Midline venous catheters as an alternative to central line catheter placement: a product evaluation

2021 ◽  
Vol 30 (8) ◽  
pp. S10-S18
Author(s):  
Amanda Carr ◽  
Jared R Green ◽  
Erin Benish ◽  
Richard Lanham ◽  
Tricia Kleidon ◽  
...  
Keyword(s):  
Intensive Care ◽  
Patient Satisfaction ◽  
Patient Outcomes ◽  
Tertiary Care ◽  
Care Facility ◽  
Product Evaluation ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Tertiary Care Facility

Midline catheters have emerged as a successful alternative to peripheral venous catheters (PVCs) and central venous catheters (CVCs) in select patients. Midline catheters allow for greater duration of access when compared with PVCs and avoid the critical complications associated with CVCs. This article describes the implementation of the Powerwand® midline at a large paediatric tertiary care facility in acute and intensive care settings, and presents illustrative cases of the catheter in use. Product evaluation was performed by a paediatric vascular access team of registered nurses and included information on patient outcomes, inserter satisfaction, patient satisfaction, and cost effectiveness.

Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center Tracking the “Idle Central Venous Catheter”

2012 ◽  
Vol 33 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Sheri Chernetsky Tejedor ◽  
David Tong ◽  
Jason Stein ◽  
Christina Payne ◽  
Daniel Dressler ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Observational Study ◽  
Dwell Time ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Care Facility ◽  
Venous Catheter ◽  
Retrospective Observational Study ◽  
Central Venous ◽  
Tertiary Care Facility

Objectives.Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed (“idle”). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards.Design.A retrospective observational study.Setting.A 579-bed acute care, academic tertiary care facility.Methods.A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used.Results.We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; P< .001). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients (P< .001). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; P = .0013).Conclusions.Significant proportions of ward CVC-days were unjustified. Reducing “idle CVC-days” and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.Infect Control Hosp Epidemiol 2012;33(1):50-57

Assessing Central Line Utilization in the Journey to Decrease CLABSI Rates in an Academic Tertiary Care Facility

2013 ◽  
Vol 41 (6) ◽  
pp. S96
Author(s):  
Kerri Adams ◽  
Zeina Khouri-Stevens ◽  
Carol Sylvester ◽  
Geeta Sood
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Central Line ◽  
Tertiary Care Facility

Use of Hypochlorite Solution to Decrease Rates of Clostridium difficile-Associated Diarrhea

2007 ◽  
Vol 28 (2) ◽  
pp. 205-207 ◽  
Author(s):  
Kathleen M. McMullen ◽  
Jeanne Zack ◽  
Craig M. Coopersmith ◽  
Marin Kollef ◽  
Erik Dubberke ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clostridium Difficile ◽  
Intensive Care Units ◽  
Tertiary Care ◽  
Care Facility ◽  
The Other ◽  
Environmental Cleaning ◽  
Hypochlorite Solution ◽  
Tertiary Care Facility ◽  
Clostridium Difficile Associated Diarrhea

An increased rate of Clostridium difficile-associated diarrhea (CDAD) was noted in 2 intensive care units of a university-affiliated tertiary care facility. One unit instituted enhanced environmental cleaning with a hypochlorite solution in all rooms, whereas the other unit used hypochlorite solution only in rooms of patients with CDAD. The CDAD rates decreased in both units.

Outcomes in Medical Intensive Care Patients Housed in Geographically Distant Units

2019 ◽  
Vol 35 (12) ◽  
pp. 1471-1475
Author(s):  
Michael H. Lazar ◽  
Eric Espinoza Moscoso ◽  
Jeffrey H. Jennings
Keyword(s):  
Intensive Care ◽  
Central Venous Catheter ◽  
Urinary Catheter ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Central Line ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Central Venous ◽  
Medical Intensive Care

Objective: The purpose of this study is to determine whether in patients admitted to a medical intensive care unit (ICU) service there are outcome differences between those in a medical ICU bed (“home”) and a geographically distant subspecialty ICU bed (“overflow”). Methods: We performed a retrospective cohort study of 4091 patients admitted to a medical ICU of a large tertiary-care urban teaching hospital. Depending on bed availability, some patients were housed in surgical or cardiac subspecialty ICUs while still being cared for by the primary medical ICU service. We assessed the association of these overflow patients with readmission rates and ICU and hospital length of stay (LOS). Potential differences in care was assessed by measuring the number of central line days, urinary catheter days, and ventilator days. Results: Of the 4091 consecutive patients admitted to the medical ICU, 362 (9%) were housed in an overflow ICU and 3729 (91%) were home patients. There was no difference in demographics, patient characteristics, ICU admission diagnosis, or risk of mortality between the 2 groups. Compared to home patients, overflow patients had a higher rate of readmission to the ICU (10.5% vs 6.63% respectively P = .006), a slightly shorter ICU LOS (median 2 [interquartile range, IQR: 1-4] days versus home group of 2 [IQR: 1-5] days; P = .001), and a slightly longer hospital LOS (overflow 7 [IQR: 4-17] days vs home 7 [IQR: 4-13] days, P = .001). There was no differences in number of central venous catheter days, urinary catheter days, ventilator days, or mortality. Conclusions: Medical ICU patients who are housed in ICUs geographically distant from the primary team’s location have increased morbidity when compared to patients admitted to the home ICU. However, there are no differences in number of central venous catheter days, urinary catheter days, ventilator days, or mortality.

The Effect of Multiple Concurrent Central Venous Catheters on Central Line–Associated Bloodstream Infections

2014 ◽  
Vol 35 (9) ◽  
pp. 1140-1146 ◽  
Author(s):  
Cathleen Concannon ◽  
Edwin van Wijngaarden ◽  
Vanessa Stevens ◽  
Ghinwa Dumyati
Keyword(s):  
Risk Factor ◽  
Disease Severity ◽  
Independent Risk Factor ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Central Line ◽  
Central Venous Catheters ◽  
Apache Ii ◽  
Central Venous

ObjectiveThe current central line–associated bloodstream infection (CLABSI) surveillance rate calculation does not account for multiple concurrent central venous catheters (CVCs). The presence of multiple CVCs creates more points of entry into the bloodstream, potentially increasing CLABSI risk. Multiple CVCs may be used in sicker patients, making it difficult to separate the relative contributions of multiple CVCs and comorbidities to CLABSI risk. We explored the relative impact of multiple CVCs, patient comorbidities, and disease severity on the risk of CLABSI.DesignCase-control study.SettingA total of 197 case patients and 201 control subjects with a CVC inserted during hospitalization at a tertiary care academic medical center from January 1, 2008, to December 31, 2010.MethodsMultiple CVCs was the exposure of interest; the primary outcome was CLABSI. Multivariable logistic regression was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) describing the association between CLABSI and multiple CVCs with and without controlling for Acute Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index (CCI) scores as measures of disease severity and patient comorbidities, respectively.ResultsPatients with multiple CVCs (n = 78) showed a 4.2 (95% CI, 2.2–8.4) times greater risk of CLABSI compared with patients with 1 CVC after adjusting for CLABSI risk factors. When including APACHE II and CCI scores, multiple CVCs remained an independent risk factor for CLABSI (OR, 3.4 [95% CI, 1.7–6.9]).ConclusionsMultiple CVCs is an independent risk factor for CLABSI even after adjusting for severity of illness. Adjustment for this risk may be necessary to accurately compare rates between hospitals.Infect Control Hosp Epidemiol 2014;35(9):1140-1146

Parents Often Urge Overtreatment

PEDIATRICS ◽  
1993 ◽  
Vol 92 (1) ◽  
pp. 187-188
Author(s):  
COLIN K. PHOON
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Medical Profession ◽  
Tertiary Care ◽  
Care Facility ◽  
Medical Establishment ◽  
Tertiary Care Facility

To the Editor.— Having recently worked in a neonatal intensive care unit at a tertiary care facility, I read Dr Silverman's essay1 with great interest. His perception that many "seriously compromised" neonates are overtreated is justified. However, he emphasized the role of the medical profession In overtreatment, while he sided with parents who have been angry with and resentful of their child's outcome. Although the medical establishment can rightly be blamed for overtreatment in many instances, my experience with who exactly is overtreating is somewhat different.

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