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Eo SJ, Ryu DS, Yun CE, Park Y, Won DS, Kim JW, Kim SH, Park JH, Kim DH. One-hand guidewire introducer kit for ultrasound-guided central venous catheterization: a proof-of-concept study. Sci Rep 2024; 14:29222. [PMID: 39587166 PMCID: PMC11589571 DOI: 10.1038/s41598-024-79784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 11/12/2024] [Indexed: 11/27/2024] Open
Abstract
Despite ultrasound guidance for central venous catheterization (CVC), the first-attempt success rate has remained around 52.6-62.1%. A significant reason is that the needle can sometimes be dislodged from the punctured vein during hand shifts. Here, a novel one-hand guidewire introducer (OGI) kit was developed to perform guidewire insertion in the central vein, eliminating hand shifts. To establish a protocol, the OGI kit was validated using a central line training phantom. A total of 48 randomized trials of guidewire insertion in the internal jugular vein in eight pigs were performed using either the conventional kit (group A) or the OGI kit (group B). All trials were technically successful with all eight pigs. First-attempt success rate (50% vs. 75%, p = 0.035) and global rating scale (12 (5-15) vs. 14 (8-15), p = 0.011) were significantly lower in group A than in group B. The number of needle redirections and guidewire insertions, time to guidewire insertion, and procedure-related complications were significantly higher in group A than in group B. Guidewire insertion using a novel OGI kit could be a promising approach for real-time ultrasound-guided CVC as it offers greater clinical usefulness.
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Affiliation(s)
- Seung Jin Eo
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dae Sung Ryu
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chae Eun Yun
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yubeen Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong-Sung Won
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Won Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Song Hee Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Alsaleh K, Alosaimi D, Almousawi A, Alshaikh M, Omar H. Effectiveness of a nurse-led peripherally inserted central catheter service: A retrospective cohort study. J Vasc Access 2024:11297298241263886. [PMID: 39129328 DOI: 10.1177/11297298241263886] [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: 08/13/2024] Open
Abstract
BACKGROUND A multitude of challenges arises from the growing utilisation of peripherally inserted central catheters (PICCs), including the ability to provide timely, effective and safe insertion, which must be ensured and prioritised in patient care. A nurse-led model of care has become more prevalent as PICCs become extensively needed due to their applications. However, despite their widespread use, such intervention is yet in its inception in Saudi Arabia, and thereby, evaluating the outcomes of this service is of utmost importance to support patient safety initiatives and quality of care. PURPOSE This research aims to assess the effectiveness of a nurse-led PICC placement service. METHODS A quantitative retrospective cohort design was used. The sample of this study was 333 random subsets of records on PICC insertion for adult patients between 1st April 2019 and 31st March 2023 in a tertiary medical facility in Riyadh, Saudi Arabia. RESULTS A nurse-led PICC service demonstrated an overall successful placement of 330 cases (99.1%), out of which 323 PICCs (97%) were successfully inserted under intra-cavitary electrocardiogram (IC-ECG) guidance, while 7 PICCs (2.1%) were successfully inserted with fluoroscopy. The overall complication rate was 2.35 occurrences per 1000 CL days, whereas the complication rate within the first 10 days after PICC insertion was 0.42 per 1000 CL days. CONCLUSION A nurse-led model for PICC insertion has remarkably high success rates and low rates of complication, highlighting the pivotal role of a specialised PICC team. This service boasted a commendable track record of achieving a high rate of success in its implementation, implying that a nurse-led PICC service operates effectively to improve the patient experience by delivering timely and high-quality healthcare service.
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Affiliation(s)
- Kawthar Alsaleh
- Medical Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Dalyal Alosaimi
- Medical Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Adnan Almousawi
- Intensive Care Unit, King Fahad Hufuf Hospital, AlAhsa Health Cluster, Ministry of Health, AlAhsa, Saudi Arabia
| | - Mohammed Alshaikh
- Interventional Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hisham Omar
- Interventional Radiology Department, King Fahad Medical City, Riyadh, Saudi Arabia
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Pitiriga V, Bakalis J, Theodoridou K, Dimitroulia E, Saroglou G, Tsakris A. Comparison of microbial colonization rates between central venous catheters and peripherally inserted central catheters. Antimicrob Resist Infect Control 2023; 12:74. [PMID: 37550791 PMCID: PMC10405474 DOI: 10.1186/s13756-023-01285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Central venous catheters (CVCs) and peripherally inserted central catheters (PICCs), have been widely used as intravascular devices in critically ill patients. However, they might evoke complications, such as catheter colonization that has been considered as predisposing factor for central line-associated bloodstream infections (CLABSIs). Although numerous studies have compared the risk of bloodstream infections between PICCs and CVCs, comparative studies on their colonization rates are limited. OBJECTIVES The episodes of catheter colonization in critically ill patients with CVCs or PICCs were retrospectively analysed during a two-year period in a Greek tertiary care hospital and colonization rates, microbial profiles and antimicrobial susceptibility patterns were compared. METHODS Clinical and laboratory data of consecutive hospitalized critically-ill patients who underwent PICC and CVC placement between May 2017-May 2019 were analysed. All catheters were examined by the semiquantitative culture technique for bacterial pathogens, either as a routine process after catheter removal or after suspicion of infection. Species identification and antimicrobial resistance patterns were determined by the Vitek2 automated system. RESULTS During the survey period a total of 122/1187 (10.28%) catheter colonization cases were identified among CVCs and 19/639 (2.97%) cases among PICCs (p = 0.001). The colonization rate was 12.48/1000 catheter-days for the CVC group and 1.71/1000 catheter-days for the PICC group (p < 0.001). The colonization rate per 1000 catheter-days due to multidrug-resistant organisms (MDROs) was 3.85 in all study cases, 7.26 (71/122) in the CVC group and 0.63 (7/19) in the PICC group (p < 0.001). Within the CVC group, the most common microorganism isolated was MDR Acinetobacter baumannii (n = 38, 31.1%) followed by MDR Klebsiella pneumoniae (n = 20, 16.4%). In the PICC group, the predominant microorganism isolated was Candida spp. (n = 5, 23.8%) followed by MDR K. pneumoniae and MDR A. baumannii in equal numbers (n = 3, 14.2%). CONCLUSION PICC lines were associated with significantly lower colonization rates comparing to the CVC ones. In addition, patterns of microbial colonization revealed a trend over the predominance of MDR gram-negatives in CVCs suggesting that PICCs might be a safer alternative for prolonged inpatient intravascular access. Prevention programs directed by local microbial ecology may diminish catheter colonization rates and CLABSIs.
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Affiliation(s)
- Vassiliki Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - Evangelia Dimitroulia
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
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Arjun R, Niyas VKM, Sasidharan A, Jomes J, Yadav MK, Kesavan S. Peripherally Inserted Central Catheters-associated blood stream infections-occurrence, risk factors, and pathogens, a single center study. J Infect Prev 2023; 24:187-192. [PMID: 37333869 PMCID: PMC10273803 DOI: 10.1177/17571774231165404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 02/26/2023] [Indexed: 06/20/2023] Open
Abstract
Background Peripherally inserted central catheters (PICCs) are central venous catheters inserted peripherally but terminate in great vessels. PICCs are widely used for patients requiring long-term intravenous therapy in both in-patient and out-patient settings. Aim This study was carried out to understand PICC-related complications, specifically infections and causal pathogens, in a tertiary care hospital in Kerala, South India. Methods A retrospective analysis of PICC insertions and follow-up during a 9 years period to look at patient demographics and infections related to PICC was carried out. Results The overall PICC-related complication rate is 28.1% (4.98 per 1000 PICC days). Commonest complication was thrombosis followed by infection, either PICC-associated bloodstream infection (PABSI) or local infection (LI). PABSI noted in this study was 1.34 per 1000 catheter days. The majority (85%) of PABSI were due to Gram-negative rods. The average duration of PICC days for occurrence of PABSI was 14 days and the majority occurred in in-patients. Conclusion Thrombosis and infection were the commonest PICC-related complications. PABSI rate was comparable to that of previous studies.
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Affiliation(s)
- Rajalakshmi Arjun
- Senior Consultant in Infectious Diseases, KIMSHEALTH, Trivandrum, India
| | | | - Aswathy Sasidharan
- Nurse Practitioner in Infectious Diseases, KIMSHEALTH, Trivandrum, India
| | - Jeffery Jomes
- Nurse Practitioner in Infectious Diseases, KIMSHEALTH, Trivandrum, India
| | | | - Suresh Kesavan
- Nursing leader, PICC team, KIMSHEALTH, Trivandrum, India
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Bahl A, Alsbrooks K, Gala S, Hoerauf K. Symptomatic Deep Vein Thrombosis Associated With Peripherally Inserted Central Catheters of Different Diameters: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2023; 29:10760296221144041. [PMID: 37366542 PMCID: PMC10328005 DOI: 10.1177/10760296221144041] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 06/28/2023] Open
Abstract
We assessed the relationship between peripherally inserted central catheter (PICC) diameters and symptomatic deep vein thrombosis (DVT) rates. We conducted a systematic search for articles published between 2010 and 2021 reporting DVT incidence by catheter diameter in patients who had a PICC, followed by meta-analyses for DVT risk in each diameter group. Pooled DVT rates were incorporated into an economic model. Of 1627 abstracts screened, 47 studies were included. The primary meta-analysis of 40 studies demonstrated the incidence of DVT was 0.89%, 3.26%, 5.46%, and 10.66% for 3, 4, 5, and 6 French (Fr) PICCs (P = .01 between 4 and 5 Fr). Rates of DVT were not significantly different between oncology and nononcology patients (P = .065 for 4 Fr and P = .99 for 5 Fr). The DVT rate was 5.08% for ICU patients and 4.58% for non-ICU patients (P = .65). The economic model demonstrated an annual, incremental cost savings of US$114 053 for every 5% absolute reduction in 6 Fr PICCs use. Using the smallest PICC that meets the patients' clinical needs may help to mitigate risks and confer savings.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine,
Beaumont Hospital, Royal Oak, MI, USA
| | | | - Smeet Gala
- Medical Affairs, Becton Dickinson and
Company, Franklin Lakes, NJ, USA
| | - Klaus Hoerauf
- Medical Affairs, Becton Dickinson and
Company, Franklin Lakes, NJ, USA
- Department of Anesthesiology and
Intensive Care, Medical University of
Vienna, Wien, Austria
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Caris MG, de Jonge NA, Punt HJ, Salet DM, de Jong VMT, Lissenberg-Witte BI, Zweegman S, Vandenbroucke-Grauls CMJE, van Agtmael MA, Janssen JJWM. Indwelling time of peripherally inserted central catheters and incidence of bloodstream infections in haematology patients: a cohort study. Antimicrob Resist Infect Control 2022; 11:37. [PMID: 35177128 PMCID: PMC8851849 DOI: 10.1186/s13756-022-01069-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to assess whether longer indwelling time of peripherally inserted central catheters (PICC) increases risk of central line associated bloodstream infections (CLABSI) in haematology patients.
Methods
Multicentre retrospective cohort study among haematology patients receiving PICCs between 2013 and 2015. Occurrence of CLABSI based on CDC definitions was assessed. We calculated incidence rates, determined risk factors for CLABSI and used Poisson regression models to assess the risk of developing CLABSI as a function of PICC dwell time. We compared diagnoses and treatment characteristics between 2013–2015 and 2015–2020.
Results
455 PICCs placed in 370 patients were included, comprising 19,063 catheter days. Median indwelling time was 26 days (range 0–385) and CLABSI incidence was 4.0 per 1000 catheter days, with a median time to CLABSI of 33 days (range 18–158). Aplastic anaemia (AA) was associated with an increased risk of CLABSI; patients undergoing autologous stem cell transplantation (SCT) were less likely to develop CLABSI. In the unadjusted analysis, PICCs with an indwelling time of 15–28 days, 29–42 days, 43–56 days and > 56 days each had an increased CLABSI incidence rate ratio of 2.4 (1.2–4.8), 2.2 (0.95–5.0), 3.4 (1.6–7.5) and 1.7 (0.9–3.5), respectively, compared to PICCs in place for < 15 days. However, after adjusting for AA and SCT, there was no significant difference in incidence rates between dwell times (p 0.067).
Conclusions
Our study shows that risk of CLABSI does not appear to increase with longer PICC indwelling time. Routine replacement of PICCs therefore is unlikely to prevent CLABSI in this population.
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Pitiriga V, Bakalis J, Theodoridou K, Kanellopoulos P, Saroglou G, Tsakris A. Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients. Antimicrob Resist Infect Control 2022; 11:137. [DOI: 10.1186/s13756-022-01180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous access in hospitalized patients. Although a number of studies suggest that PICCs are associated with a lower risk of central line-associated bloodstream infections (CLABSIs) than CVCs, recent data concerning specific patient groups support the contrary. In this regard, we are comparing CVC- and PICC-related CLABSI rates developed in a selected group of critically ill inpatients and evaluating the CLABSI microbiological distribution.
Methods
The study was conducted at a tertiary care hospital in Greece between May 2017 and May 2019. We performed a two-year retrospective analysis of the data collected from medical records of consecutive adult patients who underwent PICC or CVC placement.
Results
A total of 1187 CVCs placed for 9774 catheter-days and 639 PICCs placed for 11,110 catheter-days, were reported and analyzed during the study period. Among CVCs, a total of 59 (4.9%) CLABSIs were identified, while among PICCs, 18 (2.8%) cases presented CLABSI (p = 0.029). The CLABSI incidence rate per 1,000 catheter-days was 6.03 for CVC group and 1.62 for PICC group (p < 0.001). The CLABSI rate due to multidrug-resistant organisms (MDROs) among the two groups was 3.17 in CVC group and 0.36 in PICC group (p < 0.001). Within CLABSI-CVC group, the most common microorganism detected was MDR Acinetobacter baumannii (27.1%) followed by MDR Klebsiella pneumoniae (22%). In CLABSI-PICC group, the predominant microorganism was Candida spp. (33.3%) followed by non-MDR gram-negative pathogens (22.2%).
Conclusions
PICC lines were associated with significantly lower CLABSI rates comparing to CVC although they were in place longer than CVC lines. Given their longer time to the development of infection, PICCs may be a safer alternative for prolonged inpatient IV access. The high prevalence of CLABSI-MDROs depicts the local microbial ecology, emphasizing the need of public health awareness.
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Facilitation as a component of evidence implementation: a multinational perspective. INT J EVID-BASED HEA 2022; 20:180-188. [PMID: 36373356 DOI: 10.1097/xeb.0000000000000321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.
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Analysis of the US Safety Data for Edaravone (Radicava ®) From the Third Year After Launch. Drugs R D 2022; 22:205-211. [PMID: 35723868 PMCID: PMC9433633 DOI: 10.1007/s40268-022-00391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neuromuscular disease with no curative therapies. Edaravone (Radicava®) (Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan), approved in the United States (US) for ALS in adults in 2017, was shown in a clinical trial to slow the rate of physical functional decline in ALS and is administered intravenously. The aim of this paper is to summarize the observed safety profile from real-world patient use during the first 3 years of edaravone availability in the US. Methods Edaravone usage data were collected, and adverse events (AEs) were identified from a postmarketing safety database from August 8, 2017 through August 7, 2020 (cutoff date). Results As of October 3, 2020, 5207 ALS patients had been treated with edaravone. As of August 7, 2020, the most commonly reported AEs included death (not specified), drug ineffective, disease progression, therapeutic response unexpected, fall, asthenia, fatigue, muscular weakness, gait disturbance, and dyspnea. The most commonly reported serious AEs (SAEs) included death (not specified), pneumonia, disease progression, ALS, fall, dyspnea, respiratory failure, device-related infection, hospitalization, and injection-site infection. There were 687 deaths, with 494 reported as death without specifying the cause. Deaths were most commonly attributed to ALS, disease progression, respiratory failure, or pneumonia. Review for administration-site reactions revealed 95 AEs, including 34 site infections, with 22 SAEs (all non-fatal). Five non-fatal SAEs of anaphylaxis were reported. Conclusion In the postmarketing reporting to date, no new safety signals were identified beyond those already known from the edaravone clinical trial program.
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Li J, Xiao M, Wang Y, Yang J, Liu W. Robust and Antiswelling Hollow Hydrogel Tube with Antibacterial and Antithrombotic Ability for Emergency Vascular Replacement. ACS APPLIED BIO MATERIALS 2021; 4:3598-3607. [PMID: 35014445 DOI: 10.1021/acsabm.1c00096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infection and thrombosis are the two major complications in almost any indwelling intravascular catheters, leading to adverse consequences. Here, we report a robust and antiswelling hollow hydrogel tube that is prepared by copolymerizing a hydrogen-bonding (H-bonding) monomer and a zinc methacrylate (ZMA) monomer in the absence of any chemical cross-linker. The strong H-bonding interactions from the side chain of N-acryloylsemicarbazide (NASC) endow the hydrogel with high mechanical strength and swelling stability. Introduction of ZMA affords a superhydrophilic surface, and the release of a zinc ion (Zn2+) from the hydrogel can kill nearly 100% both of Staphylococcus aureus and Escherichia coli, indicating its excellent antibacterial ability. Importantly, the P(NASC-co-ZMA) hydrogel exhibits better antithrombosis ability due to the resistant adhesion of fibrinogen protein and platelets, as well binding calcium ions (Ca2+) from the blood. The hydrogel tube is used to connect the ex vivo arteriovenous shunt circuit or implanted into the left carotid artery in the rabbit model, showing a better patency rate. All of these results suggest that this hydrogel tube may mitigate infection and thrombosis complications, thus holding potential as an artificial blood vessel for emergency vascular replacement.
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Affiliation(s)
- Jia Li
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Meng Xiao
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Yanjie Wang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Jianhai Yang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Wenguang Liu
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
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Jin MF, Thompson SM, Comstock AC, Levy ER, Reisenauer CJ, McPhail IR, Takahashi EA. Technical success and safety of peripherally inserted central catheters in the great saphenous and anterior accessory great saphenous veins. J Vasc Access 2021; 23:280-285. [PMID: 33499716 DOI: 10.1177/1129729821989166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICC) are occasionally placed in the great saphenous vein (GSV) and anterior accessory great saphenous vein (AAGSV) in patients with inadequate upper extremity veins or contraindications to upper extremity placement. Outcomes on the placement of PICCs in these veins are limited. OBJECTIVES This study aimed to determine technical success and safety of GSV/AAGSV PICCs. MATERIALS AND METHODS This is a retrospective study that reviewed all GSV/AAGSV PICC placements between January 2011 and December 2019. A total of 29 PICC placements procedures were identified. The electronic medical record was queried for demographic, procedural, and complication data. Technical success was defined by whether the vein could be accessed and a PICC could be placed. Catheter-associated infections, dislodgement or migration, malfunction, and PICC-associated thrombosis were recorded. RESULTS Technical success of placement was 100%. Twenty-one (72%) catheters were placed in the GSV in the mid to upper thigh and eight (28%) were placed in the AAGSV. The median PICC dwell time was 13 days with a range of 3-155 days. PICC-associated complications occurred after 11 (37.9%) placements. Line associated infection was the most common complication (17.2%). CONCLUSION Due to a high complication rate, GSV/AAGSV PICC placement should be considered only when upper extremity or cervical PICC placement is not feasible or contraindicated.
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Affiliation(s)
- Mauricio F Jin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Scott M Thompson
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ann C Comstock
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Emily R Levy
- Division of Pediatric Infectious Diseases and Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher J Reisenauer
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ian R McPhail
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Edwin A Takahashi
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Nair A, Prasad Mantha S, Sai Kaushik PH, Rayani B. Placement of tunneled peripherally inserted central catheter for long-term chemotherapy in femoral vein in a patient with major vessel thrombosis of upper extremity. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2021. [DOI: 10.4103/cjhr.cjhr_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Malale K, Fu J, Nelson W, Gemuhay HM, Gan X, Mei Z. Potential Benefits of Multimedia-Based Home Catheter Management Education in Patients With Peripherally Inserted Central Catheters: Systematic Review. J Med Internet Res 2020; 22:e17899. [PMID: 33300884 PMCID: PMC7759441 DOI: 10.2196/17899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/07/2020] [Accepted: 11/11/2020] [Indexed: 01/19/2023] Open
Abstract
Background In recent years, there have been many suggestions to use multimedia as a strategy to fully meet the educational needs of patients with peripherally inserted central catheters. However, the potential benefits remain unreliable in the literature. Objective In this study, we identified the potential benefits of multimedia-based home catheter management education in patients with peripherally inserted central catheters and discussed the clinical implications. Methods We performed systematic searches of the PubMed, Cochrane Library, Embase Ovid, Medline, BioMed Central-cancer (BMC-cancer), ScienceDirect, and Google Scholar databases without date constraints until November 30, 2019. The methodological quality of the eligible studies was appraised using the Cochrane risk of bias tool. Narrative synthesis of the study findings was conducted. Results A total of 6 intervention studies met the inclusion criteria, including 3 randomized controlled trials and 3 case-control studies/quasi-experimental studies. The studies included a total of 355 subjects, including a total of 175 in the multimedia groups and 180 in the control groups. We identified 4 potential benefits to patients: (1) improved knowledge, (2) increased satisfaction, (3) reduced incidence of catheter-related complications, and (4) reduced number of cases of delayed care after complications. Conclusions The current systematic review highlights the potential benefits of multimedia-based home catheter management education for patients with peripherally inserted central catheters.
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Affiliation(s)
- Kija Malale
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jili Fu
- Daping Hospital, Army Medical University, Chongqing, China.,Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - William Nelson
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Helena Marco Gemuhay
- School of Nursing, St John's University of Tanzania, Dodoma, United Republic of Tanzania
| | - Xiuni Gan
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhechuan Mei
- Department of Gastroenterology, The Second Hospital of Chongqing Medical University, Chongqing, China
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14
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Parada G, Yu Y, Riley W, Lojovich S, Tshikudi D, Ling Q, Zhang Y, Wang J, Ling L, Yang Y, Nadkarni S, Nabzdyk C, Zhao X. Ultrathin and Robust Hydrogel Coatings on Cardiovascular Medical Devices to Mitigate Thromboembolic and Infectious Complications. Adv Healthc Mater 2020; 9:e2001116. [PMID: 32940970 DOI: 10.1002/adhm.202001116] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/21/2020] [Indexed: 01/10/2023]
Abstract
Thromboembolic and infectious complications stemming from the use of cardiovascular medical devices are still common and result in significant morbidity and mortality. There is no strategy to date that effectively addresses both challenges at the same time. Various surface modification strategies (e.g., silver, heparin, and liquid-impregnated surfaces) are proposed yet each has several limitations and shortcomings. Here, it is shown that the incorporation of an ultrathin and mechanically robust hydrogel layer reduces bacterial adhesion to medical-grade tubing by 95%. It is additionally demonstrated, through a combination of in vitro and in vivo tests, that the hydrogel layer significantly reduces the formation and adhesion of blood clots to the tubing without affecting the blood's intrinsic clotting ability. The adhesion of clots to the tubing walls is reduced by over 90% (in vitro model), which results in an ≈60% increase in the device occlusion time (time before closure due to clot formation) in an in vivo porcine model. The advantageous properties of this passive coating make it a promising surface material candidate for medical devices interfacing with blood.
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Affiliation(s)
- German Parada
- Chemical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Yan Yu
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- School of Optical and Electronic Information Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - William Riley
- Perfusion Services Massachusetts General Hospital Boston MA 02114 USA
| | - Sarah Lojovich
- Perfusion Services Massachusetts General Hospital Boston MA 02114 USA
| | - Diane Tshikudi
- Wellman Center for Photomedicine Massachusetts General Hospital Boston MA 02114 USA
| | - Qing Ling
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Yefang Zhang
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Jiaxin Wang
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Lei Ling
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Yueying Yang
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- School of Optical and Electronic Information Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Seemantini Nadkarni
- Wellman Center for Photomedicine Massachusetts General Hospital Boston MA 02114 USA
| | - Christoph Nabzdyk
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General Hospital Boston MA 02114 USA
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Rochester MN 55902 USA
| | - Xuanhe Zhao
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
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15
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Kelly L, Snowden A. How to synthesise original findings back into the literature: a reintroduction to concurrent analysis. Nurse Res 2020; 28:32-37. [PMID: 32351078 DOI: 10.7748/nr.2020.e1710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND All studies need to integrate their findings back into the literature to explain how the new knowledge changes understanding. This process can be anxiety-provoking, especially when new literature appears to threaten the originality of the study. AIM To reintroduce 'concurrent analysis' (CA) - a method of synthesising relevant literature with primary data. DISCUSSION CA treats all data as primary data. To illustrate the technique, the authors synthesise relevant literature with findings from a doctoral study of patients' experiences of vascular access devices. CONCLUSION CA raised new questions that would otherwise have remained unasked. For example, it revealed cultural differences in the way patients react to suboptimal treatment. IMPLICATIONS FOR PRACTICE Nurse researchers are best placed to influence policy and practice when they can articulate the transferability of their findings. CA is a practical method of achieving this.
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Affiliation(s)
| | - Austyn Snowden
- Mental health, School of Health and Social Care, Edinburgh Napier University, Scotland
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16
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Oliveira LBD, Fava YR, Rodrigues ARB, Franulovic AC, Ferreira NT, Püschel VADA. Management of peripherally inserted central catheter use in an intensive care unit of a teaching hospital in Brazil: a best practice implementation project. ACTA ACUST UNITED AC 2019; 16:1874-1886. [PMID: 30204672 DOI: 10.11124/jbisrir-2017-003577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This project aimed to promote evidence-based practice in the management of peripherally inserted central venous catheters (PICCs) in pediatric and adult patients in an intensive care unit (ICU). INTRODUCTION A PICC provides secure vascular access to medication, blood and nutrition administration. However, their use in the ICU is limited. Gaps in training and education in the use of these catheters are barriers to improving practice and safety. METHODS The project was conducted in an ICU of a cardiology teaching hospital in São Paulo, Brazil. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used. A baseline audit of the management of PICCs in pediatric and adult patients was conducted, with a sample size of 22 patients and 180 nursing staff. After an educational program, a follow-up audit involving 14 patients and 180 nursing staff was conducted using the same audit criteria. RESULTS The baseline audit indicated that PICC management concerning flushing had poor compliance of 2-20%. The results of the criteria related to the change in administration sets, including secondary sets and add-on devices, had better results, with moderate (65%) to high (100%) compliance. The follow-up audit showed improvement in all 10 criteria. Criteria related to flushing achieved 83% to 89% compliance; criteria related to dressing and change of administration sets achieved 100% compliance. CONCLUSIONS Increased compliance with evidence-based best practices was achieved in all assessed audit criteria. The criteria that reached the highest compliance with best practice recommendations were related to the prevention of bloodstream infection and loss of the PICC due to obstruction. Future audits are planned to ensure sustainability.
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Affiliation(s)
- Larissa Bertacchini de Oliveira
- Heart Institute (InCor) of the Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,The Brazilian Centre for Evidence-informed Healthcare: a Joanna Briggs Institute Centre of Excellence.,School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Yago Russo Fava
- Heart Institute (InCor) of the Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Alessandra Costa Franulovic
- Heart Institute (InCor) of the Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nathalia Teixeira Ferreira
- Heart Institute (InCor) of the Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vilanice Alves de Araújo Püschel
- The Brazilian Centre for Evidence-informed Healthcare: a Joanna Briggs Institute Centre of Excellence.,School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
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17
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Chasseigne V, Larbi A, Goupil J, Bouassida I, Buisson M, Beregi JP, Frandon J. PICC management led by technicians: Establishment of a cooperation program with radiologists and evaluation of complications. Diagn Interv Imaging 2019; 101:7-14. [PMID: 31324590 DOI: 10.1016/j.diii.2019.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/29/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a cooperation program in order to compare incidence of complications after peripherally inserted central catheter (PICC) placement between radiologists and technicians. MATERIALS AND METHODS PICC placement technique was standardized with ultrasound-guided puncture and fluoroscopic guidance. Numbers of PICC delegated to technicians, and PICC placement difficulties, were prospectively recorded for the whole study population whereas complications such as PICC infection, deep venous thrombosis and catheter occlusion were prospectively recorded until PICC removal for a subgroup of patients included during one month. RESULTS A total of 722 patients had PICC placement. There were 382 men and 340 women with a mean age of 66.8±15.8 (SD) years (range: 18-94years); of these, 442/722 patients (61.22%) were included in the cooperation program with 433/722 patients (59.97%) who effectively had PICC placement by technicians and 289/722 (40.03%) by radiologists. Technicians needed radiologists' help for 23/442 patients (5.20%) including 6 failed PICC placement subsequently performed by radiologists. Twenty complications (20/77; 26%) were recorded in the subgroup of 77 patients studied for complications. No differences in complications rate were found between the 33 patients who underwent PICC placement by radiologists (6/33; 18%) and the 44 patients who underwent PICC placement by technicians (14/44; 32%) (P=0.296). Complications included 8 PICC-related infections (8/77; 10.4%), 3 deep venous thromboses (3/77; 3.9%) and 9 catheter occlusions (9/77; 11.7%). CONCLUSION PICC placement led by technicians is feasible and safe without statistical difference in terms of complications compared to PICC placement made by radiologists.
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Affiliation(s)
- V Chasseigne
- Department of Pharmacy, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France
| | - A Larbi
- Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France
| | - J Goupil
- Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France
| | - I Bouassida
- Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France
| | - M Buisson
- Department of Pharmacy, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France
| | - J P Beregi
- Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France
| | - J Frandon
- Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France.
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18
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central Line Catheters and Associated Complications: A Review. Cureus 2019; 11:e4717. [PMID: 31355077 PMCID: PMC6650175 DOI: 10.7759/cureus.4717] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 01/29/2023] Open
Abstract
The use of a central line or central venous catheterization was brought to attention in 1929 when Dr. Werner Forssmann self-inserted a ureteric catheter through his cubital vein and into the right side of his heart. Since that time the central line technique has developed further and has become essential for the treatment of decompensating patients. Central lines are widely used for anything from rapid fluid resuscitation, to drug administration, to parenteral nutrition, and even for administering hemodialysis. Central lines come in different sizes, types, and sites of administration. Sometimes their use can be associated with complications as well. The following review article addresses these parameters of central lines and goes into detail regarding their complications.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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19
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Peripherally Inserted Central Catheter Postinsertion Complications: A Retrospective Study. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.java.2018.25.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Highlights
PICC offers safe intravenous access for medium- to long-term use with inpatients. There is no association between overall complication rates and PICC material type. Oncology status is the strongest predictor of complications.
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20
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Kostner R, Mairvongrasspeinten H, De Martin Polo A, Vittadello F, Ausserhofer D, Mantovan F. [Types and frequencies of complications associated with midline catheters and PICCs in a South Tyrolean district hospital: a retrospective cohort study]. Pflege 2018; 32:1-8. [PMID: 30526314 DOI: 10.1024/1012-5302/a000654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Types and frequencies of complications associated with midline catheters and PICCs in a South Tyrolean district hospital: a retrospective cohort study Abstract. BACKGROUND Specialized registered nurses play a key role in the insertion and management of peripherally inserted central catheters (PICCs) and midline catheters in Anglo-Saxon countries. From the German-speaking area no data on the use of PICCs and midline catheters are available. AIM The aim of this study was to describe the types and frequencies of complications of PICCs and midline catheters which were inserted by specialized registered nurses in a South Tyrolean district hospital. METHODS We performed a retrospective cohort study of PICCs and midline catheters inserted between 2013 and 2015 in one surgical unit in the district hospital Bruneck (South Tyrol / Italy). RESULTS Data from 900 catheters (421 midline catheters and 479 PICCs) inserted in 686 adult patients (404 women, 282 men) were analysed. The cumulative incidence was 29.2 % complications for midline catheters (incidence rate: 13 complications / 1000 catheter days) and 16.0 % for PICCs (incidence rate: 3 complications / 1000 catheter days). The most frequent complication was the removal of the catheter by the patients (PICCs: 6.7 %, midline catheters: 15.7 %). Other less frequent complications were mechanical complications, occlusions, infections and thromboses. CONCLUSIONS This study in one district hospital revealed similar types and frequencies of complications as previous international studies. Specialized and clinically competent nurses in German-speaking countries could develop advanced roles in the insertion and management of PICCs and midline catheters.
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Affiliation(s)
- Roman Kostner
- 1 Sanitätsbetrieb Südtirol, Bezirkskrankenhaus Bruneck, Italien.,* geteilte Erstautorenschaft
| | | | | | | | | | - Franco Mantovan
- 3 Landesfachhochschule für Gesundheitsberufe Claudiana, Bozen, Italien.,4 Scuola di Medicina e Chirurgia Universität Verona, Italien
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21
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Valsalva maneuver may facilitate ultrasound-guided venipuncture of deep arm veins. J Vasc Access 2017; 18:e98. [PMID: 28478631 DOI: 10.5301/jva.5000709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/20/2022] Open
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22
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The microbiological characteristics and risk factors for PICC-related bloodstream infections in intensive care unit. Sci Rep 2017; 7:15074. [PMID: 29118410 PMCID: PMC5678102 DOI: 10.1038/s41598-017-10037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/20/2017] [Indexed: 12/13/2022] Open
Abstract
The study was aimed to investigate the pathogens distribution and risk factors for PICC-related bloodstream infection in intensive care unit (ICU) patients. 402 patients placed with PICC in ICU were recruited in the study. The microbiological characteristics of PICC-related infection were investigated by Vitek 2 Compact automated microbial system. Antibiotics sensitivity was performed with disk diffusion and minimum inhibitory concentration (MIC) methods. Multivariate logistic and cox analyses were performed to identify the risk factors for PICC-related infection in ICU patients. 38 PICC-related infection cases were observed, and its morbidity was 9.45%. The morbidity was significantly higher in power PICC cases than that in common PICC cases. Gram-positive bacteria might be responsible for the major infection cases, followed by gram-negative bacteria, and fungi. Drug sensitivity analyses indicated that gram-negative bacteria showed low resistance to carbapenems antibiotics, and Cefperazone/sulbactam. The gram-positive bacterial exhibited sensitive to Teicoplanin and Vancomycin. The isolated fungi showed low resistance to the commonly used antifungal antibiotics. Multivariate analyses demonstrated that power PICC, high Charison scores, diabetes mellitus, double lumens triple lumens were risk factors for PICC-related infections among ICU patients. Power PICC, high Charison scores, diabetes mellitus, multi-lumens are risk factors for PICC-related bloodstream infection in ICU patients.
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23
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Brolin TJ, Hackett DJ, Abboud JA, Hsu JE, Namdari S. Routine cultures for seemingly aseptic revision shoulder arthroplasty: are they necessary? J Shoulder Elbow Surg 2017; 26:2060-2066. [PMID: 28865964 DOI: 10.1016/j.jse.2017.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
Propionibacterium acnes has recently gained attention as the leading cause of periprosthetic joint infections (PJIs) after shoulder arthroplasty. Unlike PJIs in the lower extremity, PJIs after shoulder arthroplasty usually have an indolent course and are notoriously difficult to diagnose. Most of the time, the diagnosis is made after positive intraoperative cultures are taken at the time of revision surgery. Adding even more complexity to the diagnosis is the high rate of P acnes-positive cultures taken at the time of primary shoulder surgery. In many cases the preoperative workup yields no suspicion for infection; however, intraoperative cultures are taken to completely eliminate the potential of an ongoing indolent infection. Concerns over how to interpret positive P acnes culture results and the high rate of culture positivity in primary shoulder arthroplasty, as well as the potentially high rate of contamination, have led surgeons to wonder about the utility of obtaining intraoperative cultures at the time of revision shoulder arthroplasty. We present evidence for and against the practice of obtaining routine intraoperative cultures at the time of seemingly aseptic revision shoulder arthroplasty.
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Affiliation(s)
- Tyler J Brolin
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel J Hackett
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, PA, USA.
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Parás-Bravo P, Paz-Zulueta M, Santibañez M, Fernández-de-Las-Peñas C, Herrero-Montes M, Caso-Álvarez V, Palacios-Ceña D. Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study. Support Care Cancer 2017; 26:441-449. [PMID: 28707169 PMCID: PMC5752737 DOI: 10.1007/s00520-017-3815-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/03/2017] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.
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Affiliation(s)
| | | | | | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University of Madrid, Madrid, Spain
| | | | | | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University of Madrid, Madrid, Spain
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