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1.
BMC Nephrol ; 23(1): 300, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36056311

RESUMO

BACKGROUND: Hemodialysis tunneled catheters are prone to failure due to infection or thrombosis. Prediction of catheter dysfunction chance and finding the predisposing risk factors might help clinicians to prolong proper catheter function. The multidimensional mechanism of failures following infection or thrombosis needs a multivariable and comprehensive analytic approach. METHODS: A longitudinal cross-sectional study was implemented on 1048 patients admitted for the first hemodialysis tunneled catheterization attempt between 2013 and 2019 in Shahid Hasheminejdad hospital, Tehran, Iran. Patients' information was extracted from digital and also paper records. Based on their criteria, single and multiple variable analyses were done separately in patients with catheter dysfunction due to thrombosis and infection. T-test and Chi-square test were performed in quantitative and categorical variables, respectively. Competing risk regression was performed under the assumption of proportionality for infection and thrombosis, and the sub-distributional hazard ratios (SHR) were calculated. All statistical inferences were made with a significance level of 0.05. RESULTS: Four hundred sixty-six patients were enrolled in the analysis based on study criteria. Samples' mean (SD) age was 54(15.54), and 322 (69.1%) patients were female. Three hundred sixty-five catheter dysfunction cases were observed due to thrombosis 123(26.4%) and infection 242(52%). The Median (range) time to catheter dysfunction event was 243(36-1131) days. Single variable analysis showed a statistically significant higher proportion of thrombosis in females (OR = 2.66, 95% CI: 1.77-4.00) and younger patients, respectively. Multivariate competing risk regression showed a statistically significant higher risk of thrombosis in females (Sub-distributional hazard (SHR) = 1.81), hypertensive (SHR = 1.82), and more obese patients (BMI SHR = 1.037). A higher risk of infection was calculated in younger (Age SHR = 0.98) and diabetic (SHR = 1.63) patients using the same method. CONCLUSION: Female and hypertensive patients are considerably at higher risk of catheter thrombosis, whereas diabetes is the most critical risk factor for infectious catheter dysfunction. Competing risk regression analysis showed a comprehensive result in the assessment of risk factors of catheter dysfunction.


Assuntos
Cateterismo Venoso Central , Trombose , Cateterismo/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia
2.
J Bronchology Interv Pulmonol ; 29(4): 244-247, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36127804

RESUMO

BACKGROUND: Indwelling pleural catheters are frequently used for the treatment of malignant pleural effusion. The PleurX catheter (Becton, Dickinson and Company) is a commonly used indwelling pleural catheter across Canada. The traditional PleurX catheter is designed with a long segment of tubing outside of the patient's chest, making insertion, drainage, and dressing changes awkward. Our clinic developed a novel, shortened, PleurX catheter that is easier to handle. METHODS: We conducted retrospective chart review for all patients treated with a shortened PleurX catheter at our center from December 2015 to May 2019 and demographics, clinical information, and complications were recorded retrospectively. A survey was designed and distributed to nurses experienced with the use of both catheters to elicit a preference between the short and long catheter. RESULTS: We analyzed data from 503 catheters placed in 491 patients. The most frequently encountered complications were loculation requiring fibrinolytic (2.4%), catheter dislodgement (1.2%), and pleural infection (0.6%). Of nurses surveyed, 74% preferred using the shortened PleurX catheter. CONCLUSION: Complication rates of the novel, shortened PleurX catheter are low. Further research is needed to better determine the optimal catheter length for ambulatory management of malignant pleural effusion.


Assuntos
Derrame Pleural Maligno , Cateteres de Demora/efeitos adversos , Drenagem , Humanos , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia , Estudos Retrospectivos
4.
Arq Bras Cir Dig ; 35: e1690, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36134821

RESUMO

BACKGROUND: The success of peritoneal dialysis depends on the proper placement and functional longevity of the dialysis catheter. Laparoscopic implantation of a catheter through a rectus sheath tunneling can minimize the risks of catheter failure. AIMS: This study aims to describe one-port simplified technique for laparoscopic placement of a peritoneal dialysis catheter with rectus sheath tunneling. METHODS: The simplified laparoscopic insertion of a Tenckhoff catheter with rectus sheath tunneling was performed in 16 patients with chronic renal failure. RESULTS: During the follow-up period, no major complications occurred. Three patients were excluded. One was referred to the renal transplant some weeks after implantation, and one died for other reasons during the follow-up. Another patient needed adhesiolysis due to previous surgery, so an additional port was necessary. The other 13 catheters worked properly, and no postoperative hemorrhage, early leaks, hernia, or catheter migration occurred. One patient had a tunnel infection 11 months after the implant. No peritonitis was observed during the follow-up. CONCLUSIONS: The technique is simple, reproducible, and safe, with good results in catheter function, few complications, and a high catheter survival rate. It does not require a special device or trocar and avoids excessive port sites.


Assuntos
Laparoscopia , Diálise Peritoneal , Cateterismo/métodos , Cateteres de Demora , Humanos , Laparoscopia/métodos , Diálise Peritoneal/métodos , Peritônio
5.
Gan To Kagaku Ryoho ; 49(8): 887-889, 2022 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-36046976

RESUMO

Subcutaneous implantable venous ports were placed in 414 patients between April 2016 and August 2021 for the purpose of breast cancer chemotherapy in our hospital. Although the internal jugular vein approach was selected to prevent fractures caused by pinch-off syndrome, catheter fracture occurred in 8 patients(1.9%). All patients were ADL-independent women aged 44-62 years(median, 50.5 years). The intravenous ports were placed on the side of the dominant and non-dominant hands in 4 and 4 patients, respectively. Six patients received perioperative chemotherapy, while 2 had advanced breast cancer. Catheter fractures occurred 17.7-54.2 months(median, 41.7 months)after placement. The fractures were discovered when the patients presented with one or more of the following conditions: poor backflow of blood (n=4), subcutaneous emphysema observed on CT(n=1), subcutaneous leakage of CT contrast media(n=3), and no sign or symptom(n=1). The fractures occurred in the clavicular subcutaneous part in all patients. Partial and complete fractures of the catheter occurred in 5 and 3 patients, respectively. In 3 patients with complete fracture of the catheter, catheter tips had strayed into the right atrium and were removed using percutaneous endovascular procedures.


Assuntos
Neoplasias da Mama , Cateterismo Venoso Central , Cateteres Venosos Centrais , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/etiologia , Neoplasias da Mama/cirurgia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Átrios do Coração , Humanos , Veias Jugulares
6.
Semin Respir Crit Care Med ; 43(4): 570-582, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36104027

RESUMO

Although the potential causes of nonmalignant pleural effusions are many, the management of a few, including complicated pleural infections and refractory heart failure and hepatic hydrothoraces, can be challenging and requires the assistance of interventional pulmonologists. A pragmatic approach to complicated parapneumonic effusions or empyemas is the insertion of a small-bore chest tube (e.g., 14-16 Fr) through which fibrinolytics (e.g., urokinase and alteplase) and DNase are administered in combination. Therapeutic thoracenteses are usually reserved for small to moderate effusions that are expected to be completely aspirated at a single time, whereas video-assisted thoracic surgery should be considered after failure of intrapleural enzyme therapy. Refractory cardiac and liver-induced pleural effusions portend a poor prognosis. In cases of heart failure-related effusions, therapeutic thoracentesis is the first-line palliative therapy. However, if it is frequently needed, an indwelling pleural catheter (IPC) is recommended. In patients with hepatic hydrothorax, repeated therapeutic thoracenteses are commonly performed while a multidisciplinary decision on the most appropriate definitive management is taken. The percutaneous creation of a portosystemic shunt may be used as a bridge to liver transplantation or as a potential definitive therapy in nontransplant candidates. In general, an IPC should be avoided because of the high risk of complications, particularly infections, that may jeopardize candidacy for liver transplantation. Even so, in noncandidates for liver transplant or surgical correction of diaphragmatic defects, IPC is a therapeutic option as valid as serial thoracenteses.


Assuntos
Insuficiência Cardíaca , Hidrotórax , Derrame Pleural , Cateteres de Demora/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Hidrotórax/etiologia , Derrame Pleural/etiologia , Derrame Pleural/terapia , Toracentese/efeitos adversos
7.
Clin Lab ; 68(7)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35975538

RESUMO

BACKGROUND: It is critical to clarify the biochemical factors associated with thrombosis development following tunneled dialysis catheter (TDC) insertion. METHODS: The study involved retrospective analysis of charts of patients hospitalized for permanent TDC placement between 2013 and 2020 in a tertiary academic center. Patients undergoing a hemodialysis schedule with permanent TDC for more than three months were included in the study. To determine predictive factors associated with thrombosis development in permanent TDC, patients were assigned to one of two groups, according to the extent of thrombosis. The groups were compared in terms of demographic characteristics, blood test values, complication and length of follow-up period. RESULTS: A total of 350 patients (204 female, 146 male) were enrolled into the study. In patients with thrombosis the mean BMI was found significantly higher (p = 0.001) and presence of diabetes mellitus was significantly common (p = 0.014). Patients with thrombosis had significantly higher D-dimer (6.5 vs. 2.4 µg/mL, p = 0.001) and procalcitonin levels (4.1 vs. 1.4 ng/mL, p = 0.001). Additionally, patients with thrombosis had a significantly higher rate of infective complications (p = 0.014). Logistic regression analysis revealed that BMI > 30 kg/m2 and infective complications increased thrombosis risk 3.842 and 3.104 times (p = 0.004 and p = 0.038, respectively). Additionally, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were significantly associated with the development of thrombosis (p = 0.001 and p = 0.007). CONCLUSIONS: The present study demonstrated that the presence of infection, higher BMI > 30 kg/m2, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were found to increase the incidence of thrombosis.


Assuntos
Cateteres de Demora , Trombose , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Masculino , Pró-Calcitonina , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Trombose/diagnóstico , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento
8.
Aktuelle Urol ; 53(4): 316, 2022 08.
Artigo em Alemão | MEDLINE | ID: mdl-35948052
9.
BMJ Case Rep ; 15(8)2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35985740

RESUMO

Malignant pleural effusion with persistent air leak (PAL) is a rare manifestation of lung malignancy. We present a woman in her 50s with postpleuroscopy PAL. Pleural biopsy confirmed adenocarcinoma with detection of epidermal growth factor receptor mutation in exon 19. An indwelling pleural catheter (IPC) was inserted and connected to an Atrium Express Mini ambulatory drain. This procedure reduced the length of hospital stay. Autopleurodesis with resolution of PAL occurred at week 3 of IPC insertion.


Assuntos
Derrame Pleural Maligno , Cateterismo , Cateteres de Demora , Drenagem/métodos , Feminino , Humanos , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia , Pleurodese/métodos
10.
Medicine (Baltimore) ; 101(31): e29694, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945766

RESUMO

BACKGROUND: We modified the blind Seldinger technique by incorporating ultrasound guidance and the use of a multifunctional bladder paracentesis trocar for PD catheter (PDC) placement, which can be easily performed by a nephrologist and is a feasible technique. To compare success rates and safety of our modified percutaneous PD catheter placement technique to open surgery. METHODS: Two hundred and twelve stage-5 chronic kidney disease(CKD) patients receiving PD therapy from June 2016 to June 2019 were included, 105 patients treated by ultrasound-guided percutaneous placement of peritoneal dialysis catheters using a multifunctional bladder paracentesis trocar (Group A) and 107 patients receiving open surgical placement (Group B). Outcomes of patients via either catheter placement technique were retrospectively compared. The clinical success rate as defined by proper catheter drainage within 4 weeks after placement, complication rates (both technical complications and infections), and 1-year catheter survival were compared. RESULTS: There was no significant difference in sex ratio, age, or previous abdominal surgery history between groups (P > .05). Both surgical time and incision length were significantly shorter in Group A than in Group B (P < .05). Clinical success rate was also higher inGroup A (P < .05). Moreover, Group A demonstrated lower overall complication rates (P < .05) and lower incidence rates of early peritonitis, initial drainage disorder, and peritubular leakage (all P < .05). One-year catheter survival was also higher in Group A (P < .05). CONCLUSION: Percutaneous placement of PD catheters using our modified technique demonstrates superior success rates and safety compared to open surgery. In addition, our modified technique can be a better alternative to traditional Seldinger percutaneous catheterization for its higher success rate and safety, more accurate positioning.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Cateterismo/efeitos adversos , Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Humanos , Falência Renal Crônica/etiologia , Paracentese/efeitos adversos , Diálise Peritoneal/métodos , Estudos Retrospectivos , Instrumentos Cirúrgicos , Ultrassonografia de Intervenção , Bexiga Urinária
11.
BMC Health Serv Res ; 22(1): 1000, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35932078

RESUMO

BACKGROUND: In hospitals, catheter acquired urinary tract infection causes significant resource waste and discomfort among admitted patients. An intervention for reducing indwelling catheterisations - No-CAUTI - was trialled across four hospitals in New South Wales, Australia. No-CAUTI includes: train-the-trainer workshops, site champions, compliance audits, and point prevalence surveys. The trial showed reductions on usual care catheterisation rates at 4- and 9-month post-intervention. This result was statistically non-significant; and post-intervention catheterisation rates rebounded between 4 and 9 months. However, No-CAUTI showed statistically significant catheterisation decreases for medical wards, female patients and for short-term catheterisations. This study presents a budget impact analysis of a projected five year No-CAUTI roll out across New South Wales public hospitals, from the cost perspective of the New South Wales Ministry of Health. METHODS: Budget forecasts were made for five year roll outs of: i) No-CAUTI; and ii) usual care, among all public hospitals in New South Wales hosting overnight stays (n=180). The roll out design maintains intervention effectiveness with ongoing workshops, quality audits, and hospital surveys. Forecasts of catheterisations, procedures and treatments were modelled on No-CAUTI trial observations. Costs were sourced from trial records, the Medical Benefits Scheme, the Pharmaceutical Benefits Scheme and public wage awards. Cost and parameter uncertainties were considered with sensitivity scenarios. RESULTS: The estimated five-year No-CAUTI roll-out cost was $1.5 million. It had an overall budget saving of $640,000 due to reductions of 100,100 catheterisations, 33,300 urine tests and 6,700 antibiotics administrations. Non-Metropolitan hospitals had a net saving of $1.2 million, while Metropolitan hospitals had a net cost of $0.54 million. CONCLUSIONS: Compared to usual care, NO-CAUTI is expected to realise overall budget savings and decreases in catheterisations over five years. These findings allow a consideration of the affordability of a wide implementation. TRIAL REGISTRATION: Registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12617000090314 ). First registered 17 January 2017, retrospectively. First enrolment, 15/11/2016.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Austrália , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/epidemiologia , Feminino , Hospitais , Humanos , New South Wales , Papel do Profissional de Enfermagem , Estudos Retrospectivos , Cateterismo Urinário , Cateteres Urinários/efeitos adversos
12.
World J Surg Oncol ; 20(1): 272, 2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36042478

RESUMO

BACKGROUND: Accurately positioning totally implantable venous access device (TIVAD) catheters and reducing complications in pediatric patients are important and challenging. A number of studies have shown methods for locating the tip of the TIVAD catheter. We assessed the success and complications of TIVAD implantation guided by transesophageal echocardiography (TEE) via the internal jugular vein (IJV) for 294 patients in this retrospective study. METHODS: From May 2019 to March 2021, 297 cases of TIVADs in our hospital were analyzed in this observational, non-randomized, single-center study. The position of the catheter tip under TEE and chest radiography and rates of periprocedural, early, and late complications were evaluated. RESULTS: The implantation was successful in 242 (82.3%) cases which was in a proper position, and the results were consistent with those of postoperative chest radiography. A total of 72 complications were recorded. Of these, 1 case had a perioperative complication, 66 had early complications, and 5 had late complications after port implantation. The most common complications were local infection and catheter malposition, namely 10 (13.9%) cases of incision infection and 58 (80.6%) cases of catheter malposition. In total, 6 (8.3%) cases of port explantation were required. CONCLUSION: Confirmation of proper TIVAD catheter positioning by TEE through an internal jugular approach in children was accurate and safe.


Assuntos
Cateterismo Venoso Central , Veias Jugulares , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres de Demora/efeitos adversos , Criança , Ecocardiografia Transesofagiana , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/cirurgia , Estudos Retrospectivos
13.
Crit Care Nurs Q ; 45(4): 290-299, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35980790

RESUMO

Despite the many advancements in infection prevention, catheter-associated urinary tract infections (CAUTI) continue to be problematic for many hospitals. The large urban teaching hospital featured in this article developed a team that consisted of a registered nurse quality Lean coach, bedside nurses from each inpatient nursing unit, physicians, an infection prevention specialist nurse, an education specialist nurse, and members of the quality department to study this matter. The team focused on understanding current practice related to the use and duration of indwelling urinary catheters. It was discovered that while some indwelling urinary catheters were justified, others could have been avoided altogether or removed earlier. Multifaceted measures were instituted at this hospital to decrease indwelling urinary catheter days and reduce CAUTI rates. The team's journey to successfully decreasing indwelling urinary catheter days by 19.79% and CAUTI rates by 38% is highlighted.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Infecções Urinárias , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora , Infecção Hospitalar/prevenção & controle , Hospitais , Humanos , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle
14.
Trials ; 23(1): 630, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927733

RESUMO

BACKGROUND: Various washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in the prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduce the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC. METHODS: CATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥ 18 years, who have had a LTC in use for ≥ 28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from general practitioner practices, secondary/tertiary care, community healthcare, care homes, and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life. DISCUSSION: This study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015). TRIAL REGISTRATION: ISRCTN ISRCTN17116445 . Registered prospectively on 06 November 2019.


Assuntos
Infecções Relacionadas a Cateter , Análise Custo-Benefício , Cateterismo Urinário , Infecções Urinárias , Adulto , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Ácido Cítrico , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Políticas , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle
15.
J Vis Exp ; (185)2022 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-35938794

RESUMO

Murine models are employed to probe various aspects of peritoneal dialysis (PD), such as peritoneal inflammation and fibrosis. These events drive peritoneal membrane failure in humans, which remains an area of intense investigation due to its profound clinical implications in managing patients with end-stage kidney disease (ESKD). Despite the clinical importance of PD and its related complications, current experimental murine models suffer from key technical challenges that compromise the models' performance. These include PD catheter migration and kinking and usually warrant earlier catheter removal. These limitations also drive the need for a greater number of animals to complete a study. Addressing these drawbacks, this study introduces technical improvements and surgical nuances to prevent commonly observed PD catheter complications in a murine model. Moreover, this modified model is validated by inducing peritoneal inflammation and fibrosis using lipopolysaccharide injections. In essence, this paper describes an improved method to create an experimental model of PD.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Animais , Cateterismo/métodos , Cateteres de Demora , Fibrose , Humanos , Inflamação , Camundongos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos
16.
J Infus Nurs ; 45(4): 210-219, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35820126

RESUMO

In 2014, a large urban community hospital adopted protected clinical indication practices as a quality improvement project. It then undertook a research study to examine bedside practices with short peripheral catheters, which included direct observation at the bedside once weekly for 6 months. A total of 4305 catheters were observed and remained in place for a total of 23 423 days. Fifty six percent of devices remained in place beyond 96 hours. The overall rate of peripheral bloodstream infection in patients enrolled in the study was 0.12/1000 peripheral intravenous days. Significant differences were noted based on which department placed the catheter, as well as which department cared for the patient during hospitalization. Patients admitted to step-down critical care units had the highest completion of therapy rates; however, those being cared for in medical/surgical units had the best outcomes. Devices placed in the emergency department had a higher successful dwell rate than those placed in critical care units. Twenty-gauge catheters were found to have the highest successful dwell rate, as well as insertion sites that were observed to be within normal limits during the weekly observation. Dressings that were noted to be clean, dry, and intact had a stronger association with completion of therapy than those that were not fully intact. Emphasis was placed on ensuring consistent practices with insertion, care, and maintenance, which contributed to more consistent outcomes between settings that insert, care for, and maintain devices. Nonmodifiable risk factors may remain.


Assuntos
Cateterismo Periférico , Sepse , Cateteres de Demora/efeitos adversos , Cuidados Críticos , Humanos , Melhoria de Qualidade
17.
Pediatr Blood Cancer ; 69(10): e29911, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35880972

RESUMO

BACKGROUND AND OBJECTIVES: To investigate the feasibility and safety of ultrasound-guided totally implantable venous access ports (TIVAPs) via the right brachiocephalic vein (BCV) in pediatric patients. METHODS: A single-institute retrospective review was performed on 35 pediatric patients with predominantly hematological malignancies (88.6%) who underwent TIVAP implantation via ultrasound-guided right BCV approach from July 2018 to June 2021. The catheter tip was adjusted to be positioned at the cavoatrial junction under pulsed fluoroscopic guidance. Technical success rate, procedural information, and TIVAP-related complications were evaluated. RESULTS: All the pediatric TIVAP devices were successfully implanted via right BCV access. Venous access was successful by first attempt in 32 children (91%), two cases (5.7%) required a second attempt, and one patient (2.9%) required a third attempt. The mean procedural time was 44.6 ± 6.4 minutes (range: 34-62 minutes). No intraoperative complications occurred. The average TIVAP indwelling time was 564 ± 208 days (range: 193-1014 days), with a cumulative 19,723 catheter-days. Overall, three patients (8.6%) experienced four postoperative complications (two cases of local hematoma and two catheter dysfunctions) at a rate of 0.2 per 1000 catheter-days. No other complications such as wound dehiscence, delayed incision healing, catheter-related thrombosis (CRT), catheter malposition/fracture, surgical site infection, catheter-related bloodstream infection (CRBSI), pinch-off syndrome, and drug extravasation were observed during follow-up. CONCLUSIONS: Ultrasound-guided right BCV access for TIVAP placement in pediatric patients appears to be technically feasible, safe, and effective. Further large-sample, prospective studies are warranted.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Veias Braquiocefálicas/diagnóstico por imagem , Cateteres de Demora , Criança , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Ultrassonografia , Ultrassonografia de Intervenção
18.
Contrast Media Mol Imaging ; 2022: 9374774, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35845735

RESUMO

In order to investigate the influence of patient position change on the position of catheter tip in arm infusion port, the clinical data of 324 patients undergoing arm infusion port implantation in a hospital were retrospectively analyzed. It could be obtained that TIVAP was successfully implanted in 324 patients with malignant tumors. In 171 cases, the TIVAP catheter tip shifted to the foot side when the position was changed from upright to decubitus, with an average displacement of (12.29 ± 7.48) mm; 149 cases had cephalic displacement with an average of (5.00 ± 3.79) mm; and 5 cases had no change. The position of the TIVAP catheter tip tended to shift to the foot side when the vertical position changed to the decubitus position, with an average displacement of (-9.32 ± 9.36) mm, and the difference had statistical significance (P < 0.0001), while there were no significant differences in gender, age, height, weight, body mass index, and catheter tip position (P > 0.05). It could be analyzed from the data that from decubitus to upright position, the tip of the arm infusion port tended to shift to the foot side, and the moving distance was related to the patient's gender, sebum thickness, and indwelling catheter length. Preoperative understanding of relevant information is helpful to determine the location and length of catheterization and reduce catheter-related complications.


Assuntos
Cateterismo Venoso Central , Neoplasias , Braço , Cateteres de Demora , Humanos , Estudos Retrospectivos
20.
Kidney360 ; 3(6): 1080-1088, 2022 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-35845334

RESUMO

Background: The optimal timing of dialysis access placement in individuals with stage 5 CKD is challenging to estimate. Preemptive living donor kidney transplant (LDKT) is the gold-standard treatment for ESKD due to superior graft survival and mortality, but dialysis initiation is often required. Among LDKT recipients, we sought to determine which clinical characteristics were associated with preemptive transplant. Among non-preemptive LDKT recipients, we sought to determine what dialysis access was used, and their duration of use before receipt of living donor transplant. Methods: We retrospectively extracted data on 569 LDKT recipients, >18 years old, who were transplanted between January 2014 and July 2019 at UCSF, including dialysis access type (arteriovenous fistula [AVF], arteriovenous graft [AVG], peritoneal dialysis catheter [PD], and venous catheter), duration of dialysis, and clinical characteristics. Results: Preemptive LDKT recipients constituted 30% of our cohort and were older, more likely to be White, more likely to have ESKD from polycystic kidney disease, and less likely to have ESKD from type 2 diabetes. Of the non-preemptive patients, 26% used AVF, 0.5% used AVG, 32% used peritoneal catheter, 11% used venous catheter, and 31% used more than one access type. Median (IQR) time on dialysis for AVF/AVG use was 1.86 (0.85-3.32) years; for PD catheters, 1.12 (0.55-1.92) years; for venous catheters, 0.66 (0.23-1.69) years; and for multimodal access, 2.15 (1.37-3.72) years. Conclusions: We characterized the dialysis access landscape in LDKT recipients. Venous catheter and PD were the most popular modality in the first quartile of dialysis, and patients using these modalities had shorter times on dialysis compared with those with an AVF. Venous catheter or PD can be considered a viable bridge therapy in patients with living donor availability given their shorter waitlist times. Earlier referral of patients with living donor prospects might further minimize dialysis need.


Assuntos
Diabetes Mellitus Tipo 2 , Diálise Renal , Adolescente , Cateteres de Demora , Humanos , Rim , Doadores Vivos , Estudos Retrospectivos
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