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Harrington EM, Trautman K, Davis MB, Varzavand K, Meacham H, Dains A, Marra AR, McDanel J, Kenne L, Hanna B, Murphy JP, Diekema DJ, Wellington M, Brust KB, Kobayashi T, Abosi OJ. Descriptive epidemiology of central line-associated bloodstream infections at an academic medical center in Iowa, 2019-2022. Am J Infect Control 2024; 52:436-442. [PMID: 37827243 DOI: 10.1016/j.ajic.2023.09.021] [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: 07/08/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) increased nationally during the COVID-19 pandemic. We described CLABSIs at our institution during 2019 to 2022. METHODS This retrospective observational study examined CLABSIs among adult inpatients at an 866-bed teaching hospital in the Midwest. CLABSI incidence was trended over time and compared to monthly COVID-19 admissions. Manual chart review was performed to obtain patient demographics, catheter-associated variables, pathogens, and clinical outcomes. RESULTS We identified 178 CLABSIs. The CLABSI incidence (cases per 1,000 line days) tripled in October 2020 as COVID-19 admissions increased. CLABSIs in 2020 were more frequently caused by coagulase-negative staphylococci and more frequently occurred in the intensive care units 7+ days after central line insertion. The CLABSI incidence normalized in early 2021 and did not increase during subsequent COVID-19 surges. Throughout 2019 to 2022, about half of the nontunneled central venous catheters involved in CLABSI were placed emergently. One-quarter of CLABSIs involved multiple central lines. Chlorhexidine skin treatment adherence was limited by patient refusal. CONCLUSIONS The increase in CLABSIs in late 2020 during a surge in COVID-19 admissions was likely related to central line maintenance but has resolved. Characterizing CLABSI cases can provide insight into adherence to guideline-recommended prevention practices and identify areas for improvement at individual institutions.
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Affiliation(s)
- Elaine M Harrington
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
| | - Kathryn Trautman
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Mary B Davis
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Kristin Varzavand
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Holly Meacham
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Angelique Dains
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Alexandre R Marra
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jennifer McDanel
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Lynnette Kenne
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Beth Hanna
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Jaime P Murphy
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Daniel J Diekema
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Melanie Wellington
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Karen B Brust
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Takaaki Kobayashi
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Oluchi J Abosi
- Quality Improvement Program, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Wang Y, Lam HK, Xu Y, Yin F, Qian K. Multi-task learning framework to predict the status of central venous catheter based on radiographs. Artif Intell Med 2023; 146:102721. [PMID: 38042594 DOI: 10.1016/j.artmed.2023.102721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Abstract
Hospital patients can have catheters and lines inserted during the course of their admission to give medicines for the treatment of medical issues, especially the central venous catheter (CVC). However, malposition of CVC will lead to many complications, even death. Clinicians always detect the status of the catheter to avoid the above issues via X-ray images. To reduce the workload of clinicians and improve the efficiency of CVC status detection, a multi-task learning framework for catheter status classification based on the convolutional neural network (CNN) is proposed. The proposed framework contains three significant components which are modified HRNet, multi-task supervision including segmentation supervision and heatmap regression supervision as well as classification branch. The modified HRNet maintaining high-resolution features from the start to the end can ensure to generation of high-quality assisted information for classification. The multi-task supervision can assist in alleviating the presence of other line-like structures such as other tubes and anatomical structures shown in the X-ray image. Furthermore, during the inference, this module is also considered as an interpretation interface to show where the framework pays attention to. Eventually, the classification branch is proposed to predict the class of the status of the catheter. A public CVC dataset is utilized to evaluate the performance of the proposed method, which gains 0.823 AUC (Area under the ROC curve) and 82.6% accuracy in the test dataset. Compared with two state-of-the-art methods (ATCM method and EDMC method), the proposed method can perform best.
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Affiliation(s)
- Yuhan Wang
- Department of Engineering, King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Hak Keung Lam
- Department of Engineering, King's College London, Strand, London, WC2R 2LS, United Kingdom.
| | - Yujia Xu
- Department of Engineering, King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Faliang Yin
- Department of Engineering, King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Kun Qian
- Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Campus, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
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Angelini F, Rossi L, Taccogna S, Crisanti A, Borra G, Gozzi E. First report of Central-line-associated bloodstream infection (CLAB- SI) due to Enterococcus raffinosus (ER) in a cancer patient. Clin Ter 2023; 174:469-472. [PMID: 38048106 DOI: 10.7417/ct.2023.5010] [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: 12/05/2023]
Abstract
Abstract Despite the advances made by therapeutic technologies, healthcare-associated infections (HAIs) are currently still a worldwide problem. Central-line-associated bloodstream infections (CLABSIs) are one of the most common causes of HAIs. The cost of CLABSIs is considerable, both for the increase in morbidity and financial resources expenses. Coagulase-negative staphylococci are the common pathogens responsible for CLABSIs, followed by Staphylococcus aureus, Enterococci, and Candida spp. The Enterococcus genus comprises of more than 50 species but E. faecalis and E. faecium are the most common causes of infections in humans. Enterococcus Raffinosus (ER) is a non-faecalis and non-faecium enterococcus even if ER has rarely been proven to be a human pathogen, recent reports of infections caused by enterococci that are relatively resistant to beta-lactam antibiotics by non-p-lactamase mechanisms have included strains of ER. Here we describe a first report of CLABSI due to Enterococcus Raffinosus in a cancer patient.
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Affiliation(s)
- F Angelini
- Medical Oncology Unit, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - L Rossi
- UOC of Oncology, ASL Latina, Distretto 1, University of Rome "Sapienza" , Aprilia (LT), Italy
| | - S Taccogna
- Department of Pathology, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - A Crisanti
- Medical Laboratory, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - G Borra
- Medical Laboratory, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - E Gozzi
- Medical Oncology Unit, ASL RM6, Polo Ospedaliero di Anzio, Rome, Italy
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Liu Y, Li J, Chang J, Xiao S, Pei W, Wang L. A new inexpensive ultrasound-guided central venous catheterization simulation model. BMC Med Educ 2023; 23:106. [PMID: 36774471 PMCID: PMC9921340 DOI: 10.1186/s12909-023-04080-z] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Central venous catheters (CVCs) are life-saving tools for fluid therapy during surgery. Ultrasound-guided CVC placement has been shown to be safe and highly efficient. However, it is difficult for medical workers with less experience in ultrasonography to acquire the necessary skill in a short time. Simulation-based training is a good way to enhance the skill of a beginner. Therefore, in this study, we introduced a new, inexpensive and easily implemented model for ultrasound-guided CVC placement training and assessed the feasibility of this model. METHODS This was a quasi-experimental study. Thirty-three anaesthesiology postgraduate year 2 and 3 residents with strong CVC interest were included in a simulator-based training workshop in a department of anaesthesiology. The simulation model consisted of a piece of pork and two latex catheters filled with red and blue ink. The workshop comprised 3 parts: a 10-min introductory lecture, a 15-min orientation on performing ultrasound-guided CVC insertion based on the model, and a 30-min practice session. Participants completed relevant questionnaires before and after the training. Moreover, an examination was held to evaluate their skill with the novel model. RESULTS All participants indicated that the novel model increased their self-perceived confidence in ultrasound-guided catheterization. They also all reported that the model was adequate for training anaesthesiology residents in ultrasound-guided catheterization. A few individuals thought the model did not mimic the progress of CVC insertion (3 of 33). After training, participants did not show a significant difference in the acquisition of central venous catheterization theory. However, their competency with ultrasound-guided CVC placement was enhanced. This was demonstrated not only based on subjective answers to the following questions, namely, "how do you perform central venous catheterization with ultrasound guidance?" (p < 0.001), "can you perform ultrasound-guided central venous catheterization?" (p < 0.001), and "how much self-confidence do you have in performing ultrasound-guided central venous catheterization?" (p < 0.001), but also in objective performance (evaluation of the core step in ultrasound-guided placement (p < 0.001)). CONCLUSION The new simulator is a feasible, inexpensive and easily reproducible tool for training anaesthesiologists in ultrasound-guided central venous catheterization. After the simulation-based training workshop, the competency of residents in performing central venous catheterization with ultrasound guidance improved.
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Affiliation(s)
- Yan Liu
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Jiemei Li
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Jinzhu Chang
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Shaoling Xiao
- Clinical Skills Center, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Wenbo Pei
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Lei Wang
- Department of Anesthesiology, Changzhi Medical College, Changzhi, 046000, Shanxi, China.
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Li S, Luo Y, Deng J, Zeng J, Fan M, Wang T, Xia Q. Risk factors for central venous catheter-related thrombosis in hospitalized children: a single-center a retrospective cohort study. Transl Pediatr 2022; 11:1840-1851. [PMID: 36506777 PMCID: PMC9732607 DOI: 10.21037/tp-22-529] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to explore the risk factors of catheter-related thrombosis (CRT) in children in Southwest China who underwent central venous catheter (CVC) insertion. METHODS An observational cohort study was conducted at a single tertiary center in southwest China between November 2019 and February 2020. All patients who received a CVC were enrolled and Doppler-ultrasound examination was performed weekly until CVC removal. All patients in this study were hospitalized and were observed and followed up in this hospital. Patient demographics, medication, biochemical indexes, catheter maintenance practice, activities after CVC placement data were analyzed. The Kaplan-Meier method was used to calculate the incidence of CRT, and the Cox regression model was used to analyze the factors influencing CRT. RESULTS A total of 594 children were included in the study, and the median indwelling time was 10 days, with the shortest being 1 day and the longest 60 days. The overall incidence of CRT was 26.60% (158/594), the 15-day cumulative incidence rate was 30.81%, and the 45-day cumulative incidence rate was 46.27%. After 45 days, the incidence of CRT further increased. Age <12 months [hazard ratio (HR), 1.654; 95% confidence interval (CI): 1.171-2.338], use of 20% mannitol or glycerol fructose (HR, 1.593; 95% CI: 1.058-2.398), CVC placement by a pediatric intensive care unit (PICU) doctor (HR, 1.921; 95% CI: 1.347-2.740), placement length ≥9 cm (HR, 1.633; 95% CI: 1.142-2.336), and D-dimer >1.5 mg/L (HR, 1.451; 95% CI: 1.044-2.015) were risk factors for CRT. Limb exercises (HR, 0.660; 95% CI: 0.469-0.929) after placement was a protective factor for CRT. CONCLUSIONS The incidence of CRT was higher in children with CVCs, and the key duration of CRT monitoring should be within 15 and 45 days after placement. Patients with age <12 months, using 20% mannitol or glycerol fructose, insertion length ≥9 cm, D-dimer >1.5 mg/L before placement are more likely to happen CVC-CRT than other patient, and it is necessary to be highly vigilant and take preventive measures.
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Affiliation(s)
- Shuangzi Li
- Neurological Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yetao Luo
- Department of Nosocomial Infection Control, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jiaxin Deng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junqi Zeng
- Neurological Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mingping Fan
- Neurological Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ting Wang
- Neurological Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qing Xia
- Neurological Department, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Maki J, Sumie M, Ide T, Nagamatsu M, Matsushita K, Shirozu K, Higashi M, Yamaura K. A pressure-resistant peripherally inserted central catheter is as useful as a central venous catheter for rapid fluid infusion: an in vitro study. BMC Anesthesiol 2022; 22:205. [PMID: 35787789 PMCID: PMC9252047 DOI: 10.1186/s12871-022-01738-x] [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: 12/13/2021] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although peripherally inserted central catheters (PICCs) have been widely used, they have not been frequently used in anesthesia practice. The central venous pressure measured via PICCs are reportedly as accurate as that measured via central venous catheters (CVCs), but the findings concerning rapid infusion are unclear. This study examined whether or not pressure-resistant PICCs could be used for rapid fluid infusion. Methods The in-line pressure was measured in similar-sized double-lumen catheters—4-Fr PICC (55, 45 and 35 cm) and 17-G CVC (20 and 13 cm)—at flow rates of saline decided using a roller pump system. We also examined the flow rate at an in-line pressure of 300 mmHg, which is the critical pressure at which hemolysis is considered to occur during blood transfusion. Results The pressure-resistant PICCs obtained a high flow rate similar to that of CVCs, but the in-line pressures increased in proportion to the flow rate and catheter length. Flow rates at an intra-circuit pressure of 300 mmHg were not significantly different between the 45-cm PICC and 20-cm CVC. Conclusion Pressure-resistant PICCs can be used for rapid fluid infusion. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01738-x.
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Affiliation(s)
- Jun Maki
- Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan
| | - Makoto Sumie
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoko Ide
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masako Nagamatsu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Katsuyuki Matsushita
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Murakoshi M, Kamei K, Ogura M, Sato M, Nada T, Suzuki R, Kamae C, Nishi K, Kanamori T, Nagano C, Nozu K, Nakanishi K, Iijima K. Unilateral nephrectomy for young infants with congenital nephrotic syndrome of the Finnish type. Clin Exp Nephrol 2021. [PMID: 34581898 DOI: 10.1007/s10157-021-02141-5] [Citation(s) in RCA: 1] [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: 05/14/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The management of congenital nephrotic syndrome of the Finnish type (CNF) is challenging. It is difficult to withdraw intravenous albumin infusions, resulting in long-term hospitalization. In addition, fatal hypotension after bilateral nephrectomy has been reported. In our center, we have performed unilateral nephrectomy during early infancy. METHODS Infants diagnosed with CNF between 2011 and 2020 in our institution were enrolled. We examined the clinical course before and after unilateral nephrectomy and evaluated the effectiveness of this strategy. RESULTS Seven patients (all showing NPHS1 mutations) were enrolled. All required daily intravenous albumin infusion via central venous catheter (CVC). Unilateral nephrectomy was performed at a median of 76 days of age (59-208 days). Surgical complications did not occur in any of patients. The mean albumin dose was decreased after unilateral nephrectomy (2.0 vs 0.4 g/kg/day; p = 0.02). Intravenous albumin infusion could be withdrawn at a median of 17 days, the CVC removed at a median of 21 days, and they discharged at a median of 82 days after unilateral nephrectomy. Although bacterial infections were noted seven times before unilateral nephrectomy, only one episode occurred after surgery. Four patients initiated peritoneal dialysis at two to three years of age and all of them underwent kidney transplantation thereafter. CONCLUSIONS Unilateral nephrectomy during early infancy may be an effective treatment allowing for withdrawal from albumin infusion, prevention of complications, withdrawal from CVCs and shortening hospital stay for patients with CNF.
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Bleker SM, van Es N, van Gils L, Daams JG, Kleinjan A, Büller HR, Di Nisio M. Clinical course of upper extremity deep vein thrombosis in patients with or without cancer: a systematic review. Thromb Res 2016; 140 Suppl 1:S81-8. [PMID: 27067985 DOI: 10.1016/S0049-3848(16)30104-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Information on the clinical course of UEDVT is scarce, especially in cancer patients. AIM To summarize the clinical evidence regarding long-term clinical outcomes of UEDVT, in terms of recurrent venous thromboembolism (VTE), mortality, and anticoagulant-related bleeding, in patients with or without concomitant cancer. METHODS A systematic search of the literature was conducted in MEDLINE, EMBASE and BIOSIS Previews. Incidence rates for all outcome variables were calculated. RESULTS In total, 45 studies comprising 4580 patients were included. No randomized controlled trials were identified. In most studies, patients were treated solely with anticoagulants. Among the prospective studies, the incidences of recurrent VTE and bleeding complications averaged 5.1% and 3.1% respectively, during 3 to 59months of follow-up. In the retrospective studies these figures were 9.8% and 6.7% respectively. Among the prospective studies, the mortality rate was 24% after one year. In the retrospective studies this rate was 35%. Cancer patients were found to have a 2- to 3-fold higher risk of recurrent VTE, an 8-fold increased risk of mortality, and a 4-fold increased risk of bleeding during anticoagulant therapy, compared to non-cancer patients. CONCLUSIONS Studies were very heterogeneous in terms of study design, study populations and treatment approaches. Follow-up durations varied greatly, hampering combined analyses of average incidence rates. There is a need for large prospective studies to provide information on the best management of this disease, especially in high risk groups such as those with cancer.
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Abstract
After the publication in 2011 of latest guidelines of the Centers for Disease Control and Prevention (CDC) for the prevention of catheter-related bloodstream infections (CRBSI) some interesting findings have been published in that field. There has been published that skin disinfection with chlorhexidine alcohol reduced the risk of CRBSI compared to skin disinfection with povidone iodine alcohol, that the implementation of quality improvement interventions reduced the incidence of CRBSI, that the use of chlorhexidine impregnated dressing compared to standard dressings reduced the risk of CRBSI and catheter related cost in an health economic model, and that the use of antimicrobial/antiseptic impregnated catheters reduced the incidence of CRBSI and catheter related cost in clinical studies.
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Affiliation(s)
- Leonardo Lorente
- Department of Critical Care, Hospital Universitario de Canarias, Ofra s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain
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Wanten GJA. Parenteral approaches in malabsorption: Home parenteral nutrition. Best Pract Res Clin Gastroenterol 2016; 30:309-18. [PMID: 27086893 DOI: 10.1016/j.bpg.2016.03.010] [Citation(s) in RCA: 6] [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: 10/27/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 01/31/2023]
Abstract
Severe malabsorption of fluids and nutrients leads to intestinal failure (IF) where intravenous supplementation of nutrients and fluids is necessary to maintain health and/or growth. Long-term treatment of IF implies the start of intravenous support in the outpatient setting (home parenteral nutrition, HPN). Although HPN has proven lifesaving for many patients for more than four decades this strategy remains associated with complications that compromise the quality of life. Many problems relate to the presence of the venous access device and concern infections or vascular occlusion due to thrombosis. Patient training remains key to prevent these complications. Also metabolic problems may arise that involve liver function or composition or bone mineralization. While intestinal transplantation remains inferior to HPN as alternative treatment strategy in terms of survival, promising developments include the introduction of hormones that promote intestinal adaptation, mixed lipid emulsions that decrease liver problems and catheter lock solutions that prevent infections.
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Affiliation(s)
- Geert J A Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Pérez-Zárate P, Aragón-Piña A, Soria-Guerra RE, González-Amaro AM, Pérez-Urizar J, Pérez-González LF, Martinez-Gutierrez F. Risk factors and biofilm detection on central venous catheters of patients attended at tertiary hospital. Micron 2015. [PMID: 26218801 DOI: 10.1016/j.micron.2015.07.001] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To determinate the significance of risk factors with the presence of biofilm on catheters of patients attended at tertiary hospital cares. MATERIAL AND METHODS A total of 126 patients were included, data collection by observing the handling of the CVC, clinical history and microbiological isolation methods of CVCs tips (Roll-plate, sonication and scanning electron microscopy) were evaluated. RESULTS Certain factors, such as the lack of proper hand washing, the use of primary barriers and preparing medications in the same hospital service, showed an important relationship between biofilm formation in CVCs. The sonication method presented that most of the samples had isolation of multispecies 29 samples (64%); in contrast with the roll-plate method, just one sample (3%) was isolated. CONCLUSIONS The importance of the strict aseptic techniques of insertion and of the handlings of CVC was highlighted, the failure of both techniques was related to the biofilm formation and was evidenced using the scanning electron microscopy. Since this tool is not available in most hospitals, we present the correlation of those evidences with other standard microbiological methods and risk factors, which are necessary for the sensible detection of the different steps of the biofilm formation on CVC and their correct interpretation with clinical evidences.
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Affiliation(s)
- Pamela Pérez-Zárate
- Laboratorio de Microbiología, Facultad de Ciencias Químicas, UASLP, San Luis Potosí, SLP, Mexico
| | | | - Ruth Elena Soria-Guerra
- Laboratorio de Microbiología, Facultad de Ciencias Químicas, UASLP, San Luis Potosí, SLP, Mexico
| | - Ana María González-Amaro
- Laboratorio Multidisciplinario de la Maestría en Endodoncia, Facultad de Estomatología, UASLP, San Luis Potosí, SLP, Mexico
| | - José Pérez-Urizar
- Laboratorio de Farmacología, Facultad de Ciencias Químicas, UASLP, San Luis Potosí, SLP, Mexico
| | | | - Fidel Martinez-Gutierrez
- Laboratorio de Microbiología, Facultad de Ciencias Químicas, UASLP, San Luis Potosí, SLP, Mexico.
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Pan KH, Gu DY, Zhou JC, Zhao HC. The carina is approximately 1-2 cm above the pericardial reflection among Chinese patients. J Thorac Dis 2014; 6:845-9. [PMID: 24977011 DOI: 10.3978/j.issn.2072-1439.2014.06.02] [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] [Received: 04/22/2014] [Accepted: 06/06/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Central venous catheters (CVCs) and central venous pressure (CVP) monitor is essential in fluid resuscitation and management for critically ill patients. Accuracy of the CVP is mainly dependent on the proper position of the catheter tip. Although the X-ray visible carina was generally recommended as the alternative of pericardial reflection (PR) to guide the placement of CVCs, few data was available with respect to the distance between the carina and PR among Chinese patients. The purpose of this study was to explore the topographic relationship between the trachea carina and PR among Chinese patients by using computed tomography (CT) images. METHODS CT images of 172 patients who underwent CT pulmonary angiogram or CT angiogram for aorta from January 1, 2013 to November 30, 2013 were retrospectively reviewed. Distances between upper margin of the right clavicular notch, trachea carina, PR and atriocaval junction (ACJ) were calculated using the table positions on axial images. RESULTS The mean length of extrapericardial superior vena cava (SVC) was 2.5 cm. For all patients, the PR was lower than the carina by average 1.6 cm. CONCLUSIONS Given the PR was average 1.6 cm lower than the carina among Chinese patients, placing the CVCs tip approximate 1.6 cm lower the carina among Chinese patients would be more likely to result in a satisfactory placement.
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Affiliation(s)
- Kong-Han Pan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Dan-Yan Gu
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Jian-Cang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Hong-Chen Zhao
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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