1
|
Fox WE, Marshall M, Walters SM, Mangunta VR, Ragosta M, Kleiman AM, McNeil JS. Bedside Clinician's Guide to Pulmonary Artery Catheters. Crit Care Nurse 2023; 43:9-18. [PMID: 37524367 DOI: 10.4037/ccn2023133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Pulmonary artery catheters provide important information about cardiac function, mixed venous oxygenation, and right-sided pressures and potentially provide temporary pacing ability. OBJECTIVE To provide bedside clinicians with guidance for techniques to insert right heart monitors and devices, describe risk factors for difficult insertion and contraindications to placement, and provide updates on new technologies that may be encountered in the intensive care unit. METHODS An extensive literature review was performed. Experienced clinicians were asked to identify topics not addressed in the literature. RESULTS Advanced imaging techniques such as transesophageal echocardiography or fluoroscopy can supplement traditional pressure waveform-guided insertion when needed, and several other techniques can be used to facilitate passage into the pulmonary artery. Caution is warranted when attempting insertion in patients with right-sided masses or preexisting conduction abnormalities. New technologies include a pacing catheter that anchors to the right ventricle and a remote monitoring device that is implanted in the pulmonary artery. DISCUSSION Bedside clinicians should be aware of risk factors such as atrial fibrillation with dilated atria, decreased ventricular function, pulmonary hypertension, and right-sided structural abnormalities that can make pulmonary artery catheter insertion challenging. Clinicians should be familiar with advanced techniques and imaging options to facilitate placement. CONCLUSION The overall risk of serious complications with right heart catheter placement and manipulation is low and often outweighed by its benefits, specifically pressure monitoring and pacing.
Collapse
Affiliation(s)
- W Everett Fox
- W. Everett Fox is an anesthesiology resident, Department of Anesthesiology, University of Virginia Health System (UVA Health), Charlottesville, Virginia
| | - Michael Marshall
- Michael Marshall is a charge and bedside registered nurse, coronary care unit, UVA Health
| | - Susan M Walters
- Susan M. Walters is a cardiothoracic anesthesiologist and an assistant professor of anesthesiology, Department of Anesthesiology, UVA Health
| | - Venkat R Mangunta
- Venkat R. Mangunta is a cardiothoracic and intensive care anesthesiologist and an assistant professor of anesthesiology, Department of Anesthesiology, UVA Health
| | - Michael Ragosta
- Michael Ragosta is a professor of cardiology and the Medical Director of the cardiac catheterization laboratory and interventional cardiology fellowship, Cardiology Division, Department of Internal Medicine, UVA Health
| | - Amanda M Kleiman
- Amanda M. Kleiman is a cardiothoracic anesthesiologist and an associate professor of anesthesiology, Department of Anesthesiology, UVA Health
| | - John S McNeil
- John S. McNeil is a cardiothoracic anesthesiologist and an associate professor of anesthesiology, Department of Anesthesiology, UVA Health
| |
Collapse
|
2
|
Patient, Operator, and Procedural Characteristics of Guidewire Retention as a Complication of Vascular Catheter Insertion. Crit Care Explor 2023; 5:e0834. [PMID: 36699255 PMCID: PMC9831189 DOI: 10.1097/cce.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Guidewire retention after intravascular catheter insertion is considered a "never event." Prior reports attribute this complication to various characteristics including uncooperative patients, operator inexperience, off-hour or emergent insertion, and underutilization of ultrasound guidance. In this descriptive analysis of consecutive events, we assessed the frequency of patient, operator, and procedural factors in guidewire retention. DESIGN Pre-specified observational analysis as part of a quality improvement study of consecutive guidewire retention events across a multihospital health system from August 2007 to October 2015. SETTING Ten hospitals within the Cleveland Clinic Health System in Ohio, United States. PATIENTS Consecutive all-comers who experienced guidewire retention after vascular catheter insertion. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data were manually obtained from the electronic medical records and reviewed for potential contributing factors for guidewire retention, stratified into patient, operator, and procedural characteristics. A total of 24 events were identified. Overall, the median age was 74 years, 58% were males, and the median body mass index was 26.5 kg/m2. A total of 12 (50%) individuals were sedated during the procedure. Most incidents (10 [42%]) occurred in internal jugular venous access sites. The majority of cases (13 [54%]) were performed or supervised by an attending. Among all cases, three (12%) were performed by first-year trainees, seven (29%) by residents, three (12%) by fellows, and four (17%) by certified nurse practitioners. Overall, 16 (67%) events occurred during regular working hours (8 amto 5 pm). In total, 22 (92%) guidewires were inserted nonemergently, with two (8%) during a cardiac arrest. Ultrasound guidance was used in all but one case. CONCLUSIONS Guidewire retention can occur even in the presence of optimal patient, operator, and procedural circumstances, highlighting the need for constant awareness of this risk. Efforts to eliminate this important complication will require attention to issues surrounding the technical performance of the procedure.
Collapse
|
3
|
Benali M, Trabelsi B, Abdouli H, Yedes A, Elhadj Kacem H, Fki M. Ultrasound guidance versus anatomical landmarks for subclavian vein catheterization: a prospective study. LA TUNISIE MEDICALE 2022; 100:520-524. [PMID: 36571740 PMCID: PMC9703904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several clinical practice guidelines strongly support the use of ultrasound guidance (USG) for internal jugular vein catheterization. The level of evidence concerning the use of USG for subclavian vein (SCV) cannulation remains low. AIM To compare the effectiveness and safety of USG and anatomical landmarks approaches for cannulation of SCV. METHODS This was a prospective randomized study. Patients aged over 18 years old who requiring elective central venous catheterization were included. Non-inclusion criteria were thrombosis of the vein or major coagulopathy. All catheterizations were performed by two anaesthesiology residents. Patients were randomized into two groups: ultrasound guidance group (US group) and anatomical landmarks (LM group). The main outcome was the success rate. The secondary outcomes were the first attempt success rate and the incidence of complications. RESULTS Seventy patients were included (35 in each group). The success rate was higher in US group compared to LM group without statistical significance (100% vs 85.7%; p=0.054). The first attempt success rate was significantly higher in the US group (82.9% vs. 40%; p <10-3). The incidence of mechanical complications was significantly lower in the US group compared to LM group (5.7% vs. 37.1%; p=0,001). CONCLUSION according to our study, US guidance for SCV catheterization seems to be an interesting alternative to anatomical landmarks approaches.
Collapse
Affiliation(s)
- Mechaal Benali
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Becem Trabelsi
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hadhemi Abdouli
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Hichem Elhadj Kacem
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Fki
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul / Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
4
|
Yong L, Jianxi G, Yanfang Z, Jian K. Complications from port-a-cath system implantation in adults with malignant tumors: A 10-year single-center retrospective study. J Interv Med 2021; 5:15-22. [PMID: 35586285 PMCID: PMC8947993 DOI: 10.1016/j.jimed.2021.12.002] [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: 09/06/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
|
5
|
Inhofer J, Bertasi A, Gangidine M, Repas SJ, Holmes J, Harris M, Stull M, Marco C. Incidence of central line associated bloodstream infection following central venous catheter placement in the emergency department. Am J Emerg Med 2021; 51:338-341. [PMID: 34808455 DOI: 10.1016/j.ajem.2021.11.018] [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: 06/06/2021] [Revised: 10/24/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Central line-associated bloodstream infections (CLABSI) are costly and can be lifethreatening. Many efforts have been taken to minimize the rates of infection, including sterile technique, pre-packaged sterile kits, site selection, and replacing infected or potentially infected lines. This study aims to identify the incidence of CLABSI following catheter placement in the ED, and to compare rates of CLABSI among ED and ICU placed catheters. METHODS This retrospective chart review was conducted at a Level 1 Trauma Center. Eligibility criteria included patients who had CVC placed in the ED or ICU from January 1st, 2018, through July 31st, 2019 who were 18 years or older. RESULTS Among 1810 patients with central lines, 1254 met eligibility criteria. There was no significant difference in infection rates when comparing lines placed in the ED (2.5 per 1000 catheter days, 95% confidence interval [CI] 0.8 to 5.8) compared to those placed in the ICU (4.6 per 1000 catheter days, 95% CI 3.0 to 6.8). The odds of CLABSI was not associated with age, sex, indication, site, location nor which type of health care professional (HCP) placed the line. CONCLUSIONS In this study, the incidence of infection was no different between lines placed in the ED compared to the ICU.
Collapse
Affiliation(s)
- Joseph Inhofer
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America.
| | - Anthony Bertasi
- 81st Medical Group, Keesler AFB, MS (July 2020 onward), Biloxi, MS, United States of America; Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, (through June 2020), United States of America
| | - Matthew Gangidine
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, (July 2020 onward), United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, (July 2020 onward), United States of America; Air Force Institute of Technology, Wright-Patterson AFB, OH, (July 2020 onward), United States of America; Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, (through June 2020), United States of America
| | - Steven J Repas
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Jasmine Holmes
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Micah Harris
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Madeline Stull
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Catherine Marco
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| |
Collapse
|
6
|
Central venous catheterization site choice based on anatomical landmark technique: a systematic review and meta-analysis. J Anesth 2021; 35:801-810. [PMID: 34341863 DOI: 10.1007/s00540-021-02976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Internal jugular vein catheterization (IJVC) and subclavian vein catheterization (SCVC) have been the most preferred central venous catheterizations (CVC) clinically. Individual preference and institutional routine dominate the traditional CVC choice; however, it is lack of high-level evidence. We sought to provide better clinical strategy for CVC site choice based on anatomical landmark technique between IJVC and SCVC. METHODS We systematically reviewed eligible studies from PubMed, OVID, Cochrane and ClinicalTrials.Gov till February 2020. The primary outcomes were catheterization time and overall success rate, and the secondary outcomes were the first-attempt success rate and the instant mechanical complications. Ethical problems are not applicable. RESULTS A total of 3378 patients from 7 studies were included in the analyses. Neither difference was found on the catheterization time (SMD 95% CI: -0.095-0.124, p = 0.792), nor any difference on the overall success rate (RR = 1.017, 95% CI: 0.927-1.117, p = 0.721, I2 = 89.6%) between the 2 procedures. However, subgroup analyses showed overall success rate of IJVC was significantly lower than that of SCVC (RR = 0.906, 95% CI: 0.850-0.965, p = 0.002) in adults. The first-attempt success rate of IJVC group was higher in the adults (RR = 1.472, 95% CI: 1.004-2.156, p = 0.047). No significance was detected in arterial injury (RR = 1.137, 95% CI: 0.541-2.387, p = 0.735) and pneumothorax (RR = 0.600, 95% CI: 0.32-1.126, p = 0.112) between the two procedures. Hematoma was significantly more in IJVC group than that in SCVC group (RR = 2.824, 95% CI: 1.181-6.751, p = 0.02). CONCLUSIONS Compared with IJVC, SCVC shows a higher overall success rate while a lower first-attempt success rate in adults, and has involved with less hematoma. PROSPERO REGISTRATION CRD42020165444.
Collapse
|
7
|
Manavi T, Vazquez P, O'Grady H, Martina J, Rose M, Nielsen D, Fitzpatrick D, Forouzan O, Nagy M, Sharif F, Zafar H. A novel wireless implant for central venous pressure measurement: First animal experience. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2020; 1:130-138. [PMID: 35265885 PMCID: PMC8890339 DOI: 10.1016/j.cvdhj.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Background/Objective Central venous pressure (CVP) serves as a surrogate for right atrial pressure, and thus could potentially predict a wider range of heart failure conditions. The purpose of this work is to assess CVP, through an implantable sensor incorporated with a novel anchor design, in the inferior and superior vena cava of an animal model. Methods Two animals (Dorset sheep) were implanted with sensors at 3 different locations: inferior vena cava (IVC), superior vena cava (SVC), and pulmonary artery (PA). Two sensors with distinct anchor designs considering anatomical requirements were used. A standard PA sensor (trade name Cordella) was deployed in the PA and SVC, whereas a sensor with a modified cylindrical anchor with various struts was designed to reside in the IVC. Each implant was calibrated against a Millar catheter reference sensor. The ability of the central venous sensors to detect changes in pressure was evaluated by modifying the fluid volume of the animal. Results The sensors implanted in both sheep were successful, which provided an opportunity to understand the relationship between PA and CVP via simultaneous readings. The mapping and implantation in the IVC took less than 15 minutes. Multiple readings were taken at each implant location using a hand-held reader device under various conditions. CVP recorded in the IVC (6.49 mm Hg) and SVC (6.14 mm Hg) were nearly the same. PA pressure (13-14 mm Hg) measured was higher than CVP, as expected. The SVC waveforms showed clear beats and respiration. Respiration could be seen in the IVC waveforms, but not all beats were easily distinguishable. Both SVC and IVC readings showed increases in pressure (3.7 and 2.7 mm Hg for SVC and IVC, respectively) after fluid overload was induced via extra saline administration. Conclusion In this work, the feasibility of measuring CVP noninvasively was demonstrated. The established ability of wireless PA pressure sensors to enable prevention of decompensation events weeks ahead can now be explored using central venous versions of such sensors.
Collapse
Affiliation(s)
- Tejaswini Manavi
- Cardiovascular Research & Innovation Centre, National University of Ireland Galway, Galway, Ireland.,Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Patricia Vazquez
- Cardiovascular Research & Innovation Centre, National University of Ireland Galway, Galway, Ireland.,Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Helen O'Grady
- Cardiovascular Research & Innovation Centre, National University of Ireland Galway, Galway, Ireland.,Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | | | | | - Faisal Sharif
- Cardiovascular Research & Innovation Centre, National University of Ireland Galway, Galway, Ireland.,Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,BioInnovate Ireland, Galway, Ireland.,Department of Cardiology, University Hospital Galway, Galway, Ireland.,CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Research & Innovation Centre, National University of Ireland Galway, Galway, Ireland.,Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,BioInnovate Ireland, Galway, Ireland
| |
Collapse
|
8
|
Wang L, Wei F, Chen H, Jia L, Li B, Jiang A. Long-term outcome of posterior approach insertion of tunneled cuffed catheter: A single clinic retrospective analysis. J Vasc Access 2020; 22:547-554. [PMID: 32830606 DOI: 10.1177/1129729820951047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES For patients who rely on a tunneled cuffed catheter, the internal jugular vein is the preferred site of insertion. A few studies have suggested that the posterior approach for central lines is equivalent or better in comparison to the conventional central approach. However, there have been fewer studies examining tunneled cuffed catheter insertion using the posterior approach. We have performed many posterior insertions of tunneled cuffed catheters in our practice, and because the technique has not yet been comprehensively studied for long-term use, we performed a retrospective study to evaluate the safety and efficacy of posterior approach for tunneled cuffed catheter in maintained hemodialysis patients. METHODS A retrospective review was conducted of 200 hemodialysis patients who were treated with tunneled cuffed catheters over a period of 3 years. There were 104 patients in the study group, as well as a 96-patient control group, who underwent catheter insertion by central approach. The clinical follow-up data were collected and analyzed. RESULTS All catheters were successfully placed. The mean primary patency days per catheter were 712 catheter days for the study group and 585 catheter days for the control group. The episode of catheter infection was similar in both groups (p = 0.874), but the case of total catheter dysfunction was significantly lower in the study group compared to the control group (p = 0.006). The cumulative patency of catheters was higher in the study group than that in the control group (p = 0.02), while patient survival was the same in the two groups (p = 0.325). CONCLUSION The posterior approach is safe, and similar infection rates were observed with lower dysfunction rates compared to tunneled catheter insertion by the conventional central approach.
Collapse
Affiliation(s)
- Lihua Wang
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fang Wei
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Haiyan Chen
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lan Jia
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bo Li
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Aili Jiang
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| |
Collapse
|
9
|
Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24:S6-S30. [PMID: 32205954 PMCID: PMC7085816 DOI: 10.5005/jp-journals-10071-g23183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. Methods This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper. Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. Results This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. Conclusion In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. Abbreviations list ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization How to cite this article Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30.
Collapse
Affiliation(s)
- Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Ganshyam Jagathkar
- Department of Critical Care Medicine, Medicover Hospital, Hyderabad, Telangana, India, e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, e-mail:
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, , e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Rahul Anil Pandit
- Department of Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Raymond Dominic Savio
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India, e-mail:
| | - Anuj M Clerk
- Department of Intensive Care, Services Sunshine Global Hospital, Surat, Gujarat, India, e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, , e-mail:
| | - Deven Juneja
- Department of Critical Care Medicine, Max Superspecialty Hospital, New Delhi, India, , e-mail:
| | - Sumit Ray
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India, e-mail:
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India, , e-mail:
| | - Srinivas Jakkinaboina
- Department of Critical Care Medicine, Citizens Specialty Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Nandhakishore Jampala
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Ravi Jain
- Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:
| |
Collapse
|
10
|
Central venous access ports in the interventional radiology suite - one-centre experience. Pol J Radiol 2019; 84:e328-e334. [PMID: 31636767 PMCID: PMC6798780 DOI: 10.5114/pjr.2019.88066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/23/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Central venous access ports (CVAP) are widely used to provide long-term vascular access for the delivery of chemotherapeutic medications. The aim of this study was to evaluate the clinical outcomes and complications following CVAP implantation in the interventional radiology suite. Material and methods A retrospective analysis was conducted on 937 oncology patients who underwent CVAP implantation between January 2009 and June 2017. Information regarding patient characteristics, operative data, and procedural outcomes was collected and analysed. Results A total of 937 patients scheduled for CVAP were included in the final analysis. Initial success was achieved in 930 patients (99.3%), and overall completion was achieved in 933 patients (99.6%). There were 63 complications overall. Among these, 19 (2.0%) occurred during the intra- and perioperative period and 44 were late complications (4.7%). No CVAP-related mortalities were observed. Conclusions The analysis in the present study revealed that the CVAP is a safe and effective route for long-term administration of chemotherapy with an overall complication rate of 6.7% throughout the entire device duration. The CVAP implantation procedure carried out in the interventional radiology suite provides an advantage in the management of procedural, vascular and catheter-related complications.
Collapse
|
11
|
Sazdov D, Srceva MJ, Todorova ZN. Comparative Analysis of Ultrasound Guided Central Venous Catheterization Compared to Blind Catheterization. ACTA ACUST UNITED AC 2019; 38:107-114. [PMID: 28991766 DOI: 10.1515/prilozi-2017-0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Central venous catheterization is performed by the landmark method and ultrasound guided method. The purpose of the study was to compare the success, average number of attempts, average time to return of blood, and complication rate between the two methods. MATERIAL AND METHODS This was a prospective study done in the Intensive Care Unit of the Acibadem Sistina Clinical Hospital, in Skopje. There were 400 patients in need of central venous catheter and they were prospectively randomized in two groups. The patients randomized in the examined-ultrasound group underwent real-time ultrasound-guided catheterization and the patients randomized in the control-landmark group were catheterized using the landmark method. Internal Jugular, Subclavian and Femoral vein were catheterized in both groups. The Overall success, success on the first attempt, time to the return of blood, number of attempts and complications at the moment of catheterization such as arterial puncture, pneumothorax and hematoma formation were the main outcome measures. RESULTS The catheterization using the landmark method was successful in 90.5% of patients, 60.5% of which during the first attempt. The cannulation using real-time ultrasound guidance was successful in 98% of patients with a first pass success of 77%. The complication rate with the landmark method was 14.5% versus 4% with real-time ultrasound guidance p<0.05(p=0.0008). CONCLUSION Real-time ultrasound guidance improves success, decreases number of attempts, decreases average time to the return of blood and reduces mechanical complications rate.
Collapse
|
12
|
Giacomini M, Iapichino G, Armani S, Cozzolino M, Brancaccio D, Gallieni M. How to avoid and manage a pneumothorax. J Vasc Access 2018; 7:7-14. [PMID: 16596523 DOI: 10.1177/112972980600700103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Pneumothorax is one of the most frequent complications during percutaneous central vascular cannulation. When choosing a site for central vascular access, the internal jugular vein is preferable to other vessels, for the lower frequency of related complications, including pneumothorax. This review intends to summarize the current state of the art on how to avoid and, if it occurs, to manage this rare but relevant complication. In order to prevent pneumothorax, as well as other relevant complications of central vein cannulation, it is advisable to use ultrasound guidance whenever possible. If pneumothorax occurs, it is important to recognize its signs and symptoms. To exclude the presence of asymptomatic pneumothorax, in the normal clinical routine a chest X-ray should be obtained within 4 hours from the procedure of central vein cannulation of subclavian and internal jugular veins. If promptly recognized, pneumothorax can be managed quickly and in a relatively easy way. Depending on its size and symptoms, and in particular when a tension pneumothorax is supected, treatment can vary from simple observation to a chest tube insertion or, in the latter case, to an emergency thoracentesis needle insertion in the pleural space.
Collapse
Affiliation(s)
- M Giacomini
- Anesthesia and Intensive Care Department, San Paolo Hospital, Milano; Universita' degli Studi di Milano, Italy
| | | | | | | | | | | |
Collapse
|
13
|
Simon EM, Summers SM. Vascular Access Complications: An Emergency Medicine Approach. Emerg Med Clin North Am 2017; 35:771-788. [PMID: 28987428 DOI: 10.1016/j.emc.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Millions of central venous and arterial catheters are placed across the United States annually as mechanisms of obtaining advanced hemodynamic monitoring and facilitating acute resuscitation. Although presumably life saving or sustaining in many circumstances, current literature identifies the preprocedural and postprocedural complications of infection, thrombosis, embolism, and iatrogenic injury as resulting in patient morbidity and mortality. Today, through the application of aseptic technique, performance of operator training, and the utilization of ultrasound, emergency physicians may limit vascular access complications and improve patient outcomes.
Collapse
Affiliation(s)
- Erica Marie Simon
- Emergency Department, San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, SAMMC, MCHE-EMR, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-6200, USA.
| | - Shane Matthew Summers
- Emergency Department, San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, SAMMC, MCHE-EMR, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-6200, USA
| |
Collapse
|
14
|
Hoffman T, Du Plessis M, Prekupec MP, Gielecki J, Zurada A, Tubbs RS, Loukas M. Ultrasound-guided central venous catheterization: A review of the relevant anatomy, technique, complications, and anatomical variations. Clin Anat 2017; 30:237-250. [PMID: 27521991 DOI: 10.1002/ca.22768] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Taryn Hoffman
- Department of Anatomical Sciences, School of Medicine; St. George's University; West Grenada Indies
| | - Maira Du Plessis
- Department of Anatomical Sciences, School of Medicine; St. George's University; West Grenada Indies
| | - Matthew P. Prekupec
- Department of Internal Medicine; University of Nevada School of Medicine; Las Vegas NV
| | - Jerzy Gielecki
- Department of Anatomy; University of Warmia and Mazury in Olsztyn; Poland
| | - Anna Zurada
- Department of Radiology, Warmia and Mazury; University Hospital; Poland
| | | | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine; St. George's University; West Grenada Indies
| |
Collapse
|
15
|
Petridis C, Nitschke M, Lehne W, Smith E, Goltz J, Lehnert H, Meier M. Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate. Eur J Vasc Endovasc Surg 2017; 53:262-267. [DOI: 10.1016/j.ejvs.2016.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
|
16
|
Chakraborty A, Agrawal S, Datta T, Mitra S, Khemka R. Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia. J Indian Assoc Pediatr Surg 2016; 21:202-204. [PMID: 27695218 PMCID: PMC4980887 DOI: 10.4103/0971-9261.186558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed.
Collapse
Affiliation(s)
| | | | - Taniya Datta
- Tata Medical Center, Kolkata, West Bengal, India
| | | | - Rakhi Khemka
- Tata Medical Center, Kolkata, West Bengal, India
| |
Collapse
|
17
|
Mahan AF, McEvoy MD, Gravenstein N. Long-axis view for ultrasound-guided central venous catheter placement via the internal jugular vein. Rom J Anaesth Intensive Care 2016; 23:27-31. [PMID: 28913474 DOI: 10.21454/rjaic.7518.231.axs] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In modern practice, real-time ultrasound guidance is commonly employed for the placement of internal jugular vein catheters. With a new tool, such as ultrasound, comes the opportunity to refine and further optimize the ultrasound view during jugular vein catheterization. We describe jugular vein access techniques and use the long-axis view as an alternative to the commonly employed short-axis cross-section view for internal jugular vein access and cannulation. CONCLUSION The long-axis ultrasound-guided internal jugular vein approach for internal jugular vein cannulation is a useful alternative technique that can provide better needle tip and guidewire visualization than the more traditional short-axis ultrasound view.
Collapse
Affiliation(s)
- Angel F Mahan
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center, Tennessee, USA
| | - Nikolaus Gravenstein
- Department of Anesthesiology and Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| |
Collapse
|
18
|
Rezayat T, Stowell JR, Kendall JL, Turner E, Fox JC, Barjaktarevic I. Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back. West J Emerg Med 2016; 17:216-21. [PMID: 26973755 PMCID: PMC4786249 DOI: 10.5811/westjem.2016.1.29462] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022] Open
Abstract
Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal “in-plane” technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself.
Collapse
Affiliation(s)
- Talayeh Rezayat
- David Geffen School of Medicine, UCLA, Division of Pulmonary and Critical Care Medicine, Los Angeles, California
| | - Jeffrey R Stowell
- Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona
| | - John L Kendall
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado
| | - Elizabeth Turner
- David Geffen School of Medicine, UCLA, Division of Pulmonary and Critical Care Medicine, Los Angeles, California
| | - J Christian Fox
- University of California, Irvine, Department of Emergency Medicine, Irvine, California
| | - Igor Barjaktarevic
- David Geffen School of Medicine, UCLA, Division of Pulmonary and Critical Care Medicine, Los Angeles, California
| |
Collapse
|
19
|
Bleeding complications of central venous catheterization in septic patients with abnormal hemostasis. Am J Emerg Med 2014; 32:737-42. [DOI: 10.1016/j.ajem.2014.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 11/20/2022] Open
|
20
|
Shah A, Smith A, Panchatsharam S. Ultrasound-guided subclavian venous catheterisation - is this the way forward? A narrative review. Int J Clin Pract 2013; 67:726-32. [PMID: 23869675 DOI: 10.1111/ijcp.12146] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/30/2013] [Indexed: 12/01/2022] Open
Abstract
Central venous catheterisation is a commonly performed procedure in anaesthesia, critical care, acute and emergency medicine. Traditionally, subclavian venous catheterisation has been performed using the landmark technique and because of the complications associated with this technique, it is not commonly performed in the United Kingdom - where the accepted practice is ultrasound-guided internal jugular vein catheterisation. Subclavian vein catheterisation offers particular advantages over the internal jugular and femoral vein sites such as reduced rates of line-related sepsis, improved patient comfort and swifter access in trauma situations where the internal jugular vein may not be easily accessible. There is a growing body of evidence to suggest a potential emerging role for ultrasound-guided subclavian vein catheterisation. Barriers to this approach include many physicians still believing that the clavicle obscures imaging of the vein. In this article, we review the evidence supporting ultrasound-guided subclavian vein catheterisation and ask the question whether, in view of it potential advantages, it could be the way forward?
Collapse
Affiliation(s)
- A Shah
- Imperial School of Anaesthesia, The Hillingdon Hospitals NHS Foundation Trust, London, UK.
| | | | | |
Collapse
|
21
|
Ge X, Cavallazzi R, Li C, Pan SM, Wang Y, Wang F. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012; 2012:CD004084. [PMID: 22419292 PMCID: PMC6516884 DOI: 10.1002/14651858.cd004084.pub3] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Central venous access (CVA) is widely used. However, its thrombotic, stenotic and infectious complications can be life-threatening and involve high-cost therapy. Research revealed that the risk of catheter-related complications varied according to the site of CVA. It would be helpful to find the preferred site of insertion to minimize the risk of catheter-related complications. This review was originally published in 2007 and was updated in 2011. OBJECTIVES 1. Our primary objective was to establish whether the jugular, subclavian or femoral CVA routes resulted in a lower incidence of venous thrombosis, venous stenosis or infections related to CVA devices in adult patients.2. Our secondary objective was to assess whether the jugular, subclavian or femoral CVA routes influenced the incidence of catheter-related mechanical complications in adult patients; and the reasons why patients left the studies early. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2011, Issue 9), MEDLINE, CINAHL, EMBASE (from inception to September 2011), four Chinese databases (CBM, WANFANG DATA, CAJD, VIP Database) (from inception to November 2011), Google Scholar and bibliographies of published reviews. The original search was performed in December 2006. We also contacted researchers in the field. There were no language restrictions. SELECTION CRITERIA We included randomized controlled trials comparing central venous catheter insertion routes. DATA COLLECTION AND ANALYSIS Three authors assessed potentially relevant studies independently. We resolved disagreements by discussion. Dichotomous data on catheter-related complications were analysed. We calculated relative risks (RR) and their 95% confidence intervals (CI) based on a random-effects model. MAIN RESULTS We identified 5854 citations from the initial search strategy; 28 references were then identified as potentially relevant. Of these, we Included four studies with data from 1513 participants. We undertook a priori subgroup analysis according to the duration of catheterization, short-term (< one month) and long-term (> one month) defined according to the Food and Drug Administration (FDA).No randomized controlled trial (RCT) was found comparing all three CVA routes and reporting the complications of venous stenosis.Regarding internal jugular versus subclavian CVA routes, the evidence was moderate and applicable for long-term catheterization in cancer patients. Subclavian and internal jugular CVA routes had similar risks for catheter-related complications. Regarding femoral versus subclavian CVA routes, the evidence was high and applicable for short-term catheterization in critically ill patients. Subclavian CVA routes were preferable to femoral CVA routes in short-term catheterization because femoral CVA routes were associated with higher risks of catheter colonization (14.18% or 19/134 versus 2.21% or 3/136) (n = 270, one RCT, RR 6.43, 95% CI 1.95 to 21.21) and thrombotic complications (21.55% or 25/116 versus 1.87% or 2/107) (n = 223, one RCT, RR 11.53, 95% CI 2.80 to 47.52) than with subclavian CVA routes. Regarding femoral versus internal jugular routes, the evidence was moderate and applicable for short-term haemodialysis catheterization in critically ill patients. No significant differences were found between femoral and internal jugular CVA routes in catheter colonization, catheter-related bloodstream infection (CRBSI) and thrombotic complications, but fewer mechanical complications occurred in femoral CVA routes (4.86% or 18/370 versus 9.56% or 35/366) (n = 736, one RCT, RR 0.51, 95% CI 0.29 to 0.88). AUTHORS' CONCLUSIONS Subclavian and internal jugular CVA routes have similar risks for catheter-related complications in long-term catheterization in cancer patients. Subclavian CVA is preferable to femoral CVA in short-term catheterization because of lower risks of catheter colonization and thrombotic complications. In short-term haemodialysis catheterization, femoral and internal jugular CVA routes have similar risks for catheter-related complications except internal jugular CVA routes are associated with higher risks of mechanical complications.
Collapse
Affiliation(s)
- Xiaoli Ge
- Xinhua Hospital, Shanghai Jiao Tong University School of MedicineEmergency Department1665 Kong Jiang RoadShanghaiChina200092
| | - Rodrigo Cavallazzi
- Department of Medicine, University of LouisvilleDivision of Pulmonary, Critical Care and Sleep MedicineA3R27, Health Science CenterAmbulatory Care Building, 550 S. Jackson StreetLouisvilleKYUSA40202
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Psychotic Disorders600 Wan Ping Nan RoadShanghaiChina
| | - Shu Ming Pan
- Xinhua Hospital, Shanghai Jiao Tong University School of MedicineEmergency Department1665 Kong Jiang RoadShanghaiChina200092
| | - Ying‐Wei Wang
- Huashan Hospital, Fudan UniversityDepartment of AnaesthesiologyNo. 12 Wulumuqi RoadShanghaiChina200040
| | - Fei‐Long Wang
- Xinhua Hospital, Shanghai Jiao Tong University School of MedicineEmergency Department1665 Kong Jiang RoadShanghaiChina200092
| | | |
Collapse
|
22
|
Kocum A, Sener M, Calıskan E, Bozdogan N, Atalay H, Aribogan A. An Alternative Central Venous Route for Cardiac Surgery: Supraclavicular Subclavian Vein Catheterization. J Cardiothorac Vasc Anesth 2011; 25:1018-23. [DOI: 10.1053/j.jvca.2011.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Indexed: 11/11/2022]
|
23
|
|
24
|
Harnage SA. Achieving Zero Catheter Related Blood Stream Infections: 15 Months Success in a Community Based Medical Center. ACTA ACUST UNITED AC 2007. [DOI: 10.2309/java.12-4-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Achieving Zero Catheter Related Blood Stream Infections: 15 Month Success In A Community Based Medical Center. Background and Purpose: Catheter related blood stream infection (CRBSI) is a major cause of patient morbidity, mortality, and cost. Lower CRBSI rates would decrease inpatient length of stay. Project: An innovative central line bundle was developed to reduce CRBSI. An innovative combination of focused nursing practice and product technologies were selected for the bundle and implemented through a defined educational program. Data was collected from thirty-two critical care beds: 16 medical/surgical ICU and 16 Trauma-Neuro ICU beds. Results: From January 2006 thru March 2007 there were Zero occurrences of CRBSI. Over this 15 month period our PICC insertions increased by 103%, and our interventional radiology referral rate decreased to less than 2%. Implications/Conclusions: A multimodality bundle, combining nursing practice interventions and technology can successfully decrease the incidence of CRBSI. While some of the bundle components have not been widely researched and instead are based on theory or accepted clinical practice, the early outcome provides a basis for additional study and refinement. It also invites research into the various components of the bundle to evaluate the effect each separate practice and product lends to its success.
Collapse
|
25
|
Perrigault PF, Jaber S, Eledjam JJ. [Catheter-related infections: how to reduce the risk?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:288-90. [PMID: 15792565 DOI: 10.1016/j.annfar.2004.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Subcutaneous tunnelling of short-term catheters and the choice of site of catheter insertion are the two factors which influence the risk of catheter-related infection. Catheters inserted into a femoral vein have been associated with a higher risk of infection than those inserted into a subclavian vein. However, a meta-analysis comparing the internal jugular and subclavian sites did not report any difference. Regarding tunnelling, two randomized studies showed a benefit in terms of infection rates for the jugular and femoral sites when the blood sampling was not performed via the catheters. For the subclavian site tunnelling does not seem to bring any advantage compared to conventional insertion.
Collapse
Affiliation(s)
- P F Perrigault
- Département d'anesthésie-réanimation B, unité de réanimation et transplantation, hôpital Saint-Eloi, 34295 Montpellier cedex 05, France.
| | | | | |
Collapse
|