line insertion
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2022 ◽  
Vol 67 ◽  
pp. 79-84
Author(s):  
Ori Galante ◽  
Re’em Sadeh ◽  
Alexander Smoliakov ◽  
Alona Muraveva ◽  
Yaniv Almog ◽  
...  

2022 ◽  
Vol 3 (1) ◽  
pp. 18-26
Author(s):  
Alexandra Miller ◽  
Elizabeth Vujcich ◽  
Jason Brown

Central line-associated bloodstream infection (CLABSI) and catheter-related bloodstream infection (CLABSI with a positive catheter tip culture, CRBSI) are preventable causes of morbidity and mortality for severe adult burns patients. Routine central line changes as a CLABSI prevention strategy in burns patients is controversial due to the paucity of evidence to guide the appropriate timing of line changes. This study aimed to address this evidence gap by investigating risk factors associated with central line sepsis, including the duration of central line insertion, in a population of severe adult burns patients (burns involving ≥20% total body surface area (TBSA)) admitted to the Royal Brisbane and Women’s Hospital Intensive Care Unit over five years (2015–2019 inclusive). On multivariate analysis, central line duration and burn TBSA were identified as independent risk factors for CLABSI, with central line duration the most significant predictor (p = 0.0008; OR 1.177, 95% CI 1.072–1.299). No risk factor independently predicted CRBSI. CLABSI detection occurred a median of 8.5 days (IQR 6.0–11.0) post central line insertion. These findings suggest further research to assess the efficacy of routine line changes prior to the at-risk period of 6–11 days post central line insertion in reducing CLABSI in severe adult burns patients may be beneficial.


Author(s):  
Alison Morag Campbell ◽  
Mahmoud Motawea ◽  
Wayne Fradley ◽  
Sean Marven

Abstract Aim In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG). Methods After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes. Results Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life—median). Fifteen SG had initial operative closure.Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups. Conclusion Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.


2021 ◽  
Vol 50 (1) ◽  
pp. 616-616
Author(s):  
Bradley Fritz ◽  
Carrie Sona ◽  
Lisa Konzen ◽  
Jason White ◽  
Jill Bertrand ◽  
...  

Author(s):  
Liyuan Wu ◽  
Lijia Wan ◽  
Min Peng ◽  
Tian Cao ◽  
Qin Wang ◽  
...  

Background Most neonates with persistent left superior vena cava (PLSVC) have no clinical symptoms or hemodynamic changes, and this anomaly is only found during cardiac catheterization, pacemaker implantation, or central venous catheterization. Electrocardiogram (ECG) localization is helpful for the application of the peripherally inserted central catheter (PICC) technique in neonates with PLSVC. Objective To explore the characteristic waveforms of the P wave when a PICC under ECG localization is applied in neonates with PLSVC. Study Design The observation and management strategies for the P wave changes during catheter insertion (CI) of two neonates with PLSVC admitted to our institution between January and July 2020, who underwent PICC line insertion, were summarized. Results The characteristic P wave changes in two children with a PICC line inserted via the PLSVC were observed. When a wide inverted P wave appeared on ECG, the catheter was immediately withdrawn by 0.5 cm, a bidirectional P wave gradually appeared and then disappeared. After that, the catheter was further withdrawn by 0.5 cm. After catheterization, the optimal position of the PICC was confirmed by X-ray photography and bedside B-ultrasound. The PICC line was removed as scheduled after indwelling for 18 and 29 days, respectively, in the two cases, and no PICC-related complications occurred during indwelling. Conclusion The characteristic P wave changes on ECG during CI provide important clinical reference values for the application of the PICC technique under ECG localization in neonates with PLSVC. Key Points


2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Mohamed Mahmoud Shalaby ◽  
Rami Mohammed Salama ◽  
Mohammed Awad Mansour

Abstract Background Central venous line insertion in neonates is an important and lifesaving procedure. It can carry significant risks and complications, including death, at the time of insertion or later. We aimed to retrospectively assess the modified Seldinger technique for open placement of a central venous catheter in neonates, regarding its safety, feasibility, operative time, and preservation of the patency of the internal jugular vein. This study was conducted on 120 neonates from March 2018 to March 2020. We closely monitored the pulse for the detection of arrhythmia or bradycardia, which might be caused during the insertion of the guide wire or the tip of the catheter. Post-operative X-ray was done immediately after the end of the procedure for all cases, to determine the site of the central venous catheter and to detect the presence of pneumothorax. Results Arrhythmia was observed in 9 cases (7.5%), and blood oozing in 5 cases (4.1%). There were 3 cases of pneumothorax (2.5%), 2 cases of neck hematoma in two cases (1.6%), 6 cases of internal jugular vein thrombosis (5%), and dislodging of the catheter in 3 cases (2.5%). There were no cases of arterial puncture, failure of cannulation, or haemothorax in our study. Conclusions The modified Seldinger technique insertion for open central venous line in neonates is a safe, accessible, and feasible method, especially in centers that lack the experience of ultrasound-guided insertion in neonates.


2021 ◽  
Vol 24 (5) ◽  
pp. E925-E934
Author(s):  
Nicholas Teman ◽  
Charles Hobson ◽  
Reid Tribble ◽  
Curt Tribble

In this treatise, we will address one of the higher-risk procedures, subclavian vein cannulation, that a practitioner may undertake in the care of complex patients. All cardiothoracic surgeons and their trainees will need, on occasion, to put in central lines in a variety of circumstances, including in the operating room, in the intensive care unit, in emergency circumstances, and, occasionally, when other practitioners have been unsuccessful in their attempts to place a central line. We will describe, in detail, the anatomy of the subclavian vein, the preparation of the patient for subclavian vein cannulation, the infraclavicular approach to cannulation of the vein, and a few notes about the supraclavicular approach to the subclavian vein. It is self-evident that the priorities of central venous cannulation include safety of insertion, minimizing clot formation, and avoiding infection. We will dwell primarily on the principles of safe subclavian line insertion.


PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258221
Author(s):  
Su Yeon Lee ◽  
Jee Hwan Ahn ◽  
Byung Ju Kang ◽  
Kyeongman Jeon ◽  
Sang-Min Lee ◽  
...  

Background According to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated. Methods We retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects’ characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed. Results In this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects’ median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization. Conclusions This physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU.


2021 ◽  
Vol 11 (11) ◽  
pp. 1222-1228
Author(s):  
Megan E. Peters ◽  
Juan P. Boriosi ◽  
Daniel J. Sklansky ◽  
Gregory A. Hollman ◽  
Jens C. Eickhoff ◽  
...  

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