Efficacy of the CathRite system to guide bedside placement of peripherally inserted central venous catheters in critically ill patients: a pilot study.

OBJECTIVES: To assess the efficacy of the CathRite system as a tool to guide clinicians in placement of peripherally inserted central catheters (PICCs) into the superior vena cava (SVC) in critically ill patients. DESIGN: Prospective, randomised, parallel controlled trial. PARTICIPANTS AND SETTING: three8 critically ill patients (mean APACHE II score, 16.6) in a mixed medical and surgical intensive care unit from 200four to 2006. INTERVENTIONS: Participants were randomised to receive PICC placement using either the CathRite system or a standard "blind" technique (control). Peripheral vein cannulation was performed for both groups under ultrasound monitoring, and the PICC was placed using the modified Seldinger technique, with position confirmed using standard chest x-ray. MAIN OUTCOME MEASURES: Proportion of PICCs guided into the SVC; placement into the lower third of the SVC; and time to complete placement. RESULTS: There was no significant difference between groups in sex distribution or age (CathRite: 12 men, 7 women; mean age +/- SEM, 61.1 +/- 3.4 years; control: 15 men, 4 women; 55.9 +/- 4.7 years). The PICC was successfully guided into the SVC in 19 patients (100%) in the CathRite group, compared with 14 (74%) in the control group (P < 0.05). Placement of catheters into the lower third of the SVC was achieved in 14 patients (74%) in the CathRite group, compared with eight (42%) in the control group (P < 0.05). Time to completion of catheter insertion was 31.4 +/- 16.2 minutes in the CathRite group compared with 24.6 +/- 14.5 minutes in the control group (P = 0.18). CONCLUSIONS: The CathRite system enabled placement of PICCs into the SVC from peripheral insertion sites and avoided ectopic placements that occurred with the blind technique.

Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity.

PURPOSE: Perianal sepsis is traditionally treated by incision and drainage, with packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone. METHODS: Healing times, analgesic requirements, pain scores, abscess recurrence, and fistula rates were compared between two randomized groups treated with and without packing of perianal abscess cavities. RESULTS: Fifty patients were recruited (7 lost to follow-up): 20 in the packing and 23 in the nonpacking arm. The groups were comparable in terms of age and gender distribution, type and size of abscess, and the presence of a fistula at operation. Mean healing times were similar ( P = 0.214). The rate of abscess recurrence was similar ( P = 0.61). Postoperative fistula rates were similar ( P = 0.38). Pain scores at the first dressing change were similar ( P = 0.296). Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance. CONCLUSIONS: Our pilot study indicates that perianal abscesses can be managed safely without continued packing of the cavity without any obvious complications.