scholarly journals Safety of Bedside Placement of Tunneled Hemodialysis Catheters In The Intensive Care Unit: Translating From The Covid-19 Experience – Retrospective Single-Center Case Series

2021 ◽  
Author(s):  
Mohammad Ahsan Sohail ◽  
Tarik Hanane ◽  
James Lane ◽  
Tushar Vachharajani
Keyword(s):  
Intensive Care Unit ◽  
Blood Flow ◽  
Intensive Care ◽  
Case Series ◽  
Air Embolism ◽  
Fluoroscopic Guidance ◽  
Single Center ◽  
Anatomic Landmarks ◽  
Hemodialysis Catheter ◽  
Venous Air Embolism

Abstract Background: Critically-ill patients with coronavirus disease-2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy (KRT), typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit (ICU) to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound (US) and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the ICU who underwent right internal jugular (RIJ) TDC insertion at the bedside between April and December 2020. Outcomes included procedural complications such as bleeding, venous air embolism, arrhythmias, pneumothorax and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform a single hemodialysis treatment. Results: We report a retrospective single-center case series of 25 patients with COVID-19 who had RIJ TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore RIJ tunneled central venous catheters (T-CVC). Continuous veno-venous hemodialysis was the KRT modality employed in all patients. A median catheter blood flow rate of 200 ml/min (IQR:200-200) was achieved in all patients without any deviation from the dialysis prescription. No catheter-related complications were observed and none of the catheter tips were mal-positioned. Conclusions: Bedside RIJ TDC placement in COVID-19 patients, using US and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission amongst healthcare workers without compromising patient safety or catheter function.

scholarly journals Safety of Bedside Placement of Tunneled Hemodialysis Catheters in the Intensive Care Unit: Translating from the COVID-19 Experience

2021 ◽  
Vol 10 (24) ◽  
pp. 5766
Author(s):  
Mohammad Ahsan Sohail ◽  
Tarik Hanane ◽  
James Lane ◽  
Tushar J. Vachharajani
Keyword(s):  
Intensive Care Unit ◽  
Blood Flow ◽  
Intensive Care ◽  
Replacement Therapy ◽  
Case Series ◽  
Central Venous Catheters ◽  
Fluoroscopic Guidance ◽  
Central Venous ◽  
Anatomic Landmarks ◽  
Kidney Replacement Therapy

Background: Critically ill patients with coronavirus disease 2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy, typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the intensive care unit who underwent right internal jugular TDC insertion at the bedside between April and December 2020. Outcomes included catheter placement-related complications such as post-procedural bleeding, air embolism, dysrhythmias, pneumothorax/hemothorax, and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform either a single intermittent or 24 h of continuous hemodialysis treatment. Results: We report a retrospective, single-center case series of 25 patients with COVID-19 who had right internal jugular TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore right internal jugular tunneled central venous catheters for infusion. Continuous veno-venous hemodialysis was utilized for kidney replacement therapy in all patients, and a median catheter blood flow rate of 200 mL/min (IQR: 200–200) was achieved without any deviation from the dialysis prescription. No catheter insertion-related complications were observed, and none of the catheter tips were malpositioned. Conclusions: Bedside right internal jugular TDC placement in COVID-19 patients, using ultrasound and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission among healthcare workers without compromising patient safety or catheter function. Concomitant insertion of tunneled central venous catheters in the right internal jugular vein for infusion may also be safely accomplished and further help limit personnel exposure to COVID-19.

scholarly journals Different presentation of pulmonary parenchymal disruption in COVID-19 pneumonia. Case series of Sub-Intensive Care Unit in Naples, Italy

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Giorgio E. Polistina ◽  
Francesca Simioli ◽  
Pasquale Imitazione ◽  
Maurizia Lanza ◽  
Anna Annunziata ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
High Resolution ◽  
Oxygen Therapy ◽  
Case Series ◽  
Single Center ◽  
High Resolution Computed Tomography ◽  
Pneumonia Case ◽  
Typical Sign

The coronavirus disease 2019 (COVID-19) is a recent pandemic that affected more than 5 million people worldwide. Chest high resolution computed tomography (HRCT) is an essential tool in diagnosis and management of the disease. Pulmonary parenchymal opacity is a typical sign of the disease, but not the only one. Pneumothorax, pneumomediastinum, bronchiectasis and cysts are probably underrated complications of COVID-19 that can worsen prognosis, in terms of prolonged hospitalization and need of oxygen therapy. In our single center case series, we outline four different manifestations of pneumothorax, pneumomediastinum and cysts in hospitalized patients with COVID-19 pneumonia.

scholarly journals Hypercoagulopathy in Overweight and Obese COVID-19 Patients: A Single-Center Case Series

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
Aman Siddiqui ◽  
Ali Totonchian ◽  
Syed Hashim Abbas Ali Bokhari ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Gastrointestinal Bleeding ◽  
Clinical Outcomes ◽  
Disseminated Intravascular Coagulation ◽  
Case Series ◽  
Obese Patients ◽  
Single Center

Abstract A case series is presented of five overweight or obese patients with confirmed coronavirus disease 2019 (COVID-19) in South Miami, Florida, United States. A multitude of coagulation parameters was suggestive of a hypercoagulable state among the hospitalized COVID-19 patients. This article reports various manifestations of hypercoagulable states in overweight and obese patients, such as overt bleeding consistent with disseminated intravascular coagulation, venous thromboembolism, gastrointestinal bleeding as well as retroperitoneal hematoma. All of the required admission to the intensive care unit and subsequently patients died. The characteristics of COVID-19-associated coagulopathy are atypical and warrant a further understanding of the pathophysiology to improve clinical outcomes, specifically in overweight or obese patients.

scholarly journals Continuous Selective Intra-Arterial Application of Nimodipine in Refractory Cerebral Vasospasm due to Aneurysmal Subarachnoid Hemorrhage

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Stephanie Ott ◽  
Sheila Jedlicka ◽  
Stefan Wolf ◽  
Mozes Peter ◽  
Christine Pudenz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Blood Flow ◽  
Intensive Care ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Case Series ◽  
Brain Tissue Oxygenation

Background. Cerebral vasospasm is one of the leading courses for disability in aneurysmal subarachnoid hemorrhage. Effective treatment of vasospasm is therefore one of the main priorities for these patients. We report about a case series of continuous intra-arterial infusion of the calcium channel antagonist nimodipine for 1–5 days on the intensive care unit.Methods. In thirty patients with aneurysmal subarachnoid hemorrhage and refractory vasospasm continuous infusion of nimodipine was started on the neurosurgical intensive care unit. The effect of nimodipine on brain perfusion, cerebral blood flow, brain tissue oxygenation, and blood flow velocity in cerebral arteries was monitored.Results. Based on Hunt & Hess grades on admission, 83% survived in a good clinical condition and 23% recovered without an apparent neurological deficit. Persistent ischemic areas were seen in 100% of patients with GOS 1–3 and in 69% of GOS 4-5 patients. Regional cerebral blood flow and computed tomography perfusion scanning showed adequate correlation with nimodipine application and angiographic vasospasm. Transcranial Doppler turned out to be unreliable with interexaminer variance and failure of detecting vasospasm or missing the improvement.Conclusion. Local continuous intra-arterial nimodipine treatment for refractory cerebral vasospasm after aSAH can be recommended as a low-risk treatment in addition to established endovascular therapies.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Infections in hematopoietic stem cell transplant patients admitted to Hematology intensive care unit: a single-center study

Hematology ◽  
2021 ◽  
Vol 26 (1) ◽  
pp. 328-339
Author(s):  
Tuğba Barlas ◽  
Kamil İnci ◽  
Gulbin Aygencel ◽  
Melda Türkoğlu ◽  
Özlem Güzel Tunçcan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Single Center ◽  
Hematopoietic Stem ◽  
Transplant Patients ◽  
Single Center Study ◽  
Center Study
Sign in / Sign up

Export Citation Format

Share Document