scholarly journals Medidas preventivas nas práticas de inserção e manipulação de cateter de hemodiálise: estudo observacional

2019 ◽  
Vol 81 (19) ◽  
Author(s):  
Thamires Assumpção Cruz Duarte ◽  
Tâmara Dias de Alencar ◽  
Natália Custódio
Keyword(s):  
Central Venous Catheter ◽  
Nursing Care ◽  
Rio De Janeiro ◽  
Renal Dialysis ◽  
Venous Catheter ◽  
Descriptive Study ◽  
Central Venous Catheters ◽  
Central Venous

Objetiva-se observar como as práticas de inserção e manipulação do cateter venoso central são realizadas em umserviço de Hemodiálise de um Hospital Federal do Rio de Janeiro. Estudo observacional de caráter descritivo denatureza quantitativa. Foram observados os procedimentos de inserção, manipulação e manutenção do catetervenoso central realizados por profi ssionais de saúde. Os resultados totalizaram 135 observações, das quais 16 foramde inserção e 119 de manipulação nos momentos pré e pós hemodiálise. No que tange à manipulação dos cateteresvenosos centrais, 62 foram observados nos momentos pré e 57 nos momentos pós-hemodiálise. Entre as observações,61% no período pré foram de conformidades e para os momentos pós, obteve-se 72% de conformidades. Conclui-seque as observações de não conformidades relacionadas às práticas de inserção e manipulação de cateter venosocentral em hemodiálise podem ter apresentado este resultado por serem realizadas de forma não sistemática, o quepode colaborar com desfechos negativos relativos à diálise.Palavras-chave: Infecções Relacionadas à Cateter; Cuidados de Enfermagem; Diálise Renal; Cateteres VenososCentrais. ABsTRAcTThe aim is to observe how the insertion and manipulation practices of the central venous catheter are performedin a hemodialysis service of a Federal Hospital in Rio de Janeiro. This observational and descriptive study of aquantitative nature. All the professionals that manipulate the catheter anyway where observed. 135 observationsregarding the insertion and manipulation of the central venous catheter where made, of witch: 16 where aboutinsertion, 135 about manipulation before hemodialysis and 119 from manipulation after hemodialysis. Theresults demonstrate that 61% practices in conformity and 39% of practices before hemodialysis non-conformities.About the practices after hemodialysis 72% where in conformity and 28% noncompliance. It concludes that thisresearch allowed to apprehend that due to the practices of insertion and manipulation of central venous catheterin hemodialysis haven’t systematically performed., nonconformities are likely to occur, with outcome to dialysisevents.Keywords: Catheter-Related Infections; Nursing Care; Renal Dialysis; Central Venous Catheters.

A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

2020 ◽  
pp. 112972982094345
Author(s):  
Maryanne Z A Mariyaselvam ◽  
Vikesh Patel ◽  
Adam Sawyer ◽  
James A Richardson ◽  
Jonathan Dean ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Patient Harm ◽  
Central Venous ◽  
Exact Test ◽  
The United Kingdom ◽  
Catheter Tip ◽  
Never Event ◽  
Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

Risk factor identification and predictive models for central line requirements for patients on vasopressors

2021 ◽  
pp. 0310057X2110242
Author(s):  
Adrian D Haimovich ◽  
Ruoyi Jiang ◽  
Richard A Taylor ◽  
Justin B Belsky
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Single Agent ◽  
Composite Endpoint ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

A New Formula-Based Measurement Guide for Optimal Positioning of Central Venous Catheters

2004 ◽  
Vol 9 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Phllip Lum
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Access Site ◽  
Insertion Sites ◽  
Tip Position ◽  
A Prospective Study ◽  
New Formula ◽  
Percutaneous Insertion

Abstract Purpose: To validate the formula-based central venous catheter (CVC) length measurement “tailored” to individual's height and access site for predicting optimum SVC tip position. Method: A prospective study of 3 percutaneous insertion sites (PICC, SCC and JC). Formula-based “LUM'S CVC MEASUREMENT GUIDE” was used to determine the catheter length. Results: Overall, 97% (373) of the total 382 insertions were successfully placed with CVC tip in the distal SVC (SVC between carina and atrio-cava junction) location. Conclusion: The “tailored fit” formula to individual patient height is a reliable tool to predict CVC length. Appropriate catheter length can greatly reduce the guesswork and possibility of complications related to tip malposition.

High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology

2019 ◽  
Vol 21 (3) ◽  
pp. 336-341
Author(s):  
Salvatore Mandolfo ◽  
Adriano Anesi ◽  
Milena Maggio ◽  
Vanina Rognoni ◽  
Franco Galli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Prognostic Index ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Removal ◽  
Renal Unit ◽  
Chronic Haemodialysis ◽  
Central Venous

Background: Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks. Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue. Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.

Trends of scientific literature on the nursing care in the use of central venous catheter insertion of peripheral

2011 ◽  
Vol 5 (3) ◽  
pp. 806
Author(s):  
Gilvânya Magna Dantas Peixoto ◽  
Ana Elza Oliveira de Mendonça ◽  
Rodrigo Assis Neves Dantas ◽  
Daniele Vieira Dantas ◽  
Gilson De Vasconcelos Torres
Keyword(s):  
Nursing Care ◽  
Scientific Literature ◽  
Venous Catheter ◽  
Descriptive Study ◽  
Venous Access ◽  
Catheter Insertion ◽  
Central Venous ◽  
Palabras Clave ◽  
Web Of Knowledge ◽  
Education Nursing

ABSTRACTObjective: to characterize the scientific literature on nursing care in the insertion/use of venous catheter peripherally inserted central (PICC). Method: this is about a bibliographic research, exploratory, descriptive and documentary study, performed with the keywords "nursing" and “catheterization, peripheral”. It were found six items, two in the LILACS, SciELO one, one and two in PUBMED in ISI Web of Knowledge. Results: most of the studies was located in LILACS (33.3%) and ISI (33.3%) in 2008 (33.3%), produced by graduate teachers (50.0%) and nurses care (50.0%), using the descriptive study (33.3%) and literature review (33.3%) with a quantitative approach (66.7%). 50.0% of the studies were about the care in the maintenance of PICC and 33.3% over the catheter insertion. 66.7% of studies were published in international journals. Conclusion: the interest for PICC continues to increase due to lower incidence of complications (compared to other venous access), ease of insertion by nursing staff, longer duration of the procedure and possible use in home care. Descriptors: catheterization, peripheral; nursing; publications; review; education, nursing, continuing.RESUMOObjetivo: caracterizar a produção científica sobre cuidado de enfermagem na inserção/utilização do cateter venoso central de inserção periférica (PICC). Método: pesquisa do tipo bibliográfica, de cunho exploratório-descritiva e documental, realizada com os descritores “enfermagem” e “cateterismo venoso periférico”. Foram encontrados seis artigos, sendo dois na LILACS, um na SCIELO, um na PUBMED e dois na ISI Web of Knowledge. Resultados: a maioria dos estudos estava localizada na LILACS (33,3%) e ISI (33,3%), em 2008 (33,3%), produzidos por docentes de pós-graduação (50,0%) e por enfermeiros assistenciais (50,0%), utilizando-se do estudo descritivo (33,3%) e revisão de literatura (33,3%), com abordagem quantitativa (66,7%). 50,0% dos estudos foram sobre os cuidados na manutenção do PICC e 33,3% sobre a inserção do cateter. 66,7% dos estudos foram publicados em revistas internacionais. Conclusão: o interesse pelo PICC continua a aumentar devido sua menor incidência de complicações (comparado a outros acessos venosos), facilidade de inserção pela equipe de enfermagem, maior duração do procedimento e possibilidade de utilização no atendimento domiciliar. Descritores: cateterismo venoso periférico; enfermagem; publicações; revisão; educação continuada em enfermagem.RESUMENObjetivo: caracterizar la literatura científica sobre los cuidados de enfermería en la inserción / uso de catéter venoso central de inserción periférica (PICC). Método: es un estúdio de investigación bibliográfica, de carácter exploratorio, descriptivo y documental, realizado con las palabras clave "enfermería" y "cateterismo venoso periférico". Se han encontrado 6 artículos, dois en el LILACS, SciELO un, un y dois en PUBMED en el ISI Web of Knowledge. Resultados: la mayoría de los estudios se encuentra en LILACS (33,3%) y el ISI (33,3%) en 2008 (33,3%), producida por profesores titulados (50,0%) y enfermeros atención (50,0%), utilizando el estudio descriptivo (33,3%) y revisión de la literatura (33,3%) con un enfoque cuantitativo (66,7%). 50,0% de los estudios eran sobre el cuidado en el mantenimiento de PICC y el 33,3% más de la inserción del catéter. 66,7% de los estudios fueron publicados en revistas internacionales. Conclusión: el interés por el PICC sigue aumentando debido a la menor incidencia de complicaciones (comparado con el acceso venoso otros), facilidad de inserción de personal de enfermería, una larga duración del procedimiento y su posible uso en la atención domiciliaria. Descriptores: cateterismo venoso periférico; enfermería; publicaciones; revisión; educación continua en enfermería.

Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

2009 ◽  
Vol 28 (3) ◽  
pp. 151-155 ◽  
Author(s):  
Sabra Curry ◽  
Michele Honeycutt ◽  
Gail Goins ◽  
Craig Gilliam
Keyword(s):  
High Risk ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Skin Antisepsis ◽  
Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

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

Catheter-Associated Deep Vein Thrombosis (CADVT) in a Pediatric ICU: A Retrospective Case-Control Study

2020 ◽  
Vol 25 (3) ◽  
pp. 45-55
Author(s):  
Sandeep Tripathi ◽  
Kimberly Burkiewicz ◽  
Jonathan A. Gehlbach ◽  
Yanzhi Wang ◽  
Michele Astle
Keyword(s):  
Deep Vein Thrombosis ◽  
Central Venous Catheter ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Retrospective Case ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Control Study

Highlights Abstract Introduction: Catheter-associated deep vein thrombosis (CADVT) in children has been recognized as a significant hospital-acquired condition. This study was undertaken to retrospectively analyze the impact of CADVT on outcomes and to identify risk factors for the development of deep vein thrombosis in children with central venous catheters. Methods: This was a single-center retrospective case-control study of patients with central venous catheters in a pediatric intensive care unit (ICU) from January 2014 to December 2018. Forty-one patients with central venous catheters who developed CADVT were compared with 100 random controls. Central venous catheter type, along with patient and disease-specific characteristics, were compared between the two groups by univariate and multivariate regression. Outcome comparison was made after adjusting for confounding variables. Results: Median time from insertion to the development of CADVT was 4 days (interquartile range, 2–9). Forty percent (16/40) of patients had a blood urea nitrogen greater than 20 mg/dL, and 86.6% (13/15) had a C-reactive protein greater than 1 mg/dL within 48 hours of development of CADVT. Central venous catheter duration (odds ratio [OR], 1.05), mechanical ventilation (OR, 7.49), and upper versus lower extremity site of the central venous catheter (OR, 0.324) were associated with the development of CADVT. Ultrasound guidance occurred significantly less in patients who developed CADVT (39.3% vs 70.7%); however, it was not independently associated with increased risk. Age, body mass index, mechanical ventilation, and severity of illness–adjusted hospital and ICU length of stay were significantly higher in patients who developed CADVT. Conclusions: CADVT is independently associated with worse outcomes. Ultrasound guidance and site selection are potential modifiable risk factors in the development of CADVT in pediatric patients. Future studies should target an effective chemoprophylaxis regimen.

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