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Glazner J, Steinfort K, Hu YJ, Browne W, Smith I, Brasher C. Short midline catheters: High success rates for antibiotic therapy in children with cystic fibrosis. J Vasc Access 2021; 24:385-390. [PMID: 34296638 DOI: 10.1177/11297298211035310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Short midline catheter use in paediatric populations appears to be increasing, however data on success rates and efficacy are sparse. This study aims to describe the success rate when midline venous catheters are employed as a single device for intravenous antibiotic therapy in paediatric patients with cystic fibrosis. METHODS A retrospective cohort study was performed in a single institution, retrieving electronic medical record data from July 2017 through March 2020. The primary outcome was device success, defined as a catheter that remained functional until the end of antibiotic therapy. Reasons for device failure were categorized in a standard fashion. RESULTS Primary outcome data were available for 116 catheter insertions, involving 49 patients and 55 proceduralists. The success rate was 84% (n = 98). Median age at insertion was 15 years (range 4-19) and median weight 52 kg (13-81). Soft, polyether block amide, Arrow® Seldinger Arterial Catheters were employed. Only 16 patients (14%) required general anaesthesia. Median time to failure was 6 days, and median time to successful completion of treatment was 13 days. Six of 18 failures occurred within 48 h and were likely insertion complications. The most common reasons for device failure were occlusion, extravasation, phlebitis and dislodgement. More than half of patients (56%) received antibiotic therapy at home. CONCLUSION There is a high single device success rate when inserting short midlines for 13-day intravenous pulmonary antibiotic therapy in children with cystic fibrosis. These results should be confirmed with a prospective study.
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Affiliation(s)
- Judith Glazner
- Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Kate Steinfort
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia
| | | | - William Browne
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Ian Smith
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Christopher Brasher
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,Critical Care, University of Melbourne, Parkville, VIC, Australia
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Hanumunthadu B, Breathnach A. Antibiotic adverse events on an outpatient parenteral antibiotic service: a retrospective cohort study. Eur J Hosp Pharm 2021. [DOI: 10.1136/ejhpharm-2019-002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Ingram PR, Kilgarriff S, Grzelak M, Jackson G, Carr P, Boan P, Italiano C, Dyer J, Raby E. Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy. J Vasc Access 2021; 23:738-742. [PMID: 33845663 DOI: 10.1177/11297298211009361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. METHODS Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. RESULTS Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). CONCLUSIONS Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.
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Affiliation(s)
- Paul R Ingram
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia.,Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Sinead Kilgarriff
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | - Gavin Jackson
- Peripherally Inserted Central Catheter service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.,Menzies Health Institute, Griffith University, Queensland, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Claire Italiano
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
| | - John Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Edward Raby
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
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Matusik PS, Łoboda P, Krzanowska K, Popiela TJ, Heba G, Pawlik W. Presence of retained calcified fibrin sheath after central venous catheter removal: A systematic literature review. J Vasc Access 2020; 23:644-652. [PMID: 33143527 DOI: 10.1177/1129729820969328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central venous catheters (CVC) are used in many clinical settings for a variety of indications. We performed a systematic literature review concerning case reports of retained calcified fibrin sheaths after dialysis CVC removal. The aim of our study was to systematize the knowledge regarding clinical management of this phenomenon, placing special emphasis on diagnostic radiological features in different imaging modalities, including chest radiography, echocardiography, computed tomography, and magnetic resonance imaging. We discuss the most common risk factors associated with this CVC complication. In our review, we found eight cases of hemodialysis patients. The most common risk factors associated with calcified fibrin sheath formation in the analyzed cases were pro-thrombotic and pro-calcification factors related to patient comorbidities, and prolonged catheter dwell time. Differentiating between a calcified fibrin sheath (present in about 6% of patients with long-term indwelling CVC as diagnosed by computed tomography) and a retained catheter tip can be challenging. The initial diagnosis based on imaging methods was incorrect in most of the analyzed cases. This suggests that some cases of retained fibrin sheaths may remain undetected or misinterpreted. This is important in patients with known pro-thrombotic and pro-calcification risk factors and prolonged catheter dwell time. Therefore, implementation of preventive strategies, familiarity with radiological findings of this phenomenon, comparison with previous imaging studies, and an overall comprehensive assessment with clinical data is imperative.
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Affiliation(s)
| | - Piotr Łoboda
- Department of Diagnostic Imaging, University Hospital, Cracow, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, Cracow, Poland
| | - Tadeusz J Popiela
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Radiology, Cracow, Poland
| | - Grzegorz Heba
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University, Cracow, Poland
| | - Wiesław Pawlik
- Department of Diagnostic Imaging, University Hospital, Cracow, Poland
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A Cluster of Failures of Midline Catheters in a Hospital in the Home Program: A Retrospective Analysis. JOURNAL OF INFUSION NURSING 2019; 42:203-208. [PMID: 31283663 DOI: 10.1097/nan.0000000000000330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A cluster of 11 midline catheter failures occurred during a 2-week period in a Hospital in the Home program in an urban tertiary hospital in Australia. These failures prompted a 4-month retrospective audit of patients receiving outpatient antimicrobial therapy between December 1, 2016 and March 1, 2017. Primary outcomes were dwell time and catheter failure. Peripherally inserted central catheters had significantly fewer failures and significantly longer dwell times compared with midline catheters. Women experienced higher rates of midline catheter failure than men. The proportion of patients with midline catheters receiving continuous infusions who experienced a failure was markedly higher than those receiving bolus doses. Suggestions for further related research are discussed.
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