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Background: Central venous catheter placement has been associated with mechanical complications, some of which can be life-threatening. Recent studies have shown that simulation-based education on ultrasound-guided central venous catheter placement improves puncture success rates; however, its effect on reducing mechanical complications remains unclear. This observational study examined how outcome-based simulation training for ultrasound-guided central venous catheter placement affects the incidence of mechanical complications in a clinical setting. Methods: The Safe Central Venous Catheter Placement and Management Committee established a reporting system to monitor central venous catheter placement. In 2016, a skill assessment of ultrasound-guided central venous catheter placement was conducted. Outcome-based simulation training was introduced in 2017. Skills were evaluated using the skill assessment tool developed by the Japanese Society for Medical Simulation. Results: After implementing skill assessment and outcome-based simulation training, the mechanical complication rate decreased from 2.2% in 2015 to 1.2% in 2023. Conclusions: A recent meta-analysis reported a 2.3% mechanical complication rate during ultrasound-guided central venous catheter placement. In comparison, the 1.2% complication rate at our institution is notably lower. This study suggests that outcome-based simulation training for ultrasound-guided central venous catheter placement may help reduce the incidence of mechanical complications in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Physical restraints may be utilized in patients with hepatic encephalopathy with the intention to ensure patient safety. Aims: Determine if racial and socioeconomic disparities exist in restraint use for patients with hepatic encephalopathy and determine clinical efficacy of restraints in hepatic encephalopathy. Methods: We performed a cross-sectional retrospective study of hospitalizations for hepatic encephalopathy from 2016 to 2021 using the National Inpatient Sample. Patient race and income were assessed for associations with restraint use and restraints themselves were then assessed for associations with clinical outcomes including mortality. Separate analyses were performed for hospitalizations with and without invasive cares defined as the presence of ICD-10 codes for mechanical ventilation, gastric tube placement and/or central venous catheter placement. Results: Restraint use was documented in 2.4% of 228,430 hospitalizations. In hospitalizations without defined invasive cares, restraint use was increased in Black patients compared to White patients (aOR = 1.57, 95% CI 1.24–1.98, p < 0.001) while lower income was not independently associated with restraint use (1st vs. 4th quartile national income aOR = 0.98, p = 0.895). In hospitalizations that did not involve other defined invasive cares, physical restraint use was associated with higher mortality (aOR = 1.71, 95% CI 1.20–2.43, p = 0.003), whereas in hospitalizations where invasive cares were employed, physical restraint use was associated with reduced mortality (aOR = 0.55, 95% CI 0.40–0.77, p < 0.001). Conclusions: Careful consideration of the necessity of restraints in hepatic encephalopathy hospitalizations without other invasive cares appears warranted as social disparities in restraint use and increased mortality were both found in this group. [ABSTRACT FROM AUTHOR]

Introduction: Chest ports are typically inserted via the right internal jugular vein with the left side being utilized in certain patient populations. The purpose of this study was to evaluate the dynamic position of the chest port and catheter tip, comparing a demographically matched cohort of female breast cancer patients with right‐ or left‐sided chest ports. Methods: 142 female patients with breast cancer requiring chest port insertion for chemotherapy and imaging confirming catheter tip position initially with supine fluoroscopy and follow‐up with erect chest radiography over a 5‐year period were identified. Data points analyzed were catheter tip‐to‐carina distance and the distance from the port to the ipsilateral infraclavicular border. Intraprocedural measurements were taken in the supine position during chest port insertion and compared with follow‐up erect chest radiography. The catheter tip position was also allocated a zone within the venous system on both image sets to assess for significant retraction to a more proximal zone in the erect position. Imaging within 12‐months of chest port insertion was also screened to identify port‐related complications. Results: The whole cohort showed significant retraction of the catheter tip (cephalad) (p < 0.001) and protraction of the port (caudal) (p < 0.001). The median tip‐to‐carina distance decreased from 38.3 mm to 28.6 mm and the port‐to‐clavicle distance increased from 31.3 mm to 64.6 mm. Right‐sided chest ports had increased tip‐to‐catheter retraction (15 mm) compared with left‐sided (6.9 mm) (p = 0.310). A complication was identified in 8.5% of the right‐sided and 11% of the left‐sided ports. Zone migration was significantly associated with the occurrence of a complication in left‐sided ports (p = 0.023). Conclusion: When assessing chest port catheter tip position between supine and erect radiographic studies in female patients with breast cancer, retraction cephalad will occur and this is more apparent in right‐sided ports. Change in catheter tip position was not associated with a significant increase in complication rate unless it occurred in left‐sided ports where zone migration was evident. [ABSTRACT FROM AUTHOR]

Background: The standard of care for placement of a central venous catheter (CVC) includes a real-time ultrasound (US)-guided technique. We describe a rare case in which the guidewire penetrated the posterior wall of the vessel, forming a knot, which precluded simple removal. This occurred despite the procedure being performed under real-time US guidance. The guidewire was eventually removed under fluoroscopic guidance in a hybrid operation room. Case presentation: An 89-year-old male underwent the placement of a CVC in the left internal jugular vein. During the US-guided procedure, the guidewire penetrated the posterior wall of the vessel and formed a knot, which impeded simple removal. This was confirmed by radiologic imaging. Using a short sheath and a push–pull technique, the radiologist was able to untangle the knot to allow for catheter removal. The guidewire was safely removed without vascular injury. Conclusions: A very rare complication of guidewire knotting was observed despite the use of US-guidance during needle and wire placement. The use of US, computed tomography, and fluoroscopy were beneficial for diagnosis, while the hybrid operating room provided the optimal environment for the removal procedure. [ABSTRACT FROM AUTHOR]

Background: This study presents a systematic approach using a natural language processing (NLP) algorithm to assess the necessity of routine imaging after central venous catheter (CVC) placement and removal. With pneumothorax being a key complication of CVC procedures, this research aims to provide evidence-based recommendations for optimizing imaging protocols and minimizing unnecessary imaging risks. Methods: We analyzed electronic health records from four university hospitals in Salzburg, Austria, focusing on X-rays performed between 2012 and 2021 following CVC procedures. A custom-built NLP algorithm identified cases of pneumothorax from radiologists' reports and clinician requests, while excluding cases with contraindications such as chest injuries, prior pneumothorax, or missing data. Chi-square tests were used to compare pneumothorax rates between CVC insertion and removal, and multivariate logistic regression identified risk factors, with a focus on age and gender. Results: This study analyzed 17,175 cases of patients aged 18 and older, with 95.4% involving CVC insertion and 4.6% involving CVC removal. Pneumothorax was observed in 106 cases post-insertion (1.3%) and in 3 cases post-removal (0.02%), with no statistically significant difference between procedures (p = 0.5025). The NLP algorithm achieved an accuracy of 93%, with a sensitivity of 97.9%, a specificity of 87.9%, and an area under the ROC curve (AUC) of 0.9283. Conclusions: The findings indicate no significant difference in pneumothorax incidence between CVC insertion and removal, supporting existing recommendations against routine imaging post-removal for asymptomatic patients and suggesting that routine imaging after CVC insertion may also be unnecessary in similar cases. This study demonstrates how advanced NLP techniques can support value-based medicine by enhancing clinical decision making and optimizing resources. [ABSTRACT FROM AUTHOR]

Background: The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school. Methods: Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores. Results: Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively. Conclusions: Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training. [ABSTRACT FROM AUTHOR]

Purpose Central line–associated bloodstream infections (CLABSIs) are hospital-acquired, serious complications that greatly affect many vulnerable neonates throughout their hospital stay. This article describes the implementation of a unique practice in which pharmacy primes continuous infusions through medication tubing for neonatal central lines in a cleanroom at Children's Hospital Colorado – Colorado Springs (CHCO-CSH). Summary This institution is a freestanding children's hospital with a level III neonatal intensive care unit (NICU) that opened in April 2019. Since then, the pharmacy department has been priming central line tubing for continuous infusions for all patients in the NICU. Neonates are at increased risk for developing CLABSIs due to their immature immune systems and frequent need for central line placement. With that in mind, the pharmacy department decided to focus efforts on this population. Pharmacists and pharmacy technicians received training on how to properly prime tubing, document when a patient received a new central line, document if a central line was removed, and record when new tubing was due based on a department policy. Conclusion This novel, pharmacy-led priming procedure resulted in a low CLABSI incidence, offering a promising strategy to reduce CLABSIs in a NICU. [ABSTRACT FROM AUTHOR]

Background: Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a 'Never Event' by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective. Methods: We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50). Results: NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398). Conclusions: The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is the most frequent cardiac arrhythmia following cardiac operations. It has been associated with an increased risk of postoperative cerebrovascular complications, morbidity and mortality. The aim of this study is to evaluate if the type of venous cannulation to institute the cardiopulmonary bypass (CPB) during major cardiac surgery procedures can influence the rate of POAF and late FA onset. Methods: We collected data from 2087 consecutive patients who have been operated at our Institution from January 2016 to December 2018. To obtain two homogenous groups we performed a propensity match analyzes: Group 1 for whom the blood drain of the CPB has been granted via peripheral cannulation (PC) through the right common femoral vein and Group 2 with patients who underwent central cannulation (CC) with insertion of a drainage cannula in the right atrium or in the superior and inferior vein cava. Results: POAF has been observed as statistically similar between the two groups. At 1250‐day follow‐up, While the incidence of POAF was 2.9% and 8.7% in the PC and CC groups, respectively (p =.04). Conclusions: our data seems to show that the two groups do not differ in terms of POAF, while the CC group may have a significantly higher rate of atrial fibrillation in the follow‐up period. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations. Case: An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories. Conclusions: Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification. [ABSTRACT FROM AUTHOR]

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The use of a rapid, easy‐to‐use intervention could improve needle‐related procedural pain management practices in the context of the Emergency Department (ED). As such, the Buzzy device seems to be a promising alternative to topical anesthetics. The aim of this study was to determine if a cold vibrating device was non‐inferior to a topical anesthetic cream for pain management in children undergoing needle‐related procedures in the ED. In this randomized controlled non‐inferiority trial, we enrolled children between 4 and 17 years presenting to the ED and requiring a needle‐related procedure. Participants were randomly assigned to either the cold vibrating device or topical anesthetic (4% liposomal lidocaine; standard of care). The primary outcome was the mean difference (MD) in adjusted procedural pain intensity on the 0–10 Color Analogue Scale (CAS), using a non‐inferiority margin of 0.70. A total of 352 participants were randomized (cold vibration device n = 176, topical anesthetic cream n = 176). Adjusted procedural pain scores' MD between groups was 0.56 (95% CI:−0.08–1.20) on the CAS, showing that the cold vibrating device was not considered non‐inferior to topical anesthetic. The cold vibrating device was not considered non‐inferior to the topical anesthetic cream for pain management in children during a needle‐related procedure in the ED. As topical anesthetic creams require an application time of 30 min, cost approximately CAD $40.00 per tube, are underused in the ED setting, the cold vibrating device remains a promising alternative as it is a rapid, easy‐to‐use, and reusable device. [ABSTRACT FROM AUTHOR]

Abstract Central venous catheter (CVC) cannulation can be accompanied by serious complications. The appearance of catheter-related infections is associated with high morbimortality. The aim of this study is to evaluate the incidences of colonization and central line-associated bloodstream infections (CLABSI) in short-term CVCs in the elective surgery setting, as well as to analyze the related risk factors. Prospective observational study including patients undergoing elective surgery with a CVC inserted perioperatively. Patients with current infection, taking preoperative antibiotics, those planning to have CVC for longer than 14 days, those under 18 years old, and those refusing to participate were excluded. Patients without cultures at the moment of CVC retrieval were not included. 200 patients were included, with a mean catheter duration of 6.8 ± 3.1 days, and a total duration of 1,358 days. Incidence of colonized catheters was 6% (8.84/1000 catheter-days), and 3.5% had CLABSI (5.15/1000 catheter-days). Catheter duration was longer in patients whose CVCs had been removed due to suspected infection (p

Central venous catheterization is an inextricable requirement in intensive care units, long surgeries, postoperative care, and as a part of malignancy treatment that delivers intravenous fluids, drugs, inotropic agents, and intravenous feeding. Recently, different approaches for brachiocephalic vein cannulation gained interest in children and adults. We aimed to describe the rare complication of pleural effusion occurred after brachiocephalic catheterization and managed the case related to cannulation. We tried to emphasize that great vigilance is required at the time of transferring the patient to prevent the displacement and dislodgement of catheter.

Abstract Despite ultrasound guidance for central venous catheterization (CVC), the first-attempt success rate has remained around 52.6−62.1%. A significant reason is that the needle can sometimes be dislodged from the punctured vein during hand shifts. Here, a novel one-hand guidewire introducer (OGI) kit was developed to perform guidewire insertion in the central vein, eliminating hand shifts. To establish a protocol, the OGI kit was validated using a central line training phantom. A total of 48 randomized trials of guidewire insertion in the internal jugular vein in eight pigs were performed using either the conventional kit (group A) or the OGI kit (group B). All trials were technically successful with all eight pigs. First-attempt success rate (50% vs. 75%, p = 0.035) and global rating scale (12 (5−15) vs. 14 (8−15), p = 0.011) were significantly lower in group A than in group B. The number of needle redirections and guidewire insertions, time to guidewire insertion, and procedure-related complications were significantly higher in group A than in group B. Guidewire insertion using a novel OGI kit could be a promising approach for real-time ultrasound-guided CVC as it offers greater clinical usefulness.

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. We presented PLSVC in a patient with end-stage renal disease (ESRD) requiring hemodialysis. The left internal jugular vein was utilized for central venous access due to difficult central vascular access, resulting in a diagnosis of PLSVC draining in the left atrium. This case underscores the importance of awareness of anatomical variations before central catheter placement.

Abstract Background Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment. Case presentation A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient’s vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient’s continued stability. Conclusion This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure’s accuracy and safety.

Introduction: The aim of this observational study was to investigate the risk factors of a failed first attempt at pediatric central venous catheter (CVC) placement and its impact on CVC-related morbidity. Materials and Methods: In this prospective observational study, we included 3-month-to 5-year-old children proposed for infraclavicular subclavian vein catheterization consecutively sing the anatomic landmark technique. Patients were divided into two groups: group 1 included single-attempt catheter placements, and Group 2 included failed first attempts at catheter placement. The management protocol was standardized for all patients. After comparing the two groups, univariable logistic regression was used to investigate the risk factors for a failed first attempt and to show the interest of the single-attempt catheter placement. Results: Among 150 pediatric CVC placements, the incidence of failed first attempts was 41.3% and its main risk factors were children with comorbidities (OR=3.11; 95%CI: 1.17–8.21), hematology and oncology patients (OR=5.6; 95%CI: 2.75–11.38), children with aplastic anemia (OR=3.05; 95%CI:1.388–6.705), and anesthesia sedation with I-Gel airway ventilation (OR=9.21; 95%CI: 1.080–78.5). On the other hand, a single-attempt catheter placement was a protective factor against catheter-related complications with OR=0.258 [0.12–0.55]. Conclusion: It seems that a single-attempt CVC placement may reduce the incidence of complications. The knowledge of the main risk factors of failed first attempts is mandatory for taking necessary precautions. [ABSTRACT FROM AUTHOR]

Objectives: To explore the risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and establish nomograms to predict the probability of CRKP infection and mortality in adult patients. Methods: Patients infected with KP from August 2019 to April 2021 in a tertiary hospital in Shanghai were enrolled. Risk factors associated with CRKP and 30-day mortality were identified using multivariate logistic regression analysis and Cox regression analysis. Results: Overall, 467 patients with KP infection were enrolled, wherein 210 (45.0%) patients were infected with CRKP and 257 (55.0%) patients with carbapenem-susceptible K. pneumoniae (CSKP). Five factors, namely Charlson's Comorbidity Index (CCI) ≥ 3, the use of central venous catheterization, prior hospitalization during the 3 months before infection, and previous exposure to carbapenems and broad-spectrum β-lactams, were found to be independently associated with CRKP infection. Based on these parameters, the nomogram showed a better performance as indicated by C-index of 0.94 (95% confidence interval [CI]: 0.92–0.96) and well-fitted calibration curves. CRKP was independently associated with 30-day mortality. Multivariate Cox regression analysis revealed that age ≥65 years, higher CCI scores, higher Sequential Organ Failure Assessment scores, the presence of respiratory failure, albumin levels ≤30 g/L, and non-appropriate treatments in 3 days, were associated with 30-day mortality. Conclusion: The predictive nomogram established in this study can facilitate the clinicians to make better clinical decisions when treating patients with KP infection. [ABSTRACT FROM AUTHOR]

Background: During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique. Methods: A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed. Results: Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53–0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49–0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41–0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48–0.87). Conclusion: US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022. [ABSTRACT FROM AUTHOR]

We aimed to ascertain the prevalence of venous and arterial thrombus, potential thrombosis-inducing factors, and underlying medical conditions in critically ill pediatric patients admitted to our pediatric intensive care unit. We included patients who were admitted to our tertiary pediatric intensive care unit for 24 hours between June 2016 and June 2021 and had venous or arterial thrombosis confirmed by Doppler ultrasonography. Thirty patients with confirmed thrombosis who underwent Doppler ultrasonography and thirty patients without thrombosis, matched based on age and gender, were included in the control group. The female gender accounted for 63.3% of the patients in the thrombosis group. There was no significant gender difference between the thrombosis group and the control group. Age (in months), height, weight, and body mass index measurements were similar in both groups. The most common reason for hospitalization in the thrombosis group was post-operative care (n = 7; 23.3%). Thrombosis typically occurred after a mean of 6.9 ± 4.9 days of hospitalization. Coagulation parameters, Protein C, Protein S, homocysteine levels, pediatric mortality index (PIM), pediatric risk of mortality (PRISM-2), and Braden Q scores evaluating pressure ulcersdid not differ significantly between the two groups. Eleven patients in the thrombosis group were screened for the prothrombin 20210A mutation, with all results being normal; eleven patients in the patient group were tested for Factor V Leiden mutation, and nine patients in the control group had no mutation. The thrombosis group had a significantly lower rate of mechanical ventilation and hemodialysis. Factors such as trauma, infection, heart failure, malignancy, history of chemotherapy, immobilization, presence of central catheter, history of surgical intervention, family history, and nephrotic syndrome were not significantly associated with thrombosis development. Central venous and arterial catheterization was identified as the most crucial acquired risk factor for thrombosis. [ABSTRACT FROM AUTHOR]

Background: To minimize adverse events of peripheral blood stem cell (PBSC) collection in healthy donors, it is reasonable to limit the total dose of granulocyte colony-stimulating factor (G-CSF) and/or the number of apheresis days without decreasing of PBSCs yield. Therefore, we have started to collect G-CSF induced PBSCs on day 4 instead of on day 5. So, we retrospectively aimed to investigate the results of this 4-day G-CSF administration. Study Design and Methods: Seventy-six healthy donors who performed on G-CSF induced PBSCs donation consecutively between January 2020 and July 2022 were included in this study. G-CSF (filgrastim) at 2 × 5 µg/kg/day subcutaneously was applied. Apheresis started on day 4. Results: Sixty-nine (90.8%) of 76 donors provided enough PBSCs on day 4 apheresis session. Younger age (p = 0.004), higher PB CD34+ cell count on the 4th day of G-CSF (p < 0.001), and male donor (p = 0.010) were correlated with increased amounts of PBSCs yield. Univariate and multivariate logistic regression analyses to predict very good mobilizers (collected PBSCs ≥8 × 106/kg after the first apheresis) were performed. In multivariate logistic regression analyses, male sex (p = 0.004), PB CD34+ cell count ≥100/µL on the 4th day of G-CSF (p < 0.001), and glomerular filtration rate ≥115 mL/min (p = 0.031) were found to be independent predicting factors to demonstrate very good mobilizer. Conclusion: It seems that starting the apheresis on the 4th day of G-CSF administration is effective and to provide minimal G-CSF exposure in healthy donors. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of a static ultrasonographic (US) examination of the central venous structures before central venous catheterization (CVC) and the success of the procedure. Materials and Methods: In this prospective study, patients who underwent CVC, in an emergency department (ED), were divided into two groups: patients who underwent CVC using the anatomical landmark technique (n = 34) and patients who underwent CVC using a static US examination (n = 33). The procedure times, success rates, and number of catheters used were compared. Results: A total of 67 patients who underwent CVC were included in the study. Compared with the anatomical landmark technique, the static US examination had a higher procedural success rate (P =.001), fewer total interventions (P =.001), and fewer postprocedural catheter dysfunctions (P =.048). While there was no difference in the duration of the CVC between groups (P =.222), the total time spent was longer using a static US examination (P =.022). Conclusion: The static US examination was a practical, easy-to-apply method that could be used for CVC placement in an ED. This study demonstrated sonography had a high success rate in CVC procedures and contributed to a reduction in the number of interventions and catheters used. [ABSTRACT FROM AUTHOR]

We report the case of a 56-year-old male diagnosed with acute myeloid leukemia who developed a severe cervical hematoma following an ultrasound-guided right internal jugular vein catheterization. Despite receiving platelet transfusions prior to the procedure, the patient experienced progressive hematoma enlargement, leading to respiratory distress. Further investigations, including carotid Computed Tomography Angiography (CTA), ruled out arterial injury, but thromboelastography revealed severe coagulation dysfunction. The patient subsequently developed cerebral hemorrhage and died despite intensive care interventions. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Discussion Arteriovenous fistulas (AVFs) and grafts are essential for long‐term hemodialysis access in patients with end‐stage renal disease. However, complications and access failure often necessitate re‐intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures.This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision.A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders.Understanding predictors of successful long‐term access outcomes can guide decision‐making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Medical residents learn how to perform many complex procedures in a short amount of time. Sequential learning, or learning in stages, is a method applied to complex motor skills to increase skill acquisition and retention but has not been widely applied in simulation-based training (SBT). Central venous catheterization (CVC) training could benefit from the implementation of sequential learning. CVC is typically taught with task trainers such as the dynamic haptic robotic trainer (DHRT). This study aims to determine the impact of sequential learning on skill gains and learning curves in CVC SBT by implementing a sequential learning walkthrough into the DHRT. METHODS: 103 medical residents participated in CVC training in 2021 and 2022. One group (N = 44) received training on the original DHRT system while the other group (N = 59) received training on the DHRTsequential with interactive videos and assessment activities. All residents were quantitatively assessed on (e.g. first trial success rate, distance to vein center, overall score) the DHRT or DHRTsequential systems. RESULTS: Residents in the DHRTsequential group exhibited a 3.58 times higher likelihood of successfully completing needle insertion on their first trial than those in the DHRT only group and required significantly fewer trials to reach a pre-defined mastery level of performance. The DHRTsequential group also had fewer significant learning curves compared to the DHRT only group. CONCLUSION: Implementing sequential learning into the DHRT system significantly benefitted CVC training by increasing the efficiency of initial skill gain, reducing the number of trials needed to complete training, and flattening the slope of the subsequent learning curve. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment. Case presentation: A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient's vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient's continued stability. Conclusion: This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To determine the impact of the protocol change from slow to fast enteral feeding progression on duration of central venous catheter placement, and the rates of late‐onset sepsis and necrotising enterocolitis.We compared the evolution of all very low‐birth‐weight infants admitted on their first postnatal day in neonatal intensive care unit during a 12‐month period, before (2021 Cohort) and after (2022 Cohort) implementation of a new feeding protocol. Linear regression model was used to adjust for confounding factors.A total of 343 VLBW infants were included (median gestational age ± SD 28.3 ± 1.7 weeks; median birth weight ± SD 980 ± 300 g). Median initial duration of central venous catheter was 5 days in 2022 cohort compared with 9 days in 2021 cohort (unadjusted p = 0.006, adjusted p = 0.001). Median time to achieve full enteral feeding was 8 days versus 12 days, p < 0.001, with no significant difference in late‐onset sepsis or necrotising enterocolitis rates.The change from slow to fast enteral feeding progression for very low‐birth‐weight infants significantly decreased the central venous catheter duration with no adverse outcomes. This is consistent with recent randomised study results and supports the safe implementation in neonatal intensive care units. [ABSTRACT FROM AUTHOR]

Rationale: The epidemiology and clinical impact of COVID‐19‐associated candidemia (CAC) remained uncertain, leaving gaps in understanding its prevalence, risk factors and outcomes. Methods: A systematic review and meta‐analysis were conducted by searching PubMed, Embase and Scopus for reports of CAC prevalence, risk factors and clinical outcomes up to June 18, 2024. The generalised linear mixed model was employed to determine the prevalence and 95% confidence intervals (CIs). The risk factors and clinical outcomes were compared between patients with and without CAC using the inverse variance method. Results: From 81 studies encompassing 29 countries and involving 351,268 patients, the global prevalence of CAC was 4.33% (95% Cl, 3.16%–5.90%) in intensive care unit (ICU) patients. In ICUs, the pooled prevalence of CAC in high‐income countries was significantly higher than that of lower‐middle‐income countries (5.99% [95% Cl, 4.24%–8.40%] vs. 2.23% [95% Cl, 1.06%–4.61%], p = 0.02). Resistant Candida species, including C. auris, C. glabrata (Nakaseomyces glabratus) and C. krusei (Pichia kudriavzveii), constituted 2% of ICU cases. The mortality rate for CAC was 68.40% (95% Cl, 61.86%–74.28%) among ICU patients. Several risk factors were associated with CAC, including antibiotic use, central venous catheter placement, dialysis, mechanical ventilation, tocilizumab, extracorporeal membrane oxygenation and total parenteral nutrition. Notably, the pooled odds ratio of tocilizumab was 2.59 (95% CI, 1.44–4.65). Conclusions: The prevalence of CAC is substantial in the ICU setting, particularly in high‐income countries. Several risk factors associated with CAC were identified, including several that are modifiable, offering the opportunity to mitigate the risk of CAC. [ABSTRACT FROM AUTHOR]

Central venous catheterization (CVC) is crucial in paediatric care but presents unique challenges, including malpositioning. This series discusses four cases highlighting complications and management strategies. An infant with congenital cardiac anomalies required repositioning of a PICC line due to jugular malposition. A preterm neonate's CVC was found extravascular, necessitating removal under surgical supervision. Additional cases involved misplacement in the subclavian vein and overlying the right ventricle, both successfully corrected. These instances underscore the importance of proper technique, monitoring, and the use of diagnostic tools to enhance patient safety and minimize complications associated with CVC insertion in children. [ABSTRACT FROM AUTHOR]

The Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee (CTMC) provides evidence-based guidance on safe and effective transfusion practices. Key developments in transfusion medicine in 2023 include findings on red blood cell transfusion strategies for myocardial infarction, updated RBC transfusion guidelines, and the impact of donor sex on transfusion outcomes. Additionally, studies on infectious diseases, blood donor screening, and collections, as well as patient blood management (PBM) metrics and effectiveness, were highlighted. The document also covers advances in hemostasis, hemoglobinopathies, immunohematology, genomics, pediatrics, apheresis, and biotherapies, including the FDA approval of gene therapies for sickle cell disease. Lastly, the text addresses healthcare disparities and diversity, equity, and inclusion (DEI) issues, such as racial disparities in postoperative transfusion outcomes and gender and racial inequity among editorial positions. [Extracted from the article]

Platelet transfusions are commonly used in critically ill patients to prevent or treat bleeding, but their benefits and potential harms are uncertain. Platelet concentrates, which are produced from donated blood, have a limited storage duration and there is a high demand for them. Manufacturing and storage of platelet concentrates can lead to changes in their structure and function. Prophylactic platelet transfusion may reduce the risk of bleeding, but the optimal thresholds for transfusion are uncertain. The dose of platelet transfusion does not affect the risk of bleeding. Post-transfusion platelet increments are often poor in critically ill patients. The use of platelet transfusions prior to certain procedures in ICU patients remains unclear. Platelet transfusions have been found to improve outcomes in severely injured bleeding patients. However, platelet transfusions are not indicated for the reversal of anti-platelet agents. Platelet transfusions can have potential side effects, including increased risk of infections and pulmonary side effects. [Extracted from the article]

This study assess the feasibility of integrating virtual reality (VR) simulation into the central venous catheter (CVC) placement training curriculum. The study consists of 3 parts: (1) Evaluating current manikin-based training for CVC placement through surveys for senior first-year anesthesia residents and cardiac anesthesia faculty who supervise resident performing the procedure; (2) Interventional study training novice trainees with VR simulator and assessing their reaction satisfaction; and (3) pilot study integrating VR training sessions into CVC training curriculum for first-year anesthesia residents. Conducted at a single academic-affiliated medical center from December 2022 to August 2023. Junior first-year anesthesia residents. VR training sessions for CVC placements using the Vantari VR system. Primary outcome: novice trainees' satisfaction with VR training for CVC procedure. Satisfaction of resident and faculty with standard manikin-based training was also collected. Faculty expressed concerns about residents' confidence and perceived knowledge in performing CVC placement independently. Novice trainees showed high satisfaction and perceived usefulness with VR training, particularly in understanding procedural steps and developing spatial awareness. Pilot integration of VR training into the curriculum demonstrated comparable training times and emphasized structured stepwise training modules to ensure completion of vital procedural steps. This study underscores the potential of VR simulation as a complementary training tool for CVC placement rather than a substitution of standard manikin training. VR is offering immersive experiences and addressing limitations of traditional manikin-based training methods. The integration of VR into training curricula warrants further exploration to optimize procedural proficiency and patient safety in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Despite advancements in ultrasonography, locating peripheral veins for catheter placement remains a challenge in patients with altered anatomy owing to multiple surgeries. Herein, we highlight the potential of using the radial vein as an alternative site for ultrasound-guided peripheral venous catheterization. Case presentation: We present two cases of patients with extensive surgical histories, including multiple abdominal surgeries, leading to difficult peripheral venous access. Traditional sites for peripheral venous catheterization were unsuitable due to vein narrowing or lack of visibility. In both cases, ultrasonography helped identify the radial vein as the only viable site for catheter placement. The patients underwent successful ultrasonography-guided catheterization of the radial vein without complications, facilitating medical management, including anesthesia induction and intraoperative monitoring. Conclusions: The radial vein is a feasible and safe alternative for ultrasound-guided peripheral venous access in patients where traditional venous access sites are compromised. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to assess the extent of knowledge and application of central line bundles in the intensive care unit (ICU) of a tertiary care hospital for the purpose of avoiding central line-associated bloodstream infections (CLABSI). This assessment was conducted through the use of a questionnaire. Materials and methods: A cross-sectional study was conducted in the ICU, involving doctors and nurses. The study was observational in nature. The study employed a methodical validated questionnaire to evaluate the level of knowledge, attitude, and practice of central line bundles for the prevention of central line-associated bloodstream infections (CLABSI). The questionnaire was designed using preexisting awareness surveillance systems, infection control measures, and patient care practices that were specifically relevant to CLABSIs in the ICU. The data were analyzed utilizing SPSS. Results: The research involved a total of 93 healthcare professionals, consisting of 67 physicians and 26 nurses. The mean knowledge score among participants was 82%, with higher scores reported in individuals who had training in central line bundles. Healthcare professionals exhibited robust compliance with hand cleanliness, antiseptic skin preparation prior to insertion, aseptic draping of the patient, utilization of utmost sterile barriers, verification of central venous catheter (CVC) tip placement using chest X-ray or fluoroscopy, and preservation of a sterile environment. Conclusion: The study emphasized the significance of training in enhancing understanding and adherence to central line bundling protocols in ICUs. Participants exhibited a high level of knowledge and commitment to recommended practices, indicating that this training can have a favorable effect on CLABSI rates. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to compare the results of ultrasound (US) guidance and the landmark (LM) technique for central venous catheter (CVC) placement in pediatric intensive care units (PICUs) as performed by clinicians. Material and Methods: The patients were divided into two groups according to the technique used: an LM group (459 patients) and a US-guided group (200 patients). We evaluated the success rate, the number of attempts, and the complication rates based on each patient's age and weight. Results: The time required for the successful placement of the CVC was significantly different between the two groups: 10.9±10.8 min in the LM group and 8.1±7.6 min in the US-guided group (p=0.012). Additionally, the average number of attempts for successful catheterization was 1.8±0.8 in the US-guided group; and 2.5 ± 1.4 in the LM group (p=0.024). A total of 115 (17.3%) complications were noted: 24 (3.6%) in the US-guided group and 91 (13.7%) in the LM group (p=0.014). The frequency of complications decreased as the age and weight of the patients increased. When the inserted catheters used by ultrasound were evaluated, 59.5% of them were placed by clinicians who had ultrasound training while 40.5% were inserted by clinicians who did not have ultrasound training. There was no significant difference in the complication rate, number of punctures, and success rates between the ultrasound-trained and untrained clinicians (p=0.476). Conclusion: This is the largest multicenter study comparing the US-guided vs. LM technique for CVC placement in children. We believe that the US-guided CVC procedure is more safe and takes less time than the LM technique. Also, point-of-care ultrasound is useful, beneficial, and easily available for pediatric intensivists. [ABSTRACT FROM AUTHOR]

Introduction: Central venous catheter (CVC) tip placement guided by chest X‐ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X‐ray landmarks. Methods: Chest CTs of 100 patients were retrospectively assessed. CT images were converted to a 'virtual CXR' using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes. Results: The mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup‐RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat‐RHB) was 18.4 mm below the CAJ. A new landmark: the mid‐superior right heart border, defined as the mid‐point between the Sup‐RHB and Lat‐RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ. Conclusion: We propose that the CVC tip can be placed at the mid‐superior right heart border landmark. [ABSTRACT FROM AUTHOR]

Background: Acutely sick patients can receive emergency intravenous access through central venous cannulation to administer fluids and medicines, perform haemodynamic monitoring and extracorporeal therapies, including plasmapheresis or haemodialysis. Using the Seldinger procedure, access is gained by percutaneous puncture, frequently guided by ultrasonography into the femoral, subclavian or internal jugular veins. This study aimed to identify ergonomic risk factors for musculoskeletal disorders (MSDs) in operators performing ultrasonography-guided internal jugular vein (IJV) cannulation at various table heights and probe orientations. Methods: Sixty emergency medicine residents participated in a cross-sectional study conducted by the Emergency and Trauma Department of Hospital Universiti Sains Malaysia, Kelantan. Participants were instructed to perform the cannulation at two distinct table heights and with two distinct probe orientations. To compute the ergonomic risk score, the Rapid Entire Body Assessment (REBA) method was used. Results: The table height of 0.5 elbow factor with varied probe resulted in a median REBA score of 5.0, whereas the table height of 0.7 elbow factor with varied probe had a median REBA score of 4.0. All four positions exhibited medium risk for MSDs. Conclusion: This study showed that the table height of 0.7 elbow factor is more ergonomically favourable while still imposed medium risk for MSDs. [ABSTRACT FROM AUTHOR]

Central venous catheterization is, now, one of the most routinely used procedures in the NICUs, helping during the care of very sick infants. Pericardial effusion is a very rare but severe complication, with a high mortality. The cases described are part of an ongoing retrospective study where the use of central catheters inserted in our surgical NICU, and its complications is being analyzed. 16 cases over 13 years are presented in this article, varying in severity from mild, self-resolving cases that were discovered during routine cardiac POCUS to cases with important hemodynamic impact associated with cardiac tamponade and cardiac arrest. Due to immediate intervention, only one of the cases led to catheter-related mortality and that was under particular conditions. Our aim is to highlight the severity of this complication, the importance of early intervention, and the impact of a highly technologized unit and widely available cardiac POCUS. [ABSTRACT FROM AUTHOR]

Thromboembolism (TE) complicates the course of pediatric cancer in a considerable number of cases. Cancer-related TE is attributed to an interaction of the underlying malignancy, the effects of therapy, and a possible thrombophilia predisposition. More specifically, recognized risk factors include a very young age and adolescence, non-O blood group, type and site of cancer, inherited thrombophilia, presence of central venous catheter, and type of chemotherapy. TE in children with cancer most commonly occurs in their extremities. In the absence of evidence-based guidelines for the management of thrombotic complications in pediatric oncology patients, TE management follows general recommendations for the management of pediatric TEs. Given the limitations of conventional anticoagulant therapy, direct oral anticoagulants could provide an alternative; however, their safety and efficacy in children with cancer remain to be seen. As for thromboprophylaxis, numerous studies have been conducted, albeit with conflicting results. Although the survival of pediatric oncology patients has significantly improved in recent years, morbidity due to cancer-related TE remains, underlying the need for large multicenter trials investigating both TE management with currently available agents and primary prevention. [ABSTRACT FROM AUTHOR]

Currently, there is a decreasing trend in the utilization of central venous catheters among medical practitioners. However, the continued relevance of central venous catheters persists, particularly in scenarios involving emergent or critically ill patients where peripheral venous access proves challenging. The insertion of central venous catheters facilitates rapid delivery of fluids and pharmacotherapy crucial for resuscitative efforts. Employing real-time ultrasound guidance enhances procedural safety from mechanical injuries, increases success rate with limited attempt and diminishes associated risks like pneumothorax, arterial puncture, and hemorrhage. Emphasizing infection prevention remains paramount. The present article underscored contemporary and safer procedural methodologies for central venous catheterization, alongside adept management of procedural complications. [ABSTRACT FROM AUTHOR]

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Abstract Background While women make up over 50% of students enrolled in medical school, disparities in self-efficacy of medical skills between men and women have been observed throughout medical education. This difference is significant because low self-efficacy can impact learning, achievement, and performance, and thus create gender-confidence gaps. Simulation-based training (SBT) employs assessments of self-efficacy, however, the Dunning-Kruger effect in self-assessment posits that trainees often struggle to recognize their skill level. Additionally, the impact of gender on self-efficacy during SBT has not been as widely studied. The objective of this study was to identify if the gender-confidence gap and the Dunning-Kruger effect exist in SBT for central venous catheterization (CVC) on the dynamic haptic robotic trainer (DHRT) utilizing comparisons of self-efficacy and performance. Methods 173 surgical residents (Nwomen=61, Nmen=112) underwent training on the DHRT system over two years. Before and after using the DHRT, residents completed a 14-item Central Line Self-Efficacy survey (CLSE). During training on the DHRT, CVC performance metrics of the number of insertion attempts, backwall puncture, and successful venipuncture were also collected. The pre- and post-CLSE, DHRT performance and their relationship were compared between men and women. Results General estimating equation results indicated that women residents were significantly more likely to report lower self-efficacy for 9 of the 14 CLSE items (p

Abstract Background Simulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone. Methods Forty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist. Results For two items on the US-IJCVC checklist, “verbalizing consent” and “aspirating blood through the catheter”, the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items “using the proper equipment in the proper order”, and “securing the catheter with suture and applying dressing” with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy. Conclusions The integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.

Background: Central venous catheterization (CVC) is a critical clinical procedure. To avoid complications, possessing good knowledge regarding the CVC care bundle and skills for the proper insertion and maintenance of CVC are important. Objectives: To evaluate the effectiveness of an educational intervention and the use of an interactive response system in enhancing the CVC bundle care and insertion skills of medical students undergoing critical care medicine training. Materials and Methods: Sixth-year medical students (equivalent to fourth-year students in the United States) engaged in didactic lessons, interactive demonstrations, and simulator training facilitated by a CVC team comprising three thoracic and two vascular surgeons (all with a minimum 5 years of experience in central venous access) during their intensive care unit (ICU) rotation. Self-reported knowledge and confidence levels were assessed using pre-and posttests administered through the Zuvio App, an interactive response system. Results: A total of 60 students underwent the educational intervention, of which 54 completed the pretest and 40 completed the posttest. In the posttest, significant improvement was found in the CVC bundle care competency and understanding (P = 0.002), preprocedural preparation (P = 0.002), insertion procedures (P = 0.004), complications (P = 0.003), and insertion depth decisions (P = 0.001). Staff and students reported that assessment and interaction via the Zuvio App were valuable, practical, and feasible in a clinical setting, providing trainees with an individual competency portfolio of receiving precise medical education. Conclusions: Integrating the training provided by a specialized team with an interactive response system enhanced the knowledge and competency level in CVC insertion among medical students in this study.

Background: While women make up over 50% of students enrolled in medical school, disparities in self-efficacy of medical skills between men and women have been observed throughout medical education. This difference is significant because low self-efficacy can impact learning, achievement, and performance, and thus create gender-confidence gaps. Simulation-based training (SBT) employs assessments of self-efficacy, however, the Dunning-Kruger effect in self-assessment posits that trainees often struggle to recognize their skill level. Additionally, the impact of gender on self-efficacy during SBT has not been as widely studied. The objective of this study was to identify if the gender-confidence gap and the Dunning-Kruger effect exist in SBT for central venous catheterization (CVC) on the dynamic haptic robotic trainer (DHRT) utilizing comparisons of self-efficacy and performance. Methods: 173 surgical residents (Nwomen=61, Nmen=112) underwent training on the DHRT system over two years. Before and after using the DHRT, residents completed a 14-item Central Line Self-Efficacy survey (CLSE). During training on the DHRT, CVC performance metrics of the number of insertion attempts, backwall puncture, and successful venipuncture were also collected. The pre- and post-CLSE, DHRT performance and their relationship were compared between men and women. Results: General estimating equation results indicated that women residents were significantly more likely to report lower self-efficacy for 9 of the 14 CLSE items (p <.0035). Mann-Whitney U and Fisher's exact tests showed there were no performance differences between men and women for successfully accessing the vein on the DHRT. Regression models relating performance and self-efficacy found no correlation for either gender. Conclusions: These results indicate that despite receiving the same SBT and performing at the same level, the gender-confidence gap exists in CVC SBT, and the Dunning-Kruger effect may also be evident. [ABSTRACT FROM AUTHOR]

Background: The post-insertion maintenance of central venous catheters(CVCs)is a common, vital procedure undertaken by nurses. Existing literature lacks a comprehensive review of evidence adoption for CVCs post-insertion maintenance specifically within the oncology context. This investigation assessed evidence-based practice by oncology nurses in the care of CVCs, elucidating facilitators and obstacles to this adoption process. Methods: This was a sequential explanatory mixed methods study, executed from May 2022 to April 2023, adhering to the GRAMMS checklist. The study commenced with a cross-sectional study through clinical observation that scrutinized the adoption of scientific evidence for CVC maintenance, analyzing 1314 records from five hospitals in China. Subsequently, a semi-structured, in-depth interview with nurses based on the i-PARIHS framework was conducted to ascertain facilitators and barriers to evidence adoption for CVCs post-insertion maintenance. Fifteen nurses were recruited through purposive sampling. Descriptive statistics were used to summarize quantitative data, while content analysis was used to analyze qualitative data. Results: An overall compliance rate of 90.0% was observed; however, two domains exhibited a lower adoption rate of less than 80%, namely disinfection of infusion connector and disinfection of skin and catheter. Three barriers and two facilitators were discerned from the interviews. Barriers encompassed (1) difficulty in accessing the evidence, (2) lack of involvement from nurse specialists, and (3) challenges from internal and external environments. Facilitators comprised (1) the positive attitudes of specialist nurses toward evidence application, and (2) the formation of a team specializing in intravenous therapy within hospitals. Conclusion: There exists a significant opportunity to improve the adoption of evidence-based practices for CVC maintenance. Considering the identified barriers and facilitators, targeted interventions should be conceived and implemented at the organizational level to augment oncology evidence-based practice, especially the clinical evidence pertinent to infection control protocols. Trial registration: This investigation was sanctioned by the Medical Ethics Committee of Henan Cancer Hospital (Number 2023-KY-0014). [ABSTRACT FROM AUTHOR]

Background: Mitochondrial cardiomyopathy occurs when impaired mitochondrial energy production leads to myocardial dysfunction. Anesthetic management in such cases is challenging due to risks of circulatory depression associated with anesthesia and mitochondrial dysfunction induced by anesthetics. Although there are reports of anesthetic management for patients with mitochondrial diseases, there are few reports specifically addressing cardiac anesthesia for patients with mitochondrial cardiomyopathy. We present a case where percutaneous mitral valve repair with MitraClip™ was successfully performed under remimazolam anesthesia in a patient with mitochondrial cardiomyopathy who developed functional mitral valve regurgitation due to low cardiac function and cardiomegaly. Case presentation: A 57-year-old woman was diagnosed with chronic cardiac failure, with a 10-year history of dilated cardiomyopathy. She was diagnosed with mitochondrial cardiomyopathy 8 years ago. Over the past 2 years, her cardiac failure worsened, and mitral valve regurgitation gradually developed. Surgical intervention was considered but deemed too risky due to her low cardiac function, with an ejection fraction of 26%. Therefore, percutaneous MitraClip™ implantation was selected. After securing radial artery and central venous catheterization under sedation with dexmedetomidine, anesthesia was induced with a low dose of remimazolam 4 mg/kg/h. Anesthesia was maintained with remimazolam 0.35–1.0 mg/kg/h and remifentanil 0.1 μg/kg/min. Noradrenaline and dobutamine were administered intraoperatively, and the procedure was completed successfully without circulatory collapse. The patient recovered smoothly from anesthesia and experienced no complications. She was discharged on the eighth day after surgery. Conclusion: Anesthesia management with remimazolam appears to be a safe and effective for MitraClip™ implantation in patients with mitochondrial cardiomyopathy. [ABSTRACT FROM AUTHOR]