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Unrecognized central venous catheter (CVC) infiltration is an uncommon but potentially life-threatening complication. For instance, a malpositioned subclavian line can infuse into the mediastinum, pleural cavity, or interstitial space of the neck. We present the case of a 30-year-old male with gunshot wounds to the right chest, resuscitated with an initially functional left subclavian CVC, which later infiltrated into the neck causing compression of the carotid sinus and consequent bradycardic arrest. Return of spontaneous circulation (ROSC) was achieved following intravenous epinephrine, cardiac massage, and emergency neck exploration and cervical fasciotomy. Our case highlights the importance of frequent reassessment of lines, especially those placed during fast-paced, high-intensity clinical situations. We recommend being mindful when using rapid transfusion devices as an interstitial catheter may not mount enough back pressure to trigger the systems alarm before significant tissue damage or compartment syndrome occurs.

Background Aim Methods Results Conclusions Central line‐associated bloodstream infections (CLABSIs) are a potential complication for home parenteral nutrition (HPN) patients.We sought to analyse risk factors of developing HPN‐related CLABSI and assess CLABSI management in the Australian context.A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a central venous catheter (CVC) at a Queensland tertiary referral centre between 2016 and 2023. Patient charts were reviewed, and Kaplan–Meier analysis was employed to determine associations between characteristics and time to CLABSI in the first CVC using Peto‐Peto Prentice test.A total of 39 CLABSI episodes occurred in 19 patients. Patients with ≥1 CLABSI used regular opioids more than those without CLABSI (P = 0.016). Fourteen (41%, n = 14/34) patients developed a CLABSI in their first CVC. No patient or line characteristics were found to be predictive of CLABSI in their first CVC. The CLABSI rate was 1.02/1000 catheter days. Most CLABSIs were caused by Enterobacterales (22%, n = 12/55) and Candida sp. (22%, n = 12/55). Empiric antimicrobial therapy was adequate in only 25% (n = 7/28), and the median time to effective antibiotic therapy was 22.7 h (interquartile range 4.8–29.8). There were three successful CVC salvages (8%, n = 3/39).In this cohort of patients, regular opioid use was associated with increased risk of developing CLABSI. Based on our findings, an empiric antimicrobial regime of vancomycin, cefepime and caspofungin will provide adequate coverage for most HPN‐related CLABSIs in Australian IF units with a similar antimicrobial distribution and resistance pattern. [ABSTRACT FROM AUTHOR]

Purpose: We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort. Methods: This study was conducted using the healthcare-associated infection surveillance cohort "REA-REZO" involving 193 intensive care units (ICUs). All CVC inserted and removed during the same ICU stay between January 1st 2018 and December 31st 2022 were eligible but only those whose tips were sent for microbiological analysis were included. Primary objective was to describe CVC insertion sites and subsequent catheter-related bloodstream infection (CRBSI). Results: Out of 126,997 CVCs, 71,314 were not sent for tip culture, and only 55,663 CVCs were included, (30,548 in internal jugular [IJ], 14,423 in femoral and 10,692 in subclavian [SC] sites). The incidence of CRBSI was 0.7 [0.6–0.8] in the IJ site, 0.7 [0.6–0.9] in the femoral site, and 0.6 [0.4–0.7] CRBSI per 1000 CVC days in the SC site (p = 0.248). The multivariable Poisson regression model showed no differences of CRBSI incidence rates between the three insertion sites. Microorganisms observed in CRBSI were coagulase-negative Staphylococci (27.9%), Enterobacterales (27.5%), non-fermenting Gram-negative Bacilli (10.4%), Candida sp. (16.9%), and Staphylococcus aureus (16.9%). Conclusion: Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is a well-recognized complication in pediatric cancer patients. We aimed to determine the frequency of central venous catheter (CVC) removal and survival impact of children with cancer who develop VTE. After ethics approval, a retrospective population-based study of cancer patients less than 21 years between 2005 and 2020, in the Maritime Provinces Nova Scotia, New Brunswick, and Prince Edward Island was conducted. Clinical data was collected from hospital charts and online medical records. Data on demographics, cancer diagnosis and treatment, diagnosis of VTE, use of CVC, were assessed. Kaplan-Meier survival curves were computed and compared among study groups. This study included 770 patients with a male to female ratio of 1.1:1. There were 49 patients with symptomatic VTE, 49 patients with clinically unsuspected VTE, and 671 patients with no VTE. There were 15 (1.9%) non-CVC-symptomatic (ncsVTE), 34 (4.4%) CVC-symptomatic (csVTE), 40 (5.2%) non-CVC-clinically unsuspected (ncuVTE), 9 (1.2%) CVC-clinically unsuspected (cVTE), and 671 (87%) no VTE patients. The mean number of CVCs required during treatment was significantly higher among patients with VTE (p < 0.001). Both symptomatic and clinically unsuspected VTE required significantly more CVCs compared to no VTE patients (p < 0.001 and p = 0.049 respectively). Kaplan-Meier survival curves showed ncsVTE patients' survival was significantly reduced compared to all other patients (p < 0.001). This study demonstrates that pediatric oncology patients with ncsVTE have significantly lower survival. This suggests that ncsVTE may be a biomarker for increased disease burden. This study also demonstrated that clinically unsuspected VTE had significantly more CVCs placed during treatment compared to patients without a VTE, indicating the need for better screening. [ABSTRACT FROM AUTHOR]

Background: The prevention of catheter-related bloodstream infections (CRBSI) is a critical priority in the clinical management of central venous catheters (CVCs). This meta-analysis aims to evaluate the efficacy of chlorhexidine gluconate antibacterial dressings in the context of CVC care. Methods: A systematic literature search was performed in PubMed, Web of Science, Embase et al. databases up to May 28, 2024. The search targeted randomized controlled trials (RCTs) that investigated the impact of chlorhexidine gluconate antibacterial dressings on CVC-related outcomes. The meta-analysis was conducted using RevMan 5.3 software. Results: The final analysis included 14 RCTs involving a total of 8920 patients with CVCs, with participants divided into a chlorhexidine antibacterial dressing group (n = 4731) and a control group (n = 4189). The chlorhexidine dressing group demonstrated a statistically significant reduction in the incidence of CRBSI compared to the control group, with a relative risk (RR) of 0.48, 95% confidence interval (CI) 0.36–0.64, P < 0.001. The chlorhexidine dressing group also showed a significant decrease in bacterial colonization, with an RR of 0.46, 95% CI 0.38–0.55, P < 0.001. Assessment of publication bias through funnel plot asymmetry and Egger's test revealed no significant bias in the included studies (all P > 0.05). Conclusions: There is a notable reduction in the incidence of CRBSI and bacterial colonization in patients with CVCs through the application of chlorhexidine gluconate dressings. Given the compelling evidence, the integration of these dressings into standard nursing care protocols for the management of CVCs is advocated. [ABSTRACT FROM AUTHOR]

The decision to convert from catheter to arteriovenous access is difficult yet very important. The ability to accurately predict fistula survival prior to surgery would significantly improve the decision making process. Many previously investigated demographic and clinical features have been associated with fistula failure. However, it is not conclusively understood how reliable predictions based on these parameters are at an individual level. The aim of this study was to investigate the probability of arteriovenous fistula maturation and survival after conversion using machine learning workflows. A retrospective cohort study on multicentre data from a large North American dialysis organisation was conducted. The study population comprised 73 031 chronic in centre haemodialysis patients. The dataset included 49 variables including demographic and clinical features. Two distinct feature selection and prediction pipelines were used: LASSO regression and Boruta followed by a random forest classifier. Predictions were facilitated for re-conversion to catheter within one year. Additionally, all cause mortality predictions were conducted to serve as a comparator. In total, 38 151 patients (52.2%) had complete data and made up the main cohort. Sensitivity analyses were conducted in 67 421 patients (92.3%) after eliminating variables with a high proportion of missing data points. Selected features diverged between datasets and workflows. A previously failed arteriovenous access appeared to be the most stable predictor for subsequent failure. Prediction of re-conversion based on the demographic and clinical information resulted in an area under the receiver operating characteristic curve (ROCAUC) between 0.541 and 0.571, whereas models predicting all cause mortality performed considerably better (ROCAUC 0.662 – 0.683). While group level depiction of major adverse outcomes after catheter to arteriovenous fistula or graft conversion is possible using the included variables, patient level predictions are associated with limited performance. Factors during and after fistula creation as well as biomolecular and genetic biomarkers might be more relevant predictors of fistula survival than baseline clinical conditions. [ABSTRACT FROM AUTHOR]

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Background: Patients with central lines face an increased risk of developing bacteremia. Preventing late-onset catheter-related infections relies on implementing various measures during manipulations of the catheter hub of central lines (e.g., during connections, disconnections, blood withdrawals, pulsed rinses, or injections performed at the first connection after the central catheter). French guidelines include, among these measures, the requirement to put on sterile gloves immediately before proximal manipulation to help prevent contamination of the catheter hub during preparation. To our knowledge, no study has reported compliance with wearing sterile gloves during these manipulations, nor the impact of not wearing sterile gloves on the cleanliness of the fingers of healthcare workers (HCWs) just before manipulating the connectors. Methods: We conducted a two-part study to assess compliance with sterile gloving and to provide direct microbiological evidence of bacterial contamination on HCWs' hands immediately before the manipulation of central lines when sterile gloving is not used. First, the use of sterile gloves was observed during proximal manipulations of central lines using a standardized grid. Second, we examined the microbial flora present on the fingers of each observed HCW just before proximal manipulation. Results: A total of 260 HCWs from 35 healthcare institutions were observed during proximal manipulation. The HCWs were distributed into three groups: 188 used sterile gloves (72%), 23 used nonsterile gloves (9%), and 49 did not wear gloves (19%). The swabbing of the fingertips revealed microbial cultures from 72 samples (28%). A total of 97 microorganisms were identified, all of which are well-recognized agents responsible for catheter-related bacteremia, predominantly coagulase-negative staphylococci (n = 36) and Bacillus sp. (n = 31). Fingertip contamination was lower for HCWs wearing sterile gloves (27/188; 14%) than for those wearing nonsterile gloves (12/23; 52%) or not wearing gloves (33/49; 67%) (p < 0.001). The contaminants were similar across the three groups. Conclusions: Our data support the positive impact of sterile gloving in ensuring clean fingertips during proximal manipulation of central lines, a key measure in preventing late-onset catheter-related bacteremia. The contamination of sterile gloves in one out of seven HCWs highlights the need for a clean care environment and minimal contact with the patient's skin and surroundings during proximal manipulation. [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]

Introduction: Central Venous Catheters (CVCs) are used for monitoring and managing critically-ill patients. However, their use can lead to serious infectious complications, resulting in significant morbidity, additional medical costs and mortality. Aim: To analyse the causative pathogens and the associated risk factors involved in the causation of central line-related infections and their outcomes. Materials and Methods: This prospective cohort study was conducted among 66 patients admitted to the 10-bed Respiratory Intensive Care Unit (RICU) at the Department of Pulmonary Medicine, SCB Medical College and Hospital, a tertiary-care teaching hospital in Cuttack, Odisha, India, from March 2021 to October 2022, who required central line placement for 48 hours or more. These patients were followed daily and upon the development of new-onset sepsis after 48 hours, two blood samples were collected from both central and peripheral sites for culture and antibiotic susceptibility testing, after excluding other sources of infections. Results: The mean age of patients with CLABSI was 62.85±14.95 years, with the most commonly affected age group being 55-74 years. Total of 66 patients had CVCs in place for more than 48 hours, resulting in 664 catheter days. The overall rate of Central Line Associated Bloodstream Infection (CLABSI) was 30.12 per 1,000 catheter days. The risk factors significantly associated with the development of CLABSI were diabetes mellitus, duration of hospitalisation, APACHE score, length of ICU stay and days of catheter in-situ. However, multivariate analysis revealed that only the length of Intensive Care Unit (ICU) stay (p=0.003) and the presence of diabetes (p=0.012) were independent predictors of acquiring CLABSI. The most common pathogens isolated were Acinetobacter (30%), followed by Enterococcus (25%), Staphylococcus aureus (20%), Methicillin-resistant Staphylococcus Aureus (MRSA) (10%), Pseudomonas (10%) and Coagulase-Negative Staphylococcus (CoNS) (5%). All Gram-positive and Gram-negative pathogens showed 100% sensitivity to linezolid, teicoplanin, vancomycin and polymyxin B, as well as tigecycline, respectively. The remaining strains were Multidrug Resistant (MDR). The overall mortality rate was 66.7%, with CLABSI-associated mortality at 60%. Conclusion: The incidence of CLABSI was high, with significant risk factors significantly associated were prolonged duration of catheterisation, length of hospital and ICU stays, Acute Physiology and Chronic Health Evaluation (APACHE) II score and diabetes mellitus. Gram-positive bacteria predominated, followed by Gram-negative bacteria, with a significant proportion of MDR organisms. [ABSTRACT FROM AUTHOR]

Objective: To assess the compliance with French guidelines for the prevention of central venous catheter (CVC)-related infections in two university hospitals. Methods: An observational audit was conducted in 7 wards using a digital tool. Results: The prerequisite of hand hygiene (HH) were respected by 90% of health-care worker; 86% performed HH prior to equipment preparation and 59% repeated it prior to infusion. Wearing gloves when necessary and rinsing were respected in 46.7% and 75.6% of the observations. Conclusion: Findings showed an acceptable level of adherence to recommended practices for CVC management. However, barriers of unrespect evidence-based recommendations need to be investigated in depth. [ABSTRACT FROM AUTHOR]

Short bowel syndrome is the most common reversible cause of intestinal failure. Most of the children are started on parenteral nutrition (PN) after surgery to enable growth and allow time for intestinal adaptation. This is a process whereby the shorter length of bowel is able to achieve complete function as if the entire length of bowel is present. With management advances, most children with short bowel syndrome can discontinue PN and establish full enteral feeds. This article mainly focuses on the complications of short bowel syndrome that need to be avoided for the child to achieve intestinal adaptation, establish on enteral feeds/oral diet and achieve enteral autonomy. [ABSTRACT FROM AUTHOR]

Background: Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines. Methods: We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018, to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes. Results: Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 5.08%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. On multivariable regression analysis, we identified autoimmune disease, dialysis frequency of > 3 × per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including B. cepacia complex, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug-resistant organisms (MDROs) comprised almost half of the isolates (n = 89, 44.5%), with Coagulase-negative Staphylococcus species having the highest proportion among gram-positive organisms and Acinetobacter spp. among gram-negative isolates. Conclusion: Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve hemodialysis patients' outcomes and reduce the CRBSI burden in our institution. [ABSTRACT FROM AUTHOR]

Central line-associated bloodstream infections (CLABSIs) can result in worse outcomes and high hospitalization cost for patients. This study aimed to assess the effectiveness of multi-department cooperation, intelligent prevention, and supervision (MDCIPS) in reducing the incidence of CLABSIs and improving the clinical outcomes of the patients. Key issues were identified through a literature review and survey on the status quo. A MDCIPS model was thus built. A total of 440 patients with indwelling central venous catheters (CVCs) were enrolled in the study. The control group (n = 219) received conventional infection-control managements, while the intervention group (n = 221) received MDCIPS interventions in addition to conventional infection-control managements. The number of CLABSIs patients, incidence of CLABSIs, average length of hospital stay, average total hospitalization cost, and disease outcomes were compared between the two groups. The intervention group had a significant reduction in the number and incidence of CLABSIs (0[0%] vs. 4[1.33%], P < 0.05). Two of the four patients with CLABSIs in the control group died. The average length of hospital stay was significantly longer in the control group than the intervention group (17 days vs. 13 days, P < 0.001). The average hospitalization cost in the control group was much higher than that in the intervention group (92.8 thousand yuan vs. 65.2 thousand yuan, P < 0.001). Patient outcome was improved in the intervention group than the control group (P = 0.001). In summary, the MDCIPS model effectively reduces the incidence of CLABSIs, alleviates the patients' economic burden, and improves the clinical outcomes of the patients. [ABSTRACT FROM AUTHOR]

Objective To explore the application effect of ultrasound-assisted vascular classification management in therapeutic apheresis (TA) patients.Methods A total of 174 patients undergoing TA in the Department of Hematology of a tertiary hospital in Xiamen from January 2019 to November 2023 were selected as the study subjects.According to the treatment time, they were divided into an observation group (January 2022 to November 2023) and a control group (January 2019 to December 2021), with 87 patients in each group.The control group had venous access placed by the TA team based on personal experience, while the observation group underwent vascular classification management assisted by B-mode ultrasound.The differences between the two groups were compared in terms of one-time puncture success rate, central venous catheter (CVC) usage rate, venous catheter complications, apheresis-related adverse reactions, venous catheter costs, and patient satisfaction.Results Both groups completed the TA.The one-time puncture success rate in the observation group was 93.1%, which was significantly higher than the 81.6% in the control group (P＜0.05). The CVC insertion rate and associated costs in the observation group were lower than those in the control group, and patient satisfaction in the observation group was higher than that in the control group, with statistically significant differences (P＜0.05). Venous catheter complications in both groups were related to CVC, but there was no statistically significant difference in the incidence rate (P＞0.05). Conclusion Ultrasound-assisted vascular classification management can improve the one-time catheterization success rate and patient satisfaction in TA patients, while reducing the CVC insertion rate and associated costs. [ABSTRACT FROM AUTHOR]

Introduction: Arteriovenous fistula (AVF) maturation assessment is essential to reduce venous catheter residence. We introduced central venous oxygen saturation (ScvO2) and estimated upper body blood flow (eUBBF) to monitor newly created fistula maturation and recorded catheter time in patients with and without ScvO2-based fistula maturation. Methods: From 2017 to 2019, we conducted a multicenter quality improvement project (QIP) in hemodialysis patients with the explicit goal to shorten catheter residence time post-AVF creation through ScvO2-based maturation monitoring. In patients with a catheter as vascular access, we tracked ScvO2 and eUBBF pre- and post-AVF creation. The primary outcome was catheter residence time post-AVF creation. We compared catheter residence time post-AVF creation between QIP patients and controls. One control group comprised concurrent patients; a second control group comprised historic controls (2014–2016). We conducted Kaplan-Meier analysis and constructed a Cox proportional hazards model with variables adjustment to assess time-to-catheter removal. Results: The QIP group comprised 44 patients (59 ± 17 years), the concurrent control group 48 patients (59 ± 16 years), the historic control group 57 patients (58 ± 15 years). Six-month post-AVF creation, the fraction of non-censored patients with catheter in place was 21% in the QIP cohort, 67% in the concurrent control group, and 68% in the historic control group. In unadjusted and adjusted analysis, catheter residence time post-fistula creation was shorter in QIP patients compared to either control groups (p < 0.001). Conclusion: ScvO2-based assessment of fistula maturation is associated with shorter catheter residence post-AVF creation. [ABSTRACT FROM AUTHOR]

Background Aim Methods Results Linking Evidence to Action Central venous catheters and midline catheters are commonly used as medium‐ to long‐term intravenous infusion tools in clinical nursing. However, there is currently no reliable conclusion on whether there are differences in complications and indwelling time between these two types of catheters.To investigate whether there are differences in the incidence of complications and indwelling time between the use of midline catheters and central venous catheters as intravenous infusion tools.A systematic search was conducted across various databases including Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Wanfang and China National Knowledge Infrastructure. The selection of studies and assessment of their quality was carried out independently by two reviewers. Meta‐analysis was conducted using the RevMan 5.3 software. Heterogeneity was evaluated, one of the pooled analyses was performed using the random‐effect model, while the others used the fixed‐effect model. Mean differences or odds ratios with corresponding 95% confidence intervals were calculated.Ten studies (1,554 participants) met the inclusion criteria. Meta‐analysis showed that there was a statistically significant difference in the complication rates [OR = 0.36, 95% CI (0.18, 0.70), p = 0.003], incidence of catheter‐related thrombosis [OR = 0.28, 95% CI (0.11, 0.71), I2 = 0%,p = 0.007], catheter‐related infection[OR = 0.36, 95% CI (0.16, 0.78), I2 = 27%, p = 0.007] and catheter blockage [OR = 0.21, 95% CI (0.09, 0.51), I2 = 18%, p = 0.0005] between midline catheters group and central venous catheters group. There was a statistically significant difference in the catheter indwelling time between the two groups [MD = 0.9, 95% CI (0.33, 1.46), I2 = 0%, p = 0.002]. There was no significant difference in other complications such as phlebitis, catheter dislodgement and leakage between the two groups.Midline catheter was superior to central venous catheter in terms of the overall complication rates and incidence of catheter‐related thrombosis, catheter blockage, catheter‐related infection and indwelling time. [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]

During the pandemic of COVID-19, the rates of bloodstream infection associated with venous catheter in patients infected with the disease admitted to an intensive care unit rose significantly. In this study, we evaluated the occurrence of bloodstream infections in patients with SARS-CoV-2 and the variables that made the patients more susceptible to the catheter-associated bloodstream infection (CABSI). Blood culture results from patients interned between March 2020 and December 2021 (n= 109) were collected electronically from the hospital information system and then analyzed. The following variables presented statistical relevance after an adjusted model as follows: obesity (p = 0.003) and time of use of catheter before infection (p = 0.019). In conclusion, patients with shorter catheter use time and obesity had higher incidence of CABSI. [ABSTRACT FROM AUTHOR]

Copyright of Nefrologia is the property of Revista Nefrologia 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.)

Purpose: Central venous catheterization (CVC) carries inherent risks which can be mitigated through the use of appropriate ultrasound-guidance during needle insertion. This study aims to comprehensively understand patient anatomy as it is visualized during CVC by employing a semi-automated image analysis method to track the internal jugular vein and carotid artery throughout recorded ultrasound videos. Methods: The ultrasound visualization of 50 CVC procedures were recorded at Penn State Health Milton S. Hershey Medical Center. The developed algorithm was used to detect the vessel edges, calculating metrics such as area, position, and eccentricity. Results: Results show typical anatomical variations of the vein and artery, with the artery being more circular and posterior to the vein in most cases. Notably, two cases revealed atypical artery positions, emphasizing the algorithm's precision in detecting anomalies. Additionally, dynamic vessel properties were analyzed, with the vein compressing on average to 13.4% of its original size and the artery expanding by 13.2%. Conclusion: This study provides valuable insights which can be used to increase the accuracy of training simulations, thus enhancing medical education and procedural expertise. Furthermore, the novel approach of employing automated data analysis techniques to clinical recordings showcases the potential for continual assessment of patient anatomy, which could be useful in future advancements. [ABSTRACT FROM AUTHOR]

Pediatric chronic intestinal failure (PIF) is a rare and heterogeneous condition characterized by the inability of the patient's intestine to adequately absorb the required fluids and/or nutrients for growth and homeostasis. As a result, patients will become dependent on home parenteral nutrition (HPN). A MEDLINE search was performed in May 2024 with keywords "intestinal failure", "parenteral nutrition" and "pediatric". Different underlying conditions which may result in PIF include short bowel syndrome, intestinal neuromuscular motility disorders and congenital enteropathies. Most common complications associated with HPN are catheter-related bloodstream infections, catheter-related thrombosis, intestinal failure-associated liver disease, small intestinal bacterial overgrowth, metabolic bone disease and renal impairment. Treatment for children with PIF has markedly improved with a great reduction in morbidity and mortality. Centralization of care in specialist centers and international collaboration between centers is paramount to further improve care for this vulnerable patient group. A recently promising medical therapy has become available for children with short bowel syndrome which includes glucagon-like peptide 2, a naturally occurring hormone which is known to delay gastric emptying and induce epithelial proliferation. Despite advances in curative and supportive treatment, further research is necessary to improve nutritional, pharmacological and surgical care and prevention of complications associated with parenteral nutrition use. [ABSTRACT FROM AUTHOR]

Abstract Background The prevention of catheter-related bloodstream infections (CRBSI) is a critical priority in the clinical management of central venous catheters (CVCs). This meta-analysis aims to evaluate the efficacy of chlorhexidine gluconate antibacterial dressings in the context of CVC care. Methods A systematic literature search was performed in PubMed, Web of Science, Embase et al. databases up to May 28, 2024. The search targeted randomized controlled trials (RCTs) that investigated the impact of chlorhexidine gluconate antibacterial dressings on CVC-related outcomes. The meta-analysis was conducted using RevMan 5.3 software. Results The final analysis included 14 RCTs involving a total of 8920 patients with CVCs, with participants divided into a chlorhexidine antibacterial dressing group (n = 4731) and a control group (n = 4189). The chlorhexidine dressing group demonstrated a statistically significant reduction in the incidence of CRBSI compared to the control group, with a relative risk (RR) of 0.48, 95% confidence interval (CI) 0.36–0.64, P 0.05). Conclusions There is a notable reduction in the incidence of CRBSI and bacterial colonization in patients with CVCs through the application of chlorhexidine gluconate dressings. Given the compelling evidence, the integration of these dressings into standard nursing care protocols for the management of CVCs is advocated.

Introduction: Central Venous Catheters (CVCs) are used for monitoring and managing critically-ill patients. However, their use can lead to serious infectious complications, resulting in significant morbidity, additional medical costs and mortality. Aim: To analyse the causative pathogens and the associated risk factors involved in the causation of central line-related infections and their outcomes. Materials and Methods: This prospective cohort study was conducted among 66 patients admitted to the 10-bed Respiratory Intensive Care Unit (RICU) at the Department of Pulmonary Medicine, SCB Medical College and Hospital, a tertiary-care teaching hospital in Cuttack, Odisha, India, from March 2021 to October 2022, who required central line placement for 48 hours or more. These patients were followed daily and upon the development of new-onset sepsis after 48 hours, two blood samples were collected from both central and peripheral sites for culture and antibiotic susceptibility testing, after excluding other sources of infections. Results: The mean age of patients with CLABSI was 62.85±14.95 years, with the most commonly affected age group being 55-74 years. Total of 66 patients had CVCs in place for more than 48 hours, resulting in 664 catheter days. The overall rate of Central Line Associated Bloodstream Infection (CLABSI) was 30.12 per 1,000 catheter days. The risk factors significantly associated with the development of CLABSI were diabetes mellitus, duration of hospitalisation, APACHE score, length of ICU stay and days of catheter in-situ. However, multivariate analysis revealed that only the length of Intensive Care Unit (ICU) stay (p=0.003) and the presence of diabetes (p=0.012) were independent predictors of acquiring CLABSI. The most common pathogens isolated were Acinetobacter (30%), followed by Enterococcus (25%), Staphylococcus aureus (20%), Methicillin-resistant Staphylococcus Aureus (MRSA) (10%), Pseudomonas (10%) and Coagulase-Negative Staphylococcus (CoNS) (5%). All Gram-positive and Gram-negative pathogens showed 100% sensitivity to linezolid, teicoplanin, vancomycin and polymyxin B, as well as tigecycline, respectively. The remaining strains were Multidrug Resistant (MDR). The overall mortality rate was 66.7%, with CLABSI-associated mortality at 60%. Conclusion: The incidence of CLABSI was high, with significant risk factors significantly associated were prolonged duration of catheterisation, length of hospital and ICU stays, Acute Physiology and Chronic Health Evaluation (APACHE) II score and diabetes mellitus. Gram-positive bacteria predominated, followed by Gram-negative bacteria, with a significant proportion of MDR organisms.

Abstract Background Patients with central lines face an increased risk of developing bacteremia. Preventing late-onset catheter-related infections relies on implementing various measures during manipulations of the catheter hub of central lines (e.g., during connections, disconnections, blood withdrawals, pulsed rinses, or injections performed at the first connection after the central catheter). French guidelines include, among these measures, the requirement to put on sterile gloves immediately before proximal manipulation to help prevent contamination of the catheter hub during preparation. To our knowledge, no study has reported compliance with wearing sterile gloves during these manipulations, nor the impact of not wearing sterile gloves on the cleanliness of the fingers of healthcare workers (HCWs) just before manipulating the connectors. Methods We conducted a two-part study to assess compliance with sterile gloving and to provide direct microbiological evidence of bacterial contamination on HCWs’ hands immediately before the manipulation of central lines when sterile gloving is not used. First, the use of sterile gloves was observed during proximal manipulations of central lines using a standardized grid. Second, we examined the microbial flora present on the fingers of each observed HCW just before proximal manipulation. Results A total of 260 HCWs from 35 healthcare institutions were observed during proximal manipulation. The HCWs were distributed into three groups: 188 used sterile gloves (72%), 23 used nonsterile gloves (9%), and 49 did not wear gloves (19%). The swabbing of the fingertips revealed microbial cultures from 72 samples (28%). A total of 97 microorganisms were identified, all of which are well-recognized agents responsible for catheter-related bacteremia, predominantly coagulase-negative staphylococci (n = 36) and Bacillus sp. (n = 31). Fingertip contamination was lower for HCWs wearing sterile gloves (27/188; 14%) than for those wearing nonsterile gloves (12/23; 52%) or not wearing gloves (33/49; 67%) (p

Abstract Background Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines. Methods We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018, to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes. Results Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 5.08%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. On multivariable regression analysis, we identified autoimmune disease, dialysis frequency of > 3 × per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including B. cepacia complex, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug-resistant organisms (MDROs) comprised almost half of the isolates (n = 89, 44.5%), with Coagulase-negative Staphylococcus species having the highest proportion among gram-positive organisms and Acinetobacter spp. among gram-negative isolates. Conclusion Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve hemodialysis patients' outcomes and reduce the CRBSI burden in our institution.

Resumen: Introducción: A pesar de las recomendaciones de las guías clínicas, el porcentaje de catéteres venosos centrales (CVC) sigue estando por encima de los estándares recomendados. Desconocemos si la utilización creciente de catéteres tiene su origen en factores inevitables o evitables y, en este último caso, estaría en nuestra mano modificar estos resultados.El objetivo de este estudio ha sido analizar las causas que condicionan el uso de CVC en una población prevalente en hemodiálisis (HD) con el fin de identificar aquellos factores modificables sobre los cuales actuar para conseguir los objetivos de las guías. Métodos: Estudio retrospectivo, descriptivo y observacional en el total de pacientes prevalentes en hemodiálisis crónica pertenecientes a siete centros de hemodiálisis extrahospitalarios de Madrid, Castilla y León y Galicia en un corte transversal realizado en junio 2021 (637 pacientes). Se analizan: edad, sexo, nacionalidad, etiología de la enfermedad renal crónica (ERC), el acceso vascular con el que iniciaron hemodiálisis, el número de fístulas arteriovenosas (FAV) previas fallidas, tiempo desde el inicio de la HD, tiempo desde la colocación del CVC por primera vez, la situación respecto a la cirugía y las causas de ser portador de CVC. En los pacientes cuya causa fue la negativa a realizarse una FAV se preguntó a los pacientes por la causa de la misma mediante interrogatorio dirigido. Resultados: De los 637 pacientes estudiados, 255 (40%) eran portadores de CVC, 346 portadores de FAV (54,3%) y 36 (5,7%) llevaban una prótesis. De los 255 pacientes portadores de CVC, 20,4% (52 pacientes) estaba pendiente de realización del acceso vascular (FAV/prótesis), 10,2% (26 pacientes) tenían la FAV realizada pero no se podía utilizar y 69,4% (177 pacientes) no se consideraron candidatos a cirugía (por cirugía vascular (16,9%; 43 pacientes), por nefrología (16,5%, 42 pacientes) y por negativa del paciente (36%; 92 pacientes). La causa más frecuente para la negativa a la FAV fue el miedo y las preferencias de los pacientes. Uno de los factores más importantes asociados al uso de CVC en pacientes prevalentes fue haber iniciado hemodiálisis mediante un CVC. El mayor uso de CVC al inicio de HD se asoció significativamente con tener más de una FAV realizada, o iniciar HD de manera urgente y no haber sido seguido y evaluado en la consulta de ERCA. Conclusiones: Existe un elevado porcentaje de pacientes con CVC por causas modificables que hace necesaria la evaluación sistemática del proceso de creación de FAV para potenciar la planificación, creación y mantenimiento del acceso vascular desde la consulta de ERCA, y alcanzar el objetivo de las guías. Abstract: Introduction: Despite the recommendations of the clinical guidelines, the percentage of central venous catheters (CVC) continues to be above the recommended standards. We do not know whether the increasing use of catheters is due to unavoidable or avoidable factors and, in the latter case, it would be in our power to modify these results.The aim of this study was to analyze the causes that condition the use of CVC in a prevalent hemodialysis (HD) population in order to identify those modifiable factors on which to act in order to achieve the objectives of the guidelines. Methods: Retrospective, descriptive and observational study in all prevalent patients on chronic hemodialysis belonging to seven hemodialysis centers in Madrid, Castilla y León and Galicia in a cross-sectional study carried out in June 2021 (637 patients). The following were analyzed: age, sex, nationality, etiology of CKD, the vascular access with which they started hemodialysis, the number of previous failed arteriovenous fistulas (AVF), time since the start of HD, time since the placement of the CVC for the first time, the situation with respect to surgery and the causes of being a CVC carrier. In patients whose cause was refusal to undergo AVF, patients were asked about the cause of the refusal by directed questioning. Results: Of the 637 patients studied, 255 (40%) had a CVC, 346 had an AVF (54.3%) and 36 (5.7%) had a prosthesis. Of the 255 patients with CVC, 20.4% (52 patients) were awaiting vascular access (AVF/prosthesis), 10.2% (26 patients) had an AVF but could not be used and 69.4% (177 patients) were not considered candidates for surgery (due to vascular surgery (16.9%; 43 patients), nephrology (16.5%, 42 patients) and patient refusal (36%; 92 patients). The most frequent cause for refusal of AVF was fear and patient preference. One of the most important factors associated with CVC use in prevalent patients was having started hemodialysis with a CVC. The greatest use of CVC at the start of HD was significantly associated with having more than one AVF performed or starting HD urgently and not having been followed up and evaluated in the ACKD consultation. Conclusions: There is a high percentage of patients with a central venous catheter due to modifiable causes, which makes it necessary to systematically evaluate the process of creating AVF in order to enhance the planning, creation and maintenance of vascular access from the ACKD clinic, and to achieve the objective of the guidelines.

Chromosomal disorders manifest with multiple congenital anomalies, which is associated with high morbidity as well as mortality. Trisomy 18 also known as Edward’s syndrome is a rare chromosomal disorder. We report a case of Edwards’ syndrome in a 15-day-old female neonate, with typical syndromic features. Infant’s clinical condition was superimposed by respiratory distress, necessitating a comprehensive, multidisciplinary management involving neonatologist, anesthesiologists, and orthopedic specialists. Considering the intricacies of Edwards’ syndrome and hence contributing to refining protocol for enhanced care and meticulous support. Furthermore, emphasizes the requirement for further research to advance understanding of the clinical condition and propagate future management.

Objective To investigate the effect of Six Sigma management in prevention of central venous catheter-related bloodstream infections (CLABSI) in children undergoing liver transplantation. Methods From January to September 2021, a total of 216 children with central venous catheter placement were selected as the control group, and 192 children with central venous catheter indwelling from January to September 2022 were selected as the intervention group. The control group received routine nursing management in the maintenance of central venous catheters, while the intervention group adopted Six Sigma management on the basis of routine care measures. The incidence of CLABSI and 1000-day catheter infection rate were compared between the two groups. Results The incidence of CLABSI in the intervention group was 1. 04%, which was lower than 1. 39% in the control group (P＜0. 05). The 1000-day catheter infection rate was 0. 64 ‰ in the intervention group, which was lower than 1. 07 ‰ in the control group (P＜0. 05). Conclusion The Six Sigma management method can effectively reduce the incidence of CLABSI in children undergoing liver transplantation and improve their safety. (目的 探讨六西格玛管理方法在预防肝移植儿童中心静脉导管相关性血流感染(CLABSI)中的应用效果。方法 选取2021年1月—9月留置中心静脉导管的216例患儿为对照组, 2022年1月—9月留置中心静脉导管192例患儿为干预组。针对肝移植儿童中心静脉导管的维护管理, 对照组实施常规护理措施, 干预组在对照组基础上采用六西格玛管理法。对比两组的CLABSI的发生率及千日导管血流感染率。结果 干预组CLABSI发生率为1. 04%, 低于对照组的1. 39%。差异有统计学意义(P＜0. 05); 干预组千日导管血流感染率为0. 64‰, 低于对照组1. 07‰, 差异有统计学意义(P＜0. 05)。结论 西格玛管理方法能有效降低肝移植儿童CLABSI发生率, 提高患儿安全。)

Abstract Background Catheter-related thrombosis (CRT) is a thrombotic complication associated with using central venous catheters (CVCs). Although risk factors for CRT were identified in children, no nomograms or predictive tools are available for the pediatric population with CVCs. This study aimed to develop and validate a prediction model of asymptomatic CRT in children with CVCs. Methods This retrospective observational study included consecutive pediatric patients who admitted to the Children’s Hospital Zhejiang University School of Medicine and received CVCs between October and December 2021. Results This study included 669 patients, 553 (314 males, aged 22.00 [0.36, 180.00] months, 62 with CRT) were in the training set, and 116 (62 males, aged 15.00 [1.13, 156.00] months, 16 with CRT) were in the validation set. Multivariate logistic regression showed that a catheter time of 0–3 days (OR = 0.201, 95%CI: 0.081–0.497, P = 0.001), catheter time of 4–7 days (OR = 0.412, 95%CI: 0.176–0.964, P = 0.041), male (OR = 3.976, 95%CI: 1.864–4.483, P

During the pandemic of COVID-19, the rates of bloodstream infection associated with venous catheter in patients infected with the disease admitted to an intensive care unit rose significantly. In this study, we evaluated the occurrence of bloodstream infections in patients with SARS-CoV-2 and the variables that made the patients more susceptible to the catheter-associated bloodstream infection (CABSI). Blood culture results from patients interned between March 2020 and December 2021 (n= 109) were collected electronically from the hospital information system and then analyzed. The following variables presented statistical relevance after an adjusted model as follows: obesity (p = 0.003) and time of use of catheter before infection (p = 0.019). In conclusion, patients with shorter catheter use time and obesity had higher incidence of CABSI.

The Ralstonia species (RB) and Burkholderia species (BB) are bacteria responsible for nosocomial infections in frail patients such as hemodialyzed (HD) patients. Here, we report how we managed an outbreak caused by RB and BB that occurred in a dialysis unit. From the 7th to the 16th of April 2021, an infection due to RB and BB occurred in 7 out of 39 (17.9%) HD patients with central venous catheter (CVC). Disinfectants, CVC-lock therapy solutions, water by reverse osmosis unit (ROW) and dialysis concentrates were cultured, including the biofilm from the loading plastic tubes (LPTs) that connect the hemodialysis consoles (HCs) to the ROW delivery line. The antibiotic treatment was successful for all patients. RB and BB were isolated in the biofilm of 11/37 LPTs. Three out of 11 positive LPTs were associated with the infected patients. The ROW delivery line was modified to provide a whole disinfection with the HCs connected, avoiding the risk of new contamination of the LPTs. A filtration module of 0.01 mm was added prior to the ROW delivery line. Our experience suggests that outbreaks sustained by unusual bacteria such as RB and BB should be promptly investigated to treat the infected patients with the appropriate therapy and to identify the possible source of infection, making the needful changes to achieve a safer dialysis unit.

Subclavian artery injuries during internal jugular vein puncture when attempting central venous catheter insertion are rare. A 60-year-old man undergoing treatment for neuromyelitis optica with paralysis and sensory loss developed a complication during catheter placement into his right internal jugular vein for plasmapheresis. His previous physician felt resistance and discontinued the procedure. The patient later developed mild dyspnea and dysphagia. Computed tomography scans indicated thrombus formation and tracheal deviation. Contrast-enhanced computed tomography scans showed right subclavian artery injury with extravasation and a large pseudoaneurysm.Following transferal to our hospital, he was stable and asymptomatic; however, contrast-enhanced computed tomography scans showed a pseudoaneurysm located proximal to the right subclavian artery. Considering challenges with compression hemostasis and the invasiveness of open surgery, endovascular treatment was selected using a VIABAHN stent graft. A balloon occlusion test of the right vertebral artery was performed to assess stroke risk. Prophylactic embolization of the right vertebral artery, internal thoracic artery, and thyrocervical trunk were performed to prevent a type 2 endoleak. On hospital day 5, our patient showed no postoperative complications and was transferred to the referring hospital. Follow-up imaging showed the graft was intact with no pseudoaneurysm, confirming successful treatment. Endovascular treatment with a stent graft is highly effective for peripheral artery injuries. Using a balloon occlusion test to assess collateral blood flow and stroke risk is essential pretreatment, especially when a graft might occlude the vertebral artery. Balloon occlusion tests are recommended when planning treatment for iatrogenic and other types of subclavian artery injuries.

Abstract Background The aim of this experimental study was to elucidate whether different distances between central venous catheter tips can affect drug clearance during continuous renal replacement therapy (CRRT). Central venous catheters (CVCs) are widely used in intensive care patients for drug infusion. If a patient receives CRRT, a second central dialysis catheter (CDC) is required. Where to insert CVCs is directed by guidelines, but recommendations regarding how to place multiple catheters are scarce. There are indications that a drug infused in a CVC with the tip close to the tip of the CDC, could be directly aspirated into the dialysis machine, with a risk of increased clearance. However, studies on whether clearance is affected by different CVC and CDC tip positions, when the two catheters are in the same vessel, are few. Methods In this model with 18 piglets, gentamicin (GM) and vancomycin (VM) were infused through a CVC during CRRT. The CVC tip was placed in different positions in relation to the CDC tip from caudal, i.e., proximal to the heart, to cranial, i.e., distal to the heart. Serum and dialysate concentrations were sampled after approximately 30 min of CRRT at four different positions: when the CVC tip was 2 cm caudally (+ 2), at the same level (0), and at 2 (− 2) and 4 (− 4) cm cranially of the tip of the CDC. Clearance was calculated. A mixed linear model was performed, and level of significance was set to p

Abstract Background Maintaining venous access is of great clinical importance. Running a slow continuous infusion to keep the vein open (KVO) is often used in peripheral intravenous catheters (PIVCs). Previous studies have compared the effects of intermittent flushing and continuous infusion via peripherally inserted central catheters (PICCs). In this study, we applied KVO to central venous catheters (CVCs) and compared the occlusion rate of this technique with that of the intermittent flushing technique. Method This is a randomized controlled trial of 14 hospitals in China. A total of 250 patients will be recruited in this study, and they will be randomized at a 1:1 ratio. After study inclusion, patients who will undergo CVC insertion will receive intermittent flushing with prefilled saline syringes (control group) or KVO infusion with elastic pumps (test group). All the catheters will be checked for patency by scoping Catheter Injection and Aspiration (CINAS) Classification on Days 3 and 7. The primary outcome is the rate of catheter occlusion in 7 days. Patients will be followed up until 9 days after CVC insertion, catheter occlusion, or catheter removal. The secondary outcomes are the rate of catheter occlusion in 3 days, nurse satisfaction, cost-effectiveness, adverse event rate, catheter-related bloodstream infection rate, catheter-related thrombosis rate, extravasation rate, phlebitis rate, and catheter migration. Discussion We expect that the trial will generate findings that can provide an evidence-based basis for the improvement and optimization of clinical catheter flushing techniques. Trial registration Chinese Clinical Trial Registry, ChiCTR2200064007. Registered on 23 September 2022. https://www.chictr.org.cn/showproj.html?proj=177311 .

Benjamin Pali&cacute;,1,2 Marija Golu&zcaron;a Sesar,3 Kristina Gali&cacute;,3 Gojko Bogdan,4 Zrinko Prskalo1 1Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; 2Department of Pathophysiology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina; 3Department of Pulmonology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; 4Department of Radiology, University Clinical Hospital Mostar, Mostar, Bosnia and HerzegovinaCorrespondence: Benjamin Pali&cacute;, Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Email benjamin314palic@gmail.comAbstract: Guidewire loss is a rare complication of central venous catheterization. A 65-year-old male was hospitalized in a high-dependency unit for exacerbation of chronic obstructive pulmonary disease, pneumonia, erythrocytosis, and clinical signs of heart failure. Upon admission, after an unsuccessful right jugular approach, a left jugular central venous catheter was placed. The next day, chest radiography revealed the catheter located in the left parasternal region, with suspected retention of the guidewire, visually confirmed by the presence of its proximal end inside the catheter. The left parasternal location of the catheter and the typical projection of the guidewire in the coronary sinus, later confirmed by echocardiography, raised suspicion of a persistent left superior vena cava (PLSVC). Agitated saline injected into the left antecubital vein confirmed bubble entry from the coronary sinus into the right atrium. After clamping the guidewire, the catheter was carefully retrieved along with the guidewire without any complications. This is the first reported case of guidewire retention in PLSVC and coronary sinus. It underscores the potential causes of guidewire loss and advocates preventive measures to avoid this potentially fatal complication.Keywords: intraoperative complication, central venous catheter, persistent left superior vena cava, congestive heart failure, chronic obstructive lung disease

Resumen: Los dispositivos intravasculares son esenciales para el abordaje diagnóstico y terapéutico de múltiples enfermedades en pediatría, siendo especialmente importantes los catéteres venosos centrales (CVC). Una de las complicaciones más frecuentes es la infección de estos dispositivos, lo cual conlleva una elevada morbimortalidad. Estas infecciones presentan una gran complejidad, precisando de un elevado consumo de recursos, tanto para su diagnóstico como para su tratamiento, afectando de manera más frecuente a pacientes pediátricos vulnerables ingresados en unidades de alta complejidad. La evidencia para su abordaje en pediatría es menor que en adultos, y no hay documentos de consenso realizados en nuestro medio. El objetivo de este documento, realizado entre la Sociedad Española de Enfermedades Infecciosas Pediátricas (SEIP) y la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), es dar recomendaciones de consenso basadas en la mayor evidencia disponible para optimizar el diagnóstico y tratamiento de las bacteriemias y fungemias relacionadas con el catéter. Este documento se centrará en pacientes pediátricos no neonatales, sin entrar en discusión sobre la prevención de estas infecciones. Abstract: Intravascular devices are essential for the diagnostic and therapeutic approach to multiple diseases in paediatrics, and central venous catheters (CVCs) are especially important. One of the most frequent complications of these devices is the infection, which is associated with a high morbidity and mortality. These infections are highly complex, requiring the use of substantial resources, both for their diagnosis and treatment, and affect vulnerable paediatric patients admitted to high-complexity units more frequently vulnerable. There is less evidence on their management in paediatric patients compared to adults, and no consensus documents on the subject have been published in Spain. The objective of this document, developed jointly by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP), is to provide consensus recommendations based on the greatest degree of evidence available to optimize the diagnosis and treatment of catheter-related bloodstream infections (CRBSIs). This document focuses on non-neonatal paediatric patients with CRBSIs and does not address the prevention of these infections.

Purpose: Patients with intestinal failure (IF) require long-term parenteral nutrition using central venous catheters (CVCs), which often require replacement. We adopted a less fallible guidewire replacement (GWR) method and verified its effectiveness and validity. Methods: We enrolled 108 cases that underwent a CVC replacement with "GWR" method with IF at our department between 2013 and 2023. We retrospectively reviewed patients' clinical details with tunneled CVC (Hickman/Broviac catheter). For the analysis, we compared for the same time period the catheter exchange method "Primary placement"; newly inserted catheter by venipuncture. Results: The success rate of catheter replacement using GWR was 94.4%. There were six unsuccessful cases. A log-rank test showed no significant difference in catheter survival between primary placement and the GWR, and the time to first infection was significantly longer in the GWR (p = 0.001). Furthermore, no significant differences were observed between the two methods until the first infection, when the exchange indication was limited to infections. In the same way, when the indication was restricted to catheter-related bloodstream infection, there was no significant difference in catheter survival between the two approaches. Conclusion: Our GWR procedure was easy to perform and stable, with a high success rate and almost no complications. Moreover, using a guidewire did not increase the frequency of catheter replacement and the infection rate. [ABSTRACT FROM AUTHOR]

Introduction: Cannulation with a central venous catheter (CVC) is a common procedure used in critical care. One of the main complications is occlusion, which can lead to delayed treatment, prolonged hospital stay, and increased health care costs. Objective: The aim of this project was to promote evidence-based practice for nurses caring for patients with a CVC in a Spanish intensive care unit. The project also aimed to reduce CVC occlusion and ensure CVC patency. Methods: This project was guided by the JBI Model of Evidence-based Healthcare and the JBI Evidence Implementation Framework. Seven phases were followed using evidence-based auditing and feedback. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to support data collection, data analysis, and implementation planning. Results: After project implementation, the following results were obtained. Criterion 1 (assessing the CVC, flushing, and aspirating) reached 100% compliance in both audits. Criterion 2 (occlusion documentation) showed a modest improvement, rising from 13.33% to 36.67%. Improvement for Criterion 3 (the need for a policy and protocol) was excellent, rising from 0% at baseline to 100% following implementation. Criterion 4 (rapid instillation of an appropriate thrombolytic agent if a CVC is occluded) remained at 0% compliance in both audits. Criterion 5 (continuing education for health care professionals) improved from 10% to 60%. Criterion 6 (flushing and locking before procedures) improved from 90% to 100%. Conclusion: The project objectives were largely met and resulted in a protocol, which has been shared with other departments within the hospital. The implementation of best clinical practice will be continued, including the use of thrombolytic agents. [ABSTRACT FROM AUTHOR]

Background: Reported bleeding incidences following central venous catheter (CVC) placement highly depend on methods of bleeding assessment. To determine the direction and magnitude of the bias associated with retrospective data collection, we used data from the PACER randomized controlled trial and a previous retrospective cohort study. Study Design and Methods: A patient‐level comparison of CVC‐related bleeding severity was made among (1) the prospectively collected clinical bleeding assessment of the PACER trial, (2) centralized assessment of CVC insertion site photographs, and (3) retrospective chart review. Interrater reliability for photographic bleeding assessment and retrospective chart review was assessed using Cohen's κ. The magnitude of underreporting of both methods compared to prospective clinical bleeding assessment at different cutoff points of clinically relevant bleeding was assessed using McNemar's test. Results: Interrater reliability was acceptable for both methods (κ = 0.583 and κ = 0.481 for photographic assessment and retrospective chart review, respectively). Photographic bleeding assessment led to significant underreporting of bleeding complications at all cutoff points. Retrospective chart review led to significant underreporting of minor bleeding complications, with an odds ratio (95% CI) of 0.17 (0.044–0.51) for the cutoff point grade 1 (i.e., self‐limiting or requiring at most 20 min of manual compression) or higher. There was no significant underreporting of major bleeding complications with retrospective chart review. Discussion: Centralized photographic bleeding assessment and retrospective chart review lead to biased bleeding assessment compared to prospective clinical bleeding assessment. [ABSTRACT FROM AUTHOR]

Background: One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology–hematology ward. Methods: a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology–hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. Results: fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259–0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). Conclusions: ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects. [ABSTRACT FROM AUTHOR]

Background: The significance of vascular access devices for patients in the emergency department (ED) is undeniable. When it comes to evaluating the effectiveness of interventions, randomised controlled trials (RCTs) stand out as the most reliable sources of evidence compared with other study designs. Aim: To explore and synthesise the findings from RCTs related to vascular access devices in the ED setting. Methods: A systematic search will be conducted in electronic medical databases including the Cochrane Central Register of Controlled Trials, Pubmed, CINAHL and Embase databases. All RCTs focusing on peripheral intravenous catheters, central venous catheters and intraosseous catheters, published in English and Chinese in peer-reviewed journals within the past decade, will be included. Conclusion: This scoping review will summarise the current state of evidence for vascular access devices in the ED setting. This will identify gaps in the literature and, in turn, assist clinicians and researchers in pinpointing areas for future exploration and provide a valuable guide for future research. [ABSTRACT FROM AUTHOR]

Introduction: Double vena cava is the most common thoracic abnormality and is mainly caused by persistence of the left superior vena cava and are usually described incidentally after placement of central venous accesses. Objective: Presentation of a clinical case where a double superior vena cava was identified after the placement of a Mahurkar-type catheter. Clinical case: A 54-year-old man was admitted to the nephrology department with a diagnosis of angioaccess-associated infection. Mahurkar catheter was placed without complications, atypical location was observed by chest X-ray, so CT angiography was requested suggestive images of left superior vena cava persistence with a central venous catheter inside are reported. Discussion: The identification of superior double vena cava in most cases occurs incidentally after the placement of a central venous access, after taking a plain chest x-ray where a persistent left superior vena cava can be observed, and it may be accompanied by other abnormalities. Conclusions: Knowing the possible vascular alterations helps prevent complications during procedures such as central venous catheter placement. [ABSTRACT FROM AUTHOR]

Children with chronic intestinal failure (IF) require a long-term central venous catheter (CVC) for provision of parenteral nutrition. Vascular, mechanical and infectious complications such as central line-associated bloodstream infections (CLABSI) may lead to progressive loss of venous access sites. Handling and management of CVCs therefore play an important role. Our vascular rehabilitation concept (VRC) is a core component of our intestinal rehabilitation program (IRP) and consists of an education program, optimization of skin care, catheter fixation and lock solution, and the use of hybrid technique for catheter placement. Aim of this study is to analyse the effectiveness of our VRC on CLABSI rates and need for CVC replacements. Retrospective analysis of all children treated in our IRP that were followed up between 2018 and 2023. A total of 117 children with chronic IF could be included for analysis of 248864 catheter days (CD). 91 patients were referred from other hospitals (127117 CD before and 89359 CD after entry into our IRP). Children receiving primary care at our IRP (32388 CD) showed a significantly lower CLABSI and line replacement rate than patients referred from external centers (p < 0.001). After entering our IRP, CLABSI rates and need for CVC replacements per 1000 CD decreased significantly in referred patients: 1.19 to 0.26 and 1.77 to 0.59, respectively (p < 0.001). Management of paediatric chronic IF patients by an IRP with a vascular rehabilitation concept significantly lowers the rate of CLABSI episodes and the need for catheter replacements. [ABSTRACT FROM AUTHOR]

Background Cardiac tamponade is a life-threatening compression of the heart caused by the accumulation of fluid in the pericardial sac. Although central venous catheters (CVCs) are essential in modern medicine, they carry a certain risk of complications including cardiac tamponade. Case summary A 12-year-old female was involved in a road accident reporting multiple severe traumatic injuries, including a left humerus fracture and subdural haemorrhage. After 2 days in the intensive care unit, she suddenly developed hypotension and cardiac tamponade was diagnosed. Analysis of the pericardial fluid showed high glucose levels comparable to the parenteral nutrition that she was receiving. Retraction of the CVC allowed resolution of the effusion. Discussion Cardiac tamponade is a rare but serious adverse event after CVC insertion, mostly among younger patients. Awareness of this risk allows physicians to promptly recognize and treat this dangerous complication. [ABSTRACT FROM AUTHOR]

Vasopressor medications for circulatory shock have historically been administered through central venous catheters due to concern for extravasation injury when given peripherally. However, recent studies have demonstrated the safety of peripheral administration of vasopressor medications at lower doses and for a limited duration. Peripheral use of vasopressors is appealing to both patients and providers, as obtaining central access is an invasive procedure associated with the risk of pneumothorax, bleeding, and infection. Furthermore, waiting to initiate these medications until central access is obtained can lead to delays in care. Conversely, valid concerns remain regarding the risk of tissue extravasation associated with peripheral vasopressors, which can be life and limb threatening. We discuss the guidelines and data for optimal dose, duration, intravenous line (IV) size, IV location, and nursing IV site monitoring for peripheral vasopressors. We then explore adverse events associated with peripheral vasopressors. Finally, we describe how this practice change may impact hospital medicine providers. [ABSTRACT FROM AUTHOR]

Background: The aim of this experimental study was to elucidate whether different distances between central venous catheter tips can affect drug clearance during continuous renal replacement therapy (CRRT). Central venous catheters (CVCs) are widely used in intensive care patients for drug infusion. If a patient receives CRRT, a second central dialysis catheter (CDC) is required. Where to insert CVCs is directed by guidelines, but recommendations regarding how to place multiple catheters are scarce. There are indications that a drug infused in a CVC with the tip close to the tip of the CDC, could be directly aspirated into the dialysis machine, with a risk of increased clearance. However, studies on whether clearance is affected by different CVC and CDC tip positions, when the two catheters are in the same vessel, are few. Methods: In this model with 18 piglets, gentamicin (GM) and vancomycin (VM) were infused through a CVC during CRRT. The CVC tip was placed in different positions in relation to the CDC tip from caudal, i.e., proximal to the heart, to cranial, i.e., distal to the heart. Serum and dialysate concentrations were sampled after approximately 30 min of CRRT at four different positions: when the CVC tip was 2 cm caudally (+ 2), at the same level (0), and at 2 (− 2) and 4 (− 4) cm cranially of the tip of the CDC. Clearance was calculated. A mixed linear model was performed, and level of significance was set to p < 0.05. Results: Clearance of GM had median values at + 2 cm, 0 cm, − 2 cm and − 4 cm of 17.3 (5.2), 18.6 (7.4), 20.0 (16.2) and 26.2 (12.2) ml/min, respectively (p = 0.04). Clearance of VM had median values at + 2 cm, 0 cm, − 2 cm and − 4 cm of 16.2 (4.5), 14.7 (4.9), 19.0 (10.2) and 21.2 (11.4) ml/min, respectively (p = 0.02). Conclusions: The distance between CVC and CDC tips can affect drug clearance during CRRT. A cranial versus a caudal tip position of the CVC in relation to the tip of the CDC led to the highest clearance. [ABSTRACT FROM AUTHOR]

Aims Design Data Sources Results Conclusion Implications for Patients Impact Patient or Public Contribution Paediatric patients with complex or acute conditions may require a central venous access device, however, almost one‐third of these devices have associated complications (e.g. infections). Implementation of evidence‐based practices regarding central venous access devices can reduce and potentially prevent complications.This scoping review aimed to explore recent interventional research in CVAD management through an implementation lens.This scoping review used the Arksey and O'Malley framework. Studies were included if they were written in English, published in 2012 to July 2023, involved children and were relevant to the study aims. Risk of bias was appraised by the Mixed Methods Appraisal Tool.Searches were undertaken in EMBASE, CINAHL (Ebsco), PubMed, Web of Science and Cochrane Library (CENTRAL).Of the 1769 studies identified in a systematic search, 46 studies were included. Studies mostly focused on health professionals and central venous access device maintenance and had quantitative pre‐post study designs. Adherence to implementation frameworks was lacking, with many studies employing quality improvement approaches. Implementation strategies were typically multipronged, using health‐professional education, bundles and working groups. Bundle compliance and reductions in central line‐associated bloodstream infections were the most featured outcomes, with most studies primarily focusing on effectiveness outcomes.Translation of evidence‐based practices to the clinical setting is difficult and current adoption of implementation frameworks (apart from ‘quality improvement’) is limited. Implementation strategies are diverse and dependent on the local context, and study outcomes typically focus on the effectiveness of the physical intervention, rather than measuring the implementation effort itself.Future intervention research requires a more uniform and deliberate application of implementation frameworks and strategies.Greater exploration of relationships between frameworks and strategies and implementation and service outcomes is required to increase understanding of their role in maximizing resources to improve health care.Adhered to best reporting guidelines as per PRISMA‐ScR (Tricco et al., 2018).No patient or public contribution. [ABSTRACT FROM AUTHOR]