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.

scholarly journals GLUCOCORTICOSTEROID DURING PATCH APPLICATION TO IMPROVE SCAR OUTCOME AFTER CENTRAL VENOUS CATHETER. A RANDOMIZED TRIAL

2021 ◽  
Author(s):  
Ida Bo Nissen ◽  
Mette Møller Handrup ◽  
Karen Bang ◽  
Henrik Hasle
Keyword(s):  
Placebo Group ◽  
Central Venous Catheter ◽  
Fusidic Acid ◽  
Intervention Group ◽  
Venous Catheter ◽  
Control Group ◽  
Neoplastic Disease ◽  
Central Venous ◽  
Silicone Gel ◽  
Significant Difference

Introduction: Children treated for cancer with a central venous catheter are often bothered by scarring. We studied whether glucocorticosteroid during patch occlusion has a beneficial effect on scar outcome in children and adolescents treated for neoplastic disease. Methods: A double-blinded placebo-controlled randomized clinical trial was performed. The main outcome was the Vancouver Scar Scale (VSS). Secondary outcomes were scar width and scar quality measured using the Patient and observer scar assessment (POSAS). The patients were divided into an intervention groups and a control group. The intervention group was randomized into two groups; Active and placebo group. The active treatment consisted of cream with glucocorticosteroid and fusidic acid. The placebo treatment consisted of cream with fusidic acid. Both groups were also treated with a silicone gel patch for three months after central venous catheter removal. The control group did not receive any specific skin care. Results: Assessment at 6 months were completed for 44 in the intervention group (21 in the active and 23 in the placebo group) and 47 in the comtrol group. The intervention group had a significantly lower VSS and a smaller scar compared to the control group (p = 0.00, p = 0.02). The POSAS by the patients and the study nurse showed no significant difference between the intervention and control groups (p = 0.84, p= 0.36). Conclusions: Silicone gel sheet alone or in combination with application of glucocorticosteroid during sheet occlusion improved scar outcome after removal of central venous catheter in children treated for neoplastic diseases.

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 Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients

2020 ◽  
Vol 2 (1) ◽  
pp. 12
Author(s):  
Gehan A. F. Atia
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Care Bundle ◽  
Central Venous ◽  
Significant Difference ◽  
Post Test ◽  
Catheter Care

Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records. Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups. Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.

Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

2018 ◽  
Vol 35 (9) ◽  
pp. 869-874 ◽  
Author(s):  
Jacob Bell ◽  
Munish Goyal ◽  
Sallie Long ◽  
Anagha Kumar ◽  
Joseph Friedrich ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Complication Rate ◽  
Venous Catheter ◽  
Complication Rates ◽  
Central Venous ◽  
Site Specific ◽  
Mechanical Complications ◽  
Significant Difference ◽  
Insertion Techniques ◽  
Delayed Complications

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. Results: In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. Conclusions: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

scholarly journals Needleless Closed System Does Not Reduce Central Venous Catheter-Related Bloodstream Infection: A Retrospective Study

2013 ◽  
Vol 98 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Mitsuru Ishizuka ◽  
Hitoshi Nagata ◽  
Kazutoshi Takagi ◽  
Keiichi Kubota
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Closed System ◽  
Venous Catheter ◽  
Time Interval ◽  
Central Venous ◽  
Significant Difference ◽  
Group 2 ◽  
Colorectal Cancer Patients ◽  
Catheter Related Bloodstream Infection

Abstract The needleless closed system (NCS) has been disseminated in several clinical fields to prevent central venous catheter–related bloodstream infection (CVC-RBSI), in place of the conventional Luer cap system (LCS). The purpose of this study is to examine whether NCS is really superior to conventional LCS for prevention of CVC-RBSI. Between May 2002 and December 2008, 1767 patients received CVC in our department. The time interval from insertion to development of CVC-RBSI was compared retrospectively between selected patients who were treated using the conventional LCS (group 1, n = 89, before June 2006) and the NCS (group 2, n = 406, June 2006 and after). Kaplan-Meier analysis revealed no significant difference in the time interval from insertion to development of CVC-RBSI between the two groups. NCS does not reduce CVC-RBSI in adult colorectal cancer patients who undergo CVC insertion.

scholarly journals Evaluation of Demographic and Clinical Characteristics of the Patients Undergoing Surgery With Ultrasound in Internal Jugular Vein Cannulation Requiring Central Venous Catheter

2020 ◽  
Vol 23 (4) ◽  
pp. 512-523
Author(s):  
Hossein Hemmati ◽  
◽  
Jalal Aboutalebi ◽  
Mohaya Farzin ◽  
Ghazaleh Hemmati ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Venous Catheter ◽  
Ethics Committee ◽  
Medical Sciences ◽  
Central Venous ◽  
Internal Jugular Vein Cannulation ◽  
Vein Cannulation ◽  
Significant Difference

Background and Aim This study aimed to investigate the demographic and clinical information of patients undergoing surgery with ultrasound in internal jugular vein cannulation. Methods & Materials After the approval of the plan in the ethics committee of Guilan University of Medical Sciences, this study was performed in the general surgery department of Razi Hospital in 2018 on 100 patients in need of central venous catheter implantation. The neck type (distance between the two designated areas) was entered in a special form made by the researcher and after the completion of the design, it was examined and statistically analyzed. Ethical Considerations This research ethically approved by the Ethics Committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.1396.20) Results The mean age of the studied patients was 58.72±16.09 years. The anatomical and sonographic margins between the two Land Mark areas were higher in men VS women, but there was no statistically significant difference (P>0.05). However, there was no statistically significant difference between the other variables. (P>0.05). Conclusion The findings of this study show that catheterization of the internal jugular vein under the guidance of ultrasound was less access time and fewer complications.

scholarly journals Central venous catheter based closed thoracic drainage in the treatment of tuberculous pleuritis

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Ling Song ◽  
Yueling Zhang ◽  
Qiong Jia
Keyword(s):  
Quality Of Life ◽  
Treatment Group ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Control Group ◽  
Central Venous ◽  
Thoracic Drainage ◽  
Significant Difference ◽  
Tuberculous Pleurisy

Objective: To explore the clinical effect of central venous catheter closed thoracic drainage in the treatment of tuberculous pleurisy. Methods: One hundred and four patients with tuberculous pleurisy who were admitted to Binzhou People’s Hospital from August 2016 to August 2017 were divided into a control group and a treatment group according to random number table method, 52 each. The control group was treated with conventional pleural puncture and drainage, while the treatment group was treated with closed central venous catheter based thoracic drainage. The clinical efficacy, improvement time of clinical symptoms, total volume of drainage, pleural thickness, and improvement of quality of life and occurrence of adverse reactions were compared between the two groups. Results: Pleural effusion, fever and chest tightness of the treatment group disappeared earlier (P<0.05); the hospitalization time in the treatment group was less than that in the control group (P<0.05); the total amount of drainage in the treatment group was lower than that in the control group (P<0.05); the pleural thickness of the treatment group was higher than that in the control group (P<0.05); the quality of life score in the treatment group was significantly higher than that in the control group (P<0.05). The total effective rates of the treatment group and the control group were 93.5% and 85%, respectively, with a significant difference (P<0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group, with a significant difference (P<0.05). Conclusion: Central venous catheter based closed thoracic drainage is more effective than conventional thoracic puncture and drainage in the treatment of tuberculous pleurisy. It can accelerate the improvement of clinical symptoms, improve the quality of life of patients, and reduce the incidence of complications. It is worth popularizing and applying. doi: https://doi.org/10.12669/pjms.35.4.63 How to cite this:Song L, Zhang Y, Jia Q. Central venous catheter based closed thoracic drainage in the treatment of tuberculous pleuritis. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.63 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Pregnancy Outcome in Late-onset Severe OHSS Patients Following Different Ascetic Fluid Drainage and Comparison With the Non-OHSS IVF Patients

2020 ◽  
Author(s):  
Ren YUN ◽  
rong li ◽  
Yang Shuo ◽  
Yang Rui ◽  
Song Dong hong ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Pregnancy Outcome ◽  
Live Birth ◽  
Late Onset ◽  
Multiple Pregnancy ◽  
Venous Catheter ◽  
Control Group ◽  
Central Venous ◽  
Significant Difference ◽  
Severe Ohss

Abstract Introduction： Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic serious complication during assisted reproductive technology, the aim of our research is to explore the differences of pregnancy outcome between severe OHSS patients and the non-OHSS IVF patients, and also compare the pregnancy outcome of different ascites drainage way of severe OHSS patients.Design: This is a retrospective cohort analysis carried out in a University-affiliated reproductive center from 2012 to 2019 ,between 359 women with severe OHSS following ascites draining and 345 non-OHSS women (matched by age and retrieved oocyte number).We examined the rates of clinical pregnancy, multiple pregnancies, miscarriage, live birth and preterm delivery between the two groups. Within the OHSS group (central venous catheter group vs paracentesis group), odds ratios (ORs) and 95% confidence intervals (CIs) of measure of clinical pregnancy were also analyzed.Result： The biochemical pregnancy loss rate of non-OHSS patients was significantly higher than that of severe OHSS patients (11.1% vs 0.6%) , the live birth, multiple pregnancy (twin pregnancy ) was much more in severe OHSS group than in control group(88.9% vs 73.5%; 57.6% vs 28.1% respectively), and there was no significant difference between singleton and twin preterm rate and neonatal birth weight between OHSS and control group. Binary logistic regression analysis revealed multiple pregnancy and long-protocol showed relatively high odds ratio, suggest that thelong-protocol of COS and multiple pregnancy are the risk factor of severe OHSS.Among severe OHSS following ascites draining, in comparison with abdominal paracentesis and central venous catheter, the ascites volume in central venous catheter group was much more than abdominal paracentesis group, there was significant difference between the two groups. There was no significant difference between the two groups in comparison of live birth, and the birth weight of singleton and twin between these two groups. but the premature birth rate of singleton in group 1 was 9.3% (10/107), whereas in group 2, it was 3.75%.Conclusion： In conclusion, this preliminary report suggests that for the IVF-ET patients, less basic follicle number, GnRH antagonist cycle, singleton maybe the protective factors for the late-onset OHSS. Paracentesis and central venous catheter are all the effective modality to manage the ascites for the severe OHSS patients. For the patients who have the possibility of repeated paracentesis, catheter is a safe and effective way.

Increased Risk for Venous Thromboembolism in Patients with Acute Leukemia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4555-4555
Author(s):  
Martin Mohren ◽  
Ilka Markmann ◽  
Kathleen Jentsch-Ullrich ◽  
Michael Koenigsmann ◽  
Gerd Lutze ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Acute Leukemia ◽  
Blast Crisis ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous ◽  
P Values ◽  
Prophylactic Measures ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction: Patients with solid tumors have an increased risk for venous thromboembolisms (VTE) associated with substantial morbidity and mortality, but so far there exists little data on hematologic malignancies. We have recently found a VTE rate of 7,7% in patients with malignant lymphoma. However, information on patients with acute leukemia (AL) is very limited so far. Patients and methods: Medical records of all patients with AL treated in our institution between january 1992 and april 2005 were reviewed and data was collected and analyzed in a microsoft excel data base. P-values to show correlation of VTE with leukemia type, patient age and gender were calculated using Fisher’s exact test. All reported p-values are two-sided. Results: Of a total of 455 patients 310 (68%) had AML, 108 (24%) had ALL and 37 (8%) had blast crisis. 248 patients (55%) were male and 207 (45%) were female, median age was 60 years. 55 patients with AL (12,1%) had at least one VTE, occuring during therapy in 82% of events. 27 patients (5,9%) had central venous catheter associated VTE, whereas 28 patients (6,2%) had deep vein thrombosis and/or pulmonary embolism. Neither leukemia lineage - myeloid versus lymphocytic - (p=1,0) nor patient gender (p=.193) had an impact on the VTE risk. However, central venous catheter associated VTE more likely occured in younger patients (< 60 years) than in patients ≥ 60 years (p=.003). There was no statistically significant difference in the incidence of non-central venous catheter associated VTE between both age groups (p=.563). Discussion: Patients with acute leukemia have a substantial risk for VTE, half of which occur with the use of central venous catheters. A recently published study analysed the incidence of VTE in close temporal relationship to onset of disease and found a VTE rate of 2,09% with equal risk in ALL and AML. Our study included VTE occuring prior to diagnosis of AL as well as during chemotherapy and follow up, revealing a VTE rate that is 6-fold higher and showing a considerable association with central venous catheters. Conclusions: The risk of VTE is surprisingly high in patients with acute leukemia, thus improvement of prophylactic measures, especially in regard to central venous catheter use is warranted.

Simple Formula to Place Central Venous Catheter Tip at T6 After Surgical Cutdown in Neonates

2015 ◽  
Vol 100 (11-12) ◽  
pp. 1424-1428
Author(s):  
Eunhye Lee ◽  
Suk-Bae Moon
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Optimal Placement ◽  
Central Venous ◽  
Entry Site ◽  
Significant Difference ◽  
Catheter Tip ◽  
Postconceptional Age

The objective of this paper was to develop a generally applicable formula to estimate correct catheter length after surgical cutdown in right internal jugular vein (RIJV) in neonates. The carina has been utilized as an anatomic landmark indicating superior vena cava-right atrium junction (SVC-RA) for the optimal placement of the central venous catheter (CVC) tip position. However, this landmark may not be accurate in neonates. Recent researches noted that the sixth vertebral body (T6) could better serve as a new landmark of SVC-RA in neonates and smaller children. We prospectively performed RIJV cutdown. For a controlled and reproducible surgical procedure, the venous entry site was consistently taken as the point where the omohyoid muscle crosses the RIJV. On intraoperative infantogram, the vertical distance between the venous entry site and T6 was measured and the catheter was inserted to this length. A linear regression model was investigated using the following variables to elicit the best prediction model for catheter length: gestational age, postconceptional age, birth weight, and weight at operation. Weight at operation best correlated with the measured CVC length (R2 = 0.916, P = 0.00), and the following linear equation was derived: estimated CVC length (mm) = 9 × [weight at operation (Kg)] + 30. There was no statistically significant difference between measured and estimated CVC length. With this formula, the optimal catheter length could easily be estimated when considering RIJV cutdown.

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