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PubMedDate not supplied

The role of transradial diagnostic angiography.

PURPOSE: To evaluate the use of 4 Fr radial artery catheters as an alternative to both transbrachial and transfemoral approaches. METHODS: Seventy examinations were performed via the transradial route using 4 Fr 130-cm-long pigtail catheters. Prior to puncture the radial artery was assessed with pulse oximetry to ensure that it did not contribute the dominant blood supply to the hand. Patients were reassessed for complications within 24 hr of the procedure. RESULTS: Acceptable images were obtained in femoral arteriography, arch aortography, and selective carotid studies. In three of six renal arteriograms, images were suboptimal. There was a total technical failure rate of 5.7%. Significant complications were encountered in 4.3%, but no hand ischemia occurred. CONCLUSION: The transradial route for arteriography is easy to learn and has a low complication rate. It is a reasonable alternative approach to transfemoral arteriography for true outpatient peripheral angiography and in cases where the transfemoral route is not feasible, though it did not prove satisfactory for renal arteriography in hypertensive patients.

Adult↗
PubMed2004

[Transradial approach for diagnostic angiography].

Seventy five arteriographies were performed via the transradial route using 5F 130cm - long catheter. Prior to puncture the radial artery was evaluated with Allen test. Satisfying quality examinations were obtained for the thoracic aorta, selective carotid arteries examinations, infra renal aorta, pelvic and legs arteries. The major advantages obtained for the technique were the very low rate complication and technical failure. Transradial route for arteriography is a reasonable alternative approach to transfemoral or brachial arteriography for out patient management (peripheral angiography) in case in which transfemoral route is not feasible but also with patients with important haemorragic-risks.

Angiography↗
PubMed2002

Shearing of a peripheral nerve catheter.

IMPLICATIONS: We report a previously undescribed complication of peripheral nerve catheter placement. The catheter was sheared when its stylet was removed with the placement needle still in the tissues. The lost distal fragment was identified with computed tomography scanning.

Aged↗
PubMedDate not supplied

A proactive approach to combating venous depletion in the hospital setting.

This study focuses on the effects of infusion nurse specialists on the culture of an institution as it relates to infusion therapy practice. During the 18-month study, data were gathered on the outcomes of the proactive approach instituted by the infusion specialists. Outcomes assessed included phlebitis prevalence, peripherally inserted catheter placements, patient satisfaction scores, and ratio of catheters being placed by interventional radiology to the bedside placements. The study discusses the methods used by the infusion team in an attempt to change the approach to infusion therapy.

Catheterization, Peripheral↗
PubMed2005

Higher levels of basal serial CSF cortisol in combat veterans with posttraumatic stress disorder.

OBJECTIVE: Results of basal peripheral cortisol measures in posttraumatic stress disorder (PTSD) have been variable. The authors' goal was to measure CSF cortisol concentrations, which more accurately reflect brain glucocorticoid exposure, in subjects with or without PTSD. METHOD: CSF was withdrawn from a subarachnoid catheter and plasma from a venous catheter, both indwelling, over a 6-hour interval to determine hourly plasma ACTH and cortisol concentrations and hourly CSF cortisol levels in eight well-characterized combat veterans with PTSD and eight matched healthy volunteers. RESULTS: Mean CSF cortisol concentrations were significantly higher in the subjects with PTSD (3.18 ng/ml, SD=0.33) than in the normal volunteers (2.33 ng/ml, SD=0.50), largely due to higher CSF cortisol concentration nadirs. No group differences were observed in either plasma ACTH or peripheral (plasma or urinary free) cortisol. CSF corticotropin-releasing hormone and CSF cortisol concentrations were positively and significantly correlated. CONCLUSIONS: Despite normal peripheral cortisol indexes in the veterans with PTSD, their CNS exposure to cortisol was greater than that of normal comparison subjects.

Adrenocorticotropic Hormone↗
PubMed2007

A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study.

BACKGROUND: Mechanical and infectious complications shorten the effective duration of peripherally inserted central venous catheters. Heparin use to prevent such complications and prolong the usability of peripherally inserted central venous catheters is inconclusive. OBJECTIVE: Our goal was to evaluate the effectiveness of heparin in prolonging the usability of peripherally inserted central venous catheters in neonates. DESIGN/METHODS: We performed a multicenter, randomized, controlled trial of heparin infusion (0.5 U/kg per hour) versus placebo for peripherally inserted central venous catheters in neonates. The primary outcome was duration of catheter use. Secondary outcomes were occlusion, catheter-related sepsis, thrombosis, and adverse effects of heparin. To detect a 168-hour (1-week) difference in the duration of catheter use, 192 patients were needed. Kaplan-Meier and Cox regression analyses were performed. RESULTS: A total of 201 neonates were enrolled (heparin group: n = 100; control group: n = 101). Baseline demographics were similar between the groups. Duration of catheter use was longer in the infants in the heparin versus the placebo group. Study center, gender, birth weight, and type and position of the catheter were not predictors of duration of catheter use. For those in the heparin versus the placebo group, the incidence of elective catheter removal (therapy completed) was 63% vs 42%, of occlusion was 6% vs 31%, of thrombosis was 20% vs 21%, and of catheter-related sepsis was 10% vs 6%, respectively. No adverse events were noted. CONCLUSIONS: Heparin infusion prolonged the duration of peripherally inserted central venous catheter usability, which permitted a higher percentage of neonates to complete therapy without increasing adverse effects.

Anticoagulants↗
PubMed2000

[The microbiology laboratory in the diagnosis of bacteremia associated with catheters].

Catheter related sepsis is an outstanding problem in patients in every age group. The microbiological diagnosis should consider the main pathways of infection (catheter-skin interface, endoluminal). With this aim we analysed 1496 central and peripheral short term catheters and 119 episodes of catheter related bacteremia. Catheters were cultured according to the quantitative technique of Brun Buisson (QT), the semiquantitative technique of Maki (SQ) and qualitative broth culture (QL). The following results of sensitivity, specificity, positive predictive value, negative predictive value and Youden index were obtained: SQ = 87%, 88%, 40%, 99%, 0.75; QT (> or = 10(2) CFU/ml) = 88%, 89%, 43%, 99%, 0.77; QT (> or = 10(3) CFU/ml) = 77%, 92%, 48%, 97%, 0.69; QL = 94%, 68%, 20%, 99%, 0.62. Results of SQ and QT > or = 10(2) were comparable, nevertheless, the addition of QT to SQ increased the detection of bacteremia by 12.8%, while in the opposite situation the increase was 10%. According to this, it is advisable to combine routinely SQ and QT. Finally, in 42 episodes of bacteremia related to implanted catheters processed by quantitative differential culture of blood drawn through the catheter and blood drawn through the peripheral vein the relationships were: > 1000 in 79% of cases, between 100 and 1000 in 9% of cases and between 5 and 10 in just 5% of cases.

Bacteremia↗
PubMed1992

Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks.

OBJECTIVE: To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. DATA SOURCES: Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. STUDY SELECTION: Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. EXTRACTION: Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. DATA SYNTHESIS: Applying a Mantel-Haenszel chi 2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR = 1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR = 0.99; 95% CI, 0.90 to 1.09). CONCLUSION: The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested.

Bacteremia↗
PubMed1990

[Arterial catheters in newborn infants].

The article summarizes one year's experience of arterial lines in at third-level department for newborn children. We successfully placed an arterial line in 69 out of 71 children. 13 out of 84 arterial lines were umbilical catheters, the others were introduced percutaneously in the radial or posterior tibial arteries. Both umbilical arterial and peripheral arterial lines were functioning satisfactorily, with very few complications, and no serious ones. An arterial line is a relatively simple and a safe method for good monitoring of newborn children in need of intensive care.

Blood Pressure Monitors↗
PubMedDate not supplied

Untoward events associated with use of midterm i.v. devices.

The placement of a peripheral i.v. device causes increased stress for many individuals, sometimes causing temporary and self-limiting responses, described as vasovagal reactions. Report monitoring has identified adverse experiences that exceed anticipated reactions to stress and that may be life threatening. Untoward events have been reported during or immediately after insertion of midterm peripheral i.v. devices made of an elastomer/hydrogel polymer. Although the cause of these reactions remains unclear, it is a reminder that to identify and evaluate device-related issues, untoward events must be assessed, treated, evaluated, documented, and reported.

Adult↗
PubMed1998

Accuracy of measurements of hemoglobin and potassium in blood samples from peripheral catheters.

OBJECTIVE: To compare measurements of hemoglobin and potassium in blood samples obtained from peripheral venous catheters with measurements in samples obtained via venipuncture. SUBJECTS: 53 adult volunteer patients admitted to a medical ward. METHODS: For each patient, a 10-mL blood sample was obtained from a 20-gauge or larger peripheral venous catheter after a 3-mL volume of fluid was discarded. Immediately afterward, additional samples were obtained by venipuncture, and all samples were sent to the laboratory for measurement of hemoglobin and potassium levels. Separate venipuncture samples were obtained from both extremities in another 10 subjects to assess intratechnique variation. Results were analyzed by using limits-of-agreement analysis. RESULTS: Blood samples were successfully obtained from a peripheral catheter in 32 (60%) of the 53 patients. The success rate was 78% with 18-gauge catheters and 42% with 20-gauge catheters (P = .021). The 95% agreement interval in the set of differences between values for samples obtained via catheter and samples obtained via venipuncture was +/- 0.37 mmol/L for potassium and +/- 7.6 g/L for hemoglobin. The 95% agreement interval for the venipuncture control group was +/- 0.21 mmol/L for potassium and +/- 7.3 g/L for hemoglobin. The preset acceptable interval for potassium measurements was +/- 0.3 mmol/L, and that for hemoglobin measurements was +/- 10 g/L. CONCLUSIONS: Obtaining blood samples from peripheral catheters is an acceptable alternative to venipuncture for hemoglobin measurements but not for potassium measurements. Larger gauge catheters are better than small-gauge catheters for obtaining blood samples.

Adult↗
PubMed1995

Cutaneous mucormycosis in a heart transplant patient associated with a peripheral catheter.

The first known case of an intravascular catheter-related primary cutaneous mucormycosis in a heart transplant patient is reported. The patient had corticosteroid-induced hyperglycemia and experienced an acute tissue rejection episode. A necrotic lesion appeared around the insertion site of a peripheral venous catheter. A biopsy revealed typical mucorales hyphae. The lesion continued to spread during the following 24 hours and necessitated amputation of the forearm. The organism was identified as a Mucor species.

Catheterization, Peripheral↗
PubMed1989

Choosing an appropriate implantable device for long-term venous access.

A variety of devices is now available for venous access in patients requiring long-term infusions of chemotherapeutic agents, hyperalimentation solutions, blood products or antibiotics. All have advantages and disadvantages which may make the selection of one type of device appropriate under a given set of circumstances but inappropriate in another. Experience has shown that patients needing intensive therapy for hematologic malignancies are best served by lines that require minimal dissection for insertion, such as the Hickman catheter. Patients who are unlikely to hemorrhage at the time of insertion and who need only intermittent therapy can take advantage of the greater convenience and cosmetic appearance of a totally implantable port. Peripheral vein cannulation by means of fine silicone rubber catheters can be performed by trained intravenous nurses to provide access of intermediate duration without the expense and inconvenience of surgical insertion in an operating room.

Catheterization, Central Venous↗
PubMed2002

Pediatric interventional venous access.

Venous access for therapy in sick children is very important, but sometimes also extremely challenging. With several advances in imaging modalities, the interventional radiologist can certainly help in these situations. This article reviews the indications, technique, and complications related to short- (peripherally inserted central catheter) and long-term (central venous lines, Port-a-catheters) venous accesses in children. A brief commentary is also made about retrieval of fragmented lines.

Catheterization, Central Venous↗
PubMedDate not supplied

Success rates for peripheral i.v. insertion in a children's hospital. Financial implications.

Although many publications have demonstrated the cost-effectiveness of using i.v. nurse specialists with adult patients, very few have explored this topic in the pediatric population. Many agencies choose to use staff RNs and physicians, with minimal training and experience, to place i.v.s in both pediatric and adult patients. This article demonstrates i.v. insertion success rates for various healthcare providers: staff RNs, physicians, and an i.v. nurse specialist in an urban pediatric hospital. The number of unsuccessful i.v. attempts for each group is calculated and further applied to costs of labor and equipment. From the data presented in this article, it may be concluded that the use of one or more i.v. specialist nurses for placement of peripheral i.v.s in children is more cost effective than using staff RNs or physicians for provision of this service. These data were collected while the author was the i.v. nurse clinician at St. Christopher's Hospital for Children in Philadelphia.

Adult↗
PubMed2000

Coronary angiography in the presence of peripheral vascular disease: femoral or brachial/radial approach?

Peripheral vascular disease is considered a relative contraindication to the femoral approach for coronary angiography, but no data exist comparing the femoral and brachial/radial routes under these circumstances. We examined the influence of vascular approach on outcome. Two hundred and ninety-seven patients, mean age 67.1 +/- 8.4 years, with clinical or radiographic evidence of aortofemoral peripheral arterial disease underwent diagnostic coronary angiography during a 3-year period at this cardiothoracic center. The approach was successful in 121 of 154 femoral cases (79%) compared with 130 of 143 brachial/radial cases (91%; P < 0.01). Of the 33 failed femoral cases, 15 were then approached from the other femoral artery, with success in 6 (40%), while 18 were approached from the arm, with success in all (100%; P < 0.01). Brachial/radial cases took significantly longer than femoral cases (51 +/- 19 vs. 42 +/- 22 mins; P < 0.01). In cases where the femoral pulse was considered normal, the femoral approach nonetheless failed in 19 of 95 (20%). Major vascular complications (e.g., pulseless limb, arterial dissection, hemorrhage, or false aneurysm) occurred in nine femoral cases vs. zero brachial/radial cases (P < 0.01). Patients with peripheral vascular disease who undergo coronary angiography from the femoral artery have a 1-in-5 risk of procedural failure, necessitating use of an alternative vascular approach, and a 1-in-20 risk of a major vascular complication. Normality of femoral arterial pulsation is not a good predictor of femoral success. Brachial/radial approaches take longer, but succeed more frequently and have a negligible major vascular complication rate. We believe that patients with peripheral vascular disease should undergo coronary angiography via brachial or radial approach. Cathet. Cardiovasc. Intervent. 49:32-37, 2000.

Aged↗