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1.
Sultan Qaboos Univ Med J ; 24(1): 37-43, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38434458

RESUMO

Objectives: This study aimed to determine the risk factors associated with the failure of arteriovenous fistulae (AVF) maturation. Methods: This retrospective cohort study was conducted from January 2014 to December 2018 in Sultan Qaboos University Hospital, Muscat, Oman. Patients were followed-up 3 months after surgery, and their electronic medical records were accessed for demographic and clinical data. Univariate analysis was used to determine the risk factors associated with early AVF maturation and multivariant analysis was used to determine the predictive factors for AVF failure. Results: A total of 269 patients were included. Female gender was a significant factor affecting AVF maturity (P = 0.049), while age (P = 0.626), diabetes (P = 0.954), hypertension (P = 0.378), dyslipidaemia (P = 0.907), coronary artery disease (P = 0.576), cerebrovascular accident (P = 0.864), congestive heart failure (P = 0.685), previous central venous catheterisation (P = 0.05), fistula type (P = 0.863) and fistula site (P = 0.861) did not affect AVF maturation. Binary logistic regression showed that all the risk factors were insignificant. Failure of early AVF maturation affected 11.5% in the cohort. Conclusion: This study found that the proportion of early AVF maturation at our hospital is at par with that in the international literature. Failure of AVF maturation was significantly associated with the female gender. These findings can help nephrologists and vascular surgeons prognosticate AVF maturation rates. However, a larger study is needed for definitive conclusions.


Assuntos
Fístula Arteriovenosa , Cateterismo Venoso Central , Humanos , Feminino , Omã/epidemiologia , Estudos Retrospectivos , Hospitais Universitários
2.
G Ital Nefrol ; 41(1)2024 Feb 28.
Artigo em Italiano | MEDLINE | ID: mdl-38426677

RESUMO

The prevalence of central venous catheters (CVC) in hemodialysis patients is around 20-30%. In this scenario, complications related to the use of the CVC are commonly observed, requiring active management by nephrologists. These include infectious complications as well as those related to CVC malfunction. Among the latter, the formation of a fibrin sheath around the catheter linked to foreign body reaction could cause CVC malfunction in various ways. Even after the removal of the catheter, the fibrin sheath can remain inside the vascular lumen (ghost fibrin sheath) and rarely undergo calcification. We describe the clinical case of a hemodialysis patient who, following the removal of a malfunctioning, stuck CVC, presented a calcified tubular structure in the lumen of the superior vena cava, diagnosed as calcified fibrin sheath (CFS). This rare occurrence, described in the literature in 8 other cases, although rare, is certainly underdiagnosed and can lead to complications such as sepsis resulting from CFS, pulmonary embolisms, and vascular thrombosis. Therapeutic approaches should be considered only in symptomatic cases and involve an invasive surgical approach.


Assuntos
Calcinose , Cateterismo Venoso Central , Cateteres Venosos Centrais , Humanos , Cateterismo Venoso Central/efeitos adversos , Veia Cava Superior , Cateteres Venosos Centrais/efeitos adversos , Diálise Renal , Fibrina , Cateteres de Demora/efeitos adversos
5.
Sci Rep ; 14(1): 5836, 2024 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-38462667

RESUMO

Vascular injury such as central venous stenosis (CVS) is a common complication in hemodialysis patients with central venous catheters (CVCs), yet the impact of the microstructure and partial physic characteristics of catheter surface on the chronic injury of central vein has not been elucidated. In this study, the microscopic morphology of tips and bodies of six different brands of polyurethane CVCs was observed and their roughness was assessed. Subsequently, an in vitro model was established to measure the coefficients of friction (COF) between CVCs (tips and bodies) and the vena cava intima of Japanese rabbits under the same condition in a linear reciprocating mode, and changes in the intima of vessels after friction were observed. The study found that there was a significant variation in surface roughness among different brands of CVCs (tips P < 0.001, bodies P = 0.02), and the COF was positively correlated with the catheter surface roughness (tips P = 0.005, R = 0.945, bodies P = 0.01, R = 0.909). Besides, the endovascular roughness increased after friction. These findings suggest that the high roughness surface of CVCs may cause chronic mechanical friction injury to the central venous intima, which is one of the potential factors leading to CVS or occlusion. This provides a breakthrough for reducing complications, improving patient prognosis, and advancing catheter surface lubrication technology.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Doenças Vasculares , Humanos , Coelhos , Animais , Cateterismo Venoso Central/efeitos adversos , Fricção , Cateteres Venosos Centrais/efeitos adversos , Diálise Renal/efeitos adversos , Veias , Doenças Vasculares/etiologia
6.
Zhonghua Zhong Liu Za Zhi ; 46(3): 256-262, 2024 Mar 23.
Artigo em Chinês | MEDLINE | ID: mdl-38494772

RESUMO

Objective: To explore the efficacy and safety of Rivaroxaban in preventing catheter related thrombosis (CRT) in patients with breast cancer who are undergoing central venous catheter chemotherapy, and provide basis for making standardized prevention and treatment strategies. Methods: In this research, a prospective cohort study was adopted, and breast cancer patients who received central venous catheter chemotherapy in Sanhuan Cancer Hospital during September 2020 to March 2022 were selected as a treatment group to take the rivaroxaban anticoagulation therapy with 10 mg.po.qd for one month. The control group got no preventive anticoagulation therapy. Vascular ultrasound examination was taken to confirm the occurrence of CRT, and a chi-square test was done for comparison the disparity between the groups. Logistic regression was applied to analyze the univariate and multivariate factors for the formation of CRT. Results: In the research, a total of 235 patients were selected, and there were a total of 19 035 days of catheterization with 81 days of catheterization on average. While in the control group, the incidence of CRT was 28.0% (33/118), the incidence of CRT in the treatment group was 20.5% (24/117), the difference was no significant (P=0.183). Subgroup analysis results showed that the peripherally inserted central catheter (PICC) was performed in 165 cases with the CRT incidence of 18.2% (30/165) and thrombosis was mostly seen around axillary vein, accounting for 63.3%. Subclavian vein catheterization was performed in 63 cases with the CRT incidence of 39.7% (25/63), and thrombosis was mostly seen around subclavian vein, accounting for 88.0% (22/25). Implantable venous access port was implanted in 7 cases around subclavian vein and internal jugular vein with the CRT incidence of 28.6% (2/7). The patients who developed CRT within 30 days after catheterization accounted for 54.4% (31/57), 22.8% (13/57) in a period during 30 days and 60 days) and 22.8% (13/57) in a period during 60 days and 180 days). The diagnosed CRT patients had been treated with rivaroxaban 15 mg.bid.po for 3 months. During the 3 months, 100.0% of the thrombosis waned, 71.9% (41/57) of the thrombosis waned within 30 days, 19.3% (11/57) in a period during 30 and 60days and 8.8% (5/57) in a period during 60 days and 90 days. Univariate and multivariate analysis indicated that the risk of CRT in subclavian vein catheterization was higher than that in PICC, respectively (OR=2.898, 95% CI:1.386-6.056 P=0.005), and the type of catheterization was an independent factor for the formation of thrombosis. Safety analysis result showed that in the prevention of CRT, rivaroxaban treatment did not induce drug-related bleeding, liver function damage, bone marrow suppression or any other side effects. While CRT diagnosed patients were treated with anticoagulation, they kept the central venous catheter, and the infusion was smooth. These patients all finished the anti-tumor treatment as planned, and no abnormalities like new thrombosis or pulmonary embolism were observed. Conclusions: In the mid-term analysis, the proportion of Rivaroxaban in preventing anticoagulant CRT decreases, but it don't reach statistical significance. The sample size should be further increased for observation. Rivaroxaban is proved effective and very safe in the treatment of CRT, and does not affect the concurrent chemotherapy. Medical personnel should carry out the policy of "early prevention, early detection and early treatment" for CRT so as to improve the patients' quality of life.


Assuntos
Neoplasias da Mama , Cateterismo Venoso Central , Cateteres Venosos Centrais , Trombose , Humanos , Feminino , Rivaroxabana/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Neoplasias da Mama/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Estudos Prospectivos , Qualidade de Vida , Trombose/etiologia , Trombose/prevenção & controle , Trombose/tratamento farmacológico , Anticoagulantes/uso terapêutico
7.
Ulus Travma Acil Cerrahi Derg ; 30(3): 210-215, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506386

RESUMO

BACKGROUND: The aim of this study was to present demographic information of patients undergoing totally implantable venous access port (TIVAP) implantation and to investigate the rates of early and late complications, assessing the benefits of performing the procedure underUS guidance. METHODS: From May 2018 to December 2023, the outcomes of a total of 537 TIVAP implantation procedures were analyzed retrospectively. Data of the surgeons' experiences for both puncture methods (anatomical landmarks and ultrasound guidance) are presented in the study. RESULTS: The average age of the patients was 53.1±11.9 years, and 261 (48.6%) were female. The right subclavian vein was the preferred insertion site. Fourteen patients developed early complications and 11 developed late complications. Arterial puncture was the most common early complication, while catheter-related infection was the most common late complication. The age, sex, and body mass index of the patients were not independent risk factors for developing complications. Early complications increased as the number of puncture attempts did (p=0.034) and developed significantly less when ultrasound guidance was used during insertion (p=0.011). CONCLUSION: The risk of developing complications was not affected by patient's age or sex. In addition, body mass index was not shown to be an independent risk factor for patients developing complications. It may be concluded from the study that early complications in particular can be reduced with ultrasound-guided implantation.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Estudos Retrospectivos , Veia Subclávia/diagnóstico por imagem , Ultrassonografia
8.
BMC Nephrol ; 25(1): 104, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500070

RESUMO

BACKGROUND: Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming 'stuck' via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period. CASE PRESENTATION: A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications. CONCLUSIONS: This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.


Assuntos
Cateterismo Venoso Central , Transplante de Rim , Feminino , Humanos , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Transplante de Rim/efeitos adversos , Remoção de Dispositivo , Diálise Renal/efeitos adversos
9.
Expert Rev Med Devices ; 21(3): 207-216, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38445649

RESUMO

INTRODUCTION: More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials. AREAS COVERED: This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence. EXPERT OPINION: Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Trombose , Humanos , Cateterismo Venoso Central/efeitos adversos , Infecções Relacionadas a Cateter/microbiologia , Hidrogéis , Cateteres , Trombose/etiologia , Cateterismo Periférico/efeitos adversos , Fatores de Risco , Estudos Retrospectivos , Cateteres de Demora/efeitos adversos
10.
Medicine (Baltimore) ; 103(12): e37184, 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38518044

RESUMO

To investigate the incidence, risk factors, and pathogenic characteristics of catheter-related bloodstream infection caused by peripherally inserted central venous catheter in neonates, and to provide references for reducing the infection rate of peripherally inserted central venous catheter. The clinical data of 680 neonates who underwent peripherally inserted central catheter (PICC) in the neonatal intensive care unit from June 2020 to June 2023 were retrospectively analyzed. The risk factors and independent risk factors of catheter-related bloodstream infection caused by PICC were determined by univariate and multivariate analysis, respectively. Catheter-related bloodstream infection occurred in 38 of 680 neonates who underwent PICC. The infection rate was 4.74%. The proportions of fungi, gram-positive bacteria, and gram-negative bacteria were 42.11%, 36.84%, and 21.05%, respectively. Candida parapsilosis was the main fungus (18.42%), coagulase negative Staphylococcus was the main gram-positive bacteria (23.68%), and Klebsiella pneumoniae and Escherichia coli were the main gram-negative bacteria (7.89%). Univariate analysis showed that gestational age ≤32 weeks, birth weight ≤1500 g, congenital diseases, nutritional support, catheterization time, 5-minute APGAR score ≤7, and neonatal respiratory distress syndrome were associated with catheter-related bloodstream infection caused by PICC. Multivariate analysis showed that premature delivery, low birth weight, parenteral nutrition, long catheterization time, and 5-minute APGAR score ≤7 were associated with catheter-related bloodstream infection caused by PICC. Among the pathogens detected, there were 6 cases of K pneumoniae, 5 cases of coagulase negative staphylococci, and 2 cases of fungi. Low birth weight, premature delivery, off-site nutrition, long catheterization time, and 5-minute APGAR score ≤7 are independent risk factors for catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. The pathogenic bacteria are fungi and multidrug-resistant bacteria.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Sepse , Recém-Nascido , Humanos , Lactente , Estudos Retrospectivos , Coagulase , Infecções Relacionadas a Cateter/microbiologia , Sepse/etiologia , Cateterismo Periférico/efeitos adversos , Fatores de Risco , Cateterismo Venoso Central/efeitos adversos
11.
J Cardiothorac Surg ; 19(1): 151, 2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521937

RESUMO

BACKGROUND: Iatrogenic complications of endovascular treatment for central venous stenosis have not yet been reported. Here we present a case of a patient on maintenance hemodialysis who developed catheter-related superior vena cava syndrome and subsequently suffered from hemorrhagic pericardial tamponade after undergoing percutaneous transluminal angioplasty and stenting. CASE PRESENTATION: A 72-year-old male patient presented with uremia, and had been receiving maintenance hemodialysis for the past five years. The patient initially presented with dysfunction of the dialysis catheter (a cuffed tunneled double-lumen catheter in the right internal jugular vein). Imaging examination revealed a segmental occlusion of the superior vena cava stretching from the distal end of the dialysis catheter up to right atrium entrance, apparent compensatory dilatation of the azygos vein, and abundant subcutaneous collaterals. The patient underwent percutaneous transluminal balloon dilatation and stenting (covered stent) of the superior vena cava in the Cath Lab. During the procedure, with forceful advancement of the guidewire, it was observed to progress for a distance before a "smoke" appeared, and an outward spillage of contrast agent was visible, which suggested a possible vessel puncture leading into the mediastinum. Unfortunately, postoperative hemorrhagic pericardial tamponade occurred and the patient developed cardiogenic shock. He experienced symptoms included chest tightness and breath shortness with a recorded blood pressure of 84/60mmHg. After draining 600 ml of bloody fluid through pericardiocentesis, the patient's symptoms alleviated and his condition improved. CONCLUSIONS: The case emphasizes the need for increased attention to iatrogenic endovascular injuries during catheter placement and endovascular treatment, such as causing pericardial hemorrhage leading to cardiac tamponade.


Assuntos
Tamponamento Cardíaco , Cateterismo Venoso Central , Derrame Pericárdico , Síndrome da Veia Cava Superior , Doenças Vasculares , Masculino , Humanos , Idoso , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Veia Cava Superior , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cateterismo Venoso Central/efeitos adversos , Diálise Renal/efeitos adversos , Cateteres/efeitos adversos , Doença Iatrogênica
12.
Support Care Cancer ; 32(4): 239, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38512390

RESUMO

PURPOSE: To identify the trends in the prevalence of peripherally inserted central catheter (PICC) related complications in cancer patients and explore the risk factors for complications and occurrence speed. METHODS: A total of 3573 cancer patients with PICC were recruited at 17 hospitals from 2016 to 2022. Logistic and COX regression were performed to identify influencing factors of PICC-related complications and incidence speed, respectively. RESULTS: The proportion of symptomatic PICC-related thrombosis, phlebitis, and infections reported had decreased from 59.1% (in 2017), 11.9% (in 2016), and 11.1% (in 2016) to 15.3% (in 2022), 2.9% (in 2022), and 7.4% (in 2022), and adhesive-related skin injuries and bleeding/oozing reported had increased from 4.8% (in 2016) and 0.0% (in 2016) to 45.5% (in 2022) and 3.4% (in 2022), respectively. Catheter occlusion showed a trend of first increasing and then decreasing from 2.4 (in 2016) to 12.0 (in 2020) to 5.8% (in 2022). Logistic regression showed that hospital level, nature, the patient's gender, age, diagnosis, history of deep vein catheterization, chemotherapy drug administration, and type of PICC were influencing factors of complications. COX regression showed that the patient's gender, age, diagnosis, history of deep vein thrombosis and thrombophlebitis, history of deep vein catheterization, chemotherapy drug administration, type of PICC, type of connector, and StatLock used for fixation were influencing factors of incidence speed. CONCLUSION: The composition ratios of PICC-related complications in cancer patients in China have changed in recent years. Chemotherapy drug administration was a significant risk factor accelerating the occurrence of complications. Maintenance factors had the maximum weight on the COX model, followed by patient factors. It is suggested that patients with high-risk factors be closely monitored and proper maintenance be performed to prevent and delay the occurrence of PICC-related complications.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Neoplasias , Humanos , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Prevalência , Neoplasias/tratamento farmacológico , Fatores de Risco , Cateterismo Periférico/efeitos adversos , Estudos Retrospectivos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia
13.
Future Oncol ; 20(8): 471-479, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38482686

RESUMO

Objective: This study was conducted to analyze the effectiveness of multidisciplinary cooperative continuous nursing combined with psychological nursing intervention in multiple myeloma (MM) patients undergoing peripherally inserted central catheter (PICC). Methods: The Numerical Pain Rating Scale (NPRS), Anxiety Self-Assessment Scale (SAS), Depression Self-Assessment Scale (SDS) and Revised Piper Fatigue Scale (PFS-R), Self-Care Ability Scale (ESCA), Quality of Life Core Questionnaire (QLQ-C30), incidence of unplanned extubation of PICC, total incidence of catheter-related complications and satisfaction with nursing were compared between the two groups of patients in a prospective study. Results: Patients in the observation group had reduced NPRS, SAS, SDS and PFS-R scores, total incidence of unplanned extubation of PICC and the total incidence of catheter-related complications, and a higher nursing satisfaction rate in comparison to those in the control group. Conclusion: Multidisciplinary cooperative continuous nursing combined with psychological nursing interventions can relieve pain in MM patients.


Assuntos
Cateterismo Venoso Central , Mieloma Múltiplo , Humanos , Mieloma Múltiplo/terapia , Estudos Prospectivos , Qualidade de Vida , Dor , Cateteres
14.
Antimicrob Resist Infect Control ; 13(1): 25, 2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38419046

RESUMO

INTRODUCTION: Intravascular catheters are crucial devices in medical practice that increase the risk of healthcare-associated infections (HAIs), and related health-economic adverse outcomes. This scoping review aims to provide a comprehensive overview of published automated algorithms for surveillance of catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). METHODS: We performed a scoping review based on a systematic search of the literature in PubMed and EMBASE from 1 January 2000 to 31 December 2021. Studies were included if they evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We assessed the design of the automated systems, including the definitions used to develop algorithms (CLABSI versus CRBSI), the datasets and denominators used, and the algorithms evaluated in each of the studies. RESULTS: We screened 586 studies based on title and abstract, and 99 were assessed based on full text. Nine studies were included in the scoping review. Most studies were monocentric (n = 5), and they identified CLABSI (n = 7) as an outcome. The majority of the studies used administrative and microbiological data (n = 9) and five studies included the presence of a vascular central line in their automated system. Six studies explained the denominator they selected, five of which chose central line-days. The most common rules and steps used in the algorithms were categorized as hospital-acquired rules, infection rules (infection versus contamination), deduplication, episode grouping, secondary BSI rules (secondary versus primary BSI), and catheter-associated rules. CONCLUSION: The automated surveillance systems that we identified were heterogeneous in terms of definitions, datasets and denominators used, with a combination of rules in each algorithm. Further guidelines and studies are needed to develop and implement algorithms to detect CLABSI/CRBSI, with standardized definitions, appropriate data sources and suitable denominators.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Infecção Hospitalar , Humanos , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Infecção Hospitalar/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Atenção à Saúde
15.
Am J Case Rep ; 25: e943270, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38379277

RESUMO

BACKGROUND Hyperparathyroidism is a common issue in patients on long-term hemodialysis, necessitating parathyroidectomy with deep venipuncture. These patients frequently exhibit a heightened incidence of vascular calcification, complicating deep venipuncture and increasing the risk of associated complications. Therefore, a crucial aspect of preoperative assessment in this population involves identifying vascular calcification, with a preference for ultrasound-guided intraplane puncture. Special care is required to prevent blood vessel injuries and postoperative complications such as deep vein thrombosis. CASE REPORT We present the case of a 66-year-old woman with secondary hyperparathyroidism who encountered challenges during an internal jugular vein puncture, leading to subsequent thrombosis. Initial attempts were hindered by calcification of the internal jugular vein's vascular wall, resulting in stratified damage to the vessel's wall. However, the ultrasound-guided in-plane puncture technique successfully allowed the insertion of a central venous catheter without further damage to the vascular wall. On the postoperative fourth day, thrombus formation was observed in the damaged vascular wall from the initial puncture. CONCLUSIONS The ultrasound-guided in-plane puncture technique is advantageous in overcoming the difficulties associated with puncturing through deep vein calcification in patients with secondary hyperparathyroidism. This technique also diminishes the likelihood of complications such as venous thrombosis.


Assuntos
Cateterismo Venoso Central , Hiperparatireoidismo Secundário , Trombose , Calcificação Vascular , Feminino , Humanos , Idoso , Cateterismo Venoso Central/efeitos adversos , Flebotomia , Veias Jugulares/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Hiperparatireoidismo Secundário/cirurgia
16.
BMJ Case Rep ; 17(2)2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38367993

RESUMO

Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.


Assuntos
Tamponamento Cardíaco , Cateterismo Venoso Central , Humanos , Recém-Nascido , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Pericardiocentese , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia
17.
BMC Anesthesiol ; 24(1): 68, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38383304

RESUMO

BACKGROUND: A previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified. METHODS: This was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8 586 patients ≥ 16 years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications. RESULTS: Female operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P = .02), were less experienced (P < .001), had more patients with invasive positive pressure ventilation (P < .001), more often chose the internal jugular vein (P < .001) and more frequently used ultrasound guidance (P < .001). Male operators more often chose the subclavian vein (P < .001) and inserted more catheters with bore size ≥ 9 Fr (P < .001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26-5.64]) after correction for other relevant independent variables. CONCLUSIONS: The hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Feminino , Humanos , Masculino , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Veias Jugulares , Estudos Prospectivos , Fatores Sexuais , Ultrassonografia , Adolescente , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Adulto
18.
Med Sci Monit ; 30: e943181, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38366581

RESUMO

The number of patients with malignant tumors is increasing in China, and venous access ports have unique advantages for chemotherapy. Currently, China's research on venous access port-mediated kinesiophobia is still in the developing stage. Using the combination of subjective words and freedom words, and based on literature traceability methods, China National Knowledge Infrastructure (CNKI), Wanfang, Vipp, Chinese Biomedical Database (CBM), Web of Science, The COCHRANE LIBRARY, Embase, and PubMed were searched. Relevant articles published from the construction of the database to October 30, 2023, were identified. Based on the many articles and analyses, the methods of assessing kinesiophobia in malignant tumors patients using venous access port, the related influencing factors and the preventive and intervention strategies were collated. We found 33 articles examining kinesiophobia in oncology patients, of which 4 were specifically conducted on patients with malignant tumors using VAPs or PICCs. The relevant preventive and therapeutic experiences regarding kinesiophobia in cancer patients with VAP still need improvement. Nursing staff can use assessment tools such as the Tampa Rating Scale for Kinesiophobia, the Fear Avoidance Beliefs Questionnaire, and the Cancer Fatigue Scale to reasonably and effectively assess kinesiophobia among patients with malignant tumors who use VAPs. Attention should be paid to the mechanisms and roles of demographic factors, pain and foreign body sensation, cancer fatigue, pain management strategies, and other factors influencing kinesiophobia. This study provides advice to nursing staff for the management of VAP. Such considerations may reduce the complications of kinesiophobia and improve the quality of life of patients.


Assuntos
Cateterismo Venoso Central , Neoplasias , Humanos , Cinesiofobia , Qualidade de Vida , Neoplasias/complicações , Fadiga
19.
Eur J Med Res ; 29(1): 130, 2024 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-38368367

RESUMO

BACKGROUND AND PURPOSE: Peripherally inserted central catheter (PICC) used in neurosurgical patients requires changes in patients' head positions. However, such changes can worsen pressure on the brain tissue, lead to sudden acute brain herniation and respiratory arrest, resulting in a higher chance of patient death. This paper addresses the aforementioned problems by introducing a new PICC catheterization method. METHOD: In a retrospective study, the records of patients with PICC from April 2020 to April 2023 were reviewed, and they were divided into three groups based on the methods employed. The first group as the conventional group, involved changing patients' body positions during catheterization. The second group, as the intracavitary electrocardiographic (IECG) group, utilized intracavitary electrocardiographic monitoring and involved changing patients' body positions during catheterization. The third group as the intracavitary electrocardiographic with improved body positioning (IECG-IBP) group, catheterization was performed with guidance from intracavitary electrocardiographs and without changing the patients' body positions. The ECG changes among patients undergoing different catheter delivery methods were then compared, as well as the rate of catheter tip misplacement. RESULT: The study encompassed a total of 354 cases. Our findings reveal distinct P wave amplitude percentages among the groups: 0% in the conventional group, 88.46% in the IECG group, and 91.78% in the IECG-IBP group. Furthermore, the following catheter tip misplacement rates were recorded: 11.54% for the conventional group, 5.39% for the IECG group, and 5.47% for the IECG-IBP group. Significantly notable differences were observed in these two key indicators between the conventional group and the IECG-IBP group. Notably, the IECG-IBP group demonstrated a more favorable outcome compared to the IECG group. CONCLUSION: In patients with neurosurgical diseases, especially those with tracheostomy and nuchal stiffness, the IECG-IBP PICC catheter insertion method can effectively reduce the patient's neck resistance, does not increase the patient's headache and dizziness symptoms, and does not reduce the success of one-time catheterization. Rate and does not increase the incidence of jugular venous ectopia.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Neurocirurgia , Humanos , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/efeitos adversos , Estudos Retrospectivos , Métodos de Alimentação , Eletrocardiografia/métodos
20.
Sensors (Basel) ; 24(3)2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38339610

RESUMO

(1) Background: The peripherally inserted central catheter (PICC) is commonly used in medicine. The tip position was shown to be a major determinant in PICC function and related complications. Recent advances in ECG guidance might facilitate daily practice. This study aimed to compare two ECG techniques, in terms of their tip-position accuracy, puncture site layout, and signal quality; (2) Methods: This randomized open study (1:1) included 320 participants. One PICC guidance technique used ECG signal transmission with saline (ST); the other technique used a guidewire (WT). Techniques were compared by the distance between the catheter tip and the cavoatrial junction (DCAJ) on chest X-rays, insertion-point hemostasis time, and the extracorporeal catheter length between the hub and the insertion point; (3) Results: The mean DCAJs were significantly different between ST (1.36 cm, 95% CI: 1.22-1.37) and WT (1.12 cm, 95% CI: 0.98-1.25; p = 0.013) groups. When DCAJs were classified as optimal, suboptimal, or inadequate, the difference between techniques had limited clinical impact (p = 0.085). However, the hemostasis time at the puncture site was significantly better with WT (no delay in 82% of patients) compared to ST (no delay in 50% of patients; p < 0.001). Conversely, ST achieved optimal and suboptimal extracorporeal lengths significantly more frequently than WT (100% vs. 66%; p < 0.001); (4) Conclusions: ECG guidance technologies achieved significantly different tip placements, but the difference had minimal clinical impact. Nevertheless, each technique displayed an important drawback at the PICC insertion point: the extracorporeal catheter was significantly longer with WT and the hemostasis delay was significantly longer with ST.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Humanos , Cateterismo Venoso Central/métodos , Radiografia , Punções , Eletrocardiografia
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