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

2021 ◽  
pp. 112972982110360
Author(s):  
Fabrizio Brescia ◽  
Mauro Pittiruti ◽  
Matthew Ostroff ◽  
Timothy R Spencer ◽  
Robert B Dawson
Keyword(s):  
Central Venous Catheters ◽  
Immediate Early ◽  
Thoracic Region ◽  
Exit Site ◽  
Central Venous ◽  
Standardized Protocol ◽  
Adequate Coverage ◽  
Tip Position ◽  
Central Catheters ◽  
Late Insertion

Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.I.C.: Safe Insertion of Centrally Inserted Central Catheters) for the systematic application of seven basic beneficial strategies to be adopted during insertion of central venous catheters in the cervico-thoracic region, aiming to minimize immediate, early, or late insertion-related complications. These strategies include: preprocedural evaluation, appropriate aseptic technique, ultrasound guided insertion, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and adequate coverage of the exit site.

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.

Reduction in catheter-related infections after switching from povidone-iodine to chlorhexidine for the exit-site care of tunneled central venous catheters in children on hemodialysis

2014 ◽  
Vol 18 ◽  
pp. S13-S18 ◽  
Author(s):  
Fabio Paglialonga ◽  
Silvia Consolo ◽  
Antonietta Biasuzzi ◽  
Jolanda Assomou ◽  
Elisabetta Gattarello ◽  
...  
Keyword(s):  
Povidone Iodine ◽  
Central Venous Catheters ◽  
Exit Site ◽  
Central Venous

A New Formula-Based Measurement Guide for Optimal Positioning of Central Venous Catheters

2004 ◽  
Vol 9 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Phllip Lum
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Access Site ◽  
Insertion Sites ◽  
Tip Position ◽  
A Prospective Study ◽  
New Formula ◽  
Percutaneous Insertion

Abstract Purpose: To validate the formula-based central venous catheter (CVC) length measurement “tailored” to individual's height and access site for predicting optimum SVC tip position. Method: A prospective study of 3 percutaneous insertion sites (PICC, SCC and JC). Formula-based “LUM'S CVC MEASUREMENT GUIDE” was used to determine the catheter length. Results: Overall, 97% (373) of the total 382 insertions were successfully placed with CVC tip in the distal SVC (SVC between carina and atrio-cava junction) location. Conclusion: The “tailored fit” formula to individual patient height is a reliable tool to predict CVC length. Appropriate catheter length can greatly reduce the guesswork and possibility of complications related to tip malposition.

Central venous catheters and arrhythmia: Two unusual cases

2020 ◽  
pp. 112972982091532
Author(s):  
R Haridian Sosa Barrios ◽  
David Lefroy ◽  
Damien Ashby ◽  
Neill Duncan
Keyword(s):  
Real Time ◽  
High Velocity ◽  
Central Venous Catheters ◽  
Fluoroscopic Guidance ◽  
Common Complication ◽  
Central Venous ◽  
Insertion Procedure ◽  
Catheter Tip ◽  
Life Threatening ◽  
Tip Position

Jugular Tesio lines (TesioCaths; MedCOMP, Harleysville, PA, USA) are frequently used as permanent vascular accesses in haemodialysis patients. During the insertion procedure, arrhythmias are a relatively common complication, usually related to an excessively advanced catheter tip, without major consequences. We present two cases of life-threatening arrhythmias triggered by the Tesio catheter eccentric high-velocity jet of blood resolved after reposition of the catheter without further episodes, despite both lines being inserted under real-time ultrasound and fluoroscopic guidance. We believe dialysis lines should be checked for tip position even when long-standing to prevent relevant complications due to catheter sliding.

Thrombus and thrombosis in cancer patients with permanent venous catheters

2000 ◽  
Vol 20 (03) ◽  
pp. 143-145
Author(s):  
H. D. Bruhn ◽  
F. Gieseler
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Clinical Studies ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Vascular Lumen ◽  
Additive Risk ◽  
Thrombotic Complications ◽  
Port Systems ◽  
Central Catheters

SummaryCancer patients have additive risk factors for thrombosis especially if permanent central catheters (port systems) are used for the delivery of chemotherapy. In our hospital the rate of thrombotic complications is below 5% for cancer patients receiving chemotherapy via port systems. This is in contrast to clinical studies, which have shown that up to 60% of catheters acquire clots that obstruct more than 50% of the vascular lumen. It is reasonable to believe that complications arising from thrombotic catheter alterations, such as bacterial hosting or micro-emboli, are clinically underestimated. The identification of thrombotic alterations of permanent central venous catheters in cancer patients receiving chemotherapy is substantial for the estimation whether anticoagulation strategies should be used as prophylaxis.

scholarly journals Increased Risk of Bacteremia in Patients Hemodialyzed Through Central Catheters

1990 ◽  
Vol 1 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Geoffrey Taylor ◽  
Teresa Kirkland ◽  
Peter Hamilton
Keyword(s):  
Staphylococcus Aureus ◽  
Vascular Grafts ◽  
Central Venous Catheters ◽  
Hemodialysis Access ◽  
Central Venous ◽  
Access Site ◽  
Prospective Survey ◽  
Increased Risk ◽  
Central Catheters

As part of an ongoing prospective survey of nosocomial bacteremias, patients developing bacteremia while undergoing in-centre hemodialysis were observed over a 23 month period. Thirty-six episodes of bacteremia occurred in 30 patients: every episode was directly attributable to hemodialysis. In 28 of the 36 episodes (78%), there was evidence of inflammation with or without drainage of pus at the hemodialysis access site.Staphylococcus aureusaccounted for 76% of the bacteremic isolates. Patients hemodialyzing through central venous catheters had a far higher incidence of bacteremia (0.01 per dialysis run) than patients hemodialyzing through vascular grafts (0.0005 per dialysis run).

scholarly journals Re-Evaluating the Protective Effect of Hemodialysis Catheter Locking Solutions in Hemodialysis Patients

2019 ◽  
Vol 8 (3) ◽  
pp. 412 ◽  
Author(s):  
Chang-Hua Chen ◽  
Yu-Min Chen ◽  
Yu Yang ◽  
Yu-Jun Chang ◽  
Li-Jhen Lin ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Treated Group ◽  
Central Venous Catheters ◽  
Exit Site ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Significant Difference ◽  
All Cause Mortality ◽  
The Impact ◽  
Catheter Function

Catheter-related bloodstream infections (CRBSIs) and exit-site infections (ESIs) are common complications associated with the use of central venous catheters for hemodialysis. The aim of this study was to analyze the impact of routine locking solutions on the incidence of CRBSI and ESI, in preserving catheter function, and on the rate of all-cause mortality in patients undergoing hemodialysis. We selected publications (from inception until July 2018) with studies comparing locking solutions for hemodialysis catheters used in patients undergoing hemodialysis. A total of 21 eligible studies were included, with a total of 4832 patients and 318,769 days of catheter use. The incidence of CRBSI and ESI was significantly lower in the treated group (citrate-based regimen) than in the controls (heparin-based regimen). No significant difference in preserving catheter function and all-cause mortality was found between the two groups. Our findings demonstrated that routine locking solutions for hemodialysis catheters effectively reduce the incidence of CRBSIs and ESIs, but our findings failed to show a benefit for preserving catheter function and mortality rates. Therefore, further studies are urgently needed to conclusively evaluate the impact of routine locking solutions on preserving catheter function and improving the rates of all-cause mortality.

CE Article: Use of an Evidence-Based Protocol for Repositioning Peripherally Inserted Central Catheters (PICCs) in Children and AdultsCE

2021 ◽  
Vol 26 (1) ◽  
pp. 6-14
Author(s):  
Jorge Mesa ◽  
Amalyn Mejia ◽  
Gareth Tiu
Keyword(s):  
Cost Savings ◽  
Intrathoracic Pressure ◽  
Evidence Based ◽  
Catheter Position ◽  
Standardized Protocol ◽  
Catheter Exchange ◽  
Unnecessary Procedures ◽  
Pediatric Populations ◽  
Tip Position ◽  
Central Catheters

Highlights Abstract Introduction: Achieving and maintaining optimal peripherally inserted central catheter (PICC) tip position can be challenging. At any time during therapies, the final catheter position can be altered due to changes in patient condition and intrathoracic pressure. Aim: To determine if the use of a standardized protocol with power flush option for repositioning the PICC tips will reduce the number of withdrawal interventions or exchange procedures. Methods: Johns Hopkins evidence-based practice (EBP) methodology was used to evaluate literature published in the past 5 years. A standardized protocol was developed and implemented in patients with malpositioned PICCs. The outcome measures were the successful repositioning of the catheter and costs for the procedure. Results: In 4 months, 43 (93%) of 46 (14 adult/32 pediatric) catheters were successfully repositioned. The withdrawal method was used to reposition 34 (73.9%). In 12 patients where a power flush was used, 9 (75%) were successfully repositioned. These changes resulted in decreased delays in treatment and financial savings of $235,210 in personnel time and supplies. Discussion: The standardized protocol provided an alternative to previous practices, extending dwell time, decreasing treatment delay, and unnecessary procedures, showing significant savings for the institution. Conclusions: The Vascular Access Team use of an evidence-based protocol was successful in reducing catheter exchange and withdrawals in malpositioned catheters among adult and pediatric populations. Relevance to Clinical Practice: The implementation of a standardized EBP to address malpositioned catheters resulted in the decreased need for catheter exchange, reduced delays in treatment, and cost savings.

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