External jugular vein cross-over as a new technique for percutaneous central venous port access in case of left central venous occlusion.

PURPOSE: To report the cross-over venous catheter technique in case of left-sided central venous (internal jugular, subclavian and innominate veins) occlusion and right-sided central vein patency. METHODS: A 60-year-old right breast cancer patient presented with a local recurrence requiring chemotherapy. He presented with a left-sided catheter-related central venous occlusion and radiodermatitis of the right chest and neck. The nonsymptomatic side of insertion was defined as the patient's left side. Successful percutaneous left-to-right external jugular vein (EJV) cross-over access tips and tricks are reported. They include performing (a) the EJV access at the lower neck, (b) the 0.032 hydrophilic guidewire (GW) catheterization of the venous curves, (c) the GW anchor technique into the inferior vena cava, (d) the GW + Glidecath catheter stiffening technique and (e) the over-the-stiff wire implantable catheter push. RESULTS: The cross-over technique was successful by using real-time ultrasonography/X-ray monitoring and interventional radiology tools (hydrophilic 0.032 in. and stiff 0.0035 in. GW and "J-shaped" Glidecath catheter) and the five-step technique. CONCLUSIONS: In case of left innominate vein occlusion and necessity of left neck venous access, percutaneous EJV access should be attempted under real-time ultrasound/X-ray monitoring when other standard (subclavian venous port and internal jugular vein) routes are no longer available.

Suscetibilidade Antimicrobiana e Fatores de Virulência de Staphylococcus em Fômites do Hospital Universitário Sul Fluminense / Antimicrobial Susceptibility and Virulence Factors of Staphylococcus in Fomites of Sul Fluminense University Hospital

Objetivo: Caracterizar os fatores de virulência e o perfil de suscetibilidade antimicrobiana de isolados de Staphylococcus spp. provenientes de amostras de jaleco e estetoscópio dos profissionais de saúde, e das maçanetas das portas da enfermaria e Unidade de Terapia Intensiva do Hospital Universitário Sul Fluminense. Material e Métodos: As amostras de estetoscópio, maçaneta e jaleco, foram coletadas com"swab" estéril umedecido em solução salina e foram colocados em caldo Infusão de Cérebro e Coração Bovino (BHI) e incubados por 24-48h a 37ºC para o crescimento. Foram feitas as identificações necessárias para caracterização dos fatores de virulência e o perfil de suscetibilidade antimicrobiana de isolados de Staphylococcus spp. no laboratório de Microbiologia da Universidade Severino Sombra. Resultados: Foi obtido um total de 59 Staphylococcus spp, identificados como Staphylococcus aureus (n=6) e Staphylococcus coagulase negativos (n=53). Do grupo coagulase-negativo foram identificados 34 isolaods de Staphylococcus epidermidis e 19 de Staphylococcus saprophyticus. Em relação aos fatores de virulência, 76,3% isolados foram produtores de "slime". A hemólise foi detectada em 50,9% dos isolados, destes 35,6% apresentaram hemólise total e 15,3% a hemólise parcial. O sinergismo hemolítico foi positivo em 59,3% dos isolados sendo que destes, 13 não apresentaram hemolisinas. De acordo com o perfil de suscetibilidade, 96,6% foram resistentes à penicilina. A gentamicina foi o antibiótico que apresentou menor percentual de resistência (15,3%). Conclusão: Os jalecos, estetoscópios e maçanetas das portas, podem ser considerados como um veículo potencial para transmissão de microorganismo dentro do ambiente hospitalar. (AU)

Objective: To characterize the virulence factors and antimicrobial susceptibility profile of Staphylococcus spp. from samples of lab coat and stethoscope of health professionals, and from the handles of the doors of the ward and intensive care unit of Sul Fluminense University Hospital. Materials and Methods: The samples from stethoscopes, handles and coats were collected using moistened sterile swabs soaked in saline. Then the swabs were placed in Brain Heart Infusion (BHI) broth and incubated for 24to 48 h at 37°C for growth. Then we further characterized the virulence factors and antimicrobial susceptibility of Staphylococcus spp. in the Microbiology Laboratory of Severino Sombra University. Results: A total of 59 isolates of Staphylococcus spp. were recovered, of which six were Staphylococcus aureus and 53 were coagulasenegative Staphylococcus. Among the coagulase-negative isolates, 34 were Staphylococcus epidermidis and 19 Staphylococcus saprophyticus. As for virulence factors, 76.3% of the isolates were slime-producers. Hemolysis was detected in 50.9% of the isolates, of which 35.6% showed total hemolysis and 15.3% partial hemolysis. The hemolytic synergism was positive in 59.3% of the isolates and of these, 13 showed no hemolysin. According to the susceptibility profile, 96.6% were resistant to penicillin. Gentamicin was an antibiotic that showed the lowest percentage of resistance (15.3%). Conclusion: Lab coats, stethoscopes and door handles can be considered as a potential vehicle for the transmission of microorganisms within the hospital environment. (AU)