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1.
Medicine (Baltimore) ; 99(1): e18494, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895783

RESUMO

INTRODUCTION: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period. MATERIAL AND METHODS: From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems. RESULTS: The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54-2.75]). Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307-2709]). CONCLUSION: Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.


Assuntos
Infecções Relacionadas a Cateter/mortalidade , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Estudos de Casos e Controles , França/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769352

RESUMO

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrassom , Doença Aguda , Adulto , Idoso , Cardiologistas , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Michigan , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Radiologistas , Estudos Retrospectivos , Especialização , Cirurgiões , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos
3.
Vasc Endovascular Surg ; 54(1): 42-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31578127

RESUMO

OBJECTIVE: In clinical practice, the incidence of femoral pseudoaneurysms requiring repair is small, but at a tertiary care center, the repair rate is higher due to referrals. We sought to specifically study patients who suffered postcatheterization pseudoaneurysms requiring thrombin injection or operative repair and compare them to our routine transfemoral endovascular patients to identify predictors of clinically significant pseudoaneurysms. The underlying goal would be to identify what makes these patients that develop pseudoaneurysms different. METHODS: A search of our billing records for Current Procedural Technology (CPT) codes of these 2 procedures between January 2008 and April 2018 was combined with our institution's Peripheral Vascular Intervention Vascular Quality Initiative database spanning from January 2013 to December 2017. A comparison was then performed between patients who had the outcome of operative intervention for a pseudoaneurysm complication and those who did not, with the goal of elucidating patient demographics and periprocedural factors that would predict pseudoaneurysm formation using univariate and multivariate analyses. RESULTS: There were 77 patients who required thrombin injection or open repair for access-related pseudoaneurysms and 324 patients who did not. Complications occurred more often in patients who were older than 75 (40.2% vs 21.9%; P = .0009), female (57.1% vs 38.6%; P = .003), obese (59.7% vs 33.3%; P < .001), hypertensive (96.1% vs 79.3%; P = .0005), who received a sheath >6F (32.4% vs 13%; P < .0001), intraoperative and postoperative anticoagulation (77.3% vs 32.7% and 52.1% vs 24.2%, respectively; P < .0001), and periprocedural P2Y12 inhibitors (48.7% vs 28%; P = .0005). Less complications were observed in patients who had a closure device used (42.9% vs 8.45%; P < .0001) and protamine reversal (26.5% vs 13.3%; P = .0163). CONCLUSIONS: Our findings validate published reports that incriminate a larger sheath size, perioperative anticoagulation, and female gender as increasing the rate of access site complications, with the use of a closure device being protective.


Assuntos
Falso Aneurisma/etiologia , Cateterismo Periférico/efeitos adversos , Artéria Femoral/lesões , Virilha/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Demandas Administrativas em Assistência à Saúde , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Bases de Dados Factuais , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Illinois , Injeções , Masculino , Estudos Retrospectivos , Fatores de Risco , Trombina/administração & dosagem , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia
4.
JAMA ; 322(23): 2313-2322, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846015

RESUMO

Importance: Several trials have observed higher rates of perioperative stroke following transfemoral carotid artery stenting compared with carotid endarterectomy. Transcarotid artery revascularization with flow reversal was recently introduced for carotid stenting. This technique was developed to decrease stroke risk seen with the transfemoral approach; however, its outcomes, compared with transfemoral carotid artery stenting, are not well characterized. Objective: To compare outcomes associated with transcarotid artery revascularization and transfemoral carotid artery stenting. Design, Setting, and Participants: Exploratory propensity score-matched analysis of prospectively collected data from the Vascular Quality Initiative Transcarotid Artery Surveillance Project and Carotid Stent Registry of asymptomatic and symptomatic patients in the United States and Canada undergoing transcarotid artery revascularization and transfemoral carotid artery stenting for carotid artery stenosis, from September 2016 to April 2019. The final date for follow-up was May 29, 2019. Exposures: Transcarotid artery revascularization vs transfemoral carotid artery stenting. Main Outcomes and Measures: Outcomes included a composite end point of in-hospital stroke or death, stroke, death, myocardial infarction, as well as ipsilateral stroke or death at 1 year. In-hospital stroke was defined as ipsilateral or contralateral, cortical or vertebrobasilar, and ischemic or hemorrhagic stroke. Death was all-cause mortality. Results: During the study period, 5251 patients underwent transcarotid artery revascularization and 6640 patients underwent transfemoral carotid artery stenting. After matching, 3286 pairs of patients who underwent transcarotid artery revascularization or transfemoral carotid artery stenting were identified (transcarotid approach: mean [SD] age, 71.7 [9.8] years; 35.7% women; transfemoral approach: mean [SD] age, 71.6 [9.3] years; 35.1% women). Transcarotid artery revascularization was associated with a lower risk of in-hospital stroke or death (1.6% vs 3.1%; absolute difference, -1.52% [95% CI, -2.29% to -0.75%]; relative risk [RR], 0.51 [95% CI, 0.37 to 0.72]; P < .001), stroke (1.3% vs 2.4%; absolute difference, -1.10% [95% CI, -1.79% to -0.41%]; RR, 0.54 [95% CI, 0.38 to 0.79]; P = .001), and death (0.4% vs 1.0%; absolute difference, -0.55% [95% CI, -0.98% to -0.11%]; RR, 0.44 [95% CI, 0.23 to 0.82]; P = .008). There was no statistically significant difference in the risk of perioperative myocardial infarction between the 2 cohorts (0.2% for transcarotid vs 0.3% for the transfemoral approach; absolute difference, -0.09% [95% CI, -0.37% to 0.19%]; RR, 0.70 [95% CI, 0.27 to 1.84]; P = .47). At 1 year using Kaplan-Meier life-table estimation, the transcarotid approach was associated with a lower risk of ipsilateral stroke or death (5.1% vs 9.6%; hazard ratio, 0.52 [95% CI, 0.41 to 0.66]; P < .001). Transcarotid artery revascularization was associated with higher risk of access site complication resulting in interventional treatment (1.3% vs 0.8%; absolute difference, 0.52% [95% CI, -0.01% to 1.04%]; RR, 1.63 [95% CI, 1.02 to 2.61]; P = .04), whereas transfemoral carotid artery stenting was associated with more radiation (median fluoroscopy time, 5 minutes [interquartile range {IQR}, 3 to 7] vs 16 minutes [IQR, 11 to 23]; P < .001) and more contrast (median contrast used, 30 mL [IQR, 20 to 45] vs 80 mL [IQR, 55 to 122]; P < .001). Conclusions and Relevance: Among patients undergoing treatment for carotid stenosis, transcarotid artery revascularization, compared with transfemoral carotid artery stenting, was significantly associated with a lower risk of stroke or death.


Assuntos
Estenose das Carótidas/cirurgia , Cateterismo Periférico/efeitos adversos , Stents , Acidente Vascular Cerebral/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Sistema de Registros
5.
Medicine (Baltimore) ; 98(38): e16988, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567935

RESUMO

RATIONALE: Peripherally inserted central catheters (PICC), normally located at the lower 1/3rd of the superior vena cava (SVC) and cavo-atrial junction, are commonly used in cancer patients. Persistent left superior vena cava (PLSVC) is a vascular anomaly, in patients with which seldom research was reported about PICC implanted. After obtaining written informed consent, we present a case where two successful insertions of PICC were performed in a 50-year-old female patient with PLSVC and right SVC. PATIENTS CONCERNS: The patient had ovarian cancer and was admitted for chemotherapy using PICC. DIAGNOSES: Ovarian cancer and PLSVC. INTERVENTIONS AND OUTCOMES: Following insertion of PICC in PLSVC, thrombosis developed. PICC was removed after routine anticoagulation therapy. Owing to tumor recurrence, a second PICC was inserted in the right SVC without any complications. LESSONS: PICC insertion in PLSVC for chemotherapy may be associated with an increased risk of deep venous thrombosis of the upper extremity. A right catheter insertion in patient with PLSVC was preferred.


Assuntos
Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Malformações Vasculares/complicações , Veia Cava Superior/anormalidades , Trombose Venosa/diagnóstico , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Braço , Cateterismo Periférico/efeitos adversos , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Neoplasias Ovarianas/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
6.
Acta Cir Bras ; 34(8): e201900804, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618404

RESUMO

PURPOSE: To develop a rabbit model of a short peripheral catheter (SPC) and to observe the effects of different flushing methods on blood vessels. METHODS: Thirty rabbits were randomly divided into three groups (A, B, and C), with ten rabbits per group. In group A, we used pulsed flush; in group B, we used uniform flush; and no treatment was used in group C. RESULTS: We observed that a uniform flush reduced blockage, phlebitis, and exudation compared to a pulsed flush by visual observation. The histopathological examination found that the morphological changes in group A were more severe than in group B and C related to loss of venous endothelial cells, inflammatory cell infiltration, edema, epidermal and chondrocyte degeneration, except for the thrombosis on group B that was more serious than in group A, especially in the distal side of puncture points. The distal region of groups A and B had more inflammatory cell infiltration than the proximal region. Thrombosis was more severe in the distal region than in the proximal region in group B. CONCLUSIONS: The uniform flush produced less damage to the vascular endothelium and surrounding tissues and was superior to the pulsed flush. However, the uniform flush is prone to thrombosis.


Assuntos
Vasos Sanguíneos/patologia , Cateterismo Periférico/métodos , Animais , Cateterismo Periférico/efeitos adversos , Modelos Animais de Doenças , Orelha/irrigação sanguínea , Células Endoteliais , Endotélio Vascular/patologia , Endotélio Vascular/ultraestrutura , Masculino , Flebite/etiologia , Coelhos , Distribuição Aleatória , Fluxo Sanguíneo Regional
7.
Artigo em Inglês | MEDLINE | ID: mdl-31540024

RESUMO

Phlebitis leads to increased discomfort for patients, longer hospital stays, and higher healthcare costs. This study aimed to identify predictive factors of peripheral phlebitis related to intravenous injection among orthopedic inpatients, develop a prediction model, and evaluate the goodness-of-fit of the prediction model. This study included 270 orthopedic patients who were hospitalized in the orthopedic ward of a general hospital. A peripheral intravenous injection-related questionnaire based on previous studies and the modified Infusion Nurses Society scale were used to collect data. Phlebitis risk factors were identified, and a prediction model was developed using the Bayesian regression model. Vein quality, contrast medium use, hygiene duration, and period of nursing clinical experience were significant based on their 95% confidence intervals. The prediction model exhibited good discrimination. The prediction model developed in this study can be used for screening high-risk patients for peripheral intravenous catheter-related phlebitis and for providing basic data for developing interventions for the prevention and management of peripheral intravenous catheter-related phlebitis.


Assuntos
Cateterismo Periférico/efeitos adversos , Infusões Intravenosas/efeitos adversos , Modelos Teóricos , Procedimentos Ortopédicos , Flebite/etiologia , Teorema de Bayes , Feminino , Hospitais Gerais , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Fatores de Risco
8.
Artigo em Inglês | MEDLINE | ID: mdl-31500390

RESUMO

Reusable tourniquets and conventional securement dressings are considered risk factors for the occurrence of reported complications and catheter-related bloodstream infections. This study's purpose is to assess the impact of single-use disposable tourniquets and advanced occlusive polyurethane dressings with reinforced cloth borders on peripheral intravenous catheter (PIVC)-related complications and contamination. A pre- and post-interventional prospective observational study was conducted in a cardiology ward of a tertiary hospital between April 2018 and February 2019. Overall, demographic and clinical data from 156 patients and PIVC-related outcomes were collected (n = 296) as well as PIVC tips for microbiological analysis (n = 90). In the pre-intervention phase (n = 118), complication rates of 62.1% were reported, while 44.1% of the PIVCs were contaminated (n = 34). In the post-intervention phase (n = 178), complication rates decreased to 57.3%, while contamination rates significantly decreased to 17.9% (p = 0.014; n = 56). Through a logistic regression, it was found that the use of innovative technologies reduces the chance of PIVC contamination by 79% (odds ratio (OR): 0.21; 95% confidence interval (CI): 0.05-0.98; p = 0.046). Meanwhile, PIVC-related complications and fluid therapy emerged as predictors for PIVC contamination. Findings suggest that the adoption of these innovative devices in nurses' practice contributes to the significant reduction of PIVC contamination.


Assuntos
Bandagens , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Torniquetes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliuretanos , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária
9.
Enferm. intensiva (Ed. impr.) ; 30(3): 116-126, jul.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182970

RESUMO

Objetivos: Evaluar las tasas y la naturaleza de las complicaciones relacionadas con el catéter venoso central de acceso periférico (CVCAP o PICC) desde su inserción hasta su retirada. Método: Estudio observacional prospectivo. Se han incluido a todos los pacientes con edad superior a 14 años a los que se les insertó un CVCAP en una unidad de cuidados intensivos (UCI) polivalente durante el año comprendido entre el 1 de mayo de 2015 al 30 de abril de 2016. Variables estudiadas: datos demográficos, vena de inserción, indicación, unidad de cuidado, duración, complicaciones y factores relacionados, tasa de infección y motivo de retirada. Resultados: Se insertaron 144 CVCAP, de los cuales 94 corresponden al grupo UCI (65,28%) y 50 (34,72%) al no-UCI. La complicación más importante fue la sospecha de infección: 17,36% (tasa de incidencia de 15,2 por 1.000 días de CVCAP). El total de infecciones confirmadas fue del 6,25% (5,5 por 1.000 días de CVCAP), siendo en el grupo UCI del 1,39% (1,2 por 1.000 días) y en el grupo no-UCI del 4,86% (4,2 por 1.000 días). Hubo 5 bacteriemias, todas en el grupo no-UCI (3 por 1.000 días). El germen más frecuente fue el Staphylococcus epidermidis (6 casos). La flebitis tuvo una incidencia del 9,03% (7,9 por 1.000 días de CVCAP). Conclusiones: El CVCAP, eficaz dispositivo de acceso venoso central debido a la mínima incidencia de riesgos en la implantación y a sus ventajas respecto a los catéteres venosos centrales clásicos, es una técnica enfermera más


Objective: To evaluate the rates and nature of the complications related to the Central Peripheral Access Catheter (CVCAP or PICC) from its insertion to its withdrawal. Methods: Prospective observational study. All patients older than 14 years of age with a PICC inserted in the polyvalent intensive care unit (ICU) during the period between May 1, 2015 and April 30, 2016 were included. Data collected included: demographic data, insertion details, reason for insertion and removal, maintenance unit, total dwell time, incidence of complications and related factors and infection rate. Results: 144 PICCs were inserted, of which 94 corresponded to the ICU group (65.28%) and 50 (34.72%) to the non-ICU group. The most important complication was the suspicion of infection: 17.36% (rate of 15.2 per 1000 days of PICC). The total number of confirmed infections was 6.25% (5.5 per 1000 days of PICC), 1.39% (1.2 per 1000 days) being in the ICU group and 4.86% (4.2 per 1000 days) in the non-ICU group. There were 5 bacteraemias, all in the non-ICU group (3 per 1000 days). The most frequent germ was Staphylococcus epidermidis (6 cases). Phlebitis had an incidence of 9.03% (7.9 per 1000 days of PICC). Conclusions: PICC, effective device for central venous access due to the minimal incidence of risks in implantation and to its advantages with regard to the classic central venous catheters, is a further nursing technique


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Infecções Relacionadas a Cateter/complicações , Flebite/complicações , Cateterismo Periférico/efeitos adversos , Estudos Prospectivos , Unidades de Terapia Intensiva
10.
J Clin Nurs ; 28(23-24): 4488-4495, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410906

RESUMO

AIMS AND OBJECTIVES: To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients. BACKGROUND: Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure. DESIGN: Prospective, observational study. We have complied with the STROBE checklist of items. METHODS: This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables. RESULTS: A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events. CONCLUSIONS: The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr. RELEVANCE TO CLINICAL PRACTICE: The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Adulto , Cateterismo Periférico/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Tempo
11.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 170-173, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31465185

RESUMO

AIM: To compare the effect on epidural catheter migration of three different types of dressing used in labor. INTRODUCTION: Failure of labor epidural is due to multiple factors including catheter migration. Epidural catheter migration has been showed to be related to body mass index and patient position. The dressing technique also influences catheter migration and the risk of epidural failure. METHODS: Patients were randomly allocated to one of three groups based on type of dressing of labor epidural: TegadermTM (Group T), TegadermTM with sticky pad (Group P), and TegadermTM with Steri-StripTM (Group S). Measured variables included parity, gestational age, body mass index (BMI), level of puncture and distance of epidural catheter migration. RESULTS: There was an overall difference in epidural catheter migration (ECM) distance among different groups (p<0.05). Pairwise comparison revealed only a significant difference between groups P and T (0.76±1.35 vs. -0.14±1.03, p<0.01). CONCLUSION: Taping the lumbar epidural catheter used for labor analgesia with TegadermTM is inferior to TegadermTM with sticky pad or with Steri-StripTM in terms of catheter migration. There is no association of catheter migration and BMI.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Migração de Corpo Estranho/prevenção & controle , Complicações do Trabalho de Parto/prevenção & controle , Adulto , Analgesia Epidural/instrumentação , Analgesia Epidural/métodos , Analgesia Obstétrica/instrumentação , Analgesia Obstétrica/métodos , Bandagens , Índice de Massa Corporal , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Complicações do Trabalho de Parto/etiologia , Gravidez , Fatores de Risco
12.
Vasc Endovascular Surg ; 53(7): 558-562, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327305

RESUMO

OBJECTIVE: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. METHODS: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. RESULTS: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts (P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group (P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. CONCLUSION: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Isquemia/terapia , Doença Arterial Periférica/terapia , Terapia Trombolítica , Trombose/terapia , Terapia por Ultrassom , Doença Aguda , Idoso , Amputação , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Registros Eletrônicos de Saúde , Desenho de Equipamento , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Parenterais , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos , Terapia por Ultrassom/instrumentação , Dispositivos de Acesso Vascular
13.
EuroIntervention ; 15(9): e749-e756, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31334701

RESUMO

AIMS: The aim of this study was to evaluate the impact of a horizontal aorta (HA) on device success and short-term clinical outcomes of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We retrospectively assessed 547 consecutive patients treated with transfemoral second-generation non-balloon-expandable (NBE) (n=447) and balloon-expandable (BE) (n=100) TAVI for symptomatic severe aortic stenosis. Aortic angulation (AA) was evaluated with preprocedural computed tomography. Patients were dichotomised according to a previously established AA cut-point: HA group (AA ≥48°, n=230) and normal aorta (NA) group (AA <48°, n=317). Endpoints were considered according to the Valve Academic Research Consortium-2 definitions. Fluoroscopy time (32.8±16.4 vs 30.3±13.9 minutes, p=0.060) and radiation dose (kerma area product 120.8±99.7 vs 103.7±81.1 Gy·cm2, p=0.033) were higher in the HA group as compared to the NA group. No difference in device success was observed between patients with and without an HA (88.3% vs 88.0%, p=0.929). No differences in device success and 30-day outcomes were observed when comparing HA and NA patients, according to BE and NBE prostheses. CONCLUSIONS: The presence of an HA has no impact on device success and short-term clinical outcomes of TAVI with either second-generation NBE or BE devices.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Aorta/diagnóstico por imagem , Valvuloplastia com Balão/efeitos adversos , Cateterismo Periférico/efeitos adversos , Fluoroscopia , Humanos , Desenho de Prótese , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
14.
J Infus Nurs ; 42(4): 203-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283663

RESUMO

A cluster of 11 midline catheter failures occurred during a 2-week period in a Hospital in the Home program in an urban tertiary hospital in Australia. These failures prompted a 4-month retrospective audit of patients receiving outpatient antimicrobial therapy between December 1, 2016 and March 1, 2017. Primary outcomes were dwell time and catheter failure. Peripherally inserted central catheters had significantly fewer failures and significantly longer dwell times compared with midline catheters. Women experienced higher rates of midline catheter failure than men. The proportion of patients with midline catheters receiving continuous infusions who experienced a failure was markedly higher than those receiving bolus doses. Suggestions for further related research are discussed.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Hospitais/estatística & dados numéricos , Infusões Intravenosas , Antibacterianos/administração & dosagem , Austrália , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
16.
Vasc Med ; 24(5): 442-451, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31354089

RESUMO

Few studies have documented relationships between endovascular therapy, duplex ultrasonography (DUS), post-thrombotic syndrome (PTS), and quality of life (QOL). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial randomized 692 patients with acute proximal deep vein thrombosis (DVT) to receive anticoagulation or anticoagulation plus pharmacomechanical catheter-directed thrombolysis (PCDT). Compression DUS was obtained at baseline, 1 month and 12 months. Reflux DUS was obtained at 12 months in a subset of 126 patients. Clinical outcomes were collected over 24 months. At 1 month, patients who received PCDT had less residual thrombus compared to Control patients, evidenced by non-compressible common femoral vein (CFV) (21% vs 35%, p < 0.0001), femoral vein (51% vs 70%, p < 0.0001), and popliteal vein (61% vs 74%, p < 0.0001). At 12 months, in the ultrasound substudy, valvular reflux prevalence was similar between groups (85% vs 91%, p = 0.35). CFV non-compressibility at 1 month was associated with higher rates of any PTS (61% vs 46%, p < 0.001), a higher incidence of moderate-or-severe PTS (30% vs 19%, p = 0.003), and worse QOL (difference 8.2 VEINES-QOL (VEnous INsufficiency Epidemiological and Economic Study on Quality of Life) points; p = 0.004) at 24 months. Valvular reflux at 12 months was associated with moderate-or-severe PTS at 24 months (30% vs 0%, p = 0.01). In summary, PCDT results in less residual thrombus but does not reduce venous valvular reflux. CFV non-compressibility at 1 month is associated with more PTS, more severe PTS, and worse QOL at 24 months. Valvular reflux may predispose to moderate-or-severe PTS. ClinicalTrials.gov Identifier NCT00790335.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Terapia Trombolítica , Ultrassonografia Doppler Dupla , Trombose Venosa/terapia , Administração Intravenosa , Adulto , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Síndrome Pós-Trombótica/fisiopatologia , Valor Preditivo dos Testes , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
17.
PLoS One ; 14(5): e0217641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150465

RESUMO

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.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Procedimentos Neurocirúrgicos/métodos , Trombose/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Radiologistas , Trombose/fisiopatologia , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/efeitos adversos
18.
Ann Vasc Surg ; 60: 236-245, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200041

RESUMO

BACKGROUND: The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography. METHODS: Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study. RESULTS: A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5 ± 3.4 min, the average operation duration was 47 ± 3.7 (range 50-90) min, and the average dosage of contrast agent was 112.3 ± 8.1 mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2 hr after operation; this patient was re-pressurized and re-timed. CONCLUSIONS: This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.


Assuntos
Artéria Carótida Primitiva , Cateterismo Periférico/instrumentação , Angiografia Cerebral/instrumentação , Transtornos Cerebrovasculares/diagnóstico por imagem , Artéria Radial , Artéria Subclávia , Dispositivos de Acesso Vascular , Artéria Vertebral , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Primitiva/diagnóstico por imagem , Cateterismo Periférico/efeitos adversos , Angiografia Cerebral/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Fatores de Risco , Artéria Subclávia/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem
19.
Ann Vasc Surg ; 60: 327-334.e2, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200055

RESUMO

BACKGROUND: Infrainguinal peripheral vascular interventions (PVIs) can be performed with a variety of sheath sizes. Our aim was to investigate the effect of sheath size on postprocedural complications after infrainguinal PVIs. METHODS: The Vascular Quality Initiative (2010-2017) was queried for patients undergoing infrainguinal PVIs via retrograde common femoral artery access. Univariable and multivariable methods were performed to compare the effects of sheath size on access site complications, length of stay (LOS), and 30-day mortality. RESULTS: Of the 36,901 infrainguinal PVI procedures in the data set, the mean age was 69 years, and 59.1% of patients were male. Indications for intervention were claudication (41.6%), rest pain (13.2%), and tissue loss (45.2%). The femoropopliteal and tibial arteries were treated in 84.7% and 35.4% of cases, respectively. Interventions included stenting (39.2%) and atherectomy (21.3%). Sheath sizes of 7F, 6F, 5F, and 4F were used in 5225 (14.1%), 24,541 (66.5%), 6221 (16.9%), and 914 (2.5%) cases, respectively. Differences among sheath sizes were observed based on the ambulatory status; presence of diabetes, end-stage renal disease, previously stented ipsilateral extremities, anemia, preprocedural anticoagulation; and procedural details including indications, location of intervention, and intervention type (P < 0.001 for all). On univariable analysis, sheath size (7F vs 6F vs 5F vs 4F) was associated with differences in access site hematoma (3.5% vs 2.7% vs 2.5% vs 1.2%, P < 0.001), postprocedural LOS > 1 day (18.1% vs 25.3% vs 31.1% vs 27.9%, P < 0.001), and 30-day mortality (0.9% vs 1.4% vs 1.5% vs 1.5%, P = 0.007). There was no difference in hematoma requiring intervention or access site stenosis/occlusion based on sheath size. Multivariable analysis revealed that a larger sheath size was independently associated with access site hematoma (7F: odds ratio [OR] = 4.24, 95% confidence interval [CI] = 2.28-7.89, P < 0.001; 6F: OR = 3.11, 95% CI = 1.69-5.7, P < 0.001; 5F: OR = 2.72, 95% CI = 1.46-5.05, P = 0.002) and postprocedural LOS > 1 day (7F: OR = 1.69, 95% CI = 1.39-2.05, P < 0.001; 6F: OR = 1.5, 95% CI = 1.26-1.78, P < 0.001; 5F: OR = 1.51, 95% CI = 1.26-1.8, P < 0.001). Access site hematoma requiring intervention and 30-day mortality were not independently associated with sheath size. CONCLUSIONS: In infrainguinal PVIs, larger sheaths increased the risk of minor access site hematomas, but not major morbidity or mortality. Larger sheaths were associated with longer postprocedural LOS, possibly because of conservative management of hematomas.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Femoral , Hematoma/etiologia , Doença Arterial Periférica/terapia , Dispositivos de Acesso Vascular , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/mortalidade , Bases de Dados Factuais , Procedimentos Endovasculares/mortalidade , Desenho de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , América do Norte , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
J Card Surg ; 34(6): 447-452, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31058374

RESUMO

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be life-saving in refractory cardiogenic shock but carries a risk of neurologic complications such as stroke and hemorrhage. As little is known about the effects of different peripheral VA-ECMO cannulation sites on cerebral blood flow (CBF), transcranial Doppler (TCD) was used to determine whether the cannulation site affects CBF. METHODS: Thirty-seven patients receiving VA-ECMO for cardiogenic shock via axillary or femoral artery cannulation were prospectively enrolled. Measured bilateral middle cerebral artery (MCA), mean flow velocities (MFV), and pulsatility indices (PI) were the primary outcomes and adverse neurologic events were secondary outcomes. RESULTS: The median age was 58 years (IQR 51-66) with 26 (70%) males. Median VA-ECMO flow was 3.8 L/min (IQR 3.2-4.9) with mean arterial pressures of 80 mm Hg (IQR 75-86). Nineteen patients received right axillary artery cannulation while 18 underwent femoral cannulation. Compared with the femoral group, MFV was higher in the axillary group in the right MCA (46 cm/s [IQR 26-57] vs 27 [17-36], P = 0.03) and left (43 [IQR 35-60] vs 29 cm/s [16-48], P = 0.05). Axillary PI was significantly lower compared with the femoral group (right: 0.48 cm/s [0.25-0.65] vs 0.83 [0.66-0.93], P = 0.02; left: 0.41 cm/s [0.29-0.63] vs 1.02 [0.7-1.3], P = 0.004). One axillary patient experienced a stroke with deficits. CONCLUSIONS: TCD appears to be an effective tool for indirect monitoring of CBF in patients with ECMO with limited pulsatility. Axillary artery cannulation seems to provide higher cerebral flow rates without any difference in neurologic outcomes. Future studies may incorporate TCD into regulating ECMO flows to achieve physiologic CBF.


Assuntos
Artéria Axilar , Cateterismo Periférico/métodos , Circulação Cerebrovascular/fisiologia , Oxigenação por Membrana Extracorpórea/métodos , Ultrassonografia Doppler/métodos , Idoso , Velocidade do Fluxo Sanguíneo , Cateterismo Periférico/efeitos adversos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Artéria Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia
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