Intensive care medicine in 2050: towards critical care without central lines

Tip orientation under real-time point-of-care neck ultrasonic monitoring is advantageous in peripherally inserted central catheter procedures: a retrospective cohort study

Background

We analyzed the success and catheter tip malposition rates of peripherally inserted central catheter (PICC) placement using ultrasonic monitoring.

Methods

A total of 564 patients were recruited and assigned to either the intervention or control group. In the intervention group, 282 patients underwent ultrasound-guided PICC insertion, which helped to identify the position and depth of the catheter tip. From a total of 9000 patients, 282 were selectively chosen to receive the traditional method using body surface measurements (control group). The primary endpoint was the success rate; the secondary endpoint was the catheter tip malposition rate as detected by postprocedure chest radiography.

Results

In the intervention group, a total of 94 catheters were in a suboptimal position; 26 were too deep, 68 were too shallow, and 1 was inserted into the subclavian vein, with success and malposition rates of 66.3% and 0.4%, respectively. In the control group, 139 catheters were in a suboptimal position; 88 were too deep, 51 were too shallow, 9 were inserted into the jugular vein, and 2 were inserted into the subclavian vein, with success and malposition rates of 46.8% (P < 0.001) and 3.9% (P = 0.004), respectively. Significant differences were observed in success and malposition rates between the 2 groups.

Conclusion

Ultrasound-guided PICC procedures achieved higher success rates and lower malposition rates.

Retrospective analysis of central venous catheters in elective intracranial surgery - Is there any benefit?

Background

It remains unclear whether the use of central venous catheters (CVC) improves a patient's clinical outcome after elective intracranial supratentorial procedures.

Methods

This two-armed, single-center retrospective study sought to compare patients undergoing elective intracranial surgery with and without CVCs. Standard anaesthesia procedures were modified during the study period resulting in the termination of obligatory CVC instrumentation for supratentorial procedures. Peri-operative adverse events (AEs) were evaluated as primary endpoint.

Results

The data of 621 patients in total was analysed in this study (301 with and 320 without CVC). Patient characteristics and surgical procedures were comparable between both study groups. A total of 132 peri-operative AEs (81 in the group with CVC vs. 51 in the group without CVC) regarding neurological, neurosurgical, cardiovascular events and death were observed. CVC patients suffer from AEs almost twice as often as non CVC patients (OR_adjusted = 1.98; 95%CI[1.28–3.06]; p = 0.002). Complications related to catheter placement (pneumothorax and arterial malpuncture) were observed in 1.0% of the cases. The ICU treatment period in patients with CVC was 22 (19;24) vs. 21 (19;24) hours (p = 0.413). The duration of hospital stay was also similar between groups (9 (7;13) vs. 8 (7;11) days, p = 0.210). The total time of ventilation (350 (300;440) vs. 335 (281;405) min, p = 0.003) and induction time (40 (35;50) vs. 30 (25;35) min, p<0.001) was found to be prolonged significantly in the group with CVCs. There were no differences found in post-operative inflammatory markers as well as antibiotic treatment.

Conclusion

The data of our retrospective study suggests that patients undergoing elective neurosurgical procedures with CVCs do not demonstrate any additional benefits in comparison to patients without a CVC.