Spontaneous migration of long-term indwelling venous catheters

Our institution recently encountered two patients with an unusual complication of indwelling catheters, spontaneous migration of the catheter tip. Both patients had indwelling subcutaneous ports placed via the left subclavian vein into the superior vena cava for the treatment of breast cancer. Both catheters functioned well but were noted on follow-up radiographs to have repositioned themselves, one into the azygous vein and the other into the internal jugular vein. One patient required surgical intervention to properly position the catheter for further chemotherapy. Chest roentgenograms are indicated to confirm the continued appropriate position of indwelling catheters when their position is in doubt to minimize the likelihood of complications associated with delivery of caustic chemotherapeutic agents in low flow vessels.     

Rupture of indwelling venous catheters

Recently a design change in certain Broviac and Hickman catheters has created a serious problem. The paper described the defect and a means of reinforcing the catheter both before it is inserted and after it is in place.     

Complications of chronic indwelling urinary catheters

Chronic indwelling catheters are used to manage urinary retention, especially in the presence of urethral obstruction, and to facilitate healing of incontinence-related skin breakdown. These indwelling foreign bodies become coated and sometimes obstructed by biofilm laden with bacteria and struvite crystals. Bacteria invariably colonize the system and may invade the blood stream following trauma or obstruction. Staff should maintain a closed, dependent system to avoid introducing new organisms and be vigilant for the development of obstruction, avoid trauma, and consider chronic catheters and drainage bags to be potential sources of antibiotic-resistant bacteria for secretion containment and when antibiotics are selected for empiric therapy. Suprapubic catheters should be considered when urethral catheters are associated with discomfort or periurethral suppurative complications, especially in males.     

Appropriate and inappropriate use of indwelling urinary catheters

- Many hospitalized patients receive a urinary catheter during their stay. In 21-54% of patients, however, there is no appropriate indication for this.- The most significant complication caused by the use of urinary catheters is the development of a urinary tract infection (UTI), one of the most common nosocomial infections. - In 71-80% of hospital acquired UTIs a urinary catheter is present. - The duration of the presence of a catheter is the major risk factor for catheter-associated UTI.- Reducing the number of inappropriate catheterisations is an effective way of preventing catheter-related UTIs. - Inapprpriate use of indwelling urinary catheters can be reduced by maintaining strict guidelines on justifiable indications for inserting a urinary catheter, verifying daily whether the indication still applies, and by timely removal of the catheter when it is not or no longer needed.     

静脉留置导管抗菌涂层的研究进展

随着医用导管的应用,为临床疾病的诊治带来了极大方便,提高了疾病的诊治效果,但目前临床使用的静脉留置导管容易引起血栓阻塞,微生物定植等缺陷。导管留置体内期间容易诱发感染,主要原因是导管材料易引起病原菌定植以及宿主蛋白吸附、免疫激活。理想的导管是由具备生物相容性、抗菌防污性的材料制成的。尽管在过去的数十年针对此课题进行了大量的研究,但是理想的抗菌生物材料,特别是用于长期留置静脉的材料,仍然有待开发。     

Varicella: previously healthy children sometimes develop complications

Three healthy boys, 3.5, 5 and 1.5 years of age, were admitted to hospital with a severe bacterial skin infection, cerebellar ataxia, and pneumonia, respectively, one week after the onset of varicella. They recovered completely after treatment. Studies in Europe report complications from varicella in 2.5% of healthy children. Most of these are neurological complications and secondary bacterial infections of skin and soft tissue. Last year, a European consensus was published that recommended that all healthy children be vaccinated against chickenpox. In The Netherlands, routine varicella zoster virus (VZV) vaccination has not (yet) been implemented. We propose a new discussion on the possible inclusion of VZV vaccination in the national vaccination programme.     

MICU患者留置导管培养结果分析

目的 分析内科重症监护病房(MICU)患者各种留置导管(包括气管插管、深静脉导管、留置导尿管和留置胃管)的微生物定植以及相关感染等,为临床预防医院感染提供依据.方法 对2009年9月-2010年5月MICU患者各种留置导管及送检临床标本进行培养,结合患者的临床资料进行判断.结果 共培养标本224份,其中气管插管标本58份,培养阳性55份,阳性率94.8％,发生VAP17例,发生率为29.3％,检出病原菌以鲍氏不动杆菌及铜绿假单胞菌为主;深静脉留置针标本33份,培养阳性5份,阳性率为15.2％,发生导管相关性血流感染1例,发生率为3.0％,检出病原菌以假丝酵母菌属为主;留置导尿管标本78份,培养阳性40份,阳性率51.3％,发生导管相关性尿道感染8例,发生率为20.0％,检出病原菌以大肠埃希菌最常见;留置胃管标本55份,培养阳性47份,阳性率85.5％,检出病原菌以铜绿假单胞菌、鲍氏不动杆菌为主,其中有9株病原菌与VAP的病原菌一致.结论 不同留置导管病原菌的感染率、种类不同,临床工作中对不同的导管及可能发生的相关感染应采取针对性的预防措施和不同的治疗方案.     

Subclavian venous thrombosis due to indwelling catheters: a prospective study on 52 patients

Clinical occurrence of subclavian venous thrombosis due to indwelling catheters is rare, but there is some evidence that subclinical thrombosis frequently occurs. It is purpose of this study to report the results of a prospective investigation in patients with subclavian vein catheters. Fifty-two patients admitted to the Istituto Nazionale Tumori of Milan and candidate to infraclavicular percutaneous catheterization of the subclavian vein were evaluated. There were 26 polyvinyl chloride and 26 rubber silicone catheters, which were correctly positioned in the superior vena cava-atrium. Average duration of the intravenous stay was 12.8 days. Asymptomatic thrombosis was venographically demonstrated in 46.1% of the polyvinyl chloride catheters and in 11.5% of the silicone ones (p = 0.005). The average age of catheters with or without thrombosis was 10.8 and 13.8 days, respectively. Addition of heparin to the infusate (1 U/ml) did not reduce the thrombosis rate in polyvinyl chloride or in silicone catheters, but risk of thrombosis was significantly higher (p = 0.03) in polyvinyl chloride catheters without heparin in comparison to the silicone ones. Osmolarity of the infusional fluid, manipulation during the cannulation, colonization of the catheter tip, and duration of the intravenous stay of the catheter apparently did not influence the rate of thrombosis. Since the natural history of the thrombotic subclavian veins is not known, some caution must be paid to repeat the percutaneous cannulation of the same vein and the change the catheter over a guidewire.     

Long-term indwelling silastic central venous catheters: clinical audit leading to improved surgical technique.

A retrospective audit of the surgical insertion and clinical outcome of silastic venous catheters on our Haematology Unit was performed for the period 1985 to 1988. Twenty-three (58%) of the 40 lines had complications, and analysis showed that many were due to problems related to the surgical technique used. This altered our clinical practice, and over a 12 month period (January 1989 to January 1990) 26 central venous catheters have been placed in 24 patients by a dedicated surgical team using a standardized, altered technique. This has been to place all catheters via the right internal jugular vein and to confirm line position by on-table radiographic screening. A significant improvement in results is presented.     

The effect on bacteriuria of removal of indwelling catheters and treatment with co-trimoxazole

After removal of an indwelling cathether from 54 geriatric patients, 14 became non-bacteriuric during treatment with absorbent pads. The remaining 40 patients with bacteriuria showed a significant reduction in the number of Gram-negative strains of probable nosocomial type in their urine when compared to the previous period of catheter treatment. Of these 40 patients, 27 were non-bacteriuric after a week's treatment with cotrimoxazole. Seven weeks after treatment, 15 of these patients were still non-bacteriuric. This two-step model, removal of the indwelling catheter followed by a short course of treatment with a suitable antibiotic, demonstrates a possible approach to the problem of incontinence and hospital-acquired bacteriuria in long-term care.     

Appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy.

By reviewing medical records, we evaluated the appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy. The inappropriate use of an indwelling urinary tract catheter (in 138 [30%] of 461 patients) was significantly associated with greater age, not having undergone a surgical intervention, a good state of consciousness, presence of chronic comorbidities, duration of catheterization, and ward of admission.     

Modeling the cost of influenza: the impact of missing costs of unreported complications and sick leave

Background  

Estimating the economic impact of influenza is complicated because the disease may have non-specific symptoms, and many patients with influenza are registered with other diagnoses. Furthermore, in some countries like Norway, employees can be on paid sick leave for a specified number of days without a doctor's certificate ("self-reported sick leave") and these sick leaves are not registered. Both problems result in gaps in the existing literature: costs associated with influenza-related illness and self-reported sick leave are rarely included. The aim of this study was to improve estimates of total influenza-related health-care costs and productivity losses by estimating these missing costs.     

Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service.

Of 836 medical admissions evaluated over a 1-month period, 89 (10.7%) had a urinary catheter placed within 24 hours; 34 placements (38%) had no justifiable indication. Risk for inappropriate catheterization was independent of age, gender, functional status, and mental status at admission. Preventive measures should focus on increasing awareness among healthcare providers.