Central venous access in intensive care unit patients: is the subclavian vein the royal route?

Objective: The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU). Methods: Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018–2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU. Results: Placement of ST-FICCs were successful in 100% of neonates ( n = 82/82) with 94% to the right ( n = 77/82) and 6% to the left common femoral veins ( n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr ( n = 80/82), 2.6Fr ( n = 1/82), and 3-Fr ( n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) ( n = 33/82), IVC/right atrial junction ( n = 31/82), or right atrium ( n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins ( n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter. Conclusion: Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

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Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)

British Journal of Nursing ◽

10.12968/bjon.2021.30.8.s37 ◽

2021 ◽

Vol 30 (8) ◽

pp. S37-S42

Author(s):

France Paquet ◽

Janette Morlese ◽

Charles Frenette

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

Blood Stream ◽

Central Line ◽

Surgical Intensive Care Unit ◽

Central Venous ◽

Surgical Intensive Care ◽

Venous Access Devices

This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings. Results: In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

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Catheter Related Blood Stream Infections In Patients Of The Intensive Care Unit

International Archives of Medicine ◽

10.3823/2398 ◽

2017 ◽

Vol 10 ◽

Author(s):

Ana Carolina Coimbra De Castro ◽

Odinéa Maria Amorim Batista ◽

Maria Eliete Batista Moura ◽

Maria Zélia de Araújo Madeira ◽

Layze Braz de Oliveira ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bloodstream Infection ◽

Central Venous Access ◽

Venous Access ◽

Blood Stream ◽

Central Venous ◽

Blood Stream Infections ◽

Skin Antisepsis ◽

Lumen Catheter

Objective: To identify the prevalence of bloodstream infection associated with the Catheter related Blood stream infections in patients of the Intensive Care Unit, and the characteristics of its use and handling. Methods: Descriptive and transversal study with a sample of 88 participants. Data were collected through the observational method and the records in the medical records. The absolute and relative frequencies were used for data analysis. Results: 73.86% of the patients had central venous access in the subclavian vein, 100% used double lumen Catheter related Blood stream infections, 0.5% chlorhexidine solution for skin antisepsis, dressing coverage is performed mostly with Sterile gauze and tape, with a daily exchange. The rate of infection related to the use of the Catheter related Blood stream infections was (6.81%). The most infused pharmacological drugs were antimicrobials (69.32%). Conclusion: The study showed that care with central venous accesses is performed according to recommendations for prevention of bloodstream infection related to the use of these devices. The infection rate is close to the standards found in the literature. Key words: Central Venous Catheterization. Hospital Infection. Intensive care unit. Risk factors. Catheter-Related Infection..

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Ultrasound-Guided Central Venous Access With Different Anesthesia Methods in Neonatal Intensive Care Unit

Cureus ◽

10.7759/cureus.15753 ◽

2021 ◽

Author(s):

Mustafa Okumuş ◽

Adil Umut Zubarioglu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

Ultrasound Guided ◽

Central Venous

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Ultrasound-guided central venous access for patients in the Intensive Care Unit in prone position: report of three cases

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2021.10.008 ◽

2021 ◽

Author(s):

Bruno Manuel Marques Lima ◽

Linda Cheung

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prone Position ◽

Central Venous Access ◽

Venous Access ◽

Ultrasound Guided ◽

Central Venous

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Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report

Oxford Medical Case Reports ◽

10.1093/omcr/omaa066 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Ninadini Shrestha ◽

Utsav Acharya ◽

Pramesh Sunder Shrestha ◽

Subhash Prasad Acharya ◽

Bipin Karki ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Tissue Injury ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

First Report ◽

Resource Limitations ◽

Topical Nitroglycerin

ABSTRACT Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.

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Ultrasound-Guided Central Venous Access Application in the Neonatal and Early Pediatric Intensive Care Unit (Single-Center Experience in 1000 Patients)

10.1055/s-0041-1730647 ◽

2018 ◽

Author(s):

Zeinab Aly Moussa Aly ◽

Karim Abd El Tawab

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Central Venous Access ◽

Pediatric Intensive Care ◽

Venous Access ◽

Single Center ◽

Ultrasound Guided ◽

Central Venous ◽

Single Center Experience

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Reduced Complications of Supraclavicular Approach in Simulated Central Venous Access: Applicability to Military Medicine

Military Medicine ◽

10.1093/milmed/usy381 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 329-334

Author(s):

Joshua Sappenfield ◽

Sasha Grek ◽

Lou Ann Cooper ◽

David E Lizdas ◽

Samsun Lampotang

Keyword(s):

Subclavian Vein ◽

Mixed Reality ◽

Central Venous Access ◽

Military Medicine ◽

Venous Access ◽

Central Venous ◽

Supraclavicular Approach ◽

Anesthesia Providers ◽

Alternative Approach ◽

Simulation Based

Abstract In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonography during the supraclavicular approach to the subclavian vein is also described which may improve its safety profile. This technique could be more appropriate in scenarios when central venous access is preferred over intraosseous access for patients being transported to another location for further care.

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