Anaphylaxis and anaphylactoid reactions associated with the insertion of peripherally inserted central catheters: A multiyear comparative retrospective cohort study

2019 ◽  
Vol 40 (11) ◽  
pp. 1215-1221
Author(s):  
Christina S. Thornton ◽  
Jody Dumanski ◽  
Cherylanne Margherit ◽  
Sandra Vaz-Gonsalves ◽  
Sheryl McDiarmid ◽  
...  
Keyword(s):  
Adverse Events ◽  
Tertiary Care ◽  
Fisher Exact Test ◽  
Peripherally Inserted Central Catheters ◽  
Vascular Access Devices ◽  
Exact Test ◽  
Ottawa Hospital ◽  
Study Results ◽  
Anaphylactoid Reactions ◽  
Central Catheters

AbstractObjective:Peripherally inserted central catheters (PICCs) are a mainstay of nonpermanent vascular access devices. In this study, we assessed patients displaying anaphylaxis or anaphylactoid reactions to the PowerPICC SOLO and Groshong PICC (Bard Access Systems) using the Sherlock tip locating system (TLS).Methods:Patients from 2 tertiary-care hospitals were systematically monitored over 4 years for adverse events following the insertion of a PICC using the Sherlock TLS. Insertion data were also collected using the BioFlo PICC (Angiodynamics)from a third hospital site and from The Ottawa Hospital over 4 years as an additional comparator. Three definitions of anaphylaxis and anaphylactoid reactions were utilized, and the Cohen κ was used to assess interrater agreement. Analysis of reactions among the patient cohorts was performed using the χ2 test with Yates correction or the Fisher exact test as appropriate.Results:Among 8,257 insertions using the TLS PICCs, 37 potential reactions (0.45%) were recorded. Using specific definitions for anaphylaxis or anaphylactoid reactions, 54.1%–91.9% met criteria. Comparator populations using data from Calgary (n = 491) and Ottawa (n = 7,889) using the BioFlo PICC insertion found no reactions. Anaphylactic or anaphylactoid reactions were significantly associated with the PowerPICC SOLO and Groshong PICC with the TLS compared to the BioFlo PICC (P < .0001) across all definitions. The largest subset of patients experiencing adverse reactions had cystic fibrosis (CF) (n = 4, 10.8%).Conclusion:Our study results demonstrate significant adverse events associated with the PowerPICC SOLO and Groshong PICC using the Sherlock TLS inserted across a range of patient populations. The incidence rate of anaphylaxis or anaphylactoid reactions in the CF population at our center is significantly higher than in non-CF patients (P < .001).

scholarly journals Methods for measuring venous peripherally inserted central catheters in newborns

2022 ◽  
Vol 75 (2) ◽  
Author(s):  
Andreia Tomazoni ◽  
Patrícia Kuerten Rocha ◽  
Mavilde da Luz Gonçalves Pedreira ◽  
Elisa da Conceição Rodrigues ◽  
Bruna Figueiredo Manzo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Neonatal Intensive Care ◽  
Descriptive Analysis ◽  
Institutional Review Board ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Institutional Review ◽  
Significant Difference ◽  
Catheter Tip ◽  
Central Catheters

ABSTRACT Objective: to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. Methods: this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. Results: modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. Conclusions: between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.

scholarly journals Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

2020 ◽  
Author(s):  
Ramesh J. Venkatapura ◽  
Surya K. Dubey ◽  
Nidhi Panda ◽  
Dhritiman Chakrabarti ◽  
Sudhir Venkataramaiah ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Tertiary Care ◽  
Neurological Complications ◽  
Vascular Pathology ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Cranial Surgery

Abstract Background  Cranial surgery is associated with multiple postoperative complications varying from simple nausea and vomiting to devastating complications such as stroke and death. This multicentre collaborative effort was envisioned to collect observational data regarding postoperative complications in cranial surgeries among the Indian population. The aim of this study was to describe the postoperative neurological complications occurring within the first 24 hours after surgery and to identify the predictive factors. Methods Data was collected from three participating tertiary care academic institutions. The study was prospective, observational, multicentre design with data collected over a period of two months or 100 cases, whichever is earlier, from each participating institute. A predesigned Microsoft excel sheet was distributed among all three centers to maintain uniformity. All patients aged 18 years and above of both sexes undergoing elective or emergency craniotomies were included in the study. The postoperative neurological complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined as new focal neurological motor deficit relative to preoperative status. (2) Sensorium deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure activity. All possible variables associated with the above neurological complications were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors, which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5% was taken as significant. Results Data from three institutions was collected with a total of 279 cases. In total, there were 53 (19%) neurological complications. There were 28 patients with new postoperative NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological deficits were significantly less in institution 2. Diagnosis of traumatic brain injury (TBI) was associated with very low risk of ND, and vascular pathology was associated with higher chance of a ND. The duration of anesthesia was found to be significantly predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS. Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%, and 6.1%, respectively. Studies with a much larger sample size are required for a better and detailed analysis of these complications.

scholarly journals 2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S727-S727
Author(s):  
Romanee Chaiwarith ◽  
Wisarut Supparatpinyo
Keyword(s):  
Univariate Analysis ◽  
Tertiary Care ◽  
Control Measures ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Chiang Mai ◽  
Chi Square ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection. Methods A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model. Results Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia. Conclusion CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality. Disclosures All authors: No reported disclosures.

Abstract 3441: Differential endothelialization of stent struts across side branches: A Scanning Electron Microscopy analysis.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yi Zheng ◽  
Marlos R Fernandes ◽  
Guilherme V Silva ◽  
Cristiano O Cardoso ◽  
John F Canales ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Fisher Exact Test ◽  
Coronary Restenosis ◽  
Exact Test ◽  
Study Results ◽  
Electron Microscopy Analysis ◽  
Scanning Electron

Background: The higher incidence of MACE events in paclitaxel eluting stents (PES) has been attributed to the presence of coronary artery side branches (SB) within stented segments. This study aimed to evaluate PES struts overlying SB in a porcine model of coronary restenosis. Methods: In a balloon overstretch model of coronary restenosis (balloon:artery ratio =1.2:1), 20 animals were randomized to either PES or bare metal stents (BMS). After 30 days, 22 stented segments were analyzed by Low Vacuum Scanning Electron Microscopy (SEM) and endothelialization was assessed using a score (0=100% endothelialization; 1=99 – 67%; 2=66 –34%; 3=33–1%; 4=0%). Comparison of the distribution of endothelialization scores for struts overlying and non-overlying SB was performed within each group by the Fisher exact test. Results: A total of 18 struts overlying SB (10 PES and 8 BMS) sized from 200 to 1800μ m, were identified by SEM. In the BMS group, complete endothelialization was observed in 62.5% of SB struts and 100% of non-overlying SB struts. In PES only 20% of SB struts, but almost 100% of the non-overlying SB struts were completely endothelialized. The endothelialization of struts overlying SB was significantly different in PES and BMS groups(Fig 1A and Fig 1B ), with a higher frequency of impaired endothelialization (scores 3 and 4) in PES struts crossing SB. Conclusions: PES struts overlying SB showed significantly impaired endothelialization compared with BMS in a pig model of coronary restenosis. This results might offer a new insight to explain the higher incidence of adverse events in PES stented segments. Further studies are needed to confirm the present study results.

Letters

2008 ◽  
Vol 27 (6) ◽  
pp. 427-427
Author(s):  
Lee Shirland
Keyword(s):  
Vascular Access ◽  
Great Risk ◽  
Skin Closure ◽  
System State ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Vascular Access Devices ◽  
Dressing Change ◽  
Central Catheters

I am writing concerning an article titled “Neonatal Peripherally Inserted Central Catheters: Recommendations for Prevention of Insertion and Postinsertion Complications,” published in Vol. 27, No. 4 (July/August 2008), pages 245– 257. Of concern are Figures 3 and 4 on page 253 titled securing the catheter with adhesive skin closure strips and looping the catheter. The instructions and pictures demonstrate how to secure the catheter using skin closure strips and show the strips placed over the catheter. This is of great concern. The manufacturer’s recommendations on BD L-Cath System state the following on page 8 line 26, “Secure the catheter and dress the site with a sterile dressing. Tapes and securing devices should never be applied directly to the non-protected catheter.” This caution is echoed in the article titled “Tiny Patients, Tiny Dressings: A Guide to Neonatal PICC Dressing Change,” published in Advances in Neonatal Care, Vol. 8, No. 3, pages 141–162. The author states the following, “Some hospitals use skin closure strips. If these are utilized, manufacturer’s recommendations should be followed, and they should never be placed directly overlying the catheter to avoid catheter breakage and embolism.” The author supports this statement with the following reference, Frey AM. PICC complications in neonates and children. Journal of Vascular Access Devices. 1999: 17–26. It is clear that skin closure strips used to secure the peripherally inserted central catheter pose great risk and must never be applied directly over the catheter. Thank you for sharing this important information with your readers.

A Comparison of Coagulation Study Results Between Heparinized Peripherally Inserted Central Catheters and Venipunctures

2012 ◽  
Vol 26 (6) ◽  
pp. 310-316 ◽  
Author(s):  
Linda Humphries ◽  
Kathleen M. Baldwin ◽  
Kirstena L. Clark ◽  
Vivian Tenuta ◽  
Kimberly Brumley
Keyword(s):  
Peripherally Inserted Central Catheters ◽  
Study Results ◽  
Coagulation Study ◽  
Central Catheters

scholarly journals Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital

2021 ◽  
pp. 025371762110221
Author(s):  
Nisha K. Prajapati ◽  
Nimesh C. Parikh ◽  
Nilima D. Shah ◽  
Vinodkumar M. Darji ◽  
Heena B. Jariwala ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Psychiatric Morbidity ◽  
Adjustment Disorder ◽  
P Value ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Liaison Psychiatry ◽  
Exact Test ◽  
Consultation Liaison Psychiatry

Background: The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. Method: This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal–Wallis test, and fisher exact test. Results: Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. Conclusions: Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.

Intravascular Access

2018 ◽  
pp. 269-274
Author(s):  
Jenna Fine ◽  
Ndidi Nwokorie ◽  
Lia H. Lowrie
Keyword(s):  
Cognitive Ability ◽  
Vascular Access ◽  
Central Venous Catheters ◽  
Behavioral Modification ◽  
Peripherally Inserted Central Catheters ◽  
Vascular Access Devices ◽  
Intravascular Catheters ◽  
Control Pain ◽  
Central Catheters ◽  
Intravascular Access

Vascular access is necessary for routine and emergent care of patients for delivery of fluids and medications. The vascular access devices (VADs) discussed here include peripheral intravascular catheters, intraosseous needles, peripherally inserted central catheters (PICC lines), and central venous catheters. VAD insertion can be painful and frightening for children, and their inherently smaller anatomy may also make the procedure more challenging. Children often require behavioral modification as well as medications to control pain and anxiety in order to tolerate placement of VADs. The sedationist must have a good knowledge of the demands of the procedure, the patient’s level of cooperation and cognitive ability, and pharmacologic resources available to aid in the performance of the procedure.

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