Science.gov

Sample records for central venous catheters

  1. Central venous catheters - ports

    MedlinePlus

    ... of Intravascular Catheter-Related Infections. Centers For Disease Control and Prevention. April 2011. ... MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. ...

  2. Central venous catheter - flushing

    MedlinePlus

    ... To flush your catheter, you will need: Clean paper towels Saline syringes (clear), and maybe heparin syringes (yellow) ... your fingers before washing. Dry with a clean paper towel. Set up your supplies on a clean surface ...

  3. Central Venous Catheter (Central Line)

    MedlinePlus

    ... ATS Patient Education Series © 2007 American Thoracic Society ■ ■ Infection— Any tube (catheter) entering the body can make it easier for bacteria from the skin to get into the bloodstream. ...

  4. Anatomical basis of central venous catheter fracture.

    PubMed

    Jensen, Mark O

    2008-03-01

    Central venous catheter fracture is a rare complication of long-term indwelling subclavian venous access. Subclavian vein access has been the recommended approach for placing central venous catheters. The anatomical landmark method for subclavian access remains a highly successful and nonequipment-dependent method for rapid central access. More recently, the internal jugular vein approach has emerged as the preferred route for long-term central venous access. However, variations in internal jugular vein anatomy make the landmark method less reliable. Use of two-dimensional real-time ultrasound during internal jugular vein access is associated with better success, a lower complication rate, and faster access. A case of central venous catheter fracture initiated an internal review of long-term central venous access procedures. We have converted to a predominantly internal jugular vein approach. This case report and literature review may assist other physicians and institutions in re-evaluating long-term central venous access protocols.

  5. Thrombolytic therapy for central venous catheter occlusion

    PubMed Central

    Baskin, Jacquelyn L.; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Pui, Ching-Hon; Howard, Scott C.

    2012-01-01

    Background Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and Methods This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms “central venous catheter”, “central venous access device” OR “central venous line” associated with the terms “obstruction”, “occlusion” OR “thrombolytic” was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. Results Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67–74% within 30–40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16–68% in the control group to 4–23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. Conclusions Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction. PMID:22180420

  6. Infections associated with the central venous catheters.

    PubMed

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  7. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  8. Serendipitous detection of an errant central venous catheter

    SciTech Connect

    Orzel, J.A.; Romdall, K.; Griep, R.

    1985-09-01

    The inappropriate placement of a patient's central venous catheter in the pleural space by the serendipitous injection of Tc-99m labeled red blood cells through the catheter during a GI bleeding study was discovered. Position and patency of central venous lines can be incidentally evaluated by using existing central venous catheters for administration of radiopharmaceuticals during radionuclide imaging studies.

  9. Prevention of central venous catheter bloodstream infections.

    PubMed

    Walz, J Matthias; Memtsoudis, Stavros G; Heard, Stephen O

    2010-01-01

    The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. The most frequent causative organisms for CRBSI are coagulase-negative staphylococci (CoNSs), Staphylococcus aureus, enterococci, and Candida species. The path to infection frequently includes migration of skin organisms at the insertion site into the cutaneous catheter tract, resulting in microbial colonization of the catheter tip and formation of biofilm. Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of antiseptic dressings, and the use of antiseptic or antibiotic impregnated catheters. Achieving and maintaining very low rates of CRBSI requires a multidisciplinary approach involving the entire health care team, the use of novel technologies in patients with the highest risk of CRBSI, and frequent reeducation of staff.

  10. Central venous catheter - dressing change

    MedlinePlus

    ... will need: Sterile gloves Cleaning solution A special sponge A special patch, called a Biopatch A clear ... around the catheter. Clean the skin with the sponge and cleaning solution. Air dry after cleaning. Place ...

  11. Malfunctioning central venous catheters in children: a diagnostic approach

    PubMed Central

    Barnacle, Alex; Arthurs, Owen J.; Roebuck, Derek

    2007-01-01

    Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or ‘linogram’ technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications. PMID:17932667

  12. Central venous catheter placement: where is the tip?

    PubMed

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  13. Intermittent back pain after central venous catheter placement.

    PubMed

    Rosa, U W; Foreman, M; Willsie-Ediger, S

    1993-01-01

    We report a case of inadvertent azygos placement of a central venous catheter. The patient experienced ill-defined back pain associated with total parenteral nutrition infusion. The catheter malposition remained unrecognized and resulted in extensive diagnostic work-up. Symptoms resolved after the catheter was withdrawn.

  14. The stuck central venous catheter: a word of caution.

    PubMed

    Makhija, Neeti; Choudhury, Minati; Kiran, Usha; Chowdhury, Ujjwal

    2008-10-01

    The placement of central venous catheter (CVC) through internal jugular vein is not free from potential hazards. We report two cases of triple lumen central venous catheter, placed into right internal jugular vein, which got entrapped in patients who had undergone mitral valve replacement. The entrapment of catheter went unnoticed until the time of removal. Subsequent investigations, mechanism of entrapment, prevention, and removal is described. To conclude, we encountered an unusual cause of stuck central venous catheter, in the left atrial suture line. Removal of central venous catheter requires utmost care, and should never be done by forceful traction in the postoperative cardiac surgical patients, as it may lead to disruption of suture lines or rupture of vessels.

  15. [Blood culture analysis in children with central venous catheter].

    PubMed

    Delińska-Galińska, Anna; Arłukowicz, Elzbieta; Plata-Nazar, Katarzyna; Luczak, Grazyna; Kozielska, Ewa; Kotłowska-Kmieć, Aldona; Borkowska, Anna

    2008-01-01

    We analyzed 99 blood cultures taken from 28 children with central venous catheter. Children were hospitalized in pediatric, pediatric surgery and pediatric intensive care department. All samples were collected from peripherial vein. Positive blood cultures were obtained more frequently from children with central venous catheter than from children without central venous catheter (57.5% vs. 7.4%). Staphylococcus epidermidis was the most frequently obtained bacteria. The other bacterial species were obtained less frequently. The highest percentage of multi resistant straines was isolated from blood samples collected from intensive care department patients. In each departments in which coagulase-negative Staphylococci were isolated, metycillin-resistant straines dominated.

  16. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism.

    PubMed

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

  17. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

    PubMed Central

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed. PMID:28168186

  18. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters.

    PubMed

    Koh, David Boon Chai; Gowardman, John R; Rickard, Claire M; Robertson, Iain K; Brown, Andrew

    2008-02-01

    Peripheral arterial catheters are perceived as having low infective potential compared with other catheters and may be overlooked as a cause of catheter-related bloodstream infection. We aimed to measure colonization and rates of catheter-related bloodstream infection in arterial catheters, to investigate risk factors for arterial catheter colonization, and to compare arterial catheter infection rates with those in concurrently sited and managed central venous catheters. Prospective 24-month cohort study. Eight-bed combined general intensive care and high-dependency unit of a 350-bed Australian teaching hospital. Three hundred twenty-one arterial catheters in 252 adult and pediatric patients were observed for 1,082 catheter days, and 618 central venous catheters in 410 patients were observed for 4,040 catheter days. All catheters were inserted in, or presented to, the intensive care unit. Both arterial catheters and central venous catheters were inserted by trained personnel under aseptic conditions, and management was standardized. None. The incidence per 1,000 (95% confidence interval) catheter days of colonization (> or = 15 colonies) and catheter-related bloodstream infection was 15.7 (9.5-25.9) and 0.92 (0.13-6.44) for arterial catheters and 16.8 (13.3-21.3) and 2.23 (1.12-4.44) for central venous catheters. Arterial catheter colonization was not significantly different than that in central venous catheters (hazard ratio, 1.17; 95% confidence interval, 0.41-3.36; p = .77). Arterial catheter colonization increased with dwell time and was similar to central venous catheters over time. Femoral arterial catheters were colonized more often than radial arterial catheters (hazard ratio, 5.08; 95% confidence interval, 0.85, 30.3; p = .075), and colonization was significantly higher when the catheter was inserted in the operating theater or emergency department (hazard ratio, 4.45; 95% confidence interval, 1.42-13.9; p = .01) compared with the intensive care unit. The

  19. Imaging of the complications of peripherally inserted central venous catheters.

    PubMed

    Amerasekera, S S H; Jones, C M; Patel, R; Cleasby, M J

    2009-08-01

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  20. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    SciTech Connect

    Gebauer, Bernhard Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland

    2007-07-15

    Purpose. The purpose of this study was to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Materials and Methods. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5-F angiographic catheters (pigtail; Sos Omni), gooseneck snares, or combinations thereof. Results. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients port catheter malposition correction was not possible, because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. Conclusions. We conclude that in migrated catheter tips radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis port catheter correction is often more challenging.

  1. Migration of Indwelling Central Venous Catheter and Fatal Hydrothorax

    PubMed Central

    Jabeen, Shagufta; Murtaza, Ghulam; Hanif, Muhammad Zubair; Morabito, Antonino; Khalil, Basem

    2013-01-01

    Central venous catheter complications can be related to insertion, indwelling, or extraction. Most of the times, immediate complications are anticipated and managed; whereas, delayed complications can go unnoticed. In the case discussed here, migration and dislodgement of catheter tip resulted in delayed hydrothorax and sudden death of a 9-month-old female infant. PMID:25755966

  2. Misplaced central venous catheter in the jugular venous arch exposed during dissection before sternotomy.

    PubMed

    Jung, Tae-Eun; Jee, Daelim

    2008-11-01

    Subclavian vein catheterization rarely results in misplacement of the central venous catheter (CVC) into the jugular venous arch (JVA). We present a case of misplacement of the CVC into the JVA during cardiac surgery.

  3. Hemodialysis catheter-associated central venous stenosis.

    PubMed

    Yevzlin, Alexander S

    2008-01-01

    The purpose of this review is to explore the pathophysiology, epidemiology, and interventional treatment of central vein stenosis (CVS) that may result from central vein catheter (CVC) placement. The precise mechanism of CVC-associated CVS remains largely undefined, though anatomic considerations appear to play a prominent pathologic role. The impact of CVC-associated CVS on arteriovenous fistula outcomes is reviewed. The percutaneous treatment of CVS, observation, angioplasty, or angioplasty with stent placement is reviewed, along with potential surgical treatment options. As the treatment outcomes of CVC-associated CVS have been disappointing, catheter avoidance remains the best strategy.

  4. [Thrombotic complications of central venous catheters in hematooncological patients].

    PubMed

    Joks, Monika; Kroll, Renata; Komarnicki, Mieczysław

    2010-01-01

    Central venous catheters (CVC) are frequently used in patients with a hematological disorders in order to administer drugs, stem cell infusions, blood products, parenteral alimentation as well as for blood sampling. There are known mechanical, infectious and thrombotic complications of central venous catheters in hematological patients. Infectious and thrombotic complications have been considered as separate entities so far, but there are theory and accumulating evidence that they are interrelated. Since data on central venous catheters-related thrombosis in hematological patients have been obtained mainly from retrospective studies of small size, prospective randomized studies are warranted. In this review we present current opinions about epidemiology, pathogenesis, diagnosis of CVC-related thrombosis and also its correlations with infectious CVC-related complications.

  5. [Venous thrombosis associated with central venous catheter use in patients with cancer].

    PubMed

    Iglesias Rey, Leticia; Fernández Pérez, Isaura; Barbagelata López, Cristina; Rivera Gallego, Alberto

    2015-01-01

    The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment.

  6. [Placement of central venous catheters and patient safety].

    PubMed

    de Jonge, E

    2007-01-27

    Placement of a central venous catheter is one of the most common invasive procedures and is associated with septic and mechanical complications, such as bleeding and pneumothorax. Up to 30% of attempts to cannulate the central vein fail. Correct positioning of the patient can help to maximise the success rate. For placement of catheters in the subclavian vein, patients should be in the Trendelenburg position without the use of a shoulder roll to retract the shoulders. Traditionally, central venous catheters are placed using a 'blind' technique that relies on external anatomical reference marks to localise the vein. However, unnoticed anatomical variations or central venous thrombosis may contribute to cannulation failure with this technique. The use of ultrasound has been shown to increase the success rate and avoid mechanical complications when placing a catheter in the internal jugular vein. It may also increase the success rate in subclavian vein catheterisation. To increase patient safety, the use of ultrasound when placing a central venous catheter should be embraced and become the standard of care.

  7. Identifying complications of central venous catheters: infection, thrombosis, occlusion.

    PubMed

    2009-08-01

    (1) The signs of infection of implanted port catheters are inflammation along the course of a central catheter, oozing or signs of an abscess of the pocket in which the port is implanted. Catheter-related venous thrombosis should be suspected in the event of pain, oedema, local swelling, a palpable venous cord and development of superficial collateral circulation; (2) The rapid appearance of local signs and symptoms at the time of injection suggests extravasation of the injected drug; (3) Catheter patency should be checked with normal saline, never using too much force if resistance is encountered. If there is a thrombotic occlusion, the catheter can often be unblocked with heparin, or if not, with urokinase. There is only a moderate risk of bleeding if these agents are used carefully.

  8. Preventing central venous catheter-related bloodstream infection.

    PubMed

    Wilson, Charlotte

    2015-01-13

    Nurses should be able to apply evidence-based practice in a way that is appropriate for the individual patient. This article discusses one area, the incidence of central venous catheter-related bloodstream infection in acute care, to examine the available evidence and identify ways in which this evidence can be applied to practice. Research indicates that implementing best practice at the time of insertion is a principal determinant in minimising the risk of catheter-related bloodstream infection.

  9. Cardiac tamponade caused by central venous catheter in two newborns.

    PubMed

    Monteiro, Andrey José; Canale, Leonardo Secchin; Barbosa, Rodrigo; Méier, Milton

    2008-01-01

    Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  10. Pneumothorax as a complication of central venous catheter insertion.

    PubMed

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    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.

  11. Pneumothorax as a complication of central venous catheter insertion

    PubMed Central

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos

    2015-01-01

    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. PMID:25815301

  12. Catheter-related bacteremia from femoral and central internal jugular venous access.

    PubMed

    Lorente, L; Jiménez, A; García, C; Galván, R; Castedo, J; Martín, M M; Mora, M L

    2008-09-01

    The objective of this prospective observational study was to determine the influence of femoral and central internal jugular venous catheters on the incidence of catheter-related bacteremia (CRB). We included patients admitted to a 12-bed polyvalent medico-surgical intensive care unit over 4 years who received one or more femoral or central internal jugular venous catheters. We diagnosed 16 cases of CRB in 208 femoral catheters and 22 in 515 central internal jugular venous catheters. We found a higher incidence of CRB with femoral (9.52 per 1,000 catheter days) than with central internal jugular venous access (4.83 per 1,000 catheter days; risk ratio = 1.93; 95% confidence interval: 1.03-3.73; P = 0.04). Central internal jugular venous access could be considered a safer route of venous access than femoral access in minimizing the risk of central venous catheter-related bacteremia.

  13. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    PubMed

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  14. The Malposition of Central Venous Catheters in Children

    PubMed Central

    Dzierzega, Maria; Ossowska, Magdalena; Chmiel, Dariusz; Wieczorek, Aleksandra; Balwierz, Walentyna

    2014-01-01

    Summary Background Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. Material/Methods A total number of 309 CVCs were implanted at Children’s University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. Results CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. Conclusions In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them. PMID:25177409

  15. Using central venous catheter for suprapubic catheterization in cardiac surgery.

    PubMed

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2-3 attempts).

  16. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.

    PubMed

    Wang, H; Huang, T; Jing, J; Jin, J; Wang, P; Yang, M; Cui, W; Zheng, Y; Shen, H

    2010-09-01

    We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.

  17. Misplaced central venous catheters: applied anatomy and practical management.

    PubMed

    Gibson, F; Bodenham, A

    2013-03-01

    Large numbers of central venous catheters (CVCs) are placed each year and misplacement occurs frequently. This review outlines the normal and abnormal anatomy of the central veins in relation to the placement of CVCs. An understanding of normal and variant anatomy enables identification of congenital and acquired abnormalities. Embryological variations such as a persistent left-sided superior vena cava are often diagnosed incidentally only after placement of a CVC, which is seen to take an abnormal course on X-ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after such attempts. Catheters can also be misplaced outside veins in a patient with otherwise normal anatomy with potentially disastrous consequences. We discuss the possible management options for these patients including the various imaging techniques used to verify correct or incorrect catheter placement and the limitations of each. If the course of a misplaced catheter can be correctly identified as not lying within a vulnerable structure then it can be safely removed. If the misplaced catheter is lying within or traversing large and incompressible arteries or veins, it should not be removed before consideration of what is likely to happen when it is removed. Advice and further imaging should be sought, typically in conjunction with interventional radiology or vascular surgery. With regard to misplaced CVCs, in the short term, a useful aide memoir is: 'if in doubt, don't take it out'.

  18. Central Venous Catheter Insertion Site and Colonization in Pediatric Cardiac Surgery

    ClinicalTrials.gov

    2017-09-12

    Central Line-associated Bloodstream Infection (CLABSI); Central Venous Catheter Associated Bloodstream Infection; Heart; Surgery, Heart, Functional Disturbance as Result; Congenital Heart Disease; Newborn; Infection

  19. Care of central venous catheters for total parenteral nutrition.

    PubMed

    Collins, E; Lawson, L; Lau, M T; Barder, L; Weaver, F; Bayer, D; Schulz, M; Byrne, R; Hauser, M; Neubia, A; Dries, D

    1996-06-01

    This report summarizes data obtained via a mailed questionnaire from 129 Department of Veterans Affairs (VA) hospitals regarding current practices in the care of central venous catheters (CVCs) used for total parenteral nutrition (TPN). The size of VA hospitals' acute medical-surgical beds ranged from 14 to 1320 (median 168) beds. Over 6000 patients annually received CVCs for TPN. Hospitals reported using triple-lumen catheters most frequently as their CVC for TPN (80.3%). A povidone-iodine scrub was used to prepare the skin for CVC insertion by 72.6% of reporting hospitals. Sixty percent of hospitals used transparent polyurethane dressings. Care of CVCs varied among hospitals. Catheter-related infection and sepsis rates were within the national average, although < 50% of responding hospitals provided data on these outcomes. The results of this survey point to the need for a national standardized database relative to patients receiving TPN via a CVC.

  20. Neonatal central venous catheter thrombosis: diagnosis, management and outcome.

    PubMed

    Park, Christina K; Paes, Bosco A; Nagel, Kim; Chan, Anthony K; Murthy, Prashanth

    2014-03-01

    Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. There is no guideline that systematically addresses the diagnosis, management, and prevention of this complication. The objective of this review is to establish evidence-based guidance for the management of CVC-related thrombosis. A comprehensive search of the scientific literature was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged below 28 days, CVC insertion, and English language - were included for analysis. The incidence of thrombosis was 9.2% (308/3332). Singly inserted umbilical venous catheters (UVCs) and peripherally inserted central catheters accounted for over 80% of all CVCs. Frequently reported thrombotic sites were the hepatic vein, right atrium, and inferior vena cava. Symptoms included distal swelling of affected areas and thrombocytopenia. Increased length of catheter stay, infusion of blood products and malpositioned UVCs were identified as risk factors. The commonest diagnostic investigations to confirm thrombosis were echocardiography and ultrasonography. Spontaneous resolution may occur in UVC-related thrombosis, but this warrants close monitoring. Thrombolysis with urokinase alone or combined with low-molecular-weight heparin might be effective and well tolerated as treatment strategies. Prophylactic heparin increases the duration of catheter usability (P < 0.005, 95% confidence interval 0.35-0.81), decreases catheter occlusion, but may not uniformly prevent thrombosis. CVL-related thrombosis is an underreported complication because events in the majority occur silently. Currently, solid evidence-based recommendations for diagnosis and treatment are not possible. Well designed prospective studies are urgently required to establish a concrete investigational approach to CVC-related thrombosis and to institute safe therapeutic modalities.

  1. Neonatal central venous catheter thrombosis: diagnosis, management, and outcome.

    PubMed

    Park, Christina K; Paes, Bosco A; Nagel, Kim; Chan, Anthony K; Murthy, Prashanth

    2016-07-29

    Thrombotic occlusion of central venous catheters (CVCs) is a common problem in newborns. No guideline systematically addresses the diagnosis, management, and prevention of this complication. The objective of this review is to establish evidence-based guidance for the management of CVC thrombosis. A comprehensive literature search was conducted from 1948 to 2012. Twenty-six articles fulfilling four criteria - humans, neonates aged less than 28 days, CVC insertion, and English language - were included for analysis. The incidence of thrombosis was 9.2% (308/3332). Singly inserted umbilical venous catheters (UVCs) and peripherally inserted central catheters accounted for more than 80% of all CVCs. Frequently reported thrombotic sites were the hepatic vein, right atrium, and inferior vena cava. Symptoms included distal swelling of affected areas and thrombocytopenia. Increased length of catheter stay, infusion of blood products, and malpositioned UVCs were identified risk factors. The commonest diagnostic investigations confirming thrombosis were echocardiography and ultrasonography. Spontaneous resolution may occur in UVC-related thrombosis but warrants close monitoring. Thrombolysis with urokinase alone or combined with low molecular weight heparin might be effective and well tolerated. Prophylactic heparin increases the duration of catheter usability (P < 0.005, 95% confidence interval 0.35-0.81), decreases catheter occlusion, but may not uniformly prevent thrombosis. CVC-related thrombosis is an underreported complication because events in the majority occur silently. Currently, solid evidence-based recommendations for diagnosis and treatment are not possible. Well designed prospective studies are urgently required to establish a concrete investigational approach to CVC thrombosis and to institute well tolerated therapeutic modalities.

  2. The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure.

    PubMed

    Saul, Turandot; Doctor, Michael; Kaban, Nicole L; Avitabile, Nicholas C; Siadecki, Sebastian D; Lewiss, Resa E

    2015-07-01

    The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound-first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location.

  3. Urokinase therapy in neonates with catheter related central venous thrombosis.

    PubMed

    Wever, M L; Liem, K D; Geven, W B; Tanke, R B

    1995-02-01

    The results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with catheter related central venous thrombosis. Complete thrombolysis could be achieved in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen in 10 patients (38%). Therapy success was influenced by age, size and location of the thrombus. Coincidence of infection occurred in 16 patients (62%). Mild hemorrhagic complications were seen in 2 patients (8%), no other significant side effects were observed. Nine patients with residual thrombosis were treated with oral anticoagulants following urokinase resulting in resolution of the thrombus in 6 patients within 3 months (67%). The incidence of asymptomatic recurrent thrombosis was high (28%). Urokinase might be an effective and safe treatment for central venous thrombosis in neonates. Prophylactic antibiotic therapy during the infusion of urokinase and long-term treatment with oral anticoagulants after thrombosis are advisable. Early detection of thrombosis might enhance the success rate of fibrinolytic therapy. Therefore, we strongly recommend routine echocardiographic screening of central venous catheters.

  4. Heparin Leakage in Central Venous Catheters by Hemodynamic Transport

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; McGah, Patrick; Gow, Kenneth; Aliseda, Alberto

    2014-11-01

    Central venous catheters (CVCs), placed in the superior vena cava for hemodialysis, are routinely filled with heparin, an anticoagulant, while not in use to maintain patency and prevent thrombus formation at the catheter tip. However, the heparin-lock procedure places the patient at risk for systemic bleeding incidences, as heparin is known to leak into the blood stream. We propose that the driving mechanism behind heparin leakage is advective-diffusive transport due to the pulsatile blood flow surrounding the catheter tip. This novel hypothesis is based on Planar Laser Induced Fluorescence (PLIF) measurements of heparin transport from a CVC placed inside an in vitro pulsatile flow loop and validated with CFD simulations. The results show an initial, fast (<10s), advection-dominated phase that rapidly depletes the concentration of heparin at the CVC tip, followed by a slow, diffusion-limited phase inside the catheter lumen, where concentration is still high, that is insufficient at replenishing the lost heparin at the tip. These results, which estimate leakage rates consistent with published in vivo data, predict that the concentration of heparin at the catheter tip is effectively zero for the majority of the interdialytic phase, rendering the heparin lock ineffective.

  5. Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients.

    PubMed

    Sheng, W H; Ko, W J; Wang, J T; Chang, S C; Hsueh, P R; Luh, K T

    2000-09-01

    Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study to determine the efficacy by using antiseptic catheters for the prevention of central venous catheters-related infection in the intensive care units. A total of 204 patients with 235 central venous catheters were studied at the surgical intensive care units at National Taiwan University Hospital between November 1998 and June 1999. Participants received either a standard triple-lumen polyurethane catheter or an antiseptic catheter (Arrow International, Reading, Pennsylvania, USA). Both were indistinguishable from each other. Compared to standard polyurethane catheters, antiseptic catheters were less likely to be colonized by microorganisms when they were cultured at the removal (8.0 versus 20.0 colonized catheters per 100 catheters; relative risk 0.34 [95% CI, 0.15 to 0.74]; p<0.01). There was no significant differences between both groups in catheter-related infections (0.9 versus 4.9 infections per 100 catheters; relative risk 0.17 [95% CI, 0.03 to 1.15]; p = 0.07). Gram-positive cocci and fungi were more likely to colonize in the standard polyurethane catheters (p = 0.06 and 0.04, compared to antiseptic catheters respectively). Two of our cases in the control group died directly due to catheter-related candidemia. No adverse reactions such as hypersensitivity or leukopenia were found in the antiseptic catheter group. Our study showed that central venous catheters with antiseptic coating were safe and had less risk of colonization of bacteria and fungi than standard catheters in the critically ill patients.

  6. [Risk factors for the appearance of central venous catheters colonisation].

    PubMed

    Mioljević, Vesna; Suljagić, Vesna; Jovanović, Biljana; Gligorijević, Jelena; Jovanović, Snezana; Mazić, Natasa

    2007-11-01

    Intravascular device placement (IVD) is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI) and increased mortality and morbidity. Nosocomial blood infections (NBIs) account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs). Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC) was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long) were analyzed. Based on the insight into medical documentation, patients' examination and medical staff interview, catheter and patient-related characteristics were recorded. A total of 107 CVCs were analyzed, out of which 56 (52%) were sterile while 51 (48%) were colonized. The results of our study evidenced that total parenteral nutrition (TPN) (p < 0.05), number of catheterization days (p < 0.05), and central venous pressure measurement (p < 0.05) were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter colonization was found with respect to sex, age

  7. Using central venous catheter for suprapubic catheterization in cardiac surgery

    PubMed Central

    Bilehjani, Eissa; Fakhari, Solmaz

    2017-01-01

    Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2–3 attempts). PMID:28116283

  8. [Neonatology nurses' knowledge about Peripherally Inserted Central Venous Catheter].

    PubMed

    Belo, Marcela Patricia Macêdo; Silva, Roberta Albuquerque Mello de Castro; Nogueira, Isis Larissa Maia; Mizoguti, Daniele Pereira; Ventura, Claudiane Maria Urbano

    2012-01-01

    The Peripherally Inserted Central Catheter (PICC) has been used as a safe venous access for infants at risk. The aim of this study was to describe the knowledge and practice of nurses from the five public Neonatal Intensive Care Units, of Recife-PE, Brazil, about the use of the PICC. The sample was comprised by 52 nurses; data were collected from January to February/2010. It was found that 64,8% of nurses did not have license for insertion of the PICC. Only two units routinely used the PICC. About the indication of the access, the accuracy was above 70%. In unit B only 8,3% of nurses reported adequate initial location of the catheter tip. It was concluded that is necessary greater incentives to train nurses to use the PICC.

  9. Counting the cost: hospital versus home central venous catheter survival.

    PubMed

    Melville, C A; Bisset, W M; Long, S; Milla, P J

    1997-03-01

    We compared catheter survival and sepsis rates in a tertiary paediatric gastroenterology centre with those at home in the same patients. We examined whether there were differences in the safety in the two locations, and estimated the financial and opportunity cost implications of any difference. We used survival analysis to analyse differences. Surgical records were audited to determine venous access workload, and to estimate cost implications. Twenty patients with chronic intestinal failure but stable parenteral nutrition requirements, ranging from 0.04-15.83 years of age were studied. The duration of line survival and sepsis-free intervals and rates of re-operation for venous access were determined to estimate morbidity and costs. The study encompassed 28 patient-years in hospital and 48 patient-years at home. There was a significant reduction in the rate of sepsis at home compared with hospital (Z = 4.30, P < 0.00001), and a similar improvement in line survival (Z = 4.36, P < 0.00001). Line insertions accounted for 21% of minor surgery in our hospital, one third being reinsertions. We conclude that central venous catheter sepsis rates are greatly improved at home. If home results could be achieved in the hospital setting, considerable cost savings would be made.

  10. Daptomycin Antibiotic Lock Therapy in a Rat Model of Staphylococcal Central Venous Catheter Biofilm Infections▿

    PubMed Central

    Van Praagh, Andrew D. G.; Li, Tongchuan; Zhang, Shuxin; Arya, Anu; Chen, Liping; Zhang, Xi-Xian; Bertolami, Shellie; Mortin, Lawrence I.

    2011-01-01

    Antibiotic lock therapy (ALT) is an adjunctive procedure to prevent or treat central venous catheter infections, ensuing catheter-related bacteremia, and catheter-related metastatic infections. Daptomycin is a cyclic lipopeptide that is rapidly bactericidal against methicillin-susceptible and -resistant Staphylococcus aureus. The efficacies of daptomycin against central venous catheter biofilms, catheter-related bacteremia, and catheter-related metastatic infections were evaluated by adapting a previously reported central venous catheter biofilm model in rats. Combined daptomycin ALT and systemic dosing resulted in the clearance of an established in vivo S. aureus central venous catheter biofilm after just two daily ALT treatments (30 min with daptomycin at 5 mg/ml) with concurrent systemic daptomycin dosing (40 mg/kg of body weight/day subcutaneously [s.c.]; equivalent exposure of 6 mg/kg/day in people). Daptomycin ALT solutions formulated in either saline or lactated Ringer's solution were equally fast in eradicating established in vivo methicillin-resistant Staphylococcus epidermidis (MRSE) central venous catheter biofilms. However, the lactated Ringer's formulation was superior to that of saline in sustaining the bacterial clearance of treated central venous catheters (83% versus 50%). In MRSE-infected central venous catheter studies, 3 days of daptomycin or vancomycin ALT (18 h at 5 mg/ml) with systemic s.c. dosing (40 mg/kg/day daptomycin or 100 mg/kg/day vancomycin) was equally effective 1 week posttherapy in maintaining cleared central venous catheters (90% [n = 10] versus 100% [n = 8]). These results suggest that daptomycin ALT, along with systemic dosing, could be an effective treatment option for the prevention or eradication of staphylococcal central venous catheter biofilm infections, thereby reducing the occurrence of catheter-related bacteremia or catheter-related metastatic infections. PMID:21709082

  11. Prevention of central venous catheter-related infection: update.

    PubMed

    Casey, Anna L; Elliott, Tom S J

    Central venous catheters (CVCs) are an essential part of modern-day healthcare, but infections associated with these devices continue to cause significant morbidity and mortality. There are many approaches for the prevention of CVC-related infection and these are outlined in national guidelines. The Department of Health Saving Lives campaign has developed a care-bundle for the prevention of CVC-related infections that focuses on the fundamental actions to be undertaken during the catheter insertion process and ongoing care. If the rate of catheter-related infection remains high despite the implementation of these infection prevention strategies, the use of novel antimicrobial technologies and practices may be considered. These include CVCs that contain antimicrobial agents, such as antiseptics or antibiotics, needleless intravenous (IV) access devices coated with silver and/or chlorhexidine, IV dressings incorporating chlorhexidine, and the use of antimicrobial catheter lock solutions, such as antibiotics, chelators or ethanol. This article outlines the different types of CVCs available, the risk of infection associated with their use and established and novel measures for prevention of these infections.

  12. Hemodynamics of Central Venous Catheters: experiments and simulations

    NASA Astrophysics Data System (ADS)

    Barbour, Michael; McGah, Patrick; Clark, Alicia; Ng, Chin Hei; Gow, Kenneth; Aliseda, Alberto

    2013-11-01

    Central venous catheters (CVC) are used to provide vascular access during hemodialysis in patients with end-stage kidney disease. Despite several advantages and widespread use, CVCs have a high incidence rate of clot formation during the interdialytic phase (48 hrs). In an attempt the prevent clot formation, hospitals routinely administer heparin, an anticoagulant, into the catheter after a dialysis session. It has been reported, however, that up to 40% of the heparin solution will leak into the blood stream during the interdialytic phase, placing the patient at risk for systemic bleeding incidences. The aim of this study is to determine the role that advective-diffusive transport plays in the heparin leaking process. Numerical simulations of heparin convective mass transfer have been conducted, showing that while advective losses may be significant at the tip, previous studies may be overestimating the total amount of heparin leakage. To validate the quantitative prediction from the simulations, P.L.I.F. is used to experimentally measure heparin transport from CVCs placed in an idealized Superior Vena Cava with physically accurate pulsatile flow conditions. Improved understanding of flow near the catheter tip is applied to improve catheter design and heparin locking procedures.

  13. Malposition of a Peripherally Inserted Central Venous Catheter in the Graft Hepatic Vein.

    PubMed

    Ersoy, Zeynep; Araz, Coşkun; Taşkın, Duygu; Moray, Gökhan; Torgay, Adnan

    2015-11-01

    Central venous catheters are used for delivering medications and parenteral nutrition, measuring hemodynamic variations, and providing long-term intravenous access. In our clinic, during liver transection using a living-liver donor, peripherally inserted central venous catheters are generally preferred because they involve a less invasive technique with a lower risk of complications. In this report, we present the case of a 36-year-old male liver donor into whom we peripherally inserted a central venous catheter from his left basilic vein. After transecting the hepatic vein, the surgeon found foreign material inside the venous lumen, which turned out to be the distal segment of the catheter.

  14. Rare central venous catheter malposition - an ultrasound-guided approach would be helpful: a case report.

    PubMed

    Kumada, Keisuke; Murakami, Nobuo; Okada, Hideshi; Toyoda, Izumi; Ogura, Shinji; Kondo, Hiroshi; Fukuda, Atsuhiro

    2016-09-13

    A central venous catheter enables the measurement of hemodynamic variations, such as accurate central venous pressure; catheter malposition may induce potentially fatal complications. This case report describes a rare central venous catheter tip malposition in the right internal mammary artery. A 56-year-old Japanese woman who presented with severe pneumonia secondary to scleroderma was treated under ventilator support because of acute respiratory failure. A right central venous catheter was inserted using a landmark technique to monitor central venous pressure and administer medications. However, central venous waveforms detected by the catheter using a pressure lot transducer were later found to be absent. Further imaging studies, including plain radiography, computed tomography, and angiography, confirmed central venous catheter malposition in the internal mammary artery. Her right internal mammary artery was embolized using two interlocking detachable coils, and the central venous catheter was removed from her internal mammary artery without further complications. Internal mammary artery malposition is a rare but potentially lethal complication of central venous catheter catheterization; however, caution should be taken regarding the assessment of risk factors and management of a severe complication. An ultrasound-guided approach would be helpful.

  15. Ultrasound-guided peripheral venous access for therapeutic apheresis procedures reduces need for central venous catheters.

    PubMed

    Salazar, Eric; Garcia, Salvador; Miguel, Robin; Segura, Francisco J; Ipe, Tina S; Leveque, Christopher

    2017-08-01

    Therapeutic and donor apheresis requires adequate vascular access to achieve inlet flow rates of ∼50-100 mL/min. While central dialysis-type venous catheters can usually provide such access, their use includes several associated risks. Some of these risks can be avoided or diminished if adequate peripheral venous access can be established. Some patients have adequate peripheral veins for apheresis that cannot be readily identified visually or by palpation. We hypothesized that ultrasound-guided peripheral venous access would benefit such patients and would lead to placement of fewer central venous catheters. The technique of ultrasound-guided peripheral access for apheresis has been in use at Houston Methodist Hospital since 2012. We performed a prospective review of patients undergoing inpatient and outpatient apheresis at Houston Methodist Hospital from July 1, 2015 to September 30, 2015, to assess its benefit. During this time, we performed 831 procedures on 186 patients, including 787 therapeutic plasma exchanges, three red blood cell exchanges, 41 peripheral stem cell collections. Ultrasound-guided vascular access was used for 68 procedures (8% of all procedures), including 62 therapeutic plasma exchanges, 4 peripheral stem cell collections, and 2 red blood cell changes. Use of ultrasound-guided peripheral access prevented the placement of central venous catheters in 37 (20%) patients, demonstrating its utility in a busy transfusion service. © 2016 Wiley Periodicals, Inc.

  16. In situ management of confirmed central venous catheter-related bacteremia.

    PubMed

    Flynn, P M; Shenep, J L; Stokes, D C; Barrett, F F

    1987-08-01

    Thirty-one patients with suspected central venous catheter-related bacteremia were evaluated with comparative quantitative cultures of central venous and peripheral blood specimens. Using criteria developed from studies in bacteremic animals, 19 patients were confirmed to have catheter-related bacteremia. Antibiotic therapy was administered through the catheter (in situ therapy) in 17 of those patients to evaluate the feasibility of treating patients with true central venous catheter-related bacteremias without catheter removal. Bacteremia was successfully eradicated in 11 of 17 patients (65%), allowing 7 patients to retain their catheter a median of 157 days. This study validates the use of comparative quantitative blood cultures in the diagnosis of catheter-related bacteremia and indicates that in situ therapy is a rational alternative to catheter removal in patients with catheter-related bacteremia.

  17. Cost-Effectiveness of a Central Venous Catheter Care Bundle

    PubMed Central

    Halton, Kate A.; Cook, David; Paterson, David L.; Safdar, Nasia; Graves, Nicholas

    2010-01-01

    Background A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. Methods and Findings A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. Conclusions A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared

  18. Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy.

    PubMed

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co-located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing.

  19. Perforation by central venous catheters: a new testament to an old test.

    PubMed

    Malenka, D J; Ross, J M

    1989-01-01

    Perforation by central venous catheters into the extravascular space is a rare complication of central venous lines that may explain new onset shortness of breath in hospitalized patients. We found that lowering bottles containing infusate and looking for return of venous blood is a highly specific test for this problem. Using Bayes' Theorem we calculated that for prior probabilities of catheter perforation of 0.01 and 0.05, corresponding posterior probabilities ranged from 0.1 to 0.15 and 0.35 to 0.49 respectively. This test should be used in all patients with new shortness of breath who have central venous catheters.

  20. Central venous catheters in neonates: from simple monolumen to port catheter.

    PubMed

    Caruselli, Marco; Carboni, Laura; Franco, Federica; Torino, Giovanni; Camilletti, Gianfranco; Piattellini, Gianmarco; Giretti, Roberto; Pagni, Raffaella

    2011-01-01

    The use of central venous catheters (CVCs) represents an important step in the management of the surgical, onco-hematology and critically ill patients. CVCs in neonates, like in adult patients, are mainly used to infuse hyperosmolar solutions, to take blood samples and for hemodynamic monitoring. The need for CVCs is higher in neonates than in adults. Poor peripheral access and the high demand for IV access and blood samples are already valuable indications for a CVC.

  1. Central venous catheters: choosing the most appropriate access route.

    PubMed

    Hamilton, Helen

    Intravenous therapy and care is a complex and intricate area of practice, which is being subsumed into the core role of registered nurses. As more patients become recipients of a vascular access device (VAD), particularly those requiring intermediate to long-term central venous access, it is important to ensure that not only the device but also the most appropriate vein meets their clinical physiological and psychological needs. There is much research and literature on the insertion and care of central venous catheters (CVCs) as well as the detection and treatment of complications. However, apart from a few small studies comparing the performance of devices placed either in the subclavian or jugular veins, there is little to guide doctors or nurses as to which vein is preferable, if secondary complications are to be avoided. This article will describe a number of primary and secondary complications associated with both the subclavian and internal jugular veins and how these can be minimized by selecting the most appropriate vessel. The article concludes with the author's suggestions for correct patient assessment in order that the correct vein is utilized.

  2. Stenting of the superior vena cava and left brachiocephalic vein with preserving the central venous catheter in situ.

    PubMed

    Isfort, Peter; Penzkofer, Tobias; Goerg, Fabian; Mahnken, Andreas H

    2011-01-01

    Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.

  3. Accidental subclavian artery catheterization during attempted internal jugular central venous catheter placement: a case report.

    PubMed

    Paliwal, Bharat; Kamal, Manoj; Purohit, Anamika; Rana, Kirti; Chouhan, Dilip Singh

    2015-01-01

    Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

  4. Skin antisepsis for reducing central venous catheter-related infections.

    PubMed

    Lai, Nai Ming; Lai, Nai An; O'Riordan, Elizabeth; Chaiyakunapruk, Nathorn; Taylor, Jacqueline E; Tan, Kenneth

    2016-07-13

    The central venous catheter (CVC) is a device used for many functions, including monitoring haemodynamic indicators and administering intravenous medications, fluids, blood products and parenteral nutrition. However, as a foreign object, it is susceptible to colonisation by micro-organisms, which may lead to catheter-related blood stream infection (BSI) and in turn, increased mortality, morbidities and health care costs. To assess the effects of skin antisepsis as part of CVC care for reducing catheter-related BSIs, catheter colonisation, and patient mortality and morbidities. In May 2016 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. We included randomised controlled trials (RCTs) that assessed any type of skin antiseptic agent used either alone or in combination, compared with one or more other skin antiseptic agent(s), placebo or no skin antisepsis in patients with a CVC in place. Two authors independently assessed the studies for their eligibility, extracted data and assessed risk of bias. We expressed our results in terms of risk ratio (RR), absolute risk reduction (ARR) and number need to treat for an additional beneficial outcome (NNTB) for dichotomous data, and mean difference (MD) for continuous data, with 95% confidence intervals (CIs). Thirteen studies were eligible for inclusion, but only 12 studies contributed data, with a total of 3446 CVCs assessed. The total number of participants enrolled was unclear as some studies did not provide such information. The participants were mainly adults admitted to intensive care units, haematology oncology units or general wards

  5. Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax.

    PubMed

    Amir, Rabia; Knio, Ziyad O; Mahmood, Feroze; Oren-Grinberg, Achikam; Leibowitz, Akiva; Bose, Ruma; Shaefi, Shahzad; Mitchell, John D; Ahmed, Muneeb; Bardia, Amit; Talmor, Daniel; Matyal, Robina

    2017-07-01

    Although real-time ultrasound guidance during central venous catheter insertion has become a standard of care, postinsertion chest radiograph remains the gold standard to confirm central venous catheter tip position and rule out associated lung complications like pneumothorax. We hypothesize that a combination of transthoracic echocardiography and lung ultrasound is noninferior to chest radiograph when used to accurately assess central venous catheter positioning and screen for pneumothorax. All operating rooms and surgical and trauma ICUs at the institution. Single-center, prospective noninferiority study. Patients receiving ultrasound-guided subclavian or internal jugular central venous catheters. During ultrasound-guided central venous catheter placement, correct positioning of central venous catheter was accomplished by real-time visualization of the guide wire and positive right atrial swirl sign using the subcostal four-chamber view. After insertion, pneumothorax was ruled out by the presence of lung sliding and seashore sign on M-mode. Data analysis was done for 137 patients. Chest radiograph ruled out pneumothorax in 137 of 137 patients (100%). Lung ultrasound was performed in 123 of 137 patients and successfully screened for pneumothorax in 123 of 123 (100%). Chest radiograph approximated accurate catheter tip position in 136 of 137 patients (99.3%). Adequate subcostal four-chamber views could not be obtained in 13 patients. Accurate positioning of central venous catheter with ultrasound was then confirmed in 121 of 124 patients (97.6%) as described previously. Transthoracic echocardiography and lung ultrasound are noninferior to chest x-ray for screening of pneumothorax and accurate central venous catheter positioning. Thus, the point of care use of ultrasound can reduce central venous catheter insertion to use time, exposure to radiation, and improve patient safety.

  6. Central venous catheter infection with Bacillus pumilus in an immunocompetent child: a case report

    PubMed Central

    Bentur, HN; Dalzell, AM; Riordan, FAI

    2007-01-01

    Background Bacillus organisms are common laboratory contaminants. The majority of Bacillus bacteraemias are transient and not clinically significant. Clinically significant infection due to Bacillus species is rare and mostly due to Bacillus cereus infections in immuno-compromised hosts. Case presentation We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition (PN). There were three episodes of central venous catheter infection with Bacillus pumilus in three months. Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear resulting in the need for removal of the catheter for complete cure. Conclusion Bacillus species can cause clinically significant central venous catheter infection, even in an immunocompetent host. Despite adequate antibiotic treatment, the central venous catheter may need removal for complete cure. PMID:17967173

  7. Central venous catheter infection with Bacillus pumilus in an immunocompetent child: a case report.

    PubMed

    Bentur, H N; Dalzell, A M; Riordan, F A I

    2007-10-29

    Bacillus organisms are common laboratory contaminants. The majority of Bacillus bacteraemias are transient and not clinically significant. Clinically significant infection due to Bacillus species is rare and mostly due to Bacillus cereus infections in immuno-compromised hosts. We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition (PN). There were three episodes of central venous catheter infection with Bacillus pumilus in three months. Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear resulting in the need for removal of the catheter for complete cure. Bacillus species can cause clinically significant central venous catheter infection, even in an immunocompetent host. Despite adequate antibiotic treatment, the central venous catheter may need removal for complete cure.

  8. Retrograde venous cerebral air embolism from disconnected central venous catheter: an experimental model.

    PubMed

    Fracasso, Tony; Karger, Bernd; Schmidt, Peter F; Reinbold, Wolf D; Pfeiffer, Heidi

    2011-01-01

    There are few reported cases of death attributed to retrograde cerebral air embolism from central venous catheter. The pathophysiological mechanism and the necessary conditions are not fully understood, also because of missing experimental data. We performed experimental simulation while working on a possible case of retrograde cerebral air embolism. A hermetic system consisting of two containers connected to each other and to an electric pump by means of rubber hoses was built. In this system, a fluid (water and blood) could continuously flow under conditions similar to those of the common jugular vein. The part of the system representing the jugular vein could be freely positioned at angles between 0 and 90°. A central venous catheter was inserted into this part. After disconnection, the behavior of the air bubbles entering the hose through the tip of the catheter was evaluated at different positions. At angles between 0 and 45°, the air bubbles followed the fluid flow. At angles >45°, the air bubbles showed the tendency to flow upstream; this phenomenon was more evident the more vertically the hose was located. We were able to demonstrate that a retrograde air embolism can be caused by a disconnected catheter and is even more likely if the neck is in a vertical position. © 2010 American Academy of Forensic Sciences.

  9. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

    PubMed Central

    Amer, Aya; Broadbent, Roland S.; Edmonds, Liza

    2016-01-01

    Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management. PMID:28058050

  10. JUGULAR CENTRAL VENOUS CATHETER PLACEMENT THROUGH A MODIFIED SELDINGER TECHNIQUE FOR LONG-TERM VENOUS ACCESS IN CHELONIANS.

    PubMed

    Pardo, Mariana A; Divers, Stephen

    2016-03-01

    Long-term or repeated venous access in chelonians is difficult to obtain and manage, but can be critically important for administration of medications and blood sampling in hospitalized patients. Jugular catheterization provides the most rapid and secure route for vascular access, but catheters can be difficult to place, and maintaining catheter patency may be challenging. Long multilumen polyurethane catheters provide flexibility and sampling access, and minimize difficulties, such as catheter displacement, that have been encountered with traditional over-the-needle catheters. We describe placement of 4 Fr. 13-cm polyurethane catheters in three chelonians with the use of a modified Seldinger technique. Venous access was obtained with the use of an over-the-needle catheter, which allowed placement of a 0.018-in.-diameter wire, over which the polyurethane catheter was placed. Indwelling time has ranged between 1 and 4 mo currently. All tortoises were sedated for this procedure. Polyurethane central catheters provide safe, long-term venous access that allows clinicians to perform serial blood sampling as well as intravenous administration of medications, anesthetic agents, and fluids. A jugular catheter can also allow central venous pressure measurement. Utilization of central line catheters was associated with improvements in diagnostic efficiency and therapeutic case management, with minimal risks and complications.

  11. Central venous access for haemodialysis using the Hickman catheter.

    PubMed

    Cappello, M; De Pauw, L; Bastin, G; Prospert, F; Delcour, C; Thaysse, C; Dhaene, M; Vanherweghem, J L; Kinnaert, P

    1989-01-01

    One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device.

  12. [Right ventricular perforation and cardiac tamponade caused by a central venous catheter].

    PubMed

    Fukuda, H; Kasuda, H; Shimizu, R

    1993-02-01

    A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. Cardiac tamponade was revealed by rapid opening of the chest. Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.

  13. Acute mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter.

    PubMed

    Marín, Miguel Ruiz; Rodríguez, Maria Encarnación Tamayo; Buleje, Jorge Alejandro Benavides; Valverde, Francisco Miguel González; Martínez, Marcelino Méndez; Pérez, Patricia Pastor; Ruiz, María Vicente; Rodríguez, Ana Ruiz; Sales, Alejandro Puerta; Rodríguez, Pedro Marín; Blázquez, Antonio Albarracín Marín

    2012-07-01

    Mediastinitis is a complication generally associated with thoracic surgery. Its occurrence after placement of a central venous catheter is uncommon, and only a few cases have been reported. An 83-year-old man who had mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter is presented. The signs and symptoms, diagnosis, and treatment of this unusual complication are described. This complication should be included in the differential diagnosis of mediastinitis in patients with a central venous catheter in place who have not had thoracic surgery.

  14. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.

    PubMed

    Pikwer, A; Bååth, L; Davidson, B; Perstoft, I; Akeson, J

    2008-01-01

    Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. A total 1619 central venous cannulations were recorded during a three-year period with respect to patient data, information about the cannulation procedures, the radiographic catheter positions and complications during clinical use. The total incidence of radiographic catheter tip malposition, defined as extrathoracic or ventricular positioning, was 3.3% (confidence interval 25 to 4.3%). Cannulation by the right subclavian vein was associated with the highest risk of malposition, 9.1%, compared with 1.4% by the right internal jugular vein. Six of the 53 malpositioned catheters were removed or adjusted. No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.

  15. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters.

    PubMed

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

    To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ≥1 risk factor was 10.34% (12/116), in those with ≥2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis.

  16. [Advantages and disadvantages in the use of central venous catheters in children with malignant diseases].

    PubMed

    Sporisević, L; Hasanbegović, E; Hadzihasanović, E; Bajraktarević, A; Khatib, H; Hamamdzić, M

    1999-01-01

    The authors report the problem of central venous catheter appliance to the children with malignant diseases, employed for the first time in Bosnia and Herzegovina with the aim of pediatric oncologic patients treatment. During 1997 central venous catheter type Hickman was used in nine children between two and half to eleven years old (average six years and one months). The average time of catheter placement was six months, in two cases catheter were eliminated after two and three months respectively since application (spontaneous elimination and repeated septic attacks, caused bu resistant bacterial strains). Gram-positive bacteria have been isolated with eight children (Staphylococcus aureus and Staphylococcus epidermidis), and gram-negative enterobacteriaceae (Serratia marcescens, Pseudomonas aeruginosa, Klebsiella oxytocia and pneumoniae, Escherichia coli, Salmonella group C and Enterococcus faecalis) in samples taken from the catheter and hemoculture. The central venous catheter is useful in treating oncological patients, but may cause serious consequences, like local infections or septicaemia.

  17. Combined endovascular and surgical recanalization after central venous catheter-related obstructions.

    PubMed

    de Buys Roessingh, Anthony S; Portier-Marret, Nathalie; Tercier, Stéphane; Qanadli, Salah D; Joseph, Jean-Marc

    2008-06-01

    Central venous occlusion in children is a challenging problem that can occur after a central venous catheter insertion. Long-term catheter-related complications include sepsis and venous thrombosis with consequent loss of central access. We describe 2 cases of children younger than 1 year who were dependent on a central venous catheter for total parenteral nutrition. They developed a chronic extensive obstruction of the right and left brachiocephalic veins with a superior vena cava syndrome. The patients' survival was dependent on the restoration of central venous access until the planned intestinal transplantation could be performed. Retrograde recanalization of the superior vena cava was successfully achieved using a pathway created under general anesthesia from the femoral vein to, respectively, the right thyroid vein and the right subclavian vein.

  18. An effective and biocompatible antibiofilm coating for central venous catheter.

    PubMed

    Silva Paes Leme, Annelisa Farah; Ferreira, Aline Siqueira; Alves, Fernanda Aparecida Oliveira; de Azevedo, Bruna Martinho; de Bretas, Liza Porcaro; Farias, Rogerio Estevam; Oliveira, Murilo Gomes; Raposo, Nádia Rezende Barbosa

    2015-05-01

    The aim of this study was to investigate the in vitro and in vivo efficacy and the tissue reaction of an antibiofilm coating composed of xylitol, triclosan, and polyhexamethylene biguanide. The antimicrobial activity was analyzed by a turbidimetric method. Scanning electron microscopy was used to evaluate the antiadherent property of central venous catheter (CVC) fragments impregnated with an antibiofilm coating (I-CVC) in comparison with noncoated CVC (NC-CVC) fragments. Two in vivo assays using subcutaneous implantation of NC-CVC and I-CVC fragments in the dorsal area of rats were performed. The first assay comprised hematological and microbiological analysis. The second assay evaluated tissue response by examining the inflammatory reactions after 7 and 21 days. The formulation displayed antimicrobial activity against all tested strains. A biofilm disaggregation with significant reduction of microorganism's adherence in I-CVC fragments was observed. In vivo antiadherence results demonstrated a reduction of early biofilm formation of Staphylococcus aureus ATCC 25923, mainly in an external surface of the I-CVC, in comparison with the NC-CVC. All animals displayed negative hemoculture. No significant tissue reaction was observed, indicating that the antibiofilm formulation could be considered biocompatible. The use of I-CVC could decrease the probability of development of localized or systemic infections.

  19. [Procedure adverse events: nursing care in central venous catheter fracture].

    PubMed

    Pérez-Juan, Eva; Maqueda-Palau, Mònica; Romero-Grilo, Cristina; Muñoz-Moles, Yolanda

    2014-01-01

    In a intensive care unit (ICU) there are many factors that can lead to the occurrence of adverse events. A high percentage of these events are associated with the administration of drugs. Diagnostic tests, such as computed tomography, is common in critically ill patients and technique can be performed with injection of contrast agent to enhance the visualization of soft tissue. The contrast is a medication and the nurse is responsible for its proper administration. The management of the critically ill patient is complex. ICU team and radiology shares responsibility for the care and safety of the patient safety during the transfer and performing tests with contrast. The World Health Organisation patient safety strategies, recommends analysing errors and learning from them. Therefore, it was decided to investigate the causes of the category E severity adverse events that occurred in a patient who was admitted to the ICU for septic shock of abdominal origin. An abdominal computed tomography was performed with contrast which was injected through a central venous catheter. The contrast did not appear in the image. What happened? Causal analysis helped to understand what triggered the event. A care plan and an algorithm were drafted to prevent it from happening again, with the following objectives: improving knowledge, skills and promoting positive attitudes towards patient safety, working at primary, secondary and tertiary care levels.

  20. Closure Using a Surgical Closure Device of Inadvertent Subclavian Artery Punctures During Central Venous Catheter Placement

    SciTech Connect

    Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James

    2001-03-15

    Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)

  1. Usefulness of Groshong catheters for central venous access via the external jugular vein.

    PubMed

    Ishizuka, Mitsuru; Nagata, Hitoshi; Takagi, Kazutoshi; Horie, Toru; Sawada, Tokihiko; Kubota, Keiichi

    2008-01-01

    This study was designed to evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Central venous access was achieved by insertion of a single-lumen 4.0 Fr Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVC-RBSI) were evaluated from the database. Two hundred and twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (p < .01) and period (p < .01), a larger number of operations (p < .01), and more frequent use of total parenteral nutrition (TPN) (p < .01) and less frequent use of chemotherapy (p < .01) than for IJV-C. However, there were no significant differences (NS) in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C. There were no significant differences such complications as malposition, oozing or hematoma formation of insertion site, arterial bleeding, nerve damage, pneumothorax, and phlebitis between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding, and nerve damage. Thus the study concluded that EJV-C using Groshong catheters has no severe complications and has the same rates of CVC-RBSI as conventional IJV-C for central venous access.

  2. Video-based training increases sterile-technique compliance during central venous catheter insertion.

    PubMed

    Xiao, Yan; Seagull, F Jacob; Bochicchio, Grant V; Guzzo, James L; Dutton, Richard P; Sisley, Amy; Joshi, Manjari; Standiford, Harold C; Hebden, Joan N; Mackenzie, Colin F; Scalea, Thomas M

    2007-05-01

    To evaluate the effect of an online training course containing video clips of central venous catheter insertions on compliance with sterile practice. Prospective randomized controlled study. Admitting area of a university-based high-volume trauma center. Surgical and emergency medicine residents rotating through the trauma services. An online training course on recommended sterile practices during central venous catheter insertion was developed. The course contained short video clips from actual patient care demonstrating common noncompliant behaviors and breaks regarding recommended sterile practices. A 4-month study with a counterbalanced design compared residents trained by the video-based online training course (video group) with those trained with a paper version of the course (paper group). Residents who inserted central venous catheters but received neither the paper nor video training were used as a control group. Consecutive central venous catheter insertions from 12 noon to 12 midnight except Sundays were video recorded. Sterile-practice compliance was judged through video review by two surgeons blinded to the training status of the residents. Fifty residents inserted 73 elective central venous catheters (19, 31, and 23 by the video, paper, and control group operators, respectively) into 68 patients. Overall compliance with proper operator preparation, skin preparation, and draping was 49% (36 of 73 procedures). The training had no effect on selection of site and skin preparation agent. The video group was significantly more likely than the other two groups to fully comply with sterile practices (74% vs. 33%; odds ratio, 6.1; 95% confidence interval, 2.0-22.0). Even after we controlled for the number of years in residency training, specialty, number of central venous catheters inserted, and central venous catheter site chosen, the video group was more likely to comply with recommended sterile practices (p = .003). An online training course, with short

  3. Aberrant positioning of a central venous dialysis catheter to reveal a left-sided partial anomalous pulmonary venous connection

    PubMed Central

    Chintu, Manohar R; Chinnappa, Shammikumar; Bhandari, Sunil

    2008-01-01

    We describe the identification of a rare, left-sided, partial anomalous pulmonary venous connection during routine central venous catheterization. To our knowledge, this is the first report in the literature to describe this anomaly in a hemodialysis patient. A young man had anomalous connection of the veins draining the upper lobe of the left lung and left innominate vein. Our case demonstrates the importance of routine fluoroscopy during insertion of central venous catheters to detect these anomalies and minimize complications. PMID:19183765

  4. Aberrant positioning of a central venous dialysis catheter to reveal a left-sided partial anomalous pulmonary venous connection.

    PubMed

    Chintu, Manohar R; Chinnappa, Shammikumar; Bhandari, Sunil

    2008-01-01

    We describe the identification of a rare, left-sided, partial anomalous pulmonary venous connection during routine central venous catheterization. To our knowledge, this is the first report in the literature to describe this anomaly in a hemodialysis patient. A young man had anomalous connection of the veins draining the upper lobe of the left lung and left innominate vein. Our case demonstrates the importance of routine fluoroscopy during insertion of central venous catheters to detect these anomalies and minimize complications.

  5. Thrombus on Indwelling Central Venous Catheters: The Histopathology of 'Fibrin Sheaths'

    SciTech Connect

    Suojanen, James Norman; Brophy, David Paul; Nasser, Imad

    2000-03-15

    Purpose: Central venous catheters (CVC) may fail for many reasons, though 'fibrin sheaths' blocking catheter ports are usually implicated. We examined the sheaths removed from dialysis catheters to determine their histopathology.Methods: Ten catheter strippings were performed and the removed material was studied grossly and microscopically.Results: The histologic specimens showed thrombus both with and without a proteinaceous sheath.Conclusion: Dialysis catheters fail because of thrombus formation. This can occur in either the absence or presence of a protein coating on the catheter, the so-called 'fibrin sheath.'.

  6. Evaluation of the elastic behaviour of central venous PVC, polyurethane and silicone catheters.

    PubMed

    Cervera, M; Dolz, M; Herraez, J V; Belda, R

    1989-02-01

    Eighty used and 20 new silicone, polyurethane and polyvinylchloride central venous catheters were tested to establish the Young's modulus and the bending stiffness of the catheters and their introducers. The catheters were subjected to longitudinal traction forces and their lengthening measured. Young's modulus and the geometric moment of inertia were then calculated. It is shown that polyurethane catheters show least variation in their elastic characteristics, and that silicone catheters offer least resistance to bending and do not change their elastic properties after use. All catheters were equally unlikely to cause thrombus production if this is related to excessive bending stiffness.

  7. [Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review].

    PubMed

    Brachine, Juliana Dane Pereira; Peterlini, Maria Angélica Sorgini; Pedreira, Mavilde da Luz Gonçalves

    2012-12-01

    This is an integrative review of literature aimed to identify evidence-based interventions which make up care bundles to reduce central venous catheter-related or associated bloodstream infections. To collect data in Brazilian and international databases were used the key word bundle and the descriptors catheter-related infection, infection control and central venous catheterization, resulting in fifteen articles, after inclusion criteria application. This work showed five interventions as those commonly employed in the bundles methods: hand hygiene, chlorhexidine gluconate for skin antisepsis, use of maximal sterile barrier precaution during the catheter insertion, avoid the femoral access and daily review of catheter necessity with prompt removal as no longer essential. The majority of the studies showed a significant reduction in bloodstream infection related to or associated with central venous catheters.

  8. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.

    PubMed

    Ainsworth, Sean; McGuire, William

    2015-10-06

    Neonatal parenteral nutrition may be delivered via peripheral cannulas or central venous catheters (umbilical or percutaneous). As the result of complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters after initial stabilisation. Although they can be difficult to place, these catheters may be more stable than peripheral cannulae and require less frequent replacement. These delivery methods may be associated with different risks of adverse events, including acquired invasive infection and extravasation injury. To determine the effects of infusion of parenteral nutrition via percutaneous central venous catheters versus peripheral cannulae on nutrient input, growth and development and complications among hospitalised neonates receiving parenteral nutrition in terms of adverse consequences such as bacteraemia or invasive fungal infection, cardiac tamponade or other extravasation injuries. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1966 to June 2015) and EMBASE (1980 to June 2015), as well as conference proceedings and previous reviews. Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters versus peripheral cannulae in hospitalised neonates. We extracted data using standard methods of the Cochrane Neonatal Group, with separate evaluation of trial quality and data extraction by two review authors. We found six trials recruiting a total of 549 infants. One trial showed that use of a percutaneous central venous catheter was associated with a smaller deficit between prescribed and actual nutrient intake during the trial period (mean difference (MD) -7.1%, 95% confidence interval (CI) -11.02 to -3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae (MD -4.3, 95% CI -5.24, -3.43). Meta-analysis of data from all trials

  9. Use of heparin-coated central venous lines to prevent catheter-related bloodstream infection.

    PubMed

    Abdelkefi, Abderrahman; Achour, Wafa; Ben Othman, Tarek; Ladeb, Saloua; Torjman, Lamia; Lakhal, Amel; Ben Hassen, Assia; Hsairi, Mohamed; Ben Abdeladhim, Abdeladhim

    2007-06-01

    Bloodstream infections related to the use of central venous catheters are an important cause of patient morbidity, mortality, and increased health care costs. Catheter-related infection may be due to fibrin deposition associated with catheters. Interventions designed to decrease fibrin deposition have the potential to reduce catheter-related infections. This study was a randomized, controlled trial in which 246 patients with nontunneled central venous catheters were randomly assigned to receive a heparin-coated catheter with 50 mL/d of normal saline solution as a continuous infusion (heparin-coated group) or a noncoated catheter with a continuous infusion of low-dose unfractionated heparin (control group: continuous infusion of 100 U/kg/d). Catheter-related bloodstream infection occurred in 2.5% (3/120 catheters) in the heparin-coated group (0.9 events per 1,000 days) and in 9.1% (11/120 catheters) in the control group (3.5 events per 1,000 days; P = 0.027). No other risk factors were found for the development of catheter-related bloodstream infection. Six and seven patients experienced severe bleeding in the heparin-coated and control groups, respectively (P = 1.00). We did not observe heparin-induced thrombocytopenia. The use of heparin-coated catheters can be a safe and effective approach to the prevention of catheter-related bloodstream infection in patients with hematooncologic disease.

  10. Percutaneous Retrieval of a Central Venous Catheter Sutured to the Wall of the Right Atrium

    SciTech Connect

    Neuerburg, Joerg-M.; Guenther, Rolf W.; Chalabi, Khaled; Hunter, David

    1999-01-15

    A transjugular central venous catheter was inadvertently sutured to the wall of the right atrium in a 63-year-old female during coronary bypass surgery. Using two nitinol Goose Neck snares via a transfemoral and a transjugular approach the catheter was severed into two pieces and retrieved percutaneously.

  11. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.

    PubMed

    Kim, Se-Chan; Klebach, Christian; Heinze, Ingo; Hoeft, Andreas; Baumgarten, Georg; Weber, Stefan

    2014-12-23

    The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.

  12. Central venous catheter-related bloodstream infections: improving post-insertion catheter care.

    PubMed

    Shapey, I M; Foster, M A; Whitehouse, T; Jumaa, P; Bion, J F

    2009-02-01

    Patients with central venous catheters (CVCs) are at increased risk of bloodstream infections and sepsis-related death. CVC-related bloodstream infections (CRBSIs) are costly and account for a significant proportion of hospital-acquired infections. The aim of this audit was to assess current practice and staff knowledge of CVC post-insertion care and therefore identify aspects of CVC care with potential for improvement. We conducted a prospective audit over 28 consecutive days at a university teaching hospital investigating current practice of CVC post-insertion care in wards with high CVC usage. A multiple choice questionnaire on best practice of CVC insertion and care was distributed among clinical staff. Rates of breaches in catheter care and CRBSIs were calculated and statistical significance assumed when P<0.05. Data was recorded from 151 CVCs in 106 patients giving a total of 721 catheter days. In all, 323 breaches in care were identified giving a failure rate of 44.8%, with significant differences between intensive care unit (ICU) and non-ICU wards (P<0.001). Dressings (not intact) and caps and taps (incorrectly placed) were identified as the major lapses in CVC care with 158 and 156 breaches per 1000 catheter days, respectively. During the study period four CRBSIs were identified, producing a CRBSI rate of 5.5 per 1000 catheter days (95% confidence interval: 0.12-10.97). There are several opportunities to improve CVC post-insertion care. Future interventions to improve reliability of care should focus on implementing best practice rather than further education.

  13. Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.

    PubMed

    Maietta, Pauline Marie

    2012-08-01

    More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. Therefore, it is imperative that they be able to identify and react appropriately to carotid artery injury both in preexisting central lines and those that they have placed. This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.

  14. Clinical evaluation of a chlorhexidine intravascular catheter gel dressing on short-term central venous catheters.

    PubMed

    Karpanen, Tarja J; Casey, Anna L; Whitehouse, Tony; Nightingale, Peter; Das, Ira; Elliott, Thomas S J

    2016-01-01

    A major source of microbial colonization of short-term central venous catheters (CVC) is the patients' endogenous skin microorganisms located at the CVC insertion site. The aim of this study was to determine if a transparent film dressing incorporating a 2% (weight/weight) chlorhexidine gluconate (CHG) gel decreases CVC and insertion site microbial colonization compared with a nonantimicrobial dressing in adult patients in critical care. On CVC removal, samples for microbiological investigation were taken from both the skin surrounding the CVC insertion site and also from sutures securing the CVC. The sutures and intradermal and tip sections of the CVC were also collected for microbiological investigation. Microorganisms recovered from the samples were subsequently tested for susceptibility to CHG. There was a significant reduction in the number of microorganisms recovered from the CVC insertion site, suture site, sutures, and catheter surface in the CHG dressing group (n = 136) compared with the nonantimicrobial dressing group (n = 137). There was no significant difference in susceptibility to CHG between the microorganisms isolated from the CHG and standard dressing study patients. A film dressing incorporating a CHG gel pad significantly reduced the number of microorganisms at the CVC insertion and suture sites with concomitant reduced catheter colonization. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters.

    PubMed

    Au, Arthur K; Rotte, Masashi J; Grzybowski, Robert J; Ku, Bon S; Fields, J Matthew

    2012-11-01

    Obtaining intravenous (IV) access in the emergency department (ED) can be especially challenging, and physicians often resort to placement of central venous catheters (CVCs). Use of ultrasound-guided peripheral IV catheters (USGPIVs) can prevent many "unnecessary" CVCs, but the true impact of USGPIVs has never been quantified. This study set out to determine the reduction in CVCs by USGPIV placement. This was a prospective, observational study conducted in 2 urban EDs. Patients who were to undergo placement of a CVC due to inability to establish IV access by other methods were enrolled. Ultrasound-trained physicians then attempted USGPIV placement. Patients were followed up for up to 7 days to assess for CVC placement and related complications. One hundred patients were enrolled and underwent USGPIV placement. Ultrasound-guided peripheral IV catheters were initially successfully placed in all patients but failed in 12 patients (12.0%; 95 confidence interval [CI], 7.0%-19.8%) before ED disposition, resulting in 4 central lines, 7 repeated USGPIVs, and 1 patient requiring no further intervention. Through the inpatient follow-up period, another 11 patients underwent CVC placement, resulting in a total of 15 CVCs (15.0%; 95 CI, 9.3%-23.3%) placed. Of the 15 patients who did receive a CVC, 1 patient developed a catheter-related infection, resulting in a 6.7% (95 CI, 1.2%-29.8%) complication rate. Ultrasound prevented the need for CVC placement in 85% of patients with difficult IV access. This suggests that USGPIVs have the potential to reduce morbidity in this patient population. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Comparison of NHSN-defined central venous catheter day counts with a method that accounts for concurrent catheters.

    PubMed

    Talbot, Thomas R; Johnson, James G; Anders, Theodore; Hayes, Rachel M

    2015-01-01

    Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates.

  17. Nerve conduction studies are safe in patients with central venous catheters.

    PubMed

    London, Zachary N; Mundwiler, Andrew; Oral, Hakan; Gallagher, Gary W

    2017-08-01

    It is unknown if central venous catheters bypass the skin's electrical resistance and engender a risk of nerve conduction study-induced cardiac arrhythmia. The objective of this study is to determine if nerve conduction studies affect cardiac conduction and rhythm in patients with central venous catheters. Under continuous 12-lead electrocardiogram monitoring, subjects with and without central venous catheters underwent a series of upper extremity nerve conduction studies. A cardiologist reviewed the electrocardiogram tracings for evidence of cardiac conduction abnormality or arrhythmia. Ten control subjects and 10 subjects with central venous catheters underwent the nerve conduction study protocol. No malignant arrhythmias or conduction abnormalities were noted in either group. Nerve conduction studies of the upper extremities, including both proximal stimulation and repetitive stimulation, do not appear to confer increased risk of cardiac conduction abnormality in those patients with central venous catheters who are not critically ill or have a prior history of arrhythmia. Muscle Nerve 56: 321-323, 2017. © 2016 Wiley Periodicals, Inc.

  18. Implementation of a children’s hospital-wide central venous catheter insertion and maintenance bundle

    PubMed Central

    2013-01-01

    Background Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requires changes in the hospital system as well as in healthcare professionals’ behaviour. The aim of the study is to evaluate process and outcome of implementation of a state-of-the-art central venous catheter insertion and maintenance bundle in a large university children’s hospital. Methods/design An interrupted time series design will be used; the study will encompass all children who need a central venous catheter. New state-of-the-art central venous catheter bundles will be developed. The Pronovost-model will guide the implementation process. We developed a tailored multifaceted implementation strategy consisting of reminders, feedback, management support, local opinion leaders, and education. Primary outcome measure is the number of catheter-associated infections per 1000 line-days. The process outcome is degree of adherence to use of these central venous catheter bundles is the secondary outcome. A cost-effectiveness analysis is part of the study. Outcomes will be monitored during three periods: baseline, pre-intervention, and post-intervention for over 48 months. Discussion This model-based implementation strategy will reveal the challenges of implementing a hospital-wide safety program. This work will add to the body of knowledge in the field of implementation. We postulate that healthcare workers’ willingness to shift from providing habitual care to state-of-the-art care may reflect the need for consistent care improvement. Trial registration: Dutch trials registry, trial # 3635. Trial registration Dutch trials registry (http://www.trialregister.nl), trial # 3635 PMID:24125520

  19. A technique for re-utilizing catheter insertion sites in children with difficult central venous access.

    PubMed

    Johnson, S M; Garnett, G M; Woo, R K

    2017-01-01

    Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited

  20. Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization.

    PubMed

    Walz, J Matthias; Avelar, Rui L; Longtine, Karen J; Carter, Kent L; Mermel, Leonard A; Heard, Stephen O

    2010-11-01

    The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine. Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial. Twenty-five US medical center intensive care units. A total of 960 adult patients requiring central venous catheterization for up to 28 days. Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480). The primary antimicrobial outcome was a dichotomous measure (<15 colony-forming units or ≥ 15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings. Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective

  1. Attending Physician Adherence to a 29-Component Central Venous Catheter Bundle Checklist During Simulated Procedures.

    PubMed

    Barsuk, Jeffrey H; Cohen, Elaine R; Nguyen, Duyhuu; Mitra, Debi; O'Hara, Kelly; Okuda, Yasuharu; Feinglass, Joe; Cameron, Kenzie A; McGaghie, William C; Wayne, Diane B

    2016-10-01

    Central venous catheter insertions may lead to preventable adverse events. Attending physicians' central venous catheter insertion skills are not assessed routinely. We aimed to compare attending physicians' simulated central venous catheterinsertion performance to published competency standards. Prospective cohort study of attending physicians' simulated internal jugular and subclavian central venous catheter insertion skills versus a historical comparison group of residents who participated in simulation training. Fifty-eight Veterans Affairs Medical Centers from February 2014 to December 2014 during a 2-day simulation-based education curriculum and two academic medical centers in Chicago. A total of 108 experienced attending physicians and 143 internal medicine and emergency medicine residents. None. Using a previously published central venous catheter insertion skills checklist, we compared Veterans Affairs Medical Centers attending physicians' simulated central venous catheter insertion performance to the same simulated performance by internal medicine and emergency medicine residents from two academic centers. Attending physician performance was compared to residents' baseline and posttest (after simulation training) performance. Minimum passing scores were set previously by an expert panel. Attending physicians performed higher on the internal jugular (median, 75.86% items correct; interquartile range, 68.97-86.21) and subclavian (median, 83.00%; interquartile range, 59.00-86.21) assessments compared to residents' internal jugular (median, 37.04% items correct; interquartile range, 22.22-68.97) and subclavian (median, 33.33%; interquartile range, 0.00-70.37; both p < 0.001) baseline assessments. Overall simulated performance was poor because only 12 of 67 attending physicians (17.9%) met or exceeded the minimum passing score for internal jugular central venous catheter insertion and only 11 of 47 (23.4%) met or exceeded the minimum passing score for

  2. Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study.

    PubMed

    Wolf, Joshua; Tang, Li; Rubnitz, Jeffrey E; Brennan, Rachel C; Shook, David R; Stokes, Dennis C; Monagle, Paul; Curtis, Nigel; Worth, Leon J; Allison, Kim; Sun, Yilun; Flynn, Patricia M

    2015-01-01

    Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar." Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8-21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0-22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for

  3. Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study

    PubMed Central

    Wolf, Joshua; Tang, Li; Rubnitz, Jeffrey E.; Brennan, Rachel C.; Shook, David R.; Stokes, Dennis C.; Monagle, Paul; Curtis, Nigel; Worth, Leon J.; Allison, Kim; Sun, Yilun; Flynn, Patricia M.

    2015-01-01

    Background Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. Methods We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as “non-laminar.” Results Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8–21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0–22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. Conclusions In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate

  4. Creating and evaluating a data-driven curriculum for central venous catheter placement.

    PubMed

    Duncan, James R; Henderson, Katherine; Street, Mandie; Richmond, Amy; Klingensmith, Mary; Beta, Elio; Vannucci, Andrea; Murray, David

    2010-09-01

    Central venous catheter placement is a common procedure with a high incidence of error. Other fields requiring high reliability have used Failure Mode and Effects Analysis (FMEA) to prioritize quality and safety improvement efforts. To use FMEA in the development of a formal, standardized curriculum for central venous catheter training. We surveyed interns regarding their prior experience with central venous catheter placement. A multidisciplinary team used FMEA to identify high-priority failure modes and to develop online and hands-on training modules to decrease the frequency, diminish the severity, and improve the early detection of these failure modes. We required new interns to complete the modules and tracked their progress using multiple assessments. Survey results showed new interns had little prior experience with central venous catheter placement. Using FMEA, we created a curriculum that focused on planning and execution skills and identified 3 priority topics: (1) retained guidewires, which led to training on handling catheters and guidewires; (2) improved needle access, which prompted the development of an ultrasound training module; and (3) catheter-associated bloodstream infections, which were addressed through training on maximum sterile barriers. Each module included assessments that measured progress toward recognition and avoidance of common failure modes. Since introducing this curriculum, the number of retained guidewires has fallen more than 4-fold. Rates of catheter-associated infections have not yet declined, and it will take time before ultrasound training will have a measurable effect. The FMEA provided a process for curriculum development. Precise definitions of failure modes for retained guidewires facilitated development of a curriculum that contributed to a dramatic decrease in the frequency of this complication. Although infections and access complications have not yet declined, failure mode identification, curriculum development, and

  5. Creating and Evaluating a Data-Driven Curriculum for Central Venous Catheter Placement

    PubMed Central

    Duncan, James R.; Henderson, Katherine; Street, Mandie; Richmond, Amy; Klingensmith, Mary; Beta, Elio; Vannucci, Andrea; Murray, David

    2010-01-01

    Background Central venous catheter placement is a common procedure with a high incidence of error. Other fields requiring high reliability have used Failure Mode and Effects Analysis (FMEA) to prioritize quality and safety improvement efforts. Objective To use FMEA in the development of a formal, standardized curriculum for central venous catheter training. Methods We surveyed interns regarding their prior experience with central venous catheter placement. A multidisciplinary team used FMEA to identify high-priority failure modes and to develop online and hands-on training modules to decrease the frequency, diminish the severity, and improve the early detection of these failure modes. We required new interns to complete the modules and tracked their progress using multiple assessments. Results Survey results showed new interns had little prior experience with central venous catheter placement. Using FMEA, we created a curriculum that focused on planning and execution skills and identified 3 priority topics: (1) retained guidewires, which led to training on handling catheters and guidewires; (2) improved needle access, which prompted the development of an ultrasound training module; and (3) catheter-associated bloodstream infections, which were addressed through training on maximum sterile barriers. Each module included assessments that measured progress toward recognition and avoidance of common failure modes. Since introducing this curriculum, the number of retained guidewires has fallen more than 4-fold. Rates of catheter-associated infections have not yet declined, and it will take time before ultrasound training will have a measurable effect. Conclusion The FMEA provided a process for curriculum development. Precise definitions of failure modes for retained guidewires facilitated development of a curriculum that contributed to a dramatic decrease in the frequency of this complication. Although infections and access complications have not yet declined, failure

  6. Assistive technology for ultrasound-guided central venous catheter placement.

    PubMed

    Ikhsan, Mohammad; Tan, Kok Kiong; Putra, Andi Sudjana

    2017-04-19

    This study evaluated the existing technology used to improve the safety and ease of ultrasound-guided central venous catheterization. Electronic database searches were conducted in Scopus, IEEE, Google Patents, and relevant conference databases (SPIE, MICCAI, and IEEE conferences) for related articles on assistive technology for ultrasound-guided central venous catheterization. A total of 89 articles were examined and pointed to several fields that are currently the focus of improvements to ultrasound-guided procedures. These include improving needle visualization, needle guides and localization technology, image processing algorithms to enhance and segment important features within the ultrasound image, robotic assistance using probe-mounted manipulators, and improving procedure ergonomics through in situ projections of important information. Probe-mounted robotic manipulators provide a promising avenue for assistive technology developed for freehand ultrasound-guided percutaneous procedures. However, there is currently a lack of clinical trials to validate the effectiveness of these devices.

  7. Between the lines: The 50th anniversary of long-term central venous catheters.

    PubMed

    Gow, Kenneth W; Tapper, David; Hickman, Robert O

    2017-05-01

    Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used. CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. [Case of Central Venous Catheter Laceration of the Pectoralis Minor Muscle].

    PubMed

    Endo, Shunji; Furuichi, Kinya; Morimoto, Kengo; Kotsuma, Yasuyuki; Yamada, Terumasa; Ikenaga, Masakazu; Adachi, Shinichi; Ohta, Katsuya; Nakashima, Shinsuke; Ueda, Masami; Tsuda, Yujiro; Takayama, Hirotoshi; Itakura, Hiroaki; Nishikawa, Kazuhiro; Nishijima, Junichi

    2016-12-01

    A 50's underwent gastrectomy for gastric cancer 4 years before. He had received chemotherapy for para-aortic lymph node metastases. A central venous catheter with a subcutaneous port was implanted via the right subclavian vein, under ultrasonographic guidance, 1 year 3 months earlier. The patient complained of swelling in his right chest during intravenous injection of ramucirumab and paclitaxel via the port. A chest radiograph revealed that a catheter fracture. A CT scan showed that the fractured catheter had lacerated the pectoralis minor muscle and the tip was in the right inferior pulmonary artery. The catheter fragment was removed using a pigtail catheter and a snare catheter via a percutaneous transfemoral approach, without any complication. The catheter was cut at 15.5 cm from the tip. This fracture was thought to be caused by a kink in the pectoralis muscle.

  9. Life-threatening anaphylactic shock due to chlorhexidine on the central venous catheter: a case series.

    PubMed

    Weng, Meilin; Zhu, Minmin; Chen, Wankun; Miao, Changhong

    2014-01-01

    In this article, we report two life-threatening anaphylactic shocks by an antiseptic coated central venous catheter (CVC) within a 6-month period in our cancer center. Anaphylactic shock was preceded immediately after insertion of a central venous catheter (CVC) coated with silver sulphadiazine and chlorhexidine acetate (Blue FlexTip(®) ARROWg(+)ard Blue(®), 14Ga, Arrow International, Inc. USA). Though antiseptic coated CVC anaphylaxis has been reported in Japan, Europe and America, to our knowledge, this is first reported in China. We present these rare cases to remind clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening.

  10. Placement of a port catheter through collateral veins in a patient with central venous occlusion.

    PubMed

    Teichgräber, Ulf Karl-Martin; Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-01

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  11. Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

    SciTech Connect

    Teichgraeber, Ulf Karl-Martin Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-15

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  12. Measuring central venous structures in humans: implications for central-vein catheter dimensions.

    PubMed

    Twardowski, Zbylut J; Seger, Richard M

    2002-01-01

    The tip of a central vein catheter for hemodialysis should be located in the upper right atrium for the best performance. Hemodialysis catheters do have internal diameter unadjusted to the catheter length; however, the longer the catheter the slower the flow at the same pressure difference. On the other hand, the catheter diameter cannot be so large as to fill the vein too tightly as it predisposes to the damage of the vein wall, thrombosis and stenosis. Therefore, the catheter length and diameter should be appropriate for the patient. For this purpose, the exact dimensions of the venous system in vivo should be known. In this study we correlated the anthropometric measurements and the dimensions of the large upper body veins in 31 adult volunteers. After deep inspiration, magnetic resonance imaging of the chest was performed in three planes; the positions of specific points in the three-dimensional coordinate system were measured, and the distance to adjacent points was calculated according to the analytic geometry formula. The total length from the catheter entry point to the right atrium was the sum of distances between the adjacent points. The lengths of the veins were correlated with the body anthropometric measurements (height, weight, body surface area, bi-acromion span, and height plus bi-acromion span). The best overall correlations of the lengths and diameters of the large upper body veins are with the body surface area. A table is included to guide the selection of the total catheter length and diameter in relation to the body surface area and insertion site.

  13. Update on Insertion and Complications of Central Venous Catheters for Hemodialysis

    PubMed Central

    Bream, Peter R.

    2016-01-01

    Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage. This review covers insertion and complications of central venous catheters for hemodialysis, and the social and economic impact of the use of catheters for initiating dialysis is reviewed. PMID:27011425

  14. Central venous catheter-related bloodstream infections in the intensive care unit

    PubMed Central

    Patil, Harsha V.; Patil, Virendra C.; Ramteerthkar, M. N.; Kulkarni, R. D.

    2011-01-01

    Context: Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients. Aims: This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India. Settings and Design: This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004. Materials and Methods: A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software. Results: A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed

  15. Bacterial infection of central venous catheters in short-term total parenteral nutrition.

    PubMed

    Chan, L; Ngeow, Y F; Parasakthi, N

    1998-03-01

    Fourteen severely ill ventilated patients in an intensive care unit, requiring short-term total parenteral nutrition, were examined for catheter-related infection. Microbiological analysis using Maki's SQ technique was carried out on catheter exit site, catheter hub, proximal subcutaneous segment of catheter and catheter up. Qualitative cultures were carried out on total parenteral nutrition and peripheral blood samples. Twenty six of 29 catheters removed (90%) were culture positive but only 7 catheters were related to positive blood cultures, giving a catheter-related bacteremia (CRB) rate of 24%. Haematogenous seeding was strongly implicated in 7/29 (24%) of catheters. Patients' skin flora appeared to be the main source of catheter-related infection. The organisms isolated for patients with CRB included coagulase-negative staphylococci, Acinetobacter and Klebsiella. It is suggested that to control infective complications of central venous catheters, emphasis should be focused on specialised intravenous therapy teams and the use of strict protocols for insertion and care of central lines.

  16. Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia

    PubMed Central

    Chakraborty, Arunangshu; Agrawal, Sanjit; Datta, Taniya; Mitra, Suparna; Khemka, Rakhi

    2016-01-01

    Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed. PMID:27695218

  17. Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial.

    PubMed

    Schallom, Marilyn E; Prentice, Donna; Sona, Carrie; Micek, Scott T; Skrupky, Lee P

    2012-06-01

    To compare heparin (3 mL, 10 units/mL) and 0.9% sodium chloride (NaCl, 10 mL) flush solutions with respect to central venous catheter lumen patency. Single-center, randomized, open label trial. Medical intensive care unit and Surgical/Burn/Trauma intensive care unit at Barnes-Jewish Hospital, St. Louis, MO. Three hundred forty-one patients with multilumen central venous catheters. Patients with at least one lumen with a minimum of two flushes were included in the analysis. Patients were randomly assigned within 12 hrs of central venous catheter insertion to receive either heparin or 0.9% sodium chloride flush. The primary outcome was lumen nonpatency. Secondary outcomes included the rates of loss of blood return, inability to infuse or flush through the lumen (flush failure), heparin-induced thrombocytopenia, and catheter-related blood stream infection. Assessment for patency was performed every 8 hrs in lumens without continuous infusions for the duration of catheter placement or discharge from intensive care unit. Three hundred twenty-six central venous catheters were studied yielding 709 lumens for analysis. The nonpatency rate was 3.8% in the heparin group (n = 314) and 6.3% in the 0.9% sodium chloride group (n = 395) (relative risk 1.66, 95% confidence interval 0.86-3.22, p = .136). The Kaplan-Meier analysis for time to first patency loss was not significantly different (log rank = 0.093) between groups. The rates of loss of blood return and flush failure were similar between the heparin and 0.9% sodium chloride groups. Pressure-injectable central venous catheters had significantly greater rates of nonpatency (10.6% vs. 4.3%, p = .001) and loss of blood return (37.0% vs. 18.8%, p <.001) compared to nonpressure-injectable catheters. The frequencies of heparin-induced thrombocytopenia and catheter-related blood stream infection were similar between groups. 0.9% sodium chloride and heparin flushing solutions have similar rates of lumen nonpatency. Given potential

  18. Clearance of Cellulosimicrobium cellulans Bacteremia in a Child without Central Venous Catheter Removal

    PubMed Central

    Rowlinson, Marie-Claire; Bruckner, David A.; Hinnebusch, Claudia; Nielsen, Karin; Deville, Jaime G.

    2006-01-01

    Cellulosimicrobium cellulans (formerly known as Oerskovia xanthineolytica) rarely causes human infection. Infections have been reported in immunocompromised hosts or in patients with foreign bodies, such as catheters, where treatment has generally involved removal of the foreign body. We report on a case in which the organism was isolated in multiple blood cultures from a 13-year-old male. After initial therapy failed, treatment with vancomycin and rifampin resulted in infection clearance without removal of the central venous catheter. PMID:16825406

  19. Transhepatic central venous catheter for long-term access in paediatric patients.

    PubMed

    Mortell, Alan; Said, Hanan; Doodnath, Reshma; Walsh, Kevin; Corbally, Martin

    2008-02-01

    Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Access is frequently lost in this group because of thrombosis, infection, or displacement, and vascular options can quickly be exhausted. The last resort access procedure is generally a direct atrial catheter inserted via a thoracotomy. A viable alternative is the percutaneous transhepatic Broviac catheter (Bard Access Systems, Salt Lake City, UT). We retrospectively reviewed the charts of 5 patients who underwent percutaneous transhepatic Broviac insertion for long-term access over a 4-year period in a single institution. Four of the patients (80%) had a significant cardiac abnormality, with 1 patient requiring long-term parenteral nutrition after complicated necrotizing enterocolitis. All patients had significant caval thrombosis, which precluded them having placement of a standard percutaneous or openly placed central catheter. Of the 5 patients, 2 (40%) died of cardiac-related illnesses. Of the 3 surviving patients, 2 had functioning catheters electively removed because they were no longer required. One catheter was removed at thoracotomy for right atrial perforation because of catheter erosion. Vascular access in paediatric patients with chronic and/or life-threatening illness is crucial to survival. Transhepatic central venous catheters are a feasible, reliable, and relatively easily placed form of central access in patients with multiple venous thromboses requiring long-term access. This route should be considered in paediatric patients requiring central access in preference to a thoracotomy.

  20. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters

    PubMed Central

    Baskin, Jacquelyn L.; Pui, Ching-Hon; Reiss, Ulrike; Wilimas, Judith A.; Metzger, Monika L.; Ribeiro, Raul C.; Howard, Scott C.

    2010-01-01

    Long-term central venous catheters (CVC) facilitate care for patients with chronic illnesses, but catheter occlusions and catheter-related thrombosis (CRT) are common complications. This review summarizes management of CVC and CRT. Mechanical CVC occlusions require cause-specific therapy; whereas, thrombotic occlusions usually resolve with thrombolytic therapy, such as alteplase. Prophylaxis with thrombolytic flushes may decrease CVC infections and CRT, but confirmatory studies and cost-effectiveness analysis are needed. Risk factors for CRT include previous catheter infections, malposition of the catheter tip, and prothrombotic states. CRT can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. CRT is diagnosed primarily using Doppler ultrasound or venography and treated with anticoagulation for 6 weeks to a year, depending on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of CRT includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not recommended at present. PMID:19595350

  1. Protocol for Detection of Biofilms on Needleless Connectors Attached to Central Venous Catheters

    PubMed Central

    Donlan, R. M.; Murga, R.; Bell, M.; Toscano, C. M.; Carr, J. H.; Novicki, T. J.; Zuckerman, C.; Corey, L. C.; Miller, J. M.

    2001-01-01

    Central venous catheter needleless connectors (NCs) have been shown to develop microbial contamination. A protocol was developed for the collection, processing, and examination of NCs to detect and measure biofilms on these devices. Sixty-three percent of 24 NCs collected from a bone marrow transplant center contained biofilms comprised primarily of coagulase-negative staphylococci. PMID:11158143

  2. A simulation-based "just in time" and "just in place" central venous catheter education program.

    PubMed

    Lengetti, Evelyn; Monachino, Anne Marie; Scholtz, Amy

    2011-01-01

    The authors describe the Central Venous Catheter Dress Rehearsal simulation program. Teaching is conducted at the bedside, which is efficient and cost effective and allows nurses to practice in a safe environment with no harm to the patient. The educators' challenges and remediation strategies are shared. This simulation program has demonstrated improved consistency of practice and knowledge among pediatric nurses.

  3. Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

    PubMed Central

    Dubbink-Verheij, Gerdina H.; Bekker, Vincent; Pelsma, Iris C. M.; van Zwet, Erik W.; Smits-Wintjens, Vivianne E. H. J.; Steggerda, Sylke J.; te Pas, Arjan B.; Lopriore, Enrico

    2017-01-01

    Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan–Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25–5.41], male gender (HR 2.63, 95% CI 1.17–5.90), and higher birth weight (HR 1.04, 95% CI 1.002–1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12–0.52) was associated with a decreased risk. Conclusion: In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI. PMID:28676849

  4. A comparison of infections and complications in central venous catheters in adults with solid tumours.

    PubMed

    Coady, Karin; Ali, Mohammed; Sidloff, David; Kenningham, Richard R; Ahmed, Samreen

    2015-01-01

    The aim of this study is to compare the complication rates of three vascular access devices in patients with solid tumours having infusion chemotherapy. An observational study of 58 central venous catheter (CVC) lines inserted in 55 patients with solid tumours requiring infusional chemotherapy was performed. The study was conducted between January 2011 and August 2013, looking at complication and infection rates as primary outcomes. Data were recorded from patients with 19 tunnelled cuffed silicone catheters, nine with peripherally inserted central catheters (PICCs) and 30 central venous ports. The two CVC groups (ports and non-ports) matched equally in terms of tumour site; all patients with solid tumours were included, haematology patients were excluded and chemotherapy regimens were comparable. Thirteen out of 28 non- ports had complications compared with one out of 30 central venous ports. Ten out of 19 tunnelled catheters had complications including three displacements and seven were removed due to infection. There were no reports of line-related sepsis in the PICC or ports. Three out of nine PICC lines had complications including two displacements and one PICC blocked permanently requiring removal. In addition, one port out of 30 was removed due to erosion through the skin. There were no episodes of thrombosis or fibrin sheath formation related to any of the devices. In our study, we demonstrated that central venous ports and PICC lines in patients undergoing infusional chemotherapy had lower line infection rates than tunnelled catheters, and only ports have been shown to be almost complication-free. In addition, we found infection rates higher in CVCs s cared for by patient/carers rather than hospital only care, and higher in colorectal patients with stomas. Therefore, we recommend that central venous ports are a safe, acceptable CVC option for infusional chemotherapy for adults with solid tumours.

  5. Knowledge Level on Administration of Chemotherapy through Peripheral and Central Venous Catheter among Oncology Nurses

    PubMed Central

    Kapucu, Sevgisun; Özkaraman, Ayşe Özaydın; Uysal, Neşe; Bagcivan, Gulcan; Şeref, Ferhan Çetin; Elöz, Aygül

    2017-01-01

    Objective: The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration. Methods: Data collection of this descriptive study was started on April 15, 2015–July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation. Results: The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%), control of catheter before the administration (93.9%), influence of chemotherapeutic agent on length of catheter (40.6%), and management of extravasation (75.7%). Nurses also had correct information about the first use of port catheter (67.3%) and checking the catheter whether it is working properly or not (75.8%). Conclusions: In General, nurses’ level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice. PMID:28217732

  6. Central venous catheter infections in outpatients with pulmonary hypertension treated with continuous iloprost.

    PubMed

    Keusch, Stephan; Speich, Rudolf; Treder, Ulla; Ulrich Somaini, Silvia

    2013-01-01

    Intravenous prostanoid therapy is one cornerstone of therapy for patients with pre-capillary pulmonary hypertension (PH). Long-term central venous catheters expose patients to infectious complications. We report the incidence of catheter-related infection (CRI) and the spectrum of bacteria for ambulatory PH patients treated with iloprost via non-tunnelled central venous catheters from our Swiss referral centre in Zurich. Data from 15 PH patients treated with intravenous iloprost between May 2000 and June 2012 were reviewed. We found 11 CRI in 4 cases by two different organisms. Pathogens found were Brevibacterium (55%), Micrococcus luteus (18%), coagulase-negative Staphylococcus (9%) and Staphylococcus aureus (9%), as well as unusual organisms such as Agrobacterium tumefaciens or Delftia tsuruhatensis. The overall CRI rate was 1.28 per 1,000 catheter days, or 0.47 per year. The incidence of CRI using long-term, non-tunnelled central venous catheters in PH patients treated with iloprost is low. Uncommon, rare pathogens causing CRI were found in a substantial number of patients. Copyright © 2013 S. Karger AG, Basel.

  7. Risk factors for central venous catheter-related infections in a neonatal population - systematic review.

    PubMed

    Rosado, Viviane; Camargos, Paulo A M; Anchieta, Lêni M; Bouzada, Maria C F; Oliveira, Gabriela M de; Clemente, Wanessa T; Romanelli, Roberta M de C

    2017-08-30

    This was a systematic review of the incidence density and risk factors for central venous catheter-related infections in a neonatal population. The MEDLINE, Embase, Cochrane, BDENF, SciELO, and LILACS databases were used without date or language restriction. Studies that analyzed risk factors for bloodstream infections in newborns were identified. A total of 134 articles were found that met the eligibility criteria. Of these articles, 14 were selected that addressed risk factors for central venous catheter-related infection in neonates. Catheter-related bloodstream infections remain an important complication, as shown by the incidence rates reported in the studies included in this review. The observed risk factors indicate that low birth weight, prematurity, and longer catheter permanence are related to a higher incidence of bloodstream infections. It has been observed that low rates of catheter-related infections, i.e., close to zero, are already a reality in health institutions in developed countries, since they use infection surveillance and control programs. Catheter-related bloodstream infections still show high incidence density rates in developing countries. The authors emphasize the need for further longitudinal studies and the need for better strategies to prevent risk factors, aiming at the reduction of catheter-related infections. Copyright © 2017. Published by Elsevier Editora Ltda.

  8. A comparative analysis of radiological and surgical placement of central venous catheters

    SciTech Connect

    McBride, Kieran D.; Fisher, Ross; Warnock, Neil; Winfield, David A.; Reed, Malcolm W.; Gaines, Peter A.

    1997-01-15

    Purpose. To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution. Methods.A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed surgically in 107 patients. The indication was chemotherapy in 76% of radiological and in 47% of surgical cases; the remainder were for total parenteral nutrition and venous access. Results. There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p<0.001). Average catheter life-span was similar for the two placement methods (100{+-}23 days). Conclusion. Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.

  9. [Cardiac tamponade: a rare complication of central venous catheter - a clinical case report].

    PubMed

    Azevedo, Ana Catarina; Flor de Lima, Isabel; Brito, Vânia; Centeno, Maria João; Fernandes, Antero

    2016-03-22

    The extensive use of central venous catheters (CVC) in a hospital environment leads to increased iatrogenic complications, as more catheters are used enclosed and its maintenance is prolonged. Several complications are known to be related to central venous catheter, of which the uncommon cardiac tamponade (CT), hardly recognized and associated with high mortality. We present a clinical case, with favorable outcome, of a patient who developed a CT 17 days after CVC placement, and try to reflect on the measures that can be taken to reduce its incidence, as well as the therapeutic approaches to practice in the presence of a suspected CT. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Mini-review: Antimicrobial central venous catheters--recent advances and strategies.

    PubMed

    Sousa, Cláudia; Henriques, Mariana; Oliveira, Rosário

    2011-07-01

    Central venous catheters (CVCs) nowadays constitute critical devices used in medical care, namely in intensive care units. However, CVCs also represent one of the indwelling medical devices with enhanced risk of nosocomial device-related infection. Catheter-related infections (CRIs) are a major cause of patient morbidity and mortality, often justifying premature catheter removal and an increase in costs and use of resources. Adhesion and subsequent biofilm formation on the surfaces of indwelling catheters is elemental to the onset of pathogenesis. Seeking the prevention of CVC colonisation and CRI, a variety of approaches have been studied, tested and, in some cases, already applied in clinical practice. This review looks at the current preventive strategies often used to decrease the risk of CRIs due to colonization and biofilm formation on catheter surfaces, as well as at the more recent approaches under investigation.

  11. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications).

    PubMed

    Pittiruti, Mauro; Hamilton, Helen; Biffi, Roberto; MacFie, John; Pertkiewicz, Marek

    2009-08-01

    When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion

  12. The insertion of chronic indwelling central venous catheters (Hickman lines) in interventional radiology suites.

    PubMed

    Page, A C; Evans, R A; Kaczmarski, R; Mufti, G J; Gishen, P

    1990-08-01

    The insertion of Hickman central venous catheters for chronic venous access is a procedure usually conducted in the operating theatre under local or general anaesthesia. In a prospective study over a one year period we have assessed the feasibility of radiologists inserting central venous catheters for long term access. A subclavicular approach to the subclavian vein with prior digital subtraction angiography or video imaging of the vein was the technique of choice. Thirty-one Hickman catheters were inserted in 21 patients. All but two patients had a haematological malignancy. Ages ranged from 19 to 77 years. The mean time for insertion was 43 min (range 20-80 min). The catheters remained in situ for between 2 days and 242 days with a mean of 86 days. There was one documented line infection; nine patients had episodes of septicaemia with identified organisms, and a further six had pyrexias of unknown origin during the line indwelling period. There were four documented line and or ipsilateral subclavian vein thromboses, and one death occurred within 36 hours of the procedure. We conclude that radiological placement is an excellent alternative to 'blind' surgical placement. Screening during insertion provides immediate facilities for correction of malposition and monitoring of immediate complications. The time taken for catheter insertion did not impede the usual patient throughout in the interventional radiology suite.

  13. Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation.

    PubMed

    Martinho, Gláucia Helena; Romanelli, Roberta M C; Teixeira, Gustavo Machado; Macedo, Antonio V; Chaia, Juliana M C; Nobre, Vandack

    2013-07-01

    In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

  14. Central venous catheter "pinch-off" and fracture: a review of two under-recognized complications.

    PubMed

    Nace, C S; Ingle, R J

    1993-09-01

    Although uncommon, "pinch-off syndrome" and catheter fracture are reported complications of central venous catheters (CVCs). Pinch-off syndrome is characterized by intermittent catheter malfunction in conjunction with radiologic evidence of catheter compression. Warning signs of pinch-off syndrome include difficulty with-drawing blood samples and resistance to infusion of IV fluids. CVC fracture is characterized by migration of the distal catheter fragment through the heart and, often, into the pulmonary artery; it may be accompanied by the sudden onset of chest pain, palpitations, and arrhythmias. Twenty-seven cases of CVC fracture were reviewed, including 22 cases reported in the literature as well as an analysis of 5 cases that occurred at the authors' institution. Among the 22 cases reported in the literature, the average length of time between catheter insertion and fracture was 6.7 months. In 82% of these cases, the fracture occurred at the clavicle/first rib junction, where mechanical friction against the catheter has been well established as the mechanism for most fractures. In 9 of these 22 cases, evidence of catheter compression was noted on chest x-ray prior to fracture. This paper discusses assessment criteria for pinch-off syndrome and catheter fracture, as well as nursing implications regarding the prevention and early detection of these potentially serious complications.

  15. Inadvertent Puncture of the Thoracic Duct During Attempted Central Venous Catheter Placement

    SciTech Connect

    Teichgraber, Ulf K.M. Nibbe, Lutz; Gebauer, Bernhard; Wagner, Hans-Joachim

    2003-11-15

    We report a case of puncture of the thoracic duct during left subclavian vein catheterization on the intensive care unit. Computed tomography and measurement of the triglyceride levels in the aspirated fluid proved the inadvertent penetration of the guidewire into the thoracic duct. Early recognition of central line misplacement avoided serious complications. Inadvertent central venous catheter placement into the thoracic duct may have the potential complications of infusion mediastinum and chylothorax.

  16. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis

    PubMed Central

    2013-01-01

    Background Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement. Methods Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association’s Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter–related complications (MCRCs). Results Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter–related complications were most frequently seen in patients 16 years or younger. Conclusions The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD

  17. Prevention and treatment of thrombosis associated with central venous catheters in cancer patients.

    PubMed

    Jasti, Nagamallika; Streiff, Michael B

    2014-10-01

    Central venous catheters (CVC) play an essential role in the management of cancer patients. Venous thrombosis is a common complication of CVC. The incidence of CVC-associated venous thromboembolism (CVC-VTE) is 1.7 per 1000 catheter days. Risk factors for CVC-VTE include the patient's underlying cancer, a history of previous thrombotic events and the location and type of CVC. Anticoagulant prophylaxis is not effective for CVC-VTE. Anticoagulation alone is the preferred initial treatment for CVC-VTE. CVC removal may be considered in refractory cases or when anticoagulation is contraindicated. Thrombolytic therapy is reserved for patients with limb-threatening thrombosis or thrombosis unresponsive to conventional treatment. Anticoagulation should be continued for at least 3 months or as long as the CVC is present.

  18. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery.

    PubMed

    Desai, Shamit S; Konanur, Meghana; Foltz, Gretchen; Malaisrie, S Chris; Resnick, Scott

    2016-03-01

    Entrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed. Four cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers. In the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary. An endovascular algorithm to the "entrapped CVC" is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  19. [Use of ECG-EC in the positioning of central venous catheters].

    PubMed

    Calabria, Maria; Zamboli, Pasquale; D'Amelio, Alessandro; Granata, Antonio; Di Lullo, Luca; Floccari, Fulvio; Logias, Franco; Fiorini, Fulvio

    2012-01-01

    Central venous catheters (CVC) are widely used in clinical practice for the administration of chemotherapy, parental nutrition, hemodynamic monitoring, and hemodialysis. International guidelines have defined the right internal jugular vein as the preferred site of CVC insertion and underline that accurate positioning of the catheter tip is essential to maximize the blood flow and reduce long-term complications. Endocavitary electrocardiography (EC-ECG) improves the accuracy of catheter tip positioning without increasing the placement time by the recognition of typical P wave patterns during catheter insertion:the normally shaped P wave identifies the mid to upper superior vena cava, the widest P wave may be used to place the CVC tip at the superior vena cava-right atrium junction, and biphasic P waves identify the location of the right atrium. Because of its simplicity and safety, EC-ECG should always be considered during CVC placement, especially if other means of verifying correct CVC insertion are not available.

  20. A patient with an uncommon complication from insertion of a central venous catheter: A case report

    PubMed Central

    Khalid, Imran; Khalid, Tabindeh J; DiGiovine, Bruno

    2008-01-01

    Background A 72 year old male was admitted to the medical intensive care unit with septic shock. Case presentation A left subclavian central venous catheter was inserted on the day of admission whose tip was pushing against the wall of the vessel lumen. The patient's condition improved with treatment, but three days later had a new episode of acute hypotension. CT scan of the chest showed that the catheter had eroded through the superior vena cava wall. Conclusion The catheter was pulled out and patient recovered from the complication with supportive therapy. Care should be taken that the tip of the catheter is in the center of the vessel lumen to avoid this rare, but potentially life threatening, complication. PMID:19036145

  1. Influence of tracheostomy on the incidence of central venous catheter-related bacteremia.

    PubMed

    Lorente, L; Jiménez, A; Martín, M M; Castedo, J; Galván, R; García, C; Brouard, M T; Mora, M L

    2009-09-01

    Although there are many studies on catheter-related infection, there are scarce data about the influence of tracheostomy in the incidence of central venous catheter-related bacteremia (CRB). In this cohort study, we found a higher incidence of CRB in patients with tracheostomy than without (11.25 vs. 1.43 per 1,000 catheter-days; odds ratio [OR] = 7.99; 95% confidence interval [CI] = 4.38-infinite; P < 0.001). Besides, we found a higher incidence of CRB in patients with tracheostomy using the jugular access compared to subclavian access (21.64 vs. 5.11 per 1,000 catheter-days; OR = 4.23; 95% CI = 1.44-infinite; P = 0.0097).

  2. Percutaneously inserted long-term central venous catheters in pigs of different sizes.

    PubMed

    Larsson, N; Claesson Lingehall, H; Al Zaidi, N; Claesson, J; Jensen-Waern, M; Lehtipalo, S

    2015-07-01

    Pigs are used for long-term biomedical experiments requiring repeated injections, infusions and collections of blood samples. Thus, it is necessary for vascular catheters to be indwelling to avoid undue stress to the animals and the use of restraints. We propose a refined model of percutaneous insertion of long-term central venous catheters to minimize the surgical trauma and postoperative complications associated with catheter insertion. Different sizes of needles (18 Ga versus 21 Ga) for initial puncture of the veins were compared. In conventional pigs weighing less than 30 kg, catheter insertion may be facilitated by using a microintroducer set with a 21 Ga needle. In pigs weighing 50 kg, a standard 18 Ga needle may be preferable.

  3. [Injuries to blood vessels near the heart caused by central venous catheters].

    PubMed

    Abram, J; Klocker, J; Innerhofer-Pompernigg, N; Mittermayr, M; Freund, M C; Gravenstein, N; Wenzel, V

    2016-11-01

    Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible. The subclavian catheter is at a somewhat lower risk of catheter-associated sepsis and symptomatic venous thrombosis than approaches via the internal jugular and femoral veins. Indeed, access via the subclavian vein carries a substantial risk of pneumo- and hemothorax. Damage to the subclavian vein or artery can also occur during deliberate and inadvertent punctures and result in life-threatening complications. Therefore, careful consideration of the access route is required in relation to the patient and the clinical situation, to keep the incidence of complications as low as possible. For catheterization of the subclavian vein, puncture of the axillary vein in the infraclavicular fossa is a good alternative, because ultrasound imaging of the target vessel is easier than in the subclavian vein and the puncture can be performed much further from the lung.

  4. Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review 1

    PubMed Central

    Stocco, Janislei Gislei Dorociaki; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida; Meier, Marineli Joaquim

    2016-01-01

    Abstract Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects. PMID:27508901

  5. Infective Endocarditis in a Patient with Celiac Disease after Central Venous Catheter Insertion

    PubMed Central

    Mohapatra, Suryanarayan; Arobelidze, Salome; Gundelly, Parveen; Changarath Vijayan, Anil Kumar

    2017-01-01

    There is an increasing incidence of infective endocarditis secondary to central venous catheters, which is termed as 'healthcare-associated infective endocarditis'. There is an increased risk of getting infective endocarditis in conditions with malnutrition and also if the tip of the central venous catheter is deep in the right atrium close to the tricuspid valve. We present a case of 31-year-old female who had all these risk factors. She was admitted to the hospital for the work up of the weight loss and was diagnosed with celiac disease. Central venous access was obtained because of poor peripheral intravenous access via the peripherally inserted central catheter which was complicated by thrombosis and removed after three days of insertion, and she was started on anticoagulation. Two weeks after being discharged, she presented to the emergency department with fever, shortness of breath, and had signs of congestive heart failure. A computed tomography of the chest for pulmonary embolism was taken and showed small clot burden pulmonary embolism and two cavitary lesions in the right lung. A transthoracic echocardiogram was taken and showed vegetation on the tricuspid valve and blood cultures were positive for Staphylococcus aureus. Hence, a diagnosis of infective endocarditis was made, and she was treated with intravenous antibiotics for a total of six weeks after a long and complicated hospital stay. PMID:28348945

  6. [A Case of central venous catheter-related infection with Malassezia sympodialis].

    PubMed

    Kikuchi, K; Fujishiro, Y; Totsuka, K; Seshimo, A; Kameoka, S; Makimura, K; Yamaguchi, H

    2001-01-01

    We report a 63-year-old male with central venous catheter-related infection caused by Malassezia sympodialis after total gastrectomy for a gastric cancer. He had fever and his leukocyte counts and C-reactive protein were elevated 14 days after his operation. After his central venous hyperalimentation catheter was removed, the inflammatory signs immediately disappeared, suggesting an intravenous catheter-related infection. A yeast-like fungus was cultured in brain-heart infection semi-solid agar ten days later, and was diagnosed morphologically as Malassezia sp. This strain was identified as M. sympodialis by Tween assimilation test and was confirmed by whole-sequence of internal transcribed spacer 1 regions (ITS1). This is the first report of catheter-related infection caused by M. sympodialis. This strain grew and was subcultured on CHROMagar Candida, potato dextrose agar and Sabouraud agar. There have been no reports of such a lipid-independent Malassezia sp. except for M. pachydermatis. The mechanism of lipid independence of this strain is undetermined and future work is needed. Malassezia sp. is receiving increased attention as an etiologic pathogen of catheter-related fungemia in clinical microbiology laboratories and infectious disease sections.

  7. Microstructural evaluation by confocal and electron microscopy in thrombi developed in central venous catheters.

    PubMed

    Lucas, Thabata Coaglio; Silva, Eliata Ester da; Souza, Danilo Olzon Dionysio; Santos, Amanda Rodrigues Dos; Lara, Maristela Oliveira

    2017-08-28

    Evaluating thrombi microstructure developed in central venous catheters using confocal and electron microscopy. An experimental, descriptive study carrying out a microstructural evaluation of venous thrombi developed in central venous catheters using Scanning Electron Microscopy and Confocal Laser Scanning Microscopy. A total of 78 venous catheters were collected over a period of three months. Different fibrin structures were distinguished: fibrin plates, fibrin network, and fibrin fibers. It was observed that the thrombus had thick fibrin plates adhered to the catheter wall openings in both a catheter with three days of permanence as well as in a catheter with 20 days of insertion in the patient. However, a greater amount of erythrocytes and fibrin fibers were found in the central region of the thrombus. This study contributes to improving health care and can have a positive impact on clinical practice, as easy adherence of platelets and fibrins to the catheter wall demonstrated in this study makes it possible to adopt thrombus prevention strategies such as therapy discontinuation for an extended period, blood reflux by a catheter, slow infusion rate and hypercoagulo pathyclinical conditions. Avaliar a microestrutura por microscopia confocal e eletrônica em trombos desenvolvidos em cateteres venosos centrais. Pesquisa experimental, descritiva, em que foi feita uma avaliação microestrutural de trombos venosos desenvolvidos em cateteres venosos centrais por Microscopia Eletrônica de Varredura e Microscopia Confocal de Varredura a Laser. Foram coletados 78 cateteres venosos centrais num período de três meses. Distinguiram-se diferentes estruturas de fibrina: a placa de fibrina, a rede de fibrina e as fibras de fibrina. Observou-se que tanto em um cateter com três dias de permanência quanto em um cateter com 20 dias inserido no paciente o trombo apresentou placas de fibrina espessas aderidas às paredes dos orifícios dos cateteres. Na região central do

  8. Lights, camera and action in the implementation of central venous catheter dressing1

    PubMed Central

    Ferreira, Maria Verônica Ferrareze; de Godoy, Simone; de Góes, Fernanda dos Santos Nogueira; Rossini, Fernanda de Paula; de Andrade, Denise

    2015-01-01

    Objective: to develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters. PMID:26626011

  9. Successful tunneled catheter placement in a hemodialysis patient with idiopathic multiple central venous stenoses.

    PubMed

    Zhao, Yuliang; Cui, Tianlei; Yu, Yang; Liu, Fang; Fu, Ping; Zhou, Li; Li, Xiao

    2014-01-01

    Central venous stenosis (CVS) in hemodialysis patients could be secondary to central venous catheterization, high flow arteriovenous fistula, as well as extrinsic compression. However, we report a senile hemodialysis patient of left internal jugular vein stenosis and right innominate vein occlusion unrelated to any known risk factors. Aided by computed tomography and digital subtraction angiography, we managed to dilate the stenosis by percutaneous balloon angioplasty, followed by successful tunneled catheter placement. Nephrologists should be aware of idiopathic CVS and its impact on the creation and preservation of vascular access. When confronted with difficulties in catheter placement, practitioners need to consider the possibilities of idiopathic CVS and refer to radiological tests. © 2013 International Society for Hemodialysis.

  10. [Long-term central venous catheter-related infections].

    PubMed

    Lebeaux, David; Joly, Dominique; Zahar, Jean-Ralph

    2014-05-01

    Long-term intravenous catheters (LTIVC) are standard practice for patients with chronic diseases such as cancer, digestive disease requiring total parenteral nutrition or end-stage renal disease. Even if they greatly improved patients' care, the use of LTIVC is also associated with microbial contamination and subsequent infection. These catheter-related infections are associated with morbidity, mortality and increased health-care costs. As patients carrying these LTIVC stay at home for their treatment (home parenteral nutrition for instance) or between cycles of treatment (antineoplastic chemotherapy or dialysis), it is mandatory that general practitioner and nurses are aware of recent data on the epidemiology, diagnosis and treatment of LTIVC-related infections.

  11. Transbrachial Access for Radiologic Manipulation of Problematic Central Venous Catheters in a Pediatric Population

    SciTech Connect

    Rao, Sandeep Hogan, Mark J.

    2010-08-15

    A transfemoral venous approach is the current standard for accessing malpositioned and fractured central venous catheters (CVCs). The purpose of this study was (1) to describe a transbrachial approach for correction and (2) to assess the success and failure of this method in a pediatric population. A 12-year retrospective review of all patients referred for correction of malpositioned, retained, and fractured CVCs was conducted. Based on the performing interventionalist's preference, transbrachial or transfemoral venous sheaths where placed under ultrasonographic guidance. Diagnostic angiographic catheters and snares were used to manipulate the catheters. Patients who underwent the transfemoral approach received postprocedural monitoring for 4 hours, whereas patients who underwent the transbrachial approach were allowed unrestricted activity immediately after hemostasis was obtained. Technical success of malpositioned lines was defined (1) by final position in the superior vena cava or at the cavoatrial junction on postprocedural imaging or (2) by successful removal of retained catheter fragments, if present. Transbrachial approach was used for access in 11 patients. Problematic lines included malpositioned (n = 10) and retained (n = 1) lines. The ipsilateral arm was used for transbrachial entry in 7 patients. Initial use of angiographic catheters was attempted in 7 cases, of which 4 were successful. All 3 unsuccessful cases had tips positioned in the contralateral brachiocephalic vein, and these were successfully repositioned using snares. A combination of snares and angiographic catheters was used in 2 cases. Snares were used for all other cases. Technical success by way of the transbrachial approach was observed in all cases. Periprocedural follow-up demonstrated no immediate complications. We conclude that the transbrachial approach is a suitable alternative to the transfemoral approach for catheter tip position correction. Tip malposition in the contralateral

  12. Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: A prospective study

    PubMed Central

    Wilson, Sean P.; Assaf, Samer; Lahham, Shadi; Subeh, Mohammad; Chiem, Alan; Anderson, Craig; Shwe, Samantha; Nguyen, Ryan; Fox, John C.

    2017-01-01

    BACKGROUND: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation. METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC. RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8% (95%CI 77.1%–93.5%) and specificity of 100% (95%CI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes (IQR 10–29) and 32 minutes (IQR 19–45), respectively. CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a confirmatory CXR. PMID:28123616

  13. Extravasation of parenteral alimentation fluid into the renal pelvis--a complication of central venous catheter in a neonate.

    PubMed

    Nadroo, A M; al-Sowailem, A M

    2001-01-01

    Many complications of central venous catheters, which include perforation of the vessel walls and extravasation of the infusate into pericardial, pleural, and peritoneal cavities, have been reported. We report an infant with a central venous catheter in inferior vena cava who experienced extravasation of parenteral alimentation fluid into the right renal pelvis secondary to perforation of the renal vein. To our knowledge, this rare complication has not been reported earlier.

  14. Central venous catheter-related blood stream infections: incidence and an analysis of risk factors.

    PubMed

    Tan, C C; Zanariah, Y; Lim, K I; Balan, S

    2007-12-01

    Six hundred and fifty-five central venous catheters (CVC) in 496 patients in the intensive care unit of Hospital Sultanah Aminah were studied to determine the incidence and risk factors for central venous catheter-related blood stream infection (CR-BSI). CR-BSI was diagnosed in 38 catheters, giving an incidence of 9.43 CR-BSI per 1000 catheter days. The mean duration in situ was 8.4 +/- 4.9 days for infected CVCs and 6.0 +/- 3.8 days for non infected CVCs (p = 0.001). CVCs inserted in ICU had the highest infection rate (9.4%) compared to those inserted in the operating theatre (1.4%) and ward (2.8%) (p = 0.001). The highest rate of CR-BSI occurred with 4-lumen catheters (usually inserted when patients needed total parenteral nutrition) with a percentage of 15.8%. The majority of the CVCs (97.9%) were inserted via the subclavian or the internal jugular routes and there was no statistical difference in CR-BSI between them (p = 0.83). Number of attempts more than one had a higher rate of CR-BSI compared to single attempt with percentage of 7.0% vs 4.8% (p = 0.22). The top two organisms were Klebseilla pneumoniae and Pseudomonas aeruginosa. In conclusion, the incidence of CR-BSI in our ICU was 9.43 CR-BSI per 1000 catheter days. The risk factors were duration of CVC in situ, venue of insertion and use of 4 lumen catheter for total parenteral nutrition. The site of insertion, number of lumen up to 3 lumens and the number of attempts were not risk factors.

  15. Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy.

    PubMed

    Guillet, Stéphanie; Zeller, Valérie; Dubée, Vincent; Ducroquet, Françoise; Desplaces, Nicole; Horellou, Marie Hélène; Marmor, Simon; Ziza, Jean Marc

    2015-10-12

    The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ≥2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  16. Central venous catheter placement in the inferior vena cava via the direct translumbar approach.

    PubMed

    Elduayen, B; Martínez-Cuesta, A; Vivas, I; Delgado, C; Pueyo, J C; Bilbao, J I

    2000-01-01

    The aim of this study was to evaluate the technical aspects and efficacy of placing tunneled central venous access catheters (CVA) in the inferior vena cava (IVC) via a direct translumbar approach. Between August 1994 and July 1998, 50 CVA (Hickman 13.5 F) were placed in the IVC via a direct translumbar approach in 46 patients (10 males, 36 females) with a mean age of 39.9 years (age range 10-87 years). The indications were chemotherapy administration plus leukoaphoresis (n = 39), bone marrow transplantation (n = 2) and hemodialysis (n = 5). The reasons for placing the CVA in the IVC were cosmetic (n = 34), supradiaphragmatic venous thrombosis (n = 8), previous catheter infection (n = 2), and non-functioning arteriovenous fistula (n = 2). There were no immediate complications. The mean period of time the CVA was in place was 3 months (15 days to 15 months), during which the function was excellent. The commonest late complication was infection (4 local, 6 bacteremia). Others included: pain (n = 2), ureteric fistula (n = 1), pericatheter fibrin sheath formation (n = 6) and catheter-tip impaction (n = 2). Two catheters were damaged due to postprocedural inappropriate manipulations and two others fell off due to incorrect fixation. Due to these complications, it was necessary to remove ten catheters, replace an additional four and reposition two. Direct translumbar catheterization of the IVC is a safe and effective way of placing a long-term CVA with a moderate complication rate.

  17. Incidental finding of persistent left superior vena cava after 'bubble study' verification of central venous catheter.

    PubMed

    Pardinas Gutierrez, Miguel Agustin; Escobar, Luis A; Blumer, Vanessa; Cabrera, Jorge Luis

    2017-07-31

    We report a case of a patient with septic shock who underwent central venous catheter placement in the left internal jugular vein, and a bedside ultrasound 'bubble study' revealed venous cannulation. A chest X-ray postprocedure revealed concern for arterial system catheterisation. However, the possibility of a persistent left superior vena cava was discussed and confirmed with a formal transthoracic echocardiogram and CT. This case demonstrates the importance of ultrasound-guided visualisation of anatomical structures in real time during central venous catheterisation. Other similar cases from the literature are briefly described. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Central venous catheter-related thrombosis in senile male patients: New risk factors and predictors.

    PubMed

    Liu, Gao; Fu, Zhi-Qing; Zhu, Ping; Li, Shi-Jun

    2015-06-01

    Central venous catheterization (CVC)-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases (6.17%) of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization (P<0.01) and that in internal jugular vein catheterization (P<0.05). No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization (P<0.05). Previous venous thrombosis history (P<0.01), high lactate dehydrogenase level (P<0.01), low high-density lipoprotein (HDL) level (P<0.05), and low albumin level (P<0.05) were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

  19. Tunneled central venous catheter exchange: techniques to improve prevention of air embolism.

    PubMed

    Rossi, Umberto G; Torcia, Pierluca; Rigamonti, Paolo; Colombo, Francesca; Giordano, Antonino; Gallieni, Maurizio; Cariati, Maurizio

    2016-01-01

    Malfunctioning tunneled hemodialysis central venous catheters (CVCs), because of thrombotic or infectious complications, are frequently exchanged. During the CVC exchanging procedure, there are several possible technical complications, as in first insertion, including air embolism. Prevention remains the key to the management of air embolism. Herein, we emphasize the technical tricks capable of reducing the risk of air embolism in long-term CVC exchange. In particular, adoption of a 5 to 10 degrees Trendelenburg position, direct puncture of the previous CVC venous lumen for guide-wire insertion, as opposed to guide-wire introduction after cutting the CVC, a light manual compression of the internal jugular vein venotomy site after catheter removal. The Valsalva maneuvre in collaborating patients, valved introducers, and correction of hypovolemia are also useful precautions. Principles of air embolism diagnosis and treatment are also outlined in the article.

  20. Successful Retrieval of a Dismembered Central Venous Catheter Stuck to the Right Pulmonary Artery Using a Stepwise Approach

    PubMed Central

    Nomura, Hidekimi; Isomura, Daichi; Sugiura, Ryo; Oka, Toshiaki

    2016-01-01

    Recent advances in anticancer chemotherapy have resulted in an increase in the number of patients requiring a central venous port catheter, and the incidence of catheter pinch-off syndrome has been increasing. Catheter pinch-off syndrome is a rare and unusual complication. It is difficult to retrieve dislodged catheters from the pulmonary artery, especially if the catheter is stuck to the peripheral pulmonary artery. We herein describe the successful removal of a catheter stuck in the pulmonary artery with a stepwise approach. First, a pigtail catheter was used to tug the dislodged catheter in order to free the unilateral end. Then, a gooseneck snare was used to catch and pull the catheter out of the patient. The key to success is to free the end of the catheter. PMID:27668096

  1. Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.

    PubMed Central

    Brismar, B; Hårdstedt, C; Jacobson, S

    1981-01-01

    Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized. Images Fig. 1A. Fig. 1B. Fig. 2. Fig. 3. Fig. 4. PMID:7305496

  2. The power peripherally inserted central catheter is superior to a central venous catheter in management of patients with esophageal variceal bleeding undergoing devascularization.

    PubMed

    Jing, Wen; Rong, He; Li, Jiang; Xia, Zhang Hai; Yu, Zhang Hong; Ke, Zhang

    2016-10-01

    Peripherally-inserted central catheters (PICC) have a greater retention time and less complications compared to central venous catheters (CVC). The study was conducted from From January of 2014 to December 2015 at Beijing DiTan Hospital, Beijing, China, and comprised 70 patients undergoing devascularisation. Of the total, 36(51.4%) patients underwent placement of PICC (Group A), while 34(48.6%) underwent had CVC (Group B). Venous catheterisation was successful in all patients. The median duration of venous catheterization in Group A was greater than that in Group B (p=0.002). Catheter-associated complications did not differ between the groups (p=0.46). The level of blood platelet (PLT) count, Prothrombin activity (PTA) and white blood cell (WBC) count before venous catheterisation were independent risk factors for bleeding at the puncture site and catheter-related infections. A Power PICC may be a better choice than a CVC in patients undergoing devascularisation requiring catheterisation. For patients with a lower PLT count, a decreased PTA, or a decreased WBC, venous catheterisation should be performed with caution.

  3. [Failure to Remove Long-Term Indwelling Central Venous Catheters in Two Patients].

    PubMed

    Kawashima, Kazuya; Kato, Kenichi; Suzuki, Michiko; Nakayama, Manabu; Tamura, Akio; Suzuki, Tomohiro; Tanaka, Ryouichi; Tomabechi, Makiko; Matsuo, Mikaru; Nakasato, Tatsuhiko; Ehara, Shigeru

    2015-09-01

    The use ofa central venous(CV)port system has become common for the treatment of patients with tumors. We report on the failure to remove CV catheters in 2 patients. The first patient was a 50 years woman with acute myeloid leukemia. She underwent CV port implantation via the left brachial approach 11 years previously. The second patient was an 80 years man with a lower gingival carcinoma. He underwent CV port implantation via the left brachial approach 6 years previously. CV catheter removal was attempted in both patients, but was unsuccessful because of strong adhesion to the vessel wall. Based on our experience, if catheter removal is impossible, its retention is more suitable.

  4. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

    PubMed Central

    Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

    2017-01-01

    Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens. PMID:28194286

  5. Complications of Peripherally Inserted Central Venous Catheters: A Retrospective Cohort Study

    PubMed Central

    Jose Amo-Setién, Francisco; Herrero-Montes, Manuel; Olavarría-Beivíde, Encarnación; Rodríguez-Rodríguez, Mercedes; Torres-Manrique, Blanca; Rodríguez-de la Vega, Carlos; Caso-Álvarez, Vanesa; González-Parralo, Laura

    2016-01-01

    Background and Aim The use of venous catheters is a widespread practice, especially in oncological and oncohematological units. The objective of this study was to evaluate the complications associated with peripherally inserted central catheters (PICCs) in a cohort of patients. Materials and Methods In this retrospective cohort study, we included all patient carrying PICCs (n = 603) inserted at our institute between October 2010 and December 2013. The main variables collected were medical diagnosis, catheter care, location, duration of catheterization, reasons for catheter removal, complications, and nursing care. Complications were classified as infection, thrombosis, phlebitis, migration, edema, and/or ecchymosis. Results All patients were treated according to the same “nursing care” protocol. The incidence rate of complications was two cases per 1000 days of catheter duration. The most relevant complications were infection and thrombosis, both with an incidence of 0.17 cases per 1000 days of the total catheterization period. The total average duration of catheterization was 170 days [SD 6.06]. Additionally to “end of treatment” (48.42%) and “exitus”, (22.53%) the most frequent cause of removal was migration (displacement towards the exterior) of the catheter (5.80%). Conclusions PICCs are safe devices that allow the administration of long-term treatment and preserve the integrity of the venous system of the patient. Proper care of the catheter is very important to improve the quality life of patients with oncologic and hematologic conditions. Therefore, correct training of professionals and patients as well as following the latest scientific recommendations are particularly relevant. PMID:27588946

  6. Complications Related to Insertion and Use of Central Venous Catheters (CVC)

    PubMed Central

    Hodzic, Samir; Golic, Darko; Smajic, Jasmina; Sijercic, Selma; Umihanic, Sekib; Umihanic, Sefika

    2014-01-01

    ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion. PMID:25568558

  7. Routine changing of intravenous administration sets does not reduce colonization or infection in central venous catheters.

    PubMed

    Rickard, Claire M; Lipman, Jeff; Courtney, Mary; Siversen, Rosemary; Daley, Peter

    2004-08-01

    To determine the effect of routine intravenous (IV) administration set changes on central venous catheter (CVC) colonization and catheter-related bacteremia. Prospective, randomized, controlled trial. Eighteen-bed intensive care unit (ICU) in a large metropolitan hospital. Two hundred fifty-one patients with 404 chlorhexidine gluconate and silver sulfadiazine-coated multi-lumen CVCs. CVCs inserted in the ICU and in situ on day 4 were randomized to have their IV administration sets changed on day 4 (n = 203) or not at all (n = 201). Use of fluid containers and blood product administration sets was limited to 24 hours. CVCs were removed when not required, infection was suspected, or in place on day 7. Catheter cultures were performed on removal by blinded laboratory staff. Catheter-related bacteremia was diagnosed by a blinded intensivist using strict definitions. Data were collected regarding catheter duration, site, Acute Physiology and Chronic Health Evaluation (APACHE) II score, patient age, diagnosis, hyperglycemia, hypoalbuminemia, immune status, number of fluid containers and IV injections, and administration of propofol, blood, total parenteral nutrition, or lipid infusion. There were 10 colonized CVCs in the group receiving a set change and 19 in the group not receiving one. This difference was not statistically significant on Kaplan-Meier survival analysis. There were 3 cases of catheter-related bacteremia per group. Logistic regression found that burns diagnosis and increased ICU stay significantly predicted colonization. IV administration sets can be used for 7 days in patients with short-term, antiseptic-coated CVCs.

  8. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis.

    PubMed

    Chen, Kai; Agarwal, Arnav; Tassone, Maria Cristina; Shahjahan, Nadia; Walton, Mark; Chan, Anthony; Mondal, Tapas

    2016-06-01

    Central venous catheter (CVC) placement is associated with increased risk of thrombosis in the paediatric population, particularly in relation to the type of catheter and the manner of its insertion. Here, we investigate risk factors associated with CVC-related thrombosis in children, with particular emphasis on positioning of the catheter tip. Patients aged 0-18 who underwent at least one CVC placement from 2008 to 2013 at a single centre with a subsequent follow-up echocardiogram were included for a total of 104 patients and 147 lines. Data on clinical and catheter-related risk factors were collected from patient charts. Statistical analysis using Pearson's χ tests, independent samples t-test, and odds ratios were used to assess potential risk factors for thrombosis. Neither insertion site (subclavian vein or otherwise), left- vs. right-sided insertion, nor catheter type were significant risk factors for thrombosis. There were no thrombotic events reported at the superior vena cava (SVC)-right atrium junction and no significant differences in thrombotic risk with initial tip placement in the SVC-right atrium junction vs. the SVC, right atrium, or inferior vena cava. Acute lymphoblastic leukaemia was a major clinical risk factor for thrombosis. Tip movement was common and may have been an important factor in the development of CVC-related thrombi. Prospective studies can yield insight into the role of follow-up imaging in the prevention of catheter-related thrombosis in children.

  9. Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters.

    PubMed

    Linnemann, Birgit; Lindhoff-Last, Edelgard

    2012-09-01

    An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.

  10. Agitated saline bubble-enhanced transthoracic echocardiography: a novel method to visualize the position of central venous catheter.

    PubMed

    Wen, Ming; Stock, Konrad; Heemann, Uwe; Aussieker, Mario; Küchle, Claudius

    2014-03-01

    The purpose of this study is to describe a novel method to visualize the position of central venous catheters, which is safe, expeditious, and less expensive than the routine postprocedural chest radiograph. Retrospective comparative study. Dialysis Center of the Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Two hundred and two adult patients undergoing central venous catheter placement for dialysis, plasmapheresis, or administration of medication and solutions. None. Data of 202 adult patients with 219 central venous catheterizations were retrospectively analyzed. Each catheter insertion was followed by an agitated saline bubble-enhanced transthoracic echocardiography, which was used to localize the tip of the catheter. The position of catheter was then controlled by chest radiograph in all cases. During the 13-month study period, two catheter malpositions occurred. Both were identified by agitated saline bubble-enhanced transthoracic echocardiography and confirmed by chest radiograph. The mean time between catheter insertion and chest radiograph control (28.3 min) was clearly longer than agitated saline bubble-enhanced transthoracic echocardiography (3.2 min) (p < 0.001). The total costs of the procedure were reduced by 86.7-95.0%. Specific complications related to the procedure were not observed. The results revealed that the accuracy of agitated saline bubble-enhanced transthoracic echocardiography is equivalent to the chest radiograph. It offers a safe, cost-effective, expeditious alternative to routine chest radiograph for position controls of central venous catheters.

  11. Isolation of Staphylococcus epidermidis intermediately resistant to vancomycin in a case of central venous catheter-associated bloodstream infection.

    PubMed

    Nakajima, Jun; Hitomi, Shigemi; Koganemaru, Hiroshi; Nakai, Yasunobu

    2013-10-01

    The emergence and spread of vancomycin resistance among staphylococci, although rarely described in Japan to date, are major clinical concerns. We describe a case of central venous catheter-associated bloodstream infection in which Staphylococcus epidermidis intermediately resistant to vancomycin (minimum inhibitory concentration, 8 μg/ml) was isolated. The patient fully recovered with removal of the intravenous catheter.

  12. Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients.

    PubMed

    Nosari, Anna Maria; Nador, Guido; De Gasperi, Andrea; Ortisi, Giuseppe; Volonterio, Alberto; Cantoni, Silvia; Nichelatti, Michele; Marbello, Laura; Mazza, Ernestina; Mancini, Valentina; Ravelli, Erica; Ricci, Francesca; Ciapanna, Denis; Garrone, Federica; Gesu, Giovanni; Morra, Enrica

    2008-11-01

    Indwelling central venous catheters (CVCs) are used in the management of hematologic patients. However, insertion and maintenance of CVCs are susceptible to complications. Study design and methods data concerning 388 consecutive catheterisations, performed in oncohematologic patients between April 2003 and December 2004, were prospectively collected. At insertion thrombocytopenia was present in 109 cases (28.1%) and neutropenia in 67 (17.3%). Hemorrhage after CVC insertion occurred in five thrombocytopenic patients (1.3%). The median duration of catheterisation was 18.8 days (range 1-89), longer in the 7-French CVCs utilised in leukemic patients (24.3 days) and shorter in 12-French CVCs (11 days), used for PBSC harvesting. Deep venous thrombosis was diagnosed in 13 cases (3.3%). Ninety-two catheterisations (12.6/1000 days-catheter) were complicated by infections: 19 local infections (4.8%) and 73 (18.8%) bacteraemias of which 45 (11.6%) were catheter-related, mainly due to Gram positive germs (32/45, 71.1%). The frequency of catheter-related bacteraemia was 7.2 events/1000 days-catheter. Thirteen CVCs were removed due to thrombosis, 15 due to infections, 20 due to malfunction, the remaining 333 at patients discharge. At univariate analysis high-dose chemotherapy (p = 0.013), 7-Fr lumen (p = 0.023), acute myeloid leukemia (AML) (p = 0.001), duration of neutropenia >10 days and length of catheterisation were significantly correlated to infection. Multivariate analysis confirmed the duration of catheterisation, AML and high-dose chemotherapy as risk factors. Even though hematological in-patients are at increased risk for bleeding and infections, non-tunnelled CVCs offer a safe venous access also in patients affected by severe thrombocytopenia and prolonged neutropenia.

  13. Catheter malplacement during central venous cannulation through arm veins in pediatric patients.

    PubMed

    Chaturvedi, Arvind; Bithal, Parmod K; Dash, Harihar; Chauhan, Rajendra S; Mohanty, Bibekanand

    2003-07-01

    For successful catheter placement, central venous cannulation (CVC) through internal jugular vein and subclavian vein has been recommended in both adult and pediatric patients. But it carries a risk of serious complications, such as pneumothorax, carotid, or subclavian artery puncture, which can be life-threatening, particularly in critically ill children. So a prospective study was carried out to determine the success rate of correct catheter tip placement during CVC through antecubital veins in pediatric neurosurgical patients. A total of 200 pediatric patients (age 1-15 years) of either sex were studied. Basilic or cephalic veins of either arm were selected. All the patients were cannulated in the operation room under general anesthesia. Single lumen, proper size catheters (with stillete) were used for cannulation. The catheter was inserted in supine position with the arm abducted at right angle to the body and neck turned ipsilaterally. The length of insertion was determined from cubital fossa to the right second intercostal space. The exact position of the tip of the catheter was confirmed radiologically in ICU. Correct catheter tip placement was achieved in 98 (49%) patients. Multivariate logistic regression analysis of data shows that there was no statistically significant difference among correct and incorrect catheter tip placement in relation to factors including sex, side of cannulation (left or right), and type of vein (basilic or cephalic). The analysis of correct catheter tip placement in relation to age showed that the highest success rate was achieved in children of age group 6 to 10 years (60.2%) followed by 30.6% in the 11 to 15 year group. The lowest success rate of tip placement of only 9.2% was observed in younger children of age 1 to 5 years, which is statistically significant (P = 0.001). Of 102 incorrect placements reported, 37% were in 1 to 5 year age group versus 9.2% correct tip placements. The most common unsatisfactory placements were

  14. The first reported case of central venous catheter-related fungemia caused by Cryptococcus liquefaciens.

    PubMed

    Takemura, Hiromu; Ohno, Hideaki; Miura, Ikuo; Takagi, Taeko; Ohyanagi, Tadatomo; Kunishima, Hiroyuki; Okawara, Akiko; Miyazaki, Yoshitsugu; Nakashima, Hideki

    2015-05-01

    We describe a case of central venous catheter-related fungemia caused by Cryptococcus liquefaciens, a non-neoformans and non-gattii Cryptococcus, in a non-HIV patient. A 71-year-old man with diffuse large B-cell lymphoma receiving antineoplastic chemotherapy was febrile approximately 30 weeks after central venous port insertion, and C. liquefaciens was isolated from all three performed blood cultures as well as a central venous catheter tip culture. In vitro antifungal susceptibility tests showed that this yeast isolate was susceptible to low concentrations of amphotericin B, fluconazole, itraconazole and voriconazole yet was resistant to 5-fluorocytosine (MIC: >64 μg/ml), unlike Cryptococcus neoformans. Treatment of the patient with oral and intravenous voriconazole was effective and consistent with the susceptibility tests. Although non-neoformans and non-gattii Cryptococcus spp. are considered non-pathogenic environmental yeast, they may rarely be the causative agents of serious infections in humans, as in the present case. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  15. A life cycle assessment of reusable and single-use central venous catheter insertion kits.

    PubMed

    McGain, Forbes; McAlister, Scott; McGavin, Andrew; Story, David

    2012-05-01

    For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization. For the reusable central venous catheter kit, we performed a "time-in-motion" study to determine the labor costs and measured the energy and water consumption for cleaning and sterilization at Western Health, Melbourne, Australia. For the majority of the inputs for the single-use kit, we relied upon industry and inventory-sourced databases. We modeled the life cycles of the reusable and single-use central venous catheter kits with Monte Carlo analysis. Inclusive of labor, the reusable central venous catheter insertion kits cost $6.35 Australian ($A) (95% confidence interval [CI], $A5.89 to $A6.86), and the single-use kits cost $A8.65. For the reusable kit, CO(2) emissions were 1211 g (95% CI, 1099 to 1323 g) and for the single-use kit 407 g (95% CI, 379 to 442 g). Water use was 27.7 L (95% CI, 27.0 to 28.6 l) for the reusable kit and 2.5 L (95% CI, 2.1 to 2.9 l) for the single-use kit. For the reusable kit, sterilization had the greatest environmental cost, and for the single-use kit, the manufacture of plastic and metal components had the largest environmental costs. Different sources of electricity to make the reusable kits patient-ready again affected the CO(2) emissions: electricity from hospital gas cogeneration resulted in 436 g CO(2) (95% CI, 410 to 473 g CO(2)), from the United States electricity grid 764 g CO(2) (95% CI, 509 to 1174 g CO(2)), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO(2

  16. [Extravasal position of central venous catheters despite unsuspicious ECG-guidance].

    PubMed

    Schummer, W; Schummer, C; Paxian, M; Stock, U; Richter, K; Bauer, M

    2005-02-01

    Does the electrocardiographic method for central venous catheter positioning distinguish between a correct intravasal and a malpositioned extravasal position? 24 cardiac surgical patients were enrolled in this prospective observational study. In 18 patients the left, in another 6 patients the right internal jugular vein was cannulated. Using a J-wire within a triple-lumen catheter the amplitude of the P-wave was measured at 3 different intravasal sites: Intra-1: (intravasal baseline electrocardiogram), i. e. 10 cm marking of the catheter on skin level; Intra-2: clear rise of the P-wave amplitude upon further insertion of the catheter; Intra-3: maximum P-wave amplitude. At this position the control of the catheter tip was achieved by means of transoesophageal echocardiography (TOE). Intraoperatively, another J-wire within a triple-lumen catheter was placed by the heart surgeon on 3 extravasal sites and the ECG was recorded: Extra-1: extravasal at the left innominate vein above the pericardial reflection; Extra-2: extravasal on the superior vena cava below the pericardial reflection; Extra-A: extravasal on ascending aorta below the pericardial reflection. The catheter was suture fixed with its tip in position Intra-3. Post surgery a chest radiograph was taken. All catheter tips were visualised at the basis of the Crista terminals (border between right atrium and superior vena cava) by TOE control. The rise of the P wave amplitude at Intra-2, Extra-2 and Extra-A was highly significant compared to the base line at Intra-1 (Intra-1/Intra-2, Intra-1/Extra-2, Intra-1/Extra-A: p in each case < 0.001). The P wave amplitudes of the corresponding intra- and extravasal positions of the left innominate vein (Intra-1/Extra-1, n = 18, p = 0.096)) as well as those of the superior vena cava (Intra-2/Extra-2, n = 24, p = 0.859) did not differ. The electrocardiographic method can not differentiate between intra- and extravasal position of a central venous catheter, and thus

  17. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    SciTech Connect

    Desai, Shamit S.; Konanur, Meghana; Foltz, Gretchen; Malaisrie, S. Chris; Resnick, Scott

    2016-03-15

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  18. [Survival and complication rate of central venous catheters in newborns].

    PubMed

    García, Heladia Josefa; Torres-Yáñez, Héctor Leonardo

    2015-01-01

    Introducción: los catéteres venosos centrales (CVC) son de gran utilidad en la práctica médica actual; sin embargo, no están exentos de riesgos, lo que incrementa la morbilidad y mortalidad, especialmente en los recién nacidos (RN). El objetivo fue registrar la frecuencia de complicaciones de los CVC y su duración en RN en una unidad de cuidados intensivos neonatales (UCIN) de tercer nivel. Métodos: se realizó un estudio observacional descriptivo, prolectivo en la UCIN del Hospital de Pediatría del Centro Médico Nacional Siglo XXI. Se registraron variables demográficas, perinatales y del CVC. Resultados: se incluyeron 123 RN a quienes se les colocaron 152 CVC. La técnica más usada para la inserción del CVC fue la punción (percutánea o subclavia) en 56.6 % (n = 86). En 48.7 % (n = 74) de los CVC se presentó alguna complicación. Las más frecuentes fueron colonización en 32.4 % (n = 24) y bacteriemia relacionada con CVC en 27 % (n = 20). La probabilidad de duración de los CVC libres de complicaciones fue de 93.4 % a los 10 días y de 91.4 % a los 17 días. Los catéteres venosos no centrales tuvieron menor probabilidad de duración. Conclusión: la mayoría de las complicaciones de los CVC se presentaron en las primeras dos semanas de haber sido instalados. Las complicaciones infecciosas fueron las más frecuentes.

  19. Experience of Peripherally Inserted Central Venous Catheter in Patients with Hematologic Diseases

    PubMed Central

    Hashimoto, Yoshinori; Fukuta, Takanori; Maruyama, Junko; Omura, Hiromi; Tanaka, Takayuki

    2017-01-01

    Objective Although use of the peripherally inserted central venous catheter (PICC) has become increasingly common, there are few reports of PICCs used for patients with hematologic diseases. In this study, we analyzed the safety of PICC placement in patients with hematologic diseases where PICCs had been placed to perform blood collection, blood transfusion, drug administration, and hematopoietic stem cell transplantation. Methods This study included 142 PICCs placed in 95 patients managed at our department from November 2013 to December 2015. The PICCs used were the GroshongⓇ Catheter (NXT single-lumen; BARD Inc.). Results A total of 95 patients underwent the placement of 142 PICCs. The mean patient age was 65.5 years. The total duration of catheterization was 8,089 days, with a mean duration of 57.0 days. Chemotherapy was administered through 107 catheters. Stem cells were injected through 12 catheters. Although a fever was observed in association with 103 catheters, it was generally controlled by antimicrobial therapy. There were 18 catheter-related bloodstream infection (CRBSI) cases, an incidence equivalent to 2.1 cases per 1,000 catheter-days. Conclusion The present study demonstrated a low CRBSI incidence rate and found no evidence of serious complications with PICC placement. PICCs can be used for blood collection, blood transfusion, drug administration, and hematopoietic stem cell transplantation without problems. Thus, PICC placement appears to be a safe procedure for patients with hematologic diseases. Safe catheters are therefore urgently needed for these patients. We expect that PICCs will be widely adopted in Japan in the near future. PMID:28202859

  20. Gauze and tape and transparent polyurethane dressings for central venous catheters.

    PubMed

    Webster, Joan; Gillies, Donna; O'Riordan, Elizabeth; Sherriff, Karen L; Rickard, Claire M

    2011-11-09

    Central venous catheters (CVCs) facilitate venous access, allowing the intravenous administration of complex drug treatments, blood products and nutritional support, without the trauma associated with repeated venepuncture. However, CVCs are associated with a risk of infection. Some studies have indicated that the type of dressing used with them may affect the risk of infection. Gauze and tape, transparent polyurethane film dressings such as Tegaderm® and Opsite®, and highly vapour-permeable transparent polyurethane film dressings such as Opsite IV3000®, are the most common types of dressing used to secure CVCs. Currently, it is not clear which type of dressing is the most appropriate. To compare gauze and tape with transparent polyurethane CVC dressings in terms of catheter-related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised adults and children. For this third update, we searched The Cochrane Wounds Group Specialised Register (10 May 2011); The Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2011, Issue 2), Ovid MEDLINE (1950 to April Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, May 11, 2011); Ovid EMBASE (1980 to 2011 Week 18); and EBSCO CINAHL (1982 to 6 May 2011). All randomised controlled trials (RCTs) evaluating the effects of dressing type (e.g. gauze and tape versus transparent polyurethane dressings) on CVC-related infection, catheter security, tolerance to dressing material and dressing condition in hospitalised patients. Two review authors independently assessed trial quality and extracted data. We contacted study authors for missing information. Six studies were included in earlier versions of the review. In this update two of the previously included papers have been excluded and two new trials have been added. Of these six trials, four compared gauze and tape with transparent polyurethane dressings (total participants = 337) and two

  1. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service

    PubMed Central

    Barretta, Lidiane Miotto; Beccaria, Lúcia Marinilza; Cesarino, Cláudia Bernardi; Pinto, Maria Helena

    2016-01-01

    Abstract Objective: to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications. PMID:27276021

  2. Vascular Access Tracking System: a Web-Based Clinical Tracking Tool for Identifying Catheter Related Blood Stream Infections in Interventional Radiology Placed Central Venous Catheters.

    PubMed

    Morrison, James; Kaufman, John

    2016-12-01

    Vascular access is invaluable in the treatment of hospitalized patients. Central venous catheters provide a durable and long-term solution while saving patients from repeated needle sticks for peripheral IVs and blood draws. The initial catheter placement procedure and long-term catheter usage place patients at risk for infection. The goal of this project was to develop a system to track and evaluate central line-associated blood stream infections related to interventional radiology placement of central venous catheters. A customized web-based clinical database was developed via open-source tools to provide a dashboard for data mining and analysis of the catheter placement and infection information. Preliminary results were gathered over a 4-month period confirming the utility of the system. The tools and methodology employed to develop the vascular access tracking system could be easily tailored to other clinical scenarios to assist in quality control and improvement programs.

  3. Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients.

    PubMed

    Ajenjo, M Cristina; Morley, James C; Russo, Anthony J; McMullen, Kathleen M; Robinson, Catherine; Williams, Robert C; Warren, David K

    2011-02-01

    Limited data on the risk of peripherally inserted central venous catheter-associated bloodstream infections (PICC BSIs) in hospitalized patients are available. In 2007, dedicated intravenous therapy nurses were no longer available to place difficult peripheral intravenous catheters or provide PICC care Barnes-Jewish Hospital. To determine the hospital-wide incidence of PICC BSIs and to assess the effect of discontinuing intravenous therapy service on PICC use and PICC BSI rates. A 1,252-bed tertiary care teaching hospital. A 31-month retrospective cohort study was performed. PICC BSIs were defined using National Healthcare Safety Network criteria. In total, 163 PICC BSIs were identified (3.13 BSIs per 1,000 catheter-days). PICC use was higher in intensive care units (ICUs) than non-ICU areas (PICC utilization ratio, 0.109 vs 0.059 catheter-days per patient-day for ICU vs non-ICU; rate ratio [RR], 1.84 [95% confidence interval {CI}, 1.78-1.91]). PICC BSI rates were higher in ICUs (4.79 vs 2.79 episodes per 1,000 catheter-days; RR, 1.7 [95% CI, 1.10-2.61]). PICC use increased hospital-wide after the intravenous therapy service was discontinued (0.049 vs 0.097 catheter-days per patient-day; P =.01), but PICC BSI rates did not change (2.68 vs 3.63 episodes per 1,000 catheter-days; P =.06). Of PICC BSIs, 73% occurred in non-ICU patients. PICC use and PICC BSI rates were higher in ICUs; however, most of the PICC BSIs occurred in non-ICU areas. Reduction in intravenous therapy services was associated with increased PICC use across the hospital, but PICC BSI rates did not increase.

  4. A Rare Complication of Central Venous Catheter Extravasation in a Preterm Neonate: Hemidiaphragmatic Paralysis

    PubMed Central

    Hobson, C.; Dubillot, D.; Lardy, H.; Sirinelli, D.; Saliba, E.; Lopez, E.

    2017-01-01

    We report a case of a preterm neonate born at 26 weeks' of gestation diagnosed with unilateral diaphragmatic paralysis. This paralysis was a consequence of a phrenic nerve injury due to extravasation of hyperosmolar parenteral nutrition fluid in the upper thorax. Chest X-rays and ultrasonography confirmed the diagnosis. The neonate was treated with prolonged respiratory support and did not require surgical treatment. This report describes a case of hemidiaphragmatic paralysis as a complication of central venous catheter insertion. In neonates, spontaneous recovery of diaphragmatic paralysis is possible. This study concludes that recovery of extravasation injury-induced phrenic nerve palsy in the context of conservative management is possible. PMID:28405492

  5. Improving Patient Safety with a Mobile Application for Patients with Peripherally Inserted Central Venous Catheters (PICC).

    PubMed

    Nüssli, Stephan; Schnyder, Florian; Zenhäusern, Raphael; Bosshart, Katharina

    2016-01-01

    Peripherally inserted central venous catheters (PICCs) are of growing interest because they allow intravenous therapies up to several months. The appropriate management of the PICCs is crucial to minimize complications and largely depends on the right information for everyone who cares for the patient. To reach this goal we develop the mobile application "PICC App" to provide the necessary information for all involved persons in the outpatient setting. We expect to be able to report about the PICC App and the results of the usability evaluation with pilot users.

  6. Clostridium butyricum sepsis in an injection drug user with an indwelling central venous catheter.

    PubMed

    Gardner, Edward M; Kestler, Mary; Beieler, Alison; Belknap, Robert W

    2008-02-01

    Clostridium novyi has been associated with a large outbreak of severe infections in injection drug users. A case of bacteraemia with Clostridium butyricum in an injection drug user is reported. During treatment for Staphylococcus aureus osteomyelitis, the patient used an indwelling central venous catheter to inject cocaine. He was admitted with C. butyricum sepsis that responded to broad spectrum antibiotics, including vancomycin. Local investigation for other cases was unrevealing; however, growth of an unusual pathogen in clinical specimens should be investigated as it may represent a sentinel event with public health implications.

  7. Expect the unexpected: malposition of a large-bore central venous catheter in the urinary bladder.

    PubMed

    Schummer, Wolfram; Schummer, Claudia; Gorse, Andrej; Becker, Udo; Marx, Christiane; Brauer, Martin

    2004-12-01

    We report the case of a femoral vein cannulation in a critically ill trauma patient with the malposition of a large-bore central venous catheter in the urinary bladder. Recognition of the malposition was hampered by bloody tamponade of the bladder in the context of blunt thoraco-abdominal trauma with kidney and liver laceration. A high index of clinical suspicion and the institution of adequate therapy were the key to achieving a successful clinical outcome. We discuss the anatomy of femoral veins, including their close relation to a distended bladder. The application of ultrasound even in emergency situations is stressed.

  8. Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial.

    PubMed

    Rupp, Mark E; Lisco, Steven J; Lipsett, Pamela A; Perl, Trish M; Keating, Kevin; Civetta, Joseph M; Mermel, Leonard A; Lee, David; Dellinger, E Patchen; Donahoe, Michael; Giles, David; Pfaller, Michael A; Maki, Dennis G; Sherertz, Robert

    2005-10-18

    Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed. To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. Multicenter, randomized, double-blind, controlled trial. 9 university-affiliated medical centers. 780 patients in intensive care units who required central venous catheterization. Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. The antiseptic catheter was not compared with an

  9. How long should umbilical venous catheters remain in place in neonates who require long-term (≥5-7 days) central venous access?

    PubMed

    Keir, Amy; Giesinger, Regan; Dunn, Michael

    2014-08-01

    In this evidenced-based review, we examine the current available literature to help answer the question 'In neonates requiring long-term central access [patient], does removal of the umbilical venous catheter (UVC) on days 5-7 and replacement with a peripherally inserted central catheter line [intervention] compared with leaving the UVC in situ [comparison] reduce rates of central line-associated bloodstream infections [outcome]?'

  10. Delayed Haemothorax Resulting from Indwelling Right Internal Jugular Central Venous Catheter: A Rare Complication.

    PubMed

    Vinod, K V; Nishanth, S; Vidya, M V

    2016-09-01

    Haemothorax is an uncommon and serious complication, occurring most often during or immediately after percutaneous internal jugular and subclavian vein catheterizations. Delayed haemothorax is a rare complication, especially following right-sided catheterization. We report a case of acute yellow phosphorus poisoning with acute liver failure (resulting from rat killer paste ingestion) in a 28-year-old male who developed right-sided haemothorax eight days after placement of right internal jugular central venous catheter. The proposed pathogenesis involves vascular wall erosion by the indwelling catheter tip. Awareness of this complication perhaps avoids unnecessary investigations for other causes of haemothorax such as pulmonary embolism. © Journal of the Association of Physicians of India 2011.

  11. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

    PubMed Central

    Chiu, Diana Yuan Yng; Green, Darren; Kalra, Philip A.; Abidin, Nik

    2015-01-01

    Three-dimensional (3D) echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice. PMID:26688761

  12. We still go for the jugular: implications of the 3SITES central venous catheter study for nephrology.

    PubMed

    Wyatt, Christina M; Vassalotti, Joseph A

    2016-03-01

    The 3SITES study randomly assigned a nontunneled central venous catheter site in over 3000 adults treated in intensive care units. The subclavian site was associated with a lower rate of short-term complications, including catheter-related bloodstream infection and deep venous thrombosis, compared to the femoral or internal jugular site. Nephrologists should be aware of this study and should continue to advocate for alternatives to subclavian vein catheter placement in patients with chronic kidney disease who are expected to require arteriovenous access for dialysis in the future.

  13. Use of a peripherally inserted central catheter as a conduit for central venous access across thrombosed great veins.

    PubMed

    Ramkumar, Prasad Guntur; Chakraverty, Sam; Zealley, Ian

    2010-02-01

    This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.

  14. Use of a Peripherally Inserted Central Catheter as a Conduit for Central Venous Access Across Thrombosed Great Veins

    SciTech Connect

    Guntur Ramkumar, Prasad Chakraverty, Sam Zealley, Ian

    2010-02-15

    This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.

  15. [Significance of ultrasonics in the placement of a central venous catheter].

    PubMed

    Sauer, W; Luft, D; Risler, T; Renn, W; Eggstein, M

    1988-09-16

    An ultrasound investigation was undertaken of the neck region of 42 patients with normal neck anatomy in order to determine whether the results of ultrasound-gained topographical data provided pointers to the choice of entry site to the internal jugular vein (IJV). In addition, the IJV was punctured under ultrasound control in 23 patients in an intensive care unit in whom there was a problem of increased bleeding tendency, anatomical difficulty or previously failed "blind" puncture. In all of them a central venous catheter was placed without complication by the Seldinger technique via the primary chosen point for puncture. An approach through the sternocleidomastoid muscle, between the cricoid level and the "central" place of puncture between the two bellies of the sternocleidomastoid muscle proved to be the most satisfactory compromise between easy application of the ultrasound head, large vein diameter and reduction of any risk of mistakenly puncturing artery or pleura. This approach has to be varied according to the ultrasound findings. It is concluded from this experience that ultrasound is suitable for the placement of central venous catheters. But since the equipment is bulky it cannot be used in an emergency.

  16. Central venous stenosis in haemodialysis patients without a previous history of catheter placement.

    PubMed

    Oguzkurt, Levent; Tercan, Fahri; Yildirim, Sedat; Torun, Dilek

    2005-08-01

    To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

  17. Increased rates of local complication of central venous catheters in the targeted anticancer therapy era: a 2-year retrospective analysis.

    PubMed

    Berardi, R; Rinaldi, S; Santini, D; Vincenzi, B; Giampieri, R; Maccaroni, E; Marcucci, F; Francoletti, M; Onofri, A; Lucarelli, A; Pierantoni, C; Tonini, G; Cascinu, S

    2015-05-01

    Totally implantable central venous accesses (port-a-cath) are often used for chemotherapy administration or prolonged intravenous infusions in cancer patients. Local and systemic complications may occur both during and after placement of port-a-cath despite the well-established techniques for its placement and care. Out of other catheter-related local complications, thrombosis and infections represent the most common. Complications related to central venous catheter may be associated with infusion of both conventional chemotherapy and molecularly targeted therapy. Incidence and nature of complications of central venous catheter have been well established for long-term chemotherapy. However, very sparse data exists on the incidence of complications of molecularly targeted therapies administered through a central venous catheter. Hence, we decided to retrospectively analyze the local complications of a central venous catheter in patients receiving molecularly targeted therapy and conventional chemotherapy, respectively. Over a 2-year period, 459 devices were placed in two academic Italian institutions. Patients' characteristics, catheter-related complications, and their relationship with targeted therapy administration were retrospectively assessed. Catheter-related complications occurred in 30 out of the 459 analyzed cancer patients (7 %). Local complications occurred in 12 (40 %) and 18 (60 %) patients receiving standard chemotherapy and biological drugs, respectively. Eighteen (72 %) out of 25 patients developing biological complications (BC) were receiving biological drugs. Infusion of a biological drug through a central venous catheter has been shown to increase the risk of central venous catheter complications (p = 0.02). No difference between the incidence of complication between anti-angiogenic and anti-epidermal growth factor receptor (EGFR) agents was observed in our study despite the statistically significant early development of port

  18. Prevention of central venous catheter-related infections: what works other than impregnated or coated catheters?

    PubMed

    Mermel, Leonard A

    2007-06-01

    Catheter-related bloodstream infections (CRBSI) are a significant cause of morbidity and excess hospital cost. Data from prospective, randomized trials demonstrate that the risk of these infections can be minimized by simple interventions. Changing the behaviour of healthcare workers who insert and care for intravascular catheters is imperative. Creating a culture of patient safety and assuring easy access to the products necessary to maintain strict asepsis during catheter insertion, dressing changes, and when manipulating catheter hubs, will enhance adherence to optimal practice and will reduce the risk posed to the millions of patients in need of such devices.

  19. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    PubMed

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  20. Minimising central line-associated bloodstream infection rate in inserting central venous catheters in the adult intensive care units.

    PubMed

    Hina, Hedaya Rateb; McDowell, Joan R S

    2017-03-23

    To investigate the procedural aspects in inserting central venous catheters that minimise central line-associated bloodstream infection rates in adult intensive care units through a structured literature review. In adult intensive care units, central line-associated bloodstream infections are a major cause of high mortality rates and increased in costs due to the consequences of complications. Eligible articles were identified by combining indexed keywords using Boolean operator of "AND" under databases of Ovid and CINAHL. Titles and abstract of retrieved papers were screened and duplicates removed. Inclusion and exclusion criteria were applied to derive the final papers, which contained seminal studies. The quality of papers was assessed using a special data extraction form. The number of papers retrieved from all databases was 337, reduced to 302 after removing duplicates. Papers were scanned for titles and abstract to locate those relevant to the review question. After this, 250 papers were excluded for different reasons and a total of 52 papers were fully accessed to assess for eligibility. The final number of papers included was 10 articles. Many interventions can be implemented in the adult intensive care unit during the insertion of a central venous catheter to minimise central line-associated bloodstream infections rates. These include choosing the subclavian site to insert the catheters as the least infectious and decolonising patients' skin with alcoholic chlorhexidine gluconate preparation due to its broad antimicrobial effect and durability. Choosing optimal sites for central venous catheter insertion is a complex process that relies on many factors. Furthermore, the introduction of chlorhexidine gluconate preparations should be accompanied with multifaceted interventions including quality improvement initiatives to improve healthcare workers' compliance. As a quality marker in adult intensive care units, healthcare sectors should work on establishing

  1. Management of central venous catheters at the intensive care units in Yemen. Survey of practices.

    PubMed

    Al-Sayaghi, Khaled M

    2011-03-01

    To describe the intensive care units (ICU) current infection control practices regarding the management of central venous catheters (CVCs) in Yemeni hospitals and compare the current practices with the evidence-based guidelines. This study was carried out in ICUs of Sana'a hospitals, Republic of Yemen, in July 2010. We gathered the data regarding the infection control practices associated with CVC management in 25 ICUs of 14 hospitals. A self-administered questionnaire was distributed to ICUs' nurse managers in Sana'a city. The results were analyzed and tabulated using the Statistical Package for Social Sciences software version 11, and compared with the evidence-based guidelines. Only 44% of units had written policies for CVC management. The 2 most commonly used practices that comply with the guidelines were: wearing of gloves and dressing material. None of the units used 2% chlorhexidine solutions. More than half of the units were adherent to the recommended practice for hand hygiene (before and after insertion, accessing, dressing or replacing/repairing of CVC), preferred insertion site, antimicrobial-coated catheters, aseptic technique during catheter insertion and site care, disinfection of intravenous access ports, capping stopcocks and infusion set tips while they are not in use, and CVC replacement/removal. In all other sections, only the minority were adherent to the recommended practices. There is a diversity of current practices and lack of consistent adherence to the evidence-based guidelines for the prevention of intravascular catheter-related infections.

  2. Prevention of central venous catheter-related infection in the neonatal unit: a literature review.

    PubMed

    Taylor, Jacqueline E; McDonald, Susan J; Tan, Kenneth

    2015-07-01

    Central venous catheter infections are the leading cause of healthcare-associated bloodstream infections and contribute significantly to mortality and morbidity in neonatal intensive care units. Moreover, infection poses significant economic consequence which increased hospital costs and increased length of hospital stay. Prevention strategies are detailed in guidelines published by the Centers for Disease Control and Prevention (CDC) in the United States; nevertheless, recent surveys in neonatal units in the United States, and Australia and New Zealand demonstrate these are not always followed. This review discusses the numerous evidence-based strategies to prevent catheter infections including hand hygiene, maximal sterile barriers during insertion, skin disinfection, selection of insertion site, dressings, aseptic non-touch technique, disinfection of catheter hubs/ports, administration set management, prompt removal of catheter, antibiotic locks, systemic antibiotic prophylaxis and chlorhexidine bathing. Furthermore, it will describe different strategies that can be implemented into clinical practice to reduce infection rates. These include the use of care bundles including checklists, education and the use of CVC teams.

  3. Management of complications related to central venous catheters in cancer patients: an update.

    PubMed

    Linnemann, Birgit

    2014-04-01

    Central venous catheters (CVCs) are important for the treatment of patients with cancer, especially in the perioperative and palliative care settings. These devices not only allow for the administration of chemotherapy, parenteral nutrition, and other intravenous therapies, but they may also improve the patients' quality of life by reducing the need for repeated peripheral venipunctures. Thrombotic and infectious complications are common, especially in the long-term use of CVCs. There are different types of thrombotic complications associated with CVCs, that is, a thrombotic occlusion of the catheter, a mural thrombus at the catheter tip and classical deep vein thrombosis, which occurs most frequently in the upper extremity where the majority of long-term catheters are inserted. Infections are common complications associated with CVCs. Patients with cancer who receive intensive chemotherapy and those patients who undergo hematopoietic stem cell transplantation have a markedly increased risk for insertion site and bloodstream infections. In this review, the epidemiology and risk factors that predispose patients to CVC-related thrombosis and infection are discussed. The diagnostic and therapeutic options according to the published data and the current guidelines are summarized and data for establishing primary and secondary preventative strategies are provided.

  4. Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis.

    PubMed

    Yeral, Mahmut; Boga, Can; Oguzkurt, Levent; Asma, Suheyl; Kasar, Mutlu; Kozanoglu, Ilknur

    2014-01-01

    Patients with sickle cell disease (SCD) are prone to develop thrombosis and infection due to their inflammatory and immune deficiency state. These patients require red cell exchange therapy for treatment or prevention of hemoglobin S associated complications. Owing to vascular access problems, adult patients need central venous catheterization (CVC) for exchange procedures. Procedure related complications have been reported for long-term CVCs in pediatric patients. However, short-term CVC complications in adult patients are not clear. This report represents the results of documented complications of short-term CVCs in patients with SCD who undergo apheresis. A total of 142 non-tunneled catheters with average median diameter of 9 F (range 8-16 F) were implanted for apheresis. The catheters were mainly inserted through the right internal jugular vein (66.2 %). Total days of catheter were 412. Results were reported as a complication rate and event according to 1,000 catheter days and compared to a control group including 37 healthy stem cell donors. In the patient group, 1 (1 %) hematoma and 1 (1 %) infection were observed for internal jugular vein catheterization (3.7 hemorrhages and 3.7 infections according to 1,000 catheter days), whereas four (8.9 %) cases of thrombosis and 1 (2.2 %) infection (27 and 6.9 according to 1,000 catheter days) developed in femoral vein. There was a significant difference in terms of thrombosis (P = 0.009). In the control group, only individual developed thrombosis in internal jugular vein. Short-term CVC inserted through to the internal jugular vein seems to be safer than femoral vein in patients with SCD.

  5. Outcome of tunnelled central venous catheters used for haemodialysis in children weighing less than 15 kg.

    PubMed

    Lopez, Pedro-Jose; Troncoso, Bernardita; Grandy, Jean; Reed, Francisco; Ovalle, Alejandra; Celis, Soledad; Reyes, Danielle; Letelier, Nelly; Zubieta, Ricardo

    2014-08-01

    Central venous catheters (CVC) are frequently used for haemodialysis (HD) in children. However, there is paucity of information on the outcomes of CVCs when used for HD in very young patients. Our objective is to report the success, safety and complication rates of CVCs used for HD in children weighing less than 15 kg. This is a single-center retrospective study of all patients with end-stage renal disease (ESRD) weighing <15kg, who underwent a tunneled CVC placement for HD, between July 2006 and June 2012 at our institution. Analysed data included clinical background, age and weight at initiation of HD, outcome of HD, CVC vein insertion site, reason for removal, and catheter survival (in days). Thirty-one CVC were placed in 11 patients weighing <15 kg, 8 males and 3 females. The main causes of ESRD were renal dysplasia and congenital nephrotic syndrome. At the beginning of HD, mean age was 27.5 (range 5-60) months and mean weight was 10.4 kg (4.5-13 kg). The preferred insertion site was the right internal jugular vein (90%). Mean duration of HD was 312 days. Mechanical factors were the main reason for catheter removal (39%). Mean catheter survival was 110 days/catheter. We believe our study provides relevant information and encouraging data to support the use of CVC for HD in this cohort of infants; however, further improvement in prevention of catheter thrombosis and management of infections needs to be achieved. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Octenidine hydrochloride for the care of central venous catheter insertion sites in severely immunocompromised patients.

    PubMed

    Tietz, Andreas; Frei, Reno; Dangel, Marc; Bolliger, Dora; Passweg, Jakob R; Gratwohl, Alois; Widmer, Andreas E

    2005-08-01

    To determine the efficacy and tolerability of octenidine hydrochloride, a non-alcoholic skin antiseptic, for the care of central venous catheter (CVC) insertion sites. Prospective, observational study. Bone marrow transplantation unit of a university hospital. All consecutive patients with a nontunneled CVC were enrolled prospectively after informed consent. Octenidine hydrochloride (0.1%) was applied for disinfection at the CVC insertion site during dressing changes. The following cultures were performed weekly as well as at the occurrence of any systemic inflammatory response syndrome criteria: cultures of the skin surrounding the CVC entry site, cultures of the three-way hub connected to the CVC, blood cultures, and cultures of the CVC tip on removal. Enhanced microbiological methods (skin swabs of a 24-cm2 standardized area, roll plate, and sonication of catheter tips) were applied. One hundred thirty-five CVCs were inserted in 62 patients during the study period and remained for a mean period of 19.1 days, corresponding to 2,462 catheter-days. Bacterial density at the insertion site declined substantially over time, and most cultures became negative 2 weeks after insertion. Only 6 patients had a documented catheter-related bloodstream infection. The incidence density was 2.39 catheter infections per 1,000 catheter-days. No side effects were noted with application of the antiseptic. Disinfection with a skin antiseptic that contains octenidine hydrochloride is highly active and well tolerated. It leads to a decrease in skin colonization over time and may be a new option for CVC care.

  7. Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray?

    PubMed Central

    Kamalipour, Hamid; Ahmadi, Sedigheh; Kamali, Karmella; Moaref, Alireza; Shafa, Masih; Kamalipour, Parsa

    2016-01-01

    Background Chest radiography after central venous catheter (CVC) insertion is the main method of verifying the catheter location. Despite the widespread use of radiography for detecting catheter position, x-ray may not always be readily available, especially in the operating room. Objectives We aimed to compare contrast-enhanced ultrasonography (CEUS) and chest radiography for detecting the correct location of CVCs. Methods One hundred sixteen consecutive patients with indications for CVC before cardiac surgery were enrolled in this observational study. After catheter insertion, CEUS was performed. Portable radiography was obtained postoperatively in the intensive care unit. Sensitivity, specificity, and predictive values were determined by comparing the ultrasonography results with radiographic findings as a reference standard. Results Chest radiography revealed 16 CVC misplacements: two cases of intravascular and 14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter malpositionings in the RA, while it could not recognize seven catheter placements correctly. CEUS showed two false RA misplacements and five falsely correct CVC positions. A sensitivity of 98% and specificity of 69% were achieved for CEUS in detecting CVC misplacements. Positive and negative predictive values were 95% and 85%, respectively. The interrater agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001). Conclusions Despite close concordance between ultrasonography and chest radiography, CEUS is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored. PMID:27847699

  8. Are central venous catheter tip cultures reliable after 6-day refrigeration?

    PubMed

    Bouza, Emilio; Guembe, Maria; Gómez, Haydee; Martín-Rabadán, Pablo; Rivera, Marisa; Alcalá, Luis

    2009-07-01

    Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki's roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after 24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only 61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from patients with positive blood cultures reduce the workload in the microbiology laboratory without misdiagnosing CR-BSI.

  9. Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension.

    PubMed

    Doran, A K; Ivy, D D; Barst, R J; Hill, N; Murali, S; Benza, R L

    2008-07-01

    Intravenous prostanoids are the backbone of therapy for advanced pulmonary arterial hypertension (PAH) and have improved long-term outcome and quality of life. Currently, two prostanoids are approved by the US Food and Drug administration for parenteral administration: epoprostenol (Flolan) and treprostinil (Remodulin). Chronic intravenous therapy presents considerable challenges for patients and caregivers who must learn sterile preparation of the medication, operation of the pump, and care of the central venous catheter. Patients are routinely counseled and advised regarding the risks of CR-BSIs and catheter care before central line insertion. Central line infections as well as bacteremia are well documented risks of chronic intravenous therapy and may significantly contribute to morbidity and mortality. Recent reports have suggested a possible increase in CR-BSI; therefore, the Scientific Leadership Council of the Pulmonary Hypertension Association decided to provide guidelines for good clinical practice regarding catheter care. Although data exits regarding patients with central venous catheters and the risk of blood stream infections in patients with cancer or other disorders, there is little data regarding the special needs of patients with pulmonary arterial hypertension requiring central venous access. These guidelines are extrapolated from the diverse body of literature regarding central venous catheter care.

  10. The carina as a landmark for central venous catheter placement in small children.

    PubMed

    Albrecht, Knut; Breitmeier, Dirk; Panning, Bernhard; Tröger, Hans Dieter; Nave, Heike

    2006-04-01

    Central venous devices are frequently used in children to monitor haemodynamic status, to administer fluids, medication, parenteral nutrition and for blood sampling. Life-threatening complications that may occur on insertion if the central venous catheter (CVC) is misplaced, are cardiac tamponade or a hydro-/haemopericardium. There is still controversy over the optimum catheter tip position in paediatric patients, whether to place the CVC tip in the superior vena cava, outside the pericardial boundaries or in the right atrium. However, the exact location of the pericardium cannot be seen on a normal chest x-ray. The carina is a radiographic marker for CVC placement, suggested on the basis of studies with conserved and fresh adult cadavers. In order to confirm this landmark for children, the present study was performed with 31 fresh cadavers of small children (mean age 12.5+/-3.4 months) that had been selected for autopsy in the Institute of Legal Medicine. Results clearly demonstrate that the carina was 0.5+/-0.04 cm above the pericardial duplication as it transversed the SVC. In no infant cadaver was the carina inferior to the pericardium. Thus, the results are analogous to those in adults and confirm that the carina is a simple anatomical-radiological landmark, superior to the pericardial reflection, that can be used to identify the placement of CVC even in newborn and small children.

  11. Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection.

    PubMed

    Kappers-Klunne, M C; Degener, J E; Stijnen, T; Abels, J

    1989-10-15

    Forty-three evaluable patients with hematologic malignancies, mainly acute leukemia, were prospectively randomized to receive a double lumen central venous catheter or a totally implantable venous access system. The mean catheter stay was 166 days (median, 104 days) for the 23 double lumen catheters and 164 days (median, 65 days) for implanted systems. Exit site infections were not encountered in double lumen catheters, but there were two proven infections around the injection port of implanted devices. Tunnel infections did not occur. Seven double lumen catheters and four implanted systems were removed because of infection. Staphylococcus epidermidis was the predominant microorganism cultured from these catheters. Five of nine patients with double lumen catheters and catheter-related S. epidermidis infection and the two patients with implanted systems in whom S. epidermidis was cultured were on selective gut decontamination. The pattern of infection did not seem to be influenced by this regimen. Totally implantable systems proved to be as safe as double lumen central venous lines.

  12. Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit.

    PubMed

    Guzzo, James L; Seagull, F Jacob; Bochicchio, Grant V; Sisley, Amy; Mackenzie, Colin F; Dutton, Richard P; Scalea, Thomas; Xiao, Yan

    2006-02-01

    In the academic trauma unit during initial evaluation and resuscitation of trauma victims, central venous catheters are often placed by multiple operators. There are few data on compliance with accepted, standard sterile practices during such procedures. Prospective data were tabulated from video capture of 144 consecutive central venous catheterizations in a trauma resuscitation unit, during peak hours, by a team of trained video technicians. The physicians were surgical and emergency medicine residents. The number of primary operators (trainees) and secondary operators (mentors) for each line was recorded from the video analysis, as well as physician adherence to the use of maximum barrier precautions (MBP; sterile gown, gloves, full operative drape, cap, and mask). Procedures were stratified by level of urgency: Emergent (n = 7), semi-emergent (n = 20), and elective (n = 113). The subclavian vein was used for 73% of the elective catheter placements. For elective central venous catheters, 99 of 113 primary operators (88%) observed MBP, whereas only 31 of 45 secondary operators (69%) did so (p < or = 0.01). Among the 45 elective central venous catheters placed with a secondary operator, there were four instances of frank contamination (9%). Secondary operators, typically trauma surgery attendings, trauma/critical care fellows, or senior surgical residents, function as mentors in academic institutions and act as role models. Secondary operators participated in many of the studied cases, yet failed to demonstrate consistent use of MBP. In elective central venous catheter placement, those where there was the greatest opportunity to follow MBP, we observed a statistically significant difference in compliance rate between the primary and secondary operators. The study suggests the need to address the performance of the secondary operators and to educate them, as although they may be technically experienced in placing central venous catheters, they may comply less

  13. The Relationship Between Intrinsic and Extrinsic Factors and Central Venous Catheter Infections in the Acutely Ill Patient

    DTIC Science & Technology

    1991-01-01

    Extrinsic Factors and Central Venous Catheter Infections i n t-ho Arutely TI I Pat i nt 6. AUTHOR(S) Helen Frances Edwards, Captain 7. PERFORMING...AND CENTRAL VENOUS CATHETER INFECTIONS IN THE ACUTELY ILL PATIENT For by L >C Helen Frances Edwards .J l ’, r ..... :!l d By DC_ t Hb dtIi; I Dist A...obstaculo debido a educacion o lenguaje no ha impedido un entendimiento claro de su participacion en este proyecto. Firma do Investigador Firma do

  14. Venous thromboembolism in colorectal cancer patients with central venous catheters for 5-FU infusion-based pharmacokinetic modulating chemotherapy.

    PubMed

    Yoshikawa, Reigetsu; Yanagi, Hidenori; Noda, Masafumi; Ikeuchi, Hiroki; Nakano, Hiroki; Gega, Makoto; Tsukamoto, Kiyoshi; Oshima, Tsutomu; Inoue, Takashi; Fujiwara, Yoshinori; Shoji, Yasutsugu; Sakaki, Takatoshi; Higasa, Satoshi; Hashimoto-Tamaoki, Tomoko; Yamamura, Takehira

    2005-04-01

    Colorectal cancer patients with central venous catheters (CVC) for pharmacokinetic modulating chemotherapy (PMC) have a substantial risk of venous thromboembolism (VTE). PMC, designed as a hybrid of lower metronomic and higher shorter plasma 5-FU concentrations, has been clinically successful. To determine the effectiveness and safety of D-dimer tests and multidetector-row CT (MDCT) for diagnosis in cancer patients with suspected VTE, we carried out a clinical outcome study on PMC outpatients. Patients received a D-dimer test before and after commencing the PMC regimen. MDCT was performed additionally if the D-dimer test appeared positive or showed signs of VTE. When CT results were positive for thromboembolism, anticoagulation was started. The overall prevalence of VTE in PMC patients was 2.0% (7 of 350 patients). In this study, 34 out of 102 colorectal cancer patients gave a positive D-dimer test (33.3%). CT identified venous thrombi in 2 of the 102 patients (2.0%), mural thrombosis on catheterized veins in another 3 patients (2.9%), and endothelial hyperplasia on catheterized veins in 8 patients (7.8%). The catheters of these patients did not show any significant abnormalities. Patients with negative D-dimer tests showed no signs or symptoms of VTE. In colorectal cancer patients receiving continuous 5-FU infusion via CVC, a D-dimer test can be safely used as the primary diagnostic test for ruling out VTE. We suggest 7.0 microg/ml as the D-dimer cut-off value. Thromboprophylaxis should be considered in the patients showing values >7.0 microg/ml.

  15. Intensivist supervision of resident-placed central venous catheters decreases the incidence of catheter-related blood stream infections.

    PubMed

    Papadimos, Thomas J; Hensely, Sandra J; Duggan, Joan M; Hofmann, James P; Khuder, Sadik A; Borst, Marilyn J; Fath, John J

    2008-04-30

    Catheter-related blood stream infections (CRBSI) cause significant morbidity and mortality. A retrospective study of a performance improvement project in our teaching hospital's surgical intensive care unit (SICU) showed that intensivist supervision was important in reinforcing maximal sterile barriers (MSB) use during the placement of a central venous catheter (CVC) in the prevention of CRBSI. A historical control period, 1 January 2001-31 December 2003, was established for comparison. From 1 January 2003-31 December 2007, MSB use for central venous line placement was mandated for all operators. However, in 2003 there was no intensivist supervision of CVC placements in the SICU. The use of MSB alone did not cause a significant change in the CRBSI rate in the first year of the project, but close supervision by an intensivist in years 2004-2007, in conjunction with MSB use, demonstrated a significant drop in the CRBSI rate when compared to the years before intensivist supervision (2001-2003), p < .0001. A time series analysis comparing monthly rates of CRBSI (2001-2007) also revealed a significant downward trend, p = .028. Additionally, in the first year of the mandated MSB use (2003), 85 independently observed resident-placed CVCs demonstrated that breaks in sterile technique (34/85), as compared those placements that had no breaks in technique (51/85), had more CRBSI, 6/34 (17.6%) vs. 1/51 (1.9%), p < .01. Interventions to reduce CRBSI in our SICU needed emphasis on adequate supervision of trainees in CVC placement, in addition to use of MSB, to effect lower CRBSI rates.

  16. Central Venous Catheter Retention and Mortality in Children With Candidemia: A Retrospective Cohort Analysis.

    PubMed

    Fisher, Brian T; Vendetti, Neika; Bryan, Matthew; Prasad, Priya A; Russell Localio, A; Damianos, Andreas; Coffin, Susan E; Bell, Louis M; Walsh, Thomas J; Gross, Robert; Zaoutis, Theoklis E

    2016-12-01

    Candidemia causes significant morbidity and mortality among children. Removal of a central venous catheter (CVC) is often recommended for adults with candidemia to reduce persistent and metastatic infection. Pediatric-specific data on the impact of CVC retention are limited. A retrospective cohort study of inpatients <19 years with candidemia at the Children's Hospital of Philadelphia between 2000 and 2012 was performed. The final cohort included patients that had a CVC in place at time of blood culture and retained their CVC at least 1 day beyond the blood culture being positive. A structured data collection instrument was used to retrieve patient data. A discrete time failure model, adjusting for age and the complexity of clinical care before onset of candidemia, was used to assess the association of CVC retention and 30-day all-cause mortality. Two hundred eighty-five patients with candidemia and a CVC in place at the time of blood culture were identified. Among these 285 patients, 30 (10%) died within 30 days. Central venous catheter retention was associated with a significant increased risk of death on a given day (odds ratio, 2.50; 95% confidence interval, 1.06-5.91). Retention of a CVC was associated with an increased risk of death after adjusting for age and complexity of care at candidemia onset. Although there is likely persistence of unmeasured confounding, given the strong association between catheter retention and death, our data suggest that early CVC removal should be strongly considered. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  17. Multi-purpose silastic dual-lumen central venous catheters for both collection and transplantation of hematopoietic progenitor cells.

    PubMed

    Lazarus, H M; Trehan, S; Miller, R; Fox, R M; Creger, R J; Raaf, J H

    2000-04-01

    Autologous peripheral blood progenitor cell (PBPC) transplantation frequently requires sequential placement and use of two separate central venous catheters: (1) a short-term, large-bore, stiff device inserted for leukapheresis, and after removal of that device, (2) a long-term, multi-lumen, flexible, Silastic catheter for administration of high-dose chemotherapy, re-infusion of hematopoietic cells, and intensive supportive care. We reviewed our recent experience with two dual-lumen, large-bore, Silastic multi-purpose ('hybrid') catheters, each of which can be used as a single device for both leukapheresis and long-term supportive care throughout the transplant process. Quinton-Raaf PermCath and Bard-Hickman hemodialysis/apheresis dual-lumen catheters were used as the sole venous access device in 112 consecutive patients who underwent autologous PBPC collection and transplantation. The catheter exit site was monitored three times a week, and lumen patency was assessed using clinical and radiologic techniques. Catheters were removed prematurely for persistent thrombus, positive blood cultures despite appropriate antibiotics, or mechanical dysfunction. There were no intra-operative or immediate post-operative complications relating to insertion. Thirty-two patients experienced catheter occlusion necessitating urokinase instillation. Persistent occlusive problems were noted in 16 patients, and in 10 patients the catheter had to be removed. Two exit site infections and 17 bacteremias occurred. Catheters had to be removed for persistent infection in two subjects and for mechanical problems in five others. Cost analysis comparing the hybrid catheters alone vs conventional devices revealed a charge of $4230 in patients with hybrid catheters vs. $7530 in those requiring a temporary non-Silastic dialysis catheter in addition to a flexible, long-term Silastic catheter. Hybrid, Silastic, dual-lumen, large-bore central venous catheters are safe, cost-effective and convenient

  18. Incidence and risk factors for central venous catheter-related thrombosis in hematological patients.

    PubMed

    Joks, Monika; Czyż, Anna; Popławski, Dariusz; Komarnicki, Mieczysław

    2014-01-01

    Catheter-related thrombosis (CRT) is a serious complication in hematological patients, but the risk factors for its occurrence are not well established. The study objectives were to estimate the incidence of CRT and to identify the risk factors for developing CRT in hematological patients. In a prospective setting, 104 consecutive patients with 200 insertions of central venous catheters were enrolled into the study. The patients were screened for CRT by compression Doppler ultrasound every 10-14 days. Additionally, ultrasonography was performed in the case of clinical symptoms suggesting CRT. Over the course of 6,098 catheter days of follow-up, the incidence of CRT was 13.5 %. In 18/27 cases (66.6 %), radiological evidence of CRT was preceded by clinical symptoms. However, in 9/27 (33.3 %), CRT was clinically asymptomatic. The median times to symptomatic and asymptomatic CRT were 17 (range 1-49) and 8 (range 1-16) catheter days, respectively. In univariate analysis, the risk factors for CRT were exit-site infection (ESI) (P < 0.001), two or more prior chemotherapy lines (P = 0.015), catheter-related blood stream infection (P < 0.001), and Coagulase-negative staphylococci infection (P = 0.002). In multivariate analysis, ESI (OR 5.0; 95 % CI 1.6-6.3; P = 0.006) and two or more prior chemotherapy lines (OR 3.57; 95 % CI 1.27-10.11; P = 0.015) remained significantly associated with the risk of CRT. The results of our study provide information regarding the characteristic features of the patients who are at high risk of thrombosis, for whom Doppler ultrasound screening should be considered.

  19. Risk factors for central venous catheter-related bloodstream infection: a 1073-patient study.

    PubMed

    Yoshida, Junichi; Ishimaru, Toshiyuki; Fujimoto, Michiko; Hirata, Noriko; Matsubara, Nobuo; Koyanagi, Nobuhiro

    2008-12-01

    We intended to evaluate the risk factors for catheter-related bloodstream infection (CR-BSI) with central venous (CV) catheters. For the hub of the CV line, we used three-way stopcocks in the first year of the study and closed needleless connectors (NCs) in the second year. Background factors included the age and sex of patients; the ward; the specialty service; the CV catheter and its days of placement; and the staff compounding the intravenous infusion, i.e., either nurses, who disinfect hands-free, or pharmacists using clean benches. Outcome factors included positive culture from the blood-related samples and the body temperature estimate. Of a total of 29 221 device-days in 1073 patients, positive cultures showed an overall incidence of 2.26 per 1000 device-days. Multivariate analysis showed a higher odds ratio of positive cultures for the ICU (odds ratio [OR], 4.415; 95% confidence interval [CI], 2.054-9.490]) and for CV catheter placement for more than 30 days (OR, 7.529; 95% CI, 4.279-13.247), but no significance for male sex (OR, 1.752; 95% CI, 0.984-3.119) or for pharmacists' compounding (OR, 2.150; 95% CI, 0.974-4.749). Univariate analysis showed no significance for the following factors: age more than 70 years (OR, 0.968; 95% CI 0.561-1.641), the surgery service (OR, 1.029; 95% CI, 0.582-1.818), double-lumen CV catheters (OR, 0.841; 95% CI, 0.465-1.521), or the NC (1.107; 95% CI, 0.673-1.821). We conclude that the theoretical benefit of the NC, the abolished dead space in the hub, contributed little to the outcomes of blood-related culture. The hands-free disinfection may have resulted in comparable odds ratios for the nurses and the pharmacists compounding the infusions.

  20. A new central venous catheter cap: decreased microbial growth and risk for catheter-related bloodstream infection.

    PubMed

    Buchman, A L; Spapperi, J; Leopold, P

    2009-01-01

    Catheter-related blood stream infection (CRBI) is a major cause of morbidity and mortality, and is a source of significant healthcare expenditures in patients that require central venous catheters for intravenous nutrition, chemotherapy, and other products. The source of many catheter-related infections is contamination of the catheter hub. Herein an antimicrobial catheter cap, the AB Cap is described. The AB Cap device is a catheter cleaning device designed to keep needleless luer valves clean by encapsulating them in a cleaning solution. This device was evaluated using an in vitro model of hub contamination with Staphylococcus aureus, Staphylococcus epidermidis (S. epidermidis), Klebsiella pneumonia (K. pneumonia), Pseudomonas aeruginosa, Escherichia coli and Candida albicans (C. albicans). Following hub contamination on days 1, 3, 5 and 7, saline was infused through the AB Cap and effluent collected from the efferent end. The effluent fluid was cultured for the index organisms, and allowed to incubate in culture for up to 7 days. Negative control caps were not contaminated and positive controls lacked cleaning solution and were contaminated. Microbial growth developed for all index organisms, and generally within 1 day of culture growth following the first day of contamination (day 1) in effluent from all positive controls, while no growth occurred in effluent from negative controls. No growth of any organism occurred in any of the test items after the first day of contamination. Growth of three organisms was detected in two of the three test AB Caps following contamination day 3, after 1-4 days of incubation. All organisms could be cultured in the effluent from two of the three test items at contamination day 5, generally by the second day of incubation. One test item remained free of growth for the entire test period except for one organism. By day 7, this particular test item grew an additional organism and the testing was concluded. All positive growth test

  1. A Missing Guide Wire After Placement of Peripherally Inserted Central Venous Catheter

    PubMed Central

    Kashif, Muhammad; Hashmi, Hafiz; Jadhav, Preeti; Khaja, Misbahuddin

    2016-01-01

    Patient: Male, 50 Final Diagnosis: Retained guidewire removal by interventional radiology Symptoms: Swelling Medication: — Clinical Procedure: Fluoroscopic retrieval of the guidewire Specialty: Critical Care Medicine Objective: Unusual setting of medical care Background: Central venous catheterization is a common tool used in critically ill patients to monitor central venous pressure and administer fluids and medications such as vasopressors. Here we present a case of a missing guide wire after placement of peripherally inserted central catheter (PICC), which was incidentally picked up by bedside ultrasound in the intensive care unit. Case Report: A 50-year-old Hispanic male was admitted to the intensive care unit for alcohol intoxication. He was managed for septic shock and required placement of a peripherally inserted central line in his left upper extremity for antibiotics and vasopressor administration. A bedside ultrasound performed by the intensivist to evaluate upper extremity swelling revealed a foreign body in the left arm. Percutaneous procedure by Interventional radiologist was required for retrieval of the guidewire. Conclusions: Guide wire related complications are rarely reported, but are significantly associated with mortality and morbidity. The use of ultrasound guidance placement of PICC lines decreases the risk of complications, provides better optimal vein selection, and enhances success. PMID:27920421

  2. [Technical criteria of central venous catheters: Anaesthesiologist/intensivist and pharmacist opinions].

    PubMed

    Novais, T; Cabelguenne, D; Jolivet, F; Nouvel, M; Wallet, F; Piriou, V

    2015-11-01

    The lack of technical information from suppliers and from the literature, a wide variety of features and the absence of medical device reference document explain the difficulty for medical and pharmaceutical staffs to choose a central venous catheter (CVC). The aim of this study was to establish the specifications to choose a CVC according to the clinician needs. An analysis of suppliers' technical documentation and a literature review was performed to identify criteria and to collect them in a questionnaire to conduct semi-structured interviews between 1 pharmacist and 5 anaesthesiologists/intensivists. With these interviews, the technical criteria were classified according to their importance in 3 levels. Thirteen technical criteria were identified after reading the technical documents and the literature. Among them, 8 were classified as "essential criteria" (level I) by the physicians: J-shaped guide, one clamp on each way, identified lumen, radiopacity, graduation every centimeter by 5 to 20 cm from the distal extremity, a length of 15 to 25 cm, a single-lumen catheter with a 14 to 16G way and a three-lumen catheter with 14 to 18G way. Finally, three criteria were classified as "intermediate criteria" (level II) and two as "optional criteria" (level III). This collaborative approach allowed to reference new medical devices according to the clinicians needs. These CVC are a mean to respect guidelines for physicians and nurses and to secure the patient's care. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

    PubMed

    Zingg, Walter; Cartier, Vanessa; Inan, Cigdem; Touveneau, Sylvie; Theriault, Michel; Gayet-Ageron, Angèle; Clergue, François; Pittet, Didier; Walder, Bernhard

    2014-01-01

    Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.

  4. Double-lumen central venous catheters impregnated with chlorhexidine and silver sulfadiazine to prevent catheter colonisation in the intensive care unit setting: a prospective randomised study.

    PubMed

    Camargo, L F A; Marra, A R; Büchele, G L; Sogayar, A M C; Cal, R G R; de Sousa, J M A; Silva, E; Knobel, E; Edmond, M B

    2009-07-01

    Antimicrobial- and antiseptic-impregnated catheters are strategies recommended to prevent central venous catheter (CVC) colonisation. Few data regarding chlorhexidine/silver sulfadiazine-impregnated catheters in intensive care unit (ICU) patients have been reported. We performed a prospective, randomised study comparing the colonisation rates of chlorhexidine/silver sulfadiazine-impregnated CVCs (group 1) against standard CVCs (group 2). In order to assess catheter colonisation rates, a 4cm segment from the tips of aseptically removed catheters was cultured by the roll-plate method. In all, 109 patients were enrolled with successful catheter insertion, 51 of them in group 1 and 58 in group 2. There were no statistically significant differences between the two groups with regards to age, Sequential Organ Failure Assessment (SOFA) score, ICU admission diagnosis, infection risk, catheter insertion sites or catheter length of stay. The colonisation rates were 29.4% (15 catheters) for group 1 and 34.5% (20 catheters) for group 2 (P=0.50). Double-lumen CVCs impregnated with chlorhexidine and silver sulfadiazine were not effective in reducing the incidence of catheter colonisation in ICU patients.

  5. Standardizing central venous catheter care by using observations from patients with cancer.

    PubMed

    Weingart, Saul N; Hsieh, Candace; Lane, Sharon; Cleary, Angela M

    2014-06-01

    To understand the vulnerability of patients with cancer to central line-associated bloodstream infections related to tunneled central venous catheters (CVCs), patients were asked to describe their line care at home and in clinic and to characterize their knowledge and experience managing CVCs. Forty-five adult patients with cancer were recruited to participate. Patients were interviewed about the type of line, duration of use, and observations of variations in line care. They also were asked about differences between line care at home and in the clinic, precautions taken when bathing, and their education regarding line care. Demographic information and primary cancer diagnosis were taken from the patients' medical records. Patients with hematologic and gastrointestinal malignancies were heavily represented. The majority had tunneled catheters with subcutaneous implanted ports. Participants identified variations in practice among nurses who cared for them. Although many participants expressed confidence in their knowledge of line care, some were uncertain about what to do if the dressing became loose or wet, or how to recognize an infection. Patients seemed to be astute observers of their own care and offered insights into practice variation. Their observations show that CVC care practices should be standardized, and educational interventions should be created to address patients' knowledge deficits.

  6. Computed Tomography-Guided Central Venous Catheter Placement in a Patient with Superior Vena Cava and Inferior Vena Cava Occlusion

    SciTech Connect

    Rivero, Maria A.; Shaw, Dennis W.W.; Schaller, Robert T. Jr.

    1999-01-15

    An 18-year-old man with a gastrointestinal hypomotility syndrome required lifelong parenteral nutrition. Both the superior and inferior vena cava were occluded. Computed tomography guidance was used to place a long-term central venous catheter via a large tributary to the azygos vein.

  7. Supraclavicular approach to the subclavian/innominate vein for large-bore central venous catheters.

    PubMed

    Muhm, M; Sunder-Plassmann, G; Apsner, R; Kritzinger, M; Hiesmayr, M; Druml, W

    1997-12-01

    Infraclavicular and internal jugular catheterization are commonly used techniques for hemodialysis access, but may at times be impeded in patients whose anatomy makes cannulation difficult. In an effort to enlarge the spectrum of alternative access sites, we evaluated the supraclavicular approach for large-bore catheters. During an 18-month period we prospectively collected data on success rate and major and minor complications of the supraclavicular access for conventional dialysis catheters as well as Dacron-cuffed tunneled devices in 175 adult patients admitted for various extracorporeal therapies and bone marrow transplantation. Two hundred eight large-bore catheters (99 conventional dialysis catheters, 63 semirigid tunneled Dacron-cuffed catheters, and 46 Hickman catheters) were successfully placed in 164 patients (success rate, 93.8%), 58 (33.1%) of whom had been previously catheterized. Complications included pneumothorax (one patient), arterial puncture (seven patients), and puncture of the thoracic duct (two patients) without sequelae. Postinsertional chest radiographs demonstrated impressive coaxial lie of most catheters. Catheter malpositions occurred only sporadically (1%). Difficulty of introducing the catheter via a placed sheath was rarely observed. There was no clinically significant evidence of catheter-induced venous thrombosis or stenosis. We conclude that the supraclavicular route is an easy and safe first approach for large-bore catheters, as well as a useful alternative to traditional puncture sites for precatheterized and anatomically problematic patients.

  8. Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research.

    PubMed Central

    Atela, I; Coll, P; Rello, J; Quintana, E; Barrio, J; March, F; Sanchez, F; Barraquer, P; Ballus, J; Cotura, A; Prats, G

    1997-01-01

    A prospective study of 45 central venous catheters was conducted to assess, by strain delineation, the turnover of skin and catheter hub (superficial) colonization and the relative contributions of catheter hub and skin colonization to catheter tip colonization. Serial quantitative cultures of skin and catheter hub were performed. Catheter tip, blood, and specimens for culture from targeted superficial sites (TSSs) were also collected at the time of catheter removal. Strains from 17 tip-positive catheters were delineated by pulsed-field gel electrophoresis. Only 12 (28.6%) of 42 skin strains and 14 (31.1%) of 45 catheter hub strains were found to be present at the time of catheter removal. In addition, only 9 (29.0%) of the 31 tip-colonizing strains were present on TSSs. Moreover, 15 (48.4%) of the 31 tip-colonizing strains had a superficial origin, and the other 16 (51.6%) were of unknown origin. In catheters suspected of infection, cultures of TSSs had a negative predictive value for catheter-related bacteremia of 94.4% but a positive predictive value of 44.4%. When the causative agent was identified (to the strain level) these values dropped to 80.9 and 18.7%, respectively. The study shows that skin and catheter hub colonization is a common, dynamic phenomenon. Strains recovered from TSSs showed a low level of correlation with strains from previous cultures of specimens from superficial sites and catheter tip isolates. Consequently, TSSs cannot be recommended for use in determining the therapy. However, catheter-related bacteremia is uncommon when cultures of TSSs are negative. PMID:9196194

  9. [Two Cases of Retained Guide Wires after Placement of a Central Venous Catheter via the Internal Jugular Vein].

    PubMed

    Kobayashi, Yuki; Masumori, Yasushi; Tanigawa, Saori; Miyakawa, Hidetoshi; Sakamoto, Miki; Tateda, Takeshi

    2015-10-01

    We report two cases of a retained guide wire after perioperative placement of a central venous catheter during a six-month period. Case 1: A 73-year-old male was scheduled for an open cholecystectomy and hepatectomy. After induction of anesthesia, a central venous (CV) catheter was inserted via the right internal jugular vein using an ultrasound guide. Chest radiographs showed a retained guide wire in the inferior vena cava immediately after surgery, which was removed by interventional radiologist before the patient emerged from anesthesia. Case 2: A 77-year-old male was scheduled for colostomy closure. The surgeon inserted a CV catheter in the right internal jugular vein 4 days before the colostomy. Chest radiographs revealed a retained guide wire in the inferior vena cava, which was removed by interventional radiologists before the patient emerged from anesthesia. Although a retained guide wire is a rare complication, awareness of this mishap is necessary to prevent it from happening.

  10. Late onset of clinically apparent central vein stenosis due to previous central venous catheter in a patient with inherited thrombophilia.

    PubMed

    Eleftheriadis, Theodoros; Liakopoulos, Vassilios; Antoniadi, Georgia; Pissas, Georgios; Leivaditis, Konstantinos; Stefanidis, Ioannis

    2014-04-01

    We describe a case of a patient with a functional kidney transplant who was admitted to our department with clinically evident central vein stenosis (CVS) 7 years after the removal of a central venous catheter (CVC) from the right internal jugular vein. The catheter was used as a hemodialysis access for a 2-month period. In the interval before his last admission, the patient suffered two episodes of deep vein thrombosis. Investigation revealed heterozygosity for factor V Leiden, the most common inherited thrombophilia encountered in 5% of Caucasians, and anticoagulation treatment was started. Magnetic resonance angiography showed stenosis just after the convergence of the right subclavian vein with the internal jugular vein to the innominate vein. Transluminal angioplasty restored venous patency and right upper arm edema resolved. Coexistence of CVS, accompanied by hemodynamic changes and endothelial dysfunction, with thrombophilia fulfill all the elements of the Virchow's triad. Therefore, the patient was at great risk for central vein thrombosis, from which he was possibly protected by the early administration of anticoagulant treatment. This case indicates that CVS can be asymptomatic for several years after CVC removal and also raises the question if thrombophilia workup and investigation for CVS may be beneficial in every patient with CVC placement in order to avoid any harmful outcomes.

  11. A corrosive oesophageal burn model in rats: Double-lumen central venous catheter usage.

    PubMed

    Bakan, Vedat; Ciralik, Harun; Kartal, Seyfi

    2015-01-01

    We aimed to create a new and less invasive experimental corrosive oesophageal burn model using a catheter without a gastric puncture (gastrotomy). We conducted the study with two groups composed of 8 male rats. The experimental oesophageal burn was established by the application of 10% sodium hydroxide to the distal oesophagus under a pressure of 20 cmH 2 O, via 5-F double-lumen central venous catheter without a gastrotomy. The control group was given 0.9% sodium chloride. All rats were killed 24 h after administration of NaOH or 0.9% NaCl. Histologic damage to oesophageal tissue was scored by a single pathologist blind to groups. The rats in the control group were observed to have no pathological changes. Corrosive oesophagitis (tissue congestion, oedema, inflammation, ulcer and necrosis) was observed in rats exposed to NaOH. We believe that an experimental corrosive oesophageal burn can safely be created under same hydrostatic pressure without a gastric puncture using this model.

  12. A corrosive oesophageal burn model in rats: Double-lumen central venous catheter usage

    PubMed Central

    Bakan, Vedat; Çıralık, Harun; Kartal, Seyfi

    2015-01-01

    Background: We aimed to create a new and less invasive experimental corrosive oesophageal burn model using a catheter without a gastric puncture (gastrotomy). Materials and Methods: We conducted the study with two groups composed of 8 male rats. The experimental oesophageal burn was established by the application of 10% sodium hydroxide to the distal oesophagus under a pressure of 20 cmH2O, via 5-F double-lumen central venous catheter without a gastrotomy. The control group was given 0.9% sodium chloride. All rats were killed 24 h after administration of NaOH or 0.9% NaCl. Histologic damage to oesophageal tissue was scored by a single pathologist blind to groups. Results: The rats in the control group were observed to have no pathological changes. Corrosive oesophagitis (tissue congestion, oedema, inflammation, ulcer and necrosis) was observed in rats exposed to NaOH. Conclusion: We believe that an experimental corrosive oesophageal burn can safely be created under same hydrostatic pressure without a gastric puncture using this model. PMID:26712289

  13. Cuff Cath: an initial experience of cuffed polyurethane central venous catheters in children.

    PubMed

    Wheeler, R A; Griffiths, D M

    1992-01-01

    The tendency of medium- and long-term silicone central venous catheters (CVCs) to block, fracture, and become displaced has led to the evaluation of a polyurethane CVC, Cuff Cath (Viggo Spectramed, Swindon, Wilts, United Kingdom) as a possible alternative because polyurethane is smoother and stronger. We report the first prospective study of polyurethane cuffed CVCs in children. Sixty Cuff Caths were placed in 53 children, mean age 4.7 years (range, 4 days to 16.3 years), mean weight 15.6 kg (range, 3.1 to 58 kg). All CVCs were tunnelled (mean tunnel length, 12 cm; range, 5 to 20 cm) and inserted either into the subclavian vein (n = 28) or internal jugular vein (n = 32). In a total of 6363 catheter days (mean, 111 days per patient; range, 15 to 364 days), three (5%) CVCs had to be removed because of sepsis and one (2%) because of blockage. All other Cuff Caths remained patent to infusion and blood sampling. No Cuff Caths were pulled or fell out, fractured, or migrated. This study demonstrates significant advantages of polyurethane compared with previous series using silicone CVCs with respect to blockage, fragmentation, and dislodgement. A prospective, randomized, controlled trial of Cuff Cath compared with a silicone CVCs in children is required.

  14. Implementing a central venous catheter self-management education program for patients with cancer.

    PubMed

    Park, Jeong Yun

    2016-12-01

    To evaluate the effects of the central venous catheter self-management education program (CVC S-MEP) in improving knowledge, attitude, and behavior regarding CVC and in decreasing CVC-related complications in patients with cancer during homecare service. A quasi-experimental, sequential cohort design study of patients with cancer and who have CVCs was performed to compare the effect of CVC S-MEP with usual care. The study group consisted of 45 participants (26 male and 19 female), and the mean age was 46.1 (SD, 10.5) years. The subjects of the CVC S-MEP had significantly high mean levels of self-management knowledge (p = 0.007), attitude (p < 0.001), and behavior (p = 0.002). Also, the participants in the CVC S-MEP had significantly lower frequency of catheter-related complications (p = 0.030). The CVC S-MEP helped improve patients' ability to resolve problems and adequately respond to CVC-related emergency situations by fostering greater self-care ability. Additionally, providing practical information for CVC self-management in a gradual and repetitive manner had a notable positive effect on patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Inserting central venous catheter in emergency conditions in coagulopathic patients in comparison to noncoagulopathic patients

    PubMed Central

    Nasr-Esfahani, Mohammad; Kolahdouzan, Mohsen; Mousavi, Seyed Abbas

    2016-01-01

    Background: The current study was designed to compare the complications and adverse effects of central venous catheter (CVC) insertion under ultrasound guidance in patients with and without coagulopathy. Materials and Methods: In this clinical trial, 59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. The CVC inserting site was examined for hematoma and hemorrhage in four stages at different times. Results: There was no significant difference in the terms of demographic features, catheter lumen size (P = 0.43), and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confidence interval [CI] = 0.36–15.3, P = 0.39) between two groups. Seven out of 59 patients suffered from complications (11.9%) that the complications in coagulopathic patients were oozing (5.7%) and superficial hematoma (8.6%) while in noncoagulopathic patients were 4.2% for both complications (OR = 0.54, 95% CI = 0.09–3.07, P = 0.767). Conclusion: According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients. PMID:28255328

  16. Prophylaxis with urokinase in pediatric oncology patients with central venous catheters.

    PubMed

    Kalmanti, Maria; Germanakis, John; Stiakaki, Eftichia; Syfridaki, Cathrin; Christidou, Athanasia; Tsetis, Dimitris; Vardas, Panagiotis; Charisis, George

    2002-01-01

    This study evaluated the effects of urokinase in the prevention of central venous catheter (CVC)-related complications in children with malignancy. Fifteen patients with 16 CVCs (study group A) received an intraluminal application of urokinase (10,000 IU in each catheter lumen for 4 h) once a week. They were monitored prospectively with quantitative blood cultures and ultrasonography (color Doppler ultrasound of the great veins and echocardiography). The rate of complications was compared with that of 15 children with 19 CVCs without thromboprophylaxis, treated the previous significantly lower incidence of CVC dysfunction year (control group B). The authors found a wer incidence of CVC dysfunction (3/16 versus 13/19), no major thrombosis, fewer CVC-related bacteremias (2/16 versus 8/19), and a higher salvage of CVCs (1/16 versus 5/19 CVC removals due to persistent bacteremia) in the thromboprophylaxis group. Asymptomatic thrombosis rate was also lower (7/16 cases in group A versus 9/11 in group B when sonography was performed). No hemorrhagic complications were noted. Thromboprophylaxis with urokinase seems a safe and effective measure for reducing the rate of CVC-related complications.

  17. Characterizing the in vitro biofilm phenotype of Staphylococcus epidermidis isolates from central venous catheters.

    PubMed

    Van Kerckhoven, Marian; Hotterbeekx, An; Lanckacker, Ellen; Moons, Pieter; Lammens, Christine; Kerstens, Monique; Ieven, Margareta; Delputte, Peter; Jorens, Philippe G; Malhotra-Kumar, Surbhi; Goossens, Herman; Maes, Louis; Cos, Paul

    2016-08-01

    Central venous catheter (CVC)-related infections are commonly caused by Staphylococcus epidermidis that is able to form a biofilm on the catheter surface. Many studies involving biofilm formation by Staphylococcus have been published each adopting an own in vitro model. Since the capacity to form a biofilm depends on multiple environmental factors, direct comparison of results obtained in different studies remains challenging. This study characterized the phenotype (strong versus weak biofilm-producers) of S. epidermidis from CVCs in four different in vitro biofilm models, covering differences in material type (glass versus polymer) and nutrient presentation (static versus continuous flow). A good correlation in phenotype was obtained between glass and polymeric surfaces independent of nutrient flow, with 85% correspondence under static growth conditions and 80% under dynamic conditions. A 80% correspondence between static and dynamic conditions on polymeric surfaces could be demonstrated as well. Incubation time had a significant influence on the biofilm phenotype with only 55% correspondence between the dynamic models at different incubation times (48h versus 17h). Screening for the presence of biofilm-related genes only revealed that ica A was correlated with biofilm formation under static but not under dynamic conditions. In conclusion, this study highlights that a high level of standardization is necessary to interpret and compare results of different in vitro biofilm models. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. A survey of central venous catheter practices in Australian and New Zealand tertiary neonatal units.

    PubMed

    Taylor, Jacqueline E; McDonald, Susan J; Tan, Kenneth

    2014-02-01

    Infection is the most common problem with central venous catheters (CVCs) in neonates. There are two published guidelines, including the Centers for Disease Control and Prevention (CDC), for the prevention of intravascular catheter-related infection that describes evidence-based practice to reduce nosocomial infection. Our aims were to survey current medical and nursing management of central venous catheters in tertiary neonatal intensive care units in Australia and New Zealand and to compare with the CDC evidence-based practice guideline. A cross sectional survey was performed across 27 Australian and New Zealand neonatal units in September 2012. Two web-based questionnaires were distributed, one to medical directors related to the insertion of CVCs while CVC "maintenance" surveys were sent to nurse unit managers. Seventy percent (19/27) medical management and 59% (16/27) on nursing management surveys were completed. In all neonatal intensive care units (NICUs) there were guidelines for CVC maintenance and for 18 out of 19 there were guidelines for insertion. In the seven units using femoral lines, three had a guideline on insertion and four for maintenance. CVC insertion was restricted to credentialed staff in 57.9% of neonatal units. Only 26.5% used full maximal sterile barriers for insertion. Skin disinfection practices widely varied. Dressing use and dressing change regimens were standardised; all using a semi-permeable dressing. Duration of cleaning time of the access point varied significantly; however, the majority used a chlorhexidine with alcohol solution (68.8%). Line and fluid changes varied from daily to 96 h. The majority used sterile gloves and a sterile dressing pack to access the CVC (68.8%). In the majority of NICUs stopcocks were used (62.5%) with a needle-less access point attached (87.5%). In less than 50% of NICUs education was provided on insertion and maintenance. There is diversity of current practices and some aspects vary from the CDC

  19. Going with the flow or swimming against the tide: should children with central venous catheters swim?

    PubMed

    Miller, Jessica; Dalton, Meghan K; Duggan, Christopher; Lam, Shirley; Iglesias, Julie; Jaksic, Tom; Gura, Kathleen M

    2014-02-01

    Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.

  20. Frequency of dressing changes for central venous access devices on catheter-related infections.

    PubMed

    Gavin, Nicole C; Webster, Joan; Chan, Raymond J; Rickard, Claire M

    2016-02-01

    People admitted to intensive care units and those with chronic health care problems often require long-term vascular access. Central venous access devices (CVADs) are used for administering intravenous medications and blood sampling. CVADs are covered with a dressing and secured with an adhesive or adhesive tape to protect them from infection and reduce movement. Dressings are changed when they become soiled with blood or start to come away from the skin. Repeated removal and application of dressings can cause damage to the skin. The skin is an important barrier that protects the body against infection. Less frequent dressing changes may reduce skin damage, but it is unclear whether this practice affects the frequency of catheter-related infections. To assess the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections and other outcomes including pain and skin damage. In June 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trials registries for registered trials. There were no restrictions with respect to language, date of publication or study setting. All randomised controlled trials (RCTs) evaluating the effect of the frequency of CVAD dressing changes on the incidence of catheter-related infections on all patients in any healthcare setting. We used standard Cochrane review methodology. Two review authors independently assessed studies for inclusion, performed risk of bias assessment and data extraction. We undertook meta-analysis where appropriate or otherwise synthesised data descriptively when heterogeneous. We included five RCTs (2277 participants) that compared different frequencies of CVAD dressing changes. The studies were all conducted in Europe and published between 1995 and 2009. Participants

  1. Simulation improves procedural protocol adherence during central venous catheter placement: a randomized-controlled trial

    PubMed Central

    Peltan, Ithan D.; Shiga, Takashi; Gordon, James A.; Currier, Paul F.

    2015-01-01

    Background Simulation training may improve proficiency at and reduces complications from central venous catheter (CVC) placement, but the scope of simulation’s effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes. Methods Internal medicine interns were randomized to standard training for CVC insertion or standard training plus simulation-based mastery training. Standard training involved a lecture, a video-based online module, and instruction by the supervising physician during actual CVC insertions. Intervention-group subjects additionally underwent supervised training on a venous access simulator until they demonstrated procedural competence. Raters evaluated interns’ performance during internal jugular CVC placement on actual patients in the medical intensive care unit. Generalized estimating equations were used to account for outcome clustering within trainees. Results We observed 52 interns place 87 CVCs. Simulation-trained interns exhibited better adherence to prescribed procedural technique than interns who received only standard training (p=0.024). There were no significant differences detected in first-attempt or overall cannulation success rates, mean needle passes, global assessment scores or complication rates. Conclusions Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety. PMID:26154250

  2. Echocardiographic diagnosis of air embolism associated with central venous catheter placement: case report and review of the literature.

    PubMed

    Maddukuri, Prasad; Downey, Brian C; Blander, Jessica A; Pandian, Natesa G; Patel, Ayan R

    2006-04-01

    Transthoracic echocardiography (TTE) is a valuable tool in the evaluation of patients with suspected air embolism. This report describes the presentation and evaluation of a critically ill woman with spontaneous air embolism occurring during a central venous catheter replacement. Bedside TTE established the diagnosis of air embolism, allowing prompt initiation of appropriate therapy. This case report highlights this uncommon but potentially life-threatening complication of central line placement and the utility of echocardiography in its evaluation.

  3. Central venous access.

    PubMed

    Ganeshan, Arul; Warakaulle, Dinuke R; Uberoi, Raman

    2007-01-01

    Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article.

  4. Port central venous catheters-associated bloodstream infection during outpatient-based chemotherapy.

    PubMed

    Mauri, Davide; Roumbkou, Sofia; Michalopoulou, Stella; Tsali, Lamprini; Spiliopoulou, Anastasia; Panou, Charalampos; Valachis, Antonis; Panagopoulos, Angelos; Polyzos, Nikolaos P

    2010-12-01

    Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48 h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

  5. [Infections of central venous catheters in home parenteral nutrition: a retrospective monocentric study over 2 years].

    PubMed

    Moreau, E; Bresson, V; Bosdure, E; Sarles, J; Coste, M-É

    2014-06-01

    Infection of the central venous catheter (CVC) is the main aggravating factor of parenteral nutrition. The aim of this study was to determine the ecology of these infections in our home parenteral nutrition center and to evaluate our care protocol. The present study was monocentric and retrospective, and was conducted in the parenteral nutrition service of the Marseille University Hospital between 1 January 2011 and 31 May 2012. During this period, all the children who presented fever and a positive hemoculture in a medical emergency were taken into account, and the characteristics of the infection were analyzed. After 17 months, 17 children had been subject to an infection in their central catheter: 47 bacteremia were identified, which is equivalent to 5.4 infections for 1000 days of CVC. An average 2.8 hemocultures were performed during this time. The most common bacterium was Staphylococcus hominis. The children affected by a digestive stoma or by a gastrostomy were not subject to more infections and their ecology was not different. All the children were referred to the hospital and treated with an intravenous antibiotic through the CVC. As expected during the time of the study, the infection rate was very high. This finding led us to reassess our prevention protocol. It is also very likely that the number of infections was overestimated due to the protocol for sampling in the hemocultures and their subsequent analysis. Lastly, some children relapsed easily, although no predisposing factor was found in the present study. The therapy chosen was in agreement with the best practices and the ecology recovered. The high number of infections observed during the study encourages a prospective evaluation of current practices. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis.

    PubMed

    Ablordeppey, Enyo A; Drewry, Anne M; Beyer, Alexander B; Theodoro, Daniel L; Fowler, Susan A; Fuller, Brian M; Carpenter, Christopher R

    2017-04-01

    We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography. PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov. Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position. Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high. Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than

  7. Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service.

    PubMed

    Barretta, Lidiane Miotto; Beccaria, Lúcia Marinilza; Cesarino, Cláudia Bernardi; Pinto, Maria Helena

    2016-06-07

    to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications. identificar o modelo, tempo médio de permanência e complicações de cateter venoso central em pacientes submetidos ao transplante de células-tronco hematopoiéticas e verificar a relação de correspondência entre as variáveis: idade, sexo, diagnóstico médico, tipo de transplante, cateter implantado e local de inserção. retrospectivo, quantitativo, com amostra de prontuários de 188 pacientes transplantados, entre 2007 e 2011. a maioria dos pacientes utilizou o cateter de Hickman com permanência média de 47,6 dias. A complicação febre/bacteremia foi significante em jovens do sexo masculino, com linfoma não Hodgkin, submetidos ao transplante autólogo, que permaneceram com o dispositivo por longo período, em veia subclávia. os enfermeiros devem planejar com a equipe o aguardo do tempo mínimo preconizado entre o implante do cateter e início do regime de condicionamento, assim como não estender o período de permanência e realizar

  8. Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

    PubMed Central

    Yi, Jian-hua; Liu, Hua-bo; Zhang, Mao; Wu, Jun-song; Yang, Jian-xin; Chen, Jin-ming; Xu, Shan-xiang; Wang, Jian-an

    2012-01-01

    Objective: To evaluate the efficacy and safety of the treatment of traumatic hemothorax by closed pleural drainage using a central venous catheter (CVC), compared with using a conventional chest tube. Methods: A prospective controlled study with the Ethics Committee approval was undertaken. A total of 407 patients with traumatic hemothorax were involved and they were randomly assigned to undergo closed pleural drainage with CVCs (n=214) or conventional chest tubes (n=193). The Seldinger technique was used for drainage by CVC, and the conventional technique for drainage by chest tube. If the residual volume of the hemothorax was less than 200 ml after the daily volume of drainage decreased to below 100 ml for two consecutive days, the treatment was considered successful. The correlative data of efficacy and safety between the two groups were analyzed using t or chi-squared tests with SPSS 13.0. A P value of less than 0.05 was taken as indicating statistical significance. Results: Compared with the chest tube group, the operation time, fraction of analgesic treatment, time of surgical wound healing, and infection rate of surgical wounds were significantly decreased (P<0.05) in the CVC group. There were no significant differences between the two groups in the success rate of treatment and the incidence of serious complications (P>0.05), or in the mean catheter/tube indwelling time and mean medical costs of patients treated successfully (P>0.05). Conclusions: Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube. Its complications can be prevented and it has the potential to replace the large-bore chest tube. PMID:22205619

  9. Biotimer assay: A reliable and rapid method for the evaluation of central venous catheter microbial colonization.

    PubMed

    Rosa, Luigi; Cutone, Antimo; Coletti, Monica; Lepanto, Maria Stefania; Scotti, Mellani; Valenti, Piera; Raponi, Giammarco; Ghezzi, Maria Cristina; Berlutti, Francesca

    2017-09-29

    Adherent bacteria and biofilm frequently colonize central venous catheters (CVCs). CVC colonization is correlated to infections and particularly to bloodstream ones. The classical microbiological methods to determine of CVC colonization are not fully reliable and are time-consuming. BioTimer Assay (BTA) is a biological method already used to count bacteria adherent to abiotic surfaces and biofilm without sample manipulation. BTA employs specific reagents whose color changed according to bacterial metabolism. BTA is based on the principle that a metabolic reaction will be faster when more bacteria are present in the sample. Therefore, the time required for color changes of BTA reagents determines the number of bacteria present in the sample through a correlation line. Here, for the first time, we applied BTA and a specifically developed laboratory procedure to evaluate CVC colonization in comparison with the routine microbiological method (RMM). 125 CVCs removed from patients for suspected catheter-related bloodstream infection (CRBSI) or at hospital discharge were examined. BTA was reliable in assessing sterility and CVC colonization (100% agreement with RMM) and in recognizing the presence of fermenting or non-fermenting bacteria (97.1% agreement with RMM) shortening the analytical time by between 2- and 3-fold. Moreover, the reliability of BTA as early alert of CRBSI was evaluated. The sensitivity, specificity, positive, and negative predictive values for BTA as an early alert of CRBSI were 100, 40.0, 88.8 and 100%, respectively. In conclusion, BTA and the related laboratory procedure should be incorporated into routine microbiological methods since it can be considered a reliable tool to evaluate CVC colonization in a very short time and a rapid alert for CRBSIs. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Adverse events and technical complaints related to central venous catheters marketed in Brazil

    PubMed Central

    Morais, Luciene de Oliveira; Friedrich, Karen; Melchior, Stela Candioto; Silva, Michele Feitoza; Gemal, Andre Luis; Delgado, Isabella Fernandes

    2013-01-01

    Aim The objective of this study was to critically analyze data of the National Notification System for Adverse Events and Technical Complaints (Notivisa) related to central venous catheters, through an evaluation of the description of notifications recorded between 2006 and 2009. Methods Notifications were categorized and evaluated to: (i) determine the number of adverse events and technical complaints, (ii) verify compliance with the classification criteria defined by the legislation, (iii) reclassify notifications, when necessary, in order for them to fit in with the legal definitions, (iv) verify registered companies in Brazil, (v) quantify the notifications according to the registered company and product lot, and (vi) identify the country of original of the notified product. Microsoft Excel(r) 2010 was used to categorize and systematize the data. Results Some conceptual errors and incomplete records were found. Altogether, 228 notifications of technical complaints and 119 of adverse events were identified. Some notifications on guidewires and broken catheters were reported which led to the necessity of duplicating some medical procedures and to the occurrence of lesions/lacerations of vessels and tissue injury. Forty-seven percent of companies presented at least one notification in Notivisa and in all, 38 product lots had more than one notification. Conclusion These data support a necessity for cooperation between all entities of the National Health Surveillance System to check compliance of this type of product and to properly report adverse events and technical complaints. It is also important to incorporate minimum standards for the management of technologies in health services, including in the acquisition of products and training of staff. PMID:23904810

  11. [Perioperative high-caloric alimentation with the central venous catheter. Prospective study in 404 patients].

    PubMed

    Stock, W; Weber, M; Doht, R

    1985-06-14

    Peri-operative high-calorie nutrition was administered, through a total of 500 catheters introduced into the superior vena cava via the subclavian vein, to 404 patients admitted to hospital for gastro-intestinal cancer resection or other major abdominal operations, some of them taking a complicated course. Most of the catheters remained in situ for 6-20 days; the longest period was 44 days. Catheter insertion was successful in 97.8%. Faulty position of the catheter occurred in 4.4%; in 2.8% it was rectified under fluoroscopic control. In 92.2% there were no complications ascribable to the catheter. A pneumothorax resulted in 1.4% of patients, central thrombosis in 0.4%. Catheter-related sepsis was noted in 6.2%.

  12. Long-Term Central Venous Catheter Use and Risk of Infection in Older Adults With Cancer

    PubMed Central

    Lipitz-Snyderman, Allison; Sepkowitz, Kent A.; Elkin, Elena B.; Pinheiro, Laura C.; Sima, Camelia S.; Son, Crystal H.; Atoria, Coral L.; Bach, Peter B.

    2014-01-01

    Purpose Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer. Patients and Methods We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections. Conclusion Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality. PMID:24982458

  13. Long-term central venous catheter use and risk of infection in older adults with cancer.

    PubMed

    Lipitz-Snyderman, Allison; Sepkowitz, Kent A; Elkin, Elena B; Pinheiro, Laura C; Sima, Camelia S; Son, Crystal H; Atoria, Coral L; Bach, Peter B

    2014-08-01

    Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer. We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections. Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality. © 2014 by American Society of Clinical Oncology.

  14. Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

    NASA Astrophysics Data System (ADS)

    Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

    2016-05-01

    To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P <0.05). Compared with gelatin sponge and alginate dressing hemostatic effect, The difference was not statistically significant. (2) Tube maintenance cost: Puncture point using gelatin sponge, The local maintenance costs of the catheter within 72 h after insertion of the tube are lowest, compared with alginate dressing and gauze was significant (P<0.05). Conclusion: The choice of compression hemostasis material for the puncture site after PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

  15. Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters.

    PubMed

    Kayashima, Kenji

    2015-12-01

    Pediatric central venous catheter (CVC) placement is useful but associated with complications such as cardiac tamponade. We aimed to identify risk factors for death in cardiac tamponade. Published articles on pediatric CVC-associated cardiac tamponade were obtained by searching PubMed and Google and retrospectively reviewed to analyze risk factors for death. Factors examined for their effect on mortality risk included patient age, weight, CVC size, days from CVC insertion to tamponade occurrence, substances administered, insertion site, treatment, CVC material, and initial CVC tip position. Of 110 patients reported in 62 articles, 69 survived and 41 died. Among survivors, 55 of 69 patients were treated; among deaths, only 7 of 38 (OR 537.9, 95% CI 29.3-9,877, p < 0.0001). Multiple regression analysis in 44 cases showed that treatment (p < 0.0001) and initial CVC tip position (p = 0.020) were independent predictive factors related to improved cardiac tamponade survival. Past studies have mainly discussed how to avoid pediatric cardiac tamponade; by contrast, the present study focused on how to avoid deaths. The findings of this review suggest that cardiac tamponade survival is better when tamponade is detected early and treated promptly and might be affected by initial CVC tip position.

  16. Misinsertion of central venous catheter into the suspected vertebral vein: a case report

    PubMed Central

    Yang, So-Hee; Jung, Sung-Mee

    2014-01-01

    We experienced a case in which a central venous catheter (CVC) was misplaced into the wrong vein, which was mistaken for the internal jugular vein (IJV), identified by chest x-ray and ultrasound. The vertebral vein passes through the transverse foramina from the atlas to the 6th cervical vertebra. After exiting the transverse foramen of the 6th vertebra, the vein subsequently runs anterolateral to the vertebral artery and posterior to the IJV and drains the innominate vein. In this case, chest x-ray and ultrasound revealed that the inserted CVC had a course very similar to the vertebral vein. The misplacement of a CVC into the vertebral vein might occur from excessive rotation of the patient's head, which leads to alterations in the cervical vascular anatomy, and from deep insertion of the puncture needle. Therefore, it is advised, for safe CVC insertion, to minimize a patient's head rotation and to make use of ultrasound when the anatomical structures cannot be clearly identified. PMID:25473464

  17. Misinsertion of central venous catheter into the suspected vertebral vein: a case report.

    PubMed

    Yang, So-Hee; Jung, Sung-Mee; Park, Sang-Jin

    2014-11-01

    We experienced a case in which a central venous catheter (CVC) was misplaced into the wrong vein, which was mistaken for the internal jugular vein (IJV), identified by chest x-ray and ultrasound. The vertebral vein passes through the transverse foramina from the atlas to the 6th cervical vertebra. After exiting the transverse foramen of the 6th vertebra, the vein subsequently runs anterolateral to the vertebral artery and posterior to the IJV and drains the innominate vein. In this case, chest x-ray and ultrasound revealed that the inserted CVC had a course very similar to the vertebral vein. The misplacement of a CVC into the vertebral vein might occur from excessive rotation of the patient's head, which leads to alterations in the cervical vascular anatomy, and from deep insertion of the puncture needle. Therefore, it is advised, for safe CVC insertion, to minimize a patient's head rotation and to make use of ultrasound when the anatomical structures cannot be clearly identified.

  18. Large right atrial thrombus associated with central venous catheter requiring open heart surgery.

    PubMed

    Hussain, Nasir; Shattuck, Paul Eric; Senussi, Mourad Hussein; Velasquez Kho, Erwin; Mohammedabdul, Mubeenkhan; Sanghavi, Devang K; Mustafa, Usman; Balavenkataraman, Arvind; Obradovic, Dragic M

    2012-01-01

    Central venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.

  19. Position-Dependent Ventricular Tachycardia Related to Peripherally Inserted Central Venous Catheter

    PubMed Central

    Alvarez, Paulino; Schurmann, Paul; Smith, Melanie; Valderrábano, Miguel; Lin, C. Huie

    2016-01-01

    We report a case of a 51-year-old male who developed frequent nonsustained episodes of monomorphic ventricular tachycardia after being diagnosed with bioprosthetic aortic valve endocarditis and treated with intravenous antibiotics. A peripherally inserted central venous catheter (PICC) had been placed without complication less than 24 hours prior to the episodes. Ventricular tachycardia (VT) occurred during the night, while sleeping, when he assumed a right lateral decubitus position with abduction of the right arm and placement of the forearm under his head. VT occurred repeatedly when such position was assumed again upon request, and it would terminate immediately when sitting upright. The PICC was repositioned in the superior vena cava without further VT. He was discharged home the same day and underwent successful aortic valve replacement 2 months later. Position-dependent VT related to PICC requires careful history taking and PICC repositioning to make the diagnosis. X-ray in different patient positions during PICC placement can be considered to evaluate for ventricular migration. PMID:27826374

  20. Clinical and economic burden of bloodstream infections in critical care patients with central venous catheters.

    PubMed

    Brunelli, Steven M; Turenne, Wendy; Sibbel, Scott; Hunt, Abigail; Pfaffle, Antony

    2016-10-01

    Bloodstream infections (BSIs) complicate the management of intensive care unit (ICU) patients. We assessed the clinical and economic impact of BSI among patients of a managed care provider group who had a central venous catheter (CVC) placed in the ICU. We considered hospitalizations occurring between January 1, 2011, and September 30, 2014, that involved an ICU stay during which a CVC was placed. Comparisons were made between episodes where the patient did vs did not develop BSI after CVC insertion. Length of stay, costs of index hospitalization, and total costs over the 180 days after discharge were compared using linear mixed models. Inhospital mortality and 30-day readmission rates were compared using negative binomial regression models. Development of BSI was associated with longer hospital stay (+7 days), more than 3-fold increase in risk of inhospital death, and an additional $129 000 in costs for the index hospitalization. No statistically significant differences in 30-day readmission rates or costs of care over the 180-day period after discharge from the index admission were observed. Bloodstream infections after CVC placement in ICU patients are associated with significant increases in costs of care and risk of death during the index hospitalization but no differences in readmissions or costs after discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative.

    PubMed

    Bhutani, Gauri; El Ters, Mireille; Kremers, Walter K; Klunder, Joe L; Taler, Sandra J; Williams, Amy W; Stockland, Andrew H; Hogan, Marie C

    2016-09-20

    Introduction Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs, was evaluated. Methods A retrospective observational study, involving individuals ≥18 years of age who underwent TSB-CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings The study cohort included 92 patients with a median age of 55 (46-67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11-43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion TSB-CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.

  2. Carina as a useful and reliable radiological landmark for detection of accidental arterial placement of central venous catheters.

    PubMed

    Umesh, Goneppanavar; Ranjan, Shetty; Jasvinder, Kaur; Nanda, Shetty

    2010-12-01

    Central venous catheters are commonly used in the management of critically ill patients. Their insertion can be challenging in hemodynamically unstable patients and in those with altered thoracic anatomy. Although ultrasound guided insertion can reduce this problem, this facility may not be available in all locations and in all institutions. Accidental arterial puncture is one of the very serious complications that can occur during central venous catheter insertion. This is usually detected clinically by bright color and projectile/pulsatile flow of the returning blood. However, such means are known to be misleading especially in hypoxic and hemodynamically unstable patients. Other recognized measures used to identify arterial puncture would be blood gas analysis of the returning blood, use of pressure transducer to identify waveform pattern and the pressures. In this article, we propose that trachea and carina can be used as a reliable radiological landmark to identify accidental arterial placement of central venous catheters. We further conclude that this information could be useful especially when dealing with post-resuscitation victims and hemodynamically unstable critically ill patients.

  3. Skin Necrosis after a Low-Dose Vasopressin Infusion through a Central Venous Catheter for Treating Septic Shock

    PubMed Central

    Kim, Eun Hee; Lee, Sae Hwan; Byun, Seung Woon; Kang, Ho Suk; Koo, Dong Hoe; Park, Hyun-Gu

    2006-01-01

    This is a report on a case of severe skin necrosis in a vasodilatory septic shock patient after the infusion of low-dose vasopressin through a central venous catheter. An 84-year-old male was hospitalized for edema on both legs at Asan Medical Center, Seoul, Korea. On hospital day 8, the patient began to complain of dyspnea and he subsequently developed severe septic shock caused by E. coli. After being transferred to the medical intensive care unit, his hypotension, which was refractory to norepinephrine, was controlled by an infusion of low-dose vasopressin (0.02 unit/min) through a central venous catheter into the right subclavian vein. After the infusion of low-dose vasopressin, severe skin necrosis with bullous changes developed, necessitating discontinuation of the low-dose vasopressin infusion. The patient expired from refractory septic shock. Although low-dose vasopressin can control hypotension in septic shock patients, low-dose vasopressin must be used with caution because ischemic complications such as skin necrosis can develop even with administration through a central venous catheter. PMID:17249516

  4. A randomized trial comparing gentamicin/citrate and heparin locks for central venous catheters in maintenance hemodialysis patients.

    PubMed

    Moran, John; Sun, Sumi; Khababa, Ishrag; Pedan, Alexander; Doss, Sheila; Schiller, Brigitte

    2012-01-01

    Central venous catheters (CVCs) are used for vascular access in hemodialysis patients who have no alternative access or are awaiting placement or maturation of a permanent access. The major complications of CVCs are catheter-related bloodstream infection and clotting in the catheter lumen. Parallel-group, randomized, multicenter clinical trial, with patients blinded to study intervention. 16 free-standing dialysis facilities in Northern California belonging to a single provider. 303 adult maintenance hemodialysis patients who were using a tunneled cuffed CVC for vascular access. The treatment group received an antibiotic lock containing gentamicin 320 μg/mL in 4% sodium citrate, whereas the control group received the standard catheter lock containing heparin 1,000 U/mL. Both groups received triple-antibiotic ointment on the catheter exit site during dressing changes at each dialysis treatment. Catheter-related bloodstream infection and catheter clotting. Catheter-related bloodstream infection was defined as the occurrence of symptoms consistent with bacteremia together with positive blood culture results in the absence of another obvious source of infection. Catheter clotting was measured as the rate of thrombolytic agent use required to maintain adequate blood flow. A single patient could contribute more than one infection or clotting episode. The rate of catheter-related bloodstream infection was 0.91 episodes/1,000 catheter-days in the control group and 0.28 episodes/1,000 catheter-days in the treatment group (P = 0.003). The time to the first episode of bacteremia was significantly delayed (P = 0.005). The rates of tissue plasminogen activator use were similar in the treatment and control groups: 2.36 versus 3.42 events/1,000 catheter-days, respectively (P = 0.2). The requirement for dialysis facility staff to prepare the treatment intervention prevented a completely blinded study. Gentamicin 320 μg/mL in 4% sodium citrate used as a routine catheter lock in

  5. Cost/benefit analysis of chlorhexidine-silver sulfadiazine-impregnated venous catheters for femoral access.

    PubMed

    Lorente, Leonardo; Lecuona, María; Jiménez, Alejandro; Lorenzo, Lisset; Diosdado, Sara; Marca, Lucía; Mora, María L

    2014-10-01

    Sixty-four patients with chlorhexidine-silver sulfadiazine-impregnated catheters had a lower rate of catheter-related bloodstream infection and lower central venous catheter-related costs per catheter day than 190 patients with a standard catheter.

  6. Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review.

    PubMed

    Stocco, Janislei Gislei Dorociaki; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida; Meier, Marineli Joaquim

    2016-08-08

    to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects. evaluar la efectividad y seguridad del uso de catéteres venosos centrales de segunda generación, impregnados en clorhexidina y sulfadiazina de plata, comparados con otros catéteres impregnados o no impregnados, para prevención de infección de la corriente sanguínea. revisión sistemática con metaanálisis. La búsqueda fue realizada en las bases: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; fueron consultados anales de congresos y registros de ensayos clínicos. fueron identificados 1.235 estudios, 97 preseleccionados y cuatro incluidos. En la infección de la

  7. Useful equation for proper estimate of left side peripherally inserted central venous catheter length in relation to the height.

    PubMed

    Jeon, Eui-Yong; Koh, Sung Hye; Lee, In Jae; Ha, Hong-Il; Park, Bum Jung

    2015-01-01

    Direct measurement of venous length is easy to cause contamination during bedside insertion of peripherally inserted central venous catheter (PICC). It is necessary to provide an equation for proper estimate of catheter length in case of bedside insertion of PICC in relation to patient height. For 165 PICC cases through left arm vein in 151 adult patients (male: female = 72:79), the cubital crease to carina length (CCL) was calculated as follows: CCL = (distance from cubital crease to puncture point) + (length of PICC inside body) - (distance from carina to catheter tip on post-procedural chest radiograph). We analyzed the relationship between CCL and height with regression analysis and suggest a new equation of CCL based on height. The mean CCL through the left arm vein was 47.1 ± 2.6 cm in male and 44.0 ± 2.9 cm in female. CCL was significantly correlated with patient height. Equation of CCL (cm) based on height was as follows: CCL = height * 0.19 + 14. The equation of our study would provide a new equation for proper estimation of catheter length in case of bedside insertion of left arm PICC in relation to height and be helpful for optimal positioning of catheter tip of PICC.

  8. Transient neurological deficit due to a misplacement of central venous catheter despite ultrasound guidance and ultrasound assistance.

    PubMed

    Idialisoa, Rado; Jouffroy, Romain; Saint Martin, Laure Castres; Lamhaut, Lionel; Baud, Frédéric; Philippe, Pascal; Carli, Pierre; Vivien, Benoît

    2015-10-01

    Central venous catheters (CVC) are frequently used in intensive care units (ICU), with a low incidence of complications, most of them being of mechanical origin and occurring during the insertion of the catheter. To avoid such complications, "ultrasound guidance" and "ultrasound assistance" are recommended. Nevertheless, even with trained and experienced physicians, mechanical complications of IJV access such as carotid punctures are still reported. We report the case of a 75-year-old woman, admitted into the ICU for CVC insertion due to impossibility of peripheral venous access. About 12 hours after the procedure, the patient presented a neurological deficit. The cervical and thoracic CT scan showed a transfixing path of the catheter from the left IJV into the left common carotid artery, with distal extremity of the catheter localized in the ascending aorta. The catheter was removed, and thereafter the neurological deficit immediately and definitely disappeared. Onset of a neurological deficit after CVC insertion into the IJV, regardless the time of occurrence after the procedure, should suggest complication due to the CVC insertion, even if procedure was uneventful and chest radiography confirmed the apparent accurate position of CVC.

  9. The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection.

    PubMed

    Arora, Navneet; Patel, Killol; Engell, Christian A; LaRosa, Jennifer A

    2014-01-01

    Interdisciplinary team (IDT) rounds were initiated in the intensive care unit (ICU) in June 2010. All catheters were identified by location, duration, and indication. Catheters with no indication were removed. Data were collected retrospectively on catheter days and associated infections in a 20-month period before and after intervention with an aggregate of 19 207 ICU days before and 23 576 ICU days after institution of rounds. Results showed a statistically significant decrease in the number of indwelling urinary catheter (IUC) days (5304 vs 4541 days, P = .05) and catheter-associated urinary tract infection rates (4.71 vs 1.98 infections/1000 ICU days, P < .05). Central line days statistically increased after IDT rounds (3986 vs 4305 days, P < .05) but the catheter-related bloodstream infection rate trended down (3.5 vs 1.6 infections/1000 ICU days, P = .62). This analysis suggests that IDT rounds may have an impact on reducing the number of IUC days and associated infections.

  10. Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

    PubMed Central

    Larsen, Mette KS; Thomsen, Trine R; Moser, Claus; Høiby, Niels; Nielsen, Per H

    2008-01-01

    Background Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. Methods In this study traditional semiquantitative culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ hybridization. Results In accordance with previous studies, the cultivation of central venous catheters from 18 patients revealed that S. epidermidis and other coagulase-negative staphylococci were most abundant and that a few other microorganisms such as P. aeruginosa and K. pneumoniae occasionally were found on the catheters. The molecular analysis using clone libraries and sequencing, denaturant gradient gel electrophoresis and sequencing provided several important results. The species found by cultivation were confirmed by molecular methods. However, many other bacteria belonging to the phyla Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were also found, stressing that only a minor portion of the species present were found by cultivation. Some of these bacteria are known to be pathogens, some have not before been described in relation to human health, and some were not closely related to known pathogens and may represent new pathogenic species. Furthermore, there was a clear difference between the bacterial species found in biofilm on the external (exluminal) and internal (luminal) side of the central venous catheter, which can not be detected by Maki's method. Polymicrobial biofilms were observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. Conclusion The results show that diagnosis based on molecular methods

  11. A Single-Lumen Central Venous Catheter for Continuous and Direct Intra-abdominal Pressure Measurement.

    PubMed

    van Waes, Oscar J F; Jaquet, Jean B; Hop, Wim C J; Morak, Marjolein J M; Ijzermans, Jan M; Koning, Jan

    2009-12-01

    Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality rates. Therefore, the need for a good diagnostic tool to predict intra-abdominal hypertension (IAH) and progression to ACS is paramount. Bladder pressure (BP) has been used for several years for intra-abdominal pressure (IAP) measurement but has the disadvantage that it is not a continuous measurement. In this study, a single-lumen central venous catheter (CVC) is placed through the abdominal wall into the abdominal cavity to continuously and directly monitor the intraabdominal pressure (CDIAP). The aim of this study was to evaluate the use of CDIAP to measure BP as a representative of the true IAP. Both BP and CDIAP were prospectively recorded on a variety of surgical patients admitted to the intensive care unit (ICU) from March 2003 up to December 2004. At the end of the surgical procedure, the CVC was placed through the abdominal wall and connected to a pressure transducer. In addition, the BP was measured through the urine drainage port after clamping the catheter and filling the bladder with 50 ml of 0.9% saline. At least three paired measurements (BP and CDIAP) were performed for at least one day on the ICU in a standardized manner at preset time intervals on each patient. The paired measurements were compared using the Bland-Altman (B-A) method. Data are presented as mean ± standard deviation. Over a period of 22 months (March 2003 until December 2004), 125 paired measurements of both BP and CDIAP were recorded on 25 patients. The mean age was 72.4 ± 6.6 years. Eighteen patients underwent central vascular surgery, and seven patients with peritonitis received laparotomy. The mean CDIAP was 11.4 ± 4.8 (range 2-30) mmHg, and the BP was 12.9 ± 5.3 (range 3-37) mmHg. The mean difference between CDIAP and BP was 1.6 ± 2.7 mmHg. There was an acceptable level of agreement (intraclass correlation 0.82) between IAP measured by BP and IAP measured via CDIAP. Continuous direct

  12. Electronic documentation of central venous catheter-days: validation is essential.

    PubMed

    Tejedor, Sheri Chernetsky; Garrett, Gina; Jacob, Jesse T; Meyer, Ellen; Reyes, Mary Dent; Robichaux, Chad; Steinberg, James P

    2013-09-01

    Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically. To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation. Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days. At baseline, there were a mean (± standard deviation) of [Formula: see text] electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years. Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.

  13. Bacteriophage K antimicrobial-lock technique for treatment of Staphylococcus aureus central venous catheter-related infection: a leporine model efficacy analysis.

    PubMed

    Lungren, Matthew P; Donlan, Rodney M; Kankotia, Ravi; Paxton, Ben E; Falk, Irene; Christensen, Diana; Kim, Charles Y

    2014-10-01

    To determine whether a bacteriophage antimicrobial-lock technique can reduce bacterial colonization and biofilm formation on indwelling central venous catheters in a rabbit model. Cuffed central venous catheters were inserted into the jugular vein of female New Zealand White rabbits under image guidance. Catheters were inoculated for 24 hours with broth culture of methicillin-sensitive Staphylococcus aureus. The inoculum was aspirated, and rabbits were randomly assigned to two equal groups for 24 hours: (i) untreated controls (heparinized saline lock), (ii) bacteriophage antimicrobial-lock (staphylococcal bacteriophage K, propagated titer > 10(8)/mL). Blood cultures were obtained via peripheral veins, and the catheters were removed for quantitative culture and scanning electron microscopy. Mean colony-forming units (CFU) per cm(2) of the distal catheter segment, as a measure of biofilm, were significantly decreased in experimental animals compared with controls (control, 1.2 × 10(5) CFU/cm(2); experimental, 7.6 × 10(3); P = .016). Scanning electron microscopy demonstrated that biofilms were present on the surface of five of five control catheters but only one of five treated catheters (P = .048). Blood culture results were not significantly different between the groups. In a rabbit model, treatment of infected central venous catheters with a bacteriophage antimicrobial-lock technique significantly reduced bacterial colonization and biofilm presence. Our data represent a preliminary step toward use of bacteriophage therapy for prevention and treatment of central venous catheter-associated infection. Copyright © 2014 SIR. All rights reserved.

  14. Calcified Thrombus in Right Atrium: Rare but Treatable Complication of Long-term Indwelling Central Venous Catheter

    PubMed Central

    Fabi, Marianna; Gesuete, Valentina; Testa, Gabriella; Balducci, Anna; Picchio, Fernando Maria; Gargiulo, Gaetano

    2011-01-01

    Catheter-related central thrombosis is a rare complication of long-term central line. We describe the case of an asymptomatic boy who was diagnosed a calcified thrombus in right atrium eight years after the removal of a long-term central venous device. Although the most appropriate therapeutic approach for managing floating right heart thrombi remains to be determined, surgical removal is an effective and safe procedure for calcified long-standing thrombus and it is to be preferred in elective conditions especially in young asymptomatic patients without hemodynamic involvement, that are at low risk of surgery-related morbidity and mortality.

  15. Peripherally Inserted Central Venous Catheters in Pediatric Hematology/Oncology Patients in Tertiary Care Setting: A Developing Country Experience.

    PubMed

    Fadoo, Zehra; Nisar, Muhammad I; Iftikhar, Raza; Ali, Sajida; Mushtaq, Naureen; Sayani, Raza

    2015-10-01

    Peripherally inserted central venous catheters (PICC) have been successfully used to provide central access for chemotherapy and frequent transfusions. The purpose of this study was to assess the feasibility of PICCs and determine PICC-related complications in pediatric hematology/oncology patients in a resource-poor setting. All pediatric patients (age below 16 y) with hematologic and malignant disorders who underwent PICC line insertion at Aga Khan University Hospital from January 2008 to June 2010 were enrolled in the study. Demographic features, primary diagnosis, catheter days, complications, and reasons for removal of device were recorded. Total of 36 PICC lines were inserted in 32 pediatric patients. Complication rate of 5.29/1000 catheter days was recorded. Our study showed comparable complication profile such as infection rate, occlusion, breakage, and dislodgement. The median catheter life was found to be 69 days. We conclude that PICC lines are feasible in a resource-poor setting and recommend its use for chemotherapy administration and prolonged venous access.

  16. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type.

    PubMed

    Gentile, Ariane; Petit, Laurent; Masson, Françoise; Cottenceau, Vincent; Bertrand-Barat, Josseline; Freyburger, Geneviève; Pinaquy, Catherine; Léger, Alain; Cochard, Jean-François; Sztark, François

    2013-05-29

    The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters. Critically ill trauma patients needing a SCVC for their usual care were prospectively included in an observational study. Depending on the month of inclusion, patients received one of the two available products in the emergency unit: either an aromatic polyurethane SCVC or an aliphatic polyurethane SCVC. Patients were screened weekly by ultrasound for SCVC-related DVT. Potential risk factors were collected, including history-related, trauma-related and SCVC-related characteristics. A total of 186 patients were included with a median Injury Severity Sore of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37% (95% confidence interval: 26 to 40) in patients or 20/1,000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between the aromatic polyurethane and aliphatic polyurethane SCVC groups (38% vs. 36%). SCVC-related DVT independent risk factors were age>30 years, intracranial hypertension, massive transfusion (>10 packed red blood cell units), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter. SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age>30 years, intracranial hypertension or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous.

  17. Convective Leakage Makes Heparin Locking of Central Venous Catheters Ineffective within Seconds: Experimental Measurements in a Model Superior Vena Cava

    PubMed Central

    Barbour, Michael C.; McGah, Patrick M.; Ng, Chin H.; Clark, Alicia; Gow, Kenneth W.; Aliseda, Alberto

    2016-01-01

    Central venous catheters (CVCs), placed in the Superior Vena Cava (SVC) for hemodialysis or chemotherapy, are routinely filled while not in use with heparin, an anticoagulant, to maintain patency and prevent thrombus formation at the catheter tip. The heparin-locking procedure, however, places the patient at risk for systemic bleeding, as heparin is known to leak from the catheter into the blood stream. We provide evidence from detailed in-vitro experiments that shows the driving mechanism behind heparin leakage to be convective-diffusive transport due to the pulsatile flow surrounding the catheter. This novel mechanism is supported by experimental planar laser induced fluorescence (PLIF) and particle image velocimetry (PIV) measurements of flow velocity and heparin transport from a CVC placed inside a model SVC inside a pulsatile flow loop. The results predict an initial, fast (< 10s), convection-dominated phase that rapidly depletes the concentration of heparin in the near-tip region, the region of the catheter with side holes. This is followed by a slow, diffusion-limited phase inside the catheter lumen, where the concentration is still high, that is insufficient at replenishing the lost heparin concentration in the near-tip region. The results presented here, which are consistent with previous in vivo estimates of 24-hour leakage rates, predict that the concentration of heparin in the near-tip region is essentially zero for the majority of the interdialytic phase, rendering the heparin locking procedure ineffective. PMID:26418203

  18. Mechanic and surface properties of central-venous port catheters after removal: A comparison of polyurethane and silicon rubber materials.

    PubMed

    Braun, Ulrike; Lorenz, Edelgard; Weimann, Christiane; Sturm, Heinz; Karimov, Ilham; Ettl, Johannes; Meier, Reinhard; Wohlgemuth, Walter A; Berger, Hermann; Wildgruber, Moritz

    2016-12-01

    Central venous port devices made of two different polymeric materials, thermoplastic polyurethane (TPU) and silicone rubber (SiR), were compared due their material properties. Both naïve catheters as well as catheters after removal from patients were investigated. In lab experiments the influence of various chemo-therapeutic solutions on material properties was investigated, whereas the samples after removal were compared according to the implanted time in patient. The macroscopic, mechanical performance was assessed with dynamic, specially adapted tests for elasticity. The degradation status of the materials was determined with common tools of polymer characterisation, such as infrared spectroscopy, molecular weight measurements and various methods of thermal analysis. The surface morphology was analysed using scanning electron microscopy. A correlation between material properties and clinical performance was proposed. The surface morphology and chemical composition of the polyurethane catheter materials can potentially result in increased susceptibility of the catheter to bloodstream infections and thrombotic complications. The higher mechanic failure, especially with increasing implantation time of the silicone catheters is related to the lower mechanical performance compared to the polyurethane material as well as loss of barium sulphate filler particles near the surface of the catheter. This results in preformed microscopic notches, which act as predetermined sites of fracture.

  19. Spinal Infections Among Patients With Long-Term Central Venous Catheters for Home Parenteral Nutrition.

    PubMed

    Topan, Rabia; Ambrose, Tim; Small, Mia; Lightman, Elewys; Nightingale, Jeremy; Gabe, Simon M

    2017-02-01

    Spinal infections are a rare yet serious metastatic complication of bacteremia among patients with long-term central venous catheters (CVCs) for which clinicians must remain vigilant. We performed a retrospective review of all cases of spinal infection occurring in the context of a CVC for long-term parenteral nutrition (PN) managed in our department between January 2010 and October 2013, a cohort of 310 patients over this time period. Six patients were identified (mean age, 65 years; 5 male). One hundred percent of patients presented with spinal pain (5/6 cervical, 1/6 thoracic). Organisms were cultured from the CVC in 5 of 6 patients. In all cases, the white blood cell count was normal, and in 5 of 6, C-reactive protein was normal. All diagnoses were confirmed on magnetic resonance imaging (MRI), and in 3 of 6 cases, an MRI was repeated (on the advice of neurosurgical colleagues) to confirm resolution of changes after a period of antimicrobial therapy. There was no clear correlation between duration of PN or number of days following CVC insertion and onset of infection. The CVC was replaced in 4 of 6 patients at the time of diagnosis, delayed removal in 1 of 6, and salvaged in the remaining case. Although rare, a high index of suspicion is needed in patients receiving long-term PN who present with spinal pain. Peripheral inflammatory markers may not be elevated. MRI should be performed and patients should be treated with antibiotics alongside involvement of local microbiology and neurosurgical teams. Multidisciplinary discussion on CVC salvage in these cases is important, especially in cases of challenging vascular anatomy.

  20. Infections increase the risk of central venous catheter-related thrombosis in adult acute myeloid leukemia.

    PubMed

    Del Principe, Maria Ilaria; Buccisano, Francesco; Maurillo, Luca; Venditti, Daniela; Cefalo, Mariagiovanna; Sarlo, Chiara; Di Caprio, Luigi; Di Veroli, Ambra; Nasso, Daniela; Ceresoli, Eleonora; Postorino, Massimiliano; Di Piazza, Fabio; Colandrea, Giulio; Conti, Fabio; Del Poeta, Giovanni; Amadori, Sergio; Venditti, Adriano

    2013-11-01

    Central venous catheters (CVC) related thrombosis (CRT) represents a well known complication in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy but the efficacy of antithrombotic prophylaxis still remains controversial. We analyzed 71 consecutive AML patients whose CVC was inserted before each chemotherapy cycle for an overall number of 106 CVC placements. In 47/106 insertions, a prophylaxis with 100 IU/kg/day low molecular weight heparin (LMWH) was administered for 7 days after CVC insertion and additional 7 after CVC removal. This unconventional dose of LMWH, although higher than usual, appeared adequate for a short-course approach. LMWH was delivered regardless of the platelet (PLT) count once provided that it should have been maintained above 20 x 10(9)/L by transfusions. Of 106 insertions, we observed 19 (18%) episodes of CRT, 58 (54%) of sepsis and 50 (47%) infections of CVC-exit site with no difference between LMWH and no-LMWH group. Occurrence of CRT was significantly associated with CVC-exit site infections (14/19, p=0.01) and sepsis (16/19, p=0.005) with no difference between LMWH and no-LMWH group. In multivariate analysis, both CVC-exit site infections and sepsis were confirmed to be independent risk factors for CRT development. Our retrospective study, although based on a small sample size, suggests that the occurrence of CVC-exit site infections and neutropenic sepsis following chemotherapy significantly increases the risk of CRT in AML, independently from the use of LMWH prophylaxis. © 2013.

  1. Peripherally inserted central catheter - insertion

    MedlinePlus

    ... nontunneled central venous catheters. In: Mauro MA, Murphy KPJ, Thomson KR, et al., eds. Image-Guided Interventions . ... by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is ...

  2. Fibrin sheath-associated endovascular infection of the heart: the Trojan horse of indwelling central venous catheters.

    PubMed

    Sheikh, Muhammad Adil; Shokr, Mohamed; Ibrahim, Walid; Cardozo, Shaun

    2017-04-17

    Chronic indwelling central venous catheters can result in formation of fibrin sheaths increasing risk of occlusion, thrombosis and infection. Endovascular infection of right-sided heart structures induced by such sheaths is very rare. A 48-year-old woman with end-stage renal disease initially treated for diabetic ketoacidosis developed persistent Staphylococcus epidermidis bacteraemia without an identifiable source. Although transthoracic echocardiography was unremarkable, transoesophageal echocardiography revealed a fibrin sheath and vegetations in superior vena cava-right atrium junction, which was the site of the tip of a central catheter that had been removed 2 months prior, consistent with fibrin sheath-associated endovascular infection. The bacteraemia cleared and clinical improvement was seen with prolonged intravenous vancomycin. In patients with unexplained bacteraemia and history of a central catheter, rare causes of endovascular infections of right-sided heart structures like fibrin sheaths should be considered. These can persist months after catheter removal. Transoesophageal echocardiogram should be used for earlier detection. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. On-demand antimicrobial release from a temperature-sensitive polymer - comparison with ad libitum release from central venous catheters.

    PubMed

    Sjollema, Jelmer; Dijkstra, Rene J B; Abeln, Caroline; van der Mei, Henny C; van Asseldonk, Dirk; Busscher, Henk J

    2014-08-28

    Antimicrobial releasing biomaterial coatings have found application for instance in the fixation of orthopedic joint prostheses and central venous catheters. Most frequently, the release kinetics is such that antimicrobially-effective concentrations are only reached within the first days to weeks after implantation, leaving no local antimicrobial release available when a biomaterial-associated infection occurs later. Here we compare the ad libitum release of chlorhexidine and silver-sulfadiazine from a central venous catheter with their release from a new, on-demand release coating consisting of a temperature-sensitive copolymer of styrene and n-butyl (meth)acrylate. The copolymer can be loaded with an antimicrobial, which is released when the temperature is raised above its glass transition temperature. Ad libitum release of chlorhexidine and silver-sulfadiazine from a commercially-purchased catheter and associated antimicrobial efficacy against Staphylococcus aureus was limited to 16days. Consecutive temperature-triggers of our on-demand coating yielded little or no antimicrobial efficacy of silver-acetate release, but antimicrobially-effective chlorhexidine concentrations were observed over a time period of 60-80days. This attests to the clear advantage of on-demand coatings above ad libitum releasing coatings, that may have released their antimicrobial content before it is actually needed. Importantly, glass transition temperature of chlorhexidine loaded copolymers was lower (48°C) than of silver loaded ones (61°C), facilitating their clinical use.

  4. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.

    PubMed

    Salama, Mona F; Jamal, Wafaa; Al Mousa, Haifa; Rotimi, Vincent

    2016-01-01

    Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting.

  5. [Use of central venous catheters in children with hematologic neoplasms from the viewpoint of the pediatric surgeon].

    PubMed

    Horák, M; Hnilicka, B; Gál, P; Dembická, D; Mach, V; Skotáková, J

    2001-12-01

    Venous access by cannulation of the central vein is a necessary prerequisite of the oncological treatment. Within the period 1998-2001 there 395 CVCs (Central Venous Catheters) were introduced using a subcutaneous tunnel in 335 hospitalised patients at the Clinic of the Child Surgery, Orthopaedics and Traumatology FN Brno. In 310 patients Hickman CVC was used and in 25 Groshong CVC. Using the vena subclavia 1. dx., 131 CVCs were introduced, via the vena subclavia 1. sin. 264 CVCs. The average period of CVCs introduction was 3 months. In 78 introduced CVCs infectious complication developed. A local infection was noticed only 8 times, general infection at 70 cases. In 13 patients CVCs had to be removed. The authors present their experience with the introduction of tunneled CVCs in oncological patients and the options for solving the infectious complications when using CVCs.

  6. Heparin for clearance of peripherally inserted central venous catheter in newborns: an in vitro study

    PubMed Central

    Balaminut, Talita; Venturini, Danielle; da Silva, Valéria Costa Evangelista; Rossetto, Edilaine Giovanini; Zani, Adriana Valongo

    2015-01-01

    Objective: To compare the efficacy of two concentrations of heparin to clear the lumen of in vitro clotted neonatal peripherally inserted central catheters (PICCs). Methods: This is an in vitro, experimental quantitative study of 76 neonatal 2.0-Fr PICCs coagulated in vitro. The catheters were divided into two groups of 38 PICCs each. In both groups an infusion of low molecular weight heparin was administered with a dose of 25IU/mL for Group 1 and 50IU/mL for Group 2. The negative pressure technique was applied to the catheters of both groups at 5, 15 and 30min and at 4h to test their permeability. Kaplan-Meier survival analysis was used to verify the outcome of the groups according to time intervals. Results: The comparison between both groups in the first 5min showed that more catheters from Group 2 were cleared compared to Group 1 (57.9 vs. 21.1%, respectively). Kaplan-Meier survival analysis showed that less time was needed to clear catheters treated with 50IU/mL of heparin (p<0.001). Conclusions: The use of low molecular weight heparin at a concentration of 50IU/mL was more effective in restoring the permeability of neonatal PICCs occluded in vitro by a clot, and the use of this concentration is within the safety margin indicated by scientific literature. PMID:26116325

  7. Fluid mechanics and clinical success of central venous catheters for dialysis--answers to simple but persisting problems.

    PubMed

    Ash, Stephen R

    2007-01-01

    Over 60% of patients initiating chronic hemodialysis in the United States have a chronic central venous catheter (CVC) as their first blood access device. Although it would be better if these patients started dialysis with fistulas, the CVC is used because it is a reliable and relatively safe method for obtaining blood access over a period of months. Drawing blood from a vein at 300-400 ml/minute is a relatively delicate and somewhat unpredictable process, and there is always a tendency for the vein wall to draw over the arterial tip and obstruct flow. Several methods have been employed to minimize this problem and maximize blood flow, and differing catheter designs have resulted. With all of the different catheter designs now on the market, it is natural to ask what is the logic of different designs. Moreover, in the absence of many direct comparative studies it is natural to ask whether one design is really better than another. There is some misinformation regarding catheter design and function. The following is a list of 10 frequently asked questions In this review, the hydraulic features of CVC are discussed and explained, and logical answers are provided for the following questions: 1. Why do ''D'' catheters flow better than concentric or side by side catheters? 2. Why are all catheters about the same diameter? Does making them bigger really decrease the resistance to flow? 3. Why might a split tip catheter flow better than a solid body catheter? 4. What happens to injections of lock solution at catheter volume? 5. What's better-numerous side holes or none? 6. Why does blood rise into some internal jugular catheters over time, displacing the lock solution? 7. How can a little kink (or stenosis) decrease flow so much? 8. Where should the tips be placed-superior vena cava or right atrium? 9. Which is really better, splitsheath or over-the-wire placement? 10. Which dialysis access has a lower complication rate--CVC or arteriovenous (AV) graft? There remain

  8. Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement.

    PubMed

    Jagneaux, Tonya; Caffery, Terrell S; Musso, Mandi Wilkes; Long, Ann C; Zatarain, Lauren; Stopa, Erik; Freeman, Nathan; Quin, Cara Cantelli; Jones, Glenn N

    2017-10-04

    We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access. Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course. Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02). Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.

  9. [A standardized technique for ultrasound controlled placement of a central venous catheter].

    PubMed

    Mergelsberg, M

    1991-12-01

    To reduce the rate of complications and failures in central venous catheterisation a technique for ultrasonically controlled puncture of the internal jugular vein was standardised. The puncture procedure, including the application of local anaesthesia, is continuously observed and guided by real-time ultrasound. Imaging, control and practising of the puncture are described and discussed.

  10. Evaluation of routine postoperative chest roentgenogram for determination of the correct position of permanent central venous catheters tip

    PubMed Central

    Salimi, Fereshteh; Hekmatnia, Ali; Shahabi, Javad; Keshavarzian, Amir; Maracy, Mohammad Reza; Jazi, Amir Hosein Davarpanah

    2015-01-01

    Background: Proper placement of central venous catheter (CVC) tip could reduce early and late catheter-related complications. Although the live fluoroscopy is standard of care for placement of the catheter, it is not available in many centers. Therefore, the present study evaluated the sensitivity and specificity of bedside chest X-ray (CXR) for proper positioning of the catheter tip. Materials and Methods: A total of 82 adult patients undergoing elective placement of tunneled CVC were enrolled in this study during 2010-2012. The catheter tip position was evaluated by postoperative bedside chest radiographs as well as trans-thoracic echocardiogram as definite diagnostic tool. The catheter position was considered correct if the tip was positioned in the right atrium both in CXR or echocardiography. Finally, CXRs interpreted by expert radiologist. Thus findings were compared by echocardiography. Sensitivity, specificity, accuracy, positive, and negative predictive values were calculated. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL), and P < 0.05 considered as significant. Results: The patients were 57.37 ± 18.91 years of age, weighed 65.79 ± 15.58 kg and were 166.36 ± 9.91 cm tall. Sensitivity and specificity of CXR for proper catheter tip position were 74.3% and 58.3%, respectively. Positive and negative predictive values were 91.2% and 28%. In addition accuracy, positive likelihood ratio, and negative likelihood ratio were 71.9%, 1.78, and 2.27 respectively. Conclusion: Bedside CXR alone does not reliably predict malpositioning after CVC placement. PMID:25767527

  11. To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization?

    PubMed

    Nagashima, Goro; Kikuchi, Toshiki; Tsuyuzaki, Hitomi; Kawano, Rumiko; Tanaka, Hiroyuki; Nemoto, Hiroshi; Taguchi, Kazumi; Ugajin, Kazuhisa

    2006-12-01

    The most important targets of hospital-acquired infection control are to reduce the incidence of surgical-site, catheter-related, and ventilator-associated infections. In this report, we address previously presented infection-control strategies for central venous (CV) line catheterization, using a CV catheter-related infection surveillance system. Data concerning CV catheter insertion were collected from all facilities in our 650-bed hospital, excluding the operating and hemodialysis wards. Collected data included the insertion method, purpose, length of catheter inserted, duration of catheterization, infection rate, and complication rate. Catheter-related infection was diagnosed based on bacteriological examinations from blood cultures. The total number of catheterizations was 806 a year, and average duration of catheterization was 9.8 days. The purpose of catheterization was nutritional support in 210 cases, hemodialysis in 96 cases, cardiac support in 174 cases, and other treatments in 260 cases. In 66 cases, the purpose of CV catheter was not specified. The rate of positive cultures was 7.1%, and complications other than infection occurred in 0.5%. The main causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) in 38.6%, coagulase-negative Staphylococcus epidermidis (CNS) in 33.3%, and S. aureus in 12.3% of infections. Infection rates were 3.8 per 1000 catheter-days in subclavian, 6.1 in jugular, and 15.7 in femoral vein catheterization. In high-risk departments (intensive care unit [ICU] and emergency departments) the infection rate was 5.4 for subclavian and 10.2 for jugular catheterization, whereas it was 3.6 for subclavian and 4.6 for jugular catheterization in noncritical-care departments. Considering complications such as pneumothorax, CV catheterization of the jugular vein is recommended in certain situations.

  12. A crossover randomized prospective pilot study evaluating a central venous catheter team in reducing catheter-related bloodstream infections in pediatric oncology patients.

    PubMed

    Secola, Rita; Azen, Colleen; Lewis, Mary Ann; Pike, Nancy; Needleman, Jack; Sposto, Richard; Doering, Lynn

    2012-01-01

    Treatment for most children with cancer includes the use of a central venous catheter (CVC). CVCs provide reliable venous access for delivery of chemotherapy and supportive care. This advantage is mitigated by an increased risk of bloodstream infections (BSIs). Despite the ubiquitous use of CVCs, few prospective studies have been conducted to address infection prevention strategies in pediatric oncology patients. Prospective, crossover pilot study of a CVC team intervention versus standard care. Two inpatient oncology units in a metropolitan children's hospital. A total of 41 patients/135 admissions for the experimental unit (EU) and 41/129 admissions for the control unit (CU). Patients received a CVC blood draw bundle procedure by a CVC registered nurse (RN) team member (experimental intervention: EU) for 6 months and by the assigned bedside RN (standard care: CU) for 6 months. Feasibility of implementing a CVC RN team; a significant difference in CVC-related BSIs between the team intervention versus standard care and risk factors associated in the development of CVC-related BSIs were determined. There were 7 CVC-related BSIs/1238 catheter days in the EU group (5.7/1000 catheter days) versus 3 CVC-related BSIs/1419 catheter days in the CU group (2.1/1000 catheter days; P = .97). Selected risk factors were not significantly associated with the development of a CVC-related BSI. A CVC team in the care of pediatric oncology patients is feasible; however, a larger cohort will be required to adequately determine the effectiveness of the team reducing CVC-related BSIs.

  13. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    PubMed

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  14. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients.

    PubMed

    Mimoz, O; Pieroni, L; Lawrence, C; Edouard, A; Costa, Y; Samii, K; Brun-Buisson, C

    1996-11-01

    To compare the efficacy of a newly available antiseptic solution (composed of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzyl alcohol), with 10% povidone iodine, on the prevention of central venous or arterial catheter colonization and infection. Prospective, randomized clinical trial. Surgical-trauma intensive care unit (ICU) in a university hospital. All patients admitted to the ICU and requiring the insertion of a central venous and/or an arterial catheter from July 1, 1992 to October 31, 1993. Patients were randomly assigned to one of two groups according to the antiseptic solution used for insertion and catheter care. The same solution was used for skin disinfection from the time of catheter insertion to the time of removal of each catheter. Catheter distal tips were quantitatively cultured when catheters were no longer necessary, if there was a suspicion of catheter-related infection, and routinely after 7 days of use for arterial catheters, or after 15 days of use for central venous catheters. The rate of significant catheter colonization (i.e., > or = 10(3) colony-forming units [cfu]/mL by quantitative culture), and catheter-related sepsis (as defined by sepsis abating following catheter removal per 1,000 catheter-days), were significantly lower in the chlorhexidine group (12 vs. 31 [relative risk 0.4, 95% confidence interval 0.1 to 0.9, p < .01] and 6 vs. 16 [relative risk 0.4, 95% confidence interval 0.1 to 1, p = 0.5], respectively). The rate of central venous catheter colonization and central venous catheter-related sepsis per 1,000 catheter-days were also significantly lower in the chlorhexidine group (8 vs. 31 [relative risk 0.3, 95% confidence interval 0.1 to 1, p = .03] and 5 vs. 19 [relative risk 0.3, 95% confidence interval 0.1 to 1, p = .02], respectively). Finally, the rate of arterial catheter colonization per 1,000 catheter-days was significantly lower in the chlorhexidine group (15 vs. 32 [relative risk 0.5, 95

  15. In the absence of a central venous catheter, risk of venous thromboembolism is low in critically injured children, adolescents, and young adults: evidence from the National Trauma Data Bank.

    PubMed

    O'Brien, Sarah H; Candrilli, Sean D

    2011-05-01

    To describe the incidence and risk factors of venous thromboembolism in a large sample of critical care pediatric, adolescent, and young adult trauma patients. The National Trauma Data Bank-the largest and most complete aggregation of trauma registry data in the United States. Seven hundred eighty-four level I to level IV trauma centers. Patients ≤ 21 yrs of age who spent at least 1 day in a critical care unit during a trauma admission between 2001 and 2005. To characterize differences between patients with and without venous thromboembolism, we extracted variables regarding patient demographics, injury pattern and severity, procedures, total length of stay, and intensive care unit and ventilator days. Odds ratios for predictors of venous thromboembolism were estimated with a logistic regression model. Among the 135,032 critical care patients analyzed, venous thromboembolism was uncommon (6 per 1,000 discharges). Placement of a central venous catheter was a significant predictor of venous thromboembolism (odds ratio = 2.24; p < .0001) when populations were analyzed collectively. When we narrowed our focus to injuries associated with venous thromboembolism, such as lower-extremity fractures, the effects of central venous catheter were of even greater magnitude, particularly in adolescents and young adults. The risk of venous thromboembolism in critical care patients without a central venous catheter was <1% even in adolescents/young adults. Venous thromboembolism is rare in young critical care trauma patients, even older adolescents. The absence of published data on both the baseline risk of venous thromboembolism in pediatric critical care patients and the efficacy and safety of venous thromboembolism prophylaxis preclude the ability to make definitive recommendations for the use of venous thromboembolism prophylaxis in this setting. Our results, however, suggest that venous thromboembolism prophylaxis may need to be considered only in critically injured

  16. Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines Be Placed in the Intensive Care Unit Setting?

    PubMed

    Martyak, Michael; Kabir, Ishraq; Britt, Rebecca

    2017-08-01

    Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

  17. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.

    PubMed

    Sharp, Rebecca; Cummings, Melita; Fielder, Andrea; Mikocka-Walus, Antonina; Grech, Carol; Esterman, Adrian

    2015-03-01

    Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research

  18. Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution.

    PubMed

    Souza Dias, M Beatriz; Habert, Alina Bernardes; Borrasca, Vera; Stempliuk, Valeska; Ciolli, Aina; Araújo, M Rita E; Costa, Silvia F; Levin, Anna S

    2008-02-01

    To describe the management of patients with long-term central venous catheters (CVCs) during an outbreak of infection due to Pseudomonas putida and Stenotrophomonas maltophilia associated with contaminated heparin catheter-lock solution. Descriptive study. Private, 250-bed tertiary-care hospital. In March 2003, we identified 2 febrile cancer patients with P. putida bacteremia. Over 2 days, 7 cases of bacteremia were identified; lots of syringes prefilled with heparin catheter-lock solution, supplied by a compounding pharmacy, were recalled and samples were cultured. More cases of bacteremia appeared during the following days, and any patient who had had a catheter lock infused with the suspect solution was asked to provide blood samples for culture, even if the patient was asymptomatic. Isolates that were recovered from culture were typed by pulsed-field gel electrophoresis. Antimicrobial salvage treatment of long-term CVCs was attempted. A total of 154 patients had had their catheter lock infused with solution from the lots that were suspected of being contaminated. Only 48 of these patients had CVCs. By day 7 of the outbreak, 18 of these patients had become symptomatic. Twenty-six of the remaining 30 asymptomatic patients then also provided blood samples for culture, 10 of whom developed fever shortly after samples were collected. Thirty-two patients were identified who had P. putida bacteremia; 9 also had infection due to S. maltophilia. Samples from 1 of the 3 lots of prefilled syringes in use at the time of the outbreak also grew P. putida on culture. Molecular typing identified 3 different clones of P. putida from patients and heparin catheter-lock solution, and 1 clone of S. maltophilia. A total of 27 patients received antimicrobial therapy regimens, some of which included decontamination of the catheter lock with anti-infective lock solution. Of 27 patients, 19 (70%) retained their long-term CVC during the 6-month follow-up period. To our knowledge, this is

  19. Long-term central venous catheter infection in HIV-infected and cancer patients: a multicenter cohort study.

    PubMed

    Astagneau, P; Maugat, S; Tran-Minh, T; Douard, M C; Longuet, P; Maslo, C; Patte, R; Macrez, A; Brücker, G

    1999-07-01

    To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients. Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period. Services of infectious diseases and oncology of 12 university hospitals in Paris, France. In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation. Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients. Most were associated with bacteremia, most commonly coagulase-negative staphylococci. The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001). The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection. The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population. Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC.

  20. Comparative Analysis of Bacterial Community Composition and Structure in Clinically Symptomatic and Asymptomatic Central Venous Catheters.

    PubMed

    Stressmann, Franziska A; Couve-Deacon, Elodie; Chainier, Delphine; Chauhan, Ashwini; Wessel, Aimee; Durand-Fontanier, Sylvaine; Escande, Marie-Christine; Kriegel, Irène; Francois, Bruno; Ploy, Marie-Cécile; Beloin, Christophe; Ghigo, Jean-Marc

    2017-01-01

    Totally implanted venous access ports (TIVAPs) are commonly used catheters for the management of acute or chronic pathologies. Although these devices improve health care, repeated use of this type of device for venous access over long periods of time is also associated with risk of colonization and infection by pathogenic bacteria, often originating from skin. However, although the skin microbiota is composed of both pathogenic and nonpathogenic bacteria, the extent and the consequences of TIVAP colonization by nonpathogenic bacteria have rarely been studied. Here, we used culture-dependent and 16S rRNA gene-based culture-independent approaches to identify differences in bacterial colonization of TIVAPs obtained from two French hospitals. To explore the relationships between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection, we analyzed the bacterial community parameters between TIVAPs suspected (symptomatic) or not (asymptomatic) of infection. Although we did not find a particular species assemblage or community marker to distinguish infection risk on an individual sample level, we identified differences in bacterial community composition, diversity, and structure between clinically symptomatic and asymptomatic TIVAPs that could be explored further. This study therefore provides a new view of bacterial communities and colonization patterns in intravascular TIVAPs and suggests that microbial ecology approaches could improve our understanding of device-associated infections and could be a prognostic tool to monitor the evolution of bacterial communities in implants and their potential susceptibility to infections. IMPORTANCE Totally implanted venous access ports (TIVAPs) are commonly used implants for the management of acute or chronic pathologies. Although their use improves the patient's health care and quality of life, they are associated with a risk of infection and subsequent clinical complications, often leading to implant removal

  1. [Medial venous catheter or midline (MVC)].

    PubMed

    Carrero Caballero, Ma Carmen; Montealegre Sanz, María; Cubero Pérez, Ma Antonia

    2014-01-01

    Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters. Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Midlines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the necessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Midlines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In general, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings

  2. Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer

    PubMed Central

    Lipitz-Snyderman, Allison; Ma, Qinli; Pollack, Michael F.; Barron, John; Elkin, Elena B.; Bach, Peter B.; Malin, Jennifer L.

    2015-01-01

    Purpose: Despite some advantages to their use, long-term central venous catheters (CVCs) are associated with complications for patients who require chemotherapy. Understanding of these risks in commercially insured populations is limited. This information can inform medical policies that ensure the appropriate use of venous access devices. This study's objectives were to assess the extent of variation in use of long-term CVCs in a cohort of commercially insured women with breast cancer, and to assess risks of associated complications. Methods: Retrospective cohort analysis was conducted using health insurance claims between January 2006 and October 2013. The cohort included commercially insured women age ≥ 18 years diagnosed with breast cancer who received infusion chemotherapy (N = 31,047). We conducted matched and case-mix adjusted Cox proportional hazard modeling to assess differences in bloodstream infections and thrombovascular complications between patients using long-term CVCs and those using temporary intravenous catheters. Results: Approximately two thirds of the cohort had a long-term CVC, although rates varied across regions (57% to 75%), health plans (65% to 70%), and insurance coverage (63% to 68%). After propensity score matching, the adjusted hazard ratio for infection was 2.70 (95% CI, 2.31 to 3.16) and thrombovascular complications, 2.61 (95% CI, 2.33 to 2.93) in patients with long-term CVCs compared with those with temporary intravenous catheters. Conclusion: Although long-term CVCs may have benefits, they are associated with increased morbidity. Regional and health plan variation in long-term CVC insertion suggests that some of their use reflects provider- or institution-driven variation in practice. Evidence-based guidelines and tools may help decrease discretionary use of long-term CVCs. PMID:26265170

  3. Pulmonary Artery Versus Central Venous Catheter Monitoring in the Outcome of Patients Undergoing Bilateral Total Knee Replacement

    PubMed Central

    YaDeau, Jacques T.; Urban, Michael K.

    2008-01-01

    Bilateral total knee replacement (BTKR) has been associated with a higher incidence of fat embolism (FES) compared to single knee replacement. Consequently, intraoperative monitoring with a pulmonary artery catheter (PAC) has been recommended. This study compares clinical outcome in BTKR patients monitored with central venous pressure versus PAC. A retrospective chart review of 249 consecutive patients undergoing BTKR, 132 of whom had PAC insertion versus 117 who had central line insertion, over a 1-year period were included in the study. Their medical records were reviewed for co-morbidities, baseline characteristics, and type of intraoperative monitoring. Need and duration for postoperative monitoring in the postoperative care, length of hospital stay (LOHS), signs of fat embolism, development of arrhythmias, and respiratory failure were all outcome measures. A total of four patients (1.6%) had FES as per Schonfeld criteria. One of these patients died within 48 h of surgery. They all had PAC monitoring intraoperatively. Pulmonary artery pressure (PAP) remained unchanged during surgery which raises doubt as to the clinical utility and advisability of the use of PAC’s in this setting. There was no statistically significant difference in cardiac or pulmonary complications, or LOHS between the two groups. Central venous pressure monitoring appears to be sufficient in patients undergoing BTKR. PMID:19002531

  4. Recurrent bacteraemia by 2 different Bacillus cereus strains related to 2 distinct central venous catheters.

    PubMed

    Koch, Andrea; Arvand, Mardjan

    2005-01-01

    A 14-y-old girl with osteosarcoma developed 3 episodes of catheter-related bacteraemia by Bacillus cereus. After removal of the first and insertion of a second Hickman catheter, further episodes of B. cereus bacteraemia occurred. PFGE analysis revealed that bacteraemic episodes related to each catheter were caused by a distinct B. cereus strain.

  5. Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial.

    PubMed

    Dettenkofer, M; Wilson, C; Gratwohl, A; Schmoor, C; Bertz, H; Frei, R; Heim, D; Luft, D; Schulz, S; Widmer, A F

    2010-06-01

    To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol, and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the catheter tip (> or = 15 CFU); and (iii) occurrence of CVC-associated bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better option than alcohol alone for the prevention of CVC-associated infections.

  6. Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension.

    PubMed

    Sammut, D; Elliot, C A; Kiely, D G; Armstrong, I J; Martin, L; Wilkinson, J; Sephton, P; Jones, J; Hamilton, N; Hurdman, J; McLellan, E; Sabroe, I; Condliffe, R

    2013-07-01

    Catheter-related blood stream infection (CR-BSI) in patients with pulmonary hypertension (PH) receiving intravenous iloprost via an indwelling central line has previously not been fully described. Recent studies have suggested a link between the pH of prostanoid infusions and the rate and nature of CR-BSI. We have investigated CR-BSI in patients receiving intravenous iloprost at our unit. Databases and hospital records were interrogated for all patients receiving intravenous iloprost between September 2007 and June 2012. Fifty-nine patients received intravenous iloprost via an indwelling central catheter with a total of 23,072 treatment days. There were 15 episodes of CR-BSI, identified using a systematic screening protocol, involving 11 patients giving an overall CR-BSI rate of 0.65/1,000 treatment days. CR-BSI rate for Gram-positive organisms was 0.26/1,000 treatment-days and for Gram-negative organisms was 0.39/1,000 treatment-days. The pH of iloprost in typical dosing regimens was comparable to the pH used in standard-diluent treprostinil and dissimilar to alkaline epoprostenol infusions. The proportion of Gram-negative CR-BSI was similar to that reported for standard-diluent treprostinil. CRP was normal on admission in 33 % of cases of confirmed CR-BSI and remained normal in 13 % of cases. CR-BSI rates with intravenous iloprost are comparable to those observed for other prostanoids. The high proportion of Gram-negative organisms observed and the neutral pH of iloprost infusions support the previously hypothesised link between pH and antimicrobial activity. Although usually elevated during a CR-BSI, CRP may be normal in early infection and a normal result cannot completely exclude infection.

  7. [A retrospective study of the relationship between bacterial numbers from central venous catheter tip cultures and blood cultures for evaluating central line-associated bloodstream infections].

    PubMed

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Nakayama, Asami; Yonetamari, Jun; Ando, Kohei; Miyazaki, Takashi; Ohta, Hirotoshi; Furuta, Nobuyuki; Watanabe, Tamayo; Ito, Hiroyasu; Murakami, Nobuo; Seishima, Mitsuru

    2014-01-01

    Catheter-related bloodstream infection (CRBSI) is an infectious disease requiring special attention. It is a common cause of nosocomial infections; catheter insertion into the central veins particularly increases the risk of infection (CLA-BSI: central line-associated bloodstream infection). We examined the relationship between the number of bacterial colonies cultured from shredded central venous catheter (CVC) tips and from blood cultures in our hospital from 2011 to 2012. Coagulase-negative staphylococci topped the list of microbe isolated from the CVC tip culture, followed by Pseudomonas aeruginosa, Staphylococcus aureus, and Candida spp. S. aureus and Candida spp., with growth of over 15 colony-forming units in the CVC tip culture, were also detected at high rates in the blood culture. However, gramnegative bacilli (Enterobacteriaceae and P. aeruginosa) did not show a similar increase in colony number in the CVC tip culture. Because microbes adhering to shredded catheter tips are readily detected by culture, this method is useful as a routine diagnostic test. In addition, prompt clinical reporting of the bacterial number of serious CLA-BSI-causing S. aureus and Candida spp. isolated from CVC tips could contribute to earlier CLA-BSI diagnosis.

  8. Evaluation of cost-effectiveness from the funding body's point of view of ultrasound-guided central venous catheter insertion compared with the conventional technique.

    PubMed

    Noritomi, Danilo Teixeira; Zigaib, Rogério; Ranzani, Otavio T; Teich, Vanessa

    2016-01-01

    To evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique. A theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications. When considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided. Real-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this case was the SUS.

  9. Evaluation of cost-effectiveness from the funding body's point of view of ultrasound-guided central venous catheter insertion compared with the conventional technique

    PubMed Central

    Noritomi, Danilo Teixeira; Zigaib, Rogério; Ranzani, Otavio T.; Teich, Vanessa

    2016-01-01

    Objective To evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique. Methods A theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications. Results When considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided. Conclusion Real-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this

  10. New challenges in the diagnosis, management, and prevention of central venous catheter-related infections.

    PubMed

    Timsit, Jean-François; Dubois, Yohann; Minet, Clémence; Bonadona, Agnès; Lugosi, Maxime; Ara-Somohano, Claire; Hamidfar-Roy, Rebecca; Schwebel, Carole

    2011-04-01

    Catheters are the leading source of bloodstream infections in critically ill patients. Because the clinical signs of infection are nonspecific, such infections are overly suspected, which results in unnecessary removal of catheters. A conservative approach might be attempted in mild infections, whereas catheters should always be removed in cases of severe sepsis or septic shock. Nowadays, comprehensive unit-based improvement programs are effective to reduce catheter-related bloodstream infections (CR-BSIs). Rates of CR-BSI higher than 2 per 1000 catheter-days are no longer acceptable. A locally adapted checklist of preventive measures should include cutaneous antisepsis with alcoholic preparation, maximal barrier precaution, strict policy of catheter maintenance, and ablation of useless catheters. Antiseptic dressings and, to a lesser extent, antimicrobial-coated catheters, might be added to the prevention strategies if the level of infections remains high despite implementation of a prevention program. In the case of CR-BSI in intensive care units (ICUs), the catheter should be removed. In the case of persistence of fever or positive blood cultures after 3 days, inadequate antibiotic therapy, endocarditis, or thrombophlebitis should be ruled out.

  11. Pericardial effusion associated with an appropriately placed umbilical venous catheter.

    PubMed

    Sehgal, A; Cook, V; Dunn, M

    2007-05-01

    Central venous catheterization is widely used in neonatal intensive care units to support tiny preterm babies. Pericardial effusion (PCE) and cardiac tamponade are uncommon but potentially fatal complications of percutaneous, umbilical and surgically placed central venous catheters related to intracardiac position or migration. This report describes a case of PCE arising from fluid infused via umbilical venous catheter. The case study highlights two important aspects: one, occurrence of PCE in a baby with satisfactory position of the umbilical catheter, and second, the life-saving application of basic echocardiography by bedside caregivers for the diagnosis and treatment of this critical condition.

  12. Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.

    PubMed

    Raad, Issam; Chaftari, Anne-Marie; Zakhour, Ramia; Jordan, Mary; Al Hamal, Zanaib; Jiang, Ying; Yousif, Ammar; Garoge, Kumait; Mulanovich, Victor; Viola, George M; Kanj, Soha; Pravinkumar, Egbert; Rosenblatt, Joel; Hachem, Ray

    2016-06-01

    In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.).

  13. Efficacy and safety of using L-cysteine as a catheter-clearing agent for nonthrombotic occlusions of central venous catheters in children.

    PubMed

    Pai, Vinita B; Plogsted, Steven

    2014-10-01

    Critically ill pediatric patients, especially in the intensive care unit, receive multiple medications and have a higher risk of central venous catheter (CVC) occlusion. If an occlusion occurs immediately after the administration of multiple medications or incompatible medications, either an acidic solution such as 0.1 N hydrochloric acid (HCl) or a basic solution of 1 mEq/mL sodium bicarbonate or 0.1 N sodium hydroxide can be used. However, compounding and storing of 0.1 N HCl has become more complex due to USP <797> guidelines for sterile compounding, and an alternative is needed. We report a series of cases in which L-cysteine was used instead of HCl to clear CVCs occluded due to administration of multiple medications. L-cysteine is a commercially available, sterile solution with a pH of 1–2.5. CVC occlusion was resolved in 10 of the 16 episodes in 13 patients. Two of the 16 occlusions were phenytoin related and would not have responded. An L-cysteine dose of 50 mg was used during 10 of the 16 episodes, 100 mg during 5 episodes, and 25 mg during 1 episode. A correlation between catheter clearance and dose was not observed. Occlusion resolution due to L-cysteine was not correlated to the prior use of tissue plasminogen activator. Metabolic acidosis, adverse effects, or damage to the catheters due to L-cysteine were not observed. On the basis of this limited experience, we propose L-cysteine as an effective alternative to 0.1 N HCl for clearing CVC occlusions caused by drugs with an acidic pKa.

  14. Impact of hydrochloric acid instillation on salvage of infected central venous catheters in children with acute lymphoblastic leukaemia.

    PubMed

    Madsen, Mette; Rosthøj, Steen

    2013-01-01

    Bacteraemia associated with indwelling central venous catheters (CVC) causes significant morbidity in children with cancer. Hydrochloric acid (HCl) instillations have been reported to salvage CVCs with antibiotic-refractory infection. We implemented this treatment in 2002. The impact on the survival of CVCs has been evaluated in a retrospective cohort study of children with acute lymphoblastic leukaemia (ALL). Children with newly diagnosed ALL during 1999-2005 having their first CVC inserted before (n = 16) and after (n = 24) the introduction of the procedure were studied. All bacteraemic episodes were reviewed, recording bacteriological findings and treatment, and the time to premature or planned removal of the CVC was determined. In the comparison cohort, 31.0% (9/29) of bacteraemic episodes led to removal of the CVC, compared to 5.5% (2/36) in the intervention cohort (p = 0.01). Thus, the rate of catheter loss due to infection fell from 56.3% (9/16) to 8.3% (2/24) after introducing HCl treatment (p = 0.0025). Overall, the premature catheter removal rate fell from 75.0% (12/16) to 45.8% (11/24) (p = 0.10). Analysed in a CUSUM plot the reduced frequency of premature CVC removal evidently coincided with the introduction of the procedure. In a subgroup analysis of 21 monobacterial infections with coagulase-negative staphylococci, a decrease in systemic and lock antibiotic therapy was found. No adverse events were noted. HCl instillations significantly reduced the need to remove and replace CVCs. The procedure is practical, appears to be safe, and may reduce the consumption of antibiotics.

  15. Vancomycin stability in heparin and total parenteral nutrition solutions: novel approach to therapy of central venous catheter-related infections.

    PubMed

    Yao, J D; Arkin, C F; Karchmer, A W

    1992-01-01

    To facilitate therapy of central venous catheter-related Gram-positive bacterial infection in patients who require total parenteral nutrition (TPN) therapy, we studied the stability of vancomycin in a commonly used TPN solution (V-TPN) at final concentrations of 0.5 mg/mL and 1.0 mg/mL and in heparin (100 U/mL in 0.9% NaCl) at 25 micrograms/mL (V-H). Vancomycin concentrations in V-TPN and V-H after storage at 4 degrees C over 35 and 14 days, respectively, were stable (within 10% of the prestorage vancomycin concentration). After 14 days at 4 degrees C heparin activity in V-H solution was 100 +/- 4% of that noted initially. Vancomycin remained stable (100 +/- 6% of the original vancomycin concentration) when the previously refrigerated V-TPN was held for an additional 24 hours at 22 degrees C. When the previously refrigerated V-H was held for an additional 24 hours at 37 degrees C, vancomycin concentrations decreased to 78 +/- 9% of the baseline concentrations (p less than .001). The stability of vancomycin in this TPN solution allows the daily dose of vancomycin to be mixed with the solution and then infused over 10 hours. As shown with pharmacokinetic modeling, this form of therapy will achieve serum vancomycin concentrations within the therapeutic range throughout a 24-hour period. The relative stability of vancomycin in a heparin line-flush solution allows vancomycin concentration in the lumen of the catheter to be maintained at greater than or equal to 15 micrograms/mL during the interval between catheter flushing and the subsequent TPN infusion. A simplified method of administering vancomycin to patients receiving concurrent TPN is possible.

  16. [Impact of clinical practice guidelines on the incidence of bloodstream infections related to peripherally inserted central venous catheter in preterm infants].

    PubMed

    Boutaric, E; Gilardi, M; Cécile, W; Fléchelles, O

    2013-02-01

    In our neonatal intensive care unit, the incidence density of infections related to central catheters, assessed retrospectively over 2 years, exceeded that described in the literature. To reduce this incidence density, clinical practice guidelines were implemented for the insertion and maintenance of central lines. The purpose of this study was to evaluate the impact of the protocol on the incidence density and the incidence rate of nosocomial bloodborne infections. This was a prospective study in a neonatal intensive care unit of the Fort-de-France University Hospital over 17 months, which included all premature infants with a central line. We studied the adherence to the protocol, possible complications related to the protocol, the characteristics of the population, the incidence rate, and the density of specific central catheter-related infections. There were 111 children, 122 catheters, and 2575 catheter days during period 1 and 101 children, 125 catheters, and 1631 catheter days during period 2. Gestational age and birth weight were significantly lower in period 2 (29.6±2.3 GW vs 27.3±1.9, P=0.001; 1239±379g vs 915±175g, P<0.001) and the catheterization duration differed between the 2 periods (20±11 days vs 13±6 days, P<0.0001). A trend for a lower incidence density of infection was observed in the second period (16 per 1000 catheter days vs 10 per 1000 catheter days, P=0.06). Although the 2 groups' baseline characteristics were different, this study suggests a positive impact of clinical practice guidelines for the insertion and maintenance of central venous catheters on the incidence of nosocomial infections related to central catheters.

  17. [Central venous access: our experience with Hickman and Broviac catheter in children].

    PubMed

    Milanović, D; Krstić, Z; Vukadinović, V

    1994-01-01

    We report the results of a 4-years-experience with Hickman-Broviac double lumen silicone catheters. The catheters were inserted in 51 dialysed and nondialysed children. Forty three catheters were placed for temporary or permanent dialysis access, 2 in patients for plasmapheresis, 4 in severely burnt patients, and 2 in neonates with the "short gut" syndrome. The youngest patient was 7 days old and the eldest 14.5 years (mean age 5.4 years). The catheters were implanted by open surgery into the right atrium through the right (92%) or left internal jugular vein (8%) in more than 80% of patients. Ten catheters were implanted in the femoral vein (three through the saphenous vein: in a patient with extensive burns in the thorax and neck area, and in seven patients with acute renal failure and high risk for anaesthesia). The complications, except the insufficient flow, were fewer and less dangerous than those reported in literature. Therefore, we strongly recommend insertion of these catheters as the method of choice for immediate vascular access in children in whom the creation of conventional vascular access is difficult or impossible, as well as in patients in whom provision of long- term intravenous nutrition or medication is essential.

  18. Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients.

    PubMed

    Keller, Sara C; Williams, Deborah; Gavgani, Mitra; Hirsch, David; Adamovich, John; Hohl, Dawn; Krosche, Amanda; Cosgrove, Sara; Perl, Trish M

    2017-01-01

    BACKGROUND Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy. OBJECTIVE To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications. DESIGN Prospective cohort study between March and December 2015. SETTING Home infusion therapy after discharge from academic medical centers. PARTICIPANTS Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal. METHODS Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications. RESULTS Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51-15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09-5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01-0.74]). Other environmental exposures were not associated with CVC complications. CONCLUSIONS complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients. Infect Control Hosp Epidemiol 2016;1-8.

  19. Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients

    PubMed Central

    Keller, Sara C.; Williams, Deborah; Gavgani, Mitra; Hirsch, David; Adamovich, John; Hohl, Dawn; Krosche, Amanda; Cosgrove, Sara; Perl, Trish M.

    2017-01-01

    BACKGROUND Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy. OBJECTIVE To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications. DESIGN Prospective cohort study between March and December 2015. SETTING Home infusion therapy after discharge from academic medical centers. PARTICIPANTS Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal. METHODS Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications. RESULTS Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications. CONCLUSIONS complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients. PMID:27697084

  20. Central venous catheter tip migration due to tracheal extubation: a prospective randomized study.

    PubMed

    Struck, Manuel F; Jünemann, Theresa; Reinhart, Konrad; Schummer, Wolfram

    2016-07-28

    Considerable numbers of patients undergo central venous catheterization (CVC) under mechanical ventilation. We hypothesized that the return of spontaneous breathing and tracheal extubation could be associated with distal CVC tip migration towards intracardiac positions due to decreasing intrathoracic pressures and subsequent readjustment of mediastinal organs. Patients scheduled for cardiac surgery were randomized for right or left internal jugular vein (IJV) CVC placement under general anesthesia and mechanical ventilation. CVC tips were positioned at the cavoatrial junction and measured at the time of placement, postoperatively under mechanical ventilation, and after tracheal extubation until 48 h after surgery. Measurement methods included intravascular electrocardiography (ECG) P-wave amplitude, transesophageal echocardiography, and chest radiography (CXR). Out of 70 patients, 60 were eligible for final statistical analysis (31 right and 29 left IJV CVC). According to ECG interpretation, CVC tip positions remained below the pericardiac reflection point in the distal superior vena cava over the course of the three measurement intervals. The ECG revealed significant proximal migration of CVC tips from the time of placement to the time of tracheal extubation (1.19 ± 0.55 vs. 0.62 ± 0.31 mV; P < 0.001). A CXR using CVC tip to carina distances revealed no significant tip migrations in the time between postoperative assessment and following tracheal extubation (5.1 ± 1.7 vs. 5.3 ± 1.5 cm; P = 0.196). In patients with CVCs positioned at the cavoatrial junction, tracheal extubation was not associated with significant postoperative CVC tip malposition, but tended to undergo proximal migration. This trend should be considered particularly in left-sided thoracocervical puncture approaches to avoid unfavorable CVC tip positions.

  1. Factors Associated with Continuous Low Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide

    PubMed Central

    Onyeama, Sara-Jane N; Hanson, Sheila J; Dasgupta, Mahua; Hoffmann, Raymond G; Faustino, Edward Vincent S

    2016-01-01

    Objective To identify patient, hospital and central venous catheter (CVC) factors that may influence the use of low dose heparin infusion (LDHI) for CVC patency in critically ill-children. Design Secondary analysis of an international multicenter observational study. Setting 59 Pediatric Intensive Care Units (PICUs) over four study dates in 2012, involving 7 countries. Patients Children less than 18 years of age with a CVC, admitted to a participating unit and enrolled in the completed PROTRACT study were included. All overflow patients were excluded. Interventions None. Measurements and Main Results Of the 2,484 patients in the PROTRACT study, 1,312 patients had a CVC. 507 of those patients used LDHI. The frequency of LDHI was compared across various patient, hospital and CVC factors using chi-squared, Mann-Whitney and Fisher's exact tests. In the multivariate analysis, age was not a significant factor for LDHI use. Patients with pulmonary hypertension had decreased LDHI use while those with active surgical or trauma diagnoses had increased LDHI use. All central CVC insertion sites were more likely to use LDHI when compared to peripherally inserted CVCs. The Asia-Pacific region showed increased LDHI use, along with community hospitals and smaller ICUs (<10 beds). Conclusion Patient, CVC, and hospital factors are associated with the use of LDHI in critically ill children. Further study is needed to evaluate the efficacy and persistence of LDHI use. PMID:27362853

  2. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit.

    PubMed

    Advani, Sonali; Reich, Nicholas G; Sengupta, Arnab; Gosey, Leslie; Milstone, Aaron M

    2011-05-01

    Increasingly, peripherally inserted central venous catheters (PICCs) are placed for prolonged intravenous access. Few data exist regarding risk factors for central line-associated bloodstream infection (CLABSI) complicating PICCs in hospitalized children, especially children hospitalized outside the intensive care unit (ICU). We identified all children with a PICC inserted at The Johns Hopkins Hospital (Baltimore, MD) from 1 January 2003 through 31 December 2009 and used Poisson regression models to identify risk factors for PICC-associated CLABSIs. A total of 2592 PICCs were placed in 1819 children. One hundred sixteen CLABSIs occurred over 44,972 catheter-days (incidence rate [IR], 2.58 cases per 1000 catheter-days; 95% confidence interval [CI], 2.07-3.00 cases per 1000 catheter-days). Independent predictors of CLABSI in the entire cohort included PICC dwell time of > 21 days (IR ratio [IRR], 1.53; 95% CI, 1.05-2.26), parenteral nutrition as indication for insertion (IRR, 2.24; 95% CI, 1.31-3.84), prior PICC-associated CLABSI (IRR, 2.48; 95% CI, 1.18-5.25), underlying metabolic condition (IRR, 2.07; 95% CI, 1.14-3.74), and pediatric ICU exposure during hospitalization (IRR, 1.80; 95% CI, 1.18-2.75). Risk factors for CLABSI in children without PICU exposure included younger age, underlying malignancy and metabolic conditions, PICCs inserted in the lower extremity, and a prior PICC-associated CLABSI. Prolonged catheter dwell time, pediatric ICU exposure, and administration of parenteral nutrition as the indication for PICC insertion are important predictors of PICC-associated CLABSI in hospitalized children. A careful assessment of these risk factors may be important for future success in preventing CLABSIs in hospitalized children with PICCs.

  3. Central Line–Associated Bloodstream Infection in Hospitalized Children with Peripherally Inserted Central Venous Catheters: Extending Risk Analyses Outside the Intensive Care Unit

    PubMed Central

    Advani, Sonali; Reich, Nicholas G.; Sengupta, Arnab; Gosey, Leslie

    2011-01-01

    Background. Increasingly, peripherally inserted central venous catheters (PICCs) are placed for prolonged intravenous access. Few data exist regarding risk factors for central line–associated bloodstream infection (CLABSI) complicating PICCs in hospitalized children, especially children hospitalized outside the intensive care unit (ICU). Methods. We identified all children with a PICC inserted at The Johns Hopkins Hospital (Baltimore, MD) from 1 January 2003 through 31 December 2009 and used Poisson regression models to identify risk factors for PICC-associated CLABSIs. Results. A total of 2592 PICCs were placed in 1819 children. One hundred sixteen CLABSIs occurred over 44,972 catheter-days (incidence rate [IR], 2.58 cases per 1000 catheter-days; 95% confidence interval [CI], 2.07–3.00 cases per 1000 catheter-days). Independent predictors of CLABSI in the entire cohort included PICC dwell time of ≥21 days (IR ratio [IRR], 1.53; 95% CI, 1.05–2.26), parenteral nutrition as indication for insertion (IRR, 2.24; 95% CI, 1.31–3.84), prior PICC-associated CLABSI (IRR, 2.48; 95% CI, 1.18–5.25), underlying metabolic condition (IRR, 2.07; 95% CI, 1.14–3.74), and pediatric ICU exposure during hospitalization (IRR, 1.80; 95% CI, 1.18–2.75). Risk factors for CLABSI in children without PICU exposure included younger age, underlying malignancy and metabolic conditions, PICCs inserted in the lower extremity, and a prior PICC-associated CLABSI. Conclusions. Prolonged catheter dwell time, pediatric ICU exposure, and administration of parenteral nutrition as the indication for PICC insertion are important predictors of PICC-associated CLABSI in hospitalized children. A careful assessment of these risk factors may be important for future success in preventing CLABSIs in hospitalized children with PICCs. PMID:21454298

  4. Improving our ability to diagnose infections associated with central venous catheters: value of Gram's staining and culture of entry site swabs.

    PubMed Central

    McGeer, A; Righter, J

    1987-01-01

    We prospectively studied 45 central venous catheters to determine whether Gram's staining and culture of skin swabs from the entry site could be used to predict catheter-related infection. Data were collected from insertion site swabs, intracutaneous and intravascular catheter segments, and blood cultures. Surveillance site cultures at the time of dressing changes showed that bacterial growth, once established, persisted until removal of the catheter but that the time of onset of infection was not predictable. Gram's staining alone and Gram's staining combined with culture were tested for their ability to predict catheter colonization and catheter-related infection. Bacteria seen with Gram's staining invariably denoted catheter colonization. When bacteria were not seen with Gram's staining, positive results of culture did not change the pretest probabilities of colonization or infection; however, negative results of culture reduced the probability of colonization to low levels (likelihood ratio less than 0.06). We conclude that Gram's staining and culture of skin swabs from the entry site provide, without line removal, a simple, inexpensive and practical test for the diagnosis of catheter-related infection. PMID:3676944

  5. Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature

    PubMed Central

    Venugopal, Achuthan Nair; Koshy, Rachel Cherian; Koshy, Sumod M

    2013-01-01

    Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location. PMID:24106371

  6. Epidemiology and mortality of candidemia both related and unrelated to the central venous catheter: a retrospective cohort study.

    PubMed

    Arias, S; Denis, O; Montesinos, I; Cherifi, S; Miendje Deyi, V Y; Zech, F

    2017-03-01

    Our objective was to compare mortality, epidemiology, and morbidity in hospitalized patients with candidemia which was both related and unrelated to the central venous catheter (CVC). This was a monocentric, retrospective cohort study of candidemia. The sample consisted of 103 patients with laboratory-confirmed nosocomial candidemia hospitalized between 2006 and 2013 in a tertiary care public hospital. We included 65 (63.1 %) patients (24 in the CVC-positive group, 41 in the CVC-negative group). Demographic data and risk factors were recorded using a structured case report form. In the group of candidemia associated to the CVC, survival at day 50 was 58.6 ± 11.9 %, compared to 26.5 ± 8.9 % for the CVC-negative group (p-value = 0.012); the hazard ratio of death was 0.38 (95 % confidence interval 0.17-0.85, p-value = 0.019). Compared with the CVC-positive patients, CVC-negative patients were often colonized with yeast (41.5 % vs. 16.7 %, p-value = 0.041), had a shorter previous in-hospital stay (20 days vs. 34 days, p-value = 0.023), and were more severely ill (severe sepsis 85.4 % vs. 58.3 %, p-value = 0.016). In this study, when the origin of candidemia was not the CVC, patients were more seriously ill, had a higher mortality rate, and the removal of the catheter seemed to lead to disappointing results. It would be useful to explore the impact of retention of the CVC on survival in the CVC-negative patients, where the CVCs are essential to treating these patients.

  7. Post-thrombotic syndrome after central venous catheter removal in childhood cancer survivors: A prospective cohort study.

    PubMed

    Polen, E; Weintraub, M; Stoffer, C; Jaffe, D H; Burger, A; Revel-Vilk, S

    2015-02-01

    Although the use of central venous catheters (CVCs) has greatly improved the quality of care of children with cancer, these catheters increase the risk of deep vein thrombosis (DVT) and the potential long-term complication of post-thrombotic syndrome (PTS). We aimed to study PTS post-CVC removal using physical, functional and health related quality of life (HRQoL) domains in childhood cancer and bone marrow transplantation (BMT) survivors. We conducted a prospective study in a cohort of childhood cancer and BMT survivors post-CVC use. Participants were evaluated for PTS with the Modified Villalta Score (MVS) and the Manco-Johnson Instrument (MJI). HRQoL was assessed using the PedsQL™ questionnaire. A total of 158 children were enrolled at a median of 41 (4-149) months from CVC removal. Signs and symptoms of PTS were present in 34% (95% confidence interval [CI] 27-43%) (MVS criteria) and 30.5% (95% CI 23.1-37.8%) (MJI criteria). Diagnosis of PTS was associated with history of CVC occlusion, history of CVC-related DVT and the use of ≥2 CVCs. The presence of signs and symptoms of PTS was a predictor for low HRQoL tested by the PedsQL™ Total Scale scores and Physical Health Summary scores. PTS post-CVC removal in pediatric cancer survivors is not a rare event. The association between PTS and the history of CVC occlusion confirms earlier findings, and suggests that CVC occlusion may indicate asymptomatic DVT. PTS is also associated with lower HRQoL scores highlighting the need to study preventive measures, especially for high risk groups. Pediatr Blood Cancer 2015;62:285-290. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  8. The management of central venous catheters and infection control: is it time to change our approach?

    PubMed

    Langton, H

    2014-06-01

    Catheter related bloodstream infections (CR-BSIs) can lead to a number of serious conditions for the patient, including death. There is much recent evidence both in the UK and abroad which identifies the sources of CR-BSIs, yet they continue to occur. This article seeks to review some of the current evidence in relation to the prevention of CR-BSIs at insertion point.

  9. High rate of Candida deep-seated infection in patients under chronic hemodialysis with extended central venous catheter use.

    PubMed

    Ourives, Ana Paula Jafet; Gonçalves, Sarah Santos; Siqueira, Ricardo Andreotti; Souza, Ana Carolina Remondi; Canziani, Maria Eugenia F; Manfredi, Silvia Regina; Correa, Luci; Colombo, Arnaldo Lopes

    2016-01-01

    Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure. The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection. We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48h of hospital admission. We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%). CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality. Copyright © 2016 Asociación Española de Micología. Published by Elsevier Espana. All rights reserved.

  10. Establishment of rat model of central venous catheter (CVC): associated infection and evaluation of the virulence of bacterial biofilms.

    PubMed

    Ye, Lian-Hua; Huang, Yun-Chao; Guo, Feng-Li; Liu, Xin; Zhao, Guang-Qiang; Duan, Lin-Can; Jin, Cong-Guo

    2014-09-01

    In this study, a central venous catheter (CVC)-associated infection model was established in rats to investigate and evaluate the effect of biofilms on the virulence of the pathogens. Twenty-four adult SD rats were randomly divided into biofilm positive (BF+) and biofilm negative (BF-) groups to be challenged with strains of S.epidermidis. Serum levels of inflammatory cytokines were measured and the infection rate and counts of bacteria cells were studied. Compared to rats of BF- group, the serum level of TNF and IL-6 significantly increased in rats of BF+ group (P < 0.01) and the level of IL-10 and IFN-γ significantly decreased (P < 0.01), striking the balance of pro-inflammatory/anti-inflammatory cytokines. The infection rate and bacterial counts in tissues and blood of rats of BF + group were significantly higher than those of rats of BF- group (P < 0.05).Inflammatory cell infiltration in vital organs (heart, lung, liver and kidneys) was more significant in rats of BF+ group than that of rats of BF- group. CVC-associated infection model can be successfully reproduced in rats by injecting 5 × 10(6) CFU of S.epidermidis. Biofilm formation can significantly enhance the virulence of the bacteria, leading to uncontrolled infection. The serum level of inflammatory cytokines, infection rate and the extent of inflammatory cell infiltration are important markers for evaluating the virulence of biofilm.

  11. Falsely elevated cyclosporin and tacrolimus concentrations over prolonged periods of time due to reversible adsorption to central venous catheters.

    PubMed

    Hacker, Charlotte; Verbeek, Mareike; Schneider, Heike; Steimer, Werner

    2014-06-10

    Falsely elevated concentrations of immunosuppressants can be caused by reversible adsorption to central venous catheter (CVC) systems. If undetected, this may lead to dose reduction resulting in underdosage which may even entail graft-versus-host disease or organ rejection. We analyzed the adsorption and release for cyclosporine A (CsA) and tacrolimus (Tac) in vitro and in vivo. Four types of CVCs were examined in vitro: two made from polyurethane (PU), one from silicone and one from PU with an incorporated silver ion-based antimicrobial agent. All 26 CVCs analyzed in vitro showed significant reversible adsorption of CsA (n=13; p=0.001) and Tac (n=13; p=0.001, Wilcoxon signed rank test). Immediately after infusing the drugs, the mean concentrations of 6420ng/mL of CsA and 250ng/mL of Tac were measured. Flushing with NaCl lowered the drug release. Besides, blood samples of fifteen patients were taken simultaneously from all lumina of the CVC and via venipuncture. The samples from contaminated lumina showed the mean elevations by a factor of 11 for CsA (n=12) and 89 for Tac (n=3). Blood sampling for immunosuppressant monitoring should thus never be performed from lumina previously used for infusing the drug even after prolonged periods of time and extensive rinsing. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Human serum potentiates the expression of genes associated with antifungal drug resistance in C. albicans biofilms on central venous catheters.

    PubMed

    Samaranayake, L P; Anil, S; Hashem, M; Vellappally, S; Cheung, B P K

    2015-04-01

    Candida albicans is a major agent of fungaemias and frequently causes systemic disease through seeded, blood stream dissemination. These infections, particularly common in hospitalized patients with central venous catheters (CVCs), appear to persevere due to biofilm reservoirs of the yeast that tend to develop on the device. Although it is known that candidal biofilms are intrinsically resistant to antifungals compared with their planktonic counterparts, there is a paucity of data on the expression of antifungal drug resistance genes (DRGs) in candidal biofilms in CVC reservoirs. Furthermore, notwithstanding the fact that CVCs are constantly bathed in human serum, there are no studies on the effect of the latter on the DRG expression in candidal biofilms. Hence, we developed in vitro biofilms of three different C. albicans strains on silicone CVC discs immersed in human serum and evaluated the temporal expression of nine antifungal DRGs. In an attempt to evaluate the effect of hyphal elements on DRG expression, we incorporated a hyphal mutant (HM) and its wild-type (WT) counterpart, as well as a fresh clinical isolate in the studies. Human serum significantly up-regulated DRG transcripts in Candida biofilms on CVCs, at different stages of biofilm growth, while the WT strain over-expressed more DRGs than the HM strain. Here, we report, for the first time, that both human serum and the hyphal elements of the yeast have a profound modulatory effect on DRG expression in C. albicans biofilms on CVCs.

  13. Unintentional embolization of a guide wire in the inferior vena cava during central venous catheter insertion successfully retrieved percutaneously 9 months later.

    PubMed

    Trabattoni, Daniela; Andreini, Daniele; Bartorelli, Antonio L

    2014-01-01

    Central venous catheters are routinely positioned for hemodynamic monitoring and fluid administration in patients undergoing cardiac surgery, and many well-known complications associated with this manoeuver have been described. Metalic guide wire embolization is a rare complication potentially associated with nonmechanical and mechanical adverse events. The case we report is peculiar as an almost fully endothelialized guide wire was successfully retrieved 9 months after its unintentional embolization in the inferior vena cava.

  14. Prevention of central venous catheter-associated bloodstream infections: A questionnaire evaluating the knowledge of the selected 11 evidence-based guidelines by Polish nurses.

    PubMed

    Dedunska, Karina; Dyk, Danuta

    2015-12-01

    This study evaluated the questionnaire testing nurses' knowledge about the maintenance of a central venous catheter (CVC) and assessed it with regard to age, work experience, type of ward, frequency of trainings, and postgraduate education. There were 1,180 questionnaires (N = 784; 66.4% of the total sample) distributed in several regions of Poland for a period of 7 months. The difficulty level for each question ranged from 0.22-0.88.

  15. An engineered micropattern to reduce bacterial colonization, platelet adhesion and fibrin sheath formation for improved biocompatibility of central venous catheters.

    PubMed

    May, Rhea M; Magin, Chelsea M; Mann, Ethan E; Drinker, Michael C; Fraser, John C; Siedlecki, Christopher A; Brennan, Anthony B; Reddy, Shravanthi T

    2015-01-01

    Catheter-related bloodstream infections (CRBSIs) and catheter-related thrombosis (CRT) are common complications of central venous catheters (CVC), which are used to monitor patient health and deliver medications. CVCs are subject to protein adsorption and platelet adhesion as well as colonization by the natural skin flora (i.e. Staphylococcus aureus and Staphylococcus epidermidis). Antimicrobial and antithrombotic drugs can prevent infections and thrombosis-related complications, but have associated resistance and safety risks. Surface topographies have shown promise in limiting platelet and bacterial adhesion, so it was hypothesized that an engineered Sharklet micropattern, inspired by shark-skin, may provide a combined approach as it has wide reaching anti-fouling capabilities. To assess the feasibility for this micropattern to improve CVC-related healthcare outcomes, bacterial colonization and platelet interactions were analyzed in vitro on a material common for vascular access devices. To evaluate bacterial inhibition after simulated vascular exposure, micropatterned thermoplastic polyurethane surfaces were preconditioned with blood proteins in vitro then subjected to a bacterial challenge for 1 and 18 h. Platelet adhesion was assessed with fluorescent microscopy after incubation of the surfaces with platelet-rich plasma (PRP) supplemented with calcium. Platelet activation was further assessed by monitoring fibrin formation with fluorescent microscopy after exposure of the surfaces to platelet-rich plasma (PRP) supplemented with calcium in a flow-cell. Results are reported as percent reductions and significance is based on t-tests and ANOVA models of log reductions. All experiments were replicated at least three times. Blood and serum conditioned micropatterned surfaces reduced 18 h S. aureus and S. epidermidis colonization by 70% (p ≤ 0.05) and 71% (p < 0.01), respectively, when compared to preconditioned unpatterned controls. Additionally

  16. Successful use of central venous catheter as permanent hemodialysis access: 84-month follow-Up in lucania.

    PubMed

    Di Iorio, B; Lopez, T; Procida, M; Marino, P; Valente, V; Iannuzziello, F; Bombini, A; Bellizzi, V; Terracciano, V; Bagnato, C; Casino, F; Gaudiano, V; Mostacci, D; Santarsia, G; Biscione, R; Caputo, A; Ferlan, G; Lauria, M A; Marinaro, G; Molinari, R; Sanicandro, D; Lotito, M A; Plastino, G; Carretta, P

    2001-01-01

    Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in hemodialysis (HD) patients. These catheters serve an essential role in providing permanent access in subjects in whom all other access options have been exhausted. The predominant complications are catheter thrombosis, catheter fibrin sheating and infection. The aim of this study was to evaluate long-term survival and complications of permanent venous catheters (PVC) placed for the purpose of HD during the period from January 1992 to December 1998, at the Dialysis Units of Lucania (a southern Italian region). A total of 98 PVC were placed in 88 patients during this period. The catheters used were of three types: (a) 72 VasCath Soft Cell catheters (Bard Instrument Company, Toronto, Ont., Canada); (b) 22 PermCath catheters (Quinton Instrument Company, Seattle, Wash., USA), and (c) 4 Tesio catheters (Bellco SpA, Mirandola, Italy). Survival curves of catheters were calculated using the Kaplan-Meier product-limit estimator. The patient survival was 60% at the 78th month. Actually, 52 patients (27 males, 25 females) are still alive: 15 (26.9%) of these patients have diabetes mellitus and 1 has been transplanted. The actuarial survival rate of PVC was 89% in the whole population studied and 82% in subjects alive after 84 months. Twenty-five patients (28.4%) had PVC as the first reliable vascular access. Long-term complications occurred 27 times (1 episode every 44.81 month/patient) as: breakage (3.1%); thrombosis (10.2%); displacement (2.0%); subcutaneous tunnel bleeding (3.1%); inadequate blood flow (7.1%), and infection (10.2%). In conclusion, our data confirm that PVC might represent an effective long-term blood access route for HD. Again, PVC are getting the access of choice for selected patients (i.e., older subjects with cardiovascular diseases and cancer patients) and are enjoying a dramatic increase in use for subjects who are terrified of repetitive venopuncture.

  17. Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Ghods, Kamran; Razavi, Mohammad Reza; Forozeshfard, Mohammad

    2016-01-01

    Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC) for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012–2015) were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery. PMID:27826210

  18. Dramatic increase of central venous catheter-related infections associated with a high turnover of the nursing team.

    PubMed

    Mirabel-Chambaud, Eléa; N'Guyen, Michael; Valdeyron, Marie-Laure; Quessada, Thierry; Goudable, Joelle; Loras-Duclaux, Irene; Marotte, Stephanie; Heissat, Sophie; Restier, Lioara; Lachaux, Alain; Peretti, Noel

    2016-04-01

    This retrospective study evaluated the impact of new organization during the moving to a new university pediatric hospital on the incidence of central catheter-related blood stream infections (CRBSIs) among children on long-term parenteral nutrition. The study ran from April 2007 to March 2014, starting a year prior to reorganisation of the department of pediatric Hepato-Gastroenterology and Nutrition associated to moving the children to a new hospital in April 2008, and continuing for 6 years following the move. During this time, data from all children hospitalized in this department who received parenteral nutrition (PN) for more than 15 days were analysed. During this 7-years study, 183 children aged 4.6 ± 0.5 years received prolonged PN. Intestinal diseases were the main aetiologies (89%), primarily short bowel syndrome (18.4%), Hirschsprung disease and CIPO (13.5%) and inflammatory bowel disease (13.8%). The mean durations of hospitalization and of PN during hospitalization were, respectively, 70 ± 2.1 and 55.7 ± 3.6 days. During the study period, 151 CRBSIs occurred in 77 children (42% of all patients), i.e. 14.8 septic episodes/1000 PN days and 12.0 septic episodes/1000 CVC days. No patient died of a central venous catheter-related infection. However, following the move from the older hospital to the newer one, the rate of CRBSIs significantly doubled, from 3.9/1000 to 8.8/1000 CVC days (p = 0.02). During the following 4 years, the incidence of CRBSIs tended to increase between the 2nd and the 5th year after the move: 11.3 (p = NS); 21.4 (p = 0.01); 17.3 (p = NS), 20.3/1000 (p = NS) CVC days. We also observed that after evaluations by the Department of Infection Control, nurse training and stabilization of the nursing team, the incidence decreased significantly from 20.3 to 11.1/1000 CVC days during the 6th year after the move (p = 0.01). Our results reveal the deleterious impact of the reorganization during the hospital moving on the

  19. Duration and Adverse Events of Non-cuffed Catheter in Patients With Hemodialysis

    ClinicalTrials.gov

    2014-10-09

    Renal Failure Chronic Requiring Hemodialysis; Central Venous Catheterization; Inadequate Hemodialysis Blood Flow; Venous Stenosis; Venous Thrombosis; Infection Due to Central Venous Catheter; Central Venous Catheter Thrombosis

  20. Risk factors and biofilm detection on central venous catheters of patients attended at tertiary hospital.

    PubMed

    Pérez-Zárate, Pamela; Aragón-Piña, Antonio; Soria-Guerra, Ruth Elena; González-Amaro, Ana María; Pérez-Urizar, José; Pérez-González, Luis Fernando; Martinez-Gutierrez, Fidel

    2015-11-01

    To determinate the significance of risk factors with the presence of biofilm on catheters of patients attended at tertiary hospital cares. 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. 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. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. "Scrub the hub": cleaning duration and reduction in bacterial load on central venous catheters.

    PubMed

    Simmons, Sarah; Bryson, Celestina; Porter, Susan

    2011-01-01

    This article reports the results of a study on the effect of alcohol disinfection duration on bacterial load on catheter hubs. Three different levels of disinfection (3, 10, and 15 seconds) were analyzed as well as a positive and negative control. All hubs with the exception of the negative controls were contaminated with a 10 bacterial solution and allowed to dry for 24 hours. Through each hub, 1 mL of sterile saline was flushed; a 10-μL calibrated loop was used to plate the flush onto blood agar. Colony counts were performed on the plates after a 24-hour incubation period. Results revealed that the 3 different levels of disinfection duration were not found to differ significantly in reduction in bacterial load. The duration of disinfection did not significantly change the bacterial load on the hub. However, any disinfection duration significantly decreased the bacterial load as compared to the positive control. A larger study would likely detect a significant result among the disinfections.

  2. Use of a low-concentration heparin solution to extend the life of central venous catheters in African green monkeys (Chlorocebus aethiops).

    PubMed

    Gamble, Christopher S; Jacobsen, Kenneth O; Leffel, Elizabeth K; Pitt, M Louise M

    2007-05-01

    Normal hematologic values for African green monkeys have been reported, but these results are confounded by the effect of chemical restraint (for example, ketamine), physical restraint, and capture stress. The dual-lumen central venous catheter, jacket, and tether combination we describe here allows intravenous fluid administration and repeated blood sampling without the use of anesthesia or inducing capture-related stress. The use of a low-concentration heparin solution for catheter maintenance significantly increased the mean patency time, compared with a saline-only catheter flush solution. Adding a low-concentration heparin solution creates a suitable system for serial blood collection in the African green monkey for as long as 25 d.

  3. Transpulmonary thermodilution using femoral indicator injection: a prospective trial in patients with a femoral and a jugular central venous catheter

    PubMed Central

    2010-01-01

    Introduction Advanced hemodynamic monitoring using transpulmonary thermodilution (TPTD) is established for measurement of cardiac index (CI), global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI). TPTD requires indicator injection via a central venous catheter (usually placed via the jugular or subclavian vein). However, superior vena cava access is often not feasible due to the clinical situation. This study investigates the conformity of TPTD using femoral access. Methods This prospective study involved an 18-month trial at a medical intensive care unit at a university hospital. Twenty-four patients with both a superior and an inferior vena cava catheter at the same time were enrolled in the study. Results TPTD-variables were calculated from TPTD curves after injection of the indicator bolus via jugular access (TPTDjug) and femoral access (TPTDfem). GEDVIfem and GEDVIjug were significantly correlated (rm = 0.88; P < 0.001), but significantly different (1,034 ± 275 vs. 793 ± 180 mL/m2; P < 0.001). Bland-Altman analysis demonstrated a bias of +241 mL/m2 (limits of agreement: -9 and +491 mL/m2). GEDVIfem, CIfem and ideal body weight were independently associated with the bias (GEDVIfem-GEDVIjug). A correction formula of GEDVIjug after femoral TPTD, was calculated. EVLWIfem and EVLWIjug were significantly correlated (rm = 0.93; P < 0.001). Bland-Altman analysis revealed a bias of +0.83 mL/kg (limits of agreement: -2.61 and +4.28 mL/kg). Furthermore, CIfem and CIjug were significantly correlated (rm = 0.95; P < 0.001). Bland-Altman analysis demonstrated a bias of +0.29 L/min/m2 (limits of agreement -0.40 and +0.97 L/min/m2; percentage-error 16%). Conclusions TPTD after femoral injection of the thermo-bolus provides precise data on GEDVI with a high correlation, but a self-evident significant bias related to the augmented TPTD-volume. After correction of GEDVIfem using a correction formula, GEDVIfem shows high predictive capabilities

  4. Evaluation of febrile, nonneutropenic pediatric oncology patients with central venous catheters who are not given empiric antibiotics.

    PubMed

    Bartholomew, Frederick; Aftandilian, Catherine; Andrews, Jennifer; Gutierrez, Kathleen; Luna-Fineman, Sandra; Jeng, Michael

    2015-01-01

    To evaluate the practice of empiric antibiotics for febrile, nonneutropenic pediatric oncology patients with a central venous catheter (CVC) in place. Episodes of fever without neutropenia (absolute neutrophil count [ANC] ≥500 cells/mm(3)) were reviewed retrospectively in pediatric oncology patients with a CVC undergoing chemotherapy. Characteristics and symptoms were compared between patients with bacteremia and patients without bacteremia. A total of 392 episodes of nonneutropenic fever in 138 subjects (52 females; 38%) were reviewed. In this cohort, the median age at an episode was 7 years, and the majority of patients had a diagnosis of acute leukemia (54%). Median ANC was 3100 cells/mm(3) (IQR, 1570-5980 cells/mm(3)). Median temperature was 38.7°C (IQR, 38.3-39.2°C). Twenty-four infectious episodes (6%) occurred in 18 subjects, and 5 CVCs required removal; all patients requiring removal admitted and received antibiotics owing to chills. There were no significant difference in age, sex, or ANC between patients with bacteremia and those without bacteremia; however, mean temperature was higher in the patients with bacteremia (39.4°C vs 38.7°C; P = .003). No deaths due to sepsis occurred, and no CVCs were removed because antibiotics were not administered empirically. Our practice of observing pediatric oncology patients undergoing chemotherapy with CVCs who are not neutropenic does not appear to lead to increased serious adverse outcomes and avoids antibiotic exposure for >90% of patients without a bacterial infection. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Pericardial effusion with cardiac tamponade caused by a central venous catheter in a very low birth weight infant.

    PubMed

    Chioukh, Fatma-Zohra; Ameur, Karim Ben; Hmida, Hayet Ben; Monastiri, Kamel

    2016-01-01

    With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however, it is potentially reversible when it is caught in time. The authors present a case of cardiac tamponade following umbilical venous catheterisation in a neonate. The patient was diagnosed at the appropriate time by echocardiography and urgent pericardiocentesis proved lifesaving.

  6. Supraclavicular approach of central venous catheter insertion in critical patients in emergency settings: Re-visited

    PubMed Central

    Tomar, Gaurav Singh; Chawla, Sonali; Ganguly, Suprio; Cherian, Grace; Tiwari, Akhilesh

    2013-01-01

    The supraclavicular approach was first put into clinical practice in 1965 by Yoffa and is an underused method for gaining central access. It offers several advantages over the conventional infraclavicular approach to the subclavian vein. At the insertion site, the subclavian vein is closer to the skin, and the right-sided approach offers a straighter path into the subclavian vein. Also, this site is often more accessible during CPR and surgical procedures. In patients who are obese, this anatomic area is less distorted and in patient with congestive heart failure and cervical spine instability repositioning is not required. PMID:23833470

  7. Peripherally Inserted Central Catheters and Hemodialysis Outcomes.

    PubMed

    McGill, Rita L; Ruthazer, Robin; Meyer, Klemens B; Miskulin, Dana C; Weiner, Daniel E

    2016-08-08

    Use of peripherally inserted central catheters has expanded rapidly, but the consequences for patients who eventually require hemodialysis are undefined. Our national, population-based analysis included 33,918 adult Medicare beneficiaries from the US Renal Data System who initiated hemodialysis with central venous catheters as their sole vascular access in 2010 and 2011. We used linked Medicare claims to identify peripherally inserted central catheter exposures and evaluate the associations of peripherally inserted central catheter placement with transition to working arteriovenous fistulas or grafts and patient survival using a Cox model with time-dependent variables. Among 33,918 individuals initiating hemodialysis with a catheter as sole access, 12.6% had received at least one peripherally inserted central catheter. Median follow-up was 404 days (interquartile range, 103-680 days). Among 6487 peripherally inserted central catheters placed, 3435 (53%) were placed within the 2 years before hemodialysis initiation, and 3052 (47%) were placed afterward. Multiple peripherally inserted central catheters were placed in 30% of patients exposed to peripherally inserted central catheters. Recipients of peripherally inserted central catheters were more likely to be women and have comorbid diagnoses and less likely to have received predialysis nephrology care. After adjustment for clinical and demographic factors, peripherally inserted central catheters placed before or after hemodialysis initiation were independently associated with lower likelihoods of transition to any working fistula or graft (hazard ratio for prehemodialysis peripherally inserted central catheter, 0.85; 95% confidence interval, 0.79 to 0.91; hazard ratio for posthemodialysis peripherally inserted central catheter, 0.81; 95% confidence interval, 0.73 to 0.89). Peripherally inserted central catheter placement was common and associated with adverse vascular access outcomes. Recognition of potential long

  8. Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

    PubMed

    Friedman, B; Kanter, G; Titus, D

    1994-04-01

    Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

  9. Antibiotic and other lock treatments for tunnelled central venous catheter-related infections in children with cancer.

    PubMed

    Schoot, Reineke A; van Dalen, Elvira C; van Ommen, Cornelia H; van de Wetering, Marianne D

    2013-06-25

    The risk of developing a tunnelled central venous catheter (CVC)-related infection ranges between 0.1 and 2.3 per 1000 catheter days for children with cancer. These infections are difficult to treat with systemic antibiotics (salvage rate 24% - 66%) due to biofilm formation in the CVC. Lock treatments can achieve 100 - 1000 times higher concentrations locally without exposure to high systemic concentrations. Our objective was to investigate the efficacy of antibiotic and other lock treatments in the treatment of CVC-related infections in children with cancer compared to a control intervention. We also assessed adverse events of lock treatments. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, issue 3, 2011), MEDLINE/PubMed (1945 to August 2011) and EMBASE/Ovid (1980 to August 2011). In addition we searched reference lists from relevant articles and the conference proceedings of the International Society for Paediatric Oncology (SIOP) (from 2006 to 2010), American Society of Clinical Oncology (ASCO) (from 2006 to 2010), the Multinational Association of Supportive Care in Cancer (MASCC) (from 2006 to 2011), the American Society of Hematology (ASH) (from 2006 to 2010) and the International Society of Thrombosis and Haematology (ISTH) (from 2006 to 2011). We scanned the ISRCTN Register and the National Institute of Health Register for ongoing trials (www.controlled-trials.com) (August 2011). Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing an antibiotic lock or other lock treatment (with or without concomitant systemic antibiotics) with a control intervention (other lock treatment with or without concomitant systemic antibiotics or systemic antibiotics alone) for the treatment of CVC-related infections in children with cancer. For the description of adverse events, cohort studies were also eligible for inclusion. Two authors independently selected studies, extracted data and performed

  10. Cessation of In-line Filters in Central Venous Catheters Does Not Significantly Influence the Incidence of Bloodstream Infections and Mortality in a Hospital Hematological Ward.

    PubMed

    Tanaka, Hiroaki; Ambiru, Satoshi; Kawaguchi, Takeharu; Sugita, Yasumasa; Kawajiri, Chika; Nagao, Yuhei; Shimura, Takenori

    2016-01-01

    Objective The use of intravenous in-line filters is effective for the mechanical removal of large particles, precipitates, bacteria, fungi, large lipid globules, and air. However, the routine use of in-line filters remains controversial. Many patients with hematological diseases frequently suffer from bloodstream infections (BSIs) with fatal outcomes. Methods The year before cessation of an in-line filter was defined as the "filter period" and the year after its cessation was defined as the "non-filter period." The number of central line-associated bloodstream infections (CLABSIs), which are defined through surveillance, the catheter utilization rate, the number of patient deaths within 7 days after removal of the central venous catheters (CVCs), and the overall survival rate following CVC insertion were measured. Results During both periods, 84 patients had a total of 140 CVCs with a total number of catheter days of 3,407. There were 10 CVCs with CLABSIs, and the overall CLABSI rate was 2.9/1,000 catheter days, including 4 CVCs with CLABSIs (2.5/1,000 catheter days) during the filter period and 6 CVCs with CLABSIs (3.3/1,000 catheter days) during the non-filter period. The CLABSI rate, catheter utilization rate, and mortality did not differ significantly between the two periods. The only independent variable that was found to be significantly associated with the development of CLABSIs was a neutrophil count of <500×10(6)/L (p<0.05). Conclusion Our study revealed that the cessation of in-line filters from CVCs does not significantly influence the incidence of BSIs and mortality in patients with hematological disease. To confirm our results, however, a large-scale randomized controlled study is warranted.

  11. Central Venous Catheter Repair is Associated with an Increased Risk of Bacteremia and Central Line Associated Bloodstream Infection in Pediatric Patients

    PubMed Central

    LUNDGREN, INGRID S.; ZHOU, CHUAN; MALONE, FRANCES R.; MCAFEE, NANCY G.; GANTT, SOREN; ZERR, DANIELLE M.

    2011-01-01

    Background Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and CVC-associated bloodstream infections (CLABSI). Methods We conducted a retrospective case-crossover study of pediatric patients aged 1 month to 21 years with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABSI (defined by Centers for Disease Control and Prevention criteria) in the 30 days pre-repair (control period) and the 30 days post-repair (exposure period), with adjustment for within-patient correlation using conditional Poisson regression. Results The mean pre-repair rate of bacteremia was 9.9 per 1000 catheter days, which increased to 24.5 post-repair, resulting in an adjusted incidence rate ratio (IRR) of 1.87 (95% CI 1.05 – 3.33, p = 0.034). Risk of CLABSI demonstrated a greater than two-fold increase (IRR 2.15, 95% CI 1.02 – 4.53, p = 0.045) when all catheter days were included, and a four-fold increase when days on antibiotics were excluded (IRR 4.07, 95% CI 1.43 – 11.57, p = 0.008). Conclusions We found that repair of a broken CVC was associated with a two to four-fold higher risk of developing CLABSI within 30 days of repair in pediatric patients. Further studies are needed to determine interventions to reduce this risk and to better define the relative merits of CVC repair compared with replacement in selected patient populations. PMID:22146741

  12. Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects

    PubMed Central

    Chmielak, Zbigniew; Dębski, Artur; Kępka, Cezary; Rudziński, Piotr N.; Bujak, Sebastian; Skwarek, Mirosław; Kurowski, Andrzej; Dzielińska, Zofia; Demkow, Marcin

    2016-01-01

    Introduction Totally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization. Aim To present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the procedural aspects with a series of detailed angiographies. Material and methods Between January 2003 and December 2012 there were 14 (~0.025%) successful retrievals in 13 patients (44 ±16 years, 15% females) of embolized fragments of TIVAS (n = 10) or CVC (n = 1) or of dislodged guide-wires (n = 2) or knotted SG (n = 1). Results Foreign bodies with the forward end located in the right ventricle (RV), as well as those found in the pulmonary artery (PA), often required repositioning with a pigtail catheter as compared to those catheter fragments which were located in the right atrium (RA) and/or great vein and possessed an accessible free end allowing their direct ensnarement with the loop snare (57.0% (4/7) vs. 66.7% (2/3) vs. 0.0% (0/3); p = 0.074 respectively). Procedure duration was 2–3 times longer among catheters retrieved from the PA than among those with the forward edge located in the RV or RA (30 (18–68) vs. 13.5 (11–37) vs. 8 min (8–13); p = 0.054 respectively). The SG catheter knotted in the vena cava superior (VCS) was encircled with the loop snare introduced transfemorally, subsequently cut at its skin entrance and then pulled down inside the 14 Fr vascular sheath. Conclusions By using the pigtail catheter and the loop snare, it is feasible to retrieve centrally embolized fragments or knotted central venous access devices. PMID:27279874

  13. Tunnelled Central Venous Catheter-Related Problems in the Early Phase of Haematopoietic Stem Cell Transplantation and Effects on Transplant Outcome

    PubMed Central

    Yeral, Mahmut; Boğa, Can; Oğuzkurt, Levent; Alışkan, Hikmet Eda; Özdoğu, Hakan; Demiroğlu, Yusuf Ziya

    2015-01-01

    Objective: Haematopoietic stem cell recipients need central venous catheters (CVCs) for easy administration of intravenous fluid, medications, apheresis, or dialysis procedures. However, CVCs may lead to infectious or non-infectious complications such as thrombosis. The effect of these complications on transplantation outcome is not clear. This manuscript presents the complication rates of double-lumen tunnelled CVCs and their effect on transplantation outcome. Materials and Methods: Data from 111 consecutive patients, of whom 75 received autologous and 36 received allogeneic peripheral blood stem cell transplantations, were collected retrospectively. The data were validated by the Record Inspection Group of the related JACIE-accredited transplantation centre. Results: Thrombosis developed in 2.7% of recipients (0.9 per 1000 catheter days). Catheter-related infection was identified in 14 (12.6%) patients (3.6 per 1000 catheter days). Coagulase-negative Staphylococcus was the most common causative agent. Engraftment time, rate of 100-day mortality, and development of grade II-IV graft-versus-host disease were not found to be associated with catheter-related complications. Conclusion: These results indicate that adverse events related with tunnelled CVCs are manageable and have no negative effects on transplant outcome. PMID:25805675

  14. Central vascular catheters and infections.

    PubMed

    Dioni, Elisabetta; Franceschini, Renata; Marzollo, Roberto; Oprandi, Daniela; Chirico, Gaetano

    2014-03-01

    Newborn infants in critical conditions require a permanent intra-venous line to allow for the administration of fluids, parenteral nutrition and drugs. The use of central venous catheters, however, is associated with an increased risk of infections, leading to prolongation of length of stay and higher hospitalization costs, particularly in extremely preterm infants. Dwell time is a significant factor for complications, with a predicted risk of catheter related infections of about 4 per 1000 catheter-days. To reduce the incidence of complications, several requirements must be met, including adequate staff and resources to provide education, training, and quality improvement programs, within a culture of communication and teamwork. Rigorous reporting schedule on line care and the implementation of unique bundle elements, the use of health care failure mode and effect analysis, the judicious use of antibiotics through an antimicrobial stewardship strategy, the application of specific antifungal prophylaxis are among the most effective interventions, while the addition of heparin to parenteral solution, or the use of antibiotic plus heparin lock therapy are under evaluation. Nursing assistance plays a fundamental role in managing central venous lines and in reducing or preventing the incidence of infection, by the application of several complex professional strategies.

  15. Utilization Patterns and Outcomes Associated with the Central Venous Catheter in Septic Shock: A Population-Based Study

    PubMed Central

    Walkey, Allan J.; Soylemez-Wiener, Renda; Lindenauer, Peter K.

    2013-01-01

    Objective In 2001 a randomized trial showed decreased mortality with early, goal-directed therapy in septic shock, a strategy later recommended by the Surviving Sepsis Campaign. Placement of a central venous catheter (CVC) is necessary to administer goal-directed therapy. We sought to evaluate nationwide trends in: 1) CVC utilization and 2) the association between early CVC insertion and mortality in patients with septic shock. Design We retrospectively analyzed the proportion of septic shock cases receiving an early (day of admission) CVC and the odds of hospital mortality associated with receiving early CVC from years 1998-2001 compared with 2002-2009. Setting Non-federal acute care hospitalizations from the Nationwide Inpatient Sample, 1998-2009. Interventions None Patients 203,481 (population estimate: 999,545) cases admitted through an emergency department with principal diagnosis of septicemia and secondary diagnosis of shock. Measurements and Main Results From 1998-2009 population-adjusted rates of septic shock increased from 12.6 cases per 100,000 US adults to 78 cases per 100,000. During this time age-adjusted hospital mortality associated with septic shock declined from 40.4% to 31.4%. Early CVC insertion increased from 5.7% (95% CI 5.1-6.3%) to 19.2% (95% CI 18.7-19.5%) cases with septic shock, with an increased rate of early CVC placement identified after 2007. The rate of decline in age-adjusted hospital mortality was significantly greater for patients who received an early CVC (-4.2% per year, 95% CI -3.2, -4.2%) as compared with no CVC (-2.9% per year, 95% CI -2.3, -3.5%), p=0.016. Hospital mortality associated with early CVC insertion significantly decreased from a multivariable-adjusted odds ratio of 1.29 (95% CI 1.14-1.45) prior to 2001 to an adjusted odds ratio of 0.87 (95% CI 0.84-0.90) after 2001. Conclusions Placement of a CVC early in septic shock has increased 3-fold since 1998. The mortality associated with early CVC insertion decreased

  16. Pericardial effusion with cardiac tamponade caused by a central venous catheter in a very low birth weight infant

    PubMed Central

    Chioukh, Fatma-Zohra; Ameur, Karim Ben; Hmida, Hayet Ben; Monastiri, Kamel

    2016-01-01

    With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however, it is potentially reversible when it is caught in time. The authors present a case of cardiac tamponade following umbilical venous catheterisation in a neonate. The patient was diagnosed at the appropriate time by echocardiography and urgent pericardiocentesis proved lifesaving. PMID:28154705

  17. Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children.

    PubMed

    Bradford, Natalie K; Edwards, Rachel M; Chan, Raymond J

    2015-11-23

    Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and

  18. In vitro exposure of bacteria to antimicrobial impregnated-central venous catheters does not directly lead to the emergence of antimicrobial resistance.

    PubMed

    Munson, Erik L; Heard, Stephen O; Doern, Gary V

    2004-11-01

    Use of central venous catheters (CVCs) impregnated with minocycline and rifampin reduces the density of bacterial growth on catheters and decreases the incidence of catheter-related bloodstream infections. Questions have been raised over the possibility that the use of these catheters will lead to the emergence of antibiotic-resistant organisms. In this study, we sought to determine if in vitro exposure of four test organisms to catheter segments impregnated with minocycline and rifampin would lead to the development of antibiotic resistance. Catheter segments (1.0 cm) were placed on the surface of agar plates previously inoculated with bacterial suspensions, such that a subconfluent lawn of colony growth would be apparent after 24 h incubation at 35 degrees C in air. Test organisms included American Type Culture Collection strains of Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa. Zones of inhibition of colony growth surrounding catheters were measured at 24-h intervals up to 7 days (two catheter segments per test). Colonies on agar surfaces located at varying distances from catheter segments were examined for minocycline and rifampin resistance following various periods of exposure (six catheter segments per test). In addition, selected colonies were subsequently exposed to minocycline and rifampin in broth and examined for selection of minocycline and rifampin resistance (> 28 colonies per selection test). Inhibitory zones of 14 to 47 mm were observed with S aureus, S epidermidis, E faecalis, and E coli. Growth of P aeruginosa was not inhibited by CVC segments. Testing of colonies of the first four organisms at various distances from CVC segments after varying periods of exposure revealed only a single instance of the emergence of resistance (eg, S aureus vs rifampin). Recovery of resistant clones was enhanced with minocycline and rifampin broth selection; however, a direct link between CVC

  19. The effectiveness of chlorhexidine-silver sulfadiazine impregnated central venous catheters in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation.

    PubMed

    Maaskant, J M; De Boer, J P; Dalesio, O; Holtkamp, M J; Lucas, C

    2009-09-01

    Immuno-compromised patients are at high risk for all kind of infections. Unfortunately, they need central venous catheters (CVCs), which are associated with infectious complications. In this study we examined the effectiveness of chlorhexidine-silver sulfadiazine impregnated CVCs to prevent catheter-related infections in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation. This historical cohort study evaluated 139 patients of whom 70 patients were provided with non-impregnated CVCs and 69 patients with impregnated CVCs. Patients were treated for different diagnoses. The median number of days a CVC stayed in situ was 18 in the non-impregnated group and 16 in the impregnated group. The median duration of neutropenia of patients with non-impregnated CVCs was 9 days compared with 7 days of patients with impregnated CVCs. We found less catheter colonization (CC) in patients with chlorhexidine-silver sulfadiazine CVCs (RR 0.63, 95% CI 0.41-0.96; P = 0.03). Catheter-related blood stream infections (CR-BSI) were also diminished, but this result was not statistically significant (RR 0.15, 95% CI 0.02-1.15; P = 0.06). The reduction in CC and CR-BSI did not diminish the incidence of fever. We conclude that the use of chlorhexidine-silver sulfadiazine impregnated CVCs provide an important improvement in the attempt to reduce CC and CR-BSI.

  20. Prevention and treatment of implanted central venous catheter (CVC) - related sepsis: a report after six years of home parenteral nutrition (HPN).

    PubMed

    Santarpia, Lidia; Pasanisi, Fabrizio; Alfonsi, Lucia; Violante, Gerardo; Tiseo, Domenico; De Simone, Gianni; Contaldo, Franco

    2002-06-01

    Catheter-related sepsis is a serious and common complication in patients receiving home parenteral nutrition (HPN). Prevention measures, prevalence of infections, types of agents and implanted central venous catheters (CVC), effectiveness of antibiotic therapy have been evaluated in 221 patients consecutively followed in our unit from January 1995 to December 2000. The clinical diagnosis of catheter-related infection was made using well-defined criteria. Patients were divided into two groups: A and B, receiving instructions with different modalities: standard (A) and detailed (B), respectively. Sixty CVC-related sepsis occurred in 32 (14%) patients. A multivariate analysis showed that the duration of HPN (P<0.001; OR=0.9), type of catheter (P=0.009; OR=0.12) and type of disease (P=0.033; OR=4.92) significantly influence catheter infection. The type of implanted CVC (159 port-a-cath in 153 patients and 71 tunnelled in 68) seems to affect the infection rate, this being lower in tunnelled (P=0.03). Infection rate was lower in B vs A group (P<0.001) with all types of catheters, suggesting the preventive role of very careful training. In particular, the incidence of CVC-related sepsis was 6/1000 days of HPN (i.e. 6/1000 days of catheterization) in Group A and 3/1000 in Group B. Systemic and antibiotic lock therapy was performed with an 83% successful rate. Gram-positive bacteria were the most frequent CVC infection agents, which are usually eradicated by antibiotic therapy lasting 7 days.

  1. [Bases of central venous catheterization].

    PubMed

    Schmalz-Ott, Stéphane; Monti, Matteo; Vollenweider, Peter

    2008-10-29

    Central venous catheterization is a frequently performed procedure in internal medicine units. Residents in training frequently share the same questions, doubts and fears about this procedure : "Should I perform a subclavian catheterization in a patient with mild thrombopenia?"; "Which site has the lesser complication rate?"; "After how long does a catheter need to be replaced?". This mini-review of the current literature tries to answer this and other questions.

  2. Evaluation of the introduction of the Groshong central venous catheter into the oncology/haematology department of a district general hospital.

    PubMed

    Todd, J

    1997-09-01

    Technological advances in the medical management of oncological and haematological malignancies have seen the introduction of long-term central venous access as common practice in this setting. The result of this has been an influx of a variety of lines onto the market, thus creating a minefield of choice for the practitioner. As a newly appointed Macmillan clinical nurse specialist for oncology and haematology to a unit with no established policy regarding the use of central venous catheters, the author was presented with an opportunity to introduce the most advanced line into clinical practice. In this centre the decision was made to introduce this line for a number of reasons, not only for the benefits associated with enhanced patient safety but also because of the educational and supportive role Bard Access Limited had offered. When instigating change and development it was of paramount importance that all members of the health care team were well educated regarding the use and maintenance of these lines to ensure success. This paper aims to share our experience of the Groshong line and includes a detailed audit of each line placed in a 12-month period. The information collated includes details regarding insertion method, infection rates, episodes of thrombosis and numbers of catheters removed due to malfunction.

  3. Efficacy of 1.0% chlorhexidine-gluconate ethanol compared with 10% povidone-iodine for long-term central venous catheter care in hematology departments: a prospective study.

    PubMed

    Yamamoto, Natsuo; Kimura, Hideo; Misao, Hanako; Matsumoto, Hayato; Imafuku, Yuji; Watanabe, Akemi; Mori, Hiroko; Yoshida, Akiko; Miura, Saori; Abe, Yoshinobu; Toba, Mamoru; Suzuki, Hiromi; Ogawa, Kazuei; Kanemitsu, Keiji

    2014-05-01

    The efficacy of 1% chlorhexidine-gluconate ethanol and 10% povidone-iodine for skin antisepsis of central venous catheter (CVC) sites were compared among hematology patients. The CVC site colonization rates of those groups were 11.9% and 29.2%, respectively, and the catheter-associated blood stream infections were 0.75 and 3.62 per 1,000 catheter-days, respectively. One percent chlorhexidine-gluconate ethanol was superior to povidone-iodine to reduce skin colonizers at CVC sites even when catheters were used for long duration.

  4. A vancomycin-heparin lock solution for prevention of nosocomial bloodstream infection in critically ill neonates with peripherally inserted central venous catheters: a prospective, randomized trial.

    PubMed

    Garland, Jeffery S; Alex, Colleen P; Henrickson, Kelly J; McAuliffe, Timothy L; Maki, Dennis G

    2005-08-01

    Critically ill neonates are at high risk for vascular catheter-related bloodstream infection (CRBSI), most often caused by coagulase-negative staphylococci. Most CRBSIs with long-term devices derive from intraluminal contaminants. The objective of this study was to ascertain the safety and the efficacy of a vancomycin-heparin lock solution for prevention of CRBSI. A prospective, randomized double-blind trial was conducted during 2000-2001 at a community hospital level III NICU. Very low birth weight and other critically ill neonates with a newly placed peripherally inserted central venous catheter were randomized to have the catheter locked 2 or 3 times daily for 20 or 60 minutes with heparinized normal saline (n = 43) or heparinized saline that contained vancomycin 25 microg/mL (n = 42). The origin of each nosocomial bloodstream infection (BSI) was studied by culturing skin, catheter hubs, and implanted catheter segments and blood cultures, demonstrating concordance by restriction-fragment DNA subtyping. Surveillance axillary and rectal cultures were performed to detect colonization by vancomycin-resistant organisms. The main outcome measures were (1) CRBSIs and (2) colonization or infection by vancomycin-resistant Gram-positive bacteria. Two (5%) of 42 infants in the vancomycin-lock group developed a CRBSI as compared with 13 (30%) of 43 in the control group (2.3 vs 17.8 per 1000 catheter days; relative risk: 0.13; 95% confidence interval: 0.01-0.57). No vancomycin-resistant enterococci or staphylococci were recovered from any cultures. Vancomycin could not be detected in the blood of infants who did not receive systemic vancomycin therapy. Twenty-six neonates (8 vancomycin-lock group, 18 control group) had at the end of a catheter-lock period asymptomatic hypoglycemia that resolved promptly when glucose-containing intravenous fluids were restarted. Prophylactic use of a vancomycin-heparin lock solution markedly reduced the incidence of CRBSI in high

  5. A comparative study of two techniques (electrocardiogram- and landmark-guided) for correct depth of the central venous catheter placement in paediatric patients undergoing elective cardiovascular surgery

    PubMed Central

    Barnwal, Neeraj Kumar; Dave, Sona T; Dias, Raylene

    2016-01-01

    Background and Aims: The complications of central venous catheterisation can be minimized by ensuring catheter tip placement just above the superior vena cava-right atrium junction. We aimed to compare two methods, using an electrocardiogram (ECG) or landmark as guides, for assessing correct depth of central venous catheter (CVC) placement. Methods: In a prospective randomised study of sixty patients of <12 years of age, thirty patients each were allotted randomly to two groups (ECG and landmark). After induction, central venous catheterisation was performed by either of the two techniques and position of CVC tip was compared in post-operative chest X-ray with respect to carina. Unpaired t-test was used for quantitative data and Chi-square test was used for qualitative data. Results: In ECG group, positions of CVC tip were above carina in 12, at carina in 9 and below carina in 9 patients. In landmark group, the positions of CVC tips were above carina in 10, at carina in 4 and below carina in 16 patients. Mean distance of CVC tip in ECG group was 0.34 ± 0.23 cm and 0.66 ± 0.35 cm in landmark group (P = 0.0001). Complications occurred in one patient in ECG group and in nine patients in landmark group (P = 0.0056). Conclusion: Overall, landmark-guided technique was comparable with ECG technique. ECG-guided technique was more precise for CVC tip placement closer to carina. The incidence of complications was more in the landmark group. PMID:27512162

  6. Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer.

    PubMed

    Millar, M; Zhou, W; Skinner, R; Pizer, B; Hennessy, E; Wilks, M; Gilbert, R E

    2011-02-01

    Central venous catheters (CVCs) are widely used for children with cancer and are a major risk factor for bloodstream infection. Early and specific diagnosis of CVC-associated bloodstream infection allows early targeted treatment, reducing the risk of CVC removal and avoiding the operative risks and trauma of reinsertion, but peripheral vein sampling, as used in adults, improves specificity but is not usually acceptable in children. To improve the detection and treatment of CVC-associated bloodstream infection in children (aged 0-18 years) with cancer admitted with fever. There were four main studies: (1) evaluation of the diagnostic accuracy of a quantitative molecular method for the detection of bacterial deoxyribonucleic acid (DNA), based solely on blood samples drawn through the CVC; (2) analysis of the prognostic risk of CVC removal and duration of intravenous (i.v.) antibiotic treatment days in relation to presenting clinical features, blood culture results and bacterial DNA test results; (3) systematic reviews of treatment options for CVC-associated infection and a questionnaire survey of current practice in paediatric oncology centres; (4) evaluation of the clinical effectiveness of different test-treatment strategies to reduce i.v. antibiotic treatment days and unnecessary CVC removals. (1) The bacterial DNA test detected two-thirds [95% confidence interval (CI) 44% to 83%] of children classified with probable CVC-associated infection - specificity was 88% (95% CI 84% to 92%). Although high bacterial DNA concentrations were associated with subsequent CVC removal and long duration of i.v. antibiotic treatment, the test did not improve the prediction of these outcomes over and above clinical signs of CVC-associated infection combined with blood culture results. (2) High DNA load was predictive of CVC removal and i.v. treatment duration, before blood culture results became available at 48 hours after sampling. (3) There was limited evidence that antibiotic

  7. Early thrombosis of the superior vena cava in a patient with a central venous catheter and carcinoma of the ampulla of Vater.

    PubMed

    Cannon, Robert; Shah, Malay; Suydam, Erin; Gucwa, Angela; Bowden, Talmadge; Holsten, Steven B

    2008-12-01

    Superior vena cava syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology. Thrombosis of the vessel most often occurs in the setting of indwelling catheters or pacemakers. The diagnosis is suggested by the clinical manifestations of facial and upper extremity swelling, dyspnea, and cough. It is confirmed by CT scan showing the development of collateral flow around the lesion. In this report, we present a patient who developed superior vena cava thrombosis after undergoing a short period of central venous catheterization and a Whipple procedure for adenocarcinoma of the ampulla of Vater. The endothelial damage caused by the catheter, the low-flow state induced by the large fluid shifts during the operation, and the hypercoagulable state induced by malignancy fulfill Virchow's triad for venous thrombosis. To our knowledge, this is the first reported case of superior vena cava syndrome after the Whipple procedure with symptoms appearing after a shorter period of catheterization than previously reported in the adult literature.

  8. [Suppurative thrombophlebitis central venous catheterization].

    PubMed

    Ramos Martínez, A; Sánchez Romero, I; Saura Lorente, P A; Parajón Díaz, A

    2008-06-01

    Suppurative thrombophlebitisis a very infrequent complication of the central venous catheterization. The majority of the cases are produced by species of staphylococci. A 22-year-old colombian-woman, student, without toxic habits was admitted because of temporary left astrocytoma (grade II). Nine days after implementing a catheter in the right subclavian vein she presented high fever (39.5 degrees C), shivers, progressive right side neck swelling and odinofagia. She had leukocytosis (26,300 cells/microl) and normal cerebrospinal fluid. After withdrawing the catheter, Staphylococcus aureus was isolated in the tip of the catheter and in four bottles of blood cultures. A neck CT demonstrated expansion and absence of contrast in the right internal jugular vein. The patient evolved satisfactorily with cloxacillin, gentamycin and low molecular weight heparin.

  9. [Femoral venous catheter: an unusual complication].

    PubMed

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

  10. Development of X-ray micro-focus computed tomography to image and quantify biofilms in central venous catheter models in vitro.

    PubMed

    Niehaus, Wilmari L; Howlin, Robert P; Johnston, David A; Bull, Daniel J; Jones, Gareth L; Calton, Elizabeth; Mavrogordato, Mark N; Clarke, Stuart C; Thurner, Philipp J; Faust, Saul N; Stoodley, Paul

    2016-12-30

    Bacterial infections of central venous catheters (CVCs) cause much morbidity and mortality, and are usually diagnosed by concordant culture of blood and catheter tip. However, studies suggest that culture often fails to detect biofilm bacteria. This study optimizes X-ray micro-focus computed tomography (X-ray µCT) for the quantification and determination of distribution and heterogeneity of biofilms in in vitro CVC model systems. Bacterial culture and scanning electron microscopy (SEM) were used to detect Staphylococcus epidermidis ATCC 35984 biofilms grown on catheters in vitro in both flow and static biofilm models. Alongside this, X-ray µCT techniques were developed in order to detect biofilms inside CVCs. Various contrast agent stains were evaluated using energy-dispersive X-ray spectroscopy (EDS) to further optimize these methods. Catheter material and biofilm were segmented using a semi-automated matlab script and quantified using the Avizo Fire software package. X-ray µCT was capable of distinguishing between the degree of biofilm formation across different segments of a CVC flow model. EDS screening of single- and dual-compound contrast stains identified 10 nm gold and silver nitrate as the optimum contrast agent for X-ray µCT. This optimized method was then demonstrated to be capable of quantifying biofilms in an in vitro static biofilm formation model, with a strong correlation between biofilm detection via SEM and culture. X-ray µCT has good potential as a direct, non-invasive, non-destructive technology to image biofilms in CVCs, as well as other in vivo medical components in which biofilms accumulate in concealed areas.

  11. Development of X-ray micro-focus computed tomography to image and quantify biofilms in central venous catheter models in vitro.

    PubMed

    Niehaus, Wilmari L; Howlin, Robert P; Johnston, David A; Bull, Daniel J; Jones, Gareth L; Calton, Elizabeth; Mavrogordato, Mark N; Clarke, Stuart C; Thurner, Philipp J; Faust, Saul N; Stoodley, Paul

    2016-09-01

    Bacterial infections of central venous catheters (CVCs) cause much morbidity and mortality, and are usually diagnosed by concordant culture of blood and catheter tip. However, studies suggest that culture often fails to detect biofilm bacteria. This study optimizes X-ray micro-focus computed tomography (X-ray µCT) for the quantification and determination of distribution and heterogeneity of biofilms in in vitro CVC model systems.Bacterial culture and scanning electron microscopy (SEM) were used to detect Staphylococcus epidermidis ATCC 35984 biofilms grown on catheters in vitro in both flow and static biofilm models. Alongside this, X-ray µCT techniques were developed in order to detect biofilms inside CVCs. Various contrast agent stains were evaluated using energy-dispersive X-ray spectroscopy (EDS) to further optimize these methods. Catheter material and biofilm were segmented using a semi-automated matlab script and quantified using the Avizo Fire software package. X-ray µCT was capable of distinguishing between the degree of biofilm formation across different segments of a CVC flow model. EDS screening of single- and dual-compound contrast stains identified 10 nm gold and silver nitrate as the optimum contrast agent for X-ray µCT. This optimized method was then demonstrated to be capable of quantifying biofilms in an in vitro static biofilm formation model, with a strong correlation between biofilm detection via SEM and culture. X-ray µCT has good potential as a direct, non-invasive, non-destructive technology to image biofilms in CVCs, as well as other in vivo medical components in which biofilms accumulate in concealed areas.

  12. Comparison of methods and formulas used in umbilical venous catheter placement

    PubMed Central

    Mutlu, Mehmet; Parıltan, Burcu Küçükalioğlu; Aslan, Yakup; Eyüpoğlu, İlker; Kader, Şebnem; Aktürk, Filiz Acar

    2017-01-01

    Aim Central venous access is frequently provided by way of umbilical venous catheter placement in critically ill newborns. This study compared the methods of Dunn, Shukla-Ferrara, and Revised Shukla-Ferrara in determining the appropriate insertion length of umbilical vein catheters. Material and Methods This prospective observational study was carried out in 121 newborns with umbilical venous catheter, group 1 (n=41) used Dunn method, group 2 (n=40) used the Shukla-Ferrara formula, and group 3 used revised Shukla-Ferrara formula (n=40). Catheter tip position was evaluated with an anterior-posterior chest radiograph after insertion of the umbilical venous catheter. The ideal position for the umbilical venous catheter was defined as the catheter tip being visible between the 9th and 10th thoracic vertebrae on an anterior-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9th thoracic vertebra and too low if the tip was below the 10th thoracic vertebra. The following data were collected: appropriate, inappropriate (low, high) placement, and complications of umbilical venous catheterization. Results In the Shukla-Ferrara group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position, compared with 40% (12/30) in the revised Shukla-Ferrara group and 38% (11/29) in the Dunn method group. Umbilical venous catheter-related complications developed in two patients, thrombus in one, and catheter-related blood stream infection in the other. Conclusions This study showed that the Shukla-Ferrara formula is more accurate in predicting the insertion length for umbilical venous catheters, though statistical significance was not found. Further studies with larger samples are needed on this topic. PMID:28439199

  13. Comparison of methods and formulas used in umbilical venous catheter placement.

    PubMed

    Mutlu, Mehmet; Parıltan, Burcu Küçükalioğlu; Aslan, Yakup; Eyüpoğlu, İlker; Kader, Şebnem; Aktürk, Filiz Acar

    2017-03-01

    Central venous access is frequently provided by way of umbilical venous catheter placement in critically ill newborns. This study compared the methods of Dunn, Shukla-Ferrara, and Revised Shukla-Ferrara in determining the appropriate insertion length of umbilical vein catheters. This prospective observational study was carried out in 121 newborns with umbilical venous catheter, group 1 (n=41) used Dunn method, group 2 (n=40) used the Shukla-Ferrara formula, and group 3 used revised Shukla-Ferrara formula (n=40). Catheter tip position was evaluated with an anterior-posterior chest radiograph after insertion of the umbilical venous catheter. The ideal position for the umbilical venous catheter was defined as the catheter tip being visible between the 9(th) and 10(th) thoracic vertebrae on an anterior-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9(th) thoracic vertebra and too low if the tip was below the 10(th) thoracic vertebra. The following data were collected: appropriate, inappropriate (low, high) placement, and complications of umbilical venous catheterization. In the Shukla-Ferrara group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position, compared with 40% (12/30) in the revised Shukla-Ferrara group and 38% (11/29) in the Dunn method group. Umbilical venous catheter-related complications developed in two patients, thrombus in one, and catheter-related blood stream infection in the other. This study showed that the Shukla-Ferrara formula is more accurate in predicting the insertion length for umbilical venous catheters, though statistical significance was not found. Further studies with larger samples are needed on this topic.

  14. Central venous catheter-related bacteremia due to Tsukamurella species in the immunocompromised host: a case series and review of the literature.

    PubMed

    Schwartz, M A; Tabet, S R; Collier, A C; Wallis, C K; Carlson, L C; Nguyen, T T; Kattar, M M; Coyle, M B

    2002-10-01

    We report 6 cases of bacteremia due to Tsukamurella species, all of which were in immunosuppressed patients with indwelling central venous catheters (CVCs). Fewer than 20 cases of serious illness due to these gram-positive bacilli have been reported in the medical literature; these cases have mostly been ascribed to the species Tsukamurella paurometabola. Tsukamurella species are frequently misidentified as Rhodococcus or Corynebacterium species. We used high-performance liquid chromatography to identify these organisms to the genus level and 16S ribosomal RNA gene sequencing and DNA-DNA dot blots for species identification. Three of our isolates were identified as Tsukamurella pulmonis, 1 was identified as Tsukamurella tyrosinosolvans, and 1 was identified as a unique species. One isolate was not maintained long enough for species identification. All patients were successfully treated with antimicrobial therapy and CVC removal. Infection with this organism should be considered in the immunosuppressed patient with an indwelling CVC and gram-positive bacilli in the blood.

  15. Perforation of the superior vena cava 5 days after insertion of a central venous catheter through the left internal jugular vein.

    PubMed

    Kurabe, Miyuki; Watanabe, Tatsunori; Kohno, Tatsuro

    2016-06-01

    We describe a very rare case of an indwelling central venous catheter (CVC) through the left internal jugular vein that perforated the superior vena cava (SVC) wall postoperatively, although the CVC was placed in the appropriate position preoperatively. Three days after CVC insertion, a chest radiograph showed that the CVC tip had moved from the lower SVC to the upper SVC. Five days after the insertion, computed tomography showed SVC perforation and the resulting hydrothorax. In cases of CVC insertion through the left side, the CVC tip should not be placed in the upper SVC (zone B). Considering individual clinical factors and the indwelling period for the CVC, the left innominate vein (zone C) may be a suitable site for the left-sided CVC tip to reduce the risk of SVC perforation.

  16. Management of central venous catheters in pediatric onco-hematology using 0.9% sodium chloride and positive-pressure-valve needleless connector.

    PubMed

    Buchini, Sara; Scarsini, Sara; Montico, Marcella; Buzzetti, Roberto; Ronfani, Luca; Decorti, Cinzia

    2014-08-01

    To describe, in a sample of pediatric onco-hematological patients, the rate of occlusions in unused central venous catheters (CVC) flushed once a week with a 0.9% sodium chloride solution through a positive-pressure-valve needleless connector. Retrospective cohort study. Subjects aged 0-17 years were identified through a manual search in medical and nursing records and were observed for two years or until the occurrence of one of the following events: start or resume of continuous infusion; CVC removal; death. The primary study outcome was the frequency of CVC occlusion (partial or complete). Fifty-one patients were identified (median age 6 years). The median duration of follow-up was 169 days (IQR 111-305). During the follow up period, 14 patients (27%) had one CVC occlusion, in 2 cases (4%) the occlusion was complete, in 12 (23%) partial. All the occlusions were solved without the need for catheter removal. The lumen diameter ≤ 4.2 vs > 4.2 French showed a statistically significant association with occlusion at multivariate analysis (OR 4.0; 95% CI 1.1-14.7). Our findings are reassuring with respect to the management of the CVC using the adopted protocol. The study provides useful information for patient care, by verifying the performance of the adopted CVC management protocol and by identifying critical areas for nursing care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

    PubMed Central

    2012-01-01

    Background Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. Methods A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Results Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (p<0.001) and to have a higher frequency of diabetes mellitus (p = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (p<0.001) and hospital admissions (p<0.001). At the end of follow-up, HD-TCC patients had a higher rate of dialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; p<0.001) and hospitalizations (0.47 vs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (p<0.001). In multivariate analysis, HD-TCC use at the time of dialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024). Conclusion Our results suggest that HD

  18. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study.

    PubMed

    Coentrão, Luis; Santos-Araújo, Carla; Dias, Claudia; Neto, Ricardo; Pestana, Manuel

    2012-08-23

    Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation. A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC. Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (p<0.001) and to have a higher frequency of diabetes mellitus (p = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (p<0.001) and hospital admissions (p<0.001). At the end of follow-up, HD-TCC patients had a higher rate of dialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; p<0.001) and hospitalizations (0.47 vs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (p<0.001). In multivariate analysis, HD-TCC use at the time of dialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024). Our results suggest that HD vascular access type at the time of renal replacement therapy initiation

  19. [Umbilical and peripherally inserted venous central catheterization of the newborn].

    PubMed

    Bouissou, A; Rakza, T; Storme, L; Lafarghe, A; Fily, A; Diependaele, J-F; Dalmas, S

    2008-09-01

    Umbilical venous and peripherally inserted venous central catheters are widely used to perfuse low-weight preterm and term newborns in intensive care units. This catheter must be inserted carefully and monitored rigorously to prevent complications. This paper develops today's knowledge on the use and complications in the newborn population.

  20. [Central venous catheterization--experiences in neonatal intensive medicine based on scanning electron microscopy study of Silastic catheters].

    PubMed

    Kerstan, J; Lenz, W; el-Hamid, S

    1985-01-01

    This article deals with the use of 56 silastic-catheters in the intensive care of premature and new-born with mean weights of 1550 g according to the Shaw-method. The clinical use with regard to early and late complications was studied by means of scanning electron microscopy of 11 catheters. The results were compared with the complications associated with PVC-catheters. The silastic-catheters has the following advantages: over a longer period it does not lose its mechanical properties, it is athrombogenic and has only few complications regarding infection and thrombosis. Local reactions cannot, however be eliminated. We can extend the use of silastic-catheters by giving blood, drugs and by taking blood samples, by this way intensive care of the new-born is less stressful.

  1. A rare malposition of the thoracic venous catheter introduced via the left internal jugular vein

    PubMed Central

    Ghosh, Supradip; Dewan, Himanshu; Bhattacharyya, Sandip

    2008-01-01

    A rare malposition of central venous catheter in the left superior intercostal vein is described. The diagnostic features and the possible ways to prevent this complication are discussed. PMID:19742265

  2. Contralateral effusions secondary to subclavian venous catheters. Report of two cases.

    PubMed

    Ciment, L M; Rotbart, A; Galbut, R N

    1983-06-01

    Two cases of contralateral pleural effusions due to indwelling central venous catheters are presented. Radiographic contrast studies were performed to elucidate diagnosis and to define the mechanism of this complication; mediastinal leakage was documented in one case.

  3. Time-to-reporting of blood culture positivity and central venous catheter-associated Candida glabrata fungemia in cancer patients.

    PubMed

    Stempel, Jessica M; Farmakiotis, Dimitrios; Tarrand, Jeffrey J; Kontoyiannis, Dimitrios P

    2016-07-01

    Among cancer patients with Candida glabrata (the Candida species with the slowest in-vitro growth) fungemia, time-to-positive blood culture reporting (TTR) was shorter in catheter-associated candidemia (mean±standard deviation: 67±35 h) than in candidemia from other sources (79±31, P<.01). TTR<48 h was 92% specific for catheter-associated C. glabrata fungemia. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Prediction of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS).

    PubMed

    Schalk, Enrico; Hanus, Lynn; Färber, Jacqueline; Fischer, Thomas; Heidel, Florian H

    2015-09-01

    The aim of this study was to predict the probability of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified version of the Infection Probability Score (mIPS). In order to perform a prospective, mono-centric surveillance of complications in clinical routine due to short-term central venous catheters (CVCs) in consecutive patients receiving chemotherapy from March 2013 to September 2014, IPS was calculated at CVC insertion and removal (mIPSin and mIPSex, respectively). We used the 2012 Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology (AGIHO/DGHO) criteria to define CRBSI. In total, 143 patients (mean 59.5 years, 61.4 % male) with 267 triple-lumen CVCs (4044 CVC days; mean 15.1 days, range 1-60 days) were analysed. CVCs were inserted for therapy of acute leukaemia (53.2 %), multiple myeloma (24.3 %) or lymphoma (11.2 %), and 93.6 % were inserted in the jugular vein. A total of 66 CRBSI cases (24.7 %) were documented (12 definite/13 probable/41 possible). The incidence was 16.3/1000 CVC days (2.9/3.1/10.1 per 1000 CVC days for definite/probable/possible CRBSI, respectively). In CRBSI cases, the mIPSex was higher as compared to cases without CRBSI (13.1 vs. 7.1; p < 0.001). The best mIPSex cutoff for CRBSI prediction was 8 points (area under the curve (AUC) = 0.77; sensitivity = 84.9 %, specificity = 60.7 %, negative predictive value = 92.4 %). For patients with an mIPSex ≥8, the risk for a CRBSI was high (odds ratio [OR] = 5.9; p < 0.001) and even increased if, additionally, CVC had been in use for about 10 days (OR = 9.8; p < 0.001). In case other causes of infection are excluded, a mIPSex ≥8 and duration of CVC use of about 10 days predict a very high risk of CRBSI. Patients with a mIPSex <8 have a low risk of CRBSI of 8 %.

  5. Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

    PubMed Central

    2011-01-01

    Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided. PMID:21864336

  6. C-arm Cone Beam Computed Tomographic Needle Path Overlay for Fluoroscopic-Guided Placement of Translumbar Central Venous Catheters

    SciTech Connect

    Tam, Alda; Mohamed, Ashraf; Pfister, Marcus; Rohm, Esther; Wallace, Michael J.

    2009-07-15

    C-arm cone beam computed tomography is an advanced 3D imaging technology that is currently available on state-of-the-art flat-panel-based angiography systems. The overlay of cross-sectional imaging information can now be integrated with real-time fluoroscopy. This overlay technology was used to guide the placement of three percutaneous translumbar inferior vena cava catheters.

  7. Rifampicin-miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy.

    PubMed

    Lorente, L; Lecuona, M; Ramos, M J; Jiménez, A; Mora, M L; Sierra, A

    2012-08-01

    Antimicrobial-impregnated catheters are more expensive than standard catheters (S-C). A higher incidence of catheter-related bloodstream infection (CRBSI) has been found in jugular venous access with tracheostomy than without tracheostomy. The objective of this study was to determine central venous catheter (CVC)-related costs (considering only the cost of the CVC, diagnosis of CRBSI, and antimicrobial agents used to treat CRBSI) using rifampicin-miconazole-impregnated catheters (RM-C) or S-C in jugular venous access with tracheostomy. We performed a retrospective cohort study of patients admitted to the intensive care unit (ICU) with tracheostomy who received one or more jugular venous catheters. RM-C showed a lower incidence of CRBSI compared with S-C (0 vs. 20.16 CRBSI episodes/1,000 catheter-days; odds ratio=0.05; 95% confidence interval=0.001-0.32; p<0.001) and lower CVC-related costs (including the cost of the CVC, diagnosis, and treatment of CRBSI) (11.46 ± 6.25 vs. 38.11 ± 77.25; p<0.001) in jugular venous access with tracheostomy. The use of RM-C could reduce CVC-related costs in jugular venous access with tracheostomy. The results of our study may contribute to clinical decision-making and selection of those patients who could benefit from the use of antimicrobial-impregnated catheters.

  8. Sustained Nitric Oxide-Releasing Nanoparticles Interfere with Methicillin-Resistant Staphylococcus aureus Adhesion and Biofilm Formation in a Rat Central Venous Catheter Model.

    PubMed

    Mihu, Mircea Radu; Cabral, Vitor; Pattabhi, Rodney; Tar, Moses T; Davies, Kelvin P; Friedman, Adam J; Martinez, Luis R; Nosanchuk, Joshua D

    2017-01-01

    Staphylococcus aureus is frequently isolated in the setting of infections of indwelling medical devices, which are mediated by the microbe's ability to form biofilms on a variety of surfaces. Biofilm-embedded bacteria are more resistant to antimicrobial agents than their planktonic counterparts and often cause chronic infections and sepsis, particularly in patients with prolonged hospitalizations. In this study, we demonstrate that sustained nitric oxide-releasing nanoparticles (NO-np) interfere with S. aureus adhesion and prevent biofilm formation on a rat central venous catheter (CVC) model of infection. Confocal and scanning electron microscopy showed that NO-np-treated staphylococcal biofilms displayed considerably reduced thicknesses and bacterial numbers compared to those of control biofilms in vitro and in vivo, respectively. Although both phenotypes, planktonic and biofilm-associated staphylococci, of multiple clinical strains were susceptible to NO-np, bacteria within biofilms were more resistant to killing than their planktonic counterparts. Furthermore, chitosan, a biopolymer found in the exoskeleton of crustaceans and structurally integrated into the nanoparticles, seems to add considerable antimicrobial activity to the technology. Our findings suggest promising development and translational potential of NO-np for use as a prophylactic or therapeutic against bacterial biofilms on CVCs and other medical devices.

  9. Extravasation from venous catheter: a serious complication potentially missed by lung imaging

    SciTech Connect

    Spicer, K.M.; Gordon, L.

    1983-11-01

    Three patients were referred for lung ventiliation and perfusion (V/Q) imaging with symptoms strongly suggestive of pulmonary embolus (PE). Chest roentgenograms and xenon ventilation studies on all three were normal, save for prominent mediastinal silhouettes and effusions. Technetium-99m macroaggregated albumin(Tc-99m MAA), when injected through the central venous catheter (CVP), revealed mediastinal localization, whereas antecubital injections showed normal pulmonary perfusion. Contrast fluoroscopy introduced through the venous catheter in the first patient defined the extravasation. For patients under strong suspicion of PE, with a venous catheter whose distal tip is seen about the level of the heart on chest radiograph, the authors recommend administering the perfusion agent slowly through the central catheter to exclude catheter-induced complications. When extravasation is detected, injection of Tc-99m MAA by peripheral vein should be used to exclude PE.

  10. Central venous catheter-related infections in hematology and oncology : guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

    PubMed

    Wolf, Hans-Heinrich; Leithäuser, Malte; Maschmeyer, Georg; Salwender, Hans; Klein, Ulrike; Chaberny, Iris; Weissinger, Florian; Buchheidt, Dieter; Ruhnke, Markus; Egerer, Gerlinde; Cornely, Oliver; Fätkenheuer, Gerd; Mousset, Sabine

    2008-11-01

    Catheter-related infections (CRI) cause considerable morbidity in hospitalized patients. The incidence does not seem to be higher in neutropenic patients than in nonneutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the pathogens most frequently cultured, followed by Candida species. Positive blood cultures are the cornerstone in the diagnosis of CRIs, while local signs of infection are not necessarily present. Blood cultures should be taken from peripheral blood and from the venous catheter. A shorter time to positivity of catheter blood cultures as compared with peripheral blood cultures supports the diagnosis of a CRI. In many cases, a definite diagnosis requires catheter removal and microbiological analysis. The role plate method with semiquantitative cultures has been established as standard in most laboratories. Antimicrobial treatment of CRI should be directed by the in vitro susceptibility of the isolated pathogen. Primary removal of the catheter is mandatory in S. aureus and Candida infections, as well as in case of tunnel or pocket infections. Future studies will elucidate whether the rate of CRI in neutropenic patients may be reduced by catheters impregnated with antimicrobial agents.

  11. Pilot study evaluating the safety of a combined central venous catheter and inferior vena cava filter in critically ill patients at high risk of pulmonary embolism.

    PubMed

    Cadavid, Carlos A; Gil, Bladimir; Restrepo, Alvaro; Alvarez, Sergio; Echeverry, Santiago; Angel, Luis F; Tapson, Victor; Kaufman, John

    2013-04-01

    The objectives of this pilot trial were to assess the safety of a new device for pulmonary embolism (PE) prophylaxis. The device, the Angel Catheter, was placed in eight patients who were in the intensive care unit and were at high risk of PE. The device was inserted at the bedside without fluoroscopic guidance via a femoral venous approach. All eight devices were inserted and subsequently retrieved without complications (follow-up, 33-36 d). One filter trapped a large clot.

  12. Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis

    PubMed Central

    Chang, De-Hua; Mammadov, Kamal; Hickethier, Tilman; Borggrefe, Jan; Hellmich, Martin; Maintz, David; Kabbasch, Christoph

    2017-01-01

    Purpose Evaluation of the efficacy of single-shot, low-dose urokinase administration for the treatment of port catheter-associated fibrin sheaths. Methods Forty-six patients were retrospectively evaluated for 54 episodes of port catheter dysfunction. The presence of a fibrin sheath was detected by angiographic contrast examinations. On an outpatient basis, patients subsequently received thrombolysis consisting of a single injection of urokinase (15.000 IU in 1.5 mL normal saline) through the port system. A second attempt was made in cases of treatment failure. Patients were followed up for technical success, complications and long-term outcome. Results Port dysfunction occurred at a median of 117 days after implantation (range: 7–825 days). The technical success after first port dysfunction by thrombolysis was 87% (40/46); thereof, initial thrombolysis was effective in 78% (36/46). Nine patients (20%) received a second dose of urokinase after previous treatment failure. Follow-up was available for 26 of 40 patients after successful thrombolysis. In 8 of these, rethrombosis occurred after a median of 98 days (range: 21–354 days), whereby rethrombolysis was effective in 5 of 7 (63%) patients. The overall success of all thrombolyses performed was 70% (45/64). No procedure-related technical or clinical complications occurred. After first favorable thrombolysis, a Kaplan–Meier analysis yielded a 30-, 90- and 180-day probability of patency of 96%, 87% and 81%. Conclusion Thrombolytic therapy on an outpatient basis appears to be a safe and efficient. Three-month patency rates are comparable to more invasive treatment options, including catheter exchange over a guide wire and percutaneous fibrin sheath stripping. PMID:28182117

  13. [Project work: formation of health-care personnel for self-care of tunnelled central venous catheters in hemodialysis patients of the territory].

    PubMed

    Morale, Walter; Patanè, D; Incardona, C; Seminara, G; Malfa, P; L'Anfusa, G; Calcara, G; Bisceglie, P; Puliatti, D; Di Landro, D

    2013-01-01

    Scientific data from current literature demonstrate an incidence of bacteraemia due to tunnelled central venous catheter (tCVC) use accounting for 1.6 / 1000 days per tCVC, with a range of 1.5 to 1.8. In Sicily no data on the incidence of tCVC- related bacteraemia are available. In our hospital, tCVC infection occurs 2.4 times in 1000 days during CVC use. A retrospective analysis carried out from 2006 to 2012 was performed on 650 patients with tunnelled catheters. Of the subjects who received tCVC in our hospital, 90% were destined to undergo haemodialysis in a private health care environment outside our hospital. In order to improve the aforementioned infection outcome, we planned and implemented a specific work project. The work project (WP) was subdivided into two steps: 1) The first step was further subdivided into two sub-phases. The first was principally concerned with the implementation of educational courses, conducted directly on the ward and aimed at the implementation of meticulous nursing regimes for the care of tCVC by our health care nurse. The courses were entitled Management of Vascular Access: from doing - to teaching to do!. These educational courses were organized by the Nephrology Department, which takes care of the management and handling of the major complications of tCVCs for the maintenance of haemodialysis. After this first step, the nurses who had participated became the promoters of the second part of the course, which concerned the development of know-how within an outpatient clinic, which deals exclusively with the nursing management of tCVCs. 2) The title of the second phase was Therapeutic Education: self-Care and understanding and managing your venous access at home. The aim of this step was the integration of correct in-hospital care with that available in outsourced private institutions, via the involvement of the patient in the management of their own central venous access. During our training project, a more detailed analysis of

  14. [The meaningfulness of central venous blood samples. Central venous versus mixed venous O2 status].

    PubMed

    Brandt, L; Mertzlufft, F

    1991-03-01

    Both mixed-venous and "central-venous" oxygen status (O2 partial pressure [pO2], O2 saturation [sO2], O2 concentration [cO2], hemoglobin concentration [cHb]) are often considered to adequately represent total-body oxygen supply. Since modern technology has made continuously in vivo measurement possible, mixed-venous O2 saturation (svO2) and partial O2 saturation (psO2) have become extensively used for that purpose. Both venous sites of measurement are used as diagnostic adjuncts regarding hemodynamic status. However, both are associated with certain problems. There is a lack of any clear definition of a "central-venous" site of the catheter tip (right atrium, superior vena cava, inferior vena cava). Instead, the location of the catheter tip depends upon the approach to the central venous system. One must also be aware of significant migrational tendencies of the catheter tip. Thus, "central-venous" samples can only represent the situation in a single portion of the circulation, whereas the respective organ areas may vary considerably with the same catheter from one time point to another. Furthermore, the state of the coronary circulation never can be evaluated. The frequently postulated correlation of mixed-venous and "central-venous" values decreases with increasing deterioration of the cardiovascular system, especially in patients with high cardiovascular risks. The main overall parameters of mixed-venous oxygen status are oxygen content (cvO2), cardiac output (C.O.), and oxygen consumption (QO2) of the tissues. The relation between arterial and mixed-venous O2 status is given by Fick's principle: caO2-cvO2 = QO2/C.O. From this, it becomes obvious that a relation between cvO2 and C.O. may only be presumed if QO2 and caO2 remain constant. Evaluation of O2 availability (AO2) using cvO2 or the determining components of cvO2 seems reasonable only if the modulating influences of C.O. and QO2 are taken into consideration. Therefore, any empirically deduced relation

  15. Microbial Biofilms on Needleless Connectors for Central Venous Catheters: Comparison of Standard and Silver-Coated Devices Collected from Patients in an Acute Care Hospital

    PubMed Central

    Perez, Elizabeth; Williams, Margaret; Jacob, Jesse T.; Reyes, Mary Dent; Chernetsky Tejedor, Sheri; Steinberg, James P.; Rowe, Lori; Ganakammal, Satishkumar Ranganathan; Changayil, Shankar; Weil, M. Ryan

    2014-01-01

    Microorganisms may colonize needleless connectors (NCs) on intravascular catheters, forming biofilms and predisposing patients to catheter-associated infection (CAI). Standard and silver-coated NCs were collected from catheterized intensive care unit patients to characterize biofilm formation using culture-dependent and culture-independent methods and to investigate the associations between NC usage and biofilm characteristics. Viable microorganisms were detected by plate counts from 46% of standard NCs and 59% of silver-coated NCs (P = 0.11). There were no significant associations (P > 0.05, chi-square test) between catheter type, side of catheter placement, number of catheter lumens, site of catheter placement, or NC placement duration and positive NC findings. There was an association (P = 0.04, chi-square test) between infusion type and positive findings for standard NCs. Viable microorganisms exhibiting intracellular esterase activity were detected on >90% of both NC types (P = 0.751), suggesting that a large percentage of organisms were not culturable using the conditions provided in this study. Amplification of the 16S rRNA gene from selected NCs provided a substantially larger number of operational taxonomic units per NC than did plate counts (26 to 43 versus 1 to 4 operational taxonomic units/NC, respectively), suggesting that culture-dependent methods may substantially underestimate microbial diversity on NCs. NC bacterial communities were clustered by patient and venous access type and may reflect the composition of the patient's local microbiome but also may contain organisms from the health care environment. NCs provide a portal of entry for a wide diversity of opportunistic pathogens to colonize the catheter lumen, forming a biofilm and increasing the potential for CAI, highlighting the importance of catheter maintenance practices to reduce microbial contamination. PMID:24371233

  16. Microbial biofilms on needleless connectors for central venous catheters: comparison of standard and silver-coated devices collected from patients in an acute care hospital.

    PubMed

    Perez, Elizabeth; Williams, Margaret; Jacob, Jesse T; Reyes, Mary Dent; Chernetsky Tejedor, Sheri; Steinberg, James P; Rowe, Lori; Ganakammal, Satishkumar Ranganathan; Changayil, Shankar; Weil, M Ryan; Donlan, Rodney M

    2014-03-01

    Microorganisms may colonize needleless connectors (NCs) on intravascular catheters, forming biofilms and predisposing patients to catheter-associated infection (CAI). Standard and silver-coated NCs were collected from catheterized intensive care unit patients to characterize biofilm formation using culture-dependent and culture-independent methods and to investigate the associations between NC usage and biofilm characteristics. Viable microorganisms were detected by plate counts from 46% of standard NCs and 59% of silver-coated NCs (P=0.11). There were no significant associations (P>0.05, chi-square test) between catheter type, side of catheter placement, number of catheter lumens, site of catheter placement, or NC placement duration and positive NC findings. There was an association (P=0.04, chi-square test) between infusion type and positive findings for standard NCs. Viable microorganisms exhibiting intracellular esterase activity were detected on >90% of both NC types (P=0.751), suggesting that a large percentage of organisms were not culturable using the conditions provided in this study. Amplification of the 16S rRNA gene from selected NCs provided a substantially larger number of operational taxonomic units per NC than did plate counts (26 to 43 versus 1 to 4 operational taxonomic units/NC, respectively), suggesting that culture-dependent methods may substantially underestimate microbial diversity on NCs. NC bacterial communities were clustered by patient and venous access type and may reflect the composition of the patient's local microbiome but also may contain organisms from the health care environment. NCs provide a portal of entry for a wide diversity of opportunistic pathogens to colonize the catheter lumen, forming a biofilm and increasing the potential for CAI, highlighting the importance of catheter maintenance practices to reduce microbial contamination.

  17. Comparison of heparin to citrate as a catheter locking solution for non-tunneled central venous hemodialysis catheters in patients requiring renal replacement therapy for acute renal failure (VERROU-REA study): study protocol for a randomized controlled trial.

    PubMed

    Bruyère, Rémi; Soudry-Faure, Agnès; Capellier, Gilles; Binquet, Christine; Nadji, Abdelouaid; Torner, Stephane; Blasco, Gilles; Yannaraki, Maria; Barbar, Saber Davide; Quenot, Jean-Pierre

    2014-11-19

    The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters. We aim to compare citrate 4% catheter lock solution versus heparin in terms of event-free survival of the first non-tunneled hemodialysis catheter inserted in ICU patients with AKI requiring RRT. Secondary objectives are the rate of fibrinolysis, incidence of catheter thrombosis and catheter-related infection per 1,000 catheter days, length of stay in ICU and in-hospital and 28-day mortality. The VERROU-REA study is a randomized, prospective, multicenter, double-blind, parallel-group, controlled superiority study carried out in the medical, surgical and nephrological ICUs of two large university hospitals in eastern France. A catheter lock solution composed of trisodium citrate at 4% will be compared to unfractionated heparin at a concentration of 5,000 IU/mL. All consecutive adult patients with AKI requiring extracorporeal RRT, and in whom a first non-tunneled catheter is to be inserted by the jugular or femoral approach, will be eligible. Catheters inserted by the subclavian approach, patients with acute liver failure, thrombopenia or contraindication to systemic anticoagulation will be excluded. Patients will be followed up daily in accordance with standard practices for RRT until death or discharge. Data is scarce regarding the use of non-tunneled catheters in the ICU setting in patients with AKI. This study will provide an evidence base for

  18. Long-axis view for ultrasound-guided central venous catheter placement via the internal jugular vein

    PubMed Central

    Mahan, Angel F.; McEvoy, Matthew D.; Gravenstein, Nikolaus

    2016-01-01

    Background In modern practice, real-time ultrasound guidance is commonly employed for the placement of internal jugular vein catheters. With a new tool, such as ultrasound, comes the opportunity to refine and further optimize the ultrasound view during jugular vein catheterization. We describe jugular vein access techniques and use the long-axis view as an alternative to the commonly employed short-axis cross-section view for internal jugular vein access and cannulation. Conclusion The long-axis ultrasound-guided internal jugular vein approach for internal jugular vein cannulation is a useful alternative technique that can provide better needle tip and guidewire visualization than the more traditional short-axis ultrasound view. PMID:28913474

  19. Anatomic considerations for central venous cannulation

    PubMed Central

    Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela

    2011-01-01

    Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225

  20. Catheter embolization from implanted venous access devices: case reports.

    PubMed

    Carr, M E

    1989-04-01

    Two cases of catheter embolization from implanted venous access devices are reported and the available literature is reviewed. The catheter from an implanted venous access device migrated into the right heart after slippage of the O-ring, which attaches the catheter to the infusion port. The distal 6 cm of an infusion port catheter embolized to the right heart after spontaneous fracture of the catheter at the point where it passed between the clavicle and first rib. Both catheters were removed percutaneously without complication. Risk factors for embolization were apparent on x-ray films with evidence of O-ring slippage in 1 case an obvious kinking of the catheter in the other. Symptoms of embolization included chest discomfort, right upper quadrant pain, and nausea. In 1 case, an extra heart sound, initially thought to be an S3, disappeared when the catheter was removed.

  1. [Cardiac tamponade after withdrawal of a peripheral access central catheter].

    PubMed

    García-Galiana, E; Sanchis-Gil, V; Martínez-Navarrete, M Á

    2015-03-01

    Central venous catheterization is a very common technique, although its complications can be multiple and sometimes fatal. A case is presented of cardiac tamponade by parenteral nutrition a few hours after moving a central venous catheter peripherally inserted a few days before. The diagnosis was made by echocardiography, and an emergency pericardiocentesis was performed, achieving complete recovery of the patient. Peripherally inserted central venous catheters are more likely to change their position secondary to the movements of the patient's arm, thus it is important to use soft catheters, make sure the tip lies above the carina to avoid perforation of the pericardial reflexion, and fix it well to the skin. Diagnosis must be made as soon as possible, given the high mortality rate of this complication, and the essential diagnostic tool is echocardiography. Elective treatment consists of early catheter withdrawal and emergency pericardiocentesis.

  2. Analysis of different genetic traits and their association with biofilm formation in Staphylococcus epidermidis isolates from central venous catheter infections.

    PubMed

    Petrelli, D; Zampaloni, C; D'Ercole, S; Prenna, M; Ballarini, P; Ripa, S; Vitali, L A

    2006-12-01

    The aim of the present study was to characterize clinical isolates of Staphylococcus epidermidis, one of the bacterial species most often implicated in foreign-body-associated infections, for their ability to form biofilms and for the presence of mecA and IS256 element. Sixty-seven Staphylococcus epidermidis clinical isolates, obtained from implantable medical devices, were investigated. Overall, 70% of the strains were positive for ica operon genes, 85% possessed atlE, and 46% contained aap. In 89% of the population, the Congo red agar test confirmed the correlation between the presence of ica genes and slime expression. Almost all of the strains could be classified as biofilm producers by both the crystal violet assay and microscopy. The bacterial population studied showed a very high frequency of strains positive for mecA as well as for the IS256 element. Although well-structured biofilms have been previously observed only in those strains possessing genes belonging to the ica operon, this study demonstrates that strains lacking specific biofilm-formation determinants can be isolated from catheters and can form a biofilm in vitro. Hence, different and yet-to-be identified factors may work together in the formation and organization of complex staphylococcal microbial communities and sustain infections associated with implanted medical devices.

  3. Are early cannulation arteriovenous grafts (ecAVG) a viable alternative to tunnelled central venous catheters (TCVCs)? An observational "virtual study" and budget impact analysis.

    PubMed

    Aitken, Emma; Iqbal, Kashfa; Thomson, Peter; Kasthuri, Ram; Kingsmore, David

    2016-05-07

    Early cannulation arteriovenous grafts (ecAVGs) are advocated as an alternative to tunnelled central venous catheters (TCVCs). A real-time observational "virtual study" and budget impact model was performed to evaluate a strategy of ecAVG as a replacement to TCVC as a bridge to definitive access creation. Data on complications and access-related bed days was collected prospectively for all TCVCs inserted over a six-month period (n = 101). The feasibility and acceptability of an alternative strategy (ecAVGs) was also evaluated. A budget impact model comparing the two strategies was performed. Autologous access in the form of native fistula was the goal wherever possible. We found 34.7% (n = 35) of TCVCs developed significant complications (including 17 culture-proven bacteraemia and one death from line sepsis). Patients spent an average of 11.9 days/patient/year in hospital as a result of access-related complications. The wait for TCVC insertion delayed discharge in 35 patients (median: 6 days). The ecAVGs were a practical and acceptable alternative to TCVCs in over 80% of patients. Over a 6-month period, total treatment costs per patient wereGBP5882 in the TCVC strategy and GBP4954 in the ecAVG strategy, delivering potential savings ofGBP927 per patient. The ecAVGs had higher procedure and re-intervention costs (GBP3014 vs. GBP1836); however, these were offset by significant reductions in septicaemia treatment costs (GBP1322 vs. GBP2176) and in-patient waiting time bed costs (GBP619 vs. GBP1870). Adopting ecAVGs as an alternative to TCVCs in patients requiring immediate access for haemodialysis may provide better individual patient care and deliver cost savings to the hospital.

  4. Eliminating guidewire retention during ultrasound guided central venous catheter insertion via an educational program, a modified CVC set, and a drape with reminder stickers.

    PubMed

    Peh, Wee Ming; Loh, Wann Jia; Phua, Ghee Chee; Loo, Chian Min

    2016-01-01

    Guidewire retention is a severe but preventable complication from central venous catheter (CVC) insertion. There were three cases of guidewire retention during CVC insertion in the medical intensive care unit (MICU) in Singapore General Hospital, in the period between December 2011 and February 2012. The primary objective of this quality improvement project was to eliminate future incidences of guidewire retention during CVC insertion in the MICU and medical intermediate care area (MICA) via a structured educational program and a cost effective modified CVC set. The secondary objective was to perform a cost analysis and comparison between the use of the conventional hospital CVC set and drape with our newly modified CVC dressing kit. Root cause analysis of the three cases identified major factors leading to guidewire retention. Interventions were planned and tested using PDSA cycles. Internal medicine trainees rotating through MICU and MICA during the period between February 2012 and June 2013 underwent a multi-modal structured CVC insertion training program with hands on simulation. They also used a newly modified CVC dressing kit and drape. The CVC dressing kit was modified (CVC PLUS) to include a sterile drape with reminder stickers stating "REMOVE the GUIDEWIRE," as well as a sterile ultrasound sleeve. The total number of CVC insertions performed and guidewire retentions were monitored. During the period of study there were 320 CVC insertions in the MICU and MICA. Since this quality improvement project was initiated, and up to the submission of this article, there have not been any further cases of guidewire retention in the MICU and MICA. The total cost reduction per use of CVC PLUS was S$29.26 (Singaporean Dollars). A multi-modal structured training program, integrated with a modified, pre-packed CVC set, and drapes with reminder stickers (all included in CVC PLUS) were cost effective, and improved patient safety by eliminating guidewire retention during CVC

  5. 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England.

    PubMed

    Bion, Julian; Richardson, Annette; Hibbert, Peter; Beer, Jeanette; Abrusci, Tracy; McCutcheon, Martin; Cassidy, Jane; Eddleston, Jane; Gunning, Kevin; Bellingan, Geoff; Patten, Mark; Harrison, David

    2013-02-01

    Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

  6. A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis.

    PubMed

    Aitken, Emma; Thomson, Peter; Bainbridge, Leigh; Kasthuri, Ram; Mohr, Belinda; Kingsmore, David

    2017-03-01

    Early cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunneled central venous catheters (TCVCs) in patients requiring immediate vascular access for hemodialysis (HD). We compared bacteremia rates in patients treated with ecAVG and TCVC. The study randomized 121 adult patients requiring urgent vascular access for HD in a 1:1 fashion to receive an ecAVG with or without (+/-) an arteriovenous fistula (AVF; n = 60) or TCVC+/-AVF (n = 61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels, or an anticipated life expectancy <3 months. The primary end point was the culture-proven bacteremia rate at 6 months, with the trial powered to detect a reduction in bacteremia from 24% to 5% (α = .05, β = .8). Secondary end points included thrombosis, reintervention, and mortality. A cost-effectiveness analysis was also performed. Culture-proven bacteremia developed in 10 patients (16.4%) in the TCVC arm ≤6 months compared with two (3.3%) in the ecAVG+/-AVF arm (risk ratio, 0.2; 95% confidence interval, 0.12-0.56; P = .02). Mortality was also higher in the TCVC+/-AVF cohort (16% [n = 10] vs 5% [n = 3]; risk ratio, 0.3; 95% CI, 0.08-0.45; P = .04). The difference in treatment cost between the two arms was not significant (£11,393 vs £9692; P = .24). Compared with TCVC+/-AVF, a strategy of ecAVG+/-AVF reduced the rate of culture-proven bacteremia and mortality in patients requiring urgent vascular access for HD. The strategy also proved to be cost-neutral. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  7. Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial.

    PubMed

    Chan, Raymond J; Northfield, Sarah; Larsen, Emily; Mihala, Gabor; Ullman, Amanda; Hancock, Peter; Marsh, Nicole; Gavin, Nicole; Wyld, David; Allworth, Anthony; Russell, Emily; Choudhury, Md Abu; Flynn, Julie; Rickard, Claire M

    2017-10-04

    Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a large RCT of four dressing and securement methods to prevent PICC failure. This single-centre pilot RCT included 124 admitted medical/surgical/cancer patients aged ≥ 16 years with a PICC. Interventions were: (i) standard polyurethane dressing and sutureless securement device (SPU + SSD, control); (ii) polyurethane with absorbent lattice pad dressing (PAL + Tape); (iii) combination securement-dressing (CSD); and (iv) tissue adhesive (TA + SPU). All groups except TA + SPU had a chlorhexidine-gluconate (CHG) impregnated disc. Feasibility outcomes were recruitment and safety/acceptability of the interventions. The primary outcome was PICC failure, a composite of PICC removal for local infection, catheter-associated bloodstream infection, dislodgement, occlusion, and/or catheter fracture. Secondary outcomes included individual complications, dressing failure and dwell time, PICC dwell time, skin complications/phlebitis indicators, product costs, and patient and staff satisfaction. Qualitative feedback was also collected. PICC failure incidence was: PAL + CHG + Tape (1/5; 20%; 17.4/1000 days), SPU + SSD + CHG (control) (4/39; 10%; 9.0/1000 days), TA + SPU (3/35; 9%; 9.6/1000 days), and CSD + CHG (3/42; 7%; 9.4/1000 days). Recruitment to PAL + CHG + Tape was ceased after five participants due to concerns of PICC dislodgement when removing the dressing. CSD + CHG, TA + SPU (TA applied only at PICC insertion time), and control treatments were acceptable to patients and health professionals. A large RCT of CSD + CHG and TA + SPU (but not PAL

  8. Deep venous thrombosis of the neck and pulmonary embolism in patients with a central venous catheter admitted to cardiac rehabilitation after cardiac surgery: a prospective study of 815 patients.

    PubMed

    Frizzelli, Rino; Tortelli, Ornella; Di Comite, Vincenzo; Ghirardi, Redenta; Pinzi, Claudio; Scarduelli, Cleante

    2008-12-01

    Central venous catheters (CVCs) are widely used for therapeutic purposes and to measure hemodynamic variables that cannot be recorded from a peripheral vein. However, the method can involve complications. In cardiac surgery, CVCs are electively placed in the right internal jugular vein but there is little information on deep venous thrombosis (DVT) in catheterized veins (CVC-related DVT) or on secondary pulmonary embolism (PE). The impact of CVC-related DVT and PE in cardiac surgery and measures to prevent PE were assessed. We used ultrasonography (US) to check the point of insertion of CVC in 815 patients in the intensive cardiac rehabilitation unit after heart surgery. In this series, 386 patients (48%) had CVC-related DVT; those already receiving anticoagulant, and considered at low risk, continued that therapy, while those taking an antiplatelet agent (aspirin 100 mg daily) but deemed at high risk of PE from the US findings were given an anticoagulant instead. Only patients with CVC-related DVT at low risk of PE continued taking aspirin. At 3 months, there were no cases of PE among patients receiving an anticoagulant, but six on antiplatelet had non-fatal PE. The prevalence of PE in the whole series of 815 patients was 0.7%. CVC-related DVT is a frequent complication of heart surgery. Anticoagulant therapy started early does not prevent thrombus formation but probably prevents PE, whereas antiplatelet gives no such protection. Sonographic screening of the CVC removal in intensive care unit may be useful for avoiding PE after CVC-related DVT.

  9. Central Venous Occlusion in the Hemodialysis Patient.

    PubMed

    Krishna, Vinay Narasimha; Eason, Joseph B; Allon, Michael

    2016-11-01

    Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS. Previously unsuspected CVS may become symptomatic after placement of an ipsilateral vascular access. The likelihood of symptomatic CVS may be affected by the central venous catheter (CVC) location; CVC side; duration of CVC dependence; type, location, and blood flow of the ipsilateral access; and extent of collateral veins. Venous angiography is the gold standard for diagnosis. Percutaneous transluminal angioplasty and stent placement can improve the stenosis and alleviate symptoms, but CVS typically recurs frequently, requiring repeated interventions. Refractory symptomatic CVS may require ligation of the ipsilateral vascular access. Because no available treatment option is curative, the goal should be to prevent CVS by minimizing catheters and central vein instrumentation in patients with chronic kidney disease and dialysis patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  10. Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic Patients with a Long-Term Central Venous Catheter.

    PubMed

    Martinez, Jose Manuel; Leite, Luís; França, Daniela; Capela, Rita; Viterbo, Luísa; Varajão, Natalina; Martins, Ângelo; Oliveira, Isabel; Domingues, Nélson; Moreira, Ilídia; Santo, Ana; Trigo, Filipe; Mariz, Jose

    2015-01-01

    Introdução: O objetivo deste estudo foi reduzir através de um pacote de medidas as infeções sistémicas e as taxas de infeções com origem no cateter venoso central nos doentes hematológicos em neutropenia com cateter venoso central de longa duração. Material e Métodos: Estudo prospetivo não randomizado realizado na unidade onco-hematológica do Instituto Português de Oncologia do Porto no período compreendido entre 1 de agosto de 2010 até 31 de janeiro de 2012. Durante este período foi introduzido um pacote de medidas (grupo estudo) e comparados os resultados nos 6 meses anteriores à sua implementação (grupo de controlo). As medidas consistiram na utilização de conectores de pressão neutra em detrimento dos conectores de pressão positiva, na sua troca mais frequente e numa solução anti-séptica mais eficaz. Foram incluídos neste estudo 116 doentes hematológicos com cateter venoso central de longa duração inserido por um período superior a 72 h. Foram contabilizados 8 867 dias de cateter (6 756 dias de cateter venoso central no grupo estudo e 2 111 dias de cateter venoso central no grupo de controlo). Resultados: Obteve-se uma redução significativa nas taxas de infeções sistémicas e infeções com origem no cateter venoso central. As taxas de infeções sistémicas: [32,69 (grupo de controlo) vs. 9,43 (grupo estudo)], com uma redução de incidência de 71% [risco relativo 0,2886, CI 95% (0,1793 - 0,4647), p < 0,001] e taxas de infeções com origem no cateter venoso central: [17,53 (grupo de controlo) vs. 4,73 (grupo estudo)], com redução de incidência de 71% [risco relativo 0,2936, CI 95% (0,1793 - 0,5615), p < 0,014]. Não foi encontrada diferença significativa (p > 0,05) na contagem de neutrófilos à data da colheita das amostras de hemoculturas entre ambos os grupos: 69% (< 500 neutrófilos/mm3) [71% (grupo estudo) vs. 68% (grupo de controlo)]. Conclusões: A introdução deste pacote de medidas baseado nas variáveis do

  11. Risk factors for central line-associated bloodstream infection in patients with major burns and the efficacy of the topical application of mupirocin at the central venous catheter exit site.

    PubMed

    Tao, Liju; Zhou, Junyi; Gong, Yali; Liu, Wen; Long, Ting; Huang, Xianhui; Luo, Gaoxing; Peng, Yizhi; Wu, Jun

    2015-12-01

    The aim of this study was to evaluate the efficacy of the topical administration of mupirocin and other practices in central venous catheter (CVC) care to prevent central line-associated bloodstream infections (CLABSI) in patients with major burns. Patients with major burns admitted to a burn ICU were divided into four groups and disinfected at the CVC exit site with single povidone iodine (PVP-I) or PVP-I plus topical mupirocin ointment three times a day or once a day, respectively. The bacterial colonization of the skin at the CVC exit site and CVC tips and the incidence of CLABSI were recorded, and the risk factors were analyzed. Administering mupirocin (RR=0.316, p=0.001), increasing the frequency of insertion-site care (RR=0.604, p=0.008), and avoiding cannulation at the burn site (RR=0.148, p<0.001) reduced skin colonization at the CVC insertion site. Topical administration of mupirocin significantly reduces both the bacterial colonization rate at CVC tips (RR=0.316, p=0.001) and the incidence of CLABSI (5.3 vs. 29.1 per 1000 catheter days, p<0.001). Mupirocin is effective in the prophylaxis of CLABSI. Other CVC care practices were also found to affect the level of bacterial colonization, but their efficacy in preventing CLABSI needs to be evaluated further. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Double-lumen, silicone rubber, indwelling venous catheters. A new modality for angioaccess.

    PubMed

    Schanzer, H; Kaplan, S; Bosch, J; Glabman, S; Burrows, L

    1986-02-01

    This report presents our experience using double-lumen, silicone rubber, indwelling central venous catheters with a subcutaneous Dacron cuff as access for hemodialysis. Twenty-seven catheters were placed in 27 patients through venous cutdowns. A 10-cm subcutaneous tunnel was created leaving the Dacron cuff 2 cm from the external exit. Sixteen Raaf catheters (lumen diameter [LD], 1 mm), three double-lumen Hickman catheters (LD, 1.6 mm) and eight HemoCath catheters (LD, 2 mm) were used. The tip of the catheter was positioned fluoroscopically in either the superior vena cava or the right atrium. One hundred fifty-nine treatments were done with the Raaf catheters (mean blood flow [MBF], 188.1 +/- 26.4 mL/min); two of these catheters became obstructed and could not be used further. Three double-lumen Hickman catheters were used in 12 hemodialysis treatments (MBF, 216.3 +/- 27.1 mL/min). One hundred fifty-five treatments were done using the HemoCath catheters (MBF, 236.7 +/- 5.5 mL/min). The degree of recirculation of these catheters was 8.56% +/- 4.34%. The major advantages of this modality include simplicity of introduction, lack of serious complications, no sacrifice of major arteries, no need for venipuncture, and potential use in either short- or long-term hemodialysis.

  13. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    PubMed

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  14. Catheter fracture: a rare complication of totally implantable subclavian venous access devices.

    PubMed

    Klotz, H P; Schöpke, W; Kohler, A; Pestalozzi, B; Largiadèr, F

    1996-07-01

    Catheter fracture represents a rare problem among non-infectious complications following the insertion of totally implantable long-term central venous access systems for the application of chemotherapeutic agents. A literature survey revealed a total incidence of catheter fractures of 0-2.1%. Imminent catheter fracture can be identified radiologically, using different degrees of catheter narrowing between the clavicle and the first rib, called pinch-off sign. Two cases of catheter fracture are described and potential causes are discussed. Recommendations to avoid the pinch-off sign with the subsequent risk of catheter fracture and migration include a more lateral and direct puncture of the subclavian vein. In case of catheter narrowing in the clavicular-first rib angle, patients should be followed carefully by chest X-rays every 4 weeks. Whenever possible, the system should be removed within 6 months following insertion.

  15. Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion: A before and after intervention study.

    PubMed

    Cartier, Vanessa; Inan, Cigdem; Zingg, Walter; Delhumeau, Cecile; Walder, Bernard; Savoldelli, Georges L

    2016-08-01

    Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion. To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion. Before and after intervention study. University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012. Residents in anaesthesiology aware of the Seldinger technique for vascular puncture. Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase). The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test. Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (±SD 4.08) before training, 32.2 (±4.51) after training (P < 0.001 for comparison with pretraining scores) and 26.5 (±5.34) in the sustainability phase (P = 0.040 for comparison with pretraining scores). The average hand hygiene compliance score was 2.8 (±1.0) points before training, 5.0 (±1.04) after training (P < 0.001 for comparison with pretraining scores) and 3.7 (±1.75) in the sustainability phase (P = 0.038 for comparison with pretraining scores). The average checklist compliance was 14.9 points (±2.3) before training, 19.9 (±1.06) after training (P < 0.001 for comparison with pretraining scores) and

  16. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

    PubMed Central

    Bion, Julian; Richardson, Annette; Hibbert, Peter; Beer, Jeanette; Abrusci, Tracy; McCutcheon, Martin; Cassidy, Jane; Eddleston, Jane; Gunning, Kevin; Bellingan, Geoff; Patten, Mark; Harrison, David

    2013-01-01

    Background Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. Methods We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. Results Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. Conclusions The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care. PMID:22996571

  17. Ultrasound Identification of the Guidewire in the Brachiocephalic Vein for the Prevention of Inadvertent Arterial Catheterization During Internal Jugular Central Venous Catheter Placement.

    PubMed

    Bowdle, Andrew; Jelacic, Srdjan; Togashi, Kei; Ferreira, Renata

    2016-10-01

    Imaging the guidewire with ultrasonography in the internal jugular vein during central venous catheterization often is used to verify proper guidewire placement and to aid in prevention of inadvertent arterial catheterization. It is known, however, that inadvertent arterial catheterization can occur despite imaging the guidewire in the internal jugular vein because the guidewire may continue through the far wall of the internal jugular vein and into an adjacent artery. We propose confirmation of the guidewire in the brachiocephalic vein with ultrasonography as a more reliable method of confirming proper guidewire placement. A prospective feasibility study of 200 adult cardiothoracic surgery patients undergoing internal jugular vein catheterization was performed to determine whether the guidewire could be imaged with ultrasonography in the brachiocephalic vein. The guidewire was imaged in the internal jugular vein in a short-axis view, and the transducer was then angled caudally under the clavicle, following the guidewire into the brachiocephalic vein. The right internal jugular vein was catheterized in 193 patients and the left internal jugular in 7 patients. The brachiocephalic vein was successfully imaged in all but 2 patients. In 3 patients, the guidewire could not be clearly identified in the brachiocephalic vein because of interference from the leads of a heart rhythm device (pacemaker or defibrillator) or preexisting catheter. In 2 patients, the guidewire was not seen initially in the brachiocephalic vein because of coiling in the internal jugular vein, and in 1 patient because of the guidewire passing into the right subclavian vein, but all 3 were subsequently imaged in the brachiocephalic vein after repositioning. During internal jugular vein catheterization, the brachiocephalic vein was imaged with ultrasonography in 99% of patients (the lower 1-sided 99% confidence limit is 96%). The guidewire was imaged in the brachiocephalic vein in all cases except

  18. Randomized, prospective, observational simulation study comparing residents' needle-guided vs free-hand ultrasound techniques for central venous catheter access.

    PubMed

    Ball, R D; Scouras, N E; Orebaugh, S; Wilde, J; Sakai, T

    2012-01-01

    Short-axis ultrasound-guided placement of central venous catheters (CVCs) is widely accepted as safe practice. However, utilizing the long-axis approach could further improve safety, as it allows for better visualization of the needle as it is advanced to the target vessel. However, the long-axis approach has not widely been used due to the technical difficulty. Recently, a new needle guidance device has become available to aid in the long-axis approach. We hypothesized that the use of a needle guide paired with the long-axis approach would facilitate puncture of the target vessel in a simulation model more effectively than similar free-hand techniques. A prospective observational study of anaesthesia residents using a CVC partial-task training device was conducted. Each resident performed needle puncture of the target vessel with three different techniques, assigned in random order: short-axis free hand (S-FH), long-axis free hand (L-FH), and long-axis needle guide (NG). To prove the effectiveness of the needle guide, the fraction of time the needle tip remained in view of the ultrasound was recorded and compared. Time required for completing the task and the number of needle sticks and needle re-directions were compared. Thirty-three residents participated in the study. The fraction of time the needle tip remained in view of the ultrasound was significantly higher for the residents using NG [0.90 (0.10)] compared with residents using the other techniques [L-FH: 0.36 (0.20), S-FH: 0.18 (0.10)] (P<0.001). For each resident, the use of the needle guide in the long-axis approach increased visualization by 352 (276)% compared with that of L-FH and by 1028 (1804) % compared with that of S-FH. There was no significant difference in time required to puncture the target between NG [23.7 (14.6) s] and L-FH [30.3 (36.5) s] (P=0.21); however, both were significantly longer than S-FH [17.0 (13.3) s] (P=0.012). The numbers of needle sticks and of needle re-directions did not

  19. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients.

    PubMed

    Cesaro, Simone; Cavaliere, Mara; Pegoraro, Anna; Gamba, Piergiorgio; Zadra, Nicola; Tridello, Gloria

    2016-04-01

    We report our decennial experience with 1161 newly-placed long-term central venous catheters inserted in 919 hematology-oncology patients for a total of 413,901 CVC-days of observation. Most of the CVCs were partially-implanted, open-ended, Broviac-Hickman type of CVC (95 %). One thousand and twenty-four complications were recorded equal to 2.47 per 1000 CVC-days. The frequency of complications per CVC, the rate of episodes per 1000 CVC-days, and removal rate were malfunction/occlusion 42 %, 1.18/1000, and 2.3 %; mechanical (dislodgement/rupture/kinking) 18.3 %, 0.51/1000, and 77.4 %; bacteremia 14.8 %, 0.42/1000, and 18.6 %; exit-site/tunnel infection 11.5 %, 0.32/1000, and 9.7 %; thrombosis 0.86 %, 0.02/1000, and 30 %; pneumothorax 0.52 %, 0.01/1000, and 0. In multivariate analysis, the risk factors were for mechanical complications, a younger age <6.1 years at CVC insertion (HR 1.8, p = 0.0006); for bacteremia, a double lumen CVC (HR 3.1, p < 0.0001) and the surgical modality of CVC insertion (HR 1.5, p = 0.03); for exit-site/tunnel infection, a double lumen CVC (HR 2.1, p = 0.0003) and a diagnosis of leukemia or lymphoma (HR 1.8, p = 0.01); for malfunction/occlusion, an age <6.1 years (HR 1.6, p = 0.0003), the diagnosis of leukemia or lymphoma (HR 1.9, p < 0.0001) and double lumen CVC (HR 1.33, p = 0.023). The cumulative incidence of premature CVC removal was 29.2 % and the risk factors associated with this event were the surgical modality of CVC insertion (HR 1.4, p = 0.0153) and an age at CVC positioning less than 6.1 years (HR 1.6, p = 0.0025). We conclude that a best-practice set of rules resulted in reduced CVC complications.

  20. Central venous catheter-related infection due to Candida membranaefaciens, a new opportunistic azole-resistant yeast in a cancer patient: a case report and a review of literature.

    PubMed

    Fanci, Rosa; Pecile, Patrizia

    2005-09-01

    An unusual central venous catheter (CVC)-related infection caused by Candida membranaefaciens in a patient with non-Hodgkin's lymphoma is described. Clinical signs and microbiological results observed in this case may support the hypothesis of an emerging CVC-related fungaemia, because of new azole-resistant yeast, successfully treated with liposomal amphotericin B. To date C. membranaefaciens (the teleomorph of Pichia membranaefaciens) has traditionally been considered non-pathogenic and this report seems to be the first case of systemic fungal infection. We believe that another fungus can be added to the list of opportunistic strains.

  1. Peripheral venous catheter fracture with embolism into the pulmonary artery

    PubMed Central

    Ammari, Chady; Campisi, Alessio; D’Andrea, Rocco

    2016-01-01

    Peripheral vein catheterization is generally considered a harmless procedure. Venous catheter rupture associated with pulmonary embolism is an unlikely but potentially serious complication. We report a case of a peripheral venous catheter (PVC) fracture with pulmonary artery embolization in the left lower lobe treated successfully by a surgical approach. The positioning of a PVC is not always a harmless procedure. Every time there are difficulties in positioning or in removal of a catheter device, it should be carefully inspected to verify integrity. The advisability of removal of these small foreign bodies is debated; percutaneous retrieval is preferred, while surgery should be discussed case by case. PMID:28149586

  2. Central vascular catheter infections in a Hospital of Central Italy.

    PubMed

    Lombardi, Silvia; Scutell, Massimiliano; Felice, Valentina; Di Campli, Emanuela; Di Giulio, Mara; Cellini, Luigina

    2014-01-01

    The insertion and the permanence of central venous catheters (CVC) represent potential sources of infection contracted in hospital. The evaluation of the risk of CVC-associated infections was evaluated in a retrospective study during the period 2007-2010 in a Hospital of Central Italy. A total of 514 CVC were collected and examined by microbiological techniques and, among the examined patients, 450 CVC blood cultures were collected. Cultures were performed collecting a portion of 5-6 cm of intravenous catheters in liquid medium and spread on selective media for Gram-positive and Gram-negative bacteria and yeasts; blood specimens were obtained through peripheral venous punctures and analyzed by a commercial automated system. 308/514 (59.90%) samples were positive to the microbiological culture. Staphylococcus aureus, S. epidermidis and other coagulase negative Staphylococci (CNS) were the prevalent Gram-positive bacteria. Among Gram-negative bacteria, Enterobacteriaceae and Pseudomonaceae were the main bacteria isolated. A higher prevalence of Gram-positive bacteria was observed in Neonatal Pathology (90.90%). The Intensive Care Unit (ICU) showed 73.10% of positive cultures with 54.12% of Gram-positive isolates. Among positive blood cultures (38%), Gram-positive bacteria were the main bacteria isolated. The high prevalence of catheter-related infections requires accurate surveillance and the assumption of preventive measures in particular during catheter insertion.

  3. [Persistent left superior vena cava. Implications in central venous catheterisation].

    PubMed

    Lacuey Lecumberri, G; Ureña, M; Martínez Basterra, J; Basterra, N

    2009-01-01

    The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC). The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient.

  4. Measurement of the international normalized ratio (INR) in hemodialysis patients with heparin-locked central venous catheters: evaluation of a novel blood sampling method.

    PubMed

    Rioux, Jean-Philippe; De Bortoli, Bruno; Quérin, Serge; Déziel, Clément; Troyanov, Stéphan; Madore, François

    2009-01-01

    Accurate measurement of the international normalized ratio (INR) may be difficult in hemodialysis (HD) patients with heparin-locked central catheters. Blood contamination with locking solutions may interfere with INR measurement when samples are collected directly from the catheter. The aim of our study was to evaluate a novel sampling method for the measurement of INR in HD patients with heparin-locked central catheters. This novel method consists of measuring the INR directly from the dialysis circuit (arterial bloodline sample port) after 1 hr of treatment regardless of heparin administration during dialysis. We compared this method to the gold standard (peripheral venipuncture prior to dialysis) using the paired t-test. We included 30 patients (23 with warfarin therapy and 7 without). INRs obtained using the novel sampling method were only minimally overestimated compared to venipuncture values (mean INR overestimation: 0.2 +/- 0.2). This overestimation was not clinically significant and did not lead to changes in warfarin prescription for any of the patients. Correlation tests confirmed the influence of heparin administration on INR overestimation (R=0.4; p=0.05). This influence was present mostly among patients receiving more than 100 Units/kg of heparin during their treatment. This novel sampling technique provides a convenient and simple method of monitoring INR among HD patients.

  5. Evaluation of a Device Combining an Inferior Vena Cava Filter and a Central Venous Catheter for Preventing Pulmonary Embolism Among Critically Ill Trauma Patients.

    PubMed

    Tapson, Victor F; Hazelton, Joshua P; Myers, John; Robertson, Claudia; Gilani, Ramyar; Dunn, Julie A; Bukur, Marko; Croce, Martin A; Peick, Ann; West, Sonlee; Lottenberg, Lawrence; Doucet, Jay; Miller, Preston R; Crookes, Bruce; Gandhi, Rajesh R; Croft, Chasen A; Manasia, Anthony; Hoey, Brian A; Lieberman, Howard; Guillamondegui, Oscar D; Novack, Victor; Piazza, Gregory; Goldhaber, Samuel Z

    2017-09-01

    To evaluate efficacy and safety of a novel device that combines an inferior vena cava (IVC) filter and central venous catheter (CVC) for prevention of pulmonary embolism (PE) in critically ill patients. In a multicenter, prospective, single-arm clinical trial, the device was inserted at the bedside without fluoroscopy and subsequently retrieved before transfer from the intensive care unit (ICU). The primary efficacy endpoint was freedom from clinically significant PE or fatal PE 72 hours after device removal or discharge, whichever occurred first. Secondary endpoints were incidence of acute proximal deep venous thrombosis (DVT), catheter-related thrombosis, catheter-related bloodstream infections, major bleeding events, and clinically significant thrombus (occupying > 25% of volume of filter) detected by cavography before retrieval. The device was placed in 163 critically ill patients with contraindications to anticoagulation; 151 (93%) were critically ill trauma patients, 129 (85%) had head or spine trauma, and 102 (79%) had intracranial bleeding. The primary efficacy endpoint was achieved for all 163 (100%) patients (95% confidence interval [CI], 97.8%-100%, P < .01). Diagnosis of new or worsening acute proximal DVT was time dependent with 11 (7%) occurring during the first 7 days. There were no (0%) catheter-related bloodstream infections. There were 5 (3.1%) major bleeding events. Significant thrombus in the IVC filter occurred in 14 (8.6%) patients. Prophylactic anticoagulation was not initiated for a mean of 5.5 days ± 4.3 after ICU admission. This novel device prevented clinically significant and fatal PE among critically ill trauma patients with low risk of complications. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  6. Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis.

    PubMed

    Paglialonga, Fabio; Consolo, Silvia; Biasuzzi, Antonietta; Assomou, Jolanda; Gattarello, Elisabetta; Patricelli, Maria Grazia; Giannini, Alberto; Chidini, Giovanna; Napolitano, Luisa; Edefonti, Alberto

    2014-10-01

    Only a few studies have investigated the optimal exit site management of tunneled central venous catheters (CVCs) in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the efficacy of chlorhexidine solutions and a 5% povidone-iodine solution on the incidence of CVC-related infections in children on HD. The incidence of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) was assessed in two groups of tunneled CVCs. The iodopovidone group consisted of 14 CVCs used between 1 January 2011 and 30 June 2012 in 10 children, whose median age at the time of CVC placement was 11.8 years (range 1.2-19.2): 5% povidone-iodine was used for CVC exit-site care. From 1 August 2012 to 31 January 2014, 0.5% chlorhexidine gluconate/70% isopropyl alcohol was used for the exit site, and 2% chlorhexidine gluconate/70% isopropyl alcohol spray for the hub in 13 CVCs was used in 10 patients (chlorhexidine group), whose median age at the time of CVC placement was 10 years (range 1.2-19.2). Ten episodes of ESI were diagnosed in the iodopovidone group (incidence 3.4/1000 CVC days), and only one in the chlorhexidine group (incidence 0.36/1000 CVC days, P = 0.008). One TI was observed in the iodopovidone group (0.34/1000 CVC days), and none in the chlorhexidine group. The incidence of BSIs decreased from 1.7/1000 CVC days (5 cases) to 0.36/1000 CVC days (1 case, P = 0.06) after switching to chlorhexidine. Two CVCs were lost due to CVC-related infections in the iodopovidone group, whereas no CVC was lost due to infections in the chlorhexidine group. In comparison with 5% povidone-iodine, the use of chlorhexidine gluconate was associated with a reduction in the incidence of ESI, TI, and BSI in children on HD.

  7. Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte)

    PubMed Central

    2014-01-01

    Background Many cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as “intervention”), we compared luer lock caps with a “closed access system” consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety). Methods For determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation. Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination. Results With the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value<0.05) confirmed the significance of the result. In 50 reviewed samples (TWC’s), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%. Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%. Conclusions In the

  8. Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte).

    PubMed

    Pohl, Fabian; Hartmann, Werner; Holzmann, Thomas; Gensicke, Sandra; Kölbl, Oliver; Hautmann, Matthias G

    2014-01-25

    Many cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as "intervention"), we compared luer lock caps with a "closed access system" consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety). For determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation.Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination. With the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value<0.05) confirmed the significance of the result.In 50 reviewed samples (TWC's), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%.Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%. In the present research, the closed access system with a

  9. Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

    PubMed Central

    2013-01-01

    Background Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted “bundle” approach in controlling CVC-ABSIs outside ICU. Methods From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. Results Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in

  10. [Tunnelled central venous line-associated infections in patients with pulmonary arterial hypertension treated with intravenous prostacyclin].

    PubMed

    Boucly, Athénaïs; O'Connell, Caroline; Savale, Laurent; O'Callaghan, Dermot S; Jaïs, Xavier; Montani, David; Humbert, Marc; Simonneau, Gérald; Sitbon, Olivier

    2016-01-01

    Intravenous prostacyclins are a valuable treatment for patients with severe pulmonary arterial hypertension, leading to improved exercise capacity, haemodynamics, quality of life and survival. Unfortunately, due to the short half-life of these drugs, they need to be administered continuously through central venous catheters. Despite aseptic technique, regular dressing changes, tunneled central venous catheters and patient education, patients are exposed to central venous catheter associated infections. These infections cause significant morbidity and mortality. The clinical presentation, microbiology, consequences and management of these central venous catheter associated infections in pulmonary arterial hypertension patients treated with intravenous prostacyclins are discussed.

  11. Sustained Nitric Oxide-Releasing Nanoparticles Induce Cell Death in Candida albicans Yeast and Hyphal Cells, Preventing Biofilm Formation In Vitro and in a Rodent Central Venous Catheter Model

    PubMed Central

    Ahmadi, Mohammed S.; Lee, Hiu Ham; Sanchez, David A.; Friedman, Adam J.; Tar, Moses T.; Davies, Kelvin P.; Nosanchuk, Joshua D.

    2016-01-01

    Candida albicans is a leading nosocomial pathogen. Today, candidal biofilms are a significant cause of catheter infections, and such infections are becoming increasingly responsible for the failure of medical-implanted devices. C. albicans forms biofilms in which fungal cells are encased in an autoproduced extracellular polysaccharide matrix. Consequently, the enclosed fungi are protected from antimicrobial agents and host cells, providing a unique niche conducive to robust microbial growth and a harbor for recurring infections. Here we demonstrate that a recently developed platform comprised of nanoparticles that release therapeutic levels of nitric oxide (NO-np) inhibits candidal biofilm formation, destroys the extracellular polysaccharide matrices of mature fungal biofilms, and hinders biofilm development on surface biomaterials such as the lumen of catheters. We found NO-np to decrease both the metabolic activity of biofilms and the cell viability of C. albicans in vitro and in vivo. Furthermore, flow cytometric analysis found NO-np to induce apoptosis in biofilm yeast cells in vitro. Moreover, NO-np behave synergistically when used in combination with established antifungal drug therapies. Here we propose NO-np as a novel treatment modality, especially in combination with standard antifungals, for the prevention and/or remediation of fungal biofilms on central venous catheters and other medical devices. PMID:26810653

  12. Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies.

    PubMed

    Duesing, Lori A; Fawley, Jason A; Wagner, Amy J

    2016-08-01

    Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement. © 2016 American Society for Parenteral and Enteral Nutrition.

  13. Controlled Suction with Venous Catheter Irrigation in Neurosurgery: A Cost Effective Technique.

    PubMed

    Panigrahi, Manas; Kumari, Manoranjitha; Vooturi, Sudhindra

    2017-01-01

    Keeping the operating field clean and visible is an important technique in neurosurgery. Continuous irrigation-suction (IS) of the surgical field is currently often done using devices available that are expensive and demand technical proficiency. We report a simple method of continuous IS using a widely available central venous catheter and a controlled suction cannula. We used a controlled suction cannula attached to a central suction system. A single lumen central venous catheter is passed through the keyhole of a controlled suction cannula, which is connected to a continuous irrigation system. The operative field was clean throughout the procedure, obviating the need for an assisting surgeon to irrigate into the deep operating field and, hence, reducing the duration of surgery. The proposed IS system could be surgeon friendly, easily manageable, yet cost-effective and efficient. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Erroneous laboratory values obtained from central catheters.

    PubMed

    Johnston, J B; Messina, M

    1991-01-01

    Serious analytic errors in potassium measurements have been identified in blood specimens obtained from newly inserted central catheters. Erroneous elevated readings have been related to interactions of chemistry analyzer electrodes and substances fixed to external and intraluminal walls of the central catheter. Anecdotal summaries of this phenomenon are presented to enable the nurse to recognize potential problems when sampling blood from central catheters. Studies were performed to determine the amount of flush necessary to clear the catheter of interfering residue. To eliminate this potentially hazardous occurrence, recommended flush volumes, nursing implications, and actions are described.

  15. Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient.

    PubMed

    Villalta-García, Pedro; López-Herránz, Marta; Mazo-Pascual, Salvador; Honrubia-Fernández, Teresa; Jáñez-Escalada, Luis; Fernández-Pérez, Cristina

    2017-09-01

    Intensive care patients require a high frequency of blood testing, which results in a significant amount of blood loss. When blood is obtained from a central venous catheter (CVC), a large volume is usually discarded to obtain an unaltered sample for testing. To determine the reliability of complete blood test results in blood samples obtained from the proximal lumen of a triple-lumen CVC using a 2-mL discard volume DESIGN: Observational study with the prospective collection of data METHODS: The subjects enrolled were all patients with a subclavian triple-lumen CVC, older than 17 years and consecutively admitted to intensive care over a 2-year period. In each of the 54 participants, one blood sample was drawn from the proximal lumen of the catheter, discarding 1·61 mL of blood plus 0·39 mL of catheter deadspace (2 mL) and without interrupting infusion in the middle and distal lumens. A second sample was then obtained by direct venous puncture. The reliability of blood test results was determined by comparing sets of variables recorded for the two sampling methods through intraclass correlation coefficients in the Bland-Altman method. Inter-method reliability for the variables examined was excellent, >0·75; range (0·868-0·998). Mean differences between the two sample types for the variables most often determined in critically ill patients were leukocytes: 0·200 × 10(3) /µL, 95% confidence interval (CI) (0·025 to 0·375); erythrocytes: 0·045 × 10(6) /uL, 95% CI (-0·003 to 0·094); sodium: 0·074 mEq/L, 95% CI (-0·369 to 0·517); potassium: -0·002mEq/L, 95% CI (-0·065 to 0·061) and glucose: 2·426 mg/dL, 95% CI (0·498-4·354). The sampling method proposed minimizes blood loss while offering reliable blood test results. The main benefit of the method proposed is reduced blood loss, improving the care of a critically ill patient. © 2015 British Association of Critical Care Nurses.

  16. Case report of a cervical intraspinal misplacement of a central venous line.

    PubMed

    Glaser, Martin B; von Bruchhausen, Carla; Müller-Forell, Wibke; Klein, Klaus U; Oertel, Joachim

    2011-12-01

    A case of cervical spinal misplacement of a central venous line via the right jugular vein is reported. A review of the literature resulted in eight similar cases. Only two further adults are described. Children and patients suffering from malnutrition seem to have a higher risk for intraspinal malpositioning of central venous catheters.

  17. Central Vein Preservation in Critical Venous Access.

    PubMed

    Davidson, J; Paul, A; Patel, S; Davenport, M; Ade-Ajayi, N

    2016-08-01

    Introduction The lack of suitable veins in children with critical central venous access requirements is a major obstacle to optimal care and is potentially life-threatening. We present outcomes following the use of vein-preserving (VP) surgical techniques, notably the sheath exchange for tunneled lines (SETL). Materials and Methods A retrospective, single observer analysis of a prospectively maintained departmental logbook as well as the medical records of patients. Two broad groups of central line replacements were identified; those inserted following removal of a previous line and a traditional "plastic-free" (PF) period and those exchanged without such an interval. Results Overall, 19 lines were directly exchanged during the study period and compared with 34 inserted after a PF period. Similar catheter life spans and infection rates were demonstrated in each group; 125 (range, 78-173) days in VP exchanges versus 122 (range, 70-175) days in PF replacements (p = 0.41). Line Sepsis resulting in removal or change of line occurred at 103 (range, 60-147) days in VP group versus 104 (range, 45-164) days in PF (p = 0.73). Conclusion For children with critical venous access requirements, direct line exchange procedures are a robust and reproducible means of vein preservation. The outcomes compare favorably with those following the more traditional removal, a PF period and reinsertion.

  18. Delayed pneumothorax after central venous access: a potential hazard.

    PubMed

    Tyburski, J G; Joseph, A L; Thomas, G A; Saxe, J M; Lucas, C E

    1993-09-01

    Percutaneous central venous catheter access is common-place in surgical patients. Though several major complications of this procedure have been described, pneumothorax is the most common. Pneumothorax is routinely assessed by a chest X-ray within 2 hours after catheter placement. During a recent 6-month interval, the authors identified five patients with delayed onset and diagnosis of pneumothorax following percutaneous central venous access. All immediate post-insertion chest X-rays were normal; however, subsequent chest X-ray showed evidence of pneumothoraxes. The pneumothorax contributed to the death of one patient on positive pressure ventilation. A review of the literature revealed a total of 18 patients in the English literature with this complication. Although the incidence of delayed pneumothorax is low, it is, in some instances, life threatening, particularly in patients on positive pressure ventilation. A high index of suspicion is required to diagnosis and treat this reversible condition.

  19. A multicentre snapshot study of the incidence of serious procedural complications secondary to central venous catheterisation.