Comparison of Ultrasound-Guided Central Venous Catheter Placement Techniques Using an Easily Made Simulator Model

2021 ◽  
pp. 1-5
Author(s):  
Hasan Idil ◽  
Turgay Yilmaz Kilic
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Chicken Breast ◽  
Care Hospital ◽  
Central Venous ◽  
Tissue Model ◽  
Chicken Tissue ◽  
Significant Difference

Abstract Objectives: Central venous catheter (CVC) placement is an important procedure which is frequently performed in the emergency department (ED) and can cause serious complications. The aim of this study is to introduce a simulation-based tissue model for ultrasound (US)-guided central venous access practices and to compare the effectiveness of static and dynamic US techniques through this model. Methods: This was a prospective study on US-guided CVC placement techniques simulated with a chicken tissue model. This model is based on the principle of placing two cylindrical balloons filled with colored water (red for arterial and blue for venous) between a raw chicken breast and wrapping the formed structure with plastic wrap. The study was conducted in an academic tertiary care hospital with Emergency Medicine (EM) residents who have received basic US training, including vascular access procedures. All participants performed simulated CVC placement procedures with both static and dynamic US techniques. At the end of the study, the practitioners were asked to rate usefulness of these techniques between one and ten (one was the lowest and ten was the highest score). Results: A total of 32 EM residents were included in the study. Their median age was 29 (IQR = 27 - 31) years and 72% of them were male. Their median duration in ED was 19 (IQR = 12 - 34) months. According to the results of simulated CVC placement procedures, there was no significant difference between the static and dynamic US techniques in terms of puncture numbers, procedure durations, and success rates. However, according to the usefulness scores given by the practitioners, the dynamic US technique was found to be more useful (P < .001). Conclusions: The chicken tissue model is a convenient tool for simulating US-guided CVC placement procedures. The dynamic US technique is considered to be more useful in this field than the static technique, but the results of practitioner-dependent practices may not always support this generalization.

scholarly journals 183. Candidaemia in Children and Importance of Central Venous Catheter Removal

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S112-S113
Author(s):  
Kamile Arikan ◽  
Sevtap Arıkan-Akdaglı ◽  
Ates Kara
Keyword(s):  
Blood Culture ◽  
Central Venous Catheter ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Blood Stream ◽  
Attributable Mortality ◽  
Care Hospital ◽  
Central Venous ◽  
Candida Spp

Abstract Background Candida is the most common cause of invasive fungal infection in healthcare settings and is associated with significant increases in healthcare resource utilization and attributable mortality. Methods This study was conducted in a pediatric tertiary care hospital from Turkey. We conducted a retrospective analysis in children ≤18 years with blood culture-proven candidaemia identified between December 2013 and November 2017. Sociodemographic variables,underlying condition, mortality, additional risk factors, origin of specimens were all recorded. Results A total of 236 episodes of candidaemia were identified over the study period. The median age of the patients was 600 days (4-6482). 106 specimens (44.9%) were cultured from patients under 1 year of age and 15 of 106 specimens were cultured from neonates. The most frequently isolated Candida spp. were C. albicans (42.%), followed by C. parapsilosis (30.5%), C. glabrata (7.6%), C. tropicalis (6.4%), C. krusei (2.5%), C. lusitaine (2.5%), C. dubliniensis (2.1%), C. kefir (0.8%), and C. pelliculosa (0.4%). In 11 of the 236 episodes (4.5%), two Candida spp were cultured at the same time.The most common coinfection was C. albicans and C. parapsilosis. 112 of the 236 episodes (47.5%) was due to central venous catheter-related blood stream infection. 47.5% of these patients were receiving total parenteral nutrition at the time of candidemia. Concomitant coagulase negatif staphylococcus bacteremia was present in 50 of 236 candidemia episodes (21.2%). Of 236 isolates, 74 (31.4%) was cultured from peripheral blood culture only, 95 (40.3%) from central venous catheter only, 67 (28.4%) from both peripheral and central catheter blood culture.Trombocytopenia was noted in 117 episodes (49.6%) and neutropenia in 45 episodes (19.1 Of the 112 central venous catheter-related candidemia, 35 (31.3%) resulted in death within 30 days from the onset of candidaemia (Figure 1). In 49 (45.%) episodes of central venous catheter-related candidemia, catheter was not removed and 40% of these episodes resulted as death.Catheter removal, thrombocytopenia, total parenteral nutrion were found to be associated with increased mortality in children under 1 year of age (P < 0.001). Conclusion Clinicians must be aware of candidemia in children due to high risk of mortality. Disclosures All authors: No reported disclosures.

scholarly journals Comparison of Risks from Central Venous Catheters and Peripheral Intravenous Lines among Term Neonates in a Tertiary Care Hospital, India

2021 ◽  
Vol 10 (2) ◽  
pp. 57-61
Author(s):  
Vicknesh Ratchagame ◽  
Vetriselvi Prabakaran
Keyword(s):  
Central Venous Catheter ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Care Hospital ◽  
Central Venous ◽  
Case Record ◽  
Term Neonates

Abstract Introduction: Venous access in neonates is a basic yet critical component in neonatal intensive care unit (NICU). Central venous access and peripheral intravenous access are mostly preferred for delivering medications and intravenous fluids. This study aimed to compare the risks involved in central venous catheters and peripheral intravenous lines among term neonates. Methods: A prospective cohort study was carried out among 78 term neonates in the NICU of a tertiary care center in puducherry in India. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to demographic and clinical characteristics, cannulation details, indwelling time, and incidence of thrombosis, phlebitis, occlusion, extravasation, and sepsis were collected by direct observation and from case record. Data were analyzed using SPSS software version 21. To analyze the data, descriptive statistics including frequency, percentage, mean, and standard deviation and inferential statistics including Fisher’s exact test were utilized. Results: Our findings indicated that the risks of thrombosis and phlebitis were significantly higher in peripheral intravenous line group than the central venous group. There was no statistically significant association between the risks and demographic and clinical characteristics in both of the venous access system. Conclusion: According to our results, the use of central venous catheter among neonates showed lower risks than peripheral intravenous lines. Hence, using central venous catheter may be given priority in the NICUs.

scholarly journals A clinical study of patients with central venous catheter associated bloodstream infections in a tertiary care hospital

2020 ◽  
Vol 9 (11) ◽  
pp. 1665
Author(s):  
R. Abisha Rezia ◽  
R. Vijendra ◽  
Anjana Gopi
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Care Hospital ◽  
Central Venous ◽  
Enterococcus Spp ◽  
Acinetobacter Spp

Background: Central venous access puts the patients at risk of iatrogenic complications and is associated with bloodstream infections. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and Methicillin Resistant Staphylococcus aureus (MRSA) are responsible for at least two-thirds of the infections followed by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Enterococcus spp and Acinetobacter spp. Due to the scarcity of Central Venous Catheter associated Blood Stream Infections (CVC-BSI) data, this study was taken up in our tertiary care hospital. Aims: This study is aimed to study the profile of organisms causing CVC-BSI, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects whose central venous catheter samples (n=84) were sent for culture and sensitivity during the study period were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The catheter tips were streaked onto blood agar plate using Roll plate technique. After biochemical identification of the organisms, antimicrobial susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as per the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Growth of pathogens was seen in 64.3% (n=54). The common organisms were Coagulase Negative Staphylococcus aureus (CONS) in 27.78% (n=15), Enterococcus spp, Klebsiella pneumoniae in 14.8% each (n=8) and Acinetobacter spp in 11.1% (n=6). Resistance was seen with amoxicillin + clavulanic acid, cefepime, ciprofloxacin and cefoperazone. The organisms were sensitive to levofloxacin, tetracycline and vancomycin.Conclusion: Aseptic precautions taken by the healthcare personnel will bring down the infections and curb the spread of multi-drug resistant hospital acquired infections.

Central Venous Catheter–Related Bacteremia Due to Gram-Negative Bacilli: Significance of Catheter Removal in Preventing Relapse

2004 ◽  
Vol 25 (8) ◽  
pp. 646-649 ◽  
Author(s):  
Hend Hanna ◽  
Claude Afif ◽  
Badie Alakech ◽  
Maha Boktour ◽  
Jeffrey Tarrand ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Protective Factor ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Venous Catheter ◽  
Blood Cultures ◽  
Catheter Removal ◽  
Care Hospital ◽  
Central Venous ◽  
Gram Negative

AbstractObjective:To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal.Design:This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records.Setting:University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.Patients:Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills).Results:Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02–0.75; P = .02).Conclusion:In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.

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