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Introduction: Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure., Methods: Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters., Results: Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54-0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site., Conclusion: Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study., Competing Interests: The authors have declared that no competing interests exist.

Objective: The primary end points of this study were safety and efficacy of early cannulation of the Flixene graft (Maquet-Atrium Medical, Hudson, NH). Secondary end points were complications and patency., Methods: This is a prospective single-center nonrandomized study. Study data included patient characteristics; history of vascular access; operative technique; interval between implantation and initial cannulation; complications; and patency at 1 month, 3 months, and every 6 months. Patency rates were estimated by the Kaplan-Meier method., Results: Between January 2011 and September 2013, a total of 46 Flixene grafts were implanted in 44 patients (27 men) with a mean age of 63 years. The implantation site was the upper arm in 67% of cases, the forearm in 11%, and the thigh in 22%. Seven grafts were never cannulated during the study period. Of the remaining 39 grafts, 32 (82%) were successfully cannulated within the first week after implantation, including 16 (41%) on the first day. The median interval from implantation to initial cannulation was 2 days (interquartile range, 1-3 days). The median follow-up was 223.5 days (interquartile range, 97-600 days). Five hematomas occurred, but only one required surgical revision. Primary assisted and secondary patency rates were 65% and 86%, respectively, at 6 months and 56% and 86%, respectively, at 1 year., Conclusions: This study suggests that cannulation of the Flixene graft within 1 week after implantation is safe and effective. Early cannulation avoids or shortens the need for a temporary catheter. One-year patency rates appeared to be comparable to those achieved with conventional grafts, but long-term follow-up and randomized controlled studies will be needed to confirm this finding., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Using a multi-level logistic regression model, we determined whether there was any relationship between alcohol-based hand-rub consumption and prevalence of device-associated infections (DAIs) in French healthcare facilities (HCFs). Two national databases were used: the 2006 French prevalence survey of nosocomial infections, and the 2006 French infection control indicator database which includes alcohol-based hand-rub consumption as an indicator (ICSHA: indicateur de consommation de solution hydro-alcoolique). Only patients with at least one medical device (urinary catheter, vascular catheter or tracheal tube) who were present in an HCF for at least two days were included in the analysis. A multi-level statistical analysis was performed to assess the joint effect of patient-level and hospital-level variables. In all, 814 HCFs, each with a minimum of 15 study patients, were included, giving a total of 53,459 patients. The overall prevalence of DAI was 6.7% (95% confidence interval: 6.4-6.9). The median value of ICSHA was 37.2%. There was no association between DAI prevalence and ICSHA, but all patient-level variables were associated with DAI prevalence. Patient-level variables explain 25% of the hospital-level variation in DAI prevalence, although 60% of this variation remains unexplained when both patient and hospital variables are included in the model. To further assess any association between DAI prevalence and hand hygiene, additional studies on hand hygiene practices specifically associated with invasive medical device manipulation are required., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Infection constitutes a leading cause of morbidity and mortality in hemodialysis (HD) patients. The type of vascular access is an important determinant of the risk of infection. Therefore, identification of risk factors leading to catheter-related bacteremia (CRB) is strongly required. The aim of this prospective large cohort study of HD patients using only catheters as vascular access was to isolate risk factors for CRB., Methods: 2,230 permanent silicone dual catheters implanted in 1,749 patients between November 1982 and November 2005 were studied. The following data were collected at the time of catheter implantation: presence of hypertension, diabetes mellitus, obesity, atherosclerosis, immunodepression, Wright-Khan index, site and side of catheter insertion, and history of bacteremia., Results: The site of catheter insertion was internal jugular (n = 2,133), subclavian (n = 79) and femoral (n = 17). Duration of catheter use was as follows: 30-90 days (n = 1,607) and >90 days (n = 1,054); 226 episodes of bacteremia occurred in 197 catheters. Microorganisms responsible were mainly Staphylococcus aureus, coagulase-negative staphylococci, Enterobacter spp. and Pseudomonas aeruginosa. The overall incidence of bacteremic episodes was 0.514/1,000 catheter days. Hypertension, atherosclerosis, diabetes mellitus, site of catheter implantation, duration of catheter use, Wright-Khan comorbidity index and previous history of CRB were significant risk factors associated with bacteremia in univariate analysis. Multivariate analysis revealed that a previous history of a bacteremic episode (odds ratio, OR = 2.70, 95% confidence interval, CI = 1.56-4.68), diabetes mellitus (OR = 2.37, 95% CI = 1.65-3.39), duration of catheter use >90 days (OR = 1.85, 95% CI = 1.35-2.55) and hypertension (OR = 1.49, 95% CI = 1.08-2.04) were still significant factors associated with bacteremia., Conclusion: Reducing CRB is still a challenge for nephrologists to reduce patient morbidity and mortality. Our study could demonstrate that diabetes, previous history of CRB, site of catheter implantation and duration of catheter use were the most important risk factors for bacteremia. Therefore, to prevent CRB, particular attention should be paid to patients with diabetes and a previous history of bacteremia following strict hygienic and aseptic rules for catheter handling associated with the regular use of antiseptic lock solutions., ((c) 2009 S. Karger AG, Basel.)

Arterial and central venous catheterizations and their use for continuous infusion of vasoactive drugs could lead to serious adverses events that could be life threatening. The incidence of human errors related patient adverses events could be decreased by the uses of algorithms and procedures. Concerning the continuous infusion of vasoactive drugs, the name of drug and its concentration should be clearly notified. The use of modern pump and noncompliant pipe could reduce the frequency bolus infusion and their related haemodynamic alterations. Reasonable procedure could reduce the arterial and central venous catheters related complications. Subclavian and radial sites should be preferred for central venous and arterial catheter insertion, respectively. The use of real time echographic guidance could facilitate the catheter insertion. These catheters should be removed when they are not indicated. Concerning the pulmonary artery catheter, the balloon tip should be inflated with visual control of the pulmonary artery pressure. Its removal is recommended within the first five days.

The <> (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. In order to answer questions related to venous thromboembolic events (VTE) treatment and to central venous catheter thrombosis (CVCT) management in cancer patients, the SOR elaborated national guidelines, here presented in a short report. It results of a collaborative work with members from three learned societies ("société nationale française de médicine interne": SNFMI, "société française de médicine vasculaire": SFMV and "société française d'anesthésie-réanimation": SFAR).

The aim of this study was to rank the risk of nosocomial infection (NI) according to patient type by analysing the results of annual prevalence studies carried out in Franche-Comté from 2001 to 2004. Patients (N=14,905) were divided into four categories according to the number of endogenous risk factors (age, immunodepression, MacCabe score). The overall prevalence of infection was 6.1% and varied according to the category of patient from 1.93% (no risk factors) to 15.2% (three risk factors). The frequencies of NI related to an invasive procedure and to cross-contamination with multi-drug-resistant (MDR) bacteria were 30.9% and 12.3%, respectively; these percentages did not depend on the type of patient. The prevalence of NI decreased over time for patients with two or three risk factors, but was stable for patients with no risk factors. More than 40% of NIs were potentially avoidable (related to invasive procedures or involving cross-transmission of an MDR bacterium) regardless of the category of patient. This study suggests that at least 30% of NIs could be avoided.

Unlabelled: With the aging population, elderly patients with degenerative, severely calcified, and symptomatic aortic stenosis are becoming a frequent problem in medical decision making, particularly because many are declined for surgical valve replacement. For these patients, balloon aortic dilatation could be a palliative treatment., Patients and Methods: we analyzed retrospectively our techniques and complications during hospitalization for percutaneous aortic balloon dilatation in 141 consecutive patients (45% women, mean age 83 +/- 10 y) from January 2002 to April 2005. The Parsonnet's score was 41 +/- 8 and the Euroscore was 10 +/- 2. We excluded the patients enrolled for percutaneous aortic valve implantation. This technique was performed under local anesthesia, from retrograde or antegrade approach. Rapid pacing stimulation (220/bpm) with a pacing-lead placed in the right ventricle was performed during balloon inflation., Results: the aortic valve area was increased from 0.59 +/- 0.19 to 1.02 +/- 0.34 cm2 (p < 0.001) and the transvalvular mean gradient decreased from 49.3 +/- 21.2 to 22.2 +/- 11.8 mmHg (p < 0.001). Six patients (4%) died (3 during aortic valve dilatation) and 9 patients (6%) had non fatal complications: 2 transitory strokes, 8 non surgical vascular complications and 5 episodes of atrio-ventricular complete block (these complication were non exclusive). The patients were discharged at 5, 6 +/- 3 days., Conclusion: In the hands of skilled operators, aortic percutaneous balloon dilatation has become a simple technique, associated with a low risk of complications despite a very ill patient population. This technique remains a good option for a number of patients before the onset of percutaneous aortic valve implantation.

Catheter-related infections remain an important cause of nosocomial infection in the ICU. They include colonization of the device, exit-site infection and catheter-related bloodstream infection with or without bacteraemia. Data from clinical studies and surveillance networks should be compared cautiously due to important methodological differences and wide variations of device-utilization ratio between units or countries. In France, two regional networks (C-CLIN Paris-Nord and C-CLIN Sud-Est) produced comparable and reproducible results. Colonization represents five-six cases per 1000 catheter-days and bacteraemia represents one case per 1000 catheter-days. Incidence rates from North American studies are usually four to five times higher. Numerous risk factors have been identified. Some of them could be used to stratify patients according to risk of catheter-related infection and to allow more valid comparison between ICU's performances. Participation of French ICUs to the recent national surveillance networks (REA RAISIN and REACAT RAISIN) should be encouraged.

Whenever a catheter related infection is suspected, two main issues must be addressed: should the catheter be removed and should an empiric antibiotic treatment be prescribed? These questions are still under debate. Some differences are found between French and American guidelines. Main factors leading to decision about these questions are: severity of the sepsis, microorganisms involved and kind of patients we are dealing with.

Coagulase negative staphylococci, Staphylococcus aureus and Pseudomonas sp. are the most frequent microorganisms responsible for catheter-related infections. A relative frequency of microorganisms varies according to the countries, microenvironment and outbreaks of multiresistant bacterias. Infections due to fungi, S. aureus and Pseudomonas sp. are associated with the more severe complications. Recent data suggest that chlorhexidine, either used for cutaneous antisepsis or for catheter impregnation decreases infections due to gram positive cocci. Ecological data should be taken into account when deciding a probabilistic treatment in case of suspicion of catheter-related infection.

Objective: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU)., Design: Prospective cohort study., Setting: Sixteen-bed polyvalent ICU in a French university hospital., Interventions: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems., Main Outcome Measures: Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage., Results: The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: female sex, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization., Conclusion: In our study, the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients, removal of the bladder catheter must be performed as soon as possible.

A national survey on permanent hemodialysis catheters was conducted in 99 hemodialysis centers between january 1998 and january 2000. It was a prospective, national and multicentric study. Data were gathered in 1552 patients (mean age 65 +/- 15 years) with chronic end stage renal failure. A questionnaire was filled out each time a permanent hemodialysis catheter was inserted. Two permanent catheters (72%) were inserted under local anesthesia (92%), using the right internal jugular vein (81%) with a percutaneous technique (96%). The two main indications were: end stage chronic renal failure without creation of a vascular access (52%) and dysfunction of a preexisting vascular access (35%). Patients have been followed a mean time period of 58 days and 179 cases of death have been reported. The median duration of catheters was 500 days. The two main causes of catheter removal were creation of a functional A-V fistula (40%) and death of the patient (28%). The incidence of bacteriemia/septicemia was 0.74 episode/patient/1000 days of follow-up while that of any type of infection was 0.85 episode/patient/1000 days. The risk of infection increased with time especially in type 2 diabetes patients.

Implantable venous ports and Hickman central venous catheters are widely used in patients with cancer, blood disorders, or HIV infection, both for in-hospital care and at home. Infectious complications are among the common causes for readmission in these patients. The present review discusses the incidence, risk factors, and diagnostic tools for infectious complications associated with long-term venous access devices.

Objective: To assess the level of aseptic practice in epidural catheterization, to determine the perception of its infectious risk and the knowledge of epidural abscess symptoms., Study Design: Cross-sectional regionwide retrospective survey., Material: Questionnaire sent after telephone call to 160 anaesthesiologists performing epidural anaesthesia in Languedoc-Roussillon., Results: Replies were obtained from 96 anaesthesiologists working in 26 centres. Handwashing techniques were various: 53% onefolded with an antiseptic preparation, 38% twofolded and 9% used a simple soap; 41% did never wear a long-sleeved sterile surgical gown and only 53% wored simultaneously a cap; a surgical mask and a sterile gown; 4% of the Tuohy needles were reusable; 21% of the dressings permitted continuous inspection of the site of puncture; 12.5% admitted not to know epidural abcess symptoms and 30% ignored the most adapted radiological diagnostic means., Conclusions: Good aseptic practice in epidural catheterization should be clarified by a consensus conference. There is an obvious lack of knowledge concerning features of epidural abscess.

We have observed during a period of 24 years, 277 vascular iatrogenic injuries. An analytic study has revealed the prominent following etiologies; Injections, perfusions, catheterisms and arteriographies: 121 cas; Orthopedic surgery: 69 cas; General surgery: 14 cas; Surgery and sclerosis of varicose veins: 71 cas. The author analyse the various aspects of these lesions, most of them are due to imperfect technique or professional error. A special attention is given to the 82 very serious cases, seen in emergency with more of 50% of bad results. Vascular risk is not frequent, but it exist in very numerous medico-surgical procedures. Early recognition and early correction of the vascular lesions reduce the incidence and the gravity of complications.