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1.
Ann Palliat Med ; 10(9): 9398-9405, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628865

RESUMO

BACKGROUND: A peripherally inserted central catheter (PICC) effectively reduces frequent vein punctures in cancer patients. With increasing clinical applications, PICC-associated infections are attracting increasing attention. In this study, we retrospectively analyzed PICC-associated infections in chemotherapy patients treated at our hospital in recent years to identify risk factors for PICC-associated infections and the preventive effect of a self-efficacy intervention program. METHODS: Using a convenience sampling method, we selected 159 cancer patients who received chemotherapy through a PICC at our hospital between July 2017 and December 2018, and the patients were randomly divided to an observation group (n=79) and a control group (n=80) using a random number table. The control group received conventional intervention, and the observation group received a self-efficacy intervention. We analyzed self-efficacy scores before and after the intervention, the complication rate, the infection rate, pathogens identified, and risk factors for PICC-associated infections. RESULTS: Among the 159 chemotherapy patients, 26 (16.35%) experienced PICC-associated infections in this finished trial. Univariate analysis showed that sex, puncture site, and steroid use were unrelated to PICC-associated infections (P>0.05), whereas PICC indwelling time, white blood cell (WBC) count, a history of diabetes, and immunity were significantly related to PICC-associated infections (P<0.05). The self-efficacy score improved after the intervention in both groups, especially in the observation group (P<0.05). The incidence of complications such as catheter infection, catheter blockage, and catheter displacement was significantly lower in the observation group than in the control group (16. 67% vs. 88.10%; P<0.05). CONCLUSIONS: The self-efficacy intervention improves self-management and reduces complications in cancer patients receiving chemotherapy through a PICC. PICC indwelling time, WBC count, a history of diabetes, and immunity are independent risk factors for PICC-associated infections; thus, measures should be implemented to prevent infections. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100050651.


Assuntos
Cateterismo Venoso Central , Autoeficácia , Cateterismo Venoso Central/efeitos adversos , Cateteres , Humanos , Estudos Retrospectivos , Fatores de Risco
3.
Am J Case Rep ; 22: e932354, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34525010

RESUMO

BACKGROUND Central venous catheterization (CVC) is indispensable in the management of critically ill patients in the emergency room and intensive care units, either to avoid the various peripheral punctures and vasoactive drugs administration in decompensated patients, or even to administer parenteral nutrition. CVC is an invasive procedure with possible mechanical, infectious, and thrombotic complications. The complete knotting of a catheter is a rare complication. The aim of this study is to report a case of a simple tight knot 2 cm from the catheter tip. We provide insights for early identification of catheter knotting, as well as its management. CASE REPORT A 63-year-old man with a previous history of angioplasty and non-pharmacological coronary stent in a marginal branch of the circumflex coronary artery evolved to junctional bradycardia and cardiogenic shock and was transferred to the reference hospital. He had a CVC inserted in the right jugular vein; however, it did not have any blood flow. The hypothesis of catheter knotting was suggested and confirmed through a chest X-ray. Venotomy was performed and it was successfully removed. CONCLUSIONS Knotting in CVC obstruction is a rare complication. Recognition of this complication is essential to avoid major complications, such as catheter fragmentation and venous injury. Radiological follow-up after the procedure in patients with difficult anatomy is essential, and echo-guided catheterization should be encouraged when available. Despite the rarity of a knotted intravascular catheter, it is important to note this possible late complication that must be considered in the absence of catheter blood flow.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Estado Terminal , Humanos , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral
4.
Intern Med ; 60(17): 2765-2770, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34470985

RESUMO

Objective A central venous catheter (CVC) is often needed to treat hematologic diseases, but it is accompanied by many complications. Ultrasound guidance (USG) or a peripherally inserted central venous catheter (PICC) can reduce such complications. Meterials We collected data of patients with attempted CVC placement in our hematology unit in 2012 (before introduction of USG and PICC) and 2018 (after introduction) and compared both periods. Results In total, 187 CVC insertions were attempted in 2018 and 198 in 2012. USG was used 154 times (82%) in 2018 and 4 times (2%) in 2012 (p<0.001). The success rates of insertion were 95% in 2018 and 89% in 2012 (p=0.063). The incidence of acute complications was 4.3% in 2018 and 9.1% in 2012 (p=0.069). The incidence of CVC removal owing to delayed complications was 26% in 2018 and 21% in 2012 (p=0.327). The sites of approach in 2018 and 2012 were the internal jugular in 42 (22%) and 54 (27%), subclavian in 52 (28%) and 128 (65%), brachial (PICC) in 89 (48%) and 14 (7%), and femoral in 4 (2%) and 2 (1%), respectively (p<0.001). Conclusion USG has become commonplace since its introduction. The landmark-based subclavian approach was largely replaced by PICC with USG in 2018. USG and PICC can help improve success rates and safety profiles.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Hematologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Ultrassonografia
5.
Ann Palliat Med ; 10(8): 9105-9113, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488396

RESUMO

BACKGROUND: To evaluate the effects and safety of peripherally inserted central catheters (PICCs) and venous access ports (PORTs) for cancer patients receiving chemotherapy. METHODS: We searched randomized controlled trials and retrospective cohort studies comparing PICCs to PORTs in cancer patients receiving chemotherapy. Data were extracted from relevant studies. We sought to evaluate procedure time, quality of life and thrombosis [risk ratio (RR) =4.37, 95% CI, 2.10, 9.07, P<0.0001, I2=22%]. Sensitivity analysis and the funnel plot showed that our study was robust and exhibited low publication bias. RESULTS: Ten previous studies were incorporated into this study for a total sample size of 2,585 patients. There was no difference between the PICC and PORT groups in QOL (MD =-1.12, 95% CI, -6.14, 3.91, P=0.66, fixed effect model, I2=32%). PORT required a longer procedure time than the PICC procedure (the overall MD was -5.55 with 95% CI, -6.96, -4.14, I2=0%), and PICCs had more associated complications than PORTs including occlusion (MD =5.42, 95% CI, 2.13, 13.75, P=0.0004, I2=40%) and thrombosis (risk ratio (RR) =4.37, 95% CI, 2.10, 9.07, P<0.0001, I2=22%). Sensitivity analysis and the funnel plot showed that our study was robust and exhibited low publication bias. DISCUSSION: Our study suggested that PORTs had similar clinical effects to PICCs in cancer patients receiving chemotherapy. However, PORTs were associated with fewer complications than PICCs.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Neoplasias , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Neoplasias/tratamento farmacológico , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco
6.
Gan To Kagaku Ryoho ; 48(9): 1133-1137, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34521791

RESUMO

We conducted a questionnaire survey of patients with breast cancer who underwent implantation of a subcutaneous central venous port system for chemotherapy; we aimed to evaluate their satisfaction with the port and difficulties in daily life. Overall, 130 patients with breast cancer who underwent port implantation for chemotherapy between 2016 and 2018 responded to our survey. Although the overall satisfaction was high(78.5%), 82(63.1%)patients reported difficulties in daily life, such as"pain or discomfort,""irritation over the implanted area while wearing a seat belt,"and"unable to wear a bag across their bodies."Some patients(10.8%)responded that these negative factors were associated with difficulties in carrying out social roles. The proportion of patients who understood the explanation provided before port implantation was 80.0%, and the satisfaction of these patients tended to be high(85.6%).


Assuntos
Neoplasias da Mama , Cateterismo Venoso Central , Neoplasias da Mama/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora , Feminino , Humanos , Satisfação do Paciente , Satisfação Pessoal , Inquéritos e Questionários
7.
Rev Bras Enferm ; 74(6): e20201073, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34431937

RESUMO

OBJECTIVES: to establish the prevalence of salvage of central venous catheters in newborns with bloodstream infection caused by coagulase-negative staphylococci. METHODS: retrospective cross-sectional study with 136 newborns admitted to the Neonatal Intensive Care Unit between 2011 and 2017. The total of 143 infection events undergoing antibiotic therapy were evaluated. RESULTS: among the 143 infection events, 39 catheters in which antibiotic therapy was used were saved and in 69 cases, the device was removed. Positive central blood culture and single lumen catheter were factors associated with salvage failure. The probability of salvage decreased with infections diagnosed from 15 days of using the catheter. Negative blood culture raised the chance of salvage by fourfold. CONCLUSIONS: the use of antibiotic therapy in the treatment of infections resulted in a low prevalence of salvage of the central venous catheter. The probability of salvage was associated with variables of the device.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Sepse , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Estudos Transversais , Humanos , Recém-Nascido , Prevalência , Estudos Retrospectivos
8.
Anaesth Intensive Care ; 49(4): 275-283, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34392707

RESUMO

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Idoso , Cateterismo Venoso Central/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos , Fatores de Risco , Vasoconstritores
9.
J Med Life ; 14(3): 298-309, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34377194

RESUMO

Accessing the veins for blood delivery, sampling or nutrition is a critical factor in the process of care and management of pediatric patients. In this regard, the peripherally inserted central catheter (PICC) is one of the main alternatives which could be applied effectively as traditional central venous devices in neonates and adults. Due to their essential role in providing safe central venous entry, PICCs could be applied extensively in patients who are critically ill. The main aims of the present study are to review approximately all relevant publications concerning PICC procedures, any possible complications, and the most appropriate decision for preventing these complications due to their high mortality rate. We carried out a comprehensive search on PubMed, HubMed, EMBASE, MEDLINE, Science Direct, Scopus, MEDLINE, and EMBASE databases for identifying the most relevant publications related to potential complications following the application and insertion of PICCs in hospitalized children and infants. Through appropriate care of catheters, the rate of possible infectious, mechanical and thrombotic complications would decrease considerably compared to those patients who received traditional central venous catheters. However, the process of vascular access in neonatal and children is very challenging. Any delay or denying treatment due to the lack of vascular access is intolerable. In this regard, anesthesiologists must achieve extra knowledge of various vascular devices.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Adulto , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Criança , Estado Terminal , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos
10.
Br J Hosp Med (Lond) ; 82(7): 1-2, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338017

RESUMO

Central venous catheters are sited for a variety of reasons in the adult critically ill patient. There is clear guidance for indications and maintenance of central venous catheters, but there is no clear guidance on how long a central venous catheter should remain in situ. This article looks at evidence to answer this question.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Adulto , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Estado Terminal/terapia , Humanos
12.
Zhonghua Zhong Liu Za Zhi ; 43(8): 838-842, 2021 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-34407588

RESUMO

Objective: To explore the high risk factors of catheter-related thrombosis (CRT) in breast cancer patients, and provide the basis for the development of appropriate prevention and treatment strategies. Methods: A total of 1 432 breast cancer patients scheduled to receive central venous catheterization in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2015 to August 31, 2019 were selected. Baseline information and catheterization information of patients were collected. The occurrence of CRT was confirmed by vascular ultrasound examination, and the influencing factors of CRT were analyzed. Results: The total number of catheter days were 121, 980 days in 1 432 patients with breast cancer, and the average number of catheter days in each patient was 85.2 days. The incidence of CRT was 6.8% (97/1 432), which was 0.79 cases/1 000 catheter days. Among 815 patients with centrally inserted central venous catheters (CICC), 43 (5.3%) had CRT, which was 0.70 cases/1 000 catheter days. Among 617 patients with peripherally inserted central venous catheters (PICC), 54 (8.8%) developed CRT, which was 0.90 cases/1 000 catheter days. CRT was most common in subclavian vein (63.9%). Multivariate regression analysis showed that age ≥ 60 years old (OR=1.712, 95% CI: 1.056-2.775, P=0.029), PICC (OR=1.732, 95% CI: 1.130-2.656, P=0.012), the catheter position except subclavian vein (OR=10.420, 95% CI: 1.207-89.991), secondary adjustment of catheter position (OR=3.985, 95% CI: 1.510-10.521, P=0.005) and high D-Dimer level (OR=1.129, 95% CI: 1.026-1.241, P=0.012)were independent risk factors for CRT. Conclusions: The CRT problem can't be ignored in the clinical treatment of breast cancer patients with central venous catheterization. Screening the appropriate age of patients and the type of central venous catheters, reducing the secondary adjustment of catheter position, and timely monitoring the level of D-dimer are helpful to the prevention and treatment of CRT.


Assuntos
Neoplasias da Mama , Cateterismo Venoso Central , Cateteres Venosos Centrais , Trombose , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco
13.
Mo Med ; 118(4): 374-380, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34373674

RESUMO

Background: Peripherally inserted central catheter (PICC) placement is necessary for delivery of intravenous (IV) antibiotics to treat bone and soft tissue infections. Upper extremity deep venous thrombosis (DVT) after PICC placement is a complication with unknown incidence in the orthopaedic literature. The major objectives of this study are Identifying the rate of upper extremity PICC-associated DVTs after orthopaedic procedures;Which orthopaedic subspecialties are most likely to encounter an upper extremity PICC-associated DVT?What surgeries or medical comorbidities are risk factors for upper extremity PICC-associated DVTs?Does type of DVT chemoprophylaxis decrease the risk of an upper extremity PICC-associated DVT? Methods: A retrospective review of electronic medical records (EMR) was performed to include all patients undergoing irrigation and debridement (I&D) for treatment of orthopaedic surgery-related infections over a 10-year period. All patients with PICC placement were included for analyses. Age, sex, and medical comorbidities were extracted from the EMR. Mann-Whitney non-parametric tests, Fisher's exact tests, Chi-square tests, and Cochran-Mantel-Haenszel (CMH) tests were used to determine associations with DVT events for those with PICCs based on medical comorbidities, PICC lumen size, team placing the PICC, impact of implant removal, and protective effect of DVT chemoprophylaxis. Significance was set at p<0.05. Results: Twenty-one of 660 patients (3.18% rate) were found to have an upper extremity PICC-associated DVT. A history of DVT (OR=8.99 [95% CI: 3.39, 49.42]) was significantly associated with an upper extremity PICC-associated DVT. The greatest risk for an upper extremity PICC-associated DVT was intramedullary implant removal (OR=12.43 [95% CI: 3.13, 49.52]). The type of DVT chemoprophylaxis did not significantly affect the likelihood of an upper extremity PICC-associated DVT. Conclusion: Intramedullary implant removal and a history of DVT are risk factors for an upper extremity PICC-associated DVT. The results of this study should be of particular interest to surgeons who do not typically give DVT prophylaxis and plan to perform surgery on patients with CHF, a history of a DVT, or plan to manipulate the intramedullary canal.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Ortopedia , Trombose Venosa , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres , Desbridamento , Humanos , Estudos Retrospectivos , Fatores de Risco , Extremidade Superior , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
14.
Int J Nurs Stud ; 121: 104003, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34273807

RESUMO

BACKGROUND: The negative synergistic effect of cancer and a peripherally inserted central catheter could significantly increase the incidence of thrombosis. Rather than identifying risk factors for peripherally inserted central catheter-related thrombosis, exploring the effect of these risk factors might be a promising method to improve the outcomes of thrombosis. OBJECTIVES: To analyze the effect of systemic and local risk factors on triggering peripherally inserted central catheter-related thrombosis in the first two weeks post-insertion in cancer patients. DESIGN: A prospective cohort study. SETTING: The study was conducted at a 4500-bed university-affiliated medical center in China. PARTICIPANTS: One hundred seventy-three cancer patients with peripherally inserted central catheters were included. METHODS: Peripherally inserted central catheter-related thrombosis was assessed using ultrasound at a series of timepoints, once every two days post-insertion. Data on age, body mass index, blood hypercoagulation, insertion attempts, catheter-to-vein ratio, and blood flow velocity were collected as risk factors. Descriptive statistics and structural equation modeling were used to describe the study samples and analyze the effects of systemic and local risk factors. RESULTS: Among the 173 cancer patients included, 126 (72.8%) patients were diagnosed with peripherally inserted central catheter-related thrombosis. Most thromboses (n = 118, 93.7%) were detected within five days, and 100% were detected within nine days post-insertion. Structural equation modeling analysis showed that local risk factors [catheter-to-vein ratio (standardized path coefficient = 0.32, p < 0.05) and blood flow velocity (standardized path coefficient = -0.35, p < 0.05)] had a greater effect than systemic factors [age (standardized path coefficient = 0.13, p < 0.05) and blood hypercoagulation (standardized path coefficient = 0.17, p < 0.05)] on triggering peripherally inserted central catheter-related thrombosis. CONCLUSION: Peripherally inserted central catheter-related thrombosis is quite common and can occur very early post-insertion in cancer patients. Among the common risk factors, local risk factors reflecting peripherally inserted central catheter technology itself had a greater effect than systemic risk factors reflecting predisposition to thrombosis. Clinical Registration: Clinical Trials ChiCTR1900024890.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Neoplasias , Trombose , Trombose Venosa , Cateterismo Venoso Central/efeitos adversos , Cateteres , Humanos , Análise de Classes Latentes , Neoplasias/complicações , Estudos Prospectivos , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/etiologia
15.
Am J Crit Care ; 30(4): 295-301, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34195778

RESUMO

BACKGROUND: More than 1 billion peripheral vascular access devices are inserted annually worldwide with potential complications including infection, thrombosis, and vasculature damage. Vasculature damage can necessitate the use of central catheters, which carry additional risks such as central catheter-associated bloodstream infections. To address these concerns, one institution used expert nurses and a consult request system with algorithms embedded in the electronic medical record. OBJECTIVES: To develop a uniform process for catheter insertion by means of a peripheral vascular access service dedicated to selecting, placing, and maintaining all inpatient peripheral catheters outside of the intensive care units. METHODS: Descriptive analysis and χ2 analysis were done to describe the impact of the peripheral vascular access service. RESULTS: In 2018, 6246 consults were reviewed. Of these, 26% did not require vascular access. Similarly, in 2019, 7861 consults were reviewed, and 35.3% did not require vascular access. Use of central catheters decreased from 21% in 2017 to 17% in 2018 and 2019. CONCLUSIONS: The peripheral vascular access service allowed patients to receive appropriate peripheral vascular access devices and avoid unnecessary peripheral catheter placements. This may have preserved patients' peripheral vasculature and thus prevented premature central catheter placement and contributed to an overall decrease in central catheter days. With the peripheral vascular access service, peripheral vascular access devices were selected, placed, and maintained by experts with a standardized process that promoted a culture of quality and patient safety.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateterismo Periférico , Cateteres Venosos Centrais , Dispositivos de Acesso Vascular , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Dispositivos de Acesso Vascular/efeitos adversos
16.
BMJ Open ; 11(7): e045895, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226216

RESUMO

OBJECTIVES: Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group. DESIGN: Retrospective cohort study. SETTING: 4 tertiary hospitals in Australia and New Zealand. PARTICIPANTS: Adults who had undergone PICC insertion. PRIMARY OUTCOME MEASURE: Symptomatic thrombus of the limb in which the PICC was inserted. RESULTS: 2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions. CONCLUSIONS: Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Trombose Venosa Profunda de Membros Superiores , Adulto , Austrália , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres , Humanos , Nova Zelândia , Estudos Retrospectivos , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-34300069

RESUMO

Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous therapy and/or therapy for extended periods. The purpose of this study was to understand nurses' perspectives about PICC implementation in their clinical practice. As part of an action-research project, three focus groups were developed in June 2019 with nineteen nurses of a cardiology ward from a Portuguese tertiary hospital. From the content analysis, two main categories emerged: 'nursing practices' and 'patients'. Nurses considered PICC beneficial for their clinical practice because it facilitates maintenance care and catheter replacement rates. Moreover, nurses suggested that, since there is a need for specific skills, the constitution of vascular access teams, as recommended by international guidelines, could be an advantage. Regarding patient benefits, nurses highlighted a decrease in the number of venipunctures and also of patient discomfort, which was associated with the number of peripheral venous catheters. Infection prevention was also indicated. As an emerging medical device used among clinicians, peripherally inserted central catheters seem to be essential to clinical practice.


Assuntos
Cardiologia , Cateterismo Venoso Central , Enfermeiras e Enfermeiros , Cateterismo Venoso Central/efeitos adversos , Cateteres , Grupos Focais , Humanos
18.
BMJ Case Rep ; 14(7)2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330728

RESUMO

This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.


Assuntos
Cateterismo Venoso Central , Enfisema Mediastínico , Derrame Pleural , Adulto , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Nutrição Parenteral Total/efeitos adversos , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Veia Subclávia/diagnóstico por imagem
19.
Semin Dial ; 34(5): 360-367, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34259363

RESUMO

BACKGROUND: Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS-CoV-2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID-19 on MHD in a large cohort of patients from India. METHODS: Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox-regression analysis. RESULTS: Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID-19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID-19 (p = 0.001). Mortality was higher among patients on twice-weekly MHD than thrice-weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26-5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52-8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25-0.99, p = 0.049) had significant effect on mortality. CONCLUSION: The adjusted mortality risk of COVID-19 in MHD patients is high in patients associated with severe COVID-19 and patients having CVC as vascular access.


Assuntos
COVID-19/mortalidade , Diálise Renal , Fatores Etários , Cateterismo Venoso Central/efeitos adversos , Comorbidade , Feminino , Mortalidade Hospitalar , Unidades Hospitalares , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Estudos Prospectivos , Índice de Gravidade de Doença
20.
Paediatr Anaesth ; 31(9): 996-1002, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34166555

RESUMO

BACKGROUND: Due to excess catheter length, pediatric patients undergoing cardiac surgery frequently have the tip of the central venous catheter trimmed while on bypass to obtain optimal catheter positioning. AIMS: We sought to determine if there is a correlation between the patient's height or weight and the length of catheter removed. Our secondary aim compared the instances of central line-associated bloodstream infections and venous thromboembolisms between the trimmed and untrimmed catheters. METHODS: This retrospective study included patients having undergone cardiac surgery over a 3-year period who had an 8 cm central venous catheter placed in the right internal jugular vein. Hospital lists of central line-associated bloodstream infections and venous thromboembolisms that occurred were cross referenced with our study patients. RESULTS: There were 147 cases where the 8 cm central venous catheter was trimmed, which represents 35% of the cases. Of the catheters that were cut, on average 2.17 cm was removed. There is negligible correlation between the length of catheter removed and patient height (r = -.19, p = .021). There is negligible correlation between the length of catheter removed and patient weight (r = -.17, p = .039). There were no instances of central line-associated bloodstream infections or venous thromboembolisms attributed to the trimmed catheters. Of the 273 untrimmed catheters, there were no instances of an infection and one instance of a venous thromboembolism. CONCLUSION: Right internal jugular 8 cm central venous catheters are trimmed during pediatric cardiac surgery, and there is minimal correlation between the length removed and the patient height or weight. Due to the difficulty in estimating the proper length of a central venous catheter in smaller pediatric patients, placing an 8 cm long catheter in these patients and then trimming the distal tip while on bypass may be the most accurate way to properly position a catheter.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cateterismo Venoso Central , Cateteres Venosos Centrais , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Criança , Humanos , Veias Jugulares , Estudos Retrospectivos
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