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Giani M, Fumagalli B, Rezoagli E, Cannizzo L, Giannini L, D'Amata D, Lucchini A, Rona R, Elli S, Foti G. Midline catheters for blood gas and acid/base monitoring in critical patients: A prospective observational study. J Vasc Access 2024; 25:1443-1449. [PMID: 36971402 DOI: 10.1177/11297298231163352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Arterial lines and central venous catheter (CVC) allow to monitor patients' acid-base status and gas exchange. Their placement and maintenance may however be burdened by severe complications. Midline Catheters (MC) are peripheral venous accesses that are less invasive and easier to insert compared to CVC and arterial lines. METHODS A prospective observational study was performed including stabilized critical patients with clinical indication to midline positioning before intensive care unit (ICU) discharge. The primary aim was to assess if venous sampling from MCs can be a reliable alternative to CVC for pH and CO2 monitoring. The secondary aim was to evaluate the correlation between samplings from MC, CVC and arterial line with regards to pH, carbon dioxide tension (pCO2), lactates and electrolytes. Three samples from CVC, arterial line and MC were collected simultaneously. Agreement and correlation of the studied parameters between different sampling sites were explored. RESULTS 40 patients were included in the analysis. A good agreement for pH and pCO2 was recorded between MC and CVC: mean differences were 0.001 (95% CI -0.006 to 0.007) and 0.7 (-0.1 to 1.5), percentage error 0.4% and 11.2%, respectively. Correlation between MC and both central venous and arterial samples for pH, pCO2, lactates and electrolytes was found to be moderate-to-strong (Pearson's R coefficient range 0.59-0.99, p < 0.001 for all these parameters). CONCLUSIONS In stabilized critical patients, midline catheters represent a reliable alternative to CVC and arterial lines to monitor acid-base disturbances, CO2 levels and electrolytes. The present findings add to the known advantages of MC, which might be considered a first-line vascular access for non-critical or stabilized patients who do not require infusion of vesicant or irritant drugs.
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Affiliation(s)
- Marco Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luigi Cannizzo
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luciano Giannini
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Dario D'Amata
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Lucchini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Stefano Elli
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Scaglione G, Colaneri M, Offer M, Galli L, Borgonovo F, Genovese C, Fattore R, Schiavini M, Taino A, Calloni M, Casella F, Gidaro A, Fassio F, Breschi V, Leoni J, Cogliati C, Gori A, Foschi A. Epidemiology and Clinical Insights of Catheter-Related Candidemia in Non-ICU Patients with Vascular Access Devices. Microorganisms 2024; 12:1597. [PMID: 39203438 PMCID: PMC11356456 DOI: 10.3390/microorganisms12081597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Vascular access devices (VADs), namely peripheral VADs (PVADs) and central venous VADs (CVADs), are crucial in both intensive care unit (ICU) and non-ICU settings. However, VAD placement carries risks, notably catheter-related bloodstream infections (CRBSIs). Candida spp. is a common pathogen in CRBSIs, yet its clinical and microbiological characteristics, especially in non-ICU settings, are underexplored. METHODS We conducted a monocentric, retrospective observational study at Luigi Sacco Hospital from 1 May 2021 to 1 September 2023. We reviewed medical records of non-ICU adult patients with CVADs and PVADs. Data on demographics, clinical and laboratory results, VAD placement, and CRBSI occurrences were collected. Statistical analysis compared Candida spp. CRBSI and bacterial CRBSI groups. RESULTS Out of 1802 VAD placements in 1518 patients, 54 cases of CRBSI were identified, and Candida spp. was isolated in 30.9% of episodes. The prevalence of CRBSI was 3.05%, with Candida spp. accounting for 0.94%. Incidence rates were 2.35 per 1000 catheter days for CRBSI, with Candida albicans and Candida non-albicans at 0.47 and 0.26 per 1000 catheter days, respectively-patients with Candida spp. CRBSI had more frequent SARS-CoV-2 infection, COVID-19 pneumonia, and hypoalbuminemia. CONCLUSIONS During the COVID-19 pandemic, Candida spp. was a notable cause of CRBSIs in our center, underscoring the importance of considering Candida spp. in suspected CRBSI cases, including those in non-ICU settings and in those with PVADs.
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Affiliation(s)
- Giovanni Scaglione
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Marta Colaneri
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Martina Offer
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Lucia Galli
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Fabio Borgonovo
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Camilla Genovese
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Rebecca Fattore
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Monica Schiavini
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Alba Taino
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Maria Calloni
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Francesco Casella
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Antonio Gidaro
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Breschi
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (V.B.); (J.L.)
| | - Jessica Leoni
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (V.B.); (J.L.)
| | - Chiara Cogliati
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Andrea Gori
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Antonella Foschi
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
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Qin KR, Ensor N, D'Amore M, Barnes R, Nataraja RM, Pacilli M. A pilot workshop for ultrasound-guided insertion of long peripheral catheters. J Vasc Access 2024; 25:1031-1032. [PMID: 36750764 DOI: 10.1177/11297298221125270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Kirby R Qin
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nicholas Ensor
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Matthew D'Amore
- Department of Surgery, Austin Hospital, Heidelberg, VIC, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Health, Clayton, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Clayton, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Clayton, VIC, Australia
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Fabiani A, Aversana N, Santoro M, Sanson G. Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection. Thromb Res 2024; 236:117-126. [PMID: 38422981 DOI: 10.1016/j.thromres.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Long peripheral catheters (LPCs) and midline catheters (MCs) are indiscriminately labelled with different names, leading to misclassifications both in primary and secondary studies. The available studies used different methods to report the incidence of catheter-related complications, affecting the possibility of properly comparing the catheter outcomes. The aim of this review was to explore the complications related to LPCs and MCs after reclassifying according to their length. METHODS Systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted on PubMed, Scopus and CINAHL databases. The study protocol was registered in the International Prospective Register of Systematic Reviews. Data regarding LPCs and MCs were compared. Catheter outcomes were classified into major and minor complications, recomputed and reported as cases/1000 catheter-days. RESULTS Fourteen studies were included. Over-half of the devices were correctly labelled by the authors, misclassifications affected particularly LPCs improperly labelled MCs. The cumulative incidence of catheter-related bloodstream infections was 0.3 and 0.4/1000 catheter-days, that of symptomatic catheter-related thrombosis was 0.9 and 1.8/1000 catheter-days for MCs and LPCs, respectively. Minor complications and catheter failure were higher for LPCs. CONCLUSIONS A misclassification exists in the labelling of MCs and LPCs. A widespread heterogeneity of diagnostic criteria adopted to classify the catheters' outcomes was found, exposing the risk of misestimating the incidence of complications and undermining the possibility of effectively comparing results of the published research. We proposed a list of definitions and relevant variables as a first step toward the development of standardized criteria to be adopted for research purposes.
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Affiliation(s)
- Adam Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata - Via Montpellier 1, Rome, Italy; Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Nicola Aversana
- School of Nursing, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Cardiac Surgery Intensive Care Unit, Azienda Sanitaria Universitaria Giuliano-Isontina - Strada di Fiume 447, Trieste, Italy.
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
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Dahl RH, Larsen RW, Thormann E, Benndorf G. Fragmentation of Hydrophilic Guidewire Coatings During Neuroendovascular Therapy. Clin Neuroradiol 2023; 33:793-799. [PMID: 37185670 DOI: 10.1007/s00062-023-01283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/23/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Cerebral polymer coating embolism from intravascular devices may cause serious complications after endovascular therapy (EVT) for neurovascular diseases. Although polymer fragments are often created during endovascular procedures, exact mechanisms of their formation, especially if of small size, are largely unknown. METHODS In this study eight microguidewires (Asahi Chikai 200 cm (Asahi Intecc, Aichi, Japan), Asahi Chikai Black (Asahi Intecc), Fathom™ (Boston Scientific, Marlborough, MA, USA), Hybrid (Balt Extrusion, Montmorency, France), Radifocus® Guide Wire GT (Terumo, Leuven, Belgium), Synchro2® (Stryker, Kalamazoo, MI, USA), Transend™ EX (Boston Scientific), and Traxcess™ (MicroVention®, Tustin, CA, USA)) frequently used during EVT were investigated ex vivo using their dedicated metal or plastic insertion tools to assess for coating delamination after backloading of the microguidewires. RESULTS Backloading caused damage to the coating of all microguidewires especially when the main body of the guidewires was bent in front of the insertion tool. All studied microguidewires produced microscopic filamentous and/or band-like coating fragments. Few larger irregular fragments were observed, but also very small fragments measuring 1-3 µm in diameter were found. Spectroscopic measurements of polymer fragments and microguidewires identified various polymers. CONCLUSION Backloading of polymer-coated microguidewires during EVT should be minimized if possible. More stable hydrophilic coatings on microguidewires and less traumatic insertion tools are desirable.
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Affiliation(s)
- Rasmus Holmboe Dahl
- Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Hvidovre Hospital, Copenhagen, Denmark
| | - René Wugt Larsen
- Department of Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Esben Thormann
- Department of Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Goetz Benndorf
- Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
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Romitti MG, Perez CR, Pezzotti E, Motta M, Risso FM. Long peripheral catheters in neonates: filling the gap between short peripheral catheters and epicutaneous-caval catheters? J Vasc Access 2023; 24:920-925. [PMID: 34789024 DOI: 10.1177/11297298211057377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Non-critically ill neonates at times require venous access to provide peripherally compatible infusions for a limited period (more than 3 days). In such a situation, short peripheral cannulas are not appropriate as their average duration is about 2 days, while-on the other hand-epicutaneous-caval catheters may be too invasive. In these patients, insertion of long peripheral cannulas may be an effective option. METHODS In this observational retrospective study, we revised all "long" peripheral catheters (4 and 6 cm long) inserted by direct Seldinger technique in our neonatal intensive care unit when peripheral venous access was required for more than 3 days. RESULTS We inserted 52 2Fr polyurethane catheters, either 4 cm long (n = 25) or 6 cm long (n = 27) in 52 patients. Mean dwelling time was 4.17 days (range 1-12). Most devices were inserted in the cephalic vein (n = 18, 35%), and the rest in the saphenous vein (n = 11, 21%) and other superficial veins. There was no significant correlation between the duration of the device and type of infusion (p = 0.40). The main complications were infiltration (n = 16, 31%) and phlebitis (n = 8, 15%). The rate of removal due to complications was significantly higher (p < 0.01) in neonates with bodyweight <2000 g at the time of insertion. CONCLUSION In our experience, 2 Fr 4-6 cm long peripheral catheters may be a valid option for neonates requiring peripherally compatible infusions for more than 3 days. The limits of this study are the necessity of training in the technique of insertion and the small size of our sample. The longest dwell was observed in neonates weighing >2000 g at the time of LPC insertion.
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Affiliation(s)
- Maria Grazia Romitti
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Carmen Rodriguez Perez
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elena Pezzotti
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Motta
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
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Fabiani A, Santoro M, Sanson G. The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters. Heart Lung 2023; 60:39-44. [PMID: 36898280 DOI: 10.1016/j.hrtlng.2023.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In patients requiring a peripheral venous access for more than seven days, long peripheral catheters (LPCs) or midline catheters (MCs) are recommended. Since MCs and LPCs share many characteristics, studies comparing devices made of the same biomaterial are needed. Moreover, a catheter-to-vein ratio >45% at the insertion point has been recognized as a risk factor for catheter related complications, but no study investigated the effect of the catheter-to-vein ratio at the catheter tip level in peripheral venous devices. OBJECTIVES To compare the catheter failure risk between polyurethane MCs and LPCs, considering the effect of the catheter-to-vein ratio at the tip location. METHODS Retrospective cohort study. Adult patients having an expected need for a vascular access of more than 7 days and receiving either a polyurethane LPC or MC were included. The catheter uncomplicated indwelling time within 30 days was considered in survival analysis. RESULTS In a sample of 240 patients, the relative incidences of catheter failure were 5.13 and 3.40 cases for 1,000 catheter days for LPCs and MCs, respectively. In univariate Cox regression, MCs were associated to a statistically significant lower risk of catheter failure (HR 0.330; p = 0.048). After adjusting for other relevant conditions, a catheter-to-vein ratio >45% at the catheter tip location - not the catheter itself - was an independent predictor of a catheter failure (HR 6.762; p = 0.023). CONCLUSIONS The risk of catheter failure was strongly associated with a catheter-to-vein ratio > 45% at the catheter tip level, irrespective for having used a polyurethane LPC or MC.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marilena Santoro
- Cardiothoracic-Vascular Department, Azienda Sanitaria Giuliano Isontina, Strada di Fiume 447, Trieste 34148, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste 34148, Italy.
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Pittiruti M, Van Boxtel T, Scoppettuolo G, Carr P, Konstantinou E, Ortiz Miluy G, Lamperti M, Goossens GA, Simcock L, Dupont C, Inwood S, Bertoglio S, Nicholson J, Pinelli F, Pepe G. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. J Vasc Access 2023; 24:165-182. [PMID: 34088239 DOI: 10.1177/11297298211023274] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.
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Affiliation(s)
| | | | | | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Godelieve Alice Goossens
- Nursing Centre of Excellence, University Hospitals, Leuven, Belgium and Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
| | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Dupont
- Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, France
| | | | | | - Jackie Nicholson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- Catholic University Hospital 'A. Gemelli', Rome, Italy
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Abstract
The use of midline catheters has increased to reduce excessive use of central venous access devices, and additional data on midline catheter complications are needed. This study aimed to describe midline catheter complications among hospitalized patients. This retrospective study included a random sample of 300 hospitalized patients with a midline catheter insertion in 2019. The primary outcome was a composite end point of 8 complications: occlusion, bleeding at insertion site, infiltration/extravasation, catheter-related thrombosis, accidental removal, phlebitis, hematoma, and catheter-related infection. Midline catheter failure was defined as removal prior to the end of therapy due to complications. Among 300 midline catheters, the incidence of the composite end point of 1 or more midline complications was 38% (95% confidence interval, 33%-44%). Complications included occlusion (17.0%), bleeding at insertion site (12.0%), infiltration/extravasation (10.0%), catheter-related thrombosis (4.0%), accidental removal (3.0%), phlebitis (0.3%), hematoma (0.3%), and catheter-related infection (0.3%). Midline catheter failure occurred in 16% of midline catheters (n = 48) due to infiltration/extravasation (n = 27), accidental removal (n = 10), catheter-related thrombosis (n = 9), occlusion (n = 4), and catheter-related infection (n = 1). Three catheters had 2 types of failure. The most common complications of occlusion and bleeding rarely resulted in midline catheter failure. The most common causes of midline catheter failure were infiltration/extravasation, accidental removal, and catheter-related thrombosis.
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Burek AG, Liljestrom T, Dundon M, Shaughnessy EE, Suelzer E, Ullman A. Long peripheral catheters in children: A scoping review. J Hosp Med 2022; 17:1000-1009. [PMID: 36165458 DOI: 10.1002/jhm.12968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Long peripheral catheters (LPCs) are emerging vascular access devices used for short-medium term vascular access needs. Literature in adults suggests LPCs have longer dwell-times than peripheral intravenous catheters (PIVs) and lower rates of serious complications than peripherally inserted central catheters (PICCs). The role of LPCs in children is less established. The objective of this scoping review is to describe and synthesize the existing literature on the effectiveness and safety of LPCs in children. METHODS This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were done in MEDLINE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Scopus, CINAHL (Ebsco), and Google Scholar most recently on February 22, 2022. Studies were included if published in English on or after 2000 and included patients <18 years of age. RESULTS Twenty-one studies were included. The body of literature is variable in quality, measurements, and reported outcomes. Median dwell-time ranged from 5 to 14 days. The rate of completion of therapy ranged from 20% to 86%. Dislodgement, occlusion, and infiltration were the most common complications reported (0%-31%). Venous thromboembolism rates ranged from 0% to 13%. The rate of catheter-related bloodstream infection was 0% in 9 of 10 studies. Less than 50% of studies reported comparative outcomes. CONCLUSION LPCs show promising outcomes in select populations, with longer dwell-time than PIVs and possibly lower rates of serious complications than PICCs. However, more research is needed to clarify the optimal use of LPCs in pediatrics.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tracey Liljestrom
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Melanie Dundon
- Children's Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erin E Shaughnessy
- Department of Pediatrics, University of Alabama at Birmingham and Children's of Alabama, Birmingham, Alabama, USA
| | - Elizabeth Suelzer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amanda Ullman
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Blanco P, Figueroa L, Menéndez MF, Berrueta B. The midline venous catheter in critically ill COVID-19 patients. MEDICINA INTENSIVA (ENGLISH EDITION) 2022; 46:591-593. [PMID: 36155683 PMCID: PMC9499133 DOI: 10.1016/j.medine.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- P Blanco
- COVID-19 Intensive Care Unit-High Dependency Unit, Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave., 7630 Necochea, Argentina.
| | - L Figueroa
- COVID-19 Intensive Care Unit-High Dependency Unit, Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave., 7630 Necochea, Argentina
| | - M F Menéndez
- COVID-19 Intensive Care Unit-High Dependency Unit, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave., 7630 Necochea, Argentina
| | - B Berrueta
- COVID-19 Intensive Care Unit-High Dependency Unit, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave., 7630 Necochea, Argentina
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12
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Rizk E, Tran AT, Soto F, Putney DR, Fuentes A, Swan JT. Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S6-S16. [PMID: 35856577 DOI: 10.12968/bjon.2022.31.14.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce. AIMS This study aimed to evaluate off-label use of alteplase for midline catheter occlusions. METHOD Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study. The primary outcome was restoration of infusion or withdrawal function from at least one lumen of a treated midline catheter. FINDINGS Following alteplase administration, withdrawal function was restored in 47% (25/53) of occlusion events, infusion function was restored in 65% (11/17) of complete occlusion events, and infusion or withdrawal function was restored in 58% (31/53) of occlusion events. Only 34% (17/50) of catheters were replaced because of malfunction. Local bleeding was documented in 9% (n=5) of occlusion events after alteplase administration. CONCLUSION Most midline catheter occlusions treated with alteplase demonstrated restoration of infusion or withdrawal function.
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Affiliation(s)
- Elsie Rizk
- Pharmacy Administrative Specialist in Clinical Research, Department of Pharmacy and Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Anh Thu Tran
- Clinical Pharmacy Fellow in Outcomes Research Department of Pharmacy and Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Frank Soto
- Registered Nurse-IR/PICC, Department of Nursing, Houston Methodist Hospital, Houston, Texas, USA
| | - David R Putney
- Clinical Pharmacy Manager, Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
| | - Amaris Fuentes
- Medication Safety Pharmacist, System Quality and Patient Safety, Houston Methodist, Houston, Texas, USA
| | - Joshua T Swan
- Scientist and Associate Professor of Pharmacy in Surgery and Outcomes Research, Department of Pharmacy and Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
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13
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Larsen EN, August D, Keogh S, Flynn J, Ullman AJ, Marsh N, Cooke M, McCarthy AL, Rickard CM. Evaluating methods for the use and decontamination of needleless connectors: A qualitative inquiry. Infect Dis Health 2022; 27:175-183. [PMID: 35739036 DOI: 10.1016/j.idh.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Needleless connectors (NCs) are essential devices designed to provide safe, needle-free connection between venous access devices, syringes and infusions. There is a variety of designs, and associated decontamination products and practices; the resulting confusion can cause detrimental patient outcomes. This study aimed to explore nurses' attitudes, techniques, and practices around the use and decontamination of NCs in clinical practice. METHODS Qualitative inquiry was conducted with seven focus groups of 4-6 participants each in the cancer and surgical units of a large tertiary hospital in Australia between January and March 2019. Participants comprised nurses who had taken part in a recent clinical trial of NC decontamination. Focus group sessions were recorded, transcribed and synthesised using content analysis. RESULTS Seven focus groups were conducted (total, N = 30 participants), lasting 16-20 min. Six major themes were identified surrounding needleless connector use and decontamination: 'safety and utility'; 'terminology and technological understanding'; 'clinical practice determinants'; 'decontamination procedures and influencers'; 'education and culture'; and 'research and innovation'. CONCLUSION The participants articulated positive attitudes towards needleless connector use for needle-stick and infection prevention, however rationales for care and maintenance practices demonstrated limited understanding of guidelines (e.g., disinfection time) and specific NC function (e.g., positive, negative pressure). The findings indicated the need for targeted, standardised needleless connector education, to enhance staff confidence, improve consistency of care and ensure patient safety.
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Affiliation(s)
- Emily N Larsen
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
| | - Deanne August
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Keogh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Flynn
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Amanda J Ullman
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia; Children's Health Queensland, Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia; Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
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14
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Bayoumi MAA, van Rens R, Chandra P, Shaltout D, Gad A, Elmalik EE, Hammoudeh S. Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study. BMJ Open 2022; 12:e058866. [PMID: 35387831 PMCID: PMC8987782 DOI: 10.1136/bmjopen-2021-058866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We aimed to compare the success rates and other catheter-related parameters between peripherally inserted central catheters (PICCs) and non-tunnelled ultrasound-guided central venous catheters (USG-CVCs) including femoral, jugular, brachiocephalic and subclavian lines. DESIGN This was a retrospective observational study. SETTING The study was performed in a level III neonatal intensive care unit (NICU) in Qatar, as a single-site study. PARTICIPANTS This study included 1333 neonates who required CVC insertion in the NICU from January 2016 to December 2018. Of those, we had 1264 PICCs and 69 non-tunnelled USG-CVCs. OUTCOME MEASURES The success rate and other catheter-related complications in the two groups. RESULTS The overall success rate was 88.4% in the USG-CVCs (61/69) compared with 90% in the PICCs (1137/1264) group (p=0.68). However, the first prick success rate was 69.4% in USG-CVCs (43/69) compared with 63.6% in the PICCs (796/1264) group. Leaking and central line-associated blood stream infection (CLABSI) were significantly higher in the USG-CVC group compared with the PICC group (leaking 16.4% vs 2.3%, p=0.0001) (CLABSI 8.2% vs 3.1%, p=0.03). CLABSI rates in the PICC group were 1.75 per 1000 catheter days in 2016 and 3.3 in 2017 compared with 6.91 in 2016 (p=0.0001) and 14.32 in 2017 (p=0.0001) for the USG-CVCs. USG-CVCs had to be removed due to catheter-related complications in 52.5% of the cases compared with 29.9% in PICCs, p=0.001. In 2018, we did not have any non-tunnelled USG-CVCs insertions in our NICU. CONCLUSIONS The overall complication rate, CLABSI and leaking are significantly higher in non-tunnelled USG-CVCs compared with the PICCs. However, randomised controlled trials with larger sample sizes are desired. Proper central venous device selection and timing, early PICC insertion and early removal approach, dedicated vascular access team development, proper central venous line maintenance, central line simulation workshops and US-guided insertions are crucial elements for patient safety in NICU.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Roland van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Deena Shaltout
- Medical Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Gad
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Samer Hammoudeh
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
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15
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Bayoumi MAA, van Rens MFPT, Chandra P, Masry A, D'Souza S, Khalil AM, Shadad A, Alsayigh S, Masri RM, Shyam S, Alobaidan F, Elmalik EE. Does the antimicrobial-impregnated peripherally inserted central catheter decrease the CLABSI rate in neonates? Results from a retrospective cohort study. Front Pediatr 2022; 10:1012800. [PMID: 36507144 PMCID: PMC9730802 DOI: 10.3389/fped.2022.1012800] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of antimicrobial-impregnated peripherally inserted central catheters (PICCs) has been introduced in the last few years to neonatal units aiming to reduce central line-associated bloodstream infection (CLABSI). METHODS This retrospective observational study aimed to compare the CLABSI rates and other catheter-related parameters including the insertion success rates and catheter-related complications in the antimicrobial-impregnated and conventional (ordinary) PICCs in NICU between 2017 and 2020. RESULTS Our dedicated PICC team including physicians and nurses inserted 1,242 conventional (PremiCath and NutriLine) and 791 antimicrobial-impregnated PICCs (PremiStar) over the study period from 2017 to 2020. Of those 1,242 conventional PICCs, 1,171 (94.3%) were 1 Fr single lumen and only 71 (5.7%) were 2 Fr double lumen. The mean ± SD [median (IQR)] for the birth weight in all babies who had a PICC line was 1,343.3 ± 686.75 [1,200 (900, 1,500)] g, while the mean ± SD for the gestational age was 29.6 ± 4.03 [29 (27, 31)] weeks. The mean ± SD [median (IQR)] age at the time of insertion for all catheters was 9.3 ± 21.47 [2 (1, 9)] days, while the mean ± SD [median (IQR)] dwell time was 15.7 ± 14.03 [12 (8, 17)] days. The overall success rate of the PICC insertion is 1,815/2,033 (89.3%), while the first attempt success rate is 1,290/2,033 (63.5%). The mean ± SD [median (IQR)] gestational age, birth weight, age at catheter insertion, and catheter dwell time were 28.8 ± 3.24 [29, (26, 31)] weeks, 1,192.1 ± 410.3 [1,150, (900, 1,450)] g, 6.3 ± 10.85 [2, (1, 8)] days, and 17.73 ± 17.532 [13, (9, 18)] days in the antimicrobial-impregnated catheter compared with 30.1 ± 4.39 [29, (27, 32)] weeks (P < 0.001), 1,439.5 ± 800.8 [1,240, (920, 1,520)] g (P < 0.001), 11.1 ± 25.9 [1, (1, 9)] days (P < 0.001), and 14.30 ± 10.964 [12, (8, 17)] days (P < 0.001), respectively, in the conventional PICCs. The use of the antimicrobial-impregnated catheter was not associated with any significant reduction in the CLABSI rate (per 1,000 days dwell time), either the overall [P = 0.11, risk ratio (RR) (95% CI): 0.60 (0.32, 1.13)] or the yearly CLABSI rates. CONCLUSIONS The use of miconazole and rifampicin-impregnated PICCs did not reduce the CLABSI rate in neonates compared with conventional PICCs. However, it has a higher overall rate of elective removal after completion of therapy and less extravasation/infiltration, occlusion, and phlebitis compared with the conventional PICCs. Further large RCTs are recommended to enrich the current paucity of evidence and to reduce the risk of bias. Neonatal PICCs impregnation by other antimicrobials is a recommendation for vascular access device manufacturers.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Matheus F P T van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alaa Masry
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha D'Souza
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Amr M Khalil
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Afaf Shadad
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Safaa Alsayigh
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Razan M Masri
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha Shyam
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar.,VERITADYNE Strategic Consulting Pvt. Ltd., Delhi, India
| | - Fatima Alobaidan
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
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16
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Nickel B. Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care? Crit Care Nurse 2021; 41:e1-e21. [PMID: 34851379 DOI: 10.4037/ccn2021818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. OBJECTIVE To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. RESULTS Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. DISCUSSION Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. CONCLUSIONS Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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17
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Blanco P, Figueroa L, Menéndez MF, Berrueta B. The midline venous catheter in critically ill COVID-19 patients. Med Intensiva 2021; 46:591-593. [PMID: 34642523 PMCID: PMC8498648 DOI: 10.1016/j.medin.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pablo Blanco
- COVID-19 Intensive Care Unit- High dependency Unit, Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave, 7630 Necochea, Argentina
| | - Liliana Figueroa
- COVID-19 Intensive Care Unit- High dependency Unit, Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave, 7630 Necochea, Argentina
| | - María Fernanda Menéndez
- COVID-19 Intensive Care Unit- High dependency Unit, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave, 7630 Necochea, Argentina
| | - Belén Berrueta
- COVID-19 Intensive Care Unit- High dependency Unit, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave, 7630 Necochea, Argentina
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18
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Glazner J, Steinfort K, Hu YJ, Browne W, Smith I, Brasher C. Short midline catheters: High success rates for antibiotic therapy in children with cystic fibrosis. J Vasc Access 2021; 24:385-390. [PMID: 34296638 DOI: 10.1177/11297298211035310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Short midline catheter use in paediatric populations appears to be increasing, however data on success rates and efficacy are sparse. This study aims to describe the success rate when midline venous catheters are employed as a single device for intravenous antibiotic therapy in paediatric patients with cystic fibrosis. METHODS A retrospective cohort study was performed in a single institution, retrieving electronic medical record data from July 2017 through March 2020. The primary outcome was device success, defined as a catheter that remained functional until the end of antibiotic therapy. Reasons for device failure were categorized in a standard fashion. RESULTS Primary outcome data were available for 116 catheter insertions, involving 49 patients and 55 proceduralists. The success rate was 84% (n = 98). Median age at insertion was 15 years (range 4-19) and median weight 52 kg (13-81). Soft, polyether block amide, Arrow® Seldinger Arterial Catheters were employed. Only 16 patients (14%) required general anaesthesia. Median time to failure was 6 days, and median time to successful completion of treatment was 13 days. Six of 18 failures occurred within 48 h and were likely insertion complications. The most common reasons for device failure were occlusion, extravasation, phlebitis and dislodgement. More than half of patients (56%) received antibiotic therapy at home. CONCLUSION There is a high single device success rate when inserting short midlines for 13-day intravenous pulmonary antibiotic therapy in children with cystic fibrosis. These results should be confirmed with a prospective study.
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Affiliation(s)
- Judith Glazner
- Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Kate Steinfort
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia
| | | | - William Browne
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Ian Smith
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Christopher Brasher
- Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,Critical Care, University of Melbourne, Parkville, VIC, Australia
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19
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Terminology for vascular access devices. J Vasc Surg 2021; 74:344-345. [PMID: 34172194 PMCID: PMC8217067 DOI: 10.1016/j.jvs.2020.12.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
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20
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Giustivi D, Gidaro A, Baroni M, Paglia S. Tunneling technique of PICCs and Midline catheters. J Vasc Access 2021; 23:610-614. [PMID: 33726584 DOI: 10.1177/11297298211002579] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The tunneling technique is currently widely used for placement of CVC. Recently, some clinicians have used this technique for peripherally inserted central catheters (PICC), or Midline catheters (MCs). Objective: To describe a safe antegrade tunneling technique for PICCs and MCs insertion with a blunt tunneler. Methods: This retrospective monocentric survey collected ASST Lodi hospital data from January 1st to December 31st, 2019. The indication for PICCs and MCs tunneled implant was to respect the correct vein/catheter ratio or special clinical situation (children, burns, wounds, and wider catheter 5/6 fr). Contraindications included the operator’s low skills and severe risk of bleeding (INR > 3; Platelet count <50’000). Results: About 390 PICCs (327 4 fr and 63 5 fr) and 183 MCs were placed. One hundred and sixty-five PICCs (42%) and 110 MCs (60%) were tunneled. Five fr PICCs were more present among tunneled catheters (54/165 [32.7%] vs 9/225 [4%] p < 0.0001). In the majority tunneling was necessary to respect the correct catheter/vein ratio. The exit site was shifted only for four special clinical situations: skin infections (one PICC and two MCs); burns (one MC). No early complication (intraprocedural, major bleeding), catheter related thrombosis, or device fractures occurred. Two catheter-related bloodstream infections (one PICC, one MC), nine dislocations (four PICCs, five MCs), one MC occlusion were recorded. Conclusions: The antegrade tunneling technique with blunt tunneler of PICCs and MCs is simple, rapid and is regarded as a safe maneuver. More in-depth and future prospective studies are needed to evaluate the impact of tunneling on early and late complications.
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Affiliation(s)
- Davide Giustivi
- Vascular Access Team, A&E Department, ASST Provincia di Lodi, Lodi, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Monica Baroni
- Vascular Access Team, A&E Department, ASST Provincia di Lodi, Lodi, Italy
| | - Stefano Paglia
- Vascular Access Team, A&E Department, ASST Provincia di Lodi, Lodi, Italy
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21
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Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. Standard Versus Long Peripheral Catheters for Multiday IV Therapy: A Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-000877. [PMID: 33446506 DOI: 10.1542/peds.2020-000877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In children, intravenous therapy (IVT) is generally administered via peripheral intravenous catheters (PIVCs) (2-6 cm in length). There is evidence that PIVCs are unreliable after 2 days. Long peripheral catheters (LPCs) (6-15 cm in length) could improve the delivery of IVT. The aim of this trial was to determine if LPCs could decrease catheter failure and the number of catheters in children receiving multiday IVT. METHODS This was an open-label randomized controlled trial conducted at Monash Children's Hospital in Melbourne, Australia. Participants were from the ages of 1 to 17 years, undergoing surgery and requiring >48 hours of postoperative IVT. Participants were randomly assigned to a 2.5-cm 22G PIVC or an 8-cm 22G LPC. RESULTS Seventy-two children were randomly assigned, 36 received PIVCs, and 36 received LPCs. The median duration of IVT was 5.1 days and was similar between groups (P = .9). Catheter failure was higher for PIVCs than LPCs (66.7% vs 19.4%; relative risk [RR]: 3.4; P = .0001 or 187.9 vs 41.0 failures per 1000 catheter-days). Infiltration was the most common reason for PIVC failure (33.3% vs 2.8%; RR: 12.0; P = .001). LPCs exhibited superior life span (4.7 vs 3.5 days [median]; P = .01). Children with LPCs were twice as likely to complete therapy with a single catheter (80.6% vs 38.9%; RR: 2.1; P = .0006). CONCLUSIONS LPCs reduce catheter failure and total catheters in children. They should be considered as the first-line device for peripheral access in any child receiving prolonged IVT.
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Affiliation(s)
- Kirby R Qin
- Departments of Paediatric Surgery and.,Departments of Paediatrics and.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Nicholas Ensor
- Departments of Paediatric Surgery and.,Departments of Paediatrics and.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Richard Barnes
- Anaesthesia, Monash Children's Hospital, Melbourne, Australia
| | - Anna Englin
- Anaesthesia, Monash Children's Hospital, Melbourne, Australia
| | - Ramesh M Nataraja
- Departments of Paediatric Surgery and.,Departments of Paediatrics and.,Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; and
| | - Maurizio Pacilli
- Departments of Paediatric Surgery and .,Departments of Paediatrics and.,Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia; and
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22
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Pavelkova K, Lisova K, Blahova P, Mokra D, Hloch O, Charvat J. Comparison of 12-cm versus 6-cm long peripheral catheters in patients with difficult intravenous access (DIVA). J Vasc Access 2020; 23:94-97. [PMID: 33349111 DOI: 10.1177/1129729820983151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long peripheral catheter is 6-15 cm long vascular device. The aim of the study was to compare the frequency of complications of two types of long peripheral catheters with different length inserted in DIVA patients. METHODS Under ultrasound navigation 2.7F 6.4 cm or 4Fr 12 cm long peripheral catheter was inserted. Complications of both long peripheral catheters were prospectively observed and their relationship to the patient's age, gender, selected vein, number of punctures and Barthel score system was evaluated. RESULTS Ninety-three 12 cm and fifty-five 6.4 cm long peripheral catheters were inserted. Median of dwelling time was 8 days for 6.4 cm and 9 days for 12 cm long peripheral catheter. There were 17 (26%) complications in 6.4 cm (38/1000 catheter days) and 15 (16%) in 12 cm catheter (17/1000 catheter days), p = 0.04. The complications of both peripheral catheters were not associated with the age of patients, gender, number of punctures and selected vein for insertion. Unlike 12 cm catheter, the complications of 6.4 cm long peripheral catheter were significantly associated with the result of Barthel scoring system (p = 0.003). CONCLUSION The frequency of complications was more common with 6,4 cm than with 12 cm catheter.
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Affiliation(s)
- Katerina Pavelkova
- Medical Department of 2nd Faculty of Medicine of Charles University and Faculty Hospital Motol, Prague, Czech Republic
| | - Katerina Lisova
- Medical Department of 2nd Faculty of Medicine of Charles University and Faculty Hospital Motol, Prague, Czech Republic
| | - Petra Blahova
- Medical Department of 2nd Faculty of Medicine of Charles University and Faculty Hospital Motol, Prague, Czech Republic
| | - Dana Mokra
- Medical Department of 2nd Faculty of Medicine of Charles University and Faculty Hospital Motol, Prague, Czech Republic
| | - Ondrej Hloch
- Medical Department of 2nd Faculty of Medicine of Charles University and Faculty Hospital Motol, Prague, Czech Republic
| | - Jiri Charvat
- Medical Department of 2nd Faculty of Medicine of Charles University and Faculty Hospital Motol, Prague, Czech Republic
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23
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Thiyagarajan S, Ravindran C. Conventional central venous catheters as tunnelled mid-clavicular midline catheters: Description of novel application and outcome analysis. J Vasc Access 2020; 23:98-104. [PMID: 33349144 DOI: 10.1177/1129729820982870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Long peripheral catheters are the ideal devices for intermediate venous access (1-4 weeks). However due to non-availability and cost constraints, these lines are not widely adapted in developing countries. In this clinical report we describe a technique of using conventional Central Venous Catheters as Midclavicular midlines for intermediate venous access and present the outcome analysis of such catheters in the last 2 years from our institute. METHODS A single lumen conventional central venous catheter (5 Fr, 20 cm) was introduced through the deep veins of the upper arm, 1 to 1.5 cm distal to the axillary crease. The catheter was tunnelled for a distance of 5 to 7 cm to exit from Dawson's green zone to reduce the incidence of Midline Associated Blood Stream Infection. Patients were followed up by trained staff nurses and outcome parameters were recorded. RESULTS Seventy six patients were enrolled and 72 patients underwent successful cannulation and completed the outcome analysis. Administration of intravenous antibiotics and chemotherapy were the commonest indications. The device served the intended duration of therapy in 66 (92%) patients for a median number of 12 (6-20) catheter days. Device related blood stream infection was 1.24/1000 catheter days and catheter related thrombosis rate was 8.3%. CONCLUSION Conventional Central Venous Catheters can be effectively used as tunnelled Midclavicular midline catheters in low resource settings. The successful outcome analysis has to be confirmed by larger studies.
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Affiliation(s)
- Sivashanmugam Thiyagarajan
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed University, Puducherry 607402, India
| | - Charulatha Ravindran
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed University, Puducherry 607402, India
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24
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Vailati D, Montrucchio G, Cerotto V, Capozzoli G, Gori F, Petrini F, Brazzi L. Choice and management of vascular access in the context of COVID-19 outbreak in Italy: Recommendations from clinical practice. J Vasc Access 2020; 23:18-23. [PMID: 33198573 DOI: 10.1177/1129729820968415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
On April 2020, during the outburst of the COVID-19 pandemic in Italy, the SIAARTI ("Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva") Research Group on Vascular Access has formulated some essential recommendations for the optimization of the selection, insertion, and maintenance of the vascular access devices, with the aim of guarantee the operator safety, ensure the effectiveness of the maneuvers, and reduce the risk of complications. Here we describe the key elements of clinical management of vascular access in patients affected by COVID-19.
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Affiliation(s)
- Davide Vailati
- Anesthesia and Intensive Care Unit, Melegnano Hospital, Milano, Italy
| | - Giorgia Montrucchio
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Vittorio Cerotto
- Anesthesia and Intensive Care Unit, Città di Castello Hospital, Perugia, Italy
| | | | - Fabio Gori
- Anesthesia and Intensive Care 1, 'Azienda Ospedaliera di Perugia', Perugia, Italy
| | - Flavia Petrini
- Anesthesia and Intensive Care, Chieti Hospital, Chieti, Italy.,Department of Medical Oral and Biotechnological Sciences, University of Chieti Pescara, Italy
| | - Luca Brazzi
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.,Department of Surgical Sciences, University of Turin, Torino, Italy
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25
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Pande RK, Bhalla A, Myatra SN, Yaddanpuddi LN, Gupta S, Sahoo TK, Prakash R, Sahu TA, Jain A, Gopal PBN, Chaudhry D, Govil D, Dixit S, Samavedam S. Procedures in COVID-19 Patients: Part-I. Indian J Crit Care Med 2020; 24:S263-S271. [PMID: 33354050 PMCID: PMC7724930 DOI: 10.5005/jp-journals-10071-23597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The number of cases with novel coronavirus disease-2019 (COVID-19) infection is increasing every day in the world, and India contributes a substantial proportion of this burden. Critical care specialists have accepted the challenges associated with the COVID-19 pandemic and are frontline warriors in this war. They have worked hard in streamlining workflow isolation of positive patients, clinical management of critically ill patients, and infection prevention practices. With no end in sight for this pandemic, intensive care unit (ICU) practitioners, hospital administrators, and policy makers have to join hands to prepare for the surge in critical care bed capacity. In this position article, we offer several suggestions on important interventions to the ICU practitioners for better management of critically ill patients. This position article highlights key interventions for COVID-19 treatment and covers several important issues such as endotracheal intubation and tracheostomy (surgical vs PCT), nebulization, bronchoscopy, and invasive procedures such as central venous catheters, arterial lines, and HD catheters. How to cite this article: Pande RK, Bhalla A, SN Myatra, Yaddanpuddi LN, Gupta S, Sahoo TK, et al. Procedures in COVID-19 Patients: Part-I. Indian J Crit Care Med 2020;24(Suppl 5):S263-S271.
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Affiliation(s)
- Rajesh K Pande
- Department of Critical Care Medicine, BLK Center for Critical Care, BLK Superspeciality Hospital, New Delhi, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lakshmi N Yaddanpuddi
- Department of Anaesthesiology and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sachin Gupta
- Department of Critical Care, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Tapas K Sahoo
- Department of Critical Care Medicine, Institute of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India
| | - Ravi Prakash
- Department of Critical Care Medicine, BLK Center for Critical Care, BLK Superspeciality Hospital, New Delhi, India
| | - Tarun A Sahu
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akansha Jain
- Department of Paediatric ICU, Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, Jharkhand, India
| | - Palepu BN Gopal
- Department of Critical Care, Continental Hospital, Hyderabad, Telangana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Department of Critical Care Medicine, Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
| | - Shubhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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26
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Qin KR, Pittiruti M, Nataraja RM, Pacilli M. Long peripheral catheters and midline catheters: Insights from a survey of vascular access specialists. J Vasc Access 2020; 22:905-910. [DOI: 10.1177/1129729820966226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Peripheral intravenous access is no longer limited to the standard intravenous catheter (cannula). Devices varying in length, material and insertion technique, are increasingly accessible. There is substantial variability surrounding the nomenclature and use of these devices in the literature. We wished to understand the attitude of vascular access specialists towards the nomenclature and use of peripheral intravenous catheters (PIVCs), long peripheral catheters (LPCs) and midline catheters (MCs). Methods: A 15-question electronic survey was sent to members of the Association of Vascular Access (AVA) regarding the nomenclature and use of PIVCs, LPCs and MCs. Results: A total of 228 participants completed the survey. Approximately two-thirds of respondents use LPCs (65.8%) and MCs (71.9%) in their clinical practice. The most common indication for LPCs was difficult venous access (56.5%), while the most common indication for MCs was medium-term (1–4 weeks) intravenous therapy (62.7%). The majority of participants (57.9%) agreed with the following classification of peripheral intravenous devices: PIVCs: 2 to 6 cm in length, terminating distal to the axilla; LPCs: 6 to 15 cm in length, terminating distal to the axilla; MCs: 15–25 cm in length, terminating in the axilla. Participants suggested that the length of the catheter should be considered a general recommendation, as LPCs and MCs should be primarily differentiated by tip location. Conclusions: The majority of vascular access specialists from AVA have incorporated LPCs and MCs into their repertoire of peripheral venous access tools. We envisage that their use will increase as the clinical community becomes more familiar with these devices.
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Affiliation(s)
- Kirby R Qin
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, Austin Health, Melbourne, Australia
| | - Mauro Pittiruti
- Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Ramesh M Nataraja
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery, Monash Children’s Hospital, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery, Monash Children’s Hospital, Melbourne, Australia
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27
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Burek AG, Parker J, Bentzien R, Talbert L, Havas M, Hanson SJ. The Development of a Long Peripheral Catheter Program at a Large Pediatric Academic Center: A Pilot Study. Hosp Pediatr 2020; 10:897-901. [PMID: 32998934 DOI: 10.1542/hpeds.2020-0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the feasibility of a new long peripheral catheter (LPC) program at a large academic center in an effort to reduce the use of peripherally inserted central catheters (PICCs) and their related complications. METHODS The pilot participants were hospitalized children, age >2 years, with a need for noncentral intravenous access for 2 to 29 days, or laboratory blood draw >5 times per day. Patients expected to discharge with intravenous access were excluded. Included in the pilot program development were a literature review, 1-year baseline data analysis, and program design and implementation. A multidisciplinary committee developed and implemented the program from December 2018 to September 2019. LPCs were placed from August to September 2019. RESULTS Regarding the baseline data, between July 2018 and June 2019, 584 PICCs were placed in 461 patients. Of these, 139 PICCs (24%) did not meet requirements necessitating central access and, potentially, could have been avoided if an LPC alternative were available at the time. For the LPC pilot program, 20 LPCs were placed in 19 patients. The median age was 11 (interquartile range of 7-15). The insertion success rate was 83%. There were no serious complications, such as venous thrombosis or catheter-related bloodstream infection. The total rate of minor complications was 35%: the rate of occlusions was 10% (n = 2), and the rate of dislodgement was 25% (n = 5). The catheter failure rate was 74 per 1000 catheter-days. The mean line duration was 6 days. CONCLUSIONS There is a role for LPCs in hospitalized children requiring durable vascular access. Multispecialty designed pilot implementation of an LPC program was successful at an academic pediatric hospital.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin; and .,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeff Parker
- Children's Wisconsin, Milwaukee, Wisconsin; and
| | | | | | - Molly Havas
- Children's Wisconsin, Milwaukee, Wisconsin; and
| | - Sheila J Hanson
- Children's Wisconsin, Milwaukee, Wisconsin; and.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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28
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Fabiani A, Eletto V, Dreas L, Beltrame D, Sanson G. Midline or long peripheral catheters in difficult venous access conditions? A comparative study in patients with acute cardiovascular diseases. Am J Infect Control 2020; 48:1158-1165. [PMID: 31973988 DOI: 10.1016/j.ajic.2019.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Midline catheters (MCs) are commonly inserted in patients with difficult venous access (DVA) needing peripheral access. Recently, the alternative placement of ultrasound-guided long peripheral catheters (LPCs) has spread. However, no study has compared the reliability of the 2 devices. This study aims to compare the safety and reliability of MCs and LPCs in DVA patients. METHODS A retrospective cohort study was conducted, enrolling 184 DVA patients. Polyurethane MCs and 2 lengths of polyethylene LPCs (8/10 cm and 18 cm) were compared. The independent effect of catheter type on uncomplicated catheter survival was determined through a Cox regression analysis. RESULTS The relative incidences of overall catheter-related complications (CRCs) were 15.84 of 1,000, 10.64 of 1,000, and 6.27 of 1,000 catheter-days for 8/10 cm-LPCs, 18 cm-LPCs, and MCs, respectively. The relative incidences of catheter-related bloodstream infections were 0.72 of 1,000 for both length LPCs and 0.48 of 1,000 catheter-days for MCs. Compared to MCs, a significant increase in CRC risk for 8/10 cm LPCs (hazard ratio [HR] 5.328; 95% confidence interval [CI] 2.118-13.404; P < 0.001) was found, along with a nonsignificant trend toward an increased risk for 18 cm-LCPs (HR 2.489; 95% CI 0.961-6.448; P = 0.060). CONCLUSION MCs allow for longer uncomplicated indwelling times than LPCs. The decision regarding which catheter to use should consider the planned duration of intravenous therapy, the patient's clinical condition, and the cost of the device.
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Affiliation(s)
- Adam Fabiani
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Valentina Eletto
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Lorella Dreas
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Daria Beltrame
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Strada di Fiume 447, Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
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29
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Benvenuti S, Parolini F, Pecorelli S, Ceresoli R, Ricca M, Jacquot L, Alberti D. Arranging an emergency Vascular Accesses Program during COVID-19 pandemic. J Vasc Access 2020; 22:856-858. [PMID: 32912108 DOI: 10.1177/1129729820957819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | - Mauro Ricca
- ASST Spedali Civili di Brescia, Brescia, Italy
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30
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Bayoumi MAA, Van Rens MFP, Chandra P, Francia ALV, D'Souza S, George M, Shahbal S, Elmalik EE, Cabanillas IJE. Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit. J Vasc Access 2020; 22:243-253. [PMID: 32602399 PMCID: PMC7983328 DOI: 10.1177/1129729820928182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced. Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018. Results: The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates. Conclusion: A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Matheus F P Van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha D'Souza
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Majee George
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Saad Shahbal
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Irian J E Cabanillas
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
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31
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Qin KR, Ensor N, Barnes R, Englin A, Nataraja RM, Pacilli M. Long peripheral catheters for intravenous access in adults and children: A systematic review of the literature. J Vasc Access 2020; 22:767-777. [PMID: 32529915 DOI: 10.1177/1129729820927272] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long peripheral catheters are peripheral intravenous catheters of 6-15 cm in length. They are commonly inserted into the forearm, antecubital fossa or upper arm using a direct Seldinger technique. They have proven to be valuable for peripheral intravenous catheters, particularly in patients with difficult intravenous access. METHODS We conducted a systematic review of studies reporting the use of long peripheral catheters. The following keywords were used: 'long', 'Seldinger', 'guidewire', 'peripheral', 'venous', 'intravenous', 'IV', 'vascular', 'cannula' and 'catheter'. RESULTS Three hundred forty-one publications were identified; 16 were included in the systematic review. There were 11 adult studies and 5 paediatric studies documenting 1288 long peripheral catheters in 1271 patients. Majority of studies (12/16) were conducted in acute care settings, (emergency department, n = 6; intensive care unit, n = 3; high dependency unit, n = 1; surgical unit, n = 2). The most frequently studied long peripheral catheter was 8 cm in length and 20 G in size. Nine studies recruited patients with difficult intravenous access; 11 studies used ultrasound guidance. Insertion success rate and mean procedural time ranged between 86% and 100% and 8 and 16.8 minutes, respectively. Average catheter duration ranged between 4 and 14.7 days (mean) and 1.1 and 9 days (median). Catheter failure occurred in 4.3-52.5% of long peripheral catheters, with leakage, infiltration and dislodgement being the most frequent causes of failure. In 3 randomised controlled trials, long peripheral catheters outperformed peripheral intravenous catheters in terms of duration and failure rate. CONCLUSION Long peripheral catheters are safe and reliable in both adults and children. In addition, long peripheral catheters may provide improved quality of care over peripheral intravenous catheters for multi-day intravenous therapy.
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Affiliation(s)
- Kirby R Qin
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Nicholas Ensor
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Anna Englin
- Department of Anaesthesia, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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32
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Pittiruti M, Pinelli F. Recommendations for the use of vascular access in the COVID-19 patients: an Italian perspective. Crit Care 2020; 24:269. [PMID: 32466803 PMCID: PMC7257200 DOI: 10.1186/s13054-020-02997-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Largo Gemelli 8, 00168, Rome, Italy.
| | - Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
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33
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Scoppettuolo G, Biasucci DG, Pittiruti M. Vascular access in COVID-19 patients: Smart decisions for maximal safety. J Vasc Access 2020; 21:408-410. [PMID: 32367764 DOI: 10.1177/1129729820923935] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The 2020 COVID pandemic has forced everyone to update the usual medical procedures and adapt them to a new situation characterized by a high risk of contamination of the health operator. The placement of a venous access device is no exception. In the experience of the vascular access team of our hospital, hit by the COVID epidemic in March 2020, the safety of both the patient and the staff can be ensured by an insertion bundle of few smart strategies, which include choice of long dwelling peripheral catheters (midline catheters) rather than short venous cannulas; use of power injectable peripherally inserted central catheters in the COVID patients in intensive care unit requiring a central line; use of wireless probes-easy to carry, easy to clean-for ultrasound guided venipuncture; avoidance of x-rays, using alternative methods for tip location such as intracavitary electrocardiography or trans-thoracic echocardiography; strict adoption of the barrier precautions recommended by the international guidelines.
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Affiliation(s)
- Giancarlo Scoppettuolo
- Department of Infective Diseases, Fondazione Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "A.Gemelli," Rome, Italy
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34
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Elli S, Pittiruti M, Pigozzo V, Cannizzo L, Giannini L, Siligato A, Rondelli E, Foti G, Lucchini A. Ultrasound-guided tip location of midline catheters. J Vasc Access 2020; 21:764-768. [DOI: 10.1177/1129729820907250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Midline catheters are widely used in clinical practice. Proper placement of midline catheter tip is usually assessed only by aspirating blood and flushing with normal saline without resistance. Purpose: To describe the ultrasound-guided tip location for midline catheters and its feasibility and to compare incidence of catheter-related venous thrombosis associated with or without ultrasound tip localization. Methods: The ultrasound-guided tip location is described step by step. Feasibility of the technique and incidence of catheter-related venous thrombosis were measured (study group) and compared with two historical groups: study group, 20-cm midline catheters inserted with ultrasound-guided tip location; group 1, 25-cm midline catheters inserted without ultrasound-guided tip location and group 2, 20-cm midline catheters inserted without ultrasound-guided tip location. Results: In the study group, ultrasound-guided tip location was easily feasible in 98.9% of patients. Incidence of catheter-related venous thrombosis was 2.42% in control group 1, 9% in control group 2 and 2.62% in the study group. Discussion: In the study group and control group 1, the tip was placed in the axillary vein, about 3 cm distal to the clavicle and in the subclavian vein. In control group 2, the tip was probably located at the transition between the axillary and the subclavian vein. It is possible that such position may have been associated with an increased incidence of catheter-related venous thrombosis. Conclusion: The ideal position of the tip of a midline catheter might be inside the axillary vein, about 3 cm distal to the axillary-subclavian transition or inside the subclavian vein. Ultrasound-guided tip location is safe, inexpensive, easy and potentially useful during midline catheters insertion.
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Affiliation(s)
- Stefano Elli
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
| | - Valentina Pigozzo
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Luigi Cannizzo
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Luciano Giannini
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Andrea Siligato
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Egle Rondelli
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Foti
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Alberto Lucchini
- General Intensive Care Unit, Emergency Department, University of Milan-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
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Patel SA, Araujo T, Rodriguez LP, Sanchez CR, Snyder A, Chopra V. Long Peripheral Catheters: A Retrospective Review of Major Complications. J Hosp Med 2019; 14:758-760. [PMID: 31634106 DOI: 10.12788/jhm.3313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The risk of infectious and noninfectious complications associated with long peripheral catheters (LPCs) is unknown. In this retrospective study of 539 catheters, we found LPCs were often placed for the indications of difficult access and long-term antibiotics. Rates of deep vein thrombosis (1.7%) and catheter-related infection (0.6%) were low. LPCs may represent a novel and safe option for short-term venous access.
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Affiliation(s)
- Sanjay A Patel
- Division of Hospital Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Tiago Araujo
- Division of Post-Graduate Education, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Luis Parra Rodriguez
- Division of Post-Graduate Education, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Claudia Ramirez Sanchez
- Division of Post-Graduate Education, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ashley Snyder
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
- VA Ann Arbor Health System, Ann Arbor, Michigan
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