Diagnostic accuracy of the Catheter Injection and Aspiration (CINAS) classification for assessing the function of totally implantable venous access devices.

PURPOSE: Intravenous catheters are used for the administration of intravenous therapy and for blood sampling. These devices are considered as well-functioning if both the injection and aspiration are easy. Malfunction is frequently observed and usually vaguely described as occlusion. We developed the CINAS, the Catheter Injection and Aspiration scheme. The CINAS is a catheter function classification tool, which classifies both the injection and the aspiration ability in a uniform way. Each CINAS class consists of a combination of an injection (IN) and an aspiration (AS) code: e.g. IN1AS1 is the CINAS class for a well-functioning catheter. In this series, we aimed to determine the accuracy of the CINAS class reported by nurses, after minimal training, versus a trained researcher, acting as a reference standard. METHODS: Catheter function was assessed during a standard blood sampling procedure through a totally implantable venous access device in a convenience sample of 150 oncology patients. One nurse researcher and 111 oncology nurses both scored the catheter function according to the CINAS classification scheme, independently. Concordance between the scores was calculated. RESULTS: For the 140 catheters scored as well-functioning (IN1AS1 score) by the researcher, 139 or 99.3 % (95 % confidence interval (CI) 96.1-99.9 %) were scored correctly by the nurse participants. Nine out of ten or 90 % (95 % CI 55.5-98.3 %) of malfunctioning catheters (researcher scores different from IN1AS1) were also identified as malfunctioning by the nurse participants and received exactly the same CINAS score in eight cases (80 %, 95 % CI 44.4-97.5 %). The overall accuracy of the CINAS scored by the nurse participants versus the researcher is (139 + 9)/150 or 98.7 % (95 % CI 95.3-99.8 %). CONCLUSIONS: Nurse participants were able to classify the catheter function of totally implantable venous access devices with the CINAS accurately after a brief explanation about the classification options.

Port navigation: let the journey begin.

Central venous access plays an important role in modern medical patient assessment and treatment. The use of central venous access devices has become routine in the oncology setting. Clinical oncology nurses need to know how the devices function, how to provide proper care, and how to manage potential side effects. The focus of this article will be on the navigation of implanted, skin-tunneled ports.

Acceso venoso prolongado en el paciente oncológico / Prolonged venous access in the oncologic patient

En el manejo actual del paciente oncológico que requiere de tratamiento sistémico prolongado, es fundamental disponer de un acceso venoso adecuado. En el transcurso del tiempo se han desarrollado y utilizado distintos procedimientos para cumplir este objetivo hasta llegar a los catéteres centrales con reservorio subcutáneo, que son los más utilizados en este momento y con los que se dispone de un acceso venoso eficiente y con el menor disconfort para los pacientes. El acceso venoso es una necesidad importante en el cuidado y manejo del paciente oncológico. El desarrollo y uso de drogas antineoplásicas sistémicas en un mayor número de patologías neoplásicas ha significado que muchos pacientes requieran el empleo de un acceso venoso central prolongado. Esto evita venopunciones repetidas y traumáticas que con el tiempo se hacen cada vez más dificultosas, agregando a esto el compromiso venotóxico que los agentes antineoplásicos producen en la integridad venosa. A través del tiempo, se han utilizado distintos procedimientos para cumplir esta necesidad

Diagnosis of central venous catheter related infection in adult patients.

Intravascular catheters are one of the main causes of bacteraemia and septicaemia in hospitalised patients and continue to be associated with a significant morbidity and mortality. Two main types of infections occur, they can be either localised at the catheter insertion site of systemic with a septicaemia. The clinical parameters related to these infections are presented. The laboratory diagnosis of these infections is also extensively reviewed and recommendations are made as to the most appropriate diagnostic method to be used.

Here we go again!

New CPT procedure codes are added annually (quarterly for Category II and Category III codes), definitions of existing codes are changed, and codes we have memorized are often deleted and replaced. In addition, guidelines for code assignment are constantly revised and may be altered based upon individual insurance payer interpretation. Remember, a code must accurately represent the service performed, and a code that is "close" to the procedure performed cannot be assigned. If the service performed is not defined by an existing procedure code (CPT Category I, II, III or HCPCS Level II), then an unlisted procedure code must be used. The forms and guidelines to request new codes or changes to procedure code descriptors are currently located on the American Medical Association website in the "CPT Process" section (www.ama-assn.org/ama/ pub/category/3112.html).

Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units.

BACKGROUND: The objective of this study was to examine central venous catheter (CVC)-related nosocomial blood stream infection risks of umbilical venous, percutaneous and Broviac catheters, as well as variations in CVC use and CVC-related risk for nosocomial blood stream infection in the neonatal intensive care unit (NICU). METHODS: A cohort study was performed based on 19,507 infants admitted to 17 NICUs in the Canadian Neonatal Network from January, 1996, through October, 1997. Information on these subjects was prospectively collected by trained abstractors. Incidence of infection was measured as infection episodes per 1000 patient days. The risk ratio (RR) of CVC use for nosocomial blood stream infection was calculated as the infection rate during catheter days divided by the infection rate during noncatheter days. Using a Poisson regression model we examined the adjusted RR of CVC use for nosocomial blood stream infection, controlling for patient characteristics and illness severity at admission. Interinstitutional variations in CVC-related infection risks were examined by stratified analyses. RESULTS: CVC were used in 22.5% of patients. The incidence of nosocomial blood stream infection was 2.9 per 1000 noncatheter days, 7.2 per 1000 umbilical venous catheter days, 13.1 per 1000 percutaneous catheter days and 12.1 per 1000 Broviac catheter days. The RR for nosocomial blood stream infection, adjusted for differences in patient characteristics and admission illness severity, was 2.5 for umbilical venous catheter, 4.6 for percutaneous catheter and 4.3 for Broviac catheter (P < 0.05). There were significant (P < 0.05) risk-adjusted variations in CVC-related infection risks among NICUs. CONCLUSIONS: CVC use increased the risk of nosocomial blood stream infection. The risk of nosocomial blood stream infection in percutaneous and Broviac catheters was 70 to 80% higher than in umbilical venous catheters. There was significant variation in CVC-related infection risks among Canadian NICUs.

Cost comparison of electrocardiography versus fluoroscopy for central venous line positioning in children.

BACKGROUND: Although most central venous lines in children are positioned using fluoroscopy, electrocardiography (ECG) has been shown to be accurate, and avoids unnecessary radiation exposure. We studied whether ECG may also have cost advantages. STUDY DESIGN: All ports and Hickman/Broviac catheters placed during a 2.5-year period were reviewed. Two surgeons routinely used fluoroscopy, and two used ECG. Costs included surgeon and anesthesia fees, operating room use, and fluoroscopy equipment and personnel. RESULTS: There were 287 cases with sufficient data to be included in the study (167 fluoroscopy and 120 ECG). In the ECG group, 12 (10%) were converted to fluoroscopy because an adequate tracing could not be obtained, but they were kept in the ECG group for data analysis. The groups were similar with regard to age, gender, indication, previous catheters, and intraoperative or postoperative complications. Time for surgical placement of the line was not significantly affected by the positioning technique. Ports placed using ECG were less costly than those placed fluoroscopically ($2,880+/-408 versus $3,595+/-357, p<0.001), and the same was true for tunneled external catheters ($2,249 +/- 435 versus $2,923+/-350, p<0.001). CONCLUSIONS: The ECG technique was less costly than fluoroscopy, despite a 10% conversion rate. At our center, the savings were approximately $700 per procedure. Because operating room time used is similar, the additional cost of fluoroscopy can be attributed to the need for x-ray equipment and personnel.

[Permanent vascular catheters for extracorporeal dialysis. Preliminary study: Canaud and Tesio catheters]. / Catetere vascolare a permanenza per dialisi extracorporea. Studio preliminare: cateteri di Canaud e Tesio.

The use of alternative permanent vascular accesses has recently become increasingly common. The possibility of using the catheterization of central venous vessels has therefore been taken into consideration, in particular the internal jugular vein. During an observation period of 32 months the catheterization of the internal jugular vein (IJV) was used as a definitive access in 34 patients (12 M, 22 F; mean age 67.5, mean dialytic age 56 months in 18 patients, in 16 patients the insertion was by primary intention). A total of 44 IJV catheters were used, of which 18 Tesio and 26 Canaud. The authors examined the immediate complications following insertion and the episodes occurring during the observation period, including the problem of infection. The insertion of catheters was possible in all cases. In terms of catheter function, blood flow was adequate for the various purifying techniques. No severe complications were reported: gaseous embolism, pneumothorax, hemothorax, hemomediastinum. Infection was observed in 11 patients and 13 catheters, of which 70% were mainly provoked by Staphylococcus aureus and epidermidis. During the observation period there was a drop-out of 14 patients, 11 of whom died (3 following sepsis that failed to respond to antibiotic therapy). This preliminary experiment shows that permanent jugular catheters may be regarded as a valid access for hemodialytic treatment both in patients with severe problems of vascular access and for patients who present a short-term prognosis of dialysis and life expectancy at the time of starting hemodialysis.

Evaluación del uso de catéter endovenoso central en niños con enfermedades neoplásicas en un hospital privado / Assessment of central venous catheter use in children with neoplasic diseases in a private hospital

Los catéteres venosos centrales (CVC) han facilitado el manejo de los niños con cáncer. El objetivo ha sido determinar en un estudio prospectivo la incidencia de obstrucciones, infecciones y salida accidental en niños con CVC para el tratamiento de enfermedades malignas en un hospital privado. Material: desde agosto 1992 a junio 1995; 51 CVC fueron instalados. Mediana 4 años (4 meses-15 años) 24 varones, 19 femeninos. Diagnóstico: 12 leucemias, 3 linfomas, 13 tumores SNC, 6 tumores óseos, 3 sarcomas, 3 neuroblastomas, 2 tumores de Wilms, 1 hepatoblastoma. Tipo de CVC: 51 CVC fueron instalados en 43 pacientes, 35 externos: 33 Hickman-Broviac (HB), 2 Groshong (G) y 16 subcutáneos (SC). Conclusión: CVC han facilitado el manejo de niños con cáncer, nuestros resultados de complicaciones y causas de remoción son similares a publicaciones extranjeras

Venous access device study: identification of number of patients with venous access device lines.

As part of the Quality Assurance and Improvement Process, the need to determine the number and location of patients having venous access devices in a 600-bed tertiary care facility was identified. In the overall study, 167 patients on 18 wards had venous access device lines in place for a total of 455 weeks. As a direct result of the study, policies/procedures and other practice changes regarding patients with venous access devices have been reviewed and revised. Furthermore, the data helped to provide an in-depth look at the central-line issues for patient care.

In vitro activity of vancomycin and teicoplanin against Staphylococcus aureus and Staphylococcus epidermidis colonizing catheters.

In a quantitative in vitro model the activity of vancomycin and teicoplanin in two concentrations (4 x MBC and 1 mg/l) against Staphylococcus aureus and a slime-producing Staphylococcus epidermidis strain colonizing the internal surface of polyurethane and silicone catheters was studied. In comparison with vancomycin, teicoplanin achieved a significantly greater reduction (p < 0.05) in the counts of Staphylococcus aureus and Staphylococcus epidermidis adhering to both polyurethane and silicone catheters.

Central venous access devices: current technologies, uses, and management strategies.

The use of central venous catheters (CVCs) for vascular access is now commonplace in a variety of care settings. Technological advances related to CVCs have introduced a multitude of catheter designs that are available to us through numerous manufacturers. To initiate the appropriate procedures for care, nurses involved in the maintenance of central venous access devices are now challenged with having to be familiar with a large variety of central venous access devices. They must be able to evaluate a CVC and determine its type, size, manufacturer, and specific characteristics as well as to initiate the appropriate management strategies related to that device. The nurse must also be able to recognize the indications, advantages and disadvantages associated with each device, and to assist the patient in making an informed decision regarding the appropriate device for his or her therapy needs. It is essential that care and maintenance procedures be delivered by those whose knowledge base and experience make them competent care providers with the expertise to initiate appropriate prevention and troubleshooting measures, as well as to evaluate and implement nursing actions related to complications.

Intravenous access. Part 3. Venous access devices.

The nursing care of the whole patient, not just the venous access device, should be the focus of the nurse. Venous access devices provide the nurse with the rare opportunity to have assured venous access for blood sampling as well as the administration of intravenous therapies. The meticulous care of venous access devices is essential if complications are to be avoided and their primary function maintained.

Nosocomial infections in patients with central catheters.

Intensive care patients with central catheters were included in a month-long study to describe the usage of central catheters and determine factors associated with nosocomial infections. Eighty-seven patients had 130 catheters of five different types used for multiple purposes. All study variables were higher for the infected group. Significant differences were found between noninfected and infected groups in regard to number of single-lumen catheters, laboratory blood draws, intermittent infusions, heparin-locked ports, types of infused solutions, dressing changes, and hospitalized days. Total hospitalization days and total number of intermittent infusions were the best predictors of infection (P less than .05).