scholarly journals Performance of 3 mL versus 5 mL Discarded Volume for Blood Sampling from Central Venous Access Device

2021 ◽  
Author(s):  
HT Lalthanthuami ◽  
MJ Kumari ◽  
R Venkateswaran ◽  
PR Lakshmi ◽  
Lakshmi Ramamoorthy
Keyword(s):  
Critical Care ◽  
Blood Loss ◽  
Central Venous Access ◽  
Intraclass Correlation ◽  
Venous Access ◽  
Blood Sampling ◽  
Central Venous ◽  
Blood Samples ◽  
Serum Parameters ◽  
Significant Difference

Abstract Background Central venous access devices (CVAD) are an essential part of safe practices in critical care, which enable effective venous access and help in avoiding repeated venipuncture. Discard method is widely practiced for blood sampling. A single occasion of blood sampling may cause minimal blood loss; however, the cumulative volume sequential sampling may become clinically significant. The study aims to reduce diagnostic blood loss, ensuring that the subsequent blood sample is not diluted or contaminated by residual intraluminal fluid. Patients and Methods Within-subjects comparative design was adopted for 64 adult patients in the medical intensive care unit of a tertiary hospital. Two blood samples, using 3 mL and 5 mL discarded volume methods, were collected from each patient. Six serum parameters were measured on each of the paired samples and compared. Statistical Analysis Used Paired t-test and Wilcoxon signed rank test were used for comparing the two methods. Bland–Altman plot analysis and intraclass correlation were used for clinically meaningful analysis. Results When tested for fixed bias, there is no statistically significant difference between the methods. Potassium and creatinine levels showed significant proportional bias. The agreement limits of sodium, potassium, creatinine, and direct bilirubin were outside the clinically accepted interval, but the proportion of samples outside these intervals was less than 10%. All serum parameters showed excellent reliability, except for sodium which demonstrated good reliability. Conclusions The practice of discarding 3 mL of blood for discard method is suggested, instead of the standard 5 mL to reduce iatrogenic blood loss. Thus, nurses in critical care are uniquely positioned to limit the diagnostic blood loss while obtaining blood samples.

Comparison of the Single-Syringe Push-Pull Technique With the Discard Technique for Obtaining Blood Samples From Pediatric Central Venous Access Devices

2017 ◽  
Vol 34 (6) ◽  
pp. 381-386
Author(s):  
Sarah Hess ◽  
Mary Decker
Keyword(s):  
Central Venous Access ◽  
Intraclass Correlation ◽  
Hospital Setting ◽  
Venous Access ◽  
Central Venous ◽  
Blood Samples ◽  
Laboratory Results ◽  
Clinically Significant ◽  
Blood Specimens ◽  
Venous Access Devices

The discard technique is the most widely used method of obtaining blood samples from patients with central venous access devices (CVADs), but risks removing more blood than is necessary for laboratory testing and may increase a patient’s risk of anemia. We hypothesized that laboratory results from pediatric blood specimens obtained via CVAD using the single-syringe push-pull (formerly called the mixing) method and the discard method would be similar. Blood samples were obtained from pediatric oncology patients in a hospital setting using both collection methods and laboratory values were analyzed for concordance using the pairwise t-test, intraclass correlation coefficient, and Bland-Altman analysis methods. Statistical analysis revealed significant differences for sodium, potassium, chloride, bicarbonate, creatinine, calcium, white blood cell count, hemoglobin, hematocrit, and platelet count, but these differences were not clinically significant and within the standard error of measurement for the instrument. Given the similarity in laboratory results, the push-pull method should be considered for obtaining blood samples from CVADs in pediatric patients to avoid unnecessary blood loss.

scholarly journals Risk factors for unsuccessful removal of central venous access ports implanted in the forearm of adult oncologic patients

2021 ◽  
Author(s):  
Mitsuhiro Kinoshita ◽  
Shoichiro Takao ◽  
Junichiro Hiraoka ◽  
Katsuya Takechi ◽  
Yoko Akagawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Central Venous Access ◽  
Univariate Analysis ◽  
Venous Access ◽  
Central Venous ◽  
Significant Difference ◽  
Oncologic Patients

Abstract Purpose To evaluate the risk factors for unsuccessful removal of a central venous access port (CV port) implanted in the forearm of adult oncologic patients. Materials and methods This study included 97 adult oncologic patients (51 males, 46 females; age range, 30–88 years; mean age, 63.7 years) in whom removal of a CV port implanted in the forearm was attempted at our hospital between January 2015 and May 2021. Gender, age at removal, body mass index, and diagnosis were examined as patient characteristics; and indwelling period, indwelling side, and indication for removal were examined as factors associated with removal of a CV port. These variables were compared between successful and unsuccessful cases using univariate analysis. Then, multivariate analysis was performed to identify independent risk factors for unsuccessful removal of a CV port using variables with a significant difference in the univariate analysis. A receiver-operating characteristics (ROC) curve was drawn for significant risk factors in the multivariate analysis and the Youden index was used to determine the optimum cut-off value for predicting unsuccessful removal of a CV port. Results Removal of CV ports was successful in 79 cases (81.4%), but unsuccessful in 18 cases (18.6%) due to fixation of the catheter to the vessel wall. Multivariate logistic regression analysis showed that the indwelling period (odds ratio 1.048; 95% confidence interval 1.026–1.070; P < 0.0001) was a significant independent risk factor for unsuccessful removal of a CV port. ROC analysis showed that the cut-off value for successful removal was 41 months, and 54% of cases with an indwelling period > 60 months had unsuccessful removal. Conclusion The indwelling period is an independent risk factor for unsuccessful removal of a CV port implanted in the forearm of adult oncologic patients, with a cut-off of 41 months.

1025: CENTRAL VENOUS ACCESS BY ADVANCED PRACTICE PROVIDERS IN THE CRITICAL CARE SETTING

2020 ◽  
Vol 48 (1) ◽  
pp. 492-492
Author(s):  
Alexander Lukic ◽  
Elizabeth Milligan ◽  
Eduardo Mireles-Cabodevila ◽  
Tarik Hanane ◽  
Siddharth Dugar
Keyword(s):  
Critical Care ◽  
Care Setting ◽  
Central Venous Access ◽  
Venous Access ◽  
Critical Care Setting ◽  
Advanced Practice ◽  
Central Venous

A step-by-step guide to placing a central venous jugular catheter

2020 ◽  
Vol 25 (7) ◽  
pp. 1-4
Author(s):  
Delphine Le Chevallier
Keyword(s):  
Veterinary Medicine ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Sampling ◽  
Seldinger Technique ◽  
Peripheral Vein ◽  
Central Venous

Placing a central venous jugular catheter is a valuable technique. The method used is the modified Seldinger technique (over the wire), which is also used to place chest drains. While intravenous catheterisation of a peripheral vein is common practice in veterinary medicine, critically ill patients may require central venous access if peripheral access is not possible. This is also useful when large volumes of fluid are required, for example for administration of irritant drugs or for parenteral nutrition, or for regular blood sampling.

scholarly journals Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242727
Author(s):  
Amine Souadka ◽  
Hajar Essangri ◽  
Imad Boualaoui ◽  
Abdelilah Ghannam ◽  
Amine Benkabbou ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Intraoperative Complications ◽  
Central Venous Access ◽  
Venous Access ◽  
Demographic Characteristics ◽  
Success Rates ◽  
Central Venous ◽  
Chemotherapy Administration ◽  
Significant Difference ◽  
Ultrasonographic Guidance

Introduction The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). Material and methods This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. Results Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. Conclusion In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.

Care Practices in Gaucher Disease: Results of a French Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4441-4441
Author(s):  
Belmatoug Nadia ◽  
Nathalie Guffon ◽  
Jérôme Stirnemann ◽  
Christine Serratrice ◽  
Alain Robert ◽  
...  
Keyword(s):  
Gaucher Disease ◽  
Central Venous Access ◽  
Venous Access ◽  
Infusion Time ◽  
Mineral Density ◽  
Central Venous ◽  
Significant Difference ◽  
The Mean ◽  
Care Practices ◽  
At Home

Abstract Abstract 4441 Introduction Gaucher Disease (GD) management is well defined but little is known about the management of patients in routine practice. To describe it, this multicentre retrospective survey was proposed to all French Hospital Departments in whom Gaucher patients are monitored. Demographic and clinical data were collected, and therapeutic regimens were detailed. Results In 2008, 118 patients were enrolled in 54 centres, including 111 type 1 (GD1) and 7 type 3 (GD3). 90% of patients were adults at inclusion. At time of diagnosis 40% of GPS patients were less than 16 years. Glucocerebrosidase activity assay and bone marrow aspiration were part of the diagnosis in 80% and 51% of patients, respectively. A family survey has been performed in all children and overall in 85 % of patients, with positive results in 44% of cases. 54% of patients are managed by the physician who diagnosed the GD and the mean annual number of visits at hospital is 10 and 4 for children and adults, respectively. In patients diagnosed after the age of 16 years, 20.7% were splenectomised at time of inclusion. On average, hemogram and chitotriosidase are assessed twice a year, as bone mineral density and skeletal MRI are performed every 2 years. Ninety-six patients are treated with imiglucerase, 3 patients with miglustat and 2 patients with a combination of both. Adult patients were treated on average for 87.6 months versus 53 months for children. The mean Imiglucerase dose is 54 U/kg by infusion for GD1 with no significant difference regarding infusions frequencies, and 96 U/kg for GD3 and The treatment is infused every two weeks in 74% of the patients, and every 3 weeks in 18% of them, using a gravity infusion in 57 % of the cases. Only 7.8% of the GPS population is infused using a central venous access with similar rates in adults and children. Infusions are administered at hospital in 60% of cases and at patient's home in 40% of cases. A central venous access is used in 11% of patients who are treated at home. Infusion time is less than 2 hours in 55% of patients and is slightly longer at home compared to hospital. Observance is good or excellent in more than 95% of cases. Conclusion This is the first large national survey about Care Practices in GD patients. The clinical and biological follow-up is globally in line with French Guidelines. Treatment with imiglucerase is administered on average at the recommended dose and frequency, but with an infusion time often longer than that recommended. Patients should be more frequently treated at home, and thus quality of life studies and encouragement of home infusions organisation should be performed in France. Disclosures: Off Label Use: Cerezyme (imiglucerase) : enzymatic replacement therapy for Gaucher disease patients. The aim of imiglucerase is to replace glucocerebrosidase deficiency; The dose of treatment initiation is 60u/kg/2 weeks.. Bruno:Genzyme: Employment.

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