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PubMed1992

Systemic candidal infections associated with use of peripheral venous catheters in neonates: a 9-year experience.

The clinical courses of 25 infants with systemic candidiasis who were treated in the neonatal intensive care unit at Kaplan Hospital, Rehovot, Israel, during the period 1980-1989 were retrospectively analyzed. Twenty-three (92%) weighted less than 1,500 g at birth. Candidemia was associated with prolonged antibiotic therapy, hyperalimentation, and intravenous fat emulsions in all cases and with previous tracheal intubation in 80% of cases. Only one infant had a central venous catheter placed; for all others, hyperalimentation was administered by means of peripheral intravenous catheters. The mean age at onset of systemic candidiasis was 30 +/- 14 days, although an earlier onset (25 +/- 8 days) was noted during the last 3 years of the study period. Candida species were isolated from the blood of 24 infants and from the urine of 10 infants. Microscopic examination of the urine was positive for Candida organisms for three infants and led to a rapid diagnosis. Candidal skin abscesses were present in 11 infants (44%); for two of these infants, the early occurrence of such abscesses prompted the initiation of therapy before confirmation of the diagnosis of systemic candidiasis. All infants were treated with intravenous amphotericin B and oral 5-fluorocytosine. The mortality rate was 20%, but death was directly attributable to candidemia in only three infants (12%).

Anti-Bacterial Agents↗

PubMed2005

[Prospective, randomized and controlled trial on the dwell time of peripheral intravenous catheters in children, according to three dressing regimens].

This prospective, randomized and controlled study verified the influence of three dressing regimens on the dwell time of peripheral intravenous catheters (PIC) in children. The study groups were composed of dressings with sterile gauze (EG 1), with sterile transparent film (EG 2) and with hypoallergenic adhesive tape (CG). Variables were selected to control for variables related to children, professionals and intravenous therapy characteristics. The 150 PIC that composed the sample were inserted in 68 children, predominantly of preschool age, male, with brown skin color, eutrophic and with gastrointestinal system diseases. The majority of the PIC was installed by nursing auxiliaries in veins of the dorsal arch of the hand. The type of dressing exerted a significant influence (p = 0.022) on the average dwell time of the studied PIC: EG 1 (46.12 hours), EG 2 (29.53 hours) and CG (38.18 hours), concluding that the dressing with sterile gauze maintained the catheter inserted for a longer time.

Bandages↗

PubMed1990

[Automated exchange transfusion in premature and newborn infants with hyperbilirubinemia using a peripheral arteriovenous vascular access device].

The technique of exchange transfusion using a plastic catheter in the umbilical vein developed by Diamond and modified by Allen was instrumental in decreasing the mortality and morbidity in newborn infants with jaundice. Allen et al. demonstrated that the development of kernicterus in infants with erythroblastosis with indirect hyperbilirubinemia could be prevented by this method. Since that time numerous modifications of this "single site, push pull technique" have been described to further reduce the risk of morbidity and mortality. On the basis of the successful use of percutaneous radial artery catheters for arterial blood gas monitoring, we developed a technique for exchange transfusion using a peripheral arterial catheter inserted in the radial artery for blood withdrawal and a peripheral venous catheter for replacement of heparinized compatible donor blood. For simultaneous withdrawal and replacement we used two volumetric infusion pumps, one aspirating patients' arterial blood, the other replacing equal volumes of donor blood at exactly the same time. We evaluated our new procedure in 19 newborn infants (group 1) with hyperbilirubinemia who required exchange transfusion. Retrospectively we analysed the data in 18 newborn infants (group 2) treated over a previous period by means of the conventional "one site, push pull" technique using the umbilical vein, and compared the data. Mean birth weights, gestational ages and Apgar scores were similar in both groups, as were volumes of blood used for exchange transfusions. The results were superior in group 1 infants, as reflected by the significantly greater percentage decreases in serum bilirubin concentration and fewer complications. No baby died.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗

PubMed1995

Randomised comparison of silicone versus Teflon cannulas for peripheral intravenous nutrition.

The use of peripheral intravenous nutrition using standard Teflon cannulas is limited by a high incidence of thrombophlebitis, with resultant frequent line changes and compromised nutritional therapy. Fine-bore silicone catheters may reduce the incidence of thrombophlebitis; we prospectively compared the silicone catheter with a Teflon cannula in a randomised trial. Seventy-nine surgical patients were randomised to receive peripheral nutrition (10 g nitrogen; 1770 kcal; 650 mOsm/l) either via a Teflon cannula (18G, 4.4 cm long) or via a silicone catheter (23G, 15 cm long). Compared with the group randomised to a standard Teflon cannula, patients fed via a silicone catheter had a significant (P < 0.001) improvement in (a) median time to survival of the first catheter (125 h vs 48 h); (b) incidence of catheter reinsertions (13% vs 75%); and (c) incidence of thrombophlebitis (10% vs 48%). Delivery of a moderately hypertonic nutritional solution through a fine-bore silicone catheter is safe, durable and well tolerated, with a low incidence of complications relative to a Teflon cannula. An expanded role for this catheter in nutritional therapy is feasible, which may reduce the requirement for central venous parenteral nutrition.

Adult↗

PubMed2001

Common femoral artery anatomy is influenced by demographics and comorbidity: implications for cardiac and peripheral invasive studies.

We assessed the angiographic size of the common femoral artery (CFA) and the influence of demographics and comorbidites. In addition, the location of the CFA bifurcation and the site of femoral puncture were also assessed. Consecutive CFA angiograms (n = 200) were prospectively analyzed. CFA diameter was 6.9 +/- 1.4 mm and length 43.3 +/- 16.2 mm. By multivariate analysis, only diabetes (P < 0.001), female gender (P < 0.0005), and small body surface area (P < 0.01) predicted small vessel size. Vessel length correlated with patient height (P < 0.0005). CFA bifurcation occurred at or below the femoral head center in 98.5%. The femoral puncture was into a vessel other than the CFA in 13%, and 54% of punctures were in a less than ideal anatomical location. In conclusion, the CFA is a relatively small diameter vessel, particularly in diabetics and women. Puncture above the femoral head center and below the superior margin of the acetabulum accurately predicts an ideal puncture site. Thus, routine fluoroscopic guidance should be considered. Cathet Cardiovasc Intervent 2001;53:289-295.

Aged↗

PubMedDate not supplied

Factors affecting the life span of peripheral intravenous lines in hospitalized infants.

A study was undertaken to identify the effect of insertion site, cannula size and brand type, blood, and unit setting on the life span of IVs in hospitalized infants. A comparative descriptive design was used to study 250 data sets gathered from charts of infants 12 months of age and under, in the NICU, PICU, and general pediatric units at a children's medical center in the Southwest. Analysis revealed no significant difference in life span of nonelectively discontinued IVs by insertion site, cannula size, or brand type. A statistical difference was found in the life span of IVs regarding blood infusion: IVs in which blood had infused lasted longer than those without blood products. A statistical difference in IV life span was also found between the unit settings, with a longer life span for IVs on the general pediatric units than for those on the NICU. Research-based knowledge about factors that influence the life span of IVs in infants could be helpful in making practice decisions and in parent teaching.

Catheterization, Peripheral↗

PubMed1990

[Endobronchial sonography in the diagnosis of pulmonary and mediastinal tumors].

Endobronchial sonography was performed during bronchoscopy in 58 patients (48 males and 10 females; mean age 59 [29-76] years) with confirmed pulmonary or mediastinal tumour using a 6.2 or 9 F ultrasound catheter. The procedure was successfully performed in 50 patients from the trachea down to the smallest bronchi (of 2 mm diameter). Tumour tissue was not visualized in five patients with small peripheral carcinomas. In three patients the catheter probe could not be passed through the tumour region. The method provided a three-dimensional image of the bronchial wall, corresponding to the histological tissue layers of mucosa, cartilage and adventitia. Pulmonary arteries were identified by the echo-free lumen and pulsatile oscillations in calibre. Tumours and lymph-nodes were echo-poor and could thus be distinguished from the echo-rich bronchial wall. Several consequences arose from these findings: laser treatment was not proceeded with in two cases, because a fairly large pulmonary artery lay near the stenosis; in three cases malignant tumours were recognized to lie either entirely intramurally or peribronchially, which had not been seen on bronchoscopy alone. It is concluded from these preliminary observations that endobronchial sonography is a highly promising addition to conventional bronchoscopy.

Adult↗

PubMedDate not supplied

Comparison of two percutaneous intravenous "midline" catheters in cystic fibrosis.

Administration of intravenous antibiotics in cystic fibrosis has been facilitated by the use of midline catheters; percutaneous lines inserted through a peripheral vein and advanced into a large but noncentral vein. In a randomized study, a 23-gauge silastic catheter (Vygon EC, Cirencester, United Kingdom) was compared with the Hydrocath (Viggo-Spectromed, Swindon, United Kingdom), a 22-gauge hydrophillic coated polyurethane catheter inserted using the Seldinger technique. Fifty eight courses of intravenous antibiotics were given, 28 through the Hydrocath (median age 11 years, range 1.5-17.5 years) and 30 through the silastic catheter, (median age 11 years, range 0.5-17.5). Mean line survival was equal. The Hydrocath took longer to insert and was associated with more pain on insertion. However, administration of antibiotics was easier through the Hydrocath and overall satisfaction was higher in those who had the Hydrocath. Both catheters performed well, but administration of antibiotics was easier through the Hydrocath.

Anti-Bacterial Agents↗

PubMed1987

Local thrombolysis in peripheral arteries and bypass grafts.

Sixty-two patients hospitalized for recent angiographically documented arterial occlusion in the legs (46 femoropopliteal arteries and 16 grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a No. 4F or No. 5F catheter. This therapy combined a continuous urokinase (UK) infusion of 1000 U/kg/hr and a lysyl plasminogen (LYS-PLG) infusion of 15 mukat every 30 minutes. Angiographically confirmed lysis was obtained in 77% of the cases. Five percent of the patients had major and 8% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK and LYS-PLG is as effective as streptokinase but produces lower systemic fibrinolysis. However, local fibrinolysis remains a potentially hazardous procedure (10% suffered major complications) and must only be applied to patients with severe ischemia and little or no possibility of surgical intervention.

Adult↗

PubMed1997

Absorption and metabolism of nivalenol in pigs.

The absorption and metabolism of nivalenol (NIV) were studied in pigs fed 0.05 mg NIV/kg BW, twice daily. Blood samples were taken during the first and third day, through catheters in the hepatic portal vein and peripheral mesenteric artery. Nivalenol was detected in most of the earliest blood samples, taken twenty minutes after the start of feeding. During 7.5 hrs after feeding, 11-43% of the NIV dose was absorbed. The systemic peak concentrations were 3-6 ng NIV/ml, mostly occurring 2.5-4.5 h after feeding. Sixteen hours after feeding, NIV was still being absorbed from the intestine, and the systemic concentrations were 1-3 ng NIV/ml. Nivalenol was mainly excreted in faeces, which contained concentrations up to 3.2 mg NIV/kg. No metabolites of NIV were found in plasma, urine, and faeces, either as glucuronic acid or sulphate conjugates, or as de-epoxy-NIV, indicating a lack of metabolism. The feeding of NIV did not cause feed refusal, and measured clinical plasma parameters were within the normal ranges.

Alanine Transaminase↗

PubMedDate not supplied

Outpatient parenteral antimicrobial therapy in osteoarticular infections in children.

There are few data on the use of outpatient parenteral antimicrobial therapy (OPAT) in the management of osteoarticular infections (OAIs) in childhood. The objective of this study was to determine if OPAT is safe and effective in the management of OAIs. Using their OPAT database, the authors evaluated the use of OPAT in children younger than 18 years old treated for OAIs between January 1, 1995, and December 31, 1999. One hundred eighty-four OAIs were treated in 179 patients over 5 years. OPAT involved central venous lines (CVLs) in 110 (59.8%), peripherally inserted central catheters (PICCs) in 71 (38.6%), and peripheral cannulas in 3 (1.6%). One hundred eighteen (64%) OPAT courses were completed without interruption. Rehospitalization occurred in 48 (26.1%) courses and occurred earlier with PICC. OPAT complications were catheter-related in 58 (30%) courses, not catheter-related in 60 (32%), and unknown in 10 (5.3%). The mechanical complication rate was 6.3 per 1,000 catheter-days (CVL 4.2, PICC 10.6), and the rate of infectious complications was 2.7 per 1,000 catheter-days (CVL 2.8, PICC 2.4). One hundred sixty-eight (98%) of 172 evaluable OAIs were cured. Four (2.2%) patients failed treatment: one had recurrence and three had persistent infection. The authors conclude that OPAT can be safely used to manage OAIs in children without compromising outcome. Mechanical complications are more common with PICCs.

Acute Disease↗

PubMed1991

[Surgical management of peripheral vascular disease in patients with severe coronary artery disease: importance of operative concept to reconstruct catheter insertion route for PTCA or CABG].

We discussed the operative concept of revascularization of lower extremities in patients associated with severe, coronary artery disease (CAD). Those with symptomatic CAD may undergo coronary artery bypass (CABG) or percutaneous coronary angioplasty (PTCA) with or without intraaortic balloon pump (IABP). Special attention should be paid during operation in these patients in order to reconstruct the arterial catheter route, which gives us the best way to percutaneous transfemoral approach to the aorta or the coronary arteries. One should not choose arbitrarily extra-anatomical bypass, such as axillo-femoral or femorofemoral, in these cases. Also, artificial graft should not be applied in the common femoral arteries, which will make percutaneous approach difficult. Common femoral arteries, if needed, are best reconstructed by means of thromboendarterectomy. Attaining smooth, bilateral aorto-ilio-femoral continuity is the main goal of revascularization of lower extremities in patients with CAD.

Aged↗

PubMedDate not supplied

Skilled iv therapy clinicians' product evaluation of open-ended versus closed-ended valve PICC lines: a cost savings clinical report.

The IV therapy clinician team at Florida Hospital has become active product selectors of IV therapy materials for the institution. It is recognized for its expertise, experience, and knowledge in IV therapy. As end users of many IV therapy products, members are well-qualified to act as principal product selectors of these patient care items. These clinicians identified costly problems with the performance of a conventional open-ended peripherally inserted central catheter (PICC) product being used. A market search for a better product was done and the Bard Groshong closed-ended valve PICC (Bard Access Systems, Inc., Salt Lake City, UT) was selected. These PICCs were used for a 6-week trial period. The 58 inserted Groshong closed-ended valve PICCs were compared with the last 58 open-ended PICCs inserted. Greater quality assessment was apparent in its performance. A substantial cost savings of 21% also was achieved by using the Groshong closed-ended valve PICCs. A clinical report comparing these two products was presented to the value analysis committee. The validated superior performance of the Groshong closed-ended valve PICC with the cost savings for the 6-week trial period won the committee's approval and the change was made to the Groshong closed-ended valve PICC.

Catheterization, Central Venous↗

PubMed1997

Recirculation, urea disequilibrium, and dialysis efficiency: peripheral arteriovenous versus central venovenous vascular access.

When accurate, non-urea-based methods of measuring recirculation are used, recirculation is usually absent in arteriovenous (AV) accesses. When urea-based methods are used to measure recirculation in AV accesses, falsely elevated recirculation rates are common. These errors are due to AV and venovenous disequilibrium (peripheral vein method), delayed systemic sampling (two-needle methods), and errors in urea measurement (all methods). The literature suggests that recirculation in central venovenous (CV) catheters is approximately 5%. The methods used for these determinations have all been urea based. However, there are few theoretical problems in using urea-based measurements for measuring recirculation in this setting, making it more likely that these values are accurate. When hemodialysis via CV and AV accesses are compared, equilibrated Kt/V values differ significantly for the same single-pool Kt/V when 15-second postdialysis blood urea nitrogen values are used for modeling, but differ minimally when 2-minute postdialysis samples are used. The impact of transient retrograde blood flow in the superior vena cava on recirculation and whether dialysis efficiency is influenced by the exact site of CV catheter placement (superior vena cava v right atrium) is uncertain.

Blood Circulation↗

PubMed2002

Antibiotics differ in their tendency to cause infusion phlebitis: a prospective observational study.

Intravenous administration of antibiotics is a known risk factor for infusion phlebitis. We have previously demonstrated differences in cell toxicity for 4 antibiotics. Clinical experience indicates that antibiotics differ in their tendency to cause phlebitis. The present study was done prospectively on 550 patients with 1386 peripheral venous catheters. The incidence of phlebitis was 18.5% with antibiotics and 8.8% without (odds ratio 2.34). Dicloxacillin (odds ratio 5.74) and erythromycin (odds ratio 5.33) had the greatest tendency to cause phlebitis in univariate, multivariate and Cox regression analyses. Benzylpenicillin, cefuroxime and cloxacillin were also associated with a greater risk of phlebitis, whereas ampicillin, imipenem/cilastatin, clindamycin, netilmicin and vancomycin were not. Other risk factors were the site of insertion and age 51-60 y. Medication with warfarin was found to be protective, but not with aspirin. Treatment with low molecular weight heparin reduced the risk of phlebitis, but the difference was not significant. With regard to when antibiotics were given, the day-specific risk increased between Days 1 and 2, but no further on subsequent days. The hypothesis that antibiotics differ in their tendency to cause phlebitis was confirmed.

Adult↗

PubMed1993

The Australian Incident Monitoring Study. Problems associated with vascular access: an analysis of 2000 incident reports.

There were 65 incidents involving access to the vascular system amongst the first 2000 reported to the Australian Incident Monitoring Study. Thirty-three involved peripheral venous access (14 cases of extravascular extravasation, 8 of unintended arterial cannulation, 6 of disruptions to intravenous lines, and 5 of problems with infusion lines, taps, pumps and connectors). Eighteen cases involved central venous access (9 cases of arterial puncture with haematomas, 5 with morbidity and/or prolonged admission), 5 of catheter misplacement and pneumo- or hydro-thorax and 4 of problems arising from operator inexperience. Thirteen cases involved peripheral arterial access (5 involved equipment problems (3 with possible air embolism), 3 of mistaking an arterial for a venous line (drugs were injected in 2), 3 of losing arterial lines or signals, and 2 in which the presence of an arterial line placed the patient at risk). The anaesthetist should always question the continued integrity of any vascular access system, even when it has recently been shown to be functioning, and the possibility of later "migration" and misplacement should always be borne in mind. Whenever possible, correct placement of the tip should be checked (e.g. by visual inspection of the site, use of test doses, aspiration of blood, pressure measurement, X-rays). When there is more than one line, all lines and sites of access (e.g. 3-way taps) should be clearly labelled and checked before anything is injected or infused.

Accidents↗

PubMed2002

Initial clinical results of tenecteplase (TNK) in catheter-directed thrombolytic therapy.

PURPOSE: To investigate the safety and immediate efficacy of 2 different doses of tenecteplase (TNK) in peripheral catheter-directed thrombolytic therapy of arterial occlusions and deep vein thrombosis (DVT). METHODS: Over a 20-month period, 63 nonconsecutive patients underwent catheter-directed thrombolytic therapy with either 0.25 mg/h or 0.50 mg/h of TNK in a nonrandomized, open-label study. Of these, 55 patients (60 limbs) were treated for DVT (36 limbs in 16 men and 15 women; mean age 41 years, range 21-73) or peripheral arterial occlusions (24 limbs in 16 men and 8 women; mean age 63 years, range 32-91). The primary endpoints were major bleeding complications and angiographic reduction in clot burden. RESULTS: The mean duration of infusion was 18 +/- 4 hours in patients with arterial occlusions and 30 +/- 13 in those with DVT. Twenty-one (87.5%) patients with occlusive disease had marked or complete lysis of clot. Thirty (83.3%) limbs with DVT had either marked or complete resolution of thrombus. There were 4 (7.3%) episodes of minor bleeding with 1 (1.8%) major hemorrhagic event. Fibrinogen levels dropped by an average of 23%. CONCLUSIONS: Preliminary evidence suggests that TNK doses of 0.25 mg/h to 0.50 mg/h appear to be safe and effective. The potential benefits of TNK therapy warrant further investigation.

Adult↗

PubMed2006

Treatment of pediatric suppurative mastoiditis: is peripherally inserted central catheter (PICC) antibiotic therapy necessary?

OBJECTIVE: A review of the treatment of pediatric acute mastoiditis requiring surgical intervention managed with and without PICC therapy postoperatively. STUDY DESIGN AND SETTING: Retrospective study of 42 cases from 1989 to 2004 treated at a regional children's hospital. RESULTS: Sixteen patients received postoperative PICC therapy and 26 received a course of oral antibiotics. The PICC group received on average 12.12 days of intravenous antibiotics compared to only 3.53 days for the non-PICC group (P < 0.001). No differences were observed between the two groups in treatment outcomes. One patient from each group required rehospitalization. One minor complication was experienced in a patient in the PICC group. There were no surgical complications. The total cost for outpatient PICC therapy increased treatment costs by approximately $1500 to $2500. CONCLUSIONS: Oral antibiotic therapy is sufficient after surgical intervention for acute pediatric suppurative mastoiditis without intracranial complications and does not result in adverse treatment outcome. SIGNIFICANCE: Use of PICC therapy after surgical intervention for mastoiditis should be limited. EBM RATING: B-3b.

Acute Disease↗