line placement
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Author(s):  
Audrey Marie O'Neil ◽  
Cassandra Rush ◽  
Laura Griffard ◽  
David Roggy ◽  
Allison Boyd ◽  
...  

Abstract Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.


Author(s):  
Olivia Paradis ◽  
Lauren Bitterman ◽  
Kimberly H. Park ◽  
Stacey Ernest ◽  
Amy Russell ◽  
...  
Keyword(s):  

2021 ◽  
Vol 50 (1) ◽  
pp. 507-507
Author(s):  
Adewale Olayode ◽  
John Oropello ◽  
Atinuke Shittu ◽  
Roopa Kohli-Seth

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4037-4037
Author(s):  
Henna Butt ◽  
Natalie Davis ◽  
Regina A. Macatangay

Abstract Background: Once diagnosis of malignancy is made in pediatric patients, it can be important to initiate therapy to prevent delay in benefits derived from treatment. In certain diagnoses, prompt initiation of chemotherapy can help reduce complications such as hyperleukocytosis, mass effect from solid tumors, and spread of malignancy. These patients require provision of central vascular access in order to begin treatment. In children's hospitals patients often receive central venous catheters in the operating room under general anesthesia. However, this requires scheduling for the operating room, availability of pediatric surgeons, appropriate anesthesia consent and examination ahead of time for safety of proceeding. The benefit of having a pediatric vascular access team (PVAT) is that these providers are flexible with their availability, the time required to place the lines is often less and it eliminates the need for general anesthesia as well as the cost of the operating room. The aim of this study was to compare vascular access provision by a designated pediatric vascular access team with surgical placement of central venous access in pediatric oncology patients. Methods: This was an IRB-approved retrospective medical record review of subjects diagnosed with an oncologic malignancy with inclusion criteria: ages 0-21 years of age, treatment for pediatric malignancy at the University of Maryland Children's Hospital between 1/1/2017-12/31/2019. We performed bivariate analyses comparing variables between patients who had line placement by PVAT vs surgical placement. Analyses was performed using SAS 9.4. Results: We identified 69 patients who met inclusion criteria with 39% (n=27) having undergone line placement by PVAT. Surgical placement occurred for 55% (n=38), with interventional radiology (IR) or other placement making up the remainder 6% of patients (n=4). The mean age was noted to be younger in the surgical group (8.6 +/- 6 years) in comparison to the PVAT group (13+/-6.3 years), p=0.0061. The mean time from consult to line placement was 10 (+/-9) hours in the PVAT group vs 76 (+/-56) hours in the surgery group (p<0.0001). There was a statistically significant difference in procedure duration, with PVAT placement requiring less time (27+/-12 minutes) vs surgical placement (48+/-19 minutes), p=0.0005. There were no statistically significant differences among groups in race, sex, time-to-initiation of treatment after line placement, or complications. There was a small difference in mean number of attempts, with surgical requiring 1 (+/-0) vs. PVAT 1.2 (+/-0.4) attempts. Compared to complications of surgical line placement, the complications experienced by our PVAT team were largely related to need for revision of line placement, although not frequent enough to be statistically significant. Conclusion: Data show that having a PVAT for central line insertions demonstrates good safety profiles, successful insertion and low complication rates. PVAT has also increased the efficiency of vascular access at large academic institutions. The presence of vascular access teams allows for initiation of therapy in a timely fashion and allows central line placement under anesthesia to occur at a safer time. At our institution, having a PVAT in house has allowed for more efficient line placements, shorter time to provision of access and transition to placement of surgical lines when more stable. This allows for not only patients to receive care faster, but also to have lines placed in shorter times while optimizing patient safety. Schultz TR, Durning S, Niewinski M, Frey AM. A multidisciplinary approach to vascular access in children. J Spec Pediatr Nurs. 2006;11(4):254-256. doi:10.1111/j.1744-6155.2006.00078. Disclosures No relevant conflicts of interest to declare.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S234-S235
Author(s):  
Lefko T Charalambous ◽  
Billy Kim ◽  
Ayden Case ◽  
Ian Duensing ◽  
Meredith Brown ◽  
...  

Abstract Background Peri-prosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty (TJA) requiring surgical intervention and prolonged parenteral antibiotics. Often plagued by complications, the purpose of this study was to characterize the postoperative PICC (peripherally-inserted central catheter) line related complications and readmissions. Causes for 90-Day ED Visits after Revision Surgery for PJI. The figure quantifies causes for ED visits after PJI revision surgery with subsequent PICC line placement. Readmissions from ED are highlighted in blue. PICC-specific problems at ED visit. The figure quantifies the specific PICC-line problems that brought patients to the ED. Readmissions from ED are highlighted in blue. Methods We retrospectively queried an institutional database for total hip (THA) and total knee (TKA) arthroplasty patients from January 2015 through December 2020 that developed a PJI and required PICC placement. Patient demographics, comorbidities, readmissions, and emergency department (ED) visits were collected. Results 889 patients (48.3% female) with a mean age of 64.6 years (18.7-95.2) underwent 435 THA and 454 TKA that were revised for PJI. The cohort had 275 (30.9%) 90-day ED visits and 284 readmissions (31.9%). Of ED visits, 51 (18.5%) were PICC-related, with only five (9.8%) leading to readmission for a PICC complication. Average time from discharge to PICC ED visit was 26.2 days (0.3-89.4). The most common reasons for 90-day ED visit after revision and PICC line placement were issues related to the joint replacement or wound site (“MSK”, n=116, 42.2%) and PICC complaints (n=51, 18.5%). A multivariable logistic regression demonstrated that non-Caucasian race (OR 2.24, 95% CI 1.24-4.04, p=0.007) and younger age (OR 0.98, 95% CI 0.95-1.00, p=0.035) were associated with PICC-related ED visits. Malpositioning (41.2%) and occlusion (35.3%) were the most common PICC complications leading to ED presentation. Conclusion PICC complications are common after PJI treatment accounting for nearly 20% of 90-day ED visits. Of these, malpositioning and occlusion of the PICC line occupy the vast majority of these complaints. This high level of utilization early in the course of outpatient parenteral antibiotic therapy represents areas of optimization and potential cost containment in the postoperative care of PJI patients. Disclosures William Jiranek, MD, Depuy Synthes (Other Financial or Material Support, Royalty/Licensing) Michael Bolognesi, MD, Heron Therapeutics, Inc. (Consultant)Total Joint Orthopedics, Inc. (Other Financial or Material Support, Royalty/Licensing)Zimmer Biomet Holdings, Inc. (Other Financial or Material Support, Royalty/Licensing) Thorsten Seyler, MD/PhD, Depuy Synthes (Other Financial or Material Support, Resident Educational Support)Extrel Therapeutics (Board Member, Shareholder)Heraeus Medical (Consultant)MiCare Path (Board Member, Shareholder)OREF (Grant/Research Support)Pattern health (Board Member)Restor3D (Other Financial or Material Support, Royalties)Smith+Nephew, Inc. (Grant/Research Support, Speaker’s Bureau)Stryker (Other Financial or Material Support, Resident Educational Support)Total Joint Orthopedics, Inc. (Consultant)Wolters Kluwer Health (Other Financial or Material Support, Royalties)Zimmer Biomet (Grant/Research Support)


Author(s):  
J.L. Ruikka ◽  
C. Acun ◽  
S. Karnati

Peripherally inserted central catheter line entrapment is a rare complication in the neonatal intensive care unit and only a small number of cases have been reported. While studies have suggested recommendations for removal, there is still a need for surgical intervention in some cases. This is a case of a premature infant with long term peripherally inserted central catheter line placement with fibrin sheath formation that required multiple attempts before successful noninvasive removal and a review of the cases with difficult peripherally inserted central catheter removal in newborns.


Ultrasound Guided Procedures and Radiologic Imaging for Pediatric Anesthesiologists is intended as a ready resource for both experts and novices. It will be useful to those with extensive training and experience as well as beginners and those with distant experience or training. A wealth of knowledge in the human factors of procedure design and use has been applied throughout to ensure that desired information can be easily located, that steps are clearly identified and comprehensible, and that additional information of high relevance to procedure completion is co-located and salient. This book begins with the basics but quickly progresses to advanced skill sets. It is divided into four parts. Part I starts with a primer on ultrasound machine functionality as well as procedural chapters on lung ultrasound to detect a mainstem intubation or pneumothorax and gastric ultrasound to assess gastric contents in incompletely fasted patients. Part II covers ultrasound guided peripheral intravenous line placement through the incremental advancement method, ultrasound guided arterial line placement, and ultrasound guided central line placement. Part III details several ultrasound guided regional anesthesia techniques. Part IV covers radiology of the pediatric airway and mediastinum, lungs, gastrointestinal, genitourinary, musculoskeletal, and neurologic systems.


Author(s):  
Anna Clebone

Chapter 4 discusses the dynamic use of ultrasound to guide the placement of a peripheral intravenous (IV) line. Ultrasound can be used to guide placement of multiple types of vascular access. Arteries and veins are sonographically similar in cross section: hyperechoic circles with hypoechoic interiors. Arteries are thicker walled and characteristically pulsatile. Veins are more susceptible to compression. Doppler or color flow can distinguish the amplitude and direction of flow. Skill with placing peripheral ultrasound guided IV lines in patients with difficult IV access can often help the practitioner avoid the need to place a central line, assuming the central line is not needed for other indications.


Author(s):  
Michael R. King ◽  
Ramesh Kodavatiganti ◽  
Hubert A. Benzon

Chapter 5 covers the fundamentals and techniques of arterial line placement, including the palpation technique, ultrasound guided arterial line placement, and the cutdown technique. Arterial line placement involves inserting a catheter into a peripheral artery, most commonly the radial or femoral artery. Arterial lines provide beat-to-beat blood pressure monitoring as well as a readily available means of obtaining blood samples to check arterial blood gas measurements and other labs. Cannulation of the ulnar, brachial, axillary, posterior tibial, dorsalis pedis, and umbilical (in neonates) arteries has also been described, although these sites may be higher risk. Although the techniques described in this chapter focus on the radial, femoral, and posterior tibial approaches, many of the general principles apply to the other arteries as well.


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