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Munroe ES, Heath ME, Eteer M, Gershengorn HB, Horowitz JK, Jones J, Kaatz S, Tamae Kakazu M, McLaughlin E, Flanders SA, Prescott HC. Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals: A Retrospective Cohort Study. Chest 2024; 165:847-857. [PMID: 37898185 DOI: 10.1016/j.chest.2023.10.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Vasopressors traditionally are administered via central access, but newer data suggest that peripheral administration may be safe and may avoid delays and complications associated with central line placement. RESEARCH QUESTION How commonly are vasopressors initiated through peripheral IV lines in routine practice? Is vasopressor initiation route associated with in-hospital mortality? STUDY DESIGN AND METHODS This retrospective cohort study included adults hospitalized with sepsis (November 2020-September 2022) at 29 hospitals in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan. We assessed route of early vasopressor initiation, factors and outcomes associated with peripheral initiation, and timing of central line placement. RESULTS Five hundred ninety-four patients received vasopressors within 6 h of hospital arrival and were included in this study. Peripheral vasopressor initiation was common (400/594 [67.3%]). Patients with peripheral vs central initiation were similar; BMI was the only patient factor associated independently with initiation route (adjusted OR [aOR] of peripheral initiation [per 1-kg/m2 increase], 0.98; 95% CI, 0.97-1.00; P = .015). The specific hospital showed a large impact on initiation route (median OR, 2.19; 95% CI, 1.31-3.07). Compared with central initiation, peripheral initiation was faster (median, 2.5 h vs 2.7 h from hospital arrival; P = .002), but was associated with less initial norepinephrine use (84.3% vs 96.8%; P = .001). We found no independent association between initiation route and in-hospital mortality (32.3% vs 42.2%; aOR, 0.66; 95% CI, 0.39-1.12). No tissue injury from peripheral vasopressors was documented. Of patients with peripheral initiation, 135 of 400 patients (33.8%) never received a central line. INTERPRETATION Peripheral vasopressor initiation was common across Michigan hospitals and had practical benefits, including expedited vasopressor administration and avoidance of central line placement in one-third of patients. However, the findings of wide practice variation that was not explained by patient case mix and lower use of first-line norepinephrine with peripheral administration suggest that additional standardization may be needed.
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Affiliation(s)
- Elizabeth S Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI.
| | - Megan E Heath
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI; The Michigan Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, MI
| | - Mousab Eteer
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, MI
| | - Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL; Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Jennifer K Horowitz
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI; The Michigan Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, MI
| | - Jessica Jones
- Department of Pharmacy, Corewell Health, Dearborn, MI
| | - Scott Kaatz
- Division of Hospital Medicine, Henry Ford Health, Detroit, MI
| | | | - Elizabeth McLaughlin
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI; The Michigan Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, MI
| | - Scott A Flanders
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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Koppitz J, Ascherl RG, Thome UH, Pulzer F. Incorporating anti-infective drugs into peripherally inserted catheters does not reduce infection rates in neonates. Front Pediatr 2024; 11:1255492. [PMID: 38250594 PMCID: PMC10796449 DOI: 10.3389/fped.2023.1255492] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose This study assesses whether peripherally inserted central venous catheters (PICC), impregnated with anti-infective drugs, reduce the rate of infections in neonates compared with unimpregnated catheters. Methods A retrospective analysis was conducted on electronic patient records of neonates born between August 2014 and May 2020, who had PICCs inserted, either standard (S-PICC) or with anti-infective drugs (A-PICC). Catheter-related bloodstream infections (CRBSI) were diagnosed based on clinical symptoms, laboratory results, and mentioning of infection in the patient record. Data on dwell time, mechanical ventilation, insertion site, maximum C-reactive protein (CRP) concentration, and anti-infective drug use were analyzed. Results A total of 223 PICCs were included. The infection rates were A-PICC (18.9%) and S-PICC (12.5%), which were not significantly different (p = 0.257). A-PICCs had significantly longer dwell times than S-PICCs (median 372 vs. 219 h, p = 0.004). The time to infection was not different between the groups (p = 0.3). There were also no significant differences in maximum CRP, insertion site abnormalities, or anti-infective drug use between the groups. Conclusion This retrospective study did not find a significant reduction in infection rates by using PICCs containing anti-infective drugs in neonates. Current antibiotic impregnations do not seem to be effective in preventing blood stream infections.
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Affiliation(s)
- Julia Koppitz
- Neonatologie, Universitätsklinikum Leipzig, Leipzig, Germany
- Kinder- und Jugendklinik, Universitätsmedizin Rostock, Rostock, Germany
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Wong CCH, Choi HCW, Lee VHF. Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4712. [PMID: 37835406 PMCID: PMC10571956 DOI: 10.3390/cancers15194712] [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: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27-19.10) was higher than that for central lines (1.44%, 95% CI 0.30-4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00-9.62) was also higher than that with central lines (0.96%, 95% CI 0.12-3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00-12.22) compared to central lines (0.48%, 95% CI 0.01-2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.
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Affiliation(s)
| | - Horace Cheuk-Wai Choi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, Centre of Cancer Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Sellamuthu R, Nair S, Chandrasekar J, Kesavan S, Shivam V. Risk Factors of Central Line-Associated Bloodstream Infection (CLABSI): A Prospective Study From a Paediatric Intensive Care Unit in South India. Cureus 2023; 15:e43349. [PMID: 37700998 PMCID: PMC10493200 DOI: 10.7759/cureus.43349] [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] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Background Central line-associated bloodstream infection (CLABSI) is the most common hospital-acquired infection. However, studies evaluating the factors associated with the risk of CLABSI in pediatric intensive care units (PICU) were limited in India. Objective The objective of our study is to evaluate the association of factors and the etiology causing CLABSI. Study design This is a hospital-based single-center prospective study conducted in the pediatric intensive care unit (PICU) of our tertiary care hospital spanning one year. Participants Children aged between two months to 15 years admitted in the PICU for more than 48 hours with central venous catheterization were included. Pearson's chi-squared test with Yates' continuity correction and logistic regression with odds ratio were calculated by R statistical software (R Foundation for Statistical Computing, Vienna, Austria) and a p-value less than 0.05 was considered statistically significant. Results Our analysis showed that factors such as young age (2-12 months), high pediatric risk of mortality (PRISM III) score (> 15), leukocytosis, neutrophilia, anemia, change of central venous catheter, duration of catheterization (>7 days), exposure to blood products, use of steroids, inotropes, and prophylactic antibiotics were significantly associated with increased risk of CLABSIs with an odds ratio of 4.53, 4.54, 2.91, 4.56, 4.76, 3.74, 2.49, 2.41, 7.22, 6.77 and 5.16 respectively (p<0.05). Further, factors such as older age (>12 months) and low PRISM III score (≤ 15) significantly reduce the risk of CLABSIs by 83.64% and 69.14% respectively (p<0.05). Conclusion In conclusion, our results revealed that factors such as young age, high PRISM III score, leukocytosis, neutrophilia, anemia, change of central venous catheter, duration of catheterization (> 7 days), exposure to blood products during the hospital stay, use of steroids, inotropes, and prophylactic antibiotics were identified as risk factors for CLABSI.
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Affiliation(s)
- Ravina Sellamuthu
- Pediatrics, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | - Sajitha Nair
- Pediatrics, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
| | | | - Sajith Kesavan
- Pediatrics, Amrita Institute of Medical Sciences and Research Centre, Kochi, IND
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Walker SD, Agree O, Harris R, DesRosiers TT. Leveling the Battlefield: Development of a Pre-Deployment Vascular Access Curriculum for the Nonsurgical Provider. J Spec Oper Med 2023:HKH7-GWDW. [PMID: 37302144 DOI: 10.55460/hkh7-gwdw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Timely vascular access is critical, as hemorrhage is the number one cause of death on the battlefield. Anecdotal evidence in the Military Health System identified an operationally relevant procedural skills gap in vascular access, and data exist in civilian literature showing high rates of iatrogenic injuries when lack of robust procedural opportunity exists. Multiple pre-deployment training courses are available for surgical providers, but no comprehensive pre-deployment vascular access training exists for non-surgical providers. METHODS This mixed-method review aimed to find relevant, operationally focused, vascular access training publications. A literature review was done to identify both relevant military clinical practice guidelines (CPGs) and full text articles. Reviewers also investigated available pre-deployment trainings for both surgeons and non-surgeons in which course administrators were contacted and details regarding the courses were described. RESULTS We identified seven full-text articles and four CPGs. Two existing surgical training programs and Army, Navy, and Air Force pre-deployment training standards for non-surgeons were evaluated. CONCLUSION A cost-effective and accessible pre-deployment curriculum utilizing reviewed literature in a "learn, do, perfect" structure is suggested, building on pre-existing structures while incorporating remotely accessible didactics, hands-on practice with portable simulation models, and live-feedback training.
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Hassan E, Mathew B, Poehler J, Kopischke K, Zoesch G, Attallah N, Jama AB, Jain NK, Gomez Urena EO, Khan SA. Quality Improvement Initiative in a Community Hospital to Reduce Central Line Device Utilization Rate. Cureus 2023; 15:e41037. [PMID: 37519512 PMCID: PMC10373900 DOI: 10.7759/cureus.41037] [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] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Background The intensive care unit (ICU) in a community hospital in southwest Minnesota saw a steady increase in central line-associated bloodstream infections (CLABSI) and an increase in the utilization of central lines. The baseline CLABSI rate was 11.36 at the start of the project, which was the highest in the last five years. The corresponding device utilization rate (DUR) was 64%, which increased from a pre-COVID pandemic rate of 45%. Aim The aim of this project was to decrease the ICU DUR by 37.5% from a baseline of 64% to 40% within six months without adversely impacting staff satisfaction. Methods A multidisciplinary team using the define, measure, analyze, improve, and control (DMAIC) methodology reviewed the potential causes of the increased use of central lines in the ICU. The team identified the following major causal themes: process, communication, education, and closed-loop feedback. Once the root causes were determined, suitable countermeasures were identified and implemented to address these barriers. These included reviewing current guidelines, enhanced care team rounding, staff education, and the creation of a vascular access indication algorithm. The team met biweekly to study the current state, determine the future state, evaluate feedback, and guide implementation. Results The pandemic saw a surge in the number of severely ill patients in the ICU, which may have caused an increase in the DUR. The project heightened the awareness of the increased DUR and its impact on the CLABSI rate. The initiation of discussion around this project led to an immediate decline in DUR via increased awareness and focus. As interventions were introduced and implemented, the DUR continued to decrease at a steady rate. Post implementation, the DUR met the project goal of less than 40%. The team continued to track progress and monitor feedback. The DUR continued to meet the goal for three months post implementation. Since the start of the project, there have been no CLABSI events reported. This effort has positively impacted safety and patient outcomes. Conclusions Through a defined process, the central line utilization rate in our ICU was decreased to 37.5% to meet the target goal and has been sustained.
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Affiliation(s)
- Esraa Hassan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Bijoy Mathew
- Strategy Consulting Services, Mayo Clinic, Rochester, USA
| | - Jessica Poehler
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | | | - Greta Zoesch
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Noura Attallah
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Abbas B Jama
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Nitesh K Jain
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | | | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
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Arunan B, Ahmed NH, Kapil A, Vikram NK, Sinha S, Biswas A, Satpathy G, Wig N. Central Line-Associated Bloodstream Infections: Effect of Patient and Pathogen Factors on Outcome. J Glob Infect Dis 2023; 15:59-65. [PMID: 37469474 PMCID: PMC10353639 DOI: 10.4103/jgid.jgid_213_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious concern in health-care settings, as the infections difficult to treat. In this study, we evaluated the common bacteria causing CLABSI, and various patient and pathogen factors affecting the clinical outcome. Methods In the prospective observational study, patients diagnosed with CLABSI were recruited. Extensive clinical, microbiological, and other laboratory workup was done, and observations were recorded. Congo red agar method, tube test, and microtiter plate assay were used for eliciting the biofilm-forming attributes of the bacterial pathogens. Results Klebsiella pneumoniae was responsible for 48% of CLABSI, followed by Coagulase-negative Staphylococci (16%) and Staphylococcus aureus and Acinetobacter baumannii (12% each). Fifty-six percent of the isolates produced biofilms. The median (interquartile range) duration of hospital stay till death or discharge was 30 (20, 43) days. The all-cause mortality was 44%. Patients having a deranged liver function on the day of diagnosis (P value for total bilirubin 0.001 and for aspartate transaminase 0.02), and those infected with multidrug-resistant organisms (P value = 0.04) had significantly poor prognosis. The difference in the demographic, clinical, laboratory profile, and outcome of patients infected with biofilm producers and nonproducers was not found to be statistically significant. Conclusion The study throws light on various host and pathogen factors determining the cause and outcome of CLABSI patients. To the best of our knowledge, this is the first study trying to decipher the role of biofilm formation in the virulence of pathogens and the prognosis of CLABSI.
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Affiliation(s)
- Bharathi Arunan
- Department of Medicine and Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nishat H. Ahmed
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gita Satpathy
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Iankovitch A, Ledley JS, Almabrouk T, Al-Jaberi N, Coey J. Anatomical variations of the internal jugular vein in the context of central line placement: A visual approach to data processing. Clin Anat 2023; 36:172-177. [PMID: 35869858 DOI: 10.1002/ca.23939] [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: 11/03/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
Central line placement in the internal jugular vein (IJV) can result in complications. Previous studies that examined variations in geometric anatomical parameters in pediatric populations have reduced these risks in children. The aim of this study was to establish possible anatomical variations to improve central line placement in the adult population and demonstrate the use of a correlation heatmap in processing large amounts of data. Twenty-seven volunteers were imaged using ultrasound at three different neck levels on right and left sides and various anatomical parameters were measured. Demographic information was also collected and included in the data processing. The Pearson coefficient was derived from each possible relationship between the measured parameters and was plotted in a correlation heatmap. Strong correlations were observed between the body mass index and the depth of the IJV and common carotid artery (CCA), the relative depth of the IJV to the CCA. No significant correlations were found in the dimensions of both vessels. Anatomical variations were more common than anticipated and should be taken into account when performing central line catheterization in order to minimize post-procedure complications.
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Affiliation(s)
- Anna Iankovitch
- St. George's University School of Medicine, St. George's University, Grenada, West Indies
| | - Johanna Shapiro Ledley
- St. George's University School of Medicine, St. George's University, Grenada, West Indies
| | - Tarek Almabrouk
- Department of Anatomy, St. George's University School of Medicine, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nahidh Al-Jaberi
- Department of Anatomy, St. George's University School of Medicine, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - James Coey
- St. George's University School of Medicine, St. George's University, Grenada, West Indies.,Department of Anatomy, St. George's University School of Medicine, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Thakur A, Modi M, Kler N, Garg P. Neonatologist-Performed Ultrasound-Guided Internal Jugular Vein Cannulation. Indian Pediatr 2023; 60. [PMCID: PMC9885405 DOI: 10.1007/s13312-023-2700-0] [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] [Indexed: 01/31/2023]
Abstract
We retrieved data of ultrasound-guided neonatal internal jugular vein (IJV) cannulations done between November, 2020 and March, 2021. Of the 33 ultrasound-guided IJV cannulation in neonates, 32 were successful with overall success rate of 97%. Median (IQR) number of attempts per insertion was 2 (1,3.5). There were no major complications observed during the insertion of the catheter. In one instance, inadvertent carotid artery puncture was encountered, without significant bleeding.
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Affiliation(s)
- Anup Thakur
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Manoj Modi
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Neelam Kler
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Pankaj Garg
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Thakur A, Modi M, Kler N, Garg P. Neonatologist-Performed Ultrasound-Guided Internal Jugular Vein Cannulation. Indian Pediatr 2023; 60:72-74. [PMID: 36639975 PMCID: PMC9885405] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We retrieved data of ultrasound-guided neonatal internal jugular vein (IJV) cannulations done between November, 2020 and March, 2021. Of the 33 ultrasound-guided IJV cannulation in neonates, 32 were successful with overall success rate of 97%. Median (IQR) number of attempts per insertion was 2 (1,3.5). There were no major complications observed during the insertion of the catheter. In one instance, inadvertent carotid artery puncture was encountered, without significant bleeding.
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Affiliation(s)
- Anup Thakur
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi
| | - Manoj Modi
- grid.415985.40000 0004 1767 8547Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Neelam Kler
- grid.415985.40000 0004 1767 8547Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Pankaj Garg
- grid.415985.40000 0004 1767 8547Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Romańska J, Wawrzoniak T, Krajewski P, Seliga-Siwecka J, Brunets N, Lehman I, Bokiniec R, Adamska E, Królak-Olejnik B, Modzelewski J, Szczapa T. Effects of Early versus Standard Central Line Removal on the Growth of Preterm Infants with Very Low Birth Weight: A Non-Inferiority, Randomized Clinical Trial. Nutrients 2022; 14. [PMID: 36432453 DOI: 10.3390/nu14224766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Very preterm infants are usually supported by parenteral nutrition delivered through central lines (CLs) while progressing with enteral intake, although the optimal time point for their removal is unclear. This study evaluated the impact of the CL discontinuation time on the short-term growth outcomes of preterm infants. A non-inferiority, parallel-group, randomized controlled trial was conducted in four neonatal intensive care units in Poland. Preterm infants with very low birth weight (VLBW) without congenital abnormalities were eligible. Patients were allocated to discontinue central access at an enteral feeding volume of 100 mL/kg/day (intervention group) or 140 mL/kg/day (control group). The study's primary outcome was weight at 36 weeks' postmenstrual age, with a non-inferiority margin of -210 g. Overall, 211 patients were allocated to the intervention or control groups between January 2019 and February 2021, of which 101 and 100 were eligible for intention-to-treat analysis, respectively. The mean weight was 2232 g and 2200 g at 36 weeks' postmenstrual age in the intervention and control groups, respectively. The mean between-group difference was 32 g (95% confidence interval, -68 to 132; p = 0.531), which did not cross the specified margin of non-inferiority. No intervention-related adverse events were observed. Early CL removal was non-inferior to the standard type for short-term growth outcomes in VLBW infants.
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Melhorn JL, Burkett M. Decreasing Skin Breakdown Around Central Lines in Patients Receiving Thiotepa Prior to Bone Marrow Transplantation. J Pediatr Hematol Oncol Nurs 2022; 39:396-401. [PMID: 35730158 DOI: 10.1177/275275302110560011074261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Skin breakdown occurring around central line dressings increases the risk for infection and bacteremia in all patients. The risk is magnified when experienced in pediatric patients receiving marrow-ablative therapy. A staff nurse on an inpatient pediatric oncology and bone marrow transplant unit noted an increased incidence of skin breakdown around central line dressings in patients receiving Thiotepa prior to bone marrow transplantation. Although there is a wealth of information surrounding routine care of central venous access devices, there is little evidence surrounding care with impaired skin integrity. A staff nurse turned to expert opinion and consensus revealed the use of nonocclusive dressings for central lines. A new protocol for changing central line dressings was developed to decrease the rate of skin breakdown. The protocol utilized gauze and a self-adherent wrap instead of tape to secure central lines. Bone marrow transplant staff nurses were educated prior to the practice change, and compliance was monitored through observation and review of documentation in the electronic medical record. A retrospective chart review compared the rate of skin breakdown and central line associated blood stream infections pre- and postpractice change. The overall percentage of skin breakdown surrounding central lines was reduced by over 80%.
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Affiliation(s)
- Jami L Melhorn
- 6619UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Marnie Burkett
- University of Pittsburgh and a Clinical Education Specialist at UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Bogdan L, Malavade T. Tunneled dialysis line-associated hemorrhagic shock following self-inflicted trauma in a hemodialysis patient: A case report. Hemodial Int 2022; 26:E37-E40. [PMID: 35732603 DOI: 10.1111/hdi.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Complications of tunneled central venous catheters (CVCs) for hemodialysis are frequent, and most commonly include bacteremia, thrombosis, and stenosis. While bleeding is a relatively rare complication of dialysis lines overall, tunneled CVCs may present a unique bleeding risk given their ability to be displaced or damaged as patients have direct access to the equipment in place. Here, we describe the case of a 68-year-old man with end-stage renal disease and neurocognitive disorder, who developed hemorrhagic shock following self-inflicted laceration of his tunneled dialysis catheter proximal to the Y. Examination of the catheter tunnel revealed that the cuff was palpable proximal to the exit site, but the opening was well retracted. In such cases, hemorrhage is particularly difficult to control because the cuff is rigid and poorly amenable to compression, in addition to being difficult to access. This case demonstrates the risk of significant hemorrhage when a tunneled CVC is damaged at this location and the potential need for the urgent removal of the retained component to prevent recurrence of bleeding. It also highlights important patient safety considerations given the risk of self-inflicted trauma in patients with a neurocognitive disorder and a language barrier affecting communication.
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Affiliation(s)
- Lucia Bogdan
- Department of Internal Medicine, University of Toronto, Toronto, Canada
| | - Tushar Malavade
- Department of Internal Medicine, University of Toronto, Toronto, Canada.,Division of Nephrology, University Health Network, Toronto, Canada
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14
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Toor H, Farr S, Savla P, Kashyap S, Wang S, Miulli DE. Prevalence of Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care and Medical-Surgical Units. Cureus 2022; 14:e22809. [PMID: 35382174 PMCID: PMC8976505 DOI: 10.7759/cureus.22809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/26/2021] [Accepted: 03/02/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) remain an important preventable healthcare-associated infection with a 2020 rate of 0.87 (per 1,000 central line days) in the United States intensive care units (ICU). METHODS This was a retrospective cohort study of all adult patients in our institution. The total number of central venous catheter (CVC) insertions and line days were determined using daily unit logs maintained by unit managers. Central line insertion practice (CLIP) compliance was calculated as the total number of CLIP forms submitted divided by the total number of newly-inserted CVCs with and without associated CLIP forms as determined by unit logs. RESULTS A total of 1,125 CVCs were reviewed (448 - ICU and 677 - medical-surgical units). Of the 13 CLABSI, one patient had internal jugular (IJ), one patient had subclavian (SC), four patients had femoral, three patients had peripherally inserted central catheter (PICC) and four patients had hemodialysis catheters. Patients with CLABSI had CVC inserted for a range of five to 92 days with the average number of line days being 29 days. CONCLUSION Based on the analysis of our CLABSI patient population, we recommend our institution implement the following criteria to decrease the prevalence of CLABSI: All patients receiving a CVC must adhere to CLIP documentation in all units, any femoral or HD CVC placed without a CLIP form should have the line changed within 48 hours, those patients with a femoral CVC or hemodialysis catheter in place for four days or greater with an abnormal WBC (<4.0 or >11 mg/dL) or abnormal temperature (<97.0F or >100.4F) should be considered for catheter exchange, and those patients with an IJ, SC, or PICC CVC in place for seven days or greater with an abnormal WBC or abnormal temperature should have the catheter changed.
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Affiliation(s)
- Harjyot Toor
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Saman Farr
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Samir Kashyap
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Sharon Wang
- Infectious Disease, Arrowhead Regional Medical Center, Colton, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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15
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Ganesan V, Sundaramurthy R, Thiruvanamalai R, Sivakumar VA, Udayasankar S, Arunagiri R, Charles J, Chavan SK, Balan Y, Sakthivadivel V. Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them? Cureus 2021; 13:e19331. [PMID: 34909294 PMCID: PMC8651063 DOI: 10.7759/cureus.19331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.
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Affiliation(s)
- Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Raja Sundaramurthy
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Rajendran Thiruvanamalai
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Vijay Anand Sivakumar
- Department of Anaesthesiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sridhurga Udayasankar
- Department of Paediatrics, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Ramesh Arunagiri
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Jhansi Charles
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sunil Kumar Chavan
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Yuvaraj Balan
- Department of Biochemistry, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
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16
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Deogaonkar G, Sinha MD, Jones M, Calder F, Karunanithy N, Qureshi SA. Percutaneous Venous Reconstruction for Central Thrombosis-Associated Chylothorax: A Safe and Efficacious Option. JACC Case Rep 2021; 3:1569-1575. [PMID: 34729502 PMCID: PMC8543144 DOI: 10.1016/j.jaccas.2021.06.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Central thrombosis–associated chylothorax is underrecognized in children and frequently refractory to conservative management. Central venous catheterizations are the predominate cause. We present 3 cases highlighting endovascular techniques used to treat persistent chylous effusions. (Level of Difficulty: Advanced.)
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Key Words
- CT, computed tomography
- CTaC, central thrombosis–associated chylothorax
- CVT, central vein thrombosis
- IVC, inferior vena cava
- MCT, medium-chain triglyceride
- MPA, main pulmonary artery
- MRI, magnetic resonance imaging
- RPA, right pulmonary artery
- SVC, superior vena cava
- TPN, total parenteral nutrition
- central line
- central vein obstruction
- chylothorax
- chylous effusion
- endovenous reconstruction
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Affiliation(s)
- Ganesh Deogaonkar
- Department of Interventional Radiology, Evelina London Children's Hospital, London, United Kingdom
| | - Manish D Sinha
- Department of Nephrology, Evelina London Children's Hospital, London, United Kingdom
| | - Matthew Jones
- Department of Pediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Francis Calder
- Department of Renal Transplantation, Evelina London Children's Hospital. London, United Kingdom
| | - Narayan Karunanithy
- Department of Interventional Radiology, Evelina London Children's Hospital, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Shakeel A Qureshi
- Department of Pediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
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17
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Chopra S, Garg A, Schlueter AJ, Blau JL. Nationwide practices in the use of central venous catheters for therapeutic plasma exchange in the inpatient setting. J Clin Apher 2021; 36:790-796. [PMID: 34379813 DOI: 10.1002/jca.21929] [Citation(s) in RCA: 2] [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: 11/23/2020] [Revised: 06/04/2021] [Accepted: 07/14/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) is often impacted by difficulties in obtaining an adequate and safe vascular access. This study evaluated the rates, predictive factors, and clinical outcomes associated with central venous catheter (CVC) use during the inpatient TPE procedures. METHODS The Nationwide Readmissions Database, 2016 to 2017 was used to identify hospitalizations with TPE with and without CVC insertion. RESULTS During the study period, there were 35 429 hospitalizations with TPE (pediatric 6.1%, mean ± standard deviation (SD) age 50.9 ± 20.0 years, female 52.7%). CVC insertion was documented in 24 414 (73.4%) adult and 1596 (73.5%) pediatric hospitalizations. In pediatric patients, age >15 years, higher disease severity, and private insurance were associated with higher odds of CVC insertion. In adults, female sex, obesity, concurrent hemodialysis, and higher disease severity were associated with CVC insertion. Adults with private insurance and both adult and pediatric hospitalizations at the teaching hospitals had lower odds of CVC placement. All patients with CVC insertion had longer length of hospital stay, and adults with CVC insertion also had higher hospital charges, higher in-hospital mortality, and lower likelihood of being discharged to home. CONCLUSION CVC insertion is performed for the majority of inpatient TPE procedures and CVC use appears to correlate with worse clinical outcomes.
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Affiliation(s)
- Saurav Chopra
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Aayushi Garg
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Annette J Schlueter
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - John L Blau
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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18
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Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are preventable complications that pose a significant health risk to patients and place a financial burden on hospitals. Central line simulation-based education (SBE) efforts vary widely in the literature. The aim of this study was to perform a value analysis of published central line SBE and develop a refined method of studying central line SBE. METHODS A database search of PubMed Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for articles mentioning "Cost and CLABSI," "Cost and Central line Associated Bloodstream Infections," and "Cost and Central Line" in their abstract and article body. Articles chosen for qualitative synthesis mentioned "simulation" in their abstract and article body and were analyzed based on the following criteria: infection rate before vs. after SBE, cost of simulation, SBE design including simulator model used, and learner analysis. RESULTS Of 215 articles identified, 23 were analyzed, 10 (43.48%) discussed cost of central line simulation with varying criteria for cost reporting, 8 (34.8%) numerically discussed central line complication rates (7 CLABSIs and 1 pneumothorax), and only 3 (13%) discussed both (Figure). Only 1 addressed the true cost of simulation (including space rental, equipment startup costs, and faculty salary) and its longitudinal effect on CLABSIs. CONCLUSION Current literature on central line SBE efforts lacks value propositions. Due to the lack of value-based data in the area of central line SBE, the authors propose a cost reporting standard for use by future studies reporting central line SBE costs.
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Affiliation(s)
| | | | | | | | - Alexander Perez
- Department of Surgery, University of Texas Medical Branch, TX, USA
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19
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Huseynova RA, A. Bin Mahmoud L, AlHemiad M, Almuhaini M, Huseynov O. Early pericardial effusion as complication of umbilical venous catheter insertion in extreme preterm baby: A case report. Clin Case Rep 2021; 9:2109-2112. [PMID: 33936648 PMCID: PMC8077324 DOI: 10.1002/ccr3.3957] [Citation(s) in RCA: 3] [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: 06/19/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
Reminder essential clinical practice: Pericardial effusion is a rare fatal condition, however potentially reversible when grasped in time. It should always be thought out in neonate with a central line who develops unexplained cardiorespiratory failure.
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Affiliation(s)
| | | | | | - Muath Almuhaini
- King Saud Medical City King Saud Medical CityRiyadhSaudi Arabia
| | - Oqtay Huseynov
- Azerbaijan Medical University Nariman NarimanovBakuAzerbaijan
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20
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Al-Hadidi A, Amine M, Batman A, Hakmeh W. Homemade cardiac and vein cannulation ultrasound phantoms for trauma management training in resource-limited settings. Avicenna J Med 2021; 11:42-45. [PMID: 33520789 PMCID: PMC7839259 DOI: 10.4103/ajm.ajm_196_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ultrasound has become an essential skill for trauma management in resource-limited areas. Prohibitive costs of commercial ultrasound phantoms limit the abilities of many hospitals to adequately train health-care providers. We assessed the utility of homemade phantoms in a wartime setting. Thirty physicians and technicians enrolled in a medical training course, sponsored by the Syrian American Medical Society (SAMS). Ultrasound simulation models were created onsite by using psyllium, gelatin, a hotel coffee maker, and Pyrex dishes. Lamb hearts were used to teach visual diagnosis and subsequent drainage of pericardial effusions. Penrose drains were used to teach vein identification and cannulation under dynamic ultrasound guidance. Two phantoms with a total of 14 penrose drains were created, serving 30 health-care providers. Feedback from participants was positive and within one month of the course, two cases of pericardial tamponade were diagnosed and surgically treated in the largest trauma hospital operated by SAMS.
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Affiliation(s)
| | | | | | - Wael Hakmeh
- Department of Emergency Medicine, School of Medicine, Western Michigan University, Kalamazoo, MI, USA
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21
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Davis JD, Treggiari MM, Dickson EA, Schulman PM. A Training Program for Real-Time Ultrasound-Guided Catheterization of the Subclavian Vein. J Med Educ Curric Dev 2021; 8:23821205211025849. [PMID: 34263058 PMCID: PMC8252398 DOI: 10.1177/23821205211025849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To develop and implement a comprehensive program to train providers to place subclavian central venous catheters (CVCs) using real-time ultrasound guidance. STUDY DESIGN Simulation-based prospective study at an academic medical center. Of 228 anesthesia providers and intensivists eligible to participate, 106 participants voluntarily enrolled. The training program consisted of a didactic module, hands-on instruction and practice using a CVC simulator and a standardized patient. The success of the program was measured by pre and post knowledge tests and direct observation during the hands-on sessions. RESULTS Of 106 participants who enrolled, 70 successfully completed the program. Out of 20 possible procedure steps, an average of 17.8 ± 2.9 were correctly performed in the simulated environment. The average time to needle insertion, defined by positive aspiration of stained saline, was 3.35 ± 3.02 min and the average time to wire insertion with ultrasound confirmation was 3.85 ± 3.12 min. CONCLUSIONS Participants learned how to successfully perform ultrasound-guided catheterization of the subclavian vein. Since ultrasound-guided subclavian CVC placement is a useful clinical skill that many practitioners are unfamiliar with, increasing competence and comfort with this procedure is an important goal. Other centers could consider adopting an approach similar to ours to train their providers to perform this technique.
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Affiliation(s)
- Jeffrey D Davis
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Miriam M Treggiari
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Esi A Dickson
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Peter M Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
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22
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Schulberg SP, Jaikaran O, Lim D, Robalino RP, Patel R, Sirsi S, Timoney M, Sinha P. An Ancillary Central Catheter Emergency Support Service Team Staffed by Surgical Personnel Improves Workflow During the Coronavirus Disease 2019 Crisis. Surg Innov 2020; 28:231-235. [PMID: 33153382 DOI: 10.1177/1553350620971181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/17/2022]
Abstract
Background. The SARS-CoV-2 novel coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to urban health centers across the United States. Many hospitals are reallocating resources to best handle the influx of critical patients. Methods. At our New York City hospital, we developed the ancillary central catheter emergency support service (ACCESS), a team for dedicated central access staffed by surgical residents to assist in the care of critical COVID-19 patients. We conducted a retrospective review of all patients for whom the team was activated. Furthermore, we distributed a survey to the critical care department to assess their perceived time saved per patient. Results. The ACCESS team placed 104 invasive catheters over 10 days with a low complication rate of .96%. All critical care providers surveyed found the service useful and felt it saved at least 30 minutes of procedural time per patient, as patient to critical care provider ratios were increased from 12 patients to one provider to 44 patients to one provider. Conclusions. The ACCESS team has helped to effectively redistribute surgical staff, provide a learning experience for residents, and improve efficiency for the critical care team during this pandemic.
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Affiliation(s)
| | - Omkaar Jaikaran
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
| | - Derek Lim
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
| | - Ryan P Robalino
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
| | - Ronak Patel
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
| | - Sandeep Sirsi
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
| | - Michael Timoney
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
| | - Prashant Sinha
- Department of Surgery, 219212NYU Langone Hospital Brooklyn, USA
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23
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Levy ER, Hutchins KA, Schears GJ, Rodriguez V, Huskins WC. How We Approach Central Venous Catheter Safety: A Multidisciplinary Perspective. J Pediatric Infect Dis Soc 2020; 9:87-91. [PMID: 31886510 DOI: 10.1093/jpids/piz096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Emily R Levy
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn A Hutchins
- Quality Management Services, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory J Schears
- Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - W Charles Huskins
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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Wang L, Meng Q, Sun C, Guo Y, Yao J, Zong B, Jiao Q. [Measurement of Coronary Artery Angle in DSA Image]. Zhongguo Yi Liao Qi Xie Za Zhi 2019; 43:401-404. [PMID: 31854522 DOI: 10.3969/j.issn.1671-7104.2019.06.003] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The digital subtraction angiography (DSA) image is processed to obtain central line and bifurcation point of coronary artery, and angle between blood vessels. METHODS The image is processed on the platform of Matlab. The central line of coronary artery is extracted by Hessian matrix. The coordinates of the bifurcation point and two other points on branch vessels are obtained by central line matrix of DSA image. Then average angle of coronary artery vessels is calculated by the three points. RESULTS For randomly selected DSA images, high accuracy values of coronary artery central line and angle may be obtained. CONCLUSIONS Accurate measurement of coronary artery vessel angel may help operators of DSA in setting body position and help researchers in image processing.
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Affiliation(s)
- Li Wang
- Department of Medical Information Engineering, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, 271016
| | - Qingmin Meng
- Department of Interventional Radiology, Tai'an Central Hospital, Tai'an, 271000
| | - Chao Sun
- Department of Medical Information Engineering, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, 271016
| | - Yongxin Guo
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, 271016
| | - Jijin Yao
- Department of Medical Information Engineering, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, 271016
| | - Baoliang Zong
- Department of Medical Information Engineering, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, 271016
| | - Qing Jiao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, 271016
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25
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Ballieu P, Besharatian Y, Ansari S. Safety and Feasibility of Phenylephrine Administration Through a Peripheral Intravenous Catheter in a Neurocritical Care Unit. J Intensive Care Med 2019; 36:101-106. [PMID: 31757173 DOI: 10.1177/0885066619887111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Blood pressure optimization and maintenance of cerebral and spinal perfusion pressure are mainstays in the treatment of a neurocritically ill patient. Traditionally, central venous access has been required for vasopressor administration, with risk of inherent complications. The authors have previously reported pilot data on the safety of peripheral administration of phenylephrine in a neurocritical care unit. In this follow-up, we report the safety, feasibility, and potential efficacy of peripheral administration of low-concentration phenylephrine in a more robust cohort. METHODS A retrospective chart review was conducted on all consecutive patients who received peripheral phenylephrine in a tertiary care hospital neurocritical care unit. RESULTS A cohort of 125 patients were identified and included in the final analysis. The average age was 59.3 years, with an average intensive care unit (ICU) length of stay of 7.61 days. The most common indication for phenylephrine use was spinal perfusion (both with/without neurogenic shock) in 38.4% of cases, followed by postsurgical/anesthesia resuscitation in 16.8% of cases; 25.6% of patients in our cohort required escalation to central venous access (central venous catheter + peripherally inserted central catheter). A total of 2880 patient-hours were recorded with peripheral phenylephrine infusion, of which 73.9% were at goal blood pressure (either systolic or mean arterial pressure). Only one major complication of thrombophlebitis and 8 minor complications were recorded. CONCLUSIONS Protocol-driven peripheral administration of lower concentration phenylephrine in an ICU setting is safe and feasible. This strategy is potentially effective at achieving hemodynamic targets in the majority of patients avoiding the need for central venous access.
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Affiliation(s)
- Paul Ballieu
- Huntsman Cancer Center, 7060University of Utah, Salt Lake City, UT, USA
| | - Yasaman Besharatian
- Department of Neurology, School of Medicine, 7060University of Utah, Salt Lake City, UT, USA
| | - Safdar Ansari
- Department of Neurology, School of Medicine, 7060University of Utah, Salt Lake City, UT, USA
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26
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Klein J, Jepsen A, Patterson A, Reich RR, Mason TM. Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Patients Undergoing Blood and Marrow Transplantation. Clin J Oncol Nurs 2019; 22:199-202. [PMID: 29547607 DOI: 10.1188/18.cjon.199-202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/17/2022]
Abstract
BACKGROUND Patients undergoing blood and marrow transplantation (BMT) use a central venous catheter (CVC); heparin is often employed to maintain patency but may increase the risk of complications. Research has not provided conclusive differences in efficacy and safety regarding heparin flushing versus normal saline flushing in CVC maintenance. Minimal research is specific to this patient population. OBJECTIVES This study aimed to determine if differences exist in CVC patency, tissue plasminogen activator usage, and the incidence of central line-associated bloodstream infections when flushing with normal saline only versus heparin and normal saline among patients undergoing BMT. METHODS A convenience sample of 30 patients undergoing allogeneic or autologous transplantation with a new non-port/non-peripherally inserted CVC were evaluated. FINDINGS Elimination of routine heparin use could positively affect outcomes in this patient population.
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Affiliation(s)
- John Klein
- H. Lee Moffitt Cancer Center and Research Institute
| | | | | | | | - Tina M Mason
- H. Lee Moffitt Cancer Center and Research Institute
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Lichliter RL, Tremewan LE, Shonka NM, Mehnert JE, Brennan L, Thrasher JM, Hernandez TL. Therapeutic antibiotic serum concentrations by two blood collection methods within the pediatric patient: A comparative effectiveness trial. J SPEC PEDIATR NURS 2018; 23:e12212. [PMID: 29461683 DOI: 10.1111/jspn.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/14/2016] [Revised: 01/04/2018] [Accepted: 01/19/2018] [Indexed: 11/26/2022]
Abstract
Repeated venipunctures and fingersticks to confirm serum drug concentrations cause pain and dissatisfaction for pediatric patients and their families. In many organizations, the standard of care to obtain therapeutic serum drug concentrations by peripheral venipuncture or capillary fingerstick, even when the patient has an existing peripheral intravenous catheter (PIV) or central venous catheter (CVC). The primary objective of this study was to assess agreement between serum tobramycin/vancomycin concentrations collected from a CVC or PIV, versus venipuncture or fingerstick. Among hospitalized pediatric patients (age 3 months to 22 years), 36 paired blood samples were collected. Serum trough vancomycin and random tobramycin concentrations were compared between peripheral intravenous or CVC samples, and venipuncture or fingerstick samples within the same patient. A strict sampling protocol for obtaining the samples was followed, that included collection of the CVC/PIV sample before the venipuncture or fingerstick, less than 2 min between collections of samples from the different sites, and a strict volume-based flush and waste protocol. Concordant correlation coefficients demonstrated substantial agreement between CVC/PIV and venipuncture/fingerstick concentrations for vancomycin (n = 17) and tobramycin (n = 19) (Rc = 0.982 for both). Bland-Altman analyses demonstrated good overall between-method agreement within subjects and minimal bias. Consequently, using a lumen volume-based flush and waste protocol, children with indwelling catheters may not require additional venipunctures and/or fingersticks for confirmation of drug concentrations while hospitalized, improving the quality of care and patient satisfaction.
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Affiliation(s)
| | | | | | | | | | | | - Teri L Hernandez
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
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Aurshina A, Hingorani A, Alsheekh A, Kibrik P, Marks N, Ascher E. Placement issues of hemodialysis catheters with pre-existing central lines and catheters. J Vasc Access 2018. [PMID: 29542366 DOI: 10.1177/1129729818757964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/16/2022] Open
Abstract
OBJECTIVE It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. METHODS A retrospective review was conducted of patients in whom hemodialysis catheters were placed over a period of 10 years. For each hemodialysis catheter that was placed, perioperative chest X-ray performed was used to evaluate for pre-existing pacemakers and central lines. The position and laterality of placement of the hemodialysis catheter along with presence of arteriovenous fistula with functional capacity for access were noted. RESULTS A total of 600 hemodialysis catheters were placed in patients over the period of 10 years. The mean age of the patients was 73.6 ± 12 years with a median age of 76 years. We found 20 pacemakers or automatic implantable cardioverter defibrillators and 19 central lines on the same side of the neck as the hemodialysis catheter that was placed in the ipsilateral jugular vein. No patient exhibited malfunction or dislodgment of the central line, the pacemaker, or automatic implantable cardioverter defibrillator or evidence of upper extremity venous obstruction based upon signs symptoms or duplex exams. CONCLUSION Based on our experience, we suggest that placement of hemodialysis catheter in the internal jugular vein ipsilateral to the pre-existing catheter/leads is safe and spares the contralateral limb for arteriovenous fistula creation.
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Affiliation(s)
| | | | | | - Pavel Kibrik
- Vascular Institute of New York, Brooklyn, NY, USA
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McCarthy EK, Ogawa MT, Hopper RK, Feinstein JA, Gans HA. Central line replacement following infection does not improve reinfection rates in pediatric pulmonary hypertension patients receiving intravenous prostanoid therapy. Pulm Circ 2018; 8:2045893218754886. [PMID: 29309237 PMCID: PMC5826011 DOI: 10.1177/2045893218754886] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treatment of pediatric pulmonary hypertension (PH) with IV prostanoids has greatly improved outcomes but requires a central line, posing inherent infection risk. This study examines the types of infections, infection rates, and importantly the effect of line management strategies on reinfection in children receiving IV prostanoids for PH. This study is a retrospective review of all pediatric PH patients receiving intravenous epoprostenol (EPO) or treprostinil (TRE) at one academic tertiary care center between 2000 and 2014. No patients declined participation in the study or were otherwise excluded. Infectious complications were characterized by organism(s), infection rates, time to next infection, and line management decisions (salvage vs. replace). Of the 40 patients followed, 13 sustained 38 infections involving 49 pathogens, with a predominance of gram-positive (GP) organisms (n = 35). The pooled infection rate was 1.06 per 1000 prostanoid days with no difference between EPO and TRE. No significant difference in reinfection rate was observed when comparing line salvage to replacement, regardless of organism type. Both overall and organism-type comparisons suggest longer time between line infections following line salvage compared with line replacement (732 vs. 410 days overall; 793 vs. 363 days for GP; 611 vs. 581 days for gram-negative [GN]; P > 0.05 for all comparisons). Central line replacement following blood stream infections in pediatric PH patients does not improve subsequent infection rates or time to next infection, and may lead to unnecessary risks associated with line replacement, including potential loss of vascular access. A revised approach to central line infections in pediatric PH is proposed.
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Affiliation(s)
- Elisa K McCarthy
- 1 12248 School of Medicine, Loyola Stritch School of Medicine, Maywood , IL, USA
| | - Michelle T Ogawa
- 2 24349 Department of Pediatrics, Division of Pediatric Cardiology, Stanford University Medical Center , Stanford, CA, USA
| | - Rachel K Hopper
- 2 24349 Department of Pediatrics, Division of Pediatric Cardiology, Stanford University Medical Center , Stanford, CA, USA
| | - Jeffrey A Feinstein
- 2 24349 Department of Pediatrics, Division of Pediatric Cardiology, Stanford University Medical Center , Stanford, CA, USA
| | - Hayley A Gans
- 3 10624 Department of Pediatrics, Division of Pediatric Infectious Diseases, Stanford University Medical Center , Stanford, CA, USA
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Alsaad AA, Bhide VY, Moss JL Jr, Silvers SM, Johnson MM, Maniaci MJ. Central Line Proficiency Test Outcomes after Simulation Training versus Traditional Training to Competence. Ann Am Thorac Soc 2017; 14:550-4. [PMID: 28145736 DOI: 10.1513/AnnalsATS.201612-987OC] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Studies have shown the importance of simulation-based training on the outcomes of central venous catheter (CVC) insertion by trainees. OBJECTIVES To compare the performance of internal medicine trainees who underwent standardized simulation training of CVC insertion with that of internal medicine trainees who had traditional CVC training and were already deemed competent to perform the procedure during a proficiency evaluation using a training mannequin. METHODS Trainees who perform CVC insertion were enrolled in the institutional Central Line Workshop, which includes both an online and an experiential simulation component. The training is followed by a certification station proficiency assessment. Residents and fellows previously certified competent to perform CVC placement without supervision completed the online module, but they could opt out of the experiential component and proceed directly to the evaluation. RESULTS Forty-eight trainees participated in the study. Twenty-one (44%), 15 (31%), 6 (13%), 1 (2%), 2 (4%), and 3 (6%) were in postgraduate year 1 (PGY1), PGY2, PGY3, PGY4, PGY5, and PGY6, respectively. Twenty-nine completed the hands-on instruction, 28 (97%) of whom successfully passed the simulation-based assessment on their first attempt. Nineteen trainees previously credentialed to perform CVC placement without supervision opted out of the simulation-based experiential training. Of these, five (26%) failed in their first attempt (P = 0.02 vs. trainees who completed the simulation training). CONCLUSIONS Standardized simulation-based training can improve CVC insertion proficiency, even among trainees with previous experience sufficient to have been deemed competent in the procedure. Improved performance at simulation-based testing may translate to improved outcomes of CVC placement by trainees.
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Huang CY, Thomas JB, Alismail A, Cohen A, Almutairi W, Daher NS, Terry MH, Tan LD. The use of augmented reality glasses in central line simulation: "see one, simulate many, do one competently, and teach everyone". Adv Med Educ Pract 2018; 9:357-363. [PMID: 29785148 PMCID: PMC5953413 DOI: 10.2147/amep.s160704] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the feasibility of using augmented reality (AR) glasses in central line simulation by novice operators and compare its efficacy to standard central line simulation/teaching. DESIGN This was a prospective randomized controlled study enrolling 32 novice operators. Subjects were randomized on a 1:1 basis to either simulation using the augmented virtual reality glasses or simulation using conventional instruction. SETTING The study was conducted in tertiary-care urban teaching hospital. SUBJECTS A total of 32 adult novice central line operators with no visual or auditory impairments were enrolled. Medical doctors, respiratory therapists, and sleep technicians were recruited from the medical field. MEASUREMENTS AND MAIN RESULTS The mean time for AR placement in the AR group was 71±43 s, and the time to internal jugular (IJ) cannulation was 316±112 s. There was no significant difference in median (minimum, maximum) time (seconds) to IJ cannulation for those who were in the AR group and those who were not (339 [130, 550] vs 287 [35, 475], p=0.09), respectively. There was also no significant difference between the two groups in median total procedure time (524 [329, 792] vs 469 [198, 781], p=0.29), respectively. There was a significant difference in the adherence level between the two groups favoring the AR group (p=0.003). CONCLUSION AR simulation of central venous catheters in manikins is feasible and efficacious in novice operators as an educational tool. Future studies are recommended in this area as it is a promising area of medical education.
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Affiliation(s)
- Cynthia Y Huang
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University, Loma Linda, CA, USA
| | | | - Abdullah Alismail
- Cardiopulmonary Sciences Department, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Avi Cohen
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Waleed Almutairi
- Cardiopulmonary Sciences Department, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Noha S Daher
- Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Michael H Terry
- Department of Respiratory Care, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Laren D Tan
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University, Loma Linda, CA, USA
- Cardiopulmonary Sciences Department, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
- Correspondence: Laren D Tan, Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University School of Medicine, 11234 Anderson Street, Suite 6439, Loma Linda, CA 92354, USA, Tel +1 909 558 8081, Fax +1 909 558 0581, Email
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Mishra SB, Misra R, Azim A, Baronia AK, Prasad KN, Dhole TN, Gurjar M, Singh RK, Poddar B. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Health Care 2017; 29:63-67. [PMID: 27940521 DOI: 10.1093/intqhc/mzw144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/26/2015] [Accepted: 11/17/2016] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the incidence, risk factors and associated mortality of central line-associated bloodstream infection (CLABSI) in an adult intensive care unit (ICU) in India. Design This prospective observational study was conducted over a period of 16 months at a tertiary care referral medical center. Setting We conducted this study over a period of 16 months at a tertiary care referral medical center. Participants All patients with a central venous catheter (CVC) for >48 h admitted to the ICU were enrolled. Intervention and main outcome measures Patient characteristics included were underlying disease, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE II) scores and outcome. Statistical analysis of risk factors for their association with mortality was also done. Results There were 3235 inpatient-days and 2698 catheter-days. About 46 cases of CLABSI were diagnosed during the study period. The overall rate of CLABSI was 17.04 per 1000 catheter-days and 14.21 per 1000 inpatient-days. The median duration of hospitalization was 23.5 days while the median number of days that a CVC was in place was 17.5. The median APACHE II and SOFA scores were 17 and 10, respectively. Klebsiella pneumoniae was the most common organism (n = 22/55, 40%). Immunosuppressed state and duration of central line more than 10 days were significant factors for developing CLABSI. SOFA and APACHE II scores showed a tendency towards significance for mortality. Conclusions Our results underscore the need for strict institutional infection control measures. Regular training module for doctors and nurses for catheter insertion and maintenance with a checklist on nurses' chart for site inspection and alerts in all shifts are some measures planned at our center.
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Affiliation(s)
- S B Mishra
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - R Misra
- Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - A Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - A K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - K N Prasad
- Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - T N Dhole
- Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - M Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - R K Singh
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
| | - B Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, India
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Karber BCF, Nielsen JC, Balsam D, Messina C, Davidson D. Optimal radiologic position of an umbilical venous catheter tip as determined by echocardiography in very low birth weight newborns. J Neonatal Perinatal Med 2017; 10:55-61. [PMID: 28304320 DOI: 10.3233/npm-1642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare chest X-ray with echocardiogram (ECHO) in the localization of an umbilical venous catheter (UVC) tip in very low birth weight infants (VLBW). Secondary objectives determined the association between techniques for tip placement by the vertebral body level on X-ray, as well as the length of the thoracic inferior vena cava-right atrial (TIVC-RA) junction by ECHO. STUDY DESIGN Prospective, sequentially enrolled, masked, single regional perinatal center study. Shortly after birth, one or more anterior-posterior X-rays were ordered by the clinical team to verify that the UVC tip was fixed in the central right atrium (cRA) or at the TIVC-RA junction. An echocardiogram was performed as soon as possible after the last X-ray and UVC tip location was interpreted by a pediatric cardiologist. The pediatric radiologist and cardiologist were masked with regard to each other's reading. RESULTS The newborns (n = 51) were 27 (±3) weeks by gestational age with birth weights of 1029 (±288) grams (mean±SD). The radiologist read 50 UVC tips (98%) in the cRA or TIVC-RA junction and 1 (2%) in the LA. The cardiologist read 22 (43%) in the cRA or TIVC-RA, 21 (41%) in the LA and 8 (16%) tips could not be located in the heart. When the UVC tip was interpreted by X-ray as located in the TIVC-RA junction 8/29 (28%) were in the LA by echocardiogram. There was no agreement between vertebral level and tip position in the TIVC-RA junction, RA or LA. The TIVC-RA junction measured 6±1 mm and correlated with birth weight r = 0.54 (p < 0.001). CONCLUSION In VLBW newborns, placement of the UVC tip into the cRA or TIVC-RA junction by X-ray does not avoid misplacement in the left atrium as demonstrated by echocardiography. For VLBW infants, it is suggested that echocardiography may be helpful in verifying that the original placement or migration of the UVC tip into the LA has not occurred.
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Affiliation(s)
- B C F Karber
- Department of Pediatrics, Stony Brook University Hospital, Stony Brook, NY, USA
| | - J C Nielsen
- Department of Pediatrics, Stony Brook University Hospital, Stony Brook, NY, USA
| | - D Balsam
- Department of Radiology Stony Brook University Hospital, Stony Brook, NY, USA
| | - C Messina
- Department of Preventive Medicine Stony Brook University Hospital, Stony Brook, NY, USA
| | - D Davidson
- Department of Pediatrics, Stony Brook University Hospital, Stony Brook, NY, USA
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Castagna H, Kawagoe J, Gonçalves P, Menezes F, Toniolo A, Silva C, Cardoso M, Santos C, Correa L. Active surveillance and safety organizational goals to reduce central line-associated bloodstream infections outside the intensive care unit: 9 years of experience. Am J Infect Control 2016; 44:1058-60. [PMID: 27156199 DOI: 10.1016/j.ajic.2016.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 11/25/2022]
Abstract
We performed a quasi-experimental, cohort study in the medical-surgical inpatient wards comparing central line-associated bloodstream infection (CLABSI) rates and microbiologic characteristics in 3 phases. The CLABSI rates decreased 60% from phase 1 to 2 and 61.5% from phase 2 to 3. Gram-positive organisms were most frequently isolated in phases 1 and 3, and gram-negative bacilli were most frequently isolated in phase 2. The CLABSI surveillance and prevention program focusing on patient safety had a significant impact on CLABSI rates.
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Hutchinson KM, Shaw SP. A Review of Central Venous Pressure and Its Reliability as a Hemodynamic Monitoring Tool in Veterinary Medicine. Top Companion Anim Med 2016; 31:109-121. [PMID: 27968811 DOI: 10.1053/j.tcam.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/04/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient. A thorough evaluation of the veterinary and human literature should be performed to evaluate the role of CVP measurements in assessing volume status in veterinary patients. DIAGNOSIS Veterinary patients that benefit from accurate CVP readings include those suffering from hypovolemic or septic shock, heart disease, or renal disease or all of these. Other patients that may benefit from CVP monitoring include high-risk anesthetic patients undergoing major surgery, trending of fluid volume status in critically ill patients, patients with continued shock, and patients that require rapid or large amounts of fluids. THERAPY The goal of CVP use is to better understand a patient's intravascular volume status, which would allow early goal-directed therapy. PROGNOSIS CVP would most likely continue to play an important role in the hemodynamic monitoring of the critically ill veterinary patient; however, when available, cardiac output methods should be considered the first choice for hemodynamic monitoring.
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Affiliation(s)
| | - Scott P Shaw
- VCA, Specialty Regional Medical Director; Northeast Los Angeles, CA, USA
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Abstract
Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications.
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Affiliation(s)
- Craig Kornbau
- Department of Surgery, Summa Akron City Hospital, Akron, Ohio, United States
| | - Kathryn C Lee
- Division of Critical Care Medicine, Summa Akron City Hospital, Akron, Ohio, United States
| | - Gwendolyn D Hughes
- Division of Critical Care Medicine, Summa Akron City Hospital, Akron, Ohio, United States
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Gardner AK, Abdelfattah K, Wiersch J, Ahmed RA, Willis RE. Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills. J Surg Educ 2015; 72:e158-62. [PMID: 26362712 DOI: 10.1016/j.jsurg.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/30/2015] [Accepted: 08/05/2015] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Error management training is an approach that encourages exposure to errors during initial skill acquisition so that learners can be equipped with important error identification, management, and metacognitive skills. The purpose of this study was to determine how an error-focused training program affected performance, retention, and transfer of central venous catheter (CVC) placement skills when compared with traditional training methodologies. METHODS Surgical interns (N = 30) participated in a 1-hour session featuring an instructional video and practice performing internal jugular (IJ) and subclavian (SC) CVC placement with guided instruction. All interns underwent baseline knowledge and skill assessment for IJ and SC (pretest) CVC placement; watched a "correct-only" (CO) or "correct + error" (CE) instructional video; practiced for 30 minutes; and were posttested on knowledge and IJ and SC CVC placement. Skill retention and transfer (femoral CVC placement) were assessed 30 days later. All skills tests (pretest, posttest, and transfer) were videorecorded and deidentified for evaluation by a single blinded instructor using a validated 17-item checklist. RESULTS Both the groups exhibited significant improvements (p < 0.001) in knowledge and skills after the 1-hour training program, but the increase of items achieved on the performance checklist did not differ between conditions (CO: IJ Δ = 35%, SC Δ = 29%; CE: IJ Δ = 36%, subclavian Δ = 33%). However, 1 month later, the CO group exhibited significant declines in skill retention on IJ CVC placement (from 68% at posttraining to 44% at day 30; p < 0.05) and SC CVC placement (from 63% at posttraining to 49% at day 30; p < 0.05), whereas the CE group did not have significant decreases in performance. The CE group performed significantly better on femoral CVC placement (i.e., transfer task; 62% vs 38%; p < 0.01) and on 2 of the 3 complication scenarios (p < 0.05) when compared with the CO group. CONCLUSIONS These data indicate that incorporating error-based activities and discussions into training programs can be beneficial for skill retention and transfer.
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Becker TK, Betcher JA, Dooley-Hash SL, Fung CH, Soyk CC, Barton DF, Theyyunni NR. A WINning Technique: The Wire-in-Needle Feasibility Study. J Emerg Med 2015; 49:785-91. [PMID: 26281803 DOI: 10.1016/j.jemermed.2015.05.042] [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: 02/03/2015] [Revised: 05/16/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dynamic ultrasound guidance reduces complications associated with central venous catheter placement. However, successful central venous cannulation often remains challenging, particularly in hypotensive patients. The new wire-in-needle (WIN) technique can further increase periprocedural safety. Here, a needle is "preloaded" with a guidewire that is then advanced toward the tip of needle. The vein is then cannulated using long-axis ultrasound guidance. OBJECTIVE To evaluate the feasibility and safety profile of the WIN technique. METHODS Medical students, and resident and attending physicians participated in this study. After a brief lecture and practice session on the WIN technique, they underwent a skills assessment evaluating different aspects of both techniques. Participants then completed a survey assessing their prior experience regarding procedural ultrasound, and their assessment of the WIN technique. RESULTS Sixty clinicians participated. The assessment of both techniques revealed no significant differences in the number of needle redirections, cannulation attempts, number of arterial punctures, or overall dexterity with the procedure. The WIN technique was faster (45.9 vs. 61.5 s, p = 0.0005) than the traditional technique. More participants confirmed the accurate position of the guidewire in the vein (75% vs. 95%, p = 0.002). More than 90% of study participants met the predefined safety aspects of the WIN technique. Almost all participants reported that they plan on using the WIN technique in their clinical practice. CONCLUSION This study demonstrates that the WIN technique can be learned quickly and easily by clinicians with various levels of training. In this study, using manikins, it was as successful and safe as the traditional short-axis approach.
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Affiliation(s)
- Torben K Becker
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Joseph A Betcher
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Suzanne L Dooley-Hash
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Christopher H Fung
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Cody C Soyk
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - David F Barton
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Nik R Theyyunni
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan
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Perray S, Costes É, Héritier S. [The role of the nurse and child health nurse in a haematology day hospital]. Soins Pediatr Pueric 2015; 36:24-27. [PMID: 26183096 DOI: 10.1016/j.spp.2015.05.005] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The paediatric haemato-oncology nurse and the child health nurse in a day hospital have specific technical skills and in-depth knowledge in order to be able to provide global care for children with leukaemia. Close collaboration between the different professionals working in this care unit is essential.
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Affiliation(s)
- Stéphanie Perray
- Service d'hémato-oncologie pédiatrique, Hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - Élodie Costes
- Service d'hémato-oncologie pédiatrique, Hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Sébastien Héritier
- Service d'hémato-oncologie pédiatrique, Hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr-Arnold-Netter, 75012 Paris, France
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Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, Karavergou A, Rapti A, Trakada G, Katsikogiannis N, Tsakiridis K, Karapantzos I, Karapantzou C, Barbetakis N, Zissimopoulos A, Kuhajda I, Andjelkovic D, Zarogoulidis K, Zarogoulidis P. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med 2015; 3:40. [PMID: 25815301 DOI: 10.3978/j.issn.2305-5839.2015.02.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 12/12/2022]
Abstract
The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.
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Affiliation(s)
- Nikolaos Tsotsolis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Katerina Tsirgogianni
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ioannis Kioumis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Georgia Pitsiou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Sofia Baka
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Antonis Papaiwannou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Anastasia Karavergou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Aggeliki Rapti
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Georgia Trakada
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Nikolaos Katsikogiannis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Kosmas Tsakiridis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ilias Karapantzos
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Chrysanthi Karapantzou
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Nikos Barbetakis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Athanasios Zissimopoulos
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Ivan Kuhajda
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Dejan Andjelkovic
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Konstantinos Zarogoulidis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
| | - Paul Zarogoulidis
- 1 Anesthesiology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 2 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 5 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Ear, Nose and Throat, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece ; 9 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 10 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 11 Clinic for Thoracic Surgery, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, University of Novi Sad, Serbia
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DeAngelis V, Denny J, Chyu D, Jan T, Lemaire A, Chiricolo A, Solina A. The Optimal Angle of Head Rotation for Internal Jugular Cannulation as Determined by Ultrasound Evaluation. J Cardiothorac Vasc Anesth 2015; 29:1257-60. [PMID: 25998069 DOI: 10.1053/j.jvca.2015.02.007] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the degree of head rotation that creates the maximal anatomic separation between the right internal jugular vein and the carotid artery. DESIGN Single-center prospective, observational cohort study. SETTING University medical center. PARTICIPANTS Fifty patients aged>21 years and undergoing cardiac surgery. INTERVENTIONS An ultrasound machine equipped with a digital caliper was used to determine the relational anatomy of the internal jugular vein and the carotid artery, with patients in the Trendelenburg position at head angles of -15°, 0°,+15°,+30°,+45°,+60°,+75°, and+90°. MEASUREMENTS AND MAIN RESULTS When examining the percentage of the internal jugular vein vertical diameter that is not overlapped by the carotid artery (vertically unencumbered), there was a difference between the head angle groups (p<0.01). Unencumbered vertical distance was different between+75° versus 0°, and+75° versus+15°. At+75°, 60.3%±5.3% of the internal jugular vein was unencumbered vertically, whereas at 0°, it was 37.2%±3.9%, and at+15° it was 40.3%±3.8%. Only 72% of the patients were able to position their head at+75°, and 54% of the subjects were able to position their head at+90°. CONCLUSION The authors found the internal jugular vein becomes more vertically separated from the carotid artery at more extreme angles of contralateral head rotation.
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Affiliation(s)
| | | | | | | | - Anthony Lemaire
- Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Dhanasekaran R, Karthekeyan RB, Vakamudi M. Cardiac tamponade secondary to perforation of innominate vein following central line insertion in a neonate. Indian J Anaesth 2015; 58:749-51. [PMID: 25624543 PMCID: PMC4296364 DOI: 10.4103/0019-5049.147174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/04/2022] Open
Abstract
Cardiac tamponade following central line in a neonate is rare and an uncommon situation; however, it is potentially reversible when it is diagnosed in time. We report a case of cardiac tamponade following central line insertion. A 10-day-old 2.2 kg girl operated for obstructed total anomalous pulmonary venous connections had neckline slipped out during extubation. Attempted cannulations of right femoral vein were unsuccessful. At the end of the left internal jugular vein cannulaton, there was a sudden cardiorespiratory arrest. Immediate transthoracic echocardiogram showed left pleural and pericardial collection. Chest was opened and the catheter tip was seen in the thoracic cavity after puncturing the innominate vein. The catheter was removed and the vent was repaired.
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Affiliation(s)
- Ramkumar Dhanasekaran
- Department of Anesthesiology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Ranjith B Karthekeyan
- Department of Anesthesiology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Mahesh Vakamudi
- Department of Anesthesiology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Jobson M, Sandrof M, Valeriote T, Liberty AL, Walsh-Kelly C, Jackson C. Decreasing time to antibiotics in febrile patients with central lines in the emergency department. Pediatrics 2015; 135:e187-95. [PMID: 25489011 DOI: 10.1542/peds.2014-1192] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Rapid antibiotic administration is essential for the successful management of patients who have central lines and present with fever. We conducted an emergency department (ED) improvement initiative to deliver antibiotics to 90% of patients within 60 minutes and to minimize process variation. METHODS Our setting was an academic ED. We assembled a multidisciplinary team, identified contributing factors to the care delivery problem, determined key drivers and intervention steps, implemented changes, and used strategies to engage ED staff and promote sustainability. Outcomes were analyzed by using a time series design with baseline data and continuous postintervention monitoring. Outcomes included percentage of patients receiving antibiotics within 60 minutes, time to antibiotic administration, and accuracy for triage acuity and chief complaint. RESULTS An 8-month baseline period revealed that 63% of patients received antibiotics within 60 minutes of arrival, with a mean time to antibiotics of 65 minutes. Multiple Plan-Do-Study-Act (PDSA) cycles were used to improve patient identification and initial management processes. The percentage of patients receiving antibiotics within 60 minutes of arrival was increased to 99% (297 of 301), and mean time to administration decreased to 30 minutes (95% confidence interval: 28-32). These gains were sustained for 24 months. Subanalysis identified a racial discrepancy, with African American patients experiencing significantly longer delays than patients of other races (95 vs 61 minutes; P < .05); this discrepancy was eliminated with our initiative. CONCLUSIONS Our initiative exceeded our goal of 90% antibiotic delivery within 60 minutes for a sustained period of at least 24 months, decreased process variation and mean time to antibiotic administration, and eliminated race-based discrepancies in care.
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Affiliation(s)
| | | | | | | | - Christine Walsh-Kelly
- Pediatrics, Division of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Cheryl Jackson
- Departments of Emergency Medicine, and Pediatrics, Division of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
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Moslehi M, Cheki M, Dehghani T, Eftekhari M. Focal hot spot induced by a central subclavian line on bone scan. Adv Biomed Res 2014; 3:230. [PMID: 25538916 PMCID: PMC4260276 DOI: 10.4103/2277-9175.145723] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 12/03/2012] [Indexed: 11/04/2022] Open
Abstract
The diagnostic accuracy of nuclear medicine reporting can be improved by awareness of these instrument-related artifacts. Both awareness and experience are also important when it comes to detecting and identifying normal (and abnormal) variants. We present a case of hot spot on the upper right chest in the region of right subclavicular region resulting from injection of radiotracer from central subclavian line. A 52-year-old woman with a history of left breast cancer and recent bone pain was referred to our nuclear medicine department for skeletal survey. Anterior views of chest show a focus of increased radiotracer uptake corresponding to anterior arch of one of the right second rib. The nuclear physician reported it as a focal rib bony lesion and recommended radiological evaluation. As technician later explained, physicians realized that injection site was a central subclavian line on the right side and hot spot on that region is due to injection site. The appearance of both skeletal and soft-tissue uptake depends heavily on imaging technique (such as the route of radiotracer administration) and the interpreting physicians should be aware of the impact of technical factors on image quality.
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Affiliation(s)
- Masood Moslehi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Cheki
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Tohid Dehghani
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansoureh Eftekhari
- Department of Biology, Science and Research Branch, Islamic Azad University, Fars, Iran
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Yoshida J, Harada Y, Kikuchi T, Asano I, Ueno T, Matsubara N. Does antimicrobial use density at the ward level influence monthly central line-associated bloodstream infection rates? Infect Drug Resist 2014; 7:331-5. [PMID: 25525373 PMCID: PMC4266251 DOI: 10.2147/idr.s74347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to elucidate risk factors, including ward antimicrobial use density (AUD), for central line-associated bloodstream infection (CLABSI) as defined by the Centers for Disease Control and Prevention in a 430-bed community hospital using central venous lines with closed-hub systems. We calculated AUD as (total dose)/(defined daily dose × patient days) ×1,000 for a total of 20 drugs, nine wards, and 24 months. Into each line day data, we inputed AUD and device utilization ratios, number of central line days, and CLABSI. The ratio of susceptible strains in isolates were subjected to correlation analysis with AUD. Of a total of 9,997 line days over 24 months, CLABSI was present in 33 cases (3.3 ‰), 14 (42.4%) of which were on surgical wards out of nine wards. Of a total of 43 strains isolated, eight (18.6%) were methicillin-resistant Staphylococcus aureus (MRSA); none of the MRSA-positive patients had received cefotiam before the onset of infection. Receiver-operating characteristic analysis showed that central line day 7 had the highest accuracy. Logistic regression analysis showed the central line day showed an odds ratio of 5.511 with a 95% confidence interval of 1.936–15.690 as did AUD of cefotiam showing an odds ratio of 0.220 with 95% confidence interval of 0.00527–0.922 (P=0.038). Susceptible strains ratio and AUD showed a negative correlation (R2=0.1897). Thus, CLABSI could be prevented by making the number of central line days as short as possible. The preventative role of AUD remains to be investigated.
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Affiliation(s)
- Junichi Yoshida
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Yukiko Harada
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Tetsuya Kikuchi
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Ikuyo Asano
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Takako Ueno
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Nobuo Matsubara
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan
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46
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Abstract
Central line placement is an integral part of our daily routine and although it is necessary in a select group of patients, serious complications may occur in up to 10% of cases. Inadvertent placement in the subclavian artery is considered to be one of the most challenging complications to the vascular specialist, which is mainly due to its deep anatomical location. Several endovascular options are available and should be tailored to fit each scenario. Herein, we present different approaches for the management of three cases of inadvertent subclavian artery cannulation. The first patient was treated with a covered stent, the second with prolonged balloon inflation, and the third with a closure device.
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Affiliation(s)
- Albeir Y Mousa
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Shadi Abu-Halimah
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Aravinda Nanjundappa
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
| | - Ali F AbuRahma
- Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA
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47
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Mangum DS, Verma A, Weng C, Sheng X, Larsen R, Kirchhoff AC, Druzgal C, Fluchel M. A comparison of central lines in pediatric oncology patients: Early removal and patient centered outcomes. Pediatr Blood Cancer 2013; 60:1890-5. [PMID: 23868811 DOI: 10.1002/pbc.24687] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/14/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND While there is increasing evidence supporting the choice of subcutaneous ports (SPs) over external venous catheters (EVCs) in pediatric oncology patients, prior conflicting studies exist and little data have been gathered as to which type of central line is preferred from the patient/family perspective. PROCEDURE We performed a single institution, 10 years, retrospective analysis of central lines in pediatric oncology patients (n = 878) to evaluate unplanned early removal and cause of removal while simultaneously obtaining a cross sectional survey of 143 of the primary caretakers/parents of these patients to evaluate their overall satisfaction with the line. RESULTS EVCs have significantly higher odds of unplanned early removal in comparison to SPs (6.7% of SPs vs. 27.3% of EVCs, odds ratio (OR) = 6.3, P < 0.0001 when controlling for age and diagnosis) secondary to increased infection, malfunction and patient preference. Patients with SPs felt like their central line was easier to care for, had less daily impact in their life, and were overall more satisfied with their central line compared to patients with EVCs, even when controlling for early removal (P < 0.0001 for all). SP patients were much more likely to state that they would choose the same type of line again (OR = 15, P < 0.0001) than EVC patients. CONCLUSION SPs demonstrated lower removal rates and greater patient satisfaction than EVCs. These data should be considered when choosing a central line for pediatric cancer patients.
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Affiliation(s)
- David Spencer Mangum
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; Primary Children's Medical Center, Salt Lake City, Utah; Albert Einstein College of Medicine, Bronx, New York
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