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PubMed1993

Evaluation of possible histamine release from human peripheral blood cells using an enzyme immunoassay (HRT) with components of intravenous catheters.

The HRT Assay was evaluated for its capacity to measure histamine release from blood basophils following the introduction of extracts from catheters made of Aquavene or silicone. Blood samples were collected from twenty-one volunteers of the University of California, Davis campus and from seven individual who had experienced a systemic event during the insertion of catheters made from Aquavene. None of the blood samples released histamine in quantities that would be anticipated in an anaphylactic or anaphylactoid reaction when challenged with the extracts; all released histamine when challenged with polymyxin B, used as a positive control. Based upon these results, none of the components of either the Aquavene-based or silicone-based catheters are thought to cause a histamine-associated reaction in subjects. This assay proved to be both expedient and reliable in its determination of the release of histamine from blood basophils.

Anaphylaxis↗

PubMed2001

Randomized comparative trial between percutaneous longlines and peripheral cannulae in the delivery of neonatal parenteral nutrition.

UNLABELLED: Percutaneously inserted central venous catheters (CVCs) are frequently used for parenteral nutrition (PN) in neonates. Catheter-related sepsis (CRS) is the most commonly reported complication. The aim of this study was to compare sepsis rates between neonates receiving PN by CVC and by peripheral cannula. Neonates were randomized to receive PN either by CVC or by peripheral cannula. Primary outcomes were sepsis rates and efficacy of PN delivery. Interim analysis (49 neonates) revealed no difference in sepsis rates (CVC group 46%, cannula group 40%, p = 0.57). There was a significant discrepancy in PN delivered (median deficit 3.2% in the CVC group, 10.3% in the cannula group, p=0.0014). After consideration of these findings the study was terminated. CONCLUSION: Because the trial was stopped early, small but clinically important differences in the rates of sepsis may have been missed. Neonates in the cannula group accrued significant deficits of PN owing to a lack of venous access. This may contribute to undernutrition in neonates. CVC can be advocated for PN administration, in that sepsis appears to be no higher than when using cannulae and delivery of nutrition is significantly better.

Catheterization↗

PubMedDate not supplied

Peripherally inserted central catheters in children: a survey of practice patterns.

There is little published information describing standards of practice in the placement, use, and maintenance of peripherally inserted central catheter (PICC) devices in children. A Web-based survey tool was designed to query these issues, and 72 intravenous therapy nurses from 72 hospitals provided complete responses to the survey. The respondents were predominantly (81%) from healthcare organizations inserting 40 or fewer PICC devices per month. These hospitals were equally divided in using 0.9% sodium chloride (USP) (saline) or heparinized saline flush to maintain patency, whereas 76% used catheters for blood sampling. Flushing and blood sampling practices were not related to catheter occlusion rates. From their survey, the authors conclude that the standards of practice for 3-Fr PICC devices, the most commonly used for children, are quite variable and in need of standardization for this specific population.

Adolescent↗

PubMed1995

Vascular access in neonates and infants--indications, routes, techniques and devices, complications.

Venous cannulation has been in regular use in neonates since the 1940s. This was at first through the umbilical vein, but the frequency of complications lead to other central and peripheral routes being used for infusion of fluid, nutrients and drugs. Today, peripheral venous access is preferred except for high volume fluid resuscitation, reliable infusion of irritant drugs and long-term parenteral nutrition. Intraosseous infusion provides a reliable alternative to peripheral veins for rapid infusion of fluid. Long, thin silastic catheters can be inserted through a peripheral venous cannulae for parenteral nutrition or other central venous infusions as an alternative to direct central venous cannulation using the Seldinger or other techniques. Broviac or Hickman catheters, inserted through a subcutaneous tunnel are only considered when central venous cannulation is likely to be needed for more than six weeks. The most common serious complication of vascular access is infection. Infection associated with central venous catheters is reduced by prophylactic vancomycin or teicoplanin. Other complications of central venous infusion are associated with cannulae malpositioning, bleeding and thrombosis. Distal hypoperfusion may follow arterial cannulation. Modern emergency and intensive care paediatrics is impossible without adequate venous and arterial vascular access. However no other skill for neonatal intensive care causes more anxiety in primary care providers or is more difficult to teach.

Anti-Bacterial Agents↗

PubMed1988

Effect of transdermal glyceryl trinitrate on the survival of peripheral intravenous infusions: a double-blind prospective clinical study.

Phlebitis is the commonest complication of intravenous infusion. It has been suggested that it is initiated by venoconstriction at the infusion site, hence treatment with a vasodilator may reduce its incidence. We carried out a prospective double-blind controlled study of the effect of transdermal glyceryl trinitrate on the survival of peripheral intravenous infusions in 340 patients. Fifty-five per cent (94 out of 170) of the infusions failed in the control group compared with 19 per cent (33 out of 170) in the treatment group (chi 2 = 45, P less than 0.0005). The commonest cause of infusion failure was superficial phlebitis: 47 per cent in the control group and 17 per cent in the treatment group (chi 2 = 46, P less than 0.0005). The estimated median time of infusion survival was 74 h in the control group compared with 127 h in the treatment group (log rank chi 2 = 143, P less than 0.0001). We conclude that infusion phlebitis is a common problem in hospitalized patients and its incidence can be effectively reduced by transdermal glyceryl trinitrate.

Administration, Cutaneous↗

PubMed2004

[Aseptic meningitis after intrathecal infusion of a parenteral nutrition solution: examples of rare malpositions of central venous catheters in preterm neonates].

BACKGROUND: Central venous catheters are an indispensable part of intensive care. In the management of preterm neonates, these are introduced after puncture of a peripheral subcutaneous vein. The catheters are supposed to be pushed forward with the venous flow. A chest X-ray is usually performed for verification of the position of the catheter. Localization of the tip of the catheter is often very difficult because of its extremely small diameter. METHODS: A malposition of a central venous catheter resulting in intrathecal infusion of parenteral nutrition and subsequent aseptic meningitis in a preterm neonate is presented. Further cases of catheter malpositions leading to arthrography, arteriography and incorrect position in various parts of the venous system are discussed. DISCUSSION AND CONCLUSION: The case reports demonstrate that wire-guided central venous catheters are not only advanced by the forward blood flow but can also inadvertently end up in undesired sites and may thus induce serious side effects.

Catheterization, Peripheral↗

PubMed2006

Prostate HDR radiation therapy: a comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA.

INTRODUCTION: High dose rate (HDR) brachytherapy is considered one of the most advanced treatment technologies currently available for treatment of localized prostate cancer. It gives the advantage of applying higher dose radiation, with greater precision, directly to the tumor while sparing healthy tissue and surrounding organs, thereby resulting in fewer side effects. In this facility, the treatment requires an overnight stay in the hospital, in a supine position, with a perineal template sutured to the perineum to prevent catheter movement or dislodgement. PURPOSE: To compare the effectiveness of pain management for men with prostate cancer being treated with HDR brachytherapy using a peripheral patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). METHOD: A comparative study was conducted evaluating the effectiveness of two pain management methods for men with prostate cancer receiving HDR brachytherapy. Pain assesments were conducted by scoring pain from the Foley catheter, interstitial catheter (perineal) and back (lumbosacral), using the Brief Pain Inventory Scale. RESULTS: Patients receiving pain management with the PCEA experienced significantly less pain. CONCLUSIONS: These finding suggest that use of PCEA with bupivacaine and fentanyl is more effective in managing pain related to HDR brachytherapy for prostate cancer, and results in a positive patient outcome thereby improving patient satisfaction.

Analgesia, Epidural↗

PubMed1999

Percutaneous central catheters and peripheral intravenous catheters have similar infection rates in very low birth weight infants.

OBJECTIVE: We performed this study to determine if percutaneous central lines (PCLs) were associated with infection more often than peripherally placed intravenous catheters (PIVs). STUDY DESIGN: We conducted a retrospective, cohort study of 53 infants with PCLs inserted from March 1993 to February 1995 for evidence of catheter-related bloodstream infection and 97 cohorts with PIVs who were matched to the infants with PCLs by admission date and birth weight. We considered an infant to have catheter-related bloodstream infection if bacteremia occurred while the PCL or PIV was in place with no other identifiable infection focus. Statistical analyses were performed by using either Student's t test or the Mann-Whitney U test where appropriate. RESULTS: There were eight infections per 1000 catheter days of PCL use and nine infections per 1000 catheter days of PIV use. CONCLUSION: PCLs do not become infected more often than PIVs.

Bacteremia↗

PubMedDate not supplied

Accuracy of drawing blood through infusing intravenous lines.

OBJECTIVE: To determine the usefulness of peripheral intravenous lines as an alternative route for obtaining blood samples. DESIGN: Quasiexperimental. SETTING: Wilford Hall Medical Center, a regional level I trauma center and military teaching hospital in San Antonio, Tex. SAMPLE: A convenience sample of 64 subjects was enrolled between September 1997 and June 1998. OUTCOME MEASURES: Comparative analysis of a complete blood count and chemistry, using the patients as their own control, on the same Coulter Analyzer and Boelrringer Mannheim/Hitachi 747-200. RESULTS: A total of 559 values were evaluated. Only 2.5% of the specimens exceeded the Clinical Laboratory Improvement Act standards. None of the values was clinically significant. CONCLUSION: Intravenous devices, if used properly, are reliable tools for blood specimen collection. They yield accurate analyte levels that may used in the treatment of patients.

Adolescent↗

PubMedDate not supplied

[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement].

In 20% of cases, essential hypertension is of high renin pathogenesis which is indifferent of that of renal lesions. In these patients high blood pressure is closely related to high aldosterone generation due to elevated angiotensin II levels. Adrenal blood portalization is a possible way of abolishing secondary aldosteronism and hyperreninemia in this case. With this, 90-98% aldosterone and 20-30% renin are inactivated, which served as the basis for bilateral electrocoagulation of adrenal central veins in 13 patients with permanent and malignant arterial hypertension. The renin-dependent pattern of essential hypertension was confirmed by a positive BP response to a tested captopril dose (25 mg), the vasorenal one was ruled out on the basis of the peripheral captopril test, captopril pharmacorenography. Bilateral electrocoagulation of adrenal central veins was performed during a phlebographic examination. The manipulation proved to be successful on 11 (85%) left and 9 (70%) right adrenals. Blood pressure became lower in the first day and stable on days 4-5. There was a significant decrease in blood pressure at a year follow-up, in increased aldosterone levels, plasma renin activity with unchanged adrenocorticotropic hormone concentrations. After the manipulation, 2 patients refused to take antihypertensive drugs, 11 patients received lower doses of drugs. The method for abolishing secondary aldosteronism is considered to be promising for further clinical studies. A special attention should be given to patients with diseases concomitant with essential hypertension who have no alternative to surgical treatment.

Adrenal Glands↗

PubMed1988

Infusion thrombophlebitis: a prospective comparison of 645 Vialon and Teflon cannulae in anaesthetic and postoperative use.

A prospective study of the incidence and severity of infusion thrombophlebitis in peripheral intravenous infusions used for anaesthetic and postoperative purposes in 645 patients was conducted over a four-month period. Conditions of insertion were carefully controlled while ward management was according to standard practice. A total of 330 polyurethane Vialon and 315 FEP-A Teflon cannulae were used. The results show that the nature of the cannula was the single most important factor in the incidence and severity of infusion thrombophlebitis, Vialon cannulae being associated with a 46% lower incidence than the Teflon type. Less important but significant factors included intravenous antibiotics, duration of infusion, cannula tip damage and caesarean section. Factors not associated with infusion thrombophlebitis included potassium therapy, blood transfusion or site of insertion in the upper limb. Heparinisation increased duration of infusion without affecting the incidence of infusion thrombophlebitis.

Adult↗

PubMed2006

Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward.

BACKGROUND: Peripherally inserted central venous catheters (PICC) have supplanted central venous catheters (CVC) for the administration of intravenous antibiotics and total parenteral nutrition to patients in our hospital. From the literature, it appears that this change has occurred in a number of other surgical units. Accounting for the change are the expected advantages of low complication rates at insertion, prolonged use without complications and interruption, and cost- and time-savings. METHODS: We have proceeded with a review of the literature to understand and justify this change in practice. Our hypothesis was that the routine adoption of PICC instead of CVC for the acute care of surgical patients has occurred in the absence of strong scientific evidence. Our aim was to compare the associated infectious, thrombotic, phlebitic, and other common complications, as well as PICC and CVC durability. Articles concerning various aspects of PICC- and CVC-related complications in the acute care of adult patients were selected from the literature. Studies were excluded when they primarily addressed the use of long-term catheters, outpatient care, and pediatric patients. Data were extracted from 48 papers published between 1979 and 2004. RESULTS: Our results show that infectious complications do not significantly differ between PICC and CVC. Thrombotic complications appear to be more significant with PICC and to occur early after catheterization. Phlebitic complications accounted for premature catheter removal in approximately 6% of PICC. Finally, prospective data suggest that approximately 40% of PICC will have to be removed before completion of therapy, possibly more often and earlier than CVC. CONCLUSIONS: We believe that there is no clear evidence that PICC is superior to CVC in acute care settings. Each approach offers its own advantages and a different profile of complications. Therefore, the choice of central venous access should be individualized for surgical patients on the ward. More comparative prospective studies are needed to document the advantages of PICC over CVC.

Catheterization, Central Venous↗

PubMed2003

Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies.

BACKGROUND: In contrast to the high risk of haemorrhage associated with the implantation of a central venous catheter (CVC) via the internal jugular or subclavian access, the use of a peripherally inserted catheter (PICC) offers the advantage of a lower risk of bleeding complications. However, the rate of phlebitis is higher with the PICC and its use has been declining. We have studied the benefits and adverse events of a new type of PICC and a common type. METHODS: From October 1999 to October 2001, 70 PICCs (Olimpicc, Vygon, Germany, n=40; and LIFECATH-PICC(PUR)5FR Vygon, Germany, n=30) were inserted into 66 patients with haematological malignancies and used for high-dose chemotherapy, total parenteral nutrition and autologous blood stem cell transplantation. While removing the catheter, central and peripheral blood cultures were taken. The catheter tip was investigated by the semi-quantitative roll-out method of Maki. RESULTS: Sixty-five PICCs were removed after a median of 8.9 days. In five cases a catheter-associated significant colonisation with coagulase-negative staphylococci occurred. In two instances catheter-related bacteraemia was found. CONCLUSION: In our study this catheter system was inserted in 94% of patients without problems and showed a low incidence of phlebitis (5/65). Because of the high rate of catheter malfunction reported during and after our study, the Olimpicc catheter is no longer available. The PICC system, and the LIFECATH-PICC(PUR)5FR in particular, offers a safe and effective alternative for central venous access to the internal jugular vein.

Adult↗

PubMed2000

Risks and complications of peripherally and centrally inserted intravenous catheters.

Increased nursing vigilance is needed while caring for critically ill patients who have i.v. catheters. All i.v. sites should be selected based upon the i.v. therapy needs of the patient, using the shortest catheter and smallest size possible to meet the treatment needs of the patient while avoiding excessive repeated insertions of peripheral IVs. Meticulous handwashing, site preparation, and the use of sterile technique during insertion and maintenance are essential to minimize the risk of infection. Use multilumen catheters only when necessary because these catheters have an increased manipulation and associated infection risk. Observe for signs and symptoms of localized, systemic, mechanical, and metastatic (e.g., vertebral osteomyelitis and endocarditis) foci of infection. Additionally, remove all unnecessary or poorly performing i.v. catheters. I.v. sites that do not yield a blood return but will accept i.v. solutions are in the process of becoming occluded. Most likely, there is a fibrin sheath that is developing along the catheter's inner lumen and opening, decreasing the catheter's effectiveness. Accommodate the need to replace a catheter into the patient's plan of care rather than allowing the catheter to occlude and then replacing it under emergent or rushed conditions.

Catheterization, Central Venous↗

PubMedDate not supplied

Peripheral intravenous lines: time in situ related to complications.

The purpose of this study is to examine the relationship between time in situ and the frequency of thrombophlebitis. Nurses' care and handling when using a peripheral intravenous (p.i.v.) line was also studied. The methods used were observation, interview, and document analysis after intervention, with respect to cannula time in situ. The study included 120 patients divided in two groups: (1) experimental, time in situ less than or equal to 24 hours, and (2) control, using current/daily routines from the wards. The frequency of thrombophlebitis after a p.i.v. was inserted was significantly higher and showed more troublesome and prolonged picture complications in the control group than in the experimental group. Care and handling suffered with increased number of days in situ. The nurses' documentation of inserted or removed cannula was incomplete in most cases, and notices about the insertion area were nearly nonexistent. It was determined that a short time in situ--when using a p.i.v.--is an important factor in preventing complications.

Aged↗

PubMedDate not supplied

Pediatric peripheral i.v. insertion success rates.

Determination of an acceptable practice standard for peripheral intravenous (PIV) insertion as well as insertion success rates of inpatient medical/surgical registered nurse (RN) staff at Children's Hospital, Omaha, NE, was examined. The prospective study consisted of a non-randomized sample of 249 total i.v. placements. The inpatient medical/surgical registered nurse (RN) staff and patients were used as study participants. The data were collected on three separate occasions over 20 months by self-report. The cumulative insertion data revealed 53% successful PIV cannulation on the first attempt, 67% within two attempts, and 91% within four attempts. Additionally, the medical/surgical RN staff successfully placed 85% of the medical/surgical PIVs. As a result of this study, the standard of practice is now defined as no greater than four attempts at insertion by RN staff. Future data should be collected in order to substantiate a defined standard for PIV placement.

Adolescent↗

PubMed1991

In vitro and in vivo rates of fluid flow through catheters in peripheral veins of dogs.

In vitro and in vivo fluid flow rates of 14-, 16-, 18-, and 20-gauge catheters at fluid heights of 0.91 and 1.75 m above the catheters were determined. Flow rates were significantly faster in vitro than in vivo, at a greater height, and with larger catheter radius. In vivo flow rates averaged 7% less than in vitro flow rates. Fluid flow increased approximately 50% for each gauge catheter when the height was raised from 0.91 to 1.75 m. Flow rates increased linearly with increasing catheter radius. The flow rate of each gauge of catheter was significantly different from flow rates of all other gauges that were used. In vivo flow rates for 14-, 16-, 18-, and 20-gauge catheters at fluid heights of 0.91 and 1.75 m were 137, 88, 75, and 45 ml/min and 206, 152, 114, and 75 ml/min, respectively. Knowledge of flow rates allows selection of a catheter gauge that will provide adequate volume loading for the size of patient being treated in the time needed.

Analysis of Variance↗

PubMed2004

Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation.

BACKGROUND: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal and to discuss the results in the light of the current literature. PATIENTS AND METHODS: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. RESULTS: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. CONCLUSIONS: Severe vascular complications after Angio-Seal are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

Aneurysm, False↗