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Al-Zubeidi D, Davis MB, Rahhal R. Prevention of complications for hospitalized patients receiving parenteral nutrition: A narrative review. Nutr Clin Pract 2024. [PMID: 39152093 DOI: 10.1002/ncp.11201] [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: 05/03/2024] [Revised: 07/17/2024] [Accepted: 07/21/2024] [Indexed: 08/19/2024] Open
Abstract
Hospitalized patients may benefit from parenteral nutrition to address their compromised nutrition status attributed to limited oral/enteral intake and increased nutrient/energy requirement during acute illness. Parenteral nutrition, however, can be associated with many complications that can negatively impact patient outcomes. In this review, we focus on potential metabolic and catheter-related complications associated with parenteral nutrition use. We report on potential risk factors for such complications and highlight strategies for prevention and early recognition. To optimize outcomes, key findings include the creation and implementation of evidence-based protocols with proven efficacy. For each hospital unit delivering parenteral nutrition to patients, tracking compliance with established protocols and patient outcomes is crucial for ongoing improvement through identification of gaps, proper reeducation and training, and ongoing refinement of care protocols. Establishment of specialized inpatient nutrition support teams should be considered.
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Affiliation(s)
- Dina Al-Zubeidi
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Mary Beth Davis
- College of Nursing, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Riad Rahhal
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
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2
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Hixson R, Jensen KS, Melamed KH, Qadir N. Device associated complications in the intensive care unit. BMJ 2024; 386:e077318. [PMID: 39137947 DOI: 10.1136/bmj-2023-077318] [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] [Indexed: 08/15/2024]
Abstract
Invasive devices are routinely used in the care of critically ill patients. Although they are often essential components of patient care, devices such as intravascular catheters, endotracheal tubes, and ventilators are a common source of complications in the intensive care unit. Critical care practitioners who use these devices need to use strategies for risk reduction and understand approaches to management when adverse events occur. This review discusses the identification, prevention, and management of complications of vascular, airway, and mechanical support devices commonly used in the intensive care unit.
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Affiliation(s)
- Roxana Hixson
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kristin Schwab Jensen
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kathryn H Melamed
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Nida Qadir
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
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3
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Mestre D, Gil F. Central Venous Catheter Misplacement Presenting With Parotid Gland Swelling: A Case Report. Cureus 2024; 16:e66245. [PMID: 39238746 PMCID: PMC11375310 DOI: 10.7759/cureus.66245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
Central venous catheter (CVC) placement is a routine procedure in ICUs but can be associated with various complications, including misplacement and thrombosis. We present a rare case of parotid gland enlargement due to catheter-related thrombosis of the external jugular vein following ultrasound-guided placement through the subclavian vein in an 84-year-old woman. This case was managed with systemic anticoagulation and catheter removal. It emphasizes the importance of confirming correct CVC tip positioning and highlights the need for a post-procedure chest X-ray.
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Affiliation(s)
- David Mestre
- Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, PRT
| | - Francisco Gil
- Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, PRT
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4
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Jan KM, Ben-Jacob TK. Con: Central Lines Should Be the Preferred Method of Vasopressor Administration. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00500-7. [PMID: 39155187 DOI: 10.1053/j.jvca.2024.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Kathryn Michelle Jan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Talia Kate Ben-Jacob
- Department of Anesthesiology, Division of Critical Care Medicine, Cooper University Health Care, Camden, NJ
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5
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Brahmam D, Babu S, Gopakumar G, Koshy T. Central Venous Catheter Insertion Through the Vascular Sheath in a Cardiac Arrest Scenario in Pediatric Cardiac Catheterization Suite: An Easy and Effective Technique. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00459-2. [PMID: 39060154 DOI: 10.1053/j.jvca.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Dodda Brahmam
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Gayathri Gopakumar
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Savir S, Khan AA, Yunus RA, Gbagornah P, Levy N, Rehman TA, Saeed S, Sharkey A, Jackson CD, Mahmood F, Mitchell J, Matyal R. Virtual Reality Training for Central Venous Catheter Placement: An Interventional Feasibility Study Incorporating Virtual Reality Into a Standard Training Curriculum of Novice Trainees. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00439-7. [PMID: 39048413 DOI: 10.1053/j.jvca.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This study assess the feasibility of integrating virtual reality (VR) simulation into the central venous catheter (CVC) placement training curriculum. DESIGN The study consists of 3 parts: (1) Evaluating current manikin-based training for CVC placement through surveys for senior first-year anesthesia residents and cardiac anesthesia faculty who supervise resident performing the procedure; (2) Interventional study training novice trainees with VR simulator and assessing their reaction satisfaction; and (3) pilot study integrating VR training sessions into CVC training curriculum for first-year anesthesia residents. SETTING Conducted at a single academic-affiliated medical center from December 2022 to August 2023. PARTICIPANTS Junior first-year anesthesia residents. INTERVENTIONS VR training sessions for CVC placements using the Vantari VR system. MEASUREMENTS AND MAIN RESULTS Primary outcome: novice trainees' satisfaction with VR training for CVC procedure. Satisfaction of resident and faculty with standard manikin-based training was also collected. Faculty expressed concerns about residents' confidence and perceived knowledge in performing CVC placement independently. Novice trainees showed high satisfaction and perceived usefulness with VR training, particularly in understanding procedural steps and developing spatial awareness. Pilot integration of VR training into the curriculum demonstrated comparable training times and emphasized structured stepwise training modules to ensure completion of vital procedural steps. CONCLUSIONS This study underscores the potential of VR simulation as a complementary training tool for CVC placement rather than a substitution of standard manikin training. VR is offering immersive experiences and addressing limitations of traditional manikin-based training methods. The integration of VR into training curricula warrants further exploration to optimize procedural proficiency and patient safety in clinical practice.
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Affiliation(s)
- Shiri Savir
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Adnan A Khan
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rayaan A Yunus
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Peva Gbagornah
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nadav Levy
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Taha A Rehman
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shirin Saeed
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Cullen D Jackson
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA
| | - John Mitchell
- Department of Anesthesia, Pain Management and Perioperative Medicine, Henry Ford Health, Detroit, MI
| | - Robina Matyal
- Department of Anesthesia, Critical Care & Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA.
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Antony NR, Sundarsingh S, Radhakrishnan A, Sasidharan S. Comparison of Transesophageal Echocardiography Probe as Surface Probe with Vascular Probe During Right Internal Jugular Vein Catheterization in Cardiac Surgeries. Ann Card Anaesth 2024; 27:241-245. [PMID: 38963359 PMCID: PMC11315267 DOI: 10.4103/aca.aca_37_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/19/2024] [Accepted: 04/05/2024] [Indexed: 07/05/2024] Open
Abstract
CONTEXT USG vascular probe and TEE probe can help during central venous catheterization (CVC) and can confirm the location of guide wire in the neck vessels. We proposed this study, as there are only few studies comparing between TEE probe as surface probe and USG vascular probe for right IJV cannulation. AIMS To compare the TEE probe as a surface probe and USG vascular probe during right IJV catheterization in cardiac surgeries. SETTINGS AND DESIGN Prospective, comparative study. METHODS AND MATERIAL One twenty-four patients of either sex posted for major elective cardiac surgery were included in this study. Patients were divided into two groups (TEE group and USG group) of 62 by assigning the study participants alternatively to each group. The goal of this study was to compare the puncture time, visualization of IJV to first successful puncture, quality of the imaging with needle tip positioning, and catheter positioning using both TEE probe and vascular probe. The primary outcome was comparison of time from visualization of the IJV to successful puncture using both TEE probe as a surface probe and vascular probe. Secondary outcome was to compare the quality of image with respect to needle tip positioning and compare quality of image with respect to catheter position using both probes. STATISTICAL ANALYSIS USED Statistical analyses were performed by using a statistical software package SPSS, version 20.0. RESULTS The observation and results of our study clearly show the feasibility of TEE as surface probe for guiding central venous catheter in right IJV just like the vascular linear probe. There was no significant difference between the two groups (P > 0.05). No statistical differences were found in the puncture time, image quality, needle tip positioning, wire positioning, and catheter positioning between the two groups. All the P values were greater than 0.05. CONCLUSIONS The TEE probe can be used as an alternative method to guide IJV puncturing and catheterization when the vascular probe is not available. It is feasible especially in cardiac surgeries where the TEE monitoring machine is a must in modern anesthesia and readily available than an ultrasound machine.
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8
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Knapek K, Stein EP, Bernhardt M, Flanigan J, Lazar C, Reese SM. Using a standardized algorithm to decrease central venous catheter utilization. Am J Infect Control 2024:S0196-6553(24)00577-7. [PMID: 38942081 DOI: 10.1016/j.ajic.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
Central venous catheters (CVCs) have many benefits in patient care but are associated with increasing risks with catheter duration. A level II trauma-certified community hospital sought to decrease CVC duration utilizing a daily assessment algorithm in the critical care unit. After implementation, CVC days decreased from 490 CVC days per 1,000 patient days to 452 (odds ratio 0.86, P < .01) and catheter duration decreased from 7.71 days to 6.57 (P = .19).
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Affiliation(s)
- Kelley Knapek
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO.
| | - Emma P Stein
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - Marybell Bernhardt
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - John Flanigan
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - Catherine Lazar
- Infection Prevention, Critical Care, Good Samaritan Hospital, Lafayette, CO
| | - Sara M Reese
- Infection Prevention, Intermountain Health, Broomfield, CO
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9
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Kharduit PB, Dutta K, Lyngdoh CJ, Bhattacharyya P, Lyngdoh V, Khyriem AB, Devi SK. Monitoring and Outcomes of Central Line-Associated Bloodstream Infections in a Tertiary Care Intensive Care Unit. Cureus 2024; 16:e63428. [PMID: 39077255 PMCID: PMC11284343 DOI: 10.7759/cureus.63428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
Background Central line-associated bloodstream infections (CLABSIs) are significant healthcare-associated infections that increase morbidity, mortality, and healthcare costs. This study aims to analyze the frequency, microbiology, risk factors, and outcomes of CLABSI in an adult intensive care unit. Methods We conducted a hospital-based, prospective surveillance study in the critical care unit of a tertiary care hospital. We included patients with a central line (CL) from admission until discharge or line removal. Data collection focused on patient demographics, comorbidities, CL insertion site, and CLABSI rates. The incidence of CLABSI was calculated per 1,000 CL-days, and statistical analysis was performed using the Chi-square test. Results Of the 169 patients enrolled, 123 episodes of bloodstream infections were recorded, 56 (45.5%) of which were CLABSIs. The organisms most frequently isolated were Klebsiella pneumoniae (n = 14; 24.6%), Enterobacter cloacae complex (n = 11; 19.3%), Klebsiella species (n = 7; 12.28%), and Acinetobacter baumannii (n = 7; 12.28%). The overall CLABSI rate was 24.70 per 1,000 CL-days. No significant association was found between CLABSI and patient age, gender, or the site of CL insertion. However, a significant relationship was observed between CLABSI and the presence of comorbid conditions (p = 0.001). The study also noted a high rate of antibiotic resistance among the isolated pathogens. Conclusions Our results emphasize the need for stringent infection control measures and suggest that comorbid conditions significantly increase the risk of CLABSI. Addressing antibiotic resistance and implementing effective prevention strategies are essential for reducing the burden of CLABSIs.
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Affiliation(s)
- Peter B Kharduit
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Kaustuv Dutta
- Anesthesiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Clarissa J Lyngdoh
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Prithwis Bhattacharyya
- Anesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Valarie Lyngdoh
- Clinical Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Annie B Khyriem
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Suriya K Devi
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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10
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Hsu TY, Ho MP. Administered 3% hypertonic saline for neurologic emergency. Am J Emerg Med 2024; 80:215. [PMID: 38627126 DOI: 10.1016/j.ajem.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/11/2024] [Indexed: 05/31/2024] Open
Affiliation(s)
- Tien-You Hsu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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11
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Kodack E, Raviv A, Pantin E. Inadvertent Suturing of a Left Internal Jugular Vein Catheter Into the Innominate Vein During Coronary Artery Bypass Grafting Surgery. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00310-0. [PMID: 38937169 DOI: 10.1053/j.jvca.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Eileen Kodack
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
| | - Abrar Raviv
- Cape Fear Valley Medical Center, Fayetteville, NC
| | - Enrique Pantin
- Department of Anesthesiology and Perioperative Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
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12
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Amllay A, Owolo E, Nowicki KW, Sujijantarat N, Koo A, Antonios JP, Renedo D, Matouk CC, Hebert RM. Angiographic evidence of an inadvertent cannulation of the marginal sinus following central line migration: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23607. [PMID: 38684119 PMCID: PMC11058405 DOI: 10.3171/case23607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Central venous catheters (CVCs) play an indispensable role in clinical practice. Catheter malposition and tip migration can lead to severe complications. The authors present a case illustrating the endovascular management of inadvertent marginal sinus cannulation after an internal jugular vein (IJV) catheter tip migration. OBSERVATIONS A triple-lumen CVC was inserted without complications into the right IJV of a patient undergoing a repeat sternotomy for aortic valve replacement. Two weeks postinsertion, it was discovered that the tip had migrated superiorly, terminating below the torcula in the posterior fossa. In the interventional suite, a three-dimensional venogram confirmed the inadvertent marginal sinus cannulation. The catheter was carefully retracted to the sigmoid sinus to preserve the option of catheter exchange if embolization became necessary. After a subsequent venogram, which displayed an absence of contrast extravasation, the entire catheter was safely removed. The patient tolerated the procedure well. LESSONS Clinicians must be vigilant of catheter tip migration and malposition risks. Relying solely on postinsertion radiographs is insufficient. Once identified, prompt management of the malpositioned catheter is paramount in reducing morbidity and mortality and improving patient outcomes. Removing a malpositioned catheter constitutes a critical step, best performed by a specialized team under angiographic visualization.
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Affiliation(s)
- Abdelaziz Amllay
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Edwin Owolo
- 2Duke University School of Medicine, Durham, North Carolina
| | - Kamil W Nowicki
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Nanthiya Sujijantarat
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Andrew Koo
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Joseph P Antonios
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Daniela Renedo
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Charles C Matouk
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
| | - Ryan M Hebert
- 1Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and
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Nag DS, Swain A, Sahu S, Swain BP, Sam M. Pitfalls in internal jugular vein cannulation. World J Clin Cases 2024; 12:1714-1717. [PMID: 38660082 PMCID: PMC11036472 DOI: 10.12998/wjcc.v12.i10.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased use of ultrasound in healthcare settings. Despite the increased safety profile and insertion convenience, it has complications. Herein, we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.
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Affiliation(s)
- Deb Sanjay Nag
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Amlan Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Bhanu Pratap Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Merina Sam
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
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14
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Bianchini A, Susi F, Laici C, Zangheri E, Gollinucci B, Siniscalchi A. Preoperative point-of-care neck ultrasound: beyond the airway. J Ultrasound 2024; 27:185-190. [PMID: 38040941 PMCID: PMC10908738 DOI: 10.1007/s40477-023-00840-1] [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: 03/02/2023] [Accepted: 08/02/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE A preoperative point-of-care neck ultrasound, carried out during preoperative airway evaluation by extending the scans to the regions close to the larynx and trachea, can allow for the rapid identification of unknown pathologies or abnormalities in a cost-effective and non-invasive manner. This prospective, observational study examines a series of ultrasound findings in structures close to the airway, made through preoperative point-of-care neck ultrasound in a cohort of 230 patients. METHODS We conducted a prospective observational study, enrolling 230 adult patients selected for elective abdominal surgery. The primary goal was to verify the predictive role of airway ultrasound in identifying difficult airways, while the secondary goal was to evaluate structures close to the airway such as jugular veins, carotid arteries, thyroid gland and soft tissues. RESULTS Overall, preoperative point-of-care neck ultrasound proved to be an effective and reliable method of obtaining details about local or systemic pathologies, which could affect perioperative care. For example, the exam consistently revealed the presence of carotid plaques or venous congestion, which could be used to best determine the patient's cardiovascular risk or to instigate further investigations. It also allowed for more accurate central venous catheter placement planning and better airway management and it warned about possible thyroid or neoplastic pathologies that would have otherwise remained unknown. In some cases, information from preoperative point-of-care neck ultrasound has even led to modifications in perioperative therapy. CONCLUSION Preoperative point-of-care neck ultrasound is fast, inexpensive, and non-invasive, and it can be easily performed by a properly trained professional during the preoperative airway ultrasound evaluation. It can be considered as a new preoperative assessment tool.
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Affiliation(s)
- Amedeo Bianchini
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Susi
- Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy.
| | - Cristiana Laici
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Zangheri
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Gollinucci
- Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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15
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Bekyarova AI, Velikova AV, Atanasova NV, Zhelezov MD. A Rare Anastomosis Between the Internal and the External Jugular Veins: A Case Report. Cureus 2024; 16:e55212. [PMID: 38558638 PMCID: PMC10981499 DOI: 10.7759/cureus.55212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Usually, the external jugular vein (EJV) is located superficially over the sternocleidomastoid muscle and joins the subclavian vein or the venous angle. The internal jugular vein (IJV) lies deeply in close relation with the common carotid artery and vagus nerve, enveloped by the carotid sheath. Normally, there is no direct connection between those vessels. During a routine neck dissection, we found a rare anastomosis between IJV and EJV. The anastomosis was localized on the level of the cricoid cartilage. It was approximately 1 cm long, with the diameter of the lumen being 0.3 cm. There was no obstruction along the length of the vessel. The direction was oblique and followed the blood flow from IJV to EJV. The observed variation has high clinical importance related to numerous procedures executed in the neck region, such as placement of hemodialysis catheter in patients with renal failure, insertion of central venous line in the care of critically ill patients, and radical neck dissections.
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Affiliation(s)
| | - Adelina V Velikova
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
| | - Nikol V Atanasova
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
| | - Marin D Zhelezov
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
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Trembath HE, Caruso DM, McLean SE, Akinkuotu AC, Hayes Dixon AA, Phillips MR. Central Line-Associated Bloodstream Infection Risk Factors in a Pediatric Population. Am Surg 2024; 90:69-74. [PMID: 37571962 DOI: 10.1177/00031348231192070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates. METHODS This is a single-institution case-control study of pediatric patients (≤18 years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed. RESULTS We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors. DISCUSSION Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates.
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Affiliation(s)
- Hannah E Trembath
- Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Deanna M Caruso
- Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea A Hayes Dixon
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Phillips
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
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Bakrey H, Shivgotra R, Abdu A, Soni B, Shahtaghia NR, Jain SK, Thakur S. Use of Total Parenteral Nutrition (TPN) as a Vehicle for Drug Delivery. Curr Drug Targets 2024; 25:306-329. [PMID: 38454772 DOI: 10.2174/0113894501284598240226102943] [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: 09/28/2023] [Revised: 12/07/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
Total Parenteral Nutrition (TPN) is a method of providing nutrients directly into the bloodstream for individuals who are unable to meet their nutritional needs through the normal digestive process or gastrointestinal system. It provides macronutrients and micronutrients in a single container, reducing handling and contamination risks and making it more cost-effective. TPN has the potential to be used as a drug delivery system, with applications in combination therapies, personalized medicine, and integrating advanced technologies. It can enhance drug dosage precision and provide nutritional assistance, potentially reducing hospitalization and improving patient outcomes. However, implementing new applications requires thorough testing and regulatory approval. TPN could be particularly useful in pediatric and geriatric care and could also contribute to global health by combating malnutrition in areas with limited medical resources. Healthcare professionals prepare a sterile solution tailored to each patient's nutritional needs, and administration involves a central venous catheter. However, the simultaneous administration of medications with PN admixtures can result in pharmacological incompatibility, which can impact the stability of the oil-in-water system. The European Society for Clinical Nutrition and Metabolism and the American Society for Parenteral and Enteral Nutrition recommendations advise against including non-nutrient drugs in PN admixtures due to safety concerns. This review focuses on the utilization of Total Parenteral Nutrition (TPN) as a method for delivering drugs. It discusses the benefits and difficulties associated with its commercial application and offers suggestions for future research endeavors.
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Affiliation(s)
- Hossamaldeen Bakrey
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Riya Shivgotra
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Abdulkadir Abdu
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Bindu Soni
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Navid Reza Shahtaghia
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Subheet Kumar Jain
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
- Centre for Basic and Translational Research in Health Sciences, Guru Nanak Dev University, Amritsar, 143005, India
| | - Shubham Thakur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
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Xu H, Hyun A, Mihala G, Rickard CM, Cooke ML, Lin F, Mitchell M, Ullman AJ. The effectiveness of dressings and securement devices to prevent central venous catheter-associated complications: A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104620. [PMID: 37879273 DOI: 10.1016/j.ijnurstu.2023.104620] [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: 05/06/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and dressing products has been released, with unknown overall effectiveness to prevent these complications. OBJECTIVE To compare the effects of dressings and securement devices for central venous catheters on a range of common complications including catheter-related bloodstream infection, catheter tip colonisation, entry/exit-site infection, skin colonisation, skin irritation, failed catheter securement, dressing durability and mortality. DESIGN Systematic review with meta-analysis. METHODS Following standard Cochrane methods, a systematic search of Cochrane Wounds Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, EBSCO CINAHL, and multiple clinical trial registries was completed in November 2022. Randomised controlled trials evaluating the effectiveness of dressing and securement devices for all CVC types were included. A random-effects model was used during the meta-analysis. Results were expressed using risk ratio (RR), rate ratio, or mean difference (MD), with 95 % confidence intervals (CIs). Methodological quality and bias were assessed. RESULTS We included 46 studies involving 10,054 participants. All studies had either an unclear or high-performance bias. The blinding of outcome assessment was unclear in most studies. Chlorhexidine gluconate-impregnated dressings, compared with standard polyurethane dressings, may reduce the incidence (7 studies; N = 5816; RR 0.60, 95 % CI 0.44-0.83; low certainty evidence) and rate (4 studies; N = 4447; RR 0.51, 95 % CI 0.32-0.79; moderate certainty evidence) of catheter-related bloodstream infection and catheter tip colonisation (8 studies; N = 4788; RR 0.70, 95 % CI 0.52-0.95; very low certainty evidence). Medication-impregnated dressings may reduce the incidence of catheter-related bloodstream infection (6 studies; N = 5687; RR 0.60, 95 % CI 0.39-0.93; low certainty evidence) and catheter-tip colonisation (7 studies; N = 4769; RR 0.60, 95 % CI 0.47-0.76; low certainty evidence) relative to non-impregnated dressing types. Tissue adhesive may increase the risk of skin irritation or damage compared with integrated securement dressings (3 studies; N = 166; RR 1.88, 95 % CI 1.09-3.24; low certainty evidence) or sutureless securement devices (4 studies; N = 241; RR 1.64, 95 % CI 1.10-2.44; moderate certainty evidence). Tissue adhesive increased dressing durability compared with integrated securement dressings (MD 43.03 h, 95 % CI 4.88-81.18; moderate certainty evidence) and sutureless securement devices (MD 42.90 h, 4.64-81.16; moderate certainty evidence). Tissue adhesive increased failed catheter securement rate compared with suture (2 studies; N = 103; RR 9.33, 95 % CI 1.10-79.21; moderate certainty evidence). CONCLUSIONS The findings of the review provide insights and guidance for clinicians in selecting the appropriate dressings and securements for catheters. Findings should be interpreted with caution due to heterogeneity in catheters and patient types. REGISTRATION #CD010367. TWEETABLE ABSTRACT Time to implement chlorhexidine gluconate-impregnated dressings to prevent catheter-related bloodstream infections; a meta-analysis by @GraceNP and team.
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Affiliation(s)
- Hui Xu
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD, Australia; School of Nursing and Midwifery, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Nathan, Brisbane, QLD, Australia.
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - Gabor Mihala
- The Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Nathan, Brisbane, QLD, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, QLD, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, QLD 4006, Australia.
| | - Marie L Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Frances Lin
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; School of Health, University of the Sunshine Coast, QLD, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Nathan, Brisbane, QLD, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research (AVATAR), Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Griffith University, Nathan, Brisbane, QLD, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, QLD, Australia; Centre for Child Health Research, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
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19
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Hwang GH, Eom W. Thoracic duct cannulation during left internal jugular vein cannulation: A case report. World J Clin Cases 2023; 11:8200-8204. [PMID: 38130787 PMCID: PMC10731171 DOI: 10.12998/wjcc.v11.i34.8200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection, embolization due to air or blood clots, pneumothorax, hemothorax, and, rarely, chylothorax due to damage to the thoracic duct. Herein, we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion. Fortunately, the patient was discharged without any adverse events related to thoracic duct cannulation. CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. During anesthesia, we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein. During the procedure, blood reflux was observed when the needle tip was not within the ultrasound field of view. We did not try to find the tip; however, a guide wire and a central venous catheter were inserted without any resistance. Subsequently, when inducing blood reflux from the distal port of the central venous catheter, only clear fluid, suspected to be lymphatic fluid, was regurgitated. Further, chest X-ray revealed an appearance similar to that of the path of the thoracic duct. Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray, we suspected thoracic duct cannulation. CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.
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Affiliation(s)
- Geal Hong Hwang
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
| | - Woosik Eom
- Department of Anesthesiology and Pain Medicine, National Cancer Center, Goyang-si 10408, Gyeonggi-do, South Korea
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20
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Abu Sardaneh A, Penm J, Oliver M, Gattas D, McLachlan AJ, James C, Cella C, Aljuhani O, Acquisto NM, Patanwala AE. International pharmacy survey of peripheral vasopressor infusions in critical care (INFUSE). J Crit Care 2023; 78:154376. [PMID: 37536012 DOI: 10.1016/j.jcrc.2023.154376] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE The primary objective was to determine the proportion of hospitals that administered norepinephrine peripheral vasopressor infusions (PVIs) in critically ill adult patients. Secondary objectives were to describe how norepinephrine is used such as the maximum duration, infusion rate and concentration, and to determine the most common first-line PVI used by country. MATERIALS AND METHODS An international multi-centre cross-sectional survey study was conducted in adult intensive care units in Australia, US, UK, Canada, and Saudi Arabia. RESULTS Critical care pharmacists from 132 institutions responded to the survey. Norepinephrine PVIs were utilised in 86% of institutions (n = 113/132). The median maximum duration of norepinephrine PVIs was 24 h (IQR 24-24) (n = 57/113). The most common maximum norepinephrine PVI rate was between 11 and 20 μg/min (n = 16/113). The most common maximum norepinephrine PVI concentration was 16 μg/mL (n = 60/113). Half of the institutions had a preference to administer another PVI over norepinephrine as a first-line agent (n = 66/132). The most common alternative PVI used by country was: US (phenylephrine 41%, n = 37/90), Canada (dopamine 31%, n = 5/16), UK (metaraminol 82%, n = 9/11), and Australia (metaraminol 89%, n = 8/9). CONCLUSIONS There is variability in clinical practice regarding PVI administration in critically ill adult patients dependent on drug availability and local institutional recommendations.
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Affiliation(s)
- Arwa Abu Sardaneh
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Matthew Oliver
- Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Gattas
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Intensive Care Service, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrew J McLachlan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christie James
- Department of Pharmacy, Grange University Hospital, Cwmbran, Wales, United Kingdom
| | - Christina Cella
- Canadian Society of Hospital Pharmacists, Ottawa, Ontario, Canada
| | - Ohoud Aljuhani
- Pharmacy Practice Department, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Pharmacy, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, United States; Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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21
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Iqbal M, Mukhamedshin A, Lezzar DL, Abhishek K, McLennan AL, Lam FW, Shevkoplyas SS. Recent advances in microfluidic cell separation to enable centrifugation-free, low extracorporeal volume leukapheresis in pediatric patients. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2023; 21:494-513. [PMID: 37146298 PMCID: PMC10645346 DOI: 10.2450/bloodtransfus.506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/02/2023] [Indexed: 05/07/2023]
Abstract
Leukapheresis is a common extracorporeal procedure for leukodepletion and cellular collection. During the procedure, a patient's blood is passed through an apheresis machine to separate white blood cells (WBCs) from red blood cells (RBCs) and platelets (PLTs), which are then returned to the patient. Although it is well-tolerated by adults and older children, leukapheresis poses a significant risk to neonates and low-weight infants because the extracorporeal volume (ECV) of a typical leukapheresis circuit represents a particularly large fraction of their total blood volume. The reliance of existing apheresis technology on centrifugation for separating blood cells limits the degree to which the circuit ECV could be miniaturized. The rapidly advancing field of microfluidic cell separation holds excellent promise for devices with competitive separation performance and void volumes that are orders of magnitude smaller than their centrifugation-based counterparts. This review discusses recent advancements in the field, focusing on passive separation methods that could potentially be adapted to perform leukapheresis. We first outline the performance requirements that any separation method must meet to replace centrifugation-based methods successfully. We then provide an overview of the passive separation methods that can remove WBCs from whole blood, focusing on the technological advancements made in the last decade. We describe and compare standard performance metrics, including blood dilution requirements, WBC separation efficiency, RBC and PLT loss, and processing throughput, and discuss the potential of each separation method for future use as a high-throughput microfluidic leukapheresis platform. Finally, we outline the primary common challenges that must still be overcome for these novel microfluidic technologies to enable centrifugation-free, low-ECV leukapheresis in the pediatric setting.
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Affiliation(s)
- Mubasher Iqbal
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States of America
| | - Anton Mukhamedshin
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States of America
| | - Dalia L. Lezzar
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States of America
| | - Kumar Abhishek
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States of America
| | - Alexandra L. McLennan
- Division of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Fong W. Lam
- Division of Pediatric Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Sergey S. Shevkoplyas
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States of America
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22
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Moreta JA. Longer length peripheral catheters in sickle cell treatment: a more efficient and cost-effective care pathway. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S14-S19. [PMID: 37883315 DOI: 10.12968/bjon.2023.32.19.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Patients with sickle cell disease require frequent venous access for red blood cell exchange transfusions to manage their condition. Such frequent access can lead to scar tissue formation, increased pain on insertion, and difficult vascular access for the patients. Previous attempts at achieving successful venous access for patients with difficult venous access has been made with central venous lines, usually femoral lines, which required a large amount of nursing input and resulted in anxiety and pain on insertion for patients. In this article, the author reports on a new pathway with a longer-length peripheral intravenous catheter that reduces the nursing time burden during line insertion, requires less equipment and, crucially, results in a less painful procedure for patients. The increased efficiency of the pathway resulted in a cost saving of £149 per insertion, and patient feedback revealed that the longer-length catheter was preferred over femoral lines.
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Affiliation(s)
- Jenniferth Aviles Moreta
- Clinical Nurse Specialist, OPAT and Vascular Access Service, Homerton Healthcare NHS Foundation Trust, London
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23
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Kemp BJR, Kearns DJ, Uberoi R. ProGlide entrapment of the occlusive balloon during repair of an iatrogenic subclavian artery injury. BJR Case Rep 2023; 9:20230015. [PMID: 37780972 PMCID: PMC10513006 DOI: 10.1259/bjrcr.20230015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 10/03/2023] Open
Abstract
The insertion of any central venous catheter (CVC) is associated with a risk of damage to neurovascular structures, pneumothorax, cardiac arrhythmias, and infection1. Unintentional arterial puncture remains rare, occurring in 6.3-9.4% of attempted internal jugular vein (IJV) catheterisation and 3.1-4.9% of attempted subclavian vein catheterisation2. We present a previously undocumented complication encountered while utilising the Perclose ProGlide device in the case of a 59-year-old male who underwent right subclavian artery closure following the accidental insertion of a 14Fr Vascath into the right subclavian artery. This was performed using two ProGlide devices and one Angio-Seal device. Following deployment of the ProGlide devices, an uninflated balloon passed into the subclavian artery as a precaution, but not used, was removed. One of the ProGlide devices became dislodged having been deployed into the balloon, threatening haemostasis.
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Affiliation(s)
| | | | - Raman Uberoi
- Oxford University Hospitals, Oxford, United Kingdom
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24
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Jones JW, Ballard DP, Hillman TA, Chen DA. Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes. EAR, NOSE & THROAT JOURNAL 2023; 102:673-679. [PMID: 34130511 DOI: 10.1177/01455613211025742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea. METHODS A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes). RESULTS There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant (P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = -3.3 dB, P = .02) with no significant difference in word recognition scores (P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures. CONCLUSIONS Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.
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Affiliation(s)
- Joel W Jones
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Daniel P Ballard
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Todd A Hillman
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Douglas A Chen
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
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Asher E, Karameh H, Nassar H, Yosefy C, Marmor D, Perel N, Taha L, Tabi M, Braver O, Shuvy M, Wiener-Well Y, Glikson M, Bruoha S. Safety and Outcomes of Peripherally Administered Vasopressor Infusion in Patients Admitted with Shock to an Intensive Cardiac Care Unit-A Single-Center Prospective Study. J Clin Med 2023; 12:5734. [PMID: 37685801 PMCID: PMC10488618 DOI: 10.3390/jcm12175734] [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: 07/09/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Vasopressors are frequently utilized for blood pressure stabilization in patients with cardiogenic shock (CS), although with a questionable benefit. Obtaining central venous access is time consuming and may be associated with serious complications. Hence, we thought to evaluate whether the administration of vasopressors through a peripheral venous catheter (PVC) is a safe and effective alternative for the management of patients with CS presenting to the intensive cardiovascular care unit (ICCU). METHODS A prospective single-center study was conducted to compare the safety and outcomes of vasopressors administered via a PVC vs. a central venous catheter (CVC) in patients presenting with CS over a 12-month period. RESULTS A total of 1100 patients were included; of them, 139 (12.6%) required a vasopressor treatment due to shock, with 108 (78%) treated via a PVC and 31 (22%) treated via a CVC according to the discretion of the treating physician. The duration of the vasopressor administration was shorter in the PVC group compared with the CVC group (2.5 days vs. 4.2 days, respectively, p < 0.05). Phlebitis and the extravasation of vasopressors occurred at similar rates in the PVC and CVC groups (5.7% vs. 3.3%, respectively, p = 0.33; 0.9% vs. 3.3%, respectively, p = 0.17). Nevertheless, the bleeding rate was higher in the CVC group compared with the PVC group (3% vs. 0%, p = 0.03). CONCLUSIONS The administration of vasopressor infusions via PVC for the management of patients with CS is feasible and safe in patients with cardiogenic shock. Further studies are needed to establish this method of treatment.
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Affiliation(s)
- Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Hani Karameh
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Hamed Nassar
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Chaim Yosefy
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (C.Y.); (O.B.)
| | - David Marmor
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Louay Taha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Meir Tabi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (C.Y.); (O.B.)
| | - Mony Shuvy
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Yonit Wiener-Well
- Infectious Diseases Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel;
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91121, Israel; (E.A.); (H.K.); (H.N.); (D.M.); (N.P.); (L.T.); (M.T.); (M.S.); (M.G.)
| | - Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, The Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel; (C.Y.); (O.B.)
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Phillips MC, Wald-Dickler N, Davar K, Lee R, Baden R, Holtom P, Spellberg B. Choosing patients over placebos: oral transitional therapy vs. IV-only therapy for bacteraemia and infective endocarditis. Clin Microbiol Infect 2023; 29:1126-1132. [PMID: 37179005 DOI: 10.1016/j.cmi.2023.04.030] [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: 01/31/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The belief that antibiotics must be administered intravenously (IV) to treat bacteraemia and endocarditis has its origins 70 years ago and has engrained itself in the psyche of the medical community and the public at large. This has led to hesitancy in adopting evidence-based strategies utilizing oral transitional therapy for the treatment of these infections. We aim to reframe the narrative around this debate, focusing on patient safety over vestigial psychology. OBJECTIVES This narrative review summarizes the current state of the literature regarding the use of oral transitional therapy for the treatment of bacteraemia and infective endocarditis, focusing on studies comparing it to the traditional, IV-only approach. SOURCES Relevant studies and abstracts from PubMed reviewed in April 2023. CONTENT Treating bacteraemia with oral transitional therapy has been studied in 9 randomized controlled trials (RCTs), totalling 625 patients, as well as numerous large, retrospective cohorts, including 3 published in the last 5 years alone, totalling 4763 patients. We identified 3 large, retrospective cohort studies; one quasi-experimental, pre-post study, and 3 RCTs of patients with endocarditis, totalling 748 patients in the retrospective cohorts and 815 patients in prospective, controlled studies. In all these studies, no worse outcomes were observed in the oral transitional therapy arm as compared with IV-only therapy. The main difference has consistently been longer durations of inpatient hospitalization and increased risk of catheter-related adverse events like venous thrombosis and line-associated blood stream infections in the IV-only groups. IMPLICATIONS There are ample data showing that choosing oral therapy reduces hospital stay and has fewer adverse events for patients than IV-only therapy, all with similar or better outcomes. In selected patients, choosing IV-only therapy may serve more as an anxiolytic "placebo" for the patient and provider rather than a necessity for treating the actual infection.
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Affiliation(s)
- Matthew C Phillips
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Noah Wald-Dickler
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States
| | - Kusha Davar
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States
| | - Rachael Lee
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rachel Baden
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States
| | - Paul Holtom
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States
| | - Brad Spellberg
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States
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Powell SM, Faust AC, George S, Townsend R, Eubank D, Kim R. Effect of Peripherally Infused Norepinephrine on Reducing Central Venous Catheter Utilization. JOURNAL OF INFUSION NURSING 2023; 46:210-216. [PMID: 37406335 DOI: 10.1097/nan.0000000000000508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The purpose of this retrospective study was to evaluate the impact of peripherally administered norepinephrine on avoiding central venous catheter insertion while maintaining safety of the infusion. An institutional guideline allows peripheral infusion of norepinephrine via dedicated, 16- to 20-gauge, mid-to-upper arm intravenous (IV) catheters for up to 24 hours. The primary outcome was the need for central venous access in patients initially started on peripherally infused norepinephrine. A total of 124 patients were evaluated (98 initially on peripherally infused norepinephrine vs 26 with central catheter only administration). Thirty-six (37%) of the 98 patients who were started on peripheral norepinephrine avoided the need for central catheter placement, which was associated with $8,900 in direct supply cost avoidance. Eighty (82%) of the 98 patients who started peripherally infused norepinephrine required the vasopressor for ≤12 hours. No extravasation or local complications were observed in any of the 124 patients, regardless of site of infusion. Administration of norepinephrine via a dedicated peripheral IV site appears safe and may lead to a reduction in the need for subsequent central venous access. To achieve timely resuscitation goals, as well as to minimize complications associated with central access, initial peripheral administration should be considered for all patients.
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Affiliation(s)
- Sara M Powell
- Department of Pharmacy (Drs Powell, Faust, and George) and Infusion Support Team, Department of Nursing (Mr Townsend and Ms Eubank), Texas Health Presbyterian Hospital Dallas, Dallas, Texas; Sound Physician Group, Pulmonary/Critical Care Medicine, Dallas, Texas (Dr Kim)
- Sara M. Powell, PharmD, MS, is the current postgraduate year 2 Critical Care pharmacy resident at Texas Health Dallas, where she also completed her postgraduate year 1 Pharmacy Practice residency. She received her Master of Science degree in 2016 and Doctor of Pharmacy degree in 2021 from Texas Tech University Health Sciences Center in Lubbock, Texas. Dr Powell has research and practice interests in anticoagulant reversal, septic shock management, antimicrobial stewardship, and trauma. Andrew C. Faust, PharmD, BCPS, is the current medical intensive care unit clinical pharmacy specialist at Texas Health Dallas and has been in this role since 2011. He graduated pharmacy school from the University of Texas at Austin in 2009 and followed that with a postgraduate year 1 Pharmacy Practice residency at University Health in San Antonio, Texas, and a postgraduate year 2 Critical Care pharmacy residency at Methodist University Hospital in Memphis, Tennessee. Dr Faust has published multiple articles in the areas of critical care, anticoagulation, and infectious diseases and has interests in management of sepsis/shock, rationale antimicrobial use in critically ill patients, and sedation/analgesia management. Stephy George, PharmD, BCCCP, is the current emergency department (ED)/trauma clinical pharmacy specialist. She graduated from University of Houston College of Pharmacy in 2013 and completed her pharmacotherapy postgraduate year 1 at Methodist Hospital in San Antonio and Critical Care and postgraduate year 2 at North Texas VA/Texas Tech Health Science Center in Dallas before starting her career as a critical care pharmacy specialist in 2016. Her clinical areas of interest are multimodal pain management, ICU antimicrobial stewardship, and management of agitation in the ED. Richard Townsend, RN, has worked as a vascular access nurse at Texas Health Dallas since March of 2020. He graduated from nursing school in 2006 and has prior experience in intensive care nursing, emergency nursing as a medicine and trauma nurse, and in the cardiac catheterization laboratory. Darla Eubank, RN, received her Bachelor of Science in Nursing from Abilene Christian University in 1996. After graduation, she worked as a telemetry nurse, cardiac catheterization laboratory nurse, and progressive cardiac care unit charge nurse. She has been an infusion support nurse at Texas Health Dallas since 2003 and now serves as the charge nurse for the vascular access team. Ms Eubank has received an Impact Award from Texas Christian University for her work on an evidence-based project focused on midline use in difficult access patients. Richard Kim, MD, is a board-certified internal, pulmonary, and critical care medicine physician in Dallas, Texas. He completed internal medicine residency and a pulmonary and critical care medicine fellowship at the University of Louisville in 2020. He has particular interest in sepsis, point-of-care ultrasound, and pulmonary hypertension
| | - Andrew C Faust
- Department of Pharmacy (Drs Powell, Faust, and George) and Infusion Support Team, Department of Nursing (Mr Townsend and Ms Eubank), Texas Health Presbyterian Hospital Dallas, Dallas, Texas; Sound Physician Group, Pulmonary/Critical Care Medicine, Dallas, Texas (Dr Kim)
- Sara M. Powell, PharmD, MS, is the current postgraduate year 2 Critical Care pharmacy resident at Texas Health Dallas, where she also completed her postgraduate year 1 Pharmacy Practice residency. She received her Master of Science degree in 2016 and Doctor of Pharmacy degree in 2021 from Texas Tech University Health Sciences Center in Lubbock, Texas. Dr Powell has research and practice interests in anticoagulant reversal, septic shock management, antimicrobial stewardship, and trauma. Andrew C. Faust, PharmD, BCPS, is the current medical intensive care unit clinical pharmacy specialist at Texas Health Dallas and has been in this role since 2011. He graduated pharmacy school from the University of Texas at Austin in 2009 and followed that with a postgraduate year 1 Pharmacy Practice residency at University Health in San Antonio, Texas, and a postgraduate year 2 Critical Care pharmacy residency at Methodist University Hospital in Memphis, Tennessee. Dr Faust has published multiple articles in the areas of critical care, anticoagulation, and infectious diseases and has interests in management of sepsis/shock, rationale antimicrobial use in critically ill patients, and sedation/analgesia management. Stephy George, PharmD, BCCCP, is the current emergency department (ED)/trauma clinical pharmacy specialist. She graduated from University of Houston College of Pharmacy in 2013 and completed her pharmacotherapy postgraduate year 1 at Methodist Hospital in San Antonio and Critical Care and postgraduate year 2 at North Texas VA/Texas Tech Health Science Center in Dallas before starting her career as a critical care pharmacy specialist in 2016. Her clinical areas of interest are multimodal pain management, ICU antimicrobial stewardship, and management of agitation in the ED. Richard Townsend, RN, has worked as a vascular access nurse at Texas Health Dallas since March of 2020. He graduated from nursing school in 2006 and has prior experience in intensive care nursing, emergency nursing as a medicine and trauma nurse, and in the cardiac catheterization laboratory. Darla Eubank, RN, received her Bachelor of Science in Nursing from Abilene Christian University in 1996. After graduation, she worked as a telemetry nurse, cardiac catheterization laboratory nurse, and progressive cardiac care unit charge nurse. She has been an infusion support nurse at Texas Health Dallas since 2003 and now serves as the charge nurse for the vascular access team. Ms Eubank has received an Impact Award from Texas Christian University for her work on an evidence-based project focused on midline use in difficult access patients. Richard Kim, MD, is a board-certified internal, pulmonary, and critical care medicine physician in Dallas, Texas. He completed internal medicine residency and a pulmonary and critical care medicine fellowship at the University of Louisville in 2020. He has particular interest in sepsis, point-of-care ultrasound, and pulmonary hypertension
| | - Stephy George
- Department of Pharmacy (Drs Powell, Faust, and George) and Infusion Support Team, Department of Nursing (Mr Townsend and Ms Eubank), Texas Health Presbyterian Hospital Dallas, Dallas, Texas; Sound Physician Group, Pulmonary/Critical Care Medicine, Dallas, Texas (Dr Kim)
- Sara M. Powell, PharmD, MS, is the current postgraduate year 2 Critical Care pharmacy resident at Texas Health Dallas, where she also completed her postgraduate year 1 Pharmacy Practice residency. She received her Master of Science degree in 2016 and Doctor of Pharmacy degree in 2021 from Texas Tech University Health Sciences Center in Lubbock, Texas. Dr Powell has research and practice interests in anticoagulant reversal, septic shock management, antimicrobial stewardship, and trauma. Andrew C. Faust, PharmD, BCPS, is the current medical intensive care unit clinical pharmacy specialist at Texas Health Dallas and has been in this role since 2011. He graduated pharmacy school from the University of Texas at Austin in 2009 and followed that with a postgraduate year 1 Pharmacy Practice residency at University Health in San Antonio, Texas, and a postgraduate year 2 Critical Care pharmacy residency at Methodist University Hospital in Memphis, Tennessee. Dr Faust has published multiple articles in the areas of critical care, anticoagulation, and infectious diseases and has interests in management of sepsis/shock, rationale antimicrobial use in critically ill patients, and sedation/analgesia management. Stephy George, PharmD, BCCCP, is the current emergency department (ED)/trauma clinical pharmacy specialist. She graduated from University of Houston College of Pharmacy in 2013 and completed her pharmacotherapy postgraduate year 1 at Methodist Hospital in San Antonio and Critical Care and postgraduate year 2 at North Texas VA/Texas Tech Health Science Center in Dallas before starting her career as a critical care pharmacy specialist in 2016. Her clinical areas of interest are multimodal pain management, ICU antimicrobial stewardship, and management of agitation in the ED. Richard Townsend, RN, has worked as a vascular access nurse at Texas Health Dallas since March of 2020. He graduated from nursing school in 2006 and has prior experience in intensive care nursing, emergency nursing as a medicine and trauma nurse, and in the cardiac catheterization laboratory. Darla Eubank, RN, received her Bachelor of Science in Nursing from Abilene Christian University in 1996. After graduation, she worked as a telemetry nurse, cardiac catheterization laboratory nurse, and progressive cardiac care unit charge nurse. She has been an infusion support nurse at Texas Health Dallas since 2003 and now serves as the charge nurse for the vascular access team. Ms Eubank has received an Impact Award from Texas Christian University for her work on an evidence-based project focused on midline use in difficult access patients. Richard Kim, MD, is a board-certified internal, pulmonary, and critical care medicine physician in Dallas, Texas. He completed internal medicine residency and a pulmonary and critical care medicine fellowship at the University of Louisville in 2020. He has particular interest in sepsis, point-of-care ultrasound, and pulmonary hypertension
| | - Richard Townsend
- Department of Pharmacy (Drs Powell, Faust, and George) and Infusion Support Team, Department of Nursing (Mr Townsend and Ms Eubank), Texas Health Presbyterian Hospital Dallas, Dallas, Texas; Sound Physician Group, Pulmonary/Critical Care Medicine, Dallas, Texas (Dr Kim)
- Sara M. Powell, PharmD, MS, is the current postgraduate year 2 Critical Care pharmacy resident at Texas Health Dallas, where she also completed her postgraduate year 1 Pharmacy Practice residency. She received her Master of Science degree in 2016 and Doctor of Pharmacy degree in 2021 from Texas Tech University Health Sciences Center in Lubbock, Texas. Dr Powell has research and practice interests in anticoagulant reversal, septic shock management, antimicrobial stewardship, and trauma. Andrew C. Faust, PharmD, BCPS, is the current medical intensive care unit clinical pharmacy specialist at Texas Health Dallas and has been in this role since 2011. He graduated pharmacy school from the University of Texas at Austin in 2009 and followed that with a postgraduate year 1 Pharmacy Practice residency at University Health in San Antonio, Texas, and a postgraduate year 2 Critical Care pharmacy residency at Methodist University Hospital in Memphis, Tennessee. Dr Faust has published multiple articles in the areas of critical care, anticoagulation, and infectious diseases and has interests in management of sepsis/shock, rationale antimicrobial use in critically ill patients, and sedation/analgesia management. Stephy George, PharmD, BCCCP, is the current emergency department (ED)/trauma clinical pharmacy specialist. She graduated from University of Houston College of Pharmacy in 2013 and completed her pharmacotherapy postgraduate year 1 at Methodist Hospital in San Antonio and Critical Care and postgraduate year 2 at North Texas VA/Texas Tech Health Science Center in Dallas before starting her career as a critical care pharmacy specialist in 2016. Her clinical areas of interest are multimodal pain management, ICU antimicrobial stewardship, and management of agitation in the ED. Richard Townsend, RN, has worked as a vascular access nurse at Texas Health Dallas since March of 2020. He graduated from nursing school in 2006 and has prior experience in intensive care nursing, emergency nursing as a medicine and trauma nurse, and in the cardiac catheterization laboratory. Darla Eubank, RN, received her Bachelor of Science in Nursing from Abilene Christian University in 1996. After graduation, she worked as a telemetry nurse, cardiac catheterization laboratory nurse, and progressive cardiac care unit charge nurse. She has been an infusion support nurse at Texas Health Dallas since 2003 and now serves as the charge nurse for the vascular access team. Ms Eubank has received an Impact Award from Texas Christian University for her work on an evidence-based project focused on midline use in difficult access patients. Richard Kim, MD, is a board-certified internal, pulmonary, and critical care medicine physician in Dallas, Texas. He completed internal medicine residency and a pulmonary and critical care medicine fellowship at the University of Louisville in 2020. He has particular interest in sepsis, point-of-care ultrasound, and pulmonary hypertension
| | - Darla Eubank
- Department of Pharmacy (Drs Powell, Faust, and George) and Infusion Support Team, Department of Nursing (Mr Townsend and Ms Eubank), Texas Health Presbyterian Hospital Dallas, Dallas, Texas; Sound Physician Group, Pulmonary/Critical Care Medicine, Dallas, Texas (Dr Kim)
- Sara M. Powell, PharmD, MS, is the current postgraduate year 2 Critical Care pharmacy resident at Texas Health Dallas, where she also completed her postgraduate year 1 Pharmacy Practice residency. She received her Master of Science degree in 2016 and Doctor of Pharmacy degree in 2021 from Texas Tech University Health Sciences Center in Lubbock, Texas. Dr Powell has research and practice interests in anticoagulant reversal, septic shock management, antimicrobial stewardship, and trauma. Andrew C. Faust, PharmD, BCPS, is the current medical intensive care unit clinical pharmacy specialist at Texas Health Dallas and has been in this role since 2011. He graduated pharmacy school from the University of Texas at Austin in 2009 and followed that with a postgraduate year 1 Pharmacy Practice residency at University Health in San Antonio, Texas, and a postgraduate year 2 Critical Care pharmacy residency at Methodist University Hospital in Memphis, Tennessee. Dr Faust has published multiple articles in the areas of critical care, anticoagulation, and infectious diseases and has interests in management of sepsis/shock, rationale antimicrobial use in critically ill patients, and sedation/analgesia management. Stephy George, PharmD, BCCCP, is the current emergency department (ED)/trauma clinical pharmacy specialist. She graduated from University of Houston College of Pharmacy in 2013 and completed her pharmacotherapy postgraduate year 1 at Methodist Hospital in San Antonio and Critical Care and postgraduate year 2 at North Texas VA/Texas Tech Health Science Center in Dallas before starting her career as a critical care pharmacy specialist in 2016. Her clinical areas of interest are multimodal pain management, ICU antimicrobial stewardship, and management of agitation in the ED. Richard Townsend, RN, has worked as a vascular access nurse at Texas Health Dallas since March of 2020. He graduated from nursing school in 2006 and has prior experience in intensive care nursing, emergency nursing as a medicine and trauma nurse, and in the cardiac catheterization laboratory. Darla Eubank, RN, received her Bachelor of Science in Nursing from Abilene Christian University in 1996. After graduation, she worked as a telemetry nurse, cardiac catheterization laboratory nurse, and progressive cardiac care unit charge nurse. She has been an infusion support nurse at Texas Health Dallas since 2003 and now serves as the charge nurse for the vascular access team. Ms Eubank has received an Impact Award from Texas Christian University for her work on an evidence-based project focused on midline use in difficult access patients. Richard Kim, MD, is a board-certified internal, pulmonary, and critical care medicine physician in Dallas, Texas. He completed internal medicine residency and a pulmonary and critical care medicine fellowship at the University of Louisville in 2020. He has particular interest in sepsis, point-of-care ultrasound, and pulmonary hypertension
| | - Richard Kim
- Department of Pharmacy (Drs Powell, Faust, and George) and Infusion Support Team, Department of Nursing (Mr Townsend and Ms Eubank), Texas Health Presbyterian Hospital Dallas, Dallas, Texas; Sound Physician Group, Pulmonary/Critical Care Medicine, Dallas, Texas (Dr Kim)
- Sara M. Powell, PharmD, MS, is the current postgraduate year 2 Critical Care pharmacy resident at Texas Health Dallas, where she also completed her postgraduate year 1 Pharmacy Practice residency. She received her Master of Science degree in 2016 and Doctor of Pharmacy degree in 2021 from Texas Tech University Health Sciences Center in Lubbock, Texas. Dr Powell has research and practice interests in anticoagulant reversal, septic shock management, antimicrobial stewardship, and trauma. Andrew C. Faust, PharmD, BCPS, is the current medical intensive care unit clinical pharmacy specialist at Texas Health Dallas and has been in this role since 2011. He graduated pharmacy school from the University of Texas at Austin in 2009 and followed that with a postgraduate year 1 Pharmacy Practice residency at University Health in San Antonio, Texas, and a postgraduate year 2 Critical Care pharmacy residency at Methodist University Hospital in Memphis, Tennessee. Dr Faust has published multiple articles in the areas of critical care, anticoagulation, and infectious diseases and has interests in management of sepsis/shock, rationale antimicrobial use in critically ill patients, and sedation/analgesia management. Stephy George, PharmD, BCCCP, is the current emergency department (ED)/trauma clinical pharmacy specialist. She graduated from University of Houston College of Pharmacy in 2013 and completed her pharmacotherapy postgraduate year 1 at Methodist Hospital in San Antonio and Critical Care and postgraduate year 2 at North Texas VA/Texas Tech Health Science Center in Dallas before starting her career as a critical care pharmacy specialist in 2016. Her clinical areas of interest are multimodal pain management, ICU antimicrobial stewardship, and management of agitation in the ED. Richard Townsend, RN, has worked as a vascular access nurse at Texas Health Dallas since March of 2020. He graduated from nursing school in 2006 and has prior experience in intensive care nursing, emergency nursing as a medicine and trauma nurse, and in the cardiac catheterization laboratory. Darla Eubank, RN, received her Bachelor of Science in Nursing from Abilene Christian University in 1996. After graduation, she worked as a telemetry nurse, cardiac catheterization laboratory nurse, and progressive cardiac care unit charge nurse. She has been an infusion support nurse at Texas Health Dallas since 2003 and now serves as the charge nurse for the vascular access team. Ms Eubank has received an Impact Award from Texas Christian University for her work on an evidence-based project focused on midline use in difficult access patients. Richard Kim, MD, is a board-certified internal, pulmonary, and critical care medicine physician in Dallas, Texas. He completed internal medicine residency and a pulmonary and critical care medicine fellowship at the University of Louisville in 2020. He has particular interest in sepsis, point-of-care ultrasound, and pulmonary hypertension
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Chen KM, Hasoon J, Nguyen A. Anesthetic Considerations for Cardiac Tamponade after Internal Jugular Central Line Placement during Trauma Resuscitation: A Case Report. Vasc Specialist Int 2023; 39:17. [PMID: 37381155 DOI: 10.5758/vsi.230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
Numerous complications are associated with central venous catheters. Among them, cardiac tamponade is a rare but well-documented catastrophic complication. A 22-year-old healthy male presented with Code 1 trauma resulting from gunshot wounds in the abdomen. Upon examination, he was found to have a large pericardial fluid collection, a large right supraclavicular hematoma, and significant amount of bilateral pleural effusions secondary to extraluminal placement of the right internal jugular central line during resuscitation. After repairing the internal jugular injury and draining the pericardial fluid, the patient was transferred from the intensive care unit to the regular hospital floor. However, 15 days later, imaging revealed re-accumulation of a large pericardial effusion, which was eventually treated with a pericardial window operation. This case report explores potential complications that could arise from central line placement and the anesthetic considerations in a patient with cardiac tamponade from extraluminal central line placement.
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Affiliation(s)
- Kevin M Chen
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA
| | - Anvinh Nguyen
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
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29
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Hsu CC, Wu YH, Ho MP. Administered 3% hypertonic saline: Via peripheral route is safe? Am J Emerg Med 2023; 68:188. [PMID: 37120395 DOI: 10.1016/j.ajem.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023] Open
Affiliation(s)
- Chia-Chun Hsu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yuan-Hui Wu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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30
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Li L, Chen Y. Life-threatening airway obstruction due to retropharyngeal and cervicomediastinal hematomas following transjugular intrahepatic portosystemic shunt procedure for acute variceal bleeding in cirrhosis. Clin Case Rep 2023; 11:e7005. [PMID: 36911633 PMCID: PMC9992143 DOI: 10.1002/ccr3.7005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
We report a case of life-threatening airway obstruction due to retropharyngeal-cervicomediastinal hematomas following transjugular intrahepatic portosystemic shunt or acute variceal bleeding in cirrhosis. Even though this is a rare complication, clinicians should maintain a high index of suspicion and evaluate and treat it promptly to prevent a fatal outcome.
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Affiliation(s)
- Long Li
- Division of Interventional Radiology, Department of Medical Imaging Guangzhou Twelfth People's Hospital Guangzhou Guangdong China
| | - Yong Chen
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital Southern Medical University Guangzhou Guangdong China
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31
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Jahanshahi F, Parsaei A, Naderi D, Zeraatian Nejad Davani S, Khaleghian M. Potentially fatal atrium perforation due to right jugular vein catheterization recognized by venography: A case report. Clin Case Rep 2023; 11:e6911. [PMID: 36789307 PMCID: PMC9909251 DOI: 10.1002/ccr3.6911] [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: 05/16/2022] [Revised: 09/10/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Central venous catheters are the prevalent path for dialysis. Our case was a 54-years-old male with a new case of end-stage renal disease with a complaint of right jugular hemodialysis catheter dysfunction. In our case, the early dysfunctional catheter should be evaluated with contrast studies to achieve accurate information.
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Affiliation(s)
- Fatemeh Jahanshahi
- Faculty of MedicineIran University of Medical ScienceTehranIran
- Urology Research CenterTehran University of Medical SciencesTehranIran
| | | | - Delaram Naderi
- Allied Medical SciencesIran University of Medical SciencesTehranIran
| | - Sam Zeraatian Nejad Davani
- Rockingham Medical Research Center, ADKWA MedicalPerthWestern AustraliaAustralia
- Department of Cardiovascular Surgery and Faculty of Transplant and Organ DonationIran University of Medical ScienceTehranIran
| | - Mohsen Khaleghian
- Department of Vascular SurgeryIran University of Medical ScienceTehranIran
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32
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Simulation-based Mastery Learning Improves Critical Care Skills of Advanced Practice Providers. ATS Sch 2023; 4:48-60. [PMID: 37089675 PMCID: PMC10117416 DOI: 10.34197/ats-scholar.2022-0065oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
Background Advanced practice providers (APPs) are essential members of intensive care unit (ICU) interprofessional teams and are expected to be competent in performing procedures. There are no published criteria for establishing when APPs can independently perform procedures. Simulation-based mastery learning (SBML) is an effective strategy for improving critical care skills but has not been applied to practicing ICU APPs. Objective The purpose of this study was to evaluate if an SBML curriculum could improve the critical care skills and procedural self-confidence of ICU APPs. Methods We performed a pretest-posttest study of central venous catheter (CVC) insertion, thoracentesis, and mechanical ventilation (MV) management skills among ICU APPs who participated in an SBML course at an academic hospital. For each skill, APPs underwent baseline skills assessments (pretests) on a simulator using previously published checklists, followed by didactic sessions and deliberate practice with individualized feedback. Within 2 weeks, participants were required to meet or exceed previously established minimum passing standards (MPS) on simulated skills assessments (posttests) using the same checklists. Further deliberate practice was provided for those unable to meet the MPS until they retested and met this standard. We compared pretest to posttest skills checklist scores and procedural confidence. Results All 12 eligible ICU APPs participated in internal jugular CVC, subclavian CVC, and MV training. Five APPs participated in thoracentesis training. At baseline, no APPs met the MPS on all skills. At training completion, all APPs achieved the mastery standard. Internal jugular CVC pretest performance improved from a mean of 67.2% (standard deviation [SD], 28.8%) items correct to 97.1% (SD, 3.8%) at posttest (P = 0.005). Subclavian CVC pretest performance improved from 29.2% (SD, 32.7%) items correct to 93.1% (SD 3.9%) at posttest (P < 0.001). Thoracentesis pretest skill improved from 63.9% (SD, 30.6%) items correct to 99.2% (SD, 1.7%) at posttest (P = 0.054). Pretest MV skills improved from 54.8% (SD, 19.7%) items correct to 92.3% (SD, 5.0%) at posttest (P < 0.001). APP procedural confidence improved for each skill from pre to posttest. Conclusion SBML is effective for training APPs to perform ICU skills. Relying on traditional educational methods does not reliably ensure that APPs are adequately prepared to perform skills such as CVC insertion, thoracentesis, and MV management.
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Safety of peripherally administered 3% hypertonic saline. Am J Emerg Med 2023; 63:127-131. [PMID: 36371934 DOI: 10.1016/j.ajem.2022.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Administration of 3% sodium chloride through a peripheral venous catheter is associated with risk of infusion-related adverse events (IRAE) due to its high osmolarity. Given this concern and the paucity of data regarding these events, many hospitals have policies that require central line administration of 3% sodium chloride. OBJECTIVE The objective of this analysis was to evaluate the incidence of IRAE associated with peripheral administration of 3% sodium chloride. METHODS This analysis included patients who received 3% sodium chloride via a peripheral venous catheter between May 2017 and August 2019. The major endpoint of this analysis was the overall incidence of IRAE, defined as the documentation of infiltration or phlebitis. A multivariable logistic regression was performed to identify potential risk factors (e.g., age, infusion rate, infusion duration, peripheral venous catheter location, and needle gauge) for development of IRAE. RESULTS A total of 706 administrations in 422 patients were included. Seventy-four (10.5%) administrations were associated with a documented event. Based on the Infusion Nurses grading scale for infiltration or phlebitis, 48% of the events in this analysis were grade 1 in severity. Duration of infusion of 3% sodium chloride was found to be associated with an increased odds of an IRAE (OR per 1 h 1.02, 95% CI 1.01-1.02) in the multivariable analysis. Age, infusion rate, peripheral venous catheter location, and needle gauge were not independently associated with an increased risk of an IRAE. CONCLUSION These data suggest that IRAE occurred more frequently when 3% sodium chloride was administered over a longer duration and the majority of events were mild with no permanent tissue injury. It may be reasonable to consider peripheral administration of 3% sodium chloride in the acute care setting for a short duration, although additional studies are needed to continue to evaluate its safety.
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Agarwal A, Agarwal A, Goyal P. Knotted J tip guidewire during central venous catheterisation in an infant. Indian J Anaesth 2022; 66:878-879. [PMID: 36654890 PMCID: PMC9842080 DOI: 10.4103/ija.ija_657_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Aarti Agarwal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Apoorva Agarwal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Apoorva Agarwal, Department of Anaesthesia, A- Block, 1 st Floor, SGPGIMS, Raebareli Road, Lucknow - 226 014, Uttar Pradesh. India. E-mail:
| | - Puneet Goyal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Subramanian A, Richards N. Central Venous Catheter Placement Gone Awry: A Case Report of Right Internal Jugular Central Line Entering Subclavian Artery. Cureus 2022; 14:e31093. [DOI: 10.7759/cureus.31093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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Classification of Central Venous Catheter Tip Position on Chest X-ray Using Artificial Intelligence. J Pers Med 2022; 12:jpm12101637. [PMID: 36294776 PMCID: PMC9605589 DOI: 10.3390/jpm12101637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Recent studies utilizing deep convolutional neural networks (CNN) have described the central venous catheter (CVC) on chest radiography images. However, there have been no studies for the classification of the CVC tip position with a definite criterion on the chest radiograph. This study aimed to develop an algorithm for the automatic classification of proper depth with the application of automatic segmentation of the trachea and the CVC on chest radiographs using a deep CNN. This was a retrospective study that used plain chest supine anteroposterior radiographs. The trachea and CVC were segmented on images and three labels (shallow, proper, and deep position) were assigned based on the vertical distance between the tracheal carina and CVC tip. We used a two-stage approach model for the automatic segmentation of the trachea and CVC with U-net++ and automatic classification of CVC placement with EfficientNet B4. The primary outcome was a successful three-label classification through five-fold validations with segmented images and a test with segmentation-free images. Of a total of 808 images, 207 images were manually segmented and the overall accuracy of the five-fold validation for the classification of three-class labels (mean (SD)) of five-fold validation was 0.76 (0.03). In the test for classification with 601 segmentation-free images, the average accuracy, precision, recall, and F1-score were 0.82, 0.73, 0.73, and 0.73, respectively. We achieved the highest accuracy value of 0.91 in the shallow position label, while the highest F1-score was 0.82 in the deep position label. A deep CNN can achieve a comparative performance in the classification of the CVC position based on the distance from the carina to the CVC tip as well as automatic segmentation of the trachea and CVC on plain chest radiographs.
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Rzewnicki D, Loya MF, Charles H, Kokabi N, Nezami N, Majdalany BS. Lymphorrhea following Tunneled Femoral Central Venous Catheter Placement: Avoidance and Management of a Rare Complication. Semin Intervent Radiol 2022; 39:533-536. [PMID: 36561932 PMCID: PMC9767775 DOI: 10.1055/s-0042-1757943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Daniel Rzewnicki
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Mohammed F. Loya
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Hearns Charles
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bill S. Majdalany
- Department of Radiology, University of Vermont Medical Center, Burlington, Vermont
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Shao TY, Haslam DB, Bennett RJ, Way SS. Friendly fungi: symbiosis with commensal Candida albicans. Trends Immunol 2022; 43:706-717. [PMID: 35961916 PMCID: PMC10027380 DOI: 10.1016/j.it.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/22/2022]
Abstract
Mucosal tissues are constitutively colonized by a wide assortment of host-adapted microbes. This includes the polymorphic fungus Candida albicans which is a primary target of human adaptive responses. Immunogenicity is replicated after intestinal colonization in preclinical models with a surprising array of protective benefits for most hosts, but harmful consequences for a few. The interaction between fungus and host is complex, and traditionally, the masking of antigenic fungal ligands has been viewed as a tactic for fungal immune evasion during invasive infection. However, we propose that dynamic expression of cell wall moieties, host cell lysins, and other antigenic C. albicans determinants is necessary during the more ubiquitous context of intestinal colonization to prime immunogenicity and optimize mammalian host symbiosis.
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Affiliation(s)
- Tzu-Yu Shao
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Immunobiology Graduate Program, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - David B Haslam
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Richard J Bennett
- Molecular Microbiology and Immunology Department, Brown University, Providence, RI 02912, USA.
| | - Sing Sing Way
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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AlAttab N, Alshehri KM, Alturki AY, Wani T, Alwan A, Alomar K, AlGhofili H. External Carotid Artery-Jugular Vein Fistula Caused by Blunt Trauma: A Case Report & Literature Review. Vasc Endovascular Surg 2022; 56:802-807. [PMID: 35945671 DOI: 10.1177/15385744221120202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquired carotid-jugular fistula usually occurs due to neck stab wounds, gunshots, or central vein catheterization. Blunt trauma is a rare cause. These cases usually present with pulsatile swelling, tinnitus, and continued thrills in the neck. Both surgical and endovascular options have been used to manage these fistulas. Coil embolization is also applied in high-flow fistulas. We present a case of a 38-year-old woman free of any pre-existing medical conditions, presenting with a fistula between the external carotid artery and external jugular vein distally and with a high flow. She was treated with fistula embolization using coils while limiting the high flow via a balloon in the jugular vein. Our case highlights the possibility of using coils in high-flow fistulas in anatomically challenging fistulas. Furthermore, relevant literature review is presented to recapitulate unique features and effective management of carotid-jugular fistulas.
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Affiliation(s)
- Nashwan AlAttab
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khaled Mohammed Alshehri
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Tariq Wani
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulwali Alwan
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Alomar
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hesham AlGhofili
- Vascular Surgery Department, King Salman Heart Center, 37849King Fahad Medical City, Riyadh, Saudi Arabia
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Catheter-related thrombosis (CRT) in patients with solid tumors: a narrative review and clinical guidance for daily care. Support Care Cancer 2022; 30:8577-8588. [PMID: 35932317 DOI: 10.1007/s00520-022-07297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
Central venous access devices (CVADs) including central venous catheters and peripherally inserted central catheters (PICCs) are essential in the treatment of cancer. Catheter-related thrombosis (CRT) is the most frequent non-infectious complication associated with the use of central lines. The development of CRT may cause to delays in oncologic treatment and increase morbidity leading to potentially life-threatening complications. Several local and systemic risk factors are associated with the development of CRT and should be taken into account to prevent CRT by standardizing appropriate catheter placement and maintenance. The use of primary pharmacological thromboprophylaxis in order to avoid CRT is not routinely recommended, although it can be considered in selected cases. Recommendations for the management of established CRT are based on the extrapolation of anticoagulation for lower limb venous thrombosis. The present review summarizes the current evidence and recommendations for the prevention and management of CRT and identifies areas that require further research.
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Druar NM, Vosburg RW, Cahan M. Obesity increases the risk for upper extremity deep vein thrombosis and pulmonary embolism in patients with upper extremity central venous catheters. Clin Obes 2022; 12:e12526. [PMID: 35429144 DOI: 10.1111/cob.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
The morbidity and mortality of deep vein thrombosis (DVT) remain a significant burden for the healthcare system. The aim of this analysis was to examine the association of upper extremity central venous catheter (UECVC) and venous thromboembolism (UEVTE) with increasing body mass index (BMI) in a large database study and to further examine disposition. Inpatient data from the National Inpatient Sample from 2017 to 2019 were used to investigate the effect of obesity on patients diagnosed with DVT of the upper extremity or pulmonary embolism (PE) who had upper extremity venous central line placement. There was a total of 1690 cases of UEVTE and 3202 cases of PE within the sample. There was an increasing odds of UEVTE in the patients with UECVCs with increasing BMI. Patients with a BMI of 30-39, 40-49 and > 50 kg/m2 were significantly different than those with BMI of <19 and 20-29 kg/m2 in the UECVC group for UEVTE. This study demonstrated increased odds of UEVTE for patients with increased BMI. Practitioners should assume a greater risk for UEVTE and PE in patients with increased BMI when considering CVCs.
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Affiliation(s)
- Nicholas M Druar
- Department of Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
- Department of Surgery, St. Mary's Hospital, Waterbury, Connecticut, USA
| | - Ralph Wesley Vosburg
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Mitchell Cahan
- Department of Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts, USA
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Suh J, Lee SW. Preoperative prediction of the need for arterial and central venous catheterization using machine learning techniques. Sci Rep 2022; 12:11948. [PMID: 35831346 PMCID: PMC9279292 DOI: 10.1038/s41598-022-16144-z] [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: 02/15/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
Some surgical patients require an arterial or central venous catheterization intraoperatively. This decision relied solely on the experience of individual anesthesiologists; however, these decisions are not easy for clinicians who are in an emergency or inexperienced. Therefore, applying recent artificial intelligence techniques to automatically extractable data from electronic medical record (EMR) could create a very clinically useful model in this situation. This study aimed to develop a model that is easy to apply in real clinical settings by implementing a prediction model for the preoperative decision to insert an arterial and central venous catheter and that can be automatically linked to the EMR. We collected and retrospectively analyzed data from 66,522 patients, > 18 years of age, who underwent non-cardiac surgeries from March 2019 to April 2021 at the single tertiary medical center. Data included demographics, pre-operative laboratory tests, surgical information, and catheterization information. When compared with other machine learning methods, the DNN model showed the best predictive performance in terms of the area under receiver operating characteristic curve and area under the precision-recall curve. Operation code information accounted for the largest portion of the prediction. This can be applied to clinical fields using operation code and minimal preoperative clinical information.
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Affiliation(s)
- Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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DeBoer E, Alsbrooks K. Procedure Code Utilization for Vascular Access Device Placement in the Inpatient Setting: A Retrospective Analysis. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1d. [PMID: 36035331 PMCID: PMC9335166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Vascular access (VA) is essential to inpatient care, and the documentation/coding practices for vascular access device (VAD) placement procedures remain unexplored. Accurate documentation may present benefits for patients, providers, and researchers. A retrospective analysis was performed in adult inpatients (2015 to 2020) using Cerner Real World Data™ to evaluate the utilization of CPT codes for VAD placement/replacement procedures. A total of 14,253,584 patient encounters were analyzed, 0.111 percent (n=15,833) of which received at least one VAD procedure code. Non-tunneled CVC procedures had the highest code rate (0.067 percent), while PIV/midline procedures were the least likely to be coded (0.004 percent). The annual proportion of code utilization increased from 10.9 percent in 2015 to 19.7 percent in 2020 (p<0.0001). Despite widespread use of VADs in the inpatient setting, the procedure coding rate was found to be remarkably low. Appropriate coding/documentation practices may ensure proper care by capturing VA-related patient history, and improve research quality and resource/staff allocation.
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Lee KB, Pyun AJ, Praeger J, Ziegler KR, Han SM. Physician-Modified Fenestrated Endovascular Repair for Iatrogenic Innominate Vein Injury. Vasc Specialist Int 2022; 38:22. [PMID: 35770656 PMCID: PMC9244692 DOI: 10.5758/vsi.220015] [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: 03/10/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
Iatrogenic innominate vein injuries are rare complications associated with internal jugular venous catheters. These complications are accompanied by high morbidity and mortality rates in patients with severe underlying medical conditions. Without proper treatment, emergency surgery may be needed due to acute cardiac tamponade or hemothorax. Endovascular repair can be advantageous for patients with significant medical comorbidities. Herein, we report the case of a 62-year-old female with an iatrogenic injury to the innominate vein at the subclavian vein and internal jugular confluence due to a malpositioned left internal jugular catheter. A customized fenestrated endograft was positioned with fenestration oriented to the internal jugular vein and a new tunneled catheter was inserted across the fenestration into the superior vena cava upon removal of the malpositioned catheter. In addition, a brachio-basilic arteriovenous fistula was created. At one month follow-up, the patient had a palpable thrill over the arteriovenous fistula and a functioning tunneled catheter.
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Affiliation(s)
- Kyung Bae Lee
- Divisions of Vascular Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Yonsei University College of Medicine, Seoul, Korea
| | - Alyssa J. Pyun
- Divisions of Vascular Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Jonathan Praeger
- Divisions of Cardiac Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Kenneth R. Ziegler
- Divisions of Vascular Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Sukgu M. Han
- Divisions of Vascular Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
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Bogdan L, Malavade T. Tunneled dialysis line-associated hemorrhagic shock following self-inflicted trauma in a hemodialysis patient: A case report. Hemodial Int 2022; 26:E37-E40. [PMID: 35732603 DOI: 10.1111/hdi.13035] [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: 01/28/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Complications of tunneled central venous catheters (CVCs) for hemodialysis are frequent, and most commonly include bacteremia, thrombosis, and stenosis. While bleeding is a relatively rare complication of dialysis lines overall, tunneled CVCs may present a unique bleeding risk given their ability to be displaced or damaged as patients have direct access to the equipment in place. Here, we describe the case of a 68-year-old man with end-stage renal disease and neurocognitive disorder, who developed hemorrhagic shock following self-inflicted laceration of his tunneled dialysis catheter proximal to the Y. Examination of the catheter tunnel revealed that the cuff was palpable proximal to the exit site, but the opening was well retracted. In such cases, hemorrhage is particularly difficult to control because the cuff is rigid and poorly amenable to compression, in addition to being difficult to access. This case demonstrates the risk of significant hemorrhage when a tunneled CVC is damaged at this location and the potential need for the urgent removal of the retained component to prevent recurrence of bleeding. It also highlights important patient safety considerations given the risk of self-inflicted trauma in patients with a neurocognitive disorder and a language barrier affecting communication.
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Affiliation(s)
- Lucia Bogdan
- Department of Internal Medicine, University of Toronto, Toronto, Canada
| | - Tushar Malavade
- Department of Internal Medicine, University of Toronto, Toronto, Canada.,Division of Nephrology, University Health Network, Toronto, Canada
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Home Parenteral and Enteral Nutrition. Nutrients 2022; 14:nu14132558. [PMID: 35807740 PMCID: PMC9268549 DOI: 10.3390/nu14132558] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
While the history of nutrition support dates to the ancient world, modern home parenteral and enteral nutrition (HPEN) has been available since the 1960s. Home enteral nutrition is primarily for patients in whom there is a reduction in oral intake below the amount needed to maintain nutrition or hydration (i.e., oral failure), whereas home parenteral nutrition is used for patients when oral-enteral nutrition is temporarily or permanently impossible or absorption insufficient to maintain nutrition or hydration (i.e., intestinal failure). The development of home delivery of these therapies has revolutionized the field of clinical nutrition. The use of HPEN appears to be increasing on a global scale, and because of this, it is important for healthcare providers to understand all that HPEN entails to provide safe, efficacious, and cost-effective support to the HPEN patient. In this article, we provide a comprehensive review of the indications, patient requirements, monitoring, complications, and overall process of managing these therapies at home. Whereas some of the information in this article may be applicable to the pediatric patient, the focus is on the adult population.
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Ablordeppey EA, Huang W, Holley I, Willman M, Griffey R, Theodoro DL. Clinical Practices in Central Venous Catheter Mechanical Adverse Events. J Intensive Care Med 2022; 37:1215-1222. [PMID: 35723623 DOI: 10.1177/08850666221076798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Over 5 million central venous catheters (CVCs) are placed annually. Pneumothorax and catheter malpositioning are common adverse events (AE) that requires attention. This study aims to evaluate local practices of mechanical complication frequency, type, and subsequent intervention(s) related to mechanical AE with an emphasis on catheter malpositioning. Methods: This is a retrospective review of CVC placements in a tertiary hospital setting from 1/2013 to 12/2013. Pneumothorax and CVC positioning were evaluated on post-insertion chest x-ray (CXR). Malposition was defined as unintended placement of the catheter in a vessel other than the intended superior vena cava on CXR. Catheter reposition was defined as radiographic evidence of a new catheter with removal of the old catheter less than 24hrs after initial placement. Data points analyzed included pneumothorax and thoracostomy rate, CVC malposition frequency, catheter reposition rate, catheter duration, and incidence of complications such as catheter associated venous thrombosis. Result: Among 2045 eligible CVC insertions, pneumothoraces occurred in 14 (0.7%; 95%CI 0.38, 1.17) and malpositions were identified in 275 (13.4%; 95% CI 12.3, 15.3). The proportion of pneumothoraces that required tube thoracostomy was 57%. The proportion of CVCs with malposition that were removed or replaced within 24h was 32.7%. "Malpositioned" catheters that were left in place by the clinical team (n = 185) had an average catheter duration of 8.2 days (95% CI 7.2, 9.3) versus 7.2 days (95% CI 6.17, 8.23) for catheters that were replaced after initial malposition (p = 0.14, t test). The incidence of venous thrombosis in repositioned "malpositioned" catheters was 7.8% versus 4.9% for "malpositioned" catheters that were left in place. Conclusions: Clinically significant catheter malposition and pneumothorax after CVC insertion are low. In this study, replaced and non-replaced "malpositioned" catheters had similar catheter duration and rates of complications, challenging the current dogma of CVC malposition practice.
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Affiliation(s)
- Enyo A Ablordeppey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Huang
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ian Holley
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Willman
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard Griffey
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel L Theodoro
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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Shah Z, Khan I, Dixe de Oliveira Santo I. Intraperitoneal Hematoma After Femoral Catheterization: A Case Report and Literature Review. Cureus 2022; 14:e25140. [PMID: 35733506 PMCID: PMC9205448 DOI: 10.7759/cureus.25140] [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] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
Central venous catheters (CVCs) are often crucial in managing severely ill patients, especially those in the intensive care unit. It is estimated that over 5 million CVCs are inserted per year in the United States. The internal jugular, subclavian, or femoral veins are the most used access sites. The catheter is advanced until its tip lies within the proximal third of the superior vena cava, the right atrium, or the inferior vena cava. Unfortunately, the use of CVCs is not without its drawbacks, and multiple immediate and delayed complications have been described. Herein, we report a case of a 70-year-old female with a past medical history significant for chronic obstructive pulmonary disease, coronavirus disease 2019, pneumonia, type 2 diabetes mellitus, and hypertension, who presented to the emergency department from a skilled nursing facility with a two-day history of dyspnea. She was later diagnosed with an intraperitoneal hematoma, an uncommon complication caused by a CVC placement.
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Reeves HM, Maitta RW. Comparison of absolute immature platelet count to the PLASMIC score at presentation in predicting ADAMTS13 deficiency in suspected thrombotic thrombocytopenic purpura. Thromb Res 2022; 215:30-36. [DOI: 10.1016/j.thromres.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
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Ashcraft M, Douglass M, Garren M, Mondal A, Bright LE, Wu Y, Handa H. Nitric Oxide-Releasing Lock Solution for the Prevention of Catheter-Related Infection and Thrombosis. ACS APPLIED BIO MATERIALS 2022; 5:1519-1527. [PMID: 35343228 PMCID: PMC9680935 DOI: 10.1021/acsabm.1c01272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although frequently used, venous catheters are often associated with serious complications such as infection and thrombosis. Lock solution therapies are clinically used to deter these issues but generally address only infection or thrombosis with limited success. Here, we report the development of a dual-functional lock therapy using nitric oxide (NO) donor molecule, S-nitrosoglutathione (GSNO). NO is a potent, broad-spectrum antimicrobial agent that also temporarily inhibits platelet activation, preventing thrombosis. Furthermore, NO has antibiofilm actions, an ability that traditional antibiotic lock solutions lack, thus limiting their efficacy. In this work, different concentrations of GSNO were characterized via NO analysis to determine a range of NO-releasing lock solution (NOreLS) concentrations to investigate and to demonstrate prolonged potential efficacy. Tested against clinically used vancomycin and gentamicin lock solutions, GSNO-based NOreLS repeatedly outperformed in models of different stages of catheter infections. NOreLS also prevented clot formation when exposed to whole blood, showing increased efficacy compared to a heparin lock solution. Moreover, NOreLS was demonstrated to be biocompatible via hemolysis and cytotoxicity assays. NOreLS has excellent potential for safely and effectively preventing infection and thrombosis related to catheter usage.
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Affiliation(s)
- Morgan Ashcraft
- Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Mark Garren
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Arnab Mondal
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Lori Estes Bright
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Yi Wu
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
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