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2.
Khirurgiia (Mosk) ; (12): 13-17, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31825338

RESUMEN

OBJECTIVE: To analyze postoperative complications of totally implantable central venous port system (TIPCVP) deployment and develop methods of their prevention. MATERIAL AND METHODS: The study involved 43 patients who underwent TIPCVP implantation through right-sided jugular access and 3 patients with migration of the catheter transferred to the Domodedovo Central City Hospital. RESULTS: There were four perioperative and one early postoperative complication. None of the complications was the reason for removal of TIPCVP. Pinch-off syndrome occurred in two patients who were operated in other hospitals and a catheter was inserted through the right subclavian vein. CONCLUSION: Injury of the carotid artery and pneumothorax can be avoided by ultrasound navigation during internal jugular vein puncture. Catheterization of the internal jugular vein is useful to avoid pinch-off syndrome. Migration of the catheter is successfully cured by endovascular methods.


Asunto(s)
Cateterismo Venoso Central/efectos adversos , Neumotórax/prevención & control , Cateterismo Venoso Central/métodos , Catéteres de Permanencia/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Remoción de Dispositivos , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/terapia , Humanos , Venas Yugulares/diagnóstico por imagen , Venas Yugulares/lesiones , Neumotórax/etiología , Vena Subclavia/diagnóstico por imagen , Ultrasonografía Intervencional
3.
Medicine (Baltimore) ; 98(50): e18368, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852143

RESUMEN

This study evaluated the accuracy of intracavitary electrocardiogram (IC-ECG) guidance for placement of peripherally inserted central catheters (PICCs) in premature infants, relative to chest X-ray.Premature infants (n = 173) underwent placement of a PICC monitored by ECG, and a stable heart rhythm was shown. Changes in the P wave of the ECG reflected the position of the catheter tip, and a characterized P wave indicated the correct position. The P wave results were compared with a chest X-ray.P wave changes were observed in 157 (90.75%) of the premature infants on the ECG. Among them, the catheter tips of 148 (85.55%) and nine (5.20%) patients were in the correct and non-correct position, respectively, which was confirmed by chest X-ray. No characteristic P wave changes were observed in 16 (9.32%) patients on ECG, in which the catheter tips of eight (4.62%) patients each were in the correct and non-correct position, according to the chest X-ray. The accuracy of IC-ECG guidance for placement of the PICC was 90.17%. The PICC tip location results of the IC-ECGs were statistically similar to that of the chest X-rays.IC-ECG guidance is accurate for placement of PICC in premature infants, and provides an economical assessment without radiation.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Electrocardiografía/métodos , Femenino , Humanos , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recien Nacido Extremadamente Prematuro , Recién Nacido , Masculino , Radiografía Torácica
4.
Medicine (Baltimore) ; 98(47): e17894, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764785

RESUMEN

Peripherally inserted central catheter (PICC) is often applied in chemotherapy patients and commonly causes upper extremity venous thrombosis (UEVT), which should be prevented.To assess the preventive effects of the anticoagulants rivaroxaban and low molecular weight heparin (LMWH) on UEVT in patients receiving chemotherapy through PICCs.A total of 423 chemotherapy patients with continuous PICC use between January 2014 and June 2015 at the Oncology Department of Dongying People's Hospital were divided into 3 groups: rivaroxaban (10 mg/day, orally), LMWH (Enoxaparine, 4000 anti-Xa IU/day, subcutaneous injection), and control (no anticoagulant). UEVT incidence and other complications during PICC use were observed and recorded.The rivaroxaban, LMWH, and control groups included 138 (79 males; 54.9 ±â€Š11.0 years), 144 (76 males; 56.0 ±â€Š10.9 years), and 141 (71 males; 53.3 ±â€Š10.9 years) patients, (P = .402 and P = .623 for age and sex respectively). There were no differences in cancer location (P = .628), PICC implantation site (P > .05), body mass index (BMI) (P = .434), blood pressure (all P > .05), blood lipids (5 laboratory parameters included, all P > .5), smoking (P = .138), history of lower limb venous thrombosis (P = .082), and 10 other associated comorbidities (all P > .5). Twenty-nine patients withdrew from the study (5 from the rivaroxaban, 12 from the LMWH, and 12 from the control groups, respectively), and 394 patients were analyzed. There were significant differences in the rivaroxaban group and the LMWH group compared to the control group (P = .010 and P = .009, respectively), but no significant difference was observed between the rivaroxaban group and the LMWH group (P = .743).Anticoagulants such as rivaroxaban and LMWH may reduce the incidence of PICC-related UEVT in patients receiving chemotherapy.


Asunto(s)
Anticoagulantes/uso terapéutico , Cateterismo Venoso Central/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Rivaroxabán/uso terapéutico , Trombosis Venosa Profunda de la Extremidad Superior/etiología , Trombosis Venosa Profunda de la Extremidad Superior/prevención & control , Adulto , Anciano , Cateterismo Venoso Central/métodos , Cateterismo Periférico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico
5.
Medicine (Baltimore) ; 98(46): e18007, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725671

RESUMEN

Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.


Asunto(s)
Vena Axilar/cirugía , Cateterismo Venoso Central/métodos , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Análisis Costo-Beneficio , Femenino , Humanos , Venas Yugulares/cirugía , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Factores Sexuales , Factores Socioeconómicos , Vena Subclavia/cirugía
6.
Presse Med ; 48(10): 1141-1145, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31669005

RESUMEN

Some patients require iteratives intravenous administrations on a central catheter, for example in oncology or infectiology, which represents a challenge for ambulatory treatment. Interventional radiology could provide solutions with the implant and monitoring of PICC-lines and ports. These are implanted in sterile environment and under imaging guidance in an interventional radiology room by an operator and with a paramedical team that need to be experienced. This development focus on the interest of one method with respect to the other, as well as the differents ways to do, the complications that could arise and the monitoring of these devices.


Asunto(s)
Cateterismo Venoso Central/métodos , Catéteres Venosos Centrales , Radiología Intervencional , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Humanos
7.
BMC Infect Dis ; 19(1): 841, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615450

RESUMEN

BACKGROUND: The purposes of this study were to determine the incidence of central and peripheral venous catheter-related bacteraemias, the relationship between the suspected and final confirmed bacteraemia origins, and the differences in microbiological, epidemiological, clinical, and analytical characteristics between the groups, including evolution to death. METHODS: This was a 7-year descriptive retrospective populational study of all bloodstream infections, comparing central (CB) and peripheral (PB) venous catheter-related bacteraemias in patients older than 15 years. RESULTS: In all, 285 catheter-related bacteraemia patients, 220 with CBs (77.19%) and 65 with PBs (22.81%), were analysed among 1866 cases with bloodstream infections. The cumulative incidence per 1000 patients-day of hospital stay was 0.36 for CB and 0.106 for PB. In terms of the suspected origin, there was less accuracy in diagnosing catheter-related bloodstream infections (68. 2%) than those of other origins (78. 4%), p <  0.001. The accuracy was greater for PB (75%) than for CB (66. 2%), Coagulase-negative staphylococci were the most frequent microorganisms in both groups but occurred 1.57 times more frequently in CB (64.1%/40.6%) (p = 0.004), while Staphylococcus aureus (23. 4%/9.5%) (p = 0.02) and Enterobacteriae species (15.6%/6. 3%) (p = 0.003) were 2.5 times more frequent in PB. The CB patients stayed at the hospital for an average of 7.44 days longer than did the PB patients; more CB patients had active neoplasia (70. 4%/32.8%), more had surgery in the previous week (29. 2%/8. 3%), and fewer received adequate empirical treatment (53.9%/ 62.5%). Catheter was not removed in 8. 2% of CB and 3.7% of PB. On the other hand, the CB and PB patients had similar Pitt scores at blood extraction (median 0.89 versus 0.84 points, respectively; p = 0.8) and similar survival rates at hospital discharge (91.1% versus 90. 2%; p = 0.81). CONCLUSIONS: Central catheters were more frequent sources of bacteraemias than were peripheral catheters. There were important differences in the microbiological aetiology as well. PB patients received correct empirical antibiotic treatment more frequently and had a higher initial rate of correct determination of the suspected source of bacteraemia. Differences in the microbiological aetiology and empirical antibiotic treatment received, and probably catheter removal and time to catheter removal could explain why CB and PB patients had similar survival rates .


Asunto(s)
Bacteriemia/diagnóstico , Infecciones Relacionadas con Catéteres/diagnóstico , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Bacteriemia/microbiología , Bacteriemia/mortalidad , Infecciones Relacionadas con Catéteres/microbiología , Catéteres de Permanencia/microbiología , Enterobacteriaceae/aislamiento & purificación , Humanos , Tiempo de Internación , Estudios Retrospectivos , Staphylococcus aureus/aislamiento & purificación , Tasa de Supervivencia
8.
BMC Infect Dis ; 19(1): 857, 2019 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-31619174

RESUMEN

BACKGROUND: Central venous catheters (CVCs) are necessary for critically ill patients, including those with hematological malignancies. However, CVC insertion is associated with inevitable risks for various adverse events. Whether ultrasound guidance decreases the risk of catheter-related infection remains unclear. METHODS: We observed 395 consecutive CVC insertions between April 2009 and January 2013 in our hematological oncology unit. Because the routine use of ultrasound guidance upon CVC insertion was adopted based on our hospital guidelines implemented after 2012, the research period was divided into before December 2011 (early term) and after January 2012 (late term). RESULTS: Underlying diseases included hematological malignancies and immunological disorders. In total, 235 and 160 cases were included in the early- and late term groups, respectively. The median insertion duration was 26 days (range, 2-126 days) and 18 days (range, 2-104 days) in the early- and late term groups, respectively. The internal jugular, subclavian, and femoral veins were the sites of 22.6, 40.2, and 25.7% of the insertions in the early term group and 32.3, 16.9, and 25.4% of the insertions in the late term group, respectively. The frequency of catheter-related bloodstream infection (CRBSI) was 1.98/1000 catheter days and 2.17/1000 catheter days in the early- and late term groups, respectively. In the subgroup analysis, the detected causative pathogens of CRBSI did not differ between the two term groups; gram-positive cocci, gram-positive bacilli, and gram-negative bacilli were the causative pathogens in 68.9, 11.5, and 14.8% of the cases in the early term group and in 68.2, 11.4, and 18.2% of the cases in the late term group, respectively. In the multivariate analysis to determine the risk of CRBSI, only age was detected as an independent contributing factor; the indwelling catheter duration was detected as a marginal factor. A significant reduction in mechanical complications was associated with the use of ultrasound guidance. CONCLUSIONS: Ultrasound-guided CVC insertion did not decrease the incidence of CRBSI. The only identified risk factor for CRBSI was age in our cohort. However, we found that the introduction of ultrasound-guided insertion triggered an overall change in safety management with or without the physicians' intent.


Asunto(s)
Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central , Catéteres Venosos Centrales/efectos adversos , Ultrasonografía Intervencional , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/estadística & datos numéricos , Humanos , Incidencia , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/estadística & datos numéricos
9.
Br J Nurs ; 28(19): S22-S28, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31647725

RESUMEN

Health professionals are responsible for preventing and minimising complications related to vascular access devices. This is important from the perspectives of both the patient and the health economy. Practitioners have many tools at their disposal and evidence is available to assist in using these tools to enhance best practice. A relatively new tool has been acknowledged as having a role in vascular access as well as previously recognised roles in other areas of healthcare. Cyanoacrylate tissue adhesive has been approved for use with vascular access devices and the benefits of this aid to device securement are now being recognised.


Asunto(s)
Cateterismo Venoso Central/métodos , Cianoacrilatos/uso terapéutico , Adhesivos Tisulares/uso terapéutico , Adulto , Anciano , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
10.
Medicine (Baltimore) ; 98(29): e16513, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31335728

RESUMEN

RATIONALE: Central venous catheterization is a common tool used to monitor central venous pressure and administer fluid medications in patients undergoing surgery. The loss of a broken guide wire into the circulation is a rare and preventable complication. Here, we report a peculiar case of a missed guidewire puncturing the aortic arch and cerebrum. PATIENT CONCERNS: A 53-year-old man with complaints of an intermittent headache and right swollen ankle following central venous catheterization. DIAGNOSES: Using computed tomography; the patient was diagnosed with the loss of a guide wire in his body. The guide wire had migrated to the brain and punctured the vascular wall of the aortic arch. INTERVENTIONS: Due to the risks of surgery, the patient was advised to have a follow-up visit once every 3 months. OUTCOMES: At present, the patient could live like a normal person, although he suffers from intermittent headaches. LESSONS: The loss of a guide wire is a completely preventable complication, provided that a hold on the tip of the wire is maintained during placement, and the correct safety measurements and protocols are followed.


Asunto(s)
Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Cerebro/diagnóstico por imagen , Cerebro/lesiones , Migración de Cuerpo Extraño/complicaciones , Cateterismo Venoso Central/métodos , Vena Femoral , Cefalea/etiología , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
11.
J Infus Nurs ; 42(4): 193-196, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31283661

RESUMEN

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Control de Infecciones/métodos , Grupo de Atención al Paciente/normas , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/métodos , Adhesión a Directriz , Humanos , Estudios Retrospectivos
12.
Medicine (Baltimore) ; 98(26): e16126, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31261532

RESUMEN

Ultrasound-guided central venous catheterization may cause lethal mechanical complications intraoperatively. We developed a novel device to prevent such complications. It works as a needle guide to supplement the operator's skill. We evaluated the utility of this device in terms of the success rate and visualization of the needle tip while penetrating the target vessel using a simulator.This study was approved by the local ethics committee. The new device - an optical skill-assist device - has a slit and a mirror in the center. The operator can see the needle's reflection in the mirror through the slit and can thus ensure that the needle is directed in line with the ultrasound beam. Participants were recruited by placing an advertisement for a hands-on seminar on ultrasound-guided vascular access. They received hands-on training on the in-plane approach for 2 hours. Pre-test and post-test without the device and an additional test using the device were performed to evaluate the proficiency of ultrasound-guided vascular access. An endoscope inserted into the simulated vessel was used to detect the precise location of the needle tip in the vessel.The primary outcomes were the success rate of the procedure. The secondary outcome was visualization of the needle tip while penetrating the simulated vessel. The chi-squared test was used for comparing the success rate and needle tip visualization between the different tests. P < .05 was considered to indicate significant differences.Forty-two participants were enrolled in this study. The success rate did not increase after the simulation training (P = .1). Using the optical skill-assist device, the rate improved to 100%. There was a significant difference in success rate between the pre-test and additional test using the optical skill-assist device (P = .003). Needle tip visualization significantly improved with the use of the optical skill-assist device compared to the pre-test (P < .001) and post-test (P = .001).Simulation training improved participants' skill for ultrasound-guided vascular access, but the improvement depended on each participant. However, further, improvement was achieved with the use of the optical skill-assist device.The optical skill-assist device is useful for supplementing the operator's skill for ultrasound-guided central venous catheterization.


Asunto(s)
Cateterismo Venoso Central/instrumentación , Ultrasonografía Intervencional/instrumentación , Cateterismo Venoso Central/métodos , Competencia Clínica , Educación Médica , Humanos , Complicaciones Intraoperatorias/prevención & control , Aprendizaje , Imagen Óptica/instrumentación , Médicos , Complicaciones Posoperatorias/prevención & control , Datos Preliminares , Entrenamiento Simulado , Ultrasonografía Intervencional/métodos
13.
J Invasive Cardiol ; 31(7): E170-E176, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31257210

RESUMEN

OBJECTIVE: Arterial access from the wrist for cardiac catheterization is increasingly being used. Right heart catheterization (RHC) is an integral part of many of these procedures. Reliable venous access from the arm allows avoidance of femoral or jugular venous access for RHC. It is uncertain if ultrasound guidance offers a benefit for venous access of the arm for RHC. This study sought to assess the efficacy of ultrasound-guided venous access of the arm (UGVAA) for RHC. METHODS: A retrospective study was performed on consecutive patients undergoing RHC at a single institution between August 2015 and July 2016. Baseline data, procedural information, and success rates of UGVAA and RHC were assessed. RESULTS: A total of 266 consecutive RHC procedures were identified, of which 253 (95.1%) were performed via arm venous access; of these, a pre-existing intravenous catheter was used in 3 cases, UGVAA was used in 241 cases, and UGVAA was probably used but not documented in 9 cases. There was 100% success of venous cannulation and sheath placement in these 253 patients. RHC via the arm vein was successful in 248 patients (98.0%) and failed in 5 patients (2.0%). Mean procedure time for RHC via arm access was 5.7 minutes. The femoral approach was used in 12 patients (4.5%). A jugular approach was used in 1 patient (0.4%). All patients had concomitant left heart catheterization via transradial access. CONCLUSIONS: UGVAA is a highly efficacious and safe technique, with a success rate of 98% for RHC in our consecutive series of 253 patients. UGVAA may allow for near-universal use of arm veins for RHC.


Asunto(s)
Cateterismo Cardíaco/métodos , Cateterismo Venoso Central/métodos , Cardiopatías/diagnóstico , Ultrasonografía/métodos , Anciano , Femenino , Estudios de Seguimiento , Humanos , Venas Yugulares , Masculino , Estudios Retrospectivos , Factores de Tiempo
14.
J Invasive Cardiol ; 31(7): E232, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31257222

RESUMEN

Agitated saline during central line placement is described for the purpose of identifying the subclavian vein during ultrasound-guided procedures.


Asunto(s)
Cateterismo Venoso Central/métodos , Solución Salina/administración & dosificación , Vena Subclavia/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Aire , Humanos , Inyecciones Intravenosas
15.
Rev Med Chil ; 147(4): 458-464, 2019 Apr.
Artículo en Español | MEDLINE | ID: mdl-31344207

RESUMEN

BACKGROUND: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. AIM: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. MATERIAL AND METHODS: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. RESULTS: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. CONCLUSIONS: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.


Asunto(s)
Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Diálisis Renal/efectos adversos , Adulto , Anciano , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/métodos , Chile/epidemiología , Estudios Transversales , Femenino , Hematoma/epidemiología , Hematoma/etiología , Humanos , Masculino , Persona de Mediana Edad , Neumotórax/epidemiología , Neumotórax/etiología , Prevalencia , Diálisis Renal/instrumentación , Diálisis Renal/métodos , Distribución por Sexo , Ultrasonografía Intervencional/métodos
16.
Rev Bras Enferm ; 72(3): 774-779, 2019 Jun 27.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31269145

RESUMEN

OBJECTIVE: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. METHOD: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. RESULTS: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. CONCLUSION: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.


Asunto(s)
Catéteres Venosos Centrales/efectos adversos , Adhesión a Directriz/normas , Control de Infecciones/normas , Adulto , Brasil , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Catéteres Venosos Centrales/estadística & datos numéricos , Estudios Transversales , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Control de Infecciones/estadística & datos numéricos , Masculino , Garantía de la Calidad de Atención de Salud/métodos , Diálisis Renal/instrumentación , Diálisis Renal/métodos
17.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(6): 361-367, jun.-jul. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-182852

RESUMEN

Introducción: El hiperaldosteronismo primario (HAP) es la causa más frecuente de hipertensión endocrina, con una prevalencia del 6-12% en pacientes hipertensos. El cociente aldosterona/renina es el método de cribado de elección. Dada la variabilidad de sus puntos de corte, se sugiere contar con valores de referencia propios. Objetivos: 1) Optimizar los puntos de corte del cociente aldosterona/renina para el cribado de hiperaldosteronismo con la metodología actual; 2)evaluar la correlación y la sensibilidad diagnóstica de los cocientes aldosterona/actividad de renina plasmática (RAA) y aldosterona/concentración de renina (RAC) para el cribado de hiperaldosteronismo, y 3)determinar la prevalencia de hiperaldosteronismo en nuestra población. Materiales y métodos: Se determinaron los niveles de aldosterona (RIA competitivo en fase sólida RIAZENco Zentech), actividad de renina plasmática (RIA en fase sólida DiaSorin) y concentración de renina (quimioluminiscencia Liaison DiaSorin) en 345 sujetos (136 controles y 209 hipertensos). Se calcularon los cocientes RAA y RAC. Resultados: La prevalencia de HAP, tras confirmación diagnóstica, fue del 5,9% de los hipertensos. El valor de corte para sospecha de HAP determinado por curvas ROC fue 48,9(ng/dl)/(ng/ml/h) para RAA (sensibilidad 100% y especificidad 93,6%) y 2,3(ng/dl)/(μUI/ml) para RAC (sensibilidad 100% y especificidad 90,9%). Se observó buena correlación entre RAA y RAC (ρ=0,83; p<0,0001), con una concordancia diagnóstica presuntiva del 96,6%. Conclusiones: Hemos determinado en nuestra población nuevos valores de corte de RAA y RAC para el cribado de HAP, con buena sensibilidad y concordancia como métodos de cribado. Es importante contar con rangos de normalidad propios para evitar errores diagnósticos


Introduction: Primary aldosteronism (PA) is the most common cause of endocrine hypertension, with a prevalence rate of 6-12% in hypertensive patients. Aldosterone/renin ratio (ARR) is the screening test of choice for PA. Because of the variable cut-off points of ARR, reference values related to the populations and methods considered are recommended. Objectives: (i)To optimize the ARR cut-off points for PA screening with current methods; (ii)to assess the correlation and diagnostic sensitivity of the plasma aldosterone concentration/plasma renin activity (ARR) ratio and the aldosterone concentration/renin concentration (ARC) ratios for PA screening, and (iii)to determine the prevalence of PA in our population. Materials and methods: Plasma aldosterone concentration and plasma renin activity levels were measured using radioimmunoassays (RIAZENco Zentech and RIA DiaSorin respectively), while a chemiluminescence assay (Liaison Diasorin) was used to test renin concentration. ARR and ARC ratios were calculated in 345 subjects (136 healthy subjects and 209 hypertensive patients). Results: Prevalence of PA was 5.9% after diagnostic confirmation. ROC curve analysis suggested an ARR threshold of 48.9(ng/dL)/(ng/mL/h) (100% sensitivity, 93.6% specificity) and an ARC threshold of 2.3(ng/dL)/(μIU/mL) (100% sensitivity, 90.9% specificity). Good correlation was seen between ARR and ARC (ρ=.83, P<.0001), with a presumptive diagnostic concordance of 96.6%. Conclusions: New cut-off values of ARR and ARC for screening of PA, with high sensitivity and good diagnostic concordance, were determined in the study population. It is important to have valid normal ranges to avoid diagnostic errors


Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Hiperaldosteronismo/epidemiología , Sistema Renina-Angiotensina/efectos de los fármacos , Cateterismo Venoso Central/métodos , Curva ROC , Sensibilidad y Especificidad , Estudios Prospectivos , Estudios Transversales , Antropometría
18.
J Invasive Cardiol ; 31(6): E158, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31158815

RESUMEN

A patient with a history of colon cancer was admitted to our emergency department due to progressive dyspnea, chest pain, and swelling of the upper limbs and face. A central venous port device had been implanted into the right subclavian vein for administration of systemic chemotherapy several months prior. Thoracic computed tomography scan revealed a 2.8 cm-long thrombus arising from the tip of the venous catheter, which completely occluded the superior vena cava in close proximity to the right atrium.


Asunto(s)
Angioplastia de Balón/métodos , Cateterismo Venoso Central/métodos , Urgencias Médicas , Síndrome de la Vena Cava Superior/cirugía , Vena Cava Superior/diagnóstico por imagen , Anciano de 80 o más Años , Humanos , Masculino , Flebografía , Síndrome de la Vena Cava Superior/diagnóstico , Tomografía Computarizada por Rayos X
19.
Radiol Med ; 124(9): 926-933, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31175536

RESUMEN

PURPOSE: To evaluate the rate and types of complications after minimally invasive radiological central vein port implantation without ultrasound guidance. MATERIALS AND METHODS: We retrospectively evaluated 8654 patients who underwent port implantations in the subclavian vein without ultrasound guidance in our institution from 1998 to 2014 with regard to types and rates of peri-, early and late post-interventional complications according to the common classification for complications published by the Society of Interventional Radiology (SIR). Additionally, the impact of the training level of the operators on the rate of complications was analyzed. RESULTS: Successful port implantations were performed in 99.8% (8636/8654 procedures). From 1998 to 2014, a total of 565 (6.52%) complications were recorded. The overall percentage of the peri-, early and late post-interventional complications according to the SIR criteria was 1.69, 0.15 and 4.68, respectively. Significant differences due to the training level of the performing physician could be seen for the rates of pneumothorax, arterial puncture and hematoma. CONCLUSION: Minimally invasive radiological interventional port implantation is a safe treatment option with a low rate of complications even without ultrasound guidance.


Asunto(s)
Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Catéteres de Permanencia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Radiología Intervencional , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Vena Subclavia , Ultrasonografía Intervencional , Adulto Joven
20.
PLoS One ; 14(5): e0217641, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31150465

RESUMEN

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Procedimientos Neuroquirúrgicos/métodos , Trombosis/terapia , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres de Permanencia/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Femenino , Humanos , Unidades de Cuidados Intensivos , Venas Yugulares/fisiopatología , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Radiólogos , Trombosis/fisiopatología , Resultado del Tratamiento , Ultrasonografía/métodos , Ultrasonografía Intervencional/efectos adversos
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