Reduction of bacterial colonization at the exit site of peripherally inserted central catheters: A comparison between chlorhexidine-releasing sponge dressings and cyano-acrylate

2020 ◽  
pp. 112972982095474
Author(s):  
Emanuele Gilardi ◽  
Alfonso Piano ◽  
Pietro Chellini ◽  
Barbara Fiori ◽  
Laura Dolcetti ◽  
...  
Keyword(s):  
Bacterial Colonization ◽  
Central Venous Access ◽  
Exit Site ◽  
Cyanoacrylate Glue ◽  
Peripherally Inserted Central Catheters ◽  
Skin Culture ◽  
Local Bleeding ◽  
Group A ◽  
Group B ◽  
Central Catheters

Introduction: A serious complication associated with Central Venous Access Device (CVAD) is infection because of bacterial contamination, either by the extra-luminal or by the intra-luminal route. We evaluated the efficacy, the safety, and the cost-effectiveness of two strategies for non-inferiority in controlling bacterial colonization of the exit-site of Peripherally-Inserted Central Catheters (PICC). Methods: After PICC placement, a skin swab of the exit site was taken and cultured. In group A the exit site was sealed with N-butyl-cyanoacrylate glue, while in group B a chlorhexidine-releasing sponge dressing was applied. A second skin culture was taken at day 7. Results: A total of 51 patients were enrolled in each group. In 42 patients the second skin culture was not performed because of 20 patients were lost at follow-up or deceased and in 22 patients the dressing needed to be changed early, because of local bleeding (13 cases, in group B) or because of dressing detachment (four in group A and five in group B). The microbiological study was completed in 36 patients in group A and 24 in group B. No microorganisms were isolated in any patient. Conclusions: Both strategies were effective in controlling bacterial colonization. Glue was effective in reducing local bleeding, and it was more cost-effective than sponge dressing. During the first week, when local bleeding and bacterial colonization must be prevented, glue might be more appropriate than chlorhexidine-releasing dressing; after the first week chlorhexidine-releasing dressing might be preferable, considering that the safety of glue application on the skin for prolonged periods is still questionable.

The Use of Peripherally Inserted Central Catheters in Cancer Patients

2010 ◽  
Vol 15 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Su-Chen Lin ◽  
Kuei-Yen Wen ◽  
Chin-Yen Liu ◽  
Chih-Hsin Wei
Keyword(s):  
Cancer Patients ◽  
Nursing Staff ◽  
Hospice Care ◽  
Complication Rates ◽  
Infection Group ◽  
Major Purpose ◽  
Peripherally Inserted Central Catheters ◽  
Group A ◽  
Group B ◽  
Central Catheters

Abstract From 2002 to 2006, 524 cancer patients who underwent PICC insertion by nursing staff were studied. 568 PICCs were in place for a total of 32068 days (mean duration: 56 days; range: 1 to 487 days). The complication rates were phlebitis – 24.07%, broken/leaking catheter – 12.33%, accidental removal – 7.44%, occlusion – 14.68%, and infection – 1.77%. Group A patients who underwent PICC insertion for the major purpose of receiving repeated chemotherapy had higher incidences of phlebitis, broken/leakage catheter and infection. Group B patients who underwent PICC insertion for the major purpose of hospice care had a higher incidence of accidental removal.

Sharp Recanalization of a Chronically Occluded Superior Vena Cava in a Patient with Multiple Prior Peripherally Inserted Central Catheters

2019 ◽  
Vol 24 (2) ◽  
pp. 21-26
Author(s):  
Omar Shwaiki ◽  
Sarah Khoncarly ◽  
James J. Buchino ◽  
Janice McDaniel
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Collateral Flow ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Sharp Recanalization ◽  
Central Catheters

Highlights Recurrent central venous access can lead to central venous occlusions. Collateral flow can be used adventitiously for PICC tip placement. Sharp recanalization can be used to reconstitute patency of an occluded SVC.

Comparison between aspiration and incision and drainage of breast abscess

2020 ◽  
Vol 22 (1) ◽  
pp. 11-15
Author(s):  
Md Fardhus ◽  
AMSM Sharfuzzaman ◽  
Md Nayeem Dewan ◽  
Dipak Chandra Kirttania ◽  
Ahmed Sami AI Hasan ◽  
...  
Keyword(s):  
Bacterial Colonization ◽  
Needle Aspiration ◽  
Cosmetic Outcome ◽  
Breast Abscess ◽  
Incision And Drainage ◽  
Female Patients ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Drainage Group

Background: Breast abscess is defined as an acute inflammatory lump which yields pus on incision/aspiration. The frequency of occurrence is highly related to pregnancy and caused due to nipple cracking by a child during breast feeding and bacterial colonization due to improper nursing technique and incomplete emptying of the breast. Objective: The present study compares the outcome and effectiveness of traditional treatment incision and drainage against needle aspiration in the treatment of breast abscess. Methods: This is a comparative study carried out in department of general surgery, SherE- Bangla Medical College Hospital, Barisal between January 2014 and December 2014. 50 female patients of age between 20-40 years and diagnosed breast abscess with abscess size of 5'7 cm in diameter on ultrasonography were included in the study after taking written consent form. Of these 25 had undergone aspiration of the breast abscess (group A) and 25 had undergone incision and drainage (group B). Results: The mean age of the female patients in group A was 23.42 years and in Group B was 23.31. 91% of the cases were lactating. S. aureus was the common organism isolated in both lactating and non-lactating cases, encountered in 27 patients (54%). Out of that were in the aspirated group 17patients (56.67%). 10 patients were in the incised group (33.33%). The mean healing time and cosmetic outcome was significantly (p =0.001) very good in patients treated with needle aspiration compared to incision and drainage. There was no recurrence of breast abscess observed in needle aspiration group during the study. There was 3.3% recurrence rate observed in the incision and drainage group. Conclusion: Breast abscess in patients with diameter of 5'7 cm can be treated with needle aspiration successfully and with a good cosmetic outcome. Journal of Surgical Sciences (2018) Vol. 22 (1): 11-15

scholarly journals Evaluation of biofilm colonization on multi-part dental implants in a rat model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eva Blank ◽  
Jasmin Grischke ◽  
Andreas Winkel ◽  
Joerg Eberhard ◽  
Nadine Kommerein ◽  
...  
Keyword(s):  
Dental Implants ◽  
Antibiotic Treatment ◽  
Bacterial Colonization ◽  
Laser Scanning Microscopy ◽  
Treatment Groups ◽  
Implant Materials ◽  
Custom Made ◽  
Group A ◽  
Group B

Abstract Background Peri-implant mucositis and peri-implantitis are highly prevalent biofilm-associated diseases affecting the tissues surrounding dental implants. As antibiotic treatment is ineffective to fully cure biofilm mediated infections, antimicrobial modifications of implants to reduce or prevent bacterial colonization are called for. Preclinical in vivo evaluation of the functionality of new or modified implant materials concerning bacterial colonization and peri-implant health is needed to allow progress in this research field. For this purpose reliable animal models are needed. Methods Custom made endosseous dental implants were installed in female Sprague Dawley rats following a newly established three-step implantation procedure. After healing of the bone and soft tissue, the animals were assigned to two groups. Group A received a continuous antibiotic treatment for 7 weeks, while group B was repeatedly orally inoculated with human-derived strains of Streptococcus oralis, Fusobacterium nucleatum and Porphyromonas gingivalis for six weeks, followed by 1 week without inoculation. At the end of the experiment, implantation sites were clinically assessed and biofilm colonization was quantified via confocal laser scanning microscopy. Biofilm samples were tested for presence of the administered bacteria via PCR analysis. Results The inner part of the custom made implant screw could be identified as a site of reliable biofilm formation in vivo. S. oralis and F. nucleatum were detectable only in the biofilm samples from group B animals. P. gingivalis was not detectable in samples from either group. Quantification of the biofilm volume on the implant material revealed no statistically significant differences between the treatment groups. Clinical inspection of implants in group B animals showed signs of mild to moderate peri-implant mucositis (4 out of 6) whereas the mucosa of group A animals appeared healthy (8/8). The difference in the mucosa health status between the treatment groups was statistically significant (p = 0.015). Conclusions We developed a new rodent model for the preclinical evaluation of dental implant materials with a special focus on the early biofilm colonization including human-derived oral bacteria. Reliable biofilm quantification on the implant surface and the symptoms of peri-implant mucositis of the bacterially inoculated animals will serve as a readout for experimental evaluation of biofilm-reducing modifications of implant materials.

scholarly journals Reverse tapered versus non-tapered peripherally inserted central catheters: A narrative review

2021 ◽  
pp. 112972982110099
Author(s):  
Sergio Bertoglio
Keyword(s):  
Clinical Practice ◽  
Clinical Studies ◽  
Postoperative Bleeding ◽  
Narrative Review ◽  
Efficacy And Safety ◽  
Exit Site ◽  
Peripherally Inserted Central Catheters ◽  
Safety And Efficacy ◽  
Central Catheters

Introduced over 20 years ago, the reverse tapering design for PICC catheters is supposed to have some benefits in terms of both efficacy and safety. In particular, it would ensure less postoperative bleeding at the exit site and greater effectiveness in preventing kinking or twisting of the same. Since its introduction, these hypothesized advantages have never been demonstrated in clinical studies, however very scarce, which have highlighted neither advantages nor disadvantages of reverse tapered catheters when compared to non-reverse tapered ones. This narrative review analyzes some aspects of the use of reverse tapered PICCs, also paying attention to some possible undesirable effects that have arisen from the introduction into clinical practice of new subcutaneous systems of securement of PICCs to the skin. Clinicians should be aware of the fact that reverse tapering design does not represents a sure improvement in terms of safety and efficacy of PICCs and its adoption should be weighed against possible clinical disadvantages.

scholarly journals The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

2021 ◽  
pp. 112972982110414
Author(s):  
Fabrizio Brescia ◽  
Mauro Pittiruti ◽  
Matthew Ostroff ◽  
Timothy R Spencer ◽  
Robert B Dawson
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Late Complications ◽  
Exit Site ◽  
Central Venous ◽  
Standardized Protocol ◽  
Tip Position ◽  
Correct Application ◽  
Ultrasound Guided Puncture ◽  
Central Catheters

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.

Safety of administration of bevacizumab within a week from placement of a totally implantable central venous port system.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 589-589
Author(s):  
Tetsuhito Muranaka ◽  
Yoshito Komatsu ◽  
Masataka Yagisawa ◽  
Yasuyuki Kawamoto ◽  
Hiroshi Nakatsumi ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Operation Time ◽  
University Hospital ◽  
Outpatient Basis ◽  
Central Venous ◽  
Central Venous Port ◽  
Venous Port ◽  
Short Period ◽  
Group A ◽  
Group B

589 Background: Totally implantable central venous port systems (TICVP) are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access for treatment of intravenous anti-cancer chemotherapy in patients with cancer but it is needed to cut 3cm of patients’ skin at the operation. Bevacizumab is one of the anti vascular endothelial growth factor (ant-VEGF) antibody which is known to improve overall survival in patients with colorectal cancer but have a side effect of delayed wound healing. There are few reports about the safety of administration of bevacizumab in a short period of time from the small surgery such as placement of TICVP. Methods: Patients who were placed TICVP in Department of Gastroenterology of Hokkaido University Hospital from July 2009 to December 2016. We planned to compare the rate of post-operative wound dehiscence (POWD) and surgical site infection (SSI) between patients who administered bevacizumab within a week from placement of TICVP (Group A) and the other patients (Group B). Patients who didn’t receive any chemotherapy after placement of TICVP were excluded. Results: We found 432 patients who implanted TICVP, and excluded 32 patients who didn’t receive any chemotherapy. 50 patients were assigned to Group A and 350 patients were assigned to Group B. Median age in both group were 67.5 in Group A and 65 in Group B. The averages of operation time were 38.7 (+/-19.3) minutes in Group A and 36.4 (+/-19.5) minutes in Group B. Prophylactic antibiotics were given to 27 patients (54%) in Group A and 146 patients (48.7%) in Group B. The rate of POWD was 0.0% (0/50) in Group A vs 1.1% (4/350) in Group B ( p = 0.45 ) , and the rate of SSI was 0.0%(0/50) in Group A vs 1.1% (4/350) in Group B ( p = 0.45 ) . The average of operation time of patients with and without POWD was 56.4 minutes and 36.7 minutes (p = 0.013). Conclusions: In our study, it was found that there is no significant increase of incidence by administration of bevacizumab within a short period from placement of TICVP. The long operation time tends to increase the rate of POWD.

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.

The Effect of Antibiotic Prophylaxis on the Healing of Exit Sites of Peritoneal Dialysis Catheters in Rats

1998 ◽  
Vol 18 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Roberto F.S. Pecoits-Filho ◽  
Zbylut J. Twardowski ◽  
Ramesh Khanna ◽  
Yong-Lim Kim ◽  
Sharad Goel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Prophylaxis ◽  
Sprague Dawley ◽  
Exit Site ◽  
Sprague Dawley Rats ◽  
Group A ◽  
Catheter Implantation ◽  
The Mean ◽  
Group B

Objective To evaluate the influence of intraperitoneal (IP) antibiotic (AB) prophylaxis on the quality of healing and infection rates of exit sites in peritoneal dialysis catheters. Study Design Twenty-one Sprague-Dawley rats were dialyzed 3 times per day for 6 weeks. Dianeal solution containing AB was used for all the rats during the first 5 days. The animals were randomized on the sixth day into three groups: group A (AB-free after randomization), group B (AB for 3 weeks), and group C (AB during 6 weeks). Scores were given to each exit site according to the observation. Mean scores from each group were compared in an attempt to find significant differences between the groups. Dialysate and exit-site drainage samples were taken weekly for microbiology. Results Eight episodes of peritonitis were diagnosed, six in group A and two in group B. The most common bacteria causing peritonitis were gram-negative rods. The mean scores were not significantly different between groups C and B throughout the study, even after the discontinuation of the prophylaxis. Group A, when compared to the other two groups, had significantly higher scores after the second week and throughout the rest of the study. Conclusion Intraperitoneal antibiotic prophylaxis for 3 weeks after catheter implantation is an effective way to prevent early colonization of exit sites, providing a better healing quality and lower incidence of catheter-related infection. Although the extension of the prophylaxis for 6 weeks seems to be beneficial, it was not statistically proven in this study.

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