A randomized trial comparing peripherally inserted central venous catheters and peripheral intravenous catheters in infants with very low birth weight

BACKGROUND/PURPOSE: To determine whether percutaneously inserted central venous catheters (PICC) and peripheral intravenous catheters (PIV) in infants with very low birth weight (VLBW) differ with respect to (1) incidence of sepsis, (2) number of insertion attempts and catheters required for total intravenous therapy, (3) courses of antibiotics, and (4) total duration of intravenous (IV) use. METHODS: A randomized comparative trial was conducted involving 63 VLBW infants (<1,251 g) who required IV therapy. Infants were assigned randomly at 1 week of age to either a PIV or a PICC catheter and followed up prospectively until an IV was no longer required or the infant was transferred out of the neonatal intensive care unit. RESULTS: Data were analyzed on an intention-to-treat basis. There was no difference in the incidence of sepsis (P = .64), number of courses of antibiotics (P = .16), or total duration of IV use (P= .34) between the 2 groups. The number of insertion attempts required for total IV therapy was significantly lower in the PICC group than in the PIV group (P = .008). There also was a significantly lower number of total catheters utilized in the PICC group (P = .002). When data were controlled for birth weight strata the results were similar. CONCLUSION: PICC lines reduced the number of painful IV procedures in VLBW infants without additional morbidity.     

Hickman central venous catheters

Long-term central venous cannulation is frequently required for the treatment of patients with cancer. Almost 25 years ago, Hickman described the use of a long silicone catheter, incorporating a Dacron cuff, which was tunnelled over the chest wall and into the central veins. The technique has slowly evolved. Currently, a percutaneous technique incorporating a peel-away sheath introducer and accurate positioning with the aid of an image intensifier is commonly used. The tip of the catheter is placed in the right atrium to reduce pain and thrombotic complications. With meticulous aseptic technique on insertion and fastidious maintenance of hygiene, these catheters may be used for several years. Insertion complications range from minor bleeding to potentially fatal complications of pneumothorax, haemothorax and laceration of the great veins.     

经外周静脉穿刺中心静脉置管的应用进展和并发症

经外周静脉穿刺中心静脉置管(PICC)已成为一项成熟的技术,在癌症患者的长期输液、化疗和紧急救治中发挥了重要作用.尽管PICC导管的材料、类型和留置方法不断改进,但仍无法避免导管相关并发症发生,如感染、深静脉血栓形成,这些因素不仅与操作者和导管护理人员的经验水平有关,还与患者自身的免疫力和基础疾病有关.因此,在置管过程...     

Bacterial colonization and peripheral bacteraemia associated with central venous haemodialysis catheters: A cross-sectional study

Summary: Septicaemia related to internal luminal colonization of central venous catheters has been described in many clinical settings including haemodialysis. the prevalence and consequence of intraluminal colonization of central venous haemodialysis catheters is unknown. A cross-sectional study of asymptomatic patients receiving haemodialysis through central venous catheters was performed. Differential (central line and peripheral) quantitative blood cultures were taken on three occasions. Twenty-one patients were studied and 20 had colonized central venous catheters. the organisms isolated were Coagulase negative Staphylococci (16 cases), Bacillus species (three), Corynebacterium (three), Pseudomonas species (three), and others (three). Fifteen patients also had significant peripheral bacteraemia associated with the same organism that was cultured from their central line. Seven patients had septic episodes associated with these same organisms. Swabs taken of the internal catheter surfaces also cultured these organisms. the vast majority (95%) of central venous haemodialysis catheters are colonized by bacteria. Seventy-six per cent have associated peripheral bacteraemia, which can lead to systemic infection.     

乳腺癌病人留置PICC的安全管理

目的建立并实施经外周置入中心静脉导管的安全管理制度。方法2004～2008年对376例乳腺癌住院化疗病人进行PICC置管术,并实施了PICC安全使用的认知、操作、维护、出院教育等各项安全管理制度。结果本组376例留置PICC病人中340例无任何不良反应,占90．4％。其余病人未发生严重并发症。结论安全管理制度的建立与实施,保证了留置PICC的安全使用,提高了病人的生活质量。     

Candida septic thrombosis of the great central veins associated with central catheters. Clinical features and management.

Candida septic thrombosis of the great central veins is rarely diagnosed during life, and reports of survival with this condition are exceedingly rare. Eight patients with Candida septic thrombosis of the central veins, with six survivors, are reported. Seven of eight patients had multiple organ system failure following surgery or trauma. All patients had received broad spectrum antibiotics and total parenteral nutrition via a central catheter. Every patient showed features of venous thrombosis with localizing extremity edema and high grade candidemia. Intensive amphotericin B therapy (mean daily dose: 0.7 mg/kg) in all patients, combined with 5-fluorocytosine in five cases, resulted in cure and long-term survival in six patients who received 1600 to 3435 mg (mean: 26 mg/kg) total dose. None of these patients developed renal failure, while four showed improving renal function during treatment. In contrast to Candida endocarditis, septic central vein thrombosis caused by Candida appears to be curable medically in the majority of cases with intensive amphotericin B therapy (total dose: greater than or equal to 22 mg/kg), combined when feasible with 5-fluorocytosine.     

Use of peripherally inserted central catheters in the management of recalcitrant maxillofacial infection.

PURPOSE: The most common short-term method for the delivery of parenteral antimicrobial therapy in an acute hospitalized patient has traditionally been via a short peripherally inserted intravenous cannula. This approach, however, has significant limitations, particularly in patients who require prolonged, uninterrupted intravenous access. In this article, we report on our experience with an alternative method used to establish and maintain medium- to long-term intravenous access utilizing a peripherally inserted central catheter (PICC) to treat patients presenting with aggressive or recalcitrant maxillofacial head and neck infections. MATERIALS AND METHODS: We undertook a retrospective review of the medical records of 100 consecutive patients admitted to a tertiary referral teaching hospital, during the period February 2006 to February 2007, with a primary diagnosis of infection in the oral and maxillofacial region. We identified 6 patients in whom a PICC was used in the treatment of the condition. We also analyzed data obtained from an audit conducted by our infectious diseases unit. This audit recorded the outcome of 849 nurse-placed PICCs in the department's ambulatory intravenous therapy service. Using this data, we also performed a PICC line survival analysis and in so doing, calculated the complication rates. RESULTS: In our series, the delivery of PICC-based therapy accounted for 6% of the treatment provided for all cases of maxillofacial sepsis. This included 3 cases of actinomycosis, 2 cases of odontogenic osteomyelitis, and 1 case of a zoonotic facial abscess/cellulitis. In this series of patients, catheters remained in situ for an average of 33 days (range 12-42 days). The audit data demonstrated that more than 75% of nurse-placed PICCs are functional without complication at 60 days. The most common complication was phlebitis (1 per 1,000 catheter days). Infection was rare (0.2 per 1,000 catheter days). CONCLUSIONS: PICC is a safe and most reliable means of administering medium- to long-term intravenous antibiotics. We feel PICC-based therapy should be considered in the management of select patients with aggressive or recalcitrant maxillofacial head and neck sepsis.     

Usefulness of Groshong catheters for central venous access via the external jugular vein.

This study was designed to evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Central venous access was achieved by insertion of a single-lumen 4.0 Fr Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVC-RBSI) were evaluated from the database. Two hundred and twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (p < .01) and period (p < .01), a larger number of operations (p < .01), and more frequent use of total parenteral nutrition (TPN) (p < .01) and less frequent use of chemotherapy (p < .01) than for IJV-C. However, there were no significant differences (NS) in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C. There were no significant differences such complications as malposition, oozing or hematoma formation of insertion site, arterial bleeding, nerve damage, pneumothorax, and phlebitis between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding, and nerve damage. Thus the study concluded that EJV-C using Groshong catheters has no severe complications and has the same rates of CVC-RBSI as conventional IJV-C for central venous access.     

Antiseptic-bonded central venous catheters and bacterial colonisation

This study was undertaken to evaluate the impact of chlorhexidine/silver sulphadiazine-bonded catheters on the incidence of colonisation and catheter-related sepsis in critically ill patients. Threehundred and fifty-one catheters were inserted into 228 patients during the study period, 174chlorhexidine/silver sulphadiazine-bonded catheters and 177 standard catheters. Indications for catheter removal were: death, clinical redundancy and clinical evidence of local or systemic infection. All catheter tips were sent to the microbiology laboratory for semiquantitative analysis of bacterial colony count. Seventy-one (40.2%) of the standard catheters and 47 (27.2%) of the antiseptic-bonded catheters were found to be colonised on removal (p < 0.01). Eight cases (4.7%) of catheter-related sepsis were associated with standard catheters and three cases (1.7%) with antiseptic-bonded catheters, however, this reduction was not statistically significant. Our results indicate that the use of antiseptic-bonded catheters in critically ill patients significantly reduces the incidence of bacterial colonisation.     

Temporary access and central venous catheters.

The use of central venous catheters for temporary vascular access is a vital part of modern medicine and has an important role in the management of patients with renal failure. Attention to detail when addressing issues relating to temporary venous access, will pay dividends, with significant reductions in morbidity and mortality in both the short and long term.     

Safe placement of central venous catheters

Editor—We read with interest the recent paper on centralvenous catheter (CVC) tip position using the carina as a radiologicallandmark¹ having recently completed a similar retrospectiveaudit of 139 CVCs in an adult intensive care setting. Similarto Stonelake and Bodenham, we found a high incidence of CVCtips below the carina with 50 (35.9%) right-sided and 8 (5.7%)left-sided so placed. Similarly, more than half of the left-sidedcatheters that were above the carina had