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Fabiani A, Aversana N, Santoro M, Sanson G. Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection. Thromb Res 2024; 236:117-126. [PMID: 38422981 DOI: 10.1016/j.thromres.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Long peripheral catheters (LPCs) and midline catheters (MCs) are indiscriminately labelled with different names, leading to misclassifications both in primary and secondary studies. The available studies used different methods to report the incidence of catheter-related complications, affecting the possibility of properly comparing the catheter outcomes. The aim of this review was to explore the complications related to LPCs and MCs after reclassifying according to their length. METHODS Systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted on PubMed, Scopus and CINAHL databases. The study protocol was registered in the International Prospective Register of Systematic Reviews. Data regarding LPCs and MCs were compared. Catheter outcomes were classified into major and minor complications, recomputed and reported as cases/1000 catheter-days. RESULTS Fourteen studies were included. Over-half of the devices were correctly labelled by the authors, misclassifications affected particularly LPCs improperly labelled MCs. The cumulative incidence of catheter-related bloodstream infections was 0.3 and 0.4/1000 catheter-days, that of symptomatic catheter-related thrombosis was 0.9 and 1.8/1000 catheter-days for MCs and LPCs, respectively. Minor complications and catheter failure were higher for LPCs. CONCLUSIONS A misclassification exists in the labelling of MCs and LPCs. A widespread heterogeneity of diagnostic criteria adopted to classify the catheters' outcomes was found, exposing the risk of misestimating the incidence of complications and undermining the possibility of effectively comparing results of the published research. We proposed a list of definitions and relevant variables as a first step toward the development of standardized criteria to be adopted for research purposes.
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Affiliation(s)
- Adam Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata - Via Montpellier 1, Rome, Italy; Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Nicola Aversana
- School of Nursing, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
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2
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Prakash R, Ohri A, Udani A, Ali US. Survival of Tunneled Double Lumen-Cuffed Catheters in Children on Maintenance Hemodialysis - A Retrospective Cohort Study. Indian J Nephrol 2023; 33:348-355. [PMID: 37881745 PMCID: PMC10593302 DOI: 10.4103/ijn.ijn_37_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/05/2022] [Accepted: 06/22/2022] [Indexed: 10/27/2023] Open
Abstract
Introduction Survival of tunneled cuffed catheters (TCC), used widely in children, is complicated by infections and catheter dysfunction. In resource limited settings, where risk of complications could be higher and waiting period for transplantation longer, catheter survival determines patient survival. This study was conducted to determine infection free catheter survival rates, incidence of catheter failure and associated risk factors. Methods Children <18 years of age receiving maintenance hemodialysis through TCC at nephrology division of a pediatric hospital, over a period of 6 years. Data was collected with consecutive selection by a complete enumeration technique from pre-collected data sheets in the records. Exposure detected were catheter infections, thrombosis, and mechanical complications. Results Forty-five TCCs in 36 children studied for 12,590 catheter days showed catheter failure in 36%, due to catheter related infections in 75% and mechanical complications in 25%. The incidence of complications per 1000 catheter days was 1.19 infection, 1.03 thrombus, and 0.39 mechanical. Catheter-related blood stream infection (CRBSI) (15/36) was associated with thrombus in nine and led to mortality in three. The mean infection free catheter survival was 449 ± 42 days for cohort with 388 ± 38 days in Group A (premature catheter removal) and 593 ± 43 days in Group B (elective removal) (P = 0.03). Catheterization duration of 267 days predicted CRBSI (sensitivity 93%, specificity 66.7%) with area under the curve of 0.808. Conclusions Median infection free catheter survival was 449 days with catheter failure in 36%. CRBSI was the main cause of failure. Duration of catheterization greater than 267 days was a predictor of CRBSI.
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Affiliation(s)
- Richa Prakash
- Department of Pediatrics, Bai Jerbai Hospital for Children, Mumbai, Maharashtra, India
| | - Alpana Ohri
- Department of Pediatrics, Bai Jerbai Hospital for Children, Mumbai, Maharashtra, India
| | - Amish Udani
- Department of Pediatrics, Bai Jerbai Hospital for Children, Mumbai, Maharashtra, India
| | - Uma Sankari Ali
- Department of Pediatrics, Bai Jerbai Hospital for Children, Mumbai, Maharashtra, India
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Guerreiro H, Schröder H, Huber G, Busch F, Sellenschloh K, Adam G, Ittrich H, Busch JD. Quantification of mechanical properties in long-term in vivo used silicone catheter lines according to DIN 10555-3. Clin Biomech (Bristol, Avon) 2023; 107:106015. [PMID: 37321163 DOI: 10.1016/j.clinbiomech.2023.106015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Totally implantable central venous access port devices are crucial for intravenous application of chemotherapeutics and long-term therapy for chronic disease. Common complications include thrombosis and device fracture related to altered material properties through exposure in situ. This study exhibits whether uniaxial tensile properties (DIN 10555-3) of in vivo used catheters prove inferior to unused catheters. MATERIAL AND METHODS 5 unused, originally packed silicone catheters were cut into 6 segments of 50 mm: 3 segments each were cleaned via cleaning solution (n = 15) while 3 segments were left unattended (n = 15). Distal segments (50 mm) of long-term in vivo used silicone catheters were cleaned before testing (n = 33). Overall mechanical behavior was tested in a custom-made self-centering, torsion free carrier. Maximum force stress at failure, strain at failure and Young's modulus were determined and statistically analyzed. FINDINGS Unused catheters showed no significant difference in testing. in vivo used catheters exhibited 20% lower maximal force than unused catheters (p < 0.001), strain at break (p 〈0,001), and 7% higher elastic modulus (p = 0.004; power: 0.845). Due to a constant cross section area, stress at failure was proportional to maximum force (p < 0.001). Relation between determined parameters and dwell times was non-significant. INTERPRETATION In vivo long-term used silicone catheters showed significantly lower ultimate strength than unused ones. It is likely that in situ altering changes the mechanical properties of catheters and may potentially lead to failure.
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Affiliation(s)
- H Guerreiro
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - H Schröder
- Institute of Biomechanics TUHH Hamburg University of Technology, Hamburg, Germany
| | - G Huber
- Institute of Biomechanics TUHH Hamburg University of Technology, Hamburg, Germany
| | - F Busch
- Division of Neonatology, Department of Pediatrics Bern University Hospital, University of Bern, Switzerland
| | - K Sellenschloh
- Institute of Biomechanics TUHH Hamburg University of Technology, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J D Busch
- Department of Diagnostic, Interventional Radiology and Pediatrics Bern University Hospital, University of Bern, Switzerland
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Murayama R, Abe-Doi M, Masamoto Y, Kashiwabara K, Komiyama C, Sanada H, Kurokawa M. Verification study on the catheterization of an upper arm vein using the new long peripheral intravenous catheter to reduce catheter failure incidence: A randomized controlled trial. Drug Discov Ther 2023; 17:52-59. [PMID: 36858623 DOI: 10.5582/ddt.2022.01108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Intravenous infusion using a peripheral intravenous catheter (PIVC) is often complicated by catheter failure (CF). We hypothesized that catheterization of an upper arm vein instead of a forearm vein may help prevent CF. This study was designed to compare the incidence of CF in patients receiving hyper-stimulant drugs when catheters are placed in the forearm using short PIVCs (SPCs) with that when catheters are placed in the upper arm using the new long PIVCs. Patients admitted to a university hospital in Tokyo, Japan were enrolled in this study and were assigned to the SPC or the new long PIVC group. The primary outcome was the incidence of CF until 7 days. The secondary outcomes were the number of CFs per 1,000 days, the duration of the indwelling catheter, and the presence of thrombi and subcutaneous edema. Forty-seven patients were analyzed (median age, 67.0 years). The incidence of CF was 0% in the new long PIVCs and 32.0% (8 catheters) in the SPCs (p = 0.007), and the number of CF per 1,000 days was 0/1,000 and 81.7/1,000 days, respectively (p = 0.001). A significant difference in the duration of the indwelling catheter until CF occurrence was observed between the two groups (p = 0.004). Thrombi and subcutaneous edema were observed more frequently in the SPC group (p < 0.001). Catheterization of an upper arm vein using the new long PIVC to administer a hyper-stimulant drug might reduce CF compared with catheterization of a forearm vein using SPC.
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Affiliation(s)
- Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research Center for Implementation Nursing Science Initiative, Fujita Health University, Aichi, Japan
| | - Mari Abe-Doi
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Kashiwabara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Komiyama
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan.,Lifelong Learning Center IUHW, International University of Health and Welfare, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
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5
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Fabiani A, Santoro M, Sanson G. The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters. Heart Lung 2023; 60:39-44. [PMID: 36898280 DOI: 10.1016/j.hrtlng.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In patients requiring a peripheral venous access for more than seven days, long peripheral catheters (LPCs) or midline catheters (MCs) are recommended. Since MCs and LPCs share many characteristics, studies comparing devices made of the same biomaterial are needed. Moreover, a catheter-to-vein ratio >45% at the insertion point has been recognized as a risk factor for catheter related complications, but no study investigated the effect of the catheter-to-vein ratio at the catheter tip level in peripheral venous devices. OBJECTIVES To compare the catheter failure risk between polyurethane MCs and LPCs, considering the effect of the catheter-to-vein ratio at the tip location. METHODS Retrospective cohort study. Adult patients having an expected need for a vascular access of more than 7 days and receiving either a polyurethane LPC or MC were included. The catheter uncomplicated indwelling time within 30 days was considered in survival analysis. RESULTS In a sample of 240 patients, the relative incidences of catheter failure were 5.13 and 3.40 cases for 1,000 catheter days for LPCs and MCs, respectively. In univariate Cox regression, MCs were associated to a statistically significant lower risk of catheter failure (HR 0.330; p = 0.048). After adjusting for other relevant conditions, a catheter-to-vein ratio >45% at the catheter tip location - not the catheter itself - was an independent predictor of a catheter failure (HR 6.762; p = 0.023). CONCLUSIONS The risk of catheter failure was strongly associated with a catheter-to-vein ratio > 45% at the catheter tip level, irrespective for having used a polyurethane LPC or MC.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste 34148, Italy.
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Takahashi T, Minematsu T, Murayama R, Nakagami G, Mori T, Sanada H. Catheter tips are a possible resource for biological study on catheter failure. Drug Discov Ther 2019; 13:280-287. [PMID: 31723100 DOI: 10.5582/ddt.2019.01073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Few studies have investigated the molecular mechanisms of catheter failure (CF). Herein, we performed histological and molecular biological analyses of the catheter tip to demonstrate its potential as a resource for biological investigation. Additionally, we searched for risk factors for the development of inflammation and coagulation, which are pathological conditions clarified by biological analysis. The CF group included 30 failed catheters involving thrombus and subcutaneous edema identified by ultrasonography. The No-CF group included 26 catheters with no complications. The removed catheter tips were fixed for hematoxylin-eosin (HE) staining with the application of a real-time reverse transcriptase polymerase chain reaction for eukaryotic 18S ribosomal RNA (rRNA), interleukin 1β, tumor necrosis factor α, tissue plasminogen activator, and plasminogen activator inhibitor 1 (SERPINE1). HE staining identified attached nuclear cells on the inner surfaces of both CF and No-CF catheters. The 18S rRNA was amplified in all samples. The expression level of SERPINE1 was significantly higher in the CF group than in the No-CF group (p = 0.01), whereas the expression levels of other genes did not differ between the groups. Symptoms of CF associated with the expression of SERPINE1 were analyzed. The catheter being in contact with blood vessels during placement was a suggested factor related to the high expression of SERPINE1 (p = 0.04). Catheter tips are a potential resource for biological investigation, and expression analysis of the attached cells can reflect the pathological condition of the catheterized tissue. Further studies using catheter tips are required to elucidate the molecular mechanisms of CF.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoko Murayama
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mori
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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7
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Blanco-Mavillard I, Rodríguez-Calero MÁ, de Pedro-Gómez J, Parra-García G, Fernández-Fernández I, Castro-Sánchez E. Incidence of peripheral intravenous catheter failure among inpatients: variability between microbiological data and clinical signs and symptoms. Antimicrob Resist Infect Control 2019; 8:124. [PMID: 31367345 PMCID: PMC6647274 DOI: 10.1186/s13756-019-0581-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices among inpatients. Catheter-related bloodstream infections (CRBSI) are serious yet preventable events for patients. Although the contribution of PIVCs towards these infections is gradually being recognised, its role in the Spanish setting is yet to be determined. We aimed to estimate the rate and incidence of PIVC failure at Manacor hospital (Spain) as baseline within a wider quality improvement initiative. Methods Tips from all PIVC removed during December 2017 and January 2018 in hospital wards were cultured semiquantitatively. The study population included all PIVCs inserted in adult patients admitted to any of three medical and one surgical wards, emergency department, critical care unit and operating rooms. Clinical, microbiological and ward information was collected by clinical researchers for each PIVC from insertion to removal on the study sites. CRBSI was defined per international guidelines (i.e., Centers for Disease Control and Prevention, USA). Data was analysed descriptively. Results Seven hundred and eleven tips were cultured, with 41.8% (297/711) reported as PIVC failure. The PIVC failure rate density-adjusted incidence for hospital length of stay (HLOS) was 226.2 PIVC failure/1000 HLOS. 5.8% (41/711) tips yielded positive isolates, with most frequent microorganisms Staphylococcus spp (S. epidermidis 29/41, 70.7%, S. aureus 2/41, 4.9%, S. hominis 2/41, 4.9%), and Acinetobacter baumannii (1/41, 2.4%). One S. aureus isolate was methicillin-resistant. 53.6% (22/41) positive cultures were obtained from patients with local signs and symptoms compatible with catheter-related infection (CRI), 2.4% (1/41) were compatible with CRBSI type 2 and that clinical signs improve within 48 h of catheter removal (density-adjusted incidence for hospital stays of 16.7 PIVC-CRI/1000 hospital-stays and 0.76 PVC-BSI/1000 hospital-stays respectively) and no patients were diagnosed CRBSI type 3 with a bacterial growth concordant in tip and blood cultures. Most cases responded favourably to catheter removal and management. Conclusions Our findings show that almost 42% PIVCs resulted in unplanned removal, amplifying the importance in terms of morbidity, mortality and patient safety. A high number of positive tip cultures without clinical signs and symptoms was observed. We underpin the importance to remove unnecessary PIVCs for the prevention of CRBSI.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- 2Servei de Salut de les Illes Balears, Palma, Spain.,3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | - Joan de Pedro-Gómez
- 3Universitat de les Illes Balears, Palma, Spain.,Care, Chronicity and Evidence in Health Research Group, Health Institute of Health Sciences, Palma, Spain
| | | | - Ismael Fernández-Fernández
- Quality, Teaching and Research Unit, Hospital Manacor, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain
| | - Enrique Castro-Sánchez
- 6NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
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8
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Fleury Y, Arroyo D, Couchepin C, Robert-Ebadi H, Righini M, Lobrinus JA, Ricou B, Delieuvin Schmitt N, Gayet-Ageron A. Impact of intravascular thrombosis on failure of radial arterial catheters in critically ill patients: a nested case-control study. Intensive Care Med 2018; 44:553-563. [PMID: 29610936 DOI: 10.1007/s00134-018-5149-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The patency of arterial catheters is essential for reliable invasive blood pressure monitoring. We sought to determine whether radial catheter failures were associated with intravascular thrombosis in critically ill adult patients. METHODS This unmatched case-control study was conducted within a prospective cohort of patients admitted to an intensive care unit. The arterial catheter failure was the main outcome, which identified cases. Controls were patients with patent catheter until removal or 28 days of follow-up. The prevalence of intravascular thrombosis in cases and controls was determined by ultrasonography of the cannulated radial artery. Assessors were blinded to clinical findings. Failing catheters were removed and examined microscopically. RESULTS Catheter failures occurred in 25.5% of 200 patients during 584 catheter-days (incidence rate, 87/1000 catheter-days). The median patency duration was 13.1 days. An intravascular thrombosis located in front of the catheter tip was diagnosed in 42 of 50 cases (84.0%) and 24 of 139 controls (17.3%). In multivariable logistic regression analysis, the probability of catheter failure was higher in patients with intravascular thrombosis [odds ratio (OR), 36.52; 95% confidence interval (CI), 12.86-103.74] and females (OR, 3.45; 95% CI 1.32-9.05), increased proportionally to arterial blood sampling frequency (OR, 1.20; 95% CI 1.04-1.38), and decreased in thrombocytopenia (OR, 0.28; 95% CI 0.10-0.78). After removal, 15.7% of failing catheters had some luminal fibrin deposits, but none were occluded. CONCLUSIONS Most failing radial arterial catheters had no luminal obstruction, but were associated with an intravascular thrombosis. Among predictive factors, arterial blood sampling frequency is the most susceptible to intervention.
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Affiliation(s)
- Yvan Fleury
- Division of Intensive Care, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Division of Intensive Care, Fribourg Hospital, Ch. des Pensionnats 2-6, 1708, Fribourg, Switzerland.
| | - Diego Arroyo
- Division of Intensive Care, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Division of Cardiology, Fribourg Hospital, Ch. des Pensionnats 2-6, 1708, Fribourg, Switzerland
| | - Caroline Couchepin
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Department of Anaesthesia and Reanimation, University Hospital Centre of Montpellier, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Johannes A Lobrinus
- Division of Clinical Pathology, Geneva University Hospitals, 1211, Geneva 14, Switzerland
| | - Bara Ricou
- Division of Intensive Care, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 14, Switzerland
| | - Nathalie Delieuvin Schmitt
- Division of Intensive Care, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Department of Nursing, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Angèle Gayet-Ageron
- Clinical Research Centre and Division of Clinical Epidemiology, Department of Health and Community Medicine, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1211, Geneva 14, Switzerland
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9
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Busch JD, Schröder H, Sellenschloh K, Adam G, Ittrich H, Huber G. Test method for mechanical properties of implantable catheters according to DIN 10555-3. J Mech Behav Biomed Mater 2018; 82:183-186. [PMID: 29605811 DOI: 10.1016/j.jmbbm.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
To enable causal analysis of port catheter failure, this study aimed to develop an experimental setup for uniaxial tensile tests that addresses the specific requirements of highly elastic medical catheters; and to quantify parameters of the catheters' mechanical competence with respect to effects of artificial aging. Segments of 6F-polyurethane catheters were tested in their native status, after chemical and after mechanical aging. Tension experiments were performed with a rate of 220 mm/min until catheter failure. Material behavior was analyzed based on load cell measurements of the universal test system and an additional optical distance registration. The Young's modulus, the ultimate stress and the ultimate strain were determined. Chemical aging significantly decreased Young's modulus (84%; p = 0.001) and ultimate stress (83%; p < 0.001), whereas mechanical aged samples demonstrated similar results for the Young's modulus (p = 0.772) and a non-significant rise of ultimate stress (13%; p = 0.128). Ultimate strain did not differ significantly regardless of the pretreatment. The results proof reliability, reproducibility and sensitivity to quantify artificial aging induced variations and also promise to detect deviations in material features caused by long-term clinical usage of catheters.
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Affiliation(s)
- J D Busch
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - H Schröder
- Institute of Biomechanics, Otto-von-Guericke University of Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - K Sellenschloh
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - H Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - G Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestraße 15, 21073 Hamburg, Germany
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Ndlovu KCZ, Sibanda W, Assounga A. Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study. BMC Nephrol 2017; 18:48. [PMID: 28158991 PMCID: PMC5291961 DOI: 10.1186/s12882-017-0466-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations. METHODS We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis. RESULTS The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P < 0.001). When the baseline CD4 count was below 200 cells/μL, the peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P < 0.001), while a baseline CD4 count above 350 cells/μL was associated with a peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count < 200 cells/μL (HR, 3.28; CI, 1.42-7.61; P = 0.006). Catheter failure rates were 0.34 (HIV-positive cohort) and 0.24 (HIV-negative cohort) episodes/person-years (HR, 1.42; 95% CI, 0.73-2.73; P = 0.299). Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure. CONCLUSIONS HIV infection in end-stage renal disease patients managed by CAPD was associated with increased peritonitis risk; however, HIV infection did not increase the risk for CAPD catheter failure rate at 18 months.
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Affiliation(s)
- Kwazi C Z Ndlovu
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa. .,Department of Nephrology, University of KwaZulu-Natal, P/Bag X7, Congella, Durban, 4013, South Africa.
| | - Wilbert Sibanda
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Assounga
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Nephrology, University of KwaZulu-Natal, P/Bag X7, Congella, Durban, 4013, South Africa
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