scholarly journals Canadian Association of Emergency Physicians sepsis treatment checklist: optimizing sepsis care in Canadian emergency departments

CJEM ◽  
2012 ◽  
Vol 14 (01) ◽  
pp. 36-39 ◽  
Author(s):  
Dennis Djogovic ◽  
Robert Green ◽  
Robert Keyes ◽  
Sara Gray ◽  
Robert Stenstrom ◽  
...  
Keyword(s):  
Central Venous Access ◽  
Tertiary Care ◽  
Venous Access ◽  
Care Practice ◽  
Emergency Physicians ◽  
Tertiary Care Centre ◽  
Canadian Association ◽  
Level I ◽  
Practice Committee ◽  
Sepsis Care

ABSTRACT Objective: The Canadian Association of Emergency Physicians (CAEP) sepsis guidelines created by the CAEP Critical Care Practice Committee (C4) and published in the Canadian Journal of Emergency Medicine (CJEM) form the most definitive publication on Canadian emergency department (ED) sepsis care to date. Our intention was to identify which of the care items in this document are specifically necessary in the ED and then to provide these items in a tiered checklist that can be used by any Canadian ED practitioner. Methods: Practice points from the CJEM sepsis publication were identified to create a practice point list. Members of C4 then used a Delphi technique consensus process over May to October 2009 via e-mail to create a tiered checklist of sepsis care items that can or could be completed in a Canadian ED when caring for the septic shock patient. This checklist was then assessed for use by a survey of ED practitioners from varying backgrounds (rural ED, community ED, tertiary ED) from July to October 2010. Results: Twenty sepsis care items were identified in the CAEP sepsis guidelines. Fifteen items were felt to be necessary for ED care. Two levels of checklists were then created that can be used in a Canadian ED. Most ED physicians in community and tertiary care centres could complete all parts of the level I sepsis checklist. Rural centres often struggle with the ability to obtain lactate values and central venous access. Many items of the level II sepsis checklist could not be completed outside the tertiary care centre ED. Conclusion: Sepsis care continues to be an integral and major part of the ED domain. Practice points for sepsis care that require specialized monitoring and invasive techniques are often limited to larger tertiary care EDs and, although heavily emphasized by many medical bodies, cannot be reasonably expected in all centres. When the resources of a centre limit patient care, transfer may be required.

scholarly journals Intramuscular ketamine to facilitate pediatric central vascular access

CJEM ◽  
2004 ◽  
Vol 6 (04) ◽  
pp. 259-262 ◽  
Author(s):  
T. Kent Denmark ◽  
Jenny R. Hargrove ◽  
Lance Brown
Keyword(s):  
Vascular Access ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Case Series ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Venous Catheters ◽  
Emergency Physicians ◽  
Central Venous ◽  
Peripheral Venous Access

ABSTRACT Objectives: Obtaining prompt vascular access in young children presenting to the emergency department (ED) is frequently both necessary and technically challenging. The objective of our study was to describe our experience using intramuscular (IM) ketamine to facilitate the placement of central venous catheters in children presenting to our ED needing vascular access in a timely fashion. Methods: We performed a retrospective medical record review of all pediatric patients <18 years of age who presented to our tertiary care pediatric ED between May 1, 1998, and August 7, 2003, and underwent the placement of a central venous catheter facilitated by the use of IM ketamine. Results: Eleven children met our inclusion criteria. Most of the children were young and medically complicated. The children ranged in age from 6 months to 8 years. The only complication identified was vomiting experienced by an 8-year-old boy. Emergency physicians successfully obtained central venous access in all subjects in the case series. Conclusions: The use of IM ketamine to facilitate the placement of central venous catheters in children who do not have peripheral venous access appears to be helpful. Emergency physicians may find it useful to be familiar with this use of IM ketamine.

scholarly journals Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Dennis Djogovic ◽  
Shavaun MacDonald ◽  
Andrea Wensel ◽  
Rob Green ◽  
Osama Loubani ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Literature Search ◽  
Development Process ◽  
Guideline Development ◽  
Care Practice ◽  
Evidence Based ◽  
Emergency Physicians ◽  
Consensus Guidelines ◽  
Canadian Association ◽  
Practice Committee

AbstractPatients may present to Emergency Departments (ED) in shock for various reasons. Emergency medicine physicians may require the use of vasopressors or inotropes to manage these patients. The Critical Care Practice Committee of the Canadian Association of Emergency Physicians (C4) conducted an intensive literature search and guideline development process to help create an evidence based approach for use of these agents in the stabilization of shock.

Port-a-Cath fracture and migration in paediatric cancer patients: incidence and management at a tertiary care centre – a 15-year experience

2020 ◽  
Vol 30 (7) ◽  
pp. 986-990
Author(s):  
Amr Elgehiny ◽  
Khaled Ghanem ◽  
Haytham Bou Hussein ◽  
Mohamed Ahmed ◽  
Mostafa Abohelwa ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Rare Complication ◽  
Central Venous Access ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Cancer Center ◽  
Paediatric Cancer ◽  
Tertiary Care Centre ◽  
First Choice ◽  
And Migration

AbstractIntroduction:Port-a-Cath or chemoport provides prolonged central venous access for cancer patients requiring prolonged chemotherapy. Prolonged use of chemoport is associated with many complications. Dislodgement and migration of chemoport catheter is a rare and reportable complication with potentially serious consequences.Methods:The medical charts of 1222 paediatric cancer patients admitted to the Children’s Cancer Center in Lebanon who had chemoports inserted for long-term chemotherapy were retrospectively reviewed. Descriptive analysis of data was conducted.Results:Chemoport fracture and migration were found in seven cases with an incidence of 0.57%. The duration of chemoport use before the event of dislodgement varied from 2 months to 102 months. Non-functioning chemoport was the most common presentation. Totally, six cases were managed successfully by loop snaring, three cases by paediatric cardiology team, and three cases by interventional radiology team. One case was managed surgically during chemoport removal.Conclusion:Fracture and migration of chemoport catheter is a rare complication of uncertain aetiology and with potentially serious consequences. Percutaneous retrieval, done by experienced cardiologist or interventional radiologist, is the first choice for management of this complication as it is considered as a safe and effective approach.

scholarly journals American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism

2018 ◽  
Vol 2 (22) ◽  
pp. 3292-3316 ◽  
Author(s):  
Paul Monagle ◽  
Carlos A. Cuello ◽  
Caitlin Augustine ◽  
Mariana Bonduel ◽  
Leonardo R. Brandão ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Health Care Professionals ◽  
Conflicts Of Interest ◽  
Guideline Development ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Venous Access ◽  
Protein C Deficiency ◽  
Vein Thrombosis ◽  
American Society

Abstract Background: Despite an increasing incidence of venous thromboembolism (VTE) in pediatric patients in tertiary care settings, relatively few pediatric physicians have experience with antithrombotic interventions. Objective: These guidelines of the American Society of Hematology (ASH), based on the best available evidence, are intended to support patients, clinicians, and other health care professionals in their decisions about management of pediatric VTE. Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews (up to April of 2017). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 30 recommendations, covering symptomatic and asymptomatic deep vein thrombosis, with specific focus on management of central venous access device–associated VTE. The panel also addressed renal and portal vein thrombosis, cerebral sino venous thrombosis, and homozygous protein C deficiency. Conclusions: Although the panel offered many recommendations, additional research is required. Priorities include understanding the natural history of asymptomatic thrombosis, determining subgroup boundaries that enable risk stratification of children for escalation of treatment, and appropriate study of newer anticoagulant agents in children.

Safety and Feasibility of Phenylephrine Administration Through a Peripheral Intravenous Catheter in a Neurocritical Care Unit

2019 ◽  
Vol 36 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Paul Ballieu ◽  
Yasaman Besharatian ◽  
Safdar Ansari
Keyword(s):  
Blood Pressure ◽  
Neurocritical Care ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Major Complication ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Venous Access ◽  
Care Hospital ◽  
Central Venous

Background/Objective: Blood pressure optimization and maintenance of cerebral and spinal perfusion pressure are mainstays in the treatment of a neurocritically ill patient. Traditionally, central venous access has been required for vasopressor administration, with risk of inherent complications. The authors have previously reported pilot data on the safety of peripheral administration of phenylephrine in a neurocritical care unit. In this follow-up, we report the safety, feasibility, and potential efficacy of peripheral administration of low-concentration phenylephrine in a more robust cohort. Methods: A retrospective chart review was conducted on all consecutive patients who received peripheral phenylephrine in a tertiary care hospital neurocritical care unit. Results: A cohort of 125 patients were identified and included in the final analysis. The average age was 59.3 years, with an average intensive care unit (ICU) length of stay of 7.61 days. The most common indication for phenylephrine use was spinal perfusion (both with/without neurogenic shock) in 38.4% of cases, followed by postsurgical/anesthesia resuscitation in 16.8% of cases; 25.6% of patients in our cohort required escalation to central venous access (central venous catheter + peripherally inserted central catheter). A total of 2880 patient-hours were recorded with peripheral phenylephrine infusion, of which 73.9% were at goal blood pressure (either systolic or mean arterial pressure). Only one major complication of thrombophlebitis and 8 minor complications were recorded. Conclusions: Protocol-driven peripheral administration of lower concentration phenylephrine in an ICU setting is safe and feasible. This strategy is potentially effective at achieving hemodynamic targets in the majority of patients avoiding the need for central venous access.

Peripherally Inserted Central Catheters in the Intensive Care Unit

1996 ◽  
Vol 11 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Philip K. Ng ◽  
Mark J. Ault ◽  
Lawrence S. Maldonado
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Success Rate ◽  
Complication Rate ◽  
Central Venous Access ◽  
Tertiary Care ◽  
Venous Access ◽  
Success Rates ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians requested a PICC service consultation were included. Main outcome measurements included (1) the success rate for initial PICC placement, (2) the placement complication rate, and (3) the overall success and complication rate. Of the 91 consecutive attempts at PICC placement, 89 (97.8%) were successful: of the 89 successful placements, 25 (28%) required cutdown procedures. There were 20 complications of initial placement and 8 delayed complications, which occurred in 19 PICCs. Complications included recatheterization after first attempt was unsuccessful (10), catheter malposition (7), palpitations or catheter clotting (3 each), heavy bleeding or mechanical phlebitis (2 each), and arterial puncture (1). The overall success rate for completion of therapy using the PICC was 74.7%. The most frequent reasons for failure to complete therapy were catheter dislodgment in 8 patients and “infection” in 9 patients. Of these 9 patients with “infections,” 8 catheters were discontinued due to potential infection, and only 1 was removed due to confirmed infection. The confirmed infection rate was 6/10,000 patient days. The PICC appears to be a reasonable alternative to other approaches to peripheral and central venous access. The initial and overall success rates from this preliminary study justify' further evaluation of the PICC in critically ill patients.

scholarly journals Wait Time for Endoscopic Evaluation at a Canadian Tertiary Care Centre: Comparison with Canadian Association of Gastroenterology Targets

2008 ◽  
Vol 22 (7) ◽  
pp. 621-626 ◽  
Author(s):  
Derek Yu ◽  
Wilma M Hopman ◽  
William G Paterson
Keyword(s):  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Wait Time ◽  
Final Diagnosis ◽  
Screening Colonoscopy ◽  
Deficiency Anemia ◽  
Wait Times ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Canadian Association

BACKGROUND: In recent years, there has been considerable concern regarding wait times for Canadian health care, which led the Canadian Association of Gastroenterology (CAG) to develop specific wait time targets.OBJECTIVES: To quantify wait times for endoscopic procedures at a tertiary care centre and correlate these with clinical presentation, impact on quality of life (QOL) and final diagnosis; and to determine how well the CAG wait time targets are being met.METHODS: Patients completed a 12-item questionnaire regarding wait times and their impact on QOL. A blind review was performed of the endoscopic results, with a specific focus on correlating wait time with a final diagnosis of serious and treatable diseases.RESULTS: The average total wait time for the 417 participants in the present study was 229 days; 78.6% did not meet CAG wait time targets. The wait time for screening colonoscopy was longer, and the proportion of patients meeting wait time targets was significantly smaller, than for patients referred with iron deficiency anemia or a positive fecal occult blood test result. The 41 patients deemed to have a high-impact diagnosis established by endoscopy had a median wait time of 115 days, and only 23.5% met wait time targets. Overall, 38.4% of patients believed that their wait was too long, 13.9% missed school or work in the preceding month because of gastrointestinal symptoms and 23% reported being very worried about having a serious disease.CONCLUSIONS: The majority of patients waiting for endoscopy did not meet CAG wait time targets, with the screening colonoscopy group faring the worst. Many of these patients await a definitive diagnosis of serious diseases that negatively impact QOL.

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