Patterns and predictors of peripherally inserted central catheter occlusion: the 3P-O study (2023)

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VTE was defined as symptomatic deep vein thrombosis (DVT) in either extremity or symptomatic pulmonary embolism (PE) not present at catheter insertion and confirmed by imaging (ultrasound or venogram for DVT; computed tomography or ventilation-perfusion). for PE). Minor catheter complications were defined according to previously published definitions.15,16 Patients were followed up until the time of catheter removal or death, whichever occurred first.

Midline catheters are recommended over peripherally inserted central catheters as a short-term vascular access device for peripherally compatible infusions. We evaluated the efficacy and safety of midline catheters.

Data on midline catheter placements from June 2016 to May 2019 at a Veterans Administration tertiary medical center were collected retrospectively. Patients were followed until catheter removal or death, whichever came first. The primary outcome was completion of planned treatment; secondary outcomes were catheter-related complications, including major events (eg, catheter-related bloodstream infections [CRBSI] or venous thromboembolism [VTE]) and minor events (eg, catheter occlusion, kinks, displacement).

Of 115 central lines, 62 (53.9%) were for antibiotic infusion and 49 (32.6%) were difficult to access. The mean stay was 11 days (interquartile range, 5.5-19.5 days). Midline catheters lasted until completion of therapy in 93 patients (80.9%). Catheter-related complications occurred in 27 patients (23.5%), including catheter dislodgment in 10 patients (8.7%), catheter breakage in 8 (7.0%), and catheter occlusion in 3 (2.6%). Only 1 patient experienced a major complication, deep vein thrombosis (0.9%).

Central lines appear to be effective and safe for short-term vascular access in patients requiring peripherally compatible infusions. Although the major complication rate is low, minor complications requiring device removal are common.

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Alternatively, newer technology such as subcutaneous anchor devices may help avoid replacement.26,27 Similarly, it is important to prevent catheter occlusion through careful attention to irrigation and better device selection. (increased use of single-lumen devices).28 Note that this is important. to emphasize that occlusion itself does not necessarily indicate thrombosis, as occlusion more often represents intraluminal clots, drug precipitation, or fibrin sheath around the catheter tip than deep vein thrombosis.29

Catheter exchange through a guidewire is often performed due to malfunction of peripherally inserted central catheters (PICCs). It is not known whether such exchanges are associated with venous thromboembolism.

We conducted a retrospective cohort study to assess the association between PICC exchange and the risk of thromboembolism. Hospitalized adult patients who received a PICC during clinical care at one of 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium were included. The primary outcome was the risk of symptomatic venous thromboembolism (radiographically confirmed upper extremity deep vein thrombosis and pulmonary embolism) in those who underwent PICC replacement versus those who did not.

Of 23,010 patients who underwent PICC insertion in the study, 589 patients (2.6%) experienced a PICC switch. Nearly half of all exchanges were performed due to catheter dislodgement or occlusion. A total of 480 patients (2.1%) experienced deep vein thrombosis associated with PICC. The deep vein thrombosis rate was higher in those who underwent PICC replacement compared with those who did not (3.6% vs. 2.0%,PAG<.001). The median time to thrombosis was shorter among those who underwent replacement compared with those who did not (5 vs 11 days,PAG=.02). After adjustment, PICC exchange was independently associated with a 2-fold increased risk of thrombosis (hazard ratio [HR] 1.98; 95% confidence interval [CI], 1.37–2.85 ) versus no exchange. The effect size of PICC exchange on thrombosis was second in magnitude to device lumen (HR2.06; 95% CI, 1.59-2.66 and HR2.31; 95% CI, 1.6-3.33 for dual- and triple lumen) .

PICC guidewire switching may be associated with an increased risk of thrombosis. As some exchanges can be prevented, it is necessary to consider the risks and benefits of exchange in clinical practice.

Posterior cervical decompression produces favorable results for patients with ossification of the K line (+) of the posterior longitudinal ligament (OPLL). However, even for patients with the K line (+) in the neutral neck position, the K line (−) in the flexed neck position (flexion K line (−)) may affect surgical results. We investigated the influence of the K-line of flexion (-) on surgical outcomes after selective muscle-sparing laminectomy using multivariate analysis.

This study involved 113 patients with OPLL with a K(+) line in the neutral neck position who underwent selective muscle-sparing laminectomy. Patients were divided into K-line flexion (+) (norte=90) and bending line K (-) (norte=23) groups. We analyzed the influence of a flexion K line (-) on radiological and surgical results. We performed a multivariate analysis to analyze the factors that influence surgical results.

Patients with a K-line of flexion (-) had a greater C2-C7 sagittal vertical axis (preoperatively,PAG=0.042; after the operation,PAG=0.021), narrower postoperative clearance of the spinal cord (PAG=0.003), a lower proportion of segmental type OPLL (PAG<0.001), and a higher OPLL occupancy (PAG<0.001). The recovery rate as measured by the Japanese Orthopedic Association (JOA) score was worse in patients with a flexion K-line (-) (17.6 ± 32.2%) than in those with a flexion K-line (+ ) (35.3 ± 29.5 %) (PAG= 0.013). Multiple linear regression analysis revealed that the flexion K line (-) influenced the JOA score recovery rate (b=−0,233,PAG= 0,013).

Even for patients with K-line (+) OPLL, the K-line of flexion (-) affects surgical outcomes. The K-line of flexion (-) is a useful predictor of poor surgical outcome after posterior decompression surgery.

Inappropriate requests for catheters at McGill University Health Center (MUHC) led to significantly increased costs and early catheter failures or infections. Double-lumen catheters were often ordered and inserted when only a single lumen was required, and inadequate ward catheter care led to early infection or thrombosis.

A full-time RN was hired to analyze and transform the vascular access program for the MUHC. The selection of catheters was simplified based on the needs of the clinical unit. Clinical and cost data were collected between May 2011 and January 2012.

Vascular access requests have been standardized and centralized at the MUHC. Single-lumen catheters are inserted unless a specific indication is given for a double-lumen catheter. To date, data has been collected on more than 4,000 catheter insertions, both before and after switching to the single-lumen program. Double-lumen catheters have only been necessary in 50% of cases. Reinsertion rates have declined, leading to the first year-over-year reduction in peripherally inserted central venous catheters since data collection began in 2002. The program also resulted in significant reductions in bloodstream infection associated with central line and catheter-related thrombosis. Reduced maintenance and restoration costs have resulted in total savings to the MUHC of approximately $1.1 million.

Describe implementation of nurse-based venous access team (VAT) and standardized interventional radiology (IR) protocols according to Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines to provide access central venous and preserve peripheral veins in patients with chronic renal failure. disease of the disease (CKD).

The review of the reference data and location of the VAT and IR databases was carried out over a period of 12 years. Referral to SBCC was automatic for patients with creatinine levels ≥ 3 mg/dL or a kidney transplant regardless of creatinine level, unless dialysis is not planned. All SBCC insertions, regardless of referral source, were identified and reviewed, and SBCC placements resulting from K/DOQI PICC contraindications were identified. The types of catheter, indications, access sites, technical success, and complications were determined.

A total of 35,781 applications for the placement of VAT PICCs were made; 1,889 (5%) were referred to the IR for CBS placement per institutional policy, and 2,200 CBS were first attempted or placed during this period, 1,879 (85%) based on K/DOQI contraindications. The main indication for SBCC placement was antibiotic therapy (59%). Access sites included right internal jugular vein (IJV) (70%), left IJV (24%), right external jugular vein (EJV) (3%), left EJV (2%), right common femoral vein (CFV) (0.3%)) and left HRV (0.2%). The technical success rate for SBCC insertion was 99%. Six minor complications (0.3%) and three major complications (0.1%) occurred.

Automatic referral for SBCC placement in CKD patients via VAT and IR protocols can eliminate PICC placement and thus protect peripheral veins necessary for hemodialysis. SBCC placement has high technical success and low complication rates.