scholarly journals Ultrasonographic evaluation of deep vein thrombosis related to the central catheter in hemodialytic patients

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Ana Luisa Silveira Vieira ◽  
José Muniz Pazeli Júnior ◽  
Andrea Silva Matos ◽  
Andreza Marques Pereira ◽  
Izadora Rezende Pinto ◽  
...  
Keyword(s):  
Medical Students ◽  
Central Venous Catheter ◽  
Color Doppler ◽  
Venous Catheter ◽  
Routine Practice ◽  
Point Of Care Ultrasound ◽  
Practical Training ◽  
Central Venous ◽  
Compression Technique ◽  
Doppler Study

Abstract Background Point of care ultrasound (PoCUS) is a useful tool for the early diagnosis of thrombosis related to the central venous catheter for dialysis (TR-CVCd). However, the application of PoCUS is still not common as a bedside imaging examination and TR-CVCd remains often underdiagnosed in the routine practice. The aim of this study was to investigate if a compression technique for the diagnosis of TR-CVCd blindly performed by PoCUS experts and medical students is accurate when compared to a Doppler study. Methods Two medical students without prior knowledge in PoCUS received a short theoretical–practical training to evaluate TR-CVCd of the internal jugular vein by means of the ultrasound compression technique. After the training phase, patients with central venous catheter for dialysis (CVCd) were evaluated by the students in a private hemodialysis clinic. The results were compared to those obtained on the same population by doctors with solid experience in PoCUS, using both the compression technique and the color Doppler. Results Eighty-one patients were eligible for the study and the prevalence of TR-CVCd diagnosed by Doppler was 28.4%. The compression technique performed by the students and by experts presented, respectively, a sensitivity of 59.2% (CI 51.6–66.8) vs 100% and a specificity of 89.6% (CI 84.9–94.3) vs 94.8% (CI 91.4–98.2). Conclusion The compression technique in the hands of PoCUS experts demonstrated high accuracy in the diagnosis of TR-CVCd and should represent a standard in the routine examination of dialytic patients. The training of PoCUS inexperienced students for the diagnosis of TR-CVCd is feasible but did not lead to a sufficient level of sensitivity.

scholarly journals Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

2021 ◽  
Vol 10 (4) ◽  
pp. e001222
Author(s):  
Enyo A Ablordeppey ◽  
Byron Powell ◽  
Virginia McKay ◽  
Shannon Keating ◽  
Aimee James ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Acute Care ◽  
Imaging Modality ◽  
Phase 1 ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
X Ray ◽  
Chest X Ray ◽  
Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

Competence of the Internal Jugular Vein Valve Is Damaged by Cannulation and Catheterization of the Internal Jugular Vein

2000 ◽  
Vol 93 (2) ◽  
pp. 319-324 ◽  
Author(s):  
Xianren Wu ◽  
Wolfgang Studer ◽  
Thomas Erb ◽  
Karl Skarvan ◽  
Manfred D. Seeberger
Keyword(s):  
Central Venous Catheter ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Color Doppler ◽  
Venous Catheter ◽  
Color Doppler Ultrasound ◽  
Surgical Patients ◽  
Venous Cannulation ◽  
Central Venous ◽  
Distal Site

Background Experimental results suggest that the competence of the internal jugular vein (IJV) valve may be damaged when the IJV is cannulated for insertion of a central venous catheter. It has further been hypothesized that the risk of causing incompetence of the proximally located valve might be reduced by using a more distal site for venous cannulation. The present study evaluated these hypotheses in surgical patients. Methods Ninety-one patients without preexisting incompetence of the IJV valve were randomly assigned to undergo distal or proximal IJV cannulation (> or = 1 cm above or below the cricoid level, respectively). Color Doppler ultrasound was used to study whether new valvular incompetence was present during Valsalva maneuvers after insertion of a central venous catheter, immediately after removal of the catheter, and, in a subset of patients, several months after catheter removal, when compared with baseline findings before cannulation of the IJV. Results Incompetence of the IJV valve was frequently induced both by proximal and distal cannulation and catheterization of the IJV. Its incidence was higher after proximal than after distal cannulation (76% vs. 41%; P < 0.01) and tended to be so after removal of the catheter (47% vs. 28%; P = 0.07). Valvular incompetence persisting immediately after removal of the catheter did not recover within 8-27 months in most cases. Conclusions Cannulation and catheterization of the IJV may cause persistent incompetence of the IJV valve. Choosing a more distal site for venous cannulation may slightly lower the risk of causing valvular incompetence but does not reliably avoid it.

Point of care ultrasound: Central venous catheter positioning and pneumothorax search

2017 ◽  
Vol 42 ◽  
pp. 413
Author(s):  
Alejandro Enrique Barba Rodas ◽  
Alexandre Francisco Silva ◽  
Ana Beatriz Sorbile Veiga Ancora da Luz
Keyword(s):  
Central Venous Catheter ◽  
Point Of Care ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous

scholarly journals Point‐of‐care Ultrasound–guided Central Venous Catheter Confirmation in Ultrasound Nonexperts

2020 ◽  
Author(s):  
Enyo A. Ablordeppey ◽  
Anne M. Drewry ◽  
Adam L. Anderson ◽  
Diego Casali ◽  
Laura A. Wallace ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Point Of Care ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Ultrasound Guided ◽  
Central Venous

Point-of-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis

2020 ◽  
Vol 21 (6) ◽  
pp. 923-930
Author(s):  
George N Coritsidis ◽  
Orlando N Machado ◽  
Farzin Levi-Haim ◽  
Sean Yaphe ◽  
Roshan A Patel ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Arteriovenous Fistula ◽  
Point Of Care ◽  
Demographic Data ◽  
Venous Catheter ◽  
Fisher Exact Test ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Exact Test ◽  
Central Venous Catheter Removal

Background: Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. Methods: Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis. Results: A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound. Conclusion: Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.

Peripherally Inserted Central Venous Catheter in Upper Extremities Could be a Risk for Deep Vein Thrombosis in Lower Extremities and D-Dimer in Neurology Department

2020 ◽  
Author(s):  
Wanli Liu ◽  
Lianxiang He ◽  
Wenjing Zeng ◽  
Liqing Yue ◽  
Jie Wei ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Predictive Value ◽  
Color Doppler ◽  
Venous Catheter ◽  
Upper Extremities ◽  
Central Venous ◽  
Related Factors ◽  
D Dimer

Abstract Background: With the in-depth study of Peripherally Inserted Central venous Catheter (PICC) related venous thrombosis, it is found that the incidence of lower extremity deep venous thrombosis (LEDVT) in patients with PICC in upper extremities is higher than that in patients without PICC . However, there is no explanation for this clinical phenomenon that PICC related venous thrombosis seems to have exceeded the range of PICC travel . The purpose of this study is to elucidate this association between PICC in upper extremities and LEDVT by observing the changes of D-dimer . Methods: This was a retrospective cohort study of adults in Neurology department who underwent Color Doppler ultrasound and D-dimer test between 1 April 2017 to 1 April 2020. We analyzed the related factors of LEDVT and the change of D-dimer value, compared the changes of D-dimer before and after PICC insertion, and evaluated the predictive value of D-dimer in patients with and without PICC. Results: ① It was found that the presence of PICC increased the risk of lower extremity venous thrombosis by 7 times (OR = 7.048 [95% CI: 4.486-11.074]; ②It was found that the presence of PICC promoted the increase of D-dimer value (OR = 5.133 [95% CI: 3.072-8.575]). ③ For patients without LEDVT, the level of D-dimer in patients with PICC was higher than that in patients without PICC (P < 0.05). ④ The level of D-dimer after PICC insertion was significantly higher than that before PICC insertion(P < 0.05). ⑤ In patients with PICC, the AUC value of D-dimer in the diagnosis of LEDVT was 0.657 (95% CI: 0.549-0.765), and the negative predictive value was 82.35%.Conclusion:PICC insertion may increase the level of D-dimer and become an important risk factor of LEDVT; For patients with PICC , D-dimer value is not suitable to rule out LEDVT.

scholarly journals Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound

Shock ◽  
2019 ◽  
Vol 51 (5) ◽  
pp. 613-618 ◽  
Author(s):  
Enyo A. Ablordeppey ◽  
Anne M. Drewry ◽  
Daniel L. Theodoro ◽  
LinLin Tian ◽  
Brian M. Fuller ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Point Of Care ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Catheter Position ◽  
Current Practices

scholarly journals Study Protocol for Draup: De-implementation Ofroutine Chest Radiographs After Adoption of Ultrasound Guided Insertion and Confirmation of Central Venous Catheter Protocol, A Hybrid Implementation/effectiveness Study

2020 ◽  
Author(s):  
Enyo A. Ablordeppey ◽  
Byron J. Powell ◽  
Virginia R. McKay ◽  
Shannon M. Keating ◽  
Aimee S. James ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Focus Groups ◽  
Imaging Modality ◽  
Point Of Care ◽  
Implementation Strategies ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Medical Overuse ◽  
Chest X Ray

Abstract BACKGROUNDAvoiding low value medical practices is an important focus in current healthcare utilization. Despite advantages of point of care ultrasound (POCUS) over chest x-ray (CXR), including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation and exclusion of pneumothorax (PCEP) has had slow rate of adoption. This demonstrates a gap that is ripe for the development and application of de-implementation strategies that support substitution of POCUS for CXR after CVC insertion.METHODSDe-implementation of routine chest radiographs after adoption of ultrasound guided insertion and confirmation of central venous catheter protocol (DRAUP) will be created to de-implement an unnecessary imaging modality in the critical care environment. Guided by the Consolidated Framework for Implementation Research constructs, we will explore barriers and facilitators of POCUS for CVC PCEP in a single center, large tertiary, academic hospital via focus groups. The focus groups will inform the development and testing of strategies that address identified determinants of implementation and de-implementation.Operational use of the de-implementation strategies will be conceptualized using Morgan’s framework for understanding and reducing medical overuse. We will locally implement these strategies and assess them using Proctor’s outcomes (adoption, de-adoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on our selected implementation and de-implementation strategies. Secondary outcomes will include POCUS-guided CVC PCEP efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS detection.DISCUSSIONWith limited data available to inform interventions that use concurrent implementation and de-implementation strategies to substitute CXR for POCUS using DRAUP, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that would expand the knowledge of replacing low value or unnecessary care in critically ill patients. Trial Registration: ClinicalTrials.gov Identifier, NCT04324762, Registered on 27 March 2020

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