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Hearon CM, Peters K, Dias KA, Macnamara JP, Marshall JET, Campain J, Martin D, Marshal‐Goebel K, Levine BD. Assessment of venous pressure by compression sonography of the internal jugular vein during 3 days of bed rest. Exp Physiol 2023; 108:1560-1568. [PMID: 37824038 PMCID: PMC10988448 DOI: 10.1113/ep091372] [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: 06/30/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
Compression sonography has been proposed as a method for non-invasive measurement of venous pressures during spaceflight, but initial reports of venous pressure measured by compression ultrasound conflict with prior reports of invasively measured central venous pressure (CVP). The aim of this study is to determine the agreement of compression sonography of the internal jugular vein (IJVP) with invasive measures of CVP over a range of pressures relevant to microgravity exposure. Ten healthy volunteers (18-55 years, five female) completed two 3-day sessions of supine bed rest to simulate microgravity. IJVP and CVP were measured in the seated position, and in the supine position throughout 3 days of bed rest. The range of CVP recorded was in line with previous reports of CVP during changes in posture on Earth and in microgravity. The correlation between IJVP and CVP was poor when measured during spontaneous breathing (r = 0.29; R2 = 0.09; P = 0.0002; standard error of the estimate (SEE) = 3.0 mmHg) or end-expiration CVP (CVPEE ; r = 0.19; R2 = 0.04; P = 0.121; SEE = 3.0 mmHg). There was a modest correlation between the change in CVP and the change in IJVP for both spontaneous ΔCVP (r = 0.49; R2 = 0.24; P < 0.0001) and ΔCVPEE (r = 0.58; R2 = 0.34; P < 0.0001). Bland-Altman analysis of IJVP revealed a large positive bias compared to spontaneous breathing CVP (3.6 mmHg; SD = 4.0; CV = 85%; P < 0.0001) and CVPEE (3.6 mmHg; SD = 4.2; CV = 84%; P < 0.0001). Assessment of absolute IJVP via compression sonography correlated poorly with direct measurements of CVP by invasive catheterization over a range of venous pressures that are physiologically relevant to spaceflight. However, compression sonography showed modest utility for tracking changes in venous pressure over time. NEW FINDINGS: What is the central question of this study? Compression sonography has been proposed as a novel method for non-invasive measurement of venous pressures during spaceflight. However, the accuracy has not yet been confirmed in the range of CVP experienced by astronauts during spaceflight. What is the main finding and its importance? Our data show that compression sonography of the internal jugular vein correlates poorly with direct measurement of central venous pressures in a range that is physiologically relevant to spaceflight. However, compression sonography showed modest utility for tracking changes in venous pressure over time.
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Affiliation(s)
- Christopher M. Hearon
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Kirsten Peters
- University Medical CenterRadboud UniversityNijmegenthe Netherlands
| | - Katrin A. Dias
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - James P. Macnamara
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - John E. T. Marshall
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Joseph Campain
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | | | | | - Benjamin D. Levine
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
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Nathanson R, Baher H, Phillips J, Freeman M, Sehgal R, O'Rorke J, Soni NJ. Development of a Chief Resident Medical Procedure Service: a 10-Year Experience. J Gen Intern Med 2023; 38:3077-3081. [PMID: 37237120 PMCID: PMC10593632 DOI: 10.1007/s11606-023-08234-z] [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: 02/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS). AIM Describe the development and 10-year outcomes of an MPS led by IM chief residents. SETTING University-based IM residency program affiliated with a county and Veterans Affairs hospital. PARTICIPANTS Categorical IM interns (n=320) and 4th-year IM chief residents (n=48) from 2011 to 2022. PROGRAM DESCRIPTION The MPS operated on weekdays, 8 am-5 pm. After training and sign-off by the MPS director, chief residents trained and supervised interns in ultrasound-guided procedures during a 4-week rotation. PROGRAM EVALUATION From 2011 to 2022, our MPS received 5967 consults and 4465 (75%) procedures were attempted. Overall procedure success, complication, and major complication rates were 94%, 2.6%, and 0.6%, respectively. Success and complication rates for paracentesis (n=2285) were 99% and 1.1%, respectively; 99% and 4.2% for thoracentesis (n=1167); 76% and 4.5% for lumbar puncture (n=883); 83% and 1.2% for knee arthrocentesis (n=85); and 76% and 0% for central venous catheterization (n=45). The rotation was rated 4.6 out of 5 for overall learning quality. DISCUSSION A chief resident-led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.
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Affiliation(s)
- Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Hasan Baher
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jason Phillips
- Division of Cardiology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Megan Freeman
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Raj Sehgal
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jane O'Rorke
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
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Rai D, Kumar P, Gupta P, Verma PK. Surveillance of central line associated bloodstream infection (CLABSI) - comparison of current (CDC/NHSN) and modified criteria: A prospective study. J Anaesthesiol Clin Pharmacol 2023; 39:349-354. [PMID: 38025573 PMCID: PMC10661645 DOI: 10.4103/joacp.joacp_393_21] [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: 07/30/2021] [Revised: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2023] Open
Abstract
Background and Aims There is a huge load of central line-associated bloodstream infection (CLABSI) being reported in developing countries, with increased mortality and healthcare costs. Effective surveillance is a must to reduce the incidence of CLABSI. The current criteria (Centre for Disease Control and Prevention/National Healthcare Safety Network [CDC/NHSN]) for CLABSI surveillance have their own shortcomings. For diagnosing CLABSI, current CDC/NHSN CLABSI surveillance criteria are laborious and time consuming with low predictive power. Hence, modified criteria have been postulated, which are simple and implementable at resource-constrained setups. The primary objective was to compare modified criteria with CDC criteria. The secondary objective was to determine the prevalence of CRBSI. Material and Methods A total of 98 patients with central line in situ or having the central venous line removed ≤24 hrs prior to the date of the event were enrolled. Paired blood cultures were obtained and results were analyzed using differential time to positivity. Results The incidence of CLBSI was 8.16% and the device utilization rate was 11.6%. The negative predictive value of both the surveillance criteria was found to be excellent and comparable (96.2% for modified criteria and 97.1% for CDC criteria), therefore both can be used for screening purposes. AUC for current CDC/NHSN criteria was better than modified criteria (0.76 versus 0.66, P < 0.0001), suggesting it to be a better criterion for surveillance of CLABSI. Conclusion Modified criteria were not superior to CDC/NHSN criteria for surveillance. Thus, there is a scope of improving the modified criteria for the purpose of surveillance. CLBSI load was higher; CLABSI bundle for prevention is thus highly recommended.
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Affiliation(s)
- Durgesh Rai
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Pravin Kumar
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Poonam Gupta
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Pardeep K. Verma
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
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Buell KG, Hayat MH, Walsh DW, Wooldridge KT, Vasilevskis EE, Heller LT. Creation of a medical procedure service in a tertiary medical center: Blueprint and procedural outcomes. J Hosp Med 2022; 17:594-600. [PMID: 35797494 DOI: 10.1002/jhm.12901] [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: 01/04/2022] [Revised: 05/21/2022] [Accepted: 05/29/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Medical Procedure Services (MPS) may represent a solution to the educational gap in procedural training among internal medicine residents and the unmet need for the clinical provision of non-urgent inpatient procedures. However, there is little guidance available to help launch an MPS. Furthermore, procedural outcomes from a newly initiated MPS, including those comparing trainees versus attending physicians, are lacking. OBJECTIVE To describe the blueprint used in the design, implementation, and ongoing oversight of an MPS and to report its procedural outcomes. DESIGN, SETTINGS AND PARTICIPANTS Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. INTERVENTION The launch of an MPS at a large tertiary academic hospital. MAIN OUTCOME AND MEASURES 6,152 procedural consultations resulting in 5,320 attempted procedures over a four-and-a-half year period. RESULTS The primary proceduralist was a supervised resident in 58.7% (3124 /5,320) and an attending in 41.3% (2,196/5,320) of procedures. The overall success rate was 91.1% (95% CI: 90.3-91.9%) and the major complication rate was 0.7% (95% CI: 0.5-1.0%). There was no difference in the mean number of attempts required to complete a procedure (1.6 vs 1.5 attempts, p=0.68) and the complication rates between supervised residents and attending proceduralists, respectively (20/3,124 vs 20/2,196, p=0.26). CONCLUSION At a tertiary academic medical center, the implementation and maintenance of MPS is feasible, safe, and results in high rates of successful procedures performed by supervised residents. Procedures performed by supervised residents require comparable number of attempts for completion and carry similar risks as those performed alone by attendings.
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Affiliation(s)
- Kevin G Buell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Muhammad H Hayat
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David W Walsh
- Department of Medicine, Division of Hospital Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Kathleene T Wooldridge
- Department of Medicine, Division of Hospital Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eduard E Vasilevskis
- Department of Medicine, Division of Hospital Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Lawrence T Heller
- Department of Medicine, Division of Hospital Medicine and Public Health, Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Nurses and Efficacy of Ultrasound-guided Versus Traditional Venous Access: A Systemic Review and Meta-analysis. J Emerg Nurs 2022; 48:145-158.e1. [DOI: 10.1016/j.jen.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/23/2021] [Accepted: 12/11/2021] [Indexed: 11/21/2022]
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Lazaar S, Mazaud A, Delsuc C, Durand M, Delwarde B, Debord S, Hengy B, Marcotte G, Floccard B, Dailler F, Chirossel P, Bureau-Du-Colombier P, Berthiller J, Rimmelé T. Ultrasound guidance for urgent arterial and venous catheterisation: randomised controlled study. Br J Anaesth 2021; 127:871-878. [PMID: 34503827 DOI: 10.1016/j.bja.2021.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Haemodynamically unstable patients often require arterial and venous catheter insertion urgently. We hypothesised that ultrasound-guided arterial and venous catheterisation would reduce mechanical complications. METHODS We performed a prospective RCT, where patients requiring both urgent arterial and venous femoral catheterisation were randomised to either ultrasound-guided or landmark-guided catheterisation. Complications and characteristics of catheter insertion (procedure duration, number of punctures, and procedure success) were recorded at the time of insertion (immediate complications). Late complications were investigated by ultrasound examination performed between the third and seventh days after randomisation. Primary outcome was the proportion of patients with at least one mechanical complication (immediate or late), by intention-to-treat analysis. Secondary outcomes included success rate, procedure time, and number of punctures. RESULTS We analysed 136 subjects (102 [75%] male; age range: 27-62 yr) by intention to treat. The proportion of subjects with one or more complications was lower in 22/67 (33%) subjects undergoing ultrasound-guided catheterisation compared with landmark-guided catheterisation (40/69 [58%]; odds ratio: 0.35 [95% confidence interval: 0.18-0.71]; P=0.003). Ultrasound-guided catheterisation reduced both immediate (27%, compared with 51% in the landmark approach group; P=0.004) and late (10%, compared with 23% in the landmark approach group; P=0.047) complications. Ultrasound guidance also reduced the proportion of patients who developed deep vein thrombosis (4%, compared with 22% following landmark approach; P=0.012), and achieved a higher procedural success rate (96% vs 78%; P=0.004). CONCLUSIONS An ultrasound-guided approach reduced mechanical complications after urgent femoral arterial and venous catheterisation, while increasing procedural success. CLINICAL TRIAL REGISTRATION NCT02820909.
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Affiliation(s)
- Stephen Lazaar
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France.
| | - Amélie Mazaud
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Claire Delsuc
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Maeva Durand
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Benjamin Delwarde
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Sophie Debord
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Baptiste Hengy
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Marcotte
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Bernard Floccard
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Frédéric Dailler
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Pierre Wertheimer Hospital, Lyon, France
| | - Pierre Chirossel
- Hospices Civils de Lyon, Department of Vascular Explorations, Louis Pradel Hospital, Lyon, France
| | | | - Julien Berthiller
- Hospices Civils de Lyon, Epidemiology, Pharmacology and Clinical Investigations, Lyon, France
| | - Thomas Rimmelé
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France; EA7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Hospices Civils de Lyon-Biomérieux-University Claude Bernard Lyon 1, Lyon, France
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Cheves JW, DeMarinis S, Sorin C, Carino G, Sweeney JD. Causes of an elevated international normalized ratio in the intensive care unit and the implications for plasma transfusion. Transfusion 2021; 61:2862-2868. [PMID: 34292616 DOI: 10.1111/trf.16599] [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] [Received: 01/08/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The presence of an elevated international normalized ratio (INR) is common in patients in the intensive care unit (ICU), but the cause rarely determined. These patients are at risk to receive prophylactic plasma prior to invasive procedures. STUDY DESIGN AND METHODS Samples from patients with an INR of 1.5 or greater were frozen and subsequently thawed and assayed for procoagulant and anticoagulant clotting factors and anti-Xa to determine the likely cause of the INR. Samples showing a low FVII, FX, PC, and PS were categorized as a vitamin K deficiency pattern. Samples showing a low FV, low or normal fibrinogen, and high FVIII were categorized as a liver disease pattern. Samples showing an anti-Xa >0.01 IU/ml were assayed for anti-Xa DOACs. Samples which could not be categorized were grouped as equivocal. RESULTS A total of 48 samples were obtained over a 6-month period. Nineteen showed a Vitamin K deficiency pattern, 17 a liver disease pattern, 7 showed an anti-Xa DOAC and 5 were equivocal. High FVIII and D-dimers and reduced levels of the anticoagulant proteins were present in the majority of the samples. FVII levels correlated inversely with the INR (r = -0. 81), as did FX (r = -0.67) but not FV (r = -0.04) nor fibrinogen (r = -0.15). CONCLUSION Transfusion of plasma to reverse an elevated INR in the ICU should be discouraged since such a practice is either avoidable by the use of vitamin K or inappropriate in the case of liver disease or an anti-Xa DOAC.
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Affiliation(s)
- Jared W Cheves
- Intensive Care Department, The Miriam Hospital, Providence, Rhode Island, USA
| | - Sandra DeMarinis
- Department of Coagulation and Transfusion Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Claudia Sorin
- Intensive Care Department, The Miriam Hospital, Providence, Rhode Island, USA
| | - Gerardo Carino
- Intensive Care Department, The Miriam Hospital, Providence, Rhode Island, USA
| | - Joseph D Sweeney
- Department of Coagulation and Transfusion Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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Yan Y, Ye M, Dong X, Chen Q, Hong H, Chen L, Luo Y. Prevention of Contrast-Induced Nephropathy by Inferior Vena Cava Ultrasonography-Guided Hydration in Chronic Heart Failure Patients. Cardiology 2021; 146:187-194. [PMID: 33486475 DOI: 10.1159/000512434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contrast-induced nephropathy (CIN) is a common complication resulting from the administration of contrast media. This study was designed to determine whether inferior vena cava (IVC) ultrasonography (IVCU)-guided hydration can reduce the risk of CIN in chronic heart failure patients undergoing coronary angiography or coronary angiography with percutaneous coronary intervention compared with standard hydration. METHODS This prospective clinical trial enrolled 207 chronic heart failure patients from February 2016 to November 2017, who were randomly assigned to either the IVCU-guided hydration group (n = 104) or the routine hydration group (n = 103). In the IVCU-guided group, the hydration infusion rate was set according to the IVC diameter determined by IVCU, while the control group received intravenous infusion of 0.9% saline at 0.5 mL/(kg·h). Serum Cr was measured before and 48-72 h after the procedure. All patients were followed up for 18 months. The incidence of nephropathy and major adverse cardiovascular or cerebrovascular events (MACCEs) was also compared between the 2 groups. RESULTS Statistically significant difference between the 2 groups regarding the occurrence of CIN was observed (12.5 vs. 29.1%, p = 0.004). The hydration volume of the IVCU-guided group was significantly higher than that of the routine group (p < 0.001). In addition, patients receiving IVCU-guided hydration had significantly lower risk of developing MACCEs than patients in the control group during the 18-month follow-up (14.4 vs. 27.2%, p = 0.027). CONCLUSION Our findings support that IVCU-guided hydration is superior to standard hydration in prevention of CIN and may substantially reduce longtime composite major adverse events.
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Affiliation(s)
- Yuanming Yan
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingfang Ye
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xianfeng Dong
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qin Chen
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huashan Hong
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yukun Luo
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,
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Blaivas M, Arntfield R, White M. Creation and Testing of a Deep Learning Algorithm to Automatically Identify and Label Vessels, Nerves, Tendons, and Bones on Cross-sectional Point-of-Care Ultrasound Scans for Peripheral Intravenous Catheter Placement by Novices. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1721-1727. [PMID: 32181922 DOI: 10.1002/jum.15270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We sought to create a deep learning (DL) algorithm to identify vessels, bones, nerves, and tendons on transverse upper extremity (UE) ultrasound (US) images to enable providers new to US-guided peripheral vascular access to identify anatomy. METHODS We used publicly available DL architecture (YOLOv3) and deidentified transverse US videos of the UE for algorithm development. Vessels, bones, tendons, and nerves were labeled with bounding boxes. A total of 203,966 images were generated from videos, with corresponding label box coordinates in a YOLOv3 format. Training accuracy, losses, and learning curves were tracked. As a final real-world test, 50 randomly selected images from unrelated UE US videos were used to test the DL algorithm. Four different versions of the YOLOv3 algorithm were tested with varied amounts of training and sensitivity settings. The same 50 images were labeled by 2 blinded point-of-care ultrasound (POCUS) experts. The area under the curve (AUC) was calculated for the DL algorithm and POCUS expert performance. RESULTS The algorithm outperformed POCUS experts in detection of all structures in the UE, with an AUC of 0.78 versus 0.69 and 0.71, respectively. When considering vessels, only one of the POCUS experts attained an AUC of 0.85, just ahead of the DL algorithm, with an AUC of 0.83. CONCLUSIONS Our DL algorithm proved accurate at identifying 4 common structures on cross-sectional US imaging of the UE, which would allow novice POCUS providers to more confidently and accurately target vessels for cannulation, avoiding other structures. Overall, the algorithm outperformed 2 blinded POCUS experts.
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Affiliation(s)
- Michael Blaivas
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
- Department of Emergency Medicine, St Francis Hospital, Columbus, Georgia USA
| | - Robert Arntfield
- Department of Critical Care Medicine, Western University, London, Ontario, Canada
| | - Matthew White
- Department of Critical Care Medicine, Western University, London, Ontario, Canada
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Edaigbini SA, Aminu MB, Delia IZ, Bosan IB, Orogade AA, Anumenechi N. Initial Experience with Central Venous Line Insertion in a Tertiary Health Institution in Nigeria. Niger Med J 2019; 60:138-143. [PMID: 31543566 PMCID: PMC6737802 DOI: 10.4103/nmj.nmj_238_16] [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: 11/17/2022] Open
Abstract
Background: Central venous catheterization is an uncommon procedure in most hospitals in the West African subregion. This article presents our initial experience with central line insertion. Materials and Methods: Catheter sizes ranged from 5 fr for children and 7 fr for adult for intravenous therapy, while size 7 fr polyurethane catheters were used for children requiring hemodialysis and sizes 12–14 fr silicone catheters for adolescents and adults requiring hemodialysis'. Data were collected prospectively using a structured pro forma over a 2-year period (June 2010–May 2012) and analyzed with SPSS 15. Results: A total of 77 lines were inserted four as tunneled lines and 73 as nontunneled lines. Forty-seven (61.0%) patients were male, 30 (39.0%) were female, with age range of 1–80 years. The success rate was 97.4%. The overall complication rate was 16.9%. Conclusion: Our initial experience with the use of central venous lines, was marked by a high success rate, few manageable complications and no mortality over the study period. Majority of insertions were done by the bedside under local anesthesia lending credence to the assertion that it is a relatively safe procedure that can be done by any adequately trained doctor and should, therefore, be encouraged in our hospitals.
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Migowski SA, Gavronski I, Libânio CDS, Migowski ER, Duarte FD. Efficiency Losses in Healthcare Organizations Caused by Lack of Interpersonal Relationships. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2019. [DOI: 10.1590/1982-7849rac2019170396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Despite all quality management and integration literature prescriptions to implement strategies for a better organizational performance, healthcare organizations support a model that is inefficient, expensive, and unsustainable over time. This work aims to examine the interpersonal relationships in three large hospitals located in Southern Brazil and its relation with organizational efficiency. Through a qualitative and explanatory research, semi-structured interviews were applied to 32 professionals, in addition to a document analysis. The data analysis shows that integration occurs at the formal leadership level only in one of the organizations and does not involve the medical and operational professionals. Quality management seems not to be fully incorporated into care routines, and are related to efficiency losses. This scenario is probably related to the lack of integration among the professionals and the consolidation of trust, leadership, and communication.
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Affiliation(s)
| | | | | | - Eliana Rustick Migowski
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil; Universidade Feevale, Brasil
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Walton RAL, Hansen BD. Venous oxygen saturation in critical illness. J Vet Emerg Crit Care (San Antonio) 2018; 28:387-397. [PMID: 30071148 DOI: 10.1111/vec.12749] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/03/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review clinically relevant features of systemic oxygen delivery and consumption and the technique and use of venous oxygenation monitoring in human and veterinary medicine. DATA SOURCES Veterinary and human peer-reviewed medical literature including scientific reviews, clinical and laboratory research articles, and authors' clinical research experience. SUMMARY Measurement of venous hemoglobin oxygen saturation (venous oxygenation) provides insight into the balance between oxygen supply and tissue demand. In people, measurement of venous oxygen saturation can reveal decompensation that is missed by physical examination and other routinely monitored parameters. Therefore, measurement of mixed or central venous oxygenation measurement may help guide therapy and predict outcome of critically ill patients. In dogs, low central venous oxygen saturation has been associated with impaired cardiopulmonary function and poor outcome in several small studies of experimental shock or severe clinical illness, suggesting that monitoring this variable may assist the treatment of severe illness in this species as well. CONCLUSION Venous oxygenation reflects systemic oxygenation status and can be used to guide treatment and estimate prognosis in critically ill patients. Measurement of venous oxygenation in veterinary patients is feasible and is a potentially valuable tool in the management of patients with severe disease. This review is intended to increase the understanding and awareness of the potential role of venous oxygen measurement in veterinary patients.
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Affiliation(s)
- Rebecca A L Walton
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC, 27607
| | - Bernie D Hansen
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC, 27607
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Kaya H, Turan Y, Akbal S, Tosun K, Aksoy E, Tunalı Y, Özdemir Aydın G. The effect of nursing care protocol on the prevention of central venous catheter-related infections in neurosurgery intensive care unit. Appl Nurs Res 2016; 32:257-261. [DOI: 10.1016/j.apnr.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/26/2022]
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Hutchinson KM, Shaw SP. A Review of Central Venous Pressure and Its Reliability as a Hemodynamic Monitoring Tool in Veterinary Medicine. Top Companion Anim Med 2016; 31:109-121. [PMID: 27968811 DOI: 10.1053/j.tcam.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/04/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient. A thorough evaluation of the veterinary and human literature should be performed to evaluate the role of CVP measurements in assessing volume status in veterinary patients. DIAGNOSIS Veterinary patients that benefit from accurate CVP readings include those suffering from hypovolemic or septic shock, heart disease, or renal disease or all of these. Other patients that may benefit from CVP monitoring include high-risk anesthetic patients undergoing major surgery, trending of fluid volume status in critically ill patients, patients with continued shock, and patients that require rapid or large amounts of fluids. THERAPY The goal of CVP use is to better understand a patient's intravascular volume status, which would allow early goal-directed therapy. PROGNOSIS CVP would most likely continue to play an important role in the hemodynamic monitoring of the critically ill veterinary patient; however, when available, cardiac output methods should be considered the first choice for hemodynamic monitoring.
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Affiliation(s)
| | - Scott P Shaw
- VCA, Specialty Regional Medical Director; Northeast Los Angeles, CA, USA
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Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol. Antimicrob Agents Chemother 2016; 60:3426-32. [PMID: 27001822 DOI: 10.1128/aac.02565-15] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/14/2016] [Indexed: 12/15/2022] Open
Abstract
In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.).
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Sheils M, Ross M, Eatough N, Caputo ND. Intraosseous access in trauma by air medical retrieval teams. Air Med J 2016; 33:161-4. [PMID: 25049187 DOI: 10.1016/j.amj.2014.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Trauma accounts for a significant portion of overall mortality globally. Hemorrhage is the second major cause of mortality in the prehospital environment. Air medical retrieval services throughout the world have been developed to help improve the outcomes of patients suffering from a broad range of medical conditions, including trauma. These services often utilize intraosseous (IO) devices as an alternative means for access of both medically ill and traumatically injured patients in austere environments. However, studies have suggested that IO access cannot reach acceptable rates for massive transfusion. We review the subject to find the answer of whether IO access should be performed by air medical teams in the prehospital setting, or would central venous (CVC) access be more appropriate? We decided to assess the literature for capacity of IO access to meet resuscitation requirements in the prehospital management of trauma. We also decided to compare the insertion and complication characteristics of IO and CVC access.
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Affiliation(s)
| | | | | | - Nicholas D Caputo
- CareFlight, Darwin, NT Australia; Department of Emergency Medicine, Lincoln Medical and Mental Health Center Bronx, NY, USA.
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Ventricular Tachycardia from a Central Line Fracture Fragment Embolus: A Rare Complication of a Commonly Used Procedure-A Case Report and Review of the Relevant Literature. Case Rep Crit Care 2016; 2015:265326. [PMID: 26770840 PMCID: PMC4681828 DOI: 10.1155/2015/265326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022] Open
Abstract
A 22-year-old male admitted with multiple gunshot wounds (GSW) had central line placed initially for hemodynamic monitoring and later for long term antibiotics and total parenteral nutrition (TPN). On postoperative day 4 he presented with bouts of nonsustained ventricular tachycardia; the cause was unknown initially and later attributed to a catheter fragment accidentally severed and lodged in the right heart. Percutaneous retrieval technique was used to successfully extract the catheter fragment and complete recovery was achieved.
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Choron RL, Wang A, Van Orden K, Capano-Wehrle L, Seamon MJ. Emergency central venous catheterization during trauma resuscitation: a safety analysis by site. Am Surg 2015; 81:527-31. [PMID: 25975341 DOI: 10.1177/000313481508100538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may cause complications including catheter-related blood stream infection (CRBSI), deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. Our primary objective compared subclavian versus femoral CVC complications during initial trauma resuscitations. A retrospective review (2010-2011) at an urban, Level-I Trauma Center reviewed CVCs during initial trauma resuscitations. Demographics, clinical characteristics, and complications including: CRBSIs, DVTs, arterial injuries, pneumothoraces, and PEs were analyzed. Fisher's exact test and Student's t test were used; P ≤ 0.05 was considered statistically significant. Overall, 504 CVCs were placed (subclavian, n = 259; femoral, n = 245). No difference in age (47 ± 22 vs 45 ± 23 years) or body mass index (28 ± 6 vs 29 ± 16 kg/m(2)) was detected (P > 0.05) in subclavian vs femoral CVC, but subclavian CVCs had more blunt injuries (81% vs 69%), greater systolic blood pressure (95 ± 55 vs 83 ± 43 mmHg), greater Glasgow Coma Scale (10 ± 5 vs 9 ± 5), and less introducers (49% vs 73%) than femoral CVCs (all P < 0.05). Catheter related arterial injuries, PEs, and CRBSIs were similar in subclavian and femoral groups (3% vs 2%, 0% vs 1%, and 3% vs 3%; all P > 0.05). Catheter-related DVTs occurred in 2 per cent of subclavian and 9 per cent of femoral CVCs (P < 0.001). There was a 3 per cent occurrence of pneumothorax in the subclavian CVC population. In conclusion, both subclavian and femoral CVCs caused significant complications. Subclavian catheter-related pneumothoraces occurred more commonly and femoral CRBSIs less commonly than expected compared with prior literature in nonemergent scenarios. This suggests that femoral CVC may be safer than subclavian CVC during initial trauma resuscitations.
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Affiliation(s)
- Rachel L Choron
- Division of Trauma Surgery, Department of Surgery, Cooper University Hospital and Cooper Medical School at Rowan University, Camden, New Jersey, USA
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19
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Ultrasound evaluation of saphenous vein for peripheral intravenous cannulation in adults. J Vasc Access 2015; 16:418-21. [PMID: 25953210 DOI: 10.5301/jva.5000383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate variables that may affect sonographic cannulation of great saphenous vein and determine the ideal location for ultrasound-guided saphenous vein cannulation in adult emergency department (ED) patients. METHODS A prospective observational study at an academic ED. The great saphenous vein was identified in adult subjects at three distinct sites after placing the tourniquet proximal to the vein: the ankle, mid-calf, and below the knee using a 10-5 MHz linear transducer. The depth of the saphenous vein from the skin surface and its diameter were measured in supine and reverse trendelenburg positions in both extremities. RESULTS A total of 60 subjects (male 30, female 30) were enrolled in the study. The median age of the patients was 50.5 years [interquartile range (IQR) 34.5-67.5]. The median body mass index (BMI) was 27.3 (IQR, 24.2-31.8). The great saphenous vein was significantly superficial in location at the ankle level compared with the calf (p<0.001), knee (p<0.001), and left side compared with the right (p<0.001). The subject position was not significantly related to saphenous vein depth (p = 0.68). The saphenous vein diameter was significantly larger in the left lower extremity than the right side (p = 0.007), and at the ankle level compared with the calf (p<0.001) and knee (p<0.001). The diameter of the vein increased significantly when patient's position changed from supine to reverse Trendelenburg (p<0.001). CONCLUSIONS Our results support ultrasound evaluation of the course of great saphenous vein from the ankle to the knee for the selection of appropriate venipuncture site and cannulation.
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Heidari Gorji MA, Rezaei F, Jafari H, Yazdani Cherati J. Comparison of the effects of heparin and 0.9% sodium chloride solutions in maintenance of patency of central venous catheters. Anesth Pain Med 2015; 5:e22595. [PMID: 25866710 PMCID: PMC4389103 DOI: 10.5812/aapm.22595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 08/30/2014] [Accepted: 09/15/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Occlusion of central venous catheters is one of the limiting factors in using them. Heparinized saline solution is the standard solution used for keeping the catheters open. OBJECTIVES This study aimed to determine the effect of heparin saline solution and normal saline in maintenance of patency of central venous catheters. PATIENTS AND METHODS This double-blind study was performed on 84 patients of intensive care unit who had central venous catheters. The patients were randomly divided into two groups of heparin saline receivers and normal saline receivers. In the heparin group after each drug injection into the lumen, 3 mL of heparin saline solution was injected in the catheter as well. The other group only received 10 mL of normal saline instead. The catheters were examined for blood return and flushing every eight hours for 21 days. Data was analyzed using SPSS software version 20 and descriptive and analytic statistics were studied. RESULTS There was no significant difference in the rate of flushing (P = 0.872) and possibility of taking blood samples from catheters (P = 0.745) in the two groups of heparin and normal saline receivers. Furthermore, using heparin had no effect on prolonging the survival of catheters. CONCLUSIONS Considering possible side effects of heparin and the increase in treatment charges and the fact that using heparin did not have a significant effect on patency and survival of catheters in the studied patients, it is recommended to use normal saline solution to maintain the patency of central venous catheters.
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Affiliation(s)
- Mohammad Ali Heidari Gorji
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Rezaei
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hedayat Jafari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Chin JH, Jun IG, Lee J, Seo H, Hwang GS, Kim YK. Can Stroke Volume Variation Be an Alternative to Central Venous Pressure in Patients Undergoing Kidney Transplantation? Transplant Proc 2014; 46:3363-6. [DOI: 10.1016/j.transproceed.2014.09.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/27/2014] [Accepted: 09/17/2014] [Indexed: 02/03/2023]
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Abstract
BACKGROUND Placing a central venous access device via the internal jugular or subclavian vein entails significant risks to both patient and healthcare worker. PURPOSE The purpose of this randomized, prospective study was to determine whether the accelerated Seldinger technique (AST) offers significant safety advantages over the modified Seldinger technique (MST) for peripherally inserted central catheter insertion. MATERIALS AND METHODS Patients were randomly assigned to undergo introducer sheath insertion by means of either MST or AST. Primary outcome measures included time to completion of introducer sheath insertion, estimated blood loss, and success rate. Secondary outcome measures included vessel-to-air exposure events and unprotected sharps exposure. DISCUSSION While both insertion methods proved equivalent for successful vessel cannulation, AST was significantly faster (P = 0.0048) and resulted in less blood loss (P = 0.0295) than MST. Additionally, AST resulted in significantly fewer vessel-to-air exposure events (P < 0.0001) and unprotected sharps exposures (P < 0.0001). Although this was a relatively small and unblinded study, the high degree of statistical significance of the study results suggests that, for both patients and healthcare workers, AST is faster and safer than MST for PICC peelable introducer sheath insertion.
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Calvache JA, Rodríguez MV, Trochez A, Klimek M, Stolker RJ, Lesaffre E. Incidence of Mechanical Complications of Central Venous Catheterization Using Landmark Technique. J Intensive Care Med 2014; 31:397-402. [DOI: 10.1177/0885066614541407] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/28/2014] [Indexed: 12/27/2022]
Abstract
Purpose: Central venous catheterization is a standard procedure in intensive care therapy. In developing countries, this intervention is frequently performed by physicians in training and without the availability of ultrasound guidance. Purpose of this study was to determine the incidence and potential risk factors for mechanical complications during central venous catheterization in an intensive care setting performed by a mixed group of practitioners without the use of adjunct ultrasound. Methods: Prospective observational cohort study in a university teaching hospital. Three hundred critically ill patients requiring their first central venous catheter insertion were enrolled. All patients were observed for 24 hours for mechanical complications (pneumothorax, hemothorax, arterial puncture, incorrect tip position, cardiac dysrhythmia, and/or subcutaneous hematoma). Potential associations with mechanical complications were adjusted using multivariable analysis. Main outcome was the cumulative incidence of mechanical complications. Results: The incidence of mechanical complications was 17% (n = 51). After covariate adjustment, the number of punctures was significantly related to mechanical complications. Compared with 1 puncture, 3 or more attempts were significantly associated with mechanical complications (odds ratio 3.62 [95% confidence interval 1.34-9.8]; P = .011). Experience of the operator was not associated with mechanical complications. Conclusions: The incidence of mechanical complications is affected by the number of punctures performed. After adjustment, the risk increases substantially with more than 3 attempts. Limiting the number of attempts, appropriate supervision and the use of ultrasound guidance when available are recommended for the further reduction in mechanical complications of central venous catheterization.
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Affiliation(s)
- Jose-Andres Calvache
- Department of Anaesthesiology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Departamento de Anestesiología, Universidad del Cauca, Popayán, Cauca, Colombia
| | | | - Adolfo Trochez
- Departamento de Anestesiología, Universidad del Cauca, Popayán, Cauca, Colombia
- Clínica La Estancia, Intensive Care Unit, Popayán, Cauca, Colombia
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Robert-Jan Stolker
- Department of Anaesthesiology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Emmanuel Lesaffre
- Department of Biostatistics, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Mousa AY, Abu-Halimah S, Nanjundappa A, AbuRahma AF. Inadvertent subclavian artery cannulation and options for management. Vascular 2014; 23:132-7. [PMID: 24857936 DOI: 10.1177/1708538114534841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Central line placement is an integral part of our daily routine and although it is necessary in a select group of patients, serious complications may occur in up to 10% of cases. Inadvertent placement in the subclavian artery is considered to be one of the most challenging complications to the vascular specialist, which is mainly due to its deep anatomical location. Several endovascular options are available and should be tailored to fit each scenario. Herein, we present different approaches for the management of three cases of inadvertent subclavian artery cannulation. The first patient was treated with a covered stent, the second with prolonged balloon inflation, and the third with a closure device.
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Affiliation(s)
- Albeir Y Mousa
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Shadi Abu-Halimah
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Aravinda Nanjundappa
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Ali F AbuRahma
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
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Riesenberg LA, Berg K, Berg D, Davis J, Schaeffer A, Justice EM, Tinkoff G. The Development of a Validated Checklist for Femoral Venous Catheterization. Am J Med Qual 2013; 29:445-50. [DOI: 10.1177/1062860613503032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Dale Berg
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Glen Tinkoff
- Thomas Jefferson University, Philadelphia, PA
- Christiana Care Health System, Newark, DE
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Shokoohi H, Boniface K, McCarthy M, Khedir Al-tiae T, Sattarian M, Ding R, Liu YT, Pourmand A, Schoenfeld E, Scott J, Shesser R, Yadav K. Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients. Ann Emerg Med 2013; 61:198-203. [DOI: 10.1016/j.annemergmed.2012.09.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 09/14/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
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Abstract
The aim of this article is to describe the development and use of a new and unique continence control device (CCD). The Vitala TM CCD is a pouchless ostomy device that seals against the stoma and prevents the passage of stool, while allowing the release and deodorization of flatus. This will enable many end-colostomates to control their effluent. It is the first non-invasive product to temporarily meet the colostomate's need of faecal continence. The reasons why people receive stomas and the different products available for their management will be explored in this article. Issues with regard to quality of life and the patient experience are discussed in the context of results from a VitalaTM CCD phase III 12-hour study. Two short case studies are also presented to illustrate how VitalaTM CCD can be used by ostomates experiencing functional and/or psychological problems to improve quality of life by allowing them to regain continence for up to 12 hours.
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Abstract
Infections are considered nosocomial if they occur 48 hours or more after hospital admission or within 30 days after discharge. One third of these infections are considered preventable. Many studies have shown that with proper education and use of strict guidelines, we can prevent nosocomial infections in the intensive care unit. In this article, we will review the literature on preventing catheter-associated urinary tract infection, central line-associated blood stream infection, and ventilator-associated pneumonia.
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