scholarly journals Simultaneous Catheter Replacement for Infectious and Mechanical Complications without Interruption of Peritoneal Dialysis

2016 ◽  
Vol 36 (2) ◽  
pp. 182-187 ◽  
Author(s):  
John H. Crabtree ◽  
Rukhsana A. Siddiqi
Keyword(s):  
Peritoneal Dialysis ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous ◽  
Technique Survival ◽  
Mechanical Complications ◽  
Tunnel Infection ◽  
Catheter Complications ◽  
Systemic Antibiotics ◽  
Catheter Replacement

BackgroundConventional management for peritoneal dialysis (PD)-related infectious and mechanical complications that fails treatment includes catheter removal and hemodialysis (HD) via a central venous catheter with the end result that the majority of patients will not return to PD. Simultaneous catheter replacement (SCR) can retain patients on PD by avoiding the scenario of staged removal and reinsertion of catheters. The aim of this study was to evaluate a protocol for SCR without interruption of PD.MethodsClinical outcomes were analyzed for 55 consecutive SCRs performed from 2002 through 2012 and followed through 2013.ResultsSimultaneous catheter replacements were performed for 28 cases of relapsing peritonitis, 12 cases of tunnel infection, and 15 cases of mechanical catheter complications. All cases for peritonitis and tunnel infection and 80% for mechanical complications continued PD on the day of surgery using a low-volume, intermittent automated PD protocol. Systemic antibiotics were continued for 2 weeks postoperatively (up to 4 weeks for Pseudomonas). Simultaneous catheter replacement was performed as an outpatient procedure in 89.1% of cases. Only 1 of 55 procedures was complicated by peritonitis within 8 weeks. No catheter losses occurred during this postoperative timeframe. Long-term, SCR enabled a median technique survival of 5.1 years.ConclusionsIn most instances, SCR can be safely performed without interruption of PD for selected cases of peritonitis and tunnel infection and for mechanical catheter complications. The procedure spares the patient from a central venous catheter, a shift to HD, the psychological ordeal of a change in dialysis modality, and a second surgery to insert a new catheter.

Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

2018 ◽  
Vol 35 (9) ◽  
pp. 869-874 ◽  
Author(s):  
Jacob Bell ◽  
Munish Goyal ◽  
Sallie Long ◽  
Anagha Kumar ◽  
Joseph Friedrich ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Complication Rate ◽  
Venous Catheter ◽  
Complication Rates ◽  
Central Venous ◽  
Site Specific ◽  
Mechanical Complications ◽  
Significant Difference ◽  
Insertion Techniques ◽  
Delayed Complications

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. Results: In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. Conclusions: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

scholarly journals Comparison of mechanical complications of central venous catheter according to the insertion site in an intensive care unit of Bangladesh

2020 ◽  
Vol 10 (2) ◽  
pp. 115-119
Author(s):  
Debasish Kumar Saha ◽  
Suraiya Nazneen ◽  
ASM Areef Ahsan ◽  
Madhurima Saha ◽  
Kaniz Fatema ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Insertion Site ◽  
Venous Catheter ◽  
Arterial Puncture ◽  
Central Venous ◽  
Femoral Site ◽  
Mechanical Complications ◽  
Catheter Tip

Background: Central venous catheter (CVC) insertion is very common in intensive care unit (ICU). CVC is usually inserted in subclavian, internal jugular and femoral veins. However, CVC insertion may lead to significant mechanical complications. Our aim was to detect the occurrence of CVC related mechanical complications according to different insertion site. Methods: This prospective observational study was carried out during the period of May 2016 to July 2019 in Department of Critical Care Medicine, BIRDEM General Hospital, Dhaka, enrolling 349 adult patients requiring new CVC insertion in ICU. Results: Among 349 study subjects, 167 CVC were inserted through subclavian vein, 88 through internal jugular and 94 through femoral vein. There was no significant difference among three groups (subclavian / internal jugular / femoral) in terms of age, gender distribution, presence of co-morbid illness.Total mechanical complicationsin study population was 43 (12.3 %) including pneumothorax (14, 4.0%), arterial puncture (10, 2.9%), hemorrhage (11, 3.2%), catheter tip malposition (6, 1.7%), hemothorax (1, 0.3%) and lost guidewire (1, 0.3%). Pneumothorax was more with internal jugular (9.1%) than subclavian (3.6 %) route, which was statistically significant (p=0.007). Although hemorrhage and arterial puncture events were higher with femoral site than subclavian or internal jugular, which were not significant. Catheter tip malposition occurred in 4 (2.4%) patients with subclavian insertion and 2 (2.3%) patients with internal jugular site, no such event in femoral site. Hemothorax and lost guidewire occurred in only 1 patient with subclavian and internal jugular site respectively. Site-wise total mechanical complications were higher in internal jugular (17.0%) followed bysubclavian (10.8%) site and femoral site (10.6%). Conclusion: In this study, though not statistically significant, CVC related mechanical complications occurred more in subclavian site than in internal jugular or femoral insertion site. Birdem Med J 2020; 10(2): 115-119

Intraperitoneal vancomycin treatment of multifocal methicillin-resistant Staphylococcus aureus osteomyelitis in a patient on peritoneal dialysis

2020 ◽  
Vol 77 (21) ◽  
pp. 1746-1750
Author(s):  
Qassim Abid ◽  
Basim Asmar ◽  
Edward Kim ◽  
Leah Molloy ◽  
Melissa Gregory ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Central Venous Catheter ◽  
Shoulder Joint ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Area Under The Curve ◽  
Venous Catheter ◽  
Left Shoulder ◽  
Central Venous ◽  
Methicillin Resistant

Abstract Purpose We report the case of a 2-year-old girl with end-stage renal disease managed by peritoneal dialysis (PD) who developed methicillin-resistant staphylococcal osteomyelitis of the left shoulder and was successfully treated with intraperitoneal (IP) administration of vancomycin for 2 weeks followed by oral clindamycin therapy. Summary The patient was hospitalized with tactile fever and a 3-day history of worsening fussiness. Radiography of the left shoulder showed findings indicative of osteomyelitis. Vancomycin was administered via central venous line for 3 days, during which time the patient underwent PD 24 hours a day. After magnetic resonance imaging revealed proximal humeral osteomyelitis, septic arthritis of the shoulder joint, and osteomyelitis of the scapula, the patient underwent incision and drainage of the left shoulder joint. Both blood and joint drainage cultures grew methicillin-resistant Staphylococcus aureus that was sensitive to vancomycin. The patient’s central venous catheter was removed on hospital day 4; due to difficulties with peripheral i.v. access and a desire to avoid placing a peripherally inserted central venous catheter, vancomycin administration was changed to the IP route, with vancomycin added to the PD fluid. During IP treatment, serum vancomycin levels were maintained at 13.5 to 18.5 mg/L, and the calculated ratio of vancomycin area under the curve to minimum inhibitory concentration was maintained above 400. After completing a 14-day course of IP vancomycin therapy, the patient was switched to oral clindamycin, with subsequent complete resolution of osteomyelitis. Conclusion IP vancomycin was effective for treatment of invasive S. aureus infection in this case. This approach should be considered in patients undergoing PD for whom peripheral i.v. access options are limited and/or not preferred.

Central Venous Catheter Securement: Using the Healthcare and Technology Synergy Model to Take a Closer Look

2015 ◽  
Vol 20 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Denise Macklin ◽  
Paul L. Blackburn
Keyword(s):  
Central Venous Catheter ◽  
Health Care Providers ◽  
Venous Catheter ◽  
Clinical Settings ◽  
Care Providers ◽  
Central Venous ◽  
Bacterial Migration ◽  
Life Threatening ◽  
Delay Of Treatment ◽  
Catheter Replacement

Abstract Proper securement provides a safe vascular access device environment for both patients and health care providers. Successful securement protects central venous catheters from several sources of failure until the end of therapy by preventing central venous catheter movement during all phases of care. Movement causes vein trauma, bacterial migration, distal tip location variation, loss of dressing integrity, and even total dislodgement. Any of these events can have serious consequences, including catheter-related bloodstream infection, thrombosis, delay of treatment, catheter replacement, and potential hemorrhage, all of which can be life-threatening events, and increase costs. We review patient issues, practice issues, and the types of securement currently used in clinical settings.

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