MedWorm: Central Venous Catheterization

Clinical Performance and Skill Retention after Simulation‐based Education for Nephrology Fellows

Seminars In Dialysis — Tue, 07 Feb 2012 05:00:00 +0100

AbstractWe previously demonstrated that simulation‐based education (SBE) improved temporary hemodialysis catheter (THDC) insertion skills by nephrology fellows. SBE, featuring deliberate practice and rigorous achievement standards, was a powerful method to enhance THDC insertion skills in nephrology fellows. However, experts have called for further research to evaluate skill transfer from the simulated environment to actual clinical care and skill retention. This is a prospective observational cohort study of THDC insertion skills. Twelve nephrology fellows from three academic centers in Chicago were evaluated using a skills checklist from July 2008 to June 2009. Simulator‐trained fellows were tested after the SBE intervention and expected to meet or exceed a minimum passing score (MPS...

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Two case reports of the transverse cervical artery description under and below internal jugular veins in securing pediatric central venous catheters by ultrasound echo images.

Paediatric Anaesthesia — Sun, 05 Feb 2012 17:48:40 +0100

Authors: Kayashima K, Imai K, Sozen R PMID: 22272681 [PubMed - in process] (Source: Paediatric Anaesthesia)

A case report of an accidental vertebral arterial puncture videotaped during central venous catheterization in a child undergoing a ventricular septal defect repair.

Paediatric Anaesthesia — Sun, 05 Feb 2012 17:48:31 +0100

Authors: Kayashima K, Habe K PMID: 22272682 [PubMed - in process] (Source: Paediatric Anaesthesia)

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients

BioMed Central — Sat, 04 Feb 2012 05:00:00 +0100

Power injectable peripherally inserted central catheters can be used successfully in most intensive care unit patients with few contraindications and low rates of complications, similar to central venous catheters (CVC). (Source: BioMed Central)

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

Journal of Perinatology — Thu, 02 Feb 2012 05:00:00 +0100

Authors: B Isemann, R Sorrels & H Akinbi (Source: Journal of Perinatology)

Strategic patient education program to prevent catheter-related bloodstream infection.

Clinical Journal of Oncology Nursing — Wed, 01 Feb 2012 05:00:00 +0100

This article presents the history and roles of the Infusion Therapy Team at the University of Texas MD Anderson Cancer Center in CVC care and describes an organized patient education program that plays a key part in the institution's strategy to reduce and prevent CRBSI. Institutional standard policies and procedures for patient care should be in compliance with guidelines of the Centers for Disease Control and Prevention and the Joint Commission before any patient educational initiative is implemented. Such standards will serve as a guide to set up, organize, and implement an effective program. PMID: 22297016 [PubMed - in process] (Source: Clinical Journal of Oncology Nursing)

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Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring

Journal of Clinical Monitoring and Computing — Mon, 30 Jan 2012 16:07:40 +0100

In conclusion, PICCs are equivalent to CVCs when measuring static and dynamic pressure in vitro and CVP in ICU patients. Content Type Journal ArticlePages 1-6DOI 10.1007/s10877-012-9337-1Authors Heath E. Latham, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, USAScott T. Rawson, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, USATimothy T. Dwyer, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, USAChirag C. Patel, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 390...

Non-invasive estimation of jugular venous oxygen saturation: a comparison between near infrared spectroscopy and transcutaneous venous oximetry

Journal of Clinical Monitoring and Computing — Mon, 30 Jan 2012 16:07:39 +0100

This study aimed to compare two non-invasive technologies for the estimation of regional venous saturation (reflectance plethysmography and near infrared spectroscopy [NIRS]), using venous blood gas analysis as gold standard. Forty patients undergoing cardiac surgery were recruited in two groups. In the first group a reflectance pulse oximeter probe was placed on the skin overlying the internal jugular vein. In the second group, a Somanetics INVOS oximeter patch was placed on the skin overlying the internal jugular vein and overlying the ipsilateral cerebral hemisphere. Central venous catheters were placed in all patients. Oxygen saturation estimates from both groups were compared with measured saturation from venous blood. Twenty patients participated in each group. Data were analy...

Cardinal Health And Cook Medical Announce Exclusive Agreement For Customizable Vascular Access Kitting Solution

Medical Design Online News — Mon, 30 Jan 2012 14:00:00 +0100

Cardinal Health and Cook Medical today announced a two-year, exclusive agreement for the North American distribution of Cook Medical central venous catheter (CVC) sets with Cardinal Health Presource customizable procedural kits - providing clinicians with advanced technology the flexibility of customization for their vascular access needs (Source: Medical Design Online News)

Effect of acute hyperventilation on the venous-arterial PCO2 difference

Critical Care — Mon, 30 Jan 2012 05:00:00 +0100

I read with great interest the article by Morel et al. [1], suggesting that acute changes in the arterial partial pressure of carbon dioxide (PaCO2) can affect the venous-arterial difference in carbon dioxide tension ([increment]CO2). Ten ventilated and hemodynamically stable patients were included after elective cardiac surgery. Hypocapnia was induced by increasing of respiratory rate. The authors found that a decrease of PaCO2 was associated with a significant increase in [increment]CO2. This was explained by the fact that acute hypocapnia resulted in systemic vasoconstriction, thus decreasing the elimination of the total CO2 produced by the peripheral tissues, and therefore increased the gap. However, as all patients were monitored with a pulmonary artery catheter (PAC), the authors sho...

Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis

Nephrology Dialysis Transplantation — Fri, 27 Jan 2012 05:00:00 +0100

Conclusions. Dialysis modality (PD versus HD) in an acute unplanned dialysis setting showed, in our population, no significant influence on survival. HD patients had a significantly higher risk of bacteraemia, perhaps due to central venous dialysis catheter. PD seems to be a safe and efficient, at least comparable, alternative to HD in acute unplanned dialysis settings. (Source: Nephrology Dialysis Transplantation)

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A case report of an accidental vertebral arterial puncture videotaped during central venous catheterization in a child undergoing a ventricular septal defect repair

Pediatric Anesthesia — Thu, 26 Jan 2012 12:13:26 +0100

(Source: Pediatric Anesthesia)

Two case reports of the transverse cervical artery description under and below internal jugular veins in securing pediatric central venous catheters by ultrasound echo images

Pediatric Anesthesia — Thu, 26 Jan 2012 12:13:24 +0100

(Source: Pediatric Anesthesia)

Savene® (dexrazoxane) use in clinical practice

Supportive Care in Cancer — Thu, 26 Jan 2012 06:55:52 +0100

Conclusion These data are comparable with the data from previous clinical trials and confirm the efficacy and safety profile of Savene® in clinical practice for the treatment of anthracycline extravasation, including extravasations from central venous catheters. Content Type Journal ArticleCategory Short CommunicationPages 1-4DOI 10.1007/s00520-012-1382-2Authors Christel Fontaine, Department of Medical Oncology, University Hospital of Brussels, 1090 Jette, BelgiumLuc Noens, Department of Haematology, University Hospital of Ghent, 9000 Ghent, BelgiumPascal Pierre, Department of Haemato-oncology, Hospital Saint Joseph, 6700 Arlon, BelgiumJacques De Grève, Department of Medical Oncology, University Hospital of Brussels, 1090 Jette, Belgium Journal Supportive Ca...

Anti-Tumor Necrosis Factor-α Monoclonal Antibody Alleviates Parenteral Nutrition-Associated Liver Disease in Mice.

JPEN Journal Of Parenteral And Enteral Nutrition — Tue, 24 Jan 2012 05:00:00 +0100

CONCLUSIONS: Infliximab administered at a single dose of 5 mg/kg body weight ameliorated the progression of PNALD and improved the expression of hepatic ABC transporter genes. Therefore, anti-TNF-α monoclonal antibody may be a beneficial therapy for patients with PNALD. (JPEN J Parenter Enteral Nutr. XXXX;XX:xx-xx). PMID: 22275328 [PubMed - as supplied by publisher] (Source: JPEN Journal Of Parenteral And Enteral Nutrition)

Influence of Parenteral Nutrition Delivery System on the Development of Bloodstream Infections in Critically Ill Patients: An International, Multicenter, Prospective, Open-Label, Controlled Study--EPICOS Study.

JPEN Journal Of Parenteral And Enteral Nutrition — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion: Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN. Trial registration number: NCT00798681. (JPEN J Parenter Enteral Nutr. XXXX;XX:xx-xx). PMID: 22269899 [PubMed - as supplied by publisher] (Source: JPEN Journal Of Parenteral And Enteral Nutrition)

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Woman With Supposed Anaphylactic Reaction

Annals of Emergency Medicine — Fri, 20 Jan 2012 19:16:32 +0100

[Ann Emerg Med. 2012;59:98.] A 30-year-old woman was referred to the emergency department (ED) after presumably having had an anaphylactic reaction to cotrimoxazole tablets. In the ED, she was conscious, oriented, tachypneic, tachycardic, and hypotensive (systolic blood pressure of 60 mm Hg). She was fluid resuscitated; a central venous catheter was placed in the left internal jugular vein uneventfully, and an epinephrine infusion was started. A chest radiograph was obtained after line placement (). (Source: Annals of Emergency Medicine)

Central venous catheter-related bloodstream infections in the intensive care unit

Indian Journal of Critical Care Medicine — Fri, 20 Jan 2012 05:00:00 +0100

Conclusions: The overall incidence of CRI was 27.77% (15/54). Catheter-associated BSIs were 47.31 per 1000 catheter-days. CRI was low in the catheters inserted by the experienced venipuncturists, elective procedure and CVC kept in situ for ≤3 days. S. epidermidis was the most common isolate. (Source: Indian Journal of Critical Care Medicine)

Corticosteroids and rituximab as adjunctive treatments for thrombotic thrombocytopenic purpura (TTP)

American Journal of Hematology — Thu, 19 Jan 2012 05:00:00 +0100

AbstractAlthough treatment with plasma exchange increased the survival of patients with thrombotic thrombocytopenia purpura (TTP) to 80% in the 1980s, no further increase of survival occurred over the next 20 years. However more consistent use of adjuvant treatment with corticosteroids and rituximab in recent years has begun to further increase survival as well as decrease the frequency of relapse. With adjuvant treatment, durable remissions can be achieved more quickly, requiring fewer days of plasma exchange. Fewer days of plasma exchange have resulted in fewer complications, such as central venous catheter‐related systemic infections. Future potential options for adjuvant treatment, recombinant ADAMTS13 to correct severe ADAMTS13 deficiency and agents to block von Willebrand factor‐...

A novel approach to percutaneous right-ventricular mechanical support [TX [amp ] MCS]

European Journal of Cardio-Thoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS Perc CM-RVAD was feasible and provided hemodynamic improvement. (Source: European Journal of Cardio-Thoracic Surgery)

Is a Neutral Head Position Safer than 45-Degree Neck Rotation During Ultrasound-Guided Internal Jugular Vein Cannulation? Results of a Randomized Controlled Clinical Trial.

Anesthesia and Analgesia — Tue, 17 Jan 2012 05:00:00 +0100

Conclusion:A head NP was as safe as a 45-degree neck rotation during ultrasound-guided IJV cannulation with regard to both major and minor complications, and venous access time was similar. Ultrasound guidance helps determine optimal head rotation for IJV cannulation. PMID: 22253269 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

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Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance

British Journal of Anaesthesia — Mon, 16 Jan 2012 05:00:00 +0100

(Source: British Journal of Anaesthesia)

AWMSG issues Final Appraisal Recommendation on the use of alteplase (Actilyse® Cathflo® 2 mg) for unblocking occluded central venous access devices

NeLM - Drug Specific Reviews — Thu, 12 Jan 2012 05:00:00 +0100

Source: All Wales Medicines Strategy Group (AWMSG) Area: Evidence > Drug Specific Reviews The All Wales Medicines Strategy Group (AWMSG) has issued a Final Appraisal Recommendation on the use of alteplase (Actilyse® Cathflo® 2 mg) for occluded central venous access devices within NHS Wales. The Group recommends alteplase as an option for the thrombolytic treatment of occluded central venous access devices including those used for haemodialysis. The Group was also of the opinion that alteplase is not suitable for shared care within NHS Wales. Further information, including the assessment report, can be accessed via the link below. (Source: NeLM - Drug Specific Reviews)

Selection of Top 10 Quality Indicators for Nutrition Therapy.

Nutrition in Clinical Practice — Fri, 06 Jan 2012 05:00:00 +0100

CONCLUSION: The top 10 QINTs were identified according to their usefulness in clinical practice by obtaining adequate agreement and representativeness of opinion of nutrition experts. (Nutr Clin Pract. XXXX;xx:xx-xx). PMID: 22227727 [PubMed - as supplied by publisher] (Source: Nutrition in Clinical Practice)

Horizon scanning: French approval of IV treprostinil (RemodulinT) for the treatment of pulmonary arterial hypertension

NeLM - News — Wed, 04 Jan 2012 05:00:00 +0100

Source: BioSpace.com Area: News According to a BioSpace report, the French regulatory agency Agence Francaise de Securite Sanitaire des Produits de Sante (AFSSAPS) has approved intravenous (IV) use of treprostinil (RemodulinT) for the treatment of pulmonary arterial hypertension (PAH). Treprostinil is already approved in most of Europe for the continuous subcutaneous infusion treatment of idiopathic or heritable PAH to improve exercise tolerance and symptoms of the disease in patients classified as New York Heart Association (NYHA) functional class III. The risk management plans (RMPs) for treporostinil will focus on minimising the known risks of central venous catheter-related blood stream infections associated with IV administration. [Note: Treprostini...

Effect of submaximal aerobic exercise on platelet function, platelet activation, and secondary and tertiary hemostasis in dogs.

American Journal of Veterinary Research — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions and Clinical Relevance-Aerobic exercise resulted in a decrease in the number of large and thus most likely activated platelets but otherwise had no major impact on coagulation in dogs. PMID: 22204298 [PubMed - in process] (Source: American Journal of Veterinary Research)

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Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter.

J Zhejiang Univ Sci ... — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: Management of medium or large traumatic hemothoraxes by closed thoracic drainage using CVC is minimally invasive and as effective as using a conventional large-bore chest tube. Its complications can be prevented and it has the potential to replace the large-bore chest tube. PMID: 22205619 [PubMed - in process] (Source: J Zhejiang Univ Sci ...)

Cardiac-Gated Bright Blood MR Imaging to Determine Retrieval Feasibility of a Chronic Foreign Body

Journal of Vascular and Interventional Radiology : JVIR — Sun, 01 Jan 2012 05:00:00 +0100

When identified acutely, fractured central venous catheters are usually removed to prevent complications including perifragment thrombosis, infection, or potentially fatal arrhythmias. However, some clinicians are hesitant to consider retrieval when the fragment has migrated to the pulmonary artery, thinking that this scenario is not a risk to patient safety and that a fragment quickly becomes endothelialized and unretrievable. We used magnetic resonance (MR) imaging to estimate feasibility of retrieval, and report here the successful retrieval of a fragment that had been in vivo for 16 years. Letters of this nature do not require review by our institutional review board. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Unilateral recurrent pleural effusion in a renal transplant patient.

Saudi Journal of Kidney Diseases and Transplantation — Sun, 01 Jan 2012 05:00:00 +0100

We report a patient on HD with a novel cause of recurrent unilateral pleural effusion. A 45-year-old female patient on long-term maintenance HD presented to us with recurrent unilateral pleural effusion. She had a history of poor quality dialysis, severe anemia and severe hypertension. Despite correcting these factors and even after undergoing successful renal transplantation, she continued to have recurrent effusion. Left upper extremity venography demonstrated severe stenosis of the subclavian vein and an increased venous flow in the ipsilateral arteriovenous (AV) fistula. Ligation of the AV fistula led to dramatic resolution of the pleural effusion. Hemodialysis patients who develop unexplained pleural effusions ipsilateral to a functioning AV fistula should be investigated for stenosis...

An unusual complication of a central venous catheter placement.

The Netherlands Journal of Medicine — Sun, 01 Jan 2012 05:00:00 +0100

Authors: de Blauw MH Abstract No abstract available. PMID: 22271813 [PubMed - as supplied by publisher] (Source: The Netherlands Journal of Medicine)

Bloodstream Infections With Central Venous Catheters

AAP Grand Rounds — Fri, 30 Dec 2011 05:00:00 +0100

(Source: AAP Grand Rounds)

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Sustained Reduction in Neonatal Nosocomial Infections Through Quality Improvement Efforts

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: Quality improvement efforts were associated with sustained reductions in NI, bronchopulmonary dysplasia, antibiotic use, central line use, and ventilator days. (Source: PEDIATRICS)

Vascular access: choice and complications in European paediatric haemodialysis units

Pediatric Nephrology — Thu, 29 Dec 2011 06:42:24 +0100

Conclusions Central venous catheters remain the predominant choice of vascular access in Europe despite problems of malfunction and infection. AVF/AVG were predominantly used in adolescents without reported complications. More regular exit site cleaning may predispose to CVC infection, but this observation requires prospective evaluation. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00467-011-2079-3Authors Wesley N. Hayes, Paediatric Nephrology, Nottingham Children’s Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH UKAlan R. Watson, Paediatric Nephrology, Nottingham Children’s Hospital, QMC Campus, Derby Road, Nottingham, NG7 2UH UKNichola Callaghan, Paediatric Nephrology, Nottingham Children’s Hospital, QMC Campus, Derby Roa...

Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients

World Journal of Surgical Oncology — Wed, 28 Dec 2011 05:00:00 +0100

Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well a...

Ethanol Lock Therapy in Reducing Catheter-Related Bloodstream Infections in Adult Home Parenteral Nutrition Patients: Results of a Retrospective Study.

JPEN Journal Of Parenteral And Enteral Nutrition — Wed, 28 Dec 2011 05:00:00 +0100

CONCLUSIONS: This study supports the efficacy and safety of ELT in reducing CRBSI-related admissions in HPN patients and potentially helps reduce the burden of CRBSI-related healthcare costs. This novel technique shows great promise as a standard prophylaxis for CRBSI in HPN patients and must be incorporated in routine practice. (JPEN J Parenter Enteral Nutr. XXXX;XX:xxx-xxx). PMID: 22205580 [PubMed - as supplied by publisher] (Source: JPEN Journal Of Parenteral And Enteral Nutrition)

Delayed Airway Obstruction after Internal Jugular Venous Catheterization in a Patient with Anticoagulant Therapy

Clinical and Developmental Immunology — Wed, 21 Dec 2011 23:54:28 +0100

Delayed onset of neck hematoma following central venous catheterization without arterial puncture is uncommon. Herein, we present a patient who developed a delayed neck hematoma after repeated attempts at right internal jugular venous puncture and subsequent enoxaparin administration. Progressive airway obstruction occurred on the third day after surgery. Ultrasound examination revealed diffuse hematoma of the right neck, and fibreoptic examination of the airway revealed pharyngeal edema. After emergent surgical removal of the hematoma, the patient was extubated uneventfully. (Source: Clinical and Developmental Immunology)

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Rifampicin–miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy

European Journal of Clinical Microbiology and Infectious Diseases — Wed, 21 Dec 2011 19:46:25 +0100

The objective of this study was to determine central venous catheter (CVC)-related costs (considering only the cost of the CVC, diagnosis of CRBSI, and antimicrobial agents used to treat CRBSI) using rifampicin–miconazole-impregnated catheters (RM-C) or S-C in jugular venous access with tracheostomy. We performed a retrospective cohort study of patients admitted to the intensive care unit (ICU) with tracheostomy who received one or more jugular venous catheters. RM-C showed a lower incidence of CRBSI compared with S-C (0 vs. 20.16 CRBSI episodes/1,000 catheter-days; odds ratio = 0.05; 95% confidence interval = 0.001–0.32; p < 0.001) and lower CVC-related costs (including the cost of the CVC, diagnosis, and treatment of CRBSI) (€11.46 ± 6.25 vs. €38...

Is Alcohol-Based Hand Disinfection Equivalent to Surgical Scrub Before Placing a Central Venous Catheter?

Anesthesia and Analgesia — Tue, 20 Dec 2011 05:00:00 +0100

Conclusion:As the initial cleansing method, the alcohol-only cleanser (method 3) was significantly less effective than the traditional surgical scrub (method 1) (P < 0.001). PMID: 22190557 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Teaching Aseptic Technique for Central Venous Access Under Ultrasound Guidance: A Randomized Trial Comparing Didactic Training Alone to Didactic Plus Simulation-Based Training.

Anesthesia and Analgesia — Tue, 20 Dec 2011 05:00:00 +0100

Conclusions:Simulation combined with didactic training is superior to didactic training alone for acquisition of clinical skills such as US-guided CVC insertion. After combined didactic and simulation-based training, novices can outperform experienced residents in aseptic technique as well as in measurements of knowledge. PMID: 22190554 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Micropuncture Needles Combined with Ultrasound Guidance for Unusual Central Venous Cannulation: Desperate Times Call for Desperate Measures. A New Trick for Old Anesthesiologists.

Anesthesia and Analgesia — Tue, 20 Dec 2011 05:00:00 +0100

Authors: Castillo D, McEwen DS, Young L, Kirkpatrick J Abstract Central vascular access can be a very challenging task in patients with skeletal deformities such as ankylosing spondylitis, kyphosis, and chin-on-chest deformity. The use of traditional methods of accessing the central venous circulation in these patients can require multiple attempts and may lead to significant complications such as bleeding, pneumothorax, and vascular injury. Ultrasound-guided central venous access has become a very common procedure in the United States and Europe; its efficacy and safety have been demonstrated, and together with the use of micropuncture needles, the technique can facilitate central venous access in complicated cases. PMID: 22190551 [PubMed - as supplied by publisher] (Source: A...

MRI after removal of central venous access device reveals a high number of asymptomatic thromboses in children with haemophilia

Haemophilia — Mon, 19 Dec 2011 05:00:00 +0100

This study sought to determine the outcome of the vessels by magnetic resonance imaging (MRI) in children with haemophilia and to assess risk factors for development of catheter‐related deep venous thrombosis (DVT). After the removal of CVAD an MRI of the chest and neck was performed to 20 boys with haemophilia who each had 1–3 (total number 27) CVADs placed. MRI revealed DVT in five children (25%). As their CVADs were functional at the time of the removal, the DVTs were clinically silent. However, there had been suspicion of DVT leading to replacement of the CVAD in one case. All the children with DVT had their CVADs inserted initially below the age of 1 year. The clinical signs of mild post‐thrombotic syndrome (PTS) were common: dilated chest wall veins were observed in 11 (55%) ch...

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Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

Clinical and Developmental Immunology — Sun, 18 Dec 2011 23:53:19 +0100

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause. (Source: Clinical and Developmental Immunology)

Integrated studies on the use of cognitive task analysis to capture surgical expertise for central venous catheter placement and open cricothyrotomy

American Journal of Surgery — Fri, 16 Dec 2011 23:28:06 +0100

Conclusions: CTA is an effective method to capture expertise in surgery and a valuable component to improve surgical training. (Source: American Journal of Surgery)

The use of intraosseous devices during cardiopulmonary resuscitation: Is this the answer for which we have been searching?

Resuscitation — Fri, 16 Dec 2011 07:38:40 +0100

This issue of Resuscitation contains several outstanding articles addressing the use of intraosseous (IO) devices for vascular access during resuscitation of adults. The volume and quality of investigations and analyses concerning adult IO in recent years has been extraordinary, with the current works as outstanding examples. Those advocating the use of IO have focused on the technical advantages, such as ease of insertion and time to drug administration, while citing generally favourable pharmacodynamic comparisons with peripheral intravenous (IV) and central venous routes. When considering the impact of these efforts, it is worth stepping back to consider their broader context as well as the limitations of our current understanding regarding optimal resuscitation. (Source: Resuscitation)

Vascular Access Considerations for Therapeutic Apheresis Procedures

Seminars In Dialysis — Fri, 16 Dec 2011 05:00:00 +0100

AbstractThe success of therapeutic apheresis (TA), similar to hemodialysis, depends on the integrity of the extracorporeal circuit as well as a reliable vascular access. However, unlike hemodialysis, which requires high flow of blood around 400 mL/minute through the extracorporeal circuit for effective clearance, TA is usually carried out with much lower blood flow rates (<100 ml/minute). Therefore, even peripheral venous access can be considered for TA. The main determinants of the choice of vascular access for TA is the duration of the planned treatment and, to a certain degree, the indication for its use. While peripheral venous access and temporary central venous catheters are sufficient for short‐term TA, tunnelled catheters and arteriovenous fistulae (AVF) are usually used f...

Vascular Access Considerations for Therapeutic Apheresis Procedures.

Seminars in Dialysis — Fri, 16 Dec 2011 05:00:00 +0100

Authors: Okafor C, Kalantarinia K Abstract The success of therapeutic apheresis (TA), similar to hemodialysis, depends on the integrity of the extracorporeal circuit as well as a reliable vascular access. However, unlike hemodialysis, which requires high flow of blood around 400 mL/minute through the extracorporeal circuit for effective clearance, TA is usually carried out with much lower blood flow rates (<100 ml/minute). Therefore, even peripheral venous access can be considered for TA. The main determinants of the choice of vascular access for TA is the duration of the planned treatment and, to a certain degree, the indication for its use. While peripheral venous access and temporary central venous catheters are sufficient for short-term TA, tunnelled catheters and arteri...

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Catheter Dysfunction: The Role of Lock Solutions.

Seminars in Dialysis — Fri, 16 Dec 2011 05:00:00 +0100

Authors: Niyyar VD Abstract Vascular access dysfunction is a major cause of morbidity in hemodialysis (HD) patients. An upper extremity autogenous arteriovenous fistula (AVF) that preferentially involves the cephalic vein is the access of choice for HD patients, followed by autogenous AVF utilizing the basilic vein and the use of prosthetic arteriovenous grafts (AVGs). Despite these recommendations, central venous catheter (CVC) use is widespread among both incident and prevalent HD patients. Long-term use of CVCs for HD is complicated by a high rate of infection and thrombus-related dysfunction. Catheter locking solutions have been used both prophylactically and therapeutically for catheter thrombosis as well as catheter-related infections, with varying degrees of success. This re...

Thrombolytic therapy for central venous catheter occlusion.

Haematologica — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions:Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction. PMID: 22180420 [PubMed - as supplied by publisher] (Source: Haematologica)

Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center: Tracking the “Idle Central Venous Catheter”

Infect Control Hosp Epidemiol Latest Issue — Thu, 15 Dec 2011 23:19:54 +0100

Infection Control and Hospital Epidemiology, Volume 33, Issue 1, Page 50-57, January 2012. (Source: Infect Control Hosp Epidemiol Latest Issue)

Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature

Infectious Diseases in Obstetrics and Gynecology — Tue, 13 Dec 2011 16:29:07 +0100

We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur. (Source: Infectious Diseases in Obstetrics and Gynecology)

Intrauterine thrombosis of the ductus venosus leading to neonatal demise

Archives of Disease in Childhood - Fetal and Neonatal Edition — Tue, 13 Dec 2011 05:00:00 +0100

A 36-year-old, gravida-3, para-2 presented with labour at the gestational age of 41 weeks. On admission, fetal monitoring was normal. It was discontinued for commodity, but after resuming (30 min later) there was significant fetal bradycardia. A rapid spontaneous vaginal delivery revealed meconium-stained amniotic fluid (grade III). No excessive fetal or placental blood loss was noted.A female baby was born with APGAR scores of 1, 2 and 4 after 1, 5 and 10 min, respectively. She was intubated and given colloids, epinephrine, bicarbonate and calcium. Placement of an umbilical vein catheter was not possible because of resistance during placement of the catheter. An umbilical arterial blood gas showed a pH of 6.8. The infant was transported to a tertiary referral centre.Upon arrival, the arte...

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Randomized, prospective, observational simulation study comparing residents' needle-guided vs free-hand ultrasound techniques for central venous catheter access

British Journal of Anaesthesia — Mon, 12 Dec 2011 05:00:00 +0100

Conclusions The needle guide device used in the long-axis approach improved the needle visualization compared with free-hand techniques. The needle guide used in the long-axis technique, however, did not facilitate puncture of the target vessel in this simulation model when compared with free-hand techniques. (Source: British Journal of Anaesthesia)

Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children

Pediatric Blood and Cancer — Sun, 11 Dec 2011 05:00:00 +0100

ConclusionEarly CVC placement at the time of diagnosis of ALL was associated with a low surgical complication rate with no catheters requiring removal due to infection. Utilizing our current methods of preoperative preparation, surgical management and postoperative CVC care, early placement of a CVC is safe in children with ALL even when their ANC is <500/mm3, but larger cohort studies would be helpful to further clarify this issue. Pediatr Blood Cancer © 2011 Wiley Periodicals, Inc. (Source: Pediatric Blood and Cancer)

Comparison of blood samples values by direct venipuncture and Central Venous Catheters with 5 or 10 ml wasted blood

Journal of Clinical Nursing — Sat, 10 Dec 2011 15:25:32 +0100

(Source: Journal of Clinical Nursing)

Central Venous Catheter CVC

About.com Breast Cancer — Fri, 09 Dec 2011 05:00:00 +0100

Central venous catheters are used to give long-term intravenous chemotherapy. CVCs - look like PICC lines but are different. These catheters are good for patients who don't like to get stuck with needles. Learn more about central venous catheters here. (Source: About.com Breast Cancer)

Outcomes and characteristics of ertapenem-nonsusceptible Klebsiella pneumoniae bacteremia at a university hospital in Northern Taiwan: A matched case-control study.

Journal of Microbiology, Immunology, and Infection — Fri, 09 Dec 2011 05:00:00 +0100

CONCLUSION: ENSKp bacteremia had a poor outcome and the risk factors were prior exposure of 4(th) generation cephalosporins, COPD and higher Pittsburgh bacteremia score. Antibiotic stewardship may be the solution for the preventive strategy. PMID: 22154994 [PubMed - as supplied by publisher] (Source: Journal of Microbiology, Immunology, and Infection)

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Corynebacterium striatum bacteremia associated with central venous catheter infection.

Journal of Microbiology, Immunology, and Infection — Fri, 09 Dec 2011 05:00:00 +0100

Authors: Chen FL, Hsueh PR, Teng SO, Ou TY, Lee WS Abstract Corynebacterium striatum (C striatum) has been considered a contaminant of blood culture in past decades. Here we report the case of a patient with acute deterioration of chronic renal failure. She received hemodialysis and died from C striatum bacteremia. By using a randomly amplified polymorphic DNA (RAPD) method, we found that an association existed between C striatum from the bloodstream and that from the central venous catheter. We suggest that C striatum could be a pathogen of bloodstream infection in patients with such a catheter in place. PMID: 22154992 [PubMed - as supplied by publisher] (Source: Journal of Microbiology, Immunology, and Infection)

Central venous port placement in advanced breast cancer patients: comparison of the anatomic-landmark and ultrasound-guided techniques

The Chinese-German Journal of Clinical Oncology — Thu, 08 Dec 2011 18:17:30 +0100

Conclusion The findings of this study indicate that, in the placement of an internal jugular vein port, the ultrasound (US)-guided technique has several advantages over the anatomic-landmark technique. Content Type Journal ArticlePages 695-698DOI 10.1007/s10330-011-0842-3Authors Nanyan Rao, Department of breast Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guanzhou, 510260 ChinaJiannan Wu, Department of breast Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guanzhou, 510260 ChinaShunrong Li, Department of breast Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guanzhou, 510260 ChinaLiang Jin, Department of breast Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guanzhou, 510260 ChinaWeijuan Jia, Depa...

Intra‐ and postoperative adverse events in children with nephrotic syndrome requiring surgery under general anesthesia

Pediatric Anesthesia — Tue, 06 Dec 2011 05:00:00 +0100

Conclusions: Surgical procedures were seldom associated with the occurrence of perioperative adverse events. However, larger studies are needed to confirm these results. (Source: Pediatric Anesthesia)

Cook Medical Is Awarded New Contract With Novation For Cook Central Venous Catheters

Medical Design Online News — Mon, 05 Dec 2011 14:00:00 +0100

Beginning January 1, 2012, Cook Medical's central venous catheters (CVCs) will be available to the members served by Novation, the supply contracting company for more than 30,000 members of VHA Inc., UHC, and Provista (Source: Medical Design Online News)

Recurrent candidaemia and pacemaker wire infection with Candida albicans

Mycoses — Thu, 01 Dec 2011 05:00:00 +0100

SummaryRecurrent candidaemia is both a cause and a symptom of deep organ candidiasis or infection of foreign bodies (e.g. central venous line, other indwelling catheter or pacemaker wire) and is associated with significant morbidity and mortality. This case report demonstrates that in the event of pacemaker wire infection with Candida and when it is not possible to remove the infected pacemaker wire, treatment with an echinocandin, such as anidulafungin, can be safe and successful. (Source: Mycoses)

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Axillary-Renal Arteriovenous Graft: A Viable Option for Dialysis Access in Patients with Central Venous Occlusion

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Hemodialysis cases can be difficult in patients who have had multiple central venous catheters complicated by superior and inferior vena caval occlusion. One option in dealing with this problem is a left axillary artery to left renal vein prosthetic graft. The 2nd and 3rd case reports of the procedure are described. (Source: Journal of Vascular Surgery)

Modified Use of the HeRO Device for Immediate Salvage of a Threatened Dialysis Graft

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

The Hemodialysis Reliable Outflow (HeRO) device provides an additional access option for hemodialysis in patients with central venous occlusions. The HeRO device is a subcutaneously tunneled dialysis access device comprised of a standard 6mm ePTFE graft coupled to a nitinol reinforced 5mm venous outflow component. Standard placement involves tunneling the venous outflow component to the right atrium via the internal jugular vein and anastamosing the graft component to the brachial artery. This case illustrates a modified technique, employing the device for immediate salvage of a malfunctioning upper extremity dialysis graft with ipsilateral central venous occlusion. (Source: Journal of Vascular Surgery)

External jugular venous pressure as an alternative to conventional central venous pressure in right lobe donor hepatectomies.

Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Central venous pressure catheter placement can be avoided and replaced by a less-invasive method such as external jugular venous pressure (which gave an acceptable estimate of central venous pressure in all phases of right lobe resection) in living-donor liver transplant and allowed equivalent monitor even during fluid restriction phases. PMID: 22142047 [PubMed - in process] (Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation)

Confirmation of central venous catheter position by electrocardiogram.

Anesthesia and Analgesia — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Schulz-Stübner S PMID: 22116968 [PubMed - in process] (Source: Anesthesia and Analgesia)

Nosocomial infection following video-assisted thoracoscopic surgery.

Revista Espanola de Quimioterapia — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Nosocomial infection rate after VATS was low. Respiratory infection was the most common infection. Factors which affect patient immunity, preoperative stay and perioperative-related variables were independently associated with infection. PMID: 22173193 [PubMed - in process] (Source: Revista Espanola de Quimioterapia)

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Protective barrier reduces central venous catheter infection.

Nutrition in Clinical Practice — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Irving S, El-Matary W, Newland P, Dalzell AM PMID: 22205564 [PubMed - in process] (Source: Nutrition in Clinical Practice)

Use of Parenteral Lipid Emulsions in French Neonatal ICUs.

Nutrition in Clinical Practice — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Neonatologists are somewhat reluctant to use parenteral lipids when only peripheral venous access is available, despite the low osmolarity of the emulsions. This may impair, at least temporarily, the adequate supply of energy and/or essential fatty acids in infants who do not have central venous access. This study also shows a large heterogeneity of responses with regard to the contraindications for parenteral lipids. PMID: 22205555 [PubMed - as supplied by publisher] (Source: Nutrition in Clinical Practice)

National clinical guidelines and home parenteral nutrition.

Nutrition in Clinical Practice — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions are that most HPN guideline recommendations were being implemented in practice except for the care delivered by multidisciplinary experts. To ensure quality HPN outcomes, multidisciplinary teams of HPN experts are needed as are large data sets that will provide indicators of guideline use and outcomes. Furthermore, research is needed so that recommendations are not based totally on expert consensus. PMID: 22205553 [PubMed - in process] (Source: Nutrition in Clinical Practice)

Klebsiella ESBL bacteremia-mortality and risk factors.

Braz J Infect Dis — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: ESBL-producing Klebsiella bacteremia can occur early, suggesting that a carbapenem should be included in the initial empirical therapy for bacteremia in patients under mechanical ventilation and/or central venous catheter in our institution. PMID: 22218521 [PubMed - in process] (Source: Braz J Infect Dis)

Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital.

Braz J Infect Dis — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: A prevention strategy targeted at the insertion and maintenance of vascular access can decrease rates of vascular-access infections in pediatric intensive care unit. PMID: 22218517 [PubMed - in process] (Source: Braz J Infect Dis)

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Phrenic nerve injury due to thoracentesis for TPN effusion in a preterm newborn: consecutive two unusual complications.

Tuberkuloz ve Toraks — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Ozdemir R, Oğuz S, Uras N, Erdeve O, Yılmaz Y, Ulu H, Dilmen U Abstract Central venous catheters ara commonly used in neonatal intensive care units as routes of parenteral nutrition. Pleural effusions caused by extravasation of parenteral alimentation fluid are a rare complication of central venous catheters in the newborn. Diaphragmatic paralysis due to phrenic nevre injury is a rare respiratory condition which may be life-threatening in infants. PMID: 22233310 [PubMed - in process] (Source: Tuberkuloz ve Toraks)

Fungemia due to Rhodotorula mucilaginosa in an immunocompetent, critically ill patient

Journal of Infection and Chemotherapy — Wed, 30 Nov 2011 18:42:45 +0100

We present a case report of fungemia due to R. mucilaginosa in an immunocompetent, critically ill patient, with good evolution with catheter removal and fluconazole therapy. We briefly review the spectrum of infections due to R. mucilaginosa and the management of bloodstream infections due to this yeast. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s10156-011-0347-6Authors Jesús Monterrubio Villar, Intensive Care Unit, Hospital Don Benito-Villanueva, Carretera Don Benito-Villanueva Km3 s/n., 06400, Don Benito, Badajoz, SpainCarmen González Velasco, Microbiology Service, Hospital Don Benito-Villanueva, Badajoz, SpainJuan Diego Jiménez Delgado, Intensive Care Unit, Hospital Don Benito-Villanueva, Carretera Don Benito-Villanueva Km3 s/n., 06400, Don Benito, ...

Unusual Combination of Holt‐Oram Syndrome and Persistent Left Superior Vena Cava

Congenital Heart Disease — Wed, 30 Nov 2011 05:00:00 +0100

Conclusion. We report an uncommon association of HO and PLSVC. This association was only reported twice in the past and this is the first one that constitutes a casual finding during the attempt of CRT device implant. This is a combination that may complicate a device implant and recognition of it in advance may avoid performing potentially unsuccessful procedures. (Source: Congenital Heart Disease)

Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis.

Palliative Medicine — Tue, 29 Nov 2011 05:00:00 +0100

CONCLUSIONS: Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure. PMID: 22126844 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial

Intensive Care Medicine — Mon, 28 Nov 2011 16:57:32 +0100

Conclusions This study shows for the first time that citrate lock reduced catheter complications and increased catheter life span as compared to saline lock in critically ill adults requiring hemodialysis. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-011-2422-yAuthors Laure Hermite, CHU de Dijon, Hôpital du Bocage, Réanimation Traumatologique et Neurochirurgicale, Université de Bourgogne, Dijon, FranceJean-Pierre Quenot, CHU de Dijon, Hôpital du Bocage, Réanimation Médicale, Université de Bourgogne, 14 rue Paul Gaffarel, BP 77908, 21079 Dijon cedex, FranceAbdelouaid Nadji, CHU de Dijon, Hôpital du Bocage, Réanimation Traumatologique et Neurochirurgicale, Université de Bourgogne, Dijon, FranceSaber David Barbar, CHU de Dijon, Hôp...

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Catheter related blood stream infections in critically ill patients with continuous haemo(dia)filtration and temporary non-tunnelled vascular access.

Swiss Medical Weekly — Sat, 26 Nov 2011 19:06:05 +0100

CONCLUSIONS: The incidence of catheter related blood stream infection in critically ill patients on intensive care units treated with continuous veno-venous haemo(dia)filtration was 3.8 per 1000 catheter days. All catheter related blood stream infections were caused by coagulase negative staphylococci. PMID: 22101804 [PubMed - in process] (Source: Swiss Medical Weekly)

Toll like receptor 4 dependent kupffer cell activation and liver injury in a novel mouse model of parenteral nutrition

Hepatology — Sat, 26 Nov 2011 05:00:00 +0100

Conclusion:These data suggest that intestinal‐derived LPS activates Kupffer cells through TLR4 signaling in early stages of PNALI. (HEPATOLOGY 2011.) (Source: Hepatology)

Feasibility and procedure-related patient discomfort of peripheral venous access for coronary sinus cannulation during electrophysiology procedures

Journal of Interventional Cardiac Electrophysiology — Fri, 25 Nov 2011 17:56:38 +0100

Conclusion This small, randomized study indicates that peripheral venous access for CS catheter placement during EP procedures is feasible, with equivalent success rate to the central venous access approach, and associated with lower levels of self-reported patient discomfort. Content Type Journal ArticlePages 1-5DOI 10.1007/s10840-011-9635-4Authors Spyridon Deftereos, Department of Cardiology, Athens General Hospital “G. Gennimatas”, 154 Mesogeion Ave., 11527 Athens, GreeceGeorgios Giannopoulos, Department of Cardiology, Athens General Hospital “G. Gennimatas”, 154 Mesogeion Ave., 11527 Athens, GreeceCharalambos Kossyvakis, Department of Cardiology, Athens General Hospital “G. Gennimatas”, 154 Mesogeion Ave., 11527 Athens, GreeceKonstantinos Raisakis, D...

Utility of Spa typing in understanding epidemiology of Staphylococcus aureus bacteraemia isolates in a single University Hospital: Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:46 +0100

Background - Staphylococcus aureus (SA) is well known as a leading cause of human disease and nosocomial infections. In the United Kingdom around 12500 SA bacteraemia (SAB) cases occur each year of which approximately 30% die and around 50% suffer complicated infection. The emergence of meticillin-resistant SA (MRSA) still represents a major infection control problem and the appearance of some community-acquired strains (caMRSA) and healthcare associated meticillin sensitive SA (MSSA) are of great concern. In addition approximately two thirds of MSSA bacteraemias are healthcare associated, predominantly relating to central venous catheters or surgical site infection. Thus, understanding the epidemiology of all SA is an invaluable infection control tool. (Source: Journal of Infection)

Value of CVC insertion checklist as a process measurement tool to reduce catheter related bloodstream infections: Category: Scientific free paper

Journal of Infection — Fri, 25 Nov 2011 11:05:45 +0100

Catheter-related blood stream infections (CR-BSI) are common and associated with high morbidity rates. A 2006 HAI prevalence survey showed that 42.3% of blood stream infections in England were central venous catheter (CVC)-related and each CR-BSI episode led to an additional cost of £6209 per patient. (Source: Journal of Infection)

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Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients

Intensive Care Medicine — Wed, 23 Nov 2011 17:44:36 +0100

Conclusions Alterations in blood flow and consistency, but not vessel injury, appear associated with symptomatic thrombosis following placement of PICCs in neurological intensive care patients. Mannitol use and placement in a paretic arm are potentially modifiable risk factors. Given the high incidence rate of symptomatic thrombosis, future studies should focus on comparing cumulative complications of centrally inserted venous catheters and PICCs in intensive care patients. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-011-2418-7Authors Thomas J. Wilson, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Room 3552 TC, 48109-5338 Ann Arbor, MI, USADevin L. Brown, Department of Neurology, University of Michigan,...

Candidaemia in a European Paediatric University Hospital: A 10 Year Observational Study

Clinical Microbiology and Infection — Wed, 23 Nov 2011 05:00:00 +0100

AbstractIn this retrospective observational study covering 1998 through 2008, 32 patients (mean age: 7.50 years) were identified that had 35 episodes of candidaemia (0.47 cases/1000 hospital discharges). Cancer / allogeneic HSCT (43%) and congenital malformations / syndromes (21%) were the predominant underlying conditions. Central venous catheterization (90%), a history of antibacterial therapy (69%) and prior bacteraemia (54%) were frequent comorbidities. C. albicans (46%) was most common, followed by C. parapsilosis (17%) and C. glabrata (14%). Resistance was infrequent and limited to non‐albicans Candida spp. The 30‐ and 100 day mortality rates were 11.4%. (Source: Clinical Microbiology and Infection)

Candidaemia in a European Paediatric University Hospital: a 10‐year observational study

Clinical Microbiology and Infection — Wed, 23 Nov 2011 05:00:00 +0100

Clin Microbiol InfectAbstractIn this retrospective observational study covering 1998 to 2008, 32 patients (mean age: 7.50 years) were identified that had 35 episodes of candidaemia (0.47 cases/1000 hospital discharges). Cancer/allogeneic haematopoietic stem cell transplantation (43%) and congenital malformations/syndromes (21%) were the predominant underlying conditions. Central venous catheterization (90%), a history of antibacterial therapy (69%) and previous bacteraemia (54%) were frequent comorbidities. Candida albicans (46%) was most common, followed by Candida parapsilosis (17%) and Candida glabrata (14%). Resistance was infrequent and limited to non‐albicans Candida spp. The 30‐day and 100‐day mortality rates were 11.4%. (Source: Clinical Microbiology and Infection)

Introduction

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

The rapidly aging population and increased lifespan of individuals with chronic disease have resulted in an explosion in the demand for central venous access. Procedures once rare outside of the intensive care unit and operating room are now commonplace. For some, this responsibility represents a challenging burden in terms of coverage demands. For many, it represents a new service line with attractive economic potential. For patients, however, it more and more frequently represents an essential ingredient to the successful management of their care. (Source: Techniques in Vascular and Interventional Radiology)

A Concise History of Central Venous Access

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

Central venous access has become a mainstay of modern interventional radiology practice. Its history has paralleled and enabled many current medical therapies. This short overview provides an interesting historical perspective of these increasingly common interventional procedures. (Source: Techniques in Vascular and Interventional Radiology)

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Principles of Non-Tunneled Central Venous Access

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

Non-tunneled central venous access has become an important tool in the management of the sick patient, particularly in the intensive care unit. Image guidance allows more precise placement of lines with overall lower complication rates compared with guidance by physical landmarks. The use of image guidance has brought a procedure traditionally performed by surgeons into the realm of the interventional radiologist. Techniques for placement of non-tunneled central venous catheters, hemodialysis catheters, and peripherally inserted central catheter lines will be discussed. (Source: Techniques in Vascular and Interventional Radiology)

Principles of Tunneled Cuffed Catheter Placement

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

Tunneled cuffed catheters provide reliable and instant long-term intravenous access for a large variety of therapeutic purposes, including chemotherapy, parenteral nutrition, and apheresis. The most frequent application is for patients with renal failure as an access device for hemodialysis. In this capacity, the rate of catheter use has remained stable in the United States, despite the promotion of arteriovenous fistulas and arteriovenous grafts. The latter 2 procedures achieve superior longevity and much higher cost-efficiency. Tunneled catheters, however, serve as bridging devices during maturation of newly placed arteriovenous fistulas or as the final option in patients in whom fistulas and grafts have failed. High-quality vascular access is a hallmark of interventional radiology, and ...

Diagnosis and Treatment of Central Venous Access–Associated Infections

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

This paper provides readers with a basic understanding of the types of central venous access–associated infections as well as appropriate diagnostic techniques. Preventive measures are the most effective way to reduce rates of catheter-associated infection and are discussed in detail. Diagnosis and treatment of each type of infection are reviewed for nontunneled central venous catheters, tunneled dialysis catheters, and venous access ports. Readers should be able to employ the methods described in this paper to reduce the rate of central venous access–associated infections at their hospitals. (Source: Techniques in Vascular and Interventional Radiology)

Evaluation and Management of Central Venous Access Complications

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

This article discusses the most common and some unusual complications seen with the placement of these devices. We also briefly discuss the management of these complications. (Source: Techniques in Vascular and Interventional Radiology)

Venous Access Salvage Techniques

Techniques in Vascular and Interventional Radiology — Tue, 22 Nov 2011 20:38:43 +0100

For patients who need long-term central venous access but who have developed obstruction of the usual central veins, “salvage” access techniques offer successful alternatives. These techniques include translumbar inferior vena cava access, transhepatic inferior vena cava access, catheterization of small venous collaterals, and recanalization of occluded veins. Inferior vena cava access techniques allow a range of devices to be placed, including ports, infusion catheters, and hemodialysis catheters. Collateral vessels may be too small to allow for large-caliber devices, such as hemodialysis catheters. Success rates for these access techniques are high and complications are infrequent. These access routes are in general quite durable. Adults and children can be treated. Once placed, devi...

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The central vein access port and catheter in outpatient chemotherapy for colorectal cancer: a retrospective study of 101 patients

Surgery Today — Mon, 21 Nov 2011 18:06:09 +0100

Conclusions The complications of the CV-port system occurred at a defined rate, therefore the early diagnosis and the appropriate treatment to address these complications is crucial. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00595-011-0016-5Authors Hiroshi Sawayama, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556 JapanNaoko Hayashi, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556 JapanMasayuki Watanabe, Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556 JapanHiroshi Takamori, Department ...

Symptomatic and Asymptomatic Candidiasis in a Pediatric Intensive Care Unit

Italian Journal of Pediatrics — Mon, 21 Nov 2011 05:00:00 +0100

Conclusion: Surgery was the only risk factor significantly associated with symptomatic candidiasis and non-albicans Candida species were more common among the patients with symptomatic candidiasis.While treating symptomatic candidiasis in any PICU an increase in the incidence of non-albicans candidiasis should be considered. (Source: Italian Journal of Pediatrics)

Safe Placement of Central Venous Catheters: A Measured Approach

Journal of Intensive Care Medicine — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions. Using a 15-cm insertion depth via the internal jugular or subclavian vein results in safe catheter tip location in the majority of procedures consistent with FDA and manufacturer guidelines. (Source: Journal of Intensive Care Medicine)

Radiofrequency thermal wire is a useful adjunct to treat chronic central venous occlusions

Journal of Vascular Surgery — Mon, 21 Nov 2011 05:00:00 +0100

We report three patients with complicated central venous occlusions in whom conventional catheter and guidewire techniques were not successful and who were successfully treated using the PowerWire Radiofrequency Guidewire (Baylis Medical Company Inc, Montreal, QC, Canada). Occlusions were traversed using the radiofrequency wire, followed by angioplasty and stenting. The average length recanalized was 8.2 ± 3.6 cm. One patient required repeat angioplasty at 4 months. All stents were patent at 12 to 15 months. The radiofrequency wire is valuable in the management of patients with refractory central venous occlusions. (Source: Journal of Vascular Surgery)

Ultrasound use for the placement of haemodialysis catheters.

Cochrane Database of Systematic Reviews — Sun, 20 Nov 2011 22:06:03 +0100

CONCLUSIONS: Use of real-time 2-D Doppler ultrasound guidance has significant benefits with respect to the number if catheters successfully inserted on the first attempt, reduction in the risk of arterial puncture and haematomas and the time taken for successful vein puncture. PMID: 22071820 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Gauze and tape and transparent polyurethane dressings for central venous catheters.

Cochrane Database of Systematic Reviews — Sun, 20 Nov 2011 22:06:03 +0100

CONCLUSIONS: We found a four-fold increase in the rate of catheter related blood stream infection when a polyurethane dressing was used to secure the central venous catheter however this research was at risk of bias and the confidence intervals were wide indicating high uncertainty around this estimate; so the true effect could be as small as 2% or as high as 17-fold. More, better quality research is needed regarding the relative effects of gauze and tape versus polyurethane dressings for central venous catheter sites. PMID: 22071809 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Erythropoiesis-stimulating agents are not associated with increased risk of thrombosis in patients with myelodysplastic syndromes.

Haematologica — Fri, 18 Nov 2011 05:00:00 +0100

Conclusions. Despite the link between use of erythropoiesis stimulating agents and thrombosis among patients with solid tumors, this study provides evidence that their safety profile may be different among patients with myelodysplastic syndromes. PMID: 22102702 [PubMed - as supplied by publisher] (Source: Haematologica)

A Randomized Trial Comparing Gentamicin/Citrate and Heparin Locks for Central Venous Catheters in Maintenance Hemodialysis Patients

American Journal of Kidney Diseases — Wed, 16 Nov 2011 05:00:00 +0100

Conclusion: Gentamicin 320 μg/mL in 4% sodium citrate used as a routine catheter lock in CVCs in patients on maintenance hemodialysis therapy markedly decreases the incidence of catheter-related bloodstream infection and is as effective as heparin 1,000 U/mL in preventing catheter clotting. (Source: American Journal of Kidney Diseases)

Are there independent predisposing factors for postoperative infections following open heart surgery?

Journal of Cardiothoracic Surgery — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions: We concluded that diabetes mellitus, the duration of mechanical ventilation, the presence of complications irrelevant to the infection during CVICU stay and CVICU re-admission are independent risk factors for the development of postoperative infection in cardiac surgery patients. (Source: Journal of Cardiothoracic Surgery)

Central venous catheter use in severe malaria: time to reconsider the World Health Organization guidelines?

Malaria Journal — Mon, 14 Nov 2011 05:00:00 +0100

The authors recommend that the WHO recommendation for the routine insertion of a central venous catheter, and the maintenance of a central venous pressure of 0-5 cmH2O in adults with severe malaria, should be reconsidered. (Source: Malaria Journal)

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Superior vena cava obstruction due to total implantable venous access devices in cystic fibrosis: Case series and review

Respiratory Medicine CME — Sun, 13 Nov 2011 21:28:38 +0100

We report a single CF centre’s experience of SVCO associated with TIVADs in patients with CF, followed by a review of the published literature on risk factors, preventative strategies and treatment approaches. (Source: Respiratory Medicine CME)

Persistent left superior vena cava identified during central line placement: A case report

Respiratory Medicine CME — Sun, 13 Nov 2011 21:28:38 +0100

Conclusion: Our case is significant because the patient had two extra central venous catheter placements. This case strongly demonstrates the importance of knowing the thoracic venous anomalies. (Source: Respiratory Medicine CME)

Migration of central lines from the superior vena cava to the azygous vein

Clinical Radiology — Thu, 10 Nov 2011 05:00:00 +0100

Conclusion: Risk factors for migration into the azygos vein include placement from a left-sided approach and original positioning in the azygos vein with correction at placement. The depth of placement in the superior vena cava was not a protective factor. It is important to recognize migration because of the elevated risk of complications when central lines are placed in the azygos vein. (Source: Clinical Radiology)

Adjacent central venous catheters can result in immediate aspiration of infused drugs during renal replacement therapy*

Anaesthesia — Tue, 08 Nov 2011 05:00:00 +0100

SummaryDual‐lumen haemodiafiltration catheters enable continuous renal replacement therapy in the critically ill and are often co‐located with central venous catheters used to infuse drugs. The extent to which infusions are immediately aspirated by an adjacent haemodiafiltration catheter remains unknown. A bench model was constructed to evaluate this effect. A central venous catheter and a haemodiafiltration catheter were inserted into a simulated central vein and flow generated using centrifugal pumps within the simulated vein and haemodiafiltration circuit. Ink was used as a visual tracer and creatinine solution as a quantifiable tracer. Tracers were completely aspirated by the haemodiafiltration catheter unless the infusion was at least 1 cm downstream to the arterial port. No tra...

Phrenic nerve injury after image-guided insertion of a tunnelled right internal jugular central venous catheter

Pediatric Radiology — Sat, 05 Nov 2011 17:09:24 +0100

We present a 10-year-old boy who developed right hemidiaphragmatic paralysis, requiring surgical plication, following US-guided insertion of a tunnelled right internal jugular CVC. The needle trajectory for internal jugular puncture must be planned to avoid the phrenic nerve. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00247-011-2269-yAuthors Andrew Shawyer, Great Ormond Street Hospital for Sick Children, Great Ormond Street, London, WC1N 3JH UKSamantha Chippington, Great Ormond Street Hospital for Sick Children, Great Ormond Street, London, WC1N 3JH UKSadia Quyam, Great Ormond Street Hospital for Sick Children, Great Ormond Street, London, WC1N 3JH UKIngram Schulze-Neick, Great Ormond Street Hospital for Sick Children, Great Ormond Street, London, WC1N 3...

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Catheter-associated bloodstream infections (CA-BSI) in wards: a prospective comparative study between subclavian and jugular access

Jornal Vascular Brasileiro — Fri, 04 Nov 2011 08:22:32 +0100

CONCLUSIONS: The internal jugular vein access has a lesser incidence of CABSI than subclavian vein access in patients admitted to surgical wards. (Source: Jornal Vascular Brasileiro)

A rare malposition of the central venous catheter

Heart — Fri, 04 Nov 2011 04:00:00 +0100

A 27-year-old Caucasian man with recurrent Hodgkin's disease was admitted to our hospital for treatment. A central venous catheter was inserted through the left subclavian vein. Posteroanterior x-ray of the chest was obtained to confirm the position of the catheter tip (figure 1). Figure 1Postcannulation chest x-ray showing the catheter in the left pericardiacophrenic vein. Subsequently, intravenous contrast medium was injected to delineate the anatomy of the vein. Additionally, a CT scan obtained for staging shortly before was reanalysed (figure 2). It documented the prominent left pericardiacophrenic vein being cannulated. The catheter was removed and chemotherapy was applied via a placed femoral venous device. Figure 2Coronary curved reconstruction of a CT scan illustrates the location...

Outcomes of Neonatal Candidiasis: The Impact of Delayed Initiation of Antifungal Therapy

Infectious Diseases in Obstetrics and Gynecology — Fri, 04 Nov 2011 01:31:20 +0100

Conclusions. Reliance on available laboratory tools in cases of invasive neonatal candidiasis can result in delayed diagnosis and increased mortality. A risk-factor-based approach to empirical treatment could be justified in this setting. (Source: Infectious Diseases in Obstetrics and Gynecology)

Retrospective case–control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy

International Journal of Antimicrobial Agents — Wed, 02 Nov 2011 04:00:00 +0100

In conclusion, the good clinical efficacy of daptomycin is associated with a more rapid resolution of the clinical syndrome and a reduced length of hospitalisation. This latter aspect may have important pharmacoeconomic implications, promoting the use of daptomycin in the clinical setting. (Source: International Journal of Antimicrobial Agents)

The Sheared Central Venous Catheter?

Gastroenterology Research and Practice — Tue, 01 Nov 2011 23:06:17 +0100

A fractured central venous catheter (CVC) with embolization of the distal fragment may lead to life-threatening complications. We had inserted a right subclavian CVC in a 68-year-old female which upon a follow-up chest X-ray appeared to have been sheared. A guidewire was inserted through the CVC until the J-tip was just beyond the tip of the CVC which were then withdrawn as a single assembly. We suspected that the tip of the guidewire might have been entrapped in the opening of the middle port, which upon withdrawal of the guidewire could have led to CVC folding upon itself and shearing. (Source: Gastroenterology Research and Practice)

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Peritoneal Dialysis Versus Hemodialysis: Risks, Benefits, and Access Issues

Advances in Chronic Kidney Disease — Tue, 01 Nov 2011 04:00:00 +0100

Peritoneal dialysis (PD) and hemodialysis (HD) are dialysis options for end-stage renal disease patients in whom preemptive kidney transplantation is not possible. The selection of PD or HD will usually be based on patient motivation, desire, geographic distance from an HD unit, physician and/or nurse bias, and patient education. Unfortunately, many patients are not educated on PD before beginning dialysis. Most studies show that the relative risk of death in patients on in-center HD versus PD changes over time with a lower risk on PD, especially in the first 3 months of dialysis. The survival advantage of PD continues for 1.5-2 years but, over time, the risk of death with PD equals or becomes greater than with in-center HD, depending on patient factors. Thus, PD survival is best at the st...

Echocardiographically Detected Fibrinous Sheaths Associated with Central Venous Catheters

Echocardiography — Tue, 01 Nov 2011 04:00:00 +0100

We report three cases of persistent fibrin sheaths forming at the site of previously inserted tunneled catheters two of which were complicated by thrombus formation and vegetations. (Echocardiography ****;**:E1‐E4) (Source: Echocardiography)

Incidence of Healthcare‐Associated Infections in a Pediatric Population With an Extracorporeal Ventricular Assist Device

Artificial Organs — Tue, 01 Nov 2011 04:00:00 +0100

AbstractDuring the last decade, ventricular assist devices (VADs) have become a precious tool to support children with end‐stage heart failure. However, thromboembolic events, bleeding, and infections may have a considerable impact on outcome. We retrospectively analyzed the incidence of healthcare‐associated infections (HAIs) in nine patients supported by EXCOR Pediatric (Berlin Heart [BH]) VAD in a pediatric cardiosurgical intensive care unit between January 1, 2009 and March 31, 2011 (27 months). Median age was 8 months (interquartile range [IQR] 6–11), median weight 7.5 kg (IQR 4.5–8.5). Seven patients were supported with a left VAD, two with a biventricular VAD (BiVAD). Six patients with a left VAD underwent heart transplant after 89 days (median, IQR 41–143) of support. O...

Catheter Dysfunction: The Role of Lock Solutions

Seminars In Dialysis — Tue, 01 Nov 2011 04:00:00 +0100

AbstractVascular access dysfunction is a major cause of morbidity in hemodialysis (HD) patients. An upper extremity autogenous arteriovenous fistula (AVF) that preferentially involves the cephalic vein is the access of choice for HD patients, followed by autogenous AVF utilizing the basilic vein and the use of prosthetic arteriovenous grafts (AVGs). Despite these recommendations, central venous catheter (CVC) use is widespread among both incident and prevalent HD patients. Long‐term use of CVCs for HD is complicated by a high rate of infection and thrombus‐related dysfunction. Catheter locking solutions have been used both prophylactically and therapeutically for catheter thrombosis as well as catheter‐related infections, with varying degrees of success. This review aims to address t...

[DGAI-certified seminar series: anaesthesia focussed echocardiography: module 4 cardiosonography].

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Tonner PH, Bein B, Breitkreutz R, Broscheit J, Erb J, Dütschke P, Greim CA, Hansen M, Kefalianakis F, Loick HM, Schmidt C, Timpe A, Wagner G Abstract The use of ultrasonography in perioperative medicine has developed rapidly within the last decade. Today ultrasonic techniques are established methods for peripheral and central venous access as well as for regional anaesthesia. However, transthoracic ultrasonography by non-cardiologists has not yet been routinely established perioperatively, in intensive care medicine or in emergency medicine. With the current module 4: Cardiosonography of the DGAI-certified seminar series in Anaesthesia Focussed Sonography (AFS) it is intended to provide a basis for a quality assured training and implementation of transthoracic sonography ...

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Immediate complications of percutaneous central venous cannulation in children

Journal of Indian Association of Pediatric Surgeons — Mon, 31 Oct 2011 04:00:00 +0100

Conclusion: In our practice, it was observed that complications were fewer with increasing familiarity with the procedure. Hence, percutaneous central venous catheterization is a safe procedure when performed in experienced hands. (Source: Journal of Indian Association of Pediatric Surgeons)

[A "checklist" for the implantation of central venous catheters and vascular access implantable devices in Nephrology: Why?]

Nephrologie and Therapeutique — Mon, 31 Oct 2011 04:00:00 +0100

[A "checklist" for the implantation of central venous catheters and vascular access implantable devices in Nephrology: Why?] Nephrol Ther. 2011 Oct 31; Authors: Canaud B Abstract The French Health Agency (HAS), published recently a check-list for central venous catheter. The document is published for transmission to French nephrologists. PMID: 22047962 [PubMed - as supplied by publisher] (Source: Nephrologie and Therapeutique)

Intermittent heparin is not effective at preventing the occlusion of peripherally inserted central venous catheters in preterm and term neonates

Revista Brasileira de Terapia Intensiva — Thu, 27 Oct 2011 19:24:27 +0100

OBJETIVO: Verificar se a heparina em lavagens intermitentes é eficaz em reduzir oclusões de cateteres centrais inseridos perifericamente em recém-nascidos. MÉTODOS: Estudo randomizado, aberto, controlado, prospectivo. Os recém-nascidos foram alocados em dois grupos para receber lavagens ("flushes") com 0,5 mL da solução de heparina 10UI/mL (Grupo 1, n = 64) ou com 0,5 mL de salina (Grupo 2, n = 69), a cada 4 horas através do cateter central inserido perifericamente. Foram realizadas manobras de desobstrução por pressão negativa ("3-way stopcock method") nos casos de oclusão. RESULTADOS: Foram incluídos 133 recém-nascidos. Não houve diferença significativa no número de oclusões inéditas entre os grupos (26 no grupo 1, ou 31/1000 dias de cateter; 36 no grupo 2, ou 36/1000 ...

Prolonged Central Venous Desaturation Measured by Continuous Oximetry Is Associated with Adverse Outcomes in Pediatric Cardiac Surgery

Anesthesiology — Tue, 25 Oct 2011 20:49:46 +0100

Conclusions: We demonstrate that ScvO2 desaturations by continuous oximetry are associated with major adverse events in pediatric patients undergoing cardiac surgery. The most significant associations with major adverse events are seen in patients with greater than 18 min of central venous saturations less than 40%. Our results support the further investigation of ScvO2 as a potential target parameter in high-risk pediatric patients to minimize the risk of major adverse events. (Source: Anesthesiology)

Disseminated Mycobacterium gordonae Infection in a child with cystic fibrosis

Pediatric Pulmonology — Tue, 25 Oct 2011 04:00:00 +0100

AbstractA 4‐year‐old girl with cystic fibrosis (CF) presented with unrelenting pyrexia commencing shortly after flushing of the central venous catheter (CVC). Mycobacterium gordonae was subsequently isolated from bronchoalveolar lavage, gastric washings, and lung biopsy. While this case most likely represents central line infection by a non‐tuberculous mycobacterial (NTM) species, it is difficult to state this definitively in the absence of positive cultures from the CVC. We suggest that infection with NTM should always be considered in CF patients with indwelling devices and unexplained fever. Pediatr Pulmonol. © 2011 Wiley Periodicals, Inc. (Source: Pediatric Pulmonology)

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Spondylodiscitis in hemodialysis patients: a case series.

Clinical Nephrology — Sat, 22 Oct 2011 19:41:40 +0100

Conclusion: Bacterial spondylodiscitis must be suspected whenever a patient on hemodialysis is admitted with fever and/or back pain. The presence of a central venous catheter and a history of multiple vascular accesses may be important risk factors. Prolonged antibiotic therapy with initial broad-spectrum coverage seems to be the best therapeutic approach. PMID: 22000558 [PubMed - in process] (Source: Clinical Nephrology)

Commentary: Update on Emerging Infections: News From the Centers for Disease Control and Prevention

Annals of Emergency Medicine — Sat, 22 Oct 2011 06:38:25 +0100

[Ann Emerg Med. 2011;58:450-451.] From fluid resuscitation to hemodialysis, central venous catheters (CVC) are a key component of the management of critically ill patients in the emergency department (ED). They serve as avenues for administering medications and facilitate hemodynamic monitoring and transvenous cardiac pacing. CVC placement is one of the most common procedures performed by an emergency physician and, like any other invasive procedure, carries an inherent risk of infection. Most of what we know about the epidemiology of CLABSI is derived from data from ICUs. Only recently has a clearer picture started to emerge of CLABSI attributable to CVCs placed in the ED. In a busy academic, urban ED, the rate of CLABSI from 2007 to 2008 was found to be 1.93 per 1,000 catheter-days, sim...

Risk Factors and Prognosis of Lung Cancer Combined with Pulmonary Embolism

Chinese Journal of Lung Cancer — Thu, 20 Oct 2011 04:00:00 +0100

Conclusion Chemotherapy, late stage disease and high serum hemoglobin are important risk factors for lung cancer patients with concomitant pulmonary embolism. The survival time of these patients is significantly lower than that in patients without pulmonary embolism. DOI: 10.3779/j.issn.1009-3419.2011.10.03 (Source: Chinese Journal of Lung Cancer)

Strategies for catheter-related blood stream infection based on medical course in children receiving parenteral nutrition

Pediatric Surgery International — Tue, 18 Oct 2011 15:56:06 +0100

Conclusion We recommend the treatment for CRBSI be initiated when patients with CVC develop a high-grade fever, even before exact identification of the cause of infection. The treatment can be corrected after the re-evaluation at 48 h. Content Type Journal ArticleCategory Original articlePages 1-5DOI 10.1007/s00383-011-3009-yAuthors Wataru Sumida, Department of Pediatric Surgery, Aichi Children’s Health and Medical Center, 474-8710, 1-2 Osakada, Morioka-cho, Obu, Aichi, JapanYoshio Watanabe, Department of Pediatric Surgery, Aichi Children’s Health and Medical Center, 474-8710, 1-2 Osakada, Morioka-cho, Obu, Aichi, JapanHidemi Takasu, Department of Pediatric Surgery, Aichi Children’s Health and Medical Center, 474-8710, 1-2 Osakada, Morioka-cho, Obu, Aichi,...

Venous thromboembolism in cystic fibrosis

Pediatric Pulmonology — Mon, 17 Oct 2011 04:00:00 +0100

AbstractThe incidence of venous thromboembolism (VTE) is increasing in the pediatric population. Individuals with cystic fibrosis (CF) have an increased risk of thrombosis due to central venous catheters (CVCs), as well as acquired thrombophilia secondary to inflammation, or deficiencies of anticoagulant proteins due to vitamin K deficiency and/or liver dysfunction. CVC‐associated thrombosis commonly results in line occlusion, but may develop into serious life‐threatening conditions such as deep venous thrombosis (DVT), superior vena cava syndrome or pulmonary embolism (PE). Post‐thrombotic syndrome (PTS) may be a long complication. Local occlusion of the catheter tip may be managed with instillation of thrombolytics (such as tPA) within the lumen of the catheter; however, CVC‐asso...

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Nosocomial methicillin-sensitive Staphylococcal aureus (MSSA) native mitral valve acute bacterial endocarditis (ABE) due to radiofrequency catheter ablation (RCA) procedure

Heart and Lung — Sun, 16 Oct 2011 06:28:23 +0100

We present a 58-year-old man who developed nosocomial methicillin-sensitive S. aureus native mitral valve ABE a week after a radiofrequency catheter ablation (RCA) procedure. Cardiac valvular vegetations attributable to S. aureus ABE may be visualized by cardiac echocardiography as early as a week after the onset of valvular infection, as was the case here. Clinicians should be alert to the possibility of NE in patients who develop fevers and high-grade/continuous (MSSA / MRSA) bacteremias after cardiac catheterization-related interventions, eg, RCA procedures. (Source: Heart and Lung)

Correlation between jugular and central venous pressures in laterally recumbent horses

Veterinary Anaesthesia and Analgesia — Thu, 13 Oct 2011 17:21:36 +0100

Conclusion and clinical relevance Jugular vein pressure showed a strong correlation with CVP in healthy, euvolemic, laterally recumbent anesthetized adult horses. Thus, JVP cannot replace CVP but it may be used clinically to monitor CVP in laterally recumbent horses. (Source: Veterinary Anaesthesia and Analgesia)

Percutaneous Dilational Tracheotomy for Airway Management in a Newborn With Pierre-Robin Syndrome and a Glossopharyngeal Web.

Respiratory Care — Thu, 13 Oct 2011 04:00:00 +0100

We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day- old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. A direct laryngoscopy revealed a glossopharyngeal web extending from base of the tongue to the posterior pharyngeal wall. The baby was spontaneously breathing through a 2 mm diameter fistula in the center of this web. It was decided that endotracheal intubation is impossible and a PDT was planned. The trachea of the newborn was cannulated, using a 20 gauge peripheral venous catheter and a 0.028 inch guide wire was introduced through this catheter. Using 5 F, 7 F, 9 F, and 11 F central venous catheter kit dilators, staged tracheo...

Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment

Journal of Antimicrobial Chemotherapy — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined. (Source: Journal of Antimicrobial Chemotherapy)

Impact of a Multidisciplinary Team Review of Potential Outpatient Parenteral Antimicrobial Therapy Prior to Discharge from an Academic Medical Center (November).

The Annals of Pharmacotherapy — Tue, 11 Oct 2011 04:00:00 +0100

CONCLUSIONS:The OPAT team optimized safety, efficacy, and convenience of OPAT while providing substantial cost savings. Further studies are needed to confirm the program's cost-effectiveness. PMID: 21990938 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

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Tunneled‐cuffed catheter implanted into the accessory hemiazygos vein because of occlusion of the left innominate vein

Hemodialysis International — Mon, 10 Oct 2011 04:00:00 +0100

We describe a successful insertion and use of a cuffed‐tunneled catheter in a patient with unusual anatomy of the central venous system. Computed tomography angiography revealed thrombosis of the right subclavian vein and bilateral occlusion of innominate veins. The left internal jugular and subclavian veins joined to form a large vessel that drained through the accessory hemiazygos and azygos veins into the superior vena cava. The catheter was implanted through the left internal jugular vein into the accessory hemiazygos vein. The presented case demonstrates that the catheter can be implanted into distended collateral, especially when no other location is possible. (Source: Hemodialysis International)

In vitro analyses of the effect of heparin and parabens on Candida albicans biofilms and planktonic cells.

Antimicrobial Agents and Chemotherapy — Mon, 10 Oct 2011 04:00:00 +0100

Authors: Miceli MH, Bernardo SM, Ku TS, Walraven C, Lee SA Abstract Infections and thromboses are the most common complications associated with central venous catheters. Suggested strategies for prevention and management of these complications include the use of heparin-coated catheters, heparin locks, and antimicrobial lock therapy. However, the effects of heparin on Candida albicans biofilms and planktonic cells have not been previously studied. Therefore, we sought to determine the in vitro effect of a heparin sodium preparation (HP) on biofilms and planktonic cells of C. albicans. Because HP contains two preservatives, methyl paraben (MP) and propyl paraben (PP), these compounds and heparin sodium without preservatives (Pure-H) were also tested individually. The metabolic activ...

Preventing infections related to catheter occlusion.

British Journal of Nursing — Mon, 10 Oct 2011 04:00:00 +0100

Preventing infections related to catheter occlusion. Br J Nurs. 2011 Oct 28-Nov 10;20(19):S4-Unknown Authors: Ogston-Tuck S Abstract Intravenous (IV) therapy is one of the most significant areas of nursing (Royal College of Nursing (RCN), 2010). Increased IV therapy is associated with a high incidence of infection and occlusion (Cook, 1999), where bloodstream infections in connection with central venous catheters (CVCs) are a major cause of morbidity (Department of Health (DH), 2007). PMID: 22067714 [PubMed - in process] (Source: British Journal of Nursing)

Ultrasound-guided subclavian vein cannulation in infants: supraclavicular approach.

Paediatric Anaesthesia — Sun, 09 Oct 2011 19:18:15 +0100

Conclusions: This US-guided supraclavicular approach for SCV puncture is a new possibility for central venous catheterization in small infants, offering all the advantages of SCV cannulation without the risk of 'pinch-off' syndrome. This technique seems valuable for children and infants and quite easy to apply for physicians trained to US guidance punctures. PMID: 21627714 [PubMed - in process] (Source: Paediatric Anaesthesia)

Prospective study of the incidence and predictors of thrombus in children undergoing palliative surgery for single ventricle physiology

Intensive Care Medicine — Fri, 07 Oct 2011 05:47:27 +0100

Conclusion One-third of patients undergoing palliative surgery for single ventricle physiology develop thrombosis. Decreased ventricular function, low antithrombin III, and increased tissue plasminogen activator may predict those most suitable for randomized clinical trials of anticoagulation. Content Type Journal ArticleCategory Pediatric OriginalPages 1-8DOI 10.1007/s00134-011-2378-yAuthors Deanna R. Todd Tzanetos, Department of Pediatrics, Division of Critical Care, University of Kentucky School of Medicine, Lexington, KY, USAChang Yu, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USAMarta Hernanz-Schulman, Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN, USAFrederick E. Barr, Department of ...

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Essential, but at what risk?: A prospective study on central venous access in patients with haematological malignancies

Internal Medicine Journal — Fri, 07 Oct 2011 04:00:00 +0100

Conclusions: This prospective observational study found almost a quarter of haematology patients experience a CVC‐related complication. An association was found with number of attempts at insertion and immediate complications; other risk factors included anatomical location, underlying disease and duration of catheterisation. The relatively high complication rate, compared to reports of non‐haematology patients, highlights the need to improve CVC management, a vital part of care for this population. (Source: Internal Medicine Journal)

Radiofrequency Guide Wire Recanalization of Venous Occlusions in Patients with Malignant Superior Vena Cava Syndrome

CardioVascular and Interventional Radiology — Thu, 06 Oct 2011 06:29:22 +0100

We report two patients with superior vena cava syndrome in whom we successfully utilized a radiofrequency guide wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) to perforate through the occlusion and recanalize the occluded segment to alleviate symptoms. Content Type Journal ArticleCategory Technical NotePages 1-4DOI 10.1007/s00270-011-0279-7Authors Robert M. Davis, Department of Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5 CanadaElizabeth David, Department of Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5 CanadaRobyn A. Pugash, Department of Interventional Radiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5 ...

Optimized Method for CVC Placement Under ECG GuidanceOptimized Method for CVC Placement Under ECG Guidance

Medscape Today Headlines — Wed, 05 Oct 2011 12:02:21 +0100

Do ECGs provide accurate guidance when placing a central venous catheter? British Journal of Anaesthesia (Source: Medscape Today Headlines)

Central Venous Catheter Thrombosis Associated With 70% Ethanol Locks in Pediatric Intestinal Failure Patients on Home Parenteral Nutrition: A Case Series.

JPEN Journal Of Parenteral And Enteral Nutrition — Wed, 05 Oct 2011 04:00:00 +0100

Authors: Wong T, Clifford V, McCallum Z, Shalley H, Peterkin M, Paxton G, Bines JE Abstract Central venous catheter (CVC) ethanol locks may reduce catheter-related bloodstream infection (CRBSI). Four children with intestinal failure on home parenteral nutrition (HPN) were selected for 70% ethanol locks because of their high rate of CRBSI. The 70% ethanol locks were instilled at a volume equal to the estimated internal volume of the CVC. Two children (aged 4 and 11 years) received 70% ethanol locks as CRBSI prophylaxis; another 2 children (aged 10 and 11 years) received 70% ethanol locks as adjunctive treatment for CRBSI. All 4 children developed either visible thrombosis in the CVC or CVC occlusion. To the authors' knowledge, this is the first report of CVC thrombosis associated wi...

Complications associated with peripheral or central routes for central venous cannulation

Anaesthesia — Tue, 04 Oct 2011 04:00:00 +0100

SummaryWe undertook a review of studies comparing complications of centrally or peripherally inserted central venous catheters. Twelve studies were included. Catheter tip malpositioning (9.3% vs 3.4%, p = 0.0007), thrombophlebitis (78 vs 7.5 per 10 000 indwelling days, p = 0.0001) and catheter dysfunction (78 vs 14 per 10 000 indwelling days, p = 0.04) were more common with peripherally inserted catheters than with central catheter placement, respectively. There was no difference in infection rates. We found that the risks of tip malpositioning, thrombophlebitis and catheter dysfunction favour clinical use of centrally placed catheters instead of peripherally inserted central catheters, and that the two catheter types do not differ with respect to catheter‐related infecti...

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Derivation and Validation of a Simple Model to Identify Venous Thromboembolism Risk in Medical Patients

The American Journal of Medicine — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions: The 4-element RAM identified in this study may be used to identify patients at risk for VTE and improve rates of thromboprophylaxis. This simple and accurate RAM is an alternative to more complicated published VTE risk assessment tools that currently exist. (Source: The American Journal of Medicine)

Thrombosis and Malignancy: A Case-Based Review

Seminars in Hematology — Sat, 01 Oct 2011 04:00:00 +0100

The association between venous thromboembolism (VTE) and malignancy is well established. Recent interest has focused on standards of care for prophylaxis, diagnosis, and treatment of malignancy-associated thrombosis. Anticoagulant management in cancer patients has unique complexities such as prolonged hospitalization, extensive surgeries, extended periods of inactivity, indwelling central venous catheters (CVC), thrombocytopenia, and pro-thrombotic medications. Here we will explore current recommendations for various specific clinical scenarios for cancer-associated thromboses. We will make evidence-based recommendations wherever possible; however, several of the scenarios here were included because pertinent high-quality evidence does not exist. (Source: Seminars in Hematology)

Strategies for the prevention of central venous catheter infections: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review

Journal of Pediatric Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: Grade A and B recommendations can be made based on available evidence in adult and limited pediatric studies for multiple components of proper CVC insertion practices and subsequent management. These strategies can minimize the risk of CVC infections in pediatric patients. (Source: Journal of Pediatric Surgery)

J‐tip guide wire entrapment within the heart during central venous catheterization

Hemodialysis International — Sat, 01 Oct 2011 04:00:00 +0100

AbstractA 55‐year‐old female was hospitalized for melena. The patient was suspected of having uremia symptoms. Use of a tunneled cuffed hemodialysis catheter of the right internal jugular vein was planned. At one point, the wire could not be extracted or advanced. In addition, whenever the guide wire was manipulated, ventricular premature rhythms developed. Fluoroscopy revealed knotting of the guide wire in the right ventricle. A 7 French guiding catheter was inserted along the guide wire, which loosened the knotting of the guide wire. The present case shows that entrapment within the heart can develop due to use of a J‐tip guide wire. If a guide wire cannot be removed despite several attempts with gentle pressure, this event should be ruled out by fluoroscopy and chest X‐ray. Usin...

Short‐term and long‐term mortality following pediatric intensive care

Pediatrics International — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions: A two years follow up period seems sufficient for a comprehensive mortality analysis of PICU patients. Severity of critical illness is the key factor of short‐term mortality whereas co morbidities are the major determinants of long‐term mortality. (Source: Pediatrics International)

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Evaluation of the impact of a new synthetic vitamin E-bonded membrane on anemia and rHuEPO requirement in ESRD patients with central venous catheters: a pilot study

International Urology and Nephrology — Fri, 30 Sep 2011 06:30:12 +0100

In conclusion, the study suggests a role for PSVE in the reduction of ESA index in HD patients with CVCs. Content Type Journal ArticleCategory Nephrology – Original PaperPages 1-8DOI 10.1007/s11255-011-0016-9Authors S. Mandolfo, Renal Unit, Ospedale Maggiore, AO, Lodi, ItalyB. Corradi, Renal Unit, Ospedale Maggiore, AO, Lodi, ItalyR. Bucci, Renal Unit, Ospedale Maggiore, AO, Lodi, ItalyM. Farina, Renal Unit, Ospedale Maggiore, AO, Lodi, ItalyF. Pilolli, Laboratory of Clinical Biochemistry and Nutrition, University of Perugia, Perugia, ItalyF. Galli, Laboratory of Clinical Biochemistry and Nutrition, University of Perugia, Perugia, Italy Journal International Urology and NephrologyOnline ISSN 1573-2584Print ISSN 0301-1623 (Source: International Urology and Nephrology)

Coincidental Alignment of Extracorporeal Oxygenator Cannula and Central Venous Catheter [IMAGES IN CARDIOTHORACIC SURGERY]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

(Source: The Annals of Thoracic Surgery)

A prospective study of catheter-related complications in HPN patients

Clinical Nutrition — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion: CVAD complications, in particular line infection are still a major source of potentially avoidable HPN morbidity and mortality with a high cost to the healthcare system. The predominance of enteric organisms in our series raises the possibility of bacterial translocation as a significant component of the pathogenesis of line sepsis in HPN patients. (Source: Clinical Nutrition)

Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services

International Journal of Nursing Studies — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion: This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities. (Source: International Journal of Nursing Studies)