1,720,967 research outputs found
Ultrasound-guided deep-arm veins insertion of long peripheral catheters in patients with difficult venous access after cardiac surgery
No full textObjectives To analyze success rate, dwell-time, and complications of long peripheral venous catheters (L-PVCs) inserted under ultrasound guidance. Background In difficult venous access (DVA) patients, L-PVC can represent an alternative to central or midline catheters. Methods Prospective observational study. L-PVCs were positioned in DVA patients. The outcome of the cannulation procedure and the times and reasons for catheters removal were analyzed. Results A 100% placement success rate was documented. The catheter dwell-time was 14.7 ± 11.1 days. Most catheters were removed at end-use in the absence of complications. The rate of catheters appropriately or inappropriately removed before completing the intravenous therapies was 27.7/1000 catheter-days. Two thrombophlebitis (1.91/1000 catheter-days) and 1 catheter-related bloodstream infection (0.96/1000 catheter-days) occurred. Conclusions L-PVC could be a viable solution in DVA patients, as it may reduce the need for multiple vein punctures, patients' discomfort, and nursing workload. A better adherence to catheter management recommendations should further reduce complications
Complications associated to midline- and long peripheral catheters in adults. Systematic review of literature and proposal for a standardized model for data collection
Full text linkIntroduction: Long peripheral catheters (LPCs) and midline catheters (MCs) are indiscriminately labelled with different names, leading to misclassifications both in primary and secondary studies. The available studies used different methods to report the incidence of catheter-related complications, affecting the possibility of properly comparing the catheter outcomes. The aim of this review was to explore the complications related to LPCs and MCs after reclassifying according to their length. Methods: Systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted on PubMed, Scopus and CINAHL databases. The study protocol was registered in the International Prospective Register of Systematic Reviews. Data regarding LPCs and MCs were compared. Catheter outcomes were classified into major and minor complications, recomputed and reported as cases/1000 catheter-days. Results: Fourteen studies were included. Over-half of the devices were correctly labelled by the authors, misclassifications affected particularly LPCs improperly labelled MCs. The cumulative incidence of catheter-related bloodstream infections was 0.3 and 0.4/1000 catheter-days, that of symptomatic catheter-related thrombosis was 0.9 and 1.8/1000 catheter-days for MCs and LPCs, respectively. Minor complications and catheter failure were higher for LPCs. Conclusions: A misclassification exists in the labelling of MCs and LPCs. A widespread heterogeneity of diagnostic criteria adopted to classify the catheters' outcomes was found, exposing the risk of misestimating the incidence of complications and undermining the possibility of effectively comparing results of the published research. We proposed a list of definitions and relevant variables as a first step toward the development of standardized criteria to be adopted for research purposes
The dark side of the fibroblastic sleeve: Case report and literature review
No full textThe fibroblastic sleeve is a structure potentially enveloping any intravascular device. At ultrasound scan, it typically presents as a thin layer of variably echogenic material covering the catheter surface, which usually tends to remain into the vessel after the catheter removal. However, several case reports have documented its migration toward the heart or pulmonary artery after a central venous catheter removal. No case of fibroblastic sleeve embolization has ever been documented after a peripheral catheter removal. Here we report the case of a 76-year-old woman with a 3 Fr/20 cm polyurethane midline catheter on which the development of a surrounding fibroblastic sleeve was documented during serial, routine ultrasound follow-up. A few minutes after the catheter removal, a 7 cm-echogenic floating mass attached to the anterior leaflet of the tricuspid valve—which was absent the days before—was noticed by a routinely-planned transthoracic cardiac ultrasonography. Due to the very close interval between the catheter removal and the appearance of the tricuspidal mass, together with the disappearance of the fibroblastic sleeve from the cannulated vein, the ultrasound finding was attributed to the acute embolization of the fibroblastic sleeve. No respiratory, cardiovascular, or septic complication was documented in the following weeks, during which the fibroblastic tricuspidal mass progressively reduced and completely disappeared after 45 days. Despite being an extremely frequent and totally expected occurrence associated to any intravascular device, fibroblastic sleeve may occasionally lead to potentially serious complications. An accurate ultrasound follow-up of catheters positioned either in central or in deep peripheral veins should be recommended to monitor the development and the evolution of a fibroblastic sleeve or thrombosis, both during the catheter dwelling time and after its removal
The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters
No full textBackground: In patients requiring a peripheral venous access for more than seven days, long peripheral catheters (LPCs) or midline catheters (MCs) are recommended. Since MCs and LPCs share many characteristics, studies comparing devices made of the same biomaterial are needed. Moreover, a catheter-to-vein ratio >45% at the insertion point has been recognized as a risk factor for catheter related complications, but no study investigated the effect of the catheter-to-vein ratio at the catheter tip level in peripheral venous devices.
Objectives: To compare the catheter failure risk between polyurethane MCs and LPCs, considering the effect of the catheter-to-vein ratio at the tip location.
Methods: Retrospective cohort study. Adult patients having an expected need for a vascular access of more than 7 days and receiving either a polyurethane LPC or MC were included. The catheter uncomplicated indwelling time within 30 days was considered in survival analysis.
Results: In a sample of 240 patients, the relative incidences of catheter failure were 5.13 and 3.40 cases for 1,000 catheter days for LPCs and MCs, respectively. In univariate Cox regression, MCs were associated to a statistically significant lower risk of catheter failure (HR 0.330; p = 0.048). After adjusting for other relevant conditions, a catheter-to-vein ratio >45% at the catheter tip location not the catheter itself was an independent predictor of a catheter failure (HR 6.762; p = 0.023).
Conclusions: The risk of catheter failure was strongly associated with a catheter-to-vein ratio > 45% at the catheter tip level, irrespective for having used a polyurethane LPC or MC
Tunnelling a midline catheter: When the traffic light shifts from yellow to green
No full textIntroduction: A safe, largely used practice for difficult venous access patients is positioning a catheter in deeper veins under ultrasound guide. However, the risk of complications is increased when there is a high catheter-to-vein ratio or when the insertion site is in a zone with particular anatomical/physiological characteristics. Case description: A 60-year-old woman admitted to a post-operative intensive care unit after cardiac surgery had a complicated post-operative course. After the removal of a central venous catheter, it was necessary to insert a midline catheter. A complete ultrasound evaluation showed that only the axillary vein was suitable for direct cannulation. To avoid creating an exit site in the axillary cavity, the decision was made to tunnel the catheter to locate an exit site in a safer position. A guidewire was introduced through a needle in the axillary vein. A tunnel was created using a subcutaneous injection of lidocaine. A 14 G/13.3 cm peripheral venous catheter was inserted in the subcutaneous tract. A 4 Fr/20 cm catheter was introduced through the peripheral venous catheter and moved to the axillary vein through the previously inserted sheath. No acute complications occurred. The catheter was accessed several times a day during the period following its insertion to infuse drugs and take blood samples. It was removed 50 days after its placement because it was no longer needed. No symptomatic thrombosis or infections occurred. Conclusion: The placement of the tunnelled midline catheter is shown to be a safe and effective way to ensure vascular access for almost 2 months
Commercial vs. Natural Food-based Tube Feeding on Diarrhea Incidence in Critically Ill Cardiac Surgery Patients (P12-030-19)
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Predictors of extubation failure after open-chest cardiac surgery based on routinely collected data. The importance of a shared interprofessional clinical assessment
No full textBackground: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. Aim: To identify variables that are predictive of ExtF and related outcomes. Method: Prospective observational longitudinal study. Consecutively presenting patients (n=205) undergoing open-heart cardiac surgery and admitted to the Cardiosurgical Intensive Care Unit (CICU) were recruited. The clinical data were collected at CICU admission and immediately prior to extubation. ExtF was defined as the need to restart invasive or non-invasive mechanical ventilation while the patient was in the CICU. Results: The ExtF incidence was 13%. ExtF related significantly to hospital mortality, CICU length of stay and total hospital length of stay. The risk of ExtF decreased significantly, by 93% in patients with good neurological function and by 83% in those with a Rapid Shallow Breathing Index of ≥57 breaths/min per litre. Conversely, ExtF risk increased 27 times when the PaO2/FiO2 was <150 and 11 times when it was ≥450. Also, a reassuring PaO2/FiO2 value may hide critical pulmonary or extra-pulmonary conditions independent from alveolar function. Conclusion: The decision to extubate patients should be taken after thoroughly discussing and combining the data derived from nursing and medical clinical assessments. Extubation should be delayed until the patient achieves safe respiratory, oxygenation and haemodynamic conditions, and good neurocognitive function
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