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PubMed1999

Covered stents in the treatment of peripheral arterial aneurysms: procedural results and midterm follow-up.

PURPOSE: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents. METHODS: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms (7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid). RESULTS: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (<30 days), one patient died of puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage. At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%). CONCLUSION: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis.

Adolescent↗

PubMed1993

Effects of central and peripheral administration of arginine vasotocin and related neuropeptides on blood pressure and heart rate in the conscious trout.

The cardiovascular activity of neurohypophyseal peptides has been investigated in conscious trout bearing an intracerebroventricular guide cannula and a permanent intraarterial catheter. Changes in diastolic pressure, systolic pressure and heart rate were monitored during the 25-min period following intracerebroventricular or intraarterial administration of arginine vasotocin and related neuropeptides, including arginine vasopressin, oxytocin, hydrin-2, mesotocin, isotocin and conopressin-S. Intracerebroventricular injection of increasing doses of arginine vasotocin (0.62-5 pmol) induced a dose-dependent increase of diastolic and systolic pressures. The onset of the response occurred within 3-5 min after intracerebroventricular administration of arginine vasotocin and the maximal increase was reached at 10-15 min. Central administration of vasopressin and oxytocin induced a significant rise in diastolic and systolic pressures at a dose of 5 pmol while hydrin-2 only caused a significant elevation of blood pressure at a dose of 50 pmol. Central administration of mesotocin, isotocin and conopressin-S (5-500 pmol each) had no significant effect on blood pressure. No changes in heart rate occurred after intracerebroventricular injection of any of the seven neuropeptides tested. Intraarterial injection of arginine vasotocin (50 pmol) induced a significant rise in blood pressure and bradycardia. Peripheral injection of the other neuropeptides did not cause any modification of the cardiovascular activity, whatever the doses administered (5-500 pmol). The V1A receptor antagonist [d(CH2)5, Tyr(OMe)2]arginine vasopressin had no intrinsic effect on blood pressure and heart rate when injected centrally (50 pmol) or in the peripheral circulation (200 pmol). At the same doses, [d(CH2)5, Tyr(OMe)2]arginine vasopressin reduced by 50 and 66%, respectively, the increase in blood pressure evoked by intracerebroventricular (5 pmol) or intraarterial (50 pmol) injections of arginine vasotocin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2001

The safety and efficacy of peripheral intravenous catheters in ill neonates.

This article describes the use of a quality improvement clinical audit approach to identify insertion practices, duration of therapy, and complications related to peripheral intravenous catheters. These data provide evidence for adherence to practice standards and benchmarks for evaluation of new interventions to improve the safety and efficacy of intravenous access practices. Implications for quality improvement and clinical research related to intravenous-device practices within the neonatal intensive care unit are discussed.

Catheterization, Peripheral↗

PubMedDate not supplied

Peripherally inserted central catheters. Development of a hospital-based program.

Peripherally inserted central catheter lines (PICCs) are the "new kids on the block" for intravenous therapy. This paper reports on the development of a protocol and training program for nurses at a 350-bed community hospital. The paper describes the development and implementation of this pilot program in 25 patients over a 1-year period.

Catheterization, Central Venous↗

PubMed2001

The management of peripheral vascular complications associated with the use of percutaneous suture-mediated closure devices.

PURPOSE: The purpose of this study is to identify the peripheral vascular complications associated with the use of percutaneous suture-mediated closure (PSMC) devices and compare them with postcatheterization femoral artery complications not associated with PSMC devices. METHODS: This is a retrospective review of all patients admitted to the vascular surgery service at the Chattanooga Unit of the University of Tennessee Department of Surgery with a peripheral vascular complication after percutaneous femoral arteriotomy between July 1, 1998, and December 1, 1999. The complications followed the use of PSMC devices (group I, n = 11) and traditional compression therapy (group II, n = 14) to achieve arterial hemostasis. Group II was subdivided into patients who required operative intervention (group IIA, n = 8), and those who were treated without operation (group IIB, n = 6). RESULTS: No significant difference was found between groups I and II with regard to age (P =.227), time to vascular surgery consultation (P =.987), or diagnostic versus therapeutic catheterization (P =.897). A significant difference was found with regard to mean pseudoaneurysm size (group I = 5.9 cm, group II 2.9 cm; P =.003). Ultrasound compression was successfully performed in 66.6% of group II patients, but no (0.0%) patient in group I responded to this therapy (P =.016). Groups I and IIA had a significant difference for mean estimated blood loss (group I = 377.2 mL, group II = 121.8 mL; P =.017) and requirement for transfusion (P =.013). More patients in group I required extensive surgical treatment (P =.007), with six of these patients requiring vein patch angioplasty during their treatment. More patients in group I also had infectious complications (n = 3) compared with group IIA (n = 1). CONCLUSION: In comparison with complications that follow percutaneous arteriotomy when PSMC devices are not used for hemostasis: (1) pseudoaneurysms after the use of PSMC devices are larger and do not respond to ultrasound compression, (2) complications associated with PSMC devices result in more blood loss and increased need for transfusion and are more likely to require extensive operative procedures, and (3) arterial infections after the use of PSMC devices are more common and require aggressive surgical management.

Aged↗

PubMed1979

Umbilical artery catheterization in newborns. II. Infections in relation to catheterization.

Infections, as a complication of umbilical artery catheterization, were studied in 65 sick newborn infants. Every second day during the catheterization period peripheral blood cultures as well as blood samples for white cell count and platelets were taken. Cultures were taken from the catheter tips and from the umbilicus at the time of withdrawal of the catheter. Local or systemic antibiotics were not used prophylactically, but on rather broad clinical indications. No case of septicemia was found, but 8 infants had positive blood cultures and 16 had positive catheter tip cultures. Positive catheter tip culture occurred more often in infants who were born before 32 weeks of gestational age. Neither the duration of the catheterization nor the treatment with antibiotics influenced significantly the frequency of positive cultures.

Anti-Bacterial Agents↗

PubMed1998

Sepsis during total parenteral nutrition: exploration of risk factors and determination of the effectiveness of peripherally inserted central venous catheters.

BACKGROUND: Sepsis is the most frequent serious complication during total parenteral nutrition (TPN), resulting in increased morbidity, mortality and health care costs. Existing reports have not documented the risk factors of sepsis during TPN. The objectives of this study were to determine the rate of sepsis in our practice and to explore the risk factors for sepsis during TPN. We also determined the role and efficacy of using peripherally inserted central venous catheters (PCVC) as insertion catheters to administer TPN. METHODS: From October, 1994, to May, 1996, we administered TPN to 378 pediatric patients hospitalized at Mackay Memorial Hospital. We followed all cases for the occurrences of any complications while administering TPN. We studied all patients who had fever, a clinical presentation of sepsis and a positive blood culture during their course of TPN. RESULTS: During the 20-month period 378 patients received TPN for a total of 6562 days. Fifty-six patients presented with clinical sepsis and positive blood cultures. Significant features in the sepsis group included longer duration of TPN, age < 3 months, usage of central venous catheters, gastrointestinal diseases as indication for TPN, low birth weight and short gestational age in prematurity. Seven patients died despite prompt antimicrobial therapy. One hundred eleven patients received TPN via PCVC for a mean duration of 17.1 days, significantly longer than 10.4 days in the peripheral intravenous catheter group but no difference between the sepsis rates. CONCLUSION: Considering the high incidence of sepsis during TPN, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC in patients requiring prolonged nutritional support.

Catheterization, Central Venous↗

PubMed1992

Exchange transfusions via peripheral vessels.

During a 15 month period, partial exchange transfusions (ET) were done in 40 neonates with polycythemia, and double volume ET attempted in 7 neonates with hyperbilirubinemia via peripheral vessels. The procedure was effective and not associated with any complications for partial ET. During double volume ET minor complications were noted in 2 cases, both of whom recovered and subsequently successfully underwent supraumbilical ET. Of the 5 cases who had uneventful double volume exchanges, there was a significant drop in indirect serum bilirubin following the procedure. The mean pre-ET serum indirect bilirubin in these 5 cases was 334 mumol/L and mean post-ET level was 179 mumol/L with a mean drop of 155 mumol/L (46% drop). Technical difficulties in catheterization may be overcome with greater expertise and use of heparin to flush arterial catheters.

Arteries↗

PubMedDate not supplied

Comparison of two methods of peripheral intravenous cannula securement in the pediatric setting.

This prospective, nonrandomized study compared the effect of two peripheral catheter dressings (a combination transparent polyurethane film/soft cloth surgical tape dressing, and adhesive tape) on the incidence of complications in children and adolescents. A total of 407 catheter dressings were studied: 212 in the control group (adhesive tape) and 195 in the study group (transparent dressing). Catheter insertion site assessments at 24-hour intervals showed increased site visibility, better dressing adherence and less dressing reinforcement in the study group. There were few differences in the observed incidence of phlebitis or extravasation. The new combination dressing may be considered for use in children when prolonged catheterization is anticipated.

Bandages↗

PubMed1997

Axilloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass.

BACKGROUND: Peripheral arterial and venous cannulation for cardiopulmonary bypass is used increasingly for patients undergoing minimally invasive cardiac operations, complex reoperations, or repair of aortic dissection or aneurysm, and for patients with extensive arteriosclerotic aortic disease in whom aortic cannulation is a prohibitive embolic risk. The common femoral artery and vein are most commonly used for peripheral cannulation, but these sites may be predisposed to complications, primarily because the femoral vessels are commonly involved with arteriosclerotic disease. We have recently begun to use the axillary artery and axillary vein as alternative cannulation sites, achieving full cardiopulmonary bypass, providing antegrade aortic flow, and avoiding many of the complications associated with other sites. METHODS: Seven patients with peripheral vascular or aortic disease, or both, prohibiting safe aortic or femoral cannulation underwent cardiopulmonary bypass through axillary artery and axillary vein cannulation, approached through a small single subclavicular incision. RESULTS: All patients were successfully cannulated and axilloaxillary cardiopulmonary bypass was possible without the need for additional cannulas. All axillary vessels were closed primarily without complication. CONCLUSION: For an expanding population of patients with peripheral vascular and aortic disease, axilloaxillary bypass is a safe and practical alternative to aortic or femoral cannulation.

Aged↗

PubMed2001

Palliative treatment of hepatocellular carcinoma by chemoembolization.

PURPOSE: The efficacy of transcatheter arterial chemoembolization (TACE) and the correlation between iodized oil uptake pattern and tumor response were investigated in cases with inoperable hepatocellular carcinoma (HCC). MATERIAL AND METHODS: TACE, using sequential intra-arterial doxorubicin, mitomycin, iodized oil and gelatin sponge particles, was used to treat patients with inoperable HCC localized to the liver. One hundred and two patients (aged 16-80) were treated in this manner from 1995 to 2001. The objective response was determined by sequential CT. Iodized oil uptake pattern as well as the relationship between uptake pattern and tumor response was evaluated in each case. RESULTS: The one-year survival rate was 46%. Tumor response was found to be better in cases with dense and peripheral iodized oil uptake in comparison to those displaying scarce and patchy iodized oil uptake. CONCLUSION: TACE is an efficient and safe palliative treatment for inoperable HCC with prolonged survival and good life quality. Iodized oil uptake pattern can be considered a good prognostic marker.

Adolescent↗

PubMed2005

Cannula-associated Staphylococcus aureus bacteraemia: outcome in relation to treatment.

BACKGROUND: Despite the frequency of cannula-associated Staphylococcus aureus bacteraemia (CASAB) there is uncertainty regarding the duration of treatment required. AIM: To determine the relationship between the duration and type of treatment for CASAB and subsequent relapse with deep-seated S. aureus infection. METHODS: We prospectively studied 276 patients with CASAB. Patients were followed for at least 8 weeks after completion of antibiotic treatment. Initial and subsequent isolates of S. aureus were compared using molecular methods to determine strain similarity. RESULTS: Initial mortality was 9% (26 of 276) and a complicating focus of infection presented during initial treatment in 6% (15 of 250) of the survivors. There were nine relapses of deep-seated infection from the strain causing the original infection. Relapses were equally common following peripheral CASAB and central CASAB. There was no relationship between the duration of treatment and the rate of relapse of deep-seated infection (P = 0.24). This observation held true regardless of whether the duration of treatment was analysed as < or = 7 versus > or = 8, < or =10 versus > or =11, or < or=14 versus > or =15 days (P = 0.62, 0.87 and 0.16, respectively). CONCLUSION: Episodes of peripheral CASAB pose an equal risk of relapse to central cannula-related episodes. Although further studies are needed to determine the optimal treatment of CASAB, our study strongly suggests that more than 14 days treatment is excessive for most patients who respond promptly to cannula removal and antibiotic treatment.

Adolescent↗

PubMedDate not supplied

A meta-analysis of effects of heparin flush and saline flush: quality and cost implications.

The purpose of this meta-analysis was to estimate the effects of heparin flush and saline flush solutions on maintaining patency, preventing phlebitis, and increasing duration in peripheral heparin locks. The average effect size (d value) across 15 studies with a total sample size of 3,490 was .0573 for patency (clotting). The 95% credibility interval ranged from -.2267 to .3413. The average effect size across 13 studies with a total sample size of 2,356 was -.0757 for phlebitis. The 95% credibility interval ranged from -.2497 to .0983. The average effect size for duration across six samples with a total sample size of 1,960 was -.0550. The 95% credibility interval ranged from -.2424 to .1324. It can be concluded that saline is as effective as heparin in maintaining patency, preventing phlebitis, and increasing duration in peripheral intravenous locks. Quality of care can be enhanced by using saline as the flush solution, thereby eliminating problems associated with anticoagulant effects and drug incompatibilities. In addition, an estimated yearly savings of $109,100,000 to $218,200,000 U.S. health care dollars could be attained.

Catheterization, Peripheral↗

PubMed1994

Surveillance of intravenous catheter-related infections among home care clients.

BACKGROUND: Infection control in home care is an important area of study, and infection related to home infusion therapy is one component. METHODS: According to billed supplies from a 6-month period, we identified clients receiving intravenous care and conducted a chart review to determine characteristics and infection status. We reviewed each client from the start of a continuous home care period through April 30, 1992. RESULTS: Care of the catheters was done by nurses, family care givers, or the clients themselves. Intravenous catheter-related infections-site infections and bacteremia-occurred in three (4.5%) of the sample of 67; bacteremia occurred in one (1.5%). Incidence density was 12.5 infections per 10,000 catheter days (4.2 bacteremias per 10,000 days). Among those with central lines who remained without infection, 22.9% had the same line in place for 90 days or more. Among those with peripheral lines who remained without infection, 14.3% had a peripheral line, which was changed during home care, for 30 days or longer. CONCLUSIONS: Home care agencies seeking accreditation from the Joint Commission on the Accreditation of Healthcare Organizations need to establish surveillance systems; this may be one method to monitor device-related infections and to determine baseline rates.

Adolescent↗

PubMed2004

Misplaced peripherally inserted central catheter: an unusual cause of stroke.

Stroke in pediatric patients occurs with a frequency of 3 to 8 per 100,000. The postevent evaluation attempts to identify the etiology of ischemia whether anatomic, hematologic, or embolic, with the intention of preventing future events. We present the case of a previously healthy male who developed unilateral facial and extremity weakness 2 weeks after receiving an appendectomy. Once the usual etiologies of stroke in pediatric patients were excluded, an evaluation of the peripheral venous catheter (placed for postoperative antibiotic delivery) demonstrated arterial misplacement. This article presents the first reported case of such an occurrence in the literature and exhibits the need to pursue all avenues of evaluation if the etiology of a pediatric stroke is not initially identified.

Adolescent↗

PubMed2006

Switching from heparinized saline flush to normal saline flush for maintaining peripheral venous catheter patency.

BACKGROUND: The practice of using heparinized saline as a flush fluid for maintaining peripheral venous catheter patency of hospitalized patients in Siriraj Hospital in Bangkok, Thailand is not evidence-based. OBJECTIVE: To switch from heparinized saline flush to normal saline flush for maintaining peripheral venous catheter patency in the patients hospitalized to medical wards. METHODS: Study sites were 10 medical wards containing 240 beds. The interventions included (i) disseminating evidence-based clinical practice policy on using flush fluid for maintaining peripheral venous catheter patency to responsible personnel, (ii) reminding the prescribers on using normal saline flush instead of heparinized saline flush, (iii) providing technical advice on using normal saline flush to nurses who encountered peripheral venous catheter clot while using normal saline flush, (iv) confirming a necessity of heparinized saline flush order with the prescriber, and (v) setting up a regulation on marking a special symbol on heparinized saline flush prescription if one really needed heparinized saline flush. The information on using flush fluids was collected from the physicians' order sheets in the medical records at baseline, every 2-4 weeks during the intervention periods, and at 6 months after launching intervention. RESULTS: All hospitalized patients in medical wards who had peripheral venous catheter locks received heparinized saline flush in February 2005. The practice was totally switched to normal saline flush in June and November 2005. CONCLUSION: The key features critical to success of this implementation are dissemination of evidence-based clinical practice policy and a regulation of having prescriber mark a specific sign right after the heparinized saline flush order.

Catheterization, Peripheral↗

PubMed1989

Comparison of external jugular and peripheral venous administration of sodium bicarbonate in puppies.

We compared the administration of sodium bicarbonate via a catheter inserted in the external jugular and extending to the junction with the subclavian vein (group 1) and a peripheral hindpaw vein (group 2) in puppies. During spontaneous cardiac activity, the increases in pH (0.12 +/- 0.04 in group 1 vs. 0.08 +/- 0.04 in group 2) and PCO2 (11 +/- 2.8 torr in group 1 vs. 6 +/- 3.2 torr in group 2) in blood from the right atrium 10 sec after the injection of bicarbonate differed significantly. However, the increases in pH (0.31 +/- 0.07 in group 1 vs. 0.30 +/- 0.15 in group 2) and PCO2 (86 +/- 33 torr in group 1 vs. 72 +/- 35 torr in group 2) in blood from the right atrium during closed chest CPR were similar in the two groups. We found that the sodium bicarbonate reached the central circulation more rapidly when administered in the external jugular vein as compared to a peripheral site, but this difference was small and did not reach the level of significance during CPR. Our findings do not provide evidence of any advantage to obtaining central venous access (a potentially complicated procedure) in children with cardiac arrest in regard to the delivery of medications to the heart.

Animals↗

PubMed1999

Infectious complications of 393 peripherally implantable venous access devices in HIV-positive and HIV-negative patients.

PURPOSE: To compare and investigate the rate of infection in patients with and without human immunodeficiency virus (HIV) who have implantable venous access devices placed by interventional radiologists. MATERIALS AND METHODS: Three hundred ninety-one patients undergoing radiologically guided placement of peripheral arm ports were grouped according to their HIV serologic status. Findings were prospectively reviewed in 393 peripherally placed arm ports that were implanted in the basilic, cephalic, or brachial vein under fluoroscopic or sonographic guidance over a 4-year span. Infectious complications were categorized according to severity (local or systemic) and time (periprocedural or late). RESULTS: Three hundred ninety-three ports have been indwelling for a total of 97,256 patient days (range, 1-694; mean duration, 247 days). Among the 30 catheter placements in 29 HIV-positive patients with a total exposure time of 7,242 days, five (one local and four systemic) infections occurred, resulting in a 16.6% overall infection rate, yielding 0.069 infections per 100 catheter days at risk (95% confidence interval [CI], 0.032-0.127). In the remaining 362 HIV-negative patients, 27 (14 local and 13 systemic) infectious complications (7.4%) occurred, translating into 0.030 infections per 100 catheter days (95% CI, 0.021-0.042). The odds ratio of getting an infection from the implantable arm ports in the HIV-positive group was 2.5 times higher than that of the HIV-negative group. The relative risk was similar and was calculated to be 2.3. The P value was .084 (P < .05 required to be considered significant). CONCLUSIONS: These results suggest a significant difference in the infectious complication rate encountered in HIV-positive patients compared with the general population. However, the HIV-positive peripheral arm port infection rate compares favorably with the surgically placed catheters and ports. Many more arm ports in HIV-positive patients must be evaluated for the data to achieve an acceptable level of statistical significance.

Adolescent↗