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Takahashi T, Morita K, Uda K, Matsui H, Yasunaga H, Nakagami G. Complications after peripherally inserted central catheter versus central venous catheter implantation in intensive care unit: propensity score analysis using a nationwide database. Expert Rev Med Devices 2024; 21:447-453. [PMID: 38661659 DOI: 10.1080/17434440.2024.2346191] [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: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND It remains unclear whether peripherally inserted central catheters (PICCs) are superior to central venous catheters (CVCs); therefore, we compared post-implantation complications between CVC and PICC groups. RESEARCH DESIGN AND METHODS Patients who received CVCs or PICCs between April 2010 and March 2018 were identified from the Diagnosis Procedure Combination database, a national inpatient database in Japan. The outcomes of interest included catheter infection, pulmonary embolism, deep vein thrombosis, and phlebitis. Propensity score overlap weighting was used to balance patient backgrounds. Outcomes were compared using logistic regression analyses. RESULTS We identified 164,185 eligible patients, including 161,605 (98.4%) and 2,580 (1.6%) in the CVC and PICC groups, respectively. The PICC group was more likely to have overall complications (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.32-2.19), pulmonary embolism (OR, 2.32; 95% CI, 1.38-3.89), deep vein thrombosis (OR, 1.86; 95% CI, 1.16-2.99), and phlebitis (OR, 1.72; 95% CI, 1.27-2.32) than the CVC group. There was no significant intergroup difference in catheter infection (OR, 1.09; 95% CI, 0.39-3.04). CONCLUSIONS Patients with PICCs had a significantly greater incidence of complications than did those with CVCs. Further research is necessary to explore the factors contributing to these complications.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Uda
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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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Shi J, Yan JJ, Chen J, Zhang QH, Yang Y, Xing X, Cheng AY, Wang YN, Xu G, He F. The management of vascular access in hemodialysis patients during the coronavirus disease 2019 epidemic: A multicenter cross-sectional study. J Vasc Access 2020; 22:280-287. [PMID: 32623945 DOI: 10.1177/1129729820937484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Coronavirus disease 2019 is an epidemic disease throughout the world. The management of vascular access during the epidemic is currently unknown. Methods: In this multicenter cross-sectional study, we collected vascular access data from hemodialysis patients treated at 44 hospitals in Hubei from 22 January to 10 March 2020. We estimated the management of vascular access during the coronavirus disease 2019 outbreak. Results: Of the 9231 hemodialysis patients included, 5387 patients (58.4%) were men and 2959 patients (32.1%) were older than 65 years. Arteriovenous fistula was the predominant type of vascular access, accounting for 76.5%; 496 patients (5.4%) developed vascular access complications; catheter flow reduction was the most common vascular access complication, and stenosis was the predominant complication among those with arteriovenous access. Overall, 280 vascular access sites were placed in patients newly diagnosed with uremia, of whom 260 (92.8%) underwent catheter insertion; 149 rescue procedures were carried out to treat the vascular access complications, which consisted of 132 catheters, 7 percutaneous transluminal angioplasties, 6 arteriovenous fistula repairs, and 4 arteriovenous fistulas. Occlusion of the arteriovenous access had the highest rescue rate (92.7%), while many other vascular access complications remained untreated; 69 and 142 patients were diagnosed with confirmed and suspected coronavirus disease 2019, respectively. A total of 146 patients died, of whom 29 patients (19.9%) died due to vascular access complications. Conclusion: Catheter flow reduction and stenosis of arteriovenous access were the major vascular access complications. Most of the vascular access sites established were catheters, and many of the vascular access complications remained untreated.
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Affiliation(s)
- Jia Shi
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-Jun Yan
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Chen
- Department of Nephrology, Huangshi Central Hospital of Hubei Polytechnic University, Huangshi, China
| | - Qing-Hong Zhang
- Department of Nephrology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan, China
| | - Yi Yang
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Xing
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-Ying Cheng
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Nan Wang
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan He
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Germano AS, Gomes AP, Martins R, Sousa M, Nunes V. Upper limb vascular mapping with Doppler ultrasound: Technique precision evaluated in healthy volunteers. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2019; 27:225-232. [PMID: 31762780 DOI: 10.1177/1742271x19853735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 05/05/2019] [Indexed: 11/16/2022]
Abstract
Introduction Doppler ultrasound is recommended by international societies for preoperative vascular mapping in vascular access surgery. Literature is scarce regarding data on Doppler ultrasound-associated errors. Objectives Our aim was to evaluate Doppler ultrasound precision for upper limb vascular mapping. Methods Fifty-two adult healthy volunteers were evaluated for superficial vein diameter, brachial artery flow and diameter in the lower third of non-dominant arm by a dedicated vascular access radiologist blinded for the identification of the participants. Each participant was scheduled for three evaluations one week apart. Friedman test and multivariate analysis of variance for repeated measures were used. Results There were no statistical differences within subjects across the three weeks except for brachial artery flow in participants who had basilic vein as the dominant vein. Discussion Repeated anatomical and haemodynamic parameters measured by Doppler ultrasound performed by an experienced medical sonographer, according to our protocol, did not show statistical differences within subjects, independently of age, gender and body mass index.
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Affiliation(s)
- Ana S Germano
- Radiology Department, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - António P Gomes
- Surgery Department, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - Rita Martins
- Surgery Department, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - Marta Sousa
- Surgery Department, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
| | - Vitor Nunes
- Surgery Department, Hospital Prof. Doutor Fernando da Fonseca, Amadora, Portugal
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Kamyar MM, Saeed Modaghegh MH, Kazemzadeh G. Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients. Semin Vasc Surg 2017; 29:172-177. [PMID: 28779783 DOI: 10.1053/j.semvascsurg.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Placement of autogenous arteriovenous fistula (AVF) is one of the basic needs in hemodialysis patients. Although many studies have investigated the complications of AVF placement, the complaints expressed by patients have not been studied in a long-term study. The purpose of this study was to evaluate the incidence of complaints after placement of autogenous AVF in patients undergoing chronic hemodialysis. This cohort study was conducted on patients with end-stage renal disease undergoing AVF placement who were referred to Imam Reza hospital in Mashhad, Iran, from January 2015 to June 2016. The AVFs were placed in all patients and incidence rates of expressed complaints, including pain, paresthesia, and edema, were assessed up to three periods 1 month after surgery and three periods 2 months after starting use of the AVF. Data were analyzed using SPSS software, version 19. The relationship of AVF types with each of the outcomes was analyzed via χ2 test. Three hundred and eighty-eight patients (222 males and 166 females; mean age 54.3 ± 16.0 years) were studied. AVF was established in the cubital site of 230 patients, in snuff box of 103 patients, and distal forearm of 55 patients. Total incidence rate of pain within six follow-up periods and incidence rates of paresthesia and edema were determined as 18.1%, 2.6%, and 5.4%, respectively. A statistically significant relationship was observed between types of AVF and pain and paresthesia (P < .05). According to results from this study, pain and then edema were the most common complaints, followed by AVF placement in the patients. Paresthesia had lower incidence rates compared to other complaints.
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Affiliation(s)
- Mohammad Mahdi Kamyar
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran
| | - Mohammad Hadi Saeed Modaghegh
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran
| | - Gholamhossein Kazemzadeh
- Mashhad Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Alavi Hospital, Imam Reza 63 Avenue, Mashhad, Iran.
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Lin H, Zhang R, Xu W, Wang Y. Estimating time-varying treatment switching effects via local linear smoothing and quasi-likelihood. Comput Stat Data Anal 2017. [DOI: 10.1016/j.csda.2016.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bakhshoude B, Ravari H, Kazemzadeh GH, Rad MP. Diagnostic value of computerized tomography venography in detecting stenosis and occlusion of subclavian vein and superior vena in chronic renal failure patients. Electron Physician 2016; 8:2781-2786. [PMID: 27757189 PMCID: PMC5053460 DOI: 10.19082/2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/22/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Currently, venography is the standard diagnostic method to examine veins before implementing access, which is invasive in nature. Computerized tomography venography (CTV) can simultaneously indicate deep and superficial venous systems in the upper extremity and their relation to the surrounding anatomical structures; however, its diagnostic value in the detection of central venous disease has yet to be defined. The aim of this study was to determine the diagnostic value of CT venography compared to venography in the diagnosis of stenosis and the occlusion of subclavian veins and the superior vena in renal failure patients. Methods This cross-sectional study was conducted from January to September 2015 on patients with chronic renal failure undergoing upper extremity venography at the Radiology Department of Imam Reza Hospital in Mashhad, Iran. We excluded patients with catheters in their jugular and subclavian vein routes, venous hypertension with reverse-function fistula, or sensitivity to contrast agents. Several factors, including age, gender, catheterization record in jugular and subclavian veins, and fistula record in the upper extremity, as well as clinical symptoms consisting of edema, dermatitis, and ulcers in these organs, were recorded in the corresponding form. Then, the patients consecutively underwent indirect venography and CT venography and traces of stenosis (more than 50%) or complete occlusion in the subclavian vein and superior vena were recorded. The data were analyzed using SPSS software by the chi-squared test, and sensitivity, specificity, and positive and negative predictive values were calculated by means of MedCalc Online, version 16.2. Results The study was conducted on 40 patients (26 males and 14 females) with a mean age of 46.7 ± 10.4 years. In this study, 58 subclavian veins, as well as 32 superior vena cava, were studied. The results showed that the diagnostic value of CTV in the detection of subclavian stenosis had a sensitivity and a specificity of 88.2 and 97.5%, respectively. Moreover, in the superior vena cava, the greatest CTV diagnostic sensitivity and specificity was related to vein stenosis detection (sensitivity = 88.8%; specificity = 100%). Conclusion It seems that the CTV, based on its high sensitivity, specificity, and predictive value, can be used as an efficient tool in the study of stenosis in subclavian veins and superior vena in patients undergoing venography
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Affiliation(s)
- Banafsheh Bakhshoude
- M.D., Resident of Radiology, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Ravari
- M.D., Associate Professor, Department of Vascular Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholam Hosein Kazemzadeh
- M.D., Associate Professor, Department of Vascular Surgery, Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Pezeshki Rad
- M.D., Associate Professor, Department of Radiology, Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Taylor MJ, Hanson CS, Casey JR, Craig JC, Harris D, Tong A. “You know your own fistula, it becomes a part of you”-Patient perspectives on vascular access: A semistructured interview study. Hemodial Int 2015. [DOI: 10.1111/hdi.12340] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew J. Taylor
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Camilla S. Hanson
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Jordan R. Casey
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Jonathan C. Craig
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - David Harris
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Allison Tong
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
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