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Results for “Catheterization, Peripheral”

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PubMed1996

Accidental embolization of an intravenous cannula in the upper limb: retrieval following computed tomography localization.

Embolization of small foreign body particles from peripheral veins to the heart or lungs is an uncommon occurrence and, once released into the circulation, localization and retrieval may be difficult. We present a case of accidental separation and embolization of a 28 mm long distal portion of a polytetrafluoroethylene intravenous cannula that was sited in a superficial right wrist vein. The fragment travelled as far as the antecubital fossa prior to the application of a tourniquet. It was then accurately located in the cephalic vein using contiguous axial computed tomography with reconstructions, and was easily retrieved under local anaesthesia. A management approach to this uncommon but potentially serious problem is suggested.

Adult↗

PubMed1990

In vivo evaluation of simultaneous administration of incompatible drugs via a double-lumen peripheral catheter.

For the critically ill patient with complex and prolonged needs, multiple drug infusions and, when indicated, peripheral hyperalimentation require simultaneous administration through a simple peripheral catheter site with a multilumen catheter. We studied a double-lumen peripheral venous catheter. Ten domestic swine, 10 to 20 kg, were divided into two groups of five each. Total parenteral nutrition was administered through the distal port and phenytoin was administered as a bolus and as an infusion in each group. Samples were taken from two sites during the bolus and at 1, 5, and 15 min during phenytoin infusion. Electromagnetic flowmeter measurements were obtained for validation of flow. In all instances, our study showed that either the particle size was too small or the concentration of particles was less than 3 X 10(3)/microL: too small to be recovered in the study samples.

Animals↗

PubMed2005

Nickel-elicited systemic contact dermatitis from a peripheral intravenous catheter.

Nickel-elicited systemic contact dermatitis is a well-known entity, although it is far less common than allergic contact dermatitis. In most of the cases, the main way of nickel administration is oral. Clinical manifestations are miscellaneous including pompholyx, diffuse exanthema, flexural dermatitis or baboon syndrome. Systemic nickel dermatitis induced by venous catheters is very uncommon, but it is probably underdiagnosed. We report here 2 patients with diffuse recurrent maculopapular rash corresponding to nickel-elicited systemic contact dermatitis. They were both perfused during the last episode with the assistance of a peripheral polyurethane venous catheter during or just before the cutaneous eruption. At the base of the catheter, there was a small metallic eyelet on which dimethylglyoxime test was positive, indicating a release of nickel. Then, we measured nickel release in normal use conditions and found high nickel levels, although the manufacturer denied that nickel could be released. This diagnosis is important to know because such exanthema often occurred during postoperative or postpartum period. Its frequency is probably underestimated because it is often considered as a cutaneous drug reaction. To our knowledge, only 2 cases have been reported in the literature.

Adult↗

PubMedDate not supplied

Peripheral intravenous catheters: considerations in theory and practice.

Inserting peripheral intravenous catheters is a clinical skill that is increasingly becoming part of nurses' remit because of a number of changes in the NHS, including a reduction in junior doctors' working hours and role development. To undertake this skill it is important that nurses receive the appropriate education and can provide evidence of training and competence. A hospital policy is essential to standardize practice and ensure an evidence base. However, all practitioners should be aware that it is their responsibility to maintain their practice and keep up to date. This article provides both the theoretical and practical knowledge to assist nurses who wish to include cannulation as part of their clinical remit.

Catheterization, Peripheral↗

PubMed1991

Minimum pulse pressure and peripheral temperature needed for pulse oximetry during cardiac surgery with cardiopulmonary bypass.

The lowest values of pulse pressure (dPP) and peripheral temperature (Tp) associated with reliable readings from three different pulse oximeters (Biox Ohmeda 3700, Datex Satlite, and Nellcor N-200) were assessed, along with the ability of the pulse oximeters to work immediately before and after total cardiopulmonary bypass (CPB). The lowest mean dPP with a reliable O2 saturation reading was 13 mm Hg and the lowest mean Tp was 23.6 degrees C. The dPP needed for a reliable reading before total CPB did not differ significantly from that needed after total CPB. No significant differences in performance were found among the three oximeters during the study.

Adult↗

PubMed2003

The Power Infuser: a new device for rapid fluid infusion.

This study examined the effectiveness and ease of use of the ID Power Infuser, a pocket-sized device that can infuse fluid at rates up to 6 L/hr. Forty-six adults presenting with non-traumatic hypotension or clinical hypovolemia had 0.9% NaCl solution infused by the ID Power Infuser through a peripheral i.v. catheter. Eighteen patients with hemodynamic evidence of hypovolemia had a mean infusion rate of 2 L/hr with time to resolution of hypovolemia 28.5 +/- 7 min, 14 of these had an infusion rate > or = 4 L/hr with resolution of hypovolemia of 13.7 +/- 5.8 min. Resolution of hypovolemia was significantly faster compared with a group receiving gravity infusion. Use of the Power Infuser was deemed easy (VAS = 1.9 +/- 1.9 cm). The ID Power Infuser can accurately and quickly deliver i.v. crystalloid in the ED and has the potential to reduce morbidity, time in the ED, and costs.

Adult↗

PubMedDate not supplied

The effect of a mediastinal mass on the initial positioning of a peripherally inserted central venous catheter.

The purpose of this project was to assess if the presence of a mediastinal mass adversely influences peripherally inserted central catheter (PICC) positioning. A retrospective review of all PICC placements over an 18-month period in a pediatric oncology hospital was conducted in which patients were categorized by the presence or absence of a mediastinal mass. A much higher proportion of patients with a mediastinal mass (8 of 13) had a malpositioned catheter than those without a mass (3 of 38; P = .0002). A significant proportion of the malpositioned catheters in patients with a mediastinal mass terminated in the right heart chambers. These findings show that clinicians must be vigilant about checking for PICC malpositioning in this patient population.

Catheterization, Central Venous↗

PubMedDate not supplied

The design and clinical application of a new #5 French angioplasty catheter.

Although major technological advances have occurred in coronary artery angioplasty balloons and steerable wire systems, there have been surprisingly few advances in the development and designs for balloons in the peripheral circulation. For example, a #7 French shaft has become the standard for most peripheral as well as visceral angioplasty balloons. In most instances, the shaft is unnecessarily large and not only interferes with tractability over the conventional wire but in certain situations is also unnecessarily traumatic to the vascular intima as the catheter is passed to the angioplasty site. For these reasons a newly designed catheter with a shaft measuring 1.67 mm (#5 French) has been designed to incorporate a variety of dimensional balloons varying from 2 mm through 7 mm. In addition, the open end allows passage of a .035 inch wire and consequently the balloon is ideally suited for applications from vessels as small as the tibial circulation or renal visceral or iliac circulation.

Angioplasty, Balloon↗

PubMed2002

The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices.

Intravascular devices (IVDs) are widely used for vascular access but are associated with substantial risk of development of IVD-related bloodstream infection (BSI). The development of novel technologies, which are based on an understanding of pathogenesis, promises a quantum reduction in IVD-related infections in an era of growing nursing shortages. Infections of short-term IVDs (that is, those in place <10 days), including peripheral venous catheters, noncuffed and nontunneled central venous catheters (CVCs), and arterial catheters, derive mainly from microorganisms colonizing the skin around the insertion site, which most often gain access extraluminally. More-effective cutaneous antiseptics, such as chlorhexidine, a chlorhexidine-impregnated sponge dressing, CVCs with an anti-infective coating, anti-infective CVC hubs, and novel needleless connectors, have all been shown to reduce the risk of IVD-related BSI in prospective randomized trials. The challenge for the future will be to identify new preventative technologies and to begin to adapt more widely those technologies already shown to be efficacious and cost-effective.

Anti-Bacterial Agents↗

PubMed1999

Femoral catheters: safety and efficacy in peripheral blood stem cell collection.

Central venous access is necessary in patients candidate for peripheral blood stem cell (PBSC) collection. We report our experience with a dual lumen femoral catheter (Gamcath, 11 french), initially designed for hemodialysis. We studied 147 patients and performed 488 collections after mobilization with either G-CSF alone or chemotherapy + G-CSF, when the white blood cell count exceeded 1 x 10(9)/L, or when a measurable population of CD34+ cells (20/microL) was detected in peripheral blood. All patients received systemic anticoagulation with a low weight heparin and ultrasound examination was performed after the removal of the catheter. Seven patients developed thrombosis (4.7%), ten experienced hematomas at the site of catheter placement (6.8%) despite prophylactic platelet transfusions, while only one patient (0.6%) had a catheter-related infection. In conclusion, the short-term use of large bore femoral catheters in setting up PBSC collection seems to be associated with minimal risk of infection and low thrombotic incidence.

Catheterization, Peripheral↗

PubMed1995

Endothelial thrombus formation: an unusual complication related to peripherally inserted central catheters.

The Nutritional Support Service (NSS) at William Beaumont Hospital has successfully inserted over 2000 peripherally inserted central catheters (PICCs) since the inception of its PICC program in 1990. The following is a case study of a 43-year-old female with diabetes mellitus and multiple drug allergies who presented to the NSS after Wound Clinic personnel were unable to pull a 43 cm PICC more than 38 cm out of her left arm. Radiographic studies showed the remaining 5 cm of the catheter to be untangled, following the course of the cephalic vein. A surgical cutdown was performed to dilate the cephalic vein and remove the device. The PICC tip was encapsulated in an organic material which was confirmed by pathology to be a thrombus with endothelial lining.

Adult↗

PubMed1995

Intravenous catheter-related infections.

Vascular catheter-related infection is an important cause of mortality and morbidity in hospitalized patients. The mean incidence of catheter-related bloodstream infection in hospitalized pediatric patients is 2.4 episodes per 1,000 days. Totally implantable central venous catheters may be associated with a lower risk of infection. Coagulase-negative staphylococci are the predominant cause and account for about one third of episodes of catheter-related bloodstream infection. The diagnosis of catheter-related bloodstream infection is often difficult because there are frequently no signs of inflammation around the catheter. Diagnosis depends on either a positive quantitative catheter culture yielding the same microorganism recovered from the bloodstream or differential quantitative blood cultures with significantly greater colony counts from blood drawn through the catheter than from blood drawn through a peripheral vein. Alternatively, probably catheter-related sepsis can be diagnosed when clinical sepsis is refractory to antimicrobial therapy but responds to catheter removal. Often these criteria are not met but catheter-related bloodstream infection is presumed because a common skin microorganism is isolated from the blood when clinical manifestations of bloodstream infection are present and there is no other apparent source of infection. Microorganisms causing catheter-related bloodstream infection gain access to the bloodstream predominantly from either the catheter insertion site or the catheter hub. Most catheter-related infections occurring shortly after catheter insertion probably gain access to the bloodstream by extraluminal migration along the catheter from the skin at the catheter insertion site. When catheters are in place for extended periods, especially greater than 30 days, the catheter hub probably plays a major role in microorganisms gaining access and then migrating endoluminally until reaching the bloodstream. Recently employed strategies for the prevention of catheter-related infections include topical antibiotics or antiseptics at the catheter insertion site, flush solutions containing vancomycin, and bonding antimicrobial agents to the catheter. Infection of peripheral and central venous catheters generally resolves after catheter removal. For tunneled silicone catheters, most episodes of catheter-related infection can be initially managed with antimicrobial therapy infused through the catheter without catheter removal. Staphylococcus aureus is generally more aggressive and associated with more complications than coagulase-negative staphylococci. Microorganisms that usually require catheter removal include Candida and Bacillus species. Adjunctive treatments of catheter infections include the use of urokinase. Catheter-related infection remains an important complication of vascular access. Novel prevention and treatment strategies are currently being investigated. In the near future bonding of antibiotics or other agents to catheters may become routine.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacteremia↗

PubMedDate not supplied

Peripheral intravenous catheter dwell times: a comparison of 3 securement methods for implementation of a 96-hour scheduled change protocol.

A prospective, sequential clinical trial was undertaken to determine whether any of 3 methods of peripheral IV catheter (PIV) securement could extend the average survival time of such catheters sufficiently to allow the implementation of a 96-hour PIV change-protocol. Nonsterile tape, StatLock, and Hub-Guard were evaluated. The use of nonsterile tape securement resulted in an 8% PIV survival rate, HubGuard produced a 9% PIV survival rate, and Statlock produced a 52% PIV survival rate (P<.001). Although this study was not a randomized, controlled trial, it strongly suggests that a mechanical catheter securement device, as opposed to tape or die-cut tape, can render practicable the implementation of the 96-hour PIV change protocol that was sanctioned by the Centers for Disease Control and Prevention.

Adhesives↗

PubMedDate not supplied

Peripherally inserted central catheters: expanding UK nurses' practice.

Peripherally inserted central catheters (PICCs) are a group of single- and double-lumen central venous access devices, ranging in size from 2 to 6 FG. In the USA, these devices have been used to establish central venous access since the late 1970s, but they are only just beginning to be introduced into the UK. In the USA, suitably skilled nurses assume responsibility for the placement of the majority of PICCs, both in the hospital and home-care settings (Coulter, 1993). This article will explain how suitably skilled nurses in the UK could expand their clinical practice to include the placement of PICCs, and thereby improve the quality of intravenous access for many patients requiring parenteral therapies.

Catheterization, Central Venous↗

PubMedDate not supplied

I.v. access options for AIDS patients with cytomegalovirus disease.

In view of changes over the past 2 years in the intravenous (i.v.) management of patients with AIDS and cytomegalovirus (CMV) disease, a small study was carried out at the Kobler Clinic, an HIV treatment centre in London, to examine optimal i.v. access for CMV induction treatment. Thirty lines were analysed over a period of 4 months: 18 were peripherally inserted central catheters (PICCs) and 12 were midline catheters. Each line was monitored and evaluated for reason for choice of line, insertion data, line survival, patient self-administration, patient comfort scores, infection rate, and other difficulties encountered during treatment induction. The study results indicated noticeable differences between PICC and midline catheter performances, although a change in treatment protocol during the study influenced the choice of line used. There were also marked differences from other studies, carried out predominantly in non-HIV patients, when infection rate, dwell time of lines and thrombus formation were compared. Significant changes in practice have been implemented and further clinical studies/research identified.

AIDS-Related Opportunistic Infections↗

PubMed2001

[Catheter-guided thrombolysis in peripheral arterial occlusion].

By catheter-directed, regional, intravascular thrombolysis a thrombus-dissolving enzyme is applied through a catheter placed at/in the occlusion. Non-fibrin-specific (streptokinase or urokinase) and fibrin-specific agents (tissue plasminogen activators) are available. The large randomised trials (TOPAS and STILE) have serious selection bias, which makes generalisation difficult. Other studies have incomparable data and thus meta-analysis is impossible. Consequently, a recent consensus document cannot recommend an agent or principle of infusion. Thrombolysis of late, but transitory (< 14 days), occlusions seems beneficial but long-term results are lacking and recurrences are common. Exclusion of preoperative thrombolysis in late and longer lasting occlusions (> 14 days) is debatable, because of a potential thrombolysis-caused improved run-off. Individual case selection is still needed, because thrombolysis is a promising, although experimental, treatment.

Arterial Occlusive Diseases↗

PubMed1994

Endothelin-1 causes a biphasic response in systemic vasculature and increases myocardial contractility in conscious rabbits.

We studied the effects of an intravenous (i.v.) bolus of endothelin-1 (ET-1, 0.2 nmol/kg) in conscious rabbits, measuring arterial blood pressure (BP), heart rate (HR), myocardial contractility, and cardiac output and evaluating direct and indirect effects of ET-1 with pacing and pharmacologic antagonists. ET-1 caused a brief initial decrease in BP of 18 +/- 1 mm Hg, followed by a sustained increase of 26 +/- 3 mm Hg (n = 16, p < 0.001). HR increased initially by 60 +/- 11 beats/min and then decreased by 68 +/- 6 beats/min (n = 16, p < 0.001). Left ventricular (LV) dP/dt increased by 2,120 +/- 380 mm Hg/s (n = 5, p < 0.01). LV end-diastolic pressure (LVEDP) increased by 4 +/- 1 mm Hg (n = 5, p < 0.05). Cardiac output (CO) increased initially by 34 +/- 4% and then decreased by 28 +/- 3% (n = 16, p < 0.001). Total peripheral resistance (TPR) decreased initially by 34 +/- 3% and then increased by 72 +/- 13% (n = 16, p < 0.001). Pacing did not alter the effect of ET-1 on arterial BP, LVdP/dt, or LVEDP. The combination of propranolol and scopolamine significantly reduced the increase and decrease in HR and the increase in LVdP/dt. None of the antagonists significantly altered the effect of ET-1 on TPR. ET-1 causes brief initial vasodilation and increased myocardial contractility, followed by sustained vasoconstriction. The vascular effects appear to be of greater significance than the cardiac effects at the dose used.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1993

Long-term circulatory access via a peripheral implantable port.

The use of a novel indwelling central venous catheter system is described which combines the safety of peripheral venous catheter placement with a novel electromagnetic locator device for guidance of the catheter tip into the correct position. This locator system obviates the need for radiological screening or chest radiography for checking catheter placement. Fifty-one patients were studied prospectively and all were successfully cannulated. An infection rate of 0.29 per 1000 catheter-days was seen with a mean system life of 220 (range 15-510) days. The new port has a lower infection rate than other commonly used systems and eliminates complications such as pneumothorax and puncture of major arteries.

Adult↗