The microbial biofilm composition on peripherally inserted central catheters: A comparison of polyurethane and hydrophobic catheters collected from paediatric patients

2020 ◽  
pp. 112972982093242
Author(s):  
Maddie Higgins ◽  
Li Zhang ◽  
Rebecca Ford ◽  
Jeremy Brownlie ◽  
Tricia Kleidon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Microbial Communities ◽  
Bloodstream Infection ◽  
Dwell Time ◽  
Central Line ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Microbial Biofilm ◽  
Central Catheters

Background: Peripherally inserted central catheters are susceptible to microbial colonisation and subsequent biofilm formation, leading to central line–associated bloodstream infection, a serious peripherally inserted central catheter–related complication. Next-generation peripherally inserted central catheter biomaterials, such as hydrophobic materials (e.g. Endexo®), may reduce microbial biofilm formation or attachment, consequently reducing the potential for central line–associated bloodstream infection. Methods: Within a randomised controlled trial, culture-dependent and culture-independent methods were used to determine if the biomaterials used in traditional polyurethane peripherally inserted central catheters and hydrophobic peripherally inserted central catheters impacted microbial biofilm composition. This study also explored the impact of other clinical characteristics including central line–associated bloodstream infection, antibiotic therapy and dwell time on the microbial biofilm composition of peripherally inserted central catheters. Results: From a total of 32 patients, one peripherally inserted central catheter was determined to be colonised with Staphylococcus aureus, and on further analysis, the patient was diagnosed with central line–associated bloodstream infection. All peripherally inserted central catheters ( n = 17 polyurethane vs n = 15 hydrophobic) were populated with complex microbial communities, including peripherally inserted central catheters considered non-colonised. The two main microbial communities observed included Staphylococcus spp., dominant on the colonised peripherally inserted central catheter, and Enterococcus, dominant on non-colonised peripherally inserted central catheters. Both the peripherally inserted central catheter biomaterial design and antibiotic therapy had no significant impact on microbial communities. However, the diversity of microbial communities significantly decreased with dwell time. Conclusion: More diverse pathogens were present on the colonised peripherally inserted central catheter collected from the patient with central line–associated bloodstream infection. Microbial biofilm composition did not appear to be affected by the design of peripherally inserted central catheter biomaterials or antibiotic therapy. However, the diversity of the microbial communities appeared to decrease with dwell time.

Repurposing the power injectable peripherally inserted central catheter as a tunnelled, non-cuffed, centrally inserted central venous catheter in oncological patients for short- to mid-term vascular access: A pilot study

2020 ◽  
pp. 112972982094344
Author(s):  
Xi Zhen Low ◽  
Kiang Hiong Tay ◽  
Sum Leong ◽  
Richard Hoau Gong Lo ◽  
Kun Da Zhuang ◽  
...  
Keyword(s):  
Pilot Study ◽  
Vascular Access ◽  
Dwell Time ◽  
Complication Rates ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Oncological Patients ◽  
Oncologic Patients ◽  
Central Catheters

Objectives: Usual short- to mid-term vascular accesses for oncologic patients include the peripherally inserted central catheter and non-tunnelled centrally inserted central catheters, inserted in the supraclavicular or infraclavicular area. Peripherally inserted central catheters can be restrictive in active patients; supraclavicular non-tunnelled centrally inserted central catheters are not ideal in terms of exit site location and cosmesis, while infraclavicular non-tunnelled centrally inserted central catheters may be associated with puncture-related complications. In this pilot study, we have evaluated the off-label use of peripherally inserted central catheters as a tunnelled supraclavicular centrally inserted central catheter. Methods: Ten patients were recruited for this prospective study. A non-cuffed, power injectable peripherally inserted central catheter was inserted via a short subcutaneous tunnel into the internal jugular vein using the peel-away sheath and introducer as a tunneller. Puncture wounds were closed with tissue glue. Patients were followed up for comfort scores, dwell time and complications. Results: The median dwell time was 94 days (mean of 113 days). One catheter was removed due to systemic fungemia, resulting in an acceptable complication rate of 0.97 per 1000 catheter days.Mean patient-reported comfort scores was 16 (out of 20). Pressurised injections for computer tomography imaging were performed in five patients without complications. Conclusion: Despite limited numbers, this method appears to be safe and well accepted with low complication rates. This modified vascular access is low profile, easily concealed, readily removable and compatible with pressure injector and uses a commonly found catheter in a modified fashion. Larger prospective trials will be needed to ascertain if it can be a standard of care for oncological patients.

Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

2018 ◽  
Vol 19 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Soshi Nakamuta ◽  
Toshihiro Nishizawa ◽  
Shiori Matsuhashi ◽  
Arata Shimizu ◽  
Toshio Uraoka ◽  
...  
Keyword(s):  
Success Rate ◽  
Detection Rate ◽  
Ultrasound Guidance ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Ultrasound Guided ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

Types of Interventions

2021 ◽  
pp. 40-51
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Infection Prevention ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Trade Off ◽  
Central Lines ◽  
The Past ◽  
Central Catheters

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

Percutaneous removal of a precariously placed pericardial peripherally inserted central catheter

2019 ◽  
Vol 20 (6) ◽  
pp. 778-781
Author(s):  
Trevor Tyner ◽  
Noelle McNaught ◽  
Matthew B. Shall ◽  
Mark L. Lessne
Keyword(s):  
Parenteral Nutrition ◽  
Unusual Complication ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Blood Products ◽  
Peripherally Inserted Central Catheters ◽  
Percutaneous Removal ◽  
Essential Function ◽  
Central Catheters

Peripherally inserted central catheters provide access to the central chest veins and allow administration of long-term antibiotics, chemotherapy, blood products, fluids, and parenteral nutrition. Peripherally inserted central catheters provide an essential function and are routinely placed safely, but are not without risks. This case describes an unusual complication of peripherally inserted central catheter perforation into the pericardial space with subsequent successful percutaneous removal.

Peripherally inserted central catheter placement in a multidisciplinary intensive care unit: A preliminary study demonstrating safety and procedural time in critically ill subjects

2020 ◽  
pp. 112972982092861
Author(s):  
Ryan J Smith ◽  
Rodrigo Cartin-Ceba ◽  
Julie A Colquist ◽  
Amy M Muir ◽  
Jeanine M Moorhead ◽  
...  
Keyword(s):  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Time Required ◽  
Central Catheters

Objective: Peripherally inserted central catheters are a popular means of obtaining central venous access in critically ill patients. However, there is limited data regarding the rapidity of the peripherally inserted central catheter procedure in the presence of acute illness or obesity, both of which may impede central venous catheter placement. We aimed to determine the feasibility, safety, and duration of peripherally inserted central catheter placement in critically ill patients, including obese patients and patients in shock. Methods: This retrospective cohort study was performed using data on 55 peripherally inserted central catheters placed in a 30-bed multidisciplinary intensive care unit in Mayo Clinic Hospital, Phoenix, Arizona. Information on the time required to complete each step of the peripherally inserted central catheter procedure, associated complications, and patient characteristics was obtained from a prospectively assembled internal quality assurance database created through random convenience sampling. Results: The Median Procedure Time, beginning with the first needle puncture and ending when the procedure is complete, was 14 (interquartile range: 9–20) min. Neither critical illness nor obesity resulted in a statistically significant increase in the time required to complete the peripherally inserted central catheter procedure. Three (5.5%) minor complications were observed. Conclusion: Critical illness and obesity do not delay the acquisition of vascular access when placing a peripherally inserted central catheter. Concerns of delayed vascular access in critically ill patients should not deter a physician from selecting a peripherally inserted central catheter to provide vascular access when it would otherwise be appropriate.

Prone positioning for peripherally inserted central catheter on a patient with anal cancer

2019 ◽  
Vol 21 (1) ◽  
pp. 103-104
Author(s):  
Ferdinando Longo ◽  
Fabio Costa ◽  
Chiara Piliego ◽  
Felice E Agrò
Keyword(s):  
Prone Position ◽  
Anal Cancer ◽  
Peripherally Inserted Central Catheter ◽  
Prone Positioning ◽  
Central Catheter ◽  
Difficult Patient ◽  
Peripherally Inserted Central Catheters ◽  
Central Access ◽  
Central Catheters ◽  
Usual Position

Peripherally inserted central catheters are usually inserted in supine patients. What should we do when facing a patient who cannot tolerate this position? In this article, we are describing a particularly difficult patient: not only supine decubitus was intolerable to her but lying on the side was unbearable, too. That is why, to manage a patient who required a central access but could not tolerate the usual position for placing it, we tried to do that in prone position.

scholarly journals Peripherally inserted central catheter in newborns: association of number of punctures, vein, and tip positioning

2021 ◽  
Vol 55 ◽  
Author(s):  
Thaís Aquino Carneiro ◽  
Keline Soraya Santana Nobre ◽  
Fernanda Cavalcante Fontenele ◽  
Ana Paula Melo Façanha ◽  
Roberta Pinheiro Ferreira
Keyword(s):  
Incomplete Data ◽  
Maternity Hospital ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Tip ◽  
Convenience Sampling ◽  
Tip Position ◽  
Central Catheters ◽  
Indications For Use

ABSTRACT Objective: to assess the use of peripherally inserted central catheters regarding the neonate’s profile, indications for use, and catheterized vein; the relation between the number of puncture attempts and vein; and assessment of the catheter tip position. Method: documentary, descriptive, retrospective, quantitative study, developed in a tertiary maternity hospital in Ceará. A total of 3,005 PICC insertion formularies was included and 1,583 were excluded due to incomplete data, with a convenience sampling of 1,422 insertions being obtained. Results: There were 1,200 (84.4%) newborns with gestational age below 37 weeks; 781 (54.9%) males; Apgar score above 7 in the first (628–44.2%) and fifth minutes (1,085–76.3%); and weight between 1,000 and 1,499 grams on the day of insertion (417–29.3%). Antibiotic therapy had 1,155–53.8% indications for insertion; the basilic was the most used vein (485–34.1%); basilic and cephalic veins had lower median puncture attempts and 1,124–79% insertions were centrally positioned. Conclusion: The results of this research highlight the continuous need to improve technical-scientific knowledge to qualify actions in neonatology.

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