Vitamin K antagonists in children with central venous catheter on chronic haemodialysis: a pilot study

Background Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition. Method This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush. Results No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators’ diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p < .0001). The RVI-PLAX CEUS was not able to detect two central venous catheter malpositions (one atrial malposition and one left brachiocephalic vein venous catheter malposition). The capillary blood sugar was significantly elevated (8.96 mmol/L vs. 9.75 mmol/L) after D50% flush ( p < 0.005) with no complications reported within 30 minutes after the D50% flush. Conclusion RVI-PLAX view should not be used for guidewire detection. CEUS using D50% and RVI-PLAX view are potentially useful tools in detecting central venous catheter malposition. Further studies comparing them with conventional methods are needed.

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High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology

The Journal of Vascular Access ◽

10.1177/1129729819875323 ◽

2019 ◽

Vol 21 (3) ◽

pp. 336-341

Author(s):

Salvatore Mandolfo ◽

Adriano Anesi ◽

Milena Maggio ◽

Vanina Rognoni ◽

Franco Galli ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Central Venous Catheter ◽

Prognostic Index ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous Catheters ◽

Catheter Removal ◽

Renal Unit ◽

Chronic Haemodialysis ◽

Central Venous

Background: Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks. Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue. Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.

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Is a Central Venous Catheter Necessary for the Perioperative Management of Esophagectomy? A Prospective Randomized Pilot Study Comparing Two Different Perioperative Regimens

Digestive Surgery ◽

10.1159/000446572 ◽

2016 ◽

Vol 33 (6) ◽

pp. 478-487 ◽

Cited By ~ 2

Author(s):

Katsumasa Saito ◽

Yasuaki Nakajima ◽

Kenro Kawada ◽

Yutaka Tokairin ◽

Tatsuyuki Kawano

Keyword(s):

Pilot Study ◽

Central Venous Catheter ◽

Perioperative Management ◽

Venous Catheter ◽

Central Venous

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Allergic contact dermatitis resulting from a poly(carbonate urethane) chronic haemodialysis central venous catheter

Contact Dermatitis ◽

10.1111/cod.12325 ◽

2014 ◽

Vol 72 (2) ◽

pp. 124-126 ◽

Cited By ~ 3

Author(s):

Maria A. Pastor-Nieto ◽

Francisco Alcántara ◽

Adrián Ballano ◽

Aránzazu Vergara ◽

Paulina Belmar ◽

...

Keyword(s):

Contact Dermatitis ◽

Central Venous Catheter ◽

Allergic Contact Dermatitis ◽

Venous Catheter ◽

Chronic Haemodialysis ◽

Central Venous ◽

Allergic Contact ◽

Poly Carbonate

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An endoluminal brush to detect the infected central venous catheter in situ: a pilot study

BMJ ◽

10.1136/bmj.313.7071.1528 ◽

1996 ◽

Vol 313 (7071) ◽

pp. 1528-1529 ◽

Cited By ~ 30

Author(s):

M. J Tighe ◽

P. Kite ◽

W. N Fawley ◽

D. Thomas ◽

M. J McMahon

Keyword(s):

Pilot Study ◽

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous

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Comparative Study of Three Methods for Depth of Central Venous Catheter Placement in Children: An Observational Pilot Study

Turkish Journal of Anesthesia and Reanimation ◽

10.5152/tjar.2018.32748 ◽

2018 ◽

pp. 116-120 ◽

Cited By ~ 2

Author(s):

Vaishali Chaskar ◽

◽

Priyanka Pradeep Karnik ◽

Nandini Malay Dave ◽

Madhu Garasia ◽

...

Keyword(s):

Pilot Study ◽

Central Venous Catheter ◽

Comparative Study ◽

Venous Catheter ◽

Catheter Placement ◽

Central Venous ◽

Central Venous Catheter Placement

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Peripherally Infused Norepinephrine to Avoid Central Venous Catheter Placement in a Medical Intensive Care Unit: A Pilot Study

Annals of Pharmacotherapy ◽

10.1177/10600280211053318 ◽

2021 ◽

pp. 106002802110533

Author(s):

Lara M. Groetzinger ◽

Julia Williams ◽

Susan Svec ◽

Michael P. Donahoe ◽

Phillip E. Lamberty ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pilot Study ◽

Central Venous Catheter ◽

Adverse Events ◽

Medical Intensive Care Unit ◽

Venous Catheter ◽

Central Venous ◽

Unit Level ◽

Medical Intensive Care

Background: Reducing central venous catheter (CVC) utilization can reduce complications in the intensive care unit (ICU). While norepinephrine (NE) is traditionally administered via a CVC, lower concentrations may be safely administered via peripheral intravenous (PIV) lines. Objective: We aimed to describe the implementation of a pilot protocol utilizing PIVs to administer a low-dose and lower-concentration NE, review the number of CVCs avoided, and evaluate any adverse events. Methods: In a quaternary medical intensive care unit (MICU), from March 1, 2019, to February 29, 2020, we reviewed charts for CVC placement and adverse events from the pNE infusion. We also measured unit-level CVC utilization in all MICU patients and assessed the change in utilization associated with the peripheral norepinephrine (pNE) protocol. Results: Over a 1-year period, 87 patients received a pNE infusion. Overall, 44 patients (51%) never required CVC placement during their MICU stay. Three patients (3%) experienced adverse events, none of which were documented as serious and or required antidote for treatment. Implementation of the protocol was associated with a decrease in the number of patients at the unit level who received CVCs, even if they did not receive pNE. Conclusion and Relevance: In this small pilot study, we pragmatically demonstrated that pNE is safe and may reduce the need for CVC placement. This information can be used to aid in pNE protocol development and implementation at other institutions, but further research should be done to confirm the safety of routine use of pNE in clinical practice.

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