PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Catheterization, Peripheral”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1992

Bacteremia and fungemia of unknown origin in adults.

Two hundred fifteen (23%) of 955 episodes of bacteremia (defined as including fungemia) detected in adult patients during 2 years were of unknown origin. Sixty-six percent of episodes of unknown origin were hospital acquired. The median age of patients with bacteremia of unknown origin was 65 years, and their most common underlying disorders were solid malignancy (28% of patients) and diabetes mellitus (18%). Only three factors were associated with bacteremia of unknown origin (as opposed to episodes with a known source): peripheral venous catheterization, hemodialysis, and plasmapheresis. Gram-negative bacteria were isolated from the blood in 62% of episodes of unknown origin; 10% of episodes were polymicrobial. Staphylococci were isolated from 67% of patients undergoing hemodialysis and from 37% of those with diabetes; Pseudomonas species from 15% of patients with hospital-acquired episodes; and Candida species from 21% of patients with a central venous catheter. Fifteen percent of episodes in cancer patients were polymicrobial. Empirical antibiotic treatment was inappropriate in 49% of episodes of unknown origin and in 35% of episodes with a known source (P less than .001). Death rates were 44% and 25% in episodes of unknown and known origin, respectively. An unknown source of bacteremia was independently associated with a fatal outcome.

Adolescent↗
PubMedDate not supplied

Veni-Gard versus standard dressings on hemodynamic catheter sites.

Nosocomial infections result in increased costs for the patient and hospital and more importantly, these infections increase patient morbidity and mortality. Patients in intensive care areas have a higher risk of nosocomial infection than other hospitalized patients. Severity of illness and the use of multiple devices associated with high risk infection are contributing causes. The authors describe a project to improve the standard of care for patients with central and hemodynamic lines.

Bandages↗
PubMed1995

Central venous versus mixed venous oxygen content.

Mixed venous oxygen content (commonly measured as oxygen saturation) is a highly relevant parameter in the monitoring of critically ill patients; unfortunately, its measurement requires catheterization of the pulmonary artery. Though less invasive, the central venous oxygen saturation is an unsatisfactory substitute, due to fluctuations in perfusion distribution and regional oxygen extraction in the course of illness. The present study examined the relation of oxygen contents in simultaneously withdrawn central venous and mixed venous blood samples from critically ill patients, in order to validate a hypothetical algorithm for the estimation of mixed venous oxygen content from a central venous sample: Although the proposed algorithm had a fairly high power of prediction, its merits in comparison to assuming simple proportionality between central venous and mixed venous oxygen content seemed marginal. However, as it is likely that the results so far are mathematically coupled, further prospective studies are necessary.

Algorithms↗
PubMed1993

Efficacy of 1.4 percent sodium citrate in maintaining arterial catheter patency in patients in a medical ICU.

PURPOSE: The primary purpose of this study was to compare the efficacy of 1.4 percent sodium citrate with heparin, 4 U/ml, for maintaining radial artery catheter patency in patients in the medical ICU. PATIENTS AND METHODS: Patients in the medical ICU (n = 40) were randomized to either a 1.4 percent sodium citrate or heparin 4 U/ml arterial line flush solution in a double-blind, parallel fashion. The flush solutions were continuously infused at approximately 3 ml/h over a maximum of 96 h. Catheter survival rates were compared using Kaplan-Meier survival curves. The frequency of catheter malfunctions and corrective manipulations were recorded and compared. Coagulation status (APTT, PT) and ionized calcium values were monitored to evaluate the systemic effects of sodium citrate. RESULTS: Ninety-four percent of catheters flushed with sodium citrate were functional at 48 h compared with 88 percent for heparin (p > 0.05). At 96 h, 80 percent vs 88 percent of the catheters were functional in the citrate and heparin groups, respectively (p > 0.05). Frequency of catheter malfunctions did not differ between the two groups. No systemic effects of sodium citrate were observed. CONCLUSION: Arterial catheter flush solutions containing sodium citrate (1.4 percent) are an effective and safe alternative to heparin in patients requiring peripheral arterial catheterization.

Adult↗
PubMed1996

Continuous fiberoptic arterial and venous blood gas monitoring in hemorrhagic shock.

STUDY OBJECTIVE: To compare the performance of continuous fiberoptic blood gas monitoring with standard, intermittent blood gas sampling in the measurement of arterial and central venous blood gases during marked hemodynamic changes. DESIGN: Prospective, consecutive, enrollment, experimental study. SETTING: Research laboratory at a university medical center. PARTICIPANTS: Seven anesthetized, mechanically ventilated pigs. INTERVENTIONS: Severe shock was induced by hemorrhage in pigs monitored by a pulmonary artery catheter, an arterial line, and two fiberoptic blood gas sensors: one intra-arterial, and the other inserted into the superior vena cava via right internal jugular vein cutdown. Fiberoptic blood gas monitor measurements were compared with standard intermittent blood gas sampling. MEASUREMENTS AND RESULTS: A total of 184 blood gas samples were compared in seven animals at baseline, during shock, and after resuscitation. The baseline mean (+/- 1 SD) cardiac output decreased from 4.0 +/- 0.9 to 1.2 +/- 0.6 L/min during shock and returned to baseline after retransfusion (3.9 +/- 1.3 L/min). The comparison of continuous fiberoptic blood gas monitoring with intermittent blood gas sampling showed a bias+/-precision of 0.035 +/- 0.047 for arterial pH, 0.021 +/- 0.031 for central venous pH, -4.09 +/- 2.96 mm Hg (-0.55 +/- 0.39 kPa) for arterial Pco2, -3.67 +/- 2.44 mm Hg (-0.49 +/- 0.3 3 kPa) for central venous Pco2, -5.79 +/- 9.64 mm Hg (-0.77 +/- 1.29 kPa) for arterial Po2, and -7.85 +/- 8.52 mm Hg (-1.05 +/- 1.14 kPa) for central venous Po2. CONCLUSIONS: Continuous fiberoptic blood gas monitoring agrees closely with standard intermittent blood gas sampling during severe hemodynamic shifts and has a comparable accuracy for both arterial and venous blood gas measurements. Changes in venous Pco2 have recently been shown to correlate with changes in global tissue perfusion (eg, changes in cardiac output). Such data, available immediately via continuous venous blood gas monitoring, may be useful for monitoring shock and the response to resuscitation.

Animals↗
PubMed1997

Release of lactate by the lung in acute lung injury.

UNLABELLED: The pathogenesis of hyperlactatemia during sepsis is poorly understood. We have previously described an increase in lactate concentration across the lung in the dog during early endotoxemia. Accordingly, we sought to determine if the lung releases lactate in humans and what relation this has with lung injury. METHODS: We measured lactate concentrations across the lung and lung injury scores (LIS) in two groups of patients. Group 1 consisted of nine patients with acute lung injury (LIS > or = 2.0) and elevated lactate concentrations (> 2.0 mmol/L). Group 2 contained 12 patients with no acute lung injury (LIS scores < or = 1.5), with or without increased lactate concentrations. Simultaneous measurements of plasma lactate and blood gases were obtained from indwelling arterial and pulmonary artery catheters. Measurements of cardiac output were also obtained. Lactate measurements were done using a lactate analyzer (YSI; Yellow Springs, Ohio). RESULTS: For each patient with acute lung injury and hyperlactatemia, an arterial-venous lactate gradient existed demonstrating release of lactate by the lung. This gradient persisted after correction for changes in hemoconcentration across the lung. The lactate gradient across the lung was 0.4 +/- 0.2 mmol/L for group 1 vs 0.05 +/- 0.1 mmol/L for group 2 (p = 0.001). This corresponded to a mean pulmonary lactate flux of 231.3 +/- 211.3 vs 5.0 +/- 37.2 mmol/h (p = 0.001). The lactate flux and the arterial-venous lactate difference correlated with LIS both for the entire sample and for the subgroup with hyperlactatemia (r = 0.69, p < 0.01). Pulmonary lactate flux was not related to arterial lactate levels (r = 0.25). CONCLUSION: In patients with acute lung injury and hyperlactatemia, the lung is a major source of lactate and lactate flux correlates with LIS. This lactate flux could explain some of the hyperlactatemia seen in sepsis.

Adult↗
PubMed2004

Role of platelet activation in catheter-induced vascular wall injury.

PURPOSE: To investigate the role of smooth muscle cell (SMC) response and platelet activation in peripheral venous catheterization using a model of catheter injury associated with thrombocytopenic treatment. METHODS: Silicon elastic catheters were inserted into New Zealand White rabbit external jugular veins from 24 hours to 60 days. Immunocytochemical procedures with antibodies to differentiation markers specific for SMCs, myofibroblasts, and endothelial cells were used to ascertain the phenotypic features of injured venous SMCs and the tissue sleeve formed around the catheter. Thrombocytopenia was induced in rabbits by busulfan treatment and the effect on catheter injury development examined after 15 days. The putative direct effect of this drug on the venous SMC proliferation, migration, and differentiation was assayed in vitro for 48 hours. RESULTS: Catheter injury is characterized by the progressive formation of (1) a neointima, containing differentiating SMCs, which are derived from the media and adventitial layer, and (2) by the organizing thrombus formed around the catheter, which contains myofibroblasts. In busulfan-treated thrombocytopenic animals, there was no evidence for either neointimal development or thrombus formation. A direct role of this drug in the unresponsiveness of vascular wall can be excluded by the unchanged proliferation and migration pattern of cultured venous SMCs treated with busulfan compared to control cultures. CONCLUSIONS: In our model, accumulation of differentiated SMCs in the neointima and myofibroblast appearance in the thrombus are linked, although distinct, events regulated by platelet activation, which is able to furnish the appropriate microenvironment for vascular SMC recruitment from the media/adventitial layer.

Animals↗
PubMedDate not supplied

Hemodynamic changes with initiation of veno-venous bypass in orthotopic liver transplant patients.

Removal of the liver to start the anhepatic stage of liver transplantation requires cross-clamping of the portal vein, inferior vena cava, and hepatic artery. Adverse effects occur from engorged splanchnic beds and decreased venous return. A veno-venous bypass from the inferior vena cava and portal vein to the axillary vein is used in an attempt to ameliorate these changes. The purpose of this study was to evaluate the effect of institution of veno-venous bypass on hemodynamics. Eight randomly selected adult patients undergoing orthotopic liver transplantation had general anesthesia induced with thiamylal and maintained with nitrous oxide and isoflurane. Cardiopulmonary data and arterial and mixed venous blood gases were measured prospectively using radial artery and pulmonary artery catheters. Measurements were taken under four conditions: (1) 10 minutes before bypass; (2) after partial bypass (vena cava to the axillary vein); (3) after partial bypass with portal vein clamping; and (4) after full bypass (vena cava and portal vein to the axillary vein). Statistically significant changes seen were a 22% decrease in cardiac output and a 47% increase in systemic vascular resistance (SVR). Bypass flow was lower than predicted. Venovenous bypass ameliorates, but does not fully prevent, the reduction of cardiac output and rise in SVR seen with initiation of the anhepatic stage. However, bypass does prevent the hypotension experienced during cross-clamping and for these reasons should be used routinely.

Adult↗
PubMed1990

Obtaining reliable plasma sodium and glucose determinations from pulmonary artery catheters.

In critically ill patients, blood specimens are frequently withdrawn from intravascular catheters without consideration of possible infusate contamination, of test accuracy, or of undue blood loss. The reliability of sodium (Na+) and glucose determinations withdrawn from the venous infusion port of a pulmonary artery catheter was studied in 30 patients after cardiac surgery. Catheter patency was maintained by a saline and heparin infusate. Venipuncture samples for Na+ and glucose served as controls. A sample containing the dwell volume of the catheter and the stopcock (1 ml) was withdrawn and discarded, followed by fifteen 1 ml samples being taken for analysis. It was concluded that Na+ values are stable after discard of the catheter dwell volume and an additional milliliter of blood. Minimal clinical differences were found in the glucose values after discard of the catheter dwell volume and two additional milliliters of blood.

Adult↗
PubMed1995

Hepatic venous catheterization in patients undergoing positive end-expiratory pressure ventilation after OLT: technique and clinical impact.

The objective of this study was to determine the feasibility and clinical impact of hepatic venous oxygenation monitoring in patients undergoing positive end-expiratory pressure (PEEP) ventilation after OLT. The design comprised a prospective study using repeated-measures design, within an intensive-care unit for liver-transplanted patients in a university hospital. Sixteen consecutive adult patients undergoing orthotopic liver transplantation were enrolled. Postoperatively, a fiber-optic pulmonary artery catheter was inserted into the right hepatic vein. Patients were submitted to controlled ventilation with three different levels of end-expiratory pressure (PEEP): 0, 5 and 10 mbar. Hemodynamics, hepatic venous pressure, mixed venous (SvO2) and hepatic venous oxygenation (SvhO2) were measured. The average time required for hepatic venous catheterization was 2.9 +/- 1.2 min; serious complications were not observed. PEEP 5 mbar did not alter hemodynamics and SvhO2; PEEP 10 mbar significantly reduced cardiac index, SvO2 and widened arteriovenous content difference (p < 0.05). The mean difference between SvO2 and SvhO2 was 6.3 +/- 6.0% and did not change during PEEP ventilation. A significantly positive relationship was observed between SvO2 and SvhO2 (r = 0.91, p < 0.05). Hepatic venous catheterization appeared to be practical and could be utilized to evaluate the effects of therapeutic interventions on the transplanted liver. However, the small number of patients studied will not allow the assessment of any risk-benefit ratio of the technique investigated. Low levels of PEEP provided hemodynamic stability and did not alter hepatic oxygen supply-demand ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Extraction of intravascular foreign bodies].

OBJECTIVE: Loss or displacement of foreign material within the cardiovascular system is not an uncommon event. Foreign bodies include fragments of diagnosis equipment, ruptured catheters or malpositioned or displaced intravascular prostheses. The incidence has increased with the development of endovascular catheterism and raises the problem of extraction. METHODS: We report our experience with percutaneous extraction of intravascular foreign bodies. RESULTS: There were 56 cases. Percutaneous extraction was successful in 53. In 11 cases, the procedure was carried out during a catheterism procedure and in the others the initial event had occurred earlier. The delay to extraction varied from a few hours to several years. CONCLUSION: Percutaneous extraction of intravascular foreign bodies should be attempted before surgical removal, an often difficult high-risk procedure. The literature does not provide data on the frequency of intravascular foreign bodies.

Adolescent↗
PubMedDate not supplied

Routine invasive hemodynamic monitoring does not increase risk of aortic graft infection.

OBJECTIVE: To determine whether invasive hemodynamic monitoring resulted in an increased rate of aortic graft infection. DESIGN: Retrospective review with establishment of late follow-up. SETTING: Two referral teaching community medical centers. PATIENTS: Three hundred thirty consecutive patients who underwent elective aortoiliac (174), aortofemoral (91), or aortic tube (65) prosthetic graft placements during a 6-year period at the two institutions. All patients had percutaneous pulmonary artery catheter and radial artery cannula placement before surgery. Monitoring catheters were routinely removed within 72 hours. OUTCOME MEASURES: Early and late complications of catheter placement, perioperative morbidity and mortality, and late graft-related complications. RESULTS: Eighteen (5%) patients died in the perioperative period. Less than 2-year follow-up was possible in 67 patients. The remaining 245 patients were observed from 2 to 9 years (mean, 4.4 years). Graft infection was not identified in any patient. CONCLUSION: Routine invasive hemodynamic monitoring was not associated with an increase in the rate of prosthetic aortic graft infection.

Adult↗
PubMed1995

Pneumoperitoneum for laparoscopic surgery does not increase venous admixture.

Venous admixture as a measure of pulmonary gas exchange was studied before and during laparascopic cholecystectomy in 12 patients with normal healthy cardio-pulmonary function. After induction of anaesthesia the patients were studied by radial and pulmonary arterial catheterization and simultaneous arterial and mixed venous blood gas sampling in the horizontal, 15-20 degrees head-down and 15-20 degrees head-up tilt positions. After establishing the pneumoperitoneum (PP) by insufflation of carbon dioxide to an intraabdominal pressure level of 11-12 mmHg, the measurements were repeated in the same positions. The laparoscopic cholecystectomy then started and measurements were repeated every 30 min during surgery. The venous admixture was 4 +/- 0.6% (range 2-6%) in the horizontal position and was not influenced by altered body position. Immediately after establishment of PP, there was a 31 +/- 5% (P < 0.05) reduction of venous admixture and a 15 +/- 3% (P < 0.01) elevation of PaO2 compared with the control situation without PP. These changes were maintained during pneumoperitoneum and were not influenced by posture. It is suggested that alterations in the distribution of ventilation and/or lung perfusion results in a reduced venous admixture during PP without surgery. In addition, there was no indication that venous admixture is elevated as a result of laparoscopic surgery in the reversed Trendelenburg position.

Adolescent↗