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Results for “Catheterization, Peripheral”

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PubMed2006

[Contamination of blood cultures drawn from central vein catheter and peripheral venipuncture. Prospective study of 75 pairs].

OBJECTIVE: To determine the frequency of contamination, the sensitivity, specificity, and predictive values of cultures done with blood drawn through a central venous catheter or peripheral venipuncture. DESIGN: Prospective cohort study of critical ill medical surgical intensive care patients in whom samples for paired culture were drawn through a central venous catheter or peripheral venipuncture during a period of 8 months (from August 1st 2001 to Mars 31st 2002). RESULTS: During the study period, 75-paired cultures were studied. Fifteen peripheral blood cultures (20%) and 27 central blood cultures (36%) were positive and 6 peripheral blood cultures (8%) and 15 central blood cultures (20%) were contaminated (P=0.034). The organism most commonly responsible for contamination was Coagulase Negative Staphylococcus (16% of central blood cultures and 6.7% of peripheral blood cultures). The frequency of contamination was of 42.9% for blood cultures drawn through a femoral central venous catheter, of 10% for jugular, and of 19% for subclavian central venous catheter (P=0.22). For catheter draws compared with peripheral venipuncture, sensitivity was 100 and 75%, specificity was 76.2 and 90.5%, positive predictive value was 44.4 and 60% and negative predictive value was 100 and 95%. CONCLUSION: Cultures of blood drawn through a catheter are more sensible and less specific than those obtained from a peripheral venipuncture and the organism most commonly responsible for contamination of blood cultures is Coagulase Negative Staphylococcus.

Bacteria↗

PubMed2000

Continuous pH and Pco2 monitoring during respiratory failure in children with the Paratrend 7 inserted into the peripheral venous system.

CONTEXT: The Paratrend monitor provides continuous arterial blood gas monitoring after insertion through a >/=20-gauge arterial cannula. OBJECTIVE: To determine the correlation of arterial blood gas values and the Paratrend monitor placed through a peripheral intravenous catheter. DESIGN: Prospective, open-label evaluation. SETTING: University-based pediatric intensive care unit. PATIENTS: Infants and children with respiratory failure and arterial access. RESULTS: The cohort included 23 infants and children. A total of 100 sample sets (Paratrend/ABG Pco(2) and pH values) were collected. The absolute difference between the arterial and Paratrend Pco(2) was 2. 9 +/- 1.8 mm Hg (range 0 to 9 mm Hg). Linear regression analysis of Paratrend Pco(2) versus arterial Pco(2) resulted in r = 0.97 and r(2) = 0.9479 (P <.001). Bland-Altman analysis of Pco(2) values demonstrated a bias +/- precision of -2.1 +/- 2.7 mm Hg. The absolute difference between arterial and Paratrend pH was 0.04 +/- 0. 02 units (range 0 to 0.15 units). Linear regression analysis of Paratrend pH versus arterial pH resulted in r = 0.83 and r(2) = 0. 7016 (P <.0001). Bland-Altman analysis of pH values revealed a bias +/- precision of 0.03 +/- 0.03 units. CONCLUSIONS: Inserted through a peripheral intravenous cannula, the Paratrend monitor can be used to provide an accurate estimation of arterial blood gas values in children with respiratory failure.

Adolescent↗

PubMed2002

Local warming and insertion of peripheral venous cannulas: single blinded prospective randomised controlled trial and single blinded randomised crossover trial.

OBJECTIVE: To determine whether local warming of the lower arm and hand facilitates peripheral venous cannulation. DESIGN: Single blinded prospective randomised controlled trial and single blinded randomised crossover trial. SETTING: Neurosurgical unit and haematology ward of university hospital. PARTICIPANTS: 100 neurosurgical patients and 40 patients with leukaemia who required chemotherapy. INTERVENTIONS: Neurosurgical patients' hands and forearms were covered for 15 minutes with a carbon fibre heating mitt. Patients were assigned randomly to active warming at 52 degrees C or passive insulation (heater not activated). The same warming system was used for 10 minutes in patients with leukaemia. They were assigned randomly to active warming or passive insulation on day 1 and given alternative treatment during the subsequent visit. MAIN OUTCOME MEASURES: PRIMARY: success rate for insertion of 18 gauge cannula into vein on back of hand. SECONDARY: time required for successful cannulation. RESULTS: In neurosurgical patients, it took 36 seconds (95% confidence interval 31 to 40 seconds) to insert a cannula in the active warming group and 62 (50 to 74) seconds in the passive insulation group (P=0.002). Three (6%) first attempts failed in the active warming group compared with 14 (28%) in the passive insulation group (P=0.008). The crossover study in patients with leukaemia showed that insertion time was reduced by 20 seconds (8 to 32, P=0.013) with active warming and that failure rates at first attempt were 6% with warming and 30% with passive insulation (P<0.001). CONCLUSIONS: Local warming facilitates the insertion of peripheral venous cannulas, reducing both time and number of attempts required. This may decrease the time staff spend inserting cannulas, reduce supply costs, and improve patient satisfaction.

Arm↗

PubMed1989

[Intravascular catheter: prevention and therapy of infection].

Intravascular devices are widely used. If certain precautions are taken, catheter-related infections, and especially bacteremia, are infrequent. Special attention should be paid to the correct access (peripheral versus V. subclavia or V. jugularis interna), immediate stabilization of the position, the choice of dry dressings (transparent plastic dressings should be avoided on newly inserted or arterial catheters, as well as on damp wounds), and regular changing of peripheral lines. In the febrile patient with vascular access the infective source should be sought. If the insertion site shows signs of inflammation, or if septicemia occurs, catheters must be removed. In patients with peripheral suppurative thrombophlebitis, surgical excision of the vein must be considered. In contrast, in septic thrombophlebitis of a central vein, removal of the catheter and antibiotic and anticoagulation therapy may be sufficient.

Anti-Bacterial Agents↗

PubMed2004

Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.

BACKGROUND: Parenteral nutrition for newborn infants may be delivered via short peripheral cannulae or central venous catheters, which are usually sited percutaneously. The method of delivery may affect nutrient input, and consequently growth and development. Although potentially more difficult to site, percutaneous central venous catheters may be more stable than peripheral cannulae, and need less frequent replacement. These methods may also be associated with different risks of adverse events, including acquired systemic infection and extravasation injury. OBJECTIVES: To review the evidence from randomised controlled trials that, in newborn infants who require parenteral nutrition, infusion via a percutaneous central venous catheter versus a peripheral cannula improves nutrient input, and growth and development, without increasing adverse consequences including systemic infection, or extravasation injuries. SEARCH STRATEGY: We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2003), MEDLINE (1966 - October 2003), EMBASE (1980 - October 2003), conference proceedings, and previous reviews. SELECTION CRITERIA: Randomised controlled trials that compared the effect of delivering parenteral nutrition via percutaneous central venous catheters versus peripheral cannulae in newborn infants. DATA COLLECTION AND ANALYSIS: We extracted the data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author, and synthesis of data using relative risk, risk difference and mean difference. MAIN RESULTS: We found three trials eligible for inclusion. These recruited a total of 262 infants and reported a number of different outcomes. One study showed that the use of a percutaneous central venous catheter was associated with a decreased risk of cumulative nutritional deficit during the trial period: Mean difference in the percentage of the prescribed nutritional intake actually received: -7.1% (95% confidence interval -11.2, -3.2). In another trial, infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae per infant during the trial period: Mean difference in the number of catheters/cannulae per infant: -3.2 (95% confidence interval -5.13, -1.27). Meta-analysis of data from two trials did not find any evidence of an effect on the incidence of systemic infection: Typical relative risk: 0.90 (95% confidence interval 0.62, 1.32); typical risk difference: -0.04 (95% confidence interval -0.17, 0.10). REVIEWERS' CONCLUSIONS: Data from one small study suggest that the use of percutaneous central venous catheters to deliver parenteral nutrition in newborn infants improves nutrient input. The significance of this in relation to longer-term growth and developmental outcomes is unclear. Another study suggested that the use of percutaneous central venous catheters rather than peripheral cannulae decreases the number of catheters/cannulae needed to deliver the nutrition. We have not found any evidence that percutaneous central venous catheter use increases the risk of adverse events, particularly systemic infection.

Catheterization, Central Venous↗

PubMed2005

Unexpected hospital-acquired bacteraemia in patients at low risk of bloodstream infection: the role of a heparin drip.

Following a cluster of cases of unexpected hospital-acquired bacteraemia suspected to be related to an intravenous (iv) heparin drip, all cases of hospital-acquired primary bloodstream infection (BSI) in patients at low risk of bacteraemia were analysed over a four-year period. Ninety-six bacteraemic patients (6%) from 1618 episodes of hospital-acquired bacteraemia had a peripheral iv line as the only risk factor. These patients were divided into two groups: 60 patients with phlebitis and 36 without local signs of inflammation. Baseline features of the two groups were comparable, but in univariate and multivariate analysis, a significant association was found between iv heparin use, predominance of Gram-negative organisms (especially Klebsiella, Serratia and Enterobacter species), and absence of phlebitis. In spite of clear statistical association, however, the means by which the heparin solution became contaminated with Gram-negative organisms remained unknown. Following implementation of infection control methods concerning heparin handling, no more cases occurred. Unexpected hospital-acquired Gram-negative bacteraemia in patients with peripheral iv lines should prompt investigation of potential infusate-related infection, especially in patients without phlebitis and those receiving iv heparin.

Aged↗

PubMed1996

[Percutaneous dynamic atherectomy with the aid of 12-F and 14-F transluminal atherectomy catheters (TEC): initial results].

OBJECTIVE: The presented study reports on the first experience with the large diameter 12 F and 14 F TEC system for percutaneous dynamic atherectomy of peripheral vascular obstructions. METHODS AND PATIENTS: The 12 F and 14 F TEC-extraction catheter was used to recanalize peripheral vascular obstructions in 4 patients. The extracted material was continuously aspirated during the procedure. Three patients with intermittent claudication suffered from chronic arterial occlusion (two cases) or from stenosis of an implanted stent (one case) in the region of the superficial femoral artery. In another patient with long-term dialysis history an insufficient collier shunt was treated by atherectomy. RESULTS: Complete vascular recanalisation was achieved in all cases. Supplementary intervention was not necessary. There were no complications. CONCLUSION: Atherectomy with the large diameter 12 F and 14 F TEC allows a safe and complete recanalisation of complex peripheral vascular occlusions. Further studies must show whether the enlarged vascular intrusion is justified by more favourable results.

Angiography, Digital Subtraction↗

PubMedDate not supplied

Peripheral intravenous lock irrigation in children: current practice.

Current practice for irrigation of peripheral intravenous (IV) locks in children was determined from responses to a questionnaire sent to selected children's hospitals nationwide. Although considerable variation in practice exists, the most common practice is to irrigate peripheral IV locks with 1 milliliter (ml) of a solution containing 10 units of heparin per ml of normal saline every 8 hours. These results are based on a response rate of 74.4% (N = 32).

Catheterization, Peripheral↗

PubMed2003

A prospective study on ultrasound-guided compression therapy or thrombin injection for treatment of iatrogenic false aneurysms in patients receiving full-dose anti-platelet therapy.

BACKGROUND: False aneurysms (FA) develop at the puncture site in up to 6% of percutaneous cardiovascular procedures. Previous management included surgery or manual compression. Recently, selective injection of thrombin has been proposed as an alternative. However, there has been no direct comparison of thrombin injection to manual compression. AIM: To study the effectiveness of manual compression compared to that of thrombin injection in patients with false aneurysms on full-dose aspirin and clopidogrel. METHODS AND PROTOCOL: All patients with a clinically suspected FA after percutaneous invasive procedures were recruited for the study. The patients were examined with color ultrasound (7.5 MHz transducer). The minimum and maximum diameters of the false aneurysm and the distance between the surface and the false aneurysm were measured online. Under local anesthesia, manual compression was applied under sonographic guidance in all patients. If compression stopped flow into the false aneurysm, manual compression was applied for a maximum of 40 min followed by compression bandage for a minimum of 12 hours. If compression failed, thrombin was injected under ultrasound guidance. RESULTS: Thirty-six patients had a FA. Their age ranged from 58 to 90 years (mean 71+/-9 years). All patients were taking aspirin (median dose 100 mg per day) and clopidogrel (median dose 75 mg per day). Additionally, 24 patients had received subcutaneous heparin (7500 to 12 500 units) or enoxaprin (0.4-1.0 ml) 3 to 12 hours before treatment. The mean width of the false aneurysm was 22.1+/-3 mm, mean length 33.6+/-35.4 mm, and mean depth 19.5+/-8.2 mm. In six patients (17%), ultrasound-guided manual compression was tolerated, succeeding after 5 to 31 minutes. Thirty patients received thrombin injections (100-1800 units, mean 880+/-470 units, median 800 units). Complete thrombosis occurred in 28 patients (93%). Surgery was performed in the other two patients. The thrombin injection was not associated with any complications. In particular, there were no peripheral vascular complications. CONCLUSION: In patients with FA taking aspirin and clopidogrel, selective thrombin injection is more effective than manual compression.

Aged↗

PubMed1998

Safety of prolonging peripheral cannula and i.v. tubing use from 72 hours to 96 hours.

OBJECTIVE: To compare the rates of phlebitis of peripheral intravenous lines left in place for 72 hours versus rates of those left in place 96 hours. DESIGN: A prospective, nonrandomized study. SETTING: A university teaching hospital with 375 beds. PATIENTS: Consecutive adult patients who received peripheral intravenous lines and were admitted to the wards. MEASUREMENTS: The phlebitis rates were monitored by the i.v. Team for 1 month according to a predetermined definition for phlebitis: palpable cord or at least two of the following: tenderness, warmth, erythema, and induration. RESULTS: A total of 2503 peripheral lines were evaluable. The overall phlebitis rate was 6.8%. The phlebitis rates for lines left in for 72 and 96 hours were not significantly different (3.3% vs 2.6%, p = 1.000) by Fisher's Exact Test and survival analysis. It was estimated that in 1 month approximately 300 intravenous lines potentially could be prolonged beyond 72 hours; 215 lines were changed at 72 hours despite no signs of inflammation, 61 lines were kept till 96 hours, and 19 lines were kept beyond 96 hours. CONCLUSIONS: Phlebitis rate for our peripheral intravenous catheters at 96 hours was not significantly different from that at 72 hours. If intravenous cannulas and lines were prolonged to 96 hours, a potential cost saving of $61,200 per year could be realized.

Adult↗

PubMed2004

Intravenous catheter complications in the hand and forearm.

BACKGROUND: We studied the complications of peripheral intravenous (i.v.) catheters in the hand and forearm in a teaching hospital over a 3-year period. METHODS: The records of 67 patients who developed i.v. catheter-related complications were reviewed. RESULTS: The most common sites for developing complications in order of frequency were the forearm, hand, wrist, and antecubital fossa. There were 56 minor and 11 major complications. More than 50% of minor complications occurred in the hand and wrist, and more than 50% of major complications occurred in the hand. In 68% of minor complications, the patients were aged 50 years or older and 68% were women. Minor complications comprised 26 intravenous infiltrations, 23 cases of thrombophlebitis, and 7 cases of cellulitis. Ninety percent of major complication patients were aged 50 or older and 82% were women. Major complications included septic thrombophlebitis in three; hematomas resulting in skin necrosis in two; and infiltration related complications in six, resulting in skin necrosis in two, compressive nerve lesions in two, digital stiffness in one, and compartment syndrome in one. Ten patients with major complications were over the age of 50 years and nine were women. Two patients receiving anticoagulation developed large dorsal subcutaneous space hematomas. Chemotherapeutic agents contributed to two minor complications and one major complication. CONCLUSION: The hand is a common site for minor and major i.v. catheter complications. Women and older patients are more susceptible to these complications. Peripheral i.v. line complications are not uncommon and can result in morbidity and increased health care costs from prolonged hospitalization, extended use of i.v. antibiotic therapy, and surgical intervention.

Adult↗

PubMed1988

Influence of different indwelling lines on the measurement of blood cyclosporin A levels.

We studied in vivo and in vitro the possible influence of the indwelling line on the measurement of cyclosporin A (CSA) levels. CSA levels measured in samples taken from the catheter lumen used for CSA administration were significantly higher than those taken either from a second lumen or from a peripheral vein. Reversible fixation of the drug to the catheter walls might explain this alteration. The degree of fixation varies for different types of plastic material.

Bone Marrow Transplantation↗

PubMed1996

[Venous access and methods of drug application in ACLS (Advanced Cardiac Life Support)].

After initiation of cardiopulmonary resuscitation [CPR] with ventilation, chest compression and defibrillation when necessary, venous access, which allows administration of drugs and fluids, is the next measure. A large diameter peripheral vein should be the first choice and should be cannulated with a plastic catheter. If this is delayed or impossible, alternative routes such as central iv lines, intraosseous infusion or endobronchial drug administration should be considered.

Catheterization, Peripheral↗

PubMed1997

Expanding practice to include i.v. cannulation.

Peripheral i.v. cannulation is one of the most common procedures performed in hospitals. Expanding the nursing role to include i.v. cannulation has the potential to improve care. The individual practitioner is responsible for maintaining and updating such skills.

Catheterization, Peripheral↗

PubMed2002

Effects of beta(3)-adrenoceptor stimulation on prostaglandin E(2)-induced bladder hyperactivity and on the cardiovascular system in conscious rats.

AIMS: To investigate the effects of selective beta(2)- and selective beta(3)-adrenoceptor (AR) agonists on prostaglandin (PG) E(2)-induced bladder hyperactivity in conscious free-moving rats. METHODS: Female Sprague-Dawley rats were anesthetized for implantation of bladder, intravenous, and intra-arterial catheters. The effects of a beta(3)-AR agonist (CL316,243) on cystometric and cardiovascular parameters were assessed in conscious rats. Intravesical instillation of PGE(2) (20-60 microM, 6 mL/hr) in conscious rats produced a concentration-dependent increase in voiding frequency. RESULTS: In this model i.v. CL316,243 (beta(3)-AR agonist) reduced basal bladder pressure, increased micturition volume, and prolonged micturition interval in a dose-dependent manner, without affecting threshold pressure or micturition pressure. On the other hand, i.v. procaterol (beta(2)-AR agonist) did not counteract the bladder hyperactivity. Atropine (muscarinic antagonist) reduced micturition pressure and micturition volume, and shortened micturition interval. CL316,243 slightly decreased mean blood pressure and increased heart rate only when given at high doses (10 and 100 microg/kg, i.v.). In contrast, procaterol caused a significant decrease in mean blood pressure and a significant increase in heart rate. Atropine significantly increased heart rate. CONCLUSIONS: The present results clearly demonstrated that the beta(3)-AR agonist prolonged the micturition interval without producing significant cardiovascular side effects. The human detrusor, like the rat detrusor, relaxes on beta(3)-AR stimulation. Provided that these results are valid in humans, selective beta(3)-AR agonists might be clinically useful for controlling a certain type of bladder overactivity.

Adrenergic beta-2 Receptor Agonists↗

PubMed1990

Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients.

To determine the incidence rate of complications associated with vascular catheters in intensive care unit patients and to analyze risk factors for a positive vascular culture, we performed a multicenter study of intensive care unit patients at eight French hospitals. During the study period, 865 intravenous catheters were inserted in 566 patients; 362 (41.8%) were peripheral catheters, and 503 (58.2%) were central catheters. Local complications (i.e., infiltration) occurred significantly more often with peripheral than with central catheters (P less than 0.001); in contrast, fever and bacteremia were significantly more often associated with central than with peripheral catheters (P less than 0.01 and P less than 0.05, respectively). The culture of the vascular-catheter tip was positive for 24% of central catheters (32 of 1,000 catheters days) and for 9% of peripheral catheters (21 of 1,000 catheters days). Staphylococcus epidermidis was the most common microorganism isolated from both peripheral and central catheters, followed by Staphylococcus aureus and Pseudomonas aeruginosa. No significant risk factor associated with positive cultures for peripheral catheters was found by univariate analysis. In contrast, the purpose of the cannula (nutrition and monitoring of central venous pressure), the insertion site (jugular), the dressing type (semipermeable transparent dressing), the antiseptic used to prepare the insertion site (povidone iodine), and routine changing of the intravenous administration set were significantly associated with positive cultures of central catheters. Three factors, duration of catheterization, use of a semipermeable transparent dressing, and the jugular insertion site, were found to be independently associated with positive cultures of central catheters by multivariate analysis.

Catheterization↗

PubMed1994

Catheter-directed urokinase thrombolysis: an adjunct to PTA/surgery for management of lower extremity thromboembolic disease.

Catheter-directed thrombolysis was used either alone or as an adjunct to percutaneous transluminal angioplasty (PTA) or surgery for peripheral vascular occlusion on 112 occasions in 102 patients. Symptom duration ranged from < one to > twenty-eight days. Thrombolytic therapy using urokinase plasminogen activator thrombolysis (uPAT), including intrathrombic injection when possible, was successful (> 50% lysis) in 99 procedures (88%). Technical failure (< 50% lysis) occurred in 13 procedures (12%). In 9 of the 13 failures, intrathrombic injection of urokinase was not possible, but the duration of occlusion was > twenty-eight days in all but 1. Two other failures were from embolic sources and 2 more occurred in patients with a hypercoagulable state. The uPAT was adjunctive to PTA/surgery in 56 cases (50%). PTA following uPAT was required and successfully performed in 24 of 27 cases (88.9%). Surgery followed lytic therapy in another 32 (including the 3 failed PTAs). In the remaining 56 cases (50%), no additional intervention was required. There were 20 complications (18%), minor in 16 of 20 (80%). Minor complications included small puncture site hematomas and distal embolization resolved by continued lytic therapy. Four major complications occurred. One was retroperitoneal hemorrhage directly contributing to the only death in the series. The other 3 were hematuria (2) and femoral neuropathy (1). The authors conclude that catheter-directed lytic therapy alone or as an adjunct to PTA/surgery is a valuable approach to peripheral vascular thromboembolic disease. It is less likely to succeed in chronic occlusion. The incidence of complications is moderate but acceptable.

Aged↗

PubMedDate not supplied

Clinical evaluation of elastomeric hydrogel peripheral catheters during home infusion therapy.

The use of elastomeric hydrogel (Aquavene, Menlo Care, Menlo Park, Calif.) peripheral catheters in home infusion therapy was prospectively evaluated. Elastomeric hydrogel catheter composition differs from that of conventional peripheral catheters made of Teflon or silicone in that it softens upon insertion and expands two gauge sizes within 30 minutes of insertion. Fifty-four test catheters were successfully placed in 44 home infusion therapy patients, for a total dwell time of 290 days. Average dwell time was 5.37 days, with a range of 1 to 20 days. The extension of dwell time beyond the accepted standard of 72 hours was not associated with an increased incidence of phlebitis when compared to the incidence of phlebitis reported in the scientific literature. The ability to extend peripheral catheter dwell time without increasing the incidence of catheter-related complications may have major clinical and economic advantages for the payors, providers, and consumers of home infusion therapy.

Catheterization, Peripheral↗