Experience in the use of midclavicular catheters: An inception cohort study.

AIMS AND OBJECTIVES: To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal. BACKGROUND: Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length. DESIGN: Inception cohort study. METHODS: We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed. RESULTS: Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure. CONCLUSIONS: Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal. RELEVANCE TO CLINICAL PRACTICE: Midclavicular lines are a safe alternative for intravenous therapy lasting more than 6 days, even with irritant drugs.

[Low transmission of SARS-CoV-2 at school settings: a population-based study in the Basque Country.] / Baja transmisión del SARS-CoV-2 en el ámbito escolar: estudio poblacional en Euskadi.

OBJECTIVE: Studies about SARS-CoV-2 transmission at school settings have been outbreaks or schools clusters. There are scarce population-based studies has been studied. We aimed at describing SARS-CoV-2 school-related transmission and its relationship with baseline community cumulative incidence rate in the Basque Country after school reopening in order to inform Public Health decision-making. METHODS: We conducted a scholar surveillance population-based study of SARS-CoV-2 transmission from 7 September to 31 October 2020. We calculated percentages of cases in school-age population, secondary attack rates by education level among close contacts and correlation between population´s and scholars´ incidence rates at municipal level. RESULTS: There were 35,477 SARS-CoV-2 laboratory confirmed cases. Among them, 7.65% happened at school settings. Secondary attack rate at schools ranged from 2.9%, in preschools to 7.1% in high schools; Scholars caused a household and social secondary attack rate from 13% (high scholars) to 23.2% (elementary scholars). We found a low correlation between population´s and scholars´ incidence rates at municipal level (R2=0.047). CONCLUSIONS: Secondary attack rate at school settings increased as educational level did; conversely, to social and family secondary attack rate, that decreased with higher educational level. School attendance, during a SARS-CoV-2 high transmission period showed feasible and did not rise transmission. These findings happened under strict non-pharmaceutical measures at school settings and proper epidemiological surveillance, including tracing of laboratory confirmed cases of SARS-CoV-2 looking for close contacts, isolation and testing of close contacts during isolation period. The different degree of transmission of the circulating variants in the different periods of the pandemic must also be taken into account.

OBJETIVO: La transmisión del SARS-CoV-2 en escolares se ha estudiado en brotes o en conjuntos de escuelas y apenas hay estudios poblacionales. El objetivo de este estudio fue describir la transmisión de SARS-CoV-2 relacionada con el ámbito escolar y su relación con la incidencia acumulada comunitaria en Euskadi tras la reapertura de las escuelas para contribuir a la toma de decisiones en salud pública. METODOS: Se trató de un estudio poblacional, basado en el sistema de vigilancia epidemiológica, que analizó la transmisión de SARS-CoV-2 en el ámbito escolar tras la reapertura escolar el 7 de septiembre de 2020 hasta el 31 octubre de 2020. Se calcularon porcentajes de casos en población escolar, tasas de ataque secundaria por nivel educativo entre contactos estrechos, así como la correlación entre tasas de incidencia acumulada municipal y tasa en escolares. RESULTADOS: Se diagnosticaron 35.477 casos confirmados de SARS-CoV-2. Entre ellos el 7,65% sucedieron en el ámbito escolar. La tasa de ataque secundaria en dicho ámbito osciló entre un 2,9%, en educación infantil y un 7,1% en bachiller; los alumnos causaron, en el ámbito familiar y social, tasas de ataque secundarias de entre un 13% (bachiller) y un 23,2% (educación primaria). Encontramos una baja correlación entre las tasas de incidencia acumulada a nivel municipal y la de los escolares (R2=0,047). CONCLUSIONES: La tasa de ataque secundaria en ámbito escolar aumentó según el grado escolar, al contrario que la del ámbito social y familiar que disminuyó. La educación presencial no condujo a un incremento de la transmisión de SARS-CoV-2. Estos hallazgos sucedieron bajo estrictas medidas no farmacológicas en el ámbito escolar y una vigilancia epidemiológica adecuada que incluyó la búsqueda de contactos estrechos de casos de SARS-CoV-2 confirmados por laboratorio, así como el aislamiento y testeo de los contactos estrechos durante el periodo de aislamiento. Ha de tenerse en cuenta también, el diferente grado de transmisión de las variantes circulantes en los diferentes periodos de la pandemia.