Infection of Small-Bore Tunneled Central Venous Catheters.

OBJECTIVE. The purpose of this study is to evaluate the association of common clinical variables with small-bore tunneled central venous catheter (CVC) infection. MATERIALS AND METHODS. Retrospective data were collected from all small-bore (6-French) tunneled CVCs placed by the interventional radiology service between 2012 and 2015. Only patients who had a documented reason for tunneled CVC removal were included in the analysis to capture all events. Transfemoral, transhepatic, and translumbar placements were excluded to reduce cohort heterogeneity. Multiple clinical variables were collected from a review of the medical record. The t test and Fisher exact test were used for two-group comparisons for continuous variables and categoric variables, respectively. Logistic regression analyses were further used to identify variables that were associated with catheter infection. RESULTS. One hundred eighty-two patients (105 women [57.7%] and 77 men [42.3%]) with a mean (± SD) age of 49.7 ± 16 years were included. Thirty-two catheters (17.6%) were removed because of infection. Noninfected lines were removed at a mean of 39 (SD, 57.3) days, whereas infected lines were removed at a mean of 95.9 (SD, 113.4) days after placement (p < 0.001). There was a statistically significant difference in the number of tunneled CVCs removed for infection when the indication for tunneled CVC placement was the administration of IV antibiotics (p = 0.04). By multivariate analysis, only time to removal (p = 0.002; odds ratio, 0.992; 95% CI, 0.986-0.998) and a history of tunneled CVC (p = 0.01; odds ratio, 0.306; 95% CI, 0.121-0.772) were associated with catheter removal for infection. CONCLUSION. Time to catheter removal and history of tunneled CVC were associated with an increased risk of tunneled CVC removal because of infection.

An analysis of potential predictors of tunneled hemodialysis catheter infection or dysfunction.

PURPOSE: To assess the ability of various clinical factors to predict infection or dysfunction of tunneled hemodialysis catheters. METHODS: A retrospective review of all adult patients who had a tunneled hemodialysis catheter placed between 2012 and 2016 was performed. Tunneled hemodialysis catheters were considered infected based on clinical suspicion or culture-positive bacteremia. Dysfunction was defined as all other non-infectious causes for line failure. Time-to-removal or exchange was recorded. Clinical parameters analyzed as potential predictors of tunneled hemodialysis catheter infection or dysfunction, included the following: age, sex, site of placement, inpatient versus outpatient status at time of placement, body mass index, Charlson Comorbidity Index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet count, white blood cell count, international normalized ratio, and partial thromboplastin time. RESULTS: A total of 177 patients (95: female, 82: male; 71.7%: African American; mean age: 54.9 years) qualified for inclusion. The internal jugular vein was the site of placement in 97.1% of patients with 79.7% of lines being placed on the right side. One patient (0.5%) had minor bleeding after catheter insertion but no other complications were recorded. A total of 17 patients (9.6%) had lines removed or exchanged due to infection at a median of 86 (range: 13-626) days, while 68 patients (38.4%) had lines removed or exchanged due to dysfunction at a median of 42 (range: 1-531) days. A total of 92 patients (51.9%) had lines removed due to completion of therapy at a median of 68 (range: 7-433) days. Dysfunctional lines had a shorter time-to-removal than successful lines (p = 0.007). No difference was seen in time-to-removal between infected lines and successful lines (p = 0.16). Multivariate analysis showed that female sex (p = 0.003) and left-sided line placement (p = 0.007) were independent predictors of line dysfunction. No evaluated factors were predictive of tunneled hemodialysis catheter infection. CONCLUSION: Female sex and left-sided line placement were independent predictors of tunneled hemodialysis catheter dysfunction, but none of the evaluated parameters predicted tunneled hemodialysis catheter infection.

Rehabilitation Referral for Patients With Irreversible Vision Impairment Seen in a Public Safety-Net Eye Clinic.

Importance: The prevalence of irreversible vision impairment in the United States is expected to increase by 2050. Vision rehabilitation is the primary treatment option. Clinical trials have established its efficacy in improving quality of life. Yet studies indicate that patients experience many barriers to accessing low-vision care. Objectives: To examine the rate of referral for low-vision rehabilitation services by resident and attending ophthalmologists for adults with irreversible vision impairment and to assess the knowledge, attitudes, and beliefs of patients about vision rehabilitation. Design, Setting, and Participants: Cross-sectional study with enrollment from June 20, 2016, to January 31, 2017, of 143 adults 18 years or older seen in a publicly funded, comprehensive eye clinic in Jefferson County, Alabama, and having 1 or both eyes with irreversible vision impairment (visual acuity was defined as 20/60 or worse) per the electronic health record. Exposures: Demographic characteristics; patient questionnaire on knowledge, attitudes, and beliefs about vision rehabilitation; general cognitive status (Short Orientation-Memory-Concentration test); depressive symptoms (Patient Health Questionnaire-9); health literacy (Rapid Estimate of Adult Literacy in Medicine, Revised [REALM-R]); and self-reported difficulty in everyday activities. Main Outcomes and Measures: Proportion of patients with irreversible vision impairment who were referred by ophthalmologists to low-vision rehabilitation services per the electronic health record. Results: Of 143 patients enrolled with irreversible vision impairment in 1 or both eyes, the mean (SD) age was 55.4 (11.1) years and 68 (47.6%) were women. Most patients were African American (123 [86.0%]), uninsured (88 [61.5%]), and unemployed (92 [64.3%]); on average, they had normal cognitive status, minor depressive symptoms, and limited health literacy. As noted in the electronic health record, the rate of referral for low-vision rehabilitation services was 11.4% for patients with irreversible bilateral vision impairment (4 of 35 patients) and 1.9% for those with unilateral impairment (2 of 108). Most patients with bilateral (31 of 34 [91.2%]) and unilateral (90 of 97 [92.8%]) impairment indicated that they were bothered by their vision impairment, and most reported difficulty with reading (33 of 34 patients [97.1%] who were bilaterally impaired vs 85 of 104 [81.7%] who were unilaterally impaired). Conclusions and Relevance: Results of this study suggest a need to better educate ophthalmologists and residents in ophthalmology about referrals to low-vision rehabilitation services for patients with irreversible vision impairment.