Modified Seldinger technique for neonatal epicutaneo-caval catheter insertion: A non-randomised retrospective study

Background: Epicutaneo-Caval Catheters (ECCs) are critical for good neonatal care. No previous studies have evaluated which insertion method provides the highest likelihood of success. Methods: This study aimed to compare the success rates and cost of modified Seldinger technique (MST) and split needle technique (SNT). MST was introduced to St Michael’s Neonatal Unit, SNT was already in use. Routinely documented data on ECC insertion was retrospectively collected from the clinical notes. Practitioners were able to use their preferred insertion method. A sub-group analysis of success rates in patients born at ⩾35-weeks GA was performed. Results: There was a significantly higher first pass (53% vs 26%; p = 0.014) and overall (72% vs 40%; p = 0.0046) successful ECC insertion rate with fewer venipunctures per successful ECC with MST (2.5 vs 6.5; p = 0.002). Logrank test demonstrated a significantly higher successful ECC insertion with MST for patients of all GA ( p = 0.003) and for neonates born at ⩾35 weeks ( p = 0.015). The cost per successful MST ECC was £156.41 versus £152.51 for SNT. Conclusion: In this uncontrolled retrospective study, there was a higher chance of successful ECC insertion with MST, with a reduced number of venipunctures and similar costs per successful ECC. Further work in randomised studies is needed to verify this finding and should focus on other clinical outcomes, including rates in central line associated blood stream infections.

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1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?

British Journal of Surgery ◽

10.1093/bjs/znab259.683 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Win ◽

D Banerjee ◽

J Deng ◽

N Fraser

Keyword(s):

Clinical Evidence ◽

Blood Stream Infection ◽

Blood Stream ◽

Central Line ◽

Electronic Records ◽

High Morbidity ◽

Risk Of Infection ◽

Central Venous ◽

The Mean ◽

The Cost

Abstract Aim Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution. Method Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected. Results The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection. Conclusions Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.

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A New Perspective for PICC Line Insertions

Journal of the Association for Vascular Access ◽

10.2309/1552-8855-9.2.93 ◽

2004 ◽

Vol 9 (2) ◽

pp. 93-98

Author(s):

John Davis ◽

Kathy Kokotis

Keyword(s):

Success Rate ◽

Cost Effective ◽

Seldinger Technique ◽

High Tech ◽

Success Rates ◽

Portable Ultrasound ◽

Spare Time ◽

Picc Line ◽

New Perspective ◽

The Cost

Abstract PICC line insertion has been traditionally performed by non-dedicated per diem nurses who place PICC lines in their spare time, Interventional Radiology or IV Teams. A new option has developed to place PICC lines at the bedside. This option is to utilize an outside contractual agency that guarantees an insertion success of 90%–100% of PICC line placements at the bedside. Per diem nursing PICC teams often have insertion success rates of 50%–70% with 30%–50% of patients going to radiology for line placement. These per diem teams also have hidden costs associated with repeated re-training. Is it cost-effective to continuously retrain PICC line nurses who maintain an insertion success rate of 50%–70% or is an independent PICC contractor an economic substitute? Insertion proficiency is directly related to the concept practice makes perfect and the usage of modified seldinger technique and portable ultrasound. Can one train a per diem team to master the skill of utilizing high-tech tools in their spare time? Infusion Nurse Consultants began training per diem nursing PICC staff in 1998. Out of 100 nurses trained only 10 completed minimum Infusion Nursing Society Competency Guidelines. That is one out of every 10 nurses trained. As a result the organization embarked on offering independent PICC line insertions to contracted hospitals. In 2004, the service placed 900 PICC lines a month at a 98% insertion success rate at bedside. The author has discovered that the days of observing three PICC line insertions and placing three successful PICC lines does not lead to a 98% insertion success. A nurse who places PICC lines almost daily with high-tech tools masters that 90% insertion success. Hospital administrators should evaluate the cost losses and savings associated with the insertion success rate of their current PICC line inserters and consider the addition of an independent PICC contractor as an alternative option to reduce cost losses.

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Use of Antimicrobial Lock Therapy for the Treatment of Central Line-Related Blood-Stream Infections: A Case Series

10.1055/s-0038-1647089 ◽

2018 ◽

Author(s):

F. Piersigilli ◽

C. Auriti ◽

I. Bersani ◽

F. Campi ◽

I. Savarese ◽

...

Keyword(s):

Case Series ◽

Blood Stream ◽

Central Line ◽

Blood Stream Infections ◽

Lock Therapy

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Are we certain that chlorhexidine gluconate bathing is not beneficial in reducing central line associated blood stream infections among children with cancer or undergoing hematopoietic stem cell transplantation?

Cancer ◽

10.1002/cncr.33572 ◽

2021 ◽

Author(s):

Jeffrey D. Hord ◽

Christopher E. Dandoy

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Blood Stream ◽

Central Line ◽

Chlorhexidine Gluconate ◽

Blood Stream Infections ◽

Hematopoietic Stem

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Is it cost effective to use a 2% chlorhexidine wipes bath to reduce central-line associated blood stream infection? A quasi-experimental study

The Brazilian Journal of Infectious Diseases ◽

10.1016/j.bjid.2021.101538 ◽

2021 ◽

Vol 25 (1) ◽

pp. 101538

Author(s):

Diego Feriani ◽

Ercilia Evangelista Souza ◽

Larissa Gordilho Mutti Carvalho ◽

Aline Santos Ibanes ◽

Eliana Vasconcelos ◽

...

Keyword(s):

Experimental Study ◽

Blood Stream Infection ◽

Cost Effective ◽

Blood Stream ◽

Central Line ◽

Quasi Experimental

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Central Line-Associated Blood Stream Infection During COVID-19 Pandemic

Journal of Infection and Public Health ◽

10.1016/j.jiph.2021.01.017 ◽

2021 ◽

Author(s):

Fatima Aldawood ◽

Aiman El-Saed ◽

Mohammed Al Zunitan ◽

Majed Alshamrani

Keyword(s):

Blood Stream Infection ◽

Blood Stream ◽

Central Line

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Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

Annals of Intensive Care ◽

10.1186/s13613-021-00876-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ines Gragueb-Chatti ◽

Alexandre Lopez ◽

Dany Hamidi ◽

Christophe Guervilly ◽

Anderson Loundou ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Length Of Stay ◽

Critically Ill ◽

Invasive Mechanical Ventilation ◽

Blood Stream ◽

Hospital Length Of Stay ◽

Ventilator Associated Pneumonia ◽

Blood Stream Infections ◽

Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

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