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Results for “Catheterization, Peripheral”

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PubMed1989

[Excimer laser angioplasty in arterial obstructive disease. Clinical experience with guidewire-controlled catheter systems].

Percutaneous transluminal laser angioplasties (PTLA) were performed in nine patients (7 males, 2 females, aged 52-81 years) with peripheral vascular disease, stages IIB-IV (Fontaine's classification), with 75% stenosis (5 patients) or occlusion (4 patients) in the area of the superficial femoral artery. Two catheter systems were used. One was a monofiber catheter (600 microns) with eccentric guidewire, the other a multifiber catheter with 12 concentrically arranged fibres (200 microns each) and a central guidewire. An XeCl-excimer laser (308 nm), with a pulse duration of 50 ns and pulse frequency of 15-30 Hz, served as the laser source. It was possible in all patients to reduce the stenosis of 75-100% to 35-70% or reopen the occlusion without laser-associated complications. To remove the residual stenosis PTLA was followed by balloon dilatation in seven patients and by application of a Simpson atherectomy catheter in one patient: these measures reduced the degree of stenosis to 20-40%.

Aged↗

PubMed1996

Emerging technology in critical care: continuous intra-arterial blood gas monitoring.

The blood-conserving technology of continuous intra-arterial blood gas monitoring has recently been introduced into the field of critical care. This type of monitoring is a real-time method for concomitantly assessing oxygenation, ventilation, and acid-base status in pediatric and adult populations through an indwelling (in vivo) sensor residing in a peripheral artery. This article examines the technology underpinning in vivo blood gas monitoring and reviews research documenting clinical performance, as well as benefits and clinical applications of three-analyte systems in critically ill patients. A majority of research has revealed clinically acceptable accuracy and reliability of in vivo blood gas sensors in critically ill adults subjected to a variety of adverse, but common, physiological conditions. Although most clinical research in critically ill adults has revealed good clinical performance of in vivo blood gas sensors, reports of aberrant blood gas values and sensor problems remain; no reports have been published to date evaluating continuous intra-arterial blood gas monitoring in children or infants. Many benefits of this technology have been postulated, and research examining its effect on patient and cost outcomes in critically ill populations is pending. Clinicians in critical care must keep abreast of this emerging technology, because it holds significant potential for improving the quality of care and outcomes of critically ill patients.

Adult↗

PubMedDate not supplied

A fast responding intra-arterial pH electrode for use in the peripheral artery of adult humans and large mammals: a technical development for use in research.

A rapidly responding intra-arterial pH electrode has been developed to provide a continuous record of arterial pH (pHa) in the radial artery of adult humans and large mammals. The current method for measuring pHa is discontinuous and is achieved by taking blood samples and subsequently measuring pHa in a blood gas analyser. The development of an intravascular electrode is needed for studies on the chemical control of pulmonary ventilation when a continuous record of pHa is required. It will be particularly useful in rapidly changing circumstances such as at the onset and termination of exercise and at sleep onset and arousal. The sensor of the electrode system described here consists of a pH sensitive plastic membrane adherent to the tip of a catheter. This catheter is threaded down a radial artery catheter and protrudes 2-3 mm into the arterial lumen. The electrode system has been used in patients in an intensive care unit and in patients undergoing sleep studies. No adverse complications have occurred. The records obtained showed that arterial pH faithfully followed changes in pulmonary ventilation.

Adult↗

PubMed1996

Factors influencing nurses' handling and control of peripheral intravenous lines--an interview study.

The purpose of the study was to describe how nurses (n = 37) planned, took care of, and documented peripheral intravenous (vein) cannulae (PIV) and what controls their way of action. Knowledge, experience, and routine were said to govern the care and handling of PIV. The nurses' intention was that a PIV should be inserted for 1-3 days, but all of them were aware of PIV being inserted considerably longer, the reasons being forgetfulness, carelessness, mistake, no one to take responsibility, bad routines and stress. Patients who had received drugs or solutions daily were given less information and furthermore the same PIV-entry was used for drugs, solutions and blood. Only one nurse documented the insertion and the removal of a PIV. The nurses' personal comments were that the area was neglected and there were great variations in the care and handling of PIV. Their task is to systematically identify the patients' needs and risk factors, and to analyse, diagnose, plan, implement and evaluate the care given. Using a standardised guide could be a way to reduce the frequency of complications in the daily care of PIV.

Adult↗

PubMedDate not supplied

Patency and tissue response related to two types of polytetrafluoroethylene-covered stents in the dog.

PURPOSE: A canine model was used to determine tissue response related to placement of two different designs of polytetrafluoroethylene (PTFE) covered stents in the peripheral vascular system. MATERIALS AND METHODS: Two types of PTFE covered stents were implanted in the iliac arteries of 15 mongrel dogs. The tissue response within and beneath these endoprostheses was studied and compared to that for control Palmaz stents with angiographic and histologic examination at 1, 3, and 6 months. RESULTS: The bare Palmaz stent endothelialized faster and with a thinner neointima than either covered stent design. Neointima formation proceeds from the ends toward the center of PTFE-covered stents regardless of design, with minimal transgraft tissue penetration. However, the pattern of neointimal response differed for the two designs and suggests that early thrombus formation at the stent-graft interface promotes neointimal development. CONCLUSION: The bare Palmaz stent showed the least amount of luminal encroachment at all time points compared with either covered stent. Regarding the covered stents, the different patterns of tissue response with the covered stents may provide insight into the design of stent-grafts for human use.

Animals↗

PubMedDate not supplied

Sutured securement of peripherally inserted central catheters yields fewer complications in pediatric patients.

BACKGROUND: Pediatric peripherally inserted central catheters (PICCs) can be secured with tape, sutures, or sutureless securement devices. Despite widespread catheter use, no standardized method of securement has been proven superior. METHODS: A prospective randomized trial of catheter securement with either tape or suture was undertaken in pediatric patients hospitalized at a tertiary children's hospital. Patient demographics, catheter dwell time, and all catheter complications were collected. All patients were followed for the entire dwell time of the catheter, including those discharged with lines still in place. RESULTS: Sixty-six patients completed the study, with 34 children in the suture group and 32 children in the tape group. Patients' ages ranged from 9 months to 19 years. Overall complication rate in our sutured group was 5.8%, and 32.4% in the tape group. CONCLUSIONS: In this study of children of varying ages, sutured PICCs were associated with significantly fewer complications than those catheters secured with tape (p=.005). The 3 most common complications included migration, occlusion, and leaking catheters.

Adolescent↗

PubMed2006

Peripherally inserted central catheters and upper extremity deep vein thrombosis.

The purpose of the study was to determine the incidence and risk factors for venous thrombosis in patients with a peripherally inserted central catheter (PICC). A retrospective study of all upper extremity venous duplex scans was carried out in the Vascular Medicine department from year 2000 to 2002 inclusive. A chart review of positive scans was undertaken to identify possible thrombotic risk factors. Of 317 upper extremity venous duplex scans carried out, 115, or 32%, were positive for upper extremity deep vein thrombosis. Three main risk factors were identified - presence of a central line, malignancy and administration of chemotherapy. PICC were the most common central line present. Symptomatic thrombosis occurred in 7% of PICC inserted for chemotherapy compared with 1% of PICC inserted for other reasons. Ten per cent of the patients receiving chemotherapy through a PICC developed a thrombosis. The post-thrombotic syndrome was infrequent following upper extremity deep vein thrombosis. Patients receiving chemotherapy through a PICC are at increased risk of thrombosis. There may be a role for prophylactic low-dose anticoagulation in these high-risk patients.

Adolescent↗

PubMed2002

Detection of peripherally inserted central catheter occlusion by in-line pressure monitoring.

BACKGROUND: Peripherally inserted central catheters (PICC) are being increasingly used in neonatal practice. Their use is not without technical difficulty. This report describes the use of continuous pressure monitoring to detect catheter occlusion in critically ill neonates. METHODS: In-line venous pressure of the PICC line was monitored by pressure transducer in neonates; 28-gauge 20 cm PICC or 29-gauge 25 cm PICC were used. RESULTS: In-line pressure of the PICC was monitored 64 times in 50 neonates. Increases in the in-line pressure were observed when the catheter tip was against the vessel wall and the catheter was obstructed partially or completely. Decreases were observed when the infusion syringe was changed and when an inappropriate infusion rate was set. Two infants experienced marked variations of blood pressure due to intermittent catheter occlusion of the tip against the vessel wall. These infants were receiving dopamine via a PICC line. CONCLUSIONS: In critically ill infants, in-line pressure monitoring of the PICC is helpful in detecting the occlusion of the catheter.

Catheterization, Central Venous↗

PubMed2000

Comparison of in-vivo antibacterial activity of two skin disinfection procedures for insertion of peripheral catheters: povidone iodine versus chlorhexidine.

Skin disinfection is a key step in the prevention of nosocomial infections especially prior to invasive procedures such as the insertion of peripheral catheters. Alcohol-based antiseptics improve bactericidal activity and decrease the time needed for skin disinfection in emergencies. A randomized study was performed in two groups of 22 volunteers to compare the in vivo bactericidal effect of two rapid disinfection procedures using povidone iodine (PVP-I) in scrub formulation followed by alcoholic PVP-I, or chlorhexidine in scrub formulation followed by alcoholic chlorhexidine. Bacteria were recovered using the cylinder scrub method. Comparison of reductions in the aerobic and anaerobic flora from baseline levels to each of the three sampling times (30 sec, 3 min, 2 h) showed no significant difference between the two procedures Log(10)reduction after 30 seconds was around 1.5 for the aerobic flora and 1.1 for the anaerobic flora. After 3 minutes the corresponding values were 2.1 and 1.8, and after 2 hours 2.0 and 1.3. The products were well tolerated in both groups. The two procedures had comparable rapid bactericidal activity in vivo.

Adult↗

PubMedDate not supplied

Risks associated with 72- and 96-hour peripheral intravenous catheter dwell times.

BACKGROUND: The risk of complications in peripheral intravenous therapy is higher on the second day of therapy and may continue to increase with time, making routine restarts after 3 days a common practice. The objective of the study was to determine whether the risks of complications after a peripheral i.v. catheter restart after 72 hours are less than the risks of complications if the therapy is continued to 96 hours. METHODS: A retrospective chart review was completed for 722 patients in a community hospital with peripheral i.v. catheters for i.v. fluids or saline locks. Measurements collected were i.v. therapy start date, number of restarts, termination date, and reason for termination; the data were analyzed using risk models. RESULTS: There were 596 uncomplicated therapies. Complications prompted termination in 188 cases. The average duration of therapy was 1.8 days. The probability of complications was least in the first 24 hours, (0.074; standard deviation [SD], 0.013), and increased to 0.176 (SD, +/- 0.026) in the 24- to 48-hour period. The probability of a complication in the 48- to 72-hour period and the 72- to 96-hour period was 0.130 (SD, 0.026). A restarted catheter has a significantly higher risk of complication in its first 24 hours than does an initial catheter. CONCLUSIONS: From these results, the authors conclude that restarting catheters at 72 hours does not reduce the risk of complication in the next 24 hours when compared with simply continuing the therapy with the original catheter. Additional studies should be conducted to justify a policy of automatically restarting therapy after 72 hours.

Catheterization, Peripheral↗

PubMed2001

Hemodynamic effects of the different vascular accesses used for double-filtration plasmapheresis.

Systematic investigations of hemodynamic status during double filtration plasmapheresis (DFP) are rare in the literature. To investigate the hemodynamic effects of the vascular access chosen for DFP, variations in blood pressure (BP) and pulse rate (PR) induced acutely by DFP were prospectively analyzed in 46 myasthenia gravis (MG) patients a standard DFP protocol with isovolumetric saline fluid replacement. BP and PR were monitored at 30-min intervals (baseline, M30, M60, M90, and M120) during the procedures. The patients were randomized into central vein (CV) and peripheral vein (PV) groups based on the vascular access used. Systolic BP (SBP) dropped significantly at M60 (P < 0.05), M90 (P < 0.001), and M120 (P < 0.001) when compared to the baseline level. Symptomatic hypotension was not observed in any of the 46 sessions. SBP values during DFP in the CV group were significantly lower than the PV group's at M60 (93.1 vs. 101.0%, P < 0.05) and marginally lower at M90 (91.2 vs. 97.2%, P = 0.06). There was no significant difference in diastolic BP changes between the two groups. In the CV and PV groups, PR changes during plasmapheresis also differed at M90 (103.4 vs. 94.5%, P < 0.001) and M120 (101.3 vs. 95.0%, P < 0.05). The significantly lower SBP during DFP in the CV group at M60 may be due to the high central vein flow rate and resultant delay in volume replacement. In conclusion, the vascular access selected for DFP plays a role in the pathogenesis of plasmapheresis-related hypotension. Controlling flow rates may help to prevent hypotension.

Adolescent↗

PubMedDate not supplied

Intravascular site care: are critical care nurses practicing according to written protocols?

OBJECTIVE: To observe and describe site care for intravascular devices, to identify internurse variations in site care, and to compare written protocols for site care with actual practice in one geographic area. DESIGN: Observational, descriptive study. SETTING: Adult critical care units in one community, and one university teaching hospital in the Washington, D.C., metropolitan area. SAMPLE: Direct observation of 86 central and 30 peripheral site care episodes. RESULTS: A total of 116 site care episodes were observed on five critical care units. There were wide variations between units from the same hospital in gloving practices and use of aseptic technique. Significant differences across both hospitals, as well as between individual units, were noted for a number of other practices including: time since last site care, use of ointment and skin adhesive, type of dressing used, and duration of care. In both hospitals, compliance with all steps of the written protocol was similar-23.2% and 23.3%. Compliance with documentation requirements ranged from 53.3% to 85.7%, and was significantly different between the two hospitals with regard to recording the dressing change and whether the dressing label and chart agreed. CONCLUSIONS: Intravascular site care varies significantly among critical care units within the same institution, as well as between different hospitals, and varies from written protocol. Standardized, well-defined site care protocols and education of staff, along with quality improvement surveillance systems are needed to ensure consistent quality intravascular site care.

Adult↗

PubMed2002

Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates.

AIM: To determine whether the addition of heparin to total parenteral nutrition (TPN) fluid would prevent blockage of peripherally inserted central catheters (PICCs) in neonates. METHODS: This was a randomized, double-blind, controlled study of 66 eligible neonates with PICCs inserted for the administration of TPN. Infants were randomized to receive TPN containing either 1 IU ml(-1) of heparin (n = 35) or no heparin (n = 31). RESULTS: There was no significant difference in the incidence of blocked catheters between the two groups of infants (heparin: 14.3%; no-heparin: 22.6%, p = 0.4). Although a higher percentage (62.9%) of infants in the heparin group received a complete course of TPN successfully via PICC than those in the no-heparin group (48.4%), the difference was not statistically significant (p = 0.3). There were no significant differences in the incidence of catheter-related sepsis, hypertriglyceridaemia, hyperbilirubinaemia, coagulopathy or intraventricular haemorrhage between the two groups. CONCLUSION: Addition of heparin to TPN fluid was not associated with a significant reduction in the incidence of blocked PICCs. However, the sample size of this study was too small to exclude even rather marked differences between the groups.

Catheterization, Central Venous↗

PubMed2006

[Use and abuse of intravenous catheters in conventional hospital wards].

BACKGROUND: Information regarding the use intravenous catheters (IVC) in conventional hospital units and its consequence in terms of intravenous catéter-related bacteremia (ICRB) is scarce. OBJECTIVES: To evaluate the use of IVC in patients admitted in conventional wards of a general hospital and to measure IVCRB incidence in such patients. METHODS: We evaluated during one week IVC use in adult patients admitted in 12 de Octubre Hospital and we calculated la incidence density of ICRB. RESULTS: We evaluated the clinical charts of 731 patients (284 from medical wards and 447 from surgical wards), of which 338 (46.2%) had a peripheral VC inserted and 63 (8.6%) a central IVC. Central IVC had been inserted for a mean time 11.5 days globally (CI 95% 5.57-17.42), being 28.3 in medical wards and 8.32 days in surgical wards (p = 0.2). In 27.7 % of the patients with IVC intravenous antimicrobials was the only reason for the use of such catheters in spite of adequate oral tolerance in 30 % of the patients with central IVC an specific note explaining the reason for implanting such catheter was lacking in the clinical chart. IVCRB was detected in 12/401 patients (3%). The incidence density of IVCRB in central IVC was 8.28 per 1000 catheter-days. CONCLUSIONS: There are some aspects that could be clearly improved regarding the prevention of IVCRB, mostly in the indications, the excess of time those catheters are kept implanted and in the lost chances for catheter withdrawal when switch-therapy could be performed.

Adolescent↗

PubMed2004

[Intravenous catheters and nosocomial infection].

Peripheral, especially central venous catheters, are used with increasing frequency in the intensive care unit and in general medical wards to administer intravenous fluids and blood products, drugs, parenteral nutrition, and to monitor hemodynamic status. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay. Risk factors in the development of catheter colonization and bloodstream infections include patient factors (increased risk associated with malignancy, neutropenia, and shock) and treatment-related factors (increased risk associated with total parenteral nutrition, intensive care unit admission for any reason, and endotracheal intubation). In this review article terms and definitions of catheter-related infections, pathophysiology and epidemiology of "catheter sepsis", factors determining risk of infection, catheter types and materials, insertion procedure, choice of insertion site, indwelling time, dressing and care of the insertion site, various preventive strategies and future developments, special situations and procedures, and treatment are discussed. Reducing catheter infections rates requires a multiple-strategy approach. Therefore, intensive care units and other locations where catheters are used should implement strict guidelines and protocols for catheter insertion, care, and maintenance.

Antibiotic Prophylaxis↗

PubMed1993

A cluster of coagulase-negative staphylococcal bacteremias associated with peripheral vascular catheter colonization in a neonatal intensive care unit.

BACKGROUND: A cluster of six neonatal cases of coagulase-negative staphylococcal bacteremias occurred in a Los Angeles County neonatal intensive care unit in March 1989. METHODS: A retrospective cohort study assessed the impact of host-and delivery-related variables, length of hospitalization, duration of antibiotic treatment, performance or duration of invasive procedures, and staffing variables on risk of coagulase-negative staphylococcal bacteremia. RESULTS: Unstratified analyses yielded eight risk factors with risk ratios greater than 2. After stratification by gestational age (less than 29 weeks) and low birth weight (less than 1500 gm), frequency of blood transfusions, duration of respiratory therapy, heparin lock and central vascular line placement, and hyperalimentation remained associated with elevated risk. Two species were identified, arguing against a common source of infection. Of four cohort months with more than 15 very low birth weight infants in the neonatal intensive care unit, an elevation of coagulase-negative staphylococcus-positive blood cultures and diagnosed bacteremias occurred in only two. CONCLUSIONS: This cluster of coagulase-negative staphylococcal bacteremia was probably caused by frequent manipulation of catheters in neonates who were at heightened risk because of low birth weight and prematurity.

Bacteremia↗

PubMed1996

Microbial translocation in neonates and infants receiving long-term parenteral nutrition.

OBJECTIVE: To explore whether episodes of endogenous septicemias due to microbial translocation are clinically relevant in neonates and infants who are receiving long-term parenteral nutrition (PN). DESIGN: Prospective observational cohort study of 2 years. SETTING: Neonates and infants who underwent surgical procedures and required PN because of gastrointestinal abnormalities. MEASUREMENTS: Surveillance cultures of the oropharynx and gut were obtained at the first of PN and thereafter twice each week. These cultures were processed for all microorganisms, except for coagulase-negative staphylococci, in a semiquantitative manner to detect overgrowth. A blood sample was taken for culture from both the central venous line and peripheral vein on clinical indication only. Microbial translocation was diagnosed when the microorganisms that were isolated from the blood sample were also carried in the throat and/or rectum within the 2 weeks preceding the episode of septicemia. MAIN RESULTS: Of 94 infants, 10 (11%) experienced 24 episodes of septicemia (ie, 7.3 septicemic episodes per 1000 days of PN). Six infants experienced 15 episodes of microbial translocation due to enteric microorganisms, including Escherichia coli, Klebsiella, Candida species, and enterococci. Microbial translocation occurred after a median of 58 days of PN (range, 32 to 286 days). The enteric organisms that caused septicemia were always present in the throat and/or rectum and in high concentrations ( > 10(5) colony-forming units per gram [ie, overgrowth]) in 60% of the translocation episodes. All but one episode occurred in infants with an abnormal serum bilirubin level ( > 17 mumol/L [0.99 mg/dl]). CONCLUSIONS: In neonates and infants who are receiving PN, septicemia may be a gut-related phenomenon.

Abdominal Muscles↗

PubMed1994

Acute peripheral arterial occlusion: predictors of success in catheter-directed thrombolytic therapy.

PURPOSE: To determine predictors of clot dissolution in patients undergoing catheter-directed urokinase thrombolysis for peripheral arterial occlusion (PAO). MATERIALS AND METHODS: The study included 103 patients with limb-threatening symptoms of embolism lasting 14 days or less and resulting from embolism (n = 20) or thrombosis (n = 83). Successful lysis was defined as restitution of antegrade flow with less than 20% diameter reduction by residual thrombus. Stepwise logistic regression was used to analyze the data. RESULTS: Relevant clinical variables were diabetic status (odds ratio, 0.75; P = .04 for diabetic patients), conduit type (1.25; P = .04 for native artery and 1.51; P = .02 for prosthetic graft), and number of arterial segments involved (1.60; P = .02 for one level and 1.42; P = .03 for two levels). Important procedural variables included intrathrombus positioning of catheter ports (odds ratio, 7.40; P = .001) and guide wire passage through the occlusion (3.10; P = .003). Absolute thrombus volume was nonpredictive but correlated with reperfusion time (P = .02) and infusion time (P = .01). CONCLUSION: Predictive parameters may help in the selection of candidates with PAO for thrombolytic therapy.

Acute Disease↗