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Latos M, Kosson D, Zawadka M. Poland's first vascular access team 3-year analysis: Insights and learnings. J Vasc Access 2024:11297298241251502. [PMID: 38708844 DOI: 10.1177/11297298241251502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, Poland saw a surge in interest in midline catheters (MCs) and Long Peripheral Catheters (LPCs) for intravenous therapy. Before this, MCs were not extensively utilised in the country, and there was no formally established Polish vascular access team. MCs, which have been used for years in many countries, are now becoming increasingly common in Poland. This study aimed to analyse the use of MCs in a 3-year perspective of their introduction in daily clinical practice based on a nurse-led Vascular Access Team (VAT). METHODS The records of adult patients who received intravenous therapy with 727 MCs and 293 LPCs from January 2021 to December 2023 at the University Clinical Centre of the Medical University of Warsaw were analysed. RESULTS The main indication for cannulation was expected intravenous therapy over 5 days (81.66%, n = 833), of which 71.37% (n = 728) of patients in this group had concomitant difficult intravenous access (DIVA). Over 6 years, centrally inserted central catheters (CICCs) inserted due to DIVA were reduced from n = 108 in 2017 to n = 18 in 2023. The end of intravenous therapy was the reason for the removal of 64.6% of catheters (n = 659), including death and switch to CICCs as well. Complications leading to premature removal accounted for 31.2%, such as: occlusion (14.6%), patient self-removal (7.1%) and thrombosis (3.43%). CONCLUSIONS The introduction of MCs as a possible option for peripheral venous access reduces the use of CVCs. Developing MCs programmes should be based on investing in staff competencies, which increases success rates. The nurses and physicians should be trained in infusion care to achieve better results in the use of MCs and LPCs. Increasing the competence of nurses in Poland is necessary for the implementation of full-service and top-level functioning of VAT.
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Affiliation(s)
- Maciej Latos
- Department of Anaesthesiology and Intensive Care Division of Teaching, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Kosson
- Department of Anaesthesiology and Intensive Care Division of Teaching, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Zawadka
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Shen Y, Wang Q, Li X, Chang J, Zhou X. Transverse incision versus longitudinal incision in the implantation of PICC-port: A before-after study. J Vasc Access 2024; 25:892-896. [PMID: 36515358 DOI: 10.1177/11297298221143424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The peripherally inserted central catheter-port (PICC-port) technique is an innovation of the standard arm-totally implantable vascular access device. The design of surgical skin incision may have an important impact on the postoperative life of patients, the cosmetic result is important for patient satisfaction as well. OBJECTIVES To compare two different incision methods in the implantation of PICC-port. DESIGN A before-after study. SETTINGS AND PARTICIPANTS A total of 62 adult patients with malignant tumor requiring chemotherapy in Shanghai General Hospital were selected by convenience sampling, 31 in each group. All participants agreed to install PICC-port with signature from 1 Jan to 30 April, 2022. METHODS 31 patients were given longitudinal incision, about 3 cm below the puncture point obliquely. Another 31 patients were given transverse incision, about 3 cm below the puncture point. T-test, chi-square test and rank sum test were used to compare the differences between the two groups in incision healing, scar score, and operation time. RESULTS There was no statistically significant difference in incision healing between the two groups(p > 0.05). The scar scores of patients with transverse incision were higher than that of patients with longitudinal incision at 3 months (p < 0.05). And the operation time of longitudinal incision group was longer than that of transverse incision group(p < 0.05). CONCLUSIONS Our study revealed that PICC-port implantation could be considered as safe as PICC insertion conducted by nurse. During our follow-up, all patients with PICC-port implantation had good wound healing, and there were no complications such as local infection happened. The transverse incision was more easier to be operated in bag making in PICC-port implantation.
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Affiliation(s)
- Yan Shen
- Department of Intensive Care Unit, Shanghai General Hospital, Shanghai, China
| | - Qianqian Wang
- Department of Intensive Care Unit, Shanghai General Hospital, Shanghai, China
| | - Xin Li
- Department of Vascular Access Outpatient, Shanghai General Hospital, Shanghai, China
| | - Jian Chang
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Xingmei Zhou
- Department of Nursing, Shanghai General Hospital, Shanghai, China
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Pinelli F, Muzzi M, Pittiruti M. Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal? J Vasc Access 2024; 25:697-702. [PMID: 36163680 DOI: 10.1177/11297298221125965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite several effective preventive strategies peripherally inserted central catheters (PICCs)-as much as centrally inserted central catheters and femorally inserted central catheters-are inevitably associated with the potential development of catheter-related thrombosis. This complication may be symptomatic or-more often-asymptomatic. Even if remote, the chance that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism, is theoretically possible. On the other hand, the diffuse adoption of an ultrasound scan aiming at detecting an asymptomatic catheter-related thrombosis may be logistically difficult and expensive. No clear evidence-based recommendations exist on this issue and whether perform an ultrasound scan before PICC removal in asymptomatic patients remains a matter of debate. For these reasons, the authors propose few common sense recommendations that may help clinicians in weighing the clinical advantages of the exam (optimal safety for the patient) versus its practical disadvantages (logistic cost).
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Affiliation(s)
- Fulvio Pinelli
- AOUC, Anesthesia and Intensive Care, Florence, Tuscany, Italy
| | - Mirko Muzzi
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Agostino Gemelli, Rome, Lazio, Italy
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Elli S, Cannizzo L, Giannini L, Romanato F, Trimarco C, Pessina M, Lucchini A, Foti G, Rondelli E. Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization. J Vasc Access 2024; 25:808-812. [PMID: 36324227 DOI: 10.1177/11297298221132073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Femorally inserted central catheters are increasingly used, especially after the COVID-19 pandemic, also thanks to widespread of tunneling techniques that allow the exit site to be moved away from the groin. METHODS In this retrospective observational study, femorally inserted catheters, with exit site at mid-thigh and the tip in Inferior vena cava or in Inferior vena cava at the junction with right atrium, have been observed and complications have been analyzed. All catheters were inserted by trained Nurses of a tertiary hospital Vascular Access Team. RESULTS In 142 catheters (126 inserted via common femoral vein and 16 inserted via superficial femoral vein) and 3060 catheter days, we observed an infection rate of 1.3 events/1000 catheter days (all of them in oncologic patients and up to 30 days of catheterization), 2 cases of thrombotic events (1.41%) and 17 cases of accidental removal (11.97%). Other rare complications, as primary malposition, tip migration, arterial pseudoaneurysm, have been recorded. The average length of catheters inserted, from the exit site to the tip, was 47.6 ± 2.4 cm. CONCLUSION The attention to the correct position of the tip, the exit site at mid-thigh and the new techniques during insertion make these femoral catheters as safe as other central vascular access devices. For this kind of central access device, a catheter at least 50 cm long is needed.
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Affiliation(s)
- Stefano Elli
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | - Alberto Lucchini
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Pittiruti M, Salerno G, Mancino A, Carlini D, Celentano D, Annetta MG, Conti G. Ultrasound versus intracavitary electrocardiography for intraprocedural tip location during central venous catheterization in infants and children: A prospective clinical study. J Vasc Access 2024; 25:774-778. [PMID: 36267035 DOI: 10.1177/11297298221132415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both intracavitary electrocardiography (IC-ECG) and ultrasound (US) have been proven to be safe and accurate for intraprocedural tip location during central venous catheterization, and both are known to be easily applicable and feasible in pediatric patients. Though, no prospective clinical study has directly compared the two methods as regards their applicability, feasibility, and procedural time. METHODS This study prospectively enrolled all children requiring a central venous access device in non-emergency situations, during a period of 1 year. All devices were inserted according to a well-defined insertion bundle including both IC-ECG and US-based tip location. The primary endpoint of the study was to compare the two methods in terms of applicability, feasibility and time required. RESULTS This study included 100 consecutive central venous catheterizations in children of age ranging from 1 month to 18 years. The applicability of IC-ECG based tip location was 98% and its feasibility 100%; the time required for IC-ECG was 1.9 ± 2 min. The applicability of US-based tip location was 96% and its feasibility was 100%; the maneuver required 2.2 ± 3 min. CONCLUSIONS US is an appropriate alternative method for intraprocedural tip location in children. The combined use of US and IC-ECG (both maneuvers being accurate, inexpensive, cost-effective, non-invasive, and equally fast to perform) should be recommended for tip location in pediatric patients, and it will avoid completely the use of fluoroscopy or of post-procedural x-ray.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Gilda Salerno
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Debora Carlini
- Pediatric Intensive Care Unit, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Davide Celentano
- Department of Oncology, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, University Hospital 'Fondazione Policlinico A.Gemelli', Rome, Italy
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Olczyk-Miiller K, Latos M, Kosson D, Kołacz M, Hadzik R. The First Use of a Midline Catheter in Outpatient Pain Management. Healthcare (Basel) 2024; 12:856. [PMID: 38667618 PMCID: PMC11050200 DOI: 10.3390/healthcare12080856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Midline catheters (MCs) are used to deliver intravenous therapy lasting over 5 days to patients in hospitals. However, the constant development of home and outpatient care is challenging medical teams to provide effective and safe planned therapy to patients under such conditions. We describe the first time an MC was used in outpatient pain management in Poland. A 60-year-old man presented to the Pain Management Clinic with a history of RCC of the left kidney and lumbar back pain radiating to the left knee joint. The person whose case is described below had poor peripheral veins. He intravenously received lidocaine for 10 days via a midline catheter with a good response.
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Affiliation(s)
- Kinga Olczyk-Miiller
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 4 Lindleya Str., 02-005 Warsaw, Poland
| | - Maciej Latos
- Department of Anaesthesiology and Intensive Care Education, Medical University of Warsaw, 4 Oczki Str., 02-007 Warsaw, Poland (D.K.)
| | - Dariusz Kosson
- Department of Anaesthesiology and Intensive Care Education, Medical University of Warsaw, 4 Oczki Str., 02-007 Warsaw, Poland (D.K.)
| | - Marcin Kołacz
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 4 Lindleya Str., 02-005 Warsaw, Poland
| | - Robert Hadzik
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 4 Lindleya Str., 02-005 Warsaw, Poland
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Djordjevic I, Ellis E, Singh J, Ali N, Pena EM, Rajarethinam R, Manikandan L, Goh J, Lim S, Steele T. Color changing bioadhesive barrier for peripherally inserted central catheters. Biomater Sci 2024; 12:1502-1514. [PMID: 38284150 DOI: 10.1039/d3bm01347b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Bacteria migration at catheter insertion sites presents a serious complication (bacteraemia) with high mortality rates. One strategy to mediate bacteraemia is a physical barrier at the skin-catheter interface. Herein a colorimetric biosensor adhesive (CathoGlu) is designed and evaluated for both colorimetric detection of bacterial infection and application as a bacteria barrier. The design intent combines viscous, hydrophobic bioadhesive with an organic pH indicator (bromothymol blue). Visual observation can then distinguish healthy skin at pH = ∼5 from an infected catheter insertion site at pH = ∼8. The liquid-to-biorubber transition of CathoGlu formulation occurs via a brief exposure to UVA penlight, providing an elastic barrier to the skin flora. Leachates from CathoGlu demonstrate no genotoxic and skin sensitization effect, assessed by OECD-recommended in vitro and in chemico assays. The CathoGlu formulation was found non-inferior against clinically approved 2-octyl-cyanoacrylate (Dermabond™), and adhesive tape (Micropore™) within an in vivo porcine model. CathoGlu skin adhesive provides new opportunities to prevent sepsis in challenging clinical situations.
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Affiliation(s)
- Ivan Djordjevic
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Block N4.1, Singapore 639798.
| | - Elizabeth Ellis
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Block N4.1, Singapore 639798.
| | - Juhi Singh
- NTU Institute for Health Technologies, Interdisciplinary Graduate Program, Nanyang Technological University, 61 Nanyang Drive, Singapore 637335
- School of Chemistry, Chemical Engineering and Biotechnology, 70 Nanyang Drive, Block N1.3, Nanyang Technological University, Singapore 637457
| | - Naziruddin Ali
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Block N4.1, Singapore 639798.
| | - Edgar M Pena
- National Large Animal Research Facility, SingHealth Experimental Medicine Centre, Academia 20 College Road, Singapore 169856
| | - Ravisankar Rajarethinam
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673
| | - Lakshmanan Manikandan
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673
| | - Jason Goh
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos, Singapore 138673
| | - Sierin Lim
- School of Chemistry, Chemical Engineering and Biotechnology, 70 Nanyang Drive, Block N1.3, Nanyang Technological University, Singapore 637457
| | - Terry Steele
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Block N4.1, Singapore 639798.
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Barone G, Pittiruti M, Prontera G, Ancora G, D'Andrea V. A novel neonatal protocol for Safe Insertion of Umbilical Venous Catheters (SIUVeC): Minimizing complications in placement and management. J Vasc Access 2024:11297298241236220. [PMID: 38436297 DOI: 10.1177/11297298241236220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Insertion of umbilical venous catheters is a common procedure in neonatal intensive care. Though sometimes lifesaving, this maneuver is potentially associated with early and late complications, some of which may be severe and even life threatening (catheter malposition, hepatic lesions, venous thrombosis, pericardial effusion, etc.). The recent literature suggests several operative strategies that, if adopted systematically, may significantly reduce the incidence of both early and late catheter related complications. This paper describes a standardized protocol (Safe Insertion Umbilical Venous Catheter = SIUVeC) which incorporates such novel strategies, with the goal of minimizing the complications related to this procedure.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia Romagna, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Giorgia Prontera
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia Romagna, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
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D'Arrigo S, Emoli A, Marche B, Pittiruti M. A new pressure-based device for tip navigation and tip location during central venous catheterization: A prospective clinical study on a cohort of 136 adult patients. J Vasc Access 2024; 25:526-530. [PMID: 36114632 DOI: 10.1177/11297298221122092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION According to current guidelines, tip location of peripherally inserted central catheters (PICCs) should be verified during insertion, preferably using non-invasive methods such as intracavitary ECG (IC-ECG) or echocardiography. An interesting new option is represented by a new pressure-based device, the CatFinder System (CFS), which might be theoretically useful also for tip navigation. METHODS We planned a single-center, prospective, non-randomized trial on adult patients requiring PICC insertion, using simultaneously CFS and IC-ECG, with the purpose of verifying the applicability, feasibility, safety, and accuracy of CFS for intra-procedural tip location. Patients with known ECG abnormalities or cardiac diseases of any type were excluded. The ability of CFS to assess wrong directions of the catheter during insertion (tip navigation) was evaluated by comparison with ultrasound scan. RESULTS Out of 136 enrolled adult patients, CFS was found to be applicable in 131 cases (five cases were excluded because of ECG abnormalities) and feasible in 111 cases (in 20 cases, tip location by CFS could not be carried out because of technical issues). There were no complications directly or indirectly related to the CFS maneuvers. Using IC-ECG as a comparison, 87 tips placed by CFS were within 2 cm from the target, 17 were >2 cm from target. In seven cases, CFS was able to detect a wrong direction (to the ipsilateral internal jugular vein), as confirmed by ultrasound. CONCLUSION Applicability of CFS in patients with sinus rhythm was 96.3%, feasibility was 84.7%, and safety was 100%. If compared to IC-ECG, accuracy was 83.6% (accepting an error <2 cm) and 96.1% (for an error <3 cm). Unacceptable tip positions (>3 cm) were 3.8% (the tip was too high inside the SVC). This study confirms a possible future role of CFS for intra-procedural tip location and tip navigation, though its use cannot be currently recommended.
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Affiliation(s)
- Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Emoli
- Department of Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Marche
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Pittiruti M, Annetta MG, D'andrea V. Point-of-care ultrasound for vascular access in neonates and children. Eur J Pediatr 2024; 183:1073-1078. [PMID: 38117353 DOI: 10.1007/s00431-023-05378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
Ultrasound plays a major role in neonatal/pediatric vascular access, both for venous access and for arterial access, not only just for the insertion of intravascular catheters, but also for many other issues related to this type of maneuver. This "global use of ultrasound" includes a systematic and consistent adoption of this technology for several steps of vascular access: (a) the pre-procedural assessment/evaluation of the vessels, (b) the ultrasound-guided puncture and cannulation of arteries and veins, (c) the real-time diagnosis of immediate, puncture-related complications, (d) the so-called "tip navigation" (i.e., real-time intra-procedural assessment of the direction and trajectory of the guidewire and/or of the catheter inside the vasculature), (e) the so-called "tip location" (i.e., intra-procedural or post-procedural assessment of the proper position of the tip of the catheter), and (f) the early diagnosis and/or management of most non-infective late complications. CONCLUSION Therefore, any vascular access expert (nurse or physicians) should have documented competency in the use of ultrasound. This knowledge should include the use of ultrasound for assessment of vessels, for catheter insertion, for proper placement of the tip, and for real-time detection of complications. WHAT IS KNOWN • Ultrasound is obviously useful for vascular access procedures in neonates and children. WHAT IS NEW • Recent evidence suggests that ultrasound is useful for many purposes in the field of vascular access (preprocedural scan, ultrasound-guided puncture, tip navigation, tip location, diagnosis of most non-infective complications). • Recent evidence also suggests that radiological methods no longer play any role in the insertion of vascular accesses in neonates and children.
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Affiliation(s)
- Mauro Pittiruti
- Dept. of Surgery, Policlinico Universitario 'A.Gemelli', Largo Gemelli 8, 00168, Rome, Italy.
| | | | - Vito D'andrea
- Neonatal Intensive Care Unit, Policlinico Universitario 'A.Gemelli', Rome, Italy
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11
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Giustivi D, Donadoni M, Elli SM, Casella F, Quici M, Cogliati C, Cavalli S, Rizzi G, La Cava L, Bartoli A, Martini E, Taino A, Perego M, Foschi A, Castelli R, Calloni M, Gidaro A. Brachial Tunneled Peripherally Inserted Central Catheters and the Risk of Catheter Complications: A Systematic Review and Meta-Analysis. Nurs Rep 2024; 14:455-467. [PMID: 38391080 PMCID: PMC10885060 DOI: 10.3390/nursrep14010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/31/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Situations involving increased workloads and stress (i.e., the COVID-19 pandemic) underline the need for healthcare professionals to minimize patient complications. In the field of vascular access, tunneling techniques are a possible solution. This systematic review and meta-analysis aimed to compare the effectiveness of tunneled Peripherally Inserted Central Catheters (tPICCs) to conventional Peripherally Inserted Central Catheters (cPICCs) in terms of bleeding, overall success, procedural time, and late complications. METHODS Randomized controlled trials without language restrictions were searched using PUBMED®, EMBASE®, EBSCO®, CINAHL®, and the Cochrane Controlled Clinical Trials Register from August 2022 to August 2023. Five relevant papers (1238 patients) were included. RESULTS There were no significant differences in overall success and nerve or artery injuries between the two groups (p = 0.62 and p = 0.62, respectively), although cPICCs caused slightly less bleeding (0.23 mL) and had shorter procedural times (2.95 min). On the other hand, tPICCs had a significantly reduced risk of overall complications (p < 0.001; RR0.41 [0.31-0.54] CI 95%), catheter-related thrombosis (p < 0.001; RR0.35 [0.20-0.59] IC 95%), infection-triggering catheter removal (p < 0.001; RR0.33 [0.18-0.61] IC 95%), wound oozing (p < 0.001; RR0.49 [0.37-0.64] IC 95%), and dislodgement (p < 0.001; RR0.4 [0.31-0.54] CI 95%). CONCLUSIONS The tunneling technique for brachial access appears to be safe concerning intra-procedural bleeding, overall success, and procedural time, and it is effective in reducing the risk of late complications associated with catheterization.
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Affiliation(s)
| | - Mattia Donadoni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Stefano Maria Elli
- Healthcare Profession Department-PICC Team, University of Milan Bicocca, IRCCS San Gerardo dei Tintori Foundation Hospital, 20126 Monza, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Massimiliano Quici
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Silvia Cavalli
- Healthcare Profession Department-PICC Team, University of Milan Bicocca, IRCCS San Gerardo dei Tintori Foundation Hospital, 20126 Monza, Italy
| | - Giulia Rizzi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Leyla La Cava
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Arianna Bartoli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Elena Martini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Alba Taino
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Martina Perego
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Roberto Castelli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro N° 8, 07100 Sassari, Italy
| | - Maria Calloni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, 20122 Milan, Italy
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12
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Lisova K, Pavelkova K, Matejckova T, Simkova P, Hloch O, Charvat J. The difficult PICC insertion is associated with the significant increase of complications in 1 month follow-up. J Vasc Access 2024:11297298241229868. [PMID: 38337144 DOI: 10.1177/11297298241229868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND PICC is routinely inserted with assistance of ultrasonography and/or ECG navigation (RI- routine insertion). Only in a minority of patients the insertion of a PICC is difficult and fluoroscopic visualization with introduction of special guidewire is necessary for the success of the procedure (DI-difficult insertion). The aim of the study was to evaluate whether DI can be predicted and associated with a risk of complications during follow-up. METHODS The study included patients who had a PICC insertion in 2022. The number of patients with RI and DI was recorded and the significance of selected parameters during insertion and the frequency of complications during 1 month follow-up was compared. RESULTS About 1404 patients had successful PICC insertion in 2022, RI in 1360 (96.8%) and DI in 44 patients (3.2%). There was no significant effect of age, gender, selected vein, its size, insertion site, and tunneling on the course of PICC insertion. However the number of punctures for needle insertion was higher in DI. The complication rate during 1 month follow-up in DI was 9 (20.4%) versus 101 patients (7.4%) in RI (p = 0.002). CONCLUSION PICC insertion was successful in both RI and DI patients. Of the analyzed parameters, the number of needle punctures was associated with DI, and complications during the 1-month follow-up were more frequently noted in the DI group.
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Affiliation(s)
- Katerina Lisova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Katerina Pavelkova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Tereza Matejckova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Petra Simkova
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Ondrej Hloch
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
| | - Jiri Charvat
- Medical Department, 2nd Faculty of Medicine, Charles University and Faculty Hospital Motol Prague, Prague, Czech Republic
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13
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Mumoli N, Mereghetti M, Capra R, Pistoia M, Dalla Torre L, Dentali F, Giarretta I. No contraindication to internal jugular central venous catheter insertion in patients at increased risk of bleeding: Results from a prospective observational study in a internal medicine department. J Vasc Access 2024:11297298241227248. [PMID: 38303490 DOI: 10.1177/11297298241227248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Implantation of centrally inserted central venous catheter (CICC) may be complicated by bleedings particularly in patients with severe coagulopathy or taking antithrombotic drugs. It has been shown that the application of the Italian Group for Venous Access Devices (GAVeCeLT) bundle reduces the incidence of bleeding in patients admitted to intensive care units (ICU), but its effectiveness has never been demonstrated in different contexts. In this study we evaluated the incidence of bleeding after urgent internal jugular CICC (J-CICC) implantation in patients with increased or no risk of bleeding complications when recommended preventive strategies are applied systematically. We included 185 patients admitted to Internal Medicine Units who underwent urgent J-CICC implantation from April 2016 to December 2018. The incidence of major and minor bleeding immediately after the procedure and in the following 30 days was recorded. None of the enrolled patients showed major bleeding. The incidence of minor bleedings was 2.1% (95% IC: 0.03-4.2) with two patients requiring line removal and repositioning (1.1%; 95% IC: -0.45 to 2.6). Bleeds were not correlated with age or sex, although they all occurred in female subjects. The incidence of bleeds was not increased in patients with increased risk of bleeding compared with those without (5.0% vs 1.3%; p = 0.16). The use of anti-thrombotic medications was significantly associated with increased risk of minor bleedings (p = 0.03). In this study we demonstrated that the application of the GAVeCeLT suggested bundle can minimize the number of bleeding complications even in patients hospitalized in Internal Medicine Units. Further data are needed in patients taking antithrombotic drugs who appear to be more prone to minor bleeding, however the benefit of completing the procedure appears to significantly outweigh the risk of mechanical complications.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, Lombardy, Italy
| | - Marco Mereghetti
- Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, Lombardy, Italy
| | - Riccardo Capra
- Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, Lombardy, Italy
| | - Matteo Pistoia
- Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, Lombardy, Italy
| | - Laura Dalla Torre
- Department of Internal Medicine, Ospedale Fornaroli, ASST Ovest Milanese, Magenta, Lombardy, Italy
| | - Francesco Dentali
- Department of Internal Medicine, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Lombardy, Italy
| | - Igor Giarretta
- Department of Internal Medicine, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Lombardy, Italy
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14
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Giustivi D, Elli S, Airoldi C, Lo Izzo F, Rossini M, Gidaro A, Lucchini A, Privitera D. Can the length of a catheter change the time to bubble at the tip performing the "Bubble Test"? A bench study. J Vasc Access 2023:11297298231199505. [PMID: 38018777 DOI: 10.1177/11297298231199505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION Intraprocedural tip control techniques are critical during central venous catheter placement. According to international guidelines (INS 2021), intracavitary electrocardiography is the first method of choice to verify it; when this technique is not feasible, it is considered acceptable to use a contrast-enhanced ultrasound-based tip location method, commonly known as "bubble-test" as an effective alternative. OBJECTIVE To assess whether the length of the vascular catheter can alter the time between the injection of the contrast media and its appearance at the catheter tip and the injection duration. Differences between operators stratified according to experience were evaluated as secondary endpoints. METHODS A bench study was conducted using an extracorporeal circuit. For each catheter length (60, 40, and 20 cm), three injections were obtained by each of the five operators with different levels of experience for a total of 45 measurements. Differences among operators were evaluated using ANOVA, and the impact of catheter length and operator expertise on times was assessed using repeated measurement models. RESULTS Hub-to-tip times of 247.33 ms (SD 168.82), 166 ms (SD 95.46), 138 ms (SD 54.48), and injection duration of 1620 ms (SD 748.58), 1614 ms (SD 570.95), 1566 ms (SD 302.83) were observed for 60, 40, 20 cm catheter length, respectively. A significant time variability between operators was observed. Moreover, moving from 60 to 20 cm, hub-to-tip time was significantly longer for 60 cm devices (p = 0.0124), while little differences were observed for injection duration. CONCLUSIONS Catheter length can change both the time between the injection of the contrast media and its appearance at the catheter tip and the injection duration. Hub-to-tip times obtained with 20 and 40 cm and overall injection duration did not differ significantly; skilled personnel could substantially reduce both values analyzed in this study.
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Affiliation(s)
| | - Stefano Elli
- Vascular Access Team, IRCCS S.Gerardo dei Tintori, Monza, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | | | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Alberto Lucchini
- General Intensive Care Unit, IRCCS S.Gerardo dei Tintori, Monza, Italy
- Bicocca University, Milan, Italy
| | - Daniele Privitera
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan
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15
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Abstract
In the past 5 years, non-dialysis femoral venous access has changed in terms of indications, techniques of insertion, and expected incidence of complications. To the traditional non-emergency indication for femoral catheters-obstruction of the superior vena cava-many other indications have been added, both in intensive and non-intensive care. The insertion technique has evolved, thanks to ultrasound guided venipuncture, tunneling, and ultrasound based intraprocedural tip location. Insertion of femorally inserted central catheters may be today regarded as a procedure with an extremely low intraprocedural and post-procedural risk. The risk of infection is reduced by the possibility of the exit site at mid-thigh, by the use of cyanoacrylate glue for sealing the exit site, and by appropriate intraprocedural strategies of infection prevention. The risk of catheter-related thrombosis is low, due to several concomitant strategies: a proper match between vein diameter and catheter caliber; an accurate intraprocedural assessment of tip location by ultrasound and/or intracavitary ECG; the consistent use of ultrasound guided venipuncture and micro-introducer kits; an adequate stabilization of the catheter at the exit site. The risk of mechanical complications and the risk of lumen occlusion are minimized when using polyurethane, power injectable catheters. All these novelties have brought a revolution in the field of femoral venous access, so that this route may be considered as safe and effective as other approaches to central venous catheterization.
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Affiliation(s)
| | - Stefano Elli
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Bruno Marche
- Vascular Access Team, Fondazione Policlinico Universitario "A Gemelli," Roma, Italy
| | - Fulvio Pinelli
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- Vascular Access Team, Fondazione Policlinico Universitario "A Gemelli," Roma, Italy
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16
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Brescia F, Annetta MG, Pinelli F, Pittiruti M. A GAVeCeLT bundle for PICC-port insertion: The SIP-Port protocol. J Vasc Access 2023:11297298231209521. [PMID: 37953715 DOI: 10.1177/11297298231209521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
In the last decade, a new type of brachial port has been introduced in clinical practice, the so-called "PICC-port." This is a brachial port, but inserted according to the methodologies and technologies currently adopted for the insertion of peripherally inserted central catheters (PICCs). Several studies have shown that PICC-port insertion is safe, not associated with any relevant immediate or early complication, and that the expected incidence of late complications is significantly lower if compared to "traditional" brachial ports (i.e. inserted without ultrasound guidance). Furthermore, PICC-ports yield excellent esthetic results and are associated with optimal patient compliance. This paper describes an insertion bundle-developed by GAVeCeLT, the Italian Group of Long Term Venous Access Devices, and nicknamed "SIP-Port" (Safe Insertion of PICC-Ports)-which consists of few evidence-based strategies aiming to further minimize all immediate, early, or late complications potentially associated with PICC-port insertion. Also, this insertion bundle has been developed for the purpose of defining more closely the differences between a traditional brachial port and a PICC-port. The SIP-Port bundle is currently adopted by all training courses on PICC-port insertion held by GAVeCeLT. It includes eight steps: (1) preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; (2) appropriate skin antiseptic technique and maximal barrier precautions; (3) choice of appropriate vein, in terms of caliber and site; (4) clear identification of the median nerve and of the brachial artery during the venipuncture; (5) ultrasound-guided puncture and cannulation of the vein; (6) ultrasound-guided tip navigation; (7) intra-procedural assessment of tip location by intracavitary ECG or by trans-thoracic echocardiography; (8) appropriate creation and closure of the subcutaneous pocket.
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Firenze, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
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D’Andrea V, Cascini V, Russo R, Perri A, Prontera G, Ancora G, Vento G, Lisi G, Barone G. The Role of Ultrasound in Epicutaneo-Caval Catheter Insertion in Neonates: Systematic Review, Meta-Analysis and Future Perspectives. Diagnostics (Basel) 2023; 13:2850. [PMID: 37685388 PMCID: PMC10487192 DOI: 10.3390/diagnostics13172850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Chest and abdominal X-rays after the insertion of an epicutaneo-caval catheter in infants are the standard method of checking the tip location in many neonatal intensive care units. The role of ultrasound in the tip location of the epicutaneo-caval catheter in neonates has been the subject of many recent studies. This systematic review investigates the accuracy of epicutaneo-caval catheter tip location by comparing ultrasound and conventional radiology. We performed a systematic literature search in multiple databases. The selection of studies yielded nineteen articles. The systematic review and meta-analysis were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis). The analyses showed that ultrasound is a better imaging technique for epicutaneo-caval catheter tip location in the neonatal intensive care unit than conventional radiology. By improving operator training and selecting a standardized echography protocol, ultrasound could become the gold standard for visualizing the epicutaneo-caval catheter tip in the neonatal intensive care unit. This would have some important benefits: (1) increased accuracy in tip location (2); a more rapid use of the central venous access (3); and a significant reduction in radiation exposure.
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Affiliation(s)
- Vito D’Andrea
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Valentina Cascini
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Giorgia Prontera
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
- Pediatric Surgery Unit, Department of Medicine and Aging Science, “G. D’Annunzio University”, 66100 Chieti, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
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18
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Padilla-Nula F, Bergua-Lorente A, Farrero-Mena J, Escolà-Nogués A, Llauradó-Mateu M, Serret-Nuevo C, Bellon F. Effectiveness of cyanoacrylate glue in the fixation of midline catheters and peripherally inserted central catheters in hospitalised adult patients: Randomised clinical trial (CIANO-ETI). SAGE Open Med 2023; 11:20503121231170743. [PMID: 37152837 PMCID: PMC10155010 DOI: 10.1177/20503121231170743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Objective The objective of the study was to assess the efficacy of the use of cyanoacrylate glue (CAG) as a means of securing midline catheters and peripherally inserted central catheters with the modified micro-Seldinger technique in adult hospitalised patients. Methods Randomised clinical trial with two groups (1:1): control and intervention. The control group received a securement method with a sutureless device plus transparent dressing and the intervention group received the same securement method plus the CAG. The study was approved by the Drug Research Ethics Committee of the Lleida Health Region. Results A total of 216 patients were assessed. The two groups of the trial were homogenously distributed in terms of sociodemographic and clinical variables. The intervention group had a statistically significant lower incidence of peri-catheter bleeding and/or oozing during the 7-day study period (odds ratio (OR), 0.6; 95% confidence level (CI), 0.44-0.81; p < 0.001) and a statistically significant lower incidence of catheter dislodgements during the first 24 h (OR, 0.2; 95% CI, 0.04-0.91; p = 0.03). There were no statistically significant differences in the incidence of phlebitis (OR, 1.30; 95% CI, 0.60-2.83; p = 0.56) or catheter-related pain (OR, 0.88; 95% CI, 0.40-1.94; p = 0.84). Conclusion Midline catheters and peripherally inserted central catheters secured with CAG had fewer complications than catheters not secured with this adhesive.
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Affiliation(s)
- Ferran Padilla-Nula
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Alejandro Bergua-Lorente
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Jordi Farrero-Mena
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Anna Escolà-Nogués
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Miriam Llauradó-Mateu
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Carme Serret-Nuevo
- Vascular Access Unit and Angioradiology
Unit of the University Hospital Arnau de Vilanova, Catalan Institute of Health,
Lleida, Spain
| | - Filip Bellon
- GESEC Group, Department of Nursing and
Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida,
Spain
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19
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Lamberti G, Domenichelli V, Straziuso S, Pelusi G, Natile M, Ancora G, Barone G. Use of the Dialkylcarbamoylchloride Dressing in the Care of Central Venous Access Exit Site in a Pediatric and Neonatal Population. Diagnostics (Basel) 2023; 13:diagnostics13091520. [PMID: 37174912 PMCID: PMC10177172 DOI: 10.3390/diagnostics13091520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Dialkylcarbamoylchloride dressing is a fatty acid derivative that has been shown in vitro to bind a number of pathogenic microorganisms. The purpose of this prospective study was to evaluate the safety and the efficacy of this technology in the care of the exit site of central venous catheter in a paediatric and neonatal population. METHODS The study was conducted from September 2020 to December 2022 at the Infermi Hospital in Rimini. Central venous catheters were placed using the SIC bundle for insertion. Dialkylcarbamoylchloride dressing was placed below the subcutaneous anchoring at the time of CVC placement and at each dressing change. Data about the catheters and the exit site were recorded and then compared with an historical cohort. RESULTS 118 catheters were placed during the studied period. The dialkylcarbamoylchloride dressing was well-tolerated. No case of systemic or local infection was recorded. The comparison with the historical cohort showed a reduction in the rate of exit site infection (p value 0.03). CONCLUSION Dialkylcarbamoylchloride dressing is well-tolerated in paediatric and neonatal population. It represents a promising tool as a strategy for infection prevention.
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Affiliation(s)
- Giorgio Lamberti
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | | | - Simona Straziuso
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Gabriella Pelusi
- Pediatric Surgery, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, 47923 Rimini, Italy
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20
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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 2023:11297298231163352. [DOI: 10.1177/11297298231163352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] 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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21
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [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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22
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Stefano E, Dario D, Silvia C, Gloria C, Mariavittoria G, Francesco M, Jessica P, Mario R, Alberto L, Giuseppe F, Matteo P, Marco G. Impact of distance of the catheter tip from cavo-atrial junction on bubble test (delay) time: A prospective study. J Vasc Access 2023:11297298231153517. [PMID: 36765463 DOI: 10.1177/11297298231153517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Correct tip positioning is a critical aspect in central vascular access devices insertion. The verification of positioning at the cavo-atrial junction is usually performed by intracavitary electrocardiography. Recently, echocardiographic techniques were proposed, including the direct visualization of the catheter or the visualization of a saline/air bolus (i.e. "bubble test"). As for the latter, a push-to-bubbles delay time below 2 s was proposed to indicate a correct positioning of the catheter tip. The aim of this study was to measure the variations of the push-to-bubbles time at increasing distance from the cavo-atrial junction, to verify if a cut-off of 1-2 s correspond to a well-positioned catheter. METHODS We performed a prospective study including patients with clinical indication of positioning a peripherally inserted central catheter. The catheter tip was positioned at the cavo-atrial junction (P0) via intracavitary electrocardiography, and the push-to-bubbles delay time was measured. The catheter was then retracted 5 cm (P1) and 10 cm (P2), and the test was repeated at this positioning. Push-to-bubbles time measurements were performed off-line by analyzing an audio/video recording which included the echography screen and the voice signal of the operator. RESULTS Forty-nine patients were included. The average push-to-bubble time when the catheter tip was in the reference position was 0.41 ± 0.21 s. Retraction of the PICC catheter of 5 and 10 cm determined a significant increase of the push-to-bubbles time: mean time difference was +0.34 (95% IC 0.25-0.43, p < 0.001) s between P0 and P1 (5 cm distance), and +0.77 (95% IC 0.62-0.92, p < 0.001) s between P0 and P2 (10 cm distance). When the catheter was at the reference position (i.e. cavo-atrial junction) only 2.1% of bubbles delay times were above 1 s. CONCLUSION The push-to-bubbles time is very low when the catheter tip is at the cavo-atrial junction. This delay increases progressively with increasing distance from the target. Push-to-bubbles delay time above 1 s might indicate a catheter not close to the cavo-atrial junction.
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Affiliation(s)
- Elli Stefano
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - D'amata Dario
- A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | | | | | | | | | - Pozzoli Jessica
- IRCCS Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Russo Mario
- ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Lucchini Alberto
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - Foti Giuseppe
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - Pozzi Matteo
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
| | - Giani Marco
- University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Italy
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Bartoli A, Gallieni M, Cogliati C, Casella F, Calloni M, Melchionda C, Heidempergher M, Foschi A, Luca Brucato A, Rizzi G, Quici M, Gidaro A. A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study. J Vasc Access 2023:11297298231152499. [PMID: 36726229 DOI: 10.1177/11297298231152499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Kidney Disease Outcomes Quality Initiative clinical practice guidelines recommend avoiding placement of peripherally inserted vascular access devices in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. On the other hand, many patients with severe chronic kidney disease (CKD) have poor prognosis.This study carried out a global assessment of mortality at 2 years through Charlson Comorbidity Index (CCI) and Beclap score in patients with PICCs or Midlines, assuming that in those with an estimated high mortality rate at 2 years, it could be acceptable to implant a peripheral vascular access device (PVAD) despite the presence of CKD. METHODS We analyzed data on patients with PICCs or Midlines inserted from October 2018 to November 2019. CCI, Beclap score, and eGFR were calculated for each patient at the time of the catheter insertion. We then followed patients for 2 years to assess 2-year mortality for each. RESULTS One hundred and thirty-one patients were enrolled, 49 (37.4%) had eGFR<45 ml. The 2-year mortality rate was 57.3%. The cut off derived from ROC curve analysis of 15 for Beclap score and 5 for CCI, showed good sensitivity and specificity in predicting mortality of the total population, patients without an oncological disease and patients with eGFR<45 ml/min. CONCLUSION CCI and Beclap score are good predictors of mortality at 2 years.Physicians and nurses can use these tools in the evaluation of patients at risk for future dialysis, instead of relying exclusively on renal function to decide whether implanting PICCs, Midlines, or other vascular access devices.
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Affiliation(s)
- Arianna Bartoli
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maurizio Gallieni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Maria Calloni
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Melchionda
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | | | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Luca Brucato
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Giulia Rizzi
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Massimiliano Quici
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Luigi Sacco Hospital, Milan, Italy
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Zanaboni C, Bevilacqua M, Bernasconi F, Appierto L, Annetta MG, Pittiruti M. Caliber of the deep veins of the arm in infants and neonates: The VEEIN study (Vascular Echography Evaluation in Infants and Neonates). J Vasc Access 2023:11297298221150942. [PMID: 36655541 DOI: 10.1177/11297298221150942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Ultrasound-guided peripherally inserted central catheters (PICCs) are increasingly used in children, though their insertion may be limited by the small caliber of the deep veins of the arm. Previous studies have suggested to use age or weight as a guide to the feasibility of PICC insertion. We have planned an observational study with the purpose of identifying the actual feasibility of PICC insertion based on the ultrasound evaluation of the deep veins of the arm in groups of children of different weight range. METHODS We have studied 252 children weighing between 2.5 and 20 kg, divided in five different groups (group 1: 2.5-4 kg; group 2: 4.1-7 kg; group 3: 7.1-10 kg; group 4: 10.1-15 kg; group 5: 15.1-20 kg): the caliber of brachial vein, basilic vein, and cephalic vein at mid-upper arm + the caliber of the axillary vein at the axilla were measured by ultrasound scan. RESULTS Veins of caliber >3 mm (appropriate for insertion of a 3 Fr non-tunneled PICC) were found at mid-upper arm in no child of group 1 or 2, in 13% of group 3, in 28% of group 4, and in 54% of group 5. An axillary vein >3 mm (appropriate for insertion of a 3 Fr tunneled PICC) were found in 5.8% of group 1, 30.6% of group 2, 67% of group 3, 82% of group 4, and 94% of group 5. CONCLUSIONS The age and the weight of the child have a small role in predicting the caliber of the veins of the arm. Veins should be measured case by case through a proper and systematic ultrasound evaluation; however, the clinician can expect that insertion of a 3 Fr PICC may be feasible in one third of children weighing between 4 and 7 kg, and in most children weighing more than 7 kg, especially if adopting the tunneling technique.
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Affiliation(s)
- Clelia Zanaboni
- Department of Pediatric Anesthesia and Intensive Care, General Hospital, Parma, Italy
| | - Michela Bevilacqua
- Pediatric Intensive Care Unit, Pediatric Hospital "G.Gaslini," Genova, Italy
| | - Filippo Bernasconi
- Neurological Intensive Care Unit, General Hospital "Niguarda," Milano, Italy
| | - Linda Appierto
- Department of Anesthesia, Pediatric Hospital "Bambino Gesù," Roma, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, University Hospital "Gemelli," Roma, Italy
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