scholarly journals Vias para Nutrição Artificial na Criança (II): Acessos Parentéricos

2014 ◽  
Vol 27 (6) ◽  
pp. 767
Author(s):  
José Estevão-Costa
Keyword(s):  
Parenteral Nutrition ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Venous Access ◽  
The Body ◽  
Central Catheter ◽  
Maintenance Care ◽  
Central Venous ◽  
Venous Catheterization

Parenteral nutrition is crucial when the use of the gastrointestinal tract is not feasible. This article addresses the main techniques for parenteral access in children, its indications, insertion details and maintenance, and complications. The type of venous access is mainly dictated by the expected duration of parenteral nutrition and by the body weight/stature. The peripheral access is viable and advantageous for parenteral nutrition of short duration (&lt; 2 weeks); a tunneled central venous catheter (Broviac) is usually necessary in long-term parenteral nutrition (&gt; 3 weeks); a peripherally introduced central catheter is an increasingly used alternative. Parenteral<br />accesses are effective and safe, but the morbidity and mortality is not negligible particularly in cases of short bowel syndrome. Most complications are related to the catheter placement and maintenance care, and can be largely avoided when the procedures are carried out by experienced staff under strict protocols.<br /><strong>Keywords:</strong> Child; Parenteral Nutrition; Catheterization, Central Venous; Catheterization, Peripheral.

Central venous thrombosis in patients receiving long-term parenteral nutrition

2008 ◽  
Vol 33 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Donald R. Duerksen
Keyword(s):  
Parenteral Nutrition ◽  
Venous Thrombosis ◽  
Vitamin K ◽  
Central Venous Access ◽  
Anticoagulation Therapy ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Thrombosis

Long-term parenteral nutrition (PN) is administered to patients who are unable to use their gastrointestinal tract to absorb sufficient nutrients and water to maintain their nutritional status. Patients receiving long-term parenteral nutrition are at risk of numerous complications including thrombosis of the central venous catheter used to provide nutrition. Central venous access is essential to the successful delivery of long-term PN. One of the strategies to lessen the frequency of this complication is anticoagulation therapy with warfarin. The effect of warfarin in preventing this complication may be modified by vitamin K intake. Individuals with gastrointestinal failure may receive vitamin K from a variety of sources. This review summarizes the role of warfarin in preventing central venous access thrombosis. It also summarizes potential sources of vitamin K intake in home parenteral nutrition patients, examines the evidence for recommendations regarding vitamin K intake, and considers the potential impact of increased vitamin K intake on home PN patients, particularly on the prevention of central venous thrombosis.

scholarly journals Tunneled central venous catheterization, a viable option for long-term venous access in pediatric burn patients

2020 ◽  
Vol 8 (33) ◽  
pp. 29-34
Author(s):  
Clayton Wagner ◽  
Andrea Hess ◽  
Jose Olascoaga ◽  
Nicole Van Spronsen ◽  
John Griswold
Keyword(s):  
Pediatric Patients ◽  
Central Venous Catheterization ◽  
Venous Access ◽  
Small Sample ◽  
Central Vein ◽  
Burn Patients ◽  
Central Venous ◽  
Venous Catheterization ◽  
Catheterization Technique

Introduction: Pediatric patients with severe burns often require long-term venous access over the course of their recovery. The need for long-term venous access in these critically ill patients often necessitates the placement of a central venous catheter (CVC). Many techniques exist for the establishment of a CVC in pediatric burn patients, and each technique poses its own set of inherent risks. No studies to date have clearly delineated the risk associated with tunneled central venous catheterization in the pediatric burn patient population. The primary aim of this study was to evaluate the use of tunneled CVCs in pediatric burn patients at the University Medical Center Hospital in Lubbock, Texas. Methods: To evaluate this method of central venous catheterization, we retrospectively reviewed the charts of pediatric burn patients who received a tunneled CVC to determine the incidence of specific complications associated with this catheterization technique. We present our findings here in a case series format. Results: Our initial search of patient charts yielded 86 potential candidates for inclusion in the study. After reviewing each chart, 26 pediatric patients were found to have received a CVC. Of these 26 patients, five met all of the inclusion criteria of our study. In these five patients, eight tunneled CVCs were placed. The average age of the patients in this series at the time of their respective burn injuries was 3.9 years old. Mean percent TBSA involvement was 38% with an average length of stay totaling 64.6 days. The average dwell time of the tunneled CVCs in this series was 28 days, and our analysis of the data revealed one tunneled catheterrelated infection and one hemodynamic complication. Conclusions: Overall, our data show that placement of long-term tunneled CVCs in pediatric burn patients appears to be a relatively safe practice. However, our small sample size warrants more investigation into this topic.Keywords: pediatrics, burns, central vein catheters

scholarly journals Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

2020 ◽  
pp. 112972982094406
Author(s):  
Lucio Brugioni ◽  
Elisabetta Bertellini ◽  
Mirco Ravazzini ◽  
Marco Barchetti ◽  
Andrea Borsatti ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Guide Wire ◽  
Case Series ◽  
Venous Catheter ◽  
Venous Access ◽  
Late Complications ◽  
Central Catheter ◽  
Central Venous ◽  
Single Lumen ◽  
Thrombotic Complications

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

scholarly journals Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition

2019 ◽  
Vol 11 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Ashley Bond ◽  
Paul Chadwick ◽  
Trevor R Smith ◽  
Jeremy M D Nightingale ◽  
Simon Lal
Keyword(s):  
Parenteral Nutrition ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Nutrition Support ◽  
Central Venous ◽  
Short Term ◽  
Qualitative And Quantitative ◽  
Central Venous Catheter Removal ◽  
Support Team

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

scholarly journals A Five-Year Data Report of Long-Term Central Venous Catheters Focusing on Early Complications

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Harald Lenz ◽  
Kirsti Myre ◽  
Tomas Draegni ◽  
Elizabeth Dorph
Keyword(s):  
Demographic Data ◽  
Venous Catheter ◽  
Venous Access ◽  
Seldinger Technique ◽  
Published Data ◽  
Main Diagnosis ◽  
Anatomical Landmarks ◽  
Central Venous ◽  
Jugular Veins

Background. Long-term venous access has become the standard practice for the administration of chemotherapy, fluid therapy, antibiotics, and parenteral nutrition. The most commonly used methods are percutaneous puncture of the subclavian and internal jugular veins using the Seldinger technique or surgical cutdown of the cephalic vein. Methods. This study is based on a quality registry including all long-term central venous catheter insertion procedures performed in patients >18 years at our department during a five-year period. The following data were registered: demographic data, main diagnosis and indications for the procedure, preoperative blood samples, type of catheter, the venous access used, and the procedure time. In addition, procedural and early postoperative complications were registered: unsuccessful procedures, malpositioned catheters, pneumothorax, hematoma complications, infections, nerve injuries, and wound ruptures. The Seldinger technique using anatomical landmarks at the left subclavian vein was the preferred access. Fluoroscopy was not used. Results. One thousand one hundred and one procedures were performed. In eight (0.7%) cases, the insertion of a catheter was not possible, 23 (2.1%) catheters were incorrectly positioned, twelve (1.1%) patients developed pneumothorax, nine (0.8%) developed hematoma, and three (0.27%) developed infection postoperatively. One (0.1%) patient suffered nerve injury, which totally recovered. No wound ruptures were observed. Conclusions. We have a high success rate of first-attempt insertions compared with other published data, as well as an acceptable and low rate of pneumothorax, hematoma, and infections. However, the number of malpositioned catheters was relatively high. This could probably have been avoided with routine use of fluoroscopy during the procedure.

scholarly journals Can Eye Tracking be Used to Predict Performance Improvements in Simulated Medical Training? A Case Study in Central Venous Catheterization

2019 ◽  
Vol 8 (1) ◽  
pp. 110-114
Author(s):  
Hong-En Chen ◽  
Rucha R. Bhide ◽  
David F. Pepley ◽  
Cheyenne C. Sonntag ◽  
Jason Z. Moore ◽  
...  
Keyword(s):  
Eye Tracking ◽  
Medical Training ◽  
Central Venous Catheterization ◽  
Personalized Learning ◽  
Central Venous ◽  
Performance Improvements ◽  
Surgical Residents ◽  
Venous Catheterization

Manikins have traditionally been used to train ultrasound-guided Central Venous Catheterization (CVC), but are static in nature and require an expert observer to provide feedback. As a result, virtual simulation and personalized learning has been increasingly adopted in medical education to efficiently provide quantitative feedback. The Dynamic Haptic Robotic Trainer (DHRT) trains surgical residents in CVC needle insertions by simulating various patient profiles and presenting personalized feedback on objective performance. However, no studies have examined the learning gains of the personalized learning feedback or the relation of feedback to what the user is focusing on during the training. Thus, this study was developed to determine the effectiveness of the current personalized learning interface through a long-term investigation with 7 surgical residents. The eye tracking analysis showed that residents spent significantly more time fixated on percent aspiration throughout the study; the more time participants spent looking at the Number of Insertions, Percent Aspiration and the Angle of Insertion on the DHRT GUI, the better they performed on subsequent trials on the DHRT system.

Simulation Training and Its Effect on Long-Term Resident Performance in Central Venous Catheterization

2010 ◽  
Vol 5 (3) ◽  
pp. 146-151 ◽  
Author(s):  
C. Christopher Smith ◽  
Grace C. Huang ◽  
Lori R. Newman ◽  
Peter F. Clardy ◽  
David Feller-Kopman ◽  
...  
Keyword(s):  
Simulation Training ◽  
Central Venous Catheterization ◽  
Central Venous ◽  
Resident Performance ◽  
Venous Catheterization

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
Author(s):  
Timothy R Spencer ◽  
Amy J Bardin-Spencer
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Clinical Simulation ◽  
Venous Catheterization ◽  
Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

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