scholarly journals P147: International scope of emergency ultrasound: barriers to utilizing ultrasound to guide central venous catheter placement by providers in Kenya

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S127-S127
Author(s):  
F. Zaver ◽  
K. Boniface ◽  
H. Shokoohi ◽  
B. Wachira ◽  
G. Wanjiku
Keyword(s):  
Central Venous Catheter ◽  
Previous History ◽  
Venous Catheter ◽  
Standard Of Care ◽  
Comfort Level ◽  
Perceived Barriers ◽  
University Hospital ◽  
Central Venous ◽  
International Scope ◽  
Survey Responses

Introduction: While ultrasound (U/S) use for internal jugular central venous catheter (CVC) placement is standard of care in many institutions in North America, most developing countries have not adopted this practice. Previous surveys of American physicians who are not currently using U/S to place CVCs have identified lack of training and equipment availability as the most important barriers to the use of U/S. We sought to identify Kenyan physicians’ perceived barriers to the use of U/S to guide CVC insertion in a resource-constrained environment. Methods: The study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Physicians participating in a one-hour course teaching U/S guided CVC placement were asked to complete a survey before beginning training, which was used to assess previous experience with U/S, and evaluate perceived barriers to U/S. Survey responses were analyzed using summary statistics and the Rank-Sum test to compare the difference between participants’ responses based on different specialty, gender and previous history of using U/S. Results: There were 23 physicians who completed the course and the survey. They included 6 internal medicine, 5 critical care, 5 anesthesia, 2 emergency medicine and 5 physicians from other specialties. The mean length of practice was 5 years. 52% (95% CI: 0.30-0.73) had put in >20 CVCs. 21.7% (95% CI: 0.08-0.44) of participants had previous U/S training, but none have received any training on the use of U/S for CVC insertion. The respondents expressed agreement on the ease of the use, improved success rate, and decreased failure rate with U/S guidance. However, less agreement was found regarding the perceived superior convenience and cost effectiveness of U/S CVC placement (see Figure). The lack of training or comfort with the U/S and the availability of U/S and equipment to maintain sterility were reported as the main barriers for use. Neither previous U/S experience nor specialty of the respondent significantly affected responses. Conclusion: Barriers to the use of U/S guidance for the placement of CVCs in Nairobi, Kenya are similar to those found among American physicians. These include training and comfort level with U/S in placement of CVCs, as well as resources required for U/S equipment and to keep the field sterile.

scholarly journals International Scope of Emergency Ultrasound: Barriers in Applying Ultrasound to Guide Central Line Placement by Providers in Nairobi, Kenya

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Fareen Zaver ◽  
Keith Boniface ◽  
Benjamin Wachira ◽  
Grace Wanjiku ◽  
Hamid Shokoohi
Keyword(s):  
North American ◽  
Venous Catheter ◽  
Standard Of Care ◽  
Central Line ◽  
Perceived Barriers ◽  
University Hospital ◽  
Limited Availability ◽  
International Scope ◽  
Us Guidance ◽  
Survey Responses

Background. While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US. Objective. We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment. Methods. Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine previous experience and perceived barriers. Survey responses were analyzed using summary statistics and the Rank-Sum test based on different specialty, gender, and previous US experience. Results. There were 23 physicians who completed the course and the survey. 52% (95% CI: 0.30–0.73) had put in >20 CVCs. 21.7% (95% CI: 0.08–0.44) of participants had previous US training, but none in the use of US for CVC insertion. The respondents expressed agreement with statements describing the ease of the use and improved success rate with US guidance. There was less agreement to statements describing the relative convenience and cost effectiveness of US CVC placement compared to the landmark technique. The main perceived barriers to utilization of US guidance included lack of training and limited availability of US equipment and sterile sheaths. Conclusion. Perceived barriers to US-guided CVC placement in our population closely mirrored those found among North American physicians, including lack of training and limited availability of US machines and equipment. These barriers have the potential to be addressed by targeted educational and administrative interventions.

scholarly journals Association of Immediate Reinsertion of New Catheters With Subsequent Mortality Among Patients With Suspected Catheter Infection: a Cohort Study

2021 ◽  
Author(s):  
Yiyue Zhong ◽  
Liehua Deng ◽  
Limin Zhou ◽  
Shaoling Liao ◽  
Liqun Yue ◽  
...  
Keyword(s):  
Propensity Score ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Cox Proportional Hazards ◽  
University Hospital ◽  
Matched Cohort ◽  
Central Venous ◽  
Kaplan Meier ◽  
Increased Risk

Abstract BackgroundCentral venous catheter (CVC) insertion complications are a prevalent and significant problem in the intensive care unit (ICU), but optimal strategy for management in patients with suspected catheter-related bloodstream infection (CRBSI) remains unclear. We sought to determine the effect of immediate reinsertion of new catheter (IRINC) on 30-day mortality among patients after central venous catheter (CVC) removal for suspected CRBSI.MethodsWe conducted a propensity-score-matched cohort of suspected CRBSI who underwent IRINC or not in a 32-bed ICU of university hospital in China during the period from January 2009 through April 2021. We used the results of catheter tip culture to identify patients with suspected CRBSI by index for institutional electronic laboratory databases. The inclusion criteria were age ≥ 18 years, CVC and suspected CRBSI. The exclusion criteria were dialysis catheters, peripheral catheterization, length of stay less than 48 hours, and patients with no access to medical records. Kaplan-Meier method was used to analyze 30-day mortality before and after propensity-score-matching, and adjusted hazard ratio (HR) and 95% confidence interval (CI) for mortality in matched cohort were estimated with Cox proportional hazards models.ResultsIn total, 1238 patients with CVC removal due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. In 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan-Meier analysis found that IRINC showed a similar risk of mortality before matching (P=0.00096) and after matching (P=0.018). The competing risks analysis confirmed the results of the propensity score-matched analysis. The attributable risk for bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) but that for pneumonia was significantly different (HR, 1.128; 95% CI 1.031 to 1.233) in patients with suspected CRBSI in terms of 30-day mortality.ConclusionsIRINC during suspected CRBSI was associated with an increased 30-day mortality risk. These data suggest that it is necessary to focus more on other insertion-related complications along with preventing CRBSI in critically ill patients.Trial RegistrationThis study was registered with the China Clinical Trials Registry (ChiCTR1900022175), URL: http://www.chictr.org.cn/index.aspx.

Improved Clinical Outcome of Patients With Candida Bloodstream Infections Through Direct Consultation by Infectious Diseases Physicians in a Japanese University Hospital

2006 ◽  
Vol 27 (9) ◽  
pp. 964-968 ◽  
Author(s):  
Shunji Takakura ◽  
Naoko Fujihara ◽  
Takashi Saito ◽  
Terumi Kimoto ◽  
Yutaka Ito ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Infectious Diseases ◽  
Intervention Group ◽  
Venous Catheter ◽  
Antifungal Treatment ◽  
University Hospital ◽  
First Year ◽  
Central Venous ◽  
Significant Difference ◽  
Baseline Group

Objective.To examine whether intervention by infectious diseases physicians (IDPs) in the treatment decisions that emphasize adequate antifungal treatment and early removal of central venous catheter for patients with Candida bloodstream infection (BSI) improves prognosis.Design.Retrospective cohort study of patients with Candida BSI, comparing the prognosis of patients before and after the start of the intervention.Setting.A 1,240-bed, tertiary care university hospital.Patients.Forty patients with Candida BSI during a 2-year period, from January 2001 to December 2002, were included in the study Twenty-three patients in the first year after the start of intervention by IDPs (intervention group) were compared with 17 patients in the first year before the start of the IDP intervention (baseline group).Interventions.In January 2002, a total of 5 IDPs at Kyoto University Hospital gave unsolicited recommendations on antifungal treatment and advised all physicians treating inpatients who had Candida BSI to remove the central venous catheter.Results.No significant difference was seen between the 2 groups in patients' clinical background, species, and fluconazole susceptibility of the causative organisms. The 30-day survival rate was significantly better in the intervention group (18 [78%] of 23 patients) than in the baseline group (7 [44%] of 16 patients; P = .04 by Fisher's exact test). More patients in the intervention group than in the baseline group received appropriate antifungal therapy (81% vs 50%) and had their central venous catheter removed at an appropriate time (95% vs 81%)Conclusion.The introduction of an active system of IDP consultation for every case of Candida BSI in our hospital substantially improved patient outcomes.

Endovascular Management following Unintentional Subclavian Artery Injury during Central Venous Catheter Placement

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
David McGreevy
Keyword(s):  
Central Venous Catheter ◽  
Subclavian Artery ◽  
Endovascular Repair ◽  
Traumatic Injury ◽  
Venous Catheter ◽  
University Hospital ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Artery Injury ◽  
Open Surgical Treatment

Background Traumatic injury to the subclavian artery during central venous catheter (CVC) placement is rare but can be catastrophic. Standard open surgical treatment is challenging and associated with significant complications. Presented is a case of endovascular treatment of these injuries and associated complications. Methods and Results This is a description of the endovascular repair of a subclavian artery injury during CVC placement at Örebro University Hospital. Conclusion This case report suggests that endovascular repair of subclavian artery injuries a less invasive and may decrease the morbidity and mortality associated with open surgical repair.

Octenidine Hydrochloride for the Care of Central Venous Catheter Insertion Sites in Severely Immunocompromised Patients

2005 ◽  
Vol 26 (8) ◽  
pp. 703-707 ◽  
Author(s):  
Andreas Tietz ◽  
Reno Frei ◽  
Marc Dangel ◽  
Dora Bolliger ◽  
Jakob R. Passweg ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Insertion Site ◽  
Venous Catheter ◽  
University Hospital ◽  
Incidence Density ◽  
Central Venous ◽  
Entry Site ◽  
Microbiological Methods ◽  
Insertion Sites ◽  
Over Time

AbstractObjective:To determine the efficacy and tolerability of octenidine hydrochloride, a non-alcoholic skin antiseptic, for the care of central venous catheter (CVC) insertion sites.Design:Prospective, observational study.Setting:Bone marrow transplantation unit of a university hospital.Patients:All consecutive patients with a nontunneled CVC were enrolled prospectively after informed consent.Methods:Octenidine hydrochloride (0.1%) was applied for disinfection at the CVC insertion site during dressing changes. The following cultures were performed weekly as well as at the occurrence of any systemic inflammatory response syndrome criteria: cultures of the skin surrounding the CVC entry site, cultures of the three-way hub connected to the CVC, blood cultures, and cultures of the CVC tip on removal. Enhanced microbiological methods (skin swabs of a 24-cm2 standardized area, roll plate, and sonication of catheter tips) were applied.Results:One hundred thirty-five CVCs were inserted in 62 patients during the study period and remained for a mean period of 19.1 days, corresponding to 2,462 catheter-days. Bacterial density at the insertion site declined substantially over time, and most cultures became negative 2 weeks after insertion. Only 6 patients had a documented catheter-related bloodstream infection. The incidence density was 2.39 catheter infections per 1,000 catheter-days. No side effects were noted with application of the antiseptic.Conclusions:Disinfection with a skin antiseptic that contains octenidine hydrochloride is highly active and well tolerated. It leads to a decrease in skin colonization over time and may be a new option for CVC care.

scholarly journals Predisposing factors for peripheral intravenous puncture failure in children

2012 ◽  
Vol 20 (6) ◽  
pp. 1072-1080 ◽  
Author(s):  
Daniela Cavalcante de Negri ◽  
Ariane Ferreira Machado Avelar ◽  
Solange Andreoni ◽  
Mavilde da Luz Gonçalvez Pedreira
Keyword(s):  
Central Venous Catheter ◽  
Prevalence Ratio ◽  
Venous Catheter ◽  
Clinical History ◽  
Venous Access ◽  
Predisposing Factors ◽  
University Hospital ◽  
Central Venous ◽  
Cross Sectional ◽  
History Of

OBJECTIVE: To identify predisposing factors for peripheral intravenous puncture failure in children. METHODS: Cross-sectional cohort study conducted with 335 children in a pediatric ward of a university hospital after approval of the ethics committee. The Wald Chi-squared, Prevalence Ratio (PR) and backward procedure (p≤0.05) tests were applied. RESULTS: Success of peripheral intravenous puncture was obtained in 300 (89.5%) children and failure in 35 (10.4%). The failure rates were significantly influenced by: presence of clinical history of difficult venous access, malnourishment, previous use of peripherally inserted central venous catheter, previous use of central venous catheter, and history of phlebitis or infiltration. In the multivariate model, being malnourished and having previously been submitted to central venous catheterization were the predisposing factors for the failure. CONCLUSION: The failure rate of 10.4% is similar to that identified in analogous studies and was influenced by characteristics of the children and intravenous therapy. In association with this, malnutrition and previous use of a central venous catheter were the most important variables influencing increase in peripheral intravenous puncture failure.

Central Line–Associated Bloodstream Infections in Children With Hematologic and Oncologic Diseases: First Prevalence Results From a University Hospital

2019 ◽  
Vol 36 (5) ◽  
pp. 327-336
Author(s):  
Gülçin Özalp Gerçeker ◽  
Figen Yardımcı ◽  
Yeşim Aydınok
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
University Hospital ◽  
High Rate ◽  
Central Venous ◽  
Coagulase Negative Staphylococci ◽  
Cross Sectional ◽  
Pediatric Hematology

Central line–associated bloodstream infections (CLABSIs) are still a major cause of morbidity and mortality in pediatric hematology-oncology patients in many countries. This cross-sectional study was a retrospective review of CLABSI in inpatient pediatric hematology-oncology cases with long-term central venous catheter at the Pediatric Hematology Department from January 2013 to June 2014. Characteristics of CLABSI events in pediatric patients with hematologic malignancies and related nonmalignant hematologic conditions are documented. CLABSI developed in 61.8% ( n = 21) of the 34 hospitalized patients included in the study. The CLABSI rate was 7.8 per 1,000 inpatient central venous catheter days. Coagulase-negative staphylococci was the predominant pathogen in 47.6% of the patients with CLABSI. The high rate of CLABSI requires prevention strategies to reduce CLABSI immediately. This study provides guidance in prioritizing strategies for reducing rates of infection.

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