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Abstract Background Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous access in hospitalized patients. Although a number of studies suggest that PICCs are associated with a lower risk of central line-associated bloodstream infections (CLABSIs) than CVCs, recent data concerning specific patient groups support the contrary. In this regard, we are comparing CVC- and PICC-related CLABSI rates developed in a selected group of critically ill inpatients and evaluating the CLABSI microbiological distribution. Methods The study was conducted at a tertiary care hospital in Greece between May 2017 and May 2019. We performed a two-year retrospective analysis of the data collected from medical records of consecutive adult patients who underwent PICC or CVC placement. Results A total of 1187 CVCs placed for 9774 catheter-days and 639 PICCs placed for 11,110 catheter-days, were reported and analyzed during the study period. Among CVCs, a total of 59 (4.9%) CLABSIs were identified, while among PICCs, 18 (2.8%) cases presented CLABSI (p = 0.029). The CLABSI incidence rate per 1,000 catheter-days was 6.03 for CVC group and 1.62 for PICC group (p

Abstract Background A functioning vascular access (VA) is crucial to providing adequate hemodialysis (HD) and considered a critically important outcome by patients and healthcare professionals. A validated, patient-important outcome measure for VA function that can be easily measured in research and practice to harvest reliable and relevant evidence for informing patient-centered HD care is lacking. Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID) aims to assess the accuracy and feasibility of measuring a core outcome for VA function established by the international Standardized Outcomes in Nephrology (SONG) initiative. Methods VALID is a prospective, multi-center, multinational validation study that will assess the accuracy and feasibility of measuring VA function, defined as the need for interventions to enable and maintain the use of a VA for HD. The primary objective is to determine whether VA function can be measured accurately by clinical staff as part of routine clinical practice (Assessor 1) compared to the reference standard of documented VA procedures collected by a VA expert (Assessor 2) during a 6-month follow-up period. Secondary outcomes include feasibility and acceptability of measuring VA function and the time to, rate of, and type of VA interventions. An estimated 612 participants will be recruited from approximately 10 dialysis units of different size, type (home-, in-center and satellite), governance (private versus public), and location (rural versus urban) across Australia, Canada, Europe, and Malaysia. Validity will be measured by the sensitivity and specificity of the data acquisition process. The sensitivity corresponds to the proportion of correctly identified interventions by Assessor 1, among the interventions identified by Assessor 2 (reference standard). The feasibility of measuring VA function will be assessed by the average data collection time, data completeness, feasibility questionnaires and semi-structured interviews on key feasibility aspects with the assessors. Discussion Accuracy, acceptability, and feasibility of measuring VA function as part of routine clinical practice are required to facilitate global implementation of this core outcome across all HD trials. Global use of a standardized, patient-centered outcome measure for VA function in HD research will enhance the consistency and relevance of trial evidence to guide patient-centered care. Trial registration Clinicaltrials.gov: NCT03969225. Registered on 31st May 2019.

Central venous catheters are used for a variety of purposes, including emergency care, parenteral nutrition, and chemotherapy, but their insertion can cause mechanical complications such as malposition, arterial puncture, and pneumothorax. Here, we describe a rare case of guidewire knot formation during subclavian vein catheterization. A 70-year-old woman presented to our facility for central venous port placement for chemotherapy after surgical resection of a retroperitoneal liposarcoma. The left subclavian vein was selected and punctured under ultrasound guidance, and a guidewire was introduced. However, strong resistance prevented both advancement and withdrawal of the guidewire. Radiograph revealed a knot like shadow near the tip of the guidewire. After placement of a central venous port in the opposite site, the knotted guidewire was surgically removed. Intraoperatively, the guidewire was found to penetrate the vein and form a knot on the outside of the posterior wall. Although the guidewire was able to be removed, a postoperative chest x-ray revealed a left pneumothorax, which required 10 days of treatment. If a knot forms in a guidewire during catheterization, surgical removal is recommended because forcible pulling can damage the vessel. In conclusion, guidewire knot formation is a very rare complication, but physicians performing central venous catheterization should be aware of it, and this report describes how to prevent and manage it.

We have presented the successful endovascular management of an injury to the proximal left common carotid artery following attempted cannulation of the right internal jugular vein in a critically ill patient with multisystem organ failure secondary to infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).

Aim:This study was performed to evaluate the effectiveness of topical lidocaine-ibuprofen (LI) combination compared the lidocaine-prilocaine (LP) combination Xyla-P in the reduction of the pain during central venous catheter (CVC) insertion.Materials and Methods:In this randomized clinical trial, 100 adult patients requiring CVC insertion in the emergency department were enrolled. The patients were randomly divided into two groups. The site of CVC insertion was covered with topical Xyla-P cream (2 g) in the first group, and topical LI (2 g) cream in the second group. The primary outcome was the assessment of pain during CVC implantation. The secondary outcomes were physician’s satisfaction and the incidence of side effects.Results:The mean age was 41.67±9.66 years (range 18-61), and 36% of patients were female. The mean visual analog scale (VAS) pain score during CVC insertion was 4.61±2.05 in the LP group and 3.86±2.09 in the LI group, respectively [mean difference of 0.75 (95% confidence interval (CI): -0.80 to 1.56)]. The mean VAS pain score during lidocaine injection was 1.78±0.79 in the LP group and 1.52±0.79 in the LI group, respectively [mean difference of 0.26 (95% CI: -0.05 to 0.57)]. The physician’s satisfaction did not show statistically significant differences between two groups.Conclusion:This study showed that topical LI is as effective as Xyla-P in relieving acute pain during CVC insertion.

Background: Mechanical central venous catheter (CVC) placement complications are mostly malposition or iatrogenic pneumothorax. Verification of catheter position by chest X-ray (CXR) is usually performed postoperatively. Objectives: This prospective observational study assessed the diagnostic accuracy of peri-operative ultrasound and a ‘bubble test’ to detect malposition and pneumothorax. Method: Sixty-one patients undergoing peri-operative CVC placement were included. An ultrasound protocol was used to directly visualise the CVC, perform the ‘bubble test’ and assess for the presence of pneumothorax. The time from agitated saline injection to visualisation of microbubbles in the right atrium was evaluated to determine the correct position of the CVC. The time required to perform the ultrasound assessment was compared to that of conducting the CXR. Results: Chest X-ray identified 12 (19.7%) malpositions while ultrasound identified 8 (13.1%). Ultrasound showed a sensitivity of 0.85 (95% confidence interval [CI]: 0.72 to 0.93) and a specificity of 0.5 (95% CI: 0.16 to 0.84). The positive and negative predictive values were 0.92 (95% CI: 0.80 to 0.98) and 0.33 (95% CI: 0.10 to 0.65), respectively. No pneumothorax was identified on ultrasound and CXR. The median time for ultrasound assessment was significantly shorter at 4 min (interquartile range [IQR]: 3–6 min), compared to performing a CXR that required a median time of 29 min (IQR: 18–56 min) (p 0.0001). Conclusion: This study showed that ultrasound produced a high sensitivity and moderate specificity in detecting CVC malposition. Contribution: Ultrasound can improve efficiency when used as a rapid bedside screening test to detect CVC malposition.

Introduction: Vascular access for hemodialysis (HD) is essential for the patient. Even though Arteriovenous fistula (AVF) is the preferred access, in certain age groups, the central venous catheter (CVC) may provide advantages. This study aims to investigate the quality of life related to vascular access. Methods: Cross-sectional study including patients from a hospital, a home HD unit and a satellite hemodialysis center. Clinical data was collected from the patients, who went through a quality-of-life questionnaire SF12 and a Vascular Access Questionnaire (VAQ). Results: 91 patients participated, mostly male (70%), with a mean age of 68.9 ± 16.2 years. AVF was the current vascular access in 60.4%, the rest used a CVC. Home HD was performed in 12.1% of patients and 76% started it via CVC. Regarding patients who have had both AVF and CVC, 58% prefer AVF and only 26.5% of current CVC carriers would have a new AVF, mostly due to fear of pain (52%). Most people (72.5%) reported having received sufficient information, with no differences between both accesses. The SF12 results showed no differences between patients with AVF or CVC. Regarding the VAQ, patients with AVF were more satisfied with the social aspect (p = 0.036) and complications (p = 0.006). Conclusion: Patients with AVF had better outcomes than those using CVC regarding complications and social aspects. These differences are not attributable to a worse overall quality of life status of CVC patients. Most patients with CVCs refuse to go through a new AVF for fear of puncture pain.

Objective The study's objective was to use meta-analysis to assess the effectiveness of a dressing impregnated with chlorhexidine in preventing catheter-related bloodstream infections (CRBSIs) in pediatric patients. Methods The study was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A comprehensive search of 18 databases was conducted up to 5 March 2020 to identify related studies. Following the evaluation of the methodological quality, 8 studies, 1,584 catheters in 1,556 patients were added to the meta-analysis. The odds ratio and Hedge's G effect size value were employed to analyze the data. Either a fixed-effects model or a random-effects model was used to compute the effect size value with 95% confidence intervals (CIs). The heterogeneity of effect sizes was investigated using Cochrane Q statistics, I 2 , and Tau 2 tests. To test for publication bias, funnel plot, Orwin's safe n number, Begg and Mazumdar rank correlation, Egger test, and Duval and Tweedie's trim and fill procedures were all utilized. Results The catheter colonization risk was lowered by 50.7% by the chlorhexidine-impregnated (C-I) dressing (odds ratio [OR] = 0.493 [%95 CI: 0.360–0.675]; p < 0.001). The use of C-I dressing was associated with a trend toward a decrease in CRBSIs, while this association was not statistically significant (OR = 0.858 [%95 CI: 0.567–1.300]; p = 0.471). Conclusion The use of C-I dressing can effectively reduce the risk of catheter colonization, and it is also a helpful tactic in lowering CRBSIs in pediatric patients with central venous catheters, according to the findings of this meta-analysis. [ABSTRACT FROM AUTHOR]

Background: Central line‐associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. Aim: The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence‐based guidelines in practice. Design: A cross‐sectional study. Methods: Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. Results: A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence‐based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. Conclusions: Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. Relevance to Clinical Practice: The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence‐based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. [ABSTRACT FROM AUTHOR]

Background: Central venous access device (CVAD) is a common procedure in ICU which, although generally safe, can lead to acute and delayed complications. Training and accreditation process for its insertion vary worldwide. Aims: The objective of this study was to explore variability in existing training and accreditation processes for central venous access device (CVAD) insertion among different intensive care units (ICU), current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement. Methods: A prospective cross‐sectional web‐based survey was sent through email and CICM e‐newsletter to intensivists and directors of ICU across ANZ. All responses were tabulated, post‐hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarised. Results: A total of 115 responses was received from various public and private ICU from all states of ANZ; 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICU, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools and ultrasound training to improve training and assessment. Thirty‐five percent of the participants inserted 0–5 CVAD and more than half of the intensivists had inserted <10 CVAD in a 1‐year period. Two‐thirds of the respondents recommended inserting between 6 and 20 CVAD each year to maintain competence. Conclusion: The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion among intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICU. [ABSTRACT FROM AUTHOR]

Dialkylcarbamoylchloride dressing is a fatty acid derivative that has been shown in vitro to bind a number of pathogenic microorganisms. The purpose of this prospective study was to evaluate the safety and the efficacy of this technology in the care of the exit site of central venous catheter in a paediatric and neonatal population. Methods: The study was conducted from September 2020 to December 2022 at the Infermi Hospital in Rimini. Central venous catheters were placed using the SIC bundle for insertion. Dialkylcarbamoylchloride dressing was placed below the subcutaneous anchoring at the time of CVC placement and at each dressing change. Data about the catheters and the exit site were recorded and then compared with an historical cohort. Results: 118 catheters were placed during the studied period. The dialkylcarbamoylchloride dressing was well-tolerated. No case of systemic or local infection was recorded. The comparison with the historical cohort showed a reduction in the rate of exit site infection (p value 0.03). Conclusion: Dialkylcarbamoylchloride dressing is well-tolerated in paediatric and neonatal population. It represents a promising tool as a strategy for infection prevention. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of arteriovenous fistulas (AVFs) and central venous catheters (CVCs) on the left ventricular function (LVF) and prognosis of maintenance hemodialysis (MHD) patients. Methods: This retrospective cohort study included 270 patients (139 with AVF and 131 with CVC) undergoing dialysis with newly established vascular access in the blood purification center of Nanhua hospital, University of South China, from January 2019 to April 2021. Dialysis efficiencies, LVF indexes, and one-year prognoses were compared. Results: At six and twelve months after the establishment of vascular access, the mean urea clearances (Kt/V) and urea reduction ratio (URR) between the AVF- and the CVC-group were similar (P>0.05). The mean LVF values between the two groups were also similar before the establishment of vascular access (P>0.05), but the mean values of left ventricular end diastolic diameter (LVEDd), interventricular septal thickness (IVSTd), and left ventricular posterior wall thickness (LVPWT) in the AVF-group were higher than those in the CVC-group one year later, and mean early (E) and late (A) diastolic mitral velocities, E/A, and ejection fraction (EF) were lower than those in the CVC-group (P<0.05). The incidence of left ventricular hypertrophy and systolic dysfunction in the AVF-group was higher than that in the CVCgroup (P<0.05). The hospitalization rate of AVF-group (23.02%) was lower than that of the CVC-group (49.61%) (P<0.05). Conclusion: Both AVF and CVC can achieve appropriate dialysis effects in MHD patients. AVF has a negative impact on cardiac function while CVC has a high hospitalization rate. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus decolonization has proven successful in prevention of S. aureus infections and is a key strategy to maintain venous access and avoid hospitalization in patients receiving home parenteral nutrition (HPN). We aimed to determine the most effective and safe long-term S. aureus decolonization regimen. A randomized, open-label, multicenter clinical trial was conducted. Adult intestinal failure patients with HPN support and carrying S. aureus were randomly assigned to a 'continuous suppression' (CS) strategy, a repeated chronic topical antibiotic treatment or a 'search and destroy' (SD) strategy, a short and systemic antibiotic treatment. Primary outcome was the proportion of patients in whom S. aureus was totally eradicated during a 1-year period. Secondary outcomes included risk factors for decolonization failure and S. aureus infections, antimicrobial resistance, adverse events, patient compliance and cost-effectivity. 63 participants were included (CS 31; SD 32). The mean 1-year S. aureus decolonization rate was 61% (95% CI 44, 75) for the CS group and 39% (95% CI 25, 56) for the SD group with an OR of 2.38 (95% CI 0.92, 6.11, P = 0.07). More adverse effects occurred in the SD group (P = 0.01). Predictors for eradication failure were a S. aureus positive caregiver and presence of a (gastro)enterostomy. We did not demonstrate an increased efficacy of a short and systemic S. aureus decolonization strategy over a continuous topical suppression treatment. The latter may be the best option for HPN patients as it achieved a higher long-term decolonization rate and was well-tolerated (NCT03173053). [ABSTRACT FROM AUTHOR]

An umbilical venous catheter (UVC) is commonly placed for central venous access in preterm or critically ill full-term neonates to provide total parenteral nutrition (TPN) and medication. However, UVCs can result in complications, including infection, portal vein thrombosis, and hepatic tissue injury. The inadvertent administration of hypertonic fluid through a malpositioned UVC can also cause hepatic parenchymal damage with mass-like fluid collection that simulates a tumorous condition during imaging. Ultrasonography and radiographic examinations play an essential role in detecting UVC-related complications. This pictorial essay aims to present the imaging findings of UVC-related hepatic complications in neonates. [ABSTRACT FROM AUTHOR]

Antimicrobial lock solutions (ALT) in combination with systemic antibiotics can represent a valid option to attempt central venous catheter (CVC) salvage in the case of catheter-related and central-line-associated bloodstream infections (CRBSI and CLABSI). However, data concerning the effectiveness and safety of ALT in children are limited. We aimed to share our center's experience in order to contribute to investigations into the causes of ALT failure in the pediatric population. All children consecutively admitted to Meyer Children's Hospital, University of Florence, Italy, from 1 April 2016 to 30 April 2022, who received salvage ALT to treat an episode of CRBSI/CLABSI, were reviewed. According to ALT failure or success, children were compared with the aim of identifying the risk factors for unsuccessful ALT outcome. Data from 28 children, 37 CLABSI/CRBSI episodes, were included. ALT was associated with clinical and microbiologic success in 67.6% (25/37) of children. No statistically significant differences were observed between the two groups, successes and failures, considering age, gender, reason for use, duration, insertion, type and presence of insertion site infection of the CVC, laboratory data and number of CRBSI episodes. Nevertheless, a trend towards a higher success rate was observed for a dwell time of 24 h for the entire duration of ALT (88%; 22/25 vs. 66.7%; 8/12; p = 0.1827), while the use of taurolidine and the infections sustained by MDR bacteria were associated with a tendency toward greater failure (25%; 3/12 vs. 4%; 1/25; p = 0.1394; 60%; 6/10 vs. 33.3%; 8/24; p = 0.2522). No adverse events, except one CVC occlusion, were observed. ALT combined with systemic antibiotics appears to be an effective and safe strategy for treating children with CLABSI/CRBSI episodes. [ABSTRACT FROM AUTHOR]

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Introduction: Vascular access usage varies widely across countries. Previous studies have evaluated the association of clinical outcomes with the three types of vascular access, namely, arteriovenous fistula (AVF), arteriovenous graft (AVG), and tunneled and cuffed central venous catheter (TC-CVC). However, little is known regarding the association between arterial superficialization (AS) and the mortality of patients. Methods: A nationwide cohort study was conducted using data from the Japanese Society for Dialysis Therapy Renal Data Registry (2006–2007). We included patients aged ≥20 years undergoing hemodialysis with a dialysis vintage ≥6 months. The exposures of interest were the four types of vascular access: AVF, AVG, AS, and TC-CVC. Cox proportional hazard models were used to evaluate the associations of vascular access types with 1-year all-cause and cause-specific mortality. Results: A total of 183,490 maintenance hemodialysis patients were included: 90.7% with AVF, 6.9% with AVG, 2.0% with AS, and 0.4% with TC-CVC. During the 1-year follow-up period, 13,798 patients died. Compared to patients with AVF, those with AVG, AS, and TC-CVC had a significantly higher risk of all-cause mortality after adjustment for confounding factors: adjusted hazard ratios (95% confidence intervals) – 1.30 (1.20–1.41), 1.56 (1.39–1.76), and 2.15 (1.77–2.61), respectively. Similar results were obtained for infection-related and cardiovascular mortality. Conclusion: This nationwide cohort study conducted in Japan suggested that AVF usage may have the lowest risk of all-cause mortality. The study also suggested that the usage of AS may be associated with better survival rates compared to those of TC-CVC in patients who are not suitable for AVF or AVG. [ABSTRACT FROM AUTHOR]

Purpose: Central venous catheter (CVC)-related thrombosis (CRT) is a known complication in critically ill patients. However, its clinical significance remains unclear. The objective of the study was to evaluate the occurrence and evolution of CRT from CVC insertion to removal. Methods: A prospective multicenter study was conducted in 28 intensive care units (ICUs). Duplex ultrasound was performed daily from CVC insertion until at least 3 days after CVC removal or before patient discharge from the ICU to detect CRT and to follow its progression. CRT diameter and length were measured and diameter > 7 mm was considered extensive. Results: The study included 1262 patients. The incidence of CRT was 16.9% (95% confidence interval 14.8–18.9%). CRT was most commonly found in the internal jugular vein. The median time from CVC insertion to CRT onset was 4 (2–7) days, and 12% of CRTs occurred on the first day and 82% within 7 days of CVC insertion. CRT diameters > 5 mm and > 7 mm were found in 48% and 30% of thromboses. Over a 7-day follow-up, CRT diameter remained stable when the CVC was in place, whereas it gradually decreased after CVC removal. The ICU length of stay was longer in patients with CRT than in those without CRT, and the mortality was not different. Conclusion: CRT is a frequent complication. It can occur as soon as the CVC is placed and mostly during the first week following catheterization. Half of the thromboses are small but one-third are extensive. They are often non-progressive and may be resolved after CVC removal. [ABSTRACT FROM AUTHOR]

Background Most patients in the surgical intensive care unit (SICU) have anemia and undergo extensive diagnostic laboratory testing (DLT). Consequently, patients undergo RBC transfusion, and many are discharged with anemia, both of which are associated with poorer outcomes. Objective To characterize DLT blood loss in the SICU. Materials and Methods We performed a 1-year retrospective study of 291 patients admitted to a SICU. The number of draws, average volume, and estimated discard volume were recorded, along with clinical and laboratory findings. Results Patients who underwent greater amounts of DLT had lower hemoglobin levels at discharge (P ≤.001). Admissions requiring central venous catheter (CVC) access (49.8%) demonstrated significantly higher DLT draws and rates of transfusion. Conclusion Findings from this study suggest that DLT blood loss contributes to anemia in the SICU, and that the presence and duration of CVC leads to increased testing, anemia, and RBC transfusion. [ABSTRACT FROM AUTHOR]

Copyright of Gaceta Médica de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background & aim: Clinical guidelines play a significant role in improving the quality of patient care. Considering the lack of clinical guidelines for the care of central venous catheters in the country, this study aimed to compile a contextualized central venous catheter clinical guideline for being used in Iranian clinical settings. Methods: Contextualizing central venous catheters guideline was based on a developed approached by ADAPTE international collaboration network with three stages of set-up, adaptation and finalization. In the preparation stage, after establishing an organizing committee, the initial search of resources was done to check the feasibility of the study, to identify the required resources and skills and to also write the adaptation proposal. The adaptation phase started with a comprehensive search of resources to retrieve the maximum number of related guidelines. The search of sources led to the retrieval of 410 guidelines, which were reduced to 14 after screening the titles and abstracts based on the purpose of the study and the inclusion criteria. Then, the full text of the 14 included guidelines was reviewed in terms of methodological quality and the result was presented in the expert panel meeting. The methodological quality of the guidelines was evaluated with the AGREEII and a score of more than 70% was considered as an acceptable quality. In this way, one of the guidelines was selected and the adaptation process began. Finally, a translated draft of the guideline recommendations was reviewed in the expert and users panel, respectively. While making the suggested amendments, the level of their agreement with each of the recommendations were reviewed based on Likert scale from 1 to 9 (completely disagree to completely agree). Achieving a consensus more than 80 to assign grades 7 to 9 to each recommendation was resulted in keeping the recommendation. Finally, in the finalization stage, the contextualized version of the selected clinical guide was compiled for being used in Iranian clinical settings. Results: The full text of the 14 retrieved guidelines were reviewed. Among them, the "Central Venous Access Device (CVAD) Post Insertion Management" clinical practice guideline developed by NSW Agency for Clinical Innovation, with a quality score of 90.4% was selected for adoption. In addition, more than 80% of the stakeholders and expert panel agreed with assigning grades 7 to 9 to all recommendations of this guideline. As a result, all of the 50 recommendations of the guideline in assessment and intervention domains were accepted to be applied in Iranian clinical settings with a few modifications to make recommendations clearer and more understandable for users. Conclusion: The adopted version of CVAD post-insertion management clinical practice guideline with all 50 recommendations is applicable in caring of Iranian hospitalized adult patients with CVAD. [ABSTRACT FROM AUTHOR]

Vascular access in severely injured pediatric trauma patients is associated with time-critical circumstances and low incidences, whereas only scarce literature on procedure performance is available. The purpose of this study was to analyze the performance of different vascular access procedures from the first contact at the scene until three hours after admission. Intubated pediatric trauma patients admitted from the scene to a single Level I trauma center between 2008 and 2019 were analyzed regarding intravenous (IV) and intraosseous (IO) accesses, central venous catheterization (CVC) and arterial line placement. Sixty-five children with a median age of 14 years and median injury severity score of 29 points were included, of which 62 (96.6%) underwent successful prehospital IV or IO access by emergency medical service (EMS) physicians, while it failed in two children (3.1%). On emergency department (ED) admission, IV cannulas of prehospital EMS had malfunctions or were dislodged in seven of 55 children (12.7%). IO access was performed in 17 children without complications, and was associated with younger age, higher injury severity and higher mortality. Fifty-two CVC placements (58 attempts) and 55 arterial line placements (59 attempts) were performed in 45 and 52 children, respectively. All CVC and arterial line placements were performed in the ED, operating room (OR) and intensive care unit (ICU). Ten mechanical complications related to CVC placement (17.8%) and seven related to arterial line placement (10.2%) were observed, none of which had outcome-relevant consequences. This case series suggests that mechanical issues of vascular access may frequently occur, underlining the need for special preparedness in prehospital, ED, ICU and OR environments. [ABSTRACT FROM AUTHOR]

Vena cava superior (VCS) syndrome is rarely seen as a complication of central-venous-catheter placement. Usually, the syndrome appears when the presence of the catheter causes intraluminal obstruction or thrombosis. In this case report, however, we describe a patient on intermittent hemodialysis who had been free of any venous central line for over 6 years, presented with a VCS syndrome. The CT scan showed an absent VCS without extravascular compression. Previous catheter placement was diagnosed as the case of the VCS syndrome. It is important to realize that VCS syndrome can occur late after removal of central venous catheters, and thus, clinicians should be aware of its symptoms in any patient who has had an upper central line in the past medical history.

Abstract Background Central line–associated bloodstream infections (CLABSIs) remain a critical and possibly fatal outcome of hospitalization. Use of central venous catheter (CVC) bundles can considerably reduce CLABSI rates in hospitalized patients. However, despite widespread adoption of these bundles in hospitals worldwide, CLABSIs still remain prevalent. The aim of the present study was to determine whether longer duration of CVCs placement is related to CLABSIs in hospitalized adults, despite the implementation of preventive bundles. Also to analyse CLABSI pathogens distribution and antimicrobial resistance profiles in different time intervals of catheterization. Methods A retrospective study was performed among hospitalized patients who had a CVC inserted during a 24-month period (May 2017–May 2019) and developed CLABSIs. To evaluate the association between CVC placement duration and CLABSI events, we categorized events into three groups, each representing a 10-day time interval. Results A total of 59 CLABSI cases were identified among 9774 catheter/days. The CLABSI incidence rate per 1000 catheter/days was 4.80 for duration of catheterization up to 10 days, 5.92 for duration of 11–20 days, and 8.64 for duration > 20 days(p = 0.007). The CLABSI incidence rate per 1000 catheter/days due to multidrug-resistant organisms (MDROs) among the three groups was 2.62 for catheter duration of up to 10 days, 3.83 for 11–20 days, and 3.46 for > 20 days (p = 0.14). Among CLABSIs, the most common microorganism identified was multidrug-resistant Acinetobacter baumannii, which accounted for 27.1% of the cases. There was no significant difference in the type of CLABSI pathogens isolated among the 3 groups. Conclusions Our findings suggest that duration of CVC placement remains an important risk factor for CLABSIs in hospitalized patients, even after the adoption of prevention bundles. The high prevalence of MDROs in our setting reflects the local epidemiology, highlighting a significant threat of urgent public health concern.

Superior vena cava syndrome is a rare entity. The neoplastic etiology is the most relevant, as well as that related to invasive procedures with central venous catheter. A 32-year-old man consults the Emergency Department for sudden facial cyanosis, facial tightness, dry cough, odynophagia, dysphonia and vertigo without dyspnea. He presents colon neoplasia since 2019, with colostomy and left subclavian Port-catheter. At examination, facial and upper extremity edema, central cyanosis, multiple petechiae and nail bleeding on the hands. The angiotomography shows filling defect fort recent thrombosis in left internal jugular and brachiocephalic vein, right brachiocephalic vein, arch of the azygos vein and superior vena cava in its entire lumen. The surgical mechanical thromboaspiration allowed resection of the thrombus and restitution of circulation, with relative safety and low mortality.

Abstract Background A central venous catheter (CVC) is an important medical device, but it could be preceding infection and the risk of central line-associated bloodstream infection (CLABSI). CLABSI is a common healthcare-associated infection but results in high cost and mortality; therefore, various efforts to reduce CLABSI have been attempted. Methods This is a retrospective, observational, quasi-experimental study in the intensive care unit (ICU) of a single tertiary care hospital. We reviewed and analysed the data of CLABSI rates and days from the insertion to the removal of the temporary CVC between January 2018 and June 2021 with transient periods over 9 months. Sequentially, all patients with the CVC in the ICU underwent the following interventions: maximal barrier precaution, automatic notification of catheter days and 2% chlorhexidine gluconate bathing. A segmented regression analysis of interrupted time series was conducted to compare the CLABSI rates before and after the introduction of multimodal interventions. During study periods, the impact of interventions on CLABSI was evaluated using multivariate logistic regression analyses. Results A total of 76,504 patient-days, 28,312 catheter days and 66 CLABSI cases were reviewed in ICU-hospitalised patients. As additional interventions, the CLABSI rate declined from 3.1 per 1000 CVC days to 1.2 per 1000 CVC days in post-interventions. In the pre-intervention and post-intervention periods, 4146 patents had one more short-term CVC. In the multivariate logistic regression analyses, multimodal intervention was one of determinants reducing CLABSI rates (odds ratio (OR), 0.52 [95% confidence interval {CI}, 0.28–0.94]). Indwelling time of CVC over 10 days was the risk factor for CLABSI rates (OR, 6.27 [95% CI, 3.36–12.48]). Of the three interventions, the automatic notification of catheter days was associated with decreased median monthly total CVC days and duration of CVC days per patient. Conclusions Multidisciplinary and evidence-based interventions could lead to a decrease in the CLABSI rates. Moreover, the automatic notification of catheter days of the electronic medical healthcare system has shortened the time of indwelling CVC.

Hematology patients require central venous catheters for cancer treatment and nutrition, which increases their risk of intravascular device-associated bacteremia. In the absence of recent data, we investigated intravascular device-associated bacteremia in this specific context. A three-month surveillance was conducted annually in 27 hematology wards, using a protocol derived from the HAI-Net ICU ECDC protocol (2020–2024). We analyzed the characteristics of infected patients, the sources and microorganisms of healthcare-associated bacteremias, and intravascular device-associated bacteremias (including catheter type: central venous catheter (CVC), implantable venous access device (IVAD), peripherally inserted central catheter (PICC), midline catheter (MID), and peripheral venous catheter (PVC)), the time between catheter insertion and infection onset, and bacteremia incidence rates per 1,000 patient-days. Over the five-year period, 1,835 patients experienced healthcare-associated bacteremia. No significant changes were observed in patient characteristics over the five-year period. The two primary sources of bacteremias were intravascular devices (n = 682; 37.2%) and the digestive tract (n = 467; 25.4%). The incidence rates of intravascular device-associated bacteremias acquired in the participating wards remained stable. Among the 682 intravascular device-associated bacteremias, 648 (95.0%) involved central venous catheters, primarily PICCs (42.8%), IVADs (25.6%), and CVCs (24.8%). The types of central venous catheters involved shifted over the five years, with a decrease in the proportion of CVCs (from 31.1% in 2020 to 16.8% in 2024) and, conversely, an increase in PICCs (from 35.2% in 2020 to 52.8% in 2024; p = 0.007). Among the microorganisms identified, coagulase-negative Staphylococci (n = 330; 40.6%) and Enterobacterales (21.9%) were the most common. Overall, 59 bacteremias (8.6%) were associated with multidrug-resistant organisms, with no significant trend over the study period. Of the 682 cases, 88.2% were nosocomial, while 11.8% were acquired following care provided in the community or at home. The two groups of bacteremias did not differ regarding microorganisms, and the increasing proportion of PICC-associated bacteremias was noted in both populations. In contrast, the proportion of bacteremias acquired in the community or at home significantly increased over the five-year period, starting in 2022 (6.9% of bacteremias in 2020, 6.5% in 2021, 11.8% in 2022, 16.4% in 2023, and 18.0% in 2024; p = 0.006), at the expense of nosocomial bacteremias. PICC-associated bacteremias were more common in patients with bacteremias acquired in the community or at home (57.7% vs. 40.3% for nosocomial bacteremias; p = 0.021). In addition, while most intravascular device-associated bacteremias involving central venous catheters were late-onset, with the time between catheter insertion and the onset of bacteremia exceeding 7 days in 84.8% of cases, nosocomial bacteremias were less frequently late-onset (82.8%) compared to those acquired outside healthcare institutions (97.3%; p = 0.002). The mechanisms behind the increase in the proportion of PICC-associated bacteremias occurring long after catheter placement and acquired in hematology wards or in the community/at home should be investigated. Given that Staphylococci, common components of the skin flora, are involved in approximately half of PICC-associated bacteremias, our findings raise concerns about adherence to aseptic techniques during line manipulations and catheter dressing changes, both in hematology wards and in community settings. Therefore, to improve the prevention of PICC-associated bacteremias in patients, our data should encourage local infection prevention teams to implement targeted educational programs to reinforce strict aseptic practices during catheter manipulations and dressing changes. As these procedures are increasingly performed outside hospitals, training should be extended beyond healthcare workers in hematology wards to include those providing home care. [ABSTRACT FROM AUTHOR]

Abstract Background Congenital heart diseases rarely have a primary manifestation in adulthood. They are a rare cause of pulmonary hypertension in adults. Case presentation A 70-year-old woman of Eurasian descent underwent emergency surgery for bowel ischemia. Her history of mild pulmonary hypertension likely correlates with a peculiar diagnosis of an anatomic anomaly on the postoperative x-ray and computed tomography scan. The central venous catheter was misplaced. Initial management consisted of removal of the catheter. The diagnosis, partial anomalous pulmonary venous return, may pose a clinical therapeutic dilemma. Conclusions Partial anomalous pulmonary venous return is a potentially treatable cause of pulmonary hypertension. With the current trend toward more medical imaging, we expect this diagnosis to be made more often in the future.

Candida species are one of the leading causes of invasive fungal infections in pediatric patients with cancer, resulting in increased treatment related morbidity and mortality. There is limited data with respect to demography and outcomes of candidemia among children with cancer, especially from lower-middle income countries. In this retrospective observational study conducted over a 4-year Period (January-2017 to December-2021), children less than 15 years with cancer, treated at a tertiary oncology centre in India and diagnosed with candidemia were included. Data with respect to risk factors, species types, treatment, complications and mortality was gathered. One-hundred and ten children with candidemia were included. The most common underlying malignancy was acute leukemia seen in 72 (66%) patients. Seventy-five (68%) patients had neutropenia (<0.5 × 10^9/L) at the time of diagnosis of candidemia. In addition, 35 (32%) and 34 (30%) patients had prolonged exposure to steroids and antibiotics respectively. Non-albicans Candida species was isolated in majority (90%) of the cases. Fifty-seven patients required some form of modification of therapy for underlying malignancy. The 30-day mortality of the entire cohort was 36% and was 73% for patients admitted to the intensive care unit. On multivariate analysis, only prolonged use of antibiotics [odds ratio: 2.7(1.1-6.7); p = 0.027] was found to be significantly associated with worse 30-day mortality. The present study highlights the burden of candidemia among children with cancer. Despite prompt therapy, our cohort experienced increased mortality, primarily associated with prolonged antibiotic usage. These findings reinforce the critical importance of strict adherence to infection control guidelines and prudent antibiotic stewardship practices to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The use of peripherally inserted central catheters (PICCs) as an alternative to central venous catheters (CVCs) has steadily risen over the last two decades. However, there is an ongoing debate regarding research evidence that supports any clear advantages or disadvantages of them compared to traditional central venous lines. The present study was conducted to compare the indwelling time of CVC and PICC placements leading to microbial colonization by multidrug-resistant microorganisms (MDROs) in critically ill patients. Methods: A single-center retrospective descriptive study was performed that reviewed the medical records of critically ill patients with colonized CVCs and PICCs who were hospitalized during a 24-month period (May 2019–May 2021). To evaluate the association between indwelling time of catheter placement and colonization rates, events were categorized into three groups, each representing a one-week time interval of catheter indwelling time: group 1: ≤7 days, group 2: 8–14 days, and group 3: >14 days. Results: A total of 207 hospitalized patients with colonized PICCs or CVCs were included in the study. Of these, 144 (69.5%) had a CVC placement and 63 (30.5%) had a PICC placement. The overall colonization rate (per 1.000 catheter/days) was 14.73 in the CVC and 5.67 in the PICC cohort (p = 0.003). In the group of PICCs, 12/63 (19%) of the pathogens were MDROs and 51/63 (81%) were non-MDROs, while in the group of CVCs, 86/144 (59.7%) were MDROs and 58/144 (40.3%) were non-MDROs (p < 0.001). The colonization rate in the CVC cohort, was 6.98 for group 1, 21.57 for group 2, and 21.6 for group 3 (p = 0.019). The colonization rate of MDROs was 3.27 for group 1, 14.47 for group 2, and 12.96 for group 3 (p = 0.025). Regarding the PICC cohort, the colonization rate was 1.49 for group 1, 3.19 for group 2, and 8.99 for group 3 (p = 0.047). No significant difference existed between the three groups in terms of MDRO pathogens, with the colonization rate being 0 for group 1, 0.8 for group 2, and 1.69 for group 3 (p = 0.78). Within the CVC cohort, the most common isolated microorganism was MDR Acinetobacter baumannii (n = 44; 30.6%), followed by MDR Klebsiella pneumoniae (n = 27; 18.7%). In the PICC cohort, the predominant isolated microorganism was Candida non-albicans (n = 15; 23.8%), followed by Candida albicans, coagulase-negative staphylococci, and MDR Klebsiella pneumoniae in equal numbers (n = 6; 9.5%). Conclusions: Our findings show that while the indwelling time of PICC placement was longer compared to CVCs, its colonization rate was considerably lower. Furthermore, high colonization rates by microorganisms, especially MDROs, arose later during catheterization in PICCs compared to CVCs, suggesting that in terms of vascular infections, PICCs may be a safer alternative to conventional CVCs for long-term intravenous access.

Abstract Background Active learning methods, including low-fidelity simulation, are useful but the incremental learning effect of each method is however limited. We designed this study to assess if combining flipped classroom and the modified Peyton’s « 4-steps» method during procedural simulation (intervention group [IG]) would provide better learning results than simulation alone (control group [CG]) in the context of central venous catheter insertion training. Methods This prospective, single-center, and randomized study took place in 2017 in a single simulation center. All first year Anesthesiology residents of Ile de France area at the start of their residency were randomly included either in the IG or CG during a seminar aimed at providing initial procedural skills with low-fidelity simulation. A composite learning score which included knowledge MCQ and a questionnaire assessing satisfaction and value of the training session was recorded after training (primary outcome, /100). A randomized sub-group of learners of each group were video-recorded during central venous catheter insertion at the end of training and their skills were evaluated with validated tools, including a specific checklist and a global rating scale (GRS). Results Among 89 anesthesiology residents, 48 and 41 learners were randomized in the intervention and control groups respectively. Of the IG residents, 40/48 (83%) had read the learning material prior to the session. There was no significant difference regarding the composite outcome ([IG]= 81.1 vs [CG] = 80.5 /100 (p = 0.68)). Results of the post-session MCQ knowledge questionnaire were also non-significantly different. Residents were similarly satisfied and described a significant improvement of their knowledge and skills after training. Learners highly valued the training session as a mean to improve their future practice. No significant differences regarding checklist and GRS scores were observed. Conclusions A multimodal active learning strategy of procedural learning did not provide better learning outcomes when compared to a traditional simulation method. In both groups, satisfaction was high and perception of the acquired theoretical and practical knowledge was improved after training.

Abstract Background An increase in the incidence of central venous catheter (CVC)-related thrombosis (CRT) has been reported in pediatric intensive care patients over the past decade. Risk factors for the development of CRT are not well understood, especially in children. The study objective was to identify potential clinical risk factors associated with CRT with novel fusion machine learning models. Methods Patients aged 0–18 who were admitted to intensive care units from December 2015 to December 2018 and underwent at least one CVC placement were included. Two fusion model approaches (stacking and blending) were used to build a better performance model based on three widely used machine learning models (logistic regression, random forest and gradient boosting decision tree). High-impact risk factors were identified based on their contribution in both fusion artificial intelligence models. Results A total of 478 factors of 3871 patients and 3927 lines were used to build fusion models, one of which achieved quite satisfactory performance (AUC = 0.82, recall = 0.85, accuracy = 0.65) in 5-fold cross validation. A total of 11 risk factors were identified based on their independent contributions to the two fusion models. Some risk factors, such as D-dimer, thrombin time, blood acid-base balance-related factors, dehydrating agents, lymphocytes and basophils were identified or confirmed to play an important role in CRT in children. Conclusions The fusion model, which achieves better performance in CRT prediction, can better understand the risk factors for CRT and provide potential biomarkers and measures for thromboprophylaxis in pediatric intensive care settings.

Shuta Morishige,1 Yoshikazu Yamaguchi,1 Kei Nakajima,1 Sayaka Tsuboi,1 Yoh Sugawara,2 Hajime Hayami,1 Joseph D Tobias,3 Gaku Inagawa1 1Department of Anesthesiology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan; 2Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USACorrespondence: Yoshikazu Yamaguchi, Department of Anesthesiology, Yokohama Municipal Citizen’s Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama-shi, Kanagawa, 221-0855, Japan, Tel +81-45-316-4580, Fax +81-45-316-6580, Email yoshikaz@yokohama-cu.ac.jpAbstract: Cardiac surgery-associated acute kidney injury may require postoperative renal replacement therapy. Although the right internal jugular vein and femoral veins are generally the preferred insertion sites for the hemodialysis catheter for continuous renal replacement therapy, the presence of other indwelling catheters or prior thrombotic events from previous catheters may preclude use of these sites. We present a case in which the hemodialysis catheter was inserted into the distal femoral vein using point-of-care ultrasound in a patient with multiple catheter insertions after coronary artery bypass grafting. Although the tip of the dialysis catheter was more distal than the classic femoral approach, renal replacement therapy was performed without problems. Moreover, it was easier for the nurses to keep the insertion site clean and to change the patient’s position.Keywords: central venous catheter, renal replacement therapy, femoral vein

Background: The ideal central venous catheter (CVC) tip position placement is controversial, and CVCs do not remain in a fixed position after placement. This study evaluates both patient and procedural factors which may influence CVC tip migration and subsequent catheter dysfunction. Materials and Methods: This study evaluates CVC placements at a single institution. Patient age, gender, body mass index (BMI), catheter laterality, CVC type and indication for central venous access were recorded. Catheter tip location relative to the carina was measured at time of placement and removal utilizing supine fluoroscopic imaging. Patients’ electronic medical records were reviewed for evidence of catheter dysfunction. Statistical analysis was performed utilizing odds ratios and two tailed Student’s t-test. Results: 177 patients were included (101 female; mean age 55; mean BMI 29.2). Catheter types included 122 ports, 50 tunneled large bore central venous catheters (≥9 French), and 5 tunneled small bore central venous catheters (p = 0.000008). Catheters that migrated cranially by >2 cm had more than 7× greater risk of dysfunction compared to catheters that migrated ≤2 cm (odds ratio of 7.2; p = 0.0001). Left sided CVCs were significantly more likely to have >2 cm of cranial migration (odds ratio 6.9, 95% CI 3.4–14.2, p < 0.0001) and had a higher rate of dysfunction, likely due to this cranial migration (32% vs. 4.7%; p = 0.00001). Gender and BMI were not found to be associated with catheter dysfunction or an increased odds ratio of >2 cm cranial migration. Conclusions: Left-sided CVCs migrate an average of 2.4 cm cranially more than right-sided catheters. Additionally, when migration occurs, left-sided catheters are more likely to be dysfunctional. These suggest that lower initial placement may be beneficial in left-sided catheters.

ABSTRACT In this article the most relevant methods of subclavian vein catheterization were considered in order to find the optimal technique that can be used in routine clinical practice by pediatric intensive care physicians.OBJECTIVE To compare the efficiency and safety of subclavian vein catheterization by supraclavicular access under ultrasound control and subclavian access by anatomical landmarks in children.RESULTS The number of attempts for successful catheterization was statistically lower in ultrasound-control group compared to the anatomical landmarks group (1.2±0.4 vs. 2.6±1.3, p

Abstract Background Upper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space’s width as a predictive factor for UEDVT in patients receiving esophagectomy. Methods This study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space’s width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space. Results Among all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space’s width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P

Central venous catheterization is commonly used in patients undergoing cardiovascular surgery and it is a relatively safe procedure. A 62-year-old woman who underwent emergency mitral valve replacement for infective endocarditis received a central venous catheter after induction of anesthesia. Postoperative chest radiography revealed a wire-like foreign body near the puncture site of the internal jugular vein, which was later retrieved successfully using a snare catheter under fluoroscopy. This report highlights the importance of careful observation of the withdrawn guidewire and dilator and the role of perivascular ultrasound in all cases requiring this procedure.

Abstract Background The prevention of peripherally inserted central catheters (PICC)-associated BSI and central venous catheters (CVC)-associated BSI have been a topic of national importance in China. Therefore, we aimed to explore the epidemiological characteristics of central line-associated bloodstream infection (CLABSI), and to evaluate whether PICCs were associated with a protective effect for CLABSI. Methods A retrospective cohort study was conducted in teaching hospital in Western China. All adult patients received a CVC or PICC during their hospital stay were included from January 2017 to December 2020. Primary endpoint was CLABSI up to 30 days after CVC or PICC placement. Propensity scores with a 2:1 match was used to account for potential confounders, and restricted cubic spline was used to visualize the risk of CLABSI at different time points during the catheterization. Results A total of 224687 devices (180522 PICCs and 45965 CVCs) in 24879 patients were included. The overall incidence was 1.8 CLABSIs per 1000 catheter-days. The odds ratio (OR) value increased day by day after PICC insertion, reached a relatively high point on the 4th day, and decreased from days 5 through 8. From the 9th day of intubation the OR value began to gradually increase day by day again. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR = 3.27, 95% CI 2.38–4.49) compared with PICCs. Conclusions PICCs have a protective role and the effect of fluctuation curve feature in CLABSI when compared to CVCs, and the first 8 calendar days after CVC insertion are the acute stage of CVC-associated BSI.

Background and objectives: The aim of this study was to analyze risk factors for failure of subclavian vein catheterization. Methods: A retrospective analysis of 1562 patients who underwent subclavian vein puncture performed by the same experienced operator at Peking University Cancer Hospital from January 1, 2016 to January 1, 2019 was conducted. The success or failure of subclavian vein catheterization was registered in all cases. Various patient characteristics, including age, gender, body mass index (BMI), preoperative hemoglobin, preoperative hematocrit, preoperative mean corpuscular hemoglobin concentration (MCHC), preoperative albumin, preoperative serum creatinine, puncture needles from different manufacturers and previous history of subclavian vein catheterization were assessed via univariate and multivariate analyses. Results: For the included patients, landmark-guided subclavian vein puncture was successful in 1476 cases and unsuccessful in 86 cases (success rate of 94.5%). Successful subclavian vein catheterization was achieved via right and left subclavian vein puncture in 1392 and 84 cases, respectively. In univariate analyses, age and preoperative hemoglobin were associated with failure of subclavian vein catheterization. In a multivariate analysis, aged more than 60 years was a risk factor while the central venous access with Certofix® was associated with an increased rate of success (p-values of 0.001 and 0.015, respectively). Conclusions: This study has demonstrated that patient aged more than 60 years was a risk factor for failure of subclavian vein catheterization while the central venous access with Certofix® was associated with an increased rate of success.

Placement of image-guided tunneled and non-tunneled large-bore central venous catheters (CVCs) are common procedures in interventional radiology. Although leukopenia and/or thrombocytopenia are common at the time of placement, the roles these factors may have in subsequent catheter-related infection have yet to be investigated. A single-institution retrospective review was performed in patients who underwent CVC placement in interventional radiology between 11/2018–6/2019. The electronic medical record was used to obtain demographics, procedure details, pre-placement laboratory values, and the subsequent 90-day follow-up. A total of 178 tunneled and non-tunneled CVCs met inclusion criteria during this time period. White blood cell (WBC) and platelet counts were found to be significant risk factors for subsequent infection. Administration of pre-procedure antibiotics was not found to be a significant factor for subsequent infection (p = 0.075). Leukopenia and thrombocytopenia at the time of CVC placement are both risk factors of line infection for tunneled large-bore CVCs. This should lead to the consideration of using a non-tunneled CVC when clinically feasible, or the delayed placement of these catheters until counts recover.

BACKGROUND:Advanced chronic kidney disease is associated with elevated risk for cognitive impairment. However, it is not known whether and how cognitive impairment is associated with planning and preparation for end-stage renal disease. STUDY DESIGN:Retrospective observational study. SETTING & PARTICIPANTS:630 adults participating in the CRIC (Chronic Renal Insufficiency Cohort) Study who had cognitive assessments in late-stage CKD, defined as estimated glome-rular filtration rate ≤ 20mL/min/1.73m2, and subsequently initiated maintenance dialysis therapy. PREDICTOR:Predialysis cognitive impairment, defined as a score on the Modified Mini-Mental State Examination lower than previously derived age-based threshold scores. Covariates included age, race/ethnicity, educational attainment, comorbid conditions, and health literacy. OUTCOMES:Peritoneal dialysis (PD) as first dialysis modality, preemptive permanent access placement, venous catheter avoidance at dialysis therapy initiation, and preemptive wait-listing for a kidney transplant. MEASUREMENTS:Multivariable-adjusted logistic regression. RESULTS:Predialysis cognitive impairment was present in 117 (19%) participants. PD was the first dialysis modality among 16% of participants (n=100), 75% had preemptive access placed (n=473), 45% avoided using a venous catheter at dialysis therapy initiation (n=279), and 20% were preemptively wait-listed (n=126). Predialysis cognitive impairment was independently associated with 78% lower odds of PD as the first dialysis modality (adjusted OR [aOR], 0.22; 95% CI, 0.06-0.74; P=0.02) and 42% lower odds of venous catheter avoidance at dialysis therapy initiation (aOR, 0.58; 95% CI, 0.34-0.98; P=0.04). Predialysis cognitive impairment was not independently associated with preemptive permanent access placement or wait-listing. LIMITATIONS:Potential unmeasured confounders; single measure of cognitive function. CONCLUSIONS:Predialysis cognitive impairment is associated with a lower likelihood of PD as a first dialysis modality and of venous catheter avoidance at dialysis therapy initiation. Future studies may consider addressing cognitive function when testing strategies to improve patient transitions to dialysis therapy.

Hypokalaemia is a common occurrence in ICU around 40% of the patients were found to have Hypokalaemia between day 1 and day 4 of admission1, Though central venous catheter insertion is a common procedure with insertion rates in ICU (49%) or theatres (42%)2, is associated with complications which include premature atrial and ventricular contractions(pneumo/hemothorax, vessel/nerve injuries)the incidence of life-threatening ventricular arrhythmias is less than 1%3 We report a patient with severe hypokalaemia with quadriparesis who developed pulseless ventricular tachycardia while inserting central venous catheter through the right subclavian vein by landmark technique. Patient was successfully resuscitated as per the ACLS July 2020 guidelines. this case report reminds the clinician to be careful during central venous catheter insertion in critically ill ICU patients with adequate resuscitation equipment and a code blue team on standby to prevent catastrophe in what seems to be a benign day-to-day procedure. [ABSTRACT FROM AUTHOR]

In the last few years, a tremendous advancement has been made in the therapeutical management of several diseases with an increasing need for parental drug administration. To avoid repeated venous insertions and the patient's anxiety related to these procedures, it is now common practice to insert a catheter to leave it in place for a longer time. However, these procedures may generate some complications, such as failure of insertion, embolization, and infection. Different noninvasive techniques have been proposed and used for the retrieval of lost or misplaced foreign objects. Here, we presented a case of the lost fragmented catheter in a young female who underwent a central venous catheter insertion 10 years ago, incidentally detected during an echocardiographic examination. Here, we presented a case of a lost fragmented catheter in a young female who underwent a central venous catheter insertion 10 years before. [ABSTRACT FROM AUTHOR]

Simulation manikins provide anesthetists a training modality to practice ultrasound-guided central venous catheter (CVC) insertion safely without the risk of patient harm. The goals of this quality improvement (QI) project were to increase technical skills and reduce procedure time among anesthesia providers during CVC placement by implementing an ultrasound-guided, simulated CVC insertion workshop. A primary benefit of simulation-based education is the provision of a safe learning environment--one in which learners and providers may practice and increase skillsets. This QI project utilized a pretest-posttest design for which anesthesia providers completed a CVC insertion educational session and three formally evaluated simulated CVC placements: preworkshop, immediate postworkshop, and 3 months postworkshop. CVC insertion skills were evaluated by two experienced raters who established interrater reliability using a validated checklist and recorded procedure time in minutes. When comparing preworkshop median checklist score (33.74/52 [65%]), significant improvement was found in the immediate postworkshop (46.32/52 [89%]) and 3-month follow-up (44.26/52 [85%]). Time for CVC insertion significantly improved immediately postworkshop (15.7 minutes) and 3-month follow-up (15.9 minutes) when compared with preworkshop (21.5 minutes). An ultrasound-guided CVC simulation workshop can appreciably advance anesthesia providers' technical skills and decrease procedure time when performing insertion of a simulated internal jugular CVC. [ABSTRACT FROM AUTHOR]

Catheter-related bloodstream infections are common in children who require parenteral nutrition and can have serious consequences, including mortality. This study aims to evaluate the frequency and nature of catheter-related bloodstream infections in children receiving parenteral nutrition. Patients between one month and 18 years of age who received parenteral nutrition within two years were evaluated for indications and complications by focusing on catheter-related bloodstream infections. Twenty-nine different catheter-related bloodstream infections were detected in 24 of 147 episodes in which parenteral nutrition was delivered via a catheter. The frequency of catheter-related bloodstream infections was 7.7 infections per 1000 catheter days. Coagulase-negative staphylococci, Gram-negative enteric bacilli, enterococci, and Candida species were the most common causative microorganisms. Five patients died. Infection frequency increased with increasing PN duration and receiving PN via a non-tunneled internal jugular catheter. Gender, age, and the number of catheter lumens were not associated with infection frequency. Catheter-related bloodstream infection is a common complication in children receiving parenteral nutrition. Appropriate management is essential. Because parenteral nutrition duration is a risk for catheter-related bloodstream infections, the transition to enteral feeding should be considered as soon as possible. [ABSTRACT FROM AUTHOR]