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1.
J Infus Nurs ; 42(4): 193-196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283661

RESUMO

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.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/normas , Controle de Infecções/métodos , Equipe de Assistência ao Paciente/normas , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/métodos , Fidelidade a Diretrizes , Humanos , Estudos Retrospectivos
2.
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
3.
Rev Med Chil ; 147(4): 458-464, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344207

RESUMO

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.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Chile/epidemiologia , Estudos Transversais , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Prevalência , Diálise Renal/instrumentação , Diálise Renal/métodos , Distribuição por Sexo , Ultrassonografia de Intervenção/métodos
4.
Cancer Treat Res ; 179: 117-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317484

RESUMO

Central venous access devices are a critical instrument in the treatment and supportive care delivery for oncology patients. Catheter-related thrombosis (CRT) is a common complication of central venous access devices in oncology patients. Risk factors for CRT include patient-, device-, and treatment-related risk factors. Treatment of CRT is indicated to reduce symptoms, prevent catheter malfunction, prevent recurrent DVT or thromboembolic pulmonary embolism, and minimize the risk of post-thrombotic syndrome. Minimal prospective data exist on the prevention and treatment of catheter-related thromboses in cancer patients. As such recommendations largely are derived from data in the lower-extremity DVT and PE studies in cancer and non-cancer patients. Based on the available literature, primary pharmacologic prophylaxis against CRT is not recommended in cancer patients. Treatment options for CRT include catheter removal, anticoagulation, catheter-directed thrombolysis, or surgical thrombectomy. Current evidence-based guidelines recommend LMWH as the anticoagulant of choice. However, recent data showing efficacy and safety of DOACs in cancer-related VTE may be extrapolated to treatment of CRT in cancer patients. In patients with CRT, catheter removal should be pursued if continued vascular access is no longer needed, the catheter is dysfunctional, a catheter-associated infection is present, or if CRT symptoms do not resolve with anticoagulation alone. Catheter-directed thrombolysis is reserved for rare severe cases of CRT. Herein we discuss the pathophysiology, clinical presentation, diagnosis, and general management of CRT in cancer patients.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Neoplasias/complicações , Trombose/terapia , Humanos , Trombose/diagnóstico , Trombose/etiologia
5.
Medicine (Baltimore) ; 98(29): e16513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335728

RESUMO

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.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cérebro/diagnóstico por imagem , Cérebro/lesões , Migração de Corpo Estranho/complicações , Cateterismo Venoso Central/métodos , Veia Femoral , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
6.
Medicine (Baltimore) ; 98(26): e16126, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261532

RESUMO

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.


Assuntos
Cateterismo Venoso Central/instrumentação , Ultrassonografia de Intervenção/instrumentação , Cateterismo Venoso Central/métodos , Competência Clínica , Educação Médica , Humanos , Complicações Intraoperatórias/prevenção & controle , Aprendizagem , Imagem Óptica/instrumentação , Médicos , Complicações Pós-Operatórias/prevenção & controle , Dados Preliminares , Treinamento por Simulação , Ultrassonografia de Intervenção/métodos
7.
J Vasc Access ; 20(5): 567-569, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190613

RESUMO

INTRODUCTION: Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. CASE REPORT: We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. DISCUSSION: This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Falha de Equipamento , Veias Jugulares , Nefrectomia , Nefrolitíase/cirurgia , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Idoso , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Desenho de Equipamento , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Flebografia , Fatores de Tempo , Resultado do Tratamento
8.
Br J Anaesth ; 123(3): 316-324, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176448

RESUMO

BACKGROUND: Venous thrombosis (VT) in children is often associated with a central venous catheter (CVC). We aimed to determine the incidence of VT associated with percutaneous non-tunnelled CVCs in a general paediatric population, and to identify risk factors for VT in this cohort. METHODS: Observational, prospective study enrolling consecutive patients at a tertiary multi-disciplinary paediatric hospital. A total of 211 percutaneous, non-tunnelled CVCs were analysed. Data regarding potential risk factors for CVC-related VT were collected. Compression ultrasonography with colour Doppler was used to diagnose VT. RESULTS: Overall, 30.3% of children developed CVC-related VT, with an incidence rate of 29.6 (confidence interval, 22.5-36.9) cases/1000 CVC days. Upper body CVC location, multiple lumen CVCs, and male gender were independent risk factors for VT in multivariate analysis. All upper body VTs were in the internal jugular vein (IJV). The occurrence of CVC-related VT did not affect length of paediatric ICU or hospital stay. In patients with VT, femoral CVCs, young age, paediatric ICU admission, and a ratio of CVC/vein diameter >0.33 were associated with VT being symptomatic, occlusive, or both. IJV VT was often asymptomatic and non-occlusive. CONCLUSIONS: Paediatric non-tunnelled CVCs are frequently complicated by VT. Avoiding IJV CVCs and multiple lumen catheters could potentially reduce the overall risk of VT. However, IJV VT was more likely to be smaller and asymptomatic compared with femoral vein VT. More data are needed on the risk of complications from smaller, asymptomatic VT compared with the group of VT with symptoms or vein occlusion. Femoral vein CVCs and CVC/vein diameter >0.33 could be modifiable risk factors for VT with larger thrombotic mass. CLINICAL TRIAL REGISTRATION: ACTRN12615000442505.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Trombose Venosa/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Criança , Pré-Escolar , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Incidência , Lactente , Veias Jugulares/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologia , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia
9.
Gan To Kagaku Ryoho ; 46(Suppl 1): 135-137, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31189838

RESUMO

Peripherally inserted central venous catheters(PICCs)are widely used given they have lower incidence of serious complications than central venous catheters. We evaluated the safety and usefulness of ultrasound-guided PICC placement for cancer patients in palliative care settings. We attempted to insert PICCs in 42 patients, and the insertion was successful in 40 (95.2%)patients. Complications occurred in 9(22.5%)patients, but none were severe. In 30 cases, PICCs were used for infusion and drug delivery until cancer death. The duration of catheterization was 25(1-126)days. Our results suggest that ultrasound-guided PICC represents a safe and usefultoolfor cancer patients in palliative care settings.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Neoplasias , Cateteres de Demora , Humanos , Neoplasias/terapia , Cuidados Paliativos , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 98(25): e16182, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232976

RESUMO

RATIONALE: In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage. PATIENTS CONCERNS: Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis. DIAGNOSES: Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed. INTERVENTIONS: In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed. OUTCOME: In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained. LESSONS: When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Veias Jugulares/lesões , Adulto , Idoso de 80 Anos ou mais , Angiografia Digital/métodos , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Diálise Renal/métodos
12.
Soins ; 64(836): 13-16, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208575

RESUMO

Chemotherapy for cancer patients often requires a central venous catheter the insertion of which has previously been the exclusive remit of medics. As the shortage of doctors worsens, waiting times for catheter placement have increased. The implementation of the 'Transfer of competence: nurse-led central venous catheter insertion' cooperation protocol in 2016, in the Paris hospital trust (AP-HP), has enabled these waiting times to be reduced without any increase in the frequency of complications or effects on the safety of the procedure.


Assuntos
Cateterismo Venoso Central/enfermagem , Padrões de Prática em Enfermagem , Protocolos Clínicos , Comportamento Cooperativo , Humanos , Paris
13.
J Vasc Access ; 20(5): 537-544, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31084398

RESUMO

AIM: The aim of the study was to evaluate individually uploaded Internet materials about catheter insertion and removal in terms of their educative value. METHODS: YouTube videos for both catheter insertion and catheter removal were investigated. Rating, like, dislike, the position of a patient, maneuvers during removal, immediate coverage of removal site, and type of cover material were noted. A survey regarding daily practices for catheter interventions and approaches to educative social media platforms had been taken from medical professionals as well to determine the effect of social media on learning practices. RESULTS: A total of 50 insertion and 35 removal videos were investigated. The popularity of insertion and removal videos was 4.7 (1.6-16.5) and 1.88 (0.66-4.54), respectively. (p = 0.011). The position of a patient during insertion was supine in 80%, Trendelenburg in 18%, and upright in 82.9% of the removal videos (p = 0.000). The survey showed that medical professionals watched insertion videos (66%) more than removal videos (11.7%) (p = 0.002). Catheter insertion positions were similar among participants (p = 0.553). Removal positions were different in specialties (p = 0.023) in which especially nephrologists tend to remove the catheter at the sitting position. CONCLUSION: Medical professionals think that removal is an easier procedure than insertion. They both search more for insertion videos and upload more insertion videos. Insertion practices are similar among different specialties. However, removal practices are more heterogeneous. Individually uploaded catheter videos at YouTube are not reliable educative materials. More free official work should be produced to maintain sufficient qualified online material on social media platforms.


Assuntos
Cateterismo Venoso Central/métodos , Instrução por Computador/métodos , Remoção de Dispositivo/métodos , Internet , Mídias Sociais , Gravação em Vídeo , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Humanos , Posicionamento do Paciente
15.
BMC Infect Dis ; 19(1): 429, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096918

RESUMO

BACKGROUND: Several randomized controlled trials (RCTs) evaluated the role of Chlorhexidine-impregnated dressing for prophylaxis of central venous catheter (CVC) related complications, but the results remained inconsistent, updated meta-analyses on this issue are warranted. METHODS: A meta-analysis on the RCTs comparing Chlorhexidine-impregnated dressing versus other dressing or no dressing for prophylaxis of central venous catheter-related complications was performed. A comprehensive search of major databases was undertaken up to 30 Dec 2018 to identify related studies. Pooled odd ratio (OR) and mean differences (MDs) with 95% confidence intervals (CI) were calculated using either a fixed-effects or random-effects model. Subgroup analysis was performed to identify the source of heterogeneity, and funnel plot and Egger test was used to identify the publication bias. RESULTS: A total of 12 RCTs with 6028 patients were included. The Chlorhexidine-impregnated dressings provided significant benefits in reducing the risk of catheter colonization (OR = 0.46, 95% CI: 0.36 to 0.58), decreasing the incidence of catheter-related bloodstream infection (CRBSI) (OR = 0.60, 95% CI: 0.42 to 0.85). Subgroup analysis indicated that the Chlorhexidine-impregnated dressings were conducive to reduce the risk of catheter colonization and CRBSI within the included RCTs with sample size more than 200, but the differences weren't observed for those with sample less than 200. No publication bias was observed in the Egger test for the risk of CRBSI. CONCLUSIONS: Chlorhexidine-impregnated dressing is beneficial to prevent CVC-related complications. Future studies are warranted to assess the role and cost-effectiveness of Chlorhexidine-impregnated dressings.


Assuntos
Anti-Infecciosos Locais/farmacologia , Bandagens , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Clorexidina/farmacologia , Bandagens/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Clorexidina/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Rev Lat Am Enfermagem ; 27: e3125, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038627

RESUMO

OBJECTIVES: during peripheral venipuncture, health professionals are recommended to use a tourniquet above the puncture site in order to potentiate venous distension. Given its characteristics and use in clinical settings, tourniquets may represent a source of microorganism dissemination. However, the results of scientific studies in this area are scattered in the literature. This scoping review aims to map the available evidence on health professionals' practices related with tourniquet use during peripheral venipuncture and associated microbiological contamination. METHODS: scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. RESULTS: fifteen studies were included in the review. Overall, tourniquets were reused without being subject to recurring decontamination processes. It has been found that practitioners share these devices among themselves and use them successively for periods between two weeks and seven and half years. CONCLUSION: nursing practices related to tourniquet use during peripheral venipuncture are not standard. Reuse of tourniquets may jeopardize the patient's safety if reprocessing (cleaning and disinfection/sterilization) is not adequate, given the type of tourniquet material and microbiota found. New studies are needed to assess the impact of various types of reprocessing practices on tourniquet decontamination and patient safety.


Assuntos
Cateterismo Venoso Central , Desinfecção , Pessoal de Saúde , Flebotomia/métodos , Prática Profissional , Torniquetes/microbiologia , Contaminação de Equipamentos , Humanos , Segurança do Paciente , Portugal , Torniquetes/normas
17.
Anaesthesia ; 74(7): 896-903, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31062348

RESUMO

Central venous catheter insertion is a routine procedure performed by anaesthetists in the peri-operative setting. Upper body central venous catheters are usually placed such that their tip lies within the superior vena cava or at the cavo-atrial junction. Positioning the tip 'too low' in the right atrium has long been argued against on the basis that it increases the risk of perforation, leading to cardiac tamponade. Positioning the tip 'too high' in the brachiocephalic vein or above can also be problematic in that proximal migration can result in extravascular placement of the proximal lumen. Such an incident occurred at our hospital in 2016, resulting in extravasation of a vesicant medication causing tissue necrosis. We undertook a quality improvement project involving a standardised bundle of care and a peri-operative central venous catheter insertion checklist with the aim of reducing the risk of such an incident re-occurring. We conducted a three-month pre-intervention audit (n = 84) in 2016 and a post-intervention audit (n = 84) in 2017. Compared with the pre-intervention audit, the post-intervention audit coincided with a lower rate of central venous catheter tip malpositioning (5.6% vs. 9.2%); and a higher rate of 'optimal' central venous catheter tip position in the distal superior vena cava or cavo-atrial junction (45.1% vs. 29.2%). The central venous catheter insertion checklist also substantially improved documentation of sterility measures, insertion depth and post-insertional documentation of tip position on chest radiograph.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Lista de Checagem/métodos , Melhoria de Qualidade , Austrália , Humanos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
18.
J Comput Assist Tomogr ; 43(3): 423-427, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082947

RESUMO

PURPOSE: To compare the fenestrated intravenous (IV) catheter and nonfenestrated conventional IV catheter in terms of contrast enhancement and injection pressure for coronary computed tomography angiography. METHODS: Three hundred patients were prospectively and consecutively enrolled to either the 20-gauge nonfenestrated conventional (group 1) IV catheter group or the 20-gauge fenestrated (group 2) or 22-gauge fenestrated (group 3) IV catheter groups. We analyzed mean vascular attenuations in the ascending aorta, left main coronary artery, left ventricular (LV) cavity, and descending aorta. Injection pressure using pound-force per square inch (PSI) and extravasation of contrast media were recorded. RESULTS: Mean attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 2 than in group 1 (P ≤ 0.001, P ≤ 0.001, P ≤ 0.001, respectively). Moreover, injection pressure was significantly lower in group 2 than in group 1 (208.3 vs 216.9 PSI, P = 0.006). Mean vascular attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 3 than in group 1 (P = 0.016, P = 0.029, P = 0.001, respectively). However, injection pressure was not statistically significant between group 3 and group 1 (213.6 vs 216.9 PSI, P = 0.355). No extravasation occurred in any patient groups during the study. CONCLUSIONS: We suggest that fenestrated IV catheter is useful in terms of higher vascular attenuation and lower injection pressure for coronary computed tomography angiography. It has a potential merit in patients with fragile and small veins.


Assuntos
Cateterismo Venoso Central/métodos , Meios de Contraste/administração & dosagem , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Cateteres Venosos Centrais , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Intervencionista/métodos
19.
Prague Med Rep ; 120(1): 18-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31103050

RESUMO

Extravasal guide wire entrapment due to fraying during central venous catheter placement using the Seldinger technique is a rare complication, which should be resolved as soon as possible. A 68-year-old male was scheduled for open right-side decortication. After the induction of general anesthesia, an attempt was made to place a central venous line in the right subclavian vein. However, the guide wire was entrapped extravasally between the right clavicle and the first rib. The exact site was located by palpating the bend of the guide wire in the subclavian triangle and the thoracic surgeon was available. Therefore, it was decided not to try to visualize the guide wire any further and to immediately proceed with surgical removal of the guide wire. The platysma muscle was dissected allowing access to the subclavian triangle. Venotomy of the external jugular vein was performed and the entrapped guide wire was removed via the venotomy. The whole complication was resolved within 30 minutes and the primary procedure was then performed. Managing rare complications of central venous line placement requires skill, ingenuity and, sometimes, interdisciplinary cooperation, either with a radiologist or a surgeon. The decision to proceed with immediate surgical removal of the guide wire proved a right one, and, to the best of our knowledge, such a strategy has not been described in the relevant literature to date.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Remoção de Dispositivo , Idoso , Cateteres Venosos Centrais/efeitos adversos , Humanos , Veias Jugulares , Masculino , Veia Subclávia
20.
J Neurosci Nurs ; 51(3): 129-133, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30964845

RESUMO

BACKGROUND: Venous access, via a midline peripheral catheter (midline) or a peripherally inserted central catheter, is used regularly in the neurointensive care unit as a means for prolonged infusion of drugs or medications. There is little research on how to choose the appropriate access device to use in this setting. The aim of this study is to trial an algorithm to assist clinicians in determining which device to use, as a way to reduce patient complications such as central line-associated bloodstream infection and deep vein thrombosis. METHODS: This quality improvement initiative included both retrospective and prospective data. A retrospective chart review was performed, and data were analyzed for variables associated with decision making between the 2 access devices. An algorithm was developed to assist clinicians with deciding between midline access and peripherally inserted central catheter access. RESULTS: A total of 325 charts were reviewed (126 retrospective and 109 prospective). Results show no significant differences in the demographic characteristics of either group. Before intervention, clinicians chose the correct access device 86% of the time, whereas after the intervention, clinicians chose the correct device 78% of the time (P = .06). CONCLUSION: The results of this study indicate that the quality improvement intervention and algorithm decision-making tool did not improve accuracy of use of access devices.


Assuntos
Algoritmos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Tomada de Decisão Clínica , Julgamento , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
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