Care of Central Lines

2005 ◽  
pp. 929-935
Author(s):  
Steven Eyer
Keyword(s):  
Central Lines

scholarly journals Peripheral Inotropes in Critically Ill Children: Is It Safe?

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110222
Author(s):  
Ravi K. Mooli ◽  
Kalaimaran Sadasivam
Keyword(s):  
Central Venous Access ◽  
Pediatric Intensive Care ◽  
Venous Access ◽  
Critically Ill Children ◽  
Middle Income ◽  
Central Lines ◽  
Middle Income Countries ◽  
Peripheral Venous Access ◽  
Vasoactive Medications

Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

scholarly journals Does Nursing Shift Influence Adherence to Central-Line Maintenance Bundles?

2020 ◽  
Vol 41 (S1) ◽  
pp. s195-s195
Author(s):  
Josephine Fox ◽  
Robert Russell ◽  
Lydia Grimes ◽  
Heather Gasama ◽  
Carrie Sona ◽  
...  
Keyword(s):  
Multinomial Logistic Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
Night Shift ◽  
Insertion Site ◽  
Central Line ◽  
Central Lines ◽  
Bundle Compliance ◽  
Evening Shift ◽  
Infusion Tubing

Background: Proper care and maintenance of central lines is essential to prevent central-line–associated bloodstream infections (CLABSI). Our facility implemented a hospital-wide central-line maintenance bundle based on CLABSI prevention guidelines. The objective of this study was to determine whether maintenance bundle adherence was influenced by nursing shift or the day of week. Methods: A central-line maintenance bundle was implemented in April 2018 at a 1,266-bed academic medical center. The maintenance bundle components included alcohol-impregnated disinfection caps on all ports and infusion tubing, infusion tubing dated, dressings, not damp or soiled, no oozing at insertion site greater than the size of a quarter, dressings occlusive with all edges intact, transparent dressing change recorded within 7 days, and no gauze dressings in place for >48 hours. To monitor bundle compliance, 4 non–unit-based nurse observers were trained to audit central lines. Observations were collected between August 2018 and October 2019. Observations were performed during all shifts and 7 days per week. Just-in-time feedback was provided for noncompliant central lines. Nursing shifts were defined as day (7:00 a.m. to 3:00 p.m.), evening (3:00 p.m. to 11:00 p.m.), and night (11:00 p.m. to 7:00 a.m.). Central-line bundle compliance between shifts were compared using multinomial logistic regression. Bundle compliance between week day and weekend were compared using Mantel-Haenszel 2 analysis. Results: Of the 25,902 observations collected, 11,135 (42.9%) were day-shift observations, 11,559 (44.6%) occurred on evening shift, and 3,208 (12.4%) occurred on the night shift. Overall, 22,114 (85.9%) observations occurred on a week day versus 3,788 (14.6%) on a Saturday or Sunday (median observations per day of the week, 2,570; range, 1,680–6,800). In total, 4,599 CLs (17.8%) were noncompliant with >1 bundle component. The most common reasons for noncompliance were dressing not dated (n = 1,577; 44.0%) and dressings not occlusive with all edges intact (n = 1340; 37.4%). The noncompliant rates for central-line observations by shift were 12.8% (1,430 of 1,1,135) on day shift, 20.4% (2,361 of 11,559) on evening shift, and 25.2% (808 of 3,208) on night shift. Compared to day shift, evening shift (OR, 1.74; 95% CI, 1.62–1.87; P < .001) and night shift (OR, 2.29; 95% CI, 2.07–2.52; P < .001) were more likely to have a noncompliant central lines. Compared to a weekday, observations on weekend days were more likely to find a noncompliant central line: 914 of 3,788 (24.4%) weekend days versus 3,685 of 22,114 (16.7%) week days (P < .001). Conclusions: Noncompliance with central-line maintenance bundle was more likely on evening and night shifts and during the weekends.Funding: NoneDisclosures: None

Association between risk of bloodstream infection and duration of use of totally implantable access ports and central lines: A 24-month study

2011 ◽  
Vol 39 (7) ◽  
pp. e39-e43 ◽  
Author(s):  
Junichi Yoshida ◽  
Toshiyuki Ishimaru ◽  
Tetsuya Kikuchi ◽  
Nobuo Matsubara ◽  
Ikuyo Asano
Keyword(s):  
Bloodstream Infection ◽  
Central Lines

744 A Quality Improvement Project on Timely Removal of Central Venous Catheters

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Devarakonda ◽  
P J Korula ◽  
S Kandasamy
Keyword(s):  
Online Survey ◽  
Blood Stream ◽  
Central Line ◽  
High Morbidity ◽  
Alert System ◽  
Improvement Project ◽  
Central Lines ◽  
Surgical Icu ◽  
Intervention Adherence ◽  
The Mean

Abstract Introduction Central Line-Associated Blood Stream Infections are associated with high morbidity and mortality. It is essential to ensure quality in insertion, maintenance, and timely removal of central lines. Our ICU follows a protocol to remove unused lines after five days. We have an electronic alert system to monitor these lines, and we wanted to audit its usage and improve its efficacy. Method This project was designed using QI methodology and was carried out in a Level III Surgical ICU. We implemented two PDSA cycles in August and December 2020. After the first cycle, an online survey was performed among ICU doctors to gauge their knowledge of the alert system and local protocols. Based on the above results, an educational session was carried out, showing a step-by-step guide to using the alert system, and a re-audit was done in December. Results The first cycle showed that alerts were created for only 17 (25%) of 68 lines. Also, the survey revealed that about 30% of doctors were unfamiliar with the alert system. After the intervention, adherence to the alert system increased to 65% (alerts for 41 of 63 lines). There was also a significant improvement in the mean number of central line days from 6.4 (SD = 3.1) to 4.2 (SD = 2.8) [P &lt;  .05]. Conclusions It is crucial to monitor central lines, and simple educational sessions about local protocols can bring success in implementing sustainable change in quality. We suggest hospitals have systems to monitor the central lines and regularly audit their effectiveness.

Superior vena cava (SVC) filters placed over central lines – analysis of line trapping and difficulties with line retrieval: an in-vitro experimental study

2014 ◽  
Vol 55 (6) ◽  
pp. 732-736 ◽  
Author(s):  
Jorge E Lopera ◽  
Murray Shapiro ◽  
Darlene Sanchez ◽  
Carolina Maya ◽  
Ghazwan Kroma ◽  
...  
Keyword(s):  
Experimental Study ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Lines

Thrombotic Complications of Tunneled Central Lines in Children With Malignancy

2010 ◽  
Vol 32 (2) ◽  
pp. 88-92 ◽  
Author(s):  
Tomasz Ociepa ◽  
Eliza Maloney ◽  
Tomasz Urasinski ◽  
Marcin Sawicki
Keyword(s):  
Central Lines ◽  
Thrombotic Complications

scholarly journals PERIPHERAL INOTROPES IN CRITICALLY ILL CHILDREN - IS IT SAFE?

2021 ◽  
Author(s):  
Ravi K Mooli ◽  
K Sadasivam
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Critically Ill Children ◽  
Central Venous ◽  
Middle Income ◽  
Central Lines ◽  
Middle Income Countries ◽  
Peripheral Venous Access ◽  
Vasoactive Medications ◽  
Paediatric Intensive Care Units

ABSTRACTMany children needing paediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access.AimThe aim of our study was to estimate the safety of peripheral vasoactive inotropes in children.MethodsChildren requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at two time points on use and complications of peripheral vasoactive medications.ResultsEighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely.ConclusionsResults from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it can be safely administered in children at a diluted concentration.

scholarly journals Agronomic parameters and morpho-agronomic characteristics of genetically modified maize hybrids compared to conventional maize hybrids

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Leandro Nogueira Ramos ◽  
Nara Oliveira Silva Souza ◽  
Michelle Souza Vilela
Keyword(s):  
Grain Yield ◽  
Climatic Conditions ◽  
Stem Diameter ◽  
Central Lines ◽  
Maize Hybrids ◽  
Agronomic Characteristics ◽  
Bt Genes ◽  
Midwest Region ◽  
Bt Gene

The objectives were to study the behavior of fifteen pre-commercial upland maize hybrids, analyze their agronomic performance regarding grain yield, and evaluate productivity components, as well as morpho-agronomic characteristics, in the Midwest Region of Brazil. Two experiments were conducted in the municipalities of Formosa-GO and Planaltina-DF, 2016/17 crop year. Both consisted of five pre-commercial maize hybrid platforms (HPA252, HPB262, HPB621, HPB646, and HPD354). Each platform consisted of three different versions: conventional, transgenic with a Bt gene that expresses the protein Cry1F, and transgenic with two Bt genes that express the proteins Cry1F and Cry1AB. The experiment was randomized blocks with four replications. The experimental plot was four lines five meters long considering the two central lines as useful. The lines were spaced 0.75 meters apart, and the final density was five plants per linear meter. To estimate grain yield, the plots were harvested, and the weight was extrapolated to kg.ha-1. The moisture was standardized at 14%. Data were submitted to analysis of variance, and the means were compared by Tukey test at 5% probability using the Sisvar software. Grain yield between treatments ranged from 8,381 to 12,908 kg.ha-1, and the average yield was 11,234 kg.ha-1. The parameters evaluated were divided into two groups. The first group contained parameters determining grain yield: grain depth, thousand grains weight, number of rows of grains, number of grains per row, and grain yield. The second group contained morpho-agronomic parameters that directly interfere with resistance to lodging and plant breaking: plant height, ear insertion height, and mean stem diameter. There was no direct effect of the transgenes on the evaluated hybrids since the classification of productivity was not divided into conventional and transgenic classes. It is suggested that the HPA252YH, HP621H and HP646H versions be discarded because grain yield performance was unsatisfactory compared to their respective conventional and transgenic counterparts. The parameters GD and W1000 are more effective for grain yield estimation than NR and NG. It was observed for HP621H that, in addition to a lower grain yield, there was a significant reduction in stem diameter, indicating a possible reduction in lodging tolerance and/or plant breaking when exposed to adverse climatic conditions such as windstorms. For the HPD354H version, the release of the transgenic counterpart HPD354YH is preferentially indicated since the H version had a significant reduction in stem diameter and a possible greater tolerance to lodging and/or plant breaking under the same conditions.  

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