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Sample records for central venous catheter-related

  1. Central Venous Catheter-Related Hydrothorax

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    Se Hun Kim

    2015-11-01

    Full Text Available This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

  2. Central venous catheter-related infections: Risk factors and effects of glycopeptide antibiotics

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    Arsenijević Ljubica

    2007-01-01

    Full Text Available INTRODUCTION Central venous catheters (CVC are used in the treatment of critically ill patients. Indications for placement of CVCs include hemodynamic monitoring, administration of intravenous fluids, medications and total parenteral nutrition. MATERIAL AND METHODS We investigated risk factors and effects of glycopeptide antibiotics on the development of central venous catheter-related infections in 300 patients treated in intensive care units. A semiquntitative culture technique was used. The investigation included: age, diagnosis on admission, catheter insertion site, catheter duration, the first or next catheter and using of glycopeptide drugs. RESULTS 91 catheters (30.3% were colonised, catheter-related infection was found in 50 catheters (16.7%. Infections were more frequent in catheters inserted through the internal jugular vein than in subclavian venous catheters; they were also more frequent if duration of catheterization was longer than seven days, but less frequent in patients who received glycopeptide antibiotics. The isolated microorganism was Staphylococcus aureus. DISCUSSION According to the literature, a number of catheter-related risk factors for infections include: insertion site, type of catheter, the number of manipulations, inadequat asepsis, lumen number, type of antiseptic. The relative importance of one risk factor over another is difficult to assess, given that studies have no priority report. CONCLUSION The duration of catheterization and the insertion site were the most frequent risk factors for infection. The use of glycopeptide antibiotics during catheterization has protective effects.

  3. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.

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    Wang, H; Huang, T; Jing, J; Jin, J; Wang, P; Yang, M; Cui, W; Zheng, Y; Shen, H

    2010-09-01

    We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.

  4. Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients.

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    Nosari, Anna Maria; Nador, Guido; De Gasperi, Andrea; Ortisi, Giuseppe; Volonterio, Alberto; Cantoni, Silvia; Nichelatti, Michele; Marbello, Laura; Mazza, Ernestina; Mancini, Valentina; Ravelli, Erica; Ricci, Francesca; Ciapanna, Denis; Garrone, Federica; Gesu, Giovanni; Morra, Enrica

    2008-11-01

    Indwelling central venous catheters (CVCs) are used in the management of hematologic patients. However, insertion and maintenance of CVCs are susceptible to complications. Study design and methods data concerning 388 consecutive catheterisations, performed in oncohematologic patients between April 2003 and December 2004, were prospectively collected. At insertion thrombocytopenia was present in 109 cases (28.1%) and neutropenia in 67 (17.3%). Hemorrhage after CVC insertion occurred in five thrombocytopenic patients (1.3%). The median duration of catheterisation was 18.8 days (range 1-89), longer in the 7-French CVCs utilised in leukemic patients (24.3 days) and shorter in 12-French CVCs (11 days), used for PBSC harvesting. Deep venous thrombosis was diagnosed in 13 cases (3.3%). Ninety-two catheterisations (12.6/1000 days-catheter) were complicated by infections: 19 local infections (4.8%) and 73 (18.8%) bacteraemias of which 45 (11.6%) were catheter-related, mainly due to Gram positive germs (32/45, 71.1%). The frequency of catheter-related bacteraemia was 7.2 events/1000 days-catheter. Thirteen CVCs were removed due to thrombosis, 15 due to infections, 20 due to malfunction, the remaining 333 at patients discharge. At univariate analysis high-dose chemotherapy (p = 0.013), 7-Fr lumen (p = 0.023), acute myeloid leukemia (AML) (p = 0.001), duration of neutropenia >10 days and length of catheterisation were significantly correlated to infection. Multivariate analysis confirmed the duration of catheterisation, AML and high-dose chemotherapy as risk factors. Even though hematological in-patients are at increased risk for bleeding and infections, non-tunnelled CVCs offer a safe venous access also in patients affected by severe thrombocytopenia and prolonged neutropenia.

  5. Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia

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    Kawai, Eichiro; Yaoita, Hisao; Ichinoi, Natsuko; Sakamoto, Osamu; Kure, Shigeo

    2017-01-01

    Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens. PMID:28194286

  6. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis.

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    Chen, Kai; Agarwal, Arnav; Tassone, Maria Cristina; Shahjahan, Nadia; Walton, Mark; Chan, Anthony; Mondal, Tapas

    2016-06-01

    Central venous catheter (CVC) placement is associated with increased risk of thrombosis in the paediatric population, particularly in relation to the type of catheter and the manner of its insertion. Here, we investigate risk factors associated with CVC-related thrombosis in children, with particular emphasis on positioning of the catheter tip. Patients aged 0-18 who underwent at least one CVC placement from 2008 to 2013 at a single centre with a subsequent follow-up echocardiogram were included for a total of 104 patients and 147 lines. Data on clinical and catheter-related risk factors were collected from patient charts. Statistical analysis using Pearson's χ tests, independent samples t-test, and odds ratios were used to assess potential risk factors for thrombosis. Neither insertion site (subclavian vein or otherwise), left- vs. right-sided insertion, nor catheter type were significant risk factors for thrombosis. There were no thrombotic events reported at the superior vena cava (SVC)-right atrium junction and no significant differences in thrombotic risk with initial tip placement in the SVC-right atrium junction vs. the SVC, right atrium, or inferior vena cava. Acute lymphoblastic leukaemia was a major clinical risk factor for thrombosis. Tip movement was common and may have been an important factor in the development of CVC-related thrombi. Prospective studies can yield insight into the role of follow-up imaging in the prevention of catheter-related thrombosis in children.

  7. Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

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    Eraksoy Haluk

    2003-02-01

    Full Text Available Abstract Backround We undertook a prospective study of all new central venous catheters inserted into patients in the intensive care units, in order to identify the risk factors and to determine the effect of glycopeptide antibiotics on catheter – related infections. Methods During the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Data were obtained on patient age, gender, unit, primary diagnosis on admission, catheter insertion site, duration of catheterization, whether it was the first or a subsequent catheter and glycopeptide antibiotic usage. Results Ninety-one (30.3% of the catheters were colonized and infection was found with 50 (16.7% catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32–4.81, p = 0.005. The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05–3.87, p = 0.03. The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49–5.51, p = 0.005. The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01. The most commonly isolated organism was Staphylococcus aureus (n = 52, 37.1%. Conclusion Duration of catheterization and catheter insertion site were independent risk factors for catheter related infection. Use of glycopeptide antibiotic during catheterization seems to have protective effect against catheter related infection.

  8. Evaluation of mupirocin ointment in control of central venous catheter related infections: a randomized clinical trial

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    Rezaei J

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Central venous catheter (CVC related infections are important complications of cathter application. This study assessed the usefulness of mupirocin in prevention and control of these infections."n"nMethods: In this randomized clinical trial, consecutive surgical patients requiring central venous catheter (for more than 2 days in Amir-Alam Hospital from 2006-2008 were enrolled. Patients were divided in two groups; in "case group" patients received topical mupirocin 2% every 48 hours at the time of insertion of catheter and dressing change and for "control group" mupirocin was not used. All of the patients received chlorhexidine and enoxoparin as complementary treatments. Two groups were comparable in regard of age, sex and risk factors."n"nResults: One hundred eighteen patients enrolled in the study (57 in case and 61 in control group completed the study. 84 catheters in case group and 88 catheters in control group were inserted. The catheters in 90% of patients were inserted in jugular vein. At the end of study 29(16.8% patients (16 in control versus 13 in case group had catheter colonization (p=NS. Catheter related bloodstream infection was observed in 16(9.3% patients (6 in

  9. Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children.

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    Sol, Jeanine J; Knoester, Hennie; de Neef, Marjorie; Smets, Anne M J B; Betlem, Aukje; van Ommen, C Heleen

    2015-08-01

    Prescription of thromboprophylaxis is not a common practice in pediatric intensive care units. Most thrombi are catheter-related and asymptomatic, without causing acute complications. However, chronic complications of these (a)symptomatic catheter-related thrombi, that is, postthrombotic syndrome (PTS) and residual thrombosis have not been studied. To investigate these complications, critically ill children of 1 tertiary center with percutaneous inserted femoral central venous catheters (FCVCs) were prospectively followed. Symptomatic FCVC-thrombosis occurred in 10 of the 134 children (7.5%; 95% confidence interval [CI], 2.4-9.5). Only FCVC-infection appeared to be independently associated (P=0.001) with FCVC-thrombosis. At follow-up 2 of the 5 survivors diagnosed with symptomatic thrombosis developed mild PTS; one of them had an occluded vein on ultrasonography. A survivor without PTS had a partial occluded vein at follow-up. Asymptomatic FCVC-thrombosis occurred in 3 of the 42 children (7.1%; 95% CI, 0.0-16.7) screened by ultrasonography within 72 hours after catheter removal. At follow-up, mild PTS was present in 6 of the 33 (18.2%; 95% CI, 6.1-30.3) screened children. Partial and total vein occlusion was present in 1 (3%) and 4 (12%) children, respectively. In conclusion, children on pediatric intensive care units are at risk for (a)symptomatic FCVC-thrombosis, especially children with FCVC-infection. Chronic complications of FCVC-thrombosis are common. Therefore, thromboprophylaxis guidelines are warranted in pediatric intensive care units to minimize morbidity as a result of FCVC-thrombosis.

  10. Incidence and risk factors for central venous catheter-related thrombosis in hematological patients.

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    Joks, Monika; Czyż, Anna; Popławski, Dariusz; Komarnicki, Mieczysław

    2014-01-01

    Catheter-related thrombosis (CRT) is a serious complication in hematological patients, but the risk factors for its occurrence are not well established. The study objectives were to estimate the incidence of CRT and to identify the risk factors for developing CRT in hematological patients. In a prospective setting, 104 consecutive patients with 200 insertions of central venous catheters were enrolled into the study. The patients were screened for CRT by compression Doppler ultrasound every 10-14 days. Additionally, ultrasonography was performed in the case of clinical symptoms suggesting CRT. Over the course of 6,098 catheter days of follow-up, the incidence of CRT was 13.5 %. In 18/27 cases (66.6 %), radiological evidence of CRT was preceded by clinical symptoms. However, in 9/27 (33.3 %), CRT was clinically asymptomatic. The median times to symptomatic and asymptomatic CRT were 17 (range 1-49) and 8 (range 1-16) catheter days, respectively. In univariate analysis, the risk factors for CRT were exit-site infection (ESI) (P risk of CRT. The results of our study provide information regarding the characteristic features of the patients who are at high risk of thrombosis, for whom Doppler ultrasound screening should be considered.

  11. Central venous catheter-related thrombosis in senile male patients: New risk factors and predictors.

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    Liu, Gao; Fu, Zhi-Qing; Zhu, Ping; Li, Shi-Jun

    2015-06-01

    Central venous catheterization (CVC)-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases (6.17%) of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization (Pvenous thrombosis history (Prisk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

  12. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

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    Aya Amer

    2016-01-01

    Full Text Available Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC, who then developed a supraventricular tachycardia (SVT. This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management.

  13. Central Venous Catheter-Related Tachycardia in the Newborn: Case Report and Literature Review

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    Amer, Aya; Broadbent, Roland S.; Edmonds, Liza

    2016-01-01

    Central venous access is an important aspect of neonatal intensive care management. Malpositioned central catheters have been reported to induce cardiac tachyarrhythmia in adult populations and there are case reports within the neonatal population. We present a case of a preterm neonate with a preexisting umbilical venous catheter (UVC), who then developed a supraventricular tachycardia (SVT). This was initially treated with intravenous adenosine with transient reversion. Catheter migration was subsequently detected, with the UVC tip located within the heart. Upon withdrawal of the UVC and a final dose of adenosine, the arrhythmia permanently resolved. Our literature review confirms that tachyarrhythmia is a rare but recognised neonatal complication of malpositioned central venous catheters. We recommend the immediate investigation of central catheter position when managing neonatal tachyarrhythmia, as catheter repositioning is an essential aspect of management. PMID:28058050

  14. Preventing central venous catheter-related infection in a surgical intensive-care unit

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    Bijma, R; Girbes, AR; Kleijer, DJ; Zwaveling, JH

    1999-01-01

    The cumulative effect of five measures (introduction of hand disinfection with alcohol, a new type of dressing, a one-bag system for parenteral nutrition, a new intravenous connection device, and surveillance by an infection control practitioner) on central venous catheter colonization and bacteremi

  15. Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

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    Geraldo Sadoyma

    2006-04-01

    Full Text Available Although central vascular catheters (CVC are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU/20 cm² (p=0.03; odds ratio (OR =6.89 and catheter tip (p=0.01; OR=7.95. The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

  16. To reduce catheter-related bloodstream infections: is the subclavian route better than the jugular route for central venous catheterization?

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    Nagashima, Goro; Kikuchi, Toshiki; Tsuyuzaki, Hitomi; Kawano, Rumiko; Tanaka, Hiroyuki; Nemoto, Hiroshi; Taguchi, Kazumi; Ugajin, Kazuhisa

    2006-12-01

    The most important targets of hospital-acquired infection control are to reduce the incidence of surgical-site, catheter-related, and ventilator-associated infections. In this report, we address previously presented infection-control strategies for central venous (CV) line catheterization, using a CV catheter-related infection surveillance system. Data concerning CV catheter insertion were collected from all facilities in our 650-bed hospital, excluding the operating and hemodialysis wards. Collected data included the insertion method, purpose, length of catheter inserted, duration of catheterization, infection rate, and complication rate. Catheter-related infection was diagnosed based on bacteriological examinations from blood cultures. The total number of catheterizations was 806 a year, and average duration of catheterization was 9.8 days. The purpose of catheterization was nutritional support in 210 cases, hemodialysis in 96 cases, cardiac support in 174 cases, and other treatments in 260 cases. In 66 cases, the purpose of CV catheter was not specified. The rate of positive cultures was 7.1%, and complications other than infection occurred in 0.5%. The main causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) in 38.6%, coagulase-negative Staphylococcus epidermidis (CNS) in 33.3%, and S. aureus in 12.3% of infections. Infection rates were 3.8 per 1000 catheter-days in subclavian, 6.1 in jugular, and 15.7 in femoral vein catheterization. In high-risk departments (intensive care unit [ICU] and emergency departments) the infection rate was 5.4 for subclavian and 10.2 for jugular catheterization, whereas it was 3.6 for subclavian and 4.6 for jugular catheterization in noncritical-care departments. Considering complications such as pneumothorax, CV catheterization of the jugular vein is recommended in certain situations.

  17. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

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    Diana Yuan Yng Chiu

    2015-01-01

    Full Text Available Three-dimensional (3D echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice.

  18. Three-Dimensional Imaging of a Central Venous Dialysis Catheter Related Infected Thrombus

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    Chiu, Diana Yuan Yng; Green, Darren; Kalra, Philip A.; Abidin, Nik

    2015-01-01

    Three-dimensional (3D) echocardiography is becoming widely available and with novel applications. We report an interesting case of a 68-year-old lady with a central venous thrombosis coincident with both a dialysis catheter infection and a recent pacemaker insertion. Two-dimensional transesophageal echocardiography was unable to delineate whether the thrombosis was involved with the pacemaker wire or due to the tunneled catheter infection. The use of 3D echocardiography was able to produce distinct images aiding diagnosis. This circumvented the need for invasive investigations and inappropriate, high-risk removal of the pacing wire. This case highlights the emerging application of 3D echocardiography in routine nephrology practice. PMID:26688761

  19. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

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    Suresh Babu Kale

    2013-01-01

    Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

  20. Sonication for diagnosis of catheter-related infection is not better than traditional roll-plate culture: a prospective cohort study with 975 central venous catheters.

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    Erb, Stefan; Frei, Reno; Schregenberger, Katharina; Dangel, Marc; Nogarth, Danica; Widmer, Andreas F

    2014-08-15

    This prospective randomized controlled study with 975 nontunneled central venous catheters (CVCs) showed that the semiquantitative roll-plate culture technique (SQC) was as accurate as the sonication method for diagnosis of catheter-related infections. Sonication is difficult to standardize, whereas SQC is simpler, faster, and as reliable as the sonication method for culturing CVCs.

  1. A role for peripherally inserted central venous catheters in the prevention of catheter-related blood stream infections in patients with hematological malignancies.

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    Sakai, Toshiro; Kohda, Kyuhei; Konuma, Yuichi; Hiraoka, Yasuko; Ichikawa, Yukari; Ono, Kaoru; Horiguchi, Hiroto; Tatekoshi, Ayumi; Takada, Kouichi; Iyama, Satoshi; Kato, Junji

    2014-12-01

    Central venous catheter-related blood stream infections (CR-BSIs) are a serious complication in patients with hematological malignancies. However, it remains unclear whether there is a difference in the rate of CR-BSI associated with the conventional type of central venous catheters (cCVCs) and peripherally inserted CVCs (PICCs) in such patients. To address this question, we retrospectively investigated the incidence of CR-BSIs associated with PICCs versus cCVCs in patients with hematological malignancies. We used PICCs in all consecutive patients requiring CVC placement between February 2009 and February 2013. We compared the CR-BSI rate in patients with PICCs with that in patients with cCVCs treated between September 2006 and January 2009 (control group). Eighty-four patients received PICCs and 85 received cCVCs. The most common reason for removal due to catheter-related complications was CR-BSI. The CR-BSI rate in the PICC group was significantly lower than that in the cCVC group (PICCs: 1.23/1000 catheter days; cCVCs: 5.30/1000 catheter days; P Catheter-related complications other than CR-BSIs occurred at an extremely low rate in the PICC group. The median catheter-related complication-free survival duration was significantly longer in the PICC group than in the cCVC group. Our study shows that PICCs are useful in patients with hematological malignancies.

  2. Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai

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    K Chopdekar

    2011-01-01

    Full Text Available Blood stream infections related to central venous catheterization are one of the major device-associated infections reported. Patients admitted in critical care units requiring central venous catheterization and presenting with signs of septicemia during catheterization period were investigated for catheter-related blood stream infections (CRBSI. The CRBSI rate was 9.26 per 1000 catheter days in general with highest rate in neonatal intensive care unit (27.02/1000 days. Site of insertion of catheter and duration of catheterization did not show the influence on the CRBSI rate. Coagulase-negative Staphylococci were the predominant cause. Mortality of 33% was observed in patients with CRBSI. Since central venous catheters are increasingly being used in the critical care, regular surveillance for infection associated them are essential.

  3. Analysis of Central Venous Catheter-related Infections%中心静脉导管相关性感染的临床分析

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    黄业; 谢逢春; 刘凤鸣

    2015-01-01

    Objective:To analyze the central venous catheter-related infections prevention strategies.Method: 120 patients in our hospital to accept deep vein indwelling tube were selected,the prevention and control measures were analyzed.Result:Among 120 patients received the central venous catheterization,the infection of catheter export was found in 3 cases,accounting for 2.50%,5 cases of catheter-related bloodstream infection, accounting for 4.17%,both of which were recovery after the corresponding disposals.Conclusion:Strengthening education and training of medical personnel,strict aseptic can effective prevent central venous catheter-related infections.%目的:探讨中心静脉导管相关性感染预防策略。方法:抽取笔者所在医院的接受深静脉留置管的120例患者为研究对象,分析预防、控制措施。结果:在行中心静脉置管术的120例患者中,3例患者出现置管出口部位感染,占2.50%,5例患者发生导管相关血流感染,占4.17%,通过对患者进行相应的临床处理,均得到一定的改善。结论:需要加强医务人员的教育培训,严格进行无菌操作,有效预防中心静脉导管相关性感染的发生。

  4. 留置途径对中心静脉导管感染的影响%Influence of remaining needle on central venous catheter-related infection

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    李丽华; 杨筱敏

    2011-01-01

    Objective To investigate the influence of central venous catheter-related infection among different remaining needle. Methods The infection of central venous catheter with remaining needle in patients of comprehensive ICU was analyzed. Results There was the highest infection rate (31.2%) in femoral vein catheter group, followed by subclavian vein catheter group and jugular vein catheter (13.7%, 15.4%), peripheral venous catheter infection rate was lowest (3.8%). The difference among three groups was statistical significance (P<0. 01 ). Gram-positive bacteria was the major pathogenic bacterium. Conclusion The infection of central venous catheter was correlated with the puncture approach, central venous catheter to adopt the peripheral venous puncture approach may lower significantly catheter-related infection rate.%目的 探讨不同留置途径对中心静脉导管相关性感染的影响.方法 对重症监护病房采用不同途径留置中心静脉导管的患者进行回顾性分析,比较经不同途径留置中心静脉置管而发生感染的差异.结果 股静脉发生感染率最高(31.2%),锁骨下和颈内静脉置管发生感染率次之(13.7%、15.4%),经外周静脉置管发生感染率最低(3.8%),三者差异有显著性(P<0.01),并且感染的致病菌以革兰氏阳性菌为主.结论 中心静脉置管的感染与留置途径有明显的相关性,采用外周静脉置管途径可以明显降低中心静脉置管的感染率.

  5. Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients.

    Science.gov (United States)

    Koldehoff, M; Zakrzewski, J L

    2004-11-01

    Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis and was shown to be effective in the prevention of catheter-related bloodstream infections (CR-BSI). In this pilot study, we used taurolidine solution as an intravenous (i.v.) lock into the totally implantable intravascular devices of 11 consecutive oncological patients with catheter-related bloodstream infections not responding to systemic antimicrobial chemotherapy. All patients recovered completely from the infection. No adverse drug effects were seen. Three patients were successfully retreated for a recurrent infection. Our data suggest a beneficial role of taurolidine i.v. lock for the therapy of catheter-related bloodstream infections in oncological patients. Taurolidine i.v. lock application is feasible and could especially be useful in infections resistant to antibiotic chemotherapy.

  6. Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

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    David Michael Z

    2011-08-01

    Full Text Available Abstract Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

  7. Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy

    Science.gov (United States)

    Berkowitz, Joshua C.; Bhusal, Sushma; Desai, Deepak; Cerulli, Maurice A.

    2016-01-01

    Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices. PMID:27807564

  8. Risk factors associated with central venous catheter related infection%中心静脉置管相关感染影响因素分析

    Institute of Scientific and Technical Information of China (English)

    张玥琪; 李敏; 葛圣金; 薛张纲

    2012-01-01

    Objective To study the risk factors associated with central venous catheter related infectioa Methods Fifty patients receiving central venous catheterization in the general surgical wards, surgical intensive care unit and hospital observation room from May to October, 2009 were studied. The factors including demographic data, distribution of medical resources, programs and the procedures of treatment, details about central venous catheter insertion were recorded and analyzed using logistic regression analysis. Results Fifty patients received totally 61 catheter insertion. There was no catheter related infection observed in the general surgical wards or the surgical intensive care unit, while 6 cases in the hospital observation room were diagnosed Logistic regression analysis outcome showed the different environments (OR = 2. 678, 95%CI 1.154-6.235), period of the preservation of the catheter(OR=1. 372, 95%CI 1. 326-5. 735) and the existence of other infection (OR= 2.712, 95% Cl 1.181-6.174) were predicting factor of catheter related infection. Conclusion Favourable environment and professional medical treatment team could effectively prevent central venous catheter related infection%目的 分析中心静脉置管相关感染的影响因素.方法 2009年5~10月普通外科病房、外科重症监护室和留院观察室接受中心静脉导管穿刺置管的患者.调查患者一般情况、诊疗方案及诊治过程、中心静脉穿刺置管相关情况,行多因素Logistic回归分析.结果 50例患者中心静脉穿刺置管61例次.普通外科病房和外科重症监护室未观察到导管相关感染的发生,留院观察室有6例次发生导管相关血流感染.不同科室(OR=2.678,95%CI 1.154~6.235)、导管留置时间(OR=1.372,95%CI 1.326~5.735)、是否存在他处感染(OR=2.712,95%CI 1.181~6.174)是中心静脉相关感染发生的独立影响因素.结论 良好的环境、专业性强的医疗团队对于预防与控制中心

  9. Tunnelled Central Venous Catheter-Related Problems in the Early Phase of Haematopoietic Stem Cell Transplantation and Effects on Transplant Outcome

    Directory of Open Access Journals (Sweden)

    Mahmut Yeral

    2015-03-01

    Full Text Available OBJECTIVE: Haematopoietic stem cell recipients need central venous catheters (CVCs for easy administration of intravenous fluid, medications, apheresis, or dialysis procedures. However, CVCs may lead to infectious or non-infectious complications such as thrombosis. The effect of these complications on transplantation outcome is not clear. This manuscript presents the complication rates of double-lumen tunnelled CVCs and their effect on transplantation outcome. METHODS: Data from 111 consecutive patients, of whom 75 received autologous and 36 received allogeneic peripheral blood stem cell transplantations, were collected retrospectively. The data were validated by the Record Inspection Group of the related JACIE-accredited transplantation centre. RESULTS: Thrombosis developed in 2.7% of recipients (0.9 per 1000 catheter days. Catheter-related infection was identified in 14 (12.6% patients (3.6 per 1000 catheter days. Coagulase-negative Staphylococcus was the most common causative agent. Engraftment time, rate of 100-day mortality, and development of grade II-IV graft-versus-host disease were not found to be associated with catheter-related complications. CONCLUSION: Sonuçlarımız nakil hastalarında tünelli SVK komplikasyonlarının yönetilebilir olduğunu ve bu komplikasyonların nakil üzerine olumsuz bir etki yaratmadığını göstermektedir.

  10. FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN AN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Priscilla Roberta Silva Rocha

    2012-01-01

    Full Text Available Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI, which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days, most due to gram-negative organisms (45.6%. Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, 95% CI 3.28-250, p-1 in survivors vs. 73.9 mg dL-1 in non-survivors, p = 0.001. Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative. CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.

  11. Catheter related bloodstream infection (CR-BSI in ICU patients: making the decision to remove or not to remove the central venous catheter.

    Directory of Open Access Journals (Sweden)

    Rodrigo Octávio Deliberato

    Full Text Available BACKGROUND: Approximately 150 million central venous catheters (CVC are used each year in the United States. Catheter-related bloodstream infections (CR-BSI are one of the most important complications of the central venous catheters (CVCs. Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. METHODS: We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1 differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2 simultaneous quantitative blood culture with ≥ 5:1 ratio (CVC versus peripheral. RESULTS: 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208 in ICU patients. CONCLUSION: In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality.

  12. 新生儿中心静脉导管相关性感染的预防%Prevention of central venous catheter-related infections in neonates

    Institute of Scientific and Technical Information of China (English)

    王欣宁

    2010-01-01

    Central venous catheters are indispensable in modern-day medical practice in neonatal intensive care units.Infection is the most frequent serious complication during these catheter-inserted days.Several strategies to prevent catheter-related infections are disputed all over the world.Studies have shown that some measures played a role in reducing the infection rate,which include maximal sterile barrier precautions,chlorhexidine preparation for skin antisepsis,routine replacement of catheter site dressings and connection sets,time-limited catheter insert,removal catheter after infected,antibiotic locked catheters and so on.%中心静脉导管是新生儿重症监护室常用的静脉通道,而感染是中心静脉导管置管术严重的并发症,各国的新生儿中心都在积极研究各种预防措施,但其有效性仍有争议.研究表明,严格无菌操作、洗必泰皮肤消毒剂、周期性更换辅料及导管连接装置、限期拔管、感染后及时拔管、抗生素封闭导管等措施在降低感染率方面有一定的作用.

  13. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    Science.gov (United States)

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  14. 抗感染中心静脉导管预防导管相关性血流感染的效果%Effect in prevention of catheter-related bloodstream infection using antiseptic impregnated central venous catheter

    Institute of Scientific and Technical Information of China (English)

    罗蕾; 秦英; 向亚娟

    2011-01-01

    Objective To evaluate the clinical effect in prevention of catheter-related bloodstream infection(CRBSI) using antiseptic impregnated central venous catheter. Methods The incidence of catheterrelated bloodstream infection was compared between 420 cases performed with antiseptic impregnated central venous catheter ( experimental group ) and 430 cases performed with general central venous catheter (control).Besides, the categories and characteristics of pathogenic bacteria which resulted in catheter-related bloodstream infection were analyzed. Results There were 66 cases of CRBSI in 850 cases, 25 cases were inserted antiseptic impregnated central venous catheter and 41 cases inserted general central venous catheter. No significant difference in the incidence between the two groups was found during 7 days(χ2 = 0. 06 ,P > 0. 05), however, the incidence of CRBSI was lower in the experimental group than of the control group after 7 days( χ2 = 3.91,4.30 ;P 0.05),7 d后实验组CRBSI感染率较对照组低,差异有统计学意义(χ2分别为3.91,4.30,P<0.05).实验组减少导管相关性血流感染的病原体主要为革兰阳性菌.结论 抗感染中心静脉导管可明显减少导管相关性血流感染的发生,有很大的临床价值.

  15. Prediction of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS).

    Science.gov (United States)

    Schalk, Enrico; Hanus, Lynn; Färber, Jacqueline; Fischer, Thomas; Heidel, Florian H

    2015-09-01

    The aim of this study was to predict the probability of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified version of the Infection Probability Score (mIPS). In order to perform a prospective, mono-centric surveillance of complications in clinical routine due to short-term central venous catheters (CVCs) in consecutive patients receiving chemotherapy from March 2013 to September 2014, IPS was calculated at CVC insertion and removal (mIPSin and mIPSex, respectively). We used the 2012 Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology (AGIHO/DGHO) criteria to define CRBSI. In total, 143 patients (mean 59.5 years, 61.4 % male) with 267 triple-lumen CVCs (4044 CVC days; mean 15.1 days, range 1-60 days) were analysed. CVCs were inserted for therapy of acute leukaemia (53.2 %), multiple myeloma (24.3 %) or lymphoma (11.2 %), and 93.6 % were inserted in the jugular vein. A total of 66 CRBSI cases (24.7 %) were documented (12 definite/13 probable/41 possible). The incidence was 16.3/1000 CVC days (2.9/3.1/10.1 per 1000 CVC days for definite/probable/possible CRBSI, respectively). In CRBSI cases, the mIPSex was higher as compared to cases without CRBSI (13.1 vs. 7.1; p < 0.001). The best mIPSex cutoff for CRBSI prediction was 8 points (area under the curve (AUC) = 0.77; sensitivity = 84.9 %, specificity = 60.7 %, negative predictive value = 92.4 %). For patients with an mIPSex ≥8, the risk for a CRBSI was high (odds ratio [OR] = 5.9; p < 0.001) and even increased if, additionally, CVC had been in use for about 10 days (OR = 9.8; p < 0.001). In case other causes of infection are excluded, a mIPSex ≥8 and duration of CVC use of about 10 days predict a very high risk of CRBSI. Patients with a mIPSex <8 have a low risk of CRBSI of 8 %.

  16. Risk factors for central venous catheter-related infections in NICU%NICU患者中心静脉导管相关性感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    王法欣

    2013-01-01

    目的 控制神经重症监护病房(NICU)患者中心静脉导管相关性感染的危险因素.方法 收集自2007-2011年入住NICU并进行中心静脉导管置管的患者资料,按照是否发生中心静脉导管感染进行分组,使用logistic回归分析方法明确NICU患者发生中心静脉导管相关性感染的危险因素.结果 自2007-2011年NICU进行中心静脉置管778例次,发生中心静脉导管感染175例次,发生率为22.4%,发生中心静脉导管相关性感染的平均时间9.1d;送检导管中病原菌检出阳性率为40.2%,导管血送检病原菌检出率为42.5%;logistic回归分析结果显示,糖尿病史及置入三腔导管进入最终的回归模型,OR值分别为3.777、9.094和7.342.结论 NICU患者中心静脉导管相关性感染的发病率高,中重度昏迷、糖尿病史及置入三腔导管是发生中心导管相关性感染的危险因素,建议临床对该类患者进行重点防护.%OBJECTIVE To identify the risk factors of central venous catheter-related infections in neurosurgery intensive care unit (NICU). METHODS We recruited the patients with central venous catheter-related infections in NICU from 2007 to 2011. The patients were divided according to the status of the infections, the logistic regression analysis method was employed to define the risk factors for the central venous catheter-related infections. RESULTS Of 778 case-time of patients who underwent central venous catheterization during 2007 - 2011, the centralvenous catheter-related infections occurred in 175 case-times of patients with the incidence rate of 22. 4% , the median time to onset of central venous catheters related infections was 9. 1 days. The positive rate of the pathogens isolated from submitted catheters was 40. 2%, 42. 5% of the submitted catheter blood. Logistic regression analysis showed that three factors including the history of diabetes mellitus and use of three-cavity catheter entered the final regression

  17. Investigation of central venous catheter-related in ICU and non-ICU patients%ICU与非ICU患者中心静脉导管感染调查

    Institute of Scientific and Technical Information of China (English)

    魏立娜; 陈兵; 张清照; 杨莉莉; 王冬芮

    2016-01-01

    目的:比较IC U与非IC U住院患者中心静脉导管感染的状况,提出预防对策,以降低患者中心静脉导管感染率。方法选择2010年1月-2015年6月在医院IC U和非IC U行中心静脉导管的患者各200例,对疑有中心静脉导管感染的患者进行血液及中心静脉导管尖端培养,比较IC U和非IC U患者的中心静脉导管感染率、置管部位、置管类型及病原菌分布。结果 IC U和非IC U患者血液、中心静脉导管培养阳性率及导管细菌定植率比较差异均无统计学意义;普通导管和血液透析导管的感染率较高,分别为12.66%和6.67%,抗感染导管感染率为11.11%明显较低;颈内静脉置管患者中心静脉导管感染率较高为38.46%;IC U与非IC U患者病原菌检出分布差异无统计学意义;IC U与非IC U患者留置中心静脉导管1~7 d的感染率<9.00%,8~14 d感染率为22.00%,≥15 d感染率为35.00%,IC U 与非 IC U 患者的置管时间比较差异无统计学意义。结论 IC U 与非IC U患者的中心静脉导管感染发病情况基本相同:抗感染导管的感染率较低,颈内静脉置管的感染率较高,病原菌以革兰阳性菌为主。%OBJECTIVE To compare the prevalence of central venous catheter-related infections in the hospitalized ICU and non-ICU patients and put forward the prevention countermeasures so as to reduce the incidence of central venous catheter-related infections .METHODS A total of 200 ICU patients and 200 non-ICU patients who under-went the central venous catheterization from Jan 2010 to Jun 2015 were enrolled in the study .The blood specimens and tips of central venous catheters were cultured for the patients with suspected central venous catheter-related infections;the incidence of central venous catheter-related infections ,sites of intubation ,types of catheters ,and distribution of pathogens were observed and compared between the ICU

  18. 中心静脉导管相关性血流感染危险因素分析%Risk factors of central venous catheter-related bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    杨大运; 齐战; 高少伟

    2013-01-01

    目的 研究分析中心静脉导管相关性血流感染(CLABSI)的临床特征,为预防与控制CLABSI提供临床依据.方法 采用回顾性调查方法对2009-2011年CLABSI资料汇总进行统计分析.结果 600例住院患者发生CLABSI53例,发病率为7.1‰;在分离出的53株病原菌中以革兰阳性球菌为主,共27株占50.94%,真菌14株占26.42%,革兰阴性杆菌12株占22.64%;CLABSI发病率与插管时间、插管部位、导管腔数、全胃肠外营养(TPN)有关,差异有统计学意义(P<0.05),CLABSI发病率与最大无菌屏障及灌注抗菌药物无关(P>0.05).结论 插管时间、插管部位、导管腔数、全胃肠外营养是CLABSI的主要因素,应针对上述因素制定相应的干预措施,以降低CLABSI的发生.%OBJECTIVE To investigate and analyze the clinic features of central venous catheter-related infections so as to provide basis for the prevention and control of catheter-related bloodstream infections.METHODS By means of the retrospective survey,the data of the patients with central venous catheter-related infections who were hospitalized during 2009-2011 were statistically analyzed.RESULTS Of totally 600 cases of hospitalized patients,the central venous catheter-related infections occurred in 53 cases with the incidence rate of 7.1%.There were totally 53 strains of pathogens isolated,including 27 (50.94%) strains of gram-positive bacteria,14 (26.42%) strains of fungi,and 12 (22.64%) strains of gram-negative bacilli.The incidence of central venous catheterrelated infections was related to the catheterization duration,intubation site,number of catheter lumen,and total parenteral nutrition (TPN),and the difference was significant (P<0.05);the incidence of central venous catheter-related infections was not related to the maximum sterile barrier or the perfusion of antibiotics (P>0.05).CONCLUSION The catheterization duration,intubation site,number of catheter lumen,and TPN are the main

  19. 血液透析用中心静脉导管相关感染的研究%Study on Central Venous Catheter-related Infections in Hemodialysis Patients

    Institute of Scientific and Technical Information of China (English)

    张智敏; 钟汉声; 王昱景; 张志强

    2015-01-01

    目的:观察血液透析患者透析用中心静脉导管感染的相关致病菌及有效治疗。方法分别进行临时性颈内静脉置管390例次,与带cuff的中心静脉导管40例次,股静脉置管150例次,中心静脉导管留置期间共出现68例次导管感染。每例次导管感染均送实验室进行细菌培养。结果血液透析患者透析用中心静脉导管感染总感染率为11.7%,中心静脉导管感染主要致病菌分别是金黄色葡萄球菌、大肠埃希菌、鲍曼不动杆菌复合菌、表皮葡萄球菌。股静脉置管导管感染发生率高于颈内静脉置管。结论抗生素全身应用或封管局部应用及拔出中心静脉导管是中心静脉导管感染的有效治疗方法。%Objective To observe pathogens of central venous catheter-related infections in hemodialysis patients and to find an effective treatment. Methods We performed 390 cases ( cases/times) of temporary internal jugular vein catheterization, 40 cases of central venous catheter with cuffs and 150 cases of femoral vein catheterization respectively. There were 68 cases of catheter infection occurred in the central venous catheter indwelling period. Each case of catheter infection was sent to the labora-tory for bacterial culture. Results The total infection rate of central venous catheter in hemodialysis patients was 11. 7%. The predominant pathogens of central venous catheter-related infection were Staphylococcus aureus,Escherichia coli,Acinetobacter bau-mannii complex strains and Staphylococcus epidermidis respectively. The infection rate occurred in femoral vein catheter was higher than the internal jugular vein catheterization. Conclusion Systemic antibiotics or topical application for sealing central venous cathe-ters and pull out central venous catheters is effective in the treatment of central venous catheter-related infection.

  20. Efficacy of nursing interventions in prevention of central venous catheter-related infections%护理干预预防中心静脉导管相关性感染的效果评价

    Institute of Scientific and Technical Information of China (English)

    潘春芳; 窭英茹; 郑瑞强; 史甜

    2012-01-01

    目的 分析护理干预在预防ICU中心静脉导管相关性感染中的应用效果.方法 采用目标性监测方法,进行护理干预,包括:严格无菌技术、缩短导管留置时间、选择合适置管部位及导管、敷料的选择与更换、导管接头与输入装置的护理和防止血栓形成,对实施护理干预前后ICU中心静脉导管相关性感染的发生率进行统计分析.结果 实施护理干预措施之后,总置管天数明显增加(P<0.05),中心静脉导管相关性感染率从2008年的7.67/千导管日、2009年的5.69/千导管日,下降至2010年的2.28/千导管日(P<0.05).结论 护理干预能够有效降低ICU中心静脉导管相关性感染的发生率.%OBJECTIVE To analyze the effect of nursing interventions in prevention of central venous catheter-related infections in ICU. METHODS Different means of targeted surveillance and nursing interventions were carried out, including implementing strict aseptic techniques, shortening the time of catheter indwelling, selecting the appropriate site and catheter, choosing and replacing dressing, nursing of the catheter connector and input device, and preventing thrombopoiesis. The incidence of central venous catheter-related infections in ICU before and after implementing the nursing interventions was statistical analyzed. RESULTS The total indwelling catheter-days were significantly increased after the implementation of nursing interventions(P<0. 05). the incidence of central venous catheter-related infections decreased to 2. 28/thousand catheter-days in 2010, which was 7. 67/ thousand catheter-days in 2008 and 5. 69/thousand catheter-days in 2009 (P<0. 05). CONCLUSION Implementation of the nursing interventions significantly reduces the incidence rate of central venous catheter-related infections.

  1. ICU患者中心静脉导管相关性感染的危险因素分析%Risk factors for central venous catheter-related infections in ICU patients

    Institute of Scientific and Technical Information of China (English)

    张伟; 张宏; 苏萌萌

    2014-01-01

    目的:探讨重症监护病房(ICU )患者中心静脉导管相关性感染(CRI)的病原学特征以及相关危险因素,以指导临床实践,预防医院感染的发生。方法对2012年10月-2013年3月医院IC U 206例留置中心静脉导管患者进行回顾性研究,采用χ2检验及多因素非条件 logistic回归分析,统计CRI发生率、观察其病原学特征并依此分析其相关危险因素。结果206例中心静脉导管患者中34例发生CRI ,发生率为16.50%;共检出病原菌34株,其中革兰阳性球菌占50.00%、革兰阴性杆菌占26.47%、真菌占23.53%;多因素非条件 logistic回归分析提示,年龄、使用多腔导管、长期留置导管为CRI独立危险因素,差异有统计学意义(P<0.05)。结论应加强CRI危险因素控制,更换导管类型,缩短留置导管时间,预防医院感染的发生。%OBJECTIVE To explore the etiological characteristics of central venous catheter-related infections in patients of intensive care unit (ICU ) and analyze the related risk factors so as to guide the clinical practice and prevent nosocomial infections .METHODS A total of 206 patients who underwent the central venous catheterization in the ICU from Oct 2012 to Mar 2013 were retrospectively studied , then the chi-square test and the non-conditional multivariate logistic regression analysis were performed , the incidence of central venous catheter-related infections was taken for statistics ,and the etiological characteristics were observed to analyze the related risk factors .RESULTS Of the 206 patients ,the central venous catheter-related infections occurred in 34 cases with the infection rate of 16 .50% .Totally 34 strains of pathogens have been isolated ,among which the gram-positive cocci accounted for 50 .00% , the gram-negative bacilli 26 .47% , the fungi 23 .53% . The non-conditional multivariate logistic regression analysis indicated that the age ,use of

  2. Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip

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    Qanadli, S.D.; Mesurolle, B.; Sissakian, J.F.; Chagnon, S.; Lacombe, P. [Service de Radiologie, Hopital Ambroise Pare, 92 - Boulogne (France)

    2000-08-01

    We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip. (orig.)

  3. 中心静脉导管相关性感染危险因素调查分析%Risk factors of central venous catheter-related infections

    Institute of Scientific and Technical Information of China (English)

    杨梅

    2011-01-01

    OBJECTIVE To explore the risk factors and prevention measures of central venous catheter-related infections (CRI).METHODS Thirty-one cases from Jan 2007 to Dec 2008 in our hospital were analyzed retrospectively.RESULTS CRI was related to the indwelling time, location of catheter.The most susceptible crowd of central venous catheter-related infections was those patients in critical conditions, senile patients.CONCLUSION Shortening catheter indwelling time is important to prevent CRI through augmenting the monitoring and the careful nursing.%目的 通过对中心静脉导管相关性感染的调查分析,探讨中心静脉导管相关性感染的防治.方法 分析2007年1月-2008年12月临床31例中心静脉导管感染病例.结果 31例置管感染患者置管时间最短7 d,最长58 d,平均置管时间23.38 d;感染发生>7 d者29例,占93.55%,其中>2周的22例,占70.97%;20例感染前全身性使用抗菌药物,占64.52%;感染与导管留置时间、置管部位等相关,危重、老年患者是导管相关性感染的易感人群.结论 减少导管留置时间,长期留置导管患者需加强导管的监测与管理.

  4. Application of interventional techniques on central venous catheter related diseases in hemodialysis patients%介入技术在血液透析患者中心静脉导管相关问题中的应用

    Institute of Scientific and Technical Information of China (English)

    杨涛; 侯西彬; 詹申; 王新玲; 王玉柱

    2015-01-01

    目的总结介入技术在血液透析患者中心静脉导管相关性问题诊断及治疗中的应用。方法回顾性分析我院肾内科82例中心静脉导管相关性介入诊断、治疗患者的临床资料,包括导管置入、导管位置调整及单纯诊断性造影,总结导管纤维鞘的诊断和介入处理方法。结果本组中伴有糖尿病者33例(40.2%),既往平均置管次数(3.2±1.7)次;介入下置管共55例次,导管位置调整24例次。置管的患者中,造影提示38例患者存在中心静脉狭窄或闭塞;导管调整的患者均为颈内静脉置管,13例为左侧颈内静脉置管,导管调整的原因多为导管末端不能达到适当的位置;经造影诊断纤维鞘13例次。结论 X线介入下中心静脉导管相关操作可实时明确中心静脉情况,确保导管置入适当位置,并可对病变的中心静脉治疗后置入导管,也是导管纤维鞘的诊断和处理的有效方法之一。%Objective To summarize the interventional therapy on central venous catheter related diseases in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 82 patients who had received interven-tional therapy for catheter related diseases. The data was consisted of catheter insertion under the X ray, adjustment to the catheter and angiography for the catheter related diagnostic procedures. We also summarized the interventional diagnosis and therapy for catheter related fibrin sheath formation. Results The incidence of diabetes mellitus was 40.2%. On an av-erage, previous cannulation times was 3.2±1.7. The number of cannulation and adjustment to the catheter under X ray was 55 and 24 respectively. In all cannulation patients, venography revealed that central venous stenosis or obstruction were found in 38 patients. In patients whose catheter position was adjusted, the sites of puncture were internal jugular vein in all. Puncture sites were left internal jugular

  5. ICU 导管相关性血流感染危险因素分析%Influential factors of central venous catheter-related bloodstream infections in ICU patients. Zong Zhihua

    Institute of Scientific and Technical Information of China (English)

    宗志华

    2013-01-01

      目的探讨 ICU 导管相关性血流感染(catheter-related blood stream infections, CRBSI)的风险因素,及其预防对策。方法回顾性分析2008年5月至2012年5月我院实 ICU 实施中心静脉置管的患者803例,其中发生 CRBSI 46例,分析发生的原因并制订相应的对策。结果46例患者发生 CRBSI 的原因与操作不当、导管的类型和材料、置管部位、时间及患者因素等有关;其中4例患者更换导管,7例拔除了导管,其余35例感染得到控制。结论患者、导管及置管因素均影响 CRBSI 的发生,通过纠正诱发因素,降低 CRBSI 发生率,有助于改善患者预后。%Objective To investigate the influential factors of central venous catheter-related bloodstream infections (CRBSI) in ICU, so as to develop appropriate countermeasures. Methods The clinical date of 803 ICU patients from May 2008 to May 2012 treated with central venous catheter were retrospectively reviewed to find 46 cases of catheter-related bloodstream infections. The influential factors were analyzed and the countermeasures were worked out. Results 46 cases of CRBSI were related with improper operation, tube type and materials, catheter site, time and patients and other relevant factors. 4 cases were treated with catheter replacement. 7 cases were removed of the catheter and 35 cases were controled stably. Conclusion it’s possible way to reduce the incidence of CRBSI and help to improve the prognosis of patients, from correcting factors, including patients, catheter and catheter factors, which influence the occurrence of CRBSI.

  6. Risk factors and nursing countermeasures for central venous catheter-related infections in EICU%EICU中心静脉导管相关性感染的危险因素分析及护理对策

    Institute of Scientific and Technical Information of China (English)

    宋晓莉; 苗慧; 杨晓秋; 钱远宇; 孟庆义

    2012-01-01

    OBJECTIVE To investigate the risk factors and nursing countermeasures for central venous catheters related infections (CRI) in the emergency intensive care unit. METHODS Form-based recording methods were used to evaluate hand disinfection before the insertion of catheter, the choics, the sites, the frequency, the time, the care of puncture site, the connector of infusion and the choices of dressing and so on. RESULTS The incidence rate of CRI in 64 patients with venous catheters was 7. 8% , the risk factors mainly included venous catheter techniques, aseptic principles, the site of catheterization, using tine, and catheter maintenance. CONCLUSION In clinical practice, central venous catheter-related infection is inevitable because of a variety of factors. Form-based recording method for the nursing can remind ihe operators and maimainers of the preparation before the calhelerization, cooperation during the catheterization, and the nursing after the catheterization so as to reduce the incidence of infections.%目的 探讨急诊重症监护病房(EICU)患者深静脉置管后,中心静脉导管相关性感染的危险因素及护理对策.方法 采用表单式记录方法,记录置管前手消毒、置管时机、置管部位、置管顿次、置管时间、穿刺点护理、输液接头、敷料选择等内容.结果 通过对64例置管患者的—预,其导管相关性感染的发生率为7.8%,其危险因素主要与置管技术、无菌原则、插管部位、使用时间、导管维护等有关.结论 中心静脉导管在临床使用中由于多种因素的影响感染的发生难以避免,针对其危险因素,采用表单式的护理方法,可以提醒操作者及维护者在置管前的准备、置管中的配合及置管后的护理方法,从而降低感染的发生率.

  7. Impact of Cluster of Intervention Strategies on CRRT Central Venous Catheter-related Bloodstream Infections%集束化干预策略对CRRT中心静脉导管相关性血行感染的影响

    Institute of Scientific and Technical Information of China (English)

    陈刚; 黄晓铭; 陈鑫鑫

    2014-01-01

    Objective To explore the cluster intervention strategies for CRRT central venous catheter related bloodstream infections (hereinafter referred to as CRBIS). Methods Retrospective analysis of our department in August 2012-February 2013 lines of central venous catheter and conventional CRRT infection intervention measures of patients 150 cases (control group) and March 2013-September 2013 lines of central venous catheter and CRRT in 196 patients with cluster intervention strategies (observation group), compared two groups of patients the incidence of CRBIS, ICU hospitalization days and hospitalization expenses, etc. Results Cluster intervention strategies significantly reduce the rate of catheter-related bloodstream infection, which reduces the patients in ICU time, reduced the cost of patients. Conclusion Cluster intervention strategy can decrease the CRRT CRBIS rate of femoral vein, but need to improve the clinical compliance.%目的:探讨集束化干预策略对CRRT中心静脉导管相关性血流感染(以下简称 CRBIS)的影响。方法回顾性对比分析我科2012年8月~2013年2月行CRRT中心静脉导管并按常规实施感染干预措施的患者150例(对照组)与2013年3月~9月行CRRT中心静脉导管并按集束化干预策略患者196例(观察组),比较两组患者的CRBIS发生率、ICU 住院天数、住院费用等。结果集束化干预策略明显降低导管相关性血行感染,从而降低了患者入住 ICU时间,减少了患者费用。结论集束化干预策略可降低CRRT股静脉的CRBIS率,但需提高临床的依从性。

  8. The study of the risk factors associated with central venous catheter related infection%ICU中心静脉导管相关性感染危险因素的调查研究

    Institute of Scientific and Technical Information of China (English)

    单荣芳; 孙华; 李峰

    2011-01-01

    days was 3 days, 14 days, 18 days and 21 days respectively. The incidence of catheter related infection was 3.95/1000 catheter days. Conclusion The key management to control catheter- related infection in ICU is strict implement the indication of central venous catheter;patients who undergo central venous catheter with nurses' record sheets assessed and cared, the duration of catheterization shortened.

  9. Risk factors for central venous catheter-related infections in pediatric intensive care Fatores de risco para as infecções relacionadas ao caracter venoso central em terapia intensiva pediátrica

    Directory of Open Access Journals (Sweden)

    Ricardo Vilela

    2007-01-01

    Full Text Available OBJECTIVES: To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014 and duration of catheter use (p=0.0013, and protective factors included concomitant antibiotic use (p=0.0005 and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002. Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.OBJETIVOS: Identificar fatores de risco para as infecções relacionadas a cateter venoso central de curta permanência, inserido por punção, em crianças e avaliar a eficiência de um escore de mortalidade pediátrica em prever o risco

  10. Cluster of Central Venous Catheter Related Bloodstream Infections Intervention Study%集束化干预中心静脉导管相关性血流感染的研究

    Institute of Scientific and Technical Information of China (English)

    黄彩云; 庞杰媚

    2014-01-01

    目的:探讨集束化护理方案在预防中心静脉导管相关性血流感染(C RBS I )的效果。方法:对2012年8月-2014年1月收住IC U的466例中心静脉置管患者制定及实施集束化护理策略。选择集束化干预前2011年3月-2012年8月同科室置中心静脉导管的403例患者作为对照。结果:采取集束化干预后导管的使用率从63.6%升到71.6%,导管的感染率从8.61‰降低到1.49‰,下降了82.7%,干预前、后感染率差异有统计学意义。结论:集束化护理能减少中心静脉导管感染的机会。%Objective :Discusses cluster care solutions in central venous catheter related bloodstream infection (CRBSI) prevention effect. Methods :In August 2012 to January 2014 of 466 patients with central venous catheter admitted to the ICU nursing strategy formulation and implementation of cluster. Before choosing cluster change intervention in March 2011 to August 2012 of 403 patients as control of central venous catheter. Results:Take the cluster is changed after the intervention catheter utilization rose from 63. 6% to 71. 6% ,catheter infection rate reduced from 8. 61‰ to 1. 49‰ ,de‐creased by 82. 7% ,infection rate difference was statistically significant before and after intervention. Conclusion:Cluster of central venous catheter infection nursing can reduce the opportunity.

  11. Causes of central venous catheter-related infections after cardiac surgery and intervention measures%心脏术后中心静脉导管感染的原因分析及干预措施的研究

    Institute of Scientific and Technical Information of China (English)

    郭舒婕; 王晓敏; 张瑜; 张艳丽

    2012-01-01

    OBJECTIVE To analyze the causes of central venous catheter-related infections after the cardiac surgery and to explore the intervention countermeasures. METHODS A total of 100 patients who underwent cardiac surgery were selected, and all the patients underwent the central venous catheterization. RESULTS Of the 100 patients investigated, the central venous catheter-related infections occurred in 22 patients with the infection rate of 22. 0% , including 6 cases of Staphylococcus epidermidis infections, 5 cases of S. aureus infections, 4 cases of Klebsiella pneumoniae infections, 3 cases of Enterococcus faecalis infections, 1 case of Acinetobacter baumannii infection, 1 case of Enterobacter cloacae infection, 1 case of Candida albicans infection, and 1 case of Pseudomonas aeruginosa infection. The infections disappeared after being given appropriate antibiotics on the basis of drug susceptibility testing. The incidence rate of the central venous catheter-related infections in the patients with less than 50 years of age was 12. 5%, and 26. 5% of the patients with more than 50 years, the difference was statistically significant (P<0. 05). The infection rate of the patients without complications was 9. 1 % , and 28. 3% of the patients with complications, the difference was statistically significant (P<0. 05). The infection rate of the patients with the subclavian vein as puncture site was 17. 8%. and 21. 8% of the patients with internal jugular vein as the puncture site, the difference was not statistically significant. The infection rate of the patients with the joints and sealing solution optimized was 17. 6%, the conventional 37. 5%, the difference was statistically significantP<0. 05). The infection rate of the patients with dual-chamber was 21. 4% , 27. 3% of the patients with three-cavity, the difference was not statistically significant. The infection rate of the patients with the catheterization duration less than 7 days was 9. 1% , 20. 1% of the patient with the

  12. 综合护理对中心静脉导管并发症的干预作用%INTERVENTION EFFECT OF COMPREHENSIVE CARE ON CENTRAL VENOUS CATHETER RELATED ;COMPLICATIONS

    Institute of Scientific and Technical Information of China (English)

    穆树敏; 穆树林; 刘晶; 柴囡; 史素丽; 尚秀娟; 程爱斌

    2016-01-01

    目的:探讨综合性护理对中心静脉导管相关并发症的干预作用。方法选取2013年6月—2015年6月在我院留置中心静脉导管患者256例为研究对象,采用对照研究,将2013年7月—2014年6月的126例作为对照组,2014年7月—2015年6月的130例为干预组。干预组患者实施综合性护理,对照组给予常规护理,对二组患者导管留置期间的并发症和健康教育的效果进行比较,并评价患者对护理工作的满意度。结果干预组导管破损率为6.9%、导管阻塞率为8.4%、导管移位脱出率为0.8%、导管相关性感染率为9.2%、导管相关性血栓形成率为3.8%、静脉炎率为6.9%均明显低于对照组,差异有统计学意义(P <0.05);干预组对导管相关知识和维护技能的掌握程度及对护理的依从性显著高于对照组,差异有统计学意义(P <0.05);干预组和对照组对护理工作的满意度分别为94.6%和80.2%,两者比较差异有统计学意义(P <0.05)。结论通过综合护理干预可以降低导管相关并发症的发生率,提高患者对导管知识和维护技能的掌握程度及对护理的依从性和满意度。%Objective To evaluate the intervention effect of comprehensive care on central venous catheter related complications.Methods A total of 256 patients with indwelling central venous catheter were se-lected in author's hospital as the research subjects from July 2013 to June 2015.Among them,126 cases were as the control group in July 2013 to June 2014,other 130 cases were as the intervention group in July 2014 to June 2015.The patients in the intervention group were given comprehensive care,while the control group received basic nursing.Catheter-related complications in patients with two groups were compared. The health education master degree and satisfaction of nursing work for all the subjects were evaluated.Re-sults In the intervention group,the rate of catheter breakage was 6.9%,catheter blocking 8.4%,cathe

  13. 中心静脉置管易被忽略的感染因素分析与对策%Easily ignored factors of central venous catheter-related infection and countermeasures

    Institute of Scientific and Technical Information of China (English)

    张黎明; 王黎梅; 步惠琴; 张美琪

    2011-01-01

    OBJECTIVE To analyze the easily ignored factors for central venous catheter-related infection (CVC-RI)and to seek certain strategy.METHODS The easily ignored factors of CVC-RI of 63 cases in ICU and geriatric wards of the two hospitals were analyzed with retrospective analysis method and prospective intervention method.Certain solutions were proposed.RESULTS The CVC-RI incidence of 279 cases who got central venous catheter from Jan to Jul in 2009 was 10.39 %, and the CVC-RI incidence of 264 cases who got central venous catheter from Jan to Jul in 2008 was 23.86 %, the difference of CVC-RI incidence in the two groups was statistically significant.CONCLUSION Paying close attention and strengthening the catheter puncture operation and daily care for puncture site can significantly reduce the incidence of CVC-RI.%目的 分析中心静脉置管相关性感染(CVC-RI)易被忽略的危险因素及进行环节上的改进.方法 采用回顾性调查分析和前瞻性干预的方法,对2所医院ICU、老年病区2008年63例CVC-RI患者进行原因分析,查找易被忽略的危险因素,提出对策,并与2009年1月起加强了环节管理后的CVC-RI结果进行统计分析.结果 2009年1-7月实施中心静脉穿刺279例患者发生CVC-RI29例,发生率10.39%,2008年同期置管的264例患者发生CVC-RI63例,发生率23.86%,两组感染率比较,差异有统计学意义(P<0.05).结论 关注并加强置管操作和穿刺部位日常护理中的环节管理,能有效降低CVC-RI的发生率.

  14. Analysis of Risk Factors of Central Venous Catheter-related Bloodstream Infection%中心静脉导管相关血流感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    吴庆华; 傅小云

    2012-01-01

    [Objective]To explore the risk factors and prevention points of central venous catheter(CVC)-related bloodstream infections(CVC-RBI). [Methods] Clinical data of 25 patients with catheter-related infection caused by central venipuncture in critical care medicine department of affiliated hospital of Zunyi medical college were analyzed retrospectively. The types and characteristics of pathogens of patients were analyzed by the culture at distal end of the catheter and blood culture or the secretion culture at outlet of the catheter. [Results ] Among 25 patients with catheter-related infection, 4 cases were infection at the tip of the catheter, 3 cases were infection at the outlet and 18 cases were catheter-related bloodstream infection. The patient's age and sex had no relation with the infection rate( P >0. 05). Catheter time was positively correlated to infection(R = 0. 32). When catheter time was less than one week, the infection rate was 0. When catheter time was less than or equal to one week and less than one month, the infection rate was 24%. When catheter time was less than or equal to one month, the infection rate was 76%. There were significant differences among groups( P <0. 05). [Conclusion]The incidence of CVC-BSI increases with the increasing of catheter time, and is related with various of operations and the patient's status.%[目的]探讨中心静脉导管(CVC)引发的导管相关性血流感染(CVC-RBI)的危险因素及预防要点.[方法]回顾性分析遵义医学院附属医院重症医学科25例中心静脉穿刺患者发生导管性感染的资料,并通过导管末端培养与血培养,或通过导管出口部位分泌物培养,分析患者病原菌种类和特点.[结果]25例导管相关性感染患者中,导管尖端部位感染4例,出口部位感染3例,导管相关性血流感染18例.患者的年龄和性别与感染率无关( P >0.05).置管时间与感染发生率呈正相关(R=0.32 ).置管时间<1周,感染发生率为0;≤1

  15. Risk factors for central venous catheter-related infections in patients with severe trauma and countermeasures%严重创伤患者中心静脉插管相关性感染因素的分析与对策

    Institute of Scientific and Technical Information of China (English)

    鲍乐乐; 程正祥; 王秀环; 马漪洁; 陈占军; 魏丽

    2012-01-01

    OBJECTIVE To discuss the risk factors for the central venous catheter-related infections in patients with severe trauma so as to provide basis for developing treatment measures of infections. METHODS A follow-up surveillance was carried out for the patients with central venous catheter-related infections from Jan. To Dec, 2009 and from Jan. To Dec. 2010. Statistical analysis of surveillance result was performed, RESULTS The major risk factors for central venous catheter-related infections included poor sterile operation, did not pay attention to intubation care, decrease in immunity and so on. After implementing targeted monitoring and a series of intervention measures, the incidence of central venous catheter-related infections dropped from 11, 9% in 2009 to 5. 4% in 2010. CONCLUSION For the risk factors of catheter-related infections in patients with severe trauma, implementing targeted interventions can significantly reduce the incidence of the catheter-related infections,%目的 对严重创伤患者中心静脉插管相关性感染因素进行分析,为制定预防治疗对策、降低感染的发生提供依据.方法 对医院2009年1-12月及2010年1-12月中心静脉插管感染患者进行随访监测,并对监测结果进行统计分析.结果 2010年开始目标监测并实施一系列干预措施后,感染发生率由2009年的11.9%下降至2010年的5.4%;无菌操作不严格、不重视插管的护理、患者免疫力下降等是引起中心静脉插管相关性感染的主要原因.结论 针对严重创伤患者中心静脉插管的感染相关性因素,采取相应的干预措施,可明显减少中心静脉插管相关性感染的发生.

  16. Infecciones relacionadas con el catéter venoso central en pacientes con nutrición parenteral total Central venous catheters-related infections in patients with parenteral nutrition

    Directory of Open Access Journals (Sweden)

    R. Seisdedos Elcuaz

    2012-06-01

    related to central venous catheters (CVC are complications with a high prevalence and possible serious consequences. Administration of total parenteral nutrition (TPN is a risk factor, although the information available for these patients and conventional inpatient units is scarce. Objective: To determine the rate of catheter-related bacteremia (CRB in patients with TPN and to identify possible relationships with administration route or place of insertion, to determinate the current situation and identify possible preventive measures. Method: Prospective-observational study of 13 months. All adult patients who received TPN were included. Infection rate used was the CRB per 1,000 days of CVC. Results: 176 CVC were registered in 159 patients. In 47% of CVC, vein access was jugular vein, despite being a location of greatest risk of infection. In critically ill patients, which followed a zero bacteremia project, there was no cases of infection. In other patients, bacteremia rate was 13.10 per 1,000 days of CVC. The average time elapsed between catheter insertion and infection was 11 days (range: 4-22 and the most frequent species were S. epidermidis (38% and S. hominis (19%. Discussion: In our environment there is a high rate of BRC in non-critical patients, with a high proportion of CVC in locations with higher risk of infection, despite not having found in the sample a higher rate of infection depending on the access route. Place of insertion, operating room face ward, is related to a lower rate of BRC. Measures to standardize clinical practice may reduce its incidence. The zero bacteremia project is confirmed as a highly effective method.

  17. Etiological analysis and prevention of central venous catheter related infections%中心静脉导管相关感染的病原学分析与预防

    Institute of Scientific and Technical Information of China (English)

    刘凤梅; 蔡益民; 任丽霞

    2013-01-01

    Objective To investigate the distribution of pathogens and routes of infection for central venous catheter-related infections, and thereafter to provide the basis for clinical prevention. Methods Randomly select-ed 52 patients that catheter tip culture results were positive, all the patients come from a same hospital in Jilin province, and then conducted a retrospective analysis of the data. Results There are 82 pathogenic bacteria ap-peared in the experiment among the 52 infected patients. The major pathogenic bacteria were G+ (65/82 or 79.27%), G-bacteria (16/82 or 19.51%)and Fungi (1/82 or 1.22%).The route of infection is consist of catheter ex-traluminal pathogens planting, catheter connector and cavity pathogens planting, blood flow propagating. Conclu-sion Strengthen the education and training of medical staff and take positive and effective prevention measures can reduce the infection.%目的:探讨中心静脉导管相关感染的病原菌分布及感染途径,为临床预防提供依据。方法:选取吉林省某三甲医院神经外科导管尖端培养结果阳性的52例患者进行回顾性分析。结果:52例感染病例中培养出细菌82株,其中G+菌65株占79.27%,G-菌16株占19.51%,真菌1株占1.22%;导管的腔外致病菌种植、导管接头和导管腔内致病菌种植、血流播散为感染途径。结论:加强医护人员的教育培训,采取积极有效的预防措施可降低导管相关感染。

  18. 肿瘤患者中心静脉导管真菌感染的相关因素分析%Related factors for central venous catheter-related fungal infections in tumor patients

    Institute of Scientific and Technical Information of China (English)

    祖璎玲; 周健; 赵霞; 张小琴; 张龑莉; 房佰俊; 魏旭东; 宋永平

    2013-01-01

    OBJECTIVE To explore the incidence, etiology, and risk factors of central venous catheter (CVC)-related fungal infections in tumor patients so as to propose the effective prevention measures. METHODS The related factors for infections in 200 tumor patients who underwent CVC from Jan to Oct, 2011 were reviewed retrospectively. RESULTS The incidence of CVC-related fungal infections was 15. 0%. There were 26 cases with single CVC-related infections and 4 cases with fungemia. Candida parapsilosis, Candida tropicalis, Candida ruffle monilia , Candida albicans, and Candida glabrata accounted for 53. 3% , 16. 7% > 13. 3%, 10. 0% and 6. 7% , respectively. The gender, age, types of tumor, and surgery were negatively correlated with the incidence of CVC-related infections, the difference in the infection rates between the different sites of catheterization was statistically significant (P<0. 05), the difference in the catheterization duration between the patients with CVC-related infections was statistically significant(P<0. 05) , totally 26 cases with infections were cured after extuba-tion of CVC, 3 of 4 patients with fungemia were cured after the antifungal treatment, and 1 case died of the mixed pulmonary Candida infections. CONCLUSION Candida parapsilosis is the predominant pathogen causing CVC-related fungal infections in the tumor patients. Timely extubation of CVC can effectively prevent catheter-related blood stream infections.%目的 探讨肿瘤患者中心静脉导管(CVC)真菌感染的分布与发生率,分析其相关因素,提出有效的预防改进措施.方法 回顾性分析2011年1-10月医院留置CVC的200例肿瘤患者的感染情况及相关因素.结果 CVC相关性真菌感染发生率为15.0%,其中26例单纯CVC感染(CVC-RI),4例合并真菌血症,其中近平滑假丝酵母菌、热带假丝酵母菌、皱褶假丝酵母菌、白色假丝酵母菌及光滑假丝酵母菌分别占53.3%、16.7%、13.3%、10.0%及6.7%;CVC感染发

  19. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  20. 中心静脉导管留置时间与血行性感染的相关性分析%The Correlation Analysis of Central Venous Catheter Retention Time and Catheter Related Bloodstream Infection

    Institute of Scientific and Technical Information of China (English)

    徐艳; 常勇杰; 徐红炜; 张振; 胡波

    2015-01-01

    目的:探讨中心静脉导管(CVC)留置时间与导管相关性血行感染(CRBSI)的相关性。方法:收集2010年2月-2014年2月本院1086例使用过CVC的患者资料,分析CVC留置1~7 d、7~14 d、14~21 d、21~28 d和≥28 d几个不同时间段CRBSI的发病率,并对CRBSI患者不同年龄段、性别、CVC留置时间和CVC置管处皮肤细菌数做统计学分析。结果:1086例使用过CVC的患者中共发生了352例CRBSI,CVC留置1~7 d、7~14 d、14~21 d、21~28 d和≥28 d CRBSI的发病数分别为65例(5.98%)、69例(8.84%)、143例(13.17%)、198例(18.23%)和352例(32.41%)。CVC留置≤3 d比3~7 d CRBSI发病率有显著性升高,差异有统计学意义(P<0.01),≥28 d比3~28 d CRBSI发病率也有显著性升高,差异有统计学意义(P=0.04)。另外患者年龄≥60岁、CVC经皮穿刺置管和CVC置管处皮肤细菌数≥100 CFU/10 cm2也是导致CRBSI的重要因素。结论:CVC留置的前3天和后28天是CRBSI发生的高峰时间,CRBSI的发生与患者年龄大和置管处皮肤细菌数多有关。%Objective: To investigate the correlation of central venous catheter (CVC) retention time and catheter related b1oodstream infection (CRBSI).Method: A total of 1086 patients who were treated with CVC in our hospital were selected from February 2010 to February 2014,the CRBSI incidence of 1086 patients in different time periods of indwelling CVC 1-7 d, 7-14 d, 14-21 d, 21-28 d and ≥28 d were analysed,the CRBSI of different ages,gender, CVC retention time and the number of skin bacteria of indwelling CVC were statistical analysed.Result: There were 352 cases of CRBSI in 1086 patients who used CVC, CRBSI incidence were respectively 65 cases (5.98%), 69 cases (8.84%), 143 cases (13.17%), 198 cases (18.23%) and 352 cases (32.41%) in indwelling CVC 1-7 d, 7-14 d, 14-21 d, 21-28 d and≥28 d.The CRBSI incidence of indwelling CVC ≤3 days has increased significantly than 3 to

  1. 老年危重症患者中心静脉导管相关性感染的危险因素分析%Risk factors for central venous catheter-related infections in elderly patients with critical diseases

    Institute of Scientific and Technical Information of China (English)

    孙卫; 司琴

    2012-01-01

    OBJECTIVE To study the related risk factors of central venous catheter-related infection in the elderly patient with critical diseases. METHODS A total of 160 elderly patients with critical diseases were retrospectively analyzed. Multiple factor non-conditional logistic regression analysis was performed for the related factors that may lead to the central venous catheter-related infections. RESULTS The incidence of central venous catheter infections in 160 elderly patients with critical diseases was 35. 6%(57 cases). The incidence of central venous catheter infections was mainly related to the age,APACHEⅡ score, the site of indwelling catheter, the number of catheter cavity, intravenousalimentation treatment, the duration of indwelling catheterization and coexistence with other site infections (P<0. 05 or 0. 01); logistic regression analysis revealed that APACHEⅡ score, intravenousalimentation treatment, the duration of indwelling catheter, and coexistence with other site infections were the independent risk factors for the central venous catheter-related infections in the elderly patients with critical diseases. CONCLUSION It is necessary to develop the prevention programs and actively treat and reduce the incidence of infections in accordance with the independent risk factors for the central venous catheter-related infections in the elderly patients with critical disease so as to improve the patients' prognosis.%目的 探讨影响老年危重症患者中心静脉导管相关性感染发生的危险因素.方法 回顾性分析医院160例老年危重症患者的临床资料,对可能影响中心静脉导管相关性感染发生的因素进行多因素非条件logistic回归分析.结果 160例老年危重症患者中,发生中心静脉导管相关性感染57例,发生率35.6%;老年危重症患者中心静脉导管相关性感染的发生与年龄、APACHEⅡ评分、导管留置部位、导管腔数、是否有静脉营养操作、导管留置时间及

  2. Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.

    Science.gov (United States)

    Raad, Issam; Chaftari, Anne-Marie; Zakhour, Ramia; Jordan, Mary; Al Hamal, Zanaib; Jiang, Ying; Yousif, Ammar; Garoge, Kumait; Mulanovich, Victor; Viola, George M; Kanj, Soha; Pravinkumar, Egbert; Rosenblatt, Joel; Hachem, Ray

    2016-06-01

    In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.).

  3. Analysis and prevention strategies of central venous catheter-related blood stream infection in the EICU patients%急诊重症患者中心静脉导管相关血流感染的分析及防控策略研究

    Institute of Scientific and Technical Information of China (English)

    闫泽晨; 王月芹; 周芮伊; 左书强; 裴辉; 王立萍; 刘丹丹; 王家祥; 兰超

    2015-01-01

    目的:探讨中心静脉导管相关血流感染( CVCRBSIs)在EICU的防控策略。方法选取2013-01~2014-06我院EICU中心静脉置管患者165例为研究对象,并应用我院信息管理系统监测统计CVCRBSIs的情况,并总结制定相关防治措施。结果选取的中心静脉置管患者发生中心静脉导管相关感染4例,其中CVCRBSIs 3例,感染率为1.82%;静脉炎1例,感染率为0.61%。结论建立基于感染监测软件的四级防控系统等措施能够切实有效控制CVCRBSIs的发生。%Objective To discuss the prevention and treatment strategy of the central venous catheter-related blood stream infections ( CVCRBSIs ) .Methods We collected 165 patients in Emergency Intensive Care Unit ( EICU ) who have been given the central venous catheter from the Infection Monitoring software,and in order to identify the the spectrum and current infection status and prevention strategies of central venous catheter.Results There were three CVCRBSIs in four catheter-related infections among the collected cases, infection rate was 1.82%.And there was one phlebitis, infection rates was 0.61%.Conclusion The establishment of Grade-4 monitoring system based on the Infection Monitoring software and many other methods can reduce the occurrence of the CVCRBSIs.

  4. Central venous catheter-related thrombosis in elderly patients%老年患者中心静脉导管相关性血栓发生情况调查

    Institute of Scientific and Technical Information of China (English)

    柳高; 付治卿; 李世军

    2015-01-01

    Objective To analyze the risk factors for thrombosis by investigating the incidence of central venous catheter‐related thrombosis in elderly patients .Methods Four hundred and five elderly patients who underwent central venous catheterization were divided into femoral vein group(n=46) ,internal jugular vein group (n=40) and subclavian vein group (n=319) according to their catheter position ,or into thrombosis group (n=31) and non‐thrombosis group (n=374) according to the incidence of central venous catheter‐related thrombosis .T heir gender ,age ,basic diseases ,catheter position ,retention time of catheter ,and complications of central venous catheter‐related thrombosis were retrospectively analyzed .Results The incidence of central venous cathe‐ter‐related thrombosis was significantly lower in subclavian vein group than in internal jugular vein group and femoral vein group (5 .0% vs 15 .0% ,5 .0% vs 19 .6% ,P<0 .05 ,P<0 .01) .The percentage of past venous thrombosis history was significantly higher in thrombosis group than in non‐thrombosis group (19 .4% vs 6 .4% ,P<0 .05) .Conclusions Subclavian vein catheterization can significantly reduce the incidence of central venous catheter‐related thrombosis and past ve‐nous thrombosis history can predict the incidence of central venous catheter‐related thrombosis in elderly patients .%目的:调查老年患者中心静脉导管相关性血栓的发生情况,比较不同置管部位下,导管相关性血栓的发生率,将与血栓发生相关联的各种危险因素进行对比分析。方法选取接受中心静脉置管操作的老年患者405例,根据置管部位不同分为股静脉组46例,颈内静脉组40例,锁骨下静脉组319例。又根据导管相关性血栓的发生情况分为血栓组31例,非血栓组374例。对入选患者的性别、年龄、基础疾病、置管部位、导管留置时间、导管相关性血栓的发生情况等进行回顾性调查分析。

  5. Clinical investigation of catheter-related infections in two central venous cathers%两种中心静脉导管相关性感染的临床观察

    Institute of Scientific and Technical Information of China (English)

    高立平

    2012-01-01

    目的 评价抗感染中心静脉导管在减少重症监护病房(ICU)患者导管相关性感染(CRI)中的作用.方法 将248例在ICU留置中心静脉导管的患者随机分成普通中心静脉导管组(对照组120例)和抗感染中心静脉导管组(抗感染组128例),观察两组CRI的发生率和病原菌分布情况.结果 抗感染组的CRI发生率明显低于对照组(6.3%vs14.2%),差异有统计学意义(P<0.05).CRI的病原菌为金黄色葡萄球菌、鲍曼不动杆菌、阴沟肠杆菌、肠球菌、肺炎克雷伯菌和白色念珠菌,但两组患者CRI病原菌分布比较,差异无统计学意义(P>0.05).结论 抗感染中心静脉导管可明显降低ICU患者CRI的发生率.%Objective To evaluate the effect of reducing intravenous catheter-ralated infection (CRT) using antiseptic impregnated central venous catheter in patients in intensive care unit (ICU). Methods 248 patients treated in ICU who needed intravascular catheterization were randomly divided into the control group (120 cases, treated with ordinary central venous catheter) and the antiseptic group (128 cases, treated with antiseptic impregnated central venous catheter). The incidence of CRI and pathogenic distribution were observed. Results The incidence of CRI in the antiseptic group was significantly lower than that of the control group (6.3% vs 14.2%, P<0.05). The pathogens of CRI were Staphytococcus aureus, Acmetabactor baumarwiii, E. Cloacae, entemcoccus, Klebsiella pneumonias and Candida albicans. Pathogenic distribution between the two groups showed no statistically significant difference (PX).O5). Conclusion Antiseptic impregnated central venous catheter can obviously reduce the incidence of CRI in patients in ICU.

  6. Clinical characteristics and risk factors of symptomatic central venous catheter-related deep vein thrombosis in children%儿童中心静脉置管相关症状型深静脉血栓形成的临床特点和影响因素

    Institute of Scientific and Technical Information of China (English)

    裴亮; 杨雨航; 杨妮; 文广富; 许巍; 刘春峰

    2016-01-01

    Objective To investigate the clinical features and risk factors in children with symptomatic central venous catheter-related deep vein thrombosis,and to provide guidence for clinical therapy.Methods The clinical data of 105 children with central venous catheter were retrospectively analyzed.According to the thrombosis or not,these children were classified into two groups:thrombosis group and non-thrombosis group.The risk factors influencing symptomatic central venous catheter-related deep vein thrombosis forming were identified by Logistic regression analysis.Results Among the 105 cases with central venous catheter,the male to female ratio was 68:37;age ranged from 8.5 months to 13 years old with average age(5.5 ±4.0) years old.There were 98 cases in non-thrombosis group and 7 cases in thrombosis group.Factors such as age[(5.7 ±4.1)years old vs.(2.5 ± 1.8) years old],central venous catheter dwell time[(6.1 ±2.3)d vs.(8.9 ± 2.1) d],more than 7 days parenteral nutrition application (11/98 cases vs.5/7 cases) and more than 7 days intravenous application of mannitol(7/98 cases vs.4/7 cases)were found significantly different between the thrombosis group and non-thrombosis group(P < 0.05).Multivariate Logistic regression analysis showed that more than 7 days parenteral nutrition application and intravenous mannitol were the risk factors of symptomatic central venous catheter-related deep vein thrombosis [OR =50.703 (95 % CI 3.258-789.056),OR =15.590 (95 % CI 1.196-203.146),P < 0.05].Conclusion Symptomatic central venous catheter-related deep vein thrombosis is a common complication of deep venous catheterization.It cause acute pulmonary embolism and some critical diseases,and influence the prognosis and prolong hospital stay.Application of intravenous nutrition more than 7 days and intravenous mannitol more than 7 days are the risk factors of symptomatic central venous catheter-related deep vein thrombosis.%目的 调查儿童中心静脉置管相关症状

  7. 探讨ICU患者中心静脉导管相关性血流感染的集束化预防策略%Increase the bundle prevention strategies of central venous catheter-related bloodstream infection in patients of ICU

    Institute of Scientific and Technical Information of China (English)

    王艳菊; 陈奕文; 姜爱丽

    2014-01-01

    ICU收治急危重症患者,大多数患者需要使用中心静脉导管测压、输液等,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高等。选择最优的穿刺途径、严格的手卫生、消毒皮肤、最大消毒屏障以及定期更换辅料等,应用集束化预防措施进行置管及日常护理是预防导管相关性血流感染发生的重要措施。%In ICU,there are critically ill patients,and most patients require the use of central venous catheter manometer,infusion and so on.But at the same time,the occurrence of catheter-related bloodstream infection(CRBSI) risk,result in patients with prolonged hospitalization and mortality rate higher.The application of bundle preventive measures of catheter and daily care, including the selection of optimal puncture,strict hand hygiene,disinfection, the biggest disinfection and barrier regular replacement of accessories and so on,is an important measure to prevent occurrence of catheter-related bloodstream infection,.

  8. Hemodialysis Tunneled Catheter-Related Infections

    Science.gov (United States)

    Miller, Lisa M.; Clark, Edward; Dipchand, Christine; Hiremath, Swapnil; Kappel, Joanne; Kiaii, Mercedeh; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; MacRae, Jennifer

    2016-01-01

    Catheter-related bloodstream infections, exit-site infections, and tunnel infections are common complications related to hemodialysis central venous catheter use. The various definitions of catheter-related infections are reviewed, and various preventive strategies are discussed. Treatment options, for both empiric and definitive infections, including antibiotic locks and systemic antibiotics, are reviewed.

  9. 头孢拉定加肝素钠封管预防患者中心静脉置管相关性感染的效果%Preventive effect of cefradine plus heparin sealing catheters on central venous catheter-related infections

    Institute of Scientific and Technical Information of China (English)

    任昌菊; 刘静; 夏昌华; 蹇正清

    2014-01-01

    目的:探讨头孢拉定加肝素钠封管预防患者中心静脉置管相关性感染的效果。方法将112例中心静脉置管患者随机分为对照组57例和干预组55例,对照组患者中心静脉置管期间给予肝素钠封管,干预组患者给予头孢拉定加肝素钠封管。比较两组患者中心静脉置管期间导管相关性感染情况。结果对照组患者中心静脉置管期间导管相关性感染率为12.28%,干预组为0.00%,两组比较,差异具有统计学意义(P<0.01)。结论中心静脉置管患者采用头孢拉定加肝素钠溶液封管,可有效降低患者导管相关性感染。%Objective To explore the preventive effect of Cefradine plus heparin sealing catheters on central center venous (CVC)catheter-related infections.Methods One hundred and twelve patients with central venous catheter were randomly divided into control group(n=57)and intervention group(n=55).In the control group,heparin sodium was used to seal the catheters and in the intervention group Cefradine plus heparin were used.The two groups were compared in terms of central venous catheter(CVC)-related infections.Results The CVC-related infection rates are 12.28%and 0%in the control and intervention groups respectively, with statistical difference between them(P<0.01).Conclusions Cefazodine and heparin used to seal the catheters in the treatment of patients with central venous catheter can effectively reduce incidence of catheter-related infections.

  10. Effectiveness analysis of cluster nursing to reduce ICU central venous catheter-related bloodstream infection rates%集束化护理对降低ICU中心静脉导管相关性血流感染率的效果分析

    Institute of Scientific and Technical Information of China (English)

    郑贞; 严继承; 黄鑫; 杨帆

    2014-01-01

    目的:探讨集束化护理对于减少IC U中心静脉导管相关性血流感染率效果的影响。方法选取2011年6月-2012年3月行常规护理的289例中心静脉导管患者作为对照组,并选取2012年4月-2013年3月行集束化护理的327例中心静脉导管患者为试验组,对两组患者的治疗结果进行对比分析。结果试验组实施集束化护理后的中心静脉导管相关性血流感染感染率为3.36‰、对照组为6.57‰,两组比较差异有统计学意义( P<0.05);试验组患者住院天数为(6.71±0.77)d、对照组为(8.47±0.79)d ,两组比较差异有统计学意义( P<0.05);试验组患者插管天数为(9.36±0.82)d、对照组为(6.29±0.63)d ,两组比较差异有统计学意义( P<0.05)。结论集束化护理对降低IC U中心静脉导管相关性血流感染率有显著效果,同时集束化护理措施的依从性也对治疗效果有明显影响。%OBJECTIVE To study the effect of cluster nursing on reducing the ICU central venous catheter-related bloodstream infection rate .METHODS Totally 289 patients with central venous catheters receiving routine care from June 2011 to Mar .2012 were selected as the control group ,meanwhile ,327 patients with central venous catheters receiving cluster nursing during Apr .2012 to Mar 2013 were selected as the experimental group .The two groups were compared for treatment outcomes .RESULTS After the implementation of cluster nursing ,the central venous catheter-related bloodstream infection rate was 3 .36‰ in the experimental group ,significantly low-er than 6 .57‰ in the control group (P<0 .05) .The hospitalization days were approximately (6 .71 ± 0 .77)d in the experimental group ,significantly lower than (8 .47 ± 0 .79) d in the control group(P<0 .05) .The catheteriza-tion days were (9 .36 ± 0 .82) d in the experimental group and (6 .29 ± 0 .63) d in the control group ,the

  11. 中心静脉导管相关性感染因素分析及护理研究进展%Advances in Central Venous Catheter-related Infectious Agents Analysis and Nursing Research

    Institute of Scientific and Technical Information of China (English)

    马俊; 胡纨青; 方丽

    2010-01-01

    @@ 1962年美国Dudfick等首先将锁骨下静脉导管技术应用于长期TPN支持治疗[1].近30年来,随着中心静脉导管(central venous catheter,CVC)的更新换代、插管技术的普及,中心静脉置管越来越成为救治危重症患者的重要手段,并已广泛用于长期输液、肿瘤化疗、静脉营养、血液动力学监测等患者.

  12. 综合ICU导管相关性血流感染的危险因素分析%Research on risk factors for central venous catheter-related bloodstream infections in general ICU

    Institute of Scientific and Technical Information of China (English)

    许燕卿; 周立新; 罗盛鸿; 李杏崧; 李轶男; 莫韶妹; 吕春梅; 邵劲松

    2012-01-01

    目的 探讨ICU导管相关性血流感染(CRBSI)的感染率及危险因素.方法 采用前瞻性监测,对2009年7月-2010年11月入住ICU> 24 h、年龄>1月龄的置管患者进行监测,并对发生CRBSI的病例进行危险因素分析.结果 监测患者共1145例,其中接受血管内置管的患者890例,血管内导管使用率为77.7%,置管日为9189 d,发生CRBSI 26例,CRBSI感染率为2.9%,平均日感染率为2.8/千日;CRBSI感染率与置管时间、置管次数均呈正相关(x2=40.71,P=0.000;x2=28.6,P=0.000);留置天数(OR=2.415)与置管次数(OR=1.531)是综合ICU的CRBSI独立危险因素.结论 严格执行手卫生、无菌技术置管和维护、尽早拔除导管是预防CRBSI发生的关键.%OBJECTIVE To determine the incidence rate and risk factors for catheter-related bloodstream infections (CRBSI ) in general ICU. METHODS Prospective monitoring was carried out on patients aged over one month whose ICU length of stay was over 24 hours from Jul 2009 to Nov 2010. The risk factors for CRBSI were analyzed. RESULTS Among the 1145 cases surveyed,890 cases were under intravenous catheterization. The rate of intravenous catheterization was 77. 7% while the overall duration was 9189 days. A total of 26 cases of CRBSI were observed with the incidence rate of 2. 9% and the mean daily incidence rate of 2. 8 per 1,000 catheter-day; the incidence rate of CRBSI was positively correlated with the duration of catheterization (x2 =40. 71,P = 0. 000) and frequency of catheterization (x2 =28. 6, P=0. 000), respectively. The duration (OR=2. 415) and frequency (OR=l. 531) of the catheterization were the independent risk factors for CRBSI in general ICU patients with central intravenous catheter. CONCLUSION The incidence rate of CRBSI can be reduced by performing strict hand hygiene procedures, aseptic technique for insertion, care for intravascular catheters and the removal of catheters in a timely manner.

  13. 综合重症监护病房中心静脉导管相关性血流感染监测与控制效果分析%Monitor and control of central venous catheter-related bloodstream infections in general intensive care unit

    Institute of Scientific and Technical Information of China (English)

    张淑敏; 刘香玲; 冯丽媛; 宋雪苹; 张豫生

    2011-01-01

    目的 降低重症监护病房导管相关性血流感染(CRBSI)的发生率.方法 A组采取回顾性调查方法,查阅出院病历,逐项填写记录表;B组采取目标性监测方法,由两名深静脉导管专职护理护士负责具体操作,采取一系列感染控制措施,将两组资料分别进行汇总统计、分析判断、计算感染率并做比较.结果 A组导管相关性血流感染率为20.9‰,B组实行目标性监测落实感染控制各项措施后,导管相关性血流感染率下降至5.4‰,差异有统计学意义(P<0.05).结论 在综合控制措施中,提高医护人员在医疗活动中的技术水平和执行力,设专业导管护理小组进行中心静脉置管全过程质量管理,是降低导管相关性血流感染非常有效的措施.%OBJECTIVE To reduce the incidence of catheter-related bloodstream infections.METHODS A retrospective survey was performed to Group A by searching for discharged patients and completing a record sheet item by item.A targeted surveillance to Group B was performed, There were two full-time care nurses in charge of specific operations on central venous catheter by adopting a series of infection control measures, the data of the two groups were aggregated statistics, analyzed and judged, the infection rates were calculated and compared.RESULTS The catheter-related bloodstream infection rate of group A was 20.9‰, Group B took the method of targeted survey and implemented measures of infection control, the catheter-related bloodstream infection rate fell to 5.4 ‰, it was significantly different(P<0.05).CONCLUSION In the comprehensive control measures, it is a very effective measure of setting professional nursing team on the whole process of quality management on central venous catheter tube and improving the technical level and execution of the doctors and nurses in the medical activities to reduce the catheter-related bloodstream infections.

  14. Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis.

    Science.gov (United States)

    Paglialonga, Fabio; Consolo, Silvia; Biasuzzi, Antonietta; Assomou, Jolanda; Gattarello, Elisabetta; Patricelli, Maria Grazia; Giannini, Alberto; Chidini, Giovanna; Napolitano, Luisa; Edefonti, Alberto

    2014-10-01

    Only a few studies have investigated the optimal exit site management of tunneled central venous catheters (CVCs) in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the efficacy of chlorhexidine solutions and a 5% povidone-iodine solution on the incidence of CVC-related infections in children on HD. The incidence of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) was assessed in two groups of tunneled CVCs. The iodopovidone group consisted of 14 CVCs used between 1 January 2011 and 30 June 2012 in 10 children, whose median age at the time of CVC placement was 11.8 years (range 1.2-19.2): 5% povidone-iodine was used for CVC exit-site care. From 1 August 2012 to 31 January 2014, 0.5% chlorhexidine gluconate/70% isopropyl alcohol was used for the exit site, and 2% chlorhexidine gluconate/70% isopropyl alcohol spray for the hub in 13 CVCs was used in 10 patients (chlorhexidine group), whose median age at the time of CVC placement was 10 years (range 1.2-19.2). Ten episodes of ESI were diagnosed in the iodopovidone group (incidence 3.4/1000 CVC days), and only one in the chlorhexidine group (incidence 0.36/1000 CVC days, P = 0.008). One TI was observed in the iodopovidone group (0.34/1000 CVC days), and none in the chlorhexidine group. The incidence of BSIs decreased from 1.7/1000 CVC days (5 cases) to 0.36/1000 CVC days (1 case, P = 0.06) after switching to chlorhexidine. Two CVCs were lost due to CVC-related infections in the iodopovidone group, whereas no CVC was lost due to infections in the chlorhexidine group. In comparison with 5% povidone-iodine, the use of chlorhexidine gluconate was associated with a reduction in the incidence of ESI, TI, and BSI in children on HD.

  15. Hematologic patients' clinical and psychosocial experiences with implanted long-term central venous catheter

    DEFF Research Database (Denmark)

    Møller, Tom; Adamsen, Lis

    2010-01-01

    A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients.......A significant decrease in catheter-related infections was demonstrated in our earlier randomized controlled trial of central venous catheter (CVC) care in hematologic patients....

  16. IMPLEMENTATION OF CENTRAL VENOUS CATHETER - RELATED BLOODSTREAM INFECTIONS WITH KEY ASPECTS OF COMPLIANCE MONITORING ON ITS INCIDENCE%中心静脉导管相关血流感染重点环节依从性监测对其发生率的影响

    Institute of Scientific and Technical Information of China (English)

    杨洪艳; 范玲; 于晓江

    2015-01-01

    目的:探讨对预防中心静脉导管相关血流感染(catheter related blood stream infection,CRBSI)重点环节依从性监测,能否降低 CRBSI 的发生率。方法选择2013年1—10月56例中心静脉置管患者(A组),对预防 CRBSI 实施重点环节依从性监测,包括:使用抗菌药物包被导管、尽量使用锁骨下静脉置管、留置导管术时无菌屏障最大化、使用洗必泰乙醇溶液皮肤消毒、每天评估是否需要继续留置导管、严格执行定期更换穿刺点敷料要求、执行手卫生规范、使用生理盐水或肝素盐水常规冲管。观察 CRBSI 发生率,与2012年3—12月49例中心静脉患者(B 组,常规处置,无监测)的 CRBSI 发生率进行比较。结果A 组的 CRBSI 发生率0.6‰,明显低于 B 组的发生率4.9‰,差异有统计学意义。结论自2013年我院开展的预防 CRBSI 重点环节依从性监测,可进一步规范中心静脉导管置管要求,操作流程,以及护理方法等,监督医生,护士严格按要求完成中心静脉导管治疗及护理,提高留置中心静脉导管的管理水平,有效降低CRBSI 的发生率。%Objective To investigate the prevention of central venous catheter-related bloodstream infec-tions (catheter related blood stream infection CRBSI)for key aspects of compliance monitoring,the ability to reduce the incidence of CRBSI.Methods From January-October 2013,56 cases of patients with cen-tral venous catheter were enrolled at group A on the prevention of CRBSI implementation of key aspects of compliance monitoring,including:the use of catheters coated with antimicrobial drugs,to make use of the subclavian vein catheterization,indwelling catheters when sterile barrier technique to maximize the use of chlorhexidine for skin disinfection ethanol solution,assessing the need to continue daily indwelling cathe-ter,strict implementation of the puncture site dressings require periodic replacement,perform hand hygiene standards,the use of

  17. 探讨预见性护理方案对肿瘤患者中心静脉置管相关性感染的防治效果%Preventive Effect of the Predictive Nursing Plan for the Prevention of the Infection of Central Venous Catheter Related Infections in the Patients With Cancer

    Institute of Scientific and Technical Information of China (English)

    王素玲

    2015-01-01

    Objective To investigate the nursing care plan tube associated infections prevention effect cancer patients at the center vein.MethodsFrom January 2014 to December 2014 in our hospital,80 cases of central venous catheters in cancer patients were randomly divided into two groups and the control group of 40 patients,the implementation of the control group in which patients with routine care,nursing care to patients in the observation group on this basis,nursing effect compared two groups of patients.ResultsThe patients with central venous catheter-related infection rate was significantly lower than the control group,nursing satisfaction rate was higher,compare the difference between groups was statistically significant(P<0.05).Conclusion The central venous catheter nursing care for patients with cancer can reduce the risk of infection and improve patient care satisfaction rate.%目的:探讨预见性护理方案在肿瘤患者中心静脉置管相关性感染的防治效果。方法选取2014年1~12月在我院接受治疗的中心静脉置管肿瘤患者80例,将其随机分为观察组与对照组,每组患者40例。其中对照组患者实施常规护理,观察组患者在此基础上加以预见性护理,对比两组患者的护理效果。结果观察组患者中心静脉置管相关性感染率低于对照组,护理满意率高于对照组,组间比较差异具有统计学意义(P<0.05)。结论对中心静脉置管肿瘤患者实施预见性护理可降低感染率,提高患者护理满意率。

  18. Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa Método bundle en la redución de infecciones relacionadas a catéteres centrales: una revisión integrativa Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review

    Directory of Open Access Journals (Sweden)

    Juliana Dane Pereira Brachine

    2012-12-01

    Full Text Available Trata-se de uma revisão integrativa da literatura, que objetivou identificar intervenções baseadas em evidência que compõem o método bundle, designados à redução de infecção de corrente sanguínea relacionada ou associada a cateter intravenoso central. Para a coleta de dados online, em bases nacionais e internacionais, foram utilizados a palavra-chave bundle e os descritores catheter-related infection, infection control e central venous catheterization, resultando, após aplicação dos critérios de inclusão, amostra de quinze artigos. Este trabalho evidenciou cinco intervenções como as mais frequentemente empregadas na construção dos bundles: higienização das mãos, gluconato de clorexidina como antisséptico para pele, uso de barreira máxima de precaução durante a inserção cateter, evitar acessar veia femoral e verificar necessidade diária de permanência do cateter, com sua remoção imediata quando não mais indicado. A maioria dos estudos demonstrou resultados estatisticamente significantes na redução de infecção de corrente sanguínea relacionada ou associada a cateter intravenoso central.Esta es una revisión integradora tuvo como objetivo identificar intervenciones basadas en evidencias que componen método bundle de reducción de infección sanguínea relacionadas o asociadas con catéter intravenoso central. Para recopilar los datos en las bases brasileñas e internacionales, utilizando la palabra clave bundle y los descriptores infecciones relacionadas con catéteres, control de infecciones y cateterización venosa central, identificando, con los criterios de inclusión, muestra de quince artículo. Este estudio muestra cinco intervenciones como comúnmente empleadas en los métodos bundles: higiene de las manos, clorhexidina como antiséptico para la piel, uso de precaución de barrera máxima durante la inserción del catéter, evitar el acceso de la vena femoral y comprobar la necesidad diaria del cat

  19. Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials

    Directory of Open Access Journals (Sweden)

    Baltazares-Lipp Enrique

    2005-08-01

    Full Text Available Abstract Background Septic thrombophlebitis is an iatrogenic life-threatening disease associated with use of central venous devices and intravenous (IV therapy. In cancer patients receiving chemotherapy, vein resection or surgical thrombectomy in large central venous lines is time-consuming, can delay administration of chemotherapy, and therefore can compromise tumor control. Experience with thrombolysis has been published for catheter-related thrombosis but for septic thrombosis, this experience is scarce. Results We describe three patients with cancer and septic thrombophlebitis of central veins caused by Staphylococcus aureus treated with catheter removal, thrombolysis, and intravenous (IV antibiotics. In our reported cases, an initial bolus of 250,000 international units (IU of streptokinase administered during the first h followed by an infusion of 20,000–40,000 IU/h for 24–36 h through a proximal peripheral vein was sufficient to dissolve the thrombus. After thrombolyisis and parenteral antibiotic for 4–6 weeks the septic thrombosis due to Staphylococcus aureus solved in all cases. No surgical procedure was needed, and potential placement of a catheter in the same vein was permitted. Conclusion Thrombolysis with streptokinase solved symptoms, cured infection, prevented embolus, and in all cases achieved complete thrombus lysis, avoiding permanent central-vein occlusion.

  20. Risk Factors Associated with Peripherally Inserted Central Venous Catheter-related Upper-extremity Deep Vein Thrombosis in Cancer Patients%肿瘤患者PICC置管并发上肢静脉血栓的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    范彬; 黄芬; 梅赣红; 张玉红

    2016-01-01

    Objective:To evaluate the incidence and risk factors of upper-extremity deep vein thrombosis (UEDVT) related to peripherally inserted central venous catheter in cancer patients.Method:From June 2014 to November 2014,177 cases of solid tumor patients who underwent implantation of a peripherally inserted central venous catheter were selected in our hospital.All patients were examined at prescribed intervals by ultrasonography (US) to estimate the incidence of catheter-related venous thrombosis.Result:During the study period,177 PICC were placed in 177 cases of patients followed up for a total of 15 115 catheter-days,the mean duration of catheter was 85.4 d.The incidence rate of cancer patients with PICC-UEDVT was 25.42%, of which the incidence of symptomatic usm - UEDVT was 5.08%.In adjusted by Logistic analysis,distant metastasis[OR=8.537,95%CI (2.447,29.781),P=0.001],Fibrinogen>2.0 g/L[OR=6.578,95%CI(2.076,20.845),P=0.001],D-Dimer>2.0 ng/L[OR=4.873,95%CI(1.482,16.025),P=0.009],infection[OR=6.069,95%CI(1.789,20.589),P=0.004] were factors influencing the risk of DVT,the differences were statistically significant(P2.0 g/L,D-Dimer>2.0 ng/L,infection increase the risk of PICC-UEDVT.%目的:研究PICC置管后合并PICC相关性上肢深静脉血栓形成(upper extremity deep vein thrombosis,PICC-UEDVT)的发生率及危险因素。方法:连续选取本院2014年6-11月PICC置管的177例实质性肿瘤患者,采用彩色多普勒超声诊断上肢深静脉血栓,观察PICC-UEDVT的发生率及影响因素。结果:177例患者共放置PICC177根,总置管时间为15115 d,平均置管时间为85.4 d。肿瘤患者PICC-UEDVT的发生率为25.42%,其中症状性PICC-UEDVT的发生率为5.08%。Logistic回归分析显示远处转移[OR=8.537,95%CI(2.447,29.781),P=0.001]、纤维蛋白原>4.0 g/L[OR=6.578,95%CI(2.076,20.845),P=0.001]、D-二聚体>2.0 ng/L[OR=4.873,95%CI(1.482,16.025),P=0.009]、置管期间感染[OR=6

  1. Central venous catheter - flushing

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - dressing change Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/22/2016 Updated by: ...

  2. Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bouzad, Caroline, E-mail: caroline.bouzad@gmail.com [Percy Military Teaching Hospital, Radiology Department (France); Duron, Sandrine, E-mail: duronsandrine@yahoo.fr [GSBdD, Military Centre for Epidemiology and Public Health (CESPA) (France); Bousquet, Aurore, E-mail: aurorebousquet@yahoo.fr [Begin Military Teaching Hospital, Bacteriology Department (France); Arnaud, François-Xavier, E-mail: fxa0160@hotmail.com [Percy Military Teaching Hospital, Radiology Department (France); Valbousquet, Laura, E-mail: laura.valbousquet@gmail.com [Begin Military Teaching Hospital, Radiology Department (France); Weber-Donat, Gabrielle, E-mail: weberdonatgabrielle@yahoo.fr; Teriitehau, Christophe, E-mail: cteriitehau@me.com; Baccialone, Jacques, E-mail: jacques.baccialone@wanadoo.fr; Potet, Julien, E-mail: potet-julien@yahoo.fr [Percy Military Teaching Hospital, Radiology Department (France)

    2016-03-15

    PurposeTo determine the incidence and the risks factors of peripherally inserted central catheter (PICC)-related infectious complications.Materials and MethodsMedical charts of every in-patient that underwent a PICC insertion in our hospital between January 2010 and October 2013 were reviewed. All PICC-related infections were recorded and categorized as catheter-related bloodstream infections (CR-BSI), exit-site infections, and septic thrombophlebitis.ResultsNine hundred and twenty-three PICCs were placed in 644 unique patients, mostly male (68.3 %) with a median age of 58 years. 31 (3.4 %) PICC-related infections occurred during the study period corresponding to an infection rate of 1.64 per 1000 catheter-days. We observed 27 (87.1 %) CR-BSI, corresponding to a rate of 1.43 per 1000 catheter-days, 3 (9.7 %) septic thrombophlebitis, and 1 (3.2 %) exit-site infection. Multivariate logistic regression analysis showed a higher PICC-related infection rate with chemotherapy (odds ratio (OR) 7.2–confidence interval (CI) 95 % [1.77–29.5]), auto/allograft (OR 5.9–CI 95 % [1.2–29.2]), and anti-coagulant therapy (OR 2.2–95 % [1.4–12]).ConclusionChemotherapy, auto/allograft, and anti-coagulant therapy are associated with an increased risk of developing PICC-related infections.Clinical AdvanceChemotherapy, auto/allograft, and anti-coagulant therapy are important predictors of PICC-associated infections. A careful assessment of these risk factors may be important for future success in preventing PICC-related infections.

  3. Central venous line - infants

    Science.gov (United States)

    A central venous line (CVL) is a long, soft, plastic tube that is put into a large vein in the chest. WHY IS A CVL USED? A CVL is often put in when a baby cannot get a ... (MCC). A CVL can be used to give nutrients or medicines to a ...

  4. 外科ICU中心静脉导管相关血流感染的回顾性病例对照研究%Central Venous Catheter Related-Bloodstream Infection in Surgical Intensive Care unit: a Retrospective, Case-Controlled Study

    Institute of Scientific and Technical Information of China (English)

    王惠芬; 孙运波; 徐振涛; 高秋芳

    2012-01-01

    目的:了解外科ICU中心静脉导管相关血流感染(CRBSI)的发病率、病原菌分布及相关危险因素,为临床预防和经验性治疗提供依据.方法:回顾性调查我院外科ICU 2010年1月~2011年8月的中心静脉导管置管病例,根据血培养和导管培养结果分为CRBSI组和非CRBSI组,统计CRBSI的发病率、致病菌;比较CRBSI组与非CRBSI的临床资料,应用多因素Logistic回归分析筛查相关危险因素.结果:共收集249例中心静脉置管病例,CRBSI发病率为8.41例次/千导管日,病原菌分布为G+菌4例,G-菌9例,真菌8例.Logistic回归分析显示导管留置时间(OR 3.298,95% CI 1.070~10.168,P=0.038)、APACHEII评分(OR1.137,95%CI 1.067~1.213,P=0.000)、完全胃肠外营养(OR 1.117,95% CI 1.023~1.219,P=0.014)是CRBSI的独立危险因素.结论:导管留置时、APACHEII评分、完全胃肠外营养是发生CRBSI的独立危险因素.%Objective: To analyze the incidence, pathogens distribution and risk factors of centra! venous catheter related-bloodstream infection in surgical intensive care unit. Methods: Patients admitted in surgical intensive care unit of our hospital from January 2010 -August 2011 with CVC were enrolled, and divided into CRBS1 group and non-CRBSI group, on the basis of the outcomes of germicultu-re of blood samples and hub tips. Then, the incidence and pathogens of CRBSI were analyzed retrospectively. The clinical dam of CRBSI group and non-CRBSI group were compared, and a multivariate analysis has been performed with logistic regression to investigate the risk factors. Results: 249 cases with CVC has been collected, and the incidence of CRBSI is 8.41 cases per 1000 catheter days. 21 pathogens were isolated, including 4 gram-positive bacterium, 9 gram-negative bacterium and 8 fungi, and some were antibiotic-resistance strains. Logistic regression analysis showed that duration of cathetenzation (OR 3.298, 95% CI 1.070-10.168, P=0.038), APACHEII score (OR

  5. Distribution of pathogens causing postoperative central venous catheter-related infections in patients undergoing cardiopulmonary bypass heart surgery and high risk factors%体外循环心脏直视术后中心静脉导管感染的病原菌分布与危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杜守峰; 师文华; 孙君隽

    2015-01-01

    OBJECTIVE To explore the distribution of pathogens causing postoperative central venous catheter‐re‐lated infections in patients undergoing cardiopulmonary bypass heart surgery and analyze the high risk factors so as to provide guidance for the prevention of central venous catheter‐related infections .METHODS The clinical data of 137 patients who underwent the central venous catheter indwelling after the cardiopulmonary bypass heart surgery were retrospectively analyzed ;34 patients with infections were assigned as the infection group ,and 103 patients without infections were set as the non‐infection group ;the bacterial culture and the drug susceptibility testing were carried out for the infection group ,and the logistic regression analysis of the high risk factors for the central ve‐nous catheter‐related infections was performed .RESULTS Totally 34 strains of pathogens have been isolated from the 137 patients with the positive rate of 24 .82% ,including 17 (50 .00% ) strains of gram‐positive bacteria ,13 (38 .24% ) strains of gram‐negative bacteria ,and 4 (11 .76% ) strains of fungi .The drug susceptibility rates of the gram‐positive bacteria to teicoplanin and vancomycin were 100 .00% ;the drug susceptibility rate of the gram‐nega‐tive bacteria to meropenem was 100 .00% ;the drug susceptibility rate of the fungi to fluconazole was 66 .67% . There was significant difference in the catheter indwelling time ,time of cardiopulmonary bypass ,femoral venous puncture ,catheter connector ,or proportion of triple lumen catheter between the infection group and the non‐infec‐tion group (P<0 .05);the logistic regression analysis indicated that the time of cardiopulmonary bypass ,femoral venous puncture ,double lumen catheter indwelling ,and catheter indwelling time were the independent risk fac‐tors .CONCLUSION The excessively long time of cardiopulmonary bypass and catheter indwelling ,femoral venous puncture ,and double lumen catheter

  6. Effect of continuous quality improvement on central venous catheter-related infections in liver cancer patients%持续性质量改进对肝癌患者中心静脉置管相关感染的影响

    Institute of Scientific and Technical Information of China (English)

    李秀丽; 陈秀芳; 齐丽贞; 邱花叶; 刘百百

    2015-01-01

    目的:评估医院感染管理持续性质量改进对肝癌行颈内中心静脉置管患者相关感染因素,为有效预防控制感染提供依据。方法选取2010年1月-2014年12月243例住院治疗并行颈内静脉置管的肝癌患者为研究对象,根据实施医院管理持续性改进的时间分为对照组145例(改进前)和干预组98例(改进后),观察并比较两组患者颈内中心静脉置管相关感染的发生率。结果干预组98例患者中6例发生中心静脉置管相关感染,发生率为6.12%,其中导管细菌定植3例、导管局部感染1例、导管相关性血流感染2例;对照组患者中有31例发生中心静脉置管相关感染,发生率为21.38%,其中导管细菌定植14例、导管局部感染10例、导管相关性血流感染7例,干预组中心静脉置管相关感染发生率显著低于对照组(P<0.05)。结论医院感染管理持续性质量改进可以明显降低肝癌患者颈内中心静脉置管相关感染的发生率。%OBJECTIVE To evaluate the effect of the continuous quality improvement on the internal jugular central venous catheter‐related infections in the liver cancer patients so as to effectively control the infections .METHODS A total of 243 liver cancer patients who were hospitalized and underwent the internal jugular vein catheterization from Jan 2010 to Dec 2014 were recruited as the study objects and divided into the control group ( before the im‐provement ) with 145 cases and the intervention group ( after the improvement ) with 98 cases according to the time of implementation of the continuous quality improvement .The incidence of the internal jugular central venous catheter‐related infections was observed and compared between the two groups of patients .RESULTS The central venous catheter‐related infections occurred in 6 of 98 patients in the intervention group with the incidence rate of 6 .12% ,including 3 cases with

  7. Effect of transparent dressings replacing in different frequency on neonatal central venous catheter-related infections%透明敷料不同更换频率对新生儿中心静脉导管相关性感染的影响

    Institute of Scientific and Technical Information of China (English)

    凌其英; 舒辉; 陈虹; 唐敏; 金夕辉

    2016-01-01

    OBJECTIVE To investigate neonatal peripherally inserted central catheter (PICC) ,and effect of trans‐parent dressings replacing in different frequency on neonatal central venous catheter‐related infections ,in order to select the appropriate transparent dressing change frequency to provide a theoretical basis .METHODS A total of 450 neonates indwelling PICC catheter in hospital from Jun .2012 to Jun .2015 were selected as research subjects , in a random manner patients were divided into three groups ,in which group Ⅰ dressing changed once every three days ,group Ⅱonce every five days ,group Ⅲ once every 7 days ,the catheter‐related infection were analyzed and compared in three groups of children .RESULTS A total of 21 cases of patients got infections from 450 patients , and the infection rate was 4 .67% ;Staphylococcus epidermidis were the top bacteria detected out from the three groups of children ,accounting for 57 .14% ,71 .42% and 49 .99% respectively ,followed by K lebsiella pneumoni‐ae ,accounting for 42 .86% ,14 .29% and 16 .67% respectively .The incident rates of catheter‐related infection in groupⅠand Ⅱ both 0 .67% ,and group Ⅲ had no catheter‐related bloodstream infections .CONCLUSION We rec‐ommend that the dressing central venous catheters in neonates replacement frequency is 7 days /time to reduce the workload of medical staff ,reduce the incidence of nosocomial infections ,but if dressings appear moist and loose phenomenon happen ,the cathether should be replaced .%目的:探讨新生儿经外周静脉置入中心静脉导管(PICC )后,透明敷料不同更换频率对导管感染发生的影响,为透明敷料选取合适的更换频率提供理论依据。方法选取2012年6月-2015年6月在医院接受留置PICC导管的450例新生儿为研究对象,按照随机的方式将其平均分成3组,其中Ⅰ组每3 d更换一次敷料,Ⅱ组每5 d更换一次敷料,Ⅲ组每7 d更

  8. Central venous catheter - dressing change

    Science.gov (United States)

    ... during cancer treatment Bone marrow transplant - discharge Central venous catheter - flushing Peripherally inserted central catheter - flushing Sterile technique Surgical wound care - open Review Date 9/17/2016 Updated by: ...

  9. Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Christine Hohl Moinat

    2014-01-01

    Full Text Available Insertion of central venous port (CVP catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE. However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE, or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3% at 3 months, and 11.3% (IC95 9.4–13.2% at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3% at 3 months, and 15.3% (IC95 13.1–17.6% at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

  10. 集束化干预管理预防肝移植患者外周中心静脉导管相关性血流感染的效果研究%Effect of bundle care on prevention of peripherally inserted central venous catheter-related bloodstream infections in liver transplantation patients

    Institute of Scientific and Technical Information of China (English)

    王丽芹; 陈东方; 李丽

    2014-01-01

    OBJECTIVE To explore the effect of bundle care on prevention of peripherally inserted central venous catheter (PICC)‐related bloodstream infections in the liver transplantation patients so as to provide guidance for clinical prevention of the PICC‐related bloodstream infections and the standardized nursing .METHODS Totally 32 liver transplantation patients who underwent PICC from Nov 2011 to Oct 2012 and did not receive the bundle care were assigned as the control group ,and 29 liver transplantation patients who underwent PICC from Nov 2012 to Oct 2013 and received the bundle care were set as the experimental group ;the incidence of catheter‐related blood‐stream infections was observed and compared between the two groups .RESULTS The catheter indwelling time of the control group was 3 840 days ,the experimental group 4 524 days;the catheter‐related bloodstream infections occurred in 7 cases of the control group with the infection rate of 1 .82‰ and occurred in 3 cases of the experimen‐tal group with the infection rate of 0 .66‰ ,there was statistically significant difference in the incidence of catheter‐related bloodstream infections between the two groups (P<0 .05) .CONCLUSION The bundle care can effectively prevent the catheter‐related bloodstream infections in the liver transplantation patients .%目的:探讨集束化干预管理预防肝移植患者外周中心静脉导管(PICC)相关性血流感染(CRBSI)的效果,为临床预防PICC导管相关性血流感染及规范化护理提供参考依据。方法将2011年11月-2012年10月32例肝移植患者行PICC术未采取集束化干预管理的患者作为对照组,将2012年11月-2013年10月29例肝移植患者行PICC术采取集束化干预管理的患者作为试验组,比较两组CRBSI的发生率。结果对照组患者导管留置时间3840 d ,发生CRBSI 7例,CRBSI发生率1.82‰;试验组29例,导管留置时间4524 d ,发生CRBSI 3例,C RBS I

  11. Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients

    NARCIS (Netherlands)

    Nieboer, P; de Vries, Elisabeth G. E.; Mulder, Nanno; Rodenhuis, S; Bontenbal, M; van der Wall, E; van Hoesel, Q G; Smit, W M; Hupperets, P; Voest, E E; Nooij, M A; Boezen, H M; van der Graaf, W T A

    2008-01-01

    Neutropenia following high-dose chemotherapy leads to a high incidence of infectious complications, of which central venous catheter-related infections predominate. Catheter-related infections and associated risk factors in 392 patients participating in a randomized adjuvant breast cancer trial and

  12. Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients.

    NARCIS (Netherlands)

    Nieboer, P.; Vries, E.G. de; Mulder, N.H.; Rodenhuis, S.; Bontenbal, M.; Wall, E. van der; Hoesel, Q.G.C.M. van; Smit, W.M.; Hupperets, P.; Voest, E.E.; Nooij, M.A.; Boezen, H.M.; Graaf, W.T.A. van der

    2008-01-01

    Neutropenia following high-dose chemotherapy leads to a high incidence of infectious complications, of which central venous catheter-related infections predominate. Catheter-related infections and associated risk factors in 392 patients participating in a randomized adjuvant breast cancer trial and

  13. Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project)

    Science.gov (United States)

    Miliani, Katiuska; Taravella, Raphaël; Thillard, Denis; Chauvin, Valérie; Martin, Emmanuelle; Edouard, Stéphanie; Astagneau, Pascal

    2017-01-01

    Introduction Peripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors. Methods A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. Results Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. Conclusion Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings. PMID:28045921

  14. Risk factors and the outcomes of central venous catheter-related bloodstream infections in ICU wards%ICU病房中心静脉导管相关性血流感染的高危因素及预后分析

    Institute of Scientific and Technical Information of China (English)

    肖丽; 卢岩; 彭松林; 李国福; 于晓江; 安春丽

    2012-01-01

    目的 调查ICU住院患者中心静脉导管相关性血流感染(CRBSI)的发生情况、高危因素及预后,为制定合适的防治策略提供依据.方法 应用前瞻性研究方法,采用美国国家院内感染监测(NNIS)规定的统一标准系统,对2007年6月1日至2008年5月31日入住中国医科大学附属盛京医院综合性ICU的所有符合条件的病例进行调查.结果 CRBSI感染率为13.2%(23例次/174),感染密度为12.0/1000导管日.单因素分析结果,中心静脉置管的个数、CRBSI发生前抗生素应用个数、导管日差异具有统计学意义(P<0.05);多因素Logistic回归分析结果,CRBSI发生前抗生素应用个数≥3( OR=6.335)和中心静脉置管个数>1(OR=5.981)是CRBSI发生的独立危险因素(P<0.05);CRBSI组的病患粗死亡率、呼吸机日、住院总费用、药费、ICU内住院日、总住院日和平均日花费均高于非CRBSI的病患(P<0.05).结论 该院CRBSI发生率高,感染密度大,多个中心静脉置管以及抗生素应用频繁是CRBSI的高危因素.CRBSI者的预后及医疗费用的经济负担明显高于非CRBSI者.必须进一步加强有效的预防和控制措施.%Objective To identify the incidence rate, pathogenic characteristics, risk factors, and outcomes of catheter-related bloodstream infections ( CRBSI) in ICU wards. Method From June 2007 to May 2008, qualified cases in the ICU ward at the Affiliated Shengjing Hospital of China Medical University were prospectively surveyed. Result A total of 174 patients were included in the study. The duration of catheterization lasted 1,913 days. Twenty-one patients developed an infection, yielding an infection rate of 12.0/1,000, and the application rate of catheters was 72. 8% . Specifically, nine cases of infection involved G- bacteria, seven cases involved G+ bacteria, and seven cases involved fungi. After applying a single-factorial analysis, the number of catheter implantations, the number of pre-CRBS1

  15. Radiographic signs of non-venous placement of intended central venous catheters in children

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Erin C. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2016-02-15

    Central venous catheters (CVCs) are commonly used in children, and inadvertent arterial or extravascular cannulation is rare but has potentially serious complications. To identify the radiographic signs of arterial placement of CVCs. We retrospectively reviewed seven cases of arterially malpositioned CVCs on chest radiograph. These cases were identified through departmental quality-assurance mechanisms and external consultation. Comparison of arterial cases was made with 127 age-matched chest radiographs with CVCs in normal, expected venous location. On each anteroposterior (AP) radiograph we measured the distance of the catheter tip from the right lateral border of the thoracic spine, and the angle of the vertical portion of the catheter relative to the midline. On each lateral radiograph we measured the angle of the vertical portion of each catheter relative to the anterior border of the thoracic spine. When bilateral subclavian catheters were present, the catheter tips were described as crossed, overlapping or uncrossed. On AP radiographs, arterially placed CVCs were more curved to the left, with catheter tip positions located farther to the left of midline than normal venous CVCs. When bilateral, properly placed venous catheters were present, all catheters crossed at the level of the superior vena cava (SVC). When one of the bilateral catheters was in arterial position, neither of the catheters crossed or the inter-catheter crossover distance was exaggerated. On lateral radiographs, there was a marked anterior angulation of the vertical portion of the catheter (mean angle 37 ± 15 standard deviation [SD] in arterial catheters versus 5.9 ± 8.3 SD in normally placed venous catheters). Useful radiographic signs suggestive of unintentional arterial misplacement of vascular catheters include leftward curvature of the vertical portion of the catheter, left-side catheter tip position, lack of catheter crossover on the frontal radiograph, as well as exaggerated

  16. Complications Involving Central Venous Catheter Insertion in Newborns Admitted to the Neonatal Intensive Care Unit (NICU

    Directory of Open Access Journals (Sweden)

    Torkaman

    2016-04-01

    Full Text Available Background Developments in the use of central venous catheters have improved the treatment of critically ill newborns. Objectives The aim of this retrospective study was to evaluate the rate of catheter-related complications and associated risk factors in newborns. Patients and Methods This cross sectional study evaluated 60 infants with indications for central venous catheters who were selected by census from 2007 to 2014 in Baqiyatallah Hospital in Tehran, Iran. The catheters were Broviac numbers 14 - 16. Results Ultimately, 60 cases (17 males and 43 females with a mean age of 26.25 ± 20.09 days (Min = 1 day and Max = 153 days underwent analysis. The most common reasons for venous catheter placement (98.3% were prolonged hospitalization and lack of peripheral vessels. The most common complication was catheter-related infection, which occurred in 20 patients (33.3%. Death occurred in 24 patients (40.0%, but only 3 deaths (5% were due to complications from the central venous catheter. A significant relationship was evident between infection and catheterization duration (P = 0.02. Conclusions Most of the catheter-related deaths were due to severe sepsis and hemothorax, and a significant relationship was noted between infection and both the mortality rate and catheterization duration. A significant relationship was also evident between birth weight and infection rates.

  17. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

    OpenAIRE

    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J.; Wilkerson, K; Speroff, T

    2005-01-01

    

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices.

  18. Central venous line complications and tip detection

    OpenAIRE

    Ameneh Rezaee Gheshlaghi; Hamid Zamani Moghadam Dolu; Elham Pishbin; Maryam Salehi

    2015-01-01

    Central venous line is one of a creative instrument that saves human’s life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement.Central veno...

  19. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters.

    Science.gov (United States)

    Pan, Longfang; Zhao, Qianru; Yang, Xiangmei

    2014-01-01

    To evaluate the risk factors associated with an increased risk of symptomatic peripherally inserted central venous catheter (PICC)-related venous thrombosis. Retrospective analyses identified 2313 patients who received PICCs from 1 January 2012 to 31 December 2013. All 11 patients with symptomatic PICC-related venous thrombosis (thrombosis group) and 148 who did not have thromboses (non-thrombosis group) were selected randomly. The medical information of 159 patients (age, body mass index (BMI), diagnosis, smoking history, nutritional risk score, platelet count, leucocyte count as well as levels of D-dimer, fibrinogen, and degradation products of fibrin) were collected. Logistic regression analysis was undertaken to determine the risk factors for thrombosis. Of 2313 patients, 11 (0.47%) were found to have symptomatic PICC-related venous thrombosis by color Doppler ultrasound. Being bedridden for a long time (odds ratio [(OR]), 17.774; P=0.0017), D-dimer >5 mg/L (36.651; 0.0025) and suffering from one comorbidity (8.39; 0.0265) or more comorbidities (13.705; 0.0083) were the major risk factors for PICC-catheter related venous thrombosis by stepwise logistic regression analysis. Among 159 patients, the prevalence of PICC-associated venous thrombosis in those with ≥1 risk factor was 10.34% (12/116), in those with ≥2 risk factors was 20.41% (10/49), and in those with >3 risk factors was 26.67% (4/15). Being bedridden >72 h, having increased levels of D-dimer (>5 mg/L) and suffering from comorbidities were independent risk factors of PICC-related venous thrombosis.

  20. Equipe interdisciplinar reduz infecção sanguínea relacionada ao cateter venoso central em Unidade de Terapia Intensiva Pediátrica Interdisciplinary task-force reduces catheter-related bloodstream infection in a Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ricardo Vilela

    2010-12-01

    Full Text Available OBJETIVO: Avaliar o impacto de intervenções interdisciplinares nos indicadores de infecção de corrente sanguínea relacionada ao cateter venoso central e microrganismos isolados, em uma Unidade de Terapia Intensiva Pediátrica. MÉTODOS: Estudo de intervenção do tipo antes e depois. Foi criado um programa educativo e constituída uma equipe interdisciplinar de intervenção composta por médicos e enfermeiros da unidade e do Serviço de Controle de Infecção Hospitalar. As intervenções foram compostas por medidas diretas e indiretas educativas e processuais. O período pré-intervenção (Fase 1, de junho de 2003 a maio de 2004, foi comparado ao período pós-intervenção nas Fases 2 (junho de 2004 a maio de 2005 e 3 (junho de 2005 a maio de 2006. As taxas de infecção foram comparadas por ANOVA, sendo significante pOBJECTIVE: To determine the impact of interdisciplinary interventions on central venous catheter-related bloodstream infections rates in a Pediatric Intensive Care Unit (PICU and on the bloodstream infection organisms. METHODS: Interventional study type before-and-after. An educational program was performed and an interdisciplinary team of interventions was created. This team was formed by nurses and doctors of the PICU and of the Infection Control Committee. The interventions were composed by direct and indirect educational and procedural measures. Task-force interventions were developed from Jun/2003 to May/2004. This pre-intervention period (Phase 1 was compared with two post-intervention periods: Phases 2 (Jun/2004 to May/2005 and 3 (Jun/2005 to May/2006. Central venous catheter-related bloodstream infection rates during the three periods were compared by ANOVA, being significant p<0.05. RESULTS: 1,234 patients were studied from June 1st 2003 to May 31, 2006. The number of central venous catheter-related bloodstream infections was 22.72 per 1,000 catheter-days in Phase 1, and 6.81 and 5.87 in Phases 2 and 3

  1. Transpleural central venous catheter discovered during thoracotomy

    Directory of Open Access Journals (Sweden)

    Ashima Malhotra

    2014-01-01

    Full Text Available We report an uncommon complication of subclavian central venous catheterization, discovered at thoracotomy. The central venous catheter (CVC was placed by left infraclavicular route after induction of general anesthesia. CVC was secured after aspiration of blood and satisfactory central venous tracing. On thoracotomy, CVC was noticed to traverse the pleural cavity while the tracing was normal. CVC was thus removed consequent to which bleeding from each puncture site was noticed, that were secured surgically.

  2. Central venous line complications and tip detection

    Directory of Open Access Journals (Sweden)

    Ameneh Rezaee Gheshlaghi

    2015-06-01

    Full Text Available Central venous line is one of a creative instrument that saves human’s life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement.Central venous line might have some complications and complication follow-up should be considered. Thromboembolism and infection are two important medical complications. Arterial puncture, hematoma, pneumothorax and hemothorax are mechanical Central venous line complications. Chest X-ray and some other techniques should be used for detecting these complications.Central venous line tip misplace is a considerable problem for emergency department staffs, previously chest X-ray has been used for central venous line misplace detection. In some recent studies, contrast-enhanced ultrasonography and intravascular electrocardiography have been used for central venous line misplace.

  3. Catheter-related Complications in Postoperative Intraperitoneal Chemotherapy for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To analyze catheter-related complications during postoperative Intraperitoneal chemotherapy (IPCT) for gastric cancer. Methods: From December 2003 to April 2007, 80 patients with gastric cancer were treated with postoperative IPCT using central venous catheters (CVCs), during which the complications that occurred in association with CVCs were documented and analyzed. Results: Catheter-related complications were seen in 10 out of the 80 patients, yielding a total complication rate of 12.5%. Main complications included abdominal pain (3.8%), local infection (1.3%), catheter obstruction (2.5%), leakage (2.5%) and dislocation (2.5%). All patients successfully finished their IPCT, the success rate was 100%. There occurred no severe complications or treatment-related deaths. Conclusion: It is convenient and safe to carry out postoperative IPCT for gastric cancer using CVCs, which, with a low catheter-related complication rate, should be recommended for more clinic use.

  4. An unusual Complication of Central Venous Cannulation

    Directory of Open Access Journals (Sweden)

    Ashvini Kumar

    2013-04-01

    Full Text Available Central venous catheter (CVC hub fracture is a rare complication of central venous cannulation. We report a case where catheter hub fracture was detected immediately after CVC insertion. Causes of catheter hub fracture and its complications are discussed.

  5. Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: A randomized controlled trial

    NARCIS (Netherlands)

    J. Kwakman (Jan); M.C. Müller (Marcella); J.M. Binnekade (Jan); J.P. van den Akker (Johannes); C.A. de Borgie (Corianne); M.J. Schultz (Marcus); S.A.J. Zaat (Sebastiaan)

    2012-01-01

    textabstractIntroduction: Catheter-related bloodstream infections (CRBSIs) associated with short-term central venous catheters (CVCs) in intensive care unit (ICU) patients are a major clinical problem. Bacterial colonization of the skin at the CVC insertion site is an important etiologic factor for

  6. Tsukamurella catheter-related bloodstream infection in a pediatric patient with pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Kristen A. Wendorf

    2010-03-01

    Full Text Available Catheter-related bloodstream infections (CR-BSI are important complications in patients with long-term indwelling central venous catheters. In this report, we present the case of a 14-year-old male with pulmonary hypertension treated with continuous treprostinil infusion, who presented with a CR-BSI caused by a Tsukamurella species. This case highlights the potential for this unusual organism to cause infection in immunocompetent patients.

  7. Catheter-related bacteremia due to Roseomonas species in pediatric hematology/oncology patients.

    Science.gov (United States)

    McLean, Thomas W; Rouster-Stevens, Kelly; Woods, Charles R; Shetty, Avinash K

    2006-04-01

    Roseomonas is a newly described genus of pink-pigmented, gram-negative bacteria. Human infections caused by Roseomonas species are very rare. We report two cases of central venous catheter-related bacteremia associated with Roseomonas species (one case with R. gilardii and one with R. fauriae), and review the clinical spectrum of previously reported cases in the literature. Clinicals should be aware that Roseomonas species may cause serious infections in children.

  8. [Venous thromboembolism associated with long-term use of central venous catheters in cancer patients].

    Science.gov (United States)

    Debourdeau, P; Chahmi, D Kassab; Zammit, C; Farge-Bancel, D

    2008-06-01

    Increased incidence of cancers and the development of totally implanted venous access devices that contain their own port to deliver chemotherapy will lead to a greater than before numbers of central venous catheter-related thrombosis (CVCT). Medical consequences include catheter dysfunction and pulmonary embolism. Vessel injury caused by the procedure of CVC insertion is the most important risk factor for development of CVCT. This event could cause the formation of a fresh thrombus, which is reversible in the large majority of patients. In some cases, thrombus formation is not related to catheter insertion. The incidence of CVC-related DVT assessed by venography has been reported to vary from 30 to 60% but catheter-related DVT in adult patients is symptomatic in only 5% of cases. The majority of patients with CVC-related DVT is asymptomatic or has nonspecific symptoms: arm or neck swelling or pain, distal paresthesias, headache, congestion of subcutaneous collateral veins. In the case of clinical suspicion of CVC-related deep venous thrombosis (DVT), compressive ultrasonography (US), especially with doppler and color imaging, currently is first used to confirm the diagnosis. Consequently, contrast venography is reserved for clinical trials and difficult diagnostic situations. There is no consensus on the optimal management of patients with CVC-related DVT. Treatment of CVC-related VTE requires a five- to seven-day course of adjusted-dose unfractionated heparin or low molecular weight heparin (LMWH) followed by oral anticoagulants. Long-term LMWH that has been shown to be more effective than oral anticoagulant in cancer patients with lower limb DVT, could be used in these patients. The efficacy and safety of pharmacologic prophylaxis for CVC related thrombosis is not established and the last recommendations suggest that clinicians not routinely use prophylaxis to try to prevent thrombosis related to long-term indwelling CVCs in cancer patients. Additional studies

  9. Bacterial profile and antimicrobial susceptibility pattern in catheter related nosocomial infections.

    Directory of Open Access Journals (Sweden)

    Tullu M

    1998-01-01

    Full Text Available This prospective study was carried out over a period of 6 months in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital. The aim of the study was to determine the organisms causing catheter related nosocomial infections in the PICU and to study their antimicrobial susceptibility pattern. Patients with endotracheal intubation, indwelling urinary catheters and central venous catheters (CVC/venous cutdown catheters were included in the study. Colonization of the endotracheal tube, urinary catheter related infections (UCRI and colonization of the CVC/venous cutdown catheters was studied. E. coli was the commonest organism colonizing the endotracheal tube tip with maximum susceptibility to cefotaxime and amikacin. E. coli was also was the commonest organism causing UCRI with maximum susceptibility to nitrofurantoin and amikacin. Acinetobacter was the commonest organism colonizing the CVC/venous cutdown catheters with maximum susceptibility to ciprofloxacin. All these sites of catheter related infections considered together, E. coli and Klebsiella were the commonest nosocomial organisms. Both had maximum susceptibility to amikacin. Methicillin resistant Staphylococcus aureus (MRSA was isolated only from one culture. All the organisms had a poor susceptibility to cefazolin and amoxycillin. A knowledge of the resident microbial flora and their antimicrobial susceptibility pattern is necessary for formulating a rational antibiotic policy in an ICU.

  10. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

    Directory of Open Access Journals (Sweden)

    Ugas Mohamed

    2012-09-01

    Full Text Available Abstract Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

  11. Entrapment of guidewire during central venous catheterization

    Directory of Open Access Journals (Sweden)

    Tarun S.

    2016-07-01

    Full Text Available Central venous catheterization (CVC is common in the setting of ICU for various reasons like monitoring of CVP, fluid administration and vasopressor or drug infusions. Guidewires are routinely used in the Seldinger technique during central venous catheter placement CVC placement is not innocuous as numerous complications may occur, with varying frequency and severity. [Int J Res Med Sci 2016; 4(7.000: 3080-3081

  12. Interventional radiologic placement of tunneled central venous catheters : results and complications in 557 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chan Kyo; Do, Young Soo; Paik, Chul H. [Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)] (and others)

    1999-05-01

    To evaluate prospectively the results of interventional radiologic placement of tunneled central venous catheters, and subsequent complications. Between April 1997 and April 1998, a total of 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in an interventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23 and transfusion in one. Complications were evaluated prospectively by means of a chart review, chest radiography, central vein angiography and blood/catheter culture. The technical success rate for tunneled central venous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean, 112{+-}4.6) days; Hickman catheters were removed in 252 cases during follow-up. Early complications included 3 cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1 case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 cases of venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%), and 1 case of pseudoaneurysm(0.2%). The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50, respectively. The technical success rate of interventional radiologic placement of tunneled central venous catheters was high. In comparison to conventional surgical placement, it is a more reliable method and leads to fewer complications.

  13. Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

    Science.gov (United States)

    Torgay, A; Pirat, A; Candan, S; Zeyneloglu, P; Arslan, G; Haberal, M

    2005-09-01

    The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

  14. Bacterial infection of central venous catheters in short-term total parenteral nutrition.

    Science.gov (United States)

    Chan, L; Ngeow, Y F; Parasakthi, N

    1998-03-01

    Fourteen severely ill ventilated patients in an intensive care unit, requiring short-term total parenteral nutrition, were examined for catheter-related infection. Microbiological analysis using Maki's SQ technique was carried out on catheter exit site, catheter hub, proximal subcutaneous segment of catheter and catheter up. Qualitative cultures were carried out on total parenteral nutrition and peripheral blood samples. Twenty six of 29 catheters removed (90%) were culture positive but only 7 catheters were related to positive blood cultures, giving a catheter-related bacteremia (CRB) rate of 24%. Haematogenous seeding was strongly implicated in 7/29 (24%) of catheters. Patients' skin flora appeared to be the main source of catheter-related infection. The organisms isolated for patients with CRB included coagulase-negative staphylococci, Acinetobacter and Klebsiella. It is suggested that to control infective complications of central venous catheters, emphasis should be focused on specialised intravenous therapy teams and the use of strict protocols for insertion and care of central lines.

  15. The prevention, diagnosis and management of central venous line infections in children.

    Science.gov (United States)

    Chesshyre, Emily; Goff, Zoy; Bowen, Asha; Carapetis, Jonathan

    2015-06-01

    With advancing paediatric healthcare, the use of central venous lines has become a fundamental part of management of neonates and children. Uses include haemodynamic monitoring and the delivery of lifesaving treatments such as intravenous fluids, blood products, antibiotics, chemotherapy, haemodialysis and total parenteral nutrition (TPN). Despite preventative measures, central venous catheter-related infections are common, with rates of 0.5-2.8/1000 catheter days in children and 0.6-2.5/1000 catheter days in neonates. Central line infections in children are associated with increased mortality, increased length of hospital and intensive care unit stay, treatment interruptions, and increased complications. Prevention is paramount, using a variety of measures including tunnelling of long-term devices, chlorhexidine antisepsis, maximum sterile barriers, aseptic non-touch technique, minimal line accessing, and evidence-based care bundles. Diagnosis of central line infections in children is challenging. Available samples are often limited to a single central line blood culture, as clinicians are reluctant to perform painful venepuncture on children with a central, pain-free, access device. With the advancing evidence basis for antibiotic lock therapy for treatment, paediatricians are pushing the boundaries of line retention if safe to do so, due to among other reasons, often limited venous access sites. This review evaluates the available paediatric studies on management of central venous line infections and refers to consensus guidelines such as those of the Infectious Diseases Society of America (IDSA).

  16. We still go for the jugular: implications of the 3SITES central venous catheter study for nephrology.

    Science.gov (United States)

    Wyatt, Christina M; Vassalotti, Joseph A

    2016-03-01

    The 3SITES study randomly assigned a nontunneled central venous catheter site in over 3000 adults treated in intensive care units. The subclavian site was associated with a lower rate of short-term complications, including catheter-related bloodstream infection and deep venous thrombosis, compared to the femoral or internal jugular site. Nephrologists should be aware of this study and should continue to advocate for alternatives to subclavian vein catheter placement in patients with chronic kidney disease who are expected to require arteriovenous access for dialysis in the future.

  17. Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Hwa Rim Kang

    2015-08-01

    Full Text Available Central venous catheterization is a common diagnostic and therapeutic procedure in modern clinical practice. Pseudoaneurysms of the subclavian artery are rare and usually occur immediately after the causative event, whether the cause was trauma or a medical procedure. Here we report the rare case of a 71-year-old woman with delayed presentation of catheter-related subclavian pseudoaneurysm. The patient was treated for aspiration pneumonia with respiratory failure in another hospital. The patient's chest wall swelling began two weeks after the initial catheterization in the other hospital, probably because of slow leakage of blood from the injured subclavian artery caused by incomplete compression of the puncture site and uremic coagulopathy. She was successfully treated with ultrasound-guided thrombin and angiography-guided histoacryl injection without stent insertion or surgery. Her condition improved, and she was discharged to her home.

  18. Radiologic placement of tunneled central venous catheter

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Seong Tae; Yang, Po Song; Yang, Dong Hunn; Kim, Ki Tae; Kim, Choon Yul; Shinn, Kyung Sub [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of); Yun, Eun Joo [Korea Veterans Hospital, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the efficacy and safety of fluoroscopy-guided, radiologic placement of a tunneled central venous catheter into the superior vena cava (SVC). Thirty five patients underwent tunneled central venous catheter placement to facilitate long-term chemotherapy. They included 33 leukemic patients, one colon cancer patient, and one multiple myeloma patient. After confirming central venous patency with a injection of contrast media via the peripheral cephalic or basilic vein in the wrist joint, the subclavian vein was punctured under fluoroscopic guidance. A 7F double lumen TPN catheter was placed into the SVC through a subcutaneous tunnel in the anterior chest wall. Catheter placements were successful in all patients. The mean procedure time was 17.2minutes, mean fluooscopy time was 1.3minutes, mean number of punctures was 1.4, and mean volume of injhected contrast media was 43.5cc. Only two of all leukemic patients developed mild hematomas at the puncture site, but these soon resolved themselves. None of the patients developed pneumothorax or hemothorax. But late complications included local infection in two patients (6%) and thrombotic occlusion of the catheter in one (3%). The occluded catheter was successfully recanalized with Urokinase infusion. Fluoroscopy-guided, radiologic placement of a tunneled central venous catheter is an easy and safe method, and useful for patients requiring long-term venous access.

  19. Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

    DEFF Research Database (Denmark)

    Larsen, M.K.; Thomsen, T.R.; Moser, C.;

    2008-01-01

    ABSTRACT: BACKGROUND: Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. METHODS: In this study traditional semiquantitative...... culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ...... observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. CONCLUSION: The results show that diagnosis based on molecular methods improves the detection of microorganisms involved in central catheter-related infections. The importance...

  20. Multicenter study in monitoring central venous catheters complications in hematologic patiennts

    Directory of Open Access Journals (Sweden)

    Carmen García Gabás

    2013-05-01

    Full Text Available Most hematological patients suffer a significant venous damage related to different administrated intravenous therapy, being necessary to place central venous catheters (CVC. CVC is associated with various complications. The most common catheter-related complications are occlusion and infection. To avoid such of them, the development of protocols for insertion and care are needed, as well as recording and following up complications. To this end, we propose a cross-sectional carried out during 13 months whose main goal is to know the incidence of CVC- related complications (mainly occlusion and infection in hematological patients.Population included all the =14 ages patients admitted to different hematological units at Ramon y Cajal and Gregorio Marañón hospitals in Madrid and who signed informed consent. Socio-demographic, clinical characteristics and complications were entered into a log which included a pursuit of care protocol.

  1. Infections associated with the central venous catheters.

    Science.gov (United States)

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  2. Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center.

    Science.gov (United States)

    Pektaş, Ayhan; Kara, Ateş; Gurgey, Aytemiz

    2015-06-01

    Amaç: Bu çalışma, tek bir merkezde hematolojik hastalık nedeniyle tedavi edilen çocuklarda santral venöz kateter (SVK) kullanımıyla ilişkili olarak ortaya çıkan komplikasyonları belirlemeyi ve incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Beş yıl boyunca, 203 SVK uygulaması yapılan 106 çocuk hastada ortaya çıkan 175 katetere bağlı komplikasyon geriye dönük olarak değerlendirilmiştir. Bulgular: Klinik kateter enfeksiyonu, lokal kateter enfeksiyonu, venöz tromboembolizm, kanama ve mekanik komplikasyon oranları, sırasıyla, 1000 kateter gününde 2,6, 1,1, 0,2, 0,2 ve 0,2 olarak hesaplanmıştır. Metisiline dirençli Staphylococcus epidermidis, kan ve kateter kültürlerinden en çok izole edilen mikroorganizmadır. Lösemili çocuklarda klinik kateter enfeksiyonlarının sıklığı anlamlı olarak yüksektir (p=0,046). Kemik iliği transplantasyonu yapılan çocuklarda klinik kateter enfeksiyonu sıklığı anlamlı olarak düşük (p=0,043) bulunurken lokal kateter enfeksiyonu sıklığı anlamlı olarak yüksektir (p=0,003). İmplante kateteri olan çocuklarda klinik kateter enfeksiyonlarının sıklığı anlamlı olarak düşüktür (p=0,048). Trombositopenisi olan çocuklarda lokal kateter enfeksiyonları anlamlı olarak daha az görülürken klinik kateter enfeksiyonları ve katetere bağlı kanama anlamlı olarak daha sık ortaya çıkmıştır (sırasıyla p=0,001, p=0,042 ve p=0,024). Sonuç: Lösemi, kemik iliği transplantasyonu ve trombositopeni, SVK ile ilişkili olarak çocuklarda ortaya çıkan komplikasyonlar için en önemli risk etkenleridir. Kalıcı kateterler aracılığıyla gerçekleştirilen müdahale sayısındaki artış, sistemik enfeksiyon ve mekanik hasar riskindeki anlamlı yükselişten sorumlu olabilir.

  3. Guidelines for the prevention of central venous catheter-related blood stream infections with prostanoid therapy for pulmonary arterial hypertension

    OpenAIRE

    Doran, A. K.; Ivy, D. D.; Barst, R.J.; Hill, N.; Murali, S; Benza, R. L.

    2008-01-01

    Intravenous prostanoids are the backbone of therapy for advanced pulmonary arterial hypertension (PAH) and have improved long-term outcome and quality of life. Currently, two prostanoids are approved by the US Food and Drug administration for parenteral administration: epoprostenol (Flolan) and treprostinil (Remodulin). Chronic intravenous therapy presents considerable challenges for patients and caregivers who must learn sterile preparation of the medication, operation of the pump, and care ...

  4. Assessment of central venous catheter-associated infections using semi-quantitative or quantitative culture methods

    Directory of Open Access Journals (Sweden)

    E. L. Pizzolitto

    2009-01-01

    Full Text Available

    Semiquantitative (Maki and quantitative (Brun- Buisson culture techniques were employed in the diagnosis of catheter-related bloodstream infections (CRBSI in patients who have a short-term central venous catheter (inserted for 30 days. The diagnosis of CRBSI was based on the results of semiquantitative and quantitative culture of material from the removed catheters. Catheter tips (118 from 100 patients were evaluated by both methods. Semiquantitative analysis revealed 34 catheters (28.8% colonized by ≥15 colonyforming units (cfu, while quantitative cultures (34 catheters, 28.8% showed the growth of ≥103 cfu/mL. Bacteremia was confirmed in four patients by isolating microorganisms of identical species from both catheters and blood samples. Using the semiquantitative culture technique on short-term central venous catheter tips, we have shown that with a cut-off level of ≥15 cfu, the technique had 100.0% sensitivity, specificity of 68.4%, 25.0% positive predictive value (PPV and 100.0% negative predictive value (NPV, efficiency of 71.4% and a prevalence of 9.5%. The quantitative method, with a cut-off limit of ≥103 cfu/mL, gave identical values: the sensitivity was 100.0%, specificity 68.4%, positive predictive value (PPV 25.0%, negative predictive value (NPV 100.0%, efficiency 71.4% and prevalence 9.5%. We concluded that the semiquantitative and quantitative culture methods, evaluated in parallel, for the first time in Brazil, have similar sensitivity and specificity. Keywords: central venous catheter; semi-quantitative culture; quantitative culture; catheter-related bacteremia.

  5. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism.

    Science.gov (United States)

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

  6. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

    Science.gov (United States)

    Jaffray, Julie; Bauman, Mary; Massicotte, Patti

    2017-01-01

    The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed. PMID:28168186

  7. Central Venous Catheter-Associated Pericardial Tamponade in a 6-Day Old: A Case Report

    Directory of Open Access Journals (Sweden)

    Swati O. Arya

    2009-01-01

    Full Text Available Introduction. Pericardial effusion (PCE and tamponade can cause significant morbidity and mortality in neonates. Such cases have been reported in the literature in various contexts. Case Presentation. A 6-day old neonate with meconium aspiration syndrome and persistent pulmonary hypertension of newborn on high frequency oscillator ventilation and inhaled nitric oxide was referred to our hospital with a large pericardial effusion causing hemodynamic compromise. Prompt pericardiocentesis led to significant improvement in the cardio-respiratory status and removal of the central line prevented the fluid from reaccumulating. Cellular and biochemical analysis aided in the diagnosis of catheter related etiology with possibility of infusate diffusion into the pericardial space. Conclusion. We present this paper to emphasize the importance of recognizing this uncommon but serious complication of central venous catheters in intensive care units. We also discuss the proposed hypothesis for the mechanism of production of PCE.

  8. ICU深静脉导管感染的病原菌分布和耐药性分析%Investigation of distribution and drug resistance of pathogenic bacteria causing deep venous catheter related infection in ICU

    Institute of Scientific and Technical Information of China (English)

    李静; 周利霞; 范秋生

    2012-01-01

    Objective To investigate the characteristics of distribution and drug resistance of pathogenic bacteria causing deep venous catheter related infection in ICU.Methods From January 2006 to August 2010,the culture and drug sensitivity test results of 342 deep venous catheter tip from ICU were analyzed retrospectively. Results Among the results of 342 catheter tip cultures,101 strains( 29. 5% )of pathogenic bacteria were detected. The proportion of G+ bacteria,enterobacteria ceae,non-fermentation G- bacteria and fungi was 29 strains( 28.7% ),25 strains( 24. 8% ),33 strains( 32. 6% )and 14 strains ( 13.9% )respectively. The six most common pathogenic bacteria were pseudomonas aeruginosa 20 strains( 19.8% ), Klebsiella pneumonia 12 strains( 11.9% ),Staphylococcus aureus 10 strains( 9. 9% ), Staphylococcus epidermis 8 strains( 7. 9% ),En-terococcus faecium 7 strains( 6. 9% ) and Saccharomyces albicans 7 strains( 6. 9% ). 8 strains( 80. 0% )of Staphylococcus aureus were MRSA,7 strains( 63. 6% )of coagulase negative Staphylococci were MRCNS and 14 strains( 56. 0% )of Enterobacte-riaceae were ESBLs. Most isolated strains were multiple drug resistant. Conclusion The most common pathogens cultured from the deep venous catheter tip in ICU were highly resistant to antibiotics. The clinical micro-organisms laboratory should report the results of bacterial culture and drug susceptibility quickly and accurately for reasonable use of antibiotic drugs in clinical treatment.%目的 探讨ICU深静脉导管感染的病原菌分布和细菌耐药性特征.方法 对2006年1月-2010年8月ICU送检的342例次深静脉导管标本的细菌培养和药敏试验结果进行分析.结果 342份标本中共检出病原菌101株(29.5%):革兰阳性球菌、肠杆菌科、非发酵革兰阴性杆菌和真菌分别为29株(28.7%)、25株(24.8%)、33株(32.6%)和14株(13.9%).病原菌分离率前6位依次为铜绿假单胞菌20株(19.8%)、肺炎克雷伯菌12株(11.9%)

  9. Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review 1

    Science.gov (United States)

    Stocco, Janislei Gislei Dorociaki; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida; Meier, Marineli Joaquim

    2016-01-01

    Abstract Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects. PMID:27508901

  10. Central venous device-related thrombosis as imaged with MDCT in oncologic patients: prevalence and findings

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, Orlando; Castelguidone, Elisabetta de Lutio di; Granata, Vincenza; D' Errico, Adolfo Gallipoli (Dept. of Radiology, National Cancer Institute ' Fondazione G Pascale' (Italy)), email: orlandcat@tin.it; Sandomenico, Claudia (Dept. of Esophago-gastro-bilio-pancreatic Oncology, National Cancer Institute ' Fondazione G Pascale' (Italy)); Petrillo, Mario (Dept. of Radiology, Second Univ. of Naples (Italy)); Aprea, Pasquale (Dept. of Critical Illness and Anaesthesiology, National Cancer Institute ' Fondazione G Pascale' , Naples, (Italy))

    2011-02-15

    Background: Venous thrombosis is a common occurrence in cancer patients, developing spontaneously or in combination with indwelling central venous devices (CVD). Purpose: To analyze the multidetector CT (MDCT) prevalence, appearance, and significance of catheter related thoracic venous thrombosis in oncologic patients and to determine the percentage of thrombi identified in the original reports. Material and Methods: Five hundred consecutive patients were considered. Inclusion criteria were: presence of a CVD; availability of a contrast-enhanced MDCT; and cancer history. Exclusion criteria were: direct tumor compression/infiltration of the veins; poor image quality; device tip not in the scanned volume; and missing clinical data. Seventeen (3.5%) out of the final 481 patients had a diagnosis of venous thrombosis. Results: Factors showing the highest correlation with thrombosis included peripherally-inserted CVD, right brachiocephalic vein tip location, patient performance status 3, metastatic stage disease, ongoing chemotherapy, and longstanding CVD. The highest prevalence was in patients with lymphoma, lung carcinoma, melanoma, and gynecologic malignancies. Eleven out of 17 cases had not been identified in the original report. Conclusion: CVD-related thrombosis is not uncommon in cancer patients and can also be observed in outpatients with a good performance status and a non-metastatic disease. Thrombi can be very tiny. Radiologists should be aware of the possibility to identify (or overlook) small thrombi

  11. Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement

    OpenAIRE

    Wisecup, Sarah; Eades, Shannan; Turiy, Yuliya

    2015-01-01

    OBJECTIVES: With the apparent increase in venous thromboembolism noted in the pediatric population, it is important to define which children are at risk for clots and to determine optimal preventative therapy. The purpose of this study was to determine the risk factors for venous thromboembolism in pediatric patients with central venous line placement.

  12. Biofilm formation in long-term central venous catheters in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter;

    2012-01-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n...... = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi......-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream...

  13. The use of central venous lines in the treatment of chronically ill children.

    Science.gov (United States)

    Barczykowska, Ewa; Szwed-Kolińska, Marzena; Wróbel-Bania, Agnieszka; Ślusarz, Robert

    2014-01-01

    Treatment of chronic diseases in children is a special medical problem. Maintaining constant access to the central vascular system is necessary for long-term hemato-oncological and nephrological therapies as well as parenteral nutrition. Providing such access enables chemotherapic treatment, complete parenteral nutrition, long-term antibiotic therapy, hemodialysis, treatment of intensive care unit patients, monitoring blood pressure in the pulmonary artery and stimulation of heart rate in emergency situations as well as treatment of patients suffering from complications, especially when chances of access into peripheral veins are exhausted. Continuous access to the central vascular system is desirable in the treatment of chronically ill children. Insertion of a central venous catheter line eliminates the unnecessary pain and stress to a child patient accompanying injection into peripheral vessels. In order to gain long-term and secure access to the central venous system, respecting the guidelines of the Center for Disease Control and Prevention contained in the updated 'Guidelines for the Prevention of Intravascular Catheter-Related Infections' is necessary.

  14. Central Vein Preservation in Critical Venous Access.

    Science.gov (United States)

    Davidson, J; Paul, A; Patel, S; Davenport, M; Ade-Ajayi, N

    2016-08-01

    Introduction The lack of suitable veins in children with critical central venous access requirements is a major obstacle to optimal care and is potentially life-threatening. We present outcomes following the use of vein-preserving (VP) surgical techniques, notably the sheath exchange for tunneled lines (SETL). Materials and Methods A retrospective, single observer analysis of a prospectively maintained departmental logbook as well as the medical records of patients. Two broad groups of central line replacements were identified; those inserted following removal of a previous line and a traditional "plastic-free" (PF) period and those exchanged without such an interval. Results Overall, 19 lines were directly exchanged during the study period and compared with 34 inserted after a PF period. Similar catheter life spans and infection rates were demonstrated in each group; 125 (range, 78-173) days in VP exchanges versus 122 (range, 70-175) days in PF replacements (p = 0.41). Line Sepsis resulting in removal or change of line occurred at 103 (range, 60-147) days in VP group versus 104 (range, 45-164) days in PF (p = 0.73). Conclusion For children with critical venous access requirements, direct line exchange procedures are a robust and reproducible means of vein preservation. The outcomes compare favorably with those following the more traditional removal, a PF period and reinsertion.

  15. 重症监护病房老年患者导管相关性真菌感染高危因素研究%Risk Factors of Central Vein Catheter Related Fungal Infection in Elderly Patients in Intensive Care Units

    Institute of Scientific and Technical Information of China (English)

    高志凌; 俞兴群; 刘宝

    2012-01-01

    Objective To investigate the risk factors of elderly patients with central vein catheter related fungal infection in intensive care units, and to provide basis for earlier empirical antifungal treatment. Methods 47 elderly patients who admitted into ICU from August 2008 to August 2011 and who were diagnosed as central vein catheter related infection were retrospectively analyzed. All the patients were divided into fungal infection group and bacterial infection group, and the risk factors were analyzed. Results Compared with bacterial infection group, patients in fungal infection group had significantly longer catheter indwelling time, significantly more Candida parasitism and more application of broad - spectrum antibiotics ≥7 days, significantly higher APACHE II scores and significantly higher usage rate of antibacterial catheters ( P < 0. 05 ) . Multivariate logistic regression analysis showed that Candida parasitism, high APACHE II scores and application of broad - spectrum antibiotics ≥7 days were independent risk factors of central vein catheter related fungal infection. Conclusion Candida parasitism, high APACHE Ⅱ scores, using broad - spectrum antibiotics ≥ 7 days were independent risk factors of central vein catheter related fungi infection. This can guide the usage of central venous catheters and earlier empirical antifungal treatment.%目的 探讨重症监护病房(ICU)老年患者导管相关性真菌感染的危险因素,为早期经验性治疗提供依据.方法 回顾性调查2008年8月-2011年8月在我科住院并确诊为导管相关性血行性感染(CLABSI)的患者共47例,分为真菌感染组和细菌感染组,分析其危险因素.结果 真菌感染组较细菌感染组导管留置时间明显延长,念珠菌定植、应用广谱抗生素≥7 d患者明显增多,确诊感染当天急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)明显升高,抗菌导管使用率明显升高,差异均有统计学意义(P<0.05).多因

  16. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications).

    Science.gov (United States)

    Pittiruti, Mauro; Hamilton, Helen; Biffi, Roberto; MacFie, John; Pertkiewicz, Marek

    2009-08-01

    When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion

  17. Catheter-related infection in gastrointestinal fistula patients

    Institute of Scientific and Technical Information of China (English)

    Ge-Fei Wang; Jian-An Ren; Jun Jiang; Cao-Gan Fan; Xin-Bo Wang; Jie-Shou Li

    2004-01-01

    AIM: To study the incidence, bacterial spectrum and drug sensitivity of catheter-related infection (CRI) in gastrointestinal fistula patients.METHODS: A total of 216 patients with gastrointestinal fistulae during January 1998 to April 2001 were studied retrospectively. Two hundred and sixteen catheters of the 358 central venous catheters used in 216 gastrointestinal fistula patients were sent for microbiology analysis.RESULTS: Ninety-five bacteria were cultivated in 88catheters (24.6%). There were 54 Gram-negative bacteria (56.8%), 35 Gram-positive bacteria (36.8%), and 6 fungi (6.4%). During the treatment of CRI, 20 patients changed to use antibiotics or antifungal, and all patients were cured.The mean time of catheters used was 16.9±13.0 d.CONCLUSION: CRI is still the common complication during total parenteral nutrition (TPN) treatment in patients with gastrointestinal fistulae, and Gram-negative bacteria are the main pathogens, and bacterial translocation is considered the common reason for CRI.

  18. Central venous oxygen saturation during hypovolaemic shock in humans

    DEFF Research Database (Denmark)

    Madsen, P; Iversen, H; Secher, N H

    1993-01-01

    We compared central venous oxygen saturation and central venous pressure (CVP) as indices of the effective blood volume during 50 degrees head-up tilt (anti-Trendelenburg's position) induced hypovolaemic shock in eight healthy subjects. Head-up tilt increased thoracic electrical impedance from 31...

  19. The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

    Directory of Open Access Journals (Sweden)

    Amy Leung

    2016-01-01

    Full Text Available Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%. The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis.

  20. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriette; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michael A.; Spronk, Peter E.

    2012-01-01

    Objective:  The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design:  Prospective observational controlled study. Setting:  Nonacademic university-affiliated t

  1. Imaging of the complications of peripherally inserted central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Amerasekera, S.S.H. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)], E-mail: steve.amerasekera@nhs.net; Jones, C.M.; Patel, R.; Cleasby, M.J. [Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham (United Kingdom)

    2009-08-15

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  2. Imaging of the complications of peripherally inserted central venous catheters.

    Science.gov (United States)

    Amerasekera, S S H; Jones, C M; Patel, R; Cleasby, M J

    2009-08-01

    Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

  3. Bilateral Pneumothoraces Following Central Venous Cannulation

    Directory of Open Access Journals (Sweden)

    F. Pazos

    2009-01-01

    Full Text Available We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital “Buffalo chests” explaining bilateral pneumothoraces and a secondary tension pneumothorax.

  4. 静脉导管相关感染预防规范化护理流程的应用%Application of standardized nursing process for prevention of venous catheter-related infections

    Institute of Scientific and Technical Information of China (English)

    刘莉; 王海明; 陈松宽

    2015-01-01

    OBJECTIVE To investigate the clinical effect of the implementation of standardized clinical care process on deep venous catheter‐related infections (CRI) so as to provide reference for clinical nursing .METHODS Totally 616 cases in May 2011 to Dec .2013 treated with central venous catheters were enrolled ,in which 289 cases of pa‐tients with the implementation of routine care were set as the control group and 327 cases with the implementation of standardized care measures as the experiment group .The two groups of patients were compared for the infec‐tion rate and the clinical indexes .The software SPSS 21 .0 was used for statistical analysis .RESULTS The infec‐tion rate was 3 .36% in the experimental group ,which was significantly lower than 10 .73% in the control group (P=0 .021) .The number of short‐term infection cases in the experimental group was significantly less than that in the control group .The catheter plugging rate was 3 .06% ,the unplanned estuation rate 2 .45% ,the catheter days (13 .36 ± 0 .82) d ,and hospitalization days (12 .71 ± 0 .77) d in the experimental group ,which were signifi‐cently better than the control group (P<0 .05) .CONCLUSION The standardized care process helps to reduce deep venous catheter‐related infections ,prolong catheter time ,and reduce the incidence of adverse extubation ,which is beneficial for treatment recovery .%目的:探讨实施规范化护理流程对深静脉导管相关感染(CRI)的临床效果,为临床护理提供参考依据。方法选取2011年5月-2013年12月实施中心静脉导管患者616例,289例患者实施常规护理为对照组,327例患者实施规范化护理措施为试验组,对比两组患者的感染率及临床指标,采用SPSS 21.0软件进行统计分析。结果试验组患者感染率3.36%,明显低于对照组的10.73%,对比差异有统计学意义( P=0.021);试验组患者短期感染发生例数明显少于对照组;

  5. Central venous catheter placement: where is the tip?

    Science.gov (United States)

    Ibrahim, George M

    2012-09-01

    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

  6. DELAYED BILATERAL HYDROTHORAX AFTER CENTRAL VENOUS CATHERIZATION: A CASE REPORT

    OpenAIRE

    Arpana; Moses Charles D; Kutappa; Deepa

    2014-01-01

    : Central venous catheterization is a common procedure in anesthetic management of patients undergoing major surgery or care of critically ill patients. Delayed complication such as hydrothorax, hydromediastinum or cardiac tamponade is extremely rare with a few case reports. We report a case of bilateral hydrothorax due to migration of the tip of the central venous catheter from within the vein into the mediastinum following subclavian vein catheterization.

  7. [Inadvertent thoracic duct puncture during right axially central venous cannulation].

    Science.gov (United States)

    Kawashima, Shingo; Itagaki, Taiga; Adachi, Yushi; Ishii, Yasuhiro; Taniguchi, Midzuki; Doi, Matsuyuki; Sato, Shigehito

    2010-10-01

    A case of inadvertent thoracic duct puncture during right axially central venous cannulation is reported. The catheterization was performed under the real time ultrasound guidance technique and the coronal view image was continuously displayed. After confirming the feelings of venous puncture, clear yellow fluid was aspired into the connected syringe to the needle. Initially, an accidental thoracic puncture with subsequent pleural fluid aspiration was suspected;however, no finding of pleural effusion was observed with ultrasound imaging and computed tomography. Thus, an accidental thoracic duct puncture and the subsequent lymph fluid aspiration were suspected. Even in a right side approach for central venous catheterization, thoracic duct injury might ensure.

  8. Malfunction of Totally Implantable Central Venous Ports

    Directory of Open Access Journals (Sweden)

    Kim

    2016-08-01

    Full Text Available Background Malfunctions of totally implantable central venous ports (TICVPs have become a problem, as the usage of TICVPs has increased enormously. Objectives This study evaluated factors related with catheter malfunctions of TICVPs. Patients and Methods Between January 2010 and June 2012, 1,740 TICVPs in 1,740 patients (874 men and 866 women with an average age of 57.7 ± 12.8 years (range: 15 - 91 years were implanted by an interventional radiology team at our institute. Catheter malfunctions were retrospectively analyzed. In the prospective study, we randomly allocated 176 patients to two kinds of TICVPs in a 1:1 assignment ratio. The primary outcome was the malfunction of TICVPs. Results In the retrospective study, the 32 malfunctioning TICVPs were caused by fibrin sheath formations (n = 15, chamber thrombosis (n = 8, TICVP rotation (n = 5, catheter migration (n = 2, and blood clots within the catheters (n = 2. Multivariate analysis showed that being female was a significant factor for poor patency rates of TICVPs (hazard ratio: 5.06; 95% confidence interval (CI 1.32 - 19.46, P = 0.018. In the prospective study, two chamber thromboses occurred in Celsite® (n = 1 and Humanport® (n = 1. The primary patency rates of both Celsite® and Humanport® were 98.9% at 6 months, respectively. Conclusion Our data suggest that catheter malfunctions of TICVPs are more common in females than males. The incidence of TICVP malfunctions does not differ between the two devices (Celsite® vs. Humanport®.

  9. Catheter-related candidemia caused by Candida lipolytica in a child with tubercular meningitis

    Directory of Open Access Journals (Sweden)

    Agarwal Santwana

    2008-04-01

    Full Text Available Candida lipolytica is weakly pathogenic yeast, which is rarely isolated from the blood. We recovered this species from repeated blood samples and in the central venous catheter in a debilitated pediatric patient of tubercular meningitis. Identity was established on the basis of colony morphology and sugar assimilation tests (ID 32C assimilation profile. The fungemia and associated fever subsided after the removal of catheter and amphotericin B therapy. The data suggest that though of low virulence and usually a contaminant, C. lipolytica is emerging yeast pathogen in cases of catheter-related candidemia. Pathogenicity is indicated by isolation from repeated samples as in our case. Intensive therapy is recommended in cases not resolving spontaneously or responding to removal of catheter alone.

  10. Corynebacterium striatum Bacteremia Associated with a Catheter-Related Blood Stream Infection

    Science.gov (United States)

    Oishi, Tomohiro; Yamane, Kunikazu; Terada, Kihei

    2017-01-01

    A 49-year-old woman visited our emergency department because of exertional dyspnea due to severe left ventricular functional failure. It progressed to disseminated intravascular coagulation and disturbance of consciousness on day 67 of admission. Gram-positive bacilli were detected from two different blood culture samples on day 67 of admission. An API-Coryne test and sequencing (1~615 bp) of the 16S rRNA gene were performed, and the strain was identified as Corynebacterium striatum. The bacterium was detected from the removed central venous catheter tip too, and the patient was diagnosed with catheter-related bloodstream infection by C. striatum. However, treatment was not effective, and the patient died on day 73 of admission. PMID:28197349

  11. Multiple venous thrombosis complicating central venous cannulation in a non cancer patient - a case report.

    Science.gov (United States)

    Peters, Ce; Menkiti, Id; Desalu, I; Thomas, Mo

    2013-01-01

    Central venous catheterization is a common procedure for critically ill patients. Like all procedures, it has its complications, one of which is thrombosis. Reports of thrombosis are commoner among cancer patients. We present a 37 year old non cancer patient who developed thrombi in both right and left internal jugular veins, 10 and 13 days respectively after insertion of central venous catheter. This was detected by ultrasound scans of the neck while attempting re-cannulation for parenteral feeding. She also had left lower limb deep venous thrombosis, confirmed by doppler scan, which was managed with low molecular weight heparin and warfarin. The patient was subsequently treated with streptokinase. A repeat scan of the internal jugular veins 4 days after thrombolysis revealed a reduction in size of the thrombi. Symptoms of deep venous thrombosis improved and she was transferred to the wards where she made remarkable improvement. This case illustrates the potential usefulness of ultrasound guided-central line insertion in patients who have had central venous lines inserted previously in order to detect thrombi.

  12. Risk factors of the central-vein catheter related infection and advancement in nursing%中心静脉导管相关性感染危险因素及临床护理进展

    Institute of Scientific and Technical Information of China (English)

    杨屹珺

    2010-01-01

    @@ 中心静脉导管(central venous catheter,CVC)是临床上抢救危重患者的必要通道,广泛用于输液、输血、药物治疗、肠道外营养、中心静脉压检测、血液透析和心血管疾病的介入治疗等.

  13. A RARE CASE OF A MALPOSITIONED CENTRAL VENOUS CATHE TER

    Directory of Open Access Journals (Sweden)

    Rasquinha Vinay

    2012-12-01

    Full Text Available ABSTRACT: A Malpositioned Central Venous Catheter is a common but serious complication of central line placement 1-2 .However malpositioning into the contralateral subc lavian is extremely unusual. The authors describe a case in which a cat heter is inserted via a right sided infraclavicular approach and malpositions itself into the contralateral subclavian vein.

  14. New tools in diagnosing catheter-related infections.

    Science.gov (United States)

    Blot, F; Nitenberg, G; Brun-Buisson, C

    2000-07-01

    Clinical criteria alone are insufficient to allow a diagnosis of intravascular catheter-related sepsis (CRS). A definite diagnosis of CRS usually requires removal of the catheter for quantitative catheter tip culture. However, only about 15-25% of central venous catheters (CVC) removed because infection is suspected actually prove to be infected, and the diagnosis is always retrospective. Other diagnostic tests, such as differential quantitative blood cultures from samples taken simultaneously from the catheter and a peripheral vein, have been proposed to avoid unjustified removal of the catheter and the potential risks associated with the placement of a new catheter at a new site: a central-to-peripheral blood culture colony count ratio of 5:1 to 10:1 is considered indicative of CRS. Despite its high specificity, the latter diagnostic technique is not routinely used in clinical practice because of its complexity and cost. The measurement of the differential time to positivity between hub blood (taken from the catheter port) and peripheral blood cultures might be a reliable tool facilitating the diagnosis of CRS in situ. In an in vitro study, we found a strong relationship between the inoculum size of various microorganisms and the time to positivity of cultures. When the times to positivity of cultures of blood taken simultaneously from central and peripheral veins in patients with and without CRS were examined, we found that earlier positivity of central vs peripheral vein blood cultures was highly correlated with CRS. Using a cut-off value of +120 min, the "differential time to positivity" of the paired blood samples, defined as time to positivity of the peripheral blood minus that of the hub blood culture, had 91% specificity and 94% sensitivity for the diagnosis of CRS. This method may be coupled with other techniques that have high negative predictive value, such as skin cultures at the catheter exit site. This diagnostic test can be proposed for routine

  15. PROPHYLACTIC ADMINISTRATION OF DOXYCYCLINE REDUCES CENTRAL VENOUS CATHETER INFECTIONS IN PATIENTS UNDERGOING HEMATOPOIETIC CELL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    Mohamed Kharfan-Dabaja

    2013-02-01

    Full Text Available Hematopoietic stem cells are usually transfused through a central venous catheter (CVC, which also facilitates administration of medications and intravenous fluids. We had observed high rate of catheter-related blood-stream infection (CR-BSI at our Bone Marrow Transplantation (BMT unit despite prescribing fluoroquinolones for anti-bacterial prophylaxis. Accordingly, we implemented prophylactic use of a relatively inexpensive broad spectrum antibiotic, namely doxycycline to address this problem. We wanted to investigate whether doxycycline prophylaxis reduces CR-BSI rate. Data was collected retrospectively on 54 consecutive patients, 26 of whom received doxycycline (doxycycline group, and we compared their outcomes to a previous cohort of 28 patients who did not receive doxycycline (comparison group. The groups were comparable in regards to age, gender, hematopoietic cell transplant type, and primary diagnosis. No CVC infection (0% was observed in the doxycycline group, while 5 infection episodes (18.5% occurred in 4 patients in the comparison group (p<0.001. Episodes of CR-BSI were due to: Escherichia-coli (EC=1, coagulase-negative Staphylococcus-spp (CNSS=2, both EC & CNSS=1. Our results demonstrate that CR-BSI was reduced significantly after introducing doxycycline. This finding suggests a beneficial role for systemic use of doxycycline prophylaxis to prevent CR-BSI in adult BMT patients. Nevertheless, a randomized controlled study is warranted to confirm these findings.

  16. Placement of an implantable central venous access device

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon; Lee, Young Suk [Dan Kook Univ., Seoul (Korea, Republic of). Hospital

    1998-03-01

    To evaluate the efficacy and safety of placement of a central venous catheter with infusion port into the superior vena cava. Central venous catheters with a infusion port were implanted in 21 patients (M:F=4:17, age range:15-63, mean age: 41) diagnosed as suffering from breast cancer (n=9), lymphoma (n=7), thymoma (n=2) rhabdomyosarcoma(n=2) and rectal cancer (n=1). The per(n=9), lymphoma(n=7), thymoma (n=2) rhabdomyosarcoma (n=2) and rectal cancer (n=1). The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance during injection of contrast media at the site of the ipsilateral peripheral vein (20 cases) and under ultrasonographic guidance (1 case). 9.6F central venous catheters placed in the superior vena cava via the subclavian vein and the connected infusion ports were implanted in the subcutaneous pocket near the puncture site of the right anterosuperior chest wall. Radiologic placement under fluoroscopic guidance of a central venous catheter with a infusion port is easy, safe and useful for patients requiring long-term venous access. (author). 21 refs., 2 figs.

  17. Central Venous Access via Middle Approach Using the Seldinger Guidewire

    Directory of Open Access Journals (Sweden)

    Miguel Muñoz Cepero

    2013-08-01

    Full Text Available Background: In recent years, venous access via middle approach with the technique described by English has been frequently used, leading to lower risk of pneumothorax and arterial puncture. In addition, it is easy to perform. Objective: to characterize the performance of central venous access via the middle approach to the internal jugular vein using the Seldinger guidewire in patients with hematologic diseases and/or anticoagulant therapy. Methods: a descriptive study was conducted from January to December 2009 in the Surgical Unit of the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Central venous access via middle approach using the technique described by English was performed in 47 patients suffering from hematologic diseases. Variables analysed were: number of attempts, indications and complications. Results: 43 central venous catheterizations were successful (91.48 %, 35 of them were achieved in the first attempt. The use of cytostatics was indicated in more than half of the cases (55.31 %. Complications were observed in 5 patients; arterial puncture was the most common (6.38 %. Conclusions: central venous access via the middle approach using the Seldinger guidewire is a suitable option for patients with hematologic diseases. It minimizes complications in patients treated with anticoagulants. In general, it is easily accessible and has a high success rate.

  18. Central venous access: techniques and indications in oncology

    Energy Technology Data Exchange (ETDEWEB)

    Marcy, Pierre-Yves [Antoine Lacassagne Anticancer Research Institute, Department of Radiodiagnostics and Interventional Radiology, Nice, Cedex 1 (France)

    2008-10-15

    Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient's performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications. (orig.)

  19. Immediate complications of percutaneous central venous cannulation in children

    Science.gov (United States)

    Dheer, Geetika; Chaudhry, Gurmeet Kaur; Singh, Tejinder

    2011-01-01

    Objective: To study the incidence of immediate complications associated with percutaneous central venous catheterization. Materials and Methods: A total of 103 central venous catheters were inserted in 70 children over a period of 18 months, governed by a uniform protocol. Sixty-three percent of the catheters were inserted in neonates, 23.3% in infants and 13.6% in children between 1 and 12 years of age. Statistical Analysis Used: Software SPSS version 15. Results: There were a total of 41 insertion-related immediate complications, of which 75.6% were in neonates. Neonatal age, hemodynamic instability and more number of attempts to catheterize the vein had a higher risk of insertion-related problems. There was no mortality directly as a result of the procedure. 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. PMID:22121313

  20. Immediate complications of percutaneous central venous cannulation in children

    Directory of Open Access Journals (Sweden)

    Geetika Dheer

    2011-01-01

    Full Text Available Objective: To study the incidence of immediate complications associated with percutaneous central venous catheterization. Materials and Methods: A total of 103 central venous catheters were inserted in 70 children over a period of 18 months, governed by a uniform protocol. Sixty-three percent of the catheters were inserted in neonates, 23.3% in infants and 13.6% in children between 1 and 12 years of age. Statistical Analysis Used: Software SPSS version 15. Results: There were a total of 41 insertion-related immediate complications, of which 75.6% were in neonates. Neonatal age, hemodynamic instability and more number of attempts to catheterize the vein had a higher risk of insertion-related problems. There was no mortality directly as a result of the procedure. 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.

  1. Central Venous Disease in Hemodialysis Patients: An Update

    Energy Technology Data Exchange (ETDEWEB)

    Modabber, Milad, E-mail: mmodabber@gmail.com [McMaster University, Michael G. DeGroote School of Medicine (Canada); Kundu, Sanjoy [Scarborough Hospital and Scarborough Vascular Ultrasound, The Vein Institute of Toronto (Canada)

    2013-08-01

    Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.

  2. Malfunctioning central venous catheters in children: a diagnostic approach

    Energy Technology Data Exchange (ETDEWEB)

    Barnacle, Alex; Arthurs, Owen J.; Roebuck, Derek; Hiorns, Melanie P. [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2008-04-15

    Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or 'linogram' technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications. (orig.)

  3. Use of cultivation-dependent and -independent techniques to assess contamination of central venous catheters: a pilot study

    Directory of Open Access Journals (Sweden)

    Høiby Niels

    2008-10-01

    Full Text Available Abstract Background Catheters are the most common cause of nosocomial infections and are associated with increased risk of mortality, length of hospital stay and cost. Prevention of infections and fast and correct diagnosis is highly important. Methods In this study traditional semiquantitative culture-dependent methods for diagnosis of bacteria involved in central venous catheter-related infections as described by Maki were compared with the following culture-independent molecular biological methods: Clone libraries, denaturant gradient gel electrophoresis, phylogeny and fluorescence in situ hybridization. Results In accordance with previous studies, the cultivation of central venous catheters from 18 patients revealed that S. epidermidis and other coagulase-negative staphylococci were most abundant and that a few other microorganisms such as P. aeruginosa and K. pneumoniae occasionally were found on the catheters. The molecular analysis using clone libraries and sequencing, denaturant gradient gel electrophoresis and sequencing provided several important results. The species found by cultivation were confirmed by molecular methods. However, many other bacteria belonging to the phyla Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were also found, stressing that only a minor portion of the species present were found by cultivation. Some of these bacteria are known to be pathogens, some have not before been described in relation to human health, and some were not closely related to known pathogens and may represent new pathogenic species. Furthermore, there was a clear difference between the bacterial species found in biofilm on the external (exluminal and internal (luminal side of the central venous catheter, which can not be detected by Maki's method. Polymicrobial biofilms were observed on most of the catheters and were much more common than the cultivation-dependent methods indicated. Conclusion The results show that diagnosis

  4. Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients Comparação do risco de infecção relacionada a cateteres entre dois tipos de dispositivos de longa permanência em pacientes onco-hematológicos

    Directory of Open Access Journals (Sweden)

    Luís Fernando Pracchia

    2004-01-01

    Full Text Available PURPOSE: Infection is the leading complication of long-term central venous catheters, and its incidence may vary according to catheter type. The objective of this study was to compare the frequency and probability of infection between two types of long-term intravenous devices. METHODS: Retrospective study in 96 onco-hematology patients with partially implanted catheters (n = 55 or completely implanted ones (n = 42. Demographic data and catheter care were similar in both groups. Infection incidence and infection-free survival were used for the comparison of the two devices. RESULTS: In a median follow-up time of 210 days, the catheter-related infection incidence was 0.2102/100 catheter-days for the partially implanted devices and 0.0045/100 catheter-days for the completely implanted devices; the infection incidence rate was 46.7 (CI 95% = 6.2 to 348.8. The 1-year first infection-free survival ratio was 45% versus 97%, and the 1-year removal due to infection-free survival ratio was 42% versus 97% for partially and totally implanted catheters, respectively (P OBJETIVO: Infecção é a principal complicação relacionada ao uso de cateteres venosos de longa permanência em pacientes oncológicos e sua incidência pode variar a depender do tipo de cateter utilizado. O objetivo deste estudo foi comparar a freqüência e risco de infecção entre dois tipos de dispositivos de longa permanência. MÉTODOS: Estudo retrospectivo com 96 pacientes onco-hematológicos portadores de cateteres parcialmente implantáveis (n=55 ou totalmente implantáveis (n=42. Dados demográficos e cuidados com o dispositivo foram similares entre os dois grupos. A comparação entre os dispositivos foi realizada através da avaliação da incidência de infecção e da sobrevida livre de infecção. RESULTADOS: Em uma mediana de acompanhamento de 210 dias, a incidência de infecção relacionada ao cateter foi de 0,2102/100 cateter-dias para os dispositivos parcialmente

  5. ICU中心静脉导管感染患者的护理%Nursing of infections in patients with central venous catheter in ICU

    Institute of Scientific and Technical Information of China (English)

    梁月圆

    2015-01-01

    Objective:To explore the central venous catheter related infections nursing in ICU .Methods:40 infection patients with central renous catheter from December 2012-December 2013 as the research object,according to the central venous catheter patients,clinical characteristics r related infection fac-tors to explore the nursing care.Results:All of 40 patients with infection were control effectively.Conclusion:Shortening the time of catheter,center care, strict aseptic concept,strengthen the medical staff to avoid reinfection between doctor-patient and doctor-nurse,improve the level of hospital care is effec-tively reduce the central venous catheter related infections such as one of the important measures.%目的:探讨ICU中心静脉导管感染患者的的护理措施。方法:选取2012年12月~2013年12月我院收治的40例中心静脉置管感染患者作为研究对象,根据中心静脉置管技术的临床特点及相关因素实施护理。结果:40例患者感染均得到有效控制。结论:缩短置管时间,严格中心静脉置管的护理,加强医护人员的无菌观念,避免医患、医护之间的再感染,提高医院的护理水平等是有效降低中心静脉置管感染的重要措施。

  6. Human cerebral venous outflow pathway depends on posture and central venous pressure

    DEFF Research Database (Denmark)

    Gisolf, J; van Lieshout, J J; van Heusden, K;

    2004-01-01

    , but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before......Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture...... and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest...

  7. Pneumothorax as a complication of central venous catheter insertion.

    Science.gov (United States)

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

  8. Implementation of a children's hospital-wide central venous catheter insertion and maintenance bundle

    NARCIS (Netherlands)

    K. Helder MScN (Onno); R.F. Kornelisse (René); C. van der Starre (Cynthia); D. Tibboel (Dick); C.W.N. Looman (Caspar); R.M.H. Wijnen (René); M.J. Poley (Marten); E. Ista (Erwin)

    2013-01-01

    textabstractBackground: Central venous catheter-associated bloodstream infections in children are an increasingly recognized serious safety problem worldwide, but are often preventable. Central venous catheter bundles have proved effective to prevent such infections. Successful implementation requir

  9. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns

    NARCIS (Netherlands)

    Arnts, I.J.J.; Bullens, L.M.; Groenewoud, J.M.M.; Liem, K.D.

    2014-01-01

    OBJECTIVE: To compare the complication rates between umbilical central venous catheters and peripherally inserted central venous catheters in newborns and to investigate whether other variables might increase complication rates. DESIGN: A retrospective observational study. SETTING: A Level III neona

  10. Repositioning of malpositioned or flipped central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Thalhammer, A.; Jacobi, V.; Balzer, J.; Vogl, T.J. [Institute for Diagnostic and Interventional Radiology, Central Radiology Clinic, J.W. Goethe University, Frankfurt am Main (Germany)

    2002-03-01

    Primary misplaced or secondary flipped implanted catheters are located mostly in the right jugular vein. We demonstrate an effective method to replace fix implanted catheters such as Ports, Grochomg or Hickman catheters. Using a femoral venous approach, replacement into the superior vena cava can easily be done with a Sidewinder 1 catheter which is hooked over the misplaced central venous approach. In all our patients the method was successful. The repositioning technique described is simple, fast and has low costs. We can keep sterile conditions and do not need to solve the catheters' fixation. (orig.)

  11. Correlation of mixed venous and central venous oxygen saturation and its relation to cardiac index

    Directory of Open Access Journals (Sweden)

    Ramakrishna M

    2006-01-01

    Full Text Available Background and Aim: The clinical applicability of substitution of central venous oxygen saturation for mixed venous oxygen saturations in monitoring global tissue hypoxia is still a matter of controversy. Hence aim of the study is comparison of paired samples of mixed venous and central venous oxygen saturation and comparison in relation to cardiac index in varying hemodynamic conditions. Materials and Methods: Prospective clinical observation: Postoperative cardiac surgical ITU: 60 adult patients,> 18 years of age of either sex: A PAC was inserted through ® IJV, triple lumen catheter was inserted through ® IJV. Blood samples were taken from distal tip of PAC and central venous catheters. An arterial blood sample was drawn from either radial or femoral arterial line. Measurements: Continuous cardiac output monitoring. Analysis of blood samples for hemoglobin concentration and oxygen saturation. Mixed venous oxygen saturations and central venous oxygen saturations were compared. The study was carried over a period of 30h in the postoperative period and samples were taken at 6h intervals. Patients were classified into three groups as follows depending on the CI: Low (< 2.5 L/m 2, medium (2.5-4 L/m 2, high (> 4 L/m2 and correlated with Svo 2 and Scvo 2 . Results: 298 Comparative sets of samples were obtained. Svo2 was consistently lower than Scvo2 throughout the study period. The difference was statistically significant. By using Bland - Altman plot, the mean difference between Svo 2 and Scvo 2 (Svo 2 -Scvo 2 was - 2.9% ± 5.14 and confidence limits are + 7.17% and - 12.97%. The co-efficient r is > 0.7 throughout the study period for all paired samples. The correlation Svo 2 and Scvo 2 with cardiac index in all the three groups were> 0.7. Conclusion: Scvo 2 and Svo 2 are closely related and are interchangeable. Even though individual values differ trends in Scvo 2 may be substituted for trend in Svo 2

  12. Ethanol lock therapy for the treatment of catheter-related infections in haemophilia patients.

    Science.gov (United States)

    Rajpurkar, M; Boldt-Macdonald, K; McLenon, R; Callaghan, M U; Chitlur, M; Lusher, J M; Becker, C

    2009-11-01

    Central venous access devices (CVAD) are increasingly being used for optimal delivery of clotting factor concentrates in patients with haemophilia with poor peripheral venous access. The utility of CVAD is particularly well recognized in young patients starting factor prophylaxis and in patients with inhibitors undergoing immune tolerance induction (ITI). A catheter-related infection (CRI) remains the most common complication of CVAD in haemophilia patients and is the most frequent indication for its removal. Additionally, in some patients the infection results in significant morbidity and mortality and also contributes to failure of the ITI regimen. Ethanol-lock therapy (ELT) is a treatment modality that has been used to treat CRI in patients with indwelling catheters for home parenteral nutrition and chemotherapy. The aim of this study was to report the success in treating CRI in haemophilia patients using ELT. Three severe haemophilia A patients undergoing ITI regimen who developed CVAD infections resistant to conventional management with antibiotics were treated by ELT according to the institutional technique. All three patients responded well to ELT with clearance of the CVAD infection. There were no adverse side effects. To our knowledge, this is the first report of ELT in patients with haemophilia. The role of ELT needs to be investigated in larger studies for treatment of CRI in patients with bleeding disorders.

  13. Malpostion of subclavin central venous cannulation into ipsilateral jugular vein -An unusal case report

    Directory of Open Access Journals (Sweden)

    Vishal

    2013-11-01

    Full Text Available ABSTRACT: Central venous catheterization (CVC via infraclavicular subclavian approach in neurosurgical pat ients is very common practice. Malpositioning of central venous catheter inserted into subclavian vein is a known and dreaded complication. Malpositioning of catheter tip into ipsilateral jugular vein is an unusual occurrence. We hereby describe a case whe re a subclavian central venous catheter malpositioned into ipsilateral jugular vein

  14. Malpostion of subclavin central venous cannulation into ipsilateral jugular vein -An unusal case report

    OpenAIRE

    Vishal; Sumantra; Rajnikant; Dilpreet; Shweta

    2013-01-01

    ABSTRACT: Central venous catheterization (CVC) via infraclavicular subclavian approach in neurosurgical pat ients is very common practice. Malpositioning of central venous catheter inserted into subclavian vein is a known and dreaded complication. Malpositioning of catheter tip into ipsilateral jugular vein is an unusual occurrence. We hereby describe a case whe re a subclavian central venous catheter malpositioned into ipsilateral jugular vein

  15. Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Ji; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jeong, Woo Kyoung; Lee, Yong Ho [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    We evaluated the technical success and complication rates associated with the radiological placement of tunneled central venous catheters in pediatric patients. Between May 1, 2005 and March 31, 2008, a total of 46 tunneled central venous catheters were placed in 34 children (M:F = 22:12; mean age, 9.9 years [9 months to 16.8 years]). All procedures were performed under ultrasonographic and fluoroscopic guidance. Follow-up data were obtained through the retrospective review of the medical records. We used the Kaplan-Meier survival method for the evaluation of survival rate of the catheters. All procedures were technically successful. The observed periprocedural complications included hematoma formation in three patients. The mean catheter life was 189.3 days (total, 8710 days; range, 7-810). Catheters were removed due to death (n=9), the end of treatment (n=8), catheter sepsis (n=4), malfunction (n=8), and accidental removal (n=4). The rate of catheter sepsis and malfunction was 0.459 and 0.919 for every 1000 catheter days, respectively. The expected mean catheter life was 479.6 days as per the Kaplan- Meier analysis. The results suggest that the radiologic placement of a tunneled central venous catheter is an effective technique with a high technical success rate and low complication rate.

  16. Are central venous catheter tip cultures reliable after 6-day refrigeration?

    Science.gov (United States)

    Bouza, Emilio; Guembe, Maria; Gómez, Haydee; Martín-Rabadán, Pablo; Rivera, Marisa; Alcalá, Luis

    2009-07-01

    Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki's roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after 24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only 61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from patients with positive blood cultures reduce the workload in the microbiology laboratory without misdiagnosing CR-BSI.

  17. Going with the flow or swimming against the tide: should children with central venous catheters swim?

    Science.gov (United States)

    Miller, Jessica; Dalton, Meghan K; Duggan, Christopher; Lam, Shirley; Iglesias, Julie; Jaksic, Tom; Gura, Kathleen M

    2014-02-01

    Children who require long-term parenteral nutrition (PN) have central venous catheters (CVCs) in place to allow the safe and effective infusion of life-sustaining fluids and nutrition. Many consider recreational swimming to be a common part of childhood, but for some, the risk may outweigh the benefit. Children with CVCs may be at increased risk of exit site, tunnel, and catheter-related bloodstream infections (CRBSIs) if these catheters are immersed in water. The purpose of this review is to evaluate the current literature regarding the risk of infection for patients with CVCs who swim and determine if there is consensus among home PN (HPN) programs on this controversial issue. A total 45 articles were reviewed and 16 pediatric HPN programs were surveyed regarding swimming and CVCs. Due to the limited data available, a firm recommendation cannot be made. Recreational water associated outbreaks are well documented in the general public, as is the presence of human pathogens even in chlorinated swimming pools. As a medical team, practitioners can provide information and education regarding the potential risk, but ultimately the decision lies with the parents. If the parents decide swimming is worth the risk, they are encouraged to use products designed for this use and to change their child's dressing immediately after swimming. Due to our experience with a fatal event immediately after swimming, we continue to strongly discourage patients with CVCs from swimming. Further large and well-designed studies regarding the risk of swimming with a CVC are needed to make a strong, evidence-based recommendation.

  18. Development of Needle Insertion Manipulator for Central Venous Catheterization

    Science.gov (United States)

    Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

    Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

  19. Application and nursing of central venous catheter in Intensive Care Unit%中心静脉置管在ICU的应用及护理

    Institute of Scientific and Technical Information of China (English)

    赵斯芹

    2012-01-01

    Objective To investigate the nursing measures for patients who use central venous catheter in Intensive Care Unit (ICU). Methods A retrospective analysis of 204 patients with central venous catheter was conducted. Results After treatment,successful extubation was seen in 177 cases,blocked tubes 8 cases,catheter- related infection in 5 cases,catheter withdrawal in 3 cases and catheter displacement 11 cases. Conclusion According to the causes of complications of central venous catheter,timely and appropriate nursing measures can reduce or avoid such complications.%目的 探讨中心静脉置管期的护理措施.方法 对204例中心静脉置管患者进行回顾性分析.结果 治疗完毕顺利拔管177例,导管堵塞8例,导管相关感染5例,导管脱出3例,移位11例.结论 根据中心静脉置管发生并发症的原因,及时采取相应的护理措施,可以减少或避免并发症的发生.

  20. [A retrospective study of the relationship between bacterial numbers from central venous catheter tip cultures and blood cultures for evaluating central line-associated bloodstream infections].

    Science.gov (United States)

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Nakayama, Asami; Yonetamari, Jun; Ando, Kohei; Miyazaki, Takashi; Ohta, Hirotoshi; Furuta, Nobuyuki; Watanabe, Tamayo; Ito, Hiroyasu; Murakami, Nobuo; Seishima, Mitsuru

    2014-01-01

    Catheter-related bloodstream infection (CRBSI) is an infectious disease requiring special attention. It is a common cause of nosocomial infections; catheter insertion into the central veins particularly increases the risk of infection (CLA-BSI: central line-associated bloodstream infection). We examined the relationship between the number of bacterial colonies cultured from shredded central venous catheter (CVC) tips and from blood cultures in our hospital from 2011 to 2012. Coagulase-negative staphylococci topped the list of microbe isolated from the CVC tip culture, followed by Pseudomonas aeruginosa, Staphylococcus aureus, and Candida spp. S. aureus and Candida spp., with growth of over 15 colony-forming units in the CVC tip culture, were also detected at high rates in the blood culture. However, gramnegative bacilli (Enterobacteriaceae and P. aeruginosa) did not show a similar increase in colony number in the CVC tip culture. Because microbes adhering to shredded catheter tips are readily detected by culture, this method is useful as a routine diagnostic test. In addition, prompt clinical reporting of the bacterial number of serious CLA-BSI-causing S. aureus and Candida spp. isolated from CVC tips could contribute to earlier CLA-BSI diagnosis.

  1. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    Science.gov (United States)

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  2. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

    Directory of Open Access Journals (Sweden)

    Carlos J. Roldan

    2015-10-01

    Full Text Available Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  3. Biofilm formation in long-term central venous catheters in children with cancer: a randomized controlled open-labelled trial of taurolidine versus heparin

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter;

    2012-01-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n...... = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi......-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream...

  4. 儿童血液净化中心静脉导管常见并发症%Common complication of central venous catheter for pediatric blood purification

    Institute of Scientific and Technical Information of China (English)

    黄松明; 赵非

    2016-01-01

    Pediatric blood purification requires reliable access to the circulation.Central venous catheters play an important role in the delivery of pediatric blood purification.A central venous noncuffed,nontunneled catheter is the best choice for short-term(less than 3 weeks) blood purification.A cuffed,tunneled catheter is preferable to long term(more than 3 weeks) blood purification.However,there are many complications associated with central venous catheters,such as catheter-induced thrombosis,catheter-related infection,and central vein stenosis.This article reviews the prevention and treatment of complications most frequently occurring with central venous catheters.%良好的血管通路是儿童血液净化顺利开展的前提条件,中心静脉导管正逐渐成为一个重要的儿童血液净化通路.对于预期持续时间在3周内的血液净化,中心静脉临时导管是最佳选择;预期持续时间在3周以上的血液净化,建议使用中心静脉半永久导管.然而中心静脉导管会遇到诸如导管血栓、导管相关性感染、中心静脉狭窄等并发症,现就血液净化中心静脉导管常见并发症的预防和治疗进行综述.

  5. Knowledge of nursing students about central venous catheters

    Directory of Open Access Journals (Sweden)

    Mlinar Suzana

    2012-01-01

    Full Text Available Background/Aim. Central venous catheters (CVC are at the crucial importance, particulary in the intensive therapy units. In order to handle a CVC safely, nursing students need to acquire theoretical and practical knowledge during the course of their studies. The aim of the study was to establish theoretical knowledge of nursing students about the procedures of nurses in placing and removing a central venous catheter (CVC, dressing the catheter entry point, the reasons for measuring central venous pressure (CVP, possible complications and risk factors for developing infections related to CVC. Methods. The questionnaire developed specifically for this cross-sectionl study was handed out to 87 full-time students and 57 part-time students. Results. The results show that all the surveyed nursing students know why chest radiography is carried out when inserting a catheter, have relatively good knowledge of CVC insertion points, procedures carried out in case of a suspected catheter sepsis and complications and risk factors for the development of infections related to CVC. However, the study show that the majority of students have insufficient knowledge of the procedures accompanying insertion of a catheter, signs that indicate correct functioning of CVC, frequency of flushing a catheter when it is not in use and the reasons for introducing an implanted CVC. Conclusion. Based on the results of the study it can be concluded that the second-year nursing students have insufficient knowledge of CVC. In order to correctly and safely handle a CVC, good theoretical knowledge and relevant practical experience are needed. The authors therefore believe that, in future, the classes should be organized in smaller groups with step-by-step demonstrations of individual procedures in handling a CVC, and the students encouraged to learn as actively as possible.

  6. Pain and efficacy of local anesthetics for central venous access

    Directory of Open Access Journals (Sweden)

    William C Culp Jr

    2008-11-01

    Full Text Available William C Culp Jr1, Mohammed Yousaf2, Benjamin Lowry1, Timothy C McCowan3, William C Culp21Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; 2Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USAPurpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L, buffered 1% lidocaine (LB, or 2% chloroprocaine (CP injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine

  7. Bilateral pleural effusion after central venous catheterization- A rare complication.

    Directory of Open Access Journals (Sweden)

    Reyaz Ahmed Para

    2015-12-01

    Full Text Available Central venous Catherization (CVC is rarely complicated by pleural effusion. It is usually due to malpositioned catheter. Our patient was a 35-year-old man admitted with Menningoencephalitis.A cervical central vein catheter was placed into his right jugular vein after induction of anaesthesia in Emergency Room. In chest x ray we encountered bilateral pleural effusion and drained it with a chest tube. During following days the patient has daily drainage of almost 1.7 liter of clear yellowish fluid from chest tube. Fluid analysis was not diagnostic. We removed the central vein catheter and plural drainage was stopped. [Natl J Med Res 2015; 5(4.000: 329-331

  8. 水胶体敷料预防PICC患者机械性静脉炎效果的meta分析%A system review of the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis:meta-analysis

    Institute of Scientific and Technical Information of China (English)

    黎贵; 张淑香; 徐波

    2014-01-01

    目的:系统评价水胶体敷料对于PICC患者机械性静脉炎的预防效果。方法:计算机检索Cochrane Database of Systematic Reviews、JBI Database of Systematic Review、EMBase、PubMed、中国生物医学文献数据库、万方数据库和中国学术期刊全文数据库中关于水胶体敷料对于预防PICC患者机械性静脉炎效果的随机对照试验(RCT)和半随机对照试验(q-RCT),同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,对符合质量标准的RCT进行meta分析。结果:共纳入9篇文献,meta分析的结果显示水胶体敷料能降低PICC患者机械性静脉炎的发生率。结论:水胶体敷料的使用对于预防PICC机械性静脉炎的发生具有显著效果,具有一定临床推广意义。%Objective:To systematically evaluate the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis. Methods:The authors searched the Cochrane Database of Systematic Reviews, JBI Database of Systematic Review, EMBase, PubMed, CBMdisc, Wanfang Data and CNKI to collect randomized controlled trials (RCTs) and quasi-Randomized Controlled Trials (q-RCTs) which studied the effects of hydrocolloid dressing in preventing Peripherally Inserted Central Catheter-related mechanical phlebitis. The quality of RCTs and q-RCT were critically appraised and data were extracted by 2 reviewers independently. Meta-analyses were conducted for the eligible RCTs. Results:9 RCTs were included. The meta-analysis had showed that hydrocolloid dressing could decrease the rate of Peripherally Inserted Central Catheter-related mechanical phlebitis significantly. Conclusion:Hydrocolloid dressing was effective to prevent Peripherally Inserted Central Catheter-related mechanical phlebitis.

  9. Spontaneous migration of central venous catheter tip following extubation

    Directory of Open Access Journals (Sweden)

    Balaji Prabaharan

    2014-01-01

    Full Text Available Migration of the tip of central venous catheters is not an uncommon event and the mechanism for this is not clear. Increased intrathoracic pressure due to coughing, sneezing or weight lifting, changing the body position or physical movements such as abduction or adduction of the arms is thought to be the cause of such migration. We present here a case of a patient with a port catheter tip that migrated from the left subclavian to the superior vene cava following extubation.

  10. Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit.

    Science.gov (United States)

    Tena, D; Carranza, R; Barberá, J R; Valdezate, S; Garrancho, J M; Arranz, M; Sáez-Nieto, J A

    2005-11-01

    Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term intravascular catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The catheter was removed in only one patient. The three patients in whom the catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous catheters and should be called into question. Patients with long-term intravascular catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without catheter removal.

  11. 胃癌术后行胃肠外营养患者中心静脉导管相关性感染的影响因素分析%Analysis of the influence factors of central venlus catheters-related infections in postoperative patients with gastric carcinoma treated with parenteral nutrition

    Institute of Scientific and Technical Information of China (English)

    陶燕霞; 赵岳; 舒娜; 闫贵明

    2015-01-01

    目的 探讨胃癌术后行胃肠外营养患者中心静脉导管相关性感染(CVC-RI)的影响因素,为CVC-RI的预防和治疗提供科学依据.方法 采用回顾性调查方法,选择2013年12月至2014年3月胃癌术后行胃肠外营养患者150例.收集患者相关信息,包括年龄、性别、既往病史、置管时间、营养液滴速等,以及置管期间是否发生CVC-RI.发生CVC-RI者为感染组,未感染者为对照组,对其进行二项Logistic回归分析.结果 150例患者中发生CVC-RI 21例,感染率为14.00%(21/150).感染组21例,对照组129例.单因素分析表明,感染组和对照组在年龄、既往病史、置管时间和营养液滴速方面比较差异有统计学意义,x2=17.126、5.447、12.795、7.973,均P<0.05,而在患者的性别、医保、置管成功率和营养液中是否添加谷氨酰胺方面比较差异无统计学意义,P>0.05;二项Logistic回归分析表明,年龄(OR=15.927,95%CI 3.305~76.756,P<0.05)和置管时间(OR=3.511,95%CI 1.028~11.992,P<0.05)是CVC-RI的独立危险因素,而营养液滴速(OR=0.140,95%CI0.033~0.597,P<0.05)是保护因素.结论 对于胃癌术后行胃肠外营养患者,CVC-RI的发生与年龄、置管时间和营养液滴速密切相关,应尽量缩短置管时间,在病情允许下尽早恢复肠内营养,适当加快营养液滴速,同时应将老年患者作为感染监控的重点.%Objective To investigate the influence factors of central venous catheter related infections (CVC-RI) in postoperative patients with gastric carcinoma treated with parenteral nutrition,in order to provide scientific basis for prevention and treatment.Methods Using the retrospective study method,150 patients who treated with parenteral nutrition after operation of gastric carcinoma from December 2013 to March 2014 were selected.Information including age,sex,anamnesis,catheter indwelling time,infusion rate of nutrient solution,and so on were collected.Patients with

  12. Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns.

    Science.gov (United States)

    Martín-Rabadán, P; Pérez-García, F; Zamora Flores, E; Nisa, E S; Guembe, M; Bouza, E

    2017-04-01

    Accurate diagnosis of catheter-related bloodstream infection (CRBSI) is mandatory for hospital infection control. Peripherally inserted central venous catheters (PICCs) are widely used in intensive care units, but studies about procedures for detection of colonization are scarce in neonates. We sequentially processed 372 PICCs by 2 methods, first by the standard roll-plate (RP) technique and then by rubbing catheters on a blood agar plate after being longitudinally split (LS). With both techniques, we detected 133 colonized PICCs. Ninety-four events of CRBSI were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of CRBSI were 58.5%, 92.8%, 73.3%, and 86.9%, respectively, for RP technique and 96.8%, 88.5%, 74.0%, and 98.8%, respectively, for LS technique. The LS technique increased the proportion of detected CRBSI by 38.3%. Neonatal PICC tips should be cultured after cutting them open. This technique is simple and sensitive to detect catheter colonization and also to diagnose CRBSI.

  13. Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

    Energy Technology Data Exchange (ETDEWEB)

    Isfort, Peter; Penzkofer, Tobias; Goerg, Fabian; Mahnken, Andreas H. [University Hospital RWTH Aachen, Aachen(Korea, Republic of)

    2011-10-15

    Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.

  14. Central Venous Catheterization Complication: Delayed Diagnosis of Venous Perforation and Hemothorax

    Directory of Open Access Journals (Sweden)

    Murat Bağcı

    2015-12-01

    Full Text Available Mechanical complications of central venous catheterization (CVC include artery puncture, vein injuries, catheter malposition (CM, pneumothorax, hemothorax, air embolism, subcutaneous hematoma and arrhythmia. This report was aimed to present the case developing hemothorax due to multilumen catheter (MLC malposition following venous perforation which is overlooked during CVC. A 21-year old female patient was planned urgent surgery due to a sharp object injury on the right arm. MLC was inserted to left internal jugular vein (IJV using the seldinger technique in the second attempt. Despite administration of erythrocyte suspension, fluid and noradrenaline infusion through the MLC, patient’s Hct did not increase, hypotension and tachycardia were continued. Catheter was not used and peripheral venous vascular access was used for replacement and infusions. Postoperatively, opacity covering the left hemithorax was detected on the chest radiograph, marked pleural effusion and pneumothorax on the left side was detected on thorax computed tomography. MLC was removed and tube thoracostomy drainage was administered. Hemorrhagic fluid was drained from thorax. Conservative treatment was deemed appropriate since stable vital signs after chest tube application. The complication rate is low and success rate is high in CVC from IJV. Malposition is rare in CVC application from right IJV than in CVC application from left IJV. There is a sharp curve in CVC from the left IJV, which frequently leads to malposition of the MLC. CM should be suspected with no aspiration of blood through catheter or aspiration of another substance such as air, chylous fluid, etc. and non-pulsatile blood flow. If dyspnea, tachycardia, tachypnea, hypotension and desaturation develop after catheter administration we should be alert.

  15. Care of central venous catheters in Intensive Care Unit

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    Thomai Kollia

    2015-04-01

    Full Text Available Introduction: Central venous catheters (CVC are part of daily clinical practice, regarding treatment of critically ill patients in the Intensive Care Unit (ICU. Infections associated with CVC, are a serious cause of morbidity and mortality, thus making as a demanding need the adoption of clinical protocols for the care in ICU. Aim: The aim of this review was to explore the nursing care to prevent CVC’s infections in ICU. Method and material: The methodology followed included reviews and research studies. The studies were carried out during the period 2000-2014 and were drawn from foreign electronic databases (Pubmed, Medline, Cochrane and Greek (Iatrotek, on the nursing care of CVC, in the ICU to prevent infections. Results: The literature review showed that the right choice of dressings on the point of entry, the antiseptic treatment solution, the time for replacement infusion sets, the flushing of central venous catheter, the hand disinfection and finally the training of nursing staff, are the key points to prevent CVC’s infections in ICU. Conclusions: Education and compliance of nurses regarding the instructions of CVC's care, are the gold standard in the prevention of infections.

  16. Using central venous catheter for suprapubic catheterization in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Bilehjani E

    2017-01-01

    Full Text Available Eissa Bilehjani,1 Solmaz Fakhari2 1Department of Cardiovascular Anesthesia, Tabriz University of Medical Sciences, Madani Heart Hospital, 2Department of Anesthesiology, Tabriz University of Medical Sciences, Madani Heart Hospital, Tabriz, Iran Abstract: Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2–3 attempts. Keywords: suprapubic catheterization complication, urethral catheterization, central venous catheter, Seldinger’s technique, cardiac surgery

  17. Causes of central venous catheter associated infections and prevention countermeasures%中心静脉导管相关性感染原因分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    桂煜

    2011-01-01

    OBJECTIVE To understand the central venous catheter related infections and to propose preventive measures. METHODS From Apr 2008 to Mar 2010, the causes of 54 patients with deep catheter related infections were analyzed, and the definite preventive measures were taken in accordance with the causes. RESULTS Among 54 patients received the central venous catheterization, the infection of catheter export was found in 5 cases,accounting for 9.3%, 3 cases of catheter-related bloodstream infection, accounting for 5.6%, both of which were recovery after the corresponding disposals. CONCLUSIONS The risk factors of catheter related infections are the inserted time of the catheter,the sites, tle catheter types, the dressing and the nursing care of medical staff. To improve the training of the medical personnel, establish the preventive barrier to a maximum and strictly execute the aseptic manifestation is better propitious to prevent the occurrence of central venous catheter associated infection.%目的 了解中心静脉导管相关性感染的原因及应采取的预防措施.方法 分析医院2008年4月-2010年3月住院的54例深静脉留置管患者发生的导管相关性感染原因,并针对原因采取一定的预防措施.结果 54例行中心静脉置管术的患者中,置管出口部位感染5例,占9.3%;导管相关血流感染3例,占5.6%;经相应处理后均好转.结论 导管相关性感染的危险因素中重要是导管留置时间、插管部位、导管类型、敷料及医务人员操作护理;加强人员教育培训、最大限度的建立防护屏障、严格执行无菌操作等有利于更好的预防中心静脉导管相关性感染的发生.

  18. A comparison of central venous-arterial and mixed venous-arterial carbon dioxide tension gradient in circulatory failure.

    Science.gov (United States)

    Ho, K M; Harding, R; Chamberlain, J

    2007-10-01

    The arterial and mixed venous carbon dioxide tension gradient has been shown to increase when there is a decrease in cardiac output. Monitoring central venous gases is an attractive alternative to monitoring mixed venous gases in circulatory failure because central venous catheterisation is a less invasive procedure than pulmonary artery catheterisation. This study aims to evaluate the agreement between central venous-arterial carbon dioxide (CVA-CO2) and mixed venous-arterial carbon dioxide (SVA-CO2) tension gradients and assess whether CVA-CO2 tension gradient can be used to predict cardiac output in circulatory failure. Samples of arterial, central venous and mixed venous blood were obtained from 16 patients with circulatory failure at different inspired oxygen concentrations and cardiac indexes within 24 hours of study enrolment. CVA-CO2 and SVA-CO2 tension gradient were not interchangeable numerically (bias = 0.14 mmHg, 95% limits of agreement: -3.0 to 3.2 mmHg). CVA-CO2 (Spearman correlation coefficient r = -0.385) and SVA-CO, (r = -0.578) tension gradient were significantly correlated with the cardiac index but the cardiac index only accounted for 21% and 32% of the variability of CVA-CO, and SVA-CO2 tension gradient, respectively. The ability of CVA-CO2 tension gradient (area under the ROC curve = 0.77, 95% confidence interval [CI]: 0.49-0.99; P = 0.08) to predict a low cardiac output state (cardiac index tension gradient appeared to be limited to their negative predictive value to exclude a low cardiac output state when CVA-CO, or SVA-CO, tension gradient was normal (< or =5 mmHg).

  19. Ultrasonography: A novel approach to central venous cannulation

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    Agarwal Ankit

    2009-01-01

    Full Text Available Background: Portable ultrasound machines are highly valuable in ICUs, where a patient′s condition might not permit shifting the patient to the USG department for imaging. Traditionally central lines are put blindly using anatomical landmarks, which often result in complications such as difficulty in access, misplaced lines, pneumothorax, bleeding from inadvertent arterial punctures, etc. Ultrasonography provides "real time" imaging, i.e., the needle can be visualized entering the vein. Aims: We performed a study to compare USG guided central venous cannulation (CVC and conventional anatomical landmark approach to CVC, in terms of ease of cannulation, time consumed, and associated complications. Settings and Design: The study was performed in a 16-bed open ICU. Eighty patients were randomly divided in two groups. Materials and Methods: The right internal jugular vein (IJV was cannulated in all. In Group I, a portable ultrasound machine was used during cannulation. The vessels were visualized in the transverse section with the internal carotid artery (ICA identified as a circular pulsatile structure, while the IJV as a lateral, oval nonpulsatile structure. The needle was inserted perpendicular to the skin under visualization on the US screen. Central venous line was then inserted by the Seldinger technique. In Group II, CVC was performed by the conventional landmark approach. The parameters studied included time for insertion, attempts required, and complications encountered. Statistical Analysis: The database of all parameters was analyzed using SPSS software version 10.5. Results: The mean time to successful insertion was 145 and 176.4 sec in groups I and II, respectively (p = 0.00. An average of 1.2 attempts per cannulation was required for group I, while 1.53 for group II (p = 0.03: 10% witnessed arterial puncture and 2.5% pneumothorax in group I and none in group II. Conclusion: USG-guided CVC is thus easier, quicker, and safer than

  20. Malposition of a Peripherally Inserted Central Venous Catheter in the Graft Hepatic Vein.

    Science.gov (United States)

    Ersoy, Zeynep; Araz, Coşkun; Taşkın, Duygu; Moray, Gökhan; Torgay, Adnan

    2015-11-01

    Central venous catheters are used for delivering medications and parenteral nutrition, measuring hemodynamic variations, and providing long-term intravenous access. In our clinic, during liver transection using a living-liver donor, peripherally inserted central venous catheters are generally preferred because they involve a less invasive technique with a lower risk of complications. In this report, we present the case of a 36-year-old male liver donor into whom we peripherally inserted a central venous catheter from his left basilic vein. After transecting the hepatic vein, the surgeon found foreign material inside the venous lumen, which turned out to be the distal segment of the catheter.

  1. Risk factors for the appearance of central venous catheters colonization

    Directory of Open Access Journals (Sweden)

    Mioljević Vesna

    2007-01-01

    Full Text Available Introduction/Aim. Intravascular device placement (IVD is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI and increased mortality and morbidity. Nosocomial blood infections (NBIs account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs. Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. Methods. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long were analyzed. Based on the insight into medical documentation, patients’ examination and medical staff interview, catheter and patient-related characteristics were recorded. Results. A total of 107 CVCs were analyzed, out of which 56 (52% were sterile while 51 (48% were colonized. The results of our study evidenced that total parenteral nutrition (TPN (p < 0.05, number of catheterization days (p < 0.05, and central venous pressure measurement (p < 0.05 were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter

  2. Radiologic placement of hemodialysis central venous catheters: a practical guide

    Energy Technology Data Exchange (ETDEWEB)

    Schemmer, D.; Sadler, D.J.; Gray, R.R.; Saliken, J.C.; So, C.B. [Foothills Hospital, Dept. of Diagnostic Imaging, Calgary, Alberta (Canada)

    2001-04-01

    Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

  3. Accidental placement of central venous catheter in lung parenchyma causing hydrothorax

    Directory of Open Access Journals (Sweden)

    Vivek Badada

    2014-01-01

    Full Text Available Central venous catheterization is associated with its share of complications. Most of these complications can be avoided and treated by appropriate patient selection, careful insertion technique and vigilance following catheter insertion. We report a patient presenting with unilateral hydrothorax due malposition of central venous catheter in lung parenchyma. Prompt recognition of complication and its treatment remedied the situation.

  4. Case report of a cervical intraspinal misplacement of a central venous line.

    Science.gov (United States)

    Glaser, Martin B; von Bruchhausen, Carla; Müller-Forell, Wibke; Klein, Klaus U; Oertel, Joachim

    2011-12-01

    A case of cervical spinal misplacement of a central venous line via the right jugular vein is reported. A review of the literature resulted in eight similar cases. Only two further adults are described. Children and patients suffering from malnutrition seem to have a higher risk for intraspinal malpositioning of central venous catheters.

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

    NARCIS (Netherlands)

    Hanson, J.; Lam, S.W.K.; Mohanty, S.; Alam, S.; Hasan, M.M.U.; Lee, S.J.; Schultz, M.J.; Charunwatthana, P.; Cohen, S.; Kabir, A.; Mishra, S.; Day, N.P.J.; White, N.J.; Dondorp, A.M.

    2011-01-01

    ABSTRACT: BACKGROUND: To optimize the fluid status of adult patients with severe malaria, World Health Organization (WHO) guidelines recommend the insertion of a central venous catheter (CVC) and a target central venous pressure (CVP) of 0-5 cmH2O. However there are few data from clinical trials to

  6. The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure.

    Science.gov (United States)

    Saul, Turandot; Doctor, Michael; Kaban, Nicole L; Avitabile, Nicholas C; Siadecki, Sebastian D; Lewiss, Resa E

    2015-07-01

    The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound-first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location.

  7. Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis.

    Science.gov (United States)

    Ballard, David H; Samra, Navdeep S; Gifford, Karen Mathiesen; Roller, Robert; Wolfe, Bruce M; Owings, John T

    2016-06-01

    Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48 ± 11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p venous thrombosis (p catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible.

  8. [Neonatology nurses' knowledge about Peripherally Inserted Central Venous Catheter].

    Science.gov (United States)

    Belo, Marcela Patricia Macêdo; Silva, Roberta Albuquerque Mello de Castro; Nogueira, Isis Larissa Maia; Mizoguti, Daniele Pereira; Ventura, Claudiane Maria Urbano

    2012-01-01

    The Peripherally Inserted Central Catheter (PICC) has been used as a safe venous access for infants at risk. The aim of this study was to describe the knowledge and practice of nurses from the five public Neonatal Intensive Care Units, of Recife-PE, Brazil, about the use of the PICC. The sample was comprised by 52 nurses; data were collected from January to February/2010. It was found that 64,8% of nurses did not have license for insertion of the PICC. Only two units routinely used the PICC. About the indication of the access, the accuracy was above 70%. In unit B only 8,3% of nurses reported adequate initial location of the catheter tip. It was concluded that is necessary greater incentives to train nurses to use the PICC.

  9. Central Venous Line and Acute Neurological Deficit: A Case Series

    Directory of Open Access Journals (Sweden)

    SeyedHossein Ahmadi

    2015-10-01

    Full Text Available Central venous catheter (CVC insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation , unconsciousness, disorientation to time and place and  hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage.

  10. A Forgotten Guidewire: Complication of Central Venous Catheterization

    Directory of Open Access Journals (Sweden)

    Funda Gümüş

    2011-08-01

    Full Text Available Central venous catheterization is an invasive procedure commonly preferred for hemodynamic monitorization, total parenteral nutrition, cardiac pacemaker implantation, long-term use of vasoactive or irritating agents and hemodialysis. We present a 19-year-old woman with acute renal failure scheduled for hemodialysis catheterization. A catheter guidewire extending from the right internal jugular vein to the right external iliac vein was detected in the chest X-ray, taken two hours following catheterization after occurrence of arrhythmia and hypotension. Catheteter guidewire was extracted noninvasively without any complications. Most common reasons for this complication are stated to be attention deficits, lack of experience, overtired staff, and inadequate supervision of trainees. In this paper, we discussed this complication’s causes and preventive methods. (Journal of the Turkish Society Intensive Care 2011; 9:64-7

  11. Placement of a port catheter through collateral veins in a patient with central venous occlusion.

    Science.gov (United States)

    Teichgräber, Ulf Karl-Martin; Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-01

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  12. Misplaced central venous catheters: applied anatomy and practical management.

    Science.gov (United States)

    Gibson, F; Bodenham, A

    2013-03-01

    Large numbers of central venous catheters (CVCs) are placed each year and misplacement occurs frequently. This review outlines the normal and abnormal anatomy of the central veins in relation to the placement of CVCs. An understanding of normal and variant anatomy enables identification of congenital and acquired abnormalities. Embryological variations such as a persistent left-sided superior vena cava are often diagnosed incidentally only after placement of a CVC, which is seen to take an abnormal course on X-ray. Acquired abnormalities such as stenosis or thrombosis of the central veins can be problematic and can present as a failure to pass a guidewire or catheter or complications after such attempts. Catheters can also be misplaced outside veins in a patient with otherwise normal anatomy with potentially disastrous consequences. We discuss the possible management options for these patients including the various imaging techniques used to verify correct or incorrect catheter placement and the limitations of each. If the course of a misplaced catheter can be correctly identified as not lying within a vulnerable structure then it can be safely removed. If the misplaced catheter is lying within or traversing large and incompressible arteries or veins, it should not be removed before consideration of what is likely to happen when it is removed. Advice and further imaging should be sought, typically in conjunction with interventional radiology or vascular surgery. With regard to misplaced CVCs, in the short term, a useful aide memoir is: 'if in doubt, don't take it out'.

  13. [Central venous catheterization complication by a guide wire].

    Science.gov (United States)

    Araki, Yoshiyuki; Fukuda, Isao; Hirano, Masato; Matsuoka, Nobuhiro; Kazama, Tomiei

    2009-03-01

    Central venous catheterization using the Seldinger technique is a well known and often used method. On the other hand, there are also well known complications by needle puncture or by indwelling catheter, there are few reports about a guide wire which got hung up around the tricuspid valve. We report a case in which a guide wire got hung up to the chordae tendineae of the tricuspid valve. To insert the AVA 3Xi (Edwards life science Co. Iervine) from the right internal jugular vein, we inserted a guide wire without ease. Resistance appeared when we tried to remove the wire for 20 cm from the inserted state. The X-ray and the transesophageal echocardiography, showed the guide wire in the right ventricle. As actions to be taken, we advanced the central vein catheter of the EXCV catheter kit (Nippon Sherwood Medical Industries Co., Ltd.) to the tip, and a the guide wire was easily removed. There are many reports of the complication by the central venepuncture, but there are few reports about the guide wire which was entrapped in the vicinity of a tricuspid valve. The tip of the guide wire in this case was bent excessively, but the cause of the damage did not become clear by investigation. When a guide wire became hard to withdraw, we should never withdraw a guide wire blindly, but should search a cause and we should use the material which was matched with the cause.

  14. A new modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters.

    Science.gov (United States)

    Wald, Martin; Happel, Christoph M; Kirchner, Lieselotte; Jeitler, Valerie; Sasse, Michael; Wessel, Armin

    2008-11-01

    This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.

  15. The internal mammary vein: an alternate route for central venous access with an implantable port.

    Science.gov (United States)

    Jaime-Solis, E; Anaya-Ortega, M; Moctezuma-Espinosa, J

    1994-10-01

    Central venous catheterization in pediatric patients has, among other risks, flebitis and thrombosis, and finally occlusion of the superior and inferior venae cavae, making long-term catheterization and multiple venous cutdown more difficult. Use of the internal mammary vein might be an alternative procedure to provide sure and easy access to the central venous circulation. The authors report on a patient with multiple venous cutdown and thrombosis of the inferior vena cava, in whom the internal mammary vein was used for placement of a vascular device. The procedure is technically easy, and no special positioning of the patient is required.

  16. Life-threatening vascular complications after central venous catheter placement

    Energy Technology Data Exchange (ETDEWEB)

    Wicky, S.; Meuwly, J.-Y.; Doenz, F.; Uske, A.; Schnyder, P.; Denys, A. [Department of Radiology, University Hospital, Lausanne (Switzerland)

    2002-04-01

    The purpose of this retrospective study was to report 11 cases of severe vascular complications after central venous catheter misplacement. For each patient, data collection included body mass index, the diagnosis at admission, the site of the procedure, the type of catheter, coagulation parameters, the imaging modalities performed and the applied treatment. Eight patients had a lesion of the subclavian artery. Brachiocephalic vein perforations were assessed in three more patients. All patients had a chest roentgenogram after the procedure, six a CT examination, and four an angiographic procedure. Seven patients had a body mass index above 30, and 5 patients had coagulation disorders prior to the procedure. Seven patients were conservatively managed, 2 patients died despite resuscitation, 1 patient was treated with a stent graft, and one by superselective embolization. Subclavian or jugular vein temporary catheter positioning is a practical approach. Identification of any iatrogenic perforation of the subclavian artery or central veins urges obtainment a chest roentgenogram and, when required, a chest CT, selective angiograms or venograms. Body mass index superior to 30, previous unsuccessful catheterization attempts, and coagulation factor depletion seemed to account for risk factors. Recognition of clinical and radiological complications is mandatory. (orig.)

  17. Investigation and analysis of postoperative cardiac venous catheter-related bloodstream infections in children with congenital heart disease%先天性心脏病患儿术后中心静脉导管相关性血流感染的调查分析

    Institute of Scientific and Technical Information of China (English)

    贾鹏; 黄睿; 李刚; 刘斌

    2015-01-01

    OBJECTIVE To investigate postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease as well as the distribution of pathogenic bacteria ,so as to provide the basis for reducing infection rates .METHODS A total of 617 children with congenital heart disease who underwent surgical treatment in the cardiology center during May 2011 to Mar .2013 were enrolled .The targeted monitoring of central venous catheter‐related bloodstream infections was performed , and the infection incidence and the pathogen distribution were investigated .RESULTS Among the 617 children who underwent cardiac surgery and had indwelling central venous catheters ,12 cases of related bloodstream infections occurred ,the incidence was 1 .94% .Three cases (25 .00% ) had related bloodstream infections occurring in 7 days ,7 cases (58 .33% ) in 8 - 15 days and 2 cases (16 .67% ) after 15 days .Totally 21 pathogens were detected ,including 12 gram‐negative bacteria accounting for 57 .14% and 9 gram‐positive bacteria accounting for 42 .86% ,among which Acinetobacter baumannii ,Pseudomonas aeruginosa ,Staphylococcus aureus accounted for the top three .CONCLUSION The rate of postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease is relatively high .In the course of treatment ,health care workers should be strictly in accordance with the instruc‐tion manual ,implement proactive measures to prevent infection in children ,reduce central venous catheter‐related bloodstream infections ,shorten hospital stay in children and reduce mortality .%目的:探讨先天性心脏病患儿术后中心静脉导管(CVC)相关性血流感染以及病原菌分布,为临床降低其感染率提供依据。方法选取2011年5月-2013年3月心脏病治疗中心收治的617例实施手术治疗的先天性心脏病患儿,进行中心静脉导管相关血流感染目标性监测,调查研究感

  18. [Right ventricular perforation and cardiac tamponade caused by a central venous catheter].

    Science.gov (United States)

    Fukuda, H; Kasuda, H; Shimizu, R

    1993-02-01

    A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. Cardiac tamponade was revealed by rapid opening of the chest. Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.

  19. Central venous catheter (CVC) removal for patients of all ages with candidaemia

    DEFF Research Database (Denmark)

    Janum, Susanne; Afshari, Arash

    2016-01-01

    BACKGROUND: Candida bloodstream infections most often affect those already suffering serious, potentially life-threatening conditions and often cause significant morbidity and mortality. Most affected persons have a central venous catheter (CVC) in place. The best CVC management in these cases has...... conclusions. At this stage, RCTs have provided no evidence to support the benefit of early or late catheter removal for survival or other important outcomes among patients with candidaemia; no evidence with regards to assessment of harm or benefit with prompt central venous catheter removal and subsequent re......-insertion of new catheters to continue treatment; and no evidence on optimal timing of insertion of a new central venous catheter....

  20. JUGULAR CENTRAL VENOUS CATHETER PLACEMENT THROUGH A MODIFIED SELDINGER TECHNIQUE FOR LONG-TERM VENOUS ACCESS IN CHELONIANS.

    Science.gov (United States)

    Pardo, Mariana A; Divers, Stephen

    2016-03-01

    Long-term or repeated venous access in chelonians is difficult to obtain and manage, but can be critically important for administration of medications and blood sampling in hospitalized patients. Jugular catheterization provides the most rapid and secure route for vascular access, but catheters can be difficult to place, and maintaining catheter patency may be challenging. Long multilumen polyurethane catheters provide flexibility and sampling access, and minimize difficulties, such as catheter displacement, that have been encountered with traditional over-the-needle catheters. We describe placement of 4 Fr. 13-cm polyurethane catheters in three chelonians with the use of a modified Seldinger technique. Venous access was obtained with the use of an over-the-needle catheter, which allowed placement of a 0.018-in.-diameter wire, over which the polyurethane catheter was placed. Indwelling time has ranged between 1 and 4 mo currently. All tortoises were sedated for this procedure. Polyurethane central catheters provide safe, long-term venous access that allows clinicians to perform serial blood sampling as well as intravenous administration of medications, anesthetic agents, and fluids. A jugular catheter can also allow central venous pressure measurement. Utilization of central line catheters was associated with improvements in diagnostic efficiency and therapeutic case management, with minimal risks and complications.

  1. Factors Affecting Longevity of Tunneled Central Venous Cathe

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Won; Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2011-12-15

    To evaluate factors which affect the longevity of tunneled central venous catheters (T-CVCs). A retrospective study was conducted on 363 T-CVCs. We evaluated the relevant factors affecting the longevity of the T-CVCs, such as age, gender, indication for catheterization, site of entry vessel, diameter and type of T-CVC, catheter tip position, and underlying diseases. Of the 363 T-CVCs which had been inserted, 331 (91%) were placed through the right internal jugular vein (RIJV). The catheter tip position was the strongest predictor for the longevity of the T-CVC. The short limb of the catheter tip placed either at the cavoatrial junction (CA junction) or below the lower margin of the right main bronchus had a good prognosis. The vessel through which the T-CVC was placed significantly influenced the longevity of the T-CVC; the RIJV was associated with better results than the left internal jugular vein. Also, a split-type catheter was significantly associated with a better result. A two distinct and separate type T-CVC placed through the RIJV in which the short limb catheter tip position was at the level of the CA junction, significantly increased the longevity of T-CVCs.

  2. Proper Angle of Sono-guided Central Venous Line Insertion

    Science.gov (United States)

    Barzegari, Hassan; Forouzan, Arash; Fahimi, Mohammad Ali; Zohrevandi, Behzad; Ghanavati, Mandana

    2016-01-01

    Introduction: Determining the proper angle for inserting central venous catheter (CV line) is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization. Methods: In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient’s head rotation. Result: 114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male). The most common indications of catheterization were hemodialysis (55.3%) and shock state (24.6%). The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09. Conclusion: Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results. PMID:27299146

  3. Heparin Leakage in Central Venous Catheters by Hemodynamic Transport

    Science.gov (United States)

    Barbour, Michael; McGah, Patrick; Gow, Kenneth; Aliseda, Alberto

    2014-11-01

    Central venous catheters (CVCs), placed in the superior vena cava for hemodialysis, are routinely filled with heparin, an anticoagulant, while not in use to maintain patency and prevent thrombus formation at the catheter tip. However, the heparin-lock procedure places the patient at risk for systemic bleeding incidences, as heparin is known to leak into the blood stream. We propose that the driving mechanism behind heparin leakage is advective-diffusive transport due to the pulsatile blood flow surrounding the catheter tip. This novel hypothesis is based on Planar Laser Induced Fluorescence (PLIF) measurements of heparin transport from a CVC placed inside an in vitro pulsatile flow loop and validated with CFD simulations. The results show an initial, fast (catheter lumen, where concentration is still high, that is insufficient at replenishing the lost heparin at the tip. These results, which estimate leakage rates consistent with published in vivo data, predict that the concentration of heparin at the catheter tip is effectively zero for the majority of the interdialytic phase, rendering the heparin lock ineffective.

  4. Hemodynamics of Central Venous Catheters: experiments and simulations

    Science.gov (United States)

    Barbour, Michael; McGah, Patrick; Clark, Alicia; Ng, Chin Hei; Gow, Kenneth; Aliseda, Alberto

    2013-11-01

    Central venous catheters (CVC) are used to provide vascular access during hemodialysis in patients with end-stage kidney disease. Despite several advantages and widespread use, CVCs have a high incidence rate of clot formation during the interdialytic phase (48 hrs). In an attempt the prevent clot formation, hospitals routinely administer heparin, an anticoagulant, into the catheter after a dialysis session. It has been reported, however, that up to 40% of the heparin solution will leak into the blood stream during the interdialytic phase, placing the patient at risk for systemic bleeding incidences. The aim of this study is to determine the role that advective-diffusive transport plays in the heparin leaking process. Numerical simulations of heparin convective mass transfer have been conducted, showing that while advective losses may be significant at the tip, previous studies may be overestimating the total amount of heparin leakage. To validate the quantitative prediction from the simulations, P.L.I.F. is used to experimentally measure heparin transport from CVCs placed in an idealized Superior Vena Cava with physically accurate pulsatile flow conditions. Improved understanding of flow near the catheter tip is applied to improve catheter design and heparin locking procedures.

  5. Ultrasound-guided central venous catheterization in prone position

    Directory of Open Access Journals (Sweden)

    Sofi Khalid

    2010-01-01

    Full Text Available Central venous catheterization (CVC is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV, which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique.

  6. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

    Science.gov (United States)

    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J; Wilkerson, K; Speroff, T

    2005-01-01

    

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices. Design: A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers. Setting: Adult medical intensive care unit (MICU). Key measures for improvement: Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff. Strategies for change: An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs. Effects of change: The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low. Lessons learnt: Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real

  7. Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters; Clinical and radiological perspective from a tertiary centre in Oman

    Directory of Open Access Journals (Sweden)

    Rana S. Hamid

    2015-11-01

    Full Text Available Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters (TVCs at the Sultan Qaboos University Hospital (SQUH, Muscat, Oman. Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications (such as catheter-related infections or thrombosis were collected. Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female (42.2% and 93 were male (57.8%. The mean age of the patients was 54.4 ± 17.3 years. The most common reason for catheter placement was the initiation of dialysis (63.4%. A total of 203 procedures were technically successful (99.5%. The right internal jugular vein was the most common site of catheter placement (74.9%. Mild haemorrhage which resolved spontaneously occurred in 11 cases (5.4%. No other complications were observed. Subsequent follow-up data was available for 132 catheters (65.0%; of these, thrombosis-related catheter malfunction was observed in 22 cases (16.7% and catheter-related infection in 29 cases (22.0%. Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature.

  8. Evaluation of routine postoperative chest roentgenogram for determination of the correct position of permanent central venous catheters tip

    Directory of Open Access Journals (Sweden)

    Fereshteh Salimi

    2015-01-01

    Full Text Available Background: Proper placement of central venous catheter (CVC tip could reduce early and late catheter-related complications. Although the live fluoroscopy is standard of care for placement of the catheter, it is not available in many centers. Therefore, the present study evaluated the sensitivity and specificity of bedside chest X-ray (CXR for proper positioning of the catheter tip. Materials and Methods: A total of 82 adult patients undergoing elective placement of tunneled CVC were enrolled in this study during 2010-2012. The catheter tip position was evaluated by postoperative bedside chest radiographs as well as trans-thoracic echocardiogram as definite diagnostic tool. The catheter position was considered correct if the tip was positioned in the right atrium both in CXR or echocardiography. Finally, CXRs interpreted by expert radiologist. Thus findings were compared by echocardiography. Sensitivity, specificity, accuracy, positive, and negative predictive values were calculated. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, and P < 0.05 considered as significant. Results: The patients were 57.37 ± 18.91 years of age, weighed 65.79 ± 15.58 kg and were 166.36 ± 9.91 cm tall. Sensitivity and specificity of CXR for proper catheter tip position were 74.3% and 58.3%, respectively. Positive and negative predictive values were 91.2% and 28%. In addition accuracy, positive likelihood ratio, and negative likelihood ratio were 71.9%, 1.78, and 2.27 respectively. Conclusion: Bedside CXR alone does not reliably predict malpositioning after CVC placement.

  9. [Ultrasound-guided central venous access in adults and children: Procedure and pathological findings].

    Science.gov (United States)

    Scheiermann, P; Seeger, F H; Breitkreutz, R

    2010-01-01

    Central venous line placement is a standard procedure in critical care and peri-operative medicine. This procedure can be associated with severe complications. In contrast to the landmark technique, ultrasound-guided punctures can significantly reduce the rate of complications. Patients with a high risk for difficult vascular access include critical care and emergency patients as well as patients on anticoagulation medication and dialysis. Placement of central venous catheters can be difficult in ventilated patients and if there has been prior surgery in the puncture area. In children and small infants central venous access can also be challenging due to the anatomical relationship in the head and neck region. Puncture techniques are explained briefly by means of ultrasound anatomy. Typical ultrasonographic images visualize pathological findings in order to identify dangers and complications in central venous catheterization.

  10. Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies.

    NARCIS (Netherlands)

    Boersma, R.S.; Jie, K.S.; Verbon, A.; Pampus, EC van; Schouten, H.C.

    2008-01-01

    Central venous catheters (CVCs) have considerably improved the management of patients with hematological malignancies, by facilitating chemotherapy, supportive therapy and blood sampling. Complications of insertion of CVCs include mechanical (arterial puncture, pneumothorax), thrombotic and infectio

  11. A Rare And Life Threatening Complication Of Percutaneously Inserted Central Venous Catheters: Cardiac Tamponade.

    Directory of Open Access Journals (Sweden)

    seyma Kayali

    2016-09-01

    Full Text Available Percutaneously inserted central venous catheters are commonly used to provide parenteral nutrition for premature neonates. This study presents report of two preterm neonates who developed pericardial effusion resulting from osmotic damage of parenteral nutrition. When a neonate with percutaneously inserted central venous catheter clinical status worsens a high index of clinical suspicion for diagnosing pericardial effusion and immediate treatment might be life saving. [J Contemp Med 2016; 6(3.000: 226-230

  12. X-Ray of One-Sided “White Lung” after Central Venous Catheterization

    Directory of Open Access Journals (Sweden)

    Michel Casanova

    2014-01-01

    Full Text Available Complications during insertion of a subclavian central venous line are rare but potentially serious. This case report describes the radiological abnormality of a one-sided pleural effusion during a routine control directly after a difficult central venous catheterization. We illustrate the findings, the initial emergency management, and our procedure to rule out an iatrogenic hemothorax. Possible differential diagnoses and strategies for management of a suspected complication are discussed.

  13. MISPLACEMENTS OF CENTRAL VENOUS CATHETERS: INTERNAL JUGULAR VERSUS SUBCLAVIAN ACCESS IN CRITICAL CARE PATIENTS

    OpenAIRE

    2007-01-01

    Aim; In central venous catheterization (CVC), misplacement is not a rare complication since this is a blinded procedure. The aim of this study was to compare the misplacement risks of the access of internal jugular vein with that of subclavian vein catheterizations. Methods;The records of a total of 1092 patients in whom central venous catheters were placed between 2002 and 2006 in Anesthesiology Intensive Care Unit and the location of the tips was confirmed radiologically were retrospe...

  14. Radiographic mislead: apparent arterial placement of subclavian central venous catheter due to mediastinal shift

    OpenAIRE

    Shaji Mathew; Kush Goyal; Souvik Chaudhuri; Arun Kumar(University of Delhi, Delhi, India); Amjad Abdulsamad

    2014-01-01

    Optimal placement of central venous catheters (CVC) is essential for accurate monitoring of central venous pressure (CVP) in major surgeries and ensuring long-term use of the catheter for managing the critically ill patient. Accidental subclavian artery catheterization is one of the most serious complications of the procedure. Radiography is commonly used to ensure optimal placement of CVC tip and rule out subclavian artery catheterization in the absence of Doppler ultrasound and a pressure t...

  15. Analysis the related infections central venous catheter in emergency observation ward and its nursing experience%急诊观察病房中心静脉导管相关性感染分析及护理体会

    Institute of Scientific and Technical Information of China (English)

    陈英; 翟飞飞; 陆萍

    2011-01-01

    Objective:To understand the emergency ward , observe with central venous catheter related infections and related experience in nursing. Methods : A retrospective survey of 448 patients were analyzed , cultivating catheter with indwelling catheter related infections , lien venous catheter time , type , etiology . Results :448 cases , positive catheter in 36 cases , isolated strains of pathogenic 39 , gram - positive ( 18 ) . Gram - negative 16 cases , plants ,5 strains.26 cases occurred catheter local engraftment , puncture infection7 cases , bacteremia 3 cases. Conclusion : The emergency ward , observe patients with central venous catheter infections catheter related to colonize bacteria. The correct choice catheter lien vein and catheter type. Strengthen catheter operation and nursing, as shorten time. The indwelling catheter strengthen nutrition, enhance immunity can reduce catheter infections.%目的:分析急诊观察病房病人中心静脉导管相关感染因素及护理体会.方法:回顾性调查448例中心静脉置管病人导管相关性感染与导管留置静脉、导管留置时间、导管类型、病原学的关系.结果:448例病人中,导管培养阳性36例,分离出病原菌39株,其中革兰氏阳性菌18株,革兰氏阴性菌16株,真菌5株;发生导管局部定植26例,穿刺部位感染7例,菌血症3例.结论:急诊观察病房病人中心静脉导管感染与导管细菌定植等因素有关.正确选择导管留置静脉和导管类型;加强置管操作与护理;尽可能缩短导管留置时间;加强病人营养,提高免疫力,可降低导管感染率.

  16. The current understanding of arterial-catheter related bloodstream infection%当前对动脉导管相关性血流感染的认识

    Institute of Scientific and Technical Information of China (English)

    王斌; 安友仲

    2016-01-01

    导管相关性血流感染(CRBSI)是重症加强治疗病房(ICU)中常见的严重感染之一,可增加患者的病死率,延长住院时间,增加住院费用.在CRBSI中,动脉导管相关性血流感染(AC-BSI)常被忽视或低估,目前的报道显示,AC-BSI的发生率接近甚至不低于中心静脉导管相关性血流感染(CVC-BSI).一旦怀疑AC-BSI,应在留取相关培养物培养后立即拔出动脉导管,并根据患者的情况实施抗感染治疗;预防是减少AC-BSI的关键.本文作者从AC-BSI的流行病学、病原学及发病机制、危险因素、诊断、治疗和预防等方面的进展进行综述,以期为临床处理提供帮助.%Catheter-related bloodstream infection (CRBSI) is one of the common severe infections in intensive care unit (ICU),which tends to increase the mortality of patients,the length of hospital stay and the cost of hospitalization.Arterial catheter-related bloodstream infection (AC-BSI) is often overlooked or underestimated.Some studies pointed out that the incidence of AC-BSI is close to or even higher than central venous catheter related bloodstream infection (CVC-BSI),which plays an important role in catheter-related infections.Once AC-BSI is suspected,arterial catheter should be removed immediately after bacterial culture and antibiotics should be prescribed according to severities of patients.Prevention is the key to reduce AC-BSI.The research progress of epidemiology,etiology,pathogenesis,risk factors,diagnosis,treatment and prevention of AC-BSI was reviewed to facilitate the clinical decision.

  17. Ensaio clínico controlado sobre o curativo de cateter venoso central Ensayo clínico controlado sobre la cobertura de catéter venoso central Clinical controlled trial on central venous catheter dressings

    Directory of Open Access Journals (Sweden)

    Edivane Pedrolo

    2011-01-01

    Full Text Available OBJETIVO: Avaliar a eficácia dos curativos de gaze e fita e filme transparente de poliuretano para cobertura de cateteres venosos centrais. MÉTODOS: Ensaio clínico controlado randomizado. RESUlTADOS: Não foi identificada uma diferença significativa com relação à infecção relacionada ao cateter (p=1 e à fixação do curativo (p=0,670. Foi identificada diferença estatisticamente significativa com relação à absorção de exsudato (pOBJETIVO: Evaluar la eficacia de las curaciones de gasa y cinta y película transparente de poliuretano para la cobertura de catéteres venosos centrales. MÉTODOS: Ensayo clínico controlado randomizado. RESULTADOS: No se identificó una diferencia significativa con relación a la infección relacionada al catéter (p=1 y a la fijación de la curación (p=0,670. Fue identificada la diferencia estadísticamente significativa con relación a la absorción del exudado (pOBJECTIVE: To evaluate the effectiveness of gauze and tape as compared to transparent polyurethane film for dressing central venous catheters. METHODS: A randomized controlled clinical trial was conducted. RESULTS: No significant difference was identified in catheter-related infection (p = 1 or the stability of the dressing (p = 0.670. There was no statistically significant difference with respect to the absorption of exudate (p <0.001. The likelihood of local reaction in the control group (gauze and tape was different from the study group (p = 0.024. CONCLUSION: The type of dressing does not decrease the incidence of catheter-related infection, the binding capacity is similar, and the gauze dressing has the capacity to absorb exudate. However, the gauze dressing resulted in a higher probability of developing a local reaction. Record WHO: ACTRN12609000951257.

  18. Low central venous pressure reduces blood loss in hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Wei-Dong Wang; Li-Jian Liang; Xiong-Qing Huang; Xiao-Yu Yin

    2006-01-01

    AIM: To investigate the effect of low central venous pressure (LCVP) on blood loss during hepatectomy for hepatocellular carcinoma (HCC).METHODS: By the method of sealed envelope,50 HCC patients were randomized into LCVP group (n = 25) and control group (n = 25). In LCVP group,CVP was maintained at 2-4 mmHg and systolic blood pressure (SBP) above 90 mmHg by manipulation of the patient's posture and administration of drugs during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. The patients'preoperative conditions, volume of blood loss during hepatectomy, volume of blood transfusion, length of hospital stay, changes in hepatic and renal functions were compared between the two groups.RESULTS: There were no significant differences in patients' preoperative conditions, maximal tumor dimension, pattern of hepatectomy, duration of vascular occlusion, operationtime, weight of resected liver tissues, incidence of post-operative complications, hepatic and renal functions between the two groups. LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group, being 903.9±180.8 mL vs 2 329.4±2 538.4(W=495.5, P<0.01) and 672.4±429.9 mL vs1 662.6± 1932.1 (W=543.5, P<0.01). There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups. The length of hospital stay was significantly shortened in LCVP group as compared with the control group, being 16.3±6.8 d vs21.5 ± 8.6 d (W= 532.5, P<0.05).CONCLUSION: LCVP is easily achievable in technique.Maintenance of CVP≤4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function.

  19. INDICATIONS AND COMPLICATIONS OF CENTRAL VENOUS CATHETERIZATION IN CRITICALLY ILL CHILDREN IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Shwetal Bhatt

    2012-02-01

    Full Text Available Background: Nothing can be more difficult, time consuming and frustrating than obtaining vascular access in critically ill pediatric patient1 .Central venous catheters are widely used in the care of critically ill patients. Methodology: This paper reviews our experience with central lines in 28 critically ill patients including neonates and non-neonates, in a study period of October 2008 to October 2009. Of the total 28 patients, central venous catheterizations was more in those who were more than a month age and of female sex. Results: The route of insertion was femoral in approximately 89% of our patients and insertion was successful in 24 patients. The most common indication we observed for catheter use was, venous access in shock (37.1% in neonates and for monitoring the central venous pressure (32% in non neonate patients of ARDS with pulmonary edema and Shock. The central line was removed in majority of patients (60% within 24-48hrs of insertion and was kept for maximum of six days in just one patient. Organism most frequently isolated was Acinetobacter. Recommendations made include, use strict aseptic measures by restricted number of skilled operators while inserting and during maintaining central line, routine confirmatory x-ray or fluoroscopy to check the position of central line before catheter use, if possible, use for central pressure monitoring recommended. Conclusion: We concluded that central venous catheterization is a safe and effective measure so we recommend timely and judicious use of percutaneous central venous catheter in paediatric critically ill patients of PICU and NICU. [National J of Med Res 2012; 2(1.000: 85-88

  20. Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul [College of Medicine, Soonchunhyang Univ., Chonan (Korea, Republic of)

    2002-04-01

    To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required.

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

    Science.gov (United States)

    Kam, K Y R; Mari, J M; Wigmore, T J

    2012-02-01

    Dual-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 tracer was aspirated from catheters infusing at least 2 cm downstream. Orientation of side ports did not affect tracer elimination. Co-location of central venous and haemodiafiltration catheters may lead to complete aspiration of infusions into the haemodiafilter with resultant drug under-dosing.

  2. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

    Directory of Open Access Journals (Sweden)

    Felipe Jose Skupien

    2014-03-01

    Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

  3. Reductions in Central Venous Pressure by Lower Body Negative Pressure or Blood Loss Elicit Similar Hemodynamic Responses

    Science.gov (United States)

    2014-05-29

    individual r2 values and individual regression line slope values of hemodynamic variables vs. central venous pressure r2 r2 Range Slope Slope Range...JUL 2014 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Reductions in Central Venous Pressure by Lower Body Negative Pressure...ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Reductions in central venous pressure by

  4. Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

    Energy Technology Data Exchange (ETDEWEB)

    Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

    2012-09-15

    Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

  5. Subclavian artery pseudoaneurysm: a rare and serious complication of central venous catheterization in an infant

    Energy Technology Data Exchange (ETDEWEB)

    Koklu, Esad; Poyrazoglu, Hakan [Erciyes University School Medicine, Department of Paediatrics, Division of Paediatric Intensive Care Unit, Kayseri (Turkey); Yikilmaz, Ali [Erciyes University, Department of Radiology, Kayseri (Turkey); Canpolat, Mehmet; Konuskan, Bahadir [Erciyes University, Department of Paediatrics, Kayseri (Turkey)

    2008-02-15

    Serious complications of central venous access occur in 0.4-9.9% of patients undergoing attempted central venepuncture. We report an unusual case of an 18-month-old infant in whom a right subclavian artery pseudoaneurysm developed rapidly after attempted subclavian vein catheterization without US guidance failed. (orig.)

  6. Central line-related bacteraemia due to Roseomonas mucosa in a neutropenic patient with acute myeloid leukaemia in Piraeus, Greece.

    Science.gov (United States)

    Christakis, G B; Perlorentzou, S; Alexaki, P; Megalakaki, A; Zarkadis, I K

    2006-08-01

    A case of central venous catheter-related bacteraemia due to Roseomonas mucosa in a neutropenic patient with acute myelogenous leukaemia is reported. The patient was successfully treated with amikacin and piperacillin-tazobactam. The clinical isolate was identified as R. mucosa by 16S rRNA gene sequencing.

  7. [The concentration of free lidocaine in arterial, central venous and peripheral vein plasma following intravenous injection].

    Science.gov (United States)

    Nolte, H; al Saydali, B; Weissenberg, W

    1990-03-01

    Ten intensive care patients and five healthy volunteers each received a bolus injection of lidocaine HCl (100 mg, 2%) over an injection period of 5 s. After 0.5, 1, 2, 4, 8, 15 and 25 min arterial, central venous and peripheral venous blood samples were collected. In four of the volunteers, arterial and central venous samples were also taken about 10 s after the end of injection. The fluorescence polarization method by means of the Abbott-TDx system was used, and plasma concentrations of lidocaine were determined. The measurements showed that lidocaine levels in central venous plasma 10 s after the end of administration were higher than those in arterial plasma. By 30 s after administration the opposite situation had developed, so that arterial concentrations were higher than those in central venous plasma. This relation did not change throughout the study, though the two levels became closer, as is shown by the ratios (Table 3, Fig. 2). Concentrations in peripheral venous plasma increased more slowly but remained far below those in arterial and central venous plasma, at least for the first 8 min. After 15 min lidocaine levels were almost the same in all three samples. During the entire study there were no ECG changes, and neither heart rate nor blood pressure showed any significant deviation from the values obtained at the beginning. The volunteers had minor toxic manifestations, such as dizziness, tinnitus and a metallic taste in the mouth; one person had a sensation of pressure in his chest, which improved following oxygen administration.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. [Tunnelled central venous line-associated infections in patients with pulmonary arterial hypertension treated with intravenous prostacyclin].

    Science.gov (United States)

    Boucly, Athénaïs; O'Connell, Caroline; Savale, Laurent; O'Callaghan, Dermot S; Jaïs, Xavier; Montani, David; Humbert, Marc; Simonneau, Gérald; Sitbon, Olivier

    2016-01-01

    Intravenous prostacyclins are a valuable treatment for patients with severe pulmonary arterial hypertension, leading to improved exercise capacity, haemodynamics, quality of life and survival. Unfortunately, due to the short half-life of these drugs, they need to be administered continuously through central venous catheters. Despite aseptic technique, regular dressing changes, tunneled central venous catheters and patient education, patients are exposed to central venous catheter associated infections. These infections cause significant morbidity and mortality. The clinical presentation, microbiology, consequences and management of these central venous catheter associated infections in pulmonary arterial hypertension patients treated with intravenous prostacyclins are discussed.

  9. Comparison of complications between transjugular and axillosubclavian approach for placement of tunneled, central venous catheters in patients with hematological malignancy: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon; Hahn, Seong Tai [Catholic University of Korea, Diagnostic Radiology, Seoul (Korea)

    2005-06-01

    This study was designed to compare the incidence of mechanical, thrombotic and infective complications in transjugular (IJV) and axillosubclavian (SCV) central venous catheters (CVC) in patients with hematological malignancy. In a prospective observational trial, 131 consecutive patients were classified into two groups: Group A included those with IJV catheter insertions under sonography guidance (n=61) and group B included those with SCV insertions under venography guidance (n=70). After catheter placement, patients were prospectively acquired and recorded to obtain the following data: success rates, total catheter days, and complication episodes per 100 catheter days. All procedures were technically successful. Total catheter days were 7800 (group A) versus 8391(group B). Mechanical complications were observed in three cases from group A and 11 from group B, with an incidence rate of 0.04 per 100 catheter days versus 0.13 (P=0.043), respectively. Two symptomatic thrombotic complications were observed in group B. The number of infective complications was not significantly different between the two groups (P=0.312). There was no difference in infective complication incidence between the two groups. To minimize catheter-related mechanical and thrombotic complications, however, the IJV approach is superior to the SCV approach. (orig.)

  10. Biofilm formation in long-term central venous catheters in children with cancer: a randomized controlled open-labelled trial of taurolidine versus heparin.

    Science.gov (United States)

    Handrup, Mette Møller; Fuursted, Kurt; Funch, Peter; Møller, Jens Kjølseth; Schrøder, Henrik

    2012-10-01

    Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream infections (CRBSI) was 0.1 per 1000 catheter-days using taurolidine and 0.9 per 1000 catheter-days using heparin (p = 0.03). This randomized trial confirmed that the use of taurolidine as catheter-lock compared with heparin reduced the rate of CRBSIs; this reduction was not related to a reduction in the intraluminal biofilm formation and the rate of bacterial colonization detected by scanning electron microscopy in the two groups.

  11. Management Of Fever And Suspected Infection In Pediatric Patients With Central Venous Catheters.

    Science.gov (United States)

    Brennan, Courtney; Wang, Vincent J

    2015-12-01

    The use of indwelling central venous catheters is essential for pediatric patients who require hemodialysis, parenteral nutrition, chemotherapy, or other medications. Fever is a common chief complaint in the emergency department, and fever in a patient with a central venous catheter may be related to a common cause of fever, or it may be due to a catheter-associated bloodstream infection. Catheter-associated bloodstream infections may also lead to additional complications such as sepsis, septic shock, or septic complications including suppurative thrombophlebitis, endocarditis, osteomyelitis, septic emboli, and abscesses. Early resuscitation as well as timely and appropriate antibiotic therapy have been shown to improve outcomes. This issue focuses on the approach to fever in pediatric patients with central venous catheters and the management and disposition of patients with possible catheter-associated bloodstream infections.

  12. Durability of central venous catheters. A randomized trial in children with malignant diseases

    DEFF Research Database (Denmark)

    Henneberg, S W; Jungersen, D; Hole, P

    1996-01-01

    In a prospective randomized study the durability of tunnelled and non-tunnelled central venous catheters was investigated in children with malignant diseases. Twenty children were included in the study but four (two in each group) had to be excluded; three because the entry criteria turned out......, respectively. In conclusion cuffed, tunnelled central venous catheters are less prone to displacement than traditional percutaneous central venous catheters when used in children with malignant diseases....... not to be fulfilled and one because of lack of data. The median duration of the tunnelled catheters was 224 days with a range of 25-846 days which was significantly longer than that of conventional catheters (39.5 days, range 9-228 days). In addition six of eight conventional catheters were accidentally removed...

  13. Post-Fontan care based on hemodynamic characteristics, with special reference to the central venous pressure.

    Directory of Open Access Journals (Sweden)

    Nawa,Sugato

    1989-08-01

    Full Text Available Changes in the hemodynamics of six patients having received Fontan-like operations were closely observed during the first 48 h after the operation. Catheterization studies and simultaneous angiocardiography were also performed before and after the operation. Hemodynamic derangement was particularly severe during the first 24 h postoperatively as indicated by a low cardiac output of less than 2.01/min/m2, which persisted in spite of very high central venous pressure. Furthermore, the central venous pressure needed to re-establish the circulation soon after the Fontan procedure significantly correlated with the angiocardiographically assessed preoperative size of distal pulmonary arteries. Accordingly, the preoperative evaluation of the distal pulmonary arterial size is very important, that provides a good guide-line for the degree of circulatory volume expansion necessary to elevate the central venous pressure and to sustain the circulation in the early postoperative period.

  14. A technique for re-utilizing catheter insertion sites in children with difficult central venous access.

    Science.gov (United States)

    Johnson, S M; Garnett, G M; Woo, R K

    2017-01-01

    Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down." A separate exit site is then created for the new catheter and it is tunneled to the "cut-down" site per routine. The non-functioning catheter is then removed from the surgical field. The proximal fibrous sheath is finally cannulated either directly with the new catheter or with a wire/dilator system. This technique effectively re-uses the same venous access point while allowing for a complete change of the physical line and external site. Twenty attempts at this technique were made in twelve patients; six patients underwent the site re-utilization procedure multiple times. Re-using the fibrous tunnel to re-cycle the internal catheter site was successful in seventeen of twenty attempts. All patients had chronic conditions leading to difficult long-term central venous access [short bowel syndrome (6), hemophilia (2), cystic fibrosis (1), chronic need for central IV access (3)]. Indications for catheter replacement included catheter occlusion/mechanical failure/breakage (9), dislodgement (6), infection (1), and inadequate catheter length due to patient growth (4). Broviac/Hickman catheter sites were most commonly re-used (13; one failure); re-using a portcath site was successful in 5 of 7 attempts. There were no short term infections or mechanical complications. We describe a novel technique for salvaging tunneled central venous catheter access sites. This technique is well suited

  15. Prevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants

    NARCIS (Netherlands)

    Hemels, Marieke A. C.; van den Hoogen, Agnes; Verboon-Maciolek, Malgorzata A.; Fleer, Andre; Krediet, Tannette G.

    2011-01-01

    Objectives: Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagula

  16. 大面积烧伤患者预防中心静脉置管感染的护理体会%Nursing Experience of Central Venous Catheter Infection Prevention of Severe Burn Patients

    Institute of Scientific and Technical Information of China (English)

    罗红

    2013-01-01

    目的:总结大面积烧伤患者预防中心静脉置管感染的护理体会。方法对138例大面积烧伤患者中心静脉置管的预防感染护理进行总结、分析。结果82例置管患者其中4例发生脓毒血症,2例置管尖端培养细菌阳性,经抗感染治疗均痊愈出院。结论中心静脉置管护理是预防大面积烧伤患者导管相关性感染的重要环节。%Objective: To summarize the experience in nursing of patients with burn prevention of central venous catheter infection in large area. Method: 138 cases of large area burn patients center vein catheter infection prevention nursing summary, analysis. Results: 82 cases of patients with sepsis occurred in 4 cases, 2 cases of catheter tip culture positive for the bacteria, the anti infection treatment were cured. Conclusion: the central venous catheter care is an important part of catheter-related infection in burn patients with large area prevention.

  17. An unknown complication of peripherally inserted central venous catheter in a patient with ventricular assist device

    Directory of Open Access Journals (Sweden)

    Parikh M

    2011-01-01

    Full Text Available We report an unknown complication of peripherally inserted central venous catheter in a patient with Ventricular Assist Device. This rare complication led to the failure of the right ventricular assist device, which could be detrimental in patients with dilated cardiomyopathy.

  18. Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis

    NARCIS (Netherlands)

    van den Hoogen, Agnes; Brouwer, Mieke J.; Gerards, Leo J.; Fleer, Andre; Krediet, Tannette G.

    2008-01-01

    Background: Clinical signs of sepsis are frequently observed after removal of a percutaneously inserted central venous catheter (PCVC) in neonates admitted at our Neonatal Intensive Care Unit (NICU). To substantiate this finding and to evaluate the effect of antibiotics administered at the time of r

  19. In-line filters in central venous catheters in a neonatal intensive care unit

    NARCIS (Netherlands)

    van den Hoogen, A; Krediet, TG; Uiterwaal, CSPM; Bolenius, JFGA; Gerards, LJ; Fleer, A

    2006-01-01

    Nosocomial sepsis remains an important cause of morbidity in neonatal intensive care units. Central venous catheters (CVCs) and parenteral nutrition (TPN) are major risk factors. In-line filters in the intravenous (IV) administration sets prevent the infusion of particles, which may reduce infectiou

  20. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Frydenberg, Morten

    2010-01-01

    BACKGROUND: Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter. PROCEDURE: All chi...

  1. A simulation-based "just in time" and "just in place" central venous catheter education program.

    Science.gov (United States)

    Lengetti, Evelyn; Monachino, Anne Marie; Scholtz, Amy

    2011-01-01

    The authors describe the Central Venous Catheter Dress Rehearsal simulation program. Teaching is conducted at the bedside, which is efficient and cost effective and allows nurses to practice in a safe environment with no harm to the patient. The educators' challenges and remediation strategies are shared. This simulation program has demonstrated improved consistency of practice and knowledge among pediatric nurses.

  2. Coiling of central venous catheter in the left subclavian vein, a rare complication

    Directory of Open Access Journals (Sweden)

    Vipin Goyal

    2014-01-01

    Full Text Available Invasive monitoring is the need of the hour in today′s scenario in intensive care units and perioperatively in hemodynamically unstable patients. Despite careful placement using proper landmarks and USG guided methods central venous canuulation (CVC is associated sometimes with unforeseen complications. We report a rare complication of coiling of CVC in the left subclavian vein.

  3. 重症患者中心静脉导管相关血流感染护理对策分析%Nursing countermeasures for bloodstream infection induced by central venous catheter in severe patients

    Institute of Scientific and Technical Information of China (English)

    兰艳萍; 葛凯杰

    2014-01-01

    Objective To analyze the nursing countermeasures for bloodstream infection induced by central venous catheter in severe patients, to provide reference for the control of infections in severe patients. Methods Divided 116 cases of central venous catheter in several patients randomly into group A, group B, 58 cases in each group, group A was given routine nursing care, group B was implemented the optimal nursing, observed nursing effect of the two groups.Results Catheter related bloodstream infection rates of group A and group B were 13.8% and 3.45%, indwelling catheter time was (12.5±3.4)d and (16.5±4.3)d, differences were statistically significant(P<0.05).Conclusion Optimal nursing for severe patients with central venous catheter can reduce catheter-related bloodstream infection, prolong indwelling time and improve the prognosis.%目的:分析重症患者中心静脉导管相关血流感染护理对策,为重症患者感染防止提供参考。方法将116例留置中心静脉导管的重症患者随机分为A、B两组,各58例, A组实施常规护理, B组实施优化护理,观察两组护理效果。结果A、B两组导管相关血流感染率分别为13.8%及3.45%,留置导管时间分别为(12.5±3.4)d及(16.5±4.3)d,差异均有统计学意义(P<0.05)。结论对留置中心静脉导管的重症患者进行优化护理后可减少导管相关血流感染、延长置管时间、改善预后。

  4. Urinary catheter related nosocomial infections in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Tullu M

    1998-04-01

    Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.

  5. Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation.

    Science.gov (United States)

    Martinho, Gláucia Helena; Romanelli, Roberta M C; Teixeira, Gustavo Machado; Macedo, Antonio V; Chaia, Juliana M C; Nobre, Vandack

    2013-07-01

    In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

  6. Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Dharmendra Kumar

    2015-01-01

    Full Text Available Background: Central venous pressure (CVP assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP to see whether it can replace CVP. Aims: To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR in critically ill patients on mechanical ventilation. Setting and Design: Prospective observational study in Intensive Care Unit. Methods: Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°. Statistical Analysis: Pearson′s correlation and Bland-Altman′s analysis. Results: This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004 when the CVP was 10 cmH 2 O. Bland-Altman analysis showed 95% limits of agreement to be −2.912-9.472. Conclusion: PVP can replace CVP for guiding fluid therapy in critically ill patients.

  7. Catheter-related blood stream infection caused by Raoultella ornithinolytica

    OpenAIRE

    2015-01-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. o...

  8. Catheter-related blood stream infection caused by Raoultella ornithinolytica.

    Science.gov (United States)

    Sękowska, Alicja; Dylewska, Katarzyna; Gospodarek, Eugenia; Bogiel, Tomasz

    2015-11-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. ornithinolytica and successfully treated with antibiotic therapy.

  9. Calcified central venous catheter fibrin sheath: case report and review of the literature.

    Science.gov (United States)

    Keehn, Aryeh; Rabinowitz, Dan; Williams, Steve K; Taragin, Benjamin H

    2015-01-01

    We present a 6-year-old girl with acute lymphoblastic leukemia who demonstrated on chest X-ray a radiopacity in the superior vena cava after removal of an implanted venous access device. This radiopacity was initially thought to be a retained catheter fragment. On review of previous imaging, we were able to document the temporal development of a calcified catheter cast as distinct from the catheter. This case represents a rare consequence of central venous catheterization in children. Knowledge of this finding as a possible complication may help avoid performance of unnecessary follow-up imaging or invasive procedures.

  10. Central venous catheterization: comparison between interventional radiological procedure and blind surgical reocedure

    Energy Technology Data Exchange (ETDEWEB)

    Song, Won Gyu; Jin, Gong Yong; Han, Young Min; Yu, He Chul [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2002-11-01

    To determine the usefulness and safety of radiological placement of a central venous catheter by prospectively comparing the results of interventional radiology and blind surgery. For placement of a central venous catheter, the blind surgical method was used in 78 cases (77 patients), and the interventional radiological method in 56 cases (54 patients). The male to female ratio was 66:68, and the patients' mean age was 48 (range, 18-80) years. A tunneled central venous catheter was used in 74 cases, and a chemoport in 60. We evaluated the success and duration of the procedures, the number of punctures required, and ensuing complications, comparing the results of the two methods. The success rates of the interventional radiological and the blind surgical procedure were 100% and 94.8%, respectively. The duration of central catheterization was 3-395 (mean, 120) day, that of chemoport was 160.9 days, and that of tunneled central venous catheter was 95.1 days. The mean number of punctures of the subclavian vein was 1.2 of interventional radiology, and 2.1 for blind surgery. The mean duration of the interventional radiology and the blind surgical procedure was, respectively, 30 and 40 minutes. The postprocedure complication rate was 27.6% (37 cases). Early complications occurred in nine cases (6.7%): where interventional radiology was used, there was one case of hematoma, and blind surgery gave rise to hematoma (n=2), pneumothorax (n=2), and early deviation of the catheter (n=4). Late complications occurred in 32 cases (23.9%). Interventional radiology involved infection (n=4), venous thrombosis (n=1), catheter displacement (n=2) and catheter obstruction (n=5), while the blind surgical procedure gave rise to infection (n=5), venous thrombosis (n=3), catheter displacement (n=4) and catheter obstruction (n=8). The success rate of interventional radiological placement of a central venous catheter was high and the complication rate was low. In comparison with the blind

  11. Long-term central venous lines and their complications; Langfristige zentralvenoese Zugaenge und deren Komplikationsmanagement

    Energy Technology Data Exchange (ETDEWEB)

    Teichgraeber, U.K.M.; Gebauer, B. [Klinik fuer Strahlenheilkunde, Charite Campus Virchow-Klinikum, Berlin (Germany); Benter, T. [Charite Campus Buch im Helios Klinikum Berlin, Robert-Roessle-Klinik, Berlin (Germany); Wagner, J. [Medizinisches Zentrum fuer Radiologie, Klinikum der Philipps-Univ. Marburg (Germany)

    2004-07-01

    The implantation of permanent (>14 days) central venous catheters is constantly increasing, accelerated by a trend toward outpatient therapies. Subcutaneous tunneled and non-tunneled catheters as well as port systems are available. The interventional radiologist plays an important role in the implantation of central venous catheters as well as in detection and treatment of any complications. Various access ways via peripheral and central veins are described and the implantation techniques for the different systems explained. The use of peel-away sheaths allows the radiologist to implant subcutaneous tunneled catheters via the Seldinger technique without surgical preparation. Procedure-related early and late complications may occur, and the radiologist plays an important role in the surveillance and management of catheter-associated complications. This review demonstrates the different catheter systems and implantation techniques. (orig.)

  12. High risk factors and predictive nursing countermeasures of central venous catheter related infection%中心静脉置管导管相关性感染高危因素及预见性护理对策

    Institute of Scientific and Technical Information of China (English)

    陈建玲; 刘俊芝

    2015-01-01

    目的 探讨中心静脉置管导管相关性感染(CVC-RI)的独立危险因素,为制定预见性护理措施提供依据.方法 回顾性分析我院2012年12月~2013年12月收治的193例行中心静脉置管(CVC)患者的一般资料、实验化验结果、CVC-RI发生率等,分析影响CVC-RI的独立危险因素.并对医院2013年12月~2014年12月收治的85例行CVC的患者,针对CVC-RI的高危因素,实施预见性护理措施.结果 193例行CVC的患者中,CVC-RI发生率为18.7%.Logistic回归分析显示:患者导管留置时间、自身免疫力、插管时机及病情严重程度是CVC-RI的独立危险因素;实施预见性护理后,CVC-RI的发生率为5.9%,CVC-RI发生率显著降低(P<0.05).结论 CVC患者发生感染的概率较高,与患者导管留置时间、自身免疫力、插管时机及病情严重程度有关,针对高危因素实施预见性护理,可显著降低CVC-RI的发生率.

  13. Investigation of catheter-related bloodstream infections in ICU%ICU导管相关性血流感染调查研究

    Institute of Scientific and Technical Information of China (English)

    曾翠; 陈玉华; 贾会学; 李六亿; 吴安华

    2014-01-01

    OBJECTIVE To understand the utilization rate of central venous catheters in ICU and analyze the daily incidence of central venous catheter-related bloodstream infections so as to provide guidance for control of the central venous catheter-related bloodstream infections .METHODS The new definition of Central Line Associated Blood Stream Infection which was promulgated by the United States Centers for Disease Control in 2013 was viewed as the diagnostic criteria ,the patients who underwent central venous catheterization in 55 ICUs of 41 hospitals from Oct 1 , 2013 to Mar 31 , 2014 were monitored , and the baseline data , catheterization , and information of infections of the monitoring objects were completed ,and the statistical analysis was performed with the use of SPSS 10 .0 software .RESULTS A total of 4 256 patients were monitored ,with 51159 days of central venous catheter indwelling involved ;the infections occurred in 133 cases with the daily infection rate of 2 .60‰ , the daily infection rate was lowest in the ICUs of the cardiology department and the pediatric department .The daily infection rate was lowest in Guizhou province (0 .69‰) ,highest in general ICUs ( 2 .81‰) and Guangdong province (14 .22‰) .The average utilization rate of central venous catheter was 44 .12% ;the utilization rates was lowest in the ICUs of pediatric department (5 .91% ) and was lowest in Shandong province (26 .77% );the utilization rate was highest in the ICUs of surgery department (63 .21% ) and was highest in Guizhou province (90 .75% ) . CONCLUSION The average daily infection rate of central venous catheter-related bloodstream infections is slightly higher in those investigated hospitals than abroad and the rest parts of China .It is necessary to strengthen the operation training of the health care workers and pay attention to the maintenance of the catheters so as to ensure the safety of catheterization nursing of the patients .%目的:了解医院IC U中心静脉

  14. [Injuries to blood vessels near the heart caused by central venous catheters].

    Science.gov (United States)

    Abram, J; Klocker, J; Innerhofer-Pompernigg, N; Mittermayr, M; Freund, M C; Gravenstein, N; Wenzel, V

    2016-11-01

    Injuries to blood vessels near the heart can quickly become life-threatening and include arterial injuries during central venous puncture, which can lead to hemorrhagic shock. We report 6 patients in whom injury to the subclavian artery and vein led to life-threatening complications. Central venous catheters are associated with a multitude of risks, such as venous thrombosis, air embolism, systemic or local infections, paresthesia, hemothorax, pneumothorax, and cervical hematoma, which are not always immediately discernible. The subclavian catheter is at a somewhat lower risk of catheter-associated sepsis and symptomatic venous thrombosis than approaches via the internal jugular and femoral veins. Indeed, access via the subclavian vein carries a substantial risk of pneumo- and hemothorax. Damage to the subclavian vein or artery can also occur during deliberate and inadvertent punctures and result in life-threatening complications. Therefore, careful consideration of the access route is required in relation to the patient and the clinical situation, to keep the incidence of complications as low as possible. For catheterization of the subclavian vein, puncture of the axillary vein in the infraclavicular fossa is a good alternative, because ultrasound imaging of the target vessel is easier than in the subclavian vein and the puncture can be performed much further from the lung.

  15. Correlation between Arterial Lactate and Central Venous Lactate in Children with Sepsis

    Directory of Open Access Journals (Sweden)

    Jaime Fernández Sarmiento

    2016-01-01

    Full Text Available Introduction. Lactate is an important indicator of tissue perfusion. The objective of this study is to evaluate if there are significant differences between the arterial and central venous measurement of lactate in pediatric patients with sepsis and/or septic shock. Methods. Longitudinal retrospective observational study. Forty-two patients were included between the age of 1 month and 17 years, with a diagnosis of sepsis and septic shock, who were admitted to the intensive care unit of a university referral hospital. The lactate value obtained from an arterial blood sample and a central venous blood sample drawn simultaneously, and within 24 hours of admission to the unit, was recorded. Results. The median age was 2.3 years (RIC 0,3–15, with a predominance of males (71.4%, having a 2.5 : 1 ratio to females. Most of the patients had septic shock (78.5% of pulmonary origin (50.0%, followed by those of gastrointestinal origin (26.1%. Using Spearman’s Rho, a 0.872 (p<0.001 correlation was found between arterial and venous lactate, which did not vary when adjusted for age (p<0.05 and the use of vasoactive drugs (p<0.05. Conclusion. There is a good correlation between arterial and venous lactate in pediatric patients with sepsis and septic shock, which is not affected by demographic variables or type of vasoactive support.

  16. Non-invasive bedside assessment of central venous pressure: scanning into the future.

    Directory of Open Access Journals (Sweden)

    Jacques Rizkallah

    Full Text Available Noninvasive evaluation of central venous pressure (CVP can be achieved by assessing the Jugular Venous Pressure (JVP, Peripheral Venous Collapse (PVC, and ultrasound visualization of the inferior vena cava. The relative accuracy of these techniques compared to one another and their application by trainees of varying experience remains uncertain. We compare the application and utility of the JVP, PVC, and handheld Mini Echo amongst trainees of varying experience including a medical student, internal medicine resident, and cardiology fellow. We also introduce and validate a new physical exam technique to assess central venous pressures, the Anthem sign.Patients presenting for their regularly scheduled echocardiograms at the hospital echo department had clinical evaluations of their CVP using these non-invasive bedside techniques. The examiners were blinded to the echo results, each other's assessments, and patient history; their CVP estimates were compared to the gold standard level 3 echo-cardiographer's estimates at the completion of the study.325 patients combined were examined (mean age 65, s.d. 16 years. When compared to the gold standard of central venous pressure by a level 3 echocardiographer, the JVP was the most sensitive at 86%, improving with clinical experience (p<0.01. The classic PVC technique and Anthem sign had better specificity compared to the JVP. Mini Echo estimates were comparable to physical exam assessments.JVP evaluation is the most sensitive physical examination technique in CVP assessments. The PVC techniques along with the newly described Anthem sign may be of value for the early learner who still has not mastered the art of JVP assessment and in obese patients in whom JVP evaluation is problematic. Mini Echo estimates of CVPs are comparable to physical examination by trained clinicians and require less instruction. The use of Mini Echo in medical training should be further evaluated and encouraged.

  17. 心脏术后中心静脉导管不同留置途径感染的观察及分析%Infection Rate of Different Approach for Central Venous Catheter Placement after Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    安淑芬; 芮晨

    2012-01-01

    目的 观察中心静脉导管不同途径置管的感染率,探讨其相关危险因素及防治措施,为临床预防和减少导管相关性感染提供参考依据.方法 对2009~2010年的198例心脏直视术后采取经股静脉、锁骨下静脉、外周静脉放置中心静脉导管,中心静脉导管尖端培养阳性患者的临床资料进行统计性分析.结果 经锁骨下静脉途径的感染率为7.84%,经股静脉途径的感染率为23.61%,周围静脉感染率为6.89%,中心静脉管道的感染的病原菌中革兰氏阳性菌有12例,占57.1%;革兰氏阴性菌有8例,占38.1%;真菌1例,占4.8%.结论 中心静脉导管感染率与不同留置途径具有不同程度差异,但股静脉穿刺途径和锁骨下静脉及周围静脉差异有统计学意义(P<0.05),中心静脉留置管道感染的致病菌以革兰氏阳性菌为主.%Objective To observe the infection rate of different approach for central venous catheter placement after cardiac surgery and explore the related risk factors,prevention and control measures,so as to provide references for the clinical preventive practices and reducing CVC-correlated infections. Methods The 198 cases of open heart surgery from 2009 to 2010 were enrolled in this study. They underwent the central venous catheter placement by approaches of femoral vein, subclavian vein or peripheral venous. The clinical materials of patients with a positive result of bacterial culture of the catheter tips were collected and analyzed with statistical techniques. Results The infection rates of subclavian vein, femoral vein, peripheral venous catheter-related were 7. 84% ,23. 6% and 6. 89% , respectively. Among the infectious pathogenic bacteria in central venous pipeline, there were 12 cases of gram-positive bacterium which account for 57.1% ,8 cases of Gram-negative bacterium for 38.1% and 1 case of fungus for 4.8%. Conclusion The different degrees difference in the infection rates was founded

  18. Airway compromise during central venous cannulation in an undiagnosed tubercular retropharyngeal abscess: A case report

    Directory of Open Access Journals (Sweden)

    Sujay Samanta

    2015-01-01

    Full Text Available Central venous cannulation is often associated with complications during insertion even by expert′s hand and with the aid of ultrasound. We encountered a patient for central line insertion through the right internal jugular vein having a retropharyngeal abscess of tubercular origin. We accidentally punctured the abscess cavity leading to increased respiratory distress and subsequent need of intubation to the patient. This kind of complication during central line insertion has never been reported before. We intend to report such a case to alert everyone about the grave complications it can lead to and the methods to minimize them in the times ahead.

  19. Radiographic inguinal curl may indicate paraspinal misplacement of percutaneously inserted central venous catheters: report of three cases

    Energy Technology Data Exchange (ETDEWEB)

    Chedid, Faris [Al Tawam Hospital, Department of Paediatrics, Al Ain, Abu Dhabi (United Arab Emirates); Abbas, Adil [Royal Children' s Hospital, Department of Clinical Haematology/Oncology, Brisbane (Australia); Morris, Lloyd [Women' s and Children' s Hospital, Department of Medical Imaging, Adelaide (Australia)

    2005-07-01

    Misplacement of percutaneously inserted central venous catheters (PCVCs) into the paraspinal venous plexus can result in devastating outcomes. Several cases have been reported in the literature together with an explanation of the mechanism. To describe three premature babies with their PCVCs inserted through the left saphenous vein that ended up in the lumbar spinal dural venous plexus. Plain radiographs obtained to check positions showed an unusual 360 curl of the PCVC in the left inguinal area. We believe that misplacement of the catheter into the paraspinal venous plexus could be diagnosed with great accuracy if such a curl is seen. (orig.)

  20. Implantable central venous chemoport: camparision of results according to approach routes and methods

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Byung Suck; Ahn, Moon Sang [Chungnam National University Hospital, Taejon (Korea, Republic of)

    2003-09-01

    To evaluate the results and complications of placement of implantable port according to approach routes and methods. Between April 2001 and October 2002, a total of 103 implantable chemoport was placed in 95 patients for chemotherapy using preconnected type (n=39) and attachable type (n=64). Puncture sites were left subclavian vein (n=35), right subclavian vein (n=5), left internal jugular vein (n=9), right internal jugular vein (n=54). We evaluated duration of catheterization days, complications according to approach routes and methods. Implantable chemoport was placed successfully in all cases. Duration of catheterization ranged from 8 to 554 days(mean 159, total 17,872 catheter days). Procedure related complications occurred transient pulmonary air embolism (n=1), small hematoma (n=1) and malposition in using preconnected type (n=2). Late complications occurred catheter migration (n=5), catheter malfunction (n=3), occlusion (n=1) and infection (n=11). Among them 15 chemoport was removed (14.5%). Catheter migration was occured via subclavian vein in all cases (13%, p=.008). Infection developed in 10.7% of patients(0.61 per 1000 catheter days). There were no catheter-related central vein thrombosis. Implantation of chemoport is a safe procedure. Choice of right internal jugular vein than subclavian vain vein for puncture site has less complications. And selection of attachable type of chemoport is convenient than preconnected type. Adequate care of chemoport is essential for long patency.

  1. How long should umbilical venous catheters remain in place in neonates who require long-term (≥5-7 days) central venous access?

    Science.gov (United States)

    Keir, Amy; Giesinger, Regan; Dunn, Michael

    2014-08-01

    In this evidenced-based review, we examine the current available literature to help answer the question 'In neonates requiring long-term central access [patient], does removal of the umbilical venous catheter (UVC) on days 5-7 and replacement with a peripherally inserted central catheter line [intervention] compared with leaving the UVC in situ [comparison] reduce rates of central line-associated bloodstream infections [outcome]?'

  2. ICU中心静脉导管相关性血流感染持续质量改进的成效分析%Assessment of effect of continuous quality improvement on catheter-related bloodstream infections in ICU

    Institute of Scientific and Technical Information of China (English)

    林娟; 钟既宁; 陈丽; 胡才宝; 蔡国龙

    2013-01-01

    OBJECTIVE To explore the effect of targeted surveillance and interventions on prevention and control of the catheter-related bloodstream infections in the intensive care unit (ICU) so as to reduce the incidence of infections.METHODS The patients with the central venous catheter-related infections,who were hospitalized the ICU from Jan 2009 to Dec 2010,were enrolled in the study,then the incidence of the central venous catheter-related infections was investigated by using the targeted monitoring method,the causes were analyzed,the continuous quality improvement was performed,the education and supervision of the medical staff was intensified,and the quality of maintenance of the catheter was improved after the catheterization.RESULTS Totally 147 patients with indwelling central venous catheters were included before the continuous quality improvement in 2009,with the mean catheterization duration of(33.84±30.89) days,4569 days in total,23 cases were diagnosed as the infections with the mean infection rate of 5.03 per 1000 catheter-days; totally 141 cases of patients underwent central venous catheterization after the continuous quality improvement in 2010,ith the mean catheterization duration of (36.78 ±43.54) days,5014 days in total,and 13 cases were diagnosed as infections with the mean infection rate of 2.59 per 1000 catheter-days.The mean catheterization duration of the patients with bloodstream infections was (47.23 ± 37.61) days,the incidence of catheter-related infections was 8.88 % in the patients with the catheterization duration no more than 7 days,58.3% in the patients with the catheterization duration more than 90 days,with the mean incidence rate of the central venous catheter-related blood stream infections dropping from 5.03‰ in 2009 to 2.59‰ in 2010.CONCLUSION The targeted monitoring combined with continuous quality improvement can effectively reduce the incidence of central venous catheter-related bloodstream infections in the ICU patients

  3. β-Catenin-dependent transcription is central to Bmp-mediated formation of venous vessels.

    Science.gov (United States)

    Kashiwada, Takeru; Fukuhara, Shigetomo; Terai, Kenta; Tanaka, Toru; Wakayama, Yuki; Ando, Koji; Nakajima, Hiroyuki; Fukui, Hajime; Yuge, Shinya; Saito, Yoshinobu; Gemma, Akihiko; Mochizuki, Naoki

    2015-02-01

    β-catenin regulates the transcription of genes involved in diverse biological processes, including embryogenesis, tissue homeostasis and regeneration. Endothelial cell (EC)-specific gene-targeting analyses in mice have revealed that β-catenin is required for vascular development. However, the precise function of β-catenin-mediated gene regulation in vascular development is not well understood, since β-catenin regulates not only gene expression but also the formation of cell-cell junctions. To address this question, we have developed a novel transgenic zebrafish line that allows the visualization of β-catenin transcriptional activity specifically in ECs and discovered that β-catenin-dependent transcription is central to the bone morphogenetic protein (Bmp)-mediated formation of venous vessels. During caudal vein (CV) formation, Bmp induces the expression of aggf1, a putative causative gene for Klippel-Trenaunay syndrome, which is characterized by venous malformation and hypertrophy of bones and soft tissues. Subsequently, Aggf1 potentiates β-catenin transcriptional activity by acting as a transcriptional co-factor, suggesting that Bmp evokes β-catenin-mediated gene expression through Aggf1 expression. Bmp-mediated activation of β-catenin induces the expression of Nr2f2 (also known as Coup-TFII), a member of the nuclear receptor superfamily, to promote the differentiation of venous ECs, thereby contributing to CV formation. Furthermore, β-catenin stimulated by Bmp promotes the survival of venous ECs, but not that of arterial ECs. Collectively, these results indicate that Bmp-induced activation of β-catenin through Aggf1 regulates CV development by promoting the Nr2f2-dependent differentiation of venous ECs and their survival. This study demonstrates, for the first time, a crucial role of β-catenin-mediated gene expression in the development of venous vessels.

  4. Central Venous Access via Middle Approach Using the Seldinger Guidewire

    OpenAIRE

    Miguel Muñoz Cepero; Asiris García Almeida; Lisandra Muñoz López

    2013-01-01

    Fundamento: En los últimos tiempos se está realizando con mayor frecuencia el acceso venoso por vía media con la técnica descrita por English, lo que supone menor riesgo de neumotórax y de punción arterial, además de su fácil realización. Objetivo: caracterizar el empleo del acceso venoso central por vía yugular media con uso de Seldinger en pacientes con enfermedades hematológicas y/o tratamiento con anticoagulantes. Métodos: estudio descriptivo, realizado desde enero a diciembre del 2009, e...

  5. Surveillance and analysis of central venous catheter-associated bloodstream infections in children with congenital heart disease after cardiac surgery%小儿先天性心脏病手术后中心静脉导管相关性血流感染调查分析

    Institute of Scientific and Technical Information of China (English)

    胡梅英; 陈修文; 乐萍

    2013-01-01

    OBJECTIVE To investigate the incidence of the central venous catheter-associated bloodstream infections in the children with congenital heart disease (CHD) after cardiac surgery and observe the distribution of pathogens. METHODS The targeted surveillance was performed for 928 children with CHD who were treated in the cardiac ICU from Jan to Dec 2012, and the children with the indwelling catheter duration over 48 hours and the children with the extubation time less than 48 hours were selected as the study objects, then the incidence of the central venous catheter-related bloodstream infections and the isolation of pathogens were analyzed. RESULTS Totally 15 cases were diagnosed as the central venous catheter-related bloodstream infections with the incidence of 1. 62% and 3. 79/1. 000 catheter days; totally 23 strains of pathogens were isolated from peripheral vein blood and/or catheter tips, which were mainly the gram-egative bacteria, and the Acinetobacter baumannii, Pseudo-monas aeruginosa and Serratia marcescens were the top three species. CONCLUSION The children with CHD are at high risk of the central-venous catheter-related bloodstream infections, it is necessary to strengthen the surveillance of the central venous catheter-related bloodstream infections in the children after cardiac surgery and take interventions so as to reduce the incidence of nosocomial infections.%目的 探讨小儿先天性心脏病(先心病)患儿术后,中心静脉导管相关血流感染(CLA-BSI)发生水平及病原菌分布特点.方法 对2012年1-12月心脏病治疗中心手术治疗的928例先心病患儿进行CLA-BSI目标性监测,将中心静脉导管留置时间>48 h或拔除导管<48 h内的先心病术后患儿作为研究对象,对CLA-BSI发生水平和病原菌检出进行分析.结果 共诊断CLA-BSI病例15例,感染率为1.62%,每千个导管日感染为3.79%;经外周静脉血或(和)中心静脉导管尖端标本共检出病原菌23株,病原菌以革

  6. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  7. Radiographic mislead: apparent arterial placement of subclavian central venous catheter due to mediastinal shift

    Directory of Open Access Journals (Sweden)

    Shaji Mathew

    2014-01-01

    Full Text Available Optimal placement of central venous catheters (CVC is essential for accurate monitoring of central venous pressure (CVP in major surgeries and ensuring long-term use of the catheter for managing the critically ill patient. Accidental subclavian artery catheterization is one of the most serious complications of the procedure. Radiography is commonly used to ensure optimal placement of CVC tip and rule out subclavian artery catheterization in the absence of Doppler ultrasound and a pressure transducer. We present a case of a haemodynamically unstable and hypoxaemic patient with mediastinal shift, in which the anaesthesiologist was in a dilemma about the arterial placement of the right subclavian CVC. The CVC crossing the midline due to mediastinal shift gave the false impression of it being placed in subclavian artery rather than the vein. Subsequently, it was proved to be correctly placed in the subclavian vein.

  8. Lights, camera and action in the implementation of central venous catheter dressing1

    Science.gov (United States)

    Ferreira, Maria Verônica Ferrareze; de Godoy, Simone; de Góes, Fernanda dos Santos Nogueira; Rossini, Fernanda de Paula; de Andrade, Denise

    2015-01-01

    Objective: to develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters. PMID:26626011

  9. Lights, camera and action in the implementation of central venous catheter dressing

    Directory of Open Access Journals (Sweden)

    Maria Verônica Ferrareze Ferreira

    2015-12-01

    Full Text Available Objective: to develop and validate an educational digital video on changing the dressing of short-term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire's assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers' experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters.

  10. Epidemiology and prevention of catheter-related thrombosis in patients with cancer

    NARCIS (Netherlands)

    Lee, A. Y. Y.; Kamphuisen, P. W.

    2012-01-01

    . Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to

  11. Evaluation of the Necessity of Port Fixation in Central Venous Port Implantation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Su; Kim, Hyung Pil [Inje University Pusan Paik Hospital, Busan (Korea, Republic of); Bae, Jae Ik; Won, Je Hwan [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2010-06-15

    The technical success and complications were especially focused on and evaluated the need for fixation of a port under fluoroscopic guidance placement of the totally implantable central venous access ports for long term central venous access. Two hundred eighty nine consecutive patients (170 men, 119 women, mean age: 52-year-old) who underwent venous port implantation for the administration of chemotherapy were followed over a 1-month period. The procedures were performed in the angiographic suite by an interventional radiologist and all access was through the right jugular vein, except for the patients who had undergone a right mastectomy. The procedures were performed in the following order: 1) venous puncture, 2) making a pocket, 3) catheter tunneling, 4) port insertion, 5) catheter sizing, and 6) insertion. A port which was connected to the tunneled catheter was inserted into the minimally sized subcutaneous pocket with the aid of a small retractor. A follow-up was performed with medical records and chest radiographs. The follow-up period for evaluating the venous port ranged from 59 to 329 days (mean: 175 days) The procedures performed to gain right jugular vein access were successful without difficulty in all cases. The 18 patients that underwent procedures to gain left jugular vein access encountered some difficulty upon insertion of a catheter into the SVC due to encountering the tortuous left brachiocephalic vein. No complications occurred during and immediately after the procedure. In one case the port chamber rotated within the subcutaneous pocket; however, no catheter migration or malfunction occurred. If port insertion was followed by catheter insertion, the port chamber can be tightly implanted in the minimally sized pocket. This would avoid the need for fixation of the catheter to the port chamber leading into the pocket

  12. Impact of different catheter lock strategies on bacterial colonization of permanent central venous hemodialysis catheters.

    Science.gov (United States)

    Erb, Stefan; Widmer, Andreas F; Tschudin-Sutter, Sarah; Neff, Ursula; Fischer, Manuela; Dickenmann, Michael; Grosse, Philipp

    2013-12-01

    Thirty-nine hemodialysis patients with permanent central venous catheters were analyzed for bacterial catheter colonization comparing different catheter-lock strategies. The closed needleless Tego connector with sodium chloride lock solution was significantly more frequently colonized with bacteria than the standard catheter caps with antimicrobially active citrate lock solution (odds ratio, 0.22 [95% confidence interval, 0.07-0.71]; P = .011).

  13. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation

    Directory of Open Access Journals (Sweden)

    Gopal Krishan Jalwal

    2014-01-01

    Full Text Available The placement of central venous catheter using Seldinger′s technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described.

  14. Cardiac Effects of Echinocandins after Central Venous Administration in Adult Rats

    OpenAIRE

    2014-01-01

    Echinocandins have become the agents of choice for early and specific antifungal treatment in critically ill patients. In vitro studies and clinical case reports revealed a possible impact of echinocandin treatment on cardiac function. The aim of our study was to evaluate echinocandin-induced cardiac failure. Using an in vivo rat model, we assessed hemodynamic parameters and time to hemodynamic failure after central venous application (vena jugularis interna) of anidulafungin (low-dose group,...

  15. [Survival and complication rate of central venous catheters in newborns].

    Science.gov (United States)

    García, Heladia Josefa; Torres-Yáñez, Héctor Leonardo

    2015-01-01

    Introducción: los catéteres venosos centrales (CVC) son de gran utilidad en la práctica médica actual; sin embargo, no están exentos de riesgos, lo que incrementa la morbilidad y mortalidad, especialmente en los recién nacidos (RN). El objetivo fue registrar la frecuencia de complicaciones de los CVC y su duración en RN en una unidad de cuidados intensivos neonatales (UCIN) de tercer nivel. Métodos: se realizó un estudio observacional descriptivo, prolectivo en la UCIN del Hospital de Pediatría del Centro Médico Nacional Siglo XXI. Se registraron variables demográficas, perinatales y del CVC. Resultados: se incluyeron 123 RN a quienes se les colocaron 152 CVC. La técnica más usada para la inserción del CVC fue la punción (percutánea o subclavia) en 56.6 % (n = 86). En 48.7 % (n = 74) de los CVC se presentó alguna complicación. Las más frecuentes fueron colonización en 32.4 % (n = 24) y bacteriemia relacionada con CVC en 27 % (n = 20). La probabilidad de duración de los CVC libres de complicaciones fue de 93.4 % a los 10 días y de 91.4 % a los 17 días. Los catéteres venosos no centrales tuvieron menor probabilidad de duración. Conclusión: la mayoría de las complicaciones de los CVC se presentaron en las primeras dos semanas de haber sido instalados. Las complicaciones infecciosas fueron las más frecuentes.

  16. Endovascular treatment of central venous stenosis and obstruction in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    SHI Ya-xue; YE Meng; LIANG Wei; ZHANG Hao; ZHAO Yi-ping; ZHANG Ji-wei

    2013-01-01

    Background Central venous stenosis and obstruction (CVD) is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemodialysis patients.This study aimed to summarize our experience of the endovascular management of the central venous stenosis or obstruction in hemodialysis patients.Methods Twenty-four haemodialysis cases of central vein stenosis or obstruction with ipsilateral functional vascular access in our hospital between July 2006 and February 2012 were treated by interventional therapy and the data were analyzed retrospectively.Results Eighteen males and six females with mean age of (66.4±13.8) years and manifesting with arm swelling and venous hypertension were enrolled; 62.5% of them had a history of catheterization.Venography showed stenotic lesion in 10 cases including eight cases of brachiocephalic vein stenosis and two cases of subclavian vein stenosis and 14 cases of obstruction lesions including seven cases of short brachiocephalic obstruction and seven cases of long segment obstruction.Interventional therapy was performed and the technique success rate was 83.3%.Percutaneous transluminal angioplasty (PTA) was performed in nine cases and stent was performed in 11 cases firstly.The symptoms of venous hypertension were resolved after intervention in all the cases.There was no major complication and death perioperatively.During follow-up,reintervention was done,the primary patency rates were (88.9±10.5)%,(64.8±10.5)% and (48.6±18.7)% at 3 months,6 months and 1 year after treatment in the PTA group; (90.0±9.5)% and (77.1±14.4)% at 6 months and 1 year after treatment in the stent group,respectively.The secondary patency rates were (48.6±18.7)% in the PTA group and (83.3±15.2)% in the stent group 1 year after treatment,respectively.There was no significant difference between the two groups (primary patency,P=0.20; secondary patency,P=0

  17. Predicting the optimal depth of left-sided central venous catheters in children.

    Science.gov (United States)

    Kim, H; Jeong, C-H; Byon, H-J; Shin, H K; Yun, T J; Lee, J-H; Park, Y-H; Kim, J-T

    2013-10-01

    The aim of this study was to predict the optimal depth for insertion of a left-sided central venous catheter in children. Using 3D chest computed tomography angiography, we measured the distance from a point where the internal jugular vein is at the superior border of the clavicle, and from a point where the subclavian vein is inferior to the anterior border of the clavicle, to the junction of the superior vena cava and the right atrium in 257 children. Linear regression analysis revealed that the distances correlated with age, weight and height. Simple formulae for the depth of a central venous catheter via the left internal jugular vein (0.07 × height (cm)) and the left subclavian vein (0.08 × height (cm)) were developed to predict placement of the central venous catheter tip at the junction of the superior vena cava with the right atrium. Using these fomulae, the proportion of catheter tips predicted to be correctly located was 98.5% (95% CI 96.8-100%) and 94.0% (95% CI 90.8-97.3%), respectively.

  18. Central venous catheter infection of 521 patients in ICU%521例ICU患者中心静脉导管感染分析

    Institute of Scientific and Technical Information of China (English)

    张明; 钱俊英; 解建; 李涛; 徐拥庆; 杨君; 姜志明; 张众慧

    2011-01-01

    目的 分析ICU患者留置中心静脉导管感染的病原学及感染危险因素,探讨中心静脉导管感染的防治策略.方法 回顾性分析2000年1月-2009年11月ICU送检中心静脉导管尖端培养521份标本的培养结果,数据行线性趋势χ2检验.结果 521例中培养阳性209例,分离出真菌73株占34.93%,革兰阳性菌62株占29.66%,革兰阴性菌74株占35.41%;颈内静脉和股静脉导管培养阳性率大于锁骨下静脉;置管时间8~14 d的阳性率最高;普通管感染高于血液透析管和抗感染管.结论 中心静脉导管感染与静脉置管类型、部位、留置时间具有相关性,革兰阴性杆菌和真菌感染为主要的病原菌;ICU应加强对导管感染的预防措施.%OBJECTIVE To analyze the aetiology and risk factors of central venous catheter infections in ICU patients, to explore the prophylaxis and treatment for catheter-related infections.METHODS A total of 521 cases collected from Jan 2000 to Nov 2009 in intensive care unit (ICU) of our hospital were analyzed retrospectively.RESULTS Among 521 cases, 209 cases were with positive results of fungi, accounting for 34.93% and G+(29.66%) and G- (35.41%).The positive rates of internal jugular vein and femoral vein catheter were higher than that of subclavian vein catheter.The positive rates of indwelling time for 8-14 days were the highest.The infection rate of common catheter was higher than that of hemodialysis and anti-infection catheter.CONCLUSIONS Central venous cathete infection is related to the catheter type, the indwelling location and time.Fungi and G- are the major pathogens.It is necessary to adopt a series of preventive measures for the catheter infections.

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

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    Faisal A. Khasawneh

    2011-01-01

    Full Text Available Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. 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.

  20. Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

    Directory of Open Access Journals (Sweden)

    Juliana Deh Carvalho Machado

    2009-12-01

    Full Text Available OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68% estavam infectados, sendo 72% do Grupo 1 e 28% do Grupo 2 (assintomáticos. No Grupo 1, houve infecção sistêmica em 70% dos casos, já no Grupo 2 a hemocultura foi positiva em 17% dos casos. A colonização por Staphylococcus sp. ocorreu em 48% dos casos, seguida de Candida sp. (21%, Enterococcus faecalis (16%, Pseudomonas aerurginosa (10% e Proteus sp.(5%. CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed

  1. Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: Experience in a single hospital

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, C.-C.; Tsai, T.-N. [Division of Cardiology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan (China); Yang, C.-C. [Department of Medicine, Armed Forces Tao-Yuan General Hospital, Taoyuan, Taiwan (China); Han, C.-L. [Division of Cardiology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan (China)], E-mail: allexll.cheng@msa.hinet.net

    2009-02-15

    Objective: To investigate the clinical presentation of dislodged totally implantable central venous access system (central venous port-catheter) fragments and the efficacy and safety of percutaneous retrieval of them in our hospital. Materials and methods: Ninety-two cancer patients, mean age of 53.8 years old with 51.1% male, were enrolled from January 2005 to March 2007. They were referred to our catheterization laboratory for retrieval of fractured central venous port-catheter in our hospital. All patients were followed in the outpatient department for at least 1 month after surgical insertion. The characteristics of disrupted central venous port-catheter were recorded. The procedure-related clinical condition was evaluated. Results: The most common presentation of central venous port-catheter dislodgement is irrigation resistance to infusion (51/92). The most common location of fractured fragments is between superior vena cava and right atrium (i.e. proximal end remained in superior vena cava and distal end in right atrium) (22/92). The most common fracture site of the catheter is at the anastomosis between injection port and catheter (77/92). The retrieval set used mostly is loop snare. The success rate of the percutaneous retrieval of dislodged fragment was 97.8% and the complication rate was 3.3% only. Conclusion: The faulty connection between catheter and injection port contributes mainly to dislodgement of central venous port-catheter. Percutaneous retrieval of dislodged catheter is a highly successful, safe and efficient method.

  2. 抗感染中心静脉导管临床应用的研究%Effect of clinical application of anti-infective central venous catheter

    Institute of Scientific and Technical Information of China (English)

    谢明英; 申建维; 刘显畅

    2014-01-01

    目的:探讨抗感染中心静脉导管在减少导管相关性感染和细菌定植中的作用,以降低导管相关感染率。方法选取2011年5月-2013年5月于IC U行深静脉置管患者64例,随机分为观察组和对照组,各32例,对照组采用普通中心静脉导管,观察组采用黄嘧啶银和氯己定抗感染中心静脉导管,观察比较两组患者导管留置、导管拔除、导管相关性感染和细菌定植。结果留置导管时间观察组为(14.5±2.6)d,对照组为(8.3±3.7)d,观察组留置导管时间长于对照组,两组比较差异有统计学意义(χ2=6.563,P<0.05),观察组无局部感染,对照组局部感染6例感染率18.75%,观察组局部感染、导管细菌定植例数明显少于对照组,两组比较差异有统计学意义(P<0.05);观察组细菌定植和感染延时显著优于对照组,差异有统计学意义(P<0.001)。结论抗感染中心静脉导管在减少导管相关性感染和细菌定植中具有重要的积极作用,但导管留置时间>两周,抗感染中心静脉导管的细菌定植和导管相关性感染明显增加,通过缩短导管留置时间是减少导管相关性感染的重要手段。%OBJECTIVE To explore the effect of use of anti-infective central venous catheter on reduction of incidence of catheter-related infections or bacterial colonization so as to reduce the incidence of catheter-related infections .METHODS Totally 64 patients who underwent the deep venous catheterization in the ICU from May 2011 to May 2013 were enrolled in the study and randomly divided into the observation group and the control group ,with 32 cases in each group ,the control group was treated with conventional central venous catheter ,while the observation group was given yellow-Ag and chlorhexidine anti-infective central venous catheter ; the intubation ,extubation , catheter-associated infections , and bacterial

  3. The economics of hemodialysis catheter-related infection prophylaxis.

    Science.gov (United States)

    Kosa, S Daisy; Lok, Charmaine E

    2013-01-01

    Hemodialysis central venous catheter (CVC) use is associated with the highest morbidity, mortality, and cost of all types of hemodialysis vascular access. CVC-related infection drives much of the cost associated with CVC use. The magnitude of the cost associated with CVC-related infection varies depending on the type and severity of that infection; however, estimates of the total direct and indirect costs associated with hospitalizations due to hemodialysis CVC-related infections range from 17,000 USD to 32,000 USD per episode. Thus, it is critically important, to not only have effective strategies to limit CVC-related infection but also evaluate whether these strategies are an efficient use of resources. Prophylactic strategies can be considered economically efficient only if the value of its implementation and the corresponding drop in infection rate offer greater value than standard care. The optimal CVC-related infection prophylaxis strategy should work to limit infection risk with minimal risk, inconvenience, and discomfort to the patient, and at minimal cost. The aim of this review was to examine the clinical and economic impact of some commonly described interventions used for CVC infection prophylaxis.

  4. Central venous catheter insertion problem solving using intravenous catheter: technical communication

    Directory of Open Access Journals (Sweden)

    Alemohammad M

    2013-02-01

    Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

  5. Clinical Risk Factors For Central Line Associated Venous Thrombosis (CLAVT In Children

    Directory of Open Access Journals (Sweden)

    Samir H Shah

    2015-05-01

    Full Text Available ABSTRACTBackground: Identifying risk factors related to Central Venous Line (CVL placement could potentially minimize Central Line-Associated Venous Thrombosis (CLAVT. We sought to identify the clinical factors associated with CLAVT in children. Methods: Over a 3-year period, 3,733 CVLs were placed at a tertiary-care children’s hospital. Data were extracted from the electronic medical records of patients with clinical signs and symptoms of venous thromboembolism (VTE, diagnosed using Doppler ultrasonography and/or echocardiography. Statistical analyses examined differences in CLAVT occurrence between groups based on patient and CVL characteristics (type, brand, placement site, and hospital unit. Results: Femoral CVL placement was associated with greater risk for developing CLAVT (OR 11.1, 95% CI 3.9-31.6, p<0.0001. CVLs placed in the NICU were also associated with increased CLAVT occurrence (OR 5.3, 95% CI 2.1-13.2, p=0.0003. CVL brand was also significantly associated with risk of CLAVT events. Conclusion: Retrospective analyses identified femoral CVL placement and catheter type as independent risk factors for CLAVT, suggesting increased risks due to mechanical reasons. Placement of CVLs in the NICU also led to an increased risk of CLAVT, suggesting that small infants are at increased risk of thrombotic events. Alternative strategies for CVL placement, thromboprophylaxis, and earlier diagnosis may be important for reducing CLAVT events.

  6. Air Embolism after Central Venous Catheter Removal: Fibrin Sheath as the Portal of Persistent Air Entry

    Directory of Open Access Journals (Sweden)

    Meggiolaro Marco

    2013-01-01

    Full Text Available Central venous catheterization is of common practice in intensive care units; despite representing an essential device in various clinical circumstances, it represents a source of complications, sometimes even fatal, related to its management. We report the removal of a central venous catheter (CVC that had been wrongly positioned through left internal jugular vein. The vein presented complete thrombosis at vascular ultrasonography. An echocardiogram performed 24 hours after CVC removal showed the presence, apparently unjustified, of microbubbles in right chambers of the heart. A neck-thorax CT scan showed the presence of air bubbles within the left internal jugular vein, left innominate vein, and left subclavian vein. A vascular ultrasonography, focused on venous catheter insertion site, disclosed the presence of a vein-to-dermis fistula, as portal of air entry. Only after air occlusive dressing, we documented echographic disappearance of air bubbles within the right cardiac cavity. This report emphasizes possible air entry even many hours after CVC removal, making it mandatory to perform 24–72-hour air occlusive dressing or, when inadequate, to perform a purse string.

  7. Central venous stenosis in haemodialysis patients without a previous history of catheter placement

    Energy Technology Data Exchange (ETDEWEB)

    Oguzkurt, Levent [Baskent University, Adana Teaching and Medical Research Centre, Department of Radiology, Adana (Turkey)]. E-mail: loguzkurt@yahoo.com; Tercan, Fahri [Baskent University, Adana Teaching and Medical Research Centre, Department of Radiology, Adana (Turkey); Yildirim, Sedat [Baskent University, Adana Teaching and Medical Research Centre, Department of Surgery, Adana (Turkey); Torun, Dilek [Baskent University, Adana Teaching and Medical Research Centre, Department of Nephrology, Adana (Turkey)

    2005-08-01

    Objective: To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Material and methods: Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Results: Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Conclusion: Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

  8. Central venous access through the external jugular vein in children submitted to bone marrow transplantation

    Directory of Open Access Journals (Sweden)

    José Luiz de Godoy

    2005-01-01

    Full Text Available Establishment of long-term central venous access is a sine qua non step for bone marrow transplantation in children. Most frequently, long-term central venous access has been obtained via blind percutaneous cannulation of subclavian and internal jugular veins or via internal jugular vein cutdown. In order to avoid some potential minor and major complications associated with the subclavian or internal jugular approaches, the authors describe an easy, simple and safe method for central venous access through an external jugular vein cutdown that should be of interest to readers involved in the field of bone marrow transplantation. It should be also considered for children as well as adults needing central venous access via an external catheter - or totally implantable port - for reasons other than bone marrow transplantation, such as total parenteral nutrition and administration of chemotherapeutic agents.O estabelecimento de um acesso venoso central de longa duração é uma condição sine qua non para realizar o transplante de medula óssea em crianças. Com frequência, este acesso tem sido obtido através da punção percutânea das veias subclávia e jugular interna ou via dissecção da jugular interna. Com o objetivo de evitar algumas complicações maiores e menores associadas com a subclávia e a jugular interna, os autores descrevem um método simples, fácil e seguro para o acesso venoso central através de dissecção da veia jugular externa. Este método deveria ser de interesse dos leitores envolvidos com o transplante de medula óssea e ser considerado também para crianças e/ou adultos que necessitem de cateter venoso central de longa permanência (externo ou totalmente implantável devido a outras razões, como a nutrição parenteral ou a administração de agentes quimioterápicos.

  9. Culture Positivity of CVCs Used for TPN: Investigation of an Association with Catheter-Related Infection and Comparison of Causative Organisms between ICU and Non-ICU CVCs

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    Criona Walshe

    2012-01-01

    Full Text Available A relationship between central venous catheter (CVC tip colonisation and catheter-related blood-stream infection (CRBSI has been suggested. We examined culture positivity of CVC tips (colonised and infected CVCs in a total parenteral nutrition (TPN population. Our aims were to define the relationship between culture positivity and CRBSI, and to compare causative organisms between culture positive and CRBSI CVCS, and between ward and ICU CVCs. All patients receiving TPN via non-tunnelled CVCs during the study (1997–2009 were included. All CVC tips were analysed. Data were collated contemporaneously. A TPN audit committee determined whether CVC tip culture positivity reflected colonisation/CRBSI using CDC criteria. 1,392 patients received TPN via 2,565 CVCs over 15,397 CVC days. 25.4% of CVCs tips were culture positive, of these 32% developed CRBSI. There was a nonsignificant trend of higher Gram negative Bacilli isolation in ICU CVCs (=0.1, ward CVCs were associated with higher rates of staphylococcal isolation (=0.01. A similar pattern of organisms were cultured from CRBSI and culture positive CVCs. The consistent relationship between CRBSI and culture positive CVCs, and similar pattern of causative organisms further supports an aetiological relationship between culture positive CVC tips and CRBSI, supporting the contention that CVC culture-positivity may be a useful surrogate marker for CRBSI rates.

  10. Tunneled central venous catheter exchange: techniques to improve prevention of air embolism.

    Science.gov (United States)

    Rossi, Umberto G; Torcia, Pierluca; Rigamonti, Paolo; Colombo, Francesca; Giordano, Antonino; Gallieni, Maurizio; Cariati, Maurizio

    2016-01-01

    Malfunctioning tunneled hemodialysis central venous catheters (CVCs), because of thrombotic or infectious complications, are frequently exchanged. During the CVC exchanging procedure, there are several possible technical complications, as in first insertion, including air embolism. Prevention remains the key to the management of air embolism. Herein, we emphasize the technical tricks capable of reducing the risk of air embolism in long-term CVC exchange. In particular, adoption of a 5 to 10 degrees Trendelenburg position, direct puncture of the previous CVC venous lumen for guide-wire insertion, as opposed to guide-wire introduction after cutting the CVC, a light manual compression of the internal jugular vein venotomy site after catheter removal. The Valsalva maneuvre in collaborating patients, valved introducers, and correction of hypovolemia are also useful precautions. Principles of air embolism diagnosis and treatment are also outlined in the article.

  11. HEPARIN OR 0.9% SODIUM CHLORIDE TO MAINTAIN CENTRAL VENOUS CATHETER PATENCY: A RANDOMISED TRIAL

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    Mahesh Babu

    2014-01-01

    Full Text Available BACKGROUND: Maintaining the lumen patency of Central venous catheters (CVCsusing low dose Heparin is recommended in many guidelines of CVC maintenance. This study is to compare the efficacy of low - dose Heparin 3ml (10U/ml and 0.9% Sodium chloride (10ml flush solutions to maintain Centra l venous catheter (CVC lumen patency. METHODS: We s tudied 100 adult patients between March 2012 and August 2012 who required short - term CVC insertion to compare two flush solutions , Heparin and0.9% Sodium Chloride on catheter lumen patency . RESULTS : The crude catheter non patency was 4% ( two lumensin Heparin group and 8% (four lumens in the Sodium Chloride group . There was no incidence of thrombocytopenia in both the study groups. CONCLUSION : This study has demonstrated no significant difference bet ween Heparin and 0.9% Sodium Chloride flushes with regards to catheter patency in adult patients with short - term use of CVCs .

  12. [Assessment of diagnostic methods for the catheter-related bloodstream infections in intensive care units].

    Science.gov (United States)

    Ataman Hatipoğlu, Ciğdem; Ipekkan, Korhan; Oral, Behiç; Onde, Ufuk; Bulut, Cemal; Demiröz, Ali Pekcan

    2011-01-01

    The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci

  13. A European perspective on intravascular catheter-related infections

    DEFF Research Database (Denmark)

    Bouza, E; San Juan, R; Muñoz, P;

    2004-01-01

    The laboratory workload, microbiological techniques and aetiology of catheter-related infections in European hospitals are mostly unknown. The present study (ESGNI-005) comprised a 1-day (22 October 2001), laboratory-based, point-prevalence survey based on a questionnaire completed by microbiology...... by these institutions was 121,363,800, and the estimated number of admissions during 2000 was 6,712,050. The total number of catheter tips processed during 2000 was 142,727, or 21/1,000 admissions, of which 23.7% were considered to be positive in the institutions using semiquantitative or quantitative techniques....... Overall, EU centres received significantly more catheter tip samples/1,000 admissions and had a significantly higher rate of 'positivity' (p...

  14. 《ICU导管相关性血流感染预防控制质量查检单》的设计及应用%Design and application of quality improvement checklist of catheter-related blood stream infection in the intensive care units

    Institute of Scientific and Technical Information of China (English)

    方琏; 徐建宁; 冯洁惠; 俞超; 陈瑜

    2013-01-01

    目的 通过设计《ICU导管相关性血流感染预防控制质量查检单》(简称查检单),指导医护人员在临床实践中进行质量查检,以提高护理质量,保证患者安全.方法 2012年4~6月将查检单应用于ICU的中心静脉置管患者,对患者的导管相关性血流感染(catheter-related blood stream infection, CRBSI)预防控制措施进行每日查检,观察中心静脉导管的使用率及CRBSI的发生率.结果 使用查检单干预后较干预前导管使用率下降,CRBSI发生率下降,差异有统计学意义.结论 将查检单应用于ICU患者的CRBSI预防控制的质量管理中,有助于降低CRBSI的发生率.%Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU.

  15. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution.

    OpenAIRE

    Betjes, Michiel; Agteren, Madelon

    2004-01-01

    textabstractBACKGROUND: The use of haemodialysis catheters is complicated by catheter-related sepsis. Intraluminal colonization of the catheter with bacteria is important in the pathogenesis of catheter-related sepsis. The use of a catheter lock solution containing the antimicrobial taurolidine might prevent bacterial colonization, thereby reducing the incidence of catheter-related sepsis. METHODS: In a randomized prospective trial, patients receiving a dialysis catheter were included and cat...

  16. Late onset of clinically apparent central vein stenosis due to previous central venous catheter in a patient with inherited thrombophilia.

    Science.gov (United States)

    Eleftheriadis, Theodoros; Liakopoulos, Vassilios; Antoniadi, Georgia; Pissas, Georgios; Leivaditis, Konstantinos; Stefanidis, Ioannis

    2014-04-01

    We describe a case of a patient with a functional kidney transplant who was admitted to our department with clinically evident central vein stenosis (CVS) 7 years after the removal of a central venous catheter (CVC) from the right internal jugular vein. The catheter was used as a hemodialysis access for a 2-month period. In the interval before his last admission, the patient suffered two episodes of deep vein thrombosis. Investigation revealed heterozygosity for factor V Leiden, the most common inherited thrombophilia encountered in 5% of Caucasians, and anticoagulation treatment was started. Magnetic resonance angiography showed stenosis just after the convergence of the right subclavian vein with the internal jugular vein to the innominate vein. Transluminal angioplasty restored venous patency and right upper arm edema resolved. Coexistence of CVS, accompanied by hemodynamic changes and endothelial dysfunction, with thrombophilia fulfill all the elements of the Virchow's triad. Therefore, the patient was at great risk for central vein thrombosis, from which he was possibly protected by the early administration of anticoagulant treatment. This case indicates that CVS can be asymptomatic for several years after CVC removal and also raises the question if thrombophilia workup and investigation for CVS may be beneficial in every patient with CVC placement in order to avoid any harmful outcomes.

  17. Retrospective analysis of intravertebral collateral enhancement in patients with central venous obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Chang, Connie Y.; Huang, Ambrose J.; Kattapuram, Susan V.; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Bennett, Debbie L. [Saint Louis University School of Medicine, Department of Radiology, Saint Louis, MO (United States)

    2016-02-15

    To compare prevalence and patterns of intravertebral collateral enhancement in patients with and without central venous obstruction (CVO). Chest CTs performed between 1/1/2000 and 12/15/2012 with reports containing terms indicating CVO were identified. All contrast enhanced CTs were examined for the presence of CVO and collateral venous pathways. If intravertebral collateral enhancement was present, the pattern was recorded as nodular, linear, or both. In 209 suspected cases of CVO, 53 (25 %) were confirmed with obstruction and 156 (75 %) were without obstruction. In patients with CVO, 47 % (25/53) demonstrated collateral venous flow through an intravertebral marrow pathway compared to 5 % (8/156) of patients without CVO (P < 0.0001). The most common level of enhancement was the upper thoracic spine, involving only the vertebral body. Nodular, linear, and combined nodular-linear enhancement patterns were seen with similar frequency. Nodular intravertebral collateral enhancement was mistaken for sclerotic metastases in 33 % (3/9) of cases. Intravertebral collateral enhancement was seen in almost half the patients with CVO and when nodular enhancement is present, it is important to differentiate between metastatic lesions and enhancement related to CVO. (orig.)

  18. To clot or not to clot? That is the question in central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Cadman, A.; Lawrance, J.A.L. E-mail: jeremy.lawrance@btopenworld.com; Fitzsimmons, L.; Spencer-Shaw, A.; Swindell, R

    2004-04-01

    AIM: To establish the relationship between the tip position of tunnelled central venous catheters (CVC) and the incidence of venous thrombosis. MATERIALS AND METHODS: A randomly sampled, retrospective review of 428 CVC inserted into 334 patients was performed. The chest radiograph obtained post-catheter insertion, as well as follow-up radiographs, linograms, venograms and Doppler ultrasounds (US), were reviewed. RESULTS: The median follow-up was 72 days (range 1-720 days), with a total follow-up of 23,040 line days. Venous thrombosis occurred in five out of 191 (2.6%) CVC in a distal position (distal third of the superior vena cava (SVC) or right atrium (RA)), five of 95 (5.3%) in an intermediate position (middle third of the SVC) and 20 of 48 (41.7%) in a proximal position (proximal third SVC or thoracic inlet veins). There was a significant difference in thrombosis rate between lines sited with the tip in a distal compared with a proximal position (p<0.0005). CVC with tips in a proximal position were 16 times more likely to thrombose than those in a distal position. None of the 58 CVC with the tip located in the RA thrombosed or caused complications. CONCLUSION: Distal placement of tunnelled CVC, either in the distal third of the SVC or proximal RA is optimal.

  19. ICU中心静脉导管相关性感染的危险因素分析与护理研究%Risk factors analysis and nursing study of CU central venous catheter associated infection

    Institute of Scientific and Technical Information of China (English)

    李玉楠

    2016-01-01

    Objective:To investigate the risk factors and nursing of the central venous catheter related infection in ICU center..Methods:in our hospital from December 2010 to 2014 December ICU were 30 cases of catheter infection patients in 90 cases of central venous device tube patients as the research object,the relationship of their clinical characteristics,risk factors and nursing were studied.Results:the infection rates of femoral vein,jugular vein and clavicle vein were 33.33%,28.57% and 18.52%,respectively,femoral vein catheterization was the highest,and the lowest was the lowest of clavicle vein..The longer the catheter indwelling,the higher the infection rate..The infection rate of single lumen catheter is 15.87%,which is lower than that of double lumen catheter 40.74%.Conclusion:strict central venous set tube care,improve immunity of patients,shorten the time of catheter,strengthen nurse hand hygiene management and disinfection of puncture site,has a very important role in the occurrence of low central venous catheter related infections.%目的:对ICU中心静脉导管相关性感染的危险因素和护理进行探讨和分析。方法对我院2010年12月-2014年12月ICU病房收治的30例导管感染患者中90例次中心静脉置管患者作为研究对象,对他们的临床特点、危险因素和护理的关系进行研究。结果①股静脉、颈静脉和锁骨下静脉插管的的感染率分别为33.33%、28.57%和18.52%,其中股静脉置管最高,锁骨下静脉最低。②导管留置的时间越长,感染发生率越高。③单腔导管留置感染率为15.87%,低于双腔导管留置的40.74%。结论严格中心静脉置管护理,提高患者机体免疫力,缩短置管时间,加强护士手卫生的管理和穿刺部位消毒,对降低中心静脉置管相关性感染的发生具有非常重要的作用。

  20. Correlation between Central Venous Pressure and Inferior Vena Cava Sonographic Diameter; Determining the Best Anatomic Location

    Directory of Open Access Journals (Sweden)

    Bahman naghipour

    2016-04-01

    Full Text Available Introduction: The correlation of central venous pressure (CVP with inferior vena cava (IVC sonographic diameter has been reported in several studies. However, few studies have attempted to find the best anatomic location of measurement. Therefore, the purpose of this study was determining the best anatomic location to find precise correlation between CVP and IVC diameter using transesophageal echocardiography (TEE. Methods: In the present diagnostic accuracy study, patients in need of central venous catheterization and TEE were enrolled. Maximum diameter of IVC were measured during expiratory phase of respiratory cycle at the level of diaphragm, 2cm above the diaphragm and at the point of entry into the right atrium using SonoSite TEE device. CVP was measured using an electronic transducer connected to the central venous line. The best location for sonography was determined via calculating and comparing area under the receiver operating characteristics (ROC curve (AUC. Results: 39 patients were enrolled (53.8% female. Mean CVP was 6.8 ± 1.4 mmHg and 25 (64.1% patients had normal CVP, while 14 (35.9% showed elevated CVP (> 6 mmHg. Evaluating AUC showed that IVC diameter (p = 0.01, aorta diameter (p = 0.01 and IVC / aorta ratio (p = 0.004 had acceptable correlation with CVP. Point of entry of IVC into the right atrium with AUC of 0.98 (95% CI: 0.95 – 1.00 was the location of highest correlation with CVP. Conclusion: Based on the present findings, the IVC sonographic diameter and IVC / aorta ratio had acceptable correlation with CVP at the level of IVC entry into the right atrium.

  1. Evaluation of ultrasound for central venous access in ICU by an in experienced trainee

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    Neeta Bose

    2014-01-01

    Full Text Available Background and Aims: Central venous catheter placement is an important procedure for ICU (Intensive Care Unit patients. We studied the usefulness of ultrasonography for placement of central venous catheter by in-experienced anesthetists. Materials and Methods: A prospective observational study of 32 patients requiring central venous access (CVA in surgical ICU (SICU. Data collected were patient′s demographics, indication, type of catheter, success rate, attempts, complication rate and access time were recorded and compared with other studies. Result: The overall success rate was 89.5% in the IJV (Internal Jugular Vein and 92.3% for SCV (Subclavian Vein group. The success rates for insertion at first, second, and third attempt were 52.6%, 31.6%, and 5.2% for IJV and 46.2% and 53.8% for SCV. Average number of attempts made for IJV cannulation was 1.74 +/- 1.04 and 1.54 +/- 0.51 for SCV. The total time taken for IJV access was 858.78 +/- 381.9 sec, whereas in the SCV group, it was 984 +/- 328.98 seconds. In our study, overall rate of complication was 21.05% (4/19 patients for IJV and 23.07% (3/13 patients for SCV insertion. Incidence of various complications like arterial puncture, misplacement of CVC, hematoma, pneumothorax, and hemothorax were also noted. Conclusion: This study concludes that real time ultrasound guidance during IJV and SCV cannulation can achieve higher success rate, fewer complications, number of attempts, and failure rate among inexperienced anesthetists.

  2. Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography; Tamponamento cardiaco durante infusao de contraste em acesso venoso central para realizacao de tomografia computadorizada do torax em lactente

    Energy Technology Data Exchange (ETDEWEB)

    Daud, Danilo Felix; Campos, Marcos Menezes Freitas de; Fleury Neto, Augusto de Padua [Hospital Geral de Palmas, TO (Brazil)

    2013-11-15

    Complications from central venous catheterization include infectious conditions, pneumothorax, hemothorax and venous thrombosis. Pericardial effusion with cardiac tamponade hardly occurs, and in infants is generally caused by umbilical catheterization. The authors describe the case of cardiac tamponade occurred in an infant during chest computed tomography with contrast infusion through a central venous catheter inserted into the right internal jugular vein. (author)

  3. Analysis of risk factors and strategies for prevention of catheter- related infection in general intensive care unit%综合ICU导管相关性感染危险因素分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    李素玲; 蒋仕银

    2012-01-01

    Objective: To study the risk factors of central venous catheter - related infection in general ICU and its strategies for prevention. Methods; To retrospectively analyze the results of bacterial culture of samples of 218 cases with central venous catheter indwelling admitted to the general ICU from 2009 to 2010. Result: Of the 21S samples cultured, 46 were positive and the general correlated infection rate wag 21.1 %, Out of the total bacteria, positive cocci accounted for 63.04% , fungus 28.3% and negative bacilli S. 7%. There were several significant factors concerning the infection related to central venous catheter; ages, the position of indwelling and the indwelling time of the catheter, application of parenteral nutrition and tracheotomy. Conclusion; The primary pathogen of central venous catheter - related infection in general ICU is staphylococcus, and the second one is fungus. Asepsis technique during the operation should be strictly handled. Special attention should be paid to the strict nursing care, the indwelling time of the central venous catheter should be shortened. In addition, rational use of antibiotics were significant in the prevention of the infection related to central venous catheter in general ICU.%[目的]:探讨并分析综合ICU患者中心静脉导管感染的危险因素及预防对策.[方法]:选择综合ICU 2009年7月~2010年6月中心静脉置管患者218例,对所有送检的中心静脉导管的培养结果进行回顾性分析.[结果]:218例样本中细菌培养阳性46例,感染率为21.10%,其中G+球菌占63.04%,真菌占28.26%,G一杆菌占8.70%.与中心静脉导管相关性感染有显著关系的因素有年龄、置管部位、导管留置时间、应用静脉高营养、气管切开应用呼吸机等(P<0.05).[结论]:引起综合ICU中心静脉导管感染的病原菌以葡萄球菌为首位,其次为真菌.严格的无菌操作、缩短置管时间和合理使用抗菌药物,对防止综合ICU患者中

  4. When one port does not return blood: two case reports of rare causes for misplaced central venous catheters

    Directory of Open Access Journals (Sweden)

    Sandra Pereira

    2016-02-01

    Full Text Available We present two cases of misplaced central venous catheters having in common theabsence of free blood return from one lumen immediately after placement. The former is acase of right hydrothorax associated with central venous catheterization with the catheter tipin intra-pleural location. In this case the distal port was never patent. In the latter case therewas an increased aspiration pressure through the middle port due to a catheter looping.The absence of free flow on aspiration from one lumen of a central catheter should not beundervalued. In these circumstances the catheter should not be used and needs to be removed.

  5. When one port does not return blood: two case reports of rare causes for misplaced central venous catheters.

    Science.gov (United States)

    Pereira, Sandra; Preto, César; Pinho, Carla; Vasconcelos, Pedro

    2016-01-01

    We present two cases of misplaced central venous catheters having in common the absence of free blood return from one lumen immediately after placement. The former is a case of right hydrothorax associated with central venous catheterization with the catheter tip in intra-pleural location. In this case the distal port was never patent. In the latter case there was an increased aspiration pressure through the middle port due to a catheter looping. The absence of free flow on aspiration from one lumen of a central catheter should not be undervalued. In these circumstances the catheter should not be used and needs to be removed.

  6. Central venous-arterial pCO(2) difference as a tool in resuscitation of septic patients

    NARCIS (Netherlands)

    van Beest, Paul A.; Lont, Mariska C.; Holman, Nicole D.; Loef, Bert; Kuiper, Michael A.; Boerma, E. Christiaan

    2013-01-01

    To investigate the interchangeability of mixed and central venous-arterial carbon dioxide differences and the relation between the central difference (pCO(2) gap) and cardiac index (CI). We also investigated the value of the pCO(2) gap in outcome prediction. We performed a post hoc analysis of a wel

  7. Comparison of NHSN-defined central venous catheter day counts with a method that accounts for concurrent catheters.

    Science.gov (United States)

    Talbot, Thomas R; Johnson, James G; Anders, Theodore; Hayes, Rachel M

    2015-01-01

    Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates.

  8. Percutaneous Placement of Central Venous Catheters: Comparing the Anatomical Landmark Method with the Radiologically Guided Technique for Central Venous Catheterization Through the Internal Jugular Vein in Emergent Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Koroglu, M.; Demir, M.; Koroglu, B.K.; Sezer, M.T.; Akhan, O.; Yildiz, H.; Yavuz, L.; Baykal, B.; Oyar, O. [Suleyman Demirel Univ., Isparta (Turkey). Depts. of Radiology, Internal Medicine and Anesthesiology

    2006-02-15

    Purpose: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. Material and Methods: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n = 40) were compared with those of the anatomical landmark method (n 40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared. Results: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. Conclusion: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.

  9. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.

    Science.gov (United States)

    Kim, Se-Chan; Klebach, Christian; Heinze, Ingo; Hoeft, Andreas; Baumgarten, Georg; Weber, Stefan

    2014-12-23

    The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.

  10. Central venous infusion port inserted via high versus low jugular venous approaches: Retrospective comparison of outcome and complications

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk [Research Institute and Hospital, National Cancer Center, 809 Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-764 (Korea, Republic of); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)], E-mail: hpark@dreamwiz.com; Kim, Young Il; Lee, Sang Hyun; Kim, Jung Im; Seo, Hyobin; Lee, Sang Min; Lee, Youkyung; Lim, Min Kyung [Research Institute and Hospital, National Cancer Center, 809 Madu 1-dong, Ilsan-gu, Goyang-si, Gyeonggi-do 411-764 (Korea, Republic of); Park, Young Suk [Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    Purpose: To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches. Materials and methods: The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n = 7), operation scar (n = 6), radiation scar (n = 5), failure of low jugular vein puncture (n = 2), and abnormal course of right subclavian artery (n = 1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port. Results: The procedure-related complications were all minor (n = 14, 8.6%) in both groups; hematoma (n = 4, 2.8% in low jugular puncture group and n = 1, 4.8% in high jugular puncture group, p = 0.6295), air embolism (n = 2, 1.4% in low jugular puncture group and n = 0 in high jugular puncture group, p = 0.5842) and minor bleeding (n = 5, 3.5% in low jugular vein puncture group and n = 2, 9.5% in high jugular vein puncture group, p = 0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p = 0.0349). The reasons for catheter removal were patients' death (59 in low jugular puncture group and 14 in high jugular puncture group, p = 0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p = 0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p = 0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein

  11. Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury.

    Science.gov (United States)

    Gambardella, Ivancarmine; Gaudino, Mario; Ronco, Claudio; Lau, Christopher; Ivascu, Natalia; Girardi, Leonard N

    2016-11-01

    Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1.99, 95% confidence interval (95% CI) of 1.16-3.40. In cardiac surgery subsets where venous hypertension is a hallmark feature, the incidence of AKI is higher (tricuspid disease 30%, carcinoid valve disease 22%). Even in the non-chronically congested coronary artery bypass population, CVP measured 6 h postoperatively showed significant association to renal failure: risk-adjusted OR for AKI was 5.5 (95% CI 1.93-15.5; P = 0.001) with every 5 mmHg rise in CVP for patients with CVP <9 mmHg; for CVP increments of 5 mmHg above the threshold of 9 mmHg, the risk-adjusted OR for AKI was 1.3 (95% CI 1.01-1.65; P = 0.045). This and other clinical evidence are discussed along with the underlying pathophysiological mechanisms, involving the supremacy of volume receptors in regulating the autonomic output in hypervolaemia, and the regional effect of venous congestion on the nephron. The effect of CVP on renal function was found to be modulated by ventricular function class, aetiology and acuity of venous congestion. Evidence suggests that acute increases of CVP should be actively treated to avoid a deterioration of the renal function, particularly in patients with poor ventricular fraction. Besides, the practice of treating right heart failure with fluid loading should be avoided in favour of other ways to optimize haemodynamics in this setting, because of the detrimental effects on the kidney function.

  12. Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution.

    NARCIS (Netherlands)

    M.G.H. Betjes (Michiel); M. Agteren (Madelon)

    2004-01-01

    textabstractBACKGROUND: The use of haemodialysis catheters is complicated by catheter-related sepsis. Intraluminal colonization of the catheter with bacteria is important in the pathogenesis of catheter-related sepsis. The use of a catheter lock solution containing the antimicrobia

  13. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    Science.gov (United States)

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  14. ULTRASONOGRAPHY GUIDANCE FOR CENTRAL VENOUS CATHETE R – A PROSPECTIVE STUDY FOR PATIENT’S SAFETY & QUALITY CARE

    Directory of Open Access Journals (Sweden)

    Siddharth Kumar. B

    2012-10-01

    Full Text Available ABSTRACT: BACKGROUND: Context: A central venous line access is very importance in management of the critically ill patients even thoug h, it may carry a risk of complications. AIMS: Objective of this study is to assess and compare s uccess rate, attempts of cannulation and complications like inadvertent arterial puncture, hem atoma, and pneumothorax occurred during the Central Venous Catheter (CVC placement using ultrasound guidance (USG & anatomical landmark guidance (ALG. SETTINGS AND DESIGN: The prospective randomized study was carried out in 64 patients for right sided internal jugular vein CVC placement. Using computer generated randomization chart, all patients were divided randomly into two groups: Group USG and Group ALG. METHODS AND MATERIAL: Right sided internal jugular vein (IJV was cannulated with the guidance of ultrasound and anatomical landmark, respectively in group USG and group ALG. Patients were observed & data we re recorded for success rate, no. of attempts, and complications like inadvertent arterial puncture, hematoma, and pneumothorax STATISTICAL ANALYSIS USED : Database was analysed using graphpad prism 5 softwar e. RESULTS: Success rate is 31 out of 32 (96.88% in group USG while 24 out of 32 (75% in group ALG (p =0.031. Placement of central venous catheter with 1 st attempt is 28 out of 32 (87.50% in group USG while 18 out of 32 (56.25% in group ALG (p =0.012. Hematoma and overall complications are 0 versus 6 (18.75% in group USG & ALG respectively. CONCLUSIONS: Ultrasound guided central venous catheter placement is easy, safer & prudent approach than the anatomical landmark guided central venous cathe ter placement. KEY MESSAGES: We believe that Ultrasound guidance should be encourag ed for all central venous catheter placements in patients & thereby improving patient’s sa fety and quality care.

  15. PreventionandNursingOncologyCentreRiskFactorsofCatheter-relatedInfection%肿瘤科中心静脉导管感染危险因素的预防和护理

    Institute of Scientific and Technical Information of China (English)

    牟相玲

    2013-01-01

    Objective Through the investigation of patients in our hospital in oncology department of central venous catheter, through the analysis on the culture result catheter culture and blood, preventive oncology center for the study of risk factors for venous catheter-related infection and the nursing method. Methods 263 cases, patients in 2008 March to 2011 August is in the treatment of venous duct tumor coyne center in our hospital inpatients, carries on the investigation by the questionnaire. Results According to the results of the survey, this group of cases, 9 cases had phlebitis, catheter culture results were positive in 18 cases, 12 cases with positive blood culture results. This shows that lead to tumor of central venous catheter infection may be associated with age, gender, different nature of the drug, when treatment is whether the use of intravenous nutrition therapy, chemotherapy cycle time, catheter blockage and catheter indwelling time have direct or indirect relation. Conclusion As far as possible, reduce infection and prevention of central venous catheter related infection of central venous catheter, in medical usually work must regulate the related system and operating procedures, strict nursing.%  目的通过对我院就诊于肿瘤科进行中心静脉导管的患者进行调查,经过对导管培养及血培养结果的分析,研究肿瘤科中心静脉导管感染危险因素的预防及其护理方法。方法选取263例病例,病例患者是于2008年3月至2011年8月在我院肿瘤科因中心静脉导管问题就诊的住院患者,对其以问卷调查的方式进行调研。结果调查结果显示,在此组病例当中,有9例发生静脉炎,18例导管培养结果呈阳性,12例血培养结果呈阳性。这表明导致肿瘤中心静脉导管感染可能与患者的年龄、性别、不同的药物性质、治疗时是否使用静脉高营养治疗法、化疗进行的时间周期、导管的堵塞情况及置管后导

  16. Importance of blood cultures from peripheral veins in pediatric patients with cancer and a central venous line

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Rutkjaer, Cecilie

    2015-01-01

    When an infection is suspected in a child with cancer and a central venous line (CVL), cultures are often only obtained from the CVL and not from a peripheral vein (PV). This study was undertaken to evaluate the importance of concomitant blood cultures from the CVL and a PV.......When an infection is suspected in a child with cancer and a central venous line (CVL), cultures are often only obtained from the CVL and not from a peripheral vein (PV). This study was undertaken to evaluate the importance of concomitant blood cultures from the CVL and a PV....

  17. Central retinal venous pressure in eyes of normal-tension glaucoma patients with optic disc hemorrhage.

    Directory of Open Access Journals (Sweden)

    Ko Eun Kim

    Full Text Available To compare central retinal venous pressure (CRVP among eyes with and without optic disc hemorrhage (ODH in bilateral normal-tension glaucoma (NTG patients and NTG eyes without an episode of ODH.In this prospective study, 22 bilateral NTG patients showing a unilateral ODH and 29 bilateral NTG patients without an episode of ODH were included. Eyes were categorized into group A (n = 22, eyes with ODH, group B (n = 22, fellow eyes without ODH, and group C (n = 29, NTG eyes without an episode of ODH. A contact lens ophthalmodynamometer was used to measure CRVP and central retinal arterial pressure (CRAP.Intraocular pressure (IOP measured on the day of contact lens ophthalmodynamometry showed no difference among groups. However, the mean baseline IOP in group A was significantly lower than that in group C (P = .008. The CRVP in group A (29.1 ± 10.8 mmHg was significantly lower than that in group C (40.1 ± 8.8 mmHg, P = .001, but similar to that in group B (30.5 ± 8.7 mmHg, P = .409. A similar relationship was noted for CRAP. No significant eye-associated variable for ODH was found in group A and B by conditional logistic regression analysis (all P > 0.05. However, multivariate logistic regression analysis in groups A and C revealed that low mean baseline IOP (odds ratio [OR] = 0.69, 95% confidence interval [CI] 0.49-0.98, P = 0.043 and low CRVP (OR = 0.88, 95% CI 0.80-0.95, P = 0.003 were associated with ODH.CRVP was lower in NTG eyes with ODH than in eyes without an episode of ODH, but similar to that of fellow eyes without ODH. These imply less likelihood of association between increased central retinal venous resistance and ODH.

  18. Knowledge level on administration of chemotherapy through peripheral and central venous catheter among oncology nurses

    Directory of Open Access Journals (Sweden)

    Sevgisun Kapucu

    2017-01-01

    Full Text Available Objective: The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration. Methods: Data collection of this descriptive study was started on April 15, 2015–July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation. Results: The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%, control of catheter before the administration (93.9%, influence of chemotherapeutic agent on length of catheter (40.6%, and management of extravasation (75.7%. Nurses also had correct information about the first use of port catheter (67.3% and checking the catheter whether it is working properly or not (75.8%. Conclusions: In General, nurses' level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice.

  19. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Aytekin, Cueneyt E-mail: cuneytaytekin@hotmail.com; Boyvat, Fatih; Yagmurdur, Mahmut Can; Moray, Goekhan; Haberal, Mehmet

    2004-01-01

    Objective: To evaluate the efficacy of stent placement for treating upper extremity central venous obstruction in chronic hemodialysis patients. Methods and Material: Between January 1999 and October 2001, we inserted metallic stents into the upper extremity central veins of 14 patients with shunt dysfunction and/or arm swelling. The indications for stent placement were stenosis or occlusion of the central vein in the upper extremity used for dialysis. Six of the individuals were diagnosed with subclavian vein stenosis, and 5 with brachiocephalic vein stenosis. Of the remaining 3 patients, 2 had subclavian vein occlusion, and 1 had left brachiocephalic vein occlusion. Results: All the stent placement procedures were technically successful, and there were no major complications. Follow-up ranged from 2 weeks to 29 months. The 1-, 3-, 6- and 12-month primary stent patency rates were 92.8, 85.7, 50 and 14.3%, respectively. Repeat interventions, including percutaneous transluminal angioplasty and additional stent placement, were required in 9 patients. The 3-, 6-, 12-month, and 2-year assisted primary stent patency rates were 100, 88.8, 55.5 and 33.3%, respectively. Conclusion: Endovascular stent placement is an effective alternative to surgery in patients with shunt dysfunction due to obstruction of an upper extremity central vein. Repeated interventions are usually required to prolong stent patency.

  20. 126例中心静脉导管在血液净化中的临床应用%Application of central venous catheter in hemodialysis in 126 cases

    Institute of Scientific and Technical Information of China (English)

    肖琼; 李靖; 杨元媛; 韩志武

    2011-01-01

    Objective To discuss the complications and treatment of applying central venous catheter in hemodialysis by observing its application condition. Methods The clinical data of 126 patients with central venous catheter applied in hemodialysis were enrolled and analyzed retrospectively including 25 cases of long-term dual-lumen catheters and 101 cases of temporary dual-lumen catheters. The related complications and treatments were analyzed. Results The common complications occurred during catheterizations included inadvertent arterial puncture in 11 cases (8.73 % ) and ecchymoma in 6 cases (4.76%) while the complications of catheterizations included inadequate blood flow in 24 cases (19.04%) ,catheter related infection in 23 cases(18.25% ) ,local bleeding in 15 cases( 11.90% ) and catheter inadvertent withdrawal in 3 cases (2.38 % ). Above complications were recovered without recurrences after taking corresponding treatments. Conclusion Attention should be paid to the central venous catheter related complications. Improving technology, strengthening nursing care and taking timely treatment are the key points to prevent catheter functional failure.%目的 通过观察中心静脉留置导管在血液透析中使用状况,探讨中心静脉导管相关并发症及处理方法,改善血液透析患者预后.方法 回顾性分析126例使用中心静脉置管维持性血液透析患者的临床资料.其中25例为长期双腔导管,101例为临时双腔导管,分析中心静脉导管的相关并发症与处理效果.结果 置管过程中的常见并发症有:误穿动脉11例(8.73%)、皮下血肿6例(4.76%).导管留置并发症有:血流量不足24例(19.04%),导管相关感染23例(18.25%),穿刺部位渗血15例(11.90%),导管意外脱落3例(2.38%).以上并发症均在给予相应的处理后痊愈,未留下相关后遗症.结论 中心静脉导管相关并发症值得临床重视,提高置管技术,加强导管护理,及时处理是防范导管失功能的关键.

  1. Computed tomography as a problem solving tool in non-radiopaque central venous port systems – A report of three cases

    OpenAIRE

    Gossner, Johannes

    2014-01-01

    Central venous port systems are now routinely used in oncology. The non-functioning port system is a common issue in radiology departments. Fluoroscopy is a first-line imaging modality. The potential usefulness of computed tomography as a problem-solving tool in three complex cases with non-radiopaque central venous port systems is presented.

  2. The thrill of success: central arterial-venous anastomosis for hypertension.

    Science.gov (United States)

    Fudim, Marat; Stanton, Alice; Sobotka, Paul A; Dolan, Eamon; Krum, Henry

    2014-12-01

    Excess blood pressure remains the most important risk factor for cardiovascular and renal disease. Poly pharmacy has been proved safe and effective under clinical trial circumstances; however, the majority of patients fail to sustain pharmaceutical persistence and adherence. The opportunity to offer patients a treatment or device in addition or perhaps instead of drug therapy alone may significantly broaden the options for patients and allow greater success in hypertensive therapy. In this review, we examine the potential of a fixed-volume central arterial-venous anastomosis to reduce blood pressure in hypertensive patients, review possible mechanisms by which the anastomosis may reduce blood pressure, and consider the unique clinical trial opportunities posed by this therapy.

  3. [Multimedia application in mobile platform for teaching the measurement of central venous pressure].

    Science.gov (United States)

    Galvão, Elizabeth Correia Ferreira; Püschel, Vilanice Alves Araújo

    2012-10-01

    This study aimed to develop and assess an application software for the teaching of the procedure Manual Measurement of the Central Venous Pressure which can be used in mobile devices. The research was conducted in three phases (Survey of needs; Methodology for multimedia application development and evaluation of the multimedia application).The multimedia was the method chosen because it favors an encouraging and dynamic environment, as it integrates images and texts into an application software available for cell phones, constituting a mobile and autonomous means for learning. The research allowed to demonstrate the feasibility of the development from this pedagogical tool and open up prospects for believing that, in Nursing education, the technology available can uncover new ways of learning in a meaningful manner.

  4. Radiologic interventional retrieval of retained central venous catheter fragment in prematurity: case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jee Won; Jo, Jung Hyun; Park, Byeong Ho [College of Medicine, Dong-A University, Busan (Korea, Republic of)

    2007-12-15

    The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity of air embolism occurred during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach.

  5. Percutaneously inserted long-term central venous catheters in pigs of different sizes.

    Science.gov (United States)

    Larsson, N; Claesson Lingehall, H; Al Zaidi, N; Claesson, J; Jensen-Waern, M; Lehtipalo, S

    2015-07-01

    Pigs are used for long-term biomedical experiments requiring repeated injections, infusions and collections of blood samples. Thus, it is necessary for vascular catheters to be indwelling to avoid undue stress to the animals and the use of restraints. We propose a refined model of percutaneous insertion of long-term central venous catheters to minimize the surgical trauma and postoperative complications associated with catheter insertion. Different sizes of needles (18 Ga versus 21 Ga) for initial puncture of the veins were compared. In conventional pigs weighing less than 30 kg, catheter insertion may be facilitated by using a microintroducer set with a 21 Ga needle. In pigs weighing 50 kg, a standard 18 Ga needle may be preferable.

  6. Low-dosage prophylactic vancomycin in central-venous catheters for neonates.

    Science.gov (United States)

    Ocete, E; Ruíz-Extremera, A; Goicoechea, A; Lozano, E; Robles, C; Rey, M L; Salmerón, J

    1998-12-01

    Neonatal infectious pathology remains one of the main causes of morbidity and mortality in this age group. The introduction of plasticized catheters for the administration of medication, fluidotherapy and parenteral nutrition was a significant advance in treatment of patients at risk, but also led to the appearance of infectious complications. Negative coagulase staphylococcus is the principal pathogen in most neonatal intensive care units. Recent studies have examined the prophylactic use of vancomycin in preterm babies receiving parenteral nutrition. We have evaluated the efficacy of this procedure, applied via the central venous catheters employed for all neonates, within the intensive care unit over a period of one year. Prophylactic vancomycin administered via the catheters significantly reduced the incidence of Gram-positive infections, despite the presence within this group of a greater number of septic risk factors than in the control group.

  7. A survey of pediatric hematology/oncology specialists regarding management of central line associated venous thrombosis.

    Science.gov (United States)

    Witmer, Char M; Sauck, Emily; Raffini, Leslie J

    2016-12-01

    Central venous catheters (CVCs) account for the largest proportion of thrombotic events in pediatric patients. Questions remain regarding adequate treatment and prevention methods. We surveyed pediatric hematology/oncology specialists, using hypothetical cases to assess management strategies for acute CVC thrombosis and secondary prevention. Survey respondents varied in the use of the thrombophilia evaluation (33.3%, 41/123) and duration of treatment (6 weeks: 54.1%, 66/122). Secondary CVC prophylaxis was utilized by 36.6% (45/123) of respondents and by 24.4% (30/123) but only if there was a documented thrombophilia. This heterogeneity highlights the need for clinical studies to address these important clinical questions.

  8. Ultrasound Guidance for Central Venous Access by Emergency Physicians in Colorado

    Directory of Open Access Journals (Sweden)

    Brandon H. Backlund

    2012-09-01

    Full Text Available Introduction: To survey emergency physicians (EP regarding the frequency of use of ultrasound guidance for placement of central venous catheters (UGCVC and to assess their perceptions regarding the technique and barriers to its implementation.Methods: A 25-question Web-based survey was e-mailed to all members of the Colorado chapter of the American College of Emergency Physicians with a listed e-mail address. A total of 3 reminderswere sent to nonresponders.Results: Responses were received from 116 out of 330 invitations. Ninety-seven percent (n¼112 of respondents indicated they have an ultrasound machine available in their emergency department, and 78% indicated they use UGCVC. Seventy-seven percent (n ¼ 90 agreed with the statement, ‘‘Ultrasound guidance is the preferred method for central venous catheter placement in the emergencydepartment.’��� However, 23% of respondents stated they have received no specific training in UGCVC. Twenty-six percent (n ¼28 of respondents stated they felt ‘‘uncomfortable’’ or ‘‘very uncomfortable’’with UGCVC, and 47% cite lack of training in UGCVC as a barrier to performing the technique.Conclusion: Although the majority of surveyed EPs feel UGCVC is a valuable technique and do perform it, a significant percentage reported receiving no training in the procedure and also reported being uncomfortable performing it. Nearly half of those surveyed cited lack of training as a barrier to more widespread implementation of UGCVC. This suggests that there continues to be a need for education and training of EPs in UGCVC.

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

    Directory of Open Access Journals (Sweden)

    Hanson Josh

    2011-11-01

    Full Text Available Abstract Background To optimize the fluid status of adult patients with severe malaria, World Health Organization (WHO guidelines recommend the insertion of a central venous catheter (CVC and a target central venous pressure (CVP of 0-5 cmH2O. However there are few data from clinical trials to support this recommendation. Methods Twenty-eight adult Indian and Bangladeshi patients admitted to the intensive care unit with severe falciparum malaria were enrolled in the study. All patients had a CVC inserted and had regular CVP measurements recorded. The CVP measurements were compared with markers of disease severity, clinical endpoints and volumetric measures derived from transpulmonary thermodilution. Results There was no correlation between the admission CVP and patient outcome (p = 0.67 or disease severity (p = 0.33. There was no correlation between the baseline CVP and the concomitant extravascular lung water (p = 0.62, global end diastolic volume (p = 0.88 or cardiac index (p = 0.44. There was no correlation between the baseline CVP and the likelihood of a patient being fluid responsive (p = 0.37. On the occasions when the CVP was in the WHO target range patients were usually hypovolaemic and often had pulmonary oedema by volumetric measures. Seven of 28 patients suffered a complication of the CVC insertion, although none were fatal. Conclusion The WHO recommendation for the routine insertion of a CVC, and the maintenance of a CVP of 0-5 cmH2O in adults with severe malaria, should be reconsidered.

  10. End expiratory oxygen concentrations to predict central venous oxygen saturation: an observational pilot study

    Directory of Open Access Journals (Sweden)

    Steuerwald Michael

    2006-09-01

    Full Text Available Abstract Background A non-invasive surrogate measurement for central venous oxygen saturation (ScVO2 would be useful in the ED for assessing therapeutic interventions in critically ill patients. We hypothesized that either linear or nonlinear mathematical manipulation of the partial pressure of oxygen in breath at end expiration (EtO2 would accurately predict ScVO2. Methods Prospective observational study of a convenience sample of hemodialysis patients age > 17 years with existing upper extremity central venous catheters were enrolled. Using a portable respiratory device, we collected both tidal breathing and end expiratory oxygen and carbon dioxide concentrations, volume and flow on each patient. Simultaneous ScVO2 measurements were obtained via blood samples collected from the hemodialysis catheter. Two models were used to predict ScVO2: 1 Best-fit multivariate linear regression equation incorporating all respiratory variables; 2 MathCAD to model the decay curve of EtO2 versus expiratory volume using the least squares method to estimate the pO2 that would occur at Results From 21 patients, the correlation between EtO2 and measured ScVO2 yielded R2 = 0.11. The best fit multivariate equation included EtCO2 and EtO2 and when solved for ScVO2, the equation yielded a mean absolute difference from the measured ScVO2 of 8 ± 6% (range -18 to +17%. The predicted ScVO2 value was within 10% of the actual value for 57% of the patients. Modeling of the EtO2 curve did not accurately predict ScVO2 at any lung volume. Conclusion We found no significant correlation between EtO2 and ScVO2. A linear equation incorporating EtCO2 and EtO2 had at best modest predictive accuracy for ScVO2.

  11. Rhodococcus bacteremia in cancer patients is mostly catheter related and associated with biofilm formation.

    Directory of Open Access Journals (Sweden)

    Fadi Al Akhrass

    Full Text Available Rhodococcus is an emerging cause of opportunistic infection in immunocompromised patients, most commonly causing cavitary pneumonia. It has rarely been reported as a cause of isolated bacteremia. However, the relationship between bacteremia and central venous catheter is unknown. Between 2002 and 2010, the characteristics and outcomes of seventeen cancer patients with Rhodococcus bacteremia and indwelling central venous catheters were evaluated. Rhodococcus bacteremias were for the most part (94% central line-associated bloodstream infection (CLABSI. Most of the bacteremia isolates were Rhodococcus equi (82%. Rhodococcus isolates formed heavy microbial biofilm on the surface of polyurethane catheters, which was reduced completely or partially by antimicrobial lock solution. All CLABSI patients had successful response to catheter removal and antimicrobial therapy. Rhodococcus species should be added to the list of biofilm forming organisms in immunocompromised hosts and most of the Rhodococcus bacteremias in cancer patients are central line associated.

  12. Bacillus cereus catheter related bloodstream infection in a patient with acute lymphoblastic leukemia.

    Science.gov (United States)

    Gurler, N; Oksuz, L; Muftuoglu, M; Sargin, Fd; Besisik, Sk

    2012-01-01

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related bloodstream infections. Significant catheter-related bloodstream infections (CRBSI) caused by Bacillus spp. are mainly due to B. cereus and have been predominantly reported in immunocompromised hosts. Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B. cereus in a patient with acute lymphoblast c leukemia (ALL) in Istanbul Medical Faculty was presented.

  13. Central venous oxygen saturation in septic shock - a marker of cardiac output, microvascular shunting and/or dysoxia?

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders

    2011-01-01

    Shock therapy aims at increasing central venous oxygen saturation (ScvO2), which is a marker of inadequate oxygen delivery. In this issue of Critical Care, Textoris and colleagues challenge this notion by reporting that high levels of ScvO2 are associated with mortality in patients with septic...

  14. On-demand antimicrobial release from a temperature-sensitive polymer - Comparison with ad libitum release from central venous catheters

    NARCIS (Netherlands)

    Sjollema, Jelmer; Dijkstra, Rene J.B.; Abeln, Caroline; van der Mei, Henderina; Van Asseldonk, Dirk; Busscher, Hendrik

    2014-01-01

    Antimicrobial releasing biomaterial coatings have found application for instance in the fixation of orthopedic joint prostheses and central venous catheters. Most frequently, the release kinetics is such that antimicrobially-effective concentrations are only reached within the first days to weeks af

  15. Should we stop using the determination of central venous pressure as a way to estimate cardiac preload?

    Science.gov (United States)

    Muñoz Nañez, Manuel Felipe

    2012-01-01

    Introduction: The determination of the values of central venous pressure has long been used as a guideline for volumetric therapy in the resuscitation of the critical patient, but the performance of such parameter is currently being questioned as an effective measurement of cardiac preload. This has aroused great interest in the search for more accurate parameters to determine cardiac preload and a patient's blood volume. Goals and Methods: Based on literature currently available, we aim to discuss the performance of central venous pressure as an effective parameter to determine cardiac preload. Results and Conclusion: Estimating variables such as end-diastolic ventricular area and global end-diastolic volume have a better performance than central venous pressure in determining cardiac preload. Despite the best performance of these devices, central venous pressure is still considered in our setting as the most practical and most commonly available way to assess the patient's preload. Only dynamic variables such as pulse pressure change are superior in determining an individual's blood volume. PMID:24893061

  16. Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer

    NARCIS (Netherlands)

    M.M.J. Beckers; H.J.T. Ruven; C.A. Seldenrijk; M.H. Prins; D.H. Biesma

    2010-01-01

    Introduction: Thrombosis and infections are well known complications of central venous catheters and totally implanted access ports. These complications lead to increased costs due to prolonged hospitalisation, increased antibiotics use and need for replacement. The objectives of the study were to d

  17. Assessment of insertion techniques and complication rates of dual lumen central venous catheters in patients with hematological malignancies

    NARCIS (Netherlands)

    R.F.M. Jansen (Ruud); T. Wiggers (Theo); B.N. van Geel (Bert); W.L.J. van Putten (Wim)

    1990-01-01

    textabstractOne hundred and twenty-three dual lumen silicone rubber central venous catheters were inserted into 101 patients with hematological malignancies undergoing intensive treatment. There was a perioperative complication rate of 13%. Open and closed techniques for inserting the catheter were

  18. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer

    NARCIS (Netherlands)

    Debourdeau, P.; Farge, D.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Buller, H. R.; Bounameaux, H.

    2013-01-01

    . Background: Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. Objectives: To establish

  19. Predictors of Unattempted Central Venous Catheterization in Septic Patients Eligible for Early Goal-directed Therapy

    Directory of Open Access Journals (Sweden)

    David R. Vinson

    2014-02-01

    Full Text Available Introduction: Central venous catheterization (CVC can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED patients eligible for early goal-directed therapy (EGDT have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg, obesity (body mass index [BMI] ≥30, moderate thrombocytopenia (platelet count <50,000 per μL, and coagulopathy (international normalized ratio ≥2.0 with unattempted CVC in EGDT-eligible patients. Methods: This was a retrospective cohort study of 421 adults who met EGDT criteria in 5 community EDs over a period of 13 months. We compared patients with attempted thoracic (internal jugular or subclavian CVC with those who did not undergo an attempted thoracic line. We also compared patients with any attempted CVC (either thoracic or femoral with those who did not undergo any attempted central line. We used multivariate logistic regression analysis to calculate adjusted odd ratios (AORs. Results: In our study, 364 (86.5% patients underwent attempted thoracic CVC and 57 (13.5% did not. Relative normotension was significantly associated with unattempted thoracic CVC (AOR 2.6 95% confidence interval [CI], 1.6-4.3, as were moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5-10.1 and coagulopathy (AOR 2.7; 95% CI, 1.3-5.6. When assessing for attempted catheterization of any central venous site (thoracic or femoral, 382 (90.7% patients underwent attempted catheterization and 39 (9.3% patients did not. Relative normotension (AOR 2.3; 95% CI, 1.2-4.5 and moderate thrombocytopenia (AOR 3.9; 95

  20. Central venous catheters in hemodialysis: To accept recommendations or to stick to own experience

    Directory of Open Access Journals (Sweden)

    Stolić Radojica

    2008-01-01

    Full Text Available Backgraund/Aim. Hemodialysis catheter, as an integral part of hemodialysis, is a catheter placed into the jugular, subclavian and femoral vein. The most common catheter-related complications are infections and thrombosis. The aim of the study was to analyze the prevalence of complications associated with differently inserted central-vein catheters for hemodialysis. Methods. The study was organized as a prospective examination during the period from December 2003 to November 2006, and included all patients who needed an active depuration by hemodialysis, hospitalized at the Clinical Center Kragujevac. The subject of the study were 464 centralvein catheters inserted during the mentioned period and there were recorded all complications related to the placement and usage of catheters. Results. The largest percent of inserted catheters was into the femoral vein − 403 (86.8%, significantly less into the jugular vein − 42 (9.2%, while into the subclavian vein there were placed only 19 catheters (4%. The average of femoral catheter functioning was 17 catheter days, in jugular catheters it was 17.3 days while the subclavian catheters had an average rate of functioning of 25.9 catheter days; there was found a statistically significant difference regarding the duration of functioning (p = 0.03. By microbe colonization of smear culture of the skin at the catheter insertion site, in clinically present suspicion of catheter infection, there was obtained a positive finding in 5.5% of catheters placed into the femoral vein and 7.1% of catheters instilled into the jugular vein, of which Staphylococcus aureus was the most important bacterial type, without statistically significant difference (p = 0.51. Haemoculture, done when there was a suspicion of bacteriemia, was positive in 3.7% of the patients with femoral and 4.8% with jugular catheters; Staphylococcus aureus was the most common bacteria type, but there was no statistically significant difference (p

  1. Prevention of Catheter-related Bloodstream Infection in ICU%ICU患者中心静脉导管相关性血流感染的预防

    Institute of Scientific and Technical Information of China (English)

    徐文

    2011-01-01

    Central venous catheter( CVC )is one of the most common technique for monitoring and treatment in ICU. But There is a risk of catheter-related bloodstream infection causing prolonged hospital stay and increased mortality. Positioning the CVC through the subclavian vein and using a antibiotic catheter can help to reduce the incidence of CRBSI. A bundle stratige is of a crucial role in CRBSI provention.It should include strict hand hygiene, sterilizing with mixture of 70% ethano and 2% chlorhexidine, maximal sterile barrier and regular dressing change. The efficiency of regular CVC replacement and of antibiotic based catheter lock solution are not clear, and are not recommended as a routine.%留置中心静脉导管是ICU中最常用的监测和治疗措施,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高.选择锁骨下穿刺径路、使用抗生素导管可减少CRBSI的发生.应用集束化预防措施进行置管及日常护理是预防CRBSI发生的重要措施,包括严格的手卫生、应用2%氯己定和70%乙醇混合液消毒皮肤、最大消毒屏障以及定期更换辅料.定期更换导管及使用抗生素封管对预防CRBSI效果不明确,不作为常规推荐.

  2. Central venous catheters: detection of catheter complications and therapeutical options; Zentralvenoese Katheter: Diagnostik von Komplikationen und therapeutische Optionen

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Beck, A. [Universitaetsmedizin Charite, Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes-Kliniken, Friedrichshain und Am Urban, Berlin (Germany). Radiologie; Vivantes-Kliniken, Hellersdorf und Prenzlauer Berg (Germany). Radiologie

    2008-06-15

    For modern medicine central venous catheters play an important role for diagnostic and therapeutic options. Catheter implantation, complication detection and therapy of catheter complications are an increasing demand for the radiologist. The review article provides an overview of different catheter types, their indications, advantages and disadvantages. Catheter malpositions are usually detectable in conventional X-ray. Most malpositions are correctable using interventional-radiological techniques. In addition therapeutical options for thrombotic complications (venous thrombosis, catheter occlusion, fibrin sheath) are discussed. In case of an infectious catheter complication, usually a catheter extraction and re-implantation is necessary.

  3. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Shamit S., E-mail: shamit.desai@northwestern.edu [Northwestern Memorial Hospital, Department of Radiology (United States); Konanur, Meghana [Northwestern University Feinberg School of Medicine (United States); Foltz, Gretchen [Mallinckrodt Institute of Radiology at Washington University, Interventional Radiology (United States); Malaisrie, S. Chris [Northwestern Memorial Hospital, Department of Cardiothoracic Surgery (United States); Resnick, Scott, E-mail: sresnick@northwestern.edu [Northwestern University Feinberg School of Medicine, Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital (United States)

    2016-03-15

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  4. Bacillus Cereus Catheter Related Bloodstream Infection in a Patient with Acute Lymphoblastic Leukemia

    OpenAIRE

    N Gurler; Oksuz, L; M Muftuoglu; Sargin, FD; Besisik, SK

    2012-01-01

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related bloodstream infections. Significant catheter-related bloodstream infections (CRBSI) caused by Bacillus spp. are mainly due to B. cereus and have been predominantly reported in immunocompromised hosts. Catheter removal is generally advised for management of infection. In t...

  5. Improved ex vivo blood compatibility of central venous catheter with noble metal alloy coating.

    Science.gov (United States)

    Vafa Homann, Manijeh; Johansson, Dorota; Wallen, Håkan; Sanchez, Javier

    2016-10-01

    Central line associated bloodstream infections (CLABSIs) are a serious cause of morbidity and mortality induced by the use of central venous catheters (CVCs). Nobel metal alloy (NMA) coating is an advanced surface modification that prevents microbial adhesion and growth on catheters and thereby reduces the risk of infection. In vitro microbiological analyses have shown up to 90% reduction in microbial adhesion on coated CVC compared to uncoated ones. This study aimed to assess the blood compatibility of NMA-coated CVC according to ISO 10993-4. Hemolysis, thrombin-antithrombin (TAT) complex, platelet counts, fibrin deposition, and C3a and SC5b-9 complement activation were analyzed in human blood exposed to the NMA-coated and control CVCs using a Chandler-loop model. NMA-coated CVC did not induce hemolysis and fell in the "nonhemolytic" category according to ASTM F756-00. Significantly lower amounts of TAT were generated and less fibrin was deposited on NMA-coated CVC than on uncoated ones. Slightly higher platelet counts and lower complement markers were observed for NMA-coated CVC compared to uncoated ones. These data suggest that the NMA-coated CVC has better ex vivo blood compatibility compared to uncoated CVC. © 2015 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1359-1365, 2016.

  6. Validity of ICD-9-CM codes for the identification of complications related to central venous catheterization.

    Science.gov (United States)

    Tukey, Melissa H; Borzecki, Ann M; Wiener, Renda Soylemez

    2015-01-01

    Two complications of central venous catheterization (CVC), iatrogenic pneumothorax and central line-associated bloodstream infection (CLABSI), have dedicated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Despite increasing use of ICD-9-CM codes for research and pay-for-performance purposes, their validity for detecting complications of CVC has not been established. Complications of CVCs placed between July 2010 and December 2011 were identified by ICD-9-CM codes in discharge records from a single hospital and compared with those revealed by medical record abstraction. The ICD-9-CM code for iatrogenic pneumothorax had a sensitivity of 66.7%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 99.5%. The ICD-9-CM codes for CLABSI had a sensitivity of 33.3%, specificity of 99.0%, PPV of 28.6%, and NPV of 99.2%. The low sensitivity and variable PPV of ICD-9-CM codes for detection of complications of CVC raise concerns about their use for research or pay-for-performance purposes.

  7. Standardizing central venous catheter care by using observations from patients with cancer.

    Science.gov (United States)

    Weingart, Saul N; Hsieh, Candace; Lane, Sharon; Cleary, Angela M

    2014-06-01

    To understand the vulnerability of patients with cancer to central line-associated bloodstream infections related to tunneled central venous catheters (CVCs), patients were asked to describe their line care at home and in clinic and to characterize their knowledge and experience managing CVCs. Forty-five adult patients with cancer were recruited to participate. Patients were interviewed about the type of line, duration of use, and observations of variations in line care. They also were asked about differences between line care at home and in the clinic, precautions taken when bathing, and their education regarding line care. Demographic information and primary cancer diagnosis were taken from the patients' medical records. Patients with hematologic and gastrointestinal malignancies were heavily represented. The majority had tunneled catheters with subcutaneous implanted ports. Participants identified variations in practice among nurses who cared for them. Although many participants expressed confidence in their knowledge of line care, some were uncertain about what to do if the dressing became loose or wet, or how to recognize an infection. Patients seemed to be astute observers of their own care and offered insights into practice variation. Their observations show that CVC care practices should be standardized, and educational interventions should be created to address patients' knowledge deficits.

  8. Serious Gaming to Improve the Safety of Central Venous Catheter Placement

    Directory of Open Access Journals (Sweden)

    Daniel Katz

    2013-06-01

    Full Text Available Approximately 5 million central venous catheters (CVCs are placed by physicians annually in the United States, with a complication rate of 15%.1 Guidelines and recommendations are continually being established and updated regarding CVC placement.2 While much has been done regarding training the technical skills of CVC placement using part-task trainers (i.e., mannequins, successfully finding and cannulating a central vein is but one part of the process. In fact, many steps designed to prevent untoward complications involve non-technical skills which are perhaps more important in training practitioners to safely place CVCs. First in aviation and now in healthcare, practitioners are being trained in realistic and highly interactive simulated environments so they can learn not just technical skills , but the key management and non-technical steps which make their task safer.3 One modality being used to improve performance is video gaming simulation, or "serious gaming." Gaming as a learning tool is being increasingly utilized in health care fields and can lead to better skill-based outcomes.4 As such, we have developed a game based around the placement of CVCs that will be used as a new teaching modality in a pilot program for instructing residents in safe CVC placement.

  9. Regarding optical coherence tomography grading of ischemia in central retinal venous occlusion

    Directory of Open Access Journals (Sweden)

    Tripathy K

    2017-02-01

    Full Text Available Koushik TripathyDepartment of Vitreoretina and Uvea, ICARE Eye Hospital & Postgraduate Institute, Noida, Uttar Pradesh, IndiaThe author read with interest the article by Browning et al.1 The author humbly wants to discuss a few facts.1. The article1 discusses grading of retinal ischemia based on optical coherence tomography features in central retinal venous occlusion. As coexisting central retinal arterial occlusion or cilioretinal arterial occlusion may also cause inner retinal hyper-reflectivity, exclusion of such cases is an important consideration before implicating central retinal venous occlusion for the ischemia. Extensive intraretinal hemorrhages are other important hindrances to the evaluation of the perfusion status of the retina using both fluorescein angiogram and optical coherence tomography.2. It would be interesting to know the gonioscopic findings, especially neovascularization of the anterior chamber angle if it was performed at presentation and during the follow-ups.3. The manuscript documented that the incidence of anterior segment neovascularization at 1 year was 8.9% in severe ischemia group.1 The incidence of anterior segment neovascularization in perfused groups was higher (15.4% and 17.6% for mild and moderate ischemia, respectively. Although the sample size was low, such findings are contrary to the literature2 and require further discussion. Authors' replyDavid J Browning, Omar S Punjabi, Chong LeeDepartment of Ophthalmology, Charlotte Eye, Ear, Nose and Throat Associates, P.A., Charlotte, NC, USA We thank Dr Tripathy for his interest in our article and would respond to his above-mentioned points.1. We agree that excluding eyes with cilioretinal artery and central retinal artery occlusions is necessary to be able to attribute inner retinal reflectivity changes to central retinal vein occlusion. Cilioretinal artery occlusion is associated with a band of ischemic retinal whitening and central retinal artery occlusion

  10. 中央型急性期下肢DVT置管溶栓与外周溶栓的比较%Outcomes of anticoagulation and thrombolysis for acute deep venous thrombosis via central venous catheter and peripheral venous injection

    Institute of Scientific and Technical Information of China (English)

    朱少问; 郑小兵; 冯翔

    2013-01-01

    目的:比较中央型急性期DVT经外周静脉溶栓与局部置管溶栓治疗的效果,以指导临床治疗.方法:通过回顾性分析我院及江苏南通大学附属医院2010年9月~2012年7月期间收治的共42例下肢深静脉血栓形成患者的临床资料,按照治疗方法分为置管溶栓组(A组)、外周溶栓组(B组).其中外周溶栓组共20例,左侧13例,右侧6例,双侧1例.置管溶栓组共22例,左侧15例,右侧6例,双侧1例.通过监测患者临床症状,测量下肢周径变化比较两组治疗效果.结果:置管溶栓治疗方法具有平均起效时间快、总溶栓疗程短、溶栓药物总剂量低、并发症发生率及PTS发生率低等优点,而远期复发率与外周溶栓组无明显差异.结论:置管溶栓治疗方法优于外周溶栓治疗.%Objective :To compare the curative efficacy of anticoagulation and thrombolysis for acute deep venous thrombosis( DVT ) via central venous catheter management or peripheral venous management for summary of the clinical experience. Methods :The clinical data were reviewed in 42 patients with DVT undergone treatment respectively in our institution and the Affiliated Hospital of Nantong University between Sept. 2010 and Jul. 2012. The patients were randomized into either group A( n=22; 15 were symptoms of left lower extremity,6 of right and 1 of both extremities ) by thrombolytic therapy via central venous catheter or group B( n =20; 13 were acute episode of left lower limb, 6 of right and 1 of both lower limbs. ) managed with peripheral venous anticoagulation and thrombolysis. Two groups of patients were assessed for the curative efficacy by observing the relief of clinical symptoms and measuring the changes of the limb circumference. Results:Thrombolytic therapy for acute DVT via central venous catheter demonstrated advantages by earlier effects, shortened therapy duration, requirement of lower drug dosage, fewer incidence of complications and risk of developing the

  11. Single-centre experience with tunnelled central venous catheters in 150 cancer patients.

    NARCIS (Netherlands)

    Koolen, D.A.; Laarhoven, H.W.M. van; Wobbes, Th.; Punt, C.J.A.

    2002-01-01

    BACKGROUND: Tunnelled venous catheters improve venous access in cancer patients, but are associated with complications. We retrospectively analysed the outcome of Hickman catheter and Port-A-Cath (PAC) insertion in cancer patients from a department of medical oncology and compared these results with

  12. Who is teaching and supervising our junior residents' central venous catheterizations?

    Directory of Open Access Journals (Sweden)

    Roberts James M

    2011-04-01

    Full Text Available Abstract Background The extent to which medical residents are involved in the teaching and supervision of medical procedures is unknown. This study aims to evaluate the teaching and supervision of junior residents in central venous catheterization (CVC by resident-teachers. Methods All PGY-1 internal medicine residents at two Canadian academic institutions were invited to complete a survey on their CVC experience, teaching, and supervision prior to their enrolment in a simulator CVC training curriculum. Results Of the 69 eligible PGY-1 residents, 32 (46% consenting participants were included in the study. There were no significant baseline differences between participants from the two institutions in terms of sex, number of ICU months completed, previous CVC training received, number of CVCs observed and performed. Only 16 participants (50% received any CVC training at baseline. Of those who received any training, 63% were taught only by senior resident-teachers. A total of 81 CVCs were placed by 17 participants. Thirty-two CVCs (45% were supervised by resident-teachers. Conclusions Resident-teachers play a significant role both in the teaching and supervision of CVCs placed by junior residents. Educational efforts should focus on preparing residents for their role in teaching and supervision of procedures.

  13. Challenges in the Management of Pediatric Central Venous Access Devices in the Community.

    LENUS (Irish Health Repository)

    Wallace, Elaine

    2012-05-25

    Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital\\/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care ("home care") teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.

  14. Management of complications related to central venous catheters in cancer patients: an update.

    Science.gov (United States)

    Linnemann, Birgit

    2014-04-01

    Central venous catheters (CVCs) are important for the treatment of patients with cancer, especially in the perioperative and palliative care settings. These devices not only allow for the administration of chemotherapy, parenteral nutrition, and other intravenous therapies, but they may also improve the patients' quality of life by reducing the need for repeated peripheral venipunctures. Thrombotic and infectious complications are common, especially in the long-term use of CVCs. There are different types of thrombotic complications associated with CVCs, that is, a thrombotic occlusion of the catheter, a mural thrombus at the catheter tip and classical deep vein thrombosis, which occurs most frequently in the upper extremity where the majority of long-term catheters are inserted. Infections are common complications associated with CVCs. Patients with cancer who receive intensive chemotherapy and those patients who undergo hematopoietic stem cell transplantation have a markedly increased risk for insertion site and bloodstream infections. In this review, the epidemiology and risk factors that predispose patients to CVC-related thrombosis and infection are discussed. The diagnostic and therapeutic options according to the published data and the current guidelines are summarized and data for establishing primary and secondary preventative strategies are provided.

  15. Inserting central venous catheter in emergency conditions in coagulopathic patients in comparison to noncoagulopathic patients

    Directory of Open Access Journals (Sweden)

    Mohammad Nasr-Esfahani

    2016-01-01

    Full Text Available Background: The current study was designed to compare the complications and adverse effects of central venous catheter (CVC insertion under ultrasound guidance in patients with and without coagulopathy. Materials and Methods: In this clinical trial, 59 patients who needed CVC for various reasons were enrolled. Patients were divided into two groups of those with and without coagulopathy based on complete blood count, prothrombin time, partial thromboplastin time, and international normalized ratio test results, and then, CVC was inserted with ultrasound guidance in both groups. The CVC inserting site was examined for hematoma and hemorrhage in four stages at different times. Results: There was no significant difference in the terms of demographic features, catheter lumen size (P = 0.43, and number of attempting for CVC placement (odds ratio [OR] =2.35, 95% confidence interval [CI] = 0.36–15.3, P = 0.39 between two groups. Seven out of 59 patients suffered from complications (11.9% that the complications in coagulopathic patients were oozing (5.7% and superficial hematoma (8.6% while in noncoagulopathic patients were 4.2% for both complications (OR = 0.54, 95% CI = 0.09–3.07, P = 0.767. Conclusion: According to our results, it can be concluded that inserting CVC with ultrasound guidance under emergency conditions causes no serious and life-threatening complications in coagulopathic patients.

  16. Injection of gadolinium contrast through pediatric central venous catheters: a safety study

    Energy Technology Data Exchange (ETDEWEB)

    Moriarty, John M.; Ramos, Yanerys; Finn, J.P. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); Kung, Geoffrey L. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); University of California, Biomedical Engineering Interdepartmental Program, Los Angeles, CA (United States); Moghaddam, Abbas N. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); Amirkabir University of Technology (Tehran Polytechnic), Department of Biomedical Engineering, Tehran (Iran, Islamic Republic of); Ennis, Daniel B. [University of California, Department of Radiological Sciences, David Geffen School of Medicine, Los Angeles, CA (United States); University of California, Biomedical Engineering Interdepartmental Program, Los Angeles, CA (United States); University of California, Biomedical Physics Interdepartmental Program, Los Angeles, CA (United States)

    2012-09-15

    Catheter rupture during CT angiography has prompted policies prohibiting the use of electronic injectors with peripherally inserted central venous catheters (PICCs) not only for CT but also for MRI. Consequently, many institutions mandate hand injection for MR angiography, limiting precision of infusion rates and durations of delivery. To determine whether electronic injection of gadolinium-based contrast media through a range of small-caliber, single-lumen PICCs would be safe without risk of catheter rupture over the range of clinical protocols and determine whether programmed flow rates and volumes were realized when using PICCs for contrast delivery. Experiments were performed and recorded using the Medrad Spectris Solaris EP MR Injection System. PICC sizes, contrast media and flow rates were based on common institutional protocols. No catheters were damaged during any experiments. Mean difference between programmed and delivered volume was 0.07 {+-} 0.10 mL for all experiments. Reduced flow rates and prolonged injection durations were observed when the injector's pressure-limiting algorithm was triggered, only in protocols outside the clinical range. PICCs commonly used in children can withstand in vitro power injection of gadolinium-based contrast media at protocols significantly above clinical levels. (orig.)

  17. Cardiovascular system identification: Simulation study using arterial and central venous pressures.

    Science.gov (United States)

    Karamolegkos, Nikolaos; Vicario, Francesco; Chbat, Nicolas W

    2015-08-01

    The paper presents a study of the identifiability of a lumped model of the cardiovascular system. The significance of this work from the existing literature is in the potential advantage of using both arterial and central venous (CVP) pressures, two signals that are frequently monitored in the critical care unit. The analysis is done on the system's state-space representation via control theory and system identification techniques. Non-parametric state-space identification is preferred over other identification techniques as it optimally assesses the order of a model, which best describes the input-output data, without any prior knowledge about the system. In particular, a recent system identification algorithm, namely Observer Kalman Filter Identification with Deterministic Projection, is used to identify a simplified version of an existing cardiopulmonary model. The outcome of the study highlights the following two facts. In the deterministic (noiseless) case, the theoretical indicators report that the model is fully identifiable, whereas the stochastic case reveals the difficulty in determining the complete system's dynamics. This suggests that even with the use of CVP as an additional pressure signal, the identification of a more detailed (high order) model of the circulatory system remains a challenging task.

  18. Factors affecting survival in pediatric cardiac tamponade caused by central venous catheters.

    Science.gov (United States)

    Kayashima, Kenji

    2015-12-01

    Pediatric central venous catheter (CVC) placement is useful but associated with complications such as cardiac tamponade. We aimed to identify risk factors for death in cardiac tamponade. Published articles on pediatric CVC-associated cardiac tamponade were obtained by searching PubMed and Google and retrospectively reviewed to analyze risk factors for death. Factors examined for their effect on mortality risk included patient age, weight, CVC size, days from CVC insertion to tamponade occurrence, substances administered, insertion site, treatment, CVC material, and initial CVC tip position. Of 110 patients reported in 62 articles, 69 survived and 41 died. Among survivors, 55 of 69 patients were treated; among deaths, only 7 of 38 (OR 537.9, 95% CI 29.3-9,877, p tamponade survival. Past studies have mainly discussed how to avoid pediatric cardiac tamponade; by contrast, the present study focused on how to avoid deaths. The findings of this review suggest that cardiac tamponade survival is better when tamponade is detected early and treated promptly and might be affected by initial CVC tip position.

  19. The pericardial reflection and the tip of the central venous catheter - topographical analysis in stillborn babies

    Energy Technology Data Exchange (ETDEWEB)

    Eifinger, Frank; Vierzig, Anne; Roth, Bernhard [University Children' s Hospital, Department of Pediatric Critical Care Medicine and Neonatology, Cologne (Germany); Scaal, Martin [University of Cologne, Institute of Anatomy II, Cologne (Germany); Koerber, Friederike [University of Cologne, Department of Radiology, Cologne (Germany)

    2016-10-15

    Central venous cannulation is widely used in neonatal critical care. Pericardial tamponade caused by vessel wall perforation can occur if the catheter tip induces extravasation at the level of the pericardium. To investigate the level of the superior pericardial reflection in stillborn babies. We dissected 20 bodies (11 female, mean gestational age 33 6/7 weeks, range 25-43 weeks), with careful opening of the thoracic area. After injecting contrast medium into the pericardial sac, we introduced a catheter through the right internal jugular vein. We then took radiographs to analyse the relationship between visual osseous landmarks and the pericardium. Mean distance between the pericardial reflection at its upper end and the first thoracic vertebra was 1.3 cm (standard deviation [SD]: 0.3 cm) and did not extend over the 3rd intercostal space. The mean distance from the entry of the superior vena cava into the pericardial sac and the 1st thoracic vertebra was 2.3 cm (SD: 0.5). The upper end of the pericardial reflection in neonates at autopsy lies below the middle of the 3rd thoracic vertebra. The tip of an upper inserted catheter should not extend below the level of the 3rd intercostal space. (orig.)

  20. Proper Angle of Sono-guided Central Venous Line Insertion; a Brief Report

    Directory of Open Access Journals (Sweden)

    Hassan Barzegari

    2016-04-01

    Full Text Available Introduction: Determining the proper angle for inserting central venous catheter (CV line is of great importance for decreasing the complications and increasing success rate. The present study was designed to determine the proper angle of needle insertion for internal jugular vein catheterization. Methods: In the present case series study, candidate patients for catheterization of the right internal jugular vein under guidance of ultrasonography were studied. At the time of proper placing of the catheter, photograph was taken and Auto Cad 2014 software was used to measure the angles of the needle in the sagittal and axial planes, as well as patient’s head rotation. Result: 114 patients with the mean age of 56.96 ± 14.71 years were evaluated (68.4% male. The most common indications of catheterization were hemodialysis (55.3% and shock state (24.6%. The mean angles of needle insertion were 102.15 ± 6.80 for axial plane, 36.21 ± 3.12 for sagittal plane and the mean head rotation angle was 40.49 ± 5.09. Conclusion: Based on the results of the present study it seems that CV line insertion under the angles 102.15 ± 6.80 degrees in the axial plane, 36.21 ± 3.12 in the sagittal plane and 40.49 ± 5.09 head rotation yield satisfactory results. 

  1. A corrosive oesophageal burn model in rats: Double-lumen central venous catheter usage

    Directory of Open Access Journals (Sweden)

    Vedat Bakan

    2015-01-01

    Full Text Available Background: We aimed to create a new and less invasive experimental corrosive oesophageal burn model using a catheter without a gastric puncture (gastrotomy. Materials and Methods: We conducted the study with two groups composed of 8 male rats. The experimental oesophageal burn was established by the application of 10% sodium hydroxide to the distal oesophagus under a pressure of 20 cmH 2 O, via 5-F double-lumen central venous catheter without a gastrotomy. The control group was given 0.9% sodium chloride. All rats were killed 24 h after administration of NaOH or 0.9% NaCl. Histologic damage to oesophageal tissue was scored by a single pathologist blind to groups. Results: The rats in the control group were observed to have no pathological changes. Corrosive oesophagitis (tissue congestion, oedema, inflammation, ulcer and necrosis was observed in rats exposed to NaOH. Conclusion: We believe that an experimental corrosive oesophageal burn can safely be created under same hydrostatic pressure without a gastric puncture using this model.

  2. Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion

    Directory of Open Access Journals (Sweden)

    Aloka Samantaray

    2014-01-01

    Full Text Available Background and Aim: Central venous catheter (CVC insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. Methods: A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken. Patients were randomly assigned into two groups of 27 each, to receive either dexmedetomidine (1 μg/kg or 0.9% normal saline, along with LA field infiltration. Pain and discomfort score was measured at 5 time points. Results: The median pain score was worst for placebo group at local anaesthetic injection (6 [4-7] and at the end of procedure (5 [4-5], which was significantly attenuated in the dexmedetomidine group (4 [4-5] and 4 [3-5]; P = 0.007 and 0.040 respectively. The lower procedure related discomfort score in the immediate post-procedural period was statistically significant in dexmedetomidine group compared to placebo (4 [4-5] vs. 5 [4-6]; P = 0.008. Conclusions: Pre-procedural bolus dexmedetomidine infusion provides adequate analgesia and patient comfort for CVC insertion along LA field block. However, the tendency for excessive sedation and bradycardia associated with dexmedetomidine render it less desirable for this purpose.

  3. Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Nasir Hussain

    2012-01-01

    Full Text Available Central venous catheters (CVC are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.

  4. Cost of installing and turning off hemodialysis on patients with central venous catheters

    Directory of Open Access Journals (Sweden)

    Gillene Santos Ferreira

    2014-12-01

    Full Text Available The objective was to identify the average total cost (ATC for installing and turning off hemodialysis on patients with central venous catheters. This quantitative, exploratory, and descriptive research, in the mode of a single-case study, was conducted in a public university hospital. The non-probabilistic sample corresponded to the observation of 100 installations and 100 terminations of hemodialysis on 42 patients during 23 days of collection. The ATC was calculated by multiplying the time spent by nurses by the unit cost of direct labor, and adding the cost of materials, solutions, and medications. The Brazilian currency (R$ was used for the calculations. The ATC for installation was R$ 80.10 and for shutting off was R$ 13.04, totaling R$ 93.14 per hemodialysis session. The results obtained will facilitate a better planning of the allocation of human, material, and financial resources enabling the increase of managerial strategies aimed at economic efficiency. doi: 10.5216/ree.v16i4.23044.

  5. Playing games with a thrombus: a dangerous match. Paradoxical embolism from a huge central venous cathether thrombus: a case report

    Directory of Open Access Journals (Sweden)

    Mariana Sylvie

    2010-03-01

    Full Text Available Abstract Thromboembolism is a major cause of death in cancer patients. The association between paraneoplastic hypercoagulability of oncological patients and long-term central venous catheters (CVC may result in CVC associated thrombosis. Patent Foramen Ovale (PFO, especially when associated with atrial septal aneurysm (ASA is a risk factor for paradoxical embolism. We report a case of paradoxical embolism with stroke in an oncological patient with a huge CVC thrombus playing "ping-pong" with an hypermobile ASA with a PFO. We review the management of hypercoagulability in oncologic patients and discuss the potential role of routine transthoracic echocardiography before the implantation of long term central venous catheters to identify predisposing conditions to paradoxical embolism and select patients for anticoagulant therapy.

  6. Port central venous catheters-associated bloodstream infection during outpatient-based chemotherapy.

    Science.gov (United States)

    Mauri, Davide; Roumbkou, Sofia; Michalopoulou, Stella; Tsali, Lamprini; Spiliopoulou, Anastasia; Panou, Charalampos; Valachis, Antonis; Panagopoulos, Angelos; Polyzos, Nikolaos P

    2010-12-01

    Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48 h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

  7. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

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    Walter Zingg

    Full Text Available Central line-associated bloodstream infection (CLABSI is the major complication of central venous catheters (CVC. The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001 after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22. Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.

  8. Application of central venous catheter in hemodialysis in 2 000 cases%中心静脉导管在血液净化中的临床应用

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    徐晨; 黄静; 李艳春; 刘婧; 申珅

    2014-01-01

    目的 通过观察中心静脉长期、临时留置导管在血液透析中使用状况,探讨中心静脉导管相关并发症及处理方法,改善血液透析患者预后.方法 回顾性分析2 000例使用中心静脉长期、临时置管维持性血液透析患者的临床资料.其中500例为长期双腔导管,1 500例为临时双腔导管,分析中心静脉导管的相关并发症与处理效果.结果 置管过程中的常见并发症有:误穿动脉11例(0.55%)、皮下血肿6例(0.3%).导管留置并发症有:血流量不足24例(1.2%),导管相关感染23例(1.15%),穿刺部位渗血15例(0.75%),导管意外脱落3例(0.15%).以上并发症均在给予相应的处理后痊愈,未留下相关后遗症.结论 中心静脉导管相关并发症值得临床重视,提高置管技术,加强导管使用维护,及时处理是防范导管失功能的关键.%Objective To discuss the complications and treatment of applying central venous catheter in hemodialysis by observing its application condition.Methods The clinical data of 2 000 patients with centralvenous catheter applied in hemodialysis were enrolled and analyzed retrospectively including 500 cases of long-term duallumen catheters and 1 500 cases of temporary duallumen catheters.The related complications and treatments were analyzed.Results The common complications occurred during catheterizations included inadvertent arterial puncture in 11 cases (0.55%) and ecchymoma in 6 cases (0.3%),while the complications of catheterizations included inadequate blood flow in 24 cases (1.2%),catheter related infection in 23 cases (1.15%),local bleeding in 15 cases (0.75%) and catheter inadvertent withdrawal in 3 cases(0.15%).Above complications were recovered without recurrences after taking corresponding treatments.Conclusion Attention should be paid to the central venous catheter related complications.Improving technology,strengthening nursing care and taking timely treatment are the key

  9. Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative.

    Science.gov (United States)

    Bhutani, Gauri; El Ters, Mireille; Kremers, Walter K; Klunder, Joe L; Taler, Sandra J; Williams, Amy W; Stockland, Andrew H; Hogan, Marie C

    2016-09-20

    Introduction Peripherally inserted central venous catheters (PICCs) may adversely impact future successful arteriovenous fistulae (AVF). As part of a quality improvement project, the performance of tunneled small bore tunneled central venous catheters (TSB-CVCs), as alternatives to PICCs, was evaluated. Methods A retrospective observational study, involving individuals ≥18 years of age who underwent TSB-CVC placement by Interventional Radiology at Mayo Clinic, Rochester, MN between 1/1/2010 and 8/30/2013. Findings The study cohort included 92 patients with a median age of 55 (46-67) years, who underwent 108 TSB-CVC placements. Baseline renal disease was present in 71% (77/108). Most TSB-CVCs were placed in hospitalized patients (94%; 102/108); five French in diameter (61%; 66/108) and located in an internal jugular vein (84%; 91/108). Median catheter indwelling time was 20 (11-43) days (n = 84). TSB-CVC-related bloodstream infection, deep venous thrombosis (DVT), and superficial venous thrombosis (SpVT) rates per line were 0.009 (1/108), 0.018 (2/108), and 0.009 (1/108), respectively. Venous outcomes in a subgroup of 54 patients, who had documented PICC placements (n = 161) in addition to TSB-CVC (n = 58) were compared. TSB-CVC-DVT rate was lower than the PICC-DVT rate (0.017 [1/58] vs. 0.106 per line [17/161]; P = 0.04). The TSB-CVC-SpVT rate was not different from the PICC-SpVT rate (0 [0/58] vs. 0.037 [6/161] per line; P = 0.14). Discussion TSB-CVCs demonstrated an excellent safety profile in our study. These catheters should be preferentially utilized for arm vein preservation in advanced kidney disease. Their impact on future AVF success needs further evaluation.

  10. Central venous cannulation: are routine chest radiographs necessary after B-mode and colour Doppler sonography check?

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    Lanza, Cecilia; Fabrizzi, Giancarlo [Pediatric Radiology Department-Presidio Salesi, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona (Italy); Russo, Marco [Ospedale Civile Engles Profili, Servizio di Radiologia, Ancona (Italy)

    2006-12-15

    After the insertion of a central venous catheter, a chest radiograph is usually obtained to ensure correct positioning of the catheter tip. To determine in a paediatric population whether B-mode and colour Doppler sonography after central venous access is useful to evaluate catheter position, thus obviating the need for a postprocedural radiograph. A prospective study of 107 consecutive central venous access procedures placed in a paediatric intensive care unit was performed. At the end of the procedure, B-mode and colour Doppler sonography were used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients. In 96 patients postprocedural B-mode and colour Doppler sonography showed colour Doppler signals within the vena cava. Among the 11 patients predicted to have a potential complication, there was one pneumothorax and ten malpositions. Chest radiography showed a total of 13 complications - 1 pneumothorax and 12 malpositions. The concordance between colour Doppler sonography and chest radiography was 98.1% in the detection of catheter position; sonography had a sensitivity of 84.6% and a specificity of 100%. The close concordance between B-mode and colour Doppler sonography and chest radiography justifies the more frequent use of sonography to evaluate catheter position because ionizing radiation is eliminated. Chest radiography may then be performed only when there is suspected inappropriate catheter tip position after sonography. (orig.)

  11. Risk factors and current recommendations for prevention of infections associated with central venous catheters: a literature review

    Directory of Open Access Journals (Sweden)

    Danielle de Mendonça Henrique

    2014-04-01

    Full Text Available Backgound and Objectives: Infections related to central venous catheter (CVC use constitute an important a problem. It is estimated that approximately 90% of bloodstream infections (BSI are caused by CVC use. This study aims at reviewing the risk factors and current recommendations for prevention of infections associated with central venous catheter use. Methods: A total of 12 articles published in the last 5 years and indexed in the databases of the Latin American and Caribbean Literature on Health Sciences (LILACS, Nursing Database (BDENF, International Literature on Health Sciences (Medline/Pubmed were selected, as well as publications related to the recommendations for BSI prevention, such as: Institute for Healthcare Improvement (IHI, Centers for Disease Control and Prevention (CDC and the National Health Surveillance Agency (ANVISA. Results: Two categories were identified: prevention and control measures and risk factors for BSI associated with central venous catheter use. Conclusions: Some recommendations that were well-defined over the years have been questioned by some authors and continuing training and education of the multidisciplinary team are the most important factors for the prevention of bloodstream infections associated with CVC use.

  12. 氯己定醇皮肤消毒液在预防导管相关血流感染中的效果研究%Effect of chlorhexidine skin disinfectant on prevention of catheter-related bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    吴晓琴; 李兰云; 郭晶; 何金; 李琳; 徐莉; 杜永川

    2014-01-01

    目的:探讨2%葡萄糖酸氯己定(CHG)醇皮肤消毒液对预防经外周静脉导入中心静脉置管(PICC)导管相关血流感染(CRBSI)的消毒效果。方法对2013年1-12月行PICC置管的肿瘤患者进行前瞻性随机对照研究,将64例PICC置管的患者进行随机分组,观察组34例使用2% CHG醇进行皮肤消毒,对照组30例使用5%聚维酮碘进行皮肤消毒,分别于各组患者进行PICC置管前及置管后48 h对置管周围部位的皮肤采样,进行细菌监测并比较两组间的差异。结果观察组在 PICC置管前和置管后较对照组48h皮肤菌落数低、干燥时间短(P<0.05),观察组总置管日2356 d ,无CRBSI发生;对照组总置管日1970 d ,CRBSI 4例,2% CHG醇消毒液能降低CRBSI的发生率(P<0.05)。结论2% CHG醇皮肤消毒液可降低PICC导管相关血流感染的发生率,并可减少皮肤表面的暂居菌,抑制其生长从而降低CRBSI风险。%OBJECTIVE To explore the effect of 2% chlorhexidine gluconate (CHG) on prevention of peripherally inserted central venous catheter-related bloodstream infections .METHODS The prospective randomized control study was conducted for the tumor patients who underwent PICC from Jan 2013 to Dec 2013;the 64 PICC patients were randomly divided into the observation group with 34 cases and the control group with 30 cases , the observation group was treated with 2% CHG for skin disinfection ,while the control group was given 5% povidone iodine for skin disinfection .The skins around the catheter insertion sites were respectively sampled before the PICC catheterization and at 48 hours after the PICC catheterization ;the bacterial species were monitored and compared between the two groups .RESULTS The bacterial colony counts in the skin were less in the observation group than in the control group before and after the PICC catheterization ,and the drying time of the observation group was shorter

  13. Inadvertent arterial insertion of a central venous catheter: delayed recognition with abrupt changes in pressure waveform during surgery -A case report-.

    Science.gov (United States)

    Choi, Yong Sun; Park, Ji Young; Kwak, Young Lan; Lee, Jong Wha

    2011-01-01

    We present a case of inadvertent arterial insertion of a central venous catheter, identified during a pericardiectomy procedure after observing abrupt changes in pressure waveform and confirmed via arterial blood gas analysis and transesophageal echocardiography. Central venous pressure measurement was initially 20 mmHg in supine, and then elevated to 30-40 mmHg in right lateral decubitus, presumably resulting from constrictive physiology of pericarditis. The pressure waveforms, however, abruptly changed from a venous to an arterial waveform during surgery. When visual discrimination between arterial and venous blood regurgitation is unreliable, anesthesiologists should confirm that using all the available methods one has on the scene, especially after at least two unsuccessful attempts or in patients with advanced age or clinical conditions resulting in jugular venous dilation. To prevent arterial catheterization, one should limit the leftward rotation of the head by <40° and consider using ultrasound-guided method after more than two unsuccessful attempts.

  14. How correct is the correct length for central venous catheter insertion

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    Kujur Rash

    2009-01-01

    Full Text Available Background and Aim: Central venous catheters (CVC are important in the management of critically ill patients. Incorrect positioning may lead to many serious complications. Chest radiograph is a convenient means of determining the correct position of the catheter tip. The present study was designed to evaluate the depth of CVC placed through the right and left internal jugular vein (IJV in order to achieve optimum placement of the catheter tip. Materials and Methods: A total of 107 patients in whom CVCs were put through either the right or left IJV through a central approach were included in this prospective study. Catheter tip position was observed in the post procedure chest radiograph. It was considered correct if the tip was just below the carina in the left-sided catheters and just above carina in the right-sided catheters. The catheters were repositioned based on the chest radiographs. The catheter depth leading to optimum tip placement was noted. Results: In males, catheter repositioning was required in 13 of 58 patients (22.41% in the right IJV catheters, whereas in 2 of 13 patients (15.38% in the left IJV catheters. In females, repositioning was required in 12 of 25 patients (48% in the right IJV catheters and 2 of 11 patients (18.18% in the left IJV catheters. Repositioning rate was higher in females (14/36 compared with males (15/71, which was statistically significant ( P = 0.05, 95% CI. Repositioning rates were significantly higher in females (12/25 as compared with males (13/58 in the right IJV catheters ( P = 0.019, 95% CI. Conclusion: By cannulating the IJV through a central approach, the catheters can be fixed at a length of 12-13 cm in males and 11-12 cm in females in the right IJV and at a length of 13-14 cm in males and 12-13 cm in females in the left IJV in order to achieve correct positioning.

  15. Direct US-guided puncture of the innominate veins for central venous access.

    Science.gov (United States)

    Lau, T N; Kinney, T B

    2001-05-01

    Maintenance of functioning venous access is recognized as the Achilles heel of long-term hemodialysis treatment. In patients who require catheter-directed hemodialysis, the internal jugular veins are recognized as the optimal veins for insertion of dialysis catheters. When these sites are no longer available, alternative venous access sites are required. The authors describe two hemodialysis patients with limited access sites in whom hemodialysis catheters were successfully inserted directly into the innominate veins with use of ultrasound-guided punctures.

  16. Complications Related to Insertion and Use of Central Venous Catheters (CVC)

    Science.gov (United States)

    Hodzic, Samir; Golic, Darko; Smajic, Jasmina; Sijercic, Selma; Umihanic, Sekib; Umihanic, Sefika

    2014-01-01

    ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion. PMID:25568558

  17. The safety of ultrasound guided central venous cannulation in patients with liver disease

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    Shweta A Singh

    2015-01-01

    Full Text Available Background: Central venous cannulation (CVC is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP. Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC in itself reduces the incidence of complications. Aim: To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy. Setting and Design: An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center. Materials and Methods: Data was collected for all the adult patients (18-60 years of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications. Results: The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683 × 10 9 /L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing. Conclusion: Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.

  18. Managing central venous catheters: a prospective randomised trial of two methods.

    Science.gov (United States)

    Larwood, K A; Anstey, C M; Dunn, S V

    2000-05-01

    A randomised, prospective study was conducted to evaluate the impact on central venous catheter (CVC) infection when fluids and lines connected to a CVC were changed using a 'sterile' compared to an 'aseptic, non-touch' technique. The study sought to determine whether there were any differences in CVC tip colonisation (CTC) or CVC-related bacteraemia (CRB) as a result of the technique used for fluid and line changes. In the sterile technique (control) group, fluids and tubing were changed using full sterile technique. In the aseptic, non-touch (experimental) group, fluids and tubing attached to the CVC were changed using only a small sterile drape and a 2-minute clinical hand wash. When the CVC was removed, the tip was sampled and cultured using the semi-quantitative method. Blood cultures were also collected. In all, 111 samples from 79 patients were included in the trial: 61 in the sterile technique group and 50 in the non-touch, aseptic technique group. Results showed a CTC rate of 31 per cent in the control group and 14 per cent in the experimental group, while the CRB rate was 8.2 per cent and 6 per cent respectively. The most common organisms cultured were Staphylococcus aureus and S. epidermis respectively. This study indicates that it is safe to change fluids and lines attached to CVCs using the aseptic, non-touch technique, which has resulted in significant financial savings through less use of equipment and less nursing time required to perform fluid and line changes.

  19. In vitro stability and compatibility of tenecteplase in central venous access devices.

    Science.gov (United States)

    Lentz, Yvonne K; Joyce, Michael; Lam, Xanthe

    2011-04-01

    Central venous access devices (CVADs) aid in the delivery of nutritional support, infusion therapy, and hemodialysis. Maintaining continuous flow through these devices is challenging, because they are susceptible to complications such as thrombi occlusion. Therefore, CVADs may require treatment with anticoagulant or thrombolytic agents. Using these agents as locking solutions has been widely investigated; however, few publications have described the compatibility of the therapeutic with the CVAD itself. The objective of this investigation was to evaluate the in vitro stability and compatibility of a thrombolytic biologic agent, tenecteplase, with various CVAD materials. Tenecteplase was reconstituted to 1 mg/mL with either sterile water for injection or bacteriostatic water for injection (0.9% benzyl alcohol) then incubated in glass vials, polysulfone/silicone vascular access ports, and polyurethane or silicone catheters for up to 96 hours. Biochemical assays including protein monomer, protein one-chain, and in vitro bioactivity were used to assess tenecteplase's compatibility with the investigated diluents and materials every 24 hours. Antimicrobial testing was also performed for up to 28 days on bacteriostatic water for injection-reconstituted samples only. Our results showed tenecteplase to be compatible with both types of diluents (in glass vials) and catheters for up to 72 hours. Furthermore, tenecteplase was compatible with the polysulfone/silicone vascular access ports for up to 24 hours. Finally, bacteriostatic water for injection-reconstituted tenecteplase effectively met USP criteria for the inhibition of growth of micro-organisms. This study serves as an example of a best practice to evaluate the in vitro stability and compatibility of a biologic agent with CVAD materials.

  20. Warfarin for improvement the cuffed central venous catheter dysfunction and clinical analysis%华法令对于带涤纶套中央静脉导管功能不良的改善及临床分析

    Institute of Scientific and Technical Information of China (English)

    汤小芳; 严连喜; 李康峰; 石平; 王成双; 孔若曦; 严宁; 周玉坤

    2016-01-01

    blood flow,blood return venous pressure in hemodialysis and the blood urea nitrogen and creatinine,ultrafiltration before and after dialysis,urea clearance index (Kt/V) and the effect of dialysis were recorded and evaluated.Non dialysis state international normalized ratio(INR) was regularly detected.Catheter retention time and median retention time,bleeding,catheter related blood stream infection and other complications were compared between the two groups in a year.Results There were statistical differences in level of creatinine and urea nitrogen between group A and B before and after dialysis.Urea clearance index of group A was standard.There were statistical differences in blood flow and vein blood pressure in dialysis between two groups.There were also statistical differences in level of creatinine and urea nitrogen,urea clearance index and INR after dialysis between group A and group B.And there was also statistical difference in retention time of the two groups.Bleeding,complications of catheter related blood stream infection were not found in group A and B.Conclusions After cuffed central venous catheter placement,taking moderate dose warfarin with heparin sealed tube is better than aspirin,which would improve catheter dysfunctiondue due to thrombus and fibrin sheath and prolong catheter retention time with few complications.But the study is fairly small,and the observation time is short.It should be further studied in clinic to confirm clinical safety and efficacy of warfarin after cuffed central venous catheter placement.

  1. The Use of a Novel Ultrasound Guidance System for Real-time Central Venous Cannulation: Safety and Efficacy

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    Robinson M. Ferre

    2014-07-01

    Full Text Available Introduction: Real-time ultrasound guidance is considered to be the standard of care for central venous access for non-emergent central lines. However, adoption has been slow, in part because of the technical challenges and time required to become proficient. The AxoTrack® system (Soma Access Systems, Greenville, SC is a novel ultrasound guidance system recently cleared for human use by the United States Food and Drug Administration (FDA. Methods: After FDA clearance, the AxoTrack® system was released to three hospitals in the United States. Physicians and nurse practitioners who work in the intensive care unit or emergency department and who place central venous catheters were trained to use the AxoTrack® system. De-identified data about central lines placed in living patients with the AxoTrack® system was prospectively gathered at each of the three hospitals for quality assurance purposes. After institutional review board approval, we consolidated the data for the first five months of use for retrospective review. Results: The AxoTrack® system was used by 22 different health care providers in 50 consecutive patients undergoing central venous cannulation (CVC from September 2012 to February 2013. All patients had successful CVC with the guidance of the AxoTrack® system. All but one patient (98% had successful cannulation on the first site attempted. There were no reported complications, including pneumothorax, hemothorax, arterial puncture or arterial cannulation. Conclusion: The AxoTrack® system was a safe and effective means of CVC that was used by a variety of health care practitioners. [West J Emerg Med. 2014;15(4:536-540.

  2. Complications of total implantable access ports and efficacy of Taurolidine-citrate lock solution against catheter-related infections

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    Emine Ince

    2014-01-01

    Full Text Available Background: Totally, implantable access ports (TIAPs are used for long standing venous catheterization. This study was designed to present our experiences of the TIAPs applications and efficacy of Taurolidine-citrate lock solution (TCLS against catheter-related infections. Materials and Methods: We evaluated records of the 108 patients implanted with 112 TIAPs, which had been performed using heparin solution or TCLS between 2005 and 2013. Results: Duration of exposure to TIAPs was 17-2051 days (median: 411 days. The primary diagnoses were solid tumours (n = 57, lymphoma (n = 23, haematologic diseases (n = 23, nephrotic syndrome (n = 4, Hirschsprung disease (n = 1. The right external jugular vein was most frequently used vascular access route (72.3%. Mechanical complications were observed in four cases. TIAPs were removed due to remission in 19 cases and infection in 19 cases. Median time from implantation and to the development of infection was 60 days. Heparin solution had been used for care in 33 ports, whereas heparin and TCLS had been used in 79 ports. Based on statistical comparison, use of TCLS was considered to be an important factor for preventing infection (P = 0.03. Conclusion: We consider that TCLS reduces infection prevalence so TIAPs would be used more extensively and effectively to prevent infections.

  3. Diagnosis of intra vascular catheter-related infection.

    Science.gov (United States)

    Cicalini, S; Palmieri, F; Noto, P; Boumis, E; Petrosillo, N

    2002-01-01

    The use of central vascular catheters (CVC) is associated with a substantial number of complications, amongst which infections predominate. A diagnosis of CVC-related infection usually requires catheter removal for culture. Semiquantitative (roll-plate method) and quantitative methods (flush, vortex, centrifugation or sonication methods) are the most reliable diagnostic methodologies requiring catheter removal, because of their greater specificity. The roll-plate method is the simplest and most commonly used technique. This method only samples the external surface of the catheter, and is particularly indicated for recently inserted catheters in which extraluminal colonisation is the primary mechanism of infection. Luminal culture techniques, such as the quantitative methods, may be more relevant for catheters that have been in place for a long period of time. However, in up to 85% of removed CVC the culture is negative, and other diagnostic techniques that do not require catheter removal have been proposed, including paired quantitative blood cultures, endoluminal brushing, and differential time to positivity (DTP) of paired blood cultures. DTP, that compares the time to positivity for qualitative cultures of blood samples simultaneously drawn from the CVC and a peripheral vein, appears to be the most reliable in the routine clinical practice since many hospitals use automatic devices for qualitative blood culture positivity detection. More recently catheter-sparing direct diagnostic methods, which include Gram stain and acridin-orange leucocyte cytospin (AOLC) test, appeared to be especially useful because of the rapidity of results and the ability to distinguish different microorganisms, allowing early targeted antimicrobial therapy.

  4. ICU中心静脉导管相关性感染的危险因素分析%Risk factors of central venous catheters associated infection in geriatric internal ICU

    Institute of Scientific and Technical Information of China (English)

    邓小玲; 梅桂萍; 刘娟; 李艳梅; 林哲婉; 肖俊

    2011-01-01

    目的 探讨老年ICU中心静脉导管相关性感染(CRI)的发生率及其相关危险因素. 方法 回顾性分析行中心静脉插管的66例患者CRI的发生率,同时对患者CRI可能相关的25个因素进行多因素logistic回归分析,寻找与CRI相关的危险因素. 结果 66例患者插管143次,共发生CRI 46例次,CRI发生率为32.17%、千导管日感染率为28.57‰;丧失自理能力、置入三腔导管为发生老年内科ICU患者CRI的危险因素(OR值分别为3.066、1.778). 结论 老年内科ICU患者CRI的发生率高,而丧失自理能力、置入三腔导管者更易于发生CRI,尽量避免不必要的三腔静脉导管的留置、严格无菌操作和加强护理是降低该人群CRI发生率的关键.%OBJECTIVE To investigate the incident rate of central venous catheters related infection (CRI) in the geriatric internal intensive care unit and the related risk factors. METHODS The incident rate of CRI of 66 patients admitted to geriatric internal intensive care unit with venous catheter was calculated. And twenty-five possible CRI-related factors were analyzed with multivariate Logistic regression. RESULTS A total of 143 venous catheters were inserted to central venous of 66 patients admitted to the geriatric internal intensive care unit. The total incidence rate of CRI was 32.17%, the day infection rate was 28. 57%. And the loss of self-care ability and the catheter with three lumens were two independent risk factor of CRI in elder patients with critical illnesses (odd ratio equals to 3. 066 and 1. 778 respectively). CONCLUSION The incidence rate of CRI in geriatric internal intensive care unit is high. The elder patients who lost the ability of self-care and with three-lumen catheter is vulnerable to CRI. Preventing the unnecessary plantation of catheter with 3 lumens and strictly keeping the rules of sterile operation and improving nursing work are the key measures to reduce the incident rate of CRI in elder patients.

  5. Catheter-Related Bacteremia Due to Kocuria kristinae in a Patient with Ovarian Cancer

    Science.gov (United States)

    Basaglia, G.; Carretto, E.; Barbarini, D.; Moras, L.; Scalone, S.; Marone, P.; De Paoli, P.

    2002-01-01

    We report on the first case of a catheter-related recurrent bacteremia caused by Kocuria kristinae, a gram-positive microorganism belonging to the family Micrococcaceae, in a 51-year-old woman with ovarian cancer. This unusual pathogen may cause opportunistic infections in patients with severe underlying diseases. PMID:11773142

  6. Dialysis catheter-related septicaemia--focus on Staphylococcus aureus septicaemia

    DEFF Research Database (Denmark)

    Nielsen, J; Ladefoged, S D; Kolmos, H J

    1998-01-01

    BACKGROUND: Dialysis catheters are a common cause of nosocomial septicaemia in haemodialysis units usually due to staphylococci, of which Staphylococcus aureus is the most pathogenic. In this study, the epidemiology and pathogenesis of dialysis catheter-related infections were studied, and methods...

  7. Application of cluster care in the catheter-related bloodstream infections%集束化护理在导管相关性血流感染中的应用

    Institute of Scientific and Technical Information of China (English)

    陈萍燕

    2016-01-01

    目的:探讨集束化护理在预防中心静脉导管相关性血流感染中的应用价值。方法从 ICU 收治的留置中心静脉导管的患者中选取200例为研究对象,采用随机数字表法分为研究组和对照组,每组各100例,对照组患者行常规护理,研究组患者行集束化护理。比较两组置管部位、置管时间、感染发生率。结果研究组中颈内静脉置管、锁下静脉置管、股静脉置管分别为82.00%(82/100)、14.00%(14/100)、4.00%(4/100),与对照组的79.00%(79/100)、15.00%(15/100)、6.00%(6/100)比较,差异均无统计学意义(均 P >0.05);研究组置管时间为(10.36±4.67)d,与对照组的(11.28±4.58)d 相当,组间差异无统计学意义(χ2=1.406,P >0.05)。研究组导管相关性血流感染发生率为1.00%(1/100),明显低于对照组的9.00%(9/100)(χ2=6.736,P =0.009)。结论集束化护理在留置中心静脉导管患者中的应用,较常规护理模式而言,可以显著降低中心静脉导管相关性血流感染发生率,是一种有效的护理干预模式。%Objective To explore the application value of cluster nursing care in preventing central venous catheter -related bloodstream infections.Methods 200 patients with indwelling central venous catheter in ICU were selected as the research subjects.They were randomly divided into study group and control group by digital table, 100 cases in each group.The patients in the control group received routine nursing.The patients in the study group was given cluster based nursing.The catheter site,catheterization time,infection rate were compared between two groups.Results In the study group,the rates of internal jugular vein set pipe and lock venous catheter and femoral vein set tube were 82.00%(82 /100),14.00%(14 /100),4.00%(4 /100),which in the control group were 79

  8. Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection

    Directory of Open Access Journals (Sweden)

    Fernando Caravaca

    2014-01-01

    Full Text Available We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome.

  9. Venous Sampling

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Venous sampling Venous sampling is a diagnostic procedure that uses ... the limitations of venous sampling? What is venous sampling? Venous sampling is a diagnostic procedure that involves ...

  10. A retrospective clinical audit of 696 central venous catheterizations at a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Sanjay Agrawal

    2012-01-01

    Full Text Available Background: Malpositions after central venous cannulation are frequently encountered and may need a change in catheter. The incidence of malpositions are varied according to various studies and depend on the experience of the operator performing the cannulation. Aim: To access the incidence of malpositions and related complications associated with landmark-guided central venous cannulation in a 15-bedded medical surgical ICU over a period of three years. Settings and Design: Retrospective analysis of records of all the central venous cannulation done in a 15- bedded medical- surgical ICU over the period of three years (April 2008 to June 2011 were evaluated for the site and side of insertion, number of attempts of puncture, arterial puncture as well as the malpositions on post procedural chest X-ray. The records were also evaluated for the experience of the operator performing cannulation and relationship between experience of operator to malpositions of catheter. Statistical Analysis: Analysis was done using SPSS v 17.0 for Windows. Chi-square test was applied to evaluate the statistical significance. P > 0.05 was significant. Results: Records of 696 cannulations were evaluated. Malpositions occurred in 40 patients. Subclavian vein cannulation resulted in increased malpositions in relation to internal jugular vein cannulation. More common with left sided cannulation. Experience of operator had positive correlation with malpositions and arterial puncture. Arterial puncture was common in 6%, while more than one attempt for cannulation was taken in 100 patients. Conclusion: Incidence of malpositions was low. We conclude that experience of operator improves successful catheterization with lesser number of complications.

  11. Nursing care in the central venous cateterism of pheripheral access with two- lumen or multilumen catheter through the Seldinger technique

    Directory of Open Access Journals (Sweden)

    Alicia Oliva Cesar

    2007-07-01

    Full Text Available Central venous catheters are essential above all in intensive care units, to such an extent that all the patients have one or several catheters.Recently there are other alternatives for the insertion of central lines and one is the two-lumen or multilumen central line peripherally inserted through Seldinger technique which allows:- Administration of hypertonic solutions and drugs- Haemodynamic monitoring- Sample’ s extractionBut the price is the risk of nosocomial infection and for this reason nurses play a fundamental role for their direct implication in the catheter’s care since its insertion until it is removed.The aim of this work is to report in a general way which the procedures and the nursing cares are for the insertion and the maintenance of the polyurethane multilumen catheter inserted through Seldinger technique based on a wide bibliographic review and the consultation with experts on the subject.

  12. Optoacoustic measurement of central venous oxygenation for assessment of circulatory shock: clinical study in cardiac surgery patients

    Science.gov (United States)

    Petrov, Irene Y.; Prough, Donald S.; Kinsky, Michael; Petrov, Yuriy; Petrov, Andrey; Henkel, S. Nan; Seeton, Roger; Salter, Michael G.; Esenaliev, Rinat O.

    2014-03-01

    Circulatory shock is a dangerous medical condition, in which blood flow cannot provide the necessary amount of oxygen to organs and tissues. Currently, its diagnosis and therapy decisions are based on hemodynamic parameters (heart rate, blood pressure, blood gases) and mental status of a patient, which all have low specificity. Measurement of mixed or central venous blood oxygenation via catheters is more reliable, but highly invasive and associated with complications. Our previous studies in healthy volunteers demonstrated that optoacoustic systems provide non-invasive measurement of blood oxygenation in specific vessels, including central veins. Here we report our first results of a clinical study in coronary artery bypass graft (CABG) surgery patients. We used a medical-grade OPO-based optoacoustic system developed in our laboratory to measure in real time blood oxygenation in the internal jugular vein (IJV) of these patients. A clinical ultrasound imaging system (GE Vivid e) was used for IJV localization. Catheters were placed in the IJV as part of routine care and blood samples taken via the catheters were processed with a CO-oximeter. The optoacoustic oxygenation data were compared to the CO-oximeter readings. Good correlation between the noninvasive and invasive measurements was obtained. The results of these studies suggest that the optoacoustic system can provide accurate, noninvasive measurements of central venous oxygenation that can be used for patients with circulatory shock.

  13. Three-dimensional gadolinium-enhanced MR venography to evaluate central venous steno-occlusive disease in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Gao, K.; Jiang, H.; Zhai, R.Y.; Wang, J.F.; Wei, B.J. [Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing (China); Huang, Q., E-mail: hq0713@163.com [Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing (China)

    2012-06-15

    Aim: To determine the agreement and diagnostic accuracy of three-dimensional gadolinium-enhanced magnetic resonance venography (3D-Gd-MRV) in central venous steno-occlusive disease (CVSD) in haemodialysis patients. Materials and methods: Fourteen consecutive haemodialysis patients underwent interventional procedures to evaluate or treat CVSD. 3D-Gd-MRV was performed before the procedures and the results were compared with digital subtraction angiography (DSA). Results: DSA showed >50% stenosis in all 14 patients, 13 of whom were diagnosed correctly using 3D-Gd-MRV. Moderate stenosis was missed at 3D-Gd-MRV in one case whereby the indwelling dialysis central venous catheter may have caused an artefact on the images and hindered the accuracy of the result. The sensitivity of 3D-Gd-MRV in revealing stenosis was 93% (13/14). No complications caused by contrast agent toxicity occurred in any patient. Conclusion: 3D-Gd-MRV employing a non-breath-hold technique is highly sensitive in the diagnosis of CVSD and may be an alternative technique to DSA for the visualization of central veins.

  14. Central line infections - hospitals

    Science.gov (United States)

    ... infection; Central venous catheter - infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired ...

  15. Nursing Care of Patients with Tracheotomy Treated by Central Venous Catheter Inserted in Different Sites%气管切开患者不同部位中心静脉导管置管护理观察

    Institute of Scientific and Technical Information of China (English)

    钱丽芳

    2014-01-01

    Objective To study the difference and clinical significance of patients with tracheotomy treated by central venous catheter inserted in different sites. Methods A total of 75 cases with tracheotomy from February 2012 to February 2014 were divided into three groups: subclavian vein group (group A), jugular vein group (group B) and femoral vein group (group C). 25 in each group. We compared the significance in success rates, complications, hematoma and exudate of puncture site, catheter tube jam, catheter emerge, central venous catheter-related infection (CVC-RI) and dressing change rates among all the groups. Results There was no significant difference of success rates and complications among all the groups (P>0.05), but group A was better than the other two groups in the targets (P<0.05). Central venous catheter was easier to emerge in group B compared with group A and group C (P<0.05). Conclusion Subclavian vein catheter way in the patients with tracheotomy has lower CVC-RI rate, and was easier for nursing care, so it was the first selection in the patient after tracheotomy.%目的:探讨气管切开患者不同部位中心静脉置管差异及临床意义。方法收集苏州大学附属第一医院2012年02月~2014年02月收治的75例气管切开患者临床资料,随机分为锁骨下静脉置管组(A组)、颈内静脉置管组(B组)、股静脉置管组(C组),每组25例。分别对穿刺成功率、并发症、穿刺部位血肿、渗液、导管堵管、脱出、导管相关感染、敷料更换频率等指标进行观察,比较各组之间差异。结果各组患者穿刺成功率及并发症差异无统计学意义(P>0.05),其余各指标A组显著低于B、C两组,具有统计学意义(P<0.05)。其中B组患者导管更易脱出,与A、C两组差异有统计学意义(P<0.05)。结论气管切开患者选择锁骨下静脉置管具有较低的导管相关感染发生率,且便于护理治疗,应作为首选置管途径。

  16. 医护合作小组活动在预防重症监护患者导管相关感染中的作用%the Effects of Cooperative Group Activities in Preventing Catheter-related Infections in Intensive Care

    Institute of Scientific and Technical Information of China (English)

    胡小红; 陈谷霖; 张明芳; 吴玮; 黄英

    2014-01-01

    目的:探讨医护合作小组活动在预防重症监护患者导管相关感染中的作用。方法2011年1月~12月在重症监护室开展医护合作小组活动,随机抽查100例(A组)符合入选条件的患者,监测导管使用与患者导管相关性感染发生情况,并与2010年同期100例(B组)符合入选条件的患者进行对照分析。结果 A组中心静脉导管、呼吸机通气导管、导尿管使用率分别为81.13%、42、71%、60.60%,均低于B组中心静脉导管、呼吸机通气导管、导尿管使用率分别为82.95%、56.41%、81.28%,除中心静脉导管外,呼吸机通气导管与导尿管使用率两组比较有显著性差异(P<0.01);A组中心静脉导管、呼吸机通气导管、导尿管相关性感染率分别为0.52‰、3.97‰、3.48‰,均低于B组中心静脉导管、呼吸机通气导管、导尿管感染率分别为1.96‰、7.94‰、6.01‰,两组比较无显著性差异(P >0.05)。结论开展医护合作小组活动,有利于提高预防导管相关性感染各项措施执行力,降低各种导管使用率和导管相关性感染率。%Objective To explore the key role of the cooperative group activities in the prevention of intensive care pa-tients with catheter-related infections .Method To carry out medical cooperative group activities from January 2011 to De-cember 2011in the intensive care unit ,random inspection 100 cases (A group) met the inclusion criteria ,and monitor cathe-ters and the incidence of catheter-related infections ,and compared with the same period in 2010 .Results The central venous catheters ,ventilator and catheter utilization rates of A group were 81 .13% ,42 .71% ,60 .60% ,lower than that of B group which were 82 .95% ,56 .41% ,81 .28% .After statistics analysis ,breathing machine ventilation and catheter usage had sig-nificant differences except central venous catheter ,the differences had

  17. Vena cava superior izquierda persistente: Implicaciones en la cateterización venosa central Persistent left superior vena cava: Implications in central venous catheterisation

    Directory of Open Access Journals (Sweden)

    G. Lacuey

    2009-04-01

    Full Text Available La colocación de catéteres centrales por vía venosa subclavia y yugular se puede complicar con la canalización de una arteria o de una vía venosa aberrante. La anomalía más frecuente del desarrollo embriológico de la vena cava es la persistencia de la vena cava superior izquierda (VCSI. La implantación de catéteres en la VCSI se puede sospechar por el recorrido anómalo del mismo en la radiografía de tórax. La gasometría y la curva de presión del vaso permiten descartar una cateterización arterial. La confirmación diagnóstica se obtiene mediante angiografía, ecocardiografía, tomografía computerizada o cardio-resonancia. El médico que implanta habitualmente catéteres venosos centrales, debe estar familiarizado con la anatomía del sistema venoso, sus variantes y sus anomalías, ya que su presencia puede influir en el manejo del paciente.The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC. The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient.

  18. Comparing the Effect of 3 Kinds of Different Materials on the Hemostasis of the Central Venous Catheter

    Science.gov (United States)

    Li, Yan-Ming; Liang, Zhen-Zhen; Song, Chun-Lei

    2016-05-01

    To compare the effect of 3 kinds of different materials on the hemostasis of puncture site after central venous catheterization. Method: A selection of 120 patients with peripheral central venous catheter chemotherapy in the Affiliated Hospital of our university from January 2014 to April 2015, Randomly divided into 3 groups, using the same specification (3.5cm × 2cm) alginate gelatin sponge and gauze dressing, 3 kinds of material compression puncture point, 3 groups of patients after puncture 24 h within the puncture point of local blood and the catheter after the catheter 72 h within the catheter maintenance costs. Result: (1) The local infiltration of the puncture point in the 24 h tube: The use of alginate dressing and gelatin sponge hemostatic effect is better than that of compression gauze. The difference was statistically significant (P Puncture point using gelatin sponge, The local maintenance costs of the catheter within 72 h after insertion of the tube are lowest, compared with alginate dressing and gauze was significant (Ppuncture site after PICC implantation, using gelatin sponge and gauze dressing is more effective and economic.

  19. Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review

    Directory of Open Access Journals (Sweden)

    Eduardo José Ferreira dos Santos

    2015-12-01

    Full Text Available Abstract OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush for reducing the risk of occlusions in central venous catheters (CVC in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12. Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82; Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03; in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90 and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19 also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

  20. On-demand antimicrobial release from a temperature-sensitive polymer - comparison with ad libitum release from central venous catheters.

    Science.gov (United States)

    Sjollema, Jelmer; Dijkstra, Rene J B; Abeln, Caroline; van der Mei, Henny C; van Asseldonk, Dirk; Busscher, Henk J

    2014-08-28

    Antimicrobial releasing biomaterial coatings have found application for instance in the fixation of orthopedic joint prostheses and central venous catheters. Most frequently, the release kinetics is such that antimicrobially-effective concentrations are only reached within the first days to weeks after implantation, leaving no local antimicrobial release available when a biomaterial-associated infection occurs later. Here we compare the ad libitum release of chlorhexidine and silver-sulfadiazine from a central venous catheter with their release from a new, on-demand release coating consisting of a temperature-sensitive copolymer of styrene and n-butyl (meth)acrylate. The copolymer can be loaded with an antimicrobial, which is released when the temperature is raised above its glass transition temperature. Ad libitum release of chlorhexidine and silver-sulfadiazine from a commercially-purchased catheter and associated antimicrobial efficacy against Staphylococcus aureus was limited to 16days. Consecutive temperature-triggers of our on-demand coating yielded little or no antimicrobial efficacy of silver-acetate release, but antimicrobially-effective chlorhexidine concentrations were observed over a time period of 60-80days. This attests to the clear advantage of on-demand coatings above ad libitum releasing coatings, that may have released their antimicrobial content before it is actually needed. Importantly, glass transition temperature of chlorhexidine loaded copolymers was lower (48°C) than of silver loaded ones (61°C), facilitating their clinical use.

  1. Placement of central venous access via subclavian vein under fluoroscopic guidance with intravenous contrast injection

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Sung Wook; Choo, In Wook; Do, Young Soo; Kim, Seung Hoon; Yoh, Kyu Tong; Ro, Duk Woo; Kim, Bo Kyung [Samsung Medical Center, Seoul (Korea, Republic of)

    1997-01-01

    To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was as the junction of the right atrium and the superior vena cava. One hundred and eighty-six Hickman catheters were successfully placed ; the one failure was due to anatomical tortuosity of the vein (0.53%). Complications included one case of subclavian vein occlusion (0.53%) ; three of line occlusion by thrombus (1.6%) ; one of oozing at the suture site (0.53%) ; six of infection or inflammation (3.2%) ; eight of natural removal (4.2%) ; one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.

  2. Clinical Analysis of Catheter-Related Bloodstream Infection in ICU%ICU中心静脉置管患者血性感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    吴敏

    2013-01-01

    目的 对ICU中心静脉导管患者发生医院血性感染的相关情况进行分析,探讨发生特点和危险因素.方法 对785例ICU中心静脉置管患者的一般情况和临床资料进行回顾性分析,包括患者的年龄、性别、自理能力、自身免疫性疾病、置管时间、置管部位和免疫抑制剂的使用等相关性感染因素.结果 785例患者相关血性感染共发生34例,发生率4.3%.34例病原菌共检出29株,阳性率85.3%.检出以革兰氏阴性菌为主,占总检出的48.3%,其次为革兰氏阳性菌,占41.4%,再次为真菌,占10.3%.ICU中心静脉导管患者发生医院血性感染与年龄、自理能力、自身免疫性疾病、置管时间和免疫抑制剂的使用相关.结论 积极治疗患者自身免疫性疾病,对置管时间进行控制,并减少免疫抑制剂的使用,是减少ICU中心静脉导管相关血性感染的重要措施.%Objective To investigate the bloodstream infection in patients with central venous catheter in ICU,explore the risk factors.Methods Totally 785 patients with central venous catheter were chosen and studied to analyze the risk factors which might cause bloodstream infection.The correlation factors were gender,age,self-help skills,autosomal disease,insertion time,catheter site,and application of immunosuppressive.Results 34 cases catheter-related bloodstream infection cases were detected in ICU(4.3%).29 cases were detected in 34 cases of pathogens,with the positive rate of 85.3%.The most common bacteria were Gram-negative bacteria,accounting for 48.3%,followed by Gram-positive bacteria which accounting for 41.4%,and Fungi which accounting for 10.3%.The analysis of 785 cases showed that the infection rate was closely related to age,self-help skills,autosomal disease,insertion time,and application of immunosuppressive.Conclusion It was effective to reduce the infection by treating the autosomal disease positively,controlling insertion time and using

  3. Intervenções de enfermagem e flebites decorrentes de cateteres venosos periféricos. Revisão sistemática da literatura. Intervenciones de enfermería y flebitis resultantes de cateteres venosos periféricos. Revisión sistemática de la literatura Nursing interventions and peripheral venous catheter-related phlebitis. Systematic literature review

    Directory of Open Access Journals (Sweden)

    Anabela de Sousa Salgueiro Oliveira

    2010-12-01

    enfermería relacionadas con la inserción del CVP; con la vigilancia de los enfermos y con los conocimientos de los enfermeros. Las tres áreas fueron identificadas como relevantes y con influencia en la aparición de flebitis. Las intervenciones de enfermería realizadas a enfermos portadores de CVP pueden prevenir la aparición de flebitis. La producción científica es, no obstante, reducida, habiendo necesidad de profundizar e investigar sobre el impacto de la formación de los enfermeros en la práctica clínica y sus intervenciones.Nursing care provided to patients using peripheral venous catheters (PVC is a constant need due to the high frequency of catheter use. The aim of this systematic review was to define the scientific evidence on nursing interventions for patients with peripheral venous catheters and their impact on the prevention of phlebitis. Scientific studies published in reference databases, between April 2004 and March 2010, were selected following the PICOD model and previously defined inclusion/exclusion criteria. Nineteen studies were identified and divided into three main areas: nursing interventions related to PVC placement; to patient surveillance; and to nurses’ knowledge. These three areas were identified as relevant and as having an impact on the occurrence of phlebitis. Nursing interventions for patients having PVC can prevent phlebitis. However, the scientific evidence is limited, and so there is a need for further research on the impact of nurses’ training on their clinical practice and interventions.

  4. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.

    Science.gov (United States)

    Salama, Mona F; Jamal, Wafaa; Al Mousa, Haifa; Rotimi, Vincent

    2016-01-01

    Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting.

  5. Safety and feasibility in highly concentrated contrast material power injections for CT-perfusion studies of the brain using central venous catheters

    Energy Technology Data Exchange (ETDEWEB)

    Macht, Stephan, E-mail: stephan.macht@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Beseoglu, Kerim, E-mail: beseoglu@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Neurosurgery, D-40225 Dusseldorf (Germany); Eicker, Sven, E-mail: sven.eicker@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Neurosurgery, D-40225 Dusseldorf (Germany); Rybacki, Konrad, E-mail: rybacki@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Braun, Sebastian, E-mail: sebastian.braun@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Anaesthesiology, D-40225 Dusseldorf (Germany); Mathys, Christian, E-mail: mathys@uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Antoch, Gerald, E-mail: antoch@med.uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany); Turowski, Bernd, E-mail: bernd.turowski@uni-duesseldorf.de [University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf (Germany)

    2012-08-15

    Introduction: CT perfusion studies play an important role in the early detection as well as in therapy monitoring of vasospasm after subarachnoid hemorrhage. High-flow injections via central venous catheters are not recommended but may sometimes be the only possibility to obtain high-quality images. Materials and methods: We retrospectively analyzed our data for CT perfusions performed with power injection of contrast material with an iodine concentration of 400 mg/ml via the distal 16G lumen of the Arrow three and five lumen central venous catheter with preset flow rates of 5 ml/s. Results: 104 examinations with central venous catheters were evaluated (67 with five lumen and 37 with three lumen). No complications were observed. Mean flow rates were 4.4 {+-} 0.5 ml/s using the three lumen catheter and 4.6 {+-} 0.6 ml/s using the five lumen catheter respectively. The mean injection pressure measured by the power injector was 200.7 {+-} 17.5 psi for the three lumen central venous catheter and 194.5 {+-} 6.5 psi for the five lumen catheter, respectively. Conclusion: Following a strict safety protocol there were no complications associated with power injections of contrast material containing 400 mg iodine/ml with preset flow rates up to 5 ml/s via the distal 16G lumen of the Arrow multi-lumen central venous catheter. However, since power-injections are off-label use with Arrow central venous catheters, this procedure cannot be recommended until potential safety hazards have been ruled out by the manufacturer.

  6. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

    Directory of Open Access Journals (Sweden)

    Lütfiye Öksüz

    2012-01-01

    Full Text Available Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  7. Clinical-epidemiological characteristics and outcome of patients with catheter-related bloodstream infections in Europe (ESGNI-006 Study)

    DEFF Research Database (Denmark)

    Muñoz, P; Bouza, E; San Juan, R

    2004-01-01

    (1.55 vs. 0.33/1,000 admissions). Most (67%) catheters were non-tunneled central venous catheters, were in the jugular vein (44%), had been implanted for > 7 days (70%), were made of polyurethane (61%) and were multi-lumen (67%). In 36% of cases, catheters were implanted by physicians other than...

  8. 中心静脉导管合理应用的研究进展%The research progress of the reasonable application of central venous catheter

    Institute of Scientific and Technical Information of China (English)

    王雅杰; 黄抱娣; 王玲; 吕小林; 卞文霞

    2015-01-01

    With the continuous development of intravenous fluids tools, a central venous catheter (CVC), percutaneous puncture via peripheral central venous catheter (PICC) placement, fully implantable venous infusion port of central venous catheter (TIVAP) and so on. How people choose the venous catheter due to illness, is often face problems in nursing work. In this paper, various of catheter is made in this paper.%随着静脉输液工具的不断发展,出现了经皮穿刺中心静脉导管(CVC)、经外周置入中心静脉导管(PICC)、完全植入式静脉输液港(TIVAP)等中心静脉导管。如何因人因病合理选择静脉导管是护理工作中经常面临的问题。本文就各种导管的特点做了综述。

  9. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter.

    Science.gov (United States)

    Chuang, Ming-Tsung; Wu, Ding-Kwo; Chang, Cheng-Ang; Shih, Ming-Chen Paul; Ou-Yang, Fu; Chuang, Chien-Han; Tsai, Yi-Fan; Hsu, Jui-Sheng

    2011-11-01

    The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010), a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days). The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days). All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

  10. Colonization of a Central Venous Catheter by the Hyaline Fungus Fusarium solani Species Complex: A Case Report and SEM Imaging

    Directory of Open Access Journals (Sweden)

    Alberto Colombo

    2013-01-01

    Full Text Available The incidence of opportunistic infections by filamentous fungi is increasing partly due to the widespread use of central venous catheters (CVC, indwelling medical devices, and antineoplastic/immunosuppressive drugs. The case of a 13-year-old boy under treatment for acute lymphoblastic leukemia is presented. The boy was readmitted to the Pediatric Ward for intermittent fever of unknown origin. Results of blood cultures drawn from peripheral venous sites or through the CVC were compared. CVC-derived bottles (but not those from peripheral veins yielded hyaline fungi that, based on morphology, were identified as belonging to the Fusarium solani species complex. Gene amplification and direct sequencing of the fungal ITS1 rRNA region and the EF-1alpha gene confirmed the isolate as belonging to the Fusarium solani species complex. Portions of the CVC were analyzed by scanning electron microscopy. Fungi mycelia with long protruding hyphae were seen into the lumen. The firm adhesion of the fungal formation to the inner surface of the catheter was evident. In the absence of systemic infection, catheter removal and prophylactic voriconazole therapy were followed by disappearance of febrile events and recovery. Thus, indwelling catheters are prone to contamination by environmental fungi.

  11. Extra Luminal Entrapment of Guide Wire; A Rare Complication of Central Venous Catheter Placement in Right Internal Jugular Vein

    Directory of Open Access Journals (Sweden)

    Md Abu Masud Ansari

    2016-10-01

    Full Text Available Central venous Catheterization (CVC is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV, closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.

  12. Transient neurological deficit due to a misplacement of central venous catheter despite ultrasound guidance and ultrasound assistance.

    Science.gov (United States)

    Idialisoa, Rado; Jouffroy, Romain; Saint Martin, Laure Castres; Lamhaut, Lionel; Baud, Frédéric; Philippe, Pascal; Carli, Pierre; Vivien, Benoît

    2015-10-01

    Central venous catheters (CVC) are frequently used in intensive care units (ICU), with a low incidence of complications, most of them being of mechanical origin and occurring during the insertion of the catheter. To avoid such complications, "ultrasound guidance" and "ultrasound assistance" are recommended. Nevertheless, even with trained and experienced physicians, mechanical complications of IJV access such as carotid punctures are still reported. We report the case of a 75-year-old woman, admitted into the ICU for CVC insertion due to impossibility of peripheral venous access. About 12 hours after the procedure, the patient presented a neurological deficit. The cervical and thoracic CT scan showed a transfixing path of the catheter from the left IJV into the left common carotid artery, with distal extremity of the catheter localized in the ascending aorta. The catheter was removed, and thereafter the neurological deficit immediately and definitely disappeared. Onset of a neurological deficit after CVC insertion into the IJV, regardless the time of occurrence after the procedure, should suggest complication due to the CVC insertion, even if procedure was uneventful and chest radiography confirmed the apparent accurate position of CVC.

  13. Catheter-Related Acremonium kiliense Fungemia in a Patient with Ulcerative Colitis under Treatment with Infliximab

    Directory of Open Access Journals (Sweden)

    Fernando A. Díaz-Couselo

    2011-01-01

    Full Text Available Acremonium spp. are filamentous, cosmopolitan fungi commonly isolated from plant debris and soil. They are infrequent pathogens in humans. Acremonium fungemia has been reported in neutropenic patients associated with central venous catheters and in nonneutropenic patients receiving long-term total parenteral nutrition. TNF-α blockade is associated with fungal infections, but no Acremonium spp. infection had been reported up to the present. In this paper, we present a patient with ulcerative colitis who developed Acremonium kiliense fungemia associated with infliximab therapy while receiving total parenteral nutrition. The patient was successfully treated with voriconazole. Acremonium sp. infection must be suspected as another cause of fungal infection in patients under treatment with infliximab.

  14. Hemocultivos simultáneos y diagnóstico de sepsis relacionada a catéter Simultaneous haemocultures and diagnosis of catheter-related sepsis

    Directory of Open Access Journals (Sweden)

    G. González-Ávila

    2004-10-01

    Full Text Available Objetivo: determinar el valor diagnóstico de hemocultivos simultáneos. Antecedentes: El criterio clínico no es suficiente para establecer el diagnóstico de infección relacionada a catéter y en retiro por sospecha o el recambio rutinario no son prácticas recomendadas. Sujetos: Se evalúan 164 catéteres empleados para nutrición endovenosa colocados en 127 pacientes con cáncer, a quienes se les tomó una muestra simultánea de sangre a través del catéter y una vena periférica cuando existía sospecha de infección o bien cada 7 a 10 días de permanencia del catéter. Intervenciones: Se calculó la sensibilidad, especificidad y valores predictivos de los hemocultivos como método diagnóstico. El cultivo de punta constituyó el estándar de oro. Resultados: En presencia de un hemocultivo transcatéter positivo con hemocultivo negativo se identificó una sensibilidad de 87,5% y una especificidad de 97,9%, en cambio la presencia de un hemocultivo transcatéter negativo y periférico positivo mostró una sensibilidad de 62,5%. Cuando ambos hemocultivos fueron positivos se identificó correctamente la infección en el 83,3% de los casos con una sensibilidad de 93,7% y una especificidad de 93,9%. La correlación diagnóstica obtenida para ambos hemocultivos positivos fue de 0,87 y de 0,83 cuando el hemocultivo transcatéter fue positivo y el periférico negativo. Conclusiones: La toma de hemocultivos simultáneos tiene un alto valor diagnóstico.Objetive: To determine the diagnosis value of simultaneous blood cultures. Background: The clinical criteria is not enough to establish catheter-related sepsis diagnosis and remotion or replacement of catheter are not necessary. Subjects: We evaluated 164 catheters used for total parenteral nutrition placement in 127 patients with cancer. Simultaneous blood samples -central and peripheral venous- were taken after seven at ten days of permanency or infection suspicion and compared with tip culture

  15. Acesso venoso central guiado por ultrassom: qual a evidência? Ultrasound-guided central venous catheterization: what is the evidence?

    Directory of Open Access Journals (Sweden)

    Felippe Leopoldo Dexheimer Neto

    2011-06-01

    Full Text Available Recentemente, órgãos internacionais de qualidade em saúde passaram a recomendar o uso de orientação ultrassonográfica para punções venosas centrais. O objetivo deste artigo foi revisar as evidências fundamentando tais recomendações. Foi revisada a literatura no MEDLINE, PubMed e SCIELO com os seguintes termos (MeSH: acesso venoso central, ultrassom e adultos. A pesquisa realizada em 24/09/2010, com seleção de metanálises, ensaios clínicos randomizados e revisões, encontrou 291 artigos. Os 21 artigos mais importantes foram utilizados para a confecção desta revisão. A veia jugular interna é o local mais estudado para punções guiadas por ultrassonografia, com metanálises demonstrando menor risco relativo de falha e de complicações. Além disso, o maior ensaio clínico randomizado disponível também demonstrou redução na incidência de infecções de corrente sanguínea associadas aos cateteres venosos centrais. Poucos estudos existem com relação à punção da veia subclávia, porém o uso do ultrassom mostrou-se benéfico em duas metanálises (mas com um número pouco expressivo de pacientes. Quanto ao sítio venoso femoral, há apenas um ensaio clínico randomizado (20 pacientes, o qual obteve resultados positivos. Em uma avaliação britânica de custo-efetividade, houve economia de recursos com o auxílio do ultrassom na realização das punções venosas nos diferentes sítios. Fortes evidências demonstram benefício com o auxílio ultrassonográfico para punção jugular interna. Embora o método pareça atraente para os demais sítios, ainda não há estudos suficientes que sustentem alguma recomendação.In recent years, international health quality assurance organizations have been recommending ultrasound guidance for central venous punctures. This article reviews the evidence behind these recommendations. The MEDLINE, PubMed and SCIELO databases were searched for the following MeSH terms: central venous

  16. Detection of mixed microbial biofilms on central venous catheters removed from Intensive care Unit Patients Detecção de biofilmes microbianos mistos em cateters venosos de pacientes de Unidades de Terapia Intensiva

    Directory of Open Access Journals (Sweden)

    Anisio Storti

    2005-09-01

    Full Text Available Central venous catheters from intensive care unit patients were subjected to microbiological methods (semiquantitative culture and scanning electron microscopy in order to assess microbial attachment and correlate it with blood cultures. During the period of the survey, 59 patients with inserted central venous catheters were studied. The type of catheter used was nontunneled, noncuffed, single lumen, made of polyurethane. Blood samples for cultures were collected at the moment of catheter removal. Data on the patient's age, gender, catheter insertion site, and duration of catheterization were also obtained. From 63 catheters tips analysed, 30 (47.6% showed microbial colonization. Infection proved to be more prevalent in 26 (41.3% patients with catheters inserted via subclavia vein than in 2 (3.2% inserted via the jugular vein. Infection was observed more frequently in catheters which were kept in place more than seven days. A. baumannii, Citrobacter freundii, E. aerogenes, P. aeruginosa and S. saprohyticus were isolated as causal agents of catheter-related bloodstream infections. The antimicrobial agent with greater in vitro activity against Gram-negative bacteria was imipenen and against Gram-positive were vancomycin, cefepime, penicillin, rifampin and tetracycline. The SEM analyses revealed biofilms on surfaces of all the catheters examined.Cateteres venosos centrais inseridos em pacientes internados em unidade de terapia intensiva foram avaliados por métodos microbiológicos (cultura semi-quantitativa e microscopia eletrônica de varredura a fim de detectar adesão microbiana e correlacionar com a cultura de sangue. Durante o período de estudo, foram avaliados 59 pacientes com cateter venoso central. A idade dos pacientes, sexo, sítio de inserção e tempo de permanência do cateter foram anotados. O cateter era de poliuretano não tunelizado e de único lúmen. O sangue para cultura foi coletado no momento da remoção do cateter. De 63

  17. Catheter-related thrombosis in children with intestinal failure and long-term parenteral nutrition: How to treat and to prevent?

    NARCIS (Netherlands)

    C.H. van Ommen; M.M. Tabbers

    2010-01-01

    Survival of children with chronic intestinal failure has increased as result of administration of home parenteral nutrition. Crucial for the successful management of home parenteral nutrition is the availability of an adequate central venous access. Venous access can be fraught by episodes of cathet

  18. Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: A prospective observational study of 1,978 consecutive catheterizations

    Directory of Open Access Journals (Sweden)

    Gorgni Silvia

    2010-10-01

    Full Text Available Abstract Background A central venous catheter (CVC currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US guidance and to confirm its utility in clinical practice in cancer patients. Methods Consecutive adult patients attending the oncology-hematology department were eligible if they had solid or hematologic malignancies and required CVC insertion. Four types of possible complication were defined a priore: mechanical, thrombotic, infection and malfunctioning. The patient was placed in Trendelenburg's position, a 7.5 MHZ puncturing US probe was placed in the supraclavicular site and a 16-gauge needle was advanced under real-time US guidance into the last portion of internal jugular vein. The Seldinger technique was used to place the catheter, which was advanced into the superior vena cava until insertion into right atrium. Within two hours after each procedure, an upright chest X-ray and ultrasound scanning were carried out to confirm the CVC position and to rule out a pneumotorax. CVC-related infections, symptomatic vein thrombosis and malfunctioning were recorded. Results From December 2000 to January 2009, 1,978 CVC insertional procedures were applied to 1,660 consecutive patients. The procedure was performed 580 times in patients with hematologic malignancies and 1,398 times those with solid tumors. A single-needle puncture of the vein was performed on 1,948 of 1,978 procedures (98.48%; only eighteen attempts among 1,978 failed (0.9%. No pneumotorax, no major bleeding, and no nerve puncture were reported; four cases (0.2% showed self-limiting hematomas. The mean lifespan of CVC was 189

  19. Subclavian artery pseudoaneurysm complicating central venous catheterization: endovascular treatment with Amplatzer Vascular Plug 4 and covered stent.

    Science.gov (United States)

    Rossi, Umberto G; Petrocelli, Francesco; Ferro, Carlo

    2013-12-01

    Central venous catheterization is a routine vascular access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to pseudoaneurysm formation. We report a case of a 41-year-old female that developed an iatrogenic left subclavian pseudoaneurysm complicating the attempt of left internal jugular vein cannulation for temporary hemodialysis therapy. The patient underwent urgent endovascular treatment with deployment of covered stent into the left subclavian artery (SCA) after embolization of the origin of the left internal mammary artery with Amplatzer Vascular Plug 4. The patient's recovery was unremarkable. Follow-up till 24 months reveals total exclusion of the pseudoaneurysm of the left SCA with patency of the distal branches.

  20. Central venous catheterization -- an anatomical review of a clinical skill -- Part 1: subclavian vein via the infraclavicular approach.

    Science.gov (United States)

    Boon, J M; van Schoor, A N; Abrahams, P H; Meiring, J H; Welch, T; Shanahan, D

    2007-08-01

    The safe and successful performance of a central venous catheterization (CVC) requires a specific knowledge of anatomy in addition to a working knowledge. Misunderstanding the anatomy may result in failure or complications. This review aims to aid understanding of the anatomical framework, pitfalls, and complications of CVC of the subclavian (SCV). CVC is common practice amongst surgeons, anesthesiologists, and emergency room physicians during the preparations for major surgical procedures such as open-heart surgery, as well as, for intensive care monitoring and rapid restoration of blood volume. Associated with this technique are certain anatomical pitfalls and complications that can be successfully avoided if one possesses a thorough knowledge of the contraindications, regional anatomy, and rationale of the technique.

  1. Impact of Initial Central Venous Pressure on Outcomes of Conservative versus Liberal Fluid Management in Acute Respiratory Distress Syndrome

    Science.gov (United States)

    Semler, Matthew W.; Wheeler, Arthur P.; Thompson, B. Taylor; Bernard, Gordon R.; Wiedemann, Herbert P.; Rice, Todd W.

    2016-01-01

    Objective In acute respiratory distress syndrome (ARDS), conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients’ initial central venous pressure (CVP). We hypothesized initial CVP would modify the effect of fluid management on outcomes. Design Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative to liberal fluid management in ARDS. We examined the relationship between initial CVP, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Setting Twenty acute care hospitals. Patients Nine hundred and thirty-four ventilated ARDS patients with a CVP available at enrollment, 609 without baseline shock (for whom fluid balance was managed by study protocol). Interventions None. Measurements and Main Results Among patients without baseline shock, those with initial CVP > 8 mmHg experienced similar mortality with conservative and liberal fluid management (18% versus 18%, p=0.928), whereas those with CVP ≤8 mmHg experienced lower mortality with a conservative strategy (17% versus 36%, p=0.005). Multivariable analysis demonstrated an interaction between initial CVP and the effect of fluid strategy on mortality (p=0.031). At higher initial CVPs, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p=0.122). At lower initial CVPs, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p=0.013). Conclusions Conservative fluid management decreases mortality for ARDS patients with a low initial central venous pressure. In this population, the administration of intravenous fluids appears to increase mortality. PMID:26741580

  2. Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2013-03-01

    Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).

  3. [Femoral venous catheterization. Does it really need to be avoided?].

    Science.gov (United States)

    Lorente, L; León, C

    2009-12-01

    The guidelines to prevent central venous catheter related bloodstream infections (CVCBSI) of the Centers for Disease Control and Prevention (CDC) of 2002, Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias/ Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEMICYUC/SEIMC) of 2004, and the recently published guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA(IDSA) of 2008 have recommended using the subclavian vein and avoiding the use of the femoral vein. They also recommend considering the use of antiseptic- or antimicrobial-impregnated CVCs for hospital units or groups of patients with a high incidence of CVCBSI. When implementing these guidelines, two questions could be asked: 1) Could the abuse of the subclavian vein and avoiding the use of the femoral vein imply a decrease in the incidence of CVCBSI, but an increase in the rate of mechanical complications as pneumothorax and/or hemothorax? 2) Couldn't antimicrobial-impregnated CVCs be used to prevent CVCBSI when the femoral venous access is used?

  4. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

    Directory of Open Access Journals (Sweden)

    Lütfiye Öksüz

    2012-01-01

    Full Text Available

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system

    It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  5. Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy

    Directory of Open Access Journals (Sweden)

    West Cheri E

    2011-06-01

    Full Text Available Abstract Background This study assesses the impact that a resident oversight and credentialing policy for central venous catheter (CVC placement had on institution-wide central line associated bloodstream infections (CLABSI. We therefore investigated the rate of CLABSI per 1,000 line days during the 12 months before and after implementation of the policy. Methods This is a retrospective analysis of prospectively collected data at an academic medical center with four adult ICUs and a pediatric ICU. All patients undergoing non-tunneled CVC placement were included in the study. Data was collected on CLABSI, line days, and serious adverse events in the year prior to and following policy implementation on 9/01/08. Results A total of 813 supervised central lines were self-reported by residents in four departments. Statistical analysis was performed using paired Wilcoxon signed rank tests. There were reductions in median CLABSI rate (3.52 vs. 2.26; p = 0.015, number of CLBSI per month (16.0 to 10.0; p = 0.012, and line days (4495 vs. 4193; p = 0.019. No serious adverse events reported to the Pennsylvania Patient Safety Authority. Conclusions Implementation of a new CVC resident oversight and credentialing policy has been significantly associated with an institution-wide reduction in the rate of CLABSI per 1,000 central line days and total central line days. No serious adverse events were reported. Similar resident oversight policies may benefit other teaching institutions, and support concurrent organizational efforts to reduce hospital acquired infections.

  6. First reported case of Staphylococcus condimenti infection associated with catheter-related bacteraemia

    Directory of Open Access Journals (Sweden)

    Y. Misawa

    2015-01-01

    Full Text Available We report a case of a patient who experienced a catheter-related bloodstream infection caused by Staphylococcus condimenti, which was first isolated from soy sauce mash. This is the first reported case of human infection. Although blood culture isolates and the catheter tip tube did not reveal coagulase or clumping factor, false-positive results were obtained from latex agglutination tests for clumping factor and protein A due to self-agglutination. Care is needed when performing only latex agglutination test without a coagulase test. Further studies are needed to determine the pathogenic potential of S. condimenti based on appropriate identification.

  7. Application of central venous catheter in hematodialysis%中心静脉置管在血液透析中的应用

    Institute of Scientific and Technical Information of China (English)

    马樱

    2008-01-01

    Objective To approach the application and nursing strategy of central venous catheter in hematodialysis. Meth- ods Sterile operation was strictly done. The nursing of central venous catheter were strengthened. Infection of puncturation and ecchymoma were prevented. Results One hundred and thirty two patients with hematodialysis had been detained central venous catheter for 3 days to 1 months. Only 2 cases of which had infection in puncture point. Pyrogenetic reaction appeared in one case. Five patients developed phlebothrombesis, 3 had mechanical phlebophlogosis. All of above patients were cured by treat- ment. Conclusion It is a normal, safe and effect measure to detain central venous catheter in hematodialysis. The time of detain central venous catheter may be prolong by strengthening nursing, strictly operating in hematodialysis and timely changing dress- ings. Complications involving infection may be reduced.%目的 探讨中心静脉置管在血液透析中的应用和护理对策.方法 严格执行无菌操作,加强中心静脉导管留置过程中的护理,预防穿刺点感染和皮下血肿等并发症出现.结果 留置时间3 d~1个月,132例中发生穿刺点感染2例,其中出现发热反应1例,静脉血栓5例,机械性静脉炎3例,经治疗均好转.结论 中心静脉置管是血液透析最常用、安全和有效的通路,加强中心静脉留置管护理,严格透析操作,按时换药,可延长留王时间,减少感染等并发症.

  8. Case-control Study of Risk Factors of Central Venous Catheter Tip Bacterial Colonization%中心静脉导管尖端细菌定植危险因素的病例对照研究

    Institute of Scientific and Technical Information of China (English)

    闫沛; 李武平; 宋向阳; 孙惠英; 刘冰

    2011-01-01

    目的 探讨中心静脉导管尖端细菌定植的危险因素.方法 抽取一段时间内某院住院并接受中心静脉置管的患者240例,以导管尖端细菌培养阳性者作为病例组,阴性者作为对照组.对可能影响细菌定植的因素作单因素分析与Logistic多元回归分析.结果 排除可疑污染的阳性病例5例,30例导管尖端有细菌定植,单因素分析共筛选出插入导管型号、拔管前是否有发热、拔管时穿刺点皮肤、导管使用过程中抗生素的使用情况、从导管有无输血、从肝素帽推药次数6方面因素有统计学意义(P<0.05);以有细菌定植为应变量,其他因素为自变量赋值后进行非条件多因素分析,最终显示导管型号、抗生素的使用2方面因素是导管尖端细菌定植的危险因素.结论 选择合适的导管,做好穿刺点护理,严格控制置管天数,合理使用抗生素,有效预防导管相关性血流感染的发生.%Objective To explore risk factors of central venous catheter tip bacterial colonization. Methods 240 inpatients with central venous catheter were divided into case group including positive carriers of bacteria colonization and control group including negative carriers. The potential influence factors were analyzed by single factor analysis and Logistic regression analysis. Results After the exclusion of 5 possibly-polluted cases, 30 cases were with bacterial colonization in the study. Single factor analysis revealed that bacteria colonization were related with 6 factors(P<0.05), which involved catheter size, whether there was a fever before pulling the catheter, the skin of catheter insert spot, antibiotic usage during the process of catheter use, whether there was a blood transfusion from catheter and the frequency of push drugs from heparin joint Non-conditional multiple Logistic regression taking bacteria colonization as dependent variable and the other factors as independent variable indicated that risk

  9. The value of bedside ultrasound-guided puncturing and individualized heparin catheter sealing management in the prevention of catheter-related bloodstream infection of patients with tumors%床旁B超引导穿刺及个体化的肝素封管在肿瘤患者中心静脉导管感染中的预防价值

    Institute of Scientific and Technical Information of China (English)

    达春丽; 许华; 吴莉; 于湘友

    2016-01-01

    目的:比较不同穿刺置管方式及不同封管方式对ICU中导管相关性血源性感染(catheter-related blood stream infection,CRBSI)的发生及预后的影响,指导临床选择更佳的置管及封管方式。方法选择2012年6月至12月收住我院ICU需中心静脉置管且置管时间大于7天的患者80例,按置管及封管方式的不同分为四组,分别为低剂量肝素封管组(125u/ml),高剂量肝素封管组(250u/ml),低剂量肝素封管+B超引导穿刺组,高剂量肝素封管+B超引导穿刺组,比较四组病人最终发生导管堵塞及CRBSI的差异性。结果高剂量肝素封管+ B超引导穿刺组堵管率及CRBSI的发生率明显低于低剂量肝素封管+B超引导穿刺组及高剂量肝素封管组,相同剂量肝素组间比较,联合B超引导穿刺组的导管管理方式优于单纯肝素封管组。结论高剂量肝素封管+ B超引导穿刺的导管管理方式较其他穿刺、封管方式能明显减少中心静脉导管的堵管率,降低CRBSI的发生率,在临床工作中值得推广应用。%ObjectiveTo compare the incidence of CRBSI (catheter-related bloodstream infection) and difference on patients' prognosis among different central-venous-catheter puncture and catheter sealing methods, to direct a better selection in central venous catheter puncturing and sealing methods.Methods80 patients with tumor who kept central-venous-catheter indwelled for more than 7 days were selected. These patients were divided into four groups according to central-venous-catheter puncturing method and catheter sealing methods: low-dose heparin catheter sealing group (125u/ml), high-dose heparin catheter sealing group (250u/ml), low-dose heparin catheter sealing with B ultrasound-guided biopsy group and high dose heparin catheter sealing with B ultrasound-guided biopsy group. Catheter blockage and incidence rate of CRBSI in four groups were observed.ResultsThe catheter blockage and CRBSI

  10. Non-Invasive Method for the Rapid Assessment of Central Venous Pressure: Description and Validation by a Single Examiner

    Directory of Open Access Journals (Sweden)

    Zidulka, Arnold

    2008-11-01

    Full Text Available Objectives: This study describes a means of assessing the external jugular venous pressure (JVP as an indicator of normal or elevated central venous pressure (CVP.Methods: Intensive care unit patients having CVP monitoring were examined. With patients in bed, the external jugular vein (EJV was occluded at the base of the neck and observed to distend. The occlusion was then removed and the vein observed for collapse. Complete collapse was hypothesized to indicate a non-elevated CVP (≤8cm of water. In those patients whose EJV collapsed incompletely, the vein was then occluded with the finger near the angle of the jaw. With the occlusion maintained, the vein was milked downwards with the other hand to cause its emptying and was then observed for filling from below. Filling from below was hypothesized to indicate an elevated CVP (>8cm of water.Results: In 12 of the 40 patients examined, the EJV could not be assessed (EJV not seen at all: 5, and difficult to visualize: 7. For the remaining 28 patients, 11 had a CVP > 8 cm, while 17 had a CVP of < 8. EJV assessment was 100% accurate (95% Confidence Interval 88-100 in predicting whether or not a patient’s CVP was greater or less than 8 cm of water.Conclusion: EJV assessment, when visible, is accurate to clinically assess a patient’s CVP in the hands of the author. Further studies are needed to see if they are reproducible by other observer.[WestJEM. 2008;9:201-205.

  11. Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access

    Directory of Open Access Journals (Sweden)

    Pil Young Jung

    Full Text Available Background: Totally implantable access port (TIAP provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92 and subclavian approach (Group 2, n = 79 between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868. Twenty four complications were occurred (14.0%, including pneumothorax (n = 1, 0.6%, migration/malposition (n = 4, 2.3%, pinch-off syndrome (n = 4, 2.3%, malfunction (n = 2, 1.1%, infection (n = 8, 4.7%, and venous thrombosis (n = 5, 2.9%. The overall incidence was 8.7% and 20.3% in each group (p = 0.030. Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033. The mechanical complication free probability is significantly higher in group 1 (p = 0.040. Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

  12. [Artefacts in the CT scan caused by surgical clips and central venous catheters and the use of new materials].

    Science.gov (United States)

    Schadel, A; Böttcher, H D; Haverkamp, U; Wagner, W; Schmilowski, G M

    1984-03-01

    When metal clips and venous catheters have been used the computerized tomography shows artifacts, which make it computerized tomography shows artifacts, which make it difficult to have a reliable and accurate diagnosis, because the X- raying of the metal clips and the venous catheter gives radiating lines, so called streaking. We have tested new materials for the metal clips and a new polymer to replace the substance of the venous catheter with the intention that the materials should have the same density as the normal tissues. With a new metal for the clips and a new polymer for the venous catheters, mixed with metal ions, the computerized tomography does not show streaking.

  13. Central venous oxygen saturation and thoracic admittance during dialysis: new approaches to hemodynamic monitoring

    DEFF Research Database (Denmark)

    Cordtz, J.; Olde, B.; Solem, K.

    2008-01-01

    Intradialytic hypotension (IDH) is one of the most important short-term complications to hemodialysis (HD). Inadequate cardiac filling due to a reduction in the central blood volume is believed to be a major etiological factor. The aim of this study was to evaluate whether these pathophysiologic...

  14. On-line blood viscosity monitoring in vivo with a central venous catheter, using electrical impedance technique.

    Science.gov (United States)

    Pop, Gheorghe A M; Bisschops, Laurens L A; Iliev, Blagoy; Struijk, Pieter C; van der Hoeven, Johannes G; Hoedemaekers, Cornelia W E

    2013-03-15

    Blood viscosity is an important determinant of microvascular hemodynamics and also reflects systemic inflammation. Viscosity of blood strongly depends on the shear rate and can be characterized by a two parameter power-law model. Other major determinants of blood viscosity are hematocrit, level of inflammatory proteins and temperature. In-vitro studies have shown that these major parameters are related to the electrical impedance of blood. A special central venous catheter was developed to measure electrical impedance of blood in-vivo in the right atrium. Considering that blood viscosity plays an important role in cerebral blood flow, we investigated the feasibility to monitor blood viscosity by electrical bioimpedance in 10 patients during the first 3 days after successful resuscitation from a cardiac arrest. The blood viscosity-shear rate relationship was obtained from arterial blood samples analyzed using a standard viscosity meter. Non-linear regression analysis resulted in the following equation to estimate in-vivo blood viscosity (Viscosity(imp)) from plasma resistance (R(p)), intracellular resistance (R(i)) and blood temperature (T) as obtained from right atrium impedance measurements: Viscosity(imp)=(-15.574+15.576R(p)T)SR ((-.138RpT-.290Ri)). This model explains 89.2% (R(2)=.892) of the blood viscosity-shear rate relationship. The explained variance was similar for the non-linear regression model estimating blood viscosity from its major determinants hematocrit and the level of fibrinogen and C-reactive protein (R(2)=.884). Bland-Altman analysis showed a bias between the in-vitro viscosity measurement and the in-vivo impedance model of .04 mPa s at a shear rate of 5.5s(-1) with limits of agreement between -1.69 mPa s and 1.78 mPa s. In conclusion, this study demonstrates the proof of principle to monitor blood viscosity continuously in the human right atrium by a dedicated central venous catheter equipped with an impedance measuring device. No safety

  15. Remifentanil for the insertion and removal of long-term central venous access during monitored anesthesia care.

    LENUS (Irish Health Repository)

    Burlacu, Crina L

    2012-02-01

    STUDY OBJECTIVE: To determine the analgesic efficacy of three different rates of remifentanil infusion in patients undergoing insertion or removal of long-term central venous access devices during monitored anesthesia care and local anesthetic field infiltration. DESIGN: Double-blinded, randomized, controlled study. SETTING: Operating theatre of an University hospital. PATIENTS: 44 unpremedicated, ASA physical status 1 and 2 patients, aged 18-65 years, undergoing insertion or removal of a Port-a-Cath or Hickman catheter. INTERVENTIONS: Patients sedated with a propofol target-controlled infusion were randomly allocated to three groups: Group R25 (n = 14), Group R50 (n = 15), and Group R75 (n = 15), to receive remifentanil 0.025, 0.05, and 0.075 mug\\/kg\\/min, respectively. Rescue remifentanil 0.5 mug\\/kg was administered for pain scores > 3. The remifentanil infusion rate was maintained constant unless respiratory and\\/or cardiovascular unwanted events occurred, whereupon the rate was adjusted in 0.01 mug\\/kg\\/min decrements as necessary. MEASUREMENTS: Pain scores (primary outcome), sedation, and movement scores (secondary outcomes) were assessed during local anesthetic infiltration of the anterior chest wall and 5 other procedural steps. MAIN RESULTS: All infusion rates had equal analgesic efficacy, as shown by comparable pain scores, number of rescue boluses, and number of patients requiring rescue analgesia. Excessive sedation was associated with the highest remifentanil rate such that Group R75 patients were significantly more sedated than Groups R25 or R50 at selective procedural steps (P < 0.05). More Group R75 patients (6\\/15) required remifentanil rate reduction than did patients from Group R50 (1\\/15) or Group R25 (0\\/14), P < 0.01, most commonly because of respiratory depression. CONCLUSIONS: For the insertion or removal of long-term central venous access devices, all three remifentanil infusion rates proved to be equally analgesic

  16. Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

    Directory of Open Access Journals (Sweden)

    Pooja Binnani

    2012-01-01

    Full Text Available The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete-riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

  17. Inherited Thrombophilia in Pediatric Venous Thromboembolic Disease: Why and Who to Test

    Science.gov (United States)

    van Ommen, C. Heleen; Nowak-Göttl, Ulrike

    2017-01-01

    Venous thromboembolic disease in childhood is a multifactorial disease. Risk factors include acquired clinical risk factors such as a central venous catheter and underlying disease and inherited thrombophilia. Inherited thrombophilia is defined as a genetically determined tendency to develop venous thromboembolism. In contrast to adults, acquired clinical risk factors play a larger role than inherited thrombophilia in the development of thrombotic disease in children. The contributing role of inherited thrombophilia is not clear in many pediatric thrombotic events, especially catheter-related thrombosis. Furthermore, identification of inherited thrombophilia will not often influence acute management of the thrombotic event as well as the duration of anticoagulation. In some patients, however, detection of inherited thrombophilia may lead to identification of other family members who can be counseled for their thrombotic risk. This article discusses the potential arguments for testing of inherited thrombophilia, including factor V Leiden mutation, prothrombin mutation, and deficiencies of antithrombin, protein C, or protein S and suggests some patient groups in childhood, which may be tested. PMID:28352625

  18. Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Se Jin; Kimn, Hyo Cheol; Chung, Jin Wook; Yin, Yong Hu; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of); An, Sang Bu [National Cancer Center, Goyang (Korea, Republic of)

    2012-06-15

    To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.

  19. Catheter-Related Candidemia Caused by Candida lipolytica in a Patient Receiving Allogeneic Bone Marrow Transplantation

    Science.gov (United States)

    D'Antonio, Domenico; Romano, Ferdinando; Pontieri, Eugenio; Fioritoni, Giuseppe; Caracciolo, Claudia; Bianchini, Stefano; Olioso, Paola; Staniscia, Tommaso; Sferra, Roberta; Boccia, Stefania; Vetuschi, Antonella; Federico, Giovanni; Gaudio, Eugenio; Carruba, Giuseppe

    2002-01-01

    Candida lipolytica was recovered from the blood and the central venous catheter in a patient receiving allogeneic bone marrow transplantation. Two C. lipolytica strains from different geographical areas and the ATCC 9773 strain of C. lipolytica were used as controls. C. lipolytica was identified by standard methods. MICs indicated antifungal susceptibilities to amphotericin B, fluconazole, and itraconazole for all strains. In vitro testing and scanning electron microscopy showed that C. lipolytica was capable of producing large amounts of viscid slime material in glucose-containing solution, likely responsible for the ability of the yeast to adhere to catheter surfaces. Restriction fragment length polymorphisms revealed an identical profile for all clinical isolates, unrelated to those observed for the control strains. This finding suggested the absence of microevolutionary changes in the population of the infecting strain, despite the length of the sepsis and the potential selective pressure of amphotericin B, which had been administered to the patient for about 20 days. The genomic differences that emerged between the isolates and the control strains were indicative of a certain degree of genetic diversity between C. lipolytica isolates from different geographical areas. PMID:11923360

  20. Haemodialysis catheter-related bloodstream infections: current treatment options and strategies for prevention.

    Science.gov (United States)

    Saxena, Anil K; Panhotra, Bodh R

    2005-03-05

    Regardless of the repeated reservations raised by countless researchers with reference to the use of catheters as vascular access for haemodialysis (HD), central venous catheters (CVCs) remain irreplaceable tools of the modern dialysis delivery system as a reliable option for the clinical situations requiring instant access to circulation, for various reasons. Patients on long-term haemodialysis are therefore at a significantly high risk for catheterrelated bloodstream infections (CRBSI) and ensuing serious complications. Although early systemic antibiotic treatment should include the coverage for Staphylococcus aureus, the pathogen with most devastating consequences including bacterial endocarditis; optimal treatment of CRBSI while preserving the catheter site, remains contentious. Nonetheless, catheter exchange over a guide wire and antimicrobial-anticoagulant "locks" have shown promising results as novel access salvage techniques. Despite the fact that a number of novel potentially useful strategies for the prevention of CRBSI are in the pipeline; equally essential however, remains the role of rigorous implementation of standard infection control measures for hygiene and aseptic handling of CVCs in long-term HD patients. The policy of increasing the AVF (arteriovenous fistula) prevalence beyond 50% while minimising the use of CVCs, dependent largely upon the timely referrals and prudently implemented pre-ESRD program - ought to have a positive impact on long-term HD outcomes.

  1. The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter Uso de la película transparente de poliuretano en el catéter venoso central de larga permanencia O uso do filme transparente de poliuretano no cateter venoso central de longa permanência

    Directory of Open Access Journals (Sweden)

    Renata Cristina de Campos Pereira Silveira

    2010-12-01

    Full Text Available Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickman’s catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average. Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occur