scholarly journals Identifying Predictors of Peripheral Intravenous Catheter Failure Using a Novel Combination of Clinical and Ultrasonographic Assessments

2021 ◽  
Author(s):  
Amit Bahl ◽  
Steven Johnson ◽  
Nicholas Mielke ◽  
Patrick Karabon
Keyword(s):  
Large Scale ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intravenous Catheter ◽  
Subcutaneous Edema ◽  
Peripheral Intravenous Catheter ◽  
Catheter Failure ◽  
Underlying Mechanisms

Abstract Objective:Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify factors that predict premature PIVC failure.Methods:We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary goal was to identify demographic, clinical, and PIVC related variables that predicted PIVC failure. Univariate and multivariate analyses were employed to identify risk factors for PIVC failure.Results:In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of subcutaneous edema [AOR 8.29 (1.50, 45.8) p = 0.0153], an above average neutrophil to lymphocyte (N:L) ratio [AOR 4.63 (1.06, 20.3) p = 0.0422], and the administration of an irritant/vesicant [10.3 (1.46, 72.6) p = 0.0.192] were associated with increased likelihood of premature PIVC failure. Conclusions:PIVC failure is related to clinical and ultrasonographic variables associated with inflammation: elevated N:L ratio, use of caustic medications, and presence of subcutaneous edema on ultrasound. Reducing inflammation of the vein may lead to better PIVC survival outcomes. Further large-scale randomized controlled trials are needed to validate and build upon the concepts in this study.

scholarly journals Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253243
Author(s):  
Amit Bahl ◽  
Steven Johnson ◽  
Nicholas Mielke ◽  
Patrick Karabon
Keyword(s):  
Early Recognition ◽  
Strong Predictor ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Intravenous Catheter ◽  
Clinical Exam ◽  
Subcutaneous Edema ◽  
Increased Risk ◽  
Peripheral Intravenous Catheter

Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient’s vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.

scholarly journals Ultrasonographic Classification of Subcutaneous Edema Caused by Infusion via Peripheral Intravenous Catheter

2016 ◽  
Vol 24 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Koichi Yabunaka ◽  
Ryoko Murayama ◽  
Hidenori Tanabe ◽  
Toshiaki Takahashi ◽  
Makoto Oe ◽  
...  
Keyword(s):  
Intravenous Catheter ◽  
Subcutaneous Edema ◽  
Peripheral Intravenous Catheter

scholarly journals Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
C. Max Schmidt ◽  
Jennifer Choi ◽  
Emilie S. Powell ◽  
Constantin T. Yiannoutsos ◽  
Nicholas J. Zyromski ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Tertiary Care ◽  
High Volume ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Stenting ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Pancreatic Anastomosis ◽  
Septic Complications

Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.

Improving peripheral intravenous catheter failure rates

The Lancet ◽  
2018 ◽  
Vol 392 (10145) ◽  
pp. 366-367 ◽  
Author(s):  
Alexander P J Vlaar ◽  
Beverley J Hunt
Keyword(s):  
Failure Rates ◽  
Intravenous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Catheter Failure

Abstract 101: Gender Differences in the Timing of Access to the Prehospital Phase of STEMI Care

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert O’Connor ◽  
Ross Megargel ◽  
Angela DiSabatino ◽  
William Weintrub ◽  
Charles Reese
Keyword(s):  
Gender Differences ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Female Gender ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Symptom Duration ◽  
Care Hospital ◽  
Private Vehicle ◽  
Prehospital Management

Introduction : The purpose of this study is to determine the degree of gender differences in lay person recognition, emergency medical services (EMS) activation, and the prehospital management of STEMI. Methods : Data were gathered prospectively from May 1999 to January 2007 on consecutive patients with STEMI who presented to a tertiary care hospital emergency department. Patients arriving by ambulance and private vehicle were included. Data collection included determining symptom duration, whether a prehospital ECG was obtained, whether the cardiac interventional lab was activated prior to patient arrival at the hospital, patient age, and hospital length of stay. Prehospital activation of the cath lab was done by emergency medicine based on paramedic ECG interpretation in consultation with cardiology. Statistical analysis was performed using the Mann-Whitney U test, the Yates-corrected chi-square test, and linear regression. Results : A total of 3260 cases were studied, of which, 3097 had complete data for analysis. Only EMS cases were included in the ECG analysis, and only patients having a prehospital ECG were included in the prehospital activation of cath lab analysis. Regression analysis showed that older age and female gender were significant predictors of access and arrival by EMS. The mean age in years was higher for EMS arrival (69 women; 59 men) than for private vehicle (62 women; 56 men). Conclusion : Women with STEMI tend to use EMS more frequently then men, but are older and wait longer before seeking treatment. Whether these factors contribute to the longer length of stay remains to be determined.

Adverse Events in Older Patients Admitted to Acute Care: A Preliminary Cost Description

2009 ◽  
Vol 22 (3) ◽  
pp. 32-36 ◽  
Author(s):  
Stacy Ackroyd-Stolarz ◽  
Judith Read Guernsey ◽  
Neil J. MacKinnon ◽  
George Kovacs
Keyword(s):  
Adverse Events ◽  
Older Patients ◽  
Tertiary Care ◽  
Care Facility ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Financial Costs ◽  
Tertiary Care Facility ◽  
Acute Hospital Admission

The financial costs associated with Adverse Events (AEs) for older patients (≥65 years) in Canadian hospitals are unknown. The objective of this paper is to describe and compare costs between patients who experienced an AE and those who did not during an acute hospital admission to a tertiary care facility Patients with an AE had twice the hospital length of stay (20.2 versus 9.8 days, p < 0.00001), resulting in 1,400 extra days at a cost of approximately $7,500/patient.

scholarly journals Significant Variability in the Initial Workup of Thrombocytopenia in the Hematology Clinic - What Is the "Optimal" Workup?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5966-5966
Author(s):  
Aishwarya Ravindran ◽  
Ronald S. Go ◽  
Kaaren K. Reichard ◽  
Ariela L. Marshall
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Large Scale ◽  
Hepatitis A Virus ◽  
Conflicts Of Interest ◽  
Medical Condition ◽  
Care Center ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
Target Cells

Abstract BACKGROUND: Thrombocytopenia is a common hematologic condition associated with multiple etiologies ranging from benign to malignant to potentially life-threatening disorders. Given the heterogeneity of clinical presentations, available clinical information, and pertinent clinical history, there are inter-physician variations in the approach to the workup of thrombocytopenia in the hematology clinic. While a limited test repertoire may be adequate for many cases, more extensive testing may be warranted in others. We were interested in analyzing the various tests performed and testing approaches in the initial workup of thrombocytopenia. METHODS: We reviewed the records of 69 patients who were referred to our center between 2010 and 2015 for an initial workup of thrombocytopenia. We collected epidemiologic data, laboratory testing results, and pathologic findings. Pathologic results were classified as "normal" or "abnormal" and further subcategorized on the basis of review by two clinicians. Quantitative data were analyzed using JMP Pro 10.0.2 software. RESULTS: At the time of thrombocytopenia diagnosis, the median age was 59 years (range: 17-90) and majority were males (65%). The median platelet count was 91,000/µL (range: 3,000-146,000). Isolated thrombocytopenia was present in 51 cases (74%). Forty-four patients (64%) had a peripheral blood smear review and 4 (9%) contained abnormalities including hypogranular neutrophils, rouleaux formation, and target cells. Autoimmune workup included anti-platelet antibody (APA) in 34 (49%), anti-nuclear antibody (ANA) in 21 (30%), lupus anticoagulant (LA) in 4 (6%) and rheumatoid factor (RF) in 13 (19%) of cases. Autoimmune testing was positive for APA in 2 (5.9%), ANA in 4 (19%), LA in 0 (0%), and RF in 1 (8%) of patients who underwent testing, respectively. Common infectious workups included human immunodeficiency virus in 23 (33%), hepatitis A virus in 2 (3%), hepatitis B virus in 11 (16%), hepatitis C virus in 22 (32%), Epstein-Barr virus in 5 (EBV, 7%), cytomegalovirus in 7 (10%) and Helicobacter pylori in 5 (7%) of patients, and were negative in all cases except for one patient with evidence of active EBV infection. Sixteen patients (23%) underwent bone marrow biopsy, and 2 (12.5%) were diagnosed with hematologic malignancies including myelodysplastic syndrome and hairy cell leukemia. Based on results of these tests, 28 (41%) patients were diagnosed with primary immune thrombocytopenia, 19 (27%) with thrombocytopenia secondary to another medical condition, and 22 (32%) with thrombocytopenia of undefined etiology. CONCLUSION: Thrombocytopenia is a common laboratory finding, and workup involves significant inter-clinician variation, often involving multiple laboratory tests and in some cases invasive tests such as bone marrow biopsy. We found that autoimmune causes of thrombocytopenia were moderately common and infectious and malignant causes were rare. Our findings were based on a small cohort of patients but are likely to be representative of the clinical practice in a large tertiary care center. Large scale studies may be warranted to devise a protocol for a thorough yet cost-effective and stepwise initial workup of thrombocytopenia and to minimize unwarranted inter-clinician variation in such investigations. Disclosures No relevant conflicts of interest to declare.

Opioid Requirements in Laparoscopic Colectomies: Do Enhanced Recovery After Surgery Protocols Make a Difference?

2020 ◽  
pp. 000313482095631
Author(s):  
Samer Kawak ◽  
Joanna F. Wasvary ◽  
Matthew A. Ziegler
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Pain Scores ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Background With the growing opioid epidemic and recent focus on the quantity of opioids prescribed at discharge after surgery, enhanced recovery pathways provide another tool to counteract this epidemic. The aim of this current study is to analyze the differences in opioid requirements and pain scores in the immediate postoperative period for patients who underwent laparoscopic colectomies before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Materials and Methods This study is a retrospective review of patients and was conducted at an academically affiliated tertiary care hospital. In patients undergoing elective laparoscopic colectomies before December 1, 2013-July 31, 2015 and after September 1, 2015-May 31, 2018, the implementation of enhanced recovery pathways was included. The primary end point was opioid consumption from the end of surgery until 48 hours after surgery. Secondary end points included pain scores, surgery length of time, and hospital length of stay after surgery. Results A total of 242 patients (122 pre- and 120 postimplementation) were analyzed. Patient characteristics were similar between groups. Pain scores were higher in the preimplementation patients for postoperative day (POD) 0 scores ( P = .019). There was a decrease in the morphine milligram equivalents (MME) on POD 0-2 for the postimplementation patients. This decrease resulted in a 61% reduction in opioid requirements after implementation of ERAS protocols (32 vs. 12.5 MME, P < .0001). Discussion Enhanced recovery after surgery protocols can reduce opioid requirements after elective laparoscopic colectomies without negatively affecting pain scores.

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