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Lai JY, Wu MJ, Gautama MSN, Huang TW. Comparison of complication rates between midline catheters and peripherally inserted central catheters: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2024; 151:131-139. [PMID: 39032564 DOI: 10.1016/j.jhin.2024.07.003] [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: 05/11/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
Midline catheters (MCs) and peripherally inserted central catheters (PICCs) are essential for reliable vascular access in patients. Despite their prevalent use, comparative risk assessments of these catheters, particularly from randomized controlled trials (RCTs), remain scarce. This meta-analysis primarily focuses on RCTs to evaluate and compare the incidence of complications associated with MCs and PICCs. We conducted a comprehensive search of databases including the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, Scopus and ProQuest, up to April 2024. The primary outcomes analysed were total complications and catheter-related bloodstream infections (CRBSIs), while secondary outcomes included catheter dwell time and thrombosis incidence. Meta-analyses were performed using a random-effects model. Of 831 initially identified articles, five trials involving 608 patients met the inclusion criteria. MCs exhibited a significantly higher rate of total complications compared with PICCs (relative risk = 1.95, 95% confidence interval = 1.23-3.08, P=0.005, I2= 0%). MCs also had shorter dwell times and a higher incidence of premature removal. However, no significant differences were observed in the rates of CRBSIs or thrombosis between MCs and PICCs. PICCs are associated with fewer total complications and longer dwell times compared with MCs, which tend to be more often removed prematurely. Thrombosis rates were similar between the two catheter types, underscoring the need for careful catheter selection based on specific patient conditions and treatment duration. Further research, particularly additional RCTs, is necessary to confirm these findings and guide optimal catheter selection in clinical practice.
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Affiliation(s)
- J-Y Lai
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - M-J Wu
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - M S N Gautama
- Department of Nursing, Faculty of Medicine, Universitas Pendidikan Ganesha, Bali, Indonesia
| | - T-W Huang
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Hadaway L, Gorski LA. Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review. JOURNAL OF INFUSION NURSING 2024; 47:324-346. [PMID: 39250768 DOI: 10.1097/nan.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Midline catheters have recently gained popularity in clinical use, with a common reason being the reduction of central venous catheter use and central line-associated bloodstream infections. At the same time, the number of nononcology vesicant medications has increased, and midline catheters are frequently being used for infusions of vesicant medications. The Infusion Nurses Society (INS) Vesicant Task Force identified midline catheter use as a possible risk factor for extravasation and concluded that a thorough literature review was necessary. This review highlights the variations in catheter terminology and tip locations, the frequency of infiltration and extravasation in published studies, and case reports of infiltration and extravasation from midline catheters. It also examines the many clinical issues requiring evidence-based decision-making for the most appropriate type of vascular access devices. After more than 30 years of clinical practice with midline catheters and what appears to be a significant number of studies, evidence is still insufficient to answer questions about infusion of vesicant and irritant medications through midline catheters. Given the absence of consensus on tip location, inadequate evidence of clinical outcomes, and importance of patient safety, the continuous infusion of vesicants, all parenteral nutrition formulas, and infusates with extremes in pH and osmolarity should be avoided through midline catheters.
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Affiliation(s)
- Lynn Hadaway
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
| | - Lisa A Gorski
- Author Affiliations: Lynn Hadaway Associates, Inc, Milner, Georgia (Hadaway); Clinical Education Specialist, Ascension at Home, Brentwood, Tennessee (Gorski)
- Lynn Hadaway, MEd, RN, CRNI, has 50 years of experience in infusion nursing and adult education. Her clinical experience comes from infusion therapy teams in multiple acute care settings. She is president of Lynn Hadaway Associates, Inc, an education and consulting company started in 1996. She has authored more than 75 published articles on infusion therapy and vascular access, written 8 textbook chapters on infusion therapy, and is the clinical editor for the book Infusion Therapy Made Incredibly Easy. She served on the Infusion Nurses Society (INS) Standards of Practice committees to revise the 2006, 2011, 2016, and 2021 documents and the committees to revise the 2014 and 2022 SHEA Compendium CLABSI chapter. She is a past chair of the INCC Board of Directors, INS Member of the Year in 2007, and adjunct associate professor at Griffith University in Queensland, Australia. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, served as the chairperson for the 2017 and 2024 Vesicant Task Force. She has worked for more than 40 years as a clinical nurse specialist and educator. She is the author of several books and more than 70 book chapters and journal articles. She is an INS past president (2007-2008), past chair of the INCC Board of Directors, and has served as the chair of the INS Standards of Practice Committee for the 2011, 2016, and 2021 editions and co-chair for the 2024 Standards. Ms. Gorski speaks nationally and internationally on standards development, infusion therapy/vascular access, and home health care
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Krath J, Fredskilde J, Christensen SK, Baltsen CD, Valentin K, Offersen R, Juhl-Olsen P. The performance and complications of long peripheral venous catheters: A retrospective single-centre study. Acta Anaesthesiol Scand 2024. [PMID: 39183695 DOI: 10.1111/aas.14517] [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: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. METHODS Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. RESULTS During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). CONCLUSION The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.
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Affiliation(s)
- Julie Krath
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
| | - Jesper Fredskilde
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | | | - Cecilie Dahl Baltsen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Kamilla Valentin
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
| | - Ryan Offersen
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
| | - Peter Juhl-Olsen
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Meto E, Cabout E, Rosay H, Espinasse F, Lot AS, Hajjam ME, Gnamien Clermont S, Launois R. Cost comparison of four venous catheters: Short peripheral catheter, Long peripheral line, Midline, and PICC for peripheral infusion. J Vasc Access 2024:11297298241258257. [PMID: 38855974 DOI: 10.1177/11297298241258257] [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: 06/11/2024] Open
Abstract
INTRODUCTION The use of midline catheters for patients requiring a peripheral IV infusion is sometimes limited by their cost. Although decision trees allow them to be positioned in relation to short peripheral cannulas (SPC), Midlines, and PICCs, their economic impact has not yet been evaluated. A study was conducted to estimate and compare the actual costs of using the three types of catheters for durations of 7, 14, and 21 days. METHODS A budget impact analysis compared midlines or mini-midlines/long peripheral cannulas (LPCs) with SPCs and PICCs for typical medical indications excluding indications requiring central line (infusion of irritant or vesicant drugs): treatment of peritonitis over 7 days, cystic fibrosis infection over 14 days, and meningitis over 21 days. A micro-costing study identified resources used during catheter care procedures (consumables, medical/nursing care, examinations, mechanical complications). The cost of remote systemic complications was estimated from the French national cost study. Literature review compared data based on published complication frequencies. RESULTS Midline is more economic than the SPC (saving of 39€ over 7 days and 174€ over 14 days), and than the PICC (saving of 102€ over 14 days and 95€ over 21 days). DISCUSSION Despite a much higher acquisition cost of the Midline than a SPC, the cost of using a Midline is lower. Although this approach cannot be the only argument for choosing a medical device, it can contribute to it in a tense economic context. The micro-costing has been performed in a center placing PICCline using fluoroscopy for catheter tip positioning. The implantation of a PICC with ECG technique does not require an interventional radiology facility and involves significantly lower logistical and personnel costs. This factor is a limitation in this study. However, even with the use of EGC, the cost difference is in favor of Midline.
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Affiliation(s)
- Elise Meto
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| | - Elise Cabout
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
| | - Hervé Rosay
- Centre Léon Bérard, Centre de lutte contre le cancer, Lyon, France
| | | | | | | | | | - Robert Launois
- Réseau d'Evaluation en Economie de la Santé (REES France), Paris, France
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Milczarek S, Kulig P, Piotrowska O, Zuchmanska A, Bielikowicz A, Machalinski B. Catheter-related thrombosis in stem cell recipients: comparison of different types of catheter. Haematologica 2024; 109:1285-1288. [PMID: 37916397 PMCID: PMC10985456 DOI: 10.3324/haematol.2023.283924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Slawomir Milczarek
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland; Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin.
| | - Piotr Kulig
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland; Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin
| | - Oliwia Piotrowska
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin
| | - Alina Zuchmanska
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin
| | - Anna Bielikowicz
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin
| | - Bogusław Machalinski
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland; Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin
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Thomsen SL, Boa R, Vinter-Jensen L, Rasmussen BS. Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2355716. [PMID: 38349655 PMCID: PMC10865154 DOI: 10.1001/jamanetworkopen.2023.55716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Midline catheters (MCs) are widely used, but safety and efficacy compared with peripherally inserted central catheters (PICCs) has not been adequately evaluated. Objective To compare the safety and efficacy of MCs with PICCs among adult patients with an anticipated intravenous therapy lasting from 5 to 28 days. Design, Setting, and Participants This parallel, 2-group, open-label, randomized clinical trial (RCT) was conducted in Denmark from October 2018 to February 2022 at a single academic tertiary care center. Adult inpatients and outpatients were consecutively randomized. Intervention Patients were randomized in a 1:1 ratio to either the MC group or the PICC control group. Main Outcomes and Measures The primary outcome was catheter-related bloodstream infection (CRBSI), analyzed using the Fisher exact test. Secondary outcomes were symptomatic catheter-related thrombosis and catheter failure, including mechanical cause, phlebitis, infiltration, pain in relation to drug or fluid administration, and leaking from the puncture site. Incidence rate ratios (IRRs) were calculated to assess between-group failure rates over device dwell time using Poisson regression. An intention-to-treat analysis was performed. Results A total of 304 patients (mean [SD] age, 64.6 [13.5] years; 130 [42.8%] female) were included in the analysis, and 152 patients were allocated to each catheter group. The incidence of CRBSI was low, with 0 in the MC group and 1 in the PICC control group (P > .99). The MC group had a higher catheter-related complication rate (20 [13.2%] vs 11 [7.2%]), and an IRR of 2.37 (95% CI, 1.12-5.02; P = .02) for complications compared with the PICC control group. In a post hoc analysis stratified by catheter dwell time, no significant difference in complication rate (IRR, 1.16; 95% CI, 0.50-2.68; P = .73) was found between the 2 groups for catheters used less than 16 days. Conclusions and Relevance In this RCT with patients who received medium- to long-term intravenous therapy, the incidence of CRBSI was low, with no difference between MCs and PICCs. The use of MCs resulted in a higher incidence of catheter-related complications compared with use of PICCs. This finding should be balanced in the decision of type of catheter used at the individual patient level. Trial Registration ClinicalTrials.gov Identifier: NCT04140916.
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Affiliation(s)
- Simon L. Thomsen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Boa
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Vinter-Jensen
- Department of Gastroenterology, Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bodil S. Rasmussen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Scarano M, D'Arrigo S, De Letteriis S, Grasso S, Pittiruti M, Scoppettuolo G. Risk of thrombophlebitis associated with continuous peripheral infusion of vancomycin: The effect of dilution. J Vasc Access 2024; 25:107-112. [PMID: 35608270 DOI: 10.1177/11297298221095778] [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: 11/15/2022] Open
Abstract
INTRODUCTION Although several guidelines recommend that prolonged administration of vancomycin should be preferably carried out by a central venous access, vancomycin is often given peripherally. Whether such risk may be affected by different modalities of administration in terms of dilution and time of infusion, it is a matter of controversy. METHODS This single-center prospective study enrolled all consecutive patients requiring prolonged intravenous infusion of vancomycin (1 g/day) using long peripheral cannula "mini-midline." Patients were randomized in study group (4 mg/ml) and control group (20 mg/ml). All patients were systematically evaluated every 24 h by the Visual Exit-Site Score and a daily ultrasound scan of the veins of the arm. RESULTS The daily ultrasound evaluation showed venous thrombosis at the distal tip of the cannula in all patients, in both groups. After this finding in the first 14 patients, the study was interrupted. All thromboses were completely asymptomatic and occurred in absence of any sign of catheter malfunction. The onset of thrombosis was significantly earlier in the control group (ranging from 24 to 48 h) than in the study group (ranging from 48 to 96 h), with an average of 30 ± 11 versus 68 ± 16 h (p < 0.001). CONCLUSION Continuous intravenous infusion of vancomycin should be preferably delivered by a central venous access, as largely recommended by current guidelines, since peripheral infusion is inevitably associated with venous thrombosis, independently from the type of peripheral venous access device adopted (short peripheral cannula vs long peripheral cannula) and from the extent of dilution.
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Affiliation(s)
- Marianna Scarano
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Sestilio De Letteriis
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Salvatore Grasso
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Scoppettuolo
- Department of Infective Diseases, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Paje D, Heath M, Heung M, Horowitz JK, Bernstein SJ, Flanders SA, Chopra V. Midline catheters in patients with advanced chronic kidney disease. J Hosp Med 2023; 18:969-977. [PMID: 37771294 DOI: 10.1002/jhm.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Midline catheters (midlines) are increasingly used in patients with advanced chronic kidney disease (CKD). OBJECTIVE This study describes current practice and acute complications associated with midlines in CKD patients. DESIGNS, SETTING, AND PARTICIPANTS Trained abstractors at 66 hospitals from the Michigan Hospital Medicine Safety (HMS) Consortium collected data on a sample of patients who received a midline during hospitalization. Patients were classified as having advanced CKD if their estimated glomerular filtration rate was <45 mL/min/1.73 m2 . MAIN OUTCOME AND MEASURES Midline recipients with advanced CKD were compared to those without advanced CKD by patient, provider, and device characteristics, and by the occurrence of acute complications including major (e.g., upper extremity deep vein thrombosis [UE-DVT] and catheter-related bloodstream infection [CRBSI]) or minor (e.g., catheter occlusion, catheter dislodgement, infiltration, superficial thrombophlebitis, and leaking at insertion site) events. Multivariable mixed effects logistic regression was used to evaluate the association between catheter-related complications and stage of CKD. RESULTS Of 21,415 midline recipients, 5272 (24.6%) had advanced CKD, while 16,143 (75.4%) did not. Most midlines were single lumen (90.5%) and remained in place for a median of 6 days. A major or minor midline complication occurred in 804 (15.3%) patients with and 2239 (14.4%) patients without advanced CKD (adjusted odds ratios = 1.04; 95% confidence interval: 0.94-1.14). Among patients with advanced CKD, CRBSI occurred in 13 patients (0.2%) and UE-DVT occurred in 65 patients (1.2%). The proportion of advanced CKD among midline recipients and the frequency of midline-related complications varied across hospitals (interquartile range [IQR] = 19.2% to 29.8% [median = 25.0%] and IQR = 11.0%-18.9% [median = 15.4%], respectively).
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Affiliation(s)
- David Paje
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Megan Heath
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Michael Heung
- Department of Internal Medicine, Division of Nephrology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jennifer K Horowitz
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Steven J Bernstein
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Scott A Flanders
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan, USA
- Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
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Borgonovo F, Quici M, Gidaro A, Giustivi D, Cattaneo D, Gervasoni C, Calloni M, Martini E, La Cava L, Antinori S, Cogliati C, Gori A, Foschi A. Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review. Antibiotics (Basel) 2023; 12:1338. [PMID: 37627758 PMCID: PMC10451375 DOI: 10.3390/antibiotics12081338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.
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Affiliation(s)
- Fabio Borgonovo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Massimiliano Quici
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Antonio Gidaro
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Davide Giustivi
- Emergency Department and Vascular Access Team ASST Lodi, 26900 Lodi, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Cristina Gervasoni
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Maria Calloni
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Elena Martini
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Leyla La Cava
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Chiara Cogliati
- Internal Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
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Bahl A, Mielke N, Xing Y. Risk of midline catheter-related thrombosis due to catheter diameter: An observational cohort study. Thromb Res 2023; 228:172-180. [PMID: 37331120 DOI: 10.1016/j.thromres.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Deep vein thrombosis is a common and serious complication associated with midline catheters (MC). The aim of this investigation was to determine if catheter diameter is related to development of thrombosis. METHODS This was an observational cohort study conducted at a tertiary care academic center in Southeastern Michigan. Hospitalized adults that required a MC were eligible participants. Primary outcome was symptomatic MC associated upper extremity deep vein thrombosis (DVT) comparing three catheter diameters. Secondary outcomes included complications based on size and DVT comparing catheter to vein ratio. RESULTS Between January 1, 2017, and December 31, 2021, 3088 MCs met inclusion criteria; the distribution of 3 French (Fr), 4 Fr, and 5 Fr MCs was 35.1 %, 57.0 %, and 7.9 %, respectively. The majority of the population was female (61.2 %) and the average age was 64.2 years old. DVT occurred in 4.4 %, 3.9 %, and 11.9 % of 3 Fr, 4 Fr, and 5 Fr MCs, respectively (p < 0.001). In multivariable regression analysis, there was no difference in the odds of developing DVT for the 4 Fr MC compared to the 3 Fr (aOR 0.88; 95 % CI 0.59-1.31; p = 0.5243), however, there was significantly higher odds for the 5 Fr (aOR 2.72; 95 % CI 1.62-4.51; p = 0.001). Additionally, for every additional day the MC was in place, the odds of DVT increased by 3 % (aOR 1.03; 95 % CI 1.01-1.05; p = 0.0039). When comparing accuracy of the size model versus catheter to vein ratio model for predicting DVT, receiver operating characteristic curve analysis demonstrated the area under the curve for size was 73.70 % (95 % CI 68.04 %-79.36 %) compared to 73.01 % (95 % CI: 66.88 %-79.10 %) for catheter-to-vein ratio. CONCLUSIONS Smaller diameter catheters should be preferentially chosen to mitigate the risk of thrombosis when therapy via midline catheters is required. Choosing a catheter based on reduced size or 1:3 catheter to vein ratio threshold has similar accuracy in predicting DVT.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States of America.
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, United States of America
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11
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Martin Mena A, Négrier L, Treizebré A, Guilbert M, Bonnaire L, Daniau V, Leba Bonki G, Odou P, Genay S, Décaudin B. Evaluation of Strategies for Reducing Vancomycin-Piperacillin/Tazobactam Incompatibility. Pharmaceutics 2023; 15:2069. [PMID: 37631283 PMCID: PMC10459903 DOI: 10.3390/pharmaceutics15082069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Drug incompatibility is defined as a physical-chemical reaction between two or more injectable drugs and that results mainly in precipitation or insolubility. Several strategies for reducing incompatibilities have been implemented empirically in intensive care units. However, these strategies have never been compared directly (and particularly in terms of the particulate load and drug mass flow rate) under standardized conditions. The objective of the present in vitro study was to evaluate the impact of various strategies for preventing incompatibility between simultaneously infused vancomycin and piperacillin/tazobactam. METHODS An in-line filter, a dilute vancomycin solution (5 mg/mL), and an alternative saline administration line were evaluated separately. The infusion line outlet was connected to a dynamic particle counter. The antibiotic concentration was measured in an HPLC-UV assay. RESULT The use of an in-line filter and an alternative saline administration route did not significantly reduce the particulate load caused by vancomycin-piperacillin/tazobactam incompatibility. Dilution of the vancomycin solution was associated with a significantly lower particulate load and maintenance of the vancomycin mass flow rate. DISCUSSION It is important to systematically compare the efficacy of strategies for preventing drug incompatibility. The use of diluted vancomycin solution gave the best results in the case of vancomycin-piperacillin/tazobactam incompatibility.
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Affiliation(s)
- Anthony Martin Mena
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Laura Négrier
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Anthony Treizebré
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520—IEMN—Institut d’Electronique de Microélectronique et de Nanotechnologie, F-59000 Lille, France; (A.T.); (M.G.)
| | - Marie Guilbert
- Univ. Lille, CNRS, Centrale Lille, Univ. Polytechnique Hauts-de-France, UMR 8520—IEMN—Institut d’Electronique de Microélectronique et de Nanotechnologie, F-59000 Lille, France; (A.T.); (M.G.)
| | - Lucille Bonnaire
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Valentine Daniau
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Gabie Leba Bonki
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Stéphanie Genay
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France; (L.N.); (L.B.); (V.D.); (G.L.B.); (P.O.); (S.G.); (B.D.)
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12
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Massouh A, Kwan SW, Fidelman N, Higgins M, Abujudeh H, Charalel RA, Guimaraes MS, Gupta A, Lam A, Majdalany BS, Patel PJ, Stadtlander KS, Stillwell T, Teo EYL, Tong RT, Kapoor BS. ACR Appropriateness Criteria® Central Venous Access Device and Site Selection. J Am Coll Radiol 2023; 20:S3-S19. [PMID: 37236750 DOI: 10.1016/j.jacr.2023.02.021] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge. Central venous access devices may be nontunneled, tunneled, or implantable. They may be centrally or peripherally inserted by way of veins in the neck, extremities, or elsewhere. Each device and access site presents specific risks that should be considered in each clinical scenario to minimize the risk of harm. The risk of infection and mechanical injury should be minimized in all patients. In hemodialysis patients, preservation of future access is an additional important consideration. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alan Massouh
- Research Author, University of Utah, Salt Lake City, Utah.
| | - Sharon W Kwan
- University of Utah, Salt Lake City, Utah; and JACR editorial board
| | - Nicholas Fidelman
- Panel Chair, University of California San Francisco, San Francisco, California
| | - Mikhail Higgins
- Panel Vice-Chair, Boston University School of Medicine, Boston, Massachusetts
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | - Resmi A Charalel
- Weill Cornell Medicine, New York, New York; and SIR Quality Data Analytics Committee Co-Chair
| | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Alexander Lam
- University of California, San Francisco, San Francisco, California
| | | | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Terri Stillwell
- University of Michigan, Ann Arbor, Michigan; Infectious Diseases Society of America; PIDS Education Committee; SHEA Education Committee; and Panelist, IDSA
| | - Elrond Y L Teo
- Piedmont Atlanta Hospital, Atlanta, Georgia; Society of Critical Care Medicine
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13
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Vijayananthan A, Bhurani D, Sapra H, Yasuda H, Kim JY, Hoerauf K, Mifflin N, Hong SK, Sheng WH, Terasaka Y. Asia-Pacific guidelines for standardization of appropriate selection, placement, and management of vascular access devices. J Vasc Access 2023:11297298221150664. [PMID: 36688479 DOI: 10.1177/11297298221150664] [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: 01/24/2023] Open
Abstract
Vascular access devices (VADs) are common and essential in the healthcare setting. However, several factors influence VAD selection and management. Wide variations in VAD practices and the degree of VAD awareness are noted across Asia-Pacific (APAC) countries. An international panel was convened that applied the ASA 2020 method to develop standard criteria for use of VADs in the APAC region. After a literature search, scenarios related to VAD use, care, and maintenance were developed according to the patient population, indication for insertion, and duration of use. These scenarios were rated on a scale of 1-5 (1 being strongly disagreed and 5 strongly agreed) by 11 expert members. A total of 48 clinical scenarios were developed: 23 in hospitalized patients, 3 in critical patients, 4 in cancer settings, 7 pertinent to VAD placement, and 11 for VAD maintenance. The multidisciplinary panel generated several recommendations for the use, care, and management of VADs across general hospitalized patients with or without difficult venous access, critically ill patients, patients with malignancy, patients with different stages of chronic kidney disease (CKD) with or without dialysis, and in other special populations through evidence-based standards. These recommendations may help in achieving uniformity in practice patterns and improving the quality of VAD care and quality of life of patients in APAC region.
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Affiliation(s)
| | - Dinesh Bhurani
- Rajiv Gandhi Cancer Institute & Research Centre Sector 5, West Delhi, New Delhi, DL, India
| | - Harsh Sapra
- The Medicity Hospital, Gurgaon, Haryana, India
| | - Hideto Yasuda
- Department of Emergency and Critical care Medicine, Jichi Medical University Saitama Medical Center, Kyoto, Japan
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Klaus Hoerauf
- VP Global Medical Affairs, Becton, Dickinson and Company, New York City Metropolitan Area, USA
| | - Nicholas Mifflin
- Clinical Nurse Consultant Central Venous Access & Parenteral Nutrition Liverpool Hospital, Liverpool, NSW, Australia, Adjunct Fellow School of Nursing & Midwifery Western Sydney University, Blacktown, NSW, Australia
| | - Suk Kyung Hong
- University of Ulsan College of Medicine: Songpa-gu, Seoul, Korea
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City
| | - Yusuke Terasaka
- Director of Emergency Department, Kyoto Katsura Hospital, Kyoto City, Kyoto Prefecture, Japan
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14
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Buetti N, Marschall J, Catho G, Timsit JF, Mermel L. Which trial do we need? Infectious and non-infectious complications of peripherally inserted central venous catheters and midline catheters. Clin Microbiol Infect 2023; 29:568-569. [PMID: 36682453 DOI: 10.1016/j.cmi.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; INSERM, IAME, Université Paris-Cité, Paris, France.
| | - Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | | | - Leonard Mermel
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Division of Infectious Diseases, Rhode Island Hospital, Providence, RI, USA; Department of Epidemiology and Infection Prevention, Lifespan Hospital System, Providence, RI, USA
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15
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Urtecho M, Torres Roldan VD, Nayfeh T, Espinoza Suarez NR, Ranganath N, Sampathkumar P, Chopra V, Safdar N, Prokop LJ, O’Horo JC. Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad024. [PMID: 36751645 PMCID: PMC9898877 DOI: 10.1093/ofid/ofad024] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Background Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach. Results Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes. Conclusions Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
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Affiliation(s)
- Meritxell Urtecho
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
| | - Victor D Torres Roldan
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Sampathkumar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vineet Chopra
- Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasia Safdar
- Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Larry J Prokop
- Department of Library-Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Correspondence: J. C. O’Horo, MD, MPH, Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (); or M. Urtecho, MD, Mayo Clinic Evidence-based Practice Center Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ()
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Pittiruti M, Van Boxtel T, Scoppettuolo G, Carr P, Konstantinou E, Ortiz Miluy G, Lamperti M, Goossens GA, Simcock L, Dupont C, Inwood S, Bertoglio S, Nicholson J, Pinelli F, Pepe G. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. J Vasc Access 2023; 24:165-182. [PMID: 34088239 DOI: 10.1177/11297298211023274] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.
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Affiliation(s)
| | | | | | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Godelieve Alice Goossens
- Nursing Centre of Excellence, University Hospitals, Leuven, Belgium and Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
| | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Dupont
- Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, France
| | | | | | - Jackie Nicholson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- Catholic University Hospital 'A. Gemelli', Rome, Italy
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Johnson A, Gupta A, Feierabend T, Lopus T, Schildhouse R, Paje D. Midline Catheters: A 3-Year Experience at a Veterans Administration Medical Center. Am J Infect Control 2022; 51:563-566. [PMID: 35948122 DOI: 10.1016/j.ajic.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Midline catheters are recommended over peripherally inserted central catheters as short-term vascular access device for peripherally compatible infusates. We assessed the effectiveness and safety of midline catheters. METHODS Data from midline catheter placements from June 2016 to May 2019 at a tertiary-care Veterans Administration medical center were retrospectively collected. Patients were followed until catheter removal or death, whichever occurred first. The primary outcome was completion of intended therapy; secondary outcomes were catheter-related complications, including major (eg, catheter-related bloodstream infections [CRBSI] or venous thromboembolism [VTE]) and minor (eg, catheter occlusion, kinking, dislodgement) events. RESULTS Of 115 midlines, 62 (53.9%) were for antibiotic infusion and 49 (32.6%) for difficult access. The median dwell time was 11 days (interquartile range, 5.5-19.5 days). Midline catheters lasted through completion of therapy in 93 patients (80.9%). Catheter-related complications occurred in 27 patients (23.5%), including catheter dislodgement in 10 patients (8.7%), catheter kinking in 8 (7.0%), and catheter occlusion in 3 (2.6%). Only 1 patient experienced a major complication, a deep venous thrombosis (0.9%). CONCLUSIONS Midlines appear to be effective and safe for short-term vascular access in patients requiring peripherally compatible infusates. While the rate of major complications is low, minor complications that necessitate device removal are common.
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Bahl A, Hijazi M, Chen NW. Vesicant infusates are not associated with ultrasound-guided peripheral intravenous catheter failure: A secondary analysis of existing data. PLoS One 2022; 17:e0262793. [PMID: 35085318 PMCID: PMC8794136 DOI: 10.1371/journal.pone.0262793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intravenous vesicants are commonly infused via peripheral intravenous catheters (PIVC) despite guidelines recommending administration via central route. The impact of these medications on PIVC failure is unclear. We aimed to assess dose-related impact of these caustic medications on ultrasound-guided (US) PIVC survivorship. METHODS We performed a secondary analysis of a randomized control trial that compared survival of two catheters: a standard long (SL) and an ultra-long (UL) US PIVC. This study involved reviewing and recording all vesicants infusions through the PIVCs. Type and number of vesicants doses were extracted and characterized as one, two or multiple. The most commonly used vesicants were individually categorized for further analysis. The primary outcome was PIVC failure accounting for use and timing of vesicant infusates. RESULTS Between October 2018 and March 2019, 257 subjects were randomized with 131 in the UL group and 126 in the SL group. Vesicants were infused in 96 (37.4%) out of 257 study participants. In multivariable time-dependent extended Cox regression analysis, there was no significant increased risk of failure due to vesicant use [adjusted hazard ratio, aHR 1.71 (95% CI 0.76-1.81) p = 0.477]. The number of vesicant doses was not significantly associated with the increased risk of PIVC failure [(1 vs 0) aHR 1.20 (95% CI 0.71-2.02) p = 0.500], [(2 vs 0) aHR 1.51 (95% CI 0.67-3.43) p = 0.320] and [(≥ 3 vs 0) aHR 0.98 (95% CI 0.50-1.92) p = 0.952]. CONCLUSION Vesicant usage did not significantly increase the risk of PIVC failure even when multiple doses were needed in this investigation. Ultrasound-guided PIVCs represent a pragmatic option when vesicant therapy is anticipated. Nevertheless, it is notable that overall PIVC failure rates remain high and other safety events related to vesicant use should be considered when clinicians make vascular access decisions for patients.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, Michigan, United States of America
| | - Mahmoud Hijazi
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
| | - Nai-Wei Chen
- Department of Biostatistics, Beaumont Hospital, Royal Oak, Michigan, United States of America
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19
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Nickel B. Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care? Crit Care Nurse 2021; 41:e1-e21. [PMID: 34851379 DOI: 10.4037/ccn2021818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. OBJECTIVE To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. RESULTS Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. DISCUSSION Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. CONCLUSIONS Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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20
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Tomás-López MA, Cristóbal-Domínguez E, Báez-Gurruchaga O, Landa-Portilla B, González-Blas L, Lurueña-Rodríguez S, Picón-Santamaría A, Armenteros-Yeguas V. Experience in the use of midclavicular catheters: An inception cohort study. J Clin Nurs 2021; 31:2296-2308. [PMID: 34553435 DOI: 10.1111/jocn.16047] [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: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal. BACKGROUND Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length. DESIGN Inception cohort study. METHODS We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed. RESULTS Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure. CONCLUSIONS Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal. RELEVANCE TO CLINICAL PRACTICE Midclavicular lines are a safe alternative for intravenous therapy lasting more than 6 days, even with irritant drugs.
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Affiliation(s)
- María Aranzazu Tomás-López
- Oncology department nursing supervisor, Bioaraba, Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Estíbaliz Cristóbal-Domínguez
- Evidence based nursing supervisor. Bioaraba, Nursing and Health Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Oiane Báez-Gurruchaga
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Beatriz Landa-Portilla
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Laura González-Blas
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Selene Lurueña-Rodríguez
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Arantxa Picón-Santamaría
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Victoria Armenteros-Yeguas
- Vascular Care Research Group, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
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Daptomycin versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection with or without Endocarditis: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10081014. [PMID: 34439067 PMCID: PMC8389004 DOI: 10.3390/antibiotics10081014] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of invasive infections, mainly bloodstream infections (BSI) with or without endocarditis. The purpose of this meta-analysis was to compare vancomycin, the mainstay treatment, with daptomycin as therapeutic options in this context. Materials: PubMed, Embase and the Cochrane Database were searched from their inception to 15 February 2020. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, persistence of infection, length-of-stay, antibiotic discontinuation due to adverse events (AEs) and 30-day re-admission. This study was registered with PROSPERO, CRD42020169413. Results: Eight studies (1226 patients, 554 vs. 672 in daptomycin vs. vancomycin, respectively) were included. No significant difference in terms of overall mortality was observed [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.40–1.33, I2 = 67%]. Daptomycin was associated with a significantly reduced risk of clinical failure (OR 0.58, 95% CI 0.38–0.89, I2 = 60%), as confirmed by pooling adjusted effect sizes (adjusted OR against the use of vancomycin 1.94, 95%CI 1.33–1.82, I2 = 41%), and was linked with fewer treatment-limiting AEs (OR 0.15, 95%CI 0.06–0.36, I2 = 19%). No difference emerged between the two treatments as secondary outcomes. Results were not robust to unmeasured confounding (E-value lower than 95% CI 1.00 for all-cause mortality). Conclusions: Against MRSA BSI, with or without endocarditis, daptomycin seems to be associated with a lower risk of clinical failure and treatment-limiting AEs compared with vancomycin. Further studies are needed to better characterize the differences between the two drugs.
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22
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Abstract
OBJECTIVE Midline catheters are considered "midway" regarding vascular access. The objective of this systematic review was to explore the current practice, dwell time, and complication rates of midline catheters. DESIGN Systematic review. SETTING Search on four databases, PubMed, CINAHL, Scopus, and Embase, were conducted for English language articles published after the year 2000. MEASUREMENTS AND MAIN RESULTS A total of 987 articles were identified, of which 31 manuscripts met the inclusion criteria and were selected for review. Quality assurance was performed based on the Newcastle-Ottawa score. Average dwell time and complication rates were calculated for studies involving adult patients and adjusted for sample size. This analysis included data from the placement of 18,972 midline catheters across five countries. Aside from two randomized control trials, most of the studies analyzed were cohort studies. One pediatric and two neonatal studies were included. The average dwell time was 16.3 days (n = 4,412). The adjusted mean infection rate was 0.28/1,000 catheter days, with 64% of studies not reporting any infection with midline catheter. The failure rate of midline catheters was 12.5%. Adjusted average rates of other significant complications included the following: deep vein thrombosis (4.1%), dislodgement (5.0%), occlusion (3.8%), phlebitis (3.4%), and infiltration (1.9%). CONCLUSIONS The dwell times and failure rates of midline catheters compare favorably against published data on other types of catheters. Their infection rates are also lower than the reported rates of central venous catheters; however, they have a higher rate of mechanical complications. Active surveillance of infections due to midline catheters is recommended. More data are needed from pediatric and neonatal populations.
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23
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Lu H, Yang Q, Yang L, Qu K, Tian B, Xiao Q, Xin X, Lv Y, Zheng X. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis. Nurs Open 2021; 9:1873-1882. [PMID: 33991462 PMCID: PMC8994959 DOI: 10.1002/nop2.935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/15/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) can cause venous thromboembolism (VTE), but the prevalence associated with each is controversial. Objective To compare the risk of VTE between MCs and PICCs with a systematic review and meta‐analysis. Methods The Web of Science Core Collection, PubMed, Scopus, Embase, the Cochrane Library and ProQuest were searched from inception to January 2020. All studies comparing the risk of VTE between MCs and PICCs were included. Selected studies were assessed for methodological quality using the Downs and Black checklist. Two authors independently assessed the literature and extracted the data. Any different opinion was resolved through third‐party consensus. Meta‐analyses were conducted to generate estimates of VTE risk in patients with MCs versus PICCs, and publication bias was evaluated with RevMan 5.3. Results A total of 86 studies were identified. Twelve studies were recruited, involving 40,871 patients. The prevalence of VTE with MCs and PICCs was 3.97% (310/7806) and 2.29% (758/33065), respectively. Meta‐analysis showed that the prevalence of VTE with MCs was higher than that with PICCs (RR=1.53, 95% CI: 1.33–1.76, p < .00001). Subgroup analyses by age showed that the prevalence of VTE with MCs was higher than that with PICCs in the adult group (RR=1.75, 95% CI: 1.38–2.22, p < .00001), and higher than that with PICCs in the other subgroups (RR=1.42, 95% CI: 1.19–1.69, p = .0001). Subgroup analyses by nation showed that the prevalence of VTE with MCs was higher than that with PICCs (RR=1.50, 95% CI: 1.30–1.73, p < .00001) in US subgroup and higher than that with PICCs (RR=2.87, 95% CI: 1.24–6.65, p = .01) in the other nations. The sensitivity analysis shows that the results from this meta‐analysis are robust and all studies have no significant publication bias. Conclusions This study provides the first systematic assessment of the risk of VTE between MCs and PICCs. MCs are associated with a higher risk of VTE than PICCs in all patients and adults. The findings of this study have several important implications for future practice. However, the risk of VTE between MCs and PICCs in children is unclear.
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Affiliation(s)
- Huapeng Lu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Qinling Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lili Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Kai Qu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Boyan Tian
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qigui Xiao
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xia Xin
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Xuemei Zheng
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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24
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Lu H, Hou Y, Chen J, Guo Y, Lang L, Zheng X, Xin X, Lv Y, Yang Q. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis. Nurs Open 2020; 8:1292-1300. [PMID: 33372316 PMCID: PMC8046042 DOI: 10.1002/nop2.746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 11/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) can cause catheter‐related bloodstream infection (CRBSI), but the prevalence associated with each is not clear. Objective To compare the risk of CRBSI between MCs and PICCs with a meta‐analysis. Methods The Web of Science Core Collection, PubMed, Scopus, Embase, The Cochrane Library and ProQuest were searched. All studies comparing the risk of CRBSI between MCs and PICCs were included. Selected studies were assessed for methodological quality using the Downs and Black checklist. Two authors independently assessed the literature and extracted the data. A fixed effects model was used to generate estimates of CRBSI risk in patients with MCs versus PICCs. Publication bias was evaluated, and meta‐analyses were conducted with RevMan 5.3. Results A total of 167 studies were identified. Ten studies were collected, involving 33,322 patients. The prevalence of CRBSI with MCs and PICCs was 0.58% (40/6,900) and 0.48% (127/26,422), respectively. Meta‐analysis showed that the prevalence of CRBSI was not significantly different between MCs and PICCs (RR = 0.77, 95% CI: 0.50–1.17, p = .22). While the result showed that the prevalence of CRBSI with MCs was lower than that with PICCs (RR = 0.55, 95% CI: 0.33–0.92, p = .02) after poor‐quality studies were removed. The sensitivity analysis shows that the results from this meta‐analysis are fair in overall studies and non‐poor‐quality studies. All studies have no significant publication bias. Conclusions This study provides the first systematic assessment of the risk of CRBSI between MCs and PICCs and provides evidence for the selection of appropriate vascular access devices for intravenous infusion therapy in nursing. The prevalence of CRBSI was not significantly different between them.
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Affiliation(s)
- Huapeng Lu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Yeru Hou
- School of Nursing, Health Science Center, Yan'an University, Shaanxi, P. R. China
| | - Jiejie Chen
- School of Nursing, Health Science Center, Yan'an University, Shaanxi, P. R. China
| | - Yan Guo
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Lan Lang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xuemei Zheng
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xia Xin
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Yi Lv
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Qinling Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
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25
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Zhao Y, Geng J, Wu X, Xiong S, Wang L, Wang J, Ma H, Wei F, Wei Z. Safety of locating the tip of a medium-long catheter at the axillary front and clavicle midline: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23726. [PMID: 33327363 PMCID: PMC7738149 DOI: 10.1097/md.0000000000023726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medium-long catheters are being used more and more widely in clinical practice, but we still do not know the impact of different placements, but this is an important clinical issue that cannot be ignored. OBJECTIVE At present, the tip positioning of the mid-length catheter mainly includes the anterior part of the axilla and the midclavicular line. Different positioning may have different effects. Therefore, we did this research to confirm which positioning is more safety. METHODS We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, China Knowledge Network, China Biomedical Literature Database, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by 2 researchers, and finally, use Stata to carry out meta-analysis. RESULTS This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION Ethical approval is not applicable, since this is an overview based on published articles. PROTOCOL REGISTRATION NUMBER INPLASY2020110042.
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Affiliation(s)
| | - Jie Geng
- Lanzhou University Second Hospital
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xing Wu
- Lanzhou University Second Hospital
| | | | | | | | - Haijv Ma
- Lanzhou University Second Hospital
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26
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Nielsen EB, Antonsen L, Mensel C, Milandt N, Dalgaard LS, Illum BS, Arildsen H, Juhl-Olsen P. The efficacy of midline catheters-a prospective, randomized, active-controlled study. Int J Infect Dis 2020; 102:220-225. [PMID: 33129962 DOI: 10.1016/j.ijid.2020.10.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/10/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This study was performed to investigate whether an intravenous (IV) strategy based on new-generation midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. METHODS This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. RESULTS One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p < 0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0-60 days) in the midline group and 4 days (range 0-84 days) in the conventional group (p = 0.002). CONCLUSION In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs.
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Affiliation(s)
- Emma Bundgaard Nielsen
- Department of Anesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Louise Antonsen
- Department of Anesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Camilla Mensel
- Department of Anesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Nikolaj Milandt
- Department of Anesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Lars Skov Dalgaard
- Department of Medicine, The Regional Hospital West Jutland, Gl. Landevej 72, 7400 Herning, Denmark
| | - Britta Skov Illum
- Department of Anesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Hanne Arildsen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Peter Juhl-Olsen
- Department of Anesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Institute for Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
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27
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Bahl A, Hijazi M, Chen NW, Lachapelle-Clavette L, Price J. Ultralong Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasonographically Guided Catheter Survival. Ann Emerg Med 2020; 76:134-142. [DOI: 10.1016/j.annemergmed.2019.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/09/2019] [Accepted: 11/14/2019] [Indexed: 11/16/2022]
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28
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Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. Long peripheral catheters for intravenous access in adults and children: A systematic review of the literature. J Vasc Access 2020; 22:767-777. [PMID: 32529915 DOI: 10.1177/1129729820927272] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long peripheral catheters are peripheral intravenous catheters of 6-15 cm in length. They are commonly inserted into the forearm, antecubital fossa or upper arm using a direct Seldinger technique. They have proven to be valuable for peripheral intravenous catheters, particularly in patients with difficult intravenous access. METHODS We conducted a systematic review of studies reporting the use of long peripheral catheters. The following keywords were used: 'long', 'Seldinger', 'guidewire', 'peripheral', 'venous', 'intravenous', 'IV', 'vascular', 'cannula' and 'catheter'. RESULTS Three hundred forty-one publications were identified; 16 were included in the systematic review. There were 11 adult studies and 5 paediatric studies documenting 1288 long peripheral catheters in 1271 patients. Majority of studies (12/16) were conducted in acute care settings, (emergency department, n = 6; intensive care unit, n = 3; high dependency unit, n = 1; surgical unit, n = 2). The most frequently studied long peripheral catheter was 8 cm in length and 20 G in size. Nine studies recruited patients with difficult intravenous access; 11 studies used ultrasound guidance. Insertion success rate and mean procedural time ranged between 86% and 100% and 8 and 16.8 minutes, respectively. Average catheter duration ranged between 4 and 14.7 days (mean) and 1.1 and 9 days (median). Catheter failure occurred in 4.3-52.5% of long peripheral catheters, with leakage, infiltration and dislodgement being the most frequent causes of failure. In 3 randomised controlled trials, long peripheral catheters outperformed peripheral intravenous catheters in terms of duration and failure rate. CONCLUSION Long peripheral catheters are safe and reliable in both adults and children. In addition, long peripheral catheters may provide improved quality of care over peripheral intravenous catheters for multi-day intravenous therapy.
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Affiliation(s)
- Kirby R Qin
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Nicholas Ensor
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Anna Englin
- Department of Anaesthesia, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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29
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Krukas A, Franklin E, Bonk C, Howe J, Dixit R, Adams K, Krevat S, Jones R, Ratwani R. Identifying Safety Hazards Associated With Intravenous Vancomycin Through the Analysis
of Patient Safety Event Reports. PATIENT SAFETY 2020. [DOI: 10.33940/data/2020.3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Intravenous (IV) vancomycin is one of the most commonly used antibiotics in U.S. hospitals. There are several complexities associated with IV vancomycin use, including the need to have an accurate patient weight for dosing, to provide close monitoring to ensure appropriate drug levels, to monitor renal function, and to continue delivery of the medication at prescribed intervals. There are numerous healthcare system factors, including workflow processes, policies, health information technology, and clinical knowledge that impact the safe use of IV vancomycin. Past literature has identified several safety hazards associated with IV vancomycin use and there are some proposed
solutions. Despite this literature, IV vancomycin–related safety issues persist. We analyzed patient safety event reports describing IV vancomycin–related issues in order to identify where in the medication process these issues were appearing, the type of medication error associated with each report, and general contributing factor themes. Our results demonstrate that recent safety reports are aligned with the issues already identified in the literature, suggesting that improvements discussed in the literature have not translated to clinical practice. Based on our analysis and current literature,
we have developed a shareable infographic to improve clinician awareness of the complications and safety hazards associated with IV vancomycin and a self-assessment tool to support identification of opportunities to improve patient safety during IV vancomycin therapy. We also recommend development of clear guidelines to optimize health information technology systems to better support safe IV vancomycin use.
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Affiliation(s)
- Adam Krukas
- MedStar Health National Center for Human Factors in Healthcare
| | - Ella Franklin
- MedStar Health National Center for Human Factors in Healthcare
| | - Chris Bonk
- MedStar Health National Center for Human Factors in Healthcare
| | - Jessica Howe
- MedStar Health National Center for Human Factors in Healthcare
| | - Ram Dixit
- MedStar Health National Center for Human Factors in Healthcare
| | - Katie Adams
- MedStar Health National Center for Human Factors in Healthcare
| | - Seth Krevat
- MedStar Health National Center for Human Factors in Healthcare
| | | | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare and Georgetown University School of Medicine
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30
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Norris AH, Shrestha NK, Allison GM, Keller SC, Bhavan KP, Zurlo JJ, Hersh AL, Gorski LA, Bosso JA, Rathore MH, Arrieta A, Petrak RM, Shah A, Brown RB, Knight SL, Umscheid CA. 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis 2020; 68:e1-e35. [PMID: 30423035 DOI: 10.1093/cid/ciy745] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Indexed: 12/16/2022] Open
Abstract
A panel of experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.
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Affiliation(s)
- Anne H Norris
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Genève M Allison
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Sara C Keller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kavita P Bhavan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - John J Zurlo
- Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City
| | - Lisa A Gorski
- Wheaton Franciscan Home Health & Hospice, Part of Ascension at Home, Milwaukee, Wisconsin
| | - John A Bosso
- Departments of Clinical Pharmacy and Outcome Sciences and Medicine, Colleges of Pharmacy and Medicine, Medical University of South Carolina, Charleston
| | - Mobeen H Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service and Wolfson Children's Hospital, Jacksonville
| | - Antonio Arrieta
- Department of Pediatric Infectious Diseases, Children's Hospital of Orange County Division of Pediatrics, University of California-Irvine School of Medicine
| | | | - Akshay Shah
- Metro Infectious Disease Consultants, Northville, Michigan
| | - Richard B Brown
- Division of Infectious Disease Medical Center, University of Massachusetts School of Medicine, Worcester
| | - Shandra L Knight
- Library & Knowledge Services, National Jewish Health, Denver, Colorado
| | - Craig A Umscheid
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia
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31
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Spiegel RJ, Eraso D, Leibner E, Thode H, Morley EJ, Weingart S. The Utility of Midline Intravenous Catheters in Critically Ill Emergency Department Patients. Ann Emerg Med 2019; 75:538-545. [PMID: 31882244 DOI: 10.1016/j.annemergmed.2019.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Midline catheters are an alternative to more invasive types of vascular access in patients in whom obtaining peripheral access has proven difficult. Little is known of the safety and utility of midline catheters when used more broadly in critically ill patients in the emergency department (ED). These are long peripheral catheter, ranging from 10 to 25 cm in length, typically placed with assistance of ultrasound and the Seldinger's technique. We describe our experience with the use of midline catheters in the ED. METHODS We conducted a prospective observational case series of all patients who had a midline catheter insertion attempted in the ED. We prospectively captured data on indication, technique, location, catheter type, number of attempts, overall success or failure, vasoactive use, and complications (daily catheter patency, flow, site appearance, and dwell-time complications). RESULTS From January 28, 2016, to December 30, 2017, practitioners placed 403 midline catheters. Catheter insertion success was 99%, and the median number of attempts was 1 (interquartile range 1 to 1; minimum 1; maximum 3). The median number of days the catheter remained in place was 5 (interquartile range 2 to 8). Failure to aspirate occurred in 57 patients (14%; 95% confidence interval 11% to 18%). Overall, 10 patients (2.5%; 95% confidence interval 1.2% to 4.5%) experienced 10 insertion-related complications. During the study period, 49 patients (12%; 95% confidence interval 9% to 16%) experienced 60 dwell-time-related complications. Severe complications occurred in 3 patients (0.7%). CONCLUSION Midline catheters may present a feasible alternative to central venous access in certain critically ill ED patients.
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Affiliation(s)
- Rory J Spiegel
- Department of Critical Care, Department of Emergency Medicine, Washington Hospital Center, Georgetown University, Washington, DC.
| | - Daniel Eraso
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Evan Leibner
- Critical Care Medicine, Department of Emergency Medicine, Mount Sinai Hospital, New York, NY
| | - Henry Thode
- Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Eric J Morley
- Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Scott Weingart
- Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY; Division of Emergency Critical Care, Stony Brook Medicine, Stony Brook, NY
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32
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Seo H, Altshuler D, Dubrovskaya Y, Nunnally ME, Nunn C, Ello N, Papadopoulos J, Chen XJC. The Safety of Midline Catheters for Intravenous Therapy at a Large Academic Medical Center. Ann Pharmacother 2019; 54:232-238. [PMID: 31565960 DOI: 10.1177/1060028019878794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Midline catheters (MCs) have arisen as alternatives to peripherally inserted central catheters (PICCs) for both general intravenous therapy and extended outpatient parenteral therapy. However, there is a lack of data concerning the safety of medication therapy through midline for extended durations. Objective: The purpose of this study is to evaluate the safety of MCs for extended intravenous use. Methods: This was a retrospective cohort study evaluating patients who received intravenous therapy through an MC at a tertiary care academic medical center. The primary end point was the incidence of composite catheter-related adverse events that included local events, catheter dislodgment, infiltration, catheter occlusion, catheter-related venous thromboembolism, extravasation, and line-associated infection. Results: A total of 82 MC placements and 50 PICC placements were included; 50 MCs were for outpatient parenteral antimicrobial therapy, and 32 were for inpatient intravenous use. There were 21 complications per 1000 catheter-days in the outpatient group and 7 complications per 1000 catheter-days in the PICC group (P = 0.91). The median time to complication in both groups was 8 days. The antimicrobial classes commonly associated with complications were cephalosporins, carbapenems, and penicillins. Conclusion and Relevance: Our results suggest that intravenous therapy with MCs is generally safe for prolonged courses that do not exceed 14 days as compared with PICC lines, which can be placed for months. There is still limited evidence for the use of MCs between 14 and 28 days of therapy. This study can help guide our selection of intravenous catheters for the purpose of outpatient antimicrobial therapy.
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DeVries M, Lee J, Hoffman L. Infection free midline catheter implementation at a community hospital (2 years). Am J Infect Control 2019; 47:1118-1121. [PMID: 31047692 DOI: 10.1016/j.ajic.2019.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND To reduce excess central line use and provide an option for difficult venous access patients through the introduction of a midline catheter. METHODS Design included prospective monitoring of the implementation of a quality improvement project. The setting was a 576 bed, urban, community, nonprofit, Magnet recognized, level 3 trauma center serving primarily adult patients. Midline and peripherally inserted central catheters were inserted by a specialty nursing team; care and maintenance of all devices were provided by front line staff. RESULTS Zero midline catheter infections were observed in the 24 months after implementation of the fixed length, power injectable device. Completion of therapy was 80%, the most frequently encountered complication was device dislodgement. CONCLUSIONS Adoption of a vascular access nurse led midline catheter program, coupled with device selection algorithms expanded the ability to select the right device for the patient, while decreasing excess central line usage without additional increased risks to the patient.
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Affiliation(s)
- Michelle DeVries
- Infection Control, Methodist Hospitals, Gary, IN, USA; Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Janice Lee
- Vascular Access Team, Methodist Hospitals, Gary, IN, USA
| | - Lisa Hoffman
- Vascular Access Team, Methodist Hospitals, Gary, IN, USA
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34
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Bahl A, Karabon P, Chu D. Comparison of Venous Thrombosis Complications in Midlines Versus Peripherally Inserted Central Catheters: Are Midlines the Safer Option? Clin Appl Thromb Hemost 2019; 25:1076029619839150. [PMID: 30909723 PMCID: PMC6714901 DOI: 10.1177/1076029619839150] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Catheter-related (CR) thrombosis is a significant complication of midline catheters (MCs)
and peripherally inserted central catheters (PICCs). Limited existing data for MCs suggest
a favorable complication profile for MCs. To compare incidence of CR thrombosis between
MCs and PICCs and to evaluate the impact of quantity of lumens and catheter diameter on CR
thrombosis. This was a retrospective comparison spanning 13 months of MCs and PICCs for
symptomatic CR thrombosis at an 1100 bed tertiary care academic medical center. Adult
patients who had an MC or a PICC placed by the were included. Data were collected using
the electronic medical record. Statistical analysis was performed using SAS software. A
total of 2577 catheters were included in the analysis with 1094 MCs and 1483 PICCs. One
hundred thirty (11.88%) MCs developed CR thrombosis (deep vein thrombosis [DVT] or
superficial venous thrombophlebitis [SVT]) as compared to 112 (6.88%) PICCs (odds ratio
[OR]: 1.82; P < .0001). Midline catheters had a 53% greater odds of
developing CR DVT than PICCs (7.04% MCs and 4.72% PICCs; OR: 1.53; P =
.0126). For CR SVT, MCs have a 2.29-fold greater odds of developing CR SVT than PICCs
(4.84% MCs and 2.16% PICCs; OR: 2.29; P = .0002). For MCs and PICCs, the
incidence of CR thrombosis was 13.50% for double lumen/5F lines and was 6.92% for single
lumen/4F lines (OR: 2.10; P = <.0001). Symptomatic CR thrombosis is a
serious, life-threatening complication that occurs more frequently in MCs compared to
PICCs. Inserters should consider placement of single lumen catheters with the smallest
diameter to reduce this risk when a midline is used.
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Affiliation(s)
- Amit Bahl
- 1 William Beaumont Hospital, Royal Oak, MI, USA
| | - Patrick Karabon
- 2 Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - David Chu
- 2 Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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35
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Optimizing vascular-access device decision-making in the era of midline catheters. Infect Control Hosp Epidemiol 2019; 40:674-680. [PMID: 30924436 DOI: 10.1017/ice.2019.49] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This narrative review addresses vascular access device choice from peripheral intravenous catheters through central venous catheters, including the evolving use of midline catheters. The review incorporates best practices, published algorithms, and complications extending beyond CLABSI and phlebitis to assist clinicians in navigating complex vascular access decisions.
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36
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Pathak R, Bierman SF, d'Arnaud P. Inhibition of bacterial attachment and biofilm formation by a novel intravenous catheter material using an in vitro percutaneous catheter insertion model. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:427-432. [PMID: 30588133 PMCID: PMC6305250 DOI: 10.2147/mder.s183409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Despite sterile barrier precautions and vigorous skin antisepsis, percutaneous insertion of intravenous catheters has been shown to result in attachment to the catheter surface of bacteria residing in the deep structures of the skin. Such attachment poses the risk of biofilm formation and eventual catheter-related bloodstream infection (CRBSI). This study was undertaken to assess whether the non-coated surface treatment of a unique catheter material (ChronoFlex C® with BioGUARD™) could inhibit bacterial attachment and biofilm formation. Methods A novel in vitro model and fluorescence microscopy were used to compare two intravascular catheter materials with respect to bacterial attachment and biofilm formation. The control material was a commonly used polyurethane. The study material was a unique copolymer, treated so as to remove surface additives, alter hydrophobicity and create surface micro-patterning. Outcomes were assessed using both a membrane potential indicator and a cell death reporter with appropriate fluorescent channels. Thus, bacterial cells attached to the catheter surface (living and dead) were imaged without mechanical disruption. Results Both bacterial attachment and biofilm formation are significantly inhibited by the study catheter material. In fact, over 5 times more bacteria were able to attach and grow on the control polyurethane material than on the study material (P=0.0020). Moreover, those few bacteria that were able to attach to the study material had a 1.5 times greater likelihood of dying. Conclusion Using a novel in vitro percutaneous catheter insertion model, ChronoFlex C with BioGUARD is proven to significantly inhibit bacterial attachment and biofilm formation as compared with a commonly used polyurethane catheter material.
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Affiliation(s)
- Rahul Pathak
- University of Central Florida College of Medicine, Lakeland, FL 33813, USA,
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37
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Keller SC, Dzintars K, Gorski LA, Williams D, Cosgrove SE. Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy. Pharmacotherapy 2018; 38:476-481. [PMID: 29493791 PMCID: PMC5902416 DOI: 10.1002/phar.2099] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. METHODS We performed a prospective cohort study of patients requiring home-based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. RESULTS Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89-2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20-4.46] and 4.45 [95% CI: 1.02-19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09-4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12-41.97). CONCLUSIONS Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants.
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Affiliation(s)
- Sara C Keller
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn Dzintars
- Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa A Gorski
- Wheaton Franciscan Home Health, Milwaukee, Wisconsin
| | | | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Holder MR, Stutzman SE, Olson DM. Impact of Ultrasound on Short Peripheral Intravenous Catheter Placement on Vein Thrombosis Risk. JOURNAL OF INFUSION NURSING 2017; 40:176-182. [PMID: 28419014 DOI: 10.1097/nan.0000000000000219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 90% of hospitalized patients have a short peripheral intravenous catheter (SPC) placed. Methods of inserting the catheter have evolved over time and now include the use of ultrasound (US)-guided procedures for placement. Little is known about the impact that US-guided procedures have on the vein. This study compared the rate of venous thrombosis in patients with and without US-guided catheter placement. This prospective, single-blind, observational study assessed for venous thrombosis in 153 veins from 135 patients. Veins were evaluated by a research nurse blinded to the method of placement between 48 and 72 hours after the SPC was placed. The Fisher exact test showed a significant difference between vessel compressibility and catheter insertion method (P = .0012). The proportion of noncompressible veins was significantly greater when US was used in comparison with freehand SPC insertion. The Mantel-Haenszel chi-square value of 10.34 (P = .0013) showed that US insertion technique is associated with a higher likelihood of noncompressible veins. This pilot study provides compelling evidence that the use of US to assist with catheter placement is associated with a higher rate of noncompressible veins at day 2 or 3. Further studies are needed with a larger sample to determine the generalizability of the results from this pilot study.
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Affiliation(s)
- Max R Holder
- The University of Texas Southwestern Medical Center, Dallas, Texas. Max R. Holder, BSN, RN, is the manager of the vascular access team in the Imaging Department at the UT Southwestern Medical Center. Sonja E. Stutzman, PhD, is the research manager for the Neuroscience Nursing Research Center at the UT Southwestern Medical Center. DaiWai M. Olson, PhD, RN, is a staff nurse and associate professor of neurology and neurotherapeutics at the UT Southwestern Medical Center
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39
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Development of an Evidence-Based List of Noncytotoxic Vesicant Medications and Solutions. JOURNAL OF INFUSION NURSING 2017; 40:26-40. [PMID: 28030480 DOI: 10.1097/nan.0000000000000202] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infiltration of a vesicant medication, defined as extravasation, may result in significant patient injuries. The first step in preventing extravasation is the identification and recognition of vesicant medications and solutions. Because there is no list of noncytotoxic vesicants as established by a professional organization, the Infusion Nurses Society, as the global authority in infusion nursing, identified the need to address this gap. A task force was formed for the purpose of creating an evidence-based list of noncytotoxic vesicant medications and solutions.
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40
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Caparas JV, Hung HS. Vancomycin Administration Through a Novel Midline Catheter: Summary of a 5-Year, 1086-Patient Experience in an Urban Community Hospital. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.java.2016.10.092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background: The 2016 Infusion Therapy Standards of Practice no longer require that low pH (<5) medications be administered via central venous access devices. Nevertheless, the practice of placing PICCs for vancomycin administration often persists.
Purpose: To demonstrate the safety and efficacy of intravenous vancomycin administration through a short and long term midline catheter.
Methodology: A retrospective chart review was performed on 1086 patients who received intravenous vancomycin through a midline catheter.
Results: There were no catheter-associated bloodstream infections and no deep vein thromboses. Phlebitis occurred rarely (0.6%), as did benign infiltrations (1.2%). There were no extravasation injuries.
Conclusions: These outcomes summarize more than 5 years of experience administering intravenous vancomycin (4 mg/mL) safely and cost-efficiently through a nontrimmable midline catheter.
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41
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Fabiani A, Dreas L, Sanson G. Ultrasound-guided deep-arm veins insertion of long peripheral catheters in patients with difficult venous access after cardiac surgery. Heart Lung 2017; 46:46-53. [DOI: 10.1016/j.hrtlng.2016.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
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Abstract
The Infusion Nurses Society's Infusion Nursing Standards of Practice has treated pH as a critical factor in the decision-making process for vascular access device selection, stating that an infusate with a pH less than 5 or greater than 9 is not appropriate for short peripheral or midline catheters. Because of the Standards, drug pH is not an uncommon factor driving the decision for central vascular access. In this era of commitment to evidence-based practice, the pH recommendation requires reevaluation and a critical review of the research leading to infusate pH as a decisional factor. In this narrative literature review, historical and current research was appraised and synthesized for pH of intermittently delivered intravenous medications and the development of infusion thrombophlebitis. On the basis of this review, the authors conclude and assert that pH alone is not an evidence-based indication for central line placement.
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43
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Comment on: Safe Administration of Vancomycin through a Novel Midline Catheter: A Randomized, Prospective Clinical Trial. J Vasc Access 2016; 17:e91. [DOI: 10.5301/jva.5000564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2016] [Indexed: 11/20/2022] Open
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Abdullah KG, Chen HI, Lucas TH. Safety of topical vancomycin powder in neurosurgery. Surg Neurol Int 2016; 7:S919-S926. [PMID: 28031984 PMCID: PMC5180439 DOI: 10.4103/2152-7806.195227] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/28/2016] [Indexed: 12/16/2022] Open
Abstract
Surgical site infections (SSIs) remain an important cause of morbidity following neurosurgical procedures despite the best medical practices. In addition, hospital infection rates are proposed as a metric for ranking hospitals safety profiles to guide medical consumerism. Recently, the use of topical vancomycin, defined as the application of vancomycin powder directly into the surgical wound, has been described in both cranial and spinal surgeries as a method to reduce SSIs. Early results are promising. Here, we provide a concise primer on the pharmacology, bacterial spectrum, history, and clinical indications of topical vancomycin for the practicing surgeon.
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Affiliation(s)
- Kalil G Abdullah
- Department of Neurosurgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Isaac Chen
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy H Lucas
- Department of Neurosurgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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45
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Xu T, Kingsley L, DiNucci S, Messer G, Jeong JH, Morgan B, Shutt K, Yassin MH. Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center. Am J Infect Control 2016; 44:1458-1461. [PMID: 27908432 DOI: 10.1016/j.ajic.2016.09.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are a commonly used central intravenous (IV) access device, which can be associated with significant complications. Midline catheters (MCs) are peripheral IV access devices that may reduce the need for central lines and hence decrease central line-associated bloodstream infections. The objective of this study is to compare the utilization and safety of PICCs and MCs. METHODS This was a retrospective study comparing the use and outcomes of PICCs and MCs at a large academic medical center between January and May 2015. Data were collected using electronic medical records and IV team insertion data. Statistical software was used for analysis. RESULTS A total of 206 PICCs and 200 MCs were inserted in 367 patients within the study duration. Patients with MCs were more likely to have complications than those with PICCs (19.5% vs 5.8%, P < .0001). CONCLUSIONS MCs were associated with a higher risk of non-life-threatening complications versus PICCs, which showed fewer but more serious complications, including bacteremia. The decision to move toward more use of MCs is not without risk. Institutions should continue to review the utilization and safety data of IV catheter use to determine the most appropriate use of these devices.
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Affiliation(s)
- Tianyuan Xu
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Susan DiNucci
- Infection Control Department, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
| | - Gwen Messer
- Infection Control Department, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
| | - Jong-Hyeon Jeong
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA
| | - Brian Morgan
- Intravenous Access Team, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
| | - Kathleen Shutt
- Infectious Diseases Division, University of Pittsburgh, Pittsburgh, PA
| | - Mohamed H Yassin
- Infection Control Department, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA; Infectious Diseases Division, University of Pittsburgh, Pittsburgh, PA.
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Moureau N, Chopra V. Indications for Peripheral, Midline, and Central Catheters: Summary of the Michigan Appropriateness Guide for Intravenous Catheters Recommendations. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.java.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access; those requiring multiple attempts; and those who are obese, have diabetes, or have other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In clinical settings, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access. Selection of the most appropriate VAD is necessary to avoid the potentially serious complications of infection and/or thrombosis. An international panel of experts convened to establish a guide for indications and appropriate use for VADs. This article summarizes the work and recommendations of the panel that created the Michigan Appropriateness Guide for Intravenous Catheters.
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Affiliation(s)
- Nancy Moureau
- Griffith University, Brisbane, Australia
- PICC Excellence, Inc, Greenville, SC
- Greenville Memorial Hospital, Greenville, SC
| | - Vineet Chopra
- School of Medicine, University of Michigan, Ann Arbor, MI
- Ann Arbor VA Medical Center, Ann Arbor, MI
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47
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Adams DZ, Little A, Vinsant C, Khandelwal S. The Midline Catheter: A Clinical Review. J Emerg Med 2016; 51:252-8. [DOI: 10.1016/j.jemermed.2016.05.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
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Affiliation(s)
- S Bierman
- Access Scientific, Del Mar, CA, USA.
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49
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Moureau N, Chopra V. Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations. ACTA ACUST UNITED AC 2016; 25:S15-24. [DOI: 10.12968/bjon.2016.25.8.s15] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nancy Moureau
- Registered Nurse, Adjunct Associate Professor, Griffith University, Brisbane, Australia; Chief Executive Officer, PICC Excellence, Inc and Vascular Access Specialist, Greenville Memorial Hospital, Greenville, South Carolina
| | - Vineet Chopra
- Doctor of Medicine, Assistant Professor of Medicine and Research Scientist, School of Medicine, University of Michigan, and Ann Arbor VA Medical Center, Ann Arbor, Michigan
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50
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Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy. Antimicrob Agents Chemother 2015; 60:36-43. [PMID: 26459894 DOI: 10.1128/aac.00700-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ≥2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified.
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