Risk factors of implantable venous access port-related bloodstream infections in cancer patients:a Meta-analysis / 中国实用护理杂志

Objective:To systematically evaluate the risk factors of implantable venous access port-related bloodstream infections and provide basis for prevention of catheter-related bloodstream infection in tumor patients.Methods:The Cochrane Library, PubMed, EMBASE, Web of science, CNKI, Wanfang database, VIP database, CBM, Chinese and English Clinical trials Registry (ChiCTR) were searched to collect the literature on risk factors for implantable venous access port-related bloodstream infections in tumor patients from the establishment of the database to April 2022. Two evaluators independently screened and extracted the obtained literature according to the inclusion and exclusion criteria, and used the Newcastle-Ottawa Scale for quality evaluation. Meta-analysis was conducted by RevMan 5.3 software and Stata SE/MP(14.0 version).Results:A total of 13 studies were included, including 23 related risk factors. Among them, prolonged use of catheters, palliative treatment, hematological tumors, neutropenia, hospitalized patients, and chemotherapy were risk factors for implantable venous access port-related bloodstream infections in tumor patients, with statistically significant differences ( OR values ranging from 0.26 to 8.77, all P<0.05). Conclusions:The long time of catheter use, palliative treatment, hematological tumor, neutropenia and chemotherapy were the risk factors of implantable venous access port-related bloodstream infection in patients with tumor, Medical personnel should make a good assessment and strengthen health education to minimize the chances of infection and effectively reduce the incidence of infection related to the infusion port.

Application of body surface markers localization in totally implantable venous access port implantation via internal jugular vein approach / 国际外科学杂志

Objective:To investigate the feasibility of using body surface marker localization method to determine the correct position of catheter tip (lower 1/3 of the superior vena cava or the junction of superior vena cava and right atrium) in totally implantable venous access port (TIVAP) implantation via internal jugular vein approach.Methods:The clinical data of 220 patients who underwent TIVAP implantation in Beijing Tongren Hospital, Capital Medical University from June 2019 to June 2021 were retrospectively analyzed. Among them, 168 patients used the internal jugular vein approach. According to the method implemented for determining the length of central venous catheter (CVC) during the operation, the patients were divided into two groups: 136 patients using the body surface marker localization method were defined as the study group; and the remaining 32 cases treated by the intraoperative X-ray fluoroscopic localization method were defined as the control group. The difference in the excellent or good rate of CVC tip position immediately after implantation and the time of implantation was compared between the two groups. In addition, the correlation between the length of CVC indwelling, height, age, and the distance between the catheter tip and tracheal carina was analyzed for the patients with right and left internal jugular vein catheterization. Kolmogorov-Smirnov test was used for statistical distribution of measurement data. Normal distribution of measurement data was expressed as mean ± standard deviation ( ± s), independent sample t-test was used for comparison between groups. Chi-square test was used for comparison between counting data. With TIVAP catheter indenture length as dependent variable and height as independent variable, Pearson correlation analysis was performed, the relationship equation between ideal catheter indenture length and patient height was analyzed by unitary linear regression. Results:When the CVC tip was located at the second intercostal space, the third sternocostal joint and the third intercostal space, the corresponding probability of being in the correct position was 34.8%, 83.3% and 95.0% respectively. The third sternocostal joint or the third intercostal space had a higher probability of correct CVC tip location than the second intercostal space, and the difference were statistically significant ( P<0.001). Furthermore, there was no significant difference in the possibility of the CVC tip located in the correct position between the third sternocostal joint and the third intercostal space ( P=0.149). Compared with the control group (before adjusting catheter position), the proportion of excellent or good CVC position in the study group was significantly improved (94.1% vs 46.9%), and the difference was statistically significant ( χ2=41.99, P<0.001); while the total operation time was significantly shortened [(33.04±6.69) min vs (42.50±5.54) min], and the difference was statistically significant ( P<0.05). There was a linear correlation between the length of CVC insertion and height. Indwelling catheter length via right internal jugular vein approach (cm) =0.159× height (cm)-1.284 ( r=0.597, r2=0.356, P<0.001); length of catheter indwelling through the left approach (cm) =0.097× height (cm) + 12.139 ( r=0.322, r2=0.104, P=0.020). Conclusions:The third sternocostal joint or the third intercostal space would be the corresponding correct surface landmark of the CVC tip when the body surface marker localization method was adopted during the TIVAP implantation via the internal jugular vein approach. Compared with the intraoperative X-ray fluoroscopy localization, the operation time is significantly shortened with the application of the body surface marker localization method. This technique is simple and easy to master and has high reliability in determining the length of catheter and the position of CVC tip.

Safety comparison of high-dose methotrexate via different intravenous infusion devices in pediatric patients with malignant brain tumors / 中国药房

OBJECTIVE To compare the safety of high-dose methotrexate （HD-MTX） via peripherally inserted central catheter （PICC） and totally implantable venous access port （TIVAP） in pediatric patients with malignant brain tumors. METHODS Patients with malignant brain tumors who received HD-MTX via PICCs or TIVAPs in our hospital from July 2018 to April 2022 were retrospectively analyzed. Clinical data were collected to compare differences in blood concentration of methotrexate （MTX），the incidence of adverse events （including adverse drug reactions and catheter-related complications） and length of stay in hospital. Multivariate linear regression was applied to analyze the factors that influenced the blood concentration of MTX. RESULTS A total of 107 patients were included in the study，with 65 patients in the PICC group and 42 patients in the TIVAP group. Blood concentration of MTX at 24 h （C24 h） in TIVAP group was significantly higher than PICC group （[ 126.87±61.99） μmol/L vs. （102.45±48.77） μmol/L，P＜0.05）. There was no significant difference in blood concentration of MTX at 42 h （C42 h），compared with PICC group （P＞0.05）. Results of multivariate linear regression analysis showed that TIVAP was associated with the increase of C24 h（P＜0.05）. No significant differences were observed in the incidence of adverse events and the length of stay in the hospital between 2 groups （P＞0.05）. CONCLUSIONS Risk of adverse events is not increased，although the MTX C24 h level is elevated after administration of TIVAP. TIVAP is a safe choice for HD-MTX therapy with implementing therapeutic drug monitoring.

Complicaciones por accesos venosos centrales en pacientes adultos / Complications due to central venous access in adult patients

Los accesos venosos centrales son técnicas de uso regular en el ámbito hospitalario, es por ello que la investigación tiene como Objetivo: Establecer la incidencia de complicaciones asociadas a la colocación de accesos venosos centrales en pacientes atendidos en el Hospital Militar Universitario "Dr. Carlos Arvelo". Métodos: estudio prospectivo, de selección intencional de pacientes en el ámbito hospitalario que presenten complicaciones asociadas a la canalización de accesos venosos centrales; a los cuales se les aplicó un cuestionario donde se registraron, además de datos demográficos y clínicos, los resultados del funcionamiento del acceso venoso central. Al séptimo día se retiró o se recambió el acceso venoso central y se tomó muestra para cultivo y antibiograma de la punta de catéter. Los datos fueron tabulados, analizados en gráficos y tablas. Resultados: Uno de los principales hallazgos fueron las complicaciones infecciosas en un 65.93 % y producto de complicaciones mecánicas un 34.05 % del grupo de estudio. Las complicaciones infecciosas fueron atribuibles en su mayoría a Staphylococcus aureus (27,39 %), Pseudomona sp (21,91 %), Stenotrophomonas maltophilia (16,44%), Burkholderia cepacia (10,95 %) y Klebsiella pneumonia (5,48 %). En cuanto al porcentaje de éxito de las intervenciones se encontró que el promedio de intentos fue de 5 con una desviación estándar de ± 3 intentos y una duración promedio menor a 30 minutos en 90 de los casos representando el 76,27 % y duración mayor de 30 minutos en 28 casos representando 23,7 %. Conclusiones: Los accesos venosos yugulares internos fueron los procedimientos más frecuentes seguido de los accesos subclavios, sin predilección de lateralidad alguna. Al revisar los hallazgos se puede evidenciar que la punción arterial se convierte en la complicación mecánica más frecuente produciendo hematomas y equimosis con un alto porcentaje de intentos superiores a 30 minutos o un número de intentos mayores a tres, así como las complicaciones infecciosas generadas por el Staphylococcus aureus y sin que dichas complicaciones se encontraran asociadas al tipo de abordaje estudiado, tiempo de intervención u otros factores de carácter demográfico(AU)

Central venous accesses are a technique of regular use in the hospital environment, that is why the objective of this research is: to establish the incidence of complications treated at the University Military Hospital "Dr. Carlos Arvelo". Methods: prospective study, of intentional selection of patients in the hospital setting who present complications associated to the cannulation of central venous accesses; to whom a questionnaire was applied where, in addition to demographic and clinical data, the results of the central venous access operation were registered. On the seventh day, the central venous access was removed or replaced and a sample was taken for culture and antibiogram of the catheter tip. Data were tabulated, analyzed in graphs and tables. Results: One of the main findings was infectious complications in 65.93 % and mechanical complications in 34.05 % of the study group. Infectious complications were mostly attributable to Staphylococcus aureus (27.39 %), Pseudomona sp (21.91 %), Stenotrophomonas maltophilia (16.44 %), Burkholderia cepacia (10.95 %) and Klebsiella pneumonia (5.48 %). Regarding the percentage of success of the interventions, it was found that the average number of attempts was 5 with a standard deviation of ± 3 attempts and an average duration of less than 30 minutes in 90 of the cases representing 76.27 % and duration greater than 30 minutes in 28 cases representing 23.7 %. Conclusions: Internal jugular venous accesses were the most frequent procedures followed by subclavian accesses, with no predilection for laterality. When reviewing the findings, it can be evidenced that arterial puncture becomes the most frequent mechanical complication producing hematomas and ecchymosis with a high percentage of attempts longer than 30 minutes or a number of attempts longer than three, as well as infectious complications generated by Staphylococcus aureus and without these complications being associated to the type of approach studied, time of intervention or other demographic factors(AU)

Bacteriemias relacionadas con el uso del catéter venoso en una unidad de hemodiálisis en Cuba / Bacteremia related to the use of venous catheter in a hemodialysis unit in Cuba

Introducción: Las bacteriemias relacionadas con el uso de catéter (BRC) en pacientes con enfermedad renal crónica avanzada (ERCA) representan un importante problema sanitario. Objetivos: Estimar la incidencia de BRC en pacientes con ERCA en el Hospital Ciro Redondo García, Artemisa, Cuba; y describir su relación con el tipo de acceso vascular (AV), así como la conducta médica que se adopta después del diagnóstico. Métodos: Se realizó un estudio descriptivo entre mayo-octubre del 2019, en el que se incluyó el total de los pacientes (n = 78) de la unidad de hemodiálisis del hospital. Se recogió información acerca del tipo y tiempo de uso del AV. Ante un episodio sugerente de bacteriemia, se obtuvo una muestra de sangre para hemocultivo. Se informó la incidencia de BRC según los criterios de Bouza (2004). Resultados: La tasa de incidencia de BRC se estimó buena (1,18/1 000 días-catéter). Para las producidas por Staphylococcus aureus y por bacterias gramnegativas (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.) las tasas fueron excelentes: 0,44 y 0,88/1 000 días-catéter, respectivamente. Los catéteres venosos centrales se constataron como los AV predominantes. Se verificó que se impuso tratamiento empírico ante signos de probable BRC y este se modificó tras el diagnóstico etiológico específico, acompañado de la retirada del AV siempre que las condiciones clínicas lo permitieron. Conclusiones: Se mantienen en el servicio de hemodiálisis buenas prácticas clínicas para la prevención de BRC. Los agentes etiológicos demostrados obligan a mantener la indicación de tratamiento empírico con antibióticos de amplio espectro(AU)

Introduction: Catheter-related bacteremias (CRB) in patients with advanced chronic kidney diseases represent a major health problem. Objective: To estimate the incidence of CRB in patients with advanced chronic kidney diseases at Ciro Redondo García Hospital, Artemisa, Cuba; and to describe its relationship with the type of vascular access (VA), as well as the medical protocol adopted after diagnosis. Methods: A descriptive study was conducted between May and October 2019. All patients (n=78) in the hospital hemodialysis unit were included. Information about the type and duration of VA was collected. In the presence of an episode suggestive of bacteremia, a blood sample was obtained for blood culture. The incidence of CRB was informed according to Bouza´s criteria (2004). Results: The incidence rate of CRB was estimated good (1.18/1 000 1000 catheter-days). For those caused by Staphylococcus aureus and by gram-negative bacteria (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.), the rates were excellent: 0.44 and 0.88/1000 catheter -days, respectively. Central venous catheters were the predominant VAs. It was confirmed that empirical treatment was initiated in the presence of signs of a probable CRB, which was modified after specific etiological diagnosis, together with the withdrawal of the VA whenever the clinical conditions allowed it. Conclusions: Good clinical practices for the prevention of CBR are maintained at the hemodialysis service. The confirmed etiological agents make it necessary to continue with the indication of empirical treatment with broad-spectrum antibiotics(AU)

Investigation on the application of venous access in very low birth weight infants / 中国实用护理杂志

Objective:To explore the types of venous access, indwelling time and the correlation with catheter-related bloodstream infection (CRBSI) of very and extremely low birth weight infants (VLBW & ELBW) in NICU.Methods:The self-designed venous access data collection form was used to collect the venous access data of VLBW & ELBW infants who were admitted to NICU of Children′s Hospital of Fudan University from January to December 2019. SPSS 22.0 software was used for data analysis, description and binary Logistic regression analysis.Results:A total of 218 cases were collected, including 9 cases of peripheral intravenous (PIV), 30 cases of PIV+ umbilical vein catheter (UVC), 43 cases of PIV+PICC, 136 cases of PIV+UVC+PICC. The average indwelling time of UVC was 6 days, the average indwelling time of PICC was 22 days. There were 23 cases (10.55%) got CRBSI and 195 cases (89.45%) without CRBSI. Binary Logistic regression analysis showed that birth weight ( OR=1.003, 95% CI 1.000-1.006, P<0.05) and combination form of venous access ( OR=0.139, 95% CI 0.023-0.834, P<0.05) of VLBW & ELBW infants were associated with CRBSI. Conclusions:In NICU, PIV, UVC and PICC are the three main ways to indwell venous access for VLBW & ELBW infants. The occurrence of CRBSI is closely related to the type and combination of indwelling venous access.

Central venous access devices-related thrombosis in critical ill children: a literature review / 中国实用护理杂志

This paper reviewed three aspects of risk factors of catheter-related thrombosis in critically ill children with central venous access devices, including the child's own factors, catheter-related factors and external factors. It summarized the main research advances of preventive measures such as the strengthen assessment of pre-catheterization, drug and mechanical prevention of thrombosis, control of catheter-related other complications, thrombus screening routinely, risk assessment model is used. It is to provide experience for early clinical identification and formulation of preventive measures, so as to reduce the occurrence of catheter-related thrombosis in critically ill children and promote the central venous access device used safely in PICU.

Fractura de catéter implantable con reservorio por síndrome de pinch-off / Totally implantable venous access device fracture due to pinch-off syndrome

RESUMEN La fractura y embolización de un catéter implantable con reservorio es una complicación infrecuente, pero potencialmente grave. El síndrome pinch-off fue descripto en los accesos venosos subclavios, cuando la sección del catéter se produce por la compresión intermitente entre la primera costilla y la clavícula. Informamos el caso de una paciente oncológica a quien se le colocó un catéter implantable con reservorio por acceso percutáneo ecoguiado y control radioscópico en la vena subclavia. Luego de varias sesiones de quimioterapia comenzó con mal funcionamiento del catéter; la radiografía de tórax evidenció la fractura completa del catéter a nivel del espacio costoclavicular con embolia de un fragmento a las cavidades cardíacas. Se realizó la extracción endovascular del catéter fracturado me diante lazo de nitinol por acceso percutáneo femoral, sin complicaciones. Se analizan la incidencia, los factores de riesgo y las medidas para prevenir el síndrome de pinch- off en los catéteres implantables con reservorio.

ABSTRACT Fracture and migration of totally implantable venous access devices is a rare but potentially serious complication. Pinch-off syndrome was described in subclavian venous accesses when the intermittent compression of the catheter between the first rib and the clavicle produces catheter fracture. The report the case of a patient with cancer who underwent implantation of a totally implantable venous access device through the subclavian vein under ultrasound and radioscopy guidance. After several cycles of chemotherapy, the patient started with malfunctioning of the device. The chest X-ray showed a complete fracture of the catheter at the level of the costoclavicular space with migration of a fragment of the catheter to the right cardiac chambers. The fractured catheter was percutaneously removed via the right femoral vein using nitinol gooseneck snare without complications. The incidence of the pinch-off syndrome, risk factors and prevention measures in totally implantable venous access devices are analyzed.

The application effect of modified butterfly needle fixation method for implantable venous access port in breast cancer patients / 中国实用护理杂志

Objective:To study the application effect of modified butterfly needle fixation method for implantable venous access port in breast cancer patients, in order to povide reference for the clinical applicaiton.Methods:A total of 300 patients with breast cancer from Janurary to December 2019 in Sun Yat-Sen University Cancer Center were divided into two groups by random digits table method: experimental group and control group, 150 cases in each group. The experimental group was treated with modified implantable intravenous port butterfly needle fixation method, while the control group was treated with conventional fixation method. The Visual Analogue Scale of pain during needle extraction, the incidence of needle stick injury and the time of needle extraction were measured between the two groups.Results:The Visual Analogue Scale of pain, the time of needle pulling were (4.01±0.89) points, (2.71±0.52) min in the control group, and (1.84±0.84) points, (1.86±0.39) min in the experimental group, the differences were statistically significant ( t values were -21.70, -16.02, P<0.01). The incidence of needle stick injury was 4.00% (6/150) in the control group and no needlestick injury event occurred in the experimental group, the difference was statistically significant (Fisher exact probability, P<0.05). Conclusions:The modified method of dressing fixation can effectively reduce the pain during needle pulling, reduce the incidence of needle stick injury, and effectively shorten the time of needle pulling.

Analysis of factors affecting the success rate of deep venous catheterization in emergency department / 中国实用护理杂志

Objective:To explore the factors affecting the success rate of deep venous catheterization in emergency department patients.Methods:A total of 578 patients who needed deep venous catheterization in the emergency department of the Third Hospital of Hebei Medical University from December 2015 to June 2019 were selected as the research subjects. Univariate analysis and Logistic regression analysis were performed to construct the model, and receiver operating characteristic curve was used to evaluate the diagnostic efficacy.Results:Among the 578 samples, 467 (80.8%) succeeded and 111 (19.2%) failed. The results of univariate analysis showed that six factors including gender, history of deep vein insertion, catheter type, operator length of service, insertion route, and blood pressure were related to the success rate of catheterization ( χ2 value was 10.231-179.665, P<0.05). Logistic regression analysis showed that these six factors were independent predictors of the success rate of deep vein catheterization ( OR value was 1.542-8.467, P<0.05). Based on this, the model was established and the area under the receiver operating characteristic curve of the model was 0.954. Conclusions:There are many factors influencing the success rate of deep venous catheterization in the emergency department. The technical level of the operator should be improved, and the appropriate catheter type and insertion route should be selected to improve the success rate of the catheterization.

Application of Ultrasound Combined with DSA-guided Single-incision Technique via Axillary Vein Access in Implantation of Totally Implantable Venous Access Port / 肿瘤防治研究

Objective To evaluate the technical feasibility and safety of a single-incision technique via axillary vein (AV) for placement of totally implantable venous access port (TIVAP) guided by ultrasound combined with DSA in clinical application. Methods We retrospectively analyzed clinical data of 240 patients who received TIVAP by single incision technique via AV access guided by ultrasound combined with DSA. We observed and recorded operation-related information such as AV width, AV puncture success rate, implantation success rate, ultrasound-guided puncture time, operation time and intraoperative and postoperative complications, etc. Results All 240 patients were successfully implanted with TIVAP, and the success rate was 100%. In 229 cases, TIVAP was implanted through single-incision AV puncture under the guidance of ultrasound combined with DSA, and the success rate of AV puncture was 95.42% (229/240). In 11 cases, TIVAP was implanted through the ipsilateral internal jugular vein (IJV) under the guidance of ultrasound combined with DSA due to the failure of AV puncture. In the 240 patients, the average width of AV of the intended puncture segment was (7.56±1.26) mm measured by preoperative ultrasound exploration and positioning, in which 195 cases were successfully punctured once, 26 cases were successfully punctured twice, and 8 cases were successfully punctured three times, with the success rate of 81.25%, 10.83% and 3.34%, respectively. The average puncture time under ultrasound guidance was (0.85±0.52) min, and the average operation time was (25.9±4.8) min. The incidence of intraoperative complications was 1.67% (4/240). No hemothorax, hemopneumothorax or serious fatal complications occurred. The incidence of complications during TIVAP retention was 2.92% (7/240). No complication such as catheter-related bloodstream infection, catheter-related venous thrombosis, catheter rupture/displacement, clipping syndrome or drug extravasation was observed. Conclusion Ultrasound combined with DSA guided single-incision technique via AV access in the implantation of TIVAP is a feasible and safe implantation method with high technical success rate, short operation time and low risk of complications. It can be used as another choice of TIVAP implantation method.

Movement of catheter tip of chest wall access port implanted via internal jugular vein and impact factors when changing body posture / 中国介入影像与治疗学

Objective: To observe movement of catheter tip of chest wall access port implanted via the internal jugular vein and impact factors when changing from supine to vertical positions. Methods: Data of 171 patients underwent implantation of chest wall access port via the internal jugular vein and chest X-ray films on supine and vertical position postoperatively were retrospectively analyzed, and the distance from the tracheal protuberance to catheter tip was measured. Pearson correlation analysis and multivariate regression analysis were performed to observe the impact factors of moving distance of catheter tip. Results: Changing from supine to vertical position, the catheter tip was inclined to cephalad movement, and the mean moving distance was (15.82±16.87)mm. The distance of catheter tip movement was positively correlated with gender (P=0.039) and sebum thickness (P=0.011) and negatively correlated with indwelling length of catheter (P=0.039). Conclusion: The catheter tip of chest wall access port implanted via the internal jugular vein tends to shift cephalad when changing from supine to vertical position, and the distance of movement is related to patient's gender, sebaceous thickness and the length of indwelling catheter.

Anatomical Landmark Guided versus Ultrasound-Guided Technique for Subclavian Vein Cannulation in Critically Ill Patients.

Background: Central Venous Access (CVA) is acommon requirement in the critically ill patient for avariety of indications including Central VenousPressure (CVP) monitoring, haemodialysis, placementof pulmonary artery catheters, cardiac pacing and foradministration of drugs especially vasoactive,chemotherapy agents and parenteral nutrition.Traditionally, Central Venous Catheter (CVC)placement is performed using Landmark (LM)technique and is associated with complications likearterial puncture, pneumothorax, hemothorax, airembolism, catheter embolism, and cardiac arrhythmias.Use of Ultrasound (US) is currently indicated forvarious clinical situations to reduce complication rate ofLM technique. Aim and Objectives: The purpose of thisstudy was to determine whether US guidance couldimprove the success rate, number of attempts, and rateof acute complications like inadvertent arterialpuncture, hematoma formation, and pneumothorax ofsubclavian venous catheterization. Material andMethods: Sixty patients in need of central venouscatheter were prospectively randomized in two groupsof 30 each. In the LM group patients were catheterizedusing the LM method and in US group patients werecatheterized by real-time US-guidance. Number ofattempts, success rate, access time and complicationslike accidental subclavian artery puncture, haematomaformation, pneumothorax, were recorded. p values<0.05 were considered statistically significant. Results:In the US group 30 (100%) of patients were successfullycannulated with the US guidance while the landmarktechnique was successful in 26 (86.66%) of patients. Inthe US group the success on first attempt was 83.33 %which was a significantly higher from 56.67% achievedin the LM group (p=0.025). The average number ofattempts for successful cannulation in the US group was1.16 ± 0.4, while in the LM group it was 1.56 ± 0.9 withstatistically significant difference (p=0.046). Accesstime was 27.26 ± 04.62 seconds in the US group, whilethe access time was significantly more in the LM group36.56 ± 17.35 seconds (p=0.0062). Conclusion: USguidance during subclavian vein catheterizationincreases overall and first attempt success, improvesaccess time with reduced average number of attemptsand complications.

Bacteriemia relacionada con catéter por Staphylococcus aureus resistente a meticilina en pacientes con enfermedad renal crónica avanzada / Catheter-related bacteremia by methicillin-resistant Staphylococcus aureus in patients with advanced chronic kidney disease

Introducción: Staphylococcus aureus resistente a meticilina constituye la causa principal de bacteriemia relaciona a catéter en pacientes con enfermedad renal crónica avanzada en hemodiálisis. Objetivos: Estimar la tasa de incidencia de bacteriemia relaciona con catéter por Staphylococcus aureus resistente a meticilina en pacientes con enfermedad renal crónica avanzada en el Hospital General Freyre de Andrade, Cuba, y vigilar los valores de concentración mínima inhibitoria de vancomicina frente a los aislados recuperados de bacteriemia. Métodos: El estudio se realizó entre mayo 2017 y febrero 2018, el cual incluyó 64 pacientes con Staphylococcus aureus resistente a meticilina (total de los atendidos en hemodiálisis). De cada uno se recogió información acerca de tipo de acceso vascular y tiempo de uso; de los que desarrollaron un episodio sugerente de bacteriemia se obtuvieron muestras de sangre para hemocultivo. Se informó bacteriemia relacionada con catéter utilizando los criterios de Bouza y otros 2004 y estas se confirmaron debidas a Staphylococcus aureus resistente a meticilina tras determinar la concentración mínima inhibitoria de oxacilina, empleando el método de microdilución en caldo y los criterios del CLSI 2017. Asimismo se evaluó la concentración mínima inhibitoria de vancomicina. Resultados: Las tasas de incidencia de bacteriemia relaciona con catéter por S. aureus y Staphylococcus aureus resistente a meticilina fueron de 0,66 y 0,59/1000 días-catéter, respectivamente. Predominaron las bacteriemia relacionada con catéter en los pacientes con accesos vasculares temporales. No se observó incremento en la concentración mínima inhibitoria de vancomicina (1 y 2 (g/mL) para los aislados responsables de bacteriemia a repetición y persistente. Conclusiones: La tasas de incidencia de bacteriemia relacionada con catéter indican que en la unidad de hemodiálisis se mantienen buenas prácticas clínicas. Los valores de concentración mínima inhibitoria de vancomicina sugieren una reducción en la eficacia de la droga en el tratamiento(AU)

Introduction: Methicillin-resistant Staphylococcus aureus is the leading cause of catheter-related bacteremia in patients with advanced chronic kidney disease undergoing hemodialysis. Objective: Estimate the incidence rate of catheter-related bacteremia by methicillin-resistant Staphylococcus aureus in patients with advanced chronic kidney disease from General Freyre de Andrade Hospital in Cuba, and survey the vancomycin minimum inhibitory concentration values for isolates obtained from bacteremia. Methods: A study was conducted of 64 patients with methicillin-resistant Staphylococcus aureus (total of those undergoing hemodialysis) from May 2017 to February 2018. For each one of them, information was collected about vascular access type and time of use. Blood culture samples were obtained from patients who developed an episode suggesting bacteremia. Catheter-related bacteremia was reported using Bouza et al (2004) criteria, and it was confirmed as due to methicillin-resistant Staphylococcus aureus after determining oxacillin minimum inhibitory concentration by broth microdilution and CLSI 2017 criteria. Vancomycin minimum inhibitory concentration was also evaluated. Results: The incidence rates for catheter-related bacteremia by S. aureus and methicillin-resistant Staphylococcus aureus were 0.66 and 0.59/1000 catheter-days, respectively. A predominance was found of catheter-related bacteremia in patients with temporary vascular accesses. No increase was observed in vancomycin minimum inhibitory concentration (1 and 2 g/mlL for the isolates responsible for recurrent and persistent bacteremia. Conclusions: The incidence rates for catheter-related bacteremia show that good clinical practices are maintained in the hemodialysis unit. Vancomycin minimum inhibitory concentration values suggest a decrease in the efficacy of the drug during treatment(AU)

The best vein to be accessed based on descriptive study of dorsal metacarpal vein / 대한해부학회지

Analysis and treatment of complications in peripheral totally implantable venous access port / 中国实用外科杂志

OBJECTIVE: To explore the clinical application of the peripheral totally implantable venous access port(TIVAP) in breast cancer chemotherapy patients,and to understand the clinical applicability and safety of peripheral TIVAP.METHODS: The clinical data of 201 cases using peripheral TIVAP of multi-course chemotherapy in the First Affiliated Hospital of Chongqing Medical University from March 2017 to June 2018 were analyzed retrospectively.The difference of composition ratio of various complications,and difference between the conventional pressure bandaging method and the modified pressure bandaging method for incision hemorrhage,the conventional implantation method and the improved implantation method for catheter ectopic and the difference of the catheter ectopic after left/right peripheral vein TIVAP placement were compared.RESULTS: There were 50 cases(24.9%) of postoperative complications,15 cases(7.5%) of incision hemorrhage,4 cases(2.0%)of catheter-related thrombosis,3 cases(1.5%) of base exposure,4 cases(2.0%) of sack infection,15 cases(7.5%)of primary catheter ectopic,7 cases(3.5%) with no blood withdrawal,2 cases(1.0%) with catheter-related upper limb movement limitation.Using the goodness of fit test(equal ratio) to compare the composition ratio of various complications,χ~2=30.520,P<0.001,the proportion of complications was not obeyed,and the proportion of incision hemorrhage and catheter ectopic was the highest.The conventional pressure bandaging method(78 cases) and the modified pressure bandaging method(123 cases) showed incision bleeding,and the difference was statistically significant [11 cases(14.1%) vs.4 cases(3.3%),χ~2=6.642,P=0.010];the conventional implantation method(90 cases) and the modified implantation method(121 cases) were compared with catheter ectopic,and the difference was statistically significant [9 cases(10.0%) vs.3 cases(2.4%) χ~2=4.131,P=0.042];there was no statistically significant difference in catheter ectopic position after left(106 cases)/right(95 cases) peripheral TIVAP implantation [8 cases(7.5%) vs.7 cases(7.3%),χ~2=0.020,P=0.962].CONCLUSION: The complication of peripheral TIVAP can be effectively controlled through safe management,close observation and active treatment.TIVAP is still a safe and effective intravenous infusion channel for long-term clinical use if there is no contraindication.

Neumotórax iatrogénico secundario como complicación inmediata post inserción de catéter venoso central / Secondary iatrogenic phneumothorax as a complication to the insertion of a central venous catheter

RESUMEN Introducción: La cateterización percutánea por punción de una vena de gran calibre y flujo sanguíneo conocido como catéter venoso central ―CVC― es un procedimiento que no deja de ser invasivo, por lo tanto no está exento de potenciales complicaciones que pueden generar un riesgo para la vida de los pacientes como lo es el neumotórax iatrogénico secundario. Objetivo: Establecer la incidencia de neumotórax secundario iatrogénico como complicación inmediata post inserción de catéter venoso central. Materiales y métodos: Se trata de un estudio prospectivo-descriptivo y observacional de las historias clínicas de los pacientes entre 15 y 60 años de edad, de ambos sexos, que ingresaron a los diferentes servicios de hospitalización del hospital Dr. Adolfo Pons del Instituto Venezolano de los Seguros Sociales ―IVSS― (Maracaibo, Venezuela), durante el período comprendido entre enero de 2016 y junio de 2017; los cuales ameritaron inserción de un catéter percutáneo para el abordaje venoso central como indicación para manejo terapéutico o de constantes fisiológicas. Resultados: Se incluyeron 140 pacientes, en el 15,6 % (22) se identificó la presencia de neumotórax secundario en los controles radiológicos post procedimiento cuando el abordaje era la vena subclavia. Conclusiones: Se debe tener en cuenta que el neumotórax secundario representa la complicación mecánica más común en la cateterización venosa central, la cual puede poner en riesgo la integridad del paciente. Este conocimiento es fundamental para detectar esa complicación por el médico operador y poder darle la solución más acorde y adecuada para evitar las complicaciones y lograr así una medicina de mejor calidad.

ABSTRACT Introduction: Percutaneous catheterization by puncture of a large caliber vein and blood flow known as the central venous catheter (CVC), is a non-invasive procedure and, therefore, it is not free of potential complications that may generate a risk for the life of patients, as it is the secondary iatrogenic pneumothorax. Objective: To establish the incidence of secondary iatrogenic pneumothorax as an immediate complication secondary to the insertion of a CVC. Materials and methods: This is a prospective, descriptive, observational study of the medical records of patients between 15-60 years of age of both sexes, who were admitted in the different hospitalization services at Dr. Adolfo Pons Hospital from the Social Insurance Institute of Venezuela ―IVSS for its acronym in Spanish― (Maracaibo, Venezuela) during the period between January 2016 and June 2017, patients who required the insertion of a percutaneous catheter for the central venous approach, as an indication for therapeutic management or physiological constants. Results: A total of 140 patients were included; in 15.6% (22) the presence of secondary pneumothorax was identified in radiological controls when the subclavian vein was approached. Conclusions: It should be considered that secondary pneumothorax represents the most common mechanical complication in central venous catheterization that can put the integrity of the patient at risk. This knowledge is essential to detect this complication by the attending physician and can give the most adequate and appropriate solution to avoid complications and thus achieve better quality medicine.

Accesos vasculares centrales. Complicaciones en pacientes pediátricos

La necesidad de un rápido y eficaz tratamiento por vía intravenosa a pacientes críticamente enfermos y con imposibilidad de tratamiento por otras vías ha hecho imperioso el acceso a través de las vías venosas centrales (CVC), se ha asociado con eventos adversos que prolongan la estancia hospitalaria, aumentan los costos hospitalarios, pueden agregar morbilidad e incluso mortalidad al paciente. Objetivo: analizar complicaciones de los pacientes con acceso vascular central hospitalizados en los servicios de Urgencias, Terapia Intensiva Pediátrica, Cirugía General y Cuidados Intensivos Neonatales del Hospital de Niños "J.M. de los Ríos", en el período marzo-agosto 2016. Método: Estudio retrospectivo, longitudinal y descriptivo con seguimiento de la evolución según registros de la historia clínica de cada paciente. Se registraron características demográficas, diagnóstico, criterios de indicación, características de los catéteres y su localización, complicaciones infecciosas y no infecciosas, duración y tipo de manipulación del CVC. Resultados: Se estudiaron 54 pacientes en total con CVC determinando que no existe diferencia importante en cuanto al sexo, 52 % masculino frente a 48,1 % femenino. La localización más frecuente fue a nivel de la vena yugular interna derecha en 56 % de casos. En un 41 % no se cumplieron con los criterios de colocación. Se identificó un 37 % de complicaciones de las cuales 22 % fueron de causa no infecciosa destacando la obstrucción como causa más frecuente y un 15 % de etiología infecciosa siendo la bacteriemia la principal causa en un 56 %. Conclusiones: se obtuvo con mayor frecuencia aislamiento de K. pneumoniae y P. aeruginosa. La permanencia de la mayoría de CVC fue mayor de 7 días. No se cumplen con los bundles de inserción ni de mantenimiento. Al analizar los diferentes factores de riesgo para complicación infecciosa, se obtuvo que la duración del catéter incrementa el riesgo de infección.

The need for rapid and effective intravenous treatment of critically ill patients who are unable to treat by other means has made access through the central venous pathways (CVC) imperative, has been associated with adverse events that prolong hospital stay, increase hospital costs, can add morbidity and even mortality to the patient. Objective: To analyze complications of patients with central vascular access hospitalized in the Emergency Services, Pediatric Intensive Care, General Surgery and Neonatal Intensive Care of Children's Hospital "J.M. de Los Rios, in the period March-August 2016. Method: Retrospective, longitudinal and descriptive study with follow-up of the evolution according to records of the clinical history of each patient. Patient demographics, diagnosis, indication criteria, catheter characteristics and location, infectious and noninfectious complications, duration and type of CVC manipulation were recorded. Results: A total of 54 patients with CVC were studied, determining that there is no significant difference in sex, 52 % male versus 48.1 % female. The most frequent localization was at the level of the right internal jugular vein in 56 % of cases. In 41 %, the placement criteria were not met. 37 % of complications were identified, of which 22 % were of non-infectious cause, the most frequent cause being obstruction and 15 % of infectious etiology, with bacteremia being the main cause in 56 %. Conclusions: Among the isolated microorganisms K. pneumoniae and P. aeruginosa were most frequently found. The permanence of the majority of CVC was greater than 7 days. Insertion and maintenance bundles are not met. When analyzing the different risk factors for infectious complication, it was obtained that the duration of the catheter increases the risk of infection.

Biofilm fúngico asociado a dispositivo intravascular de larga permanencia: Complicaciones y dificultades terapéuticas / Fungal biofilm associated with long-term central venous access device: Complications and therapeutic difficulties

Las infecciones fúngicas asociadas a biofilms en dispositivos biomédicos son refractarias al tratamiento antifúngico y habitualmente se requiere del retiro oportuno del dispositivo, así como la administración de antifúngicos sistémicos. Presentamos el caso de una paciente mujer de 36 años que recibe terapia para el dolor administrada por dispositivo intravascular de larga permanencia, catéter Port-A-Cath, y que desarrolló candidemia y endocarditis por Candida parapsilosis asociada al catéter; el cual tuvo que ser retirado mediante toracotomía por persistencia de la infección a pesar de la terapia antifúngica sistémica. Se evidenció extenso biofilm rodeando al catéter, con aislamiento de Candida parapsilosis y se completaron seis semanas de tratamiento antifúngico con evolución clínica favorable

Fungal infections associated with biofilms in biomedical devices are refractory to antifungal treatment and usually require the timely removal of the device, as well as the administration of systemic antifungals. We present the case of a 36-year- old female patient who received pain therapy administered by a Port-A-Cath long-term central venous access device. She developed catheter-related candidemi a and endocarditis caused by Candida parapsilosis. The catheter had to be removed by thoracotomy due to persistent infection despite the systemic antifungal therapy. An extensive biofilm surrounding the catheter was observed and Candida parapsilosis was isolated. Six weeks of antifungal treatment with a favorable clinical evolution were completed