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Use of central venous catheters in children
Mestrovic, Julije,Kovacevic, Tanja,Ercegovic, Ivanka,Polic, Branka
Signa Vitae , 2006,
Abstract: The objective of this study was to evaluate the use of central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Split University Hospital (SUH). We reviewed the records of all children that had CVCs and were hospitalized between January 2002 and March 2006. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site and side of the body of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 352 CVCs were inserted in 300 children. Patient age ranged from 0 to 18 years. The average catheter insertion time was 12.88 days. We noted 66 (18.8%) CVC-related complications. Complications related to CVCs insertion were malposition of catheter (5.4%) and pneumothorax (0.9%). Occlusion of CVCs (4.3%), catheter related-bloodstream infections (CRBI) (4.0%), dislodgment (3.7%) and catheter damage (0.6%) were complications associated with lenght of CVCs use. We conclude that central venous catheterization is a safe and efficient procedure with minimal complications in pediatric patients.
Treatment of anthracycline extravasation from centrally inserted venous catheters
Seppo W. Langer
Oncology Reviews , 2011, DOI: 10.4081/117
Abstract: The treatment of accidental extravasation of anthracycline-based chemotherapy has markedly improved with the recent introduction of a systemic antidote, Savene. However, efficacy data on this treatment is mainly based on extravasation from peripheral catheters. This review presents data on 7 cases of Savene treatment of anthracycline extravasations from central venous catheters.
Knowledge of nursing students about central venous catheters  [PDF]
Mlinar Suzana,Ra?kovi?-Malnar?i? Rosanda
Vojnosanitetski Pregled , 2012, DOI: 10.2298/vsp1204333m
Abstract: Background/Aim. Central venous catheters (CVC) are at the crucial importance, particulary in the intensive therapy units. In order to handle a CVC safely, nursing students need to acquire theoretical and practical knowledge during the course of their studies. The aim of the study was to establish theoretical knowledge of nursing students about the procedures of nurses in placing and removing a central venous catheter (CVC), dressing the catheter entry point, the reasons for measuring central venous pressure (CVP), possible complications and risk factors for developing infections related to CVC. Methods. The questionnaire developed specifically for this cross-sectionl study was handed out to 87 full-time students and 57 part-time students. Results. The results show that all the surveyed nursing students know why chest radiography is carried out when inserting a catheter, have relatively good knowledge of CVC insertion points, procedures carried out in case of a suspected catheter sepsis and complications and risk factors for the development of infections related to CVC. However, the study show that the majority of students have insufficient knowledge of the procedures accompanying insertion of a catheter, signs that indicate correct functioning of CVC, frequency of flushing a catheter when it is not in use and the reasons for introducing an implanted CVC. Conclusion. Based on the results of the study it can be concluded that the second-year nursing students have insufficient knowledge of CVC. In order to correctly and safely handle a CVC, good theoretical knowledge and relevant practical experience are needed. The authors therefore believe that, in future, the classes should be organized in smaller groups with step-by-step demonstrations of individual procedures in handling a CVC, and the students encouraged to learn as actively as possible.
Stpahylococcus aureus biofilms on central venous haemodialysis catheters
Aoki, Elisabeth Eyko;Pizzolitto, Antonio Carlos;Garcia, Lourdes Botelho;Pizzolitto, Elisabeth Loshchagin;
Brazilian Journal of Microbiology , 2005, DOI: 10.1590/S1517-83822005000400007
Abstract: biofilm bacterial infections are common in patients undergoing treatment with haemodialysis. this study involved 16 patients (7 males, 9 females; ages from 22 to 81 with an average age of 50) who had had a total of 25 temporary haemodialysis polyurethane catheter insertions into the subclavian vein (22 dual-lumen and 3 triple-lumen). the catheters remained in place from 3 to 91 days, on an average of 47 days. the reasons for catheter removal were: bad functioning (44%), suspicion of catheter-related infection (20%), availability of permanent access (16%), accidental removal (12%), signs and symptoms of infection at the site of catheter insertion (4%), and exogenous contamination (4%). positive tip cultures were observed on seven of the catheters (28%), showing three positive blood cultures. the staphylococcus aureus were identified in 12% of the blood cultures and isolated from one of the hubs, and biofilms were observed on all catheter tips. the s. aureus retrieved from both blood and catheters (tips and hubs) were resistant to penicillin and susceptible to azithromycin, ciprofloxacin, clindamycin, chloramphenicol, gentamicin, oxacillin, rifampin, sulfamethoxazole, tetracycline, and vancomycin. the s. aureus strains isolated from both blood and catheters (tips and hubs) were considered to be identical based on antibiotic susceptibility patterns and genetic similarity assessed using an automated ribotyping system.
Adverse Events Related to the Use of Central Venous Catheters in Hospitalized Newborns
Franceschi, Alessandra Tomazi;Cunha, Maria Luzia Chollopetz da;
Revista Latino-Americana de Enfermagem , 2010, DOI: 10.1590/S0104-11692010000200009
Abstract: this study identifies the adverse events related to the use of central venous catheters (cvc) in newborns admitted to a neonatal care unit. this is a quantitative, descriptive and retrospective study. the population consisted of 167 newborns admitted in the neonatal unit of the hospital de clínicas at porto alegre, rs, brazil which used cvcs inserted through percutaneous puncture (picc) and surgical insertion, totaling 241 catheters. there was a higher prevalence of mechanical adverse events in the picc line insertions, with a preponderance of catheter occlusions (19.44%) and ruptures (8.8%). the surgically inserted cvcs had a higher prevalence of catheter-related infectious adverse events with the most common being clinical sepsis (16%). this study suggests that the correct insertion technique should be used and a specialized team should monitor the cvcs to ensure safety and prevent adverse events.
Risk factors for the appearance of central venous catheters colonization  [PDF]
Mioljevi? Vesna,?uljagi? Vesna,Jovanovi? Biljana,Gligorijevi? Jelena
Vojnosanitetski Pregled , 2007, DOI: 10.2298/vsp0711760m
Abstract: Introduction/Aim. Intravascular device placement (IVD) is a part of everyday medical practice, however, its application is associated with a high risk of onset of nosocomial infections (NI) and increased mortality and morbidity. Nosocomial blood infections (NBIs) account for 10% of all the registered NI. NBIs are more frequent in patients with a placed IVD and it present an important risk factor for the onset of NBI, i.e. catheter-associated NBIs (CANBIs). Pathogenesis of CANBIs is complex and conditioned by the presence of different characteristics related to a catheter, patient and a specific causative organism. The most common CRBSI causes include coagulase-negative staphylococcus, S. aureus, Enterobacter spp, Candida spp, Klebsiella spp, Pseudomonas spp. and Enterococcus spp. Methods. All the patients hospitalized at the Intensive Care Department of the Clinic of Digestive Diseases over the period January 1, 2004-September 1, 2004 were retrospectively analyzed. The study included 107 patients in whom central venous catheter (CVC) was placed for more than 48 h. All the causes isolated from a CVC segment were recorded. Culture, isolation and identification of the causative organisms were performed using standard microbiological methods in the Bacteriological Laboratory within the Emergency Center, Clinical Center of Serbia. Catheter segment samples (tip of the CVC 3-5 cm long) were analyzed. Based on the insight into medical documentation, patients’ examination and medical staff interview, catheter and patient-related characteristics were recorded. Results. A total of 107 CVCs were analyzed, out of which 56 (52%) were sterile while 51 (48%) were colonized. The results of our study evidenced that total parenteral nutrition (TPN) (p < 0.05), number of catheterization days (p < 0.05), and central venous pressure measurement (p < 0.05) were significantly associated with CVC colonization. In this study, no statistically significant difference in catheter colonization was found with respect to sex, age, anatomical insertion site and CVC placement site. Conclusion. According to the results of our study, TPN, the number of catheterization days and measurement of central venous pressure play major roles in colonization of CVC. Understanding risk factors associated with CVC colonization and onset of CANBIs is a prerequisite for quality preventive work of health professionals.
Pleural drainage using central venous catheters
Kulgit Singh, Shi Loo, Rinaldo Bellomo
Critical Care , 2003, DOI: 10.1186/cc2393
Abstract: A prospective observational study was performed in two intensive care units of university-affiliated hospitals. The study involved 10 intensive care unit patients with non-loculated large effusions. A 16 G central venous catheter was inserted at the bedside without ultrasound guidance using the Seldinger technique. The catheter was left in situ until radiological resolution of the effusion.Fifteen sets of data were obtained. The mean and standard deviation of the volumes drained at 1, 6 and 24 hours post catheter insertion were 454 ± 241 ml, 756 ± 403 ml and 1010 ± 469 ml, respectively. The largest volume drained in a single patient was 6030 ml over 11 days. The longest period for which the catheter remained in situ without evidence of infection was 14 days. There were no instances of pneumothorax, hemothorax, re-expansion pulmonary edema and catheter blockage/ disconnections.The use of an indwelling 16 G central venous catheter is efficacious in draining uncomplicated large pleural effusions. It is well tolerated by patients and is associated with minimal complications. It has the potential to avoid repeated thoracentesis or the use of large-bore chest tubes.A recent study confirmed the high incidence of pleural effusions in patients in the intensive care unit (ICU). Using criteria based on the physical examination and evaluation of chest radiographs, an annual incidence of 8.4% was recorded [1]. This incidence would probably be higher if diagnostic modalities such as ultrasound were employed [2]. The presence of a pleural effusion has diagnostic and therapeutic implications [3]. Large effusions can compress the underlying lung, resulting in atelectasis and impaired gas exchange. This may precipitate the need for invasive mechanical ventilation or may delay endotracheal decannulation.Current common practices to drain uncomplicated pleural effusions include thoracentesis via small gauge needles or trocar/venulae systems, or the use of large-bore chest tubes placed a
The influence of hand hygiene prior to insertion of peripheral venous catheters on the incidence of complications
Wewalka, Günther
GMS Krankenhaushygiene Interdisziplin?r , 2007,
Abstract: Using two studies of a simple design it has been possible to furnish proof of the influence of hand hygiene prior to insertion of peripheral venous catheters on the incidence of complications. In the first study detailed data were collected anonymously for each patient on the procedure used for catheter insertion or on any complications. Data were collected for around 64% of patients in one hospital. Evaluation of the questionnaires revealed that there was a significant increase in the incidence of complications in line with an increasing duration of the indwelling period of between 24 and 96 hours. The unexpected finding of this evaluation study was that in the case of catheters with an indwelling period of more than two days there were highly significantly lower complication rates in those cases in which hand disinfection was carried out or gloves donned before catheter placement. The second study, based on the former, documented the cases giving rise to complications. The proportion of peripheral venous catheters implicated in complications was 24%. Here, too, there was a sharp rise in the risk of complications in line with the duration of the indwelling period. Catheters placed in the OR during the patient’s hospital stay showed a significantly lower risk of complications than those inserted on wards, or even in the outpatient department. Conductance of hygienic hand disinfection or the wearing of disposable gloves resulted in significantly lower complication rates compared to normal handwashing or omission of a hand hygiene measure. The most plausible explanation for this positive effect exerted by the wearing of disposable gloves or conductance of hygienic hand disinfection prior to catheter placement is that there was no recontamination during repalpation, as often seen, of the prepared venepuncture site.
Should central venous catheters be used to drain pleural effusions? Authors' response
Kulgit Singh, Shi Loo, Rinaldo Bellomo
Critical Care , 2003, DOI: 10.1186/cc2448
Abstract: We share MacDuff and Grant's views on the need to practice safely in the current medico-legal climate. Our management is frequently influenced by the need to be seen to be medico-legally correct. This, however, has probably resulted in the increased per-patient care cost. We find this to be especially true in the use of specially designed equipment whose usage levels are fairly low. In the case of the two catheter systems mentioned by MacDuff and Grant, the prices quoted in Singapore are between eight and 10 times higher than the cost of the single lumen central lines described.We intuitively agree that these catheters with the multiple drainage lumens have a lower risk of catheter blockage compared with the central venous catheters. We are not, however, aware of any published literature that ascertains this. We have not experienced any catheter blockage with the catheters we use despite seeing fibrinous material in the drainage bag.We have been caught by surprise at the number of readers who accessed this article, perhaps because this is an Open Access article. A number of these readers may work in financially stretched healthcare systems. We hope that by sharing our experience this technique may prove useful when it is difficult to procure specially designed sets, either because they are expensive or because they are not readily available. We caution readers, however, to select their patients carefully and to monitor the efficacy of the placement of these catheters. We do not advocate using this technique for the drainage of haemothoraces or empyemas.
Should central venous catheters be used to drain pleural effusions?
Andrew MacDuff, Ian S Grant
Critical Care , 2003, DOI: 10.1186/cc2447
Abstract: We agree that the use of small-bore catheters has a number of advantages compared with repeated thoracocentesis or the use of traditional large-bore drains inserted by blunt dissection. Indeed, recent guidelines [2] support the use of smaller bore tubes (8–14 Fr; except for haemothorax) in both pleural effusions and pneumothorax.However, we have reservations regarding the routine use of central venous catheters to drain pleural effusions. Several manufacturers (including the Sims-Portex Seldinger Chest Drainage Kit and Cook Quick-Thal Chest Tube) have specific chest drainage systems that take advantage of the Seldinger dilator over a wire method of insertion. These have the advantage of having a number of side ports (two to four), which reduces the possibility of blockage by debris, and they are available in a range of sizes (8–36 Fr).While we applaud innovation, in today's medico-legal climate it is surely wiser to use specifically designed equipment if it is available.
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