Central venous catheter delivery system changes: a prospective, randomised study of two methods of managing central venous catheters

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

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Risk factor identification and predictive models for central line requirements for patients on vasopressors

Anaesthesia and Intensive Care ◽

10.1177/0310057x211024258 ◽

2021 ◽

pp. 0310057X2110242

Author(s):

Adrian D Haimovich ◽

Ruoyi Jiang ◽

Richard A Taylor ◽

Justin B Belsky

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Central Venous Catheter ◽

Single Agent ◽

Composite Endpoint ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

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A New Formula-Based Measurement Guide for Optimal Positioning of Central Venous Catheters

Journal of the Association for Vascular Access ◽

10.2309/1552-8855-9.2.80 ◽

2004 ◽

Vol 9 (2) ◽

pp. 80-85 ◽

Cited By ~ 4

Author(s):

Phllip Lum

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

Access Site ◽

Insertion Sites ◽

Tip Position ◽

A Prospective Study ◽

New Formula ◽

Percutaneous Insertion

Abstract Purpose: To validate the formula-based central venous catheter (CVC) length measurement “tailored” to individual's height and access site for predicting optimum SVC tip position. Method: A prospective study of 3 percutaneous insertion sites (PICC, SCC and JC). Formula-based “LUM'S CVC MEASUREMENT GUIDE” was used to determine the catheter length. Results: Overall, 97% (373) of the total 382 insertions were successfully placed with CVC tip in the distal SVC (SVC between carina and atrio-cava junction) location. Conclusion: The “tailored fit” formula to individual patient height is a reliable tool to predict CVC length. Appropriate catheter length can greatly reduce the guesswork and possibility of complications related to tip malposition.

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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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Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.28.3.151 ◽

2009 ◽

Vol 28 (3) ◽

pp. 151-155 ◽

Cited By ~ 36

Author(s):

Sabra Curry ◽

Michele Honeycutt ◽

Gail Goins ◽

Craig Gilliam

Keyword(s):

High Risk ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous Catheters ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Skin Antisepsis ◽

Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

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Comparison between Peripheral and Central Venous Catheters Regarding Venous Pressure and Complications among Critically Ill Patients

10.47363/jmcn/2021(2)118 ◽

2021 ◽

pp. 1-7

Author(s):

Amnah Mohammed Howthan ◽

◽

Nahed Ahmed Mersal ◽

◽

Keyword(s):

Central Venous Catheter ◽

Critically Ill ◽

Standard Method ◽

Patient Management ◽

Essential Role ◽

Venous Pressure ◽

Venous Catheter ◽

Central Venous Catheters ◽

Critically Ill Patient ◽

Central Venous

Central venous catheter (CVC) known as standard method for hemodynamic monitoring that plays an essential role in critically ill patient management. After recognizing critical condition, measuring, and evaluating the underlying pathophysiological strategies and receiving suitable therapy

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Correction: Comparison between peripherally inserted central venous catheters (PICC) and short-term central venous catheter (ST-CVC) in patients discharged from Intensive Care Unit (ICU)

Critical Care ◽

10.1186/cc8922 ◽

2010 ◽

Vol 14 (Suppl 1) ◽

pp. P604

Author(s):

S Batacchi ◽

G Zagli ◽

S Di Valvasone ◽

M Ciapetti ◽

G Cianchi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

Short Term

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Catheter-Associated Deep Vein Thrombosis (CADVT) in a Pediatric ICU: A Retrospective Case-Control Study

Journal of the Association for Vascular Access ◽

10.2309/java-d-20-00012 ◽

2020 ◽

Vol 25 (3) ◽

pp. 45-55

Author(s):

Sandeep Tripathi ◽

Kimberly Burkiewicz ◽

Jonathan A. Gehlbach ◽

Yanzhi Wang ◽

Michele Astle

Keyword(s):

Deep Vein Thrombosis ◽

Central Venous Catheter ◽

Ultrasound Guidance ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

Retrospective Case ◽

Vein Thrombosis ◽

Deep Vein ◽

Control Study

Highlights Abstract Introduction: Catheter-associated deep vein thrombosis (CADVT) in children has been recognized as a significant hospital-acquired condition. This study was undertaken to retrospectively analyze the impact of CADVT on outcomes and to identify risk factors for the development of deep vein thrombosis in children with central venous catheters. Methods: This was a single-center retrospective case-control study of patients with central venous catheters in a pediatric intensive care unit (ICU) from January 2014 to December 2018. Forty-one patients with central venous catheters who developed CADVT were compared with 100 random controls. Central venous catheter type, along with patient and disease-specific characteristics, were compared between the two groups by univariate and multivariate regression. Outcome comparison was made after adjusting for confounding variables. Results: Median time from insertion to the development of CADVT was 4 days (interquartile range, 2–9). Forty percent (16/40) of patients had a blood urea nitrogen greater than 20 mg/dL, and 86.6% (13/15) had a C-reactive protein greater than 1 mg/dL within 48 hours of development of CADVT. Central venous catheter duration (odds ratio [OR], 1.05), mechanical ventilation (OR, 7.49), and upper versus lower extremity site of the central venous catheter (OR, 0.324) were associated with the development of CADVT. Ultrasound guidance occurred significantly less in patients who developed CADVT (39.3% vs 70.7%); however, it was not independently associated with increased risk. Age, body mass index, mechanical ventilation, and severity of illness–adjusted hospital and ICU length of stay were significantly higher in patients who developed CADVT. Conclusions: CADVT is independently associated with worse outcomes. Ultrasound guidance and site selection are potential modifiable risk factors in the development of CADVT in pediatric patients. Future studies should target an effective chemoprophylaxis regimen.

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Increased Risk for Venous Thromboembolism in Patients with Acute Leukemia.

Blood ◽

10.1182/blood.v106.11.4555.4555 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4555-4555

Author(s):

Martin Mohren ◽

Ilka Markmann ◽

Kathleen Jentsch-Ullrich ◽

Michael Koenigsmann ◽

Gerd Lutze ◽

...

Keyword(s):

Central Venous Catheter ◽

Acute Leukemia ◽

Blast Crisis ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

P Values ◽

Prophylactic Measures ◽

Increased Risk ◽

Significant Difference

Abstract Introduction: Patients with solid tumors have an increased risk for venous thromboembolisms (VTE) associated with substantial morbidity and mortality, but so far there exists little data on hematologic malignancies. We have recently found a VTE rate of 7,7% in patients with malignant lymphoma. However, information on patients with acute leukemia (AL) is very limited so far. Patients and methods: Medical records of all patients with AL treated in our institution between january 1992 and april 2005 were reviewed and data was collected and analyzed in a microsoft excel data base. P-values to show correlation of VTE with leukemia type, patient age and gender were calculated using Fisher’s exact test. All reported p-values are two-sided. Results: Of a total of 455 patients 310 (68%) had AML, 108 (24%) had ALL and 37 (8%) had blast crisis. 248 patients (55%) were male and 207 (45%) were female, median age was 60 years. 55 patients with AL (12,1%) had at least one VTE, occuring during therapy in 82% of events. 27 patients (5,9%) had central venous catheter associated VTE, whereas 28 patients (6,2%) had deep vein thrombosis and/or pulmonary embolism. Neither leukemia lineage - myeloid versus lymphocytic - (p=1,0) nor patient gender (p=.193) had an impact on the VTE risk. However, central venous catheter associated VTE more likely occured in younger patients (< 60 years) than in patients ≥ 60 years (p=.003). There was no statistically significant difference in the incidence of non-central venous catheter associated VTE between both age groups (p=.563). Discussion: Patients with acute leukemia have a substantial risk for VTE, half of which occur with the use of central venous catheters. A recently published study analysed the incidence of VTE in close temporal relationship to onset of disease and found a VTE rate of 2,09% with equal risk in ALL and AML. Our study included VTE occuring prior to diagnosis of AL as well as during chemotherapy and follow up, revealing a VTE rate that is 6-fold higher and showing a considerable association with central venous catheters. Conclusions: The risk of VTE is surprisingly high in patients with acute leukemia, thus improvement of prophylactic measures, especially in regard to central venous catheter use is warranted.

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Is the removal of a central venous catheter always necessary in the context of catheter-related right atrial thrombosis?

The Journal of Vascular Access ◽

10.1177/1129729818774438 ◽

2018 ◽

Vol 20 (1) ◽

pp. 98-101 ◽

Cited By ~ 2

Author(s):

Luigi Rossi ◽

Pasquale Libutti ◽

Francesco Casucci ◽

Piero Lisi ◽

Annalisa Teutonico ◽

...

Keyword(s):

Central Venous Catheter ◽

Combination Therapy ◽

Anticoagulation Therapy ◽

Vena Cava ◽

Young Patients ◽

Venous Catheter ◽

Central Venous Catheters ◽

Right Atrial ◽

Central Venous ◽

Atrial Thrombosis

Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available. This complication seems to be closely associated with positioning of the catheter tip in the atrium, whereas it is unlikely with a tip located within superior vena cava. Herein, we report the case of a patient affected by catheter-related right atrial thrombosis, who showed a quick resolution of thrombosis with a new therapeutic scheme combining loco-regional thrombolytic therapy (urokinase as a locking solution) and systemic anticoagulation therapy (vitamin K antagonists), thus avoiding catheter removal. Neither complications of the combination therapy were reported, nor recurrence of catheter-related right atrial thrombosis occurred. In conclusion, the combination therapy here described was safe, quick and effective, achieving the goal of not removing the catheter.

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