scholarly journals Mediastinal Complications Secondary to Extravasated Peripherally Inserted Central Venous Catheter: A Case Report

2019 ◽  
Author(s):  
Ana Licina ◽  
Arya Gupta ◽  
Andrew Silvers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Thoracoscopic Surgery ◽  
Signs And Symptoms ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Gradual Improvement ◽  
Relative Safety ◽  
Increased Risk

Abstract Background Peripherally inserted central venous catheters (PICC) are increasingly used in critically ill patients for the ease of access, long-term medication and total parenteral nutrition administration. There is a perception of equivalent utility of PICC lines with a lower incidence of complications as compared to central venous lines. Despite the perception of relative safety, complications can occur. Case Presentation We describe a case of a patient who developed increasing signs and symptoms of sepsis, shortness of breath, and hypoxemia following combined liver and renal transplant 11 days following the initial procedure. Computerised tomography of neck and chest demonstrated pneumo-mediastinum, extensive retropharyngeal and subcutaneous emphysema. The patient returned to theatre on post-operative day 12, for flexible bronchoscopy, video-assisted thoracoscopic surgery and mediastinal washout. Following a further clinical and imaging review, an un-anticipated diagnosis of extravasated peripherally inserted central venous cannula (PICC) as a causative factor of multiple pathologies was made. PICC line was removed. Mediastinal and thoracoscopic examinations were performed and drains inserted. The patient returned to the intensive care unit for ongoing supportive management, with a gradual improvement of sepsis and resolution of mediastinal air distribution. Conclusions Peripherally inserted central venous catheters have an ease of insertion and appreciable favourable health economic outcomes. Recent reviews however have demonstrated an increased risk of catheter tip malposition, in addition to increased risk of thrombosis as compared to central venous lines. Due to the characteristic mobility of these devices, mediastinal and intra-thoracic extravasation of these catheters can occur with consequent severe morbidity. Awareness of the tip position and accompanying clinical and radiological enquiry, must be performed both in the differential diagnosis of chest pathology and prior to use of PICC lines in critically ill patients.

scholarly journals Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients

2020 ◽  
Vol 2 (1) ◽  
pp. 12
Author(s):  
Gehan A. F. Atia
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Care Bundle ◽  
Central Venous ◽  
Significant Difference ◽  
Post Test ◽  
Catheter Care

Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records. Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups. Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.

Dialysis and central venous catheter infections in critically ill patients: Results of a prospective study

1999 ◽  
Vol 27 (11) ◽  
pp. 2394-2398 ◽  
Author(s):  
Bertrand Souweine ◽  
Ousmane Traore ◽  
Bruno Aublet-Cuvelier ◽  
Laurence Badrikian ◽  
Laurent Bret ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Prospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Central Venous ◽  
A Prospective Study ◽  
Catheter Infections

scholarly journals Comparison between Peripheral and Central Venous Catheters Regarding Venous Pressure and Complications among Critically Ill Patients

2021 ◽  
pp. 1-7
Author(s):  
Amnah Mohammed Howthan ◽  
◽  
Nahed Ahmed Mersal ◽  
◽  
Keyword(s):  
Central Venous Catheter ◽  
Critically Ill ◽  
Standard Method ◽  
Patient Management ◽  
Essential Role ◽  
Venous Pressure ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Critically Ill Patient ◽  
Central Venous

Central venous catheter (CVC) known as standard method for hemodynamic monitoring that plays an essential role in critically ill patient management. After recognizing critical condition, measuring, and evaluating the underlying pathophysiological strategies and receiving suitable therapy

scholarly journals Secondary bloodstream infection in critically ill patients with COVID-19

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110627
Author(s):  
Junli Zhang ◽  
Peng Lan ◽  
Jun Yi ◽  
Changming Yang ◽  
Xiaoyan Gong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Secondary Infection ◽  
Venous Catheter ◽  
Urethral Catheter ◽  
Central Venous

Objective Secondary infection, especially bloodstream infection, is an important cause of death in critically ill patients with COVID-19. We aimed to describe secondary bloodstream infection (SBI) in critically ill adults with COVID-19 in the intensive care unit (ICU) and to explore risk factors related to SBI. Methods We reviewed all SBI cases among critically ill patients with COVID-19 from 12 February 2020 to 24 March 2020 in the COVID-19 ICU of Jingmen First People's Hospital. We compared risk factors associated with bloodstream infection in this study. All SBIs were confirmed by blood culture. Results We identified five cases of SBI among the 32 patients: three with Enterococcus faecium, one mixed septicemia ( E. faecium and Candida albicans), and one C. parapsilosis. There were no significant differences between the SBI group and non-SBI group. Significant risk factors for SBI were extracorporeal membrane oxygenation, central venous catheter, indwelling urethral catheter, and nasogastric tube. Conclusions Our findings confirmed that the incidence of secondary infection, particularly SBI, and mortality are high among critically ill patients with COVID-19. We showed that long-term hospitalization and invasive procedures such as tracheotomy, central venous catheter, indwelling urethral catheter, and nasogastric tube are risk factors for SBI and other complications.

Increased Risk for Venous Thromboembolism in Patients with Acute Leukemia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4555-4555
Author(s):  
Martin Mohren ◽  
Ilka Markmann ◽  
Kathleen Jentsch-Ullrich ◽  
Michael Koenigsmann ◽  
Gerd Lutze ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Acute Leukemia ◽  
Blast Crisis ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
P Values ◽  
Prophylactic Measures ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction: Patients with solid tumors have an increased risk for venous thromboembolisms (VTE) associated with substantial morbidity and mortality, but so far there exists little data on hematologic malignancies. We have recently found a VTE rate of 7,7% in patients with malignant lymphoma. However, information on patients with acute leukemia (AL) is very limited so far. Patients and methods: Medical records of all patients with AL treated in our institution between january 1992 and april 2005 were reviewed and data was collected and analyzed in a microsoft excel data base. P-values to show correlation of VTE with leukemia type, patient age and gender were calculated using Fisher’s exact test. All reported p-values are two-sided. Results: Of a total of 455 patients 310 (68%) had AML, 108 (24%) had ALL and 37 (8%) had blast crisis. 248 patients (55%) were male and 207 (45%) were female, median age was 60 years. 55 patients with AL (12,1%) had at least one VTE, occuring during therapy in 82% of events. 27 patients (5,9%) had central venous catheter associated VTE, whereas 28 patients (6,2%) had deep vein thrombosis and/or pulmonary embolism. Neither leukemia lineage - myeloid versus lymphocytic - (p=1,0) nor patient gender (p=.193) had an impact on the VTE risk. However, central venous catheter associated VTE more likely occured in younger patients (< 60 years) than in patients ≥ 60 years (p=.003). There was no statistically significant difference in the incidence of non-central venous catheter associated VTE between both age groups (p=.563). Discussion: Patients with acute leukemia have a substantial risk for VTE, half of which occur with the use of central venous catheters. A recently published study analysed the incidence of VTE in close temporal relationship to onset of disease and found a VTE rate of 2,09% with equal risk in ALL and AML. Our study included VTE occuring prior to diagnosis of AL as well as during chemotherapy and follow up, revealing a VTE rate that is 6-fold higher and showing a considerable association with central venous catheters. Conclusions: The risk of VTE is surprisingly high in patients with acute leukemia, thus improvement of prophylactic measures, especially in regard to central venous catheter use is warranted.

scholarly journals Clinical practice guidelines for the management of central venous catheter for critically ill patients

2018 ◽  
Vol 2 ◽  
pp. 53-53
Author(s):  
Zhongheng Zhang ◽  
Claudia Brusasco ◽  
Antonio Anile ◽  
Francesco Corradi ◽  
Maryanne Mariyaselvam ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Central Venous Catheter ◽  
Critically Ill ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Central Venous
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