Availability of ultrasound imaging of a guidewire parallel to the vein during internal jugular central venous catheter placement

AbstractUltrasound verification of the guidewire traveling along the vein parallel to it and without any changes in angle has been recommended for prevention of inadvertent arterial catheterization during central venous catheter (CVC) placement. The aim of this study was to determine the availability of this parallel guidewire imaging during internal jugular CVC placement. Fifty-six adult patients undergoing cardiovascular surgery were included. The success rate of acquiring a parallel guidewire image was assessed. Logistic regression models and generalized additive models were used to identify the factors contributing to achieve parallel guidewire imaging. Among 56 patients in whom the guidewire was correctly positioned, the parallel guidewire image was acquired in 45 (80%) patients. Body mass index (crude odds ratio: 0.74 [95% confidence interval: 0.61–0.91]; p = 0.004) and distance from the puncture site to the clavicle (crude odds ratio: 1.32 [95% confidence interval: 1.11–1.58]; p = 0.002) were associated with successful depiction. The predicted probability of successful visualization was 96% (95% confidence interval: 82–99%) when the distance from the puncture site to the clavicle was 50 mm. The distance is a reliable predictor for successful visualization, and thus it should be considered when performing internal jugular CVC placement.

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Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

Infection Control and Hospital Epidemiology ◽

10.1086/590356 ◽

2008 ◽

Vol 29 (10) ◽

pp. 947-950 ◽

Cited By ~ 25

Author(s):

Duk-hee Lee ◽

Koo Young Jung ◽

Yoon-Hee Choi

Keyword(s):

Multivariate Analysis ◽

Mortality Rate ◽

Central Venous Catheter ◽

Confidence Interval ◽

Bloodstream Infection ◽

Odds Ratio ◽

Venous Catheter ◽

Central Venous ◽

Factors Associated ◽

Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

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Current Status and Risk Factors of Complications Associated with Central Venous Catheterization in Pediatric Intensive Care Unit

10.21203/rs.3.rs-663239/v1 ◽

2021 ◽

Author(s):

JingMei Li ◽

JiaFei Zhang ◽

Bo Feng ◽

ChunHui Wang ◽

MeiLing Wang

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Intravenous Infusion ◽

Insertion Site ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Venous ◽

Puncture Site

Abstract Background: The objective of this study was to evaluate incidence and influencing factors of complications related to central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Xi'an Children's Hospital.Methods: We analyzed the complications of all children that had CVCs and were hospitalized between June 2020 to February 2021. A total of 334 CVCs were inserted in 310 children.Results: We noted 102 (30.54%) CVCs-related complications. Complications related to CVCs insertion were infection of catheter (13.17%) and malposition of catheter (8.38%), occlusion of CVCs (2.99%), accidental removal (0.6%), puncture site exudate (4.79%), central venous thrombosis (0.6%). Infection mainly due to Staphylococcus epidermidis. 88 cases (24.55%) of CVCs were extubated due to complications. Analysis of the frequency of maintenance-related complications except for center vein thrombosis showed no differences between the jugular, femoral and subclavian vein access (P > 0.05). It was found that the duration of the catheterization use was critical for the occurrence of CVCs-related infections, puncture site exudate, occlusion (P < 0.05). Suture-off, bleeding of insertion site, and the maximum channels of intravenous infusion in patients were dominant risk factors of catheter-related complications. Conclusion: The risk factors of complications during catheter indwelling are suture-off, bleeding of insertion site and the maximum channels of intravenous infusion in patients. Therefore, strict aseptic operation in various operations, control of the infusion channel, effective fixation of the central venous catheter, reduce the malposition and pull of the catheter, and reduce the infiltration of blood at the puncture point, are particularly important to prevent the complications related to the central venous catheter.

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NURSES' KNOWLEDGE OF INTENSIVE CARE UNIT ON CENTRAL VENOUS CATHETER DRESSING

Revista Prevenção de Infecção e Saúde ◽

10.26694/repis.v5i0.8113 ◽

2019 ◽

Vol 5 ◽

Author(s):

Fabiana Rezer ◽

Wladimir Rodrigues Faustino

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Data Collection ◽

Central Venous Catheter ◽

Hand Hygiene ◽

Venous Catheter ◽

Exploratory Research ◽

Central Venous ◽

Puncture Site ◽

Documentary Analysis

Objective: to describe the knowledge of the nurses of an Intensive Care Unit on the dressing of Central Venous Catheter. Method: descriptive, exploratory research with quantitative approach, performed with nurses in an Intensive Care Unit. A closed questionnaire was used with questions about Central Venous Catheter dressing and for documentary analysis of the patients submitted to the procedure. Data collection took place in the period from February to April 2016. The study follows all ethical and legal precepts, being approved with nº53479016.4.0000.5541. Results: Participants (100%) were right regarding hand hygiene and protection barriers; while 50% were correct in relation to the puncture site and the first dressing with gauze and micropore; 50% were correct regarding the clear membrane dressing. Conclusion: nurses have satisfactory knowledge about the dressing of central venous catheter, however, there is a need for capacity building and greater adherence in relation to nursing prescriptions.

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Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes

The Journal of Vascular Access ◽

10.1177/1129729819874531 ◽

2019 ◽

Vol 21 (3) ◽

pp. 322-327

Author(s):

Rita L McGill ◽

Eduardo K Lacson

Keyword(s):

Central Venous Catheter ◽

Arteriovenous Fistula ◽

Odds Ratio ◽

Venous Catheter ◽

The United States ◽

First Year ◽

Central Venous ◽

Arteriovenous Fistulas ◽

Arteriovenous Access ◽

One Year

Introduction: Nephrologists have increased arteriovenous access placement in patients with chronic kidney disease. Not yet usable ‘maturing’ arteriovenous fistulas and grafts are nearly as common as mature arteriovenous fistulas or grafts. Little has been reported about patients initiating haemodialysis with unready arteriovenous fistulas or grafts. Methods: The United States Renal Data System records for all adult patients initiating haemodialysis with central venous catheters between July 2010 and December 2011. Patients were categorized by whether a maturing arteriovenous fistula or graft was present. Transition to working arteriovenous fistula or graft was determined from linked Medicare claims. Modality changes and survival were ascertained. A logistic model for one-year survival and a subdistribution hazards model for transition to working arteriovenous fistula or graft, accounting for the competing risk of death, were constructed. Results: Compared to central venous catheter-only, maturing arteriovenous fistula or graft was associated with access conversion (hazard ratio = 2.23 (2.17–2.30) and 3.25 (2.97–3.56), respectively, p < 0.001 for both). Median time to conversion, among those who transitioned, was 95 days (interquartile range = 56–139) for patients with a maturing arteriovenous graft and 135 days (98–198) with a maturing arteriovenous fistula, versus 193 days (138–256) with central venous catheter-only. Pre-dialysis nephrology care, male sex and non-Caucasian race were associated with access conversion. Patients without a maturing arteriovenous fistula or graft had decreased odds of one-year survival (odds ratio = 0.61 (0.58–0.66), p < 0.001), which attenuated with adjustment for access conversion (adjusted odds ratio = 1.06 (0.98–1.13), p = 0.2). Conclusion: Maturing arteriovenous fistulas or grafts were associated with enhanced first-year survival and increased opportunity for working arteriovenous fistulas or grafts, which may reflect pre-dialysis decision-making, quality of care and comorbid diseases. Central venous catheter exposure was substantial, even among patients with maturing access. Contributory factors prolonging conversion to arteriovenous access need to be identified and addressed.

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Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study

The Journal of Vascular Access ◽

10.1177/1129729818805954 ◽

2018 ◽

Vol 20 (3) ◽

pp. 307-312 ◽

Cited By ~ 2

Author(s):

Mathijs van Oevelen ◽

Alferso C Abrahams ◽

Marcel C Weijmer ◽

Tjerko Nagtegaal ◽

Friedo W Dekker ◽

...

Keyword(s):

Cohort Study ◽

Central Venous Catheter ◽

Confidence Interval ◽

Primary Endpoint ◽

Multivariable Analysis ◽

Venous Catheter ◽

Central Venous Catheters ◽

Hazard Ratio ◽

Central Venous ◽

Catheter Malfunction

Background: The main limitations of central venous catheters for haemodialysis access are infections and catheter malfunction. Our objective was to assess whether precurved non-tunnelled central venous catheters are comparable to tunnelled central venous catheters in terms of infection and catheter malfunction and to assess whether precurved non-tunnelled catheters are superior to straight catheters. Materials and methods: In this retrospective, observational cohort study, adult patients in whom a central venous catheter for haemodialysis was inserted between 2012 and 2016 were included. The primary endpoint was a combined endpoint consisting of the first occurrence of either an infection or catheter malfunction. The secondary endpoint was a combined endpoint of the removal of the central venous catheter due to either an infection or a catheter malfunction. Using multivariable analysis, cause-specific hazard ratios for endpoints were calculated for tunnelled catheter versus precurved non-tunnelled catheter, tunnelled catheter versus non-tunnelled catheter, and precurved versus straight non-tunnelled catheter. Results: A total of 1603 patients were included. No difference in reaching the primary endpoint was seen between tunnelled catheters, compared to precurved non-tunnelled catheters (hazard ratio, 0.91; 95% confidence interval, 0.70–1.19, p = 0.48). Tunnelled catheters were removed less often, compared to precurved non-tunnelled catheters (hazard ratio, 0.65; 95% confidence interval, 0.46–0.93; p = 0.02). A trend for less infections and catheter malfunctions was seen in precurved jugular non-tunnelled catheters compared to straight non-tunnelled catheters (hazard ratio, 0.60; 95% confidence interval, 0.24–1.50; p = 0.28) and were removed less often (hazard ratio, 0.41; 95% confidence interval, 0.18–0.93; p = 0.03). Conclusion: Tunnelled central venous catheters and precurved non-tunnelled central venous catheters showed no difference in reaching the combined endpoint of catheter-related infections and catheter malfunction. Tunnelled catheters get removed less often because of infection/malfunction than precurved non-tunnelled catheters.

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The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0080 ◽

2020 ◽

Vol 42 (2) ◽

pp. 147-152

Author(s):

Jocefábia Reika Alves Lopes ◽

Ana Lígia de Barros Marques ◽

João Antonio Correa

Keyword(s):

Risk Factors ◽

Central Venous Catheter ◽

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Odds Ratio ◽

Venous Catheter ◽

Clinical Group ◽

Central Venous ◽

Significant Difference ◽

A Prospective Study

ABSTRACT Introduction: The increasing prevalence of chronic kidney disease has increased the demand for arteriovenous fistula (AVF) care. The objective of this study was to assess the relationship between some risk factors for AVF failure (advanced age, female sex, diabetes, obesity, central venous catheter, previous fistula, and hospitalization) and having a Doppler ultrasound performed preoperatively. Methods: A prospective study was performed with 228 dialysis patients from Imperatriz, Maranhão. Half of the sample was randomly selected to receive preoperative Doppler ultrasound and the other half did not, from the period of October 2016 to September 2018. Results: There were 53 total failures corresponding to 23.2% of our sample, which is almost double that of the patients in the clinical group. Considering the failures and risk factors associated with the overall sample, there was a statistically significant association between a central venous catheter on the same side of the AVF with P = 0.04 (Odds Ratio 1.24) and obesity with P = 0.05 (Odds Ratio 1.36), which was not repeated in the Doppler ultrasound group individually. There was no statistically significant difference between the Doppler group and clinical group with respect to the amount of days of previous AVF hospitalization and failure. Conclusions: We concluded that the reduction of failures with an introduction of the Doppler was statistically significant in the overall sample, but establishing a relationship between specific risk factors and failure was only possible with two of the risk factors in the study - obesity and central venous catheter on the same side of the AVF.

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