scholarly journals Is chest ultrasonography a reliable tool for the emergency diagnosis of traumatic pneumothorax. An Updated Meta-Analysis

2021 ◽  
Author(s):  
Yu Zhou ◽  
Haiyan Tian ◽  
Ton Zhang ◽  
Sanjay Rastogi ◽  
Rupshikha Choudhury
Keyword(s):  
Meta Analysis ◽  
Venous Catheter ◽  
Diagnostic Odds Ratio ◽  
Pleural Space ◽  
Central Venous ◽  
Chest Ultrasonography ◽  
Web Databases ◽  
Chest Ultrasound ◽  
Pathogenic Factors ◽  
Traumatic Pneumothorax

Aims: A commonly encountered problem in emergency care is pneumothorax, identified by air present in pleural space, occurring spontaneously, principally because of trauma or pathogenic factors like a central venous catheter, mechanical ventilation, and biopsy. Employing Chest ultrasound for diagnosing pneumothorax in an emergency is currently investigated by many researchers. The present meta-analysis aimed to assess Chest ultrasound’s diagnostic accuracy in diagnosing the pneumothorax during emergencies. Material and Methods: Literature search of published articles in MEDLINE, Embase, Ovid, Scopus, and Journal on web databases from 2000 up to November 2020 were reviewed for the pre-described outcomes. Results: 12 articles were finally chosen for quantitative analysis. The overall sensitivity of ultrasound scan in pneumothorax diagnosis was 89% (95 % CI – 86 – 91%). Specificity was 96% (CI – 95% – 97%). The diagnostic odds ratio was 193.94 (59.009 – 637.40) at 95% CI, thus demonstrating greater chest ultrasound accuracy in diagnosing pneumothorax. Conclusion: A definite evidence of chest ultrasound accuracy was noted in pneumothorax.

Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Marwa W Nasef ◽  
Maha M El-gaffary ◽  
Mervet G Mansour ◽  
Esraa S Abd El Aty
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Meta Analysis ◽  
Venous Catheter ◽  
Controlled Trials ◽  
Central Venous ◽  
Thrombotic Occlusion ◽  
Thrombotic Complications

Abstract Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.

Interventions to obstructive long-term central venous catheter in cancer patients: a meta-analysis

2018 ◽  
Vol 27 (2) ◽  
pp. 407-421 ◽  
Author(s):  
Ana Cristina Carvalho da Costa ◽  
Jéssica Marques Ribeiro ◽  
Christiane Inocêncio Vasques ◽  
Graziela De Luca Canto ◽  
André Luís Porporatti ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Venous Catheter ◽  
Central Venous

P10 Evaluation of existing line-locking practice in central venous catheters of paediatric patients on home parenteral nutrition

2018 ◽  
Vol 103 (2) ◽  
pp. e1.14-e1
Author(s):  
Tustin Amy ◽  
Hartley Karen ◽  
Derry David ◽  
Thomas Julian
Keyword(s):  
Parenteral Nutrition ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Home Parenteral Nutrition ◽  
List Type ◽  
Central Venous ◽  
Paediatric Patients

AimTo review current line-locking practice of central venous catheters (CVCs) to reduce catheter related blood stream infections (CRBSIs) and preserve line integrity in paediatric patients on home parenteral nutrition (HPN), with the secondary aim of producing a concise, evidence-based guideline for use in this cohort and inpatient PN patients as well.MethodAll 19 paediatric HPN patients were reviewed retrospectively over 6 months (January–June 2017). Data was collected from clinic letters, HPN prescriptions and blood cultures. Information gathered per patient:Line lock(s)Infective episode(s)CVC replacement(s)Establishment of current practice: All patients use TaurolockTM first-line. If CVC is stiff or stops bleeding back switch to TauroLockTM-Hep100. Should problems persist introduce alcohol 70% on alternate days or alone if recurrent infections occur on TaurolockTM. Blocked CVCs are instilled with urokinase or alteplase and CVC replaced if unsuccessful.Results18/19 patients were prescribed line locks as per above practice. One patient is prescribed heparin 10units/ml – due to a documented TauroLockTM allergy – and remained infection- free throughout. 7 infections occurred overall in 6 patients with 13 patients infection-free. 2.2 infections/1000 catheter days occurred in patients on TauroLockTM with 2 patients requiring CVC changes due to infection and broken CVC respectively.1 infection/1000 catheter days occurred on TauroLockTM- Hep100 with 2 CVC changes required due to occlusion. 11 infections/1000 catheter days occurred in 1 patient on daily alcohol 70%, although result validity is uncertain due to potential contamination of blood culture specimen from skin organisms during sampling. No infections occurred in 248 catheter days in patients alternating TauroLockTM-Hep100 and alcohol 70% with one line change required as CVC moved position.ConclusionCRBSIs pose a serious problem in paediatric HPN patients.1,2 Taurolidine has proven efficacy at preventing CRBSIs and proven superiority to heparin.3 The effectiveness of alcohol at reducing CRBSI rates and preventing CVC replacement has been proven when compared to heparin4 however, due to adverse effects (thrombosis and CVC degradation)4 use is limited to ensure benefits outweigh risks. These studies, although limited, and results in our patient cohort support the continued use of these line locks as per existing practice. Future work includes need to formalise written guideline and discuss clear pathway if patients have multiple CRBSIs on their existing line lock as presently information is unclear.ReferencesKoletzko B, Agostoni C, Ball P, et al. ESPEN/ESPGHAN guidelines on paediatric parenteral nutrition. Journal of Paediatric Gastroenterology and Nutrition2005;41:S76–S84.Candusso M, Faraguna D, Sperli D, et al. Outcome and quality of life in paediatric home parenteral nutrition. Current Opinion in Clinical Nutrition and Metabolic Care2005;5:309–14.Chu HP, Brind J, Tomar R, et al. Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr2012;55:403–7.Oliveira C, Nasr A, Brindle M, et al. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: A meta-analysis. Paediatrics2012;129:318–329.

Treatment of Pneumothorax as a Complication of Long-Term Central Venous Port Placement in Oncology Patients. An Observational Study

2001 ◽  
Vol 2 (3) ◽  
pp. 129-136 ◽  
Author(s):  
R. Biffi ◽  
S. Pozzi ◽  
U. Pace ◽  
S. Cenciarelli ◽  
M. Zambelli ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Venous Catheter ◽  
Lung Parenchyma ◽  
Pleural Space ◽  
Tube Thoracostomy ◽  
Common Finding ◽  
X Rays ◽  
Central Venous ◽  
Port Placement

Background and Purpose In percutaneous placement of central venous catheters an inadvertent, direct lesion of the lung parenchyma can occur. This is a cause of iatrogenic pneumothorax, whose incidence is approximately 1 to 4%, largely dependent on the experience of the operator, the site of venipuncture and probably the technique employed. Initial treatment currently ranges from observation alone to formal tube-thoracostomy. In an attempt to define the best initial treatment, if any, we reviewed our personal series and contributions from the literature. As a result we have produced a flow-chart proposing a rational treatment of this frequent complication. Patients and Methods One thousand four hundred twenty-one ports were placed in patients at the Department of Surgery of the European Institute of Oncology in Milan through an infraclavicular standardized percutaneous subclavian approach. They were placed during the 60-month period from January 1, 1996 to December 31, 2000 for long-term chemotherapy treatment of solid tumours. Chest upright X-rays were obtained post-operatively in all cases to check the correct position of the catheter tip and the presence of pneumothorax. Results Twenty-two patients out of 1421 (1.54%) experienced a radiologically-proven pneumothorax, ranging from 5 to 70% of the affected pleural space. Sixteen patients out of 22 (72.7%) with minor portions of affected pleural space received simple observation. In these patients the most common finding was an uncomplicated tachycardia (more than 100 beats/min); 8 of them did not complain of any symptoms. Six patients (27.2%) underwent an additional procedure (3 tube-thoracostomies and 3 aspirations of the pleural space), claiming symptoms of chest pain and various degrees of dyspnea. Tube thoracostomy was mainly adopted at the beginning of our experience, and in patients with a severe degree of pleural involvement (55 to 70% of the pleural space). Aspiration, instead, was used more recently and in patients with varying degrees of pleural space involved, ranging from 40 to 60%. Conclusions Looking at our own series and literature data, patients with iatrogenic pneumothorax following central venous cannulation who do not have a severe underlying pulmonary disease can be reassured, at the time of diagnosis, that surgery is usually unnecessary and tube thoracostomy is rarely needed. Simple aspiration of the pleural air by means of a central venous catheter inserted percutaneously into the pleural space under local anesthesia should be considered, even if the amount of affected pleural space is more than 50%, before opting for a formal tube-thoracostomy using small-bore tubes.

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