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Central venous catheter insertion

John Klein, Amelia Jepsen, Amy Patterson, Richard R Reich, Tina M Mason
BACKGROUND: Patients undergoing blood and marrow transplantation (BMT) use a central venous catheter (CVC); heparin is often employed to maintain patency but may increase the risk of complications. Research has not provided conclusive differences in efficacy and safety regarding heparin flushing versus normal saline flushing in CVC maintenance. Minimal research is specific to this patient population. OBJECTIVES: This study aimed to determine if differences exist in CVC patency, tissue plasminogen activator usage, and the incidence of central line-associated bloodstream infections when flushing with normal saline only versus heparin and normal saline among patients undergoing BMT...
April 1, 2018: Clinical Journal of Oncology Nursing
Maxim Yu Rykov, Sergei V Zaborovskij, Alexander N Shvecov, Vladimir V Shukin
PURPOSE: To review our experience with peripherally inserted central catheters in pediatric cancer patients. METHODS: The analysis included 353 patients (3 months up to 17 years, mean age 11.2 years) with a variety of cancers diseases, which in 2011-2016, 354 peripherally inserted central catheters were placed. All settings are carried out using ultrasound guidance. In 138 (39%) patients, external anatomical landmarks were used and in 216 (61%) intraoperative fluoroscopy...
March 1, 2018: Journal of Vascular Access
Kenzie A Cameron, Elaine R Cohen, Joelle R Hertz, Diane B Wayne, Debi Mitra, Jeffrey H Barsuk
OBJECTIVES: The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. METHODS: Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas...
March 14, 2018: Journal of Patient Safety
Peter Paik, Sanjay K Arukala, Anupam A Sule
Central venous catheters are placed in approximately five million patients annually in the US. The preferred site of insertion is one with fewer risks and easier access. Although the right internal jugular vein is preferred, on occasion, the left internal jugular may have to be accessed. A patient was admitted for septic shock, cerebrovascular accident, and non-ST-segment elevation myocardial infarction. A central venous line was needed for antibiotic and vasopressor administration. Due to trauma from a fall to the right side and previously failed catheterization attempts at the left subclavian and femoral veins, the left internal jugular vein was accessed...
January 9, 2018: Curēus
Jasper M Smit, Reinder Raadsen, Michiel J Blans, Manfred Petjak, Peter M Van de Ven, Pieter R Tuinman
BACKGROUND: Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US)...
March 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Maurizio Pacilli, Catherine J Bradshaw, Simon A Clarke
INTRODUCTION: Medium-term intravenous access in children is normally achieved by means of repeated multiple peripheral intravenous cannula insertions or peripherally inserted central catheters. Long peripheral cannulas might offer an alternative to these devices in children. Our aim was to clarify whether long peripheral cannulas provide reliable medium-term intravenous access avoiding the need for multiple peripheral intravenous cannulations or peripherally inserted central catheter insertion in children undergoing surgery...
March 1, 2018: Journal of Vascular Access
Manuel F Struck, Sebastian Ewens, Wolfram Schummer, Thilo Busch, Michael Bernhard, Johannes K M Fakler, Patrick Stumpp, Sebastian N Stehr, Christoph Josten, Hermann Wrigge
PURPOSE: Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography. METHODS: Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015...
March 1, 2018: Journal of Vascular Access
Fabrizio Poletti, Claudio Coccino, Davide Monolo, Paolo Crespi, Giorgio Ciccioli, Giuseppe Cordio, Giovanni Seveso, Stefano De Servi
PURPOSE: Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care...
March 1, 2018: Journal of Vascular Access
Folkert Steinhagen, Maximilian Kanthak, Guido Kukuk, Christian Bode, Andreas Hoeft, Stefan Weber, Se-Chan Kim
INTRODUCTION: A significant increase of the p-wave of a real-time intracavitary electrocardiography is a reliable and safe method to confirm the central venous catheter tip position close to the atrium. However, conflicting data about the feasibility of electrocardiography exist in patients with atrial fibrillation. METHODS: An observational prospective case-control cohort study was set up to study the feasibility and accuracy of the electrocardiography-controlled central venous catheter tip placement in 13 patients with atrial fibrillation versus 10 patients with sinus rhythm scheduled for elective surgery...
February 1, 2018: Journal of Vascular Access
Manuel F Struck, Johannes K M Fakler, Michael Bernhard, Thilo Busch, Patrick Stumpp, Gunther Hempel, André Beilicke, Sebastian N Stehr, Christoph Josten, Hermann Wrigge
This study aimes to determine the complication rates, possible risk factors and outcomes of emergency procedures performed during resuscitation of severely injured patients. The medical records of patients with an injury severity score (ISS) >15 admitted to the University Hospital Leipzig from 2010 to 2015 were reviewed. Within the first 24 hours of treatment, 526 patients had an overall mechanical complication rate of 26.2%. Multivariate analysis revealed out-of-hospital airway management (OR 3.140; 95% CI 1...
March 5, 2018: Scientific Reports
Jason Chui, Rasha Saeed, Luke Jakobowski, Wanyu Wang, Basem Eldeyasty, Angel Zhu, LeeAnne Fochesato, Ronit Lavi, Daniel Bainbridge
BACKGROUND: A routine chest X-ray (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. We sought to assess the value of a routine post-procedural CXR in the era of ultrasound-guided CVC insertion. METHODS: We performed a population-based retrospective cohort study to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008 and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion...
February 28, 2018: Chest
Ralph Gnannt, Nicolas Waespe, Michael Temple, Afsaneh Amirabadi, Kuan Liu, Leonardo R Brandão, Bairbre L Connolly
BACKGROUND: Peripherally inserted central catheters (PICCs) are associated with superficial and deep venous thrombosis of the arm. OBJECTIVE: The purpose of this study was to analyze the sequelae of repeated upper limb PICC insertions in children, in terms of the frequency of upper limb thrombosis in this patient group. MATERIALS AND METHODS: The study population included all children who underwent their first successful arm PICC insertion between January 2010 and December 2015...
February 27, 2018: Pediatric Radiology
Hany M Elrakhawy, Mohamed A Alassal, Ayman M Shaalan, Ahmed A Awad, Sameh Sayed, Mohammad M Saffan
BACKGROUND: Right ventricular (RV) dysfunction after pulmonary resection in the early postoperative period is documented by reduced RV ejection fraction and increased RV end-diastolic volume index. Supraventricular arrhythmia, particularly atrial fibrillation, is common after pulmonary resection. RV assessment can be done by non-invasive methods and/or invasive approaches such as right cardiac catheterization. Incorporation of a rapid response thermistor to pulmonary artery catheter permits continuous measurements of cardiac output, right ventricular ejection fraction, and right ventricular end-diastolic volume...
January 15, 2018: Heart Surgery Forum
Hyun-Jung Kwon, Young-Il Jeong, In-Gu Jun, Young-Jin Moon, Yu-Mi Lee
Subclavian central venous catheterization is a common procedure for which misplacement of the central venous catheter (CVC) is a frequent complication that can potentially be fatal. The carina is located in the mid-zone of the superior vena cava (SVC) and is considered a reliable landmark for CVC placement in chest radiographs. The C-length, defined as the distance from the edge of the right transverse process of the first thoracic spine to the carina, can be measured in posteroanterior chest radiographs using a picture archiving and communication system...
January 2018: Medicine (Baltimore)
Taito Kitano, Kumiko Takagi, Ikuyo Arai, Hajime Yasuhara, Reiko Ebisu, Ayako Ohgitani, Daisuke Kitagawa, Miyako Oka, Kazue Masuo, Hideki Minowa
OBJECTIVES: Although routine catheter tip cultures are not recommended, previous reports have indicated that some cases of colonization, such as with S. aureus, can lead to subsequent bacteremia. To evaluate the safety of colonized cases without antimicrobial treatment, as well as the effectiveness of routine catheter tip cultures in the neonatal intensive care unit (NICU), we performed a retrospective data analysis in a Japanese community hospital. METHODS: We reviewed all peripherally inserted central venous catheter tip culture results from the NICU ward between April 2012 and June 2017 to determine whether they had antimicrobial treatments or subsequent infections...
February 22, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
Jeffrey H Barsuk, Elaine R Cohen, Diane B Wayne, William C McGaghie, Rachel Yudkowsky
PURPOSE: Defensible minimum passing standards (MPSs) must be used to evaluate learner performance outcomes in health professions education. In this study, the authors compared the results of traditional Angoff and Hofstee standard-setting exercises with the Mastery Angoff and Patient-Safety approaches for central venous catheter (CVC) insertion skills examinations. The authors also evaluated how these standards affected evaluation of the historical performance of residents who participated in a simulation-based mastery learning (SBML) curriculum for CVC insertion skills...
February 20, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Emma K van de Weerdt, Bart J Biemond, Sacha S Zeerleder, Krijn P van Lienden, Jan M Binnekade, Alexander P J Vlaar
BACKGROUND: Severe thrombocytopenia should be corrected by prophylactic platelet transfusion prior to central venous catheter (CVC) insertion, according to national and international guidelines. Even though correction is thought to prevent bleeding complications, evidence supporting the routine administration of prophylactic platelets is absent. Furthermore, platelet transfusion bears inherent risk. Since the introduction of ultrasound-guided CVC placement, bleeding complication rates have decreased...
February 20, 2018: Trials
Christos Farazi-Chongouki, Ioannis Dalianoudis, Anestis Ninos, Pantelis Diamantopoulos, Dimitrios Filippou, Stefanos Pierrakakis, Panagiotis Skandalakis
INTRODUCTION: Various anomalies in the development of the great thoracic veins of the embryo can be incidentally discovered in the normal adult. Duplication of superior vena cava (SVC) is a rare abnormality, but the most common thoracic venous congenital anomaly. Case reports-methods: We present two cases in the intensive care unit of our hospital, of asymptomatic patients who underwent an uneventful central line placement in the left subclavian vein. The track of the catheter, as shown in the X-ray, was misplaced to the left of the aorta and further investigation with computed tomography angiography confirmed a persistent left SVC...
February 19, 2018: Acta Chirurgica Belgica
Adrian Vk Wong, Nitin Arora, Olusegun Olusanya, Ben Sharif, Robert M Lundin, A Dhadda, S Clarke, R Siviter, M Argent, Gavin Denton, Anna Dennis, Angela Day, Tamas Szakmany
Background: Central venous catheters are inserted ubiquitously in critical care and have roles in drug administration, fluid management and renal replacement therapy. They are also associated with numerous complications. The true number of central venous catheters inserted per year and the proportion of them associated with complications are unknown in the UK. Methods: We performed a prospective audit at five hospitals, as a feasibility pilot for a larger, nationwide audit...
February 2018: Journal of the Intensive Care Society
Nakul Katyal, Amanda Korzep, Christopher Newey
Central venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed...
January 2018: Journal of Neurosciences in Rural Practice
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