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Patients managing central venous catheters (CVCs) outside of hospitals need training in CVC care. Using 3 focus groups, the study identified themes in how health care personnel (HCP) prepare patients and their caregivers for CVC care at home. Four major themes and 25 nested subthemes were identified: (1) providing the right amount of education at the right time, (2) tailoring education to patient needs, (3) developing patient education tools, and (4) managing differences in recommendations to patients. HCPs in the study ensured patients and caregivers learn what they need to know when they need to know it, using appropriate patient education tools. Patients and caregivers are largely responsible for CVC care and central line-associated bloodstream infection prevention outside of acute care hospitals and long-term care settings, and HCP take seriously their obligation to provide them with appropriate education and tools to best enhance their ability to keep themselves safe. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the safety and efficacy of povidone-iodine 0.6% (PVI) irrigation for preventing recurrence of stenosis after punctoplasty in patients with punctal and proximal canalicular stenosis treated using a venous catheter as a stent. Methods: Twenty patients were enrolled and divided into two groups. Group 1 received irrigation of 1 mL 0.6% PVI, while Group 2 received 1 mL of balanced salt solution (BSS). The patients underwent baseline, 15-, 30-, and 90-day assessments using the Ocular Surface Disease Index (OSDI) questionnaire, Symptoms Assessment in Dry Eye (SANDE), Schirmer I test, tear meniscus height (TMH), bulbar redness, meibography, and non-invasive breakup time (NIKBUT) through Keratograph 5M (Oculus, Germany). Results: At three months, both groups demonstrated statistically significant improvements in symptoms and ocular surface parameters. However, Group 1 showed statistically significant improvements in OSDI, SANDE scores, bulbar redness, and NIKBUT compared to Group 2. Additionally, no patients in Group 1 presented a recurrence of stenosis, while three patients in Group 2 demonstrated stenosis relapse at the end of the follow-up period. Conclusions: The application of a venous catheter and PVI 0.6% irrigations proved to be effective in treating proximal lacrimal duct stenosis, reducing the risk of recurrence and improving tear film stability, ocular discomfort symptoms, and ocular surface parameters. [ABSTRACT FROM AUTHOR]

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Septic pulmonary embolism (SPE) is a rare lung disease that typically occurs when a thrombus containing microorganisms from a nonpulmonary infection focus settles in the pulmonary arteries via the hematogenous route and causes infarction and infection. Nonspecific symptoms such as fever, cough, and chest pain are manifested. SPE is associated with predisposing conditions such as infective endocarditis, intravenous drug addiction, venous catheter, tonsillitis, and tooth and pelvis infections. It has high morbidity and mortality, and the most important point that determines the prognosis is early diagnosis and broad-spectrum antibiotic therapy in the early phase. SPE should be considered when the primary focus of infection is accompanied by high fever and multiple nodules and/or cavitary lesions, which are signs of feeding vessels in the lungs. Here, we present a case of SPE with a hemodialysis catheter and clinical findings of sepsis, which was referred to our center with a preliminary diagnosis of tuberculosis.

Central venous catheters (CVCs), regarded as lines of life, are helpful in hemodynamic monitoring and delivering medications to patients. However, there are several complications that can result from the placement of CVCs. This includes accidental arterial puncture, which has a temporal association with hemorrhage, hematoma, and stroke. Infusion of vasopressors through such a mispositioned arterial CVC further increases the risk of these complications with potential end-organ ischemia. Here, we discuss the case of a 76-year-old woman who developed a myocardial infarction, heart failure, and subarachnoid hemorrhage following the arterial infusion of vasopressors through a malpositioned CVC. [ABSTRACT FROM AUTHOR]

Though the energy requirement for maintenance is an important part of net energy system, little is known of the metabolic characteristics of maintenance energy expenditure. This study was investigated the effect of feeding level at metabolizable energy requirement for maintenance (FLM) on plasma metabolites in growing pigs. Ten barrows (22.5 ± 0.5 kg BW) were kept in metabolism crates and catheterized in the precaval vein during adaptation period. Pigs were fed a corn-soybean meal diet at 782 kJ ME/kg BW0.6·d−1 during d 1 to 8 and then were refeeding at 2,400 kJ ME/kg BW0.6·d−1 on d 9. Plasma samples of each pig were collected by catheter on the morning of d 1, 3, 5, 7, 9, and 10, respectively, for metabolomics testing. Results showed that the concentration of plasma urea nitrogen decreased under FLM (p < 0.01) and increased significantly after refeeding (p < 0.01). The concentration of total cholesterol, high-density lipoprotein, low-density lipoprotein, and albumin in plasma were decreased significantly after refeeding (p < 0.01). Eleven identified compounds were up-regulated and six ones were down-regulated under FLM. In conclusion, the energy metabolism of growing pigs was relatively stable after 4 days of feeding at FLM.

Background: Safe use of PVCs for a long time and without any problems is very important for the continuity of the treatment. Aim: This descriptive study examined experiences and observations nurses have regarding factors related to partial or complete dislodgement of the PVCs. Methodology: This study was conducted with nurses working at a university hospital. The study was completed with 297 nurses who met the inclusion criteria and agreed to participate, between February 2019 and July 2019. The study data were collected using a questionnaire prepared by the researchers. Results: 87.5% of the nurses claimed experiencing PVC dislodgement. 66.9% of the nurses claimed observing this incident five times or more during occupational life. 66.1% stated that the patients dislodged PVCs. Nurses stated that PVC dislodgement mostly occurred among elderly patients and in surgical services. 36.6% of the nurses stated that new PVCs were inserted in patients after the PVC dislodgement. 69.6% of the nurses stated that there was no complication after the PVC dislodgement. 44.5% reported that bleeding complications developed after the PVC dislodgement. Conclusion: The partial or complete dislodgement of the PVCs is an important problem causing PVC failure. It is recommended to take necessary precautions according to clinics for patients at risk of dislodgement of the PVCs in particular and in order to prevent complications. [ABSTRACT FROM AUTHOR]

Introduction: One of the important complications of peripheral venous catheters is suppurative thrombophlebitis that would be life threatening without treatment. In this report, we introduce a patient who developed purulent thrombophlebitis due to venous catheter in the upper limb after coronary artery bypass graft surgery. Multiple abscess formation was developed on her upper limb after the third day of coronary artery bypass graft surgery (CABG). The limb was fatty and edematous; therefore, the abscesses were drained by multiple small incisions. Wounds managed to be closed as secondary wund healing. Three weeks later the patient discharged with good condition. It seems that venous excision can be avoided in some cases involved by suppurative thrombophlebitis.

Abstract Aim To investigate patient experiences with peripherally inserted venous catheters, namely PICC lines and Midlines, as well as the influence of socio‐demographic variables, length of stay, comorbidity and complications on these experiences. Design The study had a descriptive, multicentre, cross‐sectional design. Methods We used a questionnaire to investigate patient experiences (N = 359). Results Patients experiences were not optimal on each of the items in the questionnaire. Nevertheless, few respondents would have preferred a traditional peripheral venous catheter instead. Moreover, free‐text answers indicated that patients were very satisfied with their catheter. Results also indicate that the hospitals have different approach when selecting a PICC line or a Midline as route of choice. The only factor associated with patient experiences was “complications.” Conclusion Even though patients reported of several disadvantages with the PICC line/Midline, findings indicate that they would have chosen this again. PICC lines and Midlines are beneficial from the patients' perspective, even though they have disadvantages.

74 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation program, on oxygen therapy and nocturnal bi-level positive airway pressure (BiPAP) ventilation. During the night he had a traumatic rib fracture (5–11th right ribs) but still he used BiPAP ventilation during the sleep. In the morning after he presented with a diffuse and massive emphysema in the face, thorax and abdominal regions. On physical examination, the patient presented with massive swelling and crepitus on palpation. A chest computed tomography (CT) scan confirmed a diffuse subcutaneous emphysema and revealed a mediastinal emphysema and bilateral small pneumothorax. A fast resolution of the emphysema was of paramount importance as the patient was severely agitated due to his inability to open both eyes, and the need to reintroduce BiPAP ventilation as soon as possible. It was placed a fenestrated subcutaneous catheter on left hemithorax and a subcutaneous ostomy on right hemithorax for comparative purpose. It was also performed a confluent centripetal massage towards drainage orifices, with immediate and substantial improvement of emphysema, especially in left hemithorax, and progressive ocular opening. Further emphysema absorption occurred during hospitalization.

Background: Central venous cannulation or catheterization (CVC) forms the core of managing critically ill patients. Inadvertent arterial or venous injury, despite the use of duplex ultrasound (DUS), can lead to significant and devastating complications, especially when large-bore cannulas are used. This article explains the way we managed four different scenarios and suggests a step-by-step guide to insertion of a CVC and management of a misadventure. Methods: We maintained the records and followed up four adult patients requiring hemodialysis who had misadventures with CVC insertion between March 2018 and January 2019, with large-bore (>7Fr) cannulas. They were all followed up for 6 months. Results: Four patients, 2 males and 2 females, between 25 and 82 years of age, underwent CVC insertion in an intensive care setting. The youngest had a carotid-jugular arteriovenous fistula that was detected after discharge and managed successfully by open surgery. The eldest, a male patient, had a perforation of the external iliac vein, which was managed successfully with endovascular balloon inflation. The third patient had femoral artery pseudoaneurysms, which were managed successfully with serial DUS compression. The fourth had an inadvertent puncture of the right common carotid artery during the insertion of jugular CVC and was managed by manual and DUS compression. Conclusion: DUS has reduced the incidence of complications from the insertion of CVC. However, in order to further reduce or nullify the possibility of arterial punctures during CVC insertion, whether it be a small (7Fr) cannula, the operator needs to follow certain basic steps, be aware of potential complications and know how to approach an inadvertent arterial/venous/nerve injury. The literature mostly deals with how complications were managed while we impress on the need for prevention. The authors recommend that clinical guidelines be formulated and followed in hospitals.

Background/Aims: Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA. Methods: A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ2 or Student's t test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as p < 0.05. The statistical computer software package SPSSw v25 was used for the analysis. Results: A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (p = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (p = 0.001). Conclusions: The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting. [ABSTRACT FROM AUTHOR]

Rat telemetry is the assay of choice to assess the potential effects of novel drug candidates on cardiovascular parameters during early drug discovery. Telemetry device implantation can be combined with venous catheter and access button implantation when intravenous administration of the drug substance is required. Rats (Sprague Dawley or Han Wistar) were implanted with telemetry devices for arterial blood pressure measurement using either direct aortic catheterisation (n = 131) or aortic catheterisation via the femoral artery (n = 17). Bipolar leads for ECG recording were also implanted in some of the animals (n = 102). Femoral vein catheters and access buttons were implanted as a separate surgery after the initial telemetry implantation (n = 43). 128 animals (86%) were implanted successfully with telemetry devices without any notable surgical or post-surgical problems. When considering the 2 different catheterisation methods separately, the success rate of the direct aortic approach was 88% compared to 76% with the aortic placement via the femoral artery. Lameness was the most common post-surgical problem. Blood loss during surgery and ischaemic patches on the tail were also observed at a low incidence with the direct aortic approach. Catheter pull-out occurred in some rats before the first signal check reducing the overall success rate for blood pressure measurement using the direct aortic approach to 85%. A 95% success rate was observed for catheter and access button implantation. A high success rate is possible when implanting telemetry devices in rats with and without venous catheters and access buttons. We have attempted to provide solutions to problems and describe refinements to the procedure which may further improve surgical outcomes. [ABSTRACT FROM AUTHOR]

Introduction:Although placement of the central venous catheter is a routine procedure carried out by anesthesiologists, it carries a certain risk of complications. One of the complications is malposition, or inadequate catheter position. Case report: We present a case of the patient who was admitted to an intensive care unit due to head injury and blood vomiting. The central venous catheter was inserted through the right internal jugular vein. Due to haemodynamic instability and the need for fluid and blood infusion, a chest x-ray examination was not immediately performed to evaluate the position of the catheter. After the patient was stabilized, the test was performed and revealed that the tip of the catheter was not located in the superior vena cava but in the right subclavian vein. Conclusion: This case has shown that the misplacement of the central venous catheter tip is not unusual. Once in the venous system, even when it is not located in the superior vena cava, it can be used for initial fluid replacement and drug administration, and after the patient is stabilized, the repositioning or placement of a new catheter should be considered.

Background: In the present days cardiovascular surgery is embrancing minimally invasive techniques in a growing number. It consists of small incisions and the divergence of median sternotomy. This leads to shorter duration of hospitalization, decreased blood loss, less postoperative pain and scarring, and faster recovery. Objective: The aim of the study is to conduct minimally invasive surgical closure of an atrial septal defect under femoro-femoral cardiopulmonary bypass. A supplementary cannula that is inserted straight through the thoracic aperture drains the superior vena cava. We offer a present approach wherein a single two-stage femoral cannula is used to drain both vena cavae. Material and methods: The cannula is inserted through the femoral vein, its proximal holes remain in the IVC while the distal ones are directed into the SVC. To increase the venous return, a centrifugal pump is installed on the venous line between the cannula and the venous reservoir. The right atrium is isolated using clamps on the IVC and SVC cannula before the atrium is opened and the ASD is fixed. Results: We recently used this method on a 60-year-old male patient. Passive venous drainage was 2.6 l/min, while the perfusion theoretical flow was 5.4 l/min. However, adding the centrifugal pump boosted the flow to 5.4 l/min, resulting in an ideal perfusion flow. The CPB duration was 38 minutes, and the operative time was 140 without complications. The patient was discharged on postoperative day 5. Conclusions: Minimally invasive procedure is a great alternative to the transcatheter treatment,avoiding sternotomy. Administering a single venous catheter to drain both vena cavae streamlines the procedure and adds to the development of minimally invasive cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Data on complications after upper extremity vein thrombosis (UEVT) are limited and heterogeneous., Methods: The aim of the present study was to evaluate the pooled proportions of venous thromboembolism (VTE) recurrence, bleeding, and post-thrombotic syndrome (PTS) in patients with UEVT. A systematic literature review was conducted of PubMed, Embase, and the Cochrane Library databases from January 2000 to April 2023 in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. All studies included patients with UEVT and were published in English. Meta-analyses of VTE recurrence, bleeding, and of PTS after UEVT were performed to compute pooled estimates and associated 95% confidence intervals (CIs). Subgroup analyses of cancer-associated UEVT and catheter-associated venous thrombosis were conducted. Patients with Paget-Schroetter syndrome or effort thrombosis were excluded., Results: A total of 55 studies with 15,694 patients were included. The pooled proportions for VTE recurrence, major bleeding, and PTS were 4.8% (95% CI, 3.8%-6.2%), 3.0% (95% CI, 2.2%-4.0%), and 23.8% (95% CI, 17.0%-32.3%), respectively. The pooled proportion of VTE recurrence was 2.7% (95% CI, 1.6%-4.6%) for patients treated with direct oral anticoagulants (DOACs), 1.7% (95% CI, 0.8%-3.7%) for patients treated with low-molecular-weight heparin (LMWH), and 4.4% (95% CI, 1.5%-11.8%) for vitamin K antagonists (VKAs; P = .36). The pooled proportion was 6.3% (95% CI, 4.3%-9.1%) for cancer patients compared with 3.1% (95% CI, 2.1%-4.6%) for patients without cancer (P = .01). The pooled proportion of major bleeding for patients treated with DOACs, LMWH, and VKAs, was 2.1% (95% CI, 0.9%-5.1%), 3.2% (95% CI, 1.4%-7.2%), and 3.4% (95% CI, 1.4%-8.4%), respectively (P = .72). The pooled proportion of PTS for patients treated with DOACs, LMWH, and VKAs was 11.8% (95% CI, 6.5%-20.6%), 27.9% (95% CI, 20.9%-36.2%), and 24.5% (95% CI, 17.6%-33.1%), respectively (P = .02)., Conclusions: The results from this study suggest that UEVT is associated with significant rates of PTS and VTE recurrence. Treatment with DOACs might be associated with lower PTS rates than treatment with other anticoagulants., Competing Interests: Disclosures None., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

À l'heure de la multirésistance bactérienne, en particulier des entérobactéries sécrétrices de bêtalactamase à spectre étendu (E-BLSE), rendant souvent difficile un traitement per os, et dans le but de pouvoir éviter des hospitalisations prolongées, il existe à ce jour de multiples options pour envisager l'antibiothérapie parentérale à domicile en particulier dans la prise en charge des infections urinaires. Elle s'élabore généralement en partenariat avec l'urologue et le référent infectiologue de l'établissement. Nowadays, multidrug bacterial resistance, predominantly harbored by Extended-spectrum Beta-lactamases (ESBL) producing enterobacteriaceae, restricts the resort to oral antibiotic treatment. In order to limit prolonged hospital stays, many convenient options are available to consider outpatient parenteral antibiotic therapy (OPAT), particularly in urinary tracts infections (UTIs) management. Those therapeutic strategies are usually designed within a partnership between both urologist infectious diseases specialist hospital advisers. [ABSTRACT FROM AUTHOR]

Résumé Objectif Décrire les caractéristiques cliniques et les étiologies des thromboses veineuses des membres supérieurs (TVMS). Méthodes Les patients pour lesquels un écho-Doppler veineux des membres supérieurs a été demandé pour suspicion de TVMS dans un hôpital universitaire, de janvier à décembre 2016, ont été inclus rétrospectivement. Les signes cliniques faisant suspecter une TVMS, les caractéristiques cliniques, la topographie des TVMS et la prévalence des embolies pulmonaires (EP) symptomatiques ont été analysés. Les sensibilités (Se), spécificités (Sp), valeurs prédictives positives (VPP) et négatives (VPN) signes cliniques faisant suspecter une TVMS ont été estimées en comparant les patients avec TVMS confirmé à l'écho-Doppler à ceux sans TVMS. Résultats Parmi les 488 suspicions de TVMS incluses, 160 TVMS étaient confirmées par écho-Doppler, dont 80 thromboses veineuses profondes (TVP) et 80 thromboses veineuses superficielles (TVS). Une EP symptomatique était retrouvée dans 2,5 % des cas chez les patients présentant une TVMS (n = 4). Aucun des signes cliniques faisant suspecter une TVMS n'avait une sensibilité supérieure à 40 %. Pour les TVP, la présence d'un syndrome cave supérieur avait une VPP de 100 %, une VPN de 71,6 % et une Sp de 100 %. Pour les TVS, la présence d'un cordon induré avait une VPP de 85,7 %, une VPN 75,3 % et une spécificité de 98,4 %. Un dispositif endoveineux était présent dans 87,5 % des TVP et 97,5 % des TVS. Un cathéter central à insertion périphérique ou un site implantable étaient présents respectivement dans 40 % et 17,5 % des TVP. Une hémopathie maligne était présente chez 43,8 % des patients présentant une TVP et 31,3 % une TVS. Un sepsis ou une néoplasie solide était présents dans 25 % et 15 % des cas, respectivement. Aucune TVMS n'a été révélatrice de néoplasie solide, d'hémopathie ou de thrombophilie. Conclusion Les dispositifs endoveineux sont impliqués dans la 92,5 % des TVMS. La prévalence des EP symptomatiques est faible. Les hémopathies malignes, les sepsis et les néoplasies solides sont les pathologies les plus fréquemment chez les patients présentant une TVMS. Abstract Aim To describe the clinical features and etiologies of upper limb venous thrombosis (ULVT). Methods All patients with a clinically suspected ULVT, were included retrospectively from January to December 2016. Diagnosis of ULVT was based on doppler-ultrasonography. Clinical features, topography and symptomatic pulmonary embolism (PE) were analyzed. The sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative value (NPV) of clinical symptoms leading to ULVT suspicion were estimated by comparing patients with and without ULVT. Results Among 488 patients with a suspected ULVT, 160 were diagnosed with ULVT, including, 80 with deep venous thrombosis (DVT) and 80 with superficial venous thrombosis (SVT). Symptomatic PE was found in 2.5 % of cases (n = 4). None of the clinical symptoms of ULVT had a sensitivity greater than 40 %. For DVT, presence of superior vena cava syndrome had a 100 % PPV, 71.6 % NPV and 100 % Sp. For SVT, the presence of an cord-like induration had a 85.7 % PPV, 75.3 % NPV and 98.4 % Sp. An endovenous device was present in 87.5 % of DVT and 97.5 % of SVT cases. Malignant hemopathy was found in 43.8 % and 31.3 % of cases of DVT and SVT, respectively. Sepsis and solid neoplasia were present in 25 % and 15 % of cases of ULVT, respectively. Peripherally inserted central catheter or implantable sites were present in 40 % and 17.5 % of DVT patients. No solid neoplasia, hematological malignancy or thrombophilia were diagnosed in patients with ULVT. Conclusion An endovenous device was involved in 92.5 % of cases of ULVT. The prevalence of symptomatic PE was low. Hematological malignancies, sepsis and neoplasia were the most common conditions present in patients with ULVT. [ABSTRACT FROM AUTHOR]

Upper extremity deep venous thrombosis is a condition with increasing prevalence, with high risk of morbidity and mortality, due to embolic complications. In the majority of the cases, thrombosis involves more than one venous segment, most frequently being affected the subclavian vein, followed by internal jugular vein, brachiocephalic vein and basilic vein. Upper extremity deep venous thrombosis in patients without risk factors for thrombosis is called primary deep venous thrombosis and includes idiopathic thrombosis and effort thrombosis. Deep venous thrombosis of upper extremity is called secondary when there are known risk factors and it is encountered mainly in older patients, with many comorbidities. The positive diagnosis is established only after paraclinical and imaging investigations, ultrasonography being the most useful diagnostic method. The most important complication, with high risk of death, is pulmonary embolism. Treatment consists in anticoagulant therapy, for preventing thrombosis extension and pulmonary embolism.

Background and Objectives: An effective flushing technique is essential to reduce intravenous (IV)-related complications and improve patient care. New technology should contribute to such improvements, while reducing costs and increasing care efficiency. This study evaluated the efficacy, safety, and convenience of a new flushing technique using a Baro Flush™ controller. Materials and Methods: We evaluated the efficacy and safety of Baro Flush™ by measuring the infusion flushing volume and pressure in vitro. Afterwards, we prospectively enrolled 3000 patients with flushing and assigned 1500 patients with a new technique for flushing and 1500 with a conventional flushing method, which was performed by 48 registered nurses (RNs) at the Gil Medical Center in June 2018. The efficacy, safety, and convenience of the new flushing method were evaluated though a questionnaire survey. Results: The average flushing pressure was 12.5 ± 0.6 psi (86.18 ± 4.14 kPa) with 1.2 ± 0.2 mL per flush, as recommended by the Centers for Disease Control and Prevention based on 85 experiments. No IV-catheter-related complications were reported by the RNs during the study. More than 80% of the RNs reported that the new flushing method was easier to learn, improved care efficacy, and was more convenient than conventional flushing. Conclusions: The new flushing method using a Baro Flush™ controller showed improved efficacy, safety, and convenience compared with the conventional flushing method, and no IV-catheter-related complications occurred, including occlusion and inflammation. The new flushing method promises to reduce IV-catheter-related complications and shows improved efficacy, safety, and convenience.

Objectives: To evaluate the effectiveness of various taurolidine solutions in the prevention and treatment of catheter-related bloodstream infections (CRBSIs) caused by the entire spectrum of microbes in patients receiving parenteral nutrition in a shorter period of time., Methods: The in vitro method was used to test for eradication of biofilm. Different locks were used: TauroSept (2%), TauroLock (1.35%), TauroLock half concentration, and 3.5% taurolidine and tested on Staphylococcus (S.) epidermidis, S. aureus, S. hominis, methicillin-resistant S. aureus (MRSA), Pseudomonas (P.) aeruginosa (PSAE), multidrug-resistant P. aeruginosa (MR PSAE), vancomycin-resistant enterococci, Klebsiella pneumoniae producing carbapenemase (KPC), Klebsiella pneumoniae producing extended-spectrum beta-lactamase (KLPN ESBL), Candida (C.) albicans, and C. glabrata. Broviac catheters were incubated for growth of each organism and then incubated in lock solutions. Colony forming units (CFUs) were then counted after 30 min, 60 min, and 120 min of incubation., Results: A statistically significant decrease in CFUs was observed after 30 min of taurolidine exposure for S. hominis, PSAE, KLPN ESBL, KLPN KPC, C. albicans, and C. glabrata; after 60 min of exposure for S. epidermidis, PSAE, MR PSAE, KLPN ESBL, KPC, C. albicans, and C. glabrata; and after 120 min of exposure for S. epidermidis, S. hominis, S. aureus, PSAE, MR PSAE, KLPN ESBL, KPC, C. albicans, C. glabrata., Conclusions: The application of taurolidine is effective in the treatment of CRBSIs. Taurolidine proved to be more effective against Gram-negative microorganisms during a 30-min exposure. Using 0.675% taurolidine is still effective. To achieve the required antimicrobial effect, the catheter must be sanitized for at least 2 h., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home‐based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home‐based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. Methods: We performed a prospective cohort study of patients requiring home‐based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. Results: Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89–2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20–4.46] and 4.45 [95% CI: 1.02–19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09–4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12–41.97). Conclusions: Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis of the thoracic extremities is rare but severe due to its fatal complication, namely pulmonary embolism. We here report 5 cases of deep vein thrombosis of the thoracic extremities in order to provide a better understanding of this disease affecting African black subjects. Five (5) patients with vein thrombosis of the thoracic extremities documented on venous doppler ultrasound were included in the study between 01/01/2007 and 12/31/2012. The prevalence rate of vein thromboses of the thoracic extremities was 4.09%. The mean age was 48.8 ± 13.8 years. The sex-ratio was 0.67 in favor of women. It was caused by peripheral venous catheter (40%), cancer (40%) and effort-induced phlebitis (20%). Clinical signs of vein thrombosis of the thoracic extremities were dominated by the edema (100%), pain (80%) and increased heat (80%). The humeral vein was most commonly affected (80% of cases). Complications included postphlebitic sequelae in two (40%) cases, death due to comorbidity in two (40%) cases and pulmonary embolism in one case. The most commonly used protocol was based on heparinotherapy relayed by the anti-vit K (AVK). The mean follow-up after AVK treatment was 44.7 months. Deep vein thrombosis of the thoracic extremities is rare in Cotonou where it is mainly caused by venous catheter and cancer. Prevention of these secondary causes is the best treatment. [ABSTRACT FROM AUTHOR]

A 19 year old Standardbred gelding and a 5 year old Quarter Horse mare experienced an episode of air embolism due to a dislodged catheter cap. Initial clinical signs in the gelding included tachycardia, arrhythmia, tachypnoea and disorientation. The mare showed agitation, selfmutilation due to severe pruritus, tachycardia with a mill-wheel murmur and tachypnoea. Echocardiography revealed air bubbles in the right and left side of the heart, the pulmonary vessels and the aorta. An anatomical abnormality was excluded by a bubble study, proving a paradoxical air embolism. Both horses received symptomatic treatment and recovered. Air embolism rarely occurs in horses. The extent of air embolism can be shown with echocardiography, which seems to allow a better evaluation of the condition and might be helpful in determining which clinical signs are to be expected. [ABSTRACT FROM AUTHOR]

Upper extremity deep venous thrombosis is a condition with increasing prevalence, with high risk of morbidity and mortality, due to embolic complications. In the majority of the cases, thrombosis involves more than one venous segment, most frequently being affected the subclavian vein, followed by internal jugular vein, brachiocephalic vein and basilic vein. Upper extremity deep venous thrombosis in patients without risk factors for thrombosis is called primary deep venous thrombosis and includes idiopathic thrombosis and effort thrombosis. Deep venous thrombosis of upper extremity is called secondary when there are known risk factors and it is encountered mainly in older patients, with many comorbidities. The positive diagnosis is established only after paraclinical and imaging investigations, ultrasonography being the most useful diagnostic method. The most important complication, with high risk of death, is pulmonary embolism. Treatment consists in anticoagulant therapy, for preventing thrombosis extension and pulmonary embolism. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the clinical predictors of unfavorable prognosis in patients with venous catheter-related cerebral air embolism.Methods: An extensive review of English literature was performed to obtain reports on cerebral air embolism published between January 1982 and July 2014 through PubMed, Journal at Ovid, and Web of Science using the Mesh terms and keywords "cerebral air embolism" and "cerebral gas embolism." Reports not fulfilling the diagnosis of cerebral air embolism and iterant articles were excluded. Demographics, clinical manifestations, and imaging findings were recorded. The air distribution on initial brain computed tomography (CT) was recorded as gyriform air (GF), cavernous sinus bubble, venous sinus bubble, and parenchymal and subarachnoid bubble. The enrolled subjects were further divided into favorable and unfavorable outcome groups for analyses.Results: Of the 33 cases enrolled, 31 had documented follow-up outcomes, including 14 with favorable and 17 with unfavorable prognoses. Patients with unfavorable outcome had older onset age (67.5 ± 15.8 versus 46.7 ± 17.0 years, P < .001), higher frequency of GF on brain CT (58.8% versus 0%, P < .01), initial consciousness disturbance (100% versus 42.9%, P < .001), and hemiparesis (100% versus 42.9%, P < .001), but lower frequency of cardiopulmonary symptoms (5.9% versus 64.3%, P < .01). In patients with central venous catheter-related cerebral air embolism, the retrograde mechanism had a tendency for worse outcomes (43.8% versus 0%, P = .023).Conclusions: In patients with venous catheter-related cerebral air embolism, the presence of GF on brain CT imaging, old age, initial conscious disturbance, and hemiparesis may predict unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Persistent left superior vena cava is a congenital vascular anomaly, which is possibly arrhythmogenic and thrombogenic, rarely complicated with coronary sinus atresia. We treated a 42-year-old male with Hodgkin's lymphoma requiring central venous catheter placement for intensive chemotherapy. Persistent left superior vena cava was revealed after the insertion of the central venous catheter by the radiological finding of the catheter tip cannulated into the vena cava cavity. The relationship between coronary sinus atresia and persistent left superior vena cava induced by central venous catheterization remains unclear; however, the hematologist should pay attention to the malpositioning of the central venous catheter. [ABSTRACT FROM AUTHOR]

Using the main French health insurance company database over a 10-year period, the preventability of catheter-related infections of patients who claimed compensation after prosecution was reviewed by a panel expert. They occurred in 71 patients with few co-morbidities or risk factors for nosocomial infection and were mainly related to the use of a peripheral vascular catheter (42 cases) and due to Staphylococcus aureus (51 cases). Forty-two infections were considered to be preventable. Infections due to peripheral venous catheters were significantly more often preventable than those due to central ones (p < 0.05). We conclude that catheter-related infections perceived by patients and the justice system as not related to unforeseeable medical complications are mainly peripheral catheter infections due to S. aureus and might be an appropriate target for new preventive strategies. [ABSTRACT FROM AUTHOR]

Though the energy requirement for maintenance is an important part of net energy system, little is known of the metabolic characteristics of maintenance energy expenditure. This study was investigated the effect of feeding level at metabolizable energy requirement for maintenance (FLM) on plasma metabolites in growing pigs. Ten barrows (22.5 ± 0.5 kg BW) were kept in metabolism crates and catheterized in the precaval vein during adaptation period. Pigs were fed a corn-soybean meal diet at 782 kJ ME/kg BW 0.6 ·d -1 during d 1 to 8 and then were refeeding at 2,400 kJ ME/kg BW 0.6 ·d -1 on d 9. Plasma samples of each pig were collected by catheter on the morning of d 1, 3, 5, 7, 9, and 10, respectively, for metabolomics testing. Results showed that the concentration of plasma urea nitrogen decreased under FLM ( p < 0.01) and increased significantly after refeeding ( p < 0.01). The concentration of total cholesterol, high-density lipoprotein, low-density lipoprotein, and albumin in plasma were decreased significantly after refeeding ( p < 0.01). Eleven identified compounds were up-regulated and six ones were down-regulated under FLM. In conclusion, the energy metabolism of growing pigs was relatively stable after 4 days of feeding at FLM., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Chen, Wang, Jiang, Ma and Wang.)

Interventional radiologists (IRs) with expertise in image guidance have an inherent skill set for the safe and reliable placement of central venous access catheters (CVACs) in children. Above and beyond the technical requirements, IRs have an integral role as consultants in evaluating children for the most appropriate catheter to meet their short- and long-term needs. This article is meant to serve as a reference for decision making along with tips and pearls on how we approach placing CVACs in pediatric patients at our Children''s Hospital. [Copyright &y& Elsevier]

Background. Observational studies demonstrate poor clinical outcomes in chronic haemodialysis patients with venous catheters as vascular access. This longitudinal study examines the impact of vascular access change on key clinical and laboratory parameters. [ABSTRACT FROM PUBLISHER]

Background: Patients who are dependant on a percutaneous central venous catheter for dialysis have an excess morbidity and mortality compared with patients with an autologous arteriovenous fistula. Methods: In an effort to improve outcomes related to episodes of permanent access insufficiency, defined as a patient requiring a venous catheter for haemodialysis, a 12-month prospective audit of surgery carried out to establish and maintain dialysis access was carried out at our institution. Results: Effective measures that reduced the period of time that patients required a venous catheter for dialysis included regular communication between dialysis staff, the surgical service and patients attending for treatment in the dialysis unit, liberal use of duplex ultrasound imaging, pursuing autologous access in the majority of patients, early intervention to correct failing vascular access before conduit thrombosis, using both traditional open surgical and endovascular solutions in establishing and maintaining vascular access, using peritoneal dialysis as a long-term or temporary alternative to haemodialysis and, in cases of arteriovenous polytetrafluoroethylene graft occlusion, early thrombectomy and mandatory revision to provide a conduit immediately available for effective dialysis. Conclusion: Conducting an audit of surgical practice contributed to an improvement in outcomes for dialysis-dependant patients. Establishing an arteriovenous fistula in a greater proportion of cases before initiating renal replacement therapy may further address the problem of dialysis access insufficiency. [ABSTRACT FROM AUTHOR]

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Nickel-elicited systemic contact dermatitis is a well-known entity, although it is far less common than allergic contact dermatitis. In most of the cases, the main way of nickel administration is oral. Clinical manifestations are miscellaneous including pompholyx, diffuse exanthema, flexural dermatitis or baboon syndrome. Systemic nickel dermatitis induced by venous catheters is very uncommon, but it is probably underdiagnosed. We report here 2 patients with diffuse recurrent maculopapular rash corresponding to nickel-elicited systemic contact dermatitis. They were both perfused during the last episode with the assistance of a peripheral polyurethane venous catheter during or just before the cutaneous eruption. At the base of the catheter, there was a small metallic eyelet on which dimethylglyoxime test was positive, indicating a release of nickel. Then, we measured nickel release in normal use conditions and found high nickel levels, although the manufacturer denied that nickel could be released. This diagnosis is important to know because such exanthema often occurred during postoperative or postpartum period. Its frequency is probably underestimated because it is often considered as a cutaneous drug reaction. To our knowledge, only 2 cases have been reported in the literature. [ABSTRACT FROM AUTHOR]

Vascular access and increased risk of death among hemodialysis patients. Background. Hemodialysis with a venous catheter increases the risk of infection. The extent to which venous catheters are associated with an increased risk of death among hemodialysis patients has not been extensively studied. Methods. We conducted a retrospective cohort study of 7497 prevalent hemodialysis patients to assess the association between dialysis with a venous catheter and risk of death due to all causes and to infection. Results. A tunneled cuffed catheter was used for access in 12% of the patients and non-cuffed, not tunneled catheter in 2%. Younger age (P = 0.0005), black race ( P = 0.0022), female gender ( P = 0.0004), short duration since starting dialysis ( P = 0.0003) and impaired functional status ( P = 0.0001) were independently associated with increased use of catheter access. The proportion of patients who died was higher among those who were dialyzed with a non-cuffed (16.8%) or cuffed (15.2%) catheter compared to those dialyzed with either a graft (9.1%) or a fistula (7.3%; P < 0.001). The proportion of deaths due to infection was higher among patients dialyzed with a catheter (3.4%) compared to those dialyzed with either a graft (1.2%) or a fistula (0.8%; P < 0.001). The adjusted odds ratio (95% CI) for all-cause and infection-related death among patients dialyzed with a catheter was 1.4 (1.1, 1.9) and 3.0 (1.4, 6.6), respectively, compared to those with an arteriovenous (AV) fistula. Conclusion. Venous catheters are associated with an increased risk of all-cause and infection-related mortality among hemodialysis patients. [ABSTRACT FROM AUTHOR]