scholarly journals Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253243
Author(s):  
Amit Bahl ◽  
Steven Johnson ◽  
Nicholas Mielke ◽  
Patrick Karabon
Keyword(s):  
Early Recognition ◽  
Strong Predictor ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Intravenous Catheter ◽  
Clinical Exam ◽  
Subcutaneous Edema ◽  
Increased Risk ◽  
Peripheral Intravenous Catheter

Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient’s vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.

scholarly journals Identifying Predictors of Peripheral Intravenous Catheter Failure Using a Novel Combination of Clinical and Ultrasonographic Assessments

2021 ◽  
Author(s):  
Amit Bahl ◽  
Steven Johnson ◽  
Nicholas Mielke ◽  
Patrick Karabon
Keyword(s):  
Large Scale ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intravenous Catheter ◽  
Subcutaneous Edema ◽  
Peripheral Intravenous Catheter ◽  
Catheter Failure ◽  
Underlying Mechanisms

Abstract Objective:Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify factors that predict premature PIVC failure.Methods:We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary goal was to identify demographic, clinical, and PIVC related variables that predicted PIVC failure. Univariate and multivariate analyses were employed to identify risk factors for PIVC failure.Results:In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of subcutaneous edema [AOR 8.29 (1.50, 45.8) p = 0.0153], an above average neutrophil to lymphocyte (N:L) ratio [AOR 4.63 (1.06, 20.3) p = 0.0422], and the administration of an irritant/vesicant [10.3 (1.46, 72.6) p = 0.0.192] were associated with increased likelihood of premature PIVC failure. Conclusions:PIVC failure is related to clinical and ultrasonographic variables associated with inflammation: elevated N:L ratio, use of caustic medications, and presence of subcutaneous edema on ultrasound. Reducing inflammation of the vein may lead to better PIVC survival outcomes. Further large-scale randomized controlled trials are needed to validate and build upon the concepts in this study.

scholarly journals Ultrasonographic Classification of Subcutaneous Edema Caused by Infusion via Peripheral Intravenous Catheter

2016 ◽  
Vol 24 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Koichi Yabunaka ◽  
Ryoko Murayama ◽  
Hidenori Tanabe ◽  
Toshiaki Takahashi ◽  
Makoto Oe ◽  
...  
Keyword(s):  
Intravenous Catheter ◽  
Subcutaneous Edema ◽  
Peripheral Intravenous Catheter

Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Davide Cao ◽  
Matthew A Levin ◽  
Samantha Sartori ◽  
Anastasios Roumeliotis ◽  
Rishi Chandiramani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Bleeding Events ◽  
Target Vessel Revascularization ◽  
Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

Peripheral Intravenous Access: Applying Infusion Therapy Standards of Practice to Improve Patient Safety

2019 ◽  
Vol 39 (1) ◽  
pp. 61-71 ◽  
Author(s):  
Barb Nickel
Keyword(s):  
Early Recognition ◽  
Improve Patient Safety ◽  
Hospital Setting ◽  
Infusion Therapy ◽  
Intravenous Catheter ◽  
Intravenous Access ◽  
Standards Of Practice ◽  
Peripheral Intravenous Catheter ◽  
Therapy Standards ◽  
Peripheral Intravenous Access

The most common invasive procedure performed in the hospital setting worldwide is the insertion of a peripheral intravenous catheter. Although use of peripheral intravenous access is common, its presence is far from benign, with a reported 35% to 50% failure rate, even in facilities with a dedicated infusion team. Significant complications related to the presence of a peripheral intravenous site include localized infection, bacteremia, phlebitis, and infiltration or extravasation. Consistent application of evidence-based standards of practice in all aspects of peripheral intravenous catheter care is essential to provide infusion therapy that delivers safe and quality care. Management of peripheral intravenous access in the complex setting of critical care is examined in this article. A case study approach is used to illustrate application of infusion therapy standards of practice in peripheral intravenous catheter insertion, indications for catheter placement, and assessment parameters to enhance early recognition of peripheral intravenous access–related complications.

scholarly journals Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

2015 ◽  
Vol 123 (6) ◽  
pp. 1301-1311 ◽  
Author(s):  
Felix Kork ◽  
Felix Balzer ◽  
Claudia D. Spies ◽  
Klaus-Dieter Wernecke ◽  
Adit A. Ginde ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Hospital Length ◽  
Noncardiac Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Risk Of Death ◽  
Postoperative Changes ◽  
Increased Risk

Abstract Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P &lt; 0.001) and a longer HLOS of 5 days (P &lt; 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but &lt; 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P &lt; 0.001) and 2 days longer HLOS (P &lt; 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P &lt; 0.05) and a 3-day longer HLOS (P &lt; 0.01) when undergoing noncardiac surgery. Conclusions Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes.

scholarly journals Morbidity and mortality of serious gastrointestinal complications after lung transplantation

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Annette Zevallos-Villegas ◽  
Rodrigo Alonso-Moralejo ◽  
Félix Cambra ◽  
Ana Hermida-Anchuelo ◽  
Virginia Pérez-González ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Early Recognition ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Survival Function ◽  
Survival Rates ◽  
Late Complications ◽  
Morbidity And Mortality ◽  
Gastrointestinal Complications ◽  
Increased Risk

Abstract Background Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. Methods We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. Results There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). Conclusions SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.

Psoriasis does not worsen outcomes in patients admitted for ischemic stroke: an analysis of the National Inpatient Sample

2021 ◽  
pp. jim-2020-001678
Author(s):  
Ehizogie Edigin ◽  
Subuhi Kaul ◽  
Precious Obehi Eseaton ◽  
Pius Ehiremen Ojemolon ◽  
Axi Patel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Linear Regression Analysis ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Secondary Outcome ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Increased Risk

Psoriasis is a chronic inflammatory state associated with an increased risk of cardiometabolic diseases, stroke, and mortality. Although psoriasis increases the risk of ischemic stroke, whether outcomes, including mortality, are adversely affected is unknown.This study aims to compare inpatient mortality of patients admitted for ischemic stroke with and without psoriasis. The secondary outcome measures were hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator (TPA), and mechanical thrombectomy between both groups.Data were obtained from the National Inpatient Sample (NIS) 2016 and 2017 databases using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariable logistic and linear regression analysis were used accordingly to account for confounders of the outcomes.The combined 2016 and 2017 NIS database comprised over 71 million discharges. Of these, ischemic stroke accounted for 525,570 hospitalizations and 2425 (0.5%) had a concomitant diagnosis of psoriasis. Patients hospitalized for ischemic stroke with coexisting psoriasis did not have a difference in inpatient mortality (3.5% vs 5.5%; p=0.285) compared with those without psoriasis. However, psoriasis cohort had shorter LOS (5.0 vs 5.7 days; p=0.029) and lower total hospital charges ($60,471 vs $70,246; p=0.003) compared with the non-psoriasis cohort. The odds of receiving TPA and undergoing mechanical thrombectomy were not different in both groups.Inpatient mortality, odds of receiving TPA, and undergoing mechanical thrombectomy in patients who had an ischemic stroke with or without psoriasis were not different. However, patients with psoriasis had a significantly shorter LOS and lower hospital charges.

scholarly journals Factors Associated with Prolonged Hospital Length of Stay in Adults with Imported Falciparum Malaria—An Observational Study from a Tertiary Care University Hospital in Berlin, Germany

2021 ◽  
Vol 9 (9) ◽  
pp. 1941
Author(s):  
Bodo Hoffmeister
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Falciparum Malaria ◽  
Early Recognition ◽  
Tertiary Care ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Acute Pulmonary Oedema ◽  
Factors Associated

Outcome of falciparum malaria is largely influenced by the standard of care provided, which in turn depends on the available medical resources. Worldwide, the COVID-19 pandemic has had a major impact on the availability of these resources, even in resource-rich healthcare systems such as Germany’s. The present study aimed to determine the under-explored factors associated with hospital length of stay (LOS) in imported falciparum malaria to identify potential targets for improving management. This retrospective observational study used multivariate Cox proportional hazard regression with time to discharge as an endpoint for adults hospitalized between 2001 and 2015 with imported falciparum malaria in the Charité University Hospital, Berlin. The median LOS of the 535 cases enrolled was 3 days (inter-quartile range, IQR, 3–4 days). The likelihood of being discharged by day 3 strongly decreased with severe malaria (hazard ratio, HR, 0.274; 95% Confidence interval, 95%CI: 0.190–0.396) and by 40% with each additional presenting complication (HR, 0.595; 95%CI: 0.510–0.694). The 55 (10.3%) severe cases required a median LOS of 7 days (IQR, 5–12 days). In multivariate analysis, occurrence of shock (adjusted HR, aHR, 0.438; 95%CI 0.220–0.873), acute pulmonary oedema or acute respiratory distress syndrome (aHR, 0.450; 95%CI: 0.223–0.874), and the need for renal replacement therapy (aHR, 0.170; 95%CI: 0.063–0.461) were independently associated with LOS. All patients survived to discharge. This study illustrates that favourable outcomes can be achieved with high-standard care in imported falciparum malaria. Early recognition of disease severity together with targeted supportive care can lead to avoidance of manifest organ failure, thereby potentially decreasing LOS and alleviating pressure on bed capacities.

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