Cardiovascular monitoring

2019 ◽  
pp. 105-136
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Cardiovascular Monitoring ◽  
Central Venous ◽  
Volume Responsiveness ◽  
Non Invasive ◽  
Pulmonary Artery Catheters ◽  
Systemic Filling ◽  
Systemic Filling Pressure

Cardiovascular instability is one of the main reasons for admission to intensive care. Situations such as hypovolaemia, heart failure, and vasoplegia are often mixed, between them making the diagnosis more challenging. Attention to details and careful monitoring are essential at this stage. This chapter discusses cardiovascular monitoring and includes discussion on electrocardiograph monitoring, arterial pressure monitoring, insertion of central venous catheters, common problems with central venous access, pulmonary artery catheters, echocardiography, clinical applications of echocardiography in the intensive care unit, Doppler, pulse pressure algorithms, non-invasive methods, monitoring mean systemic filling pressure, and detection of volume responsiveness.

Cardiovascular monitoring

2011 ◽  
Author(s):  
Carl Waldmann ◽  
Neil Soni ◽  
Andrew Rhodes
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Ecg Monitoring ◽  
Cardiovascular Monitoring ◽  
Pressure Monitoring ◽  
Central Venous ◽  
Common Problems

ECG monitoring 98Arterial pressure monitoring 102Insertion of central venous catheters 104Common problems with central venous access 106Pulmonary artery catheter: indications and use 108Pulmonary artery catheter: insertion 110Echocardiography 112Clinical application of echocardiography in the ICU 116Doppler 118Pulse pressure algorithms ...

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

2020 ◽  
pp. 112972982096929
Author(s):  
Matthew Ostroff ◽  
Adel Zauk ◽  
Sara Chowdhury ◽  
Nancy Moureau ◽  
Carly Mobley
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Retrospective Analysis ◽  
Neonatal Intensive Care ◽  
Femoral Vein ◽  
Central Venous Access ◽  
Venous Access ◽  
Right Atrial ◽  
Central Venous

Objective: The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU). Methods: Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018–2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU. Results: Placement of ST-FICCs were successful in 100% of neonates ( n = 82/82) with 94% to the right ( n = 77/82) and 6% to the left common femoral veins ( n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr ( n = 80/82), 2.6Fr ( n = 1/82), and 3-Fr ( n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) ( n = 33/82), IVC/right atrial junction ( n = 31/82), or right atrium ( n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins ( n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter. Conclusion: Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)

2021 ◽  
Vol 30 (8) ◽  
pp. S37-S42
Author(s):  
France Paquet ◽  
Janette Morlese ◽  
Charles Frenette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Central Venous ◽  
Surgical Intensive Care ◽  
Venous Access Devices

This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings. Results: In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

scholarly journals Factors associated with neonatal near miss and death in public referral maternity hospitals

2020 ◽  
Vol 20 (3) ◽  
pp. 839-850
Author(s):  
Ocília Maria Costa Carvalho ◽  
Antônio Brazil Viana Junior ◽  
Matheus Costa Carvalho Augusto ◽  
Ana Tallita Oliveira Xavier ◽  
Ana Paula Mendes Gouveia ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Death ◽  
Neonatal Intensive Care ◽  
Central Venous Access ◽  
Venous Access ◽  
Near Miss ◽  
Central Venous ◽  
Intensive Care Admission ◽  
Factors Associated ◽  
Neonatal Near Miss

Abstract Objectives: to evaluate factors associated with neonatal near miss and death in reference hospitals. Methods: this case-control study included 364 cases and 728 controls among 4,929 births. Cases were identified by Apgar < 7 at 5 minutes, weight < 1500 g, gestational age <32 weeks, mechanical ventilation or congenital malformation. After follow-up, outcomes were reclassified into: true controls, near miss and neonatal death. Hierarchically, variables with a p-value < 0.20 were included in the multiple logistic regression. Results: the neonatal near miss rate was 54.1 per 1,000 live births, and the near-miss-to-death ratio was 2.75. Between the control and near miss groups, the predictor variables were neonatal intensive care admission [OR = 35.6 (16.7 - 75.9)] and central venous access [OR= 74.8 (29.4 - 190.4)]. Between the control and death groups, neonatal intensive care admission [OR = 100.4 (18.8 - 537.0)] and central venous access [OR = 12.7 (3.7 - 43.2)] were significant. Between the near miss and death groups, only Apgar < 7 at 5 minutes [OR = 4.1 (1.6 - 10.6)] and vasoactive drug use [OR = 42.2 (17.1 - 104.5)] were significant. Conclusion: factors associated with a greater chance of near miss and/or neonatal death were: Apgar score <7 at 5 minutes, neonatal intensive care confinement, having central venous access, and use of vasoactive drugs.

scholarly journals Catheter Related Blood Stream Infections In Patients Of The Intensive Care Unit

10.3823/2398 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Ana Carolina Coimbra De Castro ◽  
Odinéa Maria Amorim Batista ◽  
Maria Eliete Batista Moura ◽  
Maria Zélia de Araújo Madeira ◽  
Layze Braz de Oliveira ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Central Venous Access ◽  
Venous Access ◽  
Blood Stream ◽  
Central Venous ◽  
Blood Stream Infections ◽  
Skin Antisepsis ◽  
Lumen Catheter

Objective: To identify the prevalence of bloodstream infection associated with the Catheter related Blood stream infections in patients of the Intensive Care Unit, and the characteristics of its use and handling. Methods: Descriptive and transversal study with a sample of 88 participants. Data were collected through the observational method and the records in the medical records. The absolute and relative frequencies were used for data analysis. Results: 73.86% of the patients had central venous access in the subclavian vein, 100% used double lumen Catheter related Blood stream infections, 0.5% chlorhexidine solution for skin antisepsis, dressing coverage is performed mostly with Sterile gauze and tape, with a daily exchange. The rate of infection related to the use of the Catheter related Blood stream infections was (6.81%). The most infused pharmacological drugs were antimicrobials (69.32%). Conclusion: The study showed that care with central venous accesses is performed according to recommendations for prevention of bloodstream infection related to the use of these devices. The infection rate is close to the standards found in the literature. Key words: Central Venous Catheterization. Hospital Infection. Intensive care unit. Risk factors. Catheter-Related Infection..  

In defense of the use of peripherally inserted central catheters in pediatric patients

2020 ◽  
pp. 112972982093641
Author(s):  
Alessandro Crocoli ◽  
Simone Cesaro ◽  
Monica Cellini ◽  
Francesca Rossetti ◽  
Luca Sidro ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Late Complications ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Peripherally Inserted Central Catheters ◽  
Non Invasive ◽  
Venous Access Device ◽  
Central Catheters ◽  
Venous Access Devices

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

Sign in / Sign up

Export Citation Format

Share Document