scholarly journals Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045895
Author(s):  
Rebecca Sharp ◽  
Peter Carr ◽  
Jessie Childs ◽  
Andrew Scullion ◽  
Mark Young ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Outcome Measure ◽  
Diagnostic Group ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Characteristic Analysis

ObjectivesDetermine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group.DesignRetrospective cohort study.Setting4 tertiary hospitals in Australia and New Zealand.ParticipantsAdults who had undergone PICC insertion.Primary outcome measureSymptomatic thrombus of the limb in which the PICC was inserted.Results2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions.ConclusionsAdherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.

scholarly journals Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study

CMAJ Open ◽  
2017 ◽  
Vol 5 (3) ◽  
pp. E535-E539 ◽  
Author(s):  
Sheryl McDiarmid ◽  
Nicholas Scrivens ◽  
Marc Carrier ◽  
Elham Sabri ◽  
Baldwin Toye ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter

scholarly journals The diagnostic certainty levels of junior clinicians: A retrospective cohort study

2021 ◽  
pp. 183335832110191
Author(s):  
Yang Chen ◽  
Myura Nagendran ◽  
Yakup Kilic ◽  
Dominic Cavlan ◽  
Adam Feather ◽  
...  
Keyword(s):  
Cohort Study ◽  
Focus Group ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physical Sign ◽  
Course Of Action ◽  
Diagnostic Certainty ◽  
Patient Opinion

Background: Clinical decision-making is influenced by many factors, including clinicians’ perceptions of the certainty around what is the best course of action to pursue. Objective: To characterise the documentation of working diagnoses and the associated level of real-time certainty expressed by clinicians and to gauge patient opinion about the importance of research into clinician decision certainty. Method: This was a single-centre retrospective cohort study of non-consultant grade clinicians and their assessments of patients admitted from the emergency department between 01 March 2019 and 31 March 2019. De-identified electronic health record proformas were extracted that included the type of diagnosis documented and the certainty adjective used. Patient opinion was canvassed from a focus group. Results: During the study period, 850 clerking proformas were analysed; 420 presented a single diagnosis, while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign and 16 (4%) were laboratory-result-defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. The patient focus group were unanimous in their support of this research. Conclusion: The documentation of working diagnoses is highly variable among non-consultant grade clinicians. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses. Implications: Increased standardisation of documentation will help future studies to better analyse and quantify diagnostic certainty in both single and multiple working diagnoses. This could lead to subsequent examination of their association with important process or clinical outcome measures.

Management of Hospital In The Home (HITH) Peripherally Inserted Central Catheters: A Retrospective Cohort Study

2019 ◽  
Vol 32 (1) ◽  
pp. 34-39
Author(s):  
Nicole Marsh ◽  
Emily Larsen ◽  
Sam Tapp ◽  
Margarette Sommerville ◽  
Gabor Mihala ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Home Setting ◽  
Catheter Failure ◽  
Central Catheters ◽  
At Home

Worldwide, there has been a shift in health care delivery, with an increasing emphasis on avoiding hospital admissions and providing treatment such as intravenous antibiotics for patients at home, using peripherally inserted central catheters (PICCs). However, there is inadequate data to demonstrate if rates of PICC failure are similar for hospital inpatients, currently understood to be between 7% and 36%, than those cared for at home. The objective of this study was to identify prevalence, dwell time, and complications associated with PICCs in the home setting. This single-center, retrospective cohort study of adults treated by the “Hospital in the Home” (HITH) program in Queensland, was conducted between June 1, 2017 and June 15, 2018. Clinical data were collected for patient and PICC characteristics. Variables were described as frequencies and proportions, means and standard deviations, or medians and interquartile ranges. In total, 304 patients treated by HITH during this timeframe, and 164 (54%) patients with 181 PICCs were included in this study. These patients were predominately male (n = 105, 64%), with a mean age of 54 years. The most common reason for admission was a wound infection and/or bone infection (n = 120, 33%). Most PICCs were single lumen (n = 120; 67%), inserted in the basilic vein (n = 137; 80%) by nurses (n = 122; 67%). Peripherally inserted central catheter failure occurred in 10% (n = 19); the most common complications were dislodgement (n = 9; 5%) and thrombosis (n = 4; 2%). There were no confirmed catheter-related blood stream infections. Peripherally inserted central catheter failure rates are similar between hospitalized inpatients and those cared for at home.

scholarly journals Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5248
Author(s):  
Naoki Yogo ◽  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Masayasu Gakumazawa ◽  
Mafumi Shinohara ◽  
...  
Keyword(s):  
Cohort Study ◽  
Head Injury ◽  
Diagnostic Accuracy ◽  
Decision Rule ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Characteristic Curve ◽  
Clinical Decision ◽  
The Novel ◽  
Clinical Decision Rule

Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; p = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.

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