% CI 0.71 to 1.55; I² = not applicable; 2 studies (no events in 1 study); 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter breakage (RR 0.86, 95% CI 0.19 to 3.83; I² = not applicable; 1 study; 804 participants; low certainty evidence). AUTHORS' CONCLUSIONS There is limited high-quality RCT evidence available to inform clinician decision-making for PICC materials and design. Limitations of the current evidence include small sample sizes, infrequent events, and risk of bias. There may be little to no difference in the risk of VTE, PICC-associated BSI, occlusion, or mortality across PICC materials and designs. Further rigorous RCTs are needed to reduce uncertainty.
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Affiliation(s)
- Jessica A Schults
- Herston Infectious Disease Institute, Metro North Health, Brisbane, Australia
- School of Nursing Midwifery and Social Work, The Univeristy of Queensland, Brisbane, Australia
| | - Tricia Kleidon
- Vascular Access and Management Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Karina Charles
- School of Nursing Midwifery and Social Work, The Univeristy of Queensland, Brisbane, Australia
| | - Emily Rebecca Young
- Menzies Health Institute Queensland & School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Amanda J Ullman
- School of Nursing Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Yoshino N, Kimura SI, Kawamura K, Nakata Y, Matsuoka A, Ishikawa T, Meno T, Nakamura Y, Kawamura M, Kawamura S, Takeshita J, Misaki Y, Yoshimura K, Gomyo A, Okada Y, Tamaki M, Kusuda M, Kameda K, Akahoshi Y, Sato M, Tanihara A, Nakasone H, Kako S, Kanda Y. Clinical impact of a change in antibiotics or the addition of glycopeptide antibiotics for persistent febrile neutropenia after autologous stem cell transplantation. J Infect Chemother 2024:S1341-321X(24)00173-9. [PMID: 38925426 DOI: 10.1016/j.jiac.2024.06.018] [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: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND A change in empirical antibiotics or the addition of glycopeptide antibiotics is often applied in cases of persistent febrile neutropenia (FN) despite the administration of broad-spectrum antibiotics. However, the clinical benefit of these approaches remains unclear. METHODS We conducted a retrospective study to evaluate the effectiveness of a change in antibiotics or the addition of glycopeptide antibiotics for persistent FN after autologous hematopoietic cell transplantation (auto-HCT). We retrospectively reviewed the records of 208 patients who received auto-HCT at our institution between 2007 and 2019. FN that lasted for 4 days or longer was defined as persistent FN. We compared the time to defervescence between patients whose initial antibiotics were changed and/or who additionally received glycopeptide antibiotics, and those without these antibiotic modifications. RESULTS Among patients who fulfilled the criteria of persistent FN (n = 125), changes in antibiotics were not significantly associated with the time to defervescence in a multivariate analysis (hazard ratio [HR] 0.72, p = 0.27). On the other hand, the addition of glycopeptide antibiotics was paradoxically associated with a delay in defervescence (HR 0.56, p = 0.033). CONCLUSIONS Although there may be differences in patient backgrounds, no significant differences were observed in either a univariate or multivariate analysis. Since neither a change in antibiotics nor the addition of glycopeptide antibiotics was associated with earlier defervescence in persistent FN after auto-HCT, routine antibiotic modifications might not be necessary in this setting.
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Affiliation(s)
- Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Koji Kawamura
- Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuya Nakata
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akari Matsuoka
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takuto Ishikawa
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tomohiro Meno
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yuhei Nakamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yosuke Okada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
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Azad MA, Patel R. Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin Microbiol Rev 2024; 37:e0010423. [PMID: 38506553 PMCID: PMC11237642 DOI: 10.1128/cmr.00104-23] [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: 03/21/2024] Open
Abstract
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
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Affiliation(s)
- Marisa Ann Azad
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Patel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Sánchez Cánovas M, García Torralba E, Blaya Boluda N, Sánchez Saura A, Puche Palao G, Sánchez Fuentes A, Martínez Montesinos L, Poveda Ganga C, García Tomas L, Bayona Jiménez J, Cos Zapata Á, Muñoz Jurado CM, Pina Mingorance I, Caravaca Hernández MA, Vicente García V, Ayala de la Peña F. Thrombosis and infections associated with PICC in onco-hematological patients, what is their relevance? Clin Transl Oncol 2024:10.1007/s12094-024-03548-8. [PMID: 38865035 DOI: 10.1007/s12094-024-03548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Peripherally inserted central venous catheters (PICC) in the onco-hematological patients may be associated with thrombosis or infections that may have short- to medium-term repercussions. MATERIAL AND METHODS Single-centre retrospective analysis of a prospectively collected cohort. Primary objective was to establish the PICC-thrombosis and infections incidence. Secondary objectives were to analyze profile of patients suffering from these complications and variables associated with an increased likelihood of developing these events. RESULTS 549 patients were recruited. 58.5% (n = 321) were oncology patients and 41.5% (n = 228) hematology patients. The incidence of PICC-associated thrombosis was 3.5% (n = 19). Thrombosis was associated with progression of the underlying malignant pathology in 10.6% (n = 2) of cases. No association was found between clinical variables analysed and development of thrombosis. Incidence of PICC-associated infections was 7.65% (n = 42). In the 30 days prior to PICC infection, 57.1% (n = 24) had a febrile syndrome of another focus, 73.8% (n = 11) had been hospitalized, 49.5% (n = 25) had a neutrophil count of 0-500 cells/mm3 and 47.6% (n = 20) had an episode of neutropenic fever. Variables significantly associated with the development of infection were hematological patients, high-flow PICC, 3-lm PICC or PICC insertion because of administration of vesicant therapy. CONCLUSIONS Incidence of PICC-associated thrombosis is low and apparently less prognostically aggressive than other forms of thrombosis associated with cancer, without identify predictive factors. Infection was more prevalent and the identification of risk factors in our series could facilitate its prevention.
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Affiliation(s)
- Manuel Sánchez Cánovas
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain.
| | - Esmeralda García Torralba
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Noel Blaya Boluda
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Ana Sánchez Saura
- Medical Oncology Department, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Spain
| | - Gabriel Puche Palao
- Internal Medicine Department, Hospital G. Universitario Reina Sofía, Murcia, Spain
| | - Ana Sánchez Fuentes
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Lorena Martínez Montesinos
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Carmen Poveda Ganga
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Lucía García Tomas
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Josefa Bayona Jiménez
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Ángeles Cos Zapata
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Carmen María Muñoz Jurado
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Inmaculada Pina Mingorance
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - María Amor Caravaca Hernández
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Vicente Vicente García
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Francisco Ayala de la Peña
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
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Kosmeri C, Giapros V, Serbis A, Balomenou F, Baltogianni M. Antibiofilm Strategies in Neonatal and Pediatric Infections. Antibiotics (Basel) 2024; 13:509. [PMID: 38927176 PMCID: PMC11200539 DOI: 10.3390/antibiotics13060509] [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: 04/28/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Biofilm-related infections pose significant challenges in neonatal and pediatric care, contributing to increased morbidity and mortality rates. These complex microbial communities, comprising bacteria and fungi, exhibit resilience against antibiotics and host immune responses. Bacterial species such as Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis commonly form biofilms on medical devices, exacerbating infection risks. Neonates and children, particularly those in intensive care units, are highly susceptible to biofilm-associated infections due to the prolonged use of invasive devices, such as central lines and endotracheal tubes. Enteral feeding tubes, crucial for neonatal nutritional support, also serve as potential sites for biofilm formation, contributing to recurrent microbial contamination. Moreover, Candida species, including Candida pelliculosa, present emerging challenges in neonatal care, with multi-drug resistant strains posing treatment complexities. Current antimicrobial therapies, while important in managing infections, often fall short in eradicating biofilms, necessitating alternative strategies. The aim of this review is to summarize current knowledge regarding antibiofilm strategies in neonates and in children. Novel approaches focusing on biofilm inhibition and dispersal show promise, including surface modifications, matrix-degrading enzymes, and quorum-sensing inhibitors. Prudent use of medical devices and exploration of innovative antibiofilm therapies are imperative in mitigating neonatal and pediatric biofilm infections.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece; (C.K.); (A.S.)
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (F.B.); (M.B.)
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece; (C.K.); (A.S.)
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (F.B.); (M.B.)
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (F.B.); (M.B.)
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Corley A, Royle RH, Marsh N, Larsen EN, Playford EG, McGrail MR, Runnegar N, Ware RS, Gavin NC, Alexandrou E, Murgo M, Gowardman JR, Regli A, Rickard CM. Incidence and risk factors for central venous access device failure in hospitalized adults: A multivariable analysis of 1892 catheters. J Hosp Med 2024. [PMID: 38800854 DOI: 10.1002/jhm.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Central venous access devices (CVADs) allow intravenous therapy, haemodynamic monitoring and blood sampling but many fail before therapy completion. OBJECTIVE To quantify CVAD failure and complications; and identify risk factors. DESIGNS, SETTINGS AND PARTICIPANTS Secondary analysis of multicentre randomised controlled trial including patients aged ≥16 years with a non-tunnelled CVAD (NTCVAD), peripherally-inserted central catheter (PICC) or tunnelled CVAD (TCVAD). Primary outcome was incidence of all-cause CVAD failure (central line-associated bloodstream infection [CLABSI], occlusion, accidental dislodgement, catheter fracture, thrombosis, pain). Secondary outcomes were CLABSI, occlusion and dislodgement. Cox regression was used to report time-to-event associations. RESULTS In 1892 CVADs, all-cause failure occurred in 10.2% of devices: 49 NTCVADs (6.1%); 100 PICCs (13.2%); 44 TCVADs (13.4%). Failure rates for CLABSI, occlusion and dislodgement were 5.3%, 1.8%, and 1.7%, respectively. Independent CLABSI predictors were blood product administration through PICCs (hazard ratio (HR) 2.62, 95% confidence interval (CI) 1.24-5.55); and in TCVADs, one or two lumens, compared with three to four (HR 3.36, 95%CI 1.68-6.71), intravenous chemotherapy (HR 2.96, 95%CI 1.31-6.68), and diabetes (HR 3.25, 95%CI 1.40-7.57). Independent factors protective for CLABSI include antimicrobial NTCVADs (HR 0.23, 95%CI 0.08-0.63) and lipids in TCVADs (HR 0.32, 95%CI 0.14-0.72). NTCVADs inserted at another hospital (HR 7.06, 95%CI 1.48-33.7) and baseline infection in patients with PICCs (HR 2.72, 95%CI 1.08-6.83) were predictors for dislodgement. No independent occlusion predictors were found. Modifiable risk factors were identified for CVAD failure, which occurred for 1-in-10 catheters. Strict infection prevention measures and improved CVAD securement could reduce CLABSI and dislodgement risk.
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Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth H Royle
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
| | - E Geoffrey Playford
- Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, QLD, Australia
| | - Matthew R McGrail
- Rural Clinical School, The University of Queensland, Rockhampton, QLD, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, QLD, Australia
- Princess Alexandra Southside Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia
| | - Nicole C Gavin
- Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia
| | - Marghie Murgo
- UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - John R Gowardman
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Intensive Care Services and Internal Medicine and Aged Care (IMAC), Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Adrian Regli
- Intensive Care Unit, SJOG Murdoch Hospital, Perth, WA, Australia
- Medical School, The Notre Dame University, Fremantle, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
- Alliance for Vascular Access Teaching and Research Group, Schools of Nursing and Midwifery & Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- UQ Centre for Clinical Research, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
- Metro North Health, Herston Infectious Diseases Institute, Herston, QLD, Australia
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Lee Y, Kim JH, Lee JA, Ahn SM, Han M, Ahn JY, Jeong SJ, Choi JY, Yeom JS, Lee SH, Ku NS. Clinical characteristics and risk factors for right-sided infective endocarditis in Korea: a 12-year retrospective cohort study. Sci Rep 2024; 14:10466. [PMID: 38714772 PMCID: PMC11076501 DOI: 10.1038/s41598-024-60638-x] [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: 12/24/2023] [Accepted: 04/25/2024] [Indexed: 05/10/2024] Open
Abstract
Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (LSIE) and exhibits distinct epidemiological, clinical, and microbiological characteristics. Previous studies have focused primarily on RSIE in patients with intravenous drug use. We investigated the characteristics and risk factors for RSIE in an area where intravenous drug use is uncommon. A retrospective cohort study was conducted at a tertiary hospital in South Korea. Patients diagnosed with infective endocarditis between November 2005 and August 2017 were categorized into LSIE and RSIE groups. Of the 406 patients, 365 (89.9%) had LSIE and 41 (10.1%) had RSIE. The mortality rates were 31.7% in the RSIE group and 31.5% in the LSIE group (P = 0.860). Patients with RSIE had a higher prevalence of infection with Staphylococcus aureus (29.3% vs. 13.7%, P = 0.016), coagulase-negative staphylococci (17.1% vs. 6.0%, P = 0.022), and gram-negative bacilli other than HACEK (12.2% vs. 2.2%, P = 0.003). Younger age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.95-0.99, P = 0.006), implanted cardiac devices (aOR 37.75, 95% CI 11.63-141.64, P ≤ 0.001), and central venous catheterization (aOR 4.25, 95% CI 1.14-15.55, P = 0.029) were independent risk factors for RSIE. Treatment strategies that consider the epidemiologic and microbiologic characteristics of RSIE are warranted.
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Affiliation(s)
- Yongseop Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jung Ah Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Sang Min Ahn
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Min Han
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea.
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea.
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9
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Lee KW, Cheong CS, Gin GG. Peripherally Inserted Central Venous Catheter-Related Complications in Adult Patients with Haematological Malignancy. Malays J Med Sci 2024; 31:52-61. [PMID: 38694583 PMCID: PMC11057837 DOI: 10.21315/mjms2024.31.2.6] [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: 04/12/2023] [Accepted: 06/17/2023] [Indexed: 05/04/2024] Open
Abstract
Background Peripherally inserted central venous catheters (PICC) are widely used in patients with haematological malignancies owing to the requirement for prolonged intravenous therapy. However, the growing use of PICCs has resulted in a multitude of complications such as infections and thrombosis, leading to prolonged hospitalisation periods and increased morbidity. This study aimed to determine the incidence of and factors associated with PICC-related complications in patients with haematological malignancies. Methods This prospective cohort study was conducted at a single academic institution. The inclusion criteria involved all adult patients with haematological malignancies who had newly inserted PICCs. The patients were observed for a minimum duration of 60 days to evaluate the incidence of PICC-related infections and thrombosis, as well as mechanical complications. Results A total of 119 PICCs were implanted in 85 patients. Among them, more than half of the patients were diagnosed with lymphoma (55.0%). The median dwell time was 61 days (interquartile range: 98 days). The incidence of PICC-related complications was 58.0% (6.9 per 1,000 catheter-days). Specifically, 43 PICCs (36.1%, 4.3 per 1,000 catheter-days) experienced infective complications, 25 (21.1%, 2.5 per 1,000 catheter-days) encountered mechanical complications and 1 (0.8%, 0.1 per 1,000 catheter-days) exhibited thrombotic complications. Furthermore, an underlying diagnosis of acute leukaemia was significantly associated with a higher incidence of PICC-related infections. Conclusion Our study revealed higher incidence rates of PICC-related complications in adult patients with haematological malignancies compared to the finding of other studies. Notably, patients with underlying acute leukaemia displayed a higher incidence of PICC-related infections. These findings underscore the importance of implementing appropriate interventions and conducting thorough root cause analyses to effectively mitigate this complication and improve patient outcomes.
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Affiliation(s)
- Kee Wei Lee
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chin Sum Cheong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Gan Gin Gin
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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10
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Wang XX, He Y, Chu J, Xu JS. Risk factors analysis and the establishment of nomogram prediction model for PICC-related venous thrombosis in patients with lymphoma: a double-center cohort-based case-control study. Front Oncol 2024; 14:1347297. [PMID: 38559558 PMCID: PMC10979641 DOI: 10.3389/fonc.2024.1347297] [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: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The objective of this study is to examine the risk factors associated with the occurrence of PICC-Related Venous Thrombosis (PICC-RVTE) in individuals diagnosed with lymphoma, as well as to develop a predictive risk nomogram model. Methods A total of 215 patients with lymphoma treated at Yunnan Provincial Tumor Hospital from January 2017 to December 2020 were retrospectively evaluated as the training cohort; 90 patients with lymphoma treated at the Department of Oncology of the First People's Hospital of Anning, Affiliated to Kunming University of Science and Technology during the January 2021 to September 2023 were evaluated as the validation cohort. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation. Results A total of 305 lymphoma patients were selected and 35 (11.48%) PICC-RVTE occurred, the median time was 13 days. The incidence within 1-2week was 65.71%. Multivariate analysis suggested that the activity amount, thrombosis history(within the last 12 months), ATIII, Total cholesterol and D-dimer levels were independently associated with PICC-RVTE, and a nomogram was constructed based on the multivariate analysis. ROC analysis indicated good discrimination in the training set (area under the curve [AUC] = 0.907, 95%CI:0.850-0.964) and the testing set (AUC = 0.896, 95%CI: 0.782-1.000) for the PICC-RVTE nomogram. The calibration curves showed good calibration abilities, and the decision curves indicated the clinical usefulness of the prediction nomograms. Conclusions Patients should be advised to undergo color Doppler ultrasound system testing within two week after the implantation of a PICC catheter to detect PICC-RVTE at an early stage. The validated nomogram can be used to predict the risk of catheter-related thrombosis (CRT) in patients with lymphoma who received at least one chemotherapy after PICC catheterization, no bleeding tendency, no recent history of anticoagulant exposure and no severe heart, lung, renal insufficiency. This model has the potential to assist clinicians in formulating individualized treatment strategies for each patient.
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Affiliation(s)
- Xue-xing Wang
- Department of Oncology, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, China
| | - Yuan He
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Jie Chu
- Department of Oncology, The First People’s Hospital of Ziyang, Ziyang, China
| | - Jin-song Xu
- Department of Oncology, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, China
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11
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Wiesen B, Atwell M, Leavitt C, Clark N, Kessler E, Lam E, Flaig T, Kukreja J, Kim S, Maroni P, Cost NG. Use of Peripheral Intravenous Access in Patients Undergoing Chemotherapy for Testicular Cancer. JCO Oncol Pract 2024; 20:361-369. [PMID: 38127812 DOI: 10.1200/op.23.00580] [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: 09/11/2023] [Revised: 09/27/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Systemic chemotherapy, depending on the regimen, can be administered through peripheral intravenous (pIV) access or through central venous access devices (CVADs). There is no current best practice regarding optimal access for chemotherapy for patients with testicular cancer (TC). We retrospectively evaluated patients undergoing systemic chemotherapy for TC and compared baseline characteristics and complications of patients using pIV versus CVADs. METHODS We included patients with TC who underwent first-line systemic chemotherapy at the University of Colorado Hospitals from 2005 to 2020. Data were collected on demographics, cancer characteristics, type, duration of chemotherapy, pIV or CVAD use, and associated complication rates. We then performed univariate and multivariate regression analyses to compare complication rates and risk factors for each group. RESULTS One hundred fifty-four patients met inclusion criteria. Ninety-two (60%) patients used CVADs, and 62 patients (40%) used pIV for their initial treatment. Only six (9.7%) of 62 patients transitioned from pIV to CVADs during therapy. Similarly, 10 of 92 (10.9%) patients with initial CVAD needed to transition to a different type of CVAD or to pIV (P = .81). There were a greater number of venous access-related complications (48 of 92 patients, 52.2%) and overall thrombotic events (33 of 92 patients, 35.9%) for the CVAD group (P > .001) when compared with the pIV group. We observed an association between the following factors and venous access-related complications during chemotherapy: higher stage TC, increased total chemotherapy cycles, and delayed therapy. CONCLUSION Peripheral IV use for first-line nonvesicant chemotherapy in patients with TC appears to be well tolerated with high rates of therapy completion and lower rates of complications when compared with CVADs. These data support our preferred treatment approach and provide evidence that pIV access is a safe and effective way to deliver chemotherapy for patients with TC.
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Affiliation(s)
- Brett Wiesen
- The University of Colorado, Division of Urology, Aurora, CO
| | - Michael Atwell
- The University of Colorado, Division of Urology, Aurora, CO
| | - Colton Leavitt
- The University of Utah, Department of Urology, Salt Lake City, UT
| | - Nathan Clark
- The University of Colorado, Division of Urology, Aurora, CO
| | - Elizabeth Kessler
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Elaine Lam
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Thomas Flaig
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Janet Kukreja
- The University of Colorado, Division of Urology, Aurora, CO
| | - Simon Kim
- The University of Colorado, Division of Urology, Aurora, CO
| | - Paul Maroni
- The University of Colorado, Division of Urology, Aurora, CO
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12
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Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, Ray-Barruel G, Rickard CM. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud 2024; 151:104673. [PMID: 38142634 DOI: 10.1016/j.ijnurstu.2023.104673] [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: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.
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Affiliation(s)
- Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia.
| | - Emily N Larsen
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Gabor Mihala
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Marie Cooke
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; The Michigan Hospital Medicine Safety Consortium, Ann Arbor, MI, United States of America
| | - Gillian Ray-Barruel
- School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Menzies Health Institute Queensland, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Claire M Rickard
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing and Midwifery, School of Medicine, Griffith University, Nathan, Queensland, Australia; Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Queensland, Australia; Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia; UQ Centre for Clinical Research, Brisbane, Queensland, Australia
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13
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Chopra V. Finding the Middle Ground for Intravenous Therapy. JAMA Netw Open 2024; 7:e2355724. [PMID: 38349658 DOI: 10.1001/jamanetworkopen.2023.55724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Vineet Chopra
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
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14
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Thomsen SL, Boa R, Vinter-Jensen L, Rasmussen BS. Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2355716. [PMID: 38349655 PMCID: PMC10865154 DOI: 10.1001/jamanetworkopen.2023.55716] [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] [Received: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Midline catheters (MCs) are widely used, but safety and efficacy compared with peripherally inserted central catheters (PICCs) has not been adequately evaluated. Objective To compare the safety and efficacy of MCs with PICCs among adult patients with an anticipated intravenous therapy lasting from 5 to 28 days. Design, Setting, and Participants This parallel, 2-group, open-label, randomized clinical trial (RCT) was conducted in Denmark from October 2018 to February 2022 at a single academic tertiary care center. Adult inpatients and outpatients were consecutively randomized. Intervention Patients were randomized in a 1:1 ratio to either the MC group or the PICC control group. Main Outcomes and Measures The primary outcome was catheter-related bloodstream infection (CRBSI), analyzed using the Fisher exact test. Secondary outcomes were symptomatic catheter-related thrombosis and catheter failure, including mechanical cause, phlebitis, infiltration, pain in relation to drug or fluid administration, and leaking from the puncture site. Incidence rate ratios (IRRs) were calculated to assess between-group failure rates over device dwell time using Poisson regression. An intention-to-treat analysis was performed. Results A total of 304 patients (mean [SD] age, 64.6 [13.5] years; 130 [42.8%] female) were included in the analysis, and 152 patients were allocated to each catheter group. The incidence of CRBSI was low, with 0 in the MC group and 1 in the PICC control group (P > .99). The MC group had a higher catheter-related complication rate (20 [13.2%] vs 11 [7.2%]), and an IRR of 2.37 (95% CI, 1.12-5.02; P = .02) for complications compared with the PICC control group. In a post hoc analysis stratified by catheter dwell time, no significant difference in complication rate (IRR, 1.16; 95% CI, 0.50-2.68; P = .73) was found between the 2 groups for catheters used less than 16 days. Conclusions and Relevance In this RCT with patients who received medium- to long-term intravenous therapy, the incidence of CRBSI was low, with no difference between MCs and PICCs. The use of MCs resulted in a higher incidence of catheter-related complications compared with use of PICCs. This finding should be balanced in the decision of type of catheter used at the individual patient level. Trial Registration ClinicalTrials.gov Identifier: NCT04140916.
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Affiliation(s)
- Simon L. Thomsen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Boa
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Vinter-Jensen
- Department of Gastroenterology, Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil S. Rasmussen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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15
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Pitiriga VC, Bakalis J, Campos E, Kanellopoulos P, Sagris K, Saroglou G, Tsakris A. Central Venous Catheters versus Peripherally Inserted Central Catheters: A Comparison of Indwelling Time Resulting in Colonization by Multidrug-Resistant Pathogens. Antibiotics (Basel) 2024; 13:89. [PMID: 38247648 PMCID: PMC10812679 DOI: 10.3390/antibiotics13010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of peripherally inserted central catheters (PICCs) as an alternative to central venous catheters (CVCs) has steadily risen over the last two decades. However, there is an ongoing debate regarding research evidence that supports any clear advantages or disadvantages of them compared to traditional central venous lines. The present study was conducted to compare the indwelling time of CVC and PICC placements leading to microbial colonization by multidrug-resistant microorganisms (MDROs) in critically ill patients. METHODS A single-center retrospective descriptive study was performed that reviewed the medical records of critically ill patients with colonized CVCs and PICCs who were hospitalized during a 24-month period (May 2019-May 2021). To evaluate the association between indwelling time of catheter placement and colonization rates, events were categorized into three groups, each representing a one-week time interval of catheter indwelling time: group 1: ≤7 days, group 2: 8-14 days, and group 3: >14 days. RESULTS A total of 207 hospitalized patients with colonized PICCs or CVCs were included in the study. Of these, 144 (69.5%) had a CVC placement and 63 (30.5%) had a PICC placement. The overall colonization rate (per 1.000 catheter/days) was 14.73 in the CVC and 5.67 in the PICC cohort (p = 0.003). In the group of PICCs, 12/63 (19%) of the pathogens were MDROs and 51/63 (81%) were non-MDROs, while in the group of CVCs, 86/144 (59.7%) were MDROs and 58/144 (40.3%) were non-MDROs (p < 0.001). The colonization rate in the CVC cohort, was 6.98 for group 1, 21.57 for group 2, and 21.6 for group 3 (p = 0.019). The colonization rate of MDROs was 3.27 for group 1, 14.47 for group 2, and 12.96 for group 3 (p = 0.025). Regarding the PICC cohort, the colonization rate was 1.49 for group 1, 3.19 for group 2, and 8.99 for group 3 (p = 0.047). No significant difference existed between the three groups in terms of MDRO pathogens, with the colonization rate being 0 for group 1, 0.8 for group 2, and 1.69 for group 3 (p = 0.78). Within the CVC cohort, the most common isolated microorganism was MDR Acinetobacter baumannii (n = 44; 30.6%), followed by MDR Klebsiella pneumoniae (n = 27; 18.7%). In the PICC cohort, the predominant isolated microorganism was Candida non-albicans (n = 15; 23.8%), followed by Candida albicans, coagulase-negative staphylococci, and MDR Klebsiella pneumoniae in equal numbers (n = 6; 9.5%). CONCLUSIONS Our findings show that while the indwelling time of PICC placement was longer compared to CVCs, its colonization rate was considerably lower. Furthermore, high colonization rates by microorganisms, especially MDROs, arose later during catheterization in PICCs compared to CVCs, suggesting that in terms of vascular infections, PICCs may be a safer alternative to conventional CVCs for long-term intravenous access.
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Affiliation(s)
- Vassiliki C. Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Elsa Campos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Petros Kanellopoulos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Konstantinos Sagris
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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Rosich-Soteras A, Bonilla-Serrano C, Llauradó-González MÀ, Fernández-Bombín A, Triviño-López JA, Barceló-Querol L, Heredia-Aguilar L, Frías-Martín MC, Valverde-Bosch M, Corominas-Bosch ML, Domènech A. Implementation of a vascular access team and an intravenous therapy programme: A first-year activity analysis. J Vasc Access 2024:11297298231220537. [PMID: 38205609 DOI: 10.1177/11297298231220537] [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: 01/12/2024] Open
Abstract
BACKGROUND Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre's VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation. METHODOLOGY A longitudinal, descriptive study was carried out from March 2019 to March 2020. Using consecutive sampling, all VA inserted, and all consults received were included. Patients under 18 years of age were excluded. RESULTS The VAT inserted 1257 catheters into 1056 patients (291 MLs, 966 PICCs). The mean dwell time was 14.9 days for MLs and 59.07 days for PICCs. The main reason for removing VA was end of treatment (80.7%). During VA follow-up confirmed infection was detected in 1 ML (0.3%) and nine PICCs (0.9%). Symptomatic thrombosis was reported in 2 MLs (0.7%) and 16 PICCs (1.7%). The VAT received 367 consultations, and the main reason for consultation was to resolve doubts regarding the management of VA (80.9%). The insertion of ML and PICC catheters represented annual estimated economic savings of €867,688.44€. CONCLUSIONS Our study provides a detailed analysis of VAT's activity, its relevance to clinical safety, and to efficient resource management within our hospital. It demonstrates how VAT establishment can be a safe and efficient intervention that enhances care quality.
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Affiliation(s)
| | | | | | | | | | | | - Laura Heredia-Aguilar
- Trauma and Orthopaedic Surgery Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ma Carmen Frías-Martín
- Gastroenterology and Digestive Surgery Department, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | - Ariadna Domènech
- Oncology and Haematology Department, Hospital Clínic Barcelona, Barcelona, Spain
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17
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Trembath HE, Caruso DM, McLean SE, Akinkuotu AC, Hayes Dixon AA, Phillips MR. Central Line-Associated Bloodstream Infection Risk Factors in a Pediatric Population. Am Surg 2024; 90:69-74. [PMID: 37571962 DOI: 10.1177/00031348231192070] [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: 08/13/2023]
Abstract
BACKGROUND Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates. METHODS This is a single-institution case-control study of pediatric patients (≤18 years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed. RESULTS We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors. DISCUSSION Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates.
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Affiliation(s)
- Hannah E Trembath
- Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Deanna M Caruso
- Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea A Hayes Dixon
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Phillips
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
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18
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Yu K, Li J, Zhang D, Liu B, Wang K, Liu W, Shi Y, Zhao Y, Liu Y, Guo N, Sun W. Types of peripherally inserted central catheters and the risk of unplanned removals in patients: A prospective cohort study. Int J Nurs Stud 2024; 149:104621. [PMID: 37922685 DOI: 10.1016/j.ijnurstu.2023.104621] [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: 04/22/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Peripherally inserted central catheters are widely used in clinical practice. Despite the many advantages of peripherally inserted central catheters, unplanned removals can occur owing to irreversible complications and may have adverse consequences for patients. However, the relationship between peripherally inserted central catheter type and the incidence of unplanned removal is unclear. OBJECTIVE To investigate the association between the type of peripherally inserted central catheter and unplanned catheter removal. DESIGN A multicenter prospective cohort study. SETTINGS Sixty hospitals located in 30 cities across seven provinces in China. PARTICIPANTS Three thousand two hundred and twenty-two patients aged 18 years or older with one peripherally inserted central catheter inserted for treatment were enrolled, and 3166 (98.3 %) patients with follow-up data were included in the final analysis. METHODS The included participants had peripherally inserted central catheters that either had a proximal valve (n = 2436) or were open-ended (n = 730). A competing risk Cox regression model was used, and both univariate and multivariate analyses were conducted. A sub-distribution hazard model was applied to test the validity of the results. RESULTS Of the 2436 peripherally inserted central catheters with a proximal valve and 730 that were open-ended, 272 (11.2 %) and 46 (6.3 %) were removed unplanned, respectively. The whole incidence of unplanned removal was 10.04 %; multivariate Cox regression was conducted and it was determined that unplanned removal was statistically significantly associated with the proximal valve peripherally inserted central catheter type (hazard ratio: 1.86, 95 % confidence interval: 1.28 to 2.70, p = 0.001). In patients without cancer, the risk of unplanned removal of peripherally inserted central catheters with a proximal valve was 8.14 times higher than that of open-ended peripherally inserted central catheters (p < 0.001). CONCLUSIONS In this study, peripherally inserted central catheters with a proximal valve had a higher risk of unplanned removals, especially in patients without cancer. The peripherally inserted central catheter type should be considered in advance, and clinical staff should take appropriate measures to prevent unplanned removals after insertion.
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Affiliation(s)
- Kunrong Yu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaqian Li
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dingding Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Liu
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kai Wang
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weinan Liu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanping Shi
- Department of Plastic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanwei Zhao
- Department of Nursing, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Liu
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Guo
- Department of Nursing, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wenyan Sun
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Winkler MA, Spencer TR, Siddiqi N, Wallace JE, Gallien JZ, Elbalasi H, Issa M, Yu Q, Raissi D. Clinical experience with a chlorhexidine-coated PICC: A prospective, multicenter, observational study. J Vasc Access 2024; 25:225-231. [PMID: 34628991 DOI: 10.1177/11297298211049648] [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: 01/11/2023] Open
Abstract
INTRODUCTION This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations. METHODS This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records. RESULTS A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups-cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%. CONCLUSION Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.
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Affiliation(s)
- Michael A Winkler
- Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Nasir Siddiqi
- Department of Radiology, Baylor College of Medicine, Baylor University, Houston, TX, USA
| | - Jessica E Wallace
- Department of Radiology, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - John Z Gallien
- Department of Emergency, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Hossam Elbalasi
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohamed Issa
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Qian Yu
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Driss Raissi
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, KY, USA
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20
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Wu Y, Liu Y, Wang B, Feng B. Efficacy of antimicrobial peripherally inserted central catheters in line-associated bloodstream infections: A systematic review and meta-analysis. Am J Infect Control 2023; 51:1425-1429. [PMID: 37088441 DOI: 10.1016/j.ajic.2023.04.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Several studies have investigated the safety and efficacy of antimicrobial peripherally inserted central catheters (PICCs), and the results are conflicting. Therefore, in this systematic review and meta-analysis, we aimed to summarize and identify the effect of antimicrobial PICCs on central line-associated bloodstream infection (CLABSI) risk. METHODS A systematic search of PubMed, Ovid MEDLINE, Ovid Embase, and Web of Science was performed to identify relevant studies up to December 2022. RESULTS A total of 9 studies were included for analysis. There were 7 retrospective/prospective cohort studies and 2 randomized controlled trials. The 9 studies involved 51,373 patients with PICCs. Among these patients, 6,563 (12.8%) antimicrobial-coated/impregnated PICCs and 44,810 (87.2%) nonantimicrobial-impregnated PICCs were inserted. The meta-analysis showed that antimicrobial PICCs had a nonsignificant association with lower CLABSI risk compared with noncoated PICCs (relative risk [RR] = 0.67; 95% CI, 0.43-1.05). In the subgroup analysis, minocycline-rifampin-(RR = 0.30; 95% CI, 0.19-0.49) or chlorhexidine-coated (RR = 0.61; 95% CI, 0.04-8.55) PICCs showed an association with reduced risk of CLABSI. In the adult population, antimicrobial PICCs had a nonsignificant association with lower CLABSI risk (RR = 0.50; 95% CI, 0.20-1.22). CONCLUSIONS This systematic review and meta-analysis suggested that antimicrobial PICCs had a nonsignificant association with lower CLABSI risk compared with noncoated PICCs. Minocycline-rifampin-or chlorhexidine-coated PICCs showed an association with reduced risk of CLABSI.
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Affiliation(s)
- Yanyan Wu
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yaqiong Liu
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bei Wang
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bilong Feng
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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21
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Frondizi F, Dolcetti L, Pittiruti M, Calabrese M, Fantoni M, Biasucci DG, Scoppettuolo G. Complications associated with the use of peripherally inserted central catheters and midline catheters in COVID-19 patients: An observational prospective study. Am J Infect Control 2023; 51:1208-1212. [PMID: 37160191 PMCID: PMC10164288 DOI: 10.1016/j.ajic.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Among the many interesting aspects of clinical care during the SARS-CoV-2 pandemic, vascular access still deserves some attention. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) are venous access devices inserted by ultrasound-guided puncture of veins of the arm, which have been associated with the possibility of minimizing infectious complications in different populations of patients. We have investigated their performance in SARS-CoV-2 patients. METHODS As the incidence of catheter-related bloodstream infections (CRBSI) in patients hospitalized for COVID-19 is still unclear, we have designed a single-center, prospective observational study enrolling all patients with established diagnosis of SARS-CoV-2 infection who were admitted to our hospital in the period between October 2020 and April 2021 and who required either a PICC or a MC. RESULTS We recruited 227 patients. The cumulative incidence of CRBSI was 4.35% (10 cases), that is, 3.5 episodes/1,000 catheter days. Four CRBSI occurred in patients with PICCs (4.5/1,000 catheter days) and 6 in those with MCs (3.2/1,000 catheter days). CONCLUSIONS Our data suggest that COVID-19 patients may have a more pronounced tendency for the development of catheter-related infections compared to other populations of patients.
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Affiliation(s)
- Federico Frondizi
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Laura Dolcetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Calabrese
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Dipartimento di Scienze Cliniche e Medicina Translazionale, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Giancarlo Scoppettuolo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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22
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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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23
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Broermann LE, Al-Hasan MN, Withers S, Benbow KL, Ramsey T, McTavish M, Winders HR. Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species. Microorganisms 2023; 11:2313. [PMID: 37764157 PMCID: PMC10536542 DOI: 10.3390/microorganisms11092313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in uncomplicated bloodstream infections (BSIs) due to Streptococcus species compared to standard intravenous therapy. Adult patients with uncomplicated streptococcal BSIs from April 2016 to June 2020 in seven hospitals in South Carolina, USA, were evaluated. Multivariate Cox proportional hazards regression was used to examine the time to treatment failure within 90 days of a BSI after adjustment for the propensity to receive partial oral therapy. Multivariate linear regression was used to examine the hospital length of stay (HLOS). Among the 222 patients included, 99 received standard intravenous antibiotics and 123 received partial oral therapy. Of the standard intravenous therapy group, 46/99 (46.5%) required outpatient parenteral antibiotic therapy (OPAT). There was no difference in the risk of treatment failure between partial oral and standard intravenous therapy (hazards ratio 0.53, 95% CI 0.18, 1.60; p = 0.25). Partial oral therapy was independently associated with a shorter HLOS after adjustments for the propensity to receive partial oral therapy and other potential confounders (-2.23 days, 95% CI -3.53, -0.94; p < 0.001). Transitioning patients to oral antibiotics may be a reasonable strategy in the management of uncomplicated streptococcal BSIs. Partial oral therapy does not seem to have a higher risk of treatment failure and may spare patients from prolonged hospitalizations and OPAT complications.
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Affiliation(s)
- Lynn E. Broermann
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Majdi N. Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC 29209, USA
- Department of Internal Medicine, Division of Infectious Diseases, Prisma Health Midlands, Columbia, SC 29203, USA
| | | | - Kristina L. Benbow
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Taylor Ramsey
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
| | - Meghan McTavish
- University of South Carolina College of Pharmacy, Columbia, SC 29208, USA; (L.E.B.); (K.L.B.); (T.R.); (M.M.)
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24
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Arjun R, Niyas VKM, Sasidharan A, Jomes J, Yadav MK, Kesavan S. Peripherally Inserted Central Catheters-associated blood stream infections-occurrence, risk factors, and pathogens, a single center study. J Infect Prev 2023; 24:187-192. [PMID: 37333869 PMCID: PMC10273803 DOI: 10.1177/17571774231165404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 02/26/2023] [Indexed: 06/20/2023] Open
Abstract
Background Peripherally inserted central catheters (PICCs) are central venous catheters inserted peripherally but terminate in great vessels. PICCs are widely used for patients requiring long-term intravenous therapy in both in-patient and out-patient settings. Aim This study was carried out to understand PICC-related complications, specifically infections and causal pathogens, in a tertiary care hospital in Kerala, South India. Methods A retrospective analysis of PICC insertions and follow-up during a 9 years period to look at patient demographics and infections related to PICC was carried out. Results The overall PICC-related complication rate is 28.1% (4.98 per 1000 PICC days). Commonest complication was thrombosis followed by infection, either PICC-associated bloodstream infection (PABSI) or local infection (LI). PABSI noted in this study was 1.34 per 1000 catheter days. The majority (85%) of PABSI were due to Gram-negative rods. The average duration of PICC days for occurrence of PABSI was 14 days and the majority occurred in in-patients. Conclusion Thrombosis and infection were the commonest PICC-related complications. PABSI rate was comparable to that of previous studies.
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Affiliation(s)
- Rajalakshmi Arjun
- Senior Consultant in Infectious Diseases, KIMSHEALTH, Trivandrum, India
| | | | - Aswathy Sasidharan
- Nurse Practitioner in Infectious Diseases, KIMSHEALTH, Trivandrum, India
| | - Jeffery Jomes
- Nurse Practitioner in Infectious Diseases, KIMSHEALTH, Trivandrum, India
| | | | - Suresh Kesavan
- Nursing leader, PICC team, KIMSHEALTH, Trivandrum, India
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25
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Pinelli F, Little A, Kokotis K, Alsbrooks K, Pittiruti M. Assessment of the MAGIC recommendations in context of evolving evidence based on the use of PICC in ICU. J Vasc Access 2023; 24:836-847. [PMID: 34689644 DOI: 10.1177/11297298211048019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data.
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | | | - Kathy Kokotis
- Becton Dickinson and Company, Franklin Lakes, NJ, USA
| | - Kim Alsbrooks
- Becton Dickinson and Company, Franklin Lakes, NJ, USA
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
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26
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Alshahrani KM, Alhuwaishel AZ, Alangari NM, Asiri MA, Al-Shahrani NA, Alasmari AA, Alzahrani OJ, Ayedh AY, Qitmah MM. Clinical Impacts and Risk Factors for Central Line-Associated Bloodstream Infection: A Systematic Review. Cureus 2023; 15:e40954. [PMID: 37503497 PMCID: PMC10368959 DOI: 10.7759/cureus.40954] [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] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Background A central line-associated bloodstream infection (CLABSI) is defined as a primary bloodstream infection (BSI) in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream-related to an infection at another site. CLABSI is a common healthcare-associated infection and a significant cause of morbidity and mortality. Methods This systematic review included studies published within the past 13 years that examined risk factors and clinical impact variables associated with CLABSI, using the Centers for Disease Control (CDC)/National Healthcare Safety Network (NHSN) criteria for defining catheter-associated infection, and included participants of all ages. The terms "CLABSI," "central line-associated bloodstream infection," "risk factors," "predictors," "morbidity," "mortality," "healthcare costs," and "length of hospital stay" were used to find relevant publications on PubMed/Medline, Google Scholar, and Science Direct. The quality assessment of the included publications utilized the modified Newcastle-Ottawa scale (NOS) for observational studies. Results After the full-text screening, we identified 15 articles that met our inclusion and exclusion criteria. The majority of these studies were of good quality and had a low risk of bias based on our bias assessment. The studies included a total of 32,198 participants and covered a time period from 2010 to 2023. The mean age of the male patients included in the studies ranged from 0.1 months to 69.1 years. All of the included studies were either observational cohort studies, cross sectional studies, case-control studies, or case reports. The major study parameters/outcomes extracted were risk factors, CLABSI-associated mortality, hospital cost, length of hospital stay, and catheter days. With respect to predisposing factors, multilumen access catheters were identified as risk factors in three studies, use of more than one central venous catheter per case in four studies, hematologic malignancy in three studies, catheterization duration in four studies, surgical complexity in four studies, length of ICU stays in three studies, and parenteral nutrition in two studies. Conclusion The decision to place a venous device should be carefully considered by evaluating individual risk factors for the development of CLABSI. This is important due to the potential for severe clinical consequences and significant healthcare expenses associated with this complication.
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Affiliation(s)
| | | | - Norah M Alangari
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | - Malak A Asiri
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | - Norah A Al-Shahrani
- Department of Internal Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, SAU
| | - Ahmed A Alasmari
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | | | | | - Meshari M Qitmah
- Department of Internal Medicine, King Fahad Specialized Hospital, Tabouk, SAU
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Rosenthal VD, Yin R, Myatra SN, Memish ZA, Rodrigues C, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Afeef Al-Ruzzieh M, Aguirre-Avalos G, Guclu E, Gan CS, Jiménez Alvarez LF, Chawla R, Hlinkova S, Arjun R, Agha HM, Zuniga Chavarria MA, Davaadagva N, Lai YH, Gomez K, Aguilar-de-Moros D, Tai CW, Sassoe Gonzalez A, Aguilar Moreno LA, Sandhu K, Janc J, Aleman Bocanegra MC, Yildizdas D, Cano Medina YA, Villegas Mota MI, Omar AA, Duszynska W, El-Kholy AA, Alkhawaja SA, Florin GH, Medeiros EA, Tao L, Tumu N, Elanbya MG, Dongol R, Mioljević V, Raka L, Dueñas L, Carreazo NY, Dendane T, Ikram A, Kardas T, Petrov MM, Bouziri A, Viet-Hung N, Belskiy V, Elahi N, Salgado E, Jin Z. Multinational prospective study of incidence and risk factors for central-line-associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years. Infect Control Hosp Epidemiol 2023:1-11. [PMID: 37114756 DOI: 10.1017/ice.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify central-line (CL)-associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). DESIGN From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. SETTING The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PATIENTS In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. METHODS For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). RESULTS The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03-1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03-1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03-1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23-1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31-4.01; P <.0001) or at a teaching hospital (aOR, 2.91; 95% CI, 2.22-3.83; P < .0001), hospitalization in a middle-income country (aOR, 2.41; 95% CI, 2.09-2.77; P < .0001). The ICU type with highest risk was adult oncology (aOR, 4.35; 95% CI, 3.11-6.09; P < .0001), followed by pediatric oncology (aOR, 2.51;95% CI, 1.57-3.99; P < .0001), and pediatric (aOR, 2.34; 95% CI, 1.81-3.01; P < .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01; 95% CI, 2.71-3.33; P < .0001), followed by femoral (aOR, 2.29; 95% CI, 1.96-2.68; P < .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48; 95% CI, 1.02-2.18; P = .04). CONCLUSIONS The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
- INICC Foundation, International Nosocomial Infection Control Consortium, Miami, Florida, United States
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Camilla Rodrigues
- Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Chin Seng Gan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Ruzomberok, Slovakia
- Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | | | | | | | | | - Yin Hoong Lai
- International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | | | | | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | | | | | | | | | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Wieslawa Duszynska
- Wroclaw Medical University. Department of Anesthesiology and Intensive Therapy, Wroclaw, Poland
| | | | | | - George Horhat Florin
- University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
- Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua, New Guinea
| | | | | | | | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Tala Kardas
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | | | | | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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Bredenberg E, Atwater R, Grimm E, Chopra V, Dale Shamburger C, Anstett TJ. Promoting appropriate midline catheter and PICC placement through implementation of an EHR-based clinical decision support tool: An interrupted time-series analysis. J Hosp Med 2023. [PMID: 37052429 DOI: 10.1002/jhm.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Inappropriate use of peripherally inserted central catheters (PICCs), including multilumen PICCs, may increase the risk of patient complications. OBJECTIVE Implement computerized decision support to: (a) increase the use of midline catheters over PICCs when appropriate and (b) decrease PICC lumens when a PICC is necessary. DESIGNS Quasi-experimental, interrupted time series. SETTING Single tertiary academic medical center. PATIENTS Hospitalized adults who received a midline or PICC during clinical care. INTERVENTION Decision support on appropriate vascular access device choice via a set of electronic orders embedded within the electronic health record. MEASUREMENTS Proportion of midline catheter and single-lumen PICCs placed between January 2, 2017 and November 19, 2017 (preintervention) versus November 20, 2017 to December 1, 2019 (postintervention). RESULTS A total of 8758 midline and PICCs were inserted during the study period. A statistically significant increase in the insertion of midline catheters was observed during the intervention (p = .006). In parallel, single-lumen PICC insertion as a proportion of all PICCs also increased after the intervention (p = .035). Results were consistent across multiple disciplines, including internal medicine, surgery, and intensive care. After considering the hospital census, total PICC and midline utilization rates and rates of complications did not change over time. However, an increase in catheter exchanges from less to more invasive devices occurred. CONCLUSIONS In this single-center study, the implementation of electronic decision support to inform appropriate catheter use led to a more appropriate midline catheter and single-lumen PICC insertion. Dissemination of this single, effective intervention to examine efficacy in other hospital settings would be welcomed.
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Affiliation(s)
- Erin Bredenberg
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Riannon Atwater
- Internal Medicine, OHSU Health Hillsboro Internal Medicine Residency, Hillsboro, Oregon, USA
| | - Eric Grimm
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vineet Chopra
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher Dale Shamburger
- Section of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, Los Angeles, USA
| | - Tyler J Anstett
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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29
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Picardi M, Giordano C, Della Pepa R, Pugliese N, Esposito M, Abagnale DP, Giannattasio ML, Lisi D, Lamagna M, Grimaldi F, Muccioli Casadei G, Ciriello M, Persico M, Gargiulo G, Pane F. Intravascular Complications of Central Venous Catheterization by Insertion Site in Acute Leukemia during Remission Induction Chemotherapy Phase: Lower Risk with Peripherally Inserted Catheters in a Single-Center Retrospective Study. Cancers (Basel) 2023; 15:cancers15072147. [PMID: 37046808 PMCID: PMC10093126 DOI: 10.3390/cancers15072147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The basilic/brachial (BBV), internal jugular (IJV), and subclavian veins (SCV) are commonly used as central venous catheter (CVC) sites. A BBV approach [peripherally inserted central catheter (PICC)] is increasingly used for short- to intermediate-term CVCs for acute leukemias undergoing cytotoxic intensive regimens. In this retrospective study, the catheterization of the BBV, IJV, and SCV in patients with previously untreated acute leukemia was assessed. The primary outcome was the composite incidence of catheter-related symptomatic deep-vein thrombosis (sDVT) and bloodstream infection (BSI) from catheterization up to 30 days later. In a 10-year period, 336 CVC were inserted in the BBV (n = 115), IJV (n = 111), and SCV (n = 110) in 336 patients suffering from AML (n = 201) and ALL (n = 135) and undergoing induction chemotherapy. The primary outcome events were 8, 20, and 27 in the BBV, SCV and IJV cohorts (2.6, 6.9, and 9.6 per 1000 catheter-days, respectively; p = 0.002). The primary outcome risk was significantly higher in the IJV-cohort than in the BBV-cohort (HR, 3.6; 95% CI, 1.6 to 7.9; p = 0.001) and in the SCV-cohort than in the BBV-cohort (HR, 2.6; 95% CI, 1.2 to 5.9; p = 0.02). PICC was a valid CVC for the induction chemotherapy of acute leukemia for the lowest risk of sDVT and BSI.
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Affiliation(s)
- Marco Picardi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Claudia Giordano
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Roberta Della Pepa
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Novella Pugliese
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Esposito
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Davide Pio Abagnale
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Luisa Giannattasio
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Dario Lisi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Martina Lamagna
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Francesco Grimaldi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giada Muccioli Casadei
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Mauro Ciriello
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Marcello Persico
- Department of General Surgery, Endocrinology, Orthopaedics, and Rehabilitations, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Gianpaolo Gargiulo
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Fabrizio Pane
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
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30
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Barrigah-Benissan K, Ory J, Simon C, Loubet P, Martin A, Beregi JP, Lavigne JP, Sotto A, Larcher R. Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort. Antimicrob Resist Infect Control 2023; 12:5. [PMID: 36717942 PMCID: PMC9885663 DOI: 10.1186/s13756-023-01209-z] [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: 11/10/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. METHODS We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. RESULTS Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. CONCLUSIONS Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.
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Affiliation(s)
- Koko Barrigah-Benissan
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Jerome Ory
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Claire Simon
- grid.411165.60000 0004 0593 8241Department of Pharmacy, CHU Nimes, Nimes, France
| | - Paul Loubet
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Aurelie Martin
- grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Jean-Paul Beregi
- grid.411165.60000 0004 0593 8241Department of Medical Imaging, CHU Nimes, Nimes, France
| | - Jean-Philippe Lavigne
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Albert Sotto
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Romaric Larcher
- Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000, Nimes, France. .,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.
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Vijayananthan A, Bhurani D, Sapra H, Yasuda H, Kim JY, Hoerauf K, Mifflin N, Hong SK, Sheng WH, Terasaka Y. Asia-Pacific guidelines for standardization of appropriate selection, placement, and management of vascular access devices. J Vasc Access 2023:11297298221150664. [PMID: 36688479 DOI: 10.1177/11297298221150664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Vascular access devices (VADs) are common and essential in the healthcare setting. However, several factors influence VAD selection and management. Wide variations in VAD practices and the degree of VAD awareness are noted across Asia-Pacific (APAC) countries. An international panel was convened that applied the ASA 2020 method to develop standard criteria for use of VADs in the APAC region. After a literature search, scenarios related to VAD use, care, and maintenance were developed according to the patient population, indication for insertion, and duration of use. These scenarios were rated on a scale of 1-5 (1 being strongly disagreed and 5 strongly agreed) by 11 expert members. A total of 48 clinical scenarios were developed: 23 in hospitalized patients, 3 in critical patients, 4 in cancer settings, 7 pertinent to VAD placement, and 11 for VAD maintenance. The multidisciplinary panel generated several recommendations for the use, care, and management of VADs across general hospitalized patients with or without difficult venous access, critically ill patients, patients with malignancy, patients with different stages of chronic kidney disease (CKD) with or without dialysis, and in other special populations through evidence-based standards. These recommendations may help in achieving uniformity in practice patterns and improving the quality of VAD care and quality of life of patients in APAC region.
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Affiliation(s)
| | - Dinesh Bhurani
- Rajiv Gandhi Cancer Institute & Research Centre Sector 5, West Delhi, New Delhi, DL, India
| | - Harsh Sapra
- The Medicity Hospital, Gurgaon, Haryana, India
| | - Hideto Yasuda
- Department of Emergency and Critical care Medicine, Jichi Medical University Saitama Medical Center, Kyoto, Japan
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Klaus Hoerauf
- VP Global Medical Affairs, Becton, Dickinson and Company, New York City Metropolitan Area, USA
| | - Nicholas Mifflin
- Clinical Nurse Consultant Central Venous Access & Parenteral Nutrition Liverpool Hospital, Liverpool, NSW, Australia, Adjunct Fellow School of Nursing & Midwifery Western Sydney University, Blacktown, NSW, Australia
| | - Suk Kyung Hong
- University of Ulsan College of Medicine: Songpa-gu, Seoul, Korea
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City
| | - Yusuke Terasaka
- Director of Emergency Department, Kyoto Katsura Hospital, Kyoto City, Kyoto Prefecture, Japan
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32
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Urtecho M, Torres Roldan VD, Nayfeh T, Espinoza Suarez NR, Ranganath N, Sampathkumar P, Chopra V, Safdar N, Prokop LJ, O’Horo JC. Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad024. [PMID: 36751645 PMCID: PMC9898877 DOI: 10.1093/ofid/ofad024] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Background Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach. Results Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes. Conclusions Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
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Affiliation(s)
- Meritxell Urtecho
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
| | - Victor D Torres Roldan
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Sampathkumar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vineet Chopra
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasia Safdar
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Larry J Prokop
- Department of Library-Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
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Malhotra A, Chauhan SR, Rahaman M, Tripathi R, Khanuja M, Chauhan A. Phyto-assisted synthesis of zinc oxide nanoparticles for developing antibiofilm surface coatings on central venous catheters. Front Chem 2023; 11:1138333. [PMID: 37035110 PMCID: PMC10076889 DOI: 10.3389/fchem.2023.1138333] [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: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Medical devices such as Central Venous Catheters (CVCs), are routinely used in intensive and critical care settings. In the present scenario, incidences of Catheter-Related Blood Stream Infections (CRBSIs) pose a serious challenge. Despite considerable advancements in the antimicrobial therapy and material design of CVCs, clinicians continue to struggle with infection-related complications. These complications are often due colonization of bacteria on the surface of the medical devices, termed as biofilms, leading to infections. Biofilm formation is recognized as a critical virulence trait rendering infections chronic and difficult to treat even with 1,000x, the minimum inhibitory concentration (MIC) of antibiotics. Therefore, non-antibiotic-based solutions that prevent bacterial adhesion on medical devices are warranted. In our study, we report a novel and simple method to synthesize zinc oxide (ZnO) nanoparticles using ethanolic plant extracts of Eupatorium odoratum. We investigated its physio-chemical characteristics using Field Emission- Scanning Electron Microscopy and Energy dispersive X-Ray analysis, X-Ray Diffraction (XRD), Photoluminescence Spectroscopy, UV-Visible and Diffuse Reflectance spectroscopy, and Dynamic Light Scattering characterization methods. Hexagonal phase with wurtzite structure was confirmed using XRD with particle size of ∼50 nm. ZnO nanoparticles showed a band gap 3.25 eV. Photoluminescence spectra showed prominent peak corresponding to defects formed in the synthesized ZnO nanoparticles. Clinically relevant bacterial strains, viz., Proteus aeruginosa PAO1, Escherichia coli MTCC 119 and Staphylococcus aureus MTCC 7443 were treated with different concentrations of ZnO NPs. A concentration dependent increase in killing efficacy was observed with 99.99% killing at 500 μg/mL. Further, we coated the commercial CVCs using green synthesized ZnO NPs and evaluated it is in vitro antibiofilm efficacy using previously optimized in situ continuous flow model. The hydrophilic functionalized interface of CVC prevents biofilm formation by P. aeruginosa, E. coli and S. aureus. Based on our findings, we propose ZnO nanoparticles as a promising non-antibiotic-based preventive solutions to reduce the risk of central venous catheter-associated infections.
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Affiliation(s)
- Akshit Malhotra
- Department of Microbiology, Tripura University, Suryamaninagar, Tripura, India
- Invisiobiome, New Delhi, India
| | - Suchitra Rajput Chauhan
- Centre for Advanced Materials and Devices (CAMD), School of Engineering and Technology, BML Munjal University, Gurgaon, Haryana, India
| | - Mispaur Rahaman
- Central Instrumentation Centre, Tripura University, Suryamaninagar, Tripura, India
| | - Ritika Tripathi
- Centre for Advanced Materials and Devices (CAMD), School of Engineering and Technology, BML Munjal University, Gurgaon, Haryana, India
| | - Manika Khanuja
- Centre for Nanoscience and Nanotechnology, Jamia Millia Islamia, New Delhi, India
| | - Ashwini Chauhan
- Department of Microbiology, Tripura University, Suryamaninagar, Tripura, India
- *Correspondence: Ashwini Chauhan,
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Chase J, Nicholson M, Dogherty E, Garrod E, Hill J, Brar R, Weaver V, Connors WJ. Self-injecting non-prescribed substances into vascular access devices: a case study of one health system's ongoing journey from clinical concern to practice and policy response. Harm Reduct J 2022; 19:130. [PMID: 36424629 PMCID: PMC9694828 DOI: 10.1186/s12954-022-00707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Overdose-associated deaths and morbidity related to substance use is a global public health emergency with devastating social and economic costs. Complications of substance use are most pronounced among people who inject drugs (PWID), particularly infections, resulting in increased risk of hospitalization. PWID often require intravenous access for medical treatments such as antibiotics; however, vascular access may be limited due to the impacts of long-term self-venipuncture. While vascular access devices including peripherally inserted central catheters (PICCs) allow reliable and sustained routes of administration for indicated therapies, the use of PICCs among PWID presents unique challenges. The incidence and risks associated with self-injecting non-prescribed substances into vascular access devices (SIVAD) is one such concern for which there is limited evidence and absence of formal practice guidance. CASE PRESENTATION We report the experience of a multidisciplinary team at a health organization in Vancouver, Canada, working to characterize the incidence, patient and healthcare provider perspectives, and overall impact of SIVAD. The case study of SIVAD begins with a patient's perspective, including patient rationale for SIVAD, understanding of risks and the varying responses given by healthcare providers following disclosure of SIVAD. Using the limited literature available on the subject, we summarize the intersection of SIVAD and substance use and outline known and anticipated health risks. The case study is further contextualized by experience from a Vancouver in-hospital Overdose Prevention Site (OPS), where 37% of all individual visits involve SIVAD. The case study concludes by describing the systematic process by which local clinical guidance for SIVAD harm reduction was developed with stakeholder engagement, medical ethics consultation, expert consensus guideline development and implementation with staff education and planned research evaluation. CONCLUSION SIVAD is encountered with enough frequency in an urban healthcare setting in Vancouver, Canada, to warrant an organizational approach. This case study aims to enhance appreciation of SIVAD as a common and complex clinical issue with anticipated health risks. The authors conclude that using a harm reduction lens for SIVAD policy and research can provide benefit to clinicians and patients by offering a clear and a consistent healthcare response to this common issue.
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Affiliation(s)
- Jocelyn Chase
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.416553.00000 0000 8589 2327Division of Geriatric Medicine, St. Paul’s Hospital, Providence Health Care, Vancouver, BC Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Melissa Nicholson
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Elizabeth Dogherty
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Emma Garrod
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre On Substance Use, Vancouver, Canada
| | - Jocelyn Hill
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Rupinder Brar
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.498786.c0000 0001 0505 0734Vancouver Coastal Health, Vancouver, BC Canada ,grid.415289.30000 0004 0633 9101Inter-Department Division of Addiction Medicine, Providence Health Care, Vancouver, BC Canada
| | - Victoria Weaver
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre On Substance Use, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Inter-Department Division of Addiction Medicine, Providence Health Care, Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Division of Infectious Diseases, St. Paul’s Hospital, Providence Health Care, Vancouver, BC Canada
| | - William J. Connors
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Division of Infectious Diseases, St. Paul’s Hospital, Providence Health Care, Vancouver, BC Canada
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Pitiriga V, Bakalis J, Theodoridou K, Kanellopoulos P, Saroglou G, Tsakris A. Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients. Antimicrob Resist Infect Control 2022; 11:137. [DOI: 10.1186/s13756-022-01180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous access in hospitalized patients. Although a number of studies suggest that PICCs are associated with a lower risk of central line-associated bloodstream infections (CLABSIs) than CVCs, recent data concerning specific patient groups support the contrary. In this regard, we are comparing CVC- and PICC-related CLABSI rates developed in a selected group of critically ill inpatients and evaluating the CLABSI microbiological distribution.
Methods
The study was conducted at a tertiary care hospital in Greece between May 2017 and May 2019. We performed a two-year retrospective analysis of the data collected from medical records of consecutive adult patients who underwent PICC or CVC placement.
Results
A total of 1187 CVCs placed for 9774 catheter-days and 639 PICCs placed for 11,110 catheter-days, were reported and analyzed during the study period. Among CVCs, a total of 59 (4.9%) CLABSIs were identified, while among PICCs, 18 (2.8%) cases presented CLABSI (p = 0.029). The CLABSI incidence rate per 1,000 catheter-days was 6.03 for CVC group and 1.62 for PICC group (p < 0.001). The CLABSI rate due to multidrug-resistant organisms (MDROs) among the two groups was 3.17 in CVC group and 0.36 in PICC group (p < 0.001). Within CLABSI-CVC group, the most common microorganism detected was MDR Acinetobacter baumannii (27.1%) followed by MDR Klebsiella pneumoniae (22%). In CLABSI-PICC group, the predominant microorganism was Candida spp. (33.3%) followed by non-MDR gram-negative pathogens (22.2%).
Conclusions
PICC lines were associated with significantly lower CLABSI rates comparing to CVC although they were in place longer than CVC lines. Given their longer time to the development of infection, PICCs may be a safer alternative for prolonged inpatient IV access. The high prevalence of CLABSI-MDROs depicts the local microbial ecology, emphasizing the need of public health awareness.
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Ray-Barruel G, Horowitz J, McLaughlin E, Flanders S, Chopra V. Barriers and facilitators for implementing peripherally inserted central catheter (PICC) appropriateness guidelines: A longitudinal survey study from 34 Michigan hospitals. PLoS One 2022; 17:e0277302. [PMID: 36331967 PMCID: PMC9635738 DOI: 10.1371/journal.pone.0277302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Peripherally inserted central catheters (PICCs) are prevalent devices for medium-to-long-term intravenous therapy but are often associated with morbid and potentially lethal complications. This multi-center study sought to identify barriers and facilitators of implementing evidence-based appropriateness criteria to improve PICC safety and patient outcomes in a pay-for-performance model. Participating hospitals received an online toolkit with five recommendations: establishing a vascular access committee; implementing a clinical decision tool for PICC appropriateness; avoiding short-term PICC use (≤5 days); increasing use of single-lumen PICCs; and avoiding PICC placement in patients with chronic kidney disease. Longitudinal online surveys conducted biannually October 2014–November 2018 tracked implementation efforts. A total of 306 unique surveys from 34 hospitals were completed. The proportion of hospitals with a dedicated committee overseeing PICC appropriateness increased from 53% to 97%. Overall, 94% of hospitals implemented an initiative to reduce short-term and multi-lumen PICC use, and 91% integrated kidney function into PICC placement decisions. Barriers to implementation included: achieving agreement from diverse disciplines, competing hospital priorities, and delays in modifying electronic systems to enable appropriate PICC ordering. Provision of quarterly benchmarking reports, a decision algorithm, access to an online toolkit, and presence of local champion support were cited as crucial in improving practice. Structured quality improvement efforts including a multidisciplinary vascular access committee, clear targets, local champions, and support from an online education toolkit have led to sustained PICC appropriateness and improved patient safety.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Diseases Institute, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- * E-mail:
| | - Jennifer Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, United States of America
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
| | - Elizabeth McLaughlin
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, United States of America
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
| | - Scott Flanders
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, United States of America
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
| | - Vineet Chopra
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Eturajulu RC, Ng KH, Tan MP, Zakaria MI, Chinna K, Ponnampalavanar S, Vijayananthan A, Yaakup NA, Chung E. Quality Improvement Report: Safety Program for Prevention of Central Line-associated Bloodstream Infections. Radiographics 2022; 42:E216-E223. [PMID: 36269668 DOI: 10.1148/rg.220035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The increasing usage of peripherally inserted central catheters (PICCs) in medical imaging departments has led to a corresponding increase in cases of central line-associated bloodstream infection (CLABSI). However, this condition is preventable with proper monitoring and use of aseptic techniques. A Comprehensive Unit-based Safety Program (CUSP) is a quality improvement (QI) measure implemented by health care institutions to reduce the incidence of CLABSI. However, effective strategies have yet to be established. The authors describe a QI project that evaluated the implementation of CUSP at a teaching hospital to reduce PICC-associated bloodstream infection (BSI). The framework consists of a five-step process: understand and train staff on the science of safety, assemble a team, engage senior executives, identify defects through sensemaking, and implement teamwork and communication strategies in a series of related and sequential steps that use QI tools. Targets were identified for improvement from existing processes, and the workflow was reengineered. Nine months after the start of the CUSP intervention, PICC-associated BSI incidence in the hospital had been reduced from 3.4 to 2.7 per 1000 central lines days after intervention. The incidence of BSI was also reduced correspondingly from 8.8% to 5.9%. The QI processes in this study may be adopted by other hospitals, as they involve minimal cost with significant impact on patient safety and well-being. The QI sequential steps described capture the implementation processes that can be modified for use in other department settings where patient safety could be compromised. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Ravi Chanthriga Eturajulu
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Kwan Hoong Ng
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Maw Pin Tan
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Mohd Idzwan Zakaria
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Karuthan Chinna
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Sasheela Ponnampalavanar
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Anushya Vijayananthan
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Nur Adura Yaakup
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
| | - Eric Chung
- From the Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia (R.C.E.); Department of Biomedical Imaging (K.H.N., A.V., N.A.Y., E.C.), Department of Medicine (M.P.T., S.P.), and Academic Unit Trauma and Emergency (M.I.Z.), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia; Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (K.H.N.); and Faculty of Business and Management, UCSI University, Kuala Lumpur, Malaysia (K.C.)
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Gao T, Zhu X, Zeng Q, Li X, Luo M, Yu C, Hu L, He J, Li Y, Yang Z, Yang H, Huang X, Gu X, Liu Z. Peripherally inserted central catheter-related bloodstream infections in patients with hematological malignancies: A retrospective 7-years single-center study. Am J Infect Control 2022; 50:1171-1177. [PMID: 35108580 DOI: 10.1016/j.ajic.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We sought to investigate the nature and incidence of bloodstream infection complications and to identify the risk factors of central catheter-related bloodstream infections (CRBSI). METHODS During the study period, 291 consecutive patients with hematological malignancies who underwent PICC placement were retrospectively enrolled. We analyzed the covariates that were specified a priori for their association with CRBSI through multivariate Cox proportional hazards regression models. The association between each predictor and the related outcome was expressed using hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). RESULTS Of 391 peripherally inserted central catheter (PICCs) were inserted in 291 patients for a total of 63,714 catheter days during 7 years, with an infection rate of 0.71/1,000 catheter days. Among the patients with hematological malignancies, those with acute leukemia were prone to CRBSI. Having previous bloodstream infection (BSI) (HR 18.139; 95% CI, 8.19-40.174; P < .0001), the number of PICCs insertions (HR 4.695; 95% CI, 1.842-11.967; P = .001) (twice), (HR 6.794; 95% CI, 1.909-24.181; P = .003) (≥3 times) were significantly associated with CRBSI. Not accompanied by chronic comorbidities (HR 0.34; 95% CI, 0.131-0.887; P = .028) and longer duration of PICC use (days) (HR 0.997; 95% CI, 0.994-0.999; P = .008) might be protective factors preventing CRBSI. CONCLUSIONS Our finding suggests that previous BSI and a higher number of PICC insertions are associated with an increased risk of CRBSI. A lack of chronic comorbidities may help prevent CRBSI.
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Affiliation(s)
- Tianqi Gao
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangding Zhu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qingli Zeng
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaozhen Li
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Man Luo
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changhui Yu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liwen Hu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing He
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaohe Li
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiwen Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huifang Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohua Huang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuekui Gu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Zenghui Liu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Kwon Y, Kim ET, Cho SB, Lee JH, Shim DJ. Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a study protocol for a randomized controlled trial. Trials 2022; 23:781. [PMID: 36109819 PMCID: PMC9479292 DOI: 10.1186/s13063-022-06682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Peripherally inserted central catheters (PICCs) are now widely used in modern medicine, and associated complications have also increased. Central line-associated bloodstream infection (CLABSI) is the most serious complication because it can cause extended hospital stays and increase costs. Furthermore, it can contribute to dire consequences for critically ill patients. Subcutaneous tunnelling for central venous catheters is an accepted method to reduce the risk of CLABSI. However, it is not generally adopted for PICC placement in most hospitals because its safety and efficacy have not been thoroughly evaluated. Methods In this multi-institutional, prospective, non-blinded pragmatic randomized controlled trial, 1694 patients treated at five referral hospitals will be assigned to one of two parallel arms (conventional and tunnelled PICC groups) using computer-generated stratified randomization. The conventional group will undergo PICC placement by routine practice. In the tunnelled PICC (tPICC) group, additional subcutaneous tunnelling will be applied. Patients will be followed until PICC removal or the end of this study. The primary endpoint is whether subcutaneous tunnelling reduced the rate of CLABSI compared to the conventional method. The secondary endpoints are technical success rates, complications including exit-site bleeding or infection, and the procedure time between the groups. Discussion Subcutaneous tunnelling is a widely used method to reduce catheter-associated infection. However, it has not been thoroughly applied for PICC. A randomized trial is needed to objectively assess the effects of the subcutaneous tunnel in PICC placement. This TUNNEL-PICC trial will provide evidence for the effectiveness of subcutaneous tunnelling in decreasing the risk of CLABSI. Trial registration Clinical Research Information Service (CRiS) KCT0005521
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Sakuraya M, Okano H, Yoshihiro S, Niida S, Kimura K. Insertion site of central venous catheter among hospitalized adult patients: A systematic review and network meta-analysis. Front Med (Lausanne) 2022; 9:960135. [PMID: 36106316 PMCID: PMC9464814 DOI: 10.3389/fmed.2022.960135] [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: 06/02/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Central venous catheterization is a commonly performed procedure, accounting for approximately 8% of hospitalized patients. Based on the current literatures, the most acceptable site for central venous catheterization is inconclusive, considering various complications in hospitalized patients. Herein, we conducted a network meta-analysis to assess the clinically important complications among internal jugular, subclavian, femoral, and peripheral insertion. Materials and methods The Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, Ichushi databases, Clinicaltrials.gov, and International Clinical Trials Registry Platform were searched. Studies including adults aged ≥ 18 years and randomized control trials that compared two different insertion sites (internal jugular, subclavian, femoral, and peripheral vein) were selected. The primary outcomes were clinically important infectious, thrombotic, and mechanical complications. Results Among the 5,819 records initially identified, 13 trials (6,201 patients) were included for a network meta-analysis. For clinically important infectious complication, subclavian insertion decreased the complication risk, compared with internal jugular [risk ratio (RR), 0.30; 95% confidence interval (CI), 0.11-0.81; moderate certainty], and femoral insertion increased than subclavian insertion (RR 2.56; 95% CI, 1.02-6.44; moderate certainty). Peripheral insertion was also significantly associated with a lower risk compared with internal jugular (RR 0.06; 95% CI, 0.01-0.32; low certainty); subclavian (RR 0.21; 95% CI, 0.05-0.77; moderate certainty); and femoral insertion (RR 0.08; 95% CI, 0.02-0.40; low certainty). For clinically important thrombotic complication, we did not find significant differences between insertion sites. For clinically important mechanical complication, femoral insertion decreased the complication risk, compared with internal jugular (RR 0.42; 95% CI, 0.21-0.82; moderate certainty) and subclavian insertion (RR 0.33; 95% CI, 0.16-0.66; moderate certainty). Peripheral insertion was also associated with the lower complication risk compared with internal jugular (RR 0.39; 95% CI, 0.18-0.85; low certainty) and subclavian insertion (RR 0.31; 95% CI, 0.13-0.75; moderate certainty). Conclusion The insertion site of the central venous catheter, which is most likely to cause the fewest complications, should be selected. Our findings can provide the rationale for deciding the insertion site for a central venous catheter. Systematic review registration [www.protocols.io], identifier [61375].
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Affiliation(s)
- Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Hiromu Okano
- Department of Critical and Emergency Medicine, National Hospital Organization Yokohama Medical, Yokohama, Japan
| | - Shodai Yoshihiro
- Department of Pharmacy, Onomichi General Hospital, Onomichi, Japan
| | - Shoko Niida
- Department of Critical and Emergency Medicine, National Hospital Organization Yokohama Medical, Yokohama, Japan
| | - Keina Kimura
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan
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Shen BH, Mahoney L, Molino J, Mermel LA. Risk factors for early PICC removal: A retrospective study of adult inpatients at an academic medical center. PLoS One 2022; 17:e0264245. [PMID: 35802673 PMCID: PMC9269940 DOI: 10.1371/journal.pone.0264245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Use of PICCs has been rising since 2001. They are used when long-term intravenous access is needed and for blood draws in patients with difficult venous access. Objective To determine which risk factors contribute to inappropriate PICC line insertion defined as removal of a PICC within five days of insertion for reasons other than a PICC complication. Design Retrospective, observational study. Setting Tertiary-care, Level 1 trauma center. Patients Adult patients with a PICC removed 1/1/2017 to 5/4/2020. Measurements Frequency of PICC removal within five days of insertion and associated risk factors for early removal. Results Between 1/1/2017 and 5/4/2020, 995 of 5348 PICCs inserted by the IV nursing team were removed within five days (19%). In 2017, 5 of 429 PICCs developed a central line-associated infection (1.2%) and 29 of 429 PICCs developed symptomatic venous thromboembolism (6.7%). Patients with PICCs whose primary service was in an ICU were independently at higher risk of early removal (OR 1.44, 95% CI 1.14, 1.83); weekday insertion was independently associated with a lower likelihood of early removal compared to weekend insertion (OR 0.60; 95% CI 0.49, 0.75). Limitation PICC removal after discharge was not assessed and paper records were likely incomplete and biased. Conclusion Nearly one in five PICCs were removed within five days. Patients whose primary team was in an ICU and PICCs ordered on weekends were at independently higher risk of early removal.
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Affiliation(s)
- Burton H. Shen
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Medicine, Rhode Island Hospital, Providence, RI, United States of America
| | - Lindsey Mahoney
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Medicine, Rhode Island Hospital, Providence, RI, United States of America
| | - Janine Molino
- Lifespan Biostatistics Core, Lifespan Hospital System, Providence, RI, United States of America
| | - Leonard A. Mermel
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Medicine, Rhode Island Hospital, Providence, RI, United States of America
- Division of Infectious Diseases, Rhode Island Hospital, Providence, RI, United States of America
- * E-mail:
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Nakaya Y, Imasaki M, Shirano M, Shimizu K, Yagi N, Tsutsumi M, Yoshida M, Yoshimura T, Hayashi Y, Nakao T, Yamane T. Peripherally inserted central venous catheters decrease central line-associated bloodstream infections and change microbiological epidemiology in adult hematology unit: a propensity score-adjusted analysis. Ann Hematol 2022; 101:2069-2077. [PMID: 35780253 DOI: 10.1007/s00277-022-04908-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Peripherally inserted central venous catheters (PICCs) have a potential advantage in preventing central line-associated bloodstream infection (CLABSI) compared with the centrally inserted ones (CICCs). However, due to a limited number of studies with insufficient statistical evaluation, the superiority of PICCs is difficult to be generalized in adult hematology unit. We conducted a single-center retrospective study and compared the risk of CLABSI between 472 CICCs and 557 PICCs inserted in adult patients with hematological disorders through conventional multivariate models and a propensity score-adjusted analysis. The overall CLABSI incidence in CICCs and PICCs was 5.11 and 3.29 per 1000 catheter days (P = 0.024). The multivariate Cox regression analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.31-0.75; P = 0.001) and Fine-Gray subdistribution analysis (HR: 0.59; 95% CI: 0.37-0.93; P = 0.023) demonstrated that PICC was independently associated with a reduced risk of CLABSI. Moreover, the stabilized inverse probability of treatment weighting analysis, which further reduced the selection bias between CICCs and PICCs, showed that PICCs significantly prevented CLABSI (HR: 0.58; 95% CI: 0.35-0.94; P = 0.029). Microbiologically, PICCs showed a significant decrease in gram-positive cocci (P = 0.001) and an increase in gram-positive bacilli (P = 0.002) because of a remarkable reduction in Staphylococci and increase in Corynebacterium species responsible for CLABSI. Our study confirmed that PICC was a superior alternative to CICC in preventing CLABSI in the adult hematology unit, while it posed a microbiological shift in local epidemiology.
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Affiliation(s)
- Yosuke Nakaya
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.,Department of Hematology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Mika Imasaki
- Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.
| | - Katsujun Shimizu
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Naoko Yagi
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Minako Tsutsumi
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.,Department of Hematology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Masahiro Yoshida
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takuro Yoshimura
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Yoshiki Hayashi
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takafumi Nakao
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takahisa Yamane
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
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Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:553-569. [PMID: 35437133 PMCID: PMC9096710 DOI: 10.1017/ice.2022.87] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Amick AE, Feinsmith SE, Sell J, Davis EM, Wayne DB, Feinglass J, Barsuk JH. Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access. J Patient Saf 2022; 18:e697-e703. [PMID: 34570003 DOI: 10.1097/pts.0000000000000910] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Difficult intravenous (IV) access (DIVA) is a prevalent condition in the hospital setting and increases utilization of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Ultrasound-guided peripheral intravenous (USGPIV) insertion is effective at establishing intravenous access in DIVA but remains understudied in the inpatient setting. We evaluated the effect of an USGPIV simulation-based mastery learning (SBML) curriculum for nurses on MC and PICC utilization for hospitalized patients. METHODS We performed a quasi-experimental observational study. We trained nurses across all inpatient units at a large tertiary care hospital. We queried the electronic medical record to compare PICC and MC utilization for patients with DIVA during 3 periods: before USGPIV SBML training (control), during pilot testing of the intervention, and during the SBML intervention. To account for variations in insertion practices over time, we performed an interrupted time series (ITS) analysis between 2 periods, the combined control and pilot periods and the intervention period. RESULTS One hundred forty-eight nurses completed USGPIV SBML training. Midline catheters inserted monthly per 1000 patient-days for DIVA decreased significantly from 1.86 ± 0.51 (control) to 2.31 ± 0.28 (pilot) to 1.33 ± 0.51 (intervention; P = 0.001). The ITS analysis indicated a significant intervention effect (P < 0.001). Peripherally inserted central catheters inserted monthly per 1000 patient-days for DIVA also significantly decreased over the study periods; however, the ITS failed to show an intervention effect as PICC insertions were already decreasing during the control period. CONCLUSIONS A hospital-wide USGPIV SBML curriculum for inpatient nurses was associated with a significant reduction in MCs inserted for DIVA.
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Affiliation(s)
- Ashley E Amick
- From the Department of Internal Medicine and Emergency Medicine, University of Washington, Seattle, Washington
| | | | - Jordan Sell
- Northwestern University McGaw School of Medicine, Chicago, Illinois
| | - Evan M Davis
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Diane B Wayne
- Department of Medicine, Northwestern University, Evanston, Illinois
| | - Joseph Feinglass
- Department of Medicine, Northwestern University, Evanston, Illinois
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University, Evanston, Illinois
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Lv Y, Huang X, Lan Y, Xia Q, Chen F, Wu J, Li W, Cao H, Xie C, Li L, Han H, Wang H, Xiang Q. Peripherally inserted central catheters have a protective role and the effect of fluctuation curve feature in the risk of bloodstream infection compared with central venous catheters: a propensity-adjusted analysis. BMC Infect Dis 2022; 22:289. [PMID: 35346073 PMCID: PMC8961920 DOI: 10.1186/s12879-022-07265-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The prevention of peripherally inserted central catheters (PICC)-associated BSI and central venous catheters (CVC)-associated BSI have been a topic of national importance in China. Therefore, we aimed to explore the epidemiological characteristics of central line-associated bloodstream infection (CLABSI), and to evaluate whether PICCs were associated with a protective effect for CLABSI. Methods A retrospective cohort study was conducted in teaching hospital in Western China. All adult patients received a CVC or PICC during their hospital stay were included from January 2017 to December 2020. Primary endpoint was CLABSI up to 30 days after CVC or PICC placement. Propensity scores with a 2:1 match was used to account for potential confounders, and restricted cubic spline was used to visualize the risk of CLABSI at different time points during the catheterization. Results A total of 224687 devices (180522 PICCs and 45965 CVCs) in 24879 patients were included. The overall incidence was 1.8 CLABSIs per 1000 catheter-days. The odds ratio (OR) value increased day by day after PICC insertion, reached a relatively high point on the 4th day, and decreased from days 5 through 8. From the 9th day of intubation the OR value began to gradually increase day by day again. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR = 3.27, 95% CI 2.38–4.49) compared with PICCs. Conclusions PICCs have a protective role and the effect of fluctuation curve feature in CLABSI when compared to CVCs, and the first 8 calendar days after CVC insertion are the acute stage of CVC-associated BSI. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07265-x.
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Zhang J, Liu W, Shi W, Cui X, Liu Y, Lu Z, Xiao W, Hua T, Yang M. A Nomogram With Six Variables Is Useful to Predict the Risk of Acquiring Carbapenem-Resistant Microorganism Infection in ICU Patients. Front Cell Infect Microbiol 2022; 12:852761. [PMID: 35402310 PMCID: PMC8990894 DOI: 10.3389/fcimb.2022.852761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Carbapenem-resistant microorganism (CRO) transmission in the medical setting confers a global threat to public health. However, there is no established risk prediction model for infection due to CRO in ICU patients. This study aimed to develop a nomogram to predict the risk of acquiring CRO infection in patients with the first ICU admission and to determine the length of ICU stay (ICU-LOS) and 28-day survival. Methods Patient data were retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) database based on predetermined inclusion and exclusion criteria. A CRO was defined as a bacterium isolated from any humoral microbial culture that showed insensitivity or resistance to carbapenems. The characteristics of CRO and non-CRO patients in the first ICU admission were compared. Propensity score matching was applied to balance the differences between the CRO and non-CRO cohorts. Kaplan–Meier curves were constructed to determine the 28-day survival rate and ICU-LOS. Furthermore, after randomization of the CRO cohort into the training and validation sets, a predictive nomogram was constructed based on LASSO regression and Logistic regression analysis, and its performance was verified by internal validation. Results Overall, 4531 patients who had first ICU admission as recorded in MIMIC-IV were enrolled, 183 (4.04%) of whom were diagnosed with CRO infection. Moreover, CRO infection was independently associated with 28-day survival and ICU-LOS in ICU patients. Parameters eligible for inclusion in this nomogram were male sex, hemoglobin-min, temperature-max, use of a peripherally inserted central catheter line, dialysis treatment, and use of carbapenems. This nomogram showed a better performance as indicated by the area under the receiver operating characteristic curve values of 0.776 (95% confidence interval [CI] 0.667-0.750) and 0.723 (95% CI 0.556-0.855) in the training and validation sets, respectively, in terms of predicting the risk of acquiring CRO infection. Conclusions CRO infection was independently associated with ICU-LOS and 28-day survival in patients with first ICU admission. The nomogram showed the best prediction of the risk of acquiring CRO infection in ICU patients. Based on the nomogram-based scoring, we can management the risk factors and guide individualized prevention and control of CRO.
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Affiliation(s)
- Jin Zhang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanjun Liu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Shi
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuanxuan Cui
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing and Signal Processing, Ministry of Education, Anhui University, Hefei, China
| | - Zongqing Lu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Min Yang,
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Belloni S, Caruso R, Cattani D, Mandelli G, Donizetti D, Mazzoleni B, Tedeschi M. Occurrence rate and risk factors for long-term central line-associated bloodstream infections in patients with cancer: A systematic review. Worldviews Evid Based Nurs 2022; 19:100-111. [PMID: 35262257 DOI: 10.1111/wvn.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Central line-associated bloodstream infection (CLABSI) is a public health problem that harms patients' outcomes and healthcare costs, especially in susceptible populations such as patients with cancer. Overall, systematic queries about etiology, risks, and epidemiology are explained by data from observational studies, which better underline the relationship between factors and incidence of disease. However, no recent systematic reviews of observational studies on adult patients with cancer have been conducted on this topic, considering the wide range of all potential factors which can contribute to the increase in infection rate in the hospitalized adults with cancer. This study systematically reviewed observational studies investigating the occurrence rate of CLABSI and its risk factors for long-term inserted central catheter-related infections in hospitalized adult cancer patients. METHODS A systematic review was performed on four databases from the earliest available date until December 2020. Retrospective and prospective cohort studies focused on the occurrence rate of CLABSI and its risk factors in hospitalized adult cancer patients. The pooled occurrence rate of CLABSI (95% CI) was calculated by applying a random-effects model. RESULTS Of 1712 studies, 8 were eligible, and the data of device-related infection rate were meta-analyzed. The pooled occurrence rate of CLABSI was roughly 8% (95% CI [4%, 14%]). The device characteristics, device's management aspects, therapies administration, and select patients' clinical conditions represent the main risk factors for long-term catheter-related infection in cancer patients. LINKING EVIDENCE TO ACTION Considering the substantial infection rate among cancer patients, identifying risk rate factors is pivotal to support evidence-grounded preventive strategies and maximize cancer patient safety. This study's results could guide policymakers and healthcare leaders and future research studies to disseminate appropriate risk-reducing management culture and implement standardized research and clinical approach to the investigated phenomenon as an infection surveillance strategy.
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Affiliation(s)
- Silvia Belloni
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgia Mandelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniela Donizetti
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Opgenorth D, Baig N, Fiest K, Karvellas C, Kutsogiannis J, Lau V, Macintyre E, Senaratne J, Slemko J, Sligl W, Wang X, Bagshaw SM, Rewa OG. LIBERATE: a study protocol for midodrine for the early liberation from vasopressor support in the intensive care unit (LIBERATE): protocol for a randomized controlled trial. Trials 2022; 23:194. [PMID: 35246227 PMCID: PMC8896263 DOI: 10.1186/s13063-022-06115-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background Intravenous (IV) vasopressors to support hemodynamics are a primary indication for intensive care unit (ICU) admission. Utilization of oral vasopressor therapy may offer an alternative to IV vasopressor therapy in the ICU, thus decreasing the need for ICU admission. Oral vasopressors, such as midodrine, have been used for hemodynamic support in non-critically ill patients, but their evaluation in critically ill patients to potentially spare IV vasopressor therapy has been limited. Methods The LIBERATE study will be a multicenter, parallel-group, blinded, randomized placebo-controlled trial. It will recruit adult (i.e., age ≥ 18 years) critically ill patients receiving stable or decreasing doses of IV vasopressors. Eligible patients will be randomized to receive either midodrine 10 mg administered enterally every 8 h or placebo until 24 h post-discontinuation of IV vasopressors. The primary outcome will be ICU length of stay. Secondary outcomes include all-cause mortality at 90 days, hospital length of stay, length of IV vasopressor support, re-initiation of IV vasopressors, rates of ICU readmission, and occurrence of AEs. Health economic outcomes including ICU, hospital and healthcare costs, and cost-effectiveness will be evaluated. Pre-planned subgroup analyses include age, sex, frailty, severity of illness, etiology of shock, and comorbid conditions. Discussion LIBERATE will rigorously evaluate the effect of oral midodrine on duration of ICU stay and IV vasopressor support in critically ill patients. Trial registration ClinicalTrials.gov NCT05058612. Registered on September 28, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06115-0.
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Affiliation(s)
- Dawn Opgenorth
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nadia Baig
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Constantine Karvellas
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jim Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Erika Macintyre
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jocelyn Slemko
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Sligl
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Wan R, Gu L, Yin B, Cai S, Zhou R, Yang W. A six-year study of complications related to peripherally inserted central catheters: A multi-center retrospective cohort study in China. Perfusion 2022; 38:689-697. [PMID: 35236188 DOI: 10.1177/02676591221076287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Peripherally inserted central catheters (PICCs), the most frequent central venous catheter, are used to provide medical treatments, although long-term PICC-related adverse outcomes are unknown in China. This study systematically investigated PICC-related complications in four Chinese hospitals. METHODS Between January 2014 and January 2020, we analyzed the results of 3550 patients with PICC who were referred to four Chinese hospitals. All patients underwent PICC treatment in four Chinese hospitals. Patient-reported signs and symptoms of a putative PICC-related complication or functional were studied. Long-term outcomes and hospitalization costs were also evaluated. RESULTS An aggregate of 3285 patients were enrolled in the analytic cohort. 58.6% were females and 41.4% were males. The most common reasons for PICC placement included oncologic malignancy and critically ill patients. The majority of PICCs had valved systems (90.7%) and were implanted in the right side (85.5%) and into the basilic vein (87.7%). At least one potential PICC-related problem or adverse effects (AEs) was reported by 67.3% of patients. Central line-associated bloodstream infection (28.1%) and symptomatic deep vein thrombosis (20.7%) were the most common complications. The majority of PICCs were removed for causes other than AEs, with just 723 reported AEs accounting for 22.0% of all PICC removals. The most reasons for PICCs removal were occlusion (425, 12.9%) and exit-site infections (189, 5.8%). CONCLUSIONS This study is the first retrospective study in our country to explore PICC-related complications. While living with a PICC, more than 67.3% of patients report signs and symptoms of at least one PICC-related problem or adverse impacts, such as difficulties with PICC use and poor effects on physical and social function. In this group, PICCs are safe and effective, although the danger of PICC-related problems should not be disregarded.
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Affiliation(s)
- Rong Wan
- Department of Nursing, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Lilei Gu
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Bi Yin
- Department of Physical Examination, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Shengwei Cai
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Rengui Zhou
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Weilin Yang
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
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Amick AE, Feinsmith SE, Davis EM, Sell J, Macdonald V, Trinquero P, Moore AG, Gappmeier V, Colton K, Cunningham A, Ford W, Feinglass J, Barsuk JH. Simulation-Based Mastery Learning Improves Ultrasound-Guided Peripheral Intravenous Catheter Insertion Skills of Practicing Nurses. Simul Healthc 2022; 17:7-14. [PMID: 33428356 DOI: 10.1097/sih.0000000000000545] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Difficult intravenous (IV) access (DIVA) is frequently encountered in the hospital setting. Ultrasound-guided peripheral IV catheter (USGPIV) insertion has emerged as an effective procedure to establish access in patients with DIVA. Despite the increased use of USGPIV, little is known about the optimal training paradigms for bedside nurses. Therefore, we developed and evaluated a novel, sustainable, USGPIV simulation-based mastery learning (SBML) curriculum for nurses. METHODS This is a prospective cohort study of an USGPIV SBML training program for bedside nurses over a 12-month period. We evaluated skills and self-confidence before and after training and measured the proportion of the nurses achieving independent, proctor, and instructor status. Procedure logs and surveys were used to explore the nurse experience and utilization of USGPIV on real patients with DIVA 3 months after the intervention. RESULTS Two hundred thirty-eight nurses enrolled in the study. The USGPIV skill checklist scores increased from median of 6.0 [interquartile range = 4.0-9.0 (pretest) to 29.0, interquartile range = 28-30 (posttest), P < 0.001]. The USGPIV confidence improved from before (mean = 2.32, SD = 1.17) to after (mean = 3.85, SD = 0.73, P < 0.001) training (5-point Likert scale). Sixty-two percent of the nurses enrolled achieved independent status, 47.5% became proctors, and 11.3% course trainers. At 3-month posttraining, the nurses had attempted a mean of 35.6 USGPIV insertions with an 89.5% success rate. CONCLUSIONS This novel USGPIV SBML curriculum improves nurses' insertion skills, self-confidence, and progresses patient care through USGPIV insertions on hospitalized patients with DIVA.
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Affiliation(s)
- Ashley Elizabeth Amick
- From the University of Washington (A.E.A.), Seattle, WA; Loyola University (S.E.F.), Chicago, IL; University of Michigan Medical School (E.M.D.), Ann Arbor, MI; Northwestern University (J.S., P.T., A.G.M., V.G., K.C., A.C., W.F., J.F., J.H.B.), Evanston; and Northwestern Memorial Hospital (V.M.), Chicago, IL
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