Patrulla de catéteres: Análisis de la implementación de un equipo de colocación de catéteres percutáneos como estrategia menos invasiva para la terapia intravenosa / Catheter patrol: analysis of the implementation of a percutaneous catheter placement team as a less invasive strategy for intravenous therapy

En el año 2008 se creó el equipo de patrulla de catéteres para la colocación de catéteres percutáneos por punción directa para pacientes pediátricos en el Hospital de Pediatría Juan P. Garrahan, como estrategia para el cumplimiento de la terapia intravenosa. Diseño: Cohorte retrospectiva. Objetivo: evaluar resultados de la implementación de la patrulla de catéteres entre 2009 y 2013. Se analizaron factores asociados a complicaciones. Criterios de inclusión: catéteres colocados en unidades de cuidados intermedios por Enfermería de patrulla de catéteres en niños con edad entre 31 días a 17 años. Resultados: 2121 catéteres, 1,6 catéteres/paciente, edad mediana 6 años (r 1m- 17 años), permanencia mediana 9 días (7-12). Complicaciones más frecuentes: obstrucción 27,19%, desplazamiento 25,94%,ruptura 11,76%, traccionado por el paciente 11,08%, bacteriemia asociada a catéter 1,62 a 2,80 por 1000 días /catéter. La tasa de incidencia de complicaciones en los menores de 1 año fue 39,92 días catéter mientras que en los mayores de 1 año 31,14 días catéter; p=0,002, diámetro en fr y relación con complicaciones: 4fr 12,17 días/catéter, 3fr 24,25 días/catéter y 2fr 42,27dias/catéter, (p=0,000), no hubo diferencias según cantidad de lúmenes. Conclusiones: los resultados de este estudio sugieren que la edad del paciente, el tipo de cuidado y contención inciden en las complicaciones. Los dispositivos de aseguramiento deberán estar acordes a las necesidades y características del niño (AU)

In 2008, the catheter patrol team was created for the placement of percutaneous catheters by direct puncture for pediatric patients at Hospital de Pediatría Juan P. Garrahan, as a strategy to increase compliance with intravenous therapy. Design: Retrospective cohort study. Objective: to evaluate the results of the implementation of a catheter patrol between 2009 and 2013. Factors associated with complications were analyzed. Inclusion criteria: catheters placed in intermediate care units by catheter patrol nurses in children aged 31 days to 17 years. Results: 2121 catheters, 1.6 catheters/patient, median age 6 years (r 1m- 17 years), median stay 9 days (7-12). Most frequent complications: obstruction 27.19%, displacement 25.94%, rupture 11.76%, accidental pull-out by the patient 11.08%, catheter-associated bacteremia 1.62 to 2.80 per 1000 catheter-days. The incidence rate of complications in children under 1 year of age was 39.92 catheter-days while in those older than 1 year it was 31.14 catheter-days (p=0.002). Relationship between fr diameter and complications: 4fr 12.17 catheter-days, 3fr 24.25 catheter-days, and 2fr 42.27 catheter-days (p=0.000); there were no differences according to the number of lumens. Conclusions: the results of this study suggest that the age of the patient, the type of care, and containment have an impact on complications. Securement devices should be in agreement with the needs and characteristics of the child (AU)

Is Systemic Anticancer Therapy Associated With Higher Rates of Malignant Pleural Effusion Control in People With Pharmacologically Sensitive Tumors?: A Retrospective Analysis of Prospectively Collected Data.

BACKGROUND: Malignant pleural effusions (MPEs) often cause symptoms, and guidelines recommend early definitive intervention. However, observational data suggest that systemic anticancer treatment (SACT) may control MPE caused by certain pharmacologically sensitive tumors. RESEARCH QUESTION: Is SACT associated with higher rates of MPE resolution in people with pharmacologically sensitive tumors? STUDY DESIGN AND METHODS: This was a retrospective analysis of prospectively collected data from an observational cohort study of people diagnosed with MPE from lung, breast, ovarian, and hematologic malignancy between May 11, 2008, and August 6, 2017. MPE resolution (defined as radiologic resolution with removal of drain or catheter and cessation of interventions) was compared in pharmacologically sensitive (high-grade lymphoma, small cell or target-mutation-positive lung cancer, and hormone-receptor-positive breast or ovarian cancer) and nonsensitive (remainder of cohort) tumors, with and without SACT. Secondary outcomes included time to resolution, 3-month resolution rates, and total pleural interventions. RESULTS: Of 280 patients, 127 had sensitive and 153 had nonsensitive tumors. One hundred seventy-one received SACT, and 109 did not. More patients with sensitive tumors achieved MPE resolution than those with nonsensitive tumors (53/127 [41.7%] vs 42/153 [27.5%]; P = .01), and this occurred predominantly after receipt of SACT. However, hematologic malignancies were overrepresented in the sensitive group, with high rates of SACT use and MPE resolution. After adjustment for this and other confounders, no relationship was found among pharmacologic sensitivity, SACT, and MPE resolution (adjusted OR, 1.4; 95% CI, 0.5-4.1). The strongest predictor of MPE resolution was administration of chemical pleurodesis (adjusted OR, 6.2; 95% CI, 3.3-11.7). In sensitive tumors, MPE resolution occurred without chemical pleurodesis in 14 of 52 patients (26.9%; 95% CI, 15.6%-41.1%) after SACT and in 5 of 22 patients (22.7%; 95% CI, 8.2%-47.2%) without SACT. INTERPRETATION: In this observational study, SACT was not associated independently on MPE resolution in pharmacologically sensitive tumors. Randomized trials are required, but with current data, patients with symptomatic MPE should receive early definitive pleural intervention regardless of underlying tumor or intended treatment.

AABIP Evidence-informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters.

BACKGROUND: While the efficacy of Indwelling pleural catheters for palliation of malignant pleural effusions is supported by relatively robust evidence, there is less clarity surrounding the postinsertion management. METHODS: The Trustworthy Consensus-Based Statement approach was utilized to develop unbiased, scientifically valid guidance for the management of patients with malignant effusions treated with indwelling pleural catheters. A comprehensive electronic database search of PubMed was performed based on a priori crafted PICO questions (Population/Intervention/Comparator/Outcomes paradigm). Manual searches of the literature were performed to identify additional relevant literature. Dual screenings at the title, abstract, and full-text levels were performed. Identified studies were then assessed for quality based on a combination of validated tools. Appropriateness for data pooling and formation of evidence-based recommendations was assessed using predetermined criteria. All panel members participated in development of the final recommendations utilizing the modified Delphi technique. RESULTS: A total of 7 studies were identified for formal quality assessment, all of which were deemed to have a high risk of bias. There was insufficient evidence to allow for data pooling and formation of any evidence-based recommendations. Panel consensus resulted in 11 ungraded consensus-based recommendations. CONCLUSION: This manuscript was developed to provide clinicians with guidance on the management of patients with indwelling pleural catheters placed for palliation of malignant pleural effusions. Through a systematic and rigorous process, management suggestions were developed based on the best available evidence with augmentation by expert opinion when necessary. In addition, these guidelines highlight important gaps in knowledge which require further study.

Aggressive Percutaneous Catheter Drainage Protocol for Necrotic Pancreatic Collections.

BACKGROUND: Percutaneous catheter drainage (PCD) performed pro-actively for collections in acute pancreatitis (AP) is associated with better outcomes. However, there are only a few studies describing this protocol. AIM: We aimed to evaluate an aggressive PCD protocol. METHODS: Consecutive patients with AP who underwent PCD with an aggressive protocol between January 2018 and January 2019 were included. This protocol involved catheter upsizing at a pre-specified interval (every 4-6 days) as well as drainage of all the new collections. The indications and technical details of PCD and clinical outcomes were compared with patients who underwent standard PCD. RESULTS: Out of the 185 patients with AP evaluated during the study period, 110 (59.4%) underwent PCD, all with the aggressive protocol. The historical cohort of standard PCD comprised of 113 patients. There was no significant difference in the indication of PCD and interval from pain onset to PCD between the two groups. The mean number of catheters was significantly higher in the aggressive PCD group (1.86 ± 0.962 vs. 1.44 ± 0.667, p = 0.002). Additional catheters were inserted in 54.2% of patients in aggressive group vs. 36.2% in the standard group (p = 0.006). Length of hospital stay and intensive care unit (ICU) stay were significantly longer in the standard PCD group (34.3 ± 20.14 vs. 27.45 ± 14.2 days, p < 0.001 and 10.46 ± 12.29 vs. 4.12 ± 8.5, p = 0.009, respectively). There was no significant difference in mortality and surgery between the two groups. CONCLUSION: Aggressive PCD protocol results in reduced length of hospital stay and ICU stay and can reduce hospitalization costs.

Cost analysis comparison between peripherally inserted central catheters and implanted chest ports in patients with cancer-A health economic evaluation of the PICCPORT trial.

BACKGROUND: A reliable central venous access device is a cornerstone in the treatment of cancer. Both peripherally inserted central catheters (PICC) and totally implanted chest ports (PORT) are commonly used for the delivery of chemotherapy. Both types of catheter can cause adverse events such as catheter-related deep venous thrombosis (CR-DVT), infection and mechanical complications. METHOD: We conducted a randomized controlled trial including 399 patients with cancer and performed a health economic evaluation investigating the cost related to PICCs and PORTs using several clinically relevant dimensions from a healthcare perspective. The cost was determined using process and cost estimate models. RESULT: PICCs are associated with a higher total cost when compared with PORTs. Combining the costs of all categories, the prize per inserted device was 824.58 EUR for PICC and 662.34 EUR for PORT. When adjusting for total catheter dwell time the price was 6.58 EUR/day for PICC and 3.01 EUR/day for PORT. The difference in CR-DVT was the main contributor to the difference in cost. The daily cost of PICC is approximately twice to that of PORT. CONCLUSION: We have demonstrated that the cost from a healthcare perspective is higher in cancer patients receiving a PICC than to those with a PORT. The difference is driven mainly by the cost related to the management of adverse events. Our findings are relevant to anaesthetists, oncologists and vascular access clinicians and should be considered when choosing vascular access device prior to chemotherapy.

Patient-Initiated Telephone Calls in the Postoperative Period After Female Pelvic Reconstructive Surgery.

OBJECTIVE: The aim of this study was to evaluate reasons and factors associated with patient calls in the postoperative period after female pelvic medicine and reconstructive surgery. METHODS: A retrospective review using electronic medical records was performed on consecutive patients who underwent surgery within our academic female pelvic medicine and reconstructive surgery practice during a 6-month period. Calls after postoperative discharge until first scheduled postoperative visit were included. Reasons and number of calls were tabulated. Clinical and surgical factors were extracted. Continuous data were evaluated with a Student t test or analysis of variance; categorical data were evaluated with a χ test. P < 0.05 was considered significant. RESULTS: During the designated period, 302 patients underwent surgery, and 173 (57.3%) patients made 345 calls (mean ± SD, 2.0 ± 1.5 calls). Reasons were categorized under 6 distinct domains: bowel, pain, activity, medication regimen, urinary, and bleeding. The most frequent concern within each domain was constipation (11.6%), abdominal pain (6.4%), physical activity (8.7%), pain regimen (14.5%), urinary catheter related (13.3%), and vaginal bleeding (12.1%), respectively. A greater number of phone calls were recorded among patients discharged home with catheters (P = 0.015), and patients who underwent posterior colporrhaphy (P = 0.005) and retropubic urethropexy (P = 0.014). Patients discharged with home nursing (11, 6.4%) demonstrated a significantly higher number of phone calls (3.8 ± 2.5, P < 0.001). Evaluations were required for 37% of callers. Twelve patients were seen in the emergency department, of whom 3 (1.7%) were readmitted to the hospital. CONCLUSIONS: Postoperative patient-initiated telephone calls after pelvic reconstructive surgery are common. Bowel-, urinary-, and medication-based phone calls account for the highest frequency and volume.

Low rate of intraperitoneal port placement in ovarian cancer patients, a population-based assessment.

INTRODUCTION: The National Comprehensive Cancer Network (NCCN) guidelines recommend intraperitoneal chemotherapy in optimally debulked stage III ovarian cancer patients. The objective of this investigation was to determine the rate of intraperitoneal port placement in patients undergoing surgery for ovarian cancer in a national database maintained by the American College of Surgeons. METHOD: We identified ovarian cancer patients in the National Surgical Quality Improvement Program database from 2006 to 2012. Demographics, comorbidities, operative outcomes, and postoperative complications were abstracted. Descriptive analyses were conducted using Wilcoxon rank-sum and Chi square tests, and multivariate regression models were used to analyze pre-operative and post-operative variables associated with intraperitoneal port placement. RESULTS: We identified 2659 ovarian cancer patients who underwent primary surgical management. Of these patients, only 128 (4.8%) had an intraperitoneal port placed at the time of surgery. In multivariable analyses, intraperitoneal ports were associated with body mass index ≤25, disseminated cancer, later portion of the study period (2009-2012), and operative time >200 min. Intraperitoneal port placement was not associated with any difference in surgical site infection, wound disruption, major postoperative complication, readmission within 30 days, or death within 30 days. DISCUSSION: Recent investigation of practice at NCCN institutions between 2003 and 2012 found only 35% of eligible ovarian cancer patients received intraperitoneal chemotherapy. Using intraperitoneal port placement as a surrogate for intraperitoneal chemotherapy administration, our investigation suggests an even lower rate (4.8%) nationally.

Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study.

INTRODUCTION: Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. METHODS: Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. RESULTS: Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54-0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. CONCLUSION: Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study.

Perioperative Catheter Use as a Risk Factor for Surgical Site Infection After Cervical Surgery: An Analysis of 39,893 Patients.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To demonstrate the relationship between perioperative use of catheters and the incidence of surgical site infection (SSI) after cervical spine surgery, after adjusting for patient's age, severity of comorbidity, surgical approach, and use of instrumentation. SUMMARY OF BACKGROUND DATA: Although the association between SSI and the use of arterial catheters (ACs) or central venous catheters (CVCs) is established in cardiac surgery, the relation in the cervical spine was not well elucidated. METHODS: A private insurance database was analyzed. The incidence of SSI within 1 month postoperatively and the crude odds ratio (cOR) and 95% confidence interval (95% CI) were calculated based on the use of catheters. Subsequently, logistic regression analysis was performed to identify independent factors for SSI. Independent variables of the regression analysis included Charlson comorbidity index with the score of age, the use of CVC, the use of AC, surgical approach (anterior or posterior), and instrumentation (fusion or decompression alone). RESULTS: A total of 39,893 patients received cervical surgery between 2007 and 2015. Of these, 1.6% patients experienced an SSI. The incidence of SSI in patients treated with and without AC was 3.2% and 1.3%, respectively (cOR 2.44, 95% CI: 2.05-2.99, P < 0.001). Likewise, incidence of SSI in patients with and without CVC was 5.8% and 1.5%, respectively (cOR 2.61, 95% CI: 2.97-5.55, P < 0.001). Multivariate logistic regression analysis demonstrated that the adjusted OR was 1.66 in CVC use (95% CI: 1.08-2.46, P = 0.016), whereas the AC use was not significant variable (P = 0.086). CONCLUSION: The use of CVC can be a potential risk factor for SSI regardless of age, severity of comorbidity, surgical approach, or presence of instrumentation. Although the essential benefits of catheters are undisputed, our data can bring up the surgeon's attention to appropriate management of the CVC. LEVEL OF EVIDENCE: 3.

Effect of Chemotherapy on Removal of Indwelling Pleural Catheters in Breast Cancer Patients with Malignant Pleural Effusions.

BACKGROUND: Indwelling pleural catheters (IPC) are commonly used in the management of malignant pleural effusions (MPE). The effect of systemic chemotherapy on IPC removal has not been reported previously. OBJECTIVES: The purpose of this study is to identify the effect of chemotherapy on the removal of IPCs in breast cancer patients with MPEs. METHODS: In this retrospective cohort study at an academic tertiary-care center, patients with breast cancer and MPE who received an IPC between 2006 and 2016 were identified from a prospectively collected database. Patient chemotherapy data were obtained, as well estrogen receptor (ER) and human epidermal growth factor receptor-2 status at the time of diagnosis. Patients receiving chemotherapy while their IPC was in situ were compared to those who did not. The primary outcome was time to IPC removal. All patients were followed until IPC removal or death. RESULTS: A total of 207 patients and 216 IPCs were included in the analysis. There was no difference in time to IPC removal between the chemotherapy and no-chemotherapy groups (HR 0.73, 95% CI 0.50-1.07, p = 0.10) or rate of IPC removal (OR 1.16, 95% CI 0.68-1.98, p = 0.59). The risk of IPC infection was not different between patients who received chemotherapy and those who did not (RR 0.57, 95% CI 0.06-5.39, p = 0.48). CONCLUSIONS: Treatment with chemotherapy with an IPC in situ was not associated with a reduced time to IPC removal in our breast cancer population. IPC insertion in patients receiving chemotherapy is safe and not associated with an increased risk of infection.

Tunnelled central venous access devices in small children: A comparison of open vs. ultrasound-guided percutaneous insertion in children weighing ten kilograms or less.

PURPOSE: Ultrasound-guided (USG) percutaneous insertion of tunnelled central venous access devices (CVADs) has been shown to be safe and effective in adults. However, there have been concerns over the safety of this technique in small children. This paper analyses the safety of USG percutaneous CVAD insertion in the pediatric population weighing ten kilograms or less. METHOD: All surgically inserted CVADs for children weighing ten kilograms or less, between January 2010 and December 2015 at the Children's Hospital at Westmead were retrospectively reviewed. Open and USG percutaneous techniques were compared with intraoperative complications as the primary outcome variable. Secondary outcome measures included conversion to open technique, postoperative complications, operating time and catheter longevity. RESULTS: 232 cases were identified: 96 (41.4%) open, 136 (58.6%) USG percutaneous. Age ranged <1-48 months; weight 0.7-10 kg. CVADs ranged 2Fr-9Fr in size. Eleven USG percutaneous cases required conversion to open. There was no significant difference in intraoperative complication rate between open (11/96, 11.5%) and USG percutaneous (19/136, 14.0%) groups (p = 0.574). There was no significant difference in overall postoperative complications, operative time or catheter longevity. Mechanical blockage was significantly higher in the open group than the USG percutaneous group (21% vs 10%, p = 0.015). CONCLUSION: USG percutaneous CVAD insertion is safe in children weighing ten kilograms or less. Open catheter insertion may be associated with higher rates of post-operative catheter blockage in small children. LEVEL OF EVIDENCE: Level III.

A Technology Intervention for Nurses Engaged in Preventing Catheter-Associated Urinary Tract Infections.

Catheter-associated urinary tract infections account for 40% of healthcare-acquired infections. This study explored the addition of cloud-based software technology to an established nursing quality improvement program to reduce catheter-associated urinary tract infections. Unit-based nurse champions evaluated peers' evidence-based catheter-associated urinary tract infection prevention practices using manual, paper-based feedback. That process achieved reduced rates of catheter-associated urinary tract infection over 18 months. However, it was resource intensive. Cloud-based software technology was introduced to replace the paper. Nurse champions' satisfaction, catheter-associated urinary tract infection and indwelling urinary catheter utilization, and prevention practices were compared before and after the technology intervention. Compliance with the provision of a chlorhexidine bath demonstrated improvement (P = .003), while other practice measures did not significantly change. The indwelling urinary catheter utilization ratio was lower (P = .01), yet the intervention yielded no change in catheter-associated urinary tract infection rates. The short time interval of the intervention was potentially a contributing factor in no significant rate change. Nurse champions (N = 14) were more satisfied with the cloud-based technology (P = .004), the clarity of improvement targets (P = .004), and the speed of sharing data (P = .001). Their time to share data decreased from 4 days or more to 1 hour or less. Nurse champions readily adopted the cloud-based technology. These findings suggest additional research on technology innovations for nursing quality improvement is needed.

Case-matched study of short-term effects of 3D vs 2D laparoscopic radical resection of rectal cancer.

BACKGROUND: The purpose of this study is to compare and evaluate the security and efficacy of 3D vs 2D laparoscopy in rectal cancer treatment. METHODS: Forty-six patients who suffered from rectal cancer and went on laparoscopic radical resection of rectal carcinoma in Peking University Shougang Hospital from Feb. 2015 to Mar. 2016 were included in the study. They were randomly divided into two groups. The 23 patients operated with the 3D system were compared with 23 patients operated with the 2D system by perioperative data. RESULTS: There were no significant differences in age, sex, pathological type, tumor differentiation, TNM staging, and surgical procedures (P > 0.05). The average operating time of 3D laparoscopic surgery group (172.2 ± 27.5 min) was shorter than that of 2D group (192.6 ± 22.3) (P < 0.05); the rate of transfer to laparotomy is lower in 2D group (72.7%) than in 3D group (86.4%), but they have no significant difference; and the intraoperative blood loss (247.0 ± 173.6 ml vs 282.6 ± 195.6 ml), postoperative passage of flatus (2.8 ± 0.8 days vs 3.1 ± 1.0 days), and indwelling catheter time (5.6 ± 1.9 days vs 6.3 ± 2.0 days) in 3D group and 2D group (P > 0.05) were not significantly different. There were no differences in other complications between the two groups. No significantly different recrudescence and death rates were found between the two groups (P > 0.05). CONCLUSION: The 3D laparoscopy shortens the operation time of rectum cancer. 3D laparoscopic surgery is more efficient in treatment of rectal cancer than 2D laparoscopy and is worth of being generalized.

Long-term outcomes of totally implantable venous access devices.

PURPOSE: Identifying risk factors for premature totally implantable venous access device (TIVAD) catheter removal is crucial; however, because of the diversity of study methodologies, there is no consensus on such factors. The objective of the present study was to identify such risk factors by applying a cohort design study with a long-term follow-up period. METHODS: For this cohort study, we selected cancer patients who had newly implanted TIVADs between July 2008 and December 2008. The follow-up period lasted until September 2012. Univariate analysis was performed for age, gender, cancer type, TIVAD brand, puncture site, sidedness of puncture, and catheter tip position. The hazard ratio (HR) of potential risk factors was calculated using the Cox proportional hazards regression model, and Kaplan-Meier curves were applied for catheter survival analysis. RESULTS: Our study consisted of 240 people, with 5 people lost to follow-up. The cumulative premature catheter removal rate of all TIVADs was 9.8%, with the most common reason for premature removal being port-associated blood stream infection (PABSI), which proved to be highest in patients with hematology cancer (27.8%) and upper gastrointestinal cancer (19.4%). Suboptimal tip position (HR 5.13, 95% confidence interval 1.73-15.21) was also a risk factor for premature removal, and it was correlated with symptomatic TIVAD occlusion (p = 0.0004). CONCLUSIONS: PABSI was the most common reason for premature catheter removal, with a varied incidence rate between different cancer types. Suboptimal tip position was also a risk factor. Confirming the final tip position after implantation is crucial. Infection control is important for TIVAD care, especially in high-risk cancer patients.

De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study.

BACKGROUND: Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy. METHODS: In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated. DISCUSSION: This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications. TRIAL REGISTRATION: Dutch trial registry: NTR6015 . Registered 9 August 2016.

Intercorrências em dispositivos intravenosos de longa permanência na oncohematologia pediátrica: estratégias de aperfeiçoamento do manuseio / Complications in long-term intravenous devices in pediatric oncohematology: strategies for improved management

Introdução: Durante o tratamento ambulatorial da criança ou adolescente com doença oncohematológica são necessárias inúmeras internações hospitalares e o estabelecimento de um acesso venoso vascular de longa permanência se faz necessário para realização do tratamento quimioterápico. Objetivos: Identificar o perfil clínico de crianças/adolescentes com doença oncohematológica e as características dos cateteres utilizados para realização do seu tratamento; Identificar as principais complicações a partir da manipulação destes cateteres; Elaborar fluxograma de Terapia Lock em cateter totalmente implantado; Elaborar rotina de manipulação do cateter totalmente implantado; Aprimorar a ficha de vigilância epidemiológica que contemple os diferentes tipos de procedimentos realizados durante a manipulação dos cateteres; Realizar um curso de manipulação segura de Cateter Totalmente Implantado. Metodologia: Estudo descritivo, com abordagem quantitativa de 78 fichas de vigilância epidemiológica dos cateteres totalmente implantados e dos cateteres epicutâneo; o cenário do estudo foi um ambulatório de oncohematologia pediátrica localizado em um Hospital Federal do município do Rio de Janeiro, os dados foram coletados em agosto 2015. O projeto foi aprovado com o parecer de número: 1.213.979. Resultados: Os dados levantados nos mostraram que as crianças que realizam tratamento hematológico tiveram um ou mais cateteres. Observou-se que n=32 (59%) dos portadores de cateter totalmente implantado eram do sexo masculino, e n=sete (53%) dos portadores de cateter epicutâneo eram do sexo feminino, a idade variava entre 10 a 16 anos, o principal diagnóstico foi leucemia linfoide aguda em ambos. A média de utilização do cateter totalmente implantado foi 303 dias, enquanto do cateter epicutâneo foi 55 dias, o término do tratamento é o principal motivo de retirada de ambos. A falta de preenchimento de informações nas fichas foi limitador desta pesquisa. Conclusão: Conclui-se que os dois dispositivos levantados por esta pesquisa, desde que indicados e manipulados de forma correta, conseguem cumprir com o objetivo proposto que é proporcionar um tratamento ininterrupto e seguro para o paciente. Havia necessidade de padronizar a rotina de manipulação do cateter totalmente implantado afim de que toda a equipe envolvida realizasse as técnicas de forma segura e eficaz reduzindo assim as chances de complicações relacionadas a este dispositivo.

The effect of clamping the indwelling urinary catheter before removal in cervical cancer patients after radical hysterectomy.

AIMS AND OBJECTIVES: To determine the effect of clamping the indwelling urinary catheter before its removal on bladder reconditioning in patients with cervical cancer after radical hysterectomy. BACKGROUND: It is suggested that indwelling urinary catheters should be clamped intermittently to fill the bladder and restore bladder function before removal. However, indwelling urinary catheter clamping showed no effect on bladder reconditioning according to some clinical studies. DESIGN: Randomised controlled study. METHODS: A total of 210 patients with cervical cancer after type C radical hysterectomy were randomised on 1:2 into two groups. In the clamping group, indwelling urinary catheters were clamped intermittently for 48 hours before removal based on a bladder-training sheet, while in the control group, the indwelling urinary catheters were removed without clamping. The primary outcome of the study was the rate of recatheterisation. The secondary outcomes included residual urine volume 24 hours after removal, incidence of urinary tract infection and duration of recatheterisation. RESULTS: Seventy patients were assigned to the clamping group and 128 to the control group with paralleled baseline characteristics. The days of the primary catheterisation (13·20 ± 0·79 vs. 13·38 ± 1·04) and the incidence of urinary tract infection (22·9% vs. 20·3%) had no significant differences between the two groups. Ten patients in the clamping group and 19 in the control group underwent recatheterisation, the incidence of which showed no significant difference (14·3% vs. 14·8%). The days of recatheterisation were not statistically different between the two groups (11·40 ± 6·75 vs. 9·42 ± 5·23). However, the residual urine volume 24 hours after removal was higher in the clamping group than that in the control group. CONCLUSIONS: Bladder recondition through indwelling urinary catheter clamping may not restore bladder function in patients after radical hysterectomy. RELEVANCE TO CLINICAL PRACTICE: As indwelling urinary catheter clamping may increase the residual urine volume after indwelling urinary catheter removal and lead to an increased nursing workload, it should not be recommended in patients with cervical cancer postoperatively.

Indwelling Urinary Catheter-Related Problems After Laparoscopic Radical Prostatectomy.

PURPOSE: The purpose of this study was to determine occurrence rates of catheter-related problems and their association to pertinent clinical characteristics in men with indwelling urinary catheters following laparoscopic radical prostatectomy. STUDY DESIGN: Descriptive, correlational study. SUBJECTS AND SETTING: One hundred twelve men who underwent laparoscopic radical prostatectomy between December 2010 and December 2012 at the Leiden University Medical Centre in the Netherlands were included in this study. After surgery, a Charriere 20 (20F) silicone catheter was left indwelling for 1 week. METHODS: Data were gathered from 2 sources; we reviewed participants' medical records, and participants completed a questionnaire designed for this study. Pearson χ tests were used to analyze associations between dichotomous and ordinal variables and catheter-related problems. Univariate logistic regression analyses were used to analyze the relationships between continuous factors and catheter-related problems. RESULTS: Seventy-five percent of participants reported at least 1 catheter-related problem. Univariate regression analyses revealed correlations between body weight and experiencing catheter-related problems (odds ratio [OR] = 1.050; P = .028) and between body mass index and experiencing catheter-related problems (OR = 1.159; P = .049). CONCLUSION: Indwelling catheter-related problems after laparoscopic radical prostatectomy are prevalent, and they may occur at any time during the entire period of catheter use. High body mass index and high body weight were associated with an increased likelihood of catheter-related problems following radical prostatectomy.