scholarly journals Effect of ultrasound-guided central venous catheter insertion on the incidence of catheter-related bloodstream infections and mechanical complications

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Osamu Imataki ◽  
Mami Shimatani ◽  
Yukiko Ohue ◽  
Makiko Uemura
Keyword(s):  
Ultrasound Guidance ◽  
Hematological Malignancies ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Gram Positive ◽  
Indwelling Catheter ◽  
Early Term ◽  
Mechanical Complications

Abstract Background Central venous catheters (CVCs) are necessary for critically ill patients, including those with hematological malignancies. However, CVC insertion is associated with inevitable risks for various adverse events. Whether ultrasound guidance decreases the risk of catheter-related infection remains unclear. Methods We observed 395 consecutive CVC insertions between April 2009 and January 2013 in our hematological oncology unit. Because the routine use of ultrasound guidance upon CVC insertion was adopted based on our hospital guidelines implemented after 2012, the research period was divided into before December 2011 (early term) and after January 2012 (late term). Results Underlying diseases included hematological malignancies and immunological disorders. In total, 235 and 160 cases were included in the early- and late term groups, respectively. The median insertion duration was 26 days (range, 2–126 days) and 18 days (range, 2–104 days) in the early- and late term groups, respectively. The internal jugular, subclavian, and femoral veins were the sites of 22.6, 40.2, and 25.7% of the insertions in the early term group and 32.3, 16.9, and 25.4% of the insertions in the late term group, respectively. The frequency of catheter-related bloodstream infection (CRBSI) was 1.98/1000 catheter days and 2.17/1000 catheter days in the early- and late term groups, respectively. In the subgroup analysis, the detected causative pathogens of CRBSI did not differ between the two term groups; gram-positive cocci, gram-positive bacilli, and gram-negative bacilli were the causative pathogens in 68.9, 11.5, and 14.8% of the cases in the early term group and in 68.2, 11.4, and 18.2% of the cases in the late term group, respectively. In the multivariate analysis to determine the risk of CRBSI, only age was detected as an independent contributing factor; the indwelling catheter duration was detected as a marginal factor. A significant reduction in mechanical complications was associated with the use of ultrasound guidance. Conclusions Ultrasound-guided CVC insertion did not decrease the incidence of CRBSI. The only identified risk factor for CRBSI was age in our cohort. However, we found that the introduction of ultrasound-guided insertion triggered an overall change in safety management with or without the physicians’ intent.

Ultrasound-Guided Catheter Insertion Did Not Decrease Catheter-Related Blood Stream Infection in Hematological Oncology Care Unit

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2394-2394
Author(s):  
Shumpei Uchida ◽  
Osamu Imataki ◽  
Mami Shimatani ◽  
Shigeyuki Yokokura ◽  
Makiko Uemura ◽  
...  
Keyword(s):  
Nutritional Support ◽  
Hematological Malignancies ◽  
Blood Stream Infection ◽  
Insertion Site ◽  
Blood Stream ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Early Term ◽  
Ultrasound Guide ◽  
Insertion Method

Abstract Background: Central venous catheters (CVCs) are necessary for critically ill patients requiring intravenous pharmacological intervention and subsequent parenteral nutritional support. Although CVCs allow delivery of medications and nutritional support that cannot be administered safely through central venous, their use is inevitably associated with adverse events, mechanical complication and catheter-related infection. While ultrasound guide has already been proven to decrease mechanical complications, it is not fully elucidated whether ultrasound guide decrease the risk of catheter-related infection. Methods: We observed consecutive CVC insertions between April 2009 and January 2013. In total, 395 insertion cases were surveyed in the hematological oncology unit. We divided the research period into two terms: before December 2011 (early term) and after January 2012 (latter term). Between the early and latter terms, there were substantial differences regarding the use of ultrasound guides. Because insertion maneuvers changed from blind to ultrasound-guided approach after 2012. SMAC Plus MicroNeedle (15G, 13 cm or 12G, 20 cm; Covidien Tokyo, Japan) was used. Practitioners determined which CVC device and which insertion site was preferred for each patient. To determine the clinical efficacy of chlorhexidine gluconate dressing (CHGD) at catheter insertion site, we performed matched cohort analysis among the patients who underwent stem cell transplantation. Total 44 cases were included in the cohort from the total study population. Results: Underlying diseases included hematological malignancies and immunological disorders such as auto-immune diseases and solid organ malignancies. A total of 235 and 160 cases were included in early and latter terms, respectively. Insertion duration was a median 26 days (range, 2-126 days) in the early term and 18 days (range, 2-104) in the latter term. During the early term, the insertion sites were 22.6%, 40.2%, and 25.7% at the cervical, subclavian, and femoral veins, respectively, and 32.3%, 16.9%, and 25.4% in the latter term, respectively. The ultrasound-guided insertion method became a routine practice in the latter term. The frequency of catheter-related blood stream infection (CRBSI) was 8.46/person-days and 13.62/person-days in the early and latter terms, respectively. Mechanical comorbidities decreased from 0.39 (13/33) incidences/month to 0.00 (0/13) after the introduction of the ultrasound-guided insertion method. Using subgroup analysis, detected causative pathogens of CRBSI did not differ between the two terms: gram-positive coccus, gram-positive bacillus, and gram-negative bacillus were 68.9%, 11.5%, and 14.8% in the early term and 68.2%, 11.4%, and 18.2% in the latter term, respectively. Controlled-cohort study revealed CHGD decreased CRBSI caused by Staphylococcus spp. significantly, but not overall other organisms. Conclusion: Ultrasound-guided insertion did not decrease the incidence of CRBSI. However, in our survey, insertion through the cervical vein approach clearly increased after the introduction of the ultrasound-guided method, and mechanical complications decreased significantly. Ultrasound guide and cervical vein approach trended for patients with hematological diseases who required CVC and those who concurrently harbored multiple risks, including thrombocytopenia. The prevalence of CRBSI slightly increased with this trend. With respect to CRBSI, the preventative effect of CHGD in patients undergoing allogeneic stem cell transplantation was promising. We advocate trending of ultrasound-guided, cervical approach CVC with CHGD can provide the safest parental alimentation for the patients with hematological malignancies. Disclosures No relevant conflicts of interest to declare.

scholarly journals THE SUCCESS OF ULTRASOUND GUIDED INSERTION OF CENTRAL VENOUS CATHETER VERSUS LANDMARK TECHNIQUE

2021 ◽  
Vol 71 (1) ◽  
Author(s):  
Bilal Munir ◽  
Fahim Ullah Naz ◽  
Salman Saleem ◽  
Amna Khalid ◽  
Adnan Aqil Khan ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Military Hospital ◽  
Primary Study ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Group A ◽  
Group B ◽  
Landmark Technique

Objective: Central venous catheterization is an important skill for doctors working in the departments ofmedicine, surgery, critical care, anesthesiology, and emergency. The Agency for Healthcare Research and Quality, USA named ultrasound guidance of central venous catheter placement as one of 11 most underutilized practices that can enhance patient safety with greatest strength of evidence to provide clear opportunities for safety improvement. In this study, we compare the success of ultrasound-guided insertion of central venous catheter versus landmark technique. Study Design: Randomized controlled clinical trial. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jul to Dec 2016.Methodology: One hundred twenty patients admitted in its wards and undergone CVC were included. Patientswere divided into group A & group B containing 60 patients each. In ‘group A’ CVC was done with ultrasoundassistance while in ‘group B’ CVC was done with landmark technique. The primary study outcome was No. ofattempts at which CVC was done. Results: In this study, 120 patients were enrolled. There was no difference in demographic data comparison.Success rate was found to be 28 (46.67%) in-group A while 16 (26.67%) in-group B with the p-value of 0.042 which is significant. Conclusion: We concluded that CVC with ultrasound guidance is more successful than landmark technique.

scholarly journals PROVISION OF CENTRAL VENOUS ACCESS DURING ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATION

2019 ◽  
Vol 64 (4) ◽  
pp. 396-411
Author(s):  
M. V. Spirin ◽  
G. M. Galstyan ◽  
M. Yu. Drokov ◽  
L. A. Kuzmina ◽  
G. A. Klyasova ◽  
...  
Keyword(s):  
Conflict Of Interest ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Venous Access ◽  
Haematopoietic Stem Cell ◽  
Central Venous ◽  
Post Transplant ◽  
Antibacterial Coating ◽  
Mechanical Complications

Introduction. The transplantation of allogeneic haematopoietic stem cells (allo-HSCT) is impossible without a central venous catheter (CVC).Aim. To determine an optimal approach to providing venous access during allo-HSCT.Materials and methods. This prospective, non-randomised, single-centre study included 146 patients (70 men and 76 women, median age 37 years) who underwent the fi rst allo-HSCT. Prior to conditioning, one of the following CVCs was placed: Hickman or Leonard tunnelled double-lumen silicone catheters (BardAccessSystem); polyurethane non-tunnelled CVCs without (Certofi x Duo, B. Braun) or with an antibacterial coating (Certofi x Protect Duo, B. Braun). The following complications were recorded: early complications, mechanical complications, catheter-associated thrombosis (CAT), catheterrelated bloodstream infections (CRBSI), as well as catheter exit-site and tunnel infections.Results. A total of 320 CVCs were placed (146 prior to allo-HSCT and 174 in the post-transplant period); 259 of the CVCs were non-tunnelled and 61 were tunnelled. Non-tunnelled CVCs were used for 1–123 days (median 22 days), whereas tunnelled CVCs were implanted for 9–621 days (median 146 days). The use of non-tunnelled CVCs was associated with 2.7 % (1.0/1000 catheter days) of mechanical complications and 9 % of CAT (1.4 / 1000 catheter days). The use of tunnelled CVCs was associated with the following complications: accidental removal — 1 (1.6 %), catheter rupture — 4 (6.5 %), CAT — 5 (8.2 %) patients (0.3 / 1000 catheter days); 18 (29.5 %) patients exhibited catheter obstruction, with CVC function being restored in 14 (77.7 %) patients, whereas in 4 (22.3 %) patients the CVC was removed. The incidence of CRBSI associated with non-tunnelled and tunnelled CVCs was 4.4 and 1.5 per 1000 catheter days, respectively. The study revealed no significant differences in the probability of developing CRBSI between non-tunnelled CVCs with and without antibacterial coating (p = 0.298), as well as between non-tunnelled and tunnelled CVCs in the fi rst 28 days after the catheter placement (p = 0.424). The risk of developing CRBSI when using tunnelled CVCs increased after 150 days of use.Conclusion. Allo-HSCT can be performed using any CVC type. Our study revealed no advantages in employing nontunnelled CVCs with an antibacterial coating compared to those having no coating. Tunnelled CVCs (as opposed to nontunnelled ones) provide the opportunity to employ a single catheter throughout the entire transplantation and post-transplant period. It should be noted that tunnelled CVCs should not be used for more than 150 days, since prolonged use of such CVCs significantly increases the risk of infection.Conflict of interest: the authors declare no conflict of interest.Financial disclosure: the study had no sponsorship.

scholarly journals Unusual Complications of Ultrasound Guided Central Venous Cannulation

2019 ◽  
Author(s):  
Sonu Sama ◽  
Sanjay Agarwal ◽  
Vijay Adabala ◽  
Michael Leonard Anthony
Keyword(s):  
Continuous Monitoring ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Common Procedure ◽  
Open Surgical Procedure ◽  
Landmark Technique

Central venous catheter (CVC) insertion is a common procedure in operation theaters and intensive care units (ICU). The procedure is performed through anatomical landmark technique, open surgical procedure, and ultrasound-assisted insertion. In the 1990s, ultrasound guidance of CVC insertion has been advocated as a means to reduce mechanical complications and placement failures compared with the landmark technique. Still CVC complications can be related to insertion, indwelling, or extraction. There is a need for continuous monitoring to avoid possible risk factors so as to minimize the morbidity and mortality.

Transitioning from anatomic landmarks to ultrasound guided central venous catheterizations: guidelines applied to clinical practice

2017 ◽  
Vol 18 (4) ◽  
pp. 328-333 ◽  
Author(s):  
Rodrigo Oom ◽  
Rui Casaca ◽  
Rita Barroca ◽  
Sara Carvalhal ◽  
Catarina Santos ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Venous Catheter ◽  
High Volume ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Anatomic Landmarks ◽  
Effective Technique ◽  
Oncological Center ◽  
Landmark Technique ◽  
Prospective Database

Introduction Centrally inserted central catheter (CICC) insertion is a commonly performed procedure that may give rise to different complications. Despite the suggestion of guidelines to use ultrasound guidance (USG) for vascular access, not all centers use it systematically. The aim of this study is to illustrate the experience with ultrasound in CICC placement at a high-volume oncological center, in a country where the landmark technique is standard. Methods Retrospective analysis of a prospective database was performed on CICC placement under USG in the Central Venous Catheter Unit of Instituto Português de Oncologia de Lisboa Francisco Gentil, from 2012 to 2015. Results Three thousand five hundred and seventy-two procedures were recorded. From 2728 CICC placements, 1187 (43.5%) were done using USG. The majority of CICC placements were successful without immediate complications (96.1%). In 55 cases (4.6%), more than three attempts were necessary to puncture the vein. Pneumothorax occurred in 5 cases (0.4%) and arterial puncture was registered in 41 cases (3.5%). An increasing use of USG for placing CICCs was planned and observed over the years and, in the last year of the study, 67.3% of the CICC placements were with USG. Conclusions CICC placement with USG is a safe and effective technique. Despite some resistance that is observed, these results support that it is worth following the guidelines that advocate the use of the USG in the placement of CICC.

scholarly journals Research protocol for mechanical complications after central venous catheterisation: a prospective controlled multicentre observational study to determine incidence and risk factors of mechanical complications within 24 hours after cannulation

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029301
Author(s):  
Maria Adrian ◽  
Ola Borgquist ◽  
Peter Bentzer ◽  
Jonas Åkeson ◽  
Martin Spångfors ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Observational Study ◽  
Real Time ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Central Venous Catheterisation ◽  
Mechanical Complications

IntroductionCentral venous catheterisation is a common procedure in intensive care therapy and the use of central venous catheters is essential for treatment of many medical disorders. Although rare, central venous catheterisation is associated with mechanical complications that can be life-threatening if untreated. Real-time ultrasound guidance reduces the incidence of mechanical complications when compared with the anatomic landmark method. The purpose of this study is to determine the incidence of and potential risk factors associated with early mechanical complications of central venous catheterisation in an era where real-time ultrasound guidance has become clinical practice.Methods and analysisThis is a prospective, controlled, multicentre, observational study. All participating hospitals follow the same clinical guidelines for central venous catheterisation. Each central venous catheter insertion will be recorded in the common electronic chart system according to a recently revised template. An automated script-based search will identify all recorded central venous catheter insertion templates during the study period and relevant variables will be extracted. Outcome measures and independent variables are pre-defined in this study protocol. Multivariable and univariable logistic regression analysis will be used to determine associations and risk factors of mechanical complications.Ethics and disseminationThe Regional Ethical Review Board in Lund, Sweden has approved this study. The results will be submitted for publication in peer-reviewed medical journals and presented at national and international scientific meetings.Trial registration numberNCT03782324.

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