Accueil
-
Securing All intraVenous devices Effectively in hospitalised patients— the SAVE trial: study protocol for a multicentre randomised controlled trial
Over 70% of all hospital admissions have a peripheral intravenous device (PIV) inserted; however, the failure rate of PIVs is unacceptably high, with up to 69% of these devices failing before treatment is complete. Failure can be due to dislodgement, phlebitis, occlusion/infiltration and/or infection. This results in interrupted medical therapy; painful phlebitis and reinsertions; increased hospital length of stay, morbidity and mortality from infections; and wasted medical/nursing time. Appropriate PIV dressing and securement may prevent many cases of PIV failure, but little comparative data exist regarding the efficacy of various PIV dressing and securement methods.
Authors : Claire M Rickard, Nicole Marsh, Joan Webster, E Geoffrey Playford, Matthew R McGrail, Emily Larsen, Samantha Keogh, David McMillan, Jennifer A Whitty, Md Abu Choudhury, Kimble R Dunster, Heather Reynolds, Andrea Marshall, Julia Crilly, Jeanine Young, Ogilvie Thom, John Gowardman, Amanda Corley, John F Fraser
Correspondence to Professor Claire M Rickard; c.rickard@griffith.edu.au -
Novel technologies can provide effective dressing and securement for peripheral arterial catheters: A pilot randomised controlled trial in the operating theatre and the intensive care unit.
Peripheral arterial catheters are widely used in the care of intensive care patients for continuous blood pressure monitoring and blood sampling, yet failure – from dislodgement, accidental removal, and complications of phlebitis, pain, occlusion and infection – is common. While appropriate methods of dressing and securement are required to reduce these complications that cause failure, few studies have been conducted in this area.
The pilot trial showed that the novel technologies were at least as effective as the present method of a polyurethane dressing for dressing and securement of arterial catheters, and may be cost effective. The trial also provided evidence that a larger, multicentre trial would be feasible.
Authors : Heather Reynolds 1, Kersi Taraporewalla 2, Marion Tower 3, Gabor Mihala 4, Haitham W Tuffaha 4, John F Fraser 5, Claire M Rickard 6
1NHMRC Centre of Research Excellence in Nursing, Griffith University, Nathan Campus, Queensland, Australia; Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Nathan Campus, Queensland, Australia; Department of Anaesthesiology, Royal Brisbane and Women’s Hospital, Queensland, Australia; The Burns, Trauma & Critical Care Research Centre, University of Queensland, Queensland, Australia. Electronic address: h.reynolds@griffith.edu.au
2Department of Anaesthesia and Perioperative Care, Royal Brisbane and Women’s Hospital, Queensland, Australia.
3University of Queensland Mater Clinical School, Mater Education, South Brisbane, Queensland, Australia.
4Centre for Applied Health Economics, School of Medicine, Griffith University, Logan Campus, Queensland, Australia.
5The Prince Charles Hospital, Critical Care Research Group, Intensive Care Services, Chermside, Queensland, Australia; NHMRC Centre of Research Excellence in Nursing, Griffith University, Nathan Campus, Queensland, Australia.
6NHMRC Centre of Research Excellence in Nursing, Griffith University, Nathan Campus, Queensland, Australia; Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Nathan Campus, Queensland, Australia. -
A Systematic Ultrasound Evaluation of the Diameter of Deep Veins in the Newborn: Results and Implications for Clinical Practice
In adults and children, current guidelines recommend measuring the diameter of the vein before the insertion of central catheters, in order to match vein diameter with catheter caliber and thus reduce the risk of venous thrombosis.
In the neonatal intensive care unit, central catheters are often used but the vein diameter is usually not considered.
In this study, the authors assessed the diameter of the most relevant deep veins in 100 newborns ( mean gestational age of studied infants was 32 weeks and mean weight was 1,690 g. ), using a strict protocol of ultrasound evaluation.
The results in this study are: The mean diameter of the brachiocephalic vein was consistently ≥3 mm, with no significant difference between the right and the left side. The femoral vein diameter, on the other hand, was considerably smaller than 3 mm for infants with a weight <2.000g. Interobserver repeatability was found to be very high.Their conclusion is : Preprocedural ultrasound scan of veins is feasible and easy, also in newborns, and it should be recommended for optimizing central venous catheterization.
Authors : Giovanni Baronea Vito D’Andreaa Giovanni Ventoa Mauro Pittirutib
a Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy;
b Department of Surgery, Fondazione Policlinico A. Gemelli IRCSS, Rome, ItalyNeonatology 2019;115:335–340
-
Comparison between sedation room and operating room in central venous catheter positioning in children
Placement of central venous access devices is a clinical procedure associated with some risk of adverse events and with a relevant cost. Careful choice of the device, appropriate insertion technique, and proper management of the device are well-known strategies commonly adopted to achieve an optimal clinical result. However, the environment where the procedure takes place may have an impact on the overall outcome in terms of safety and cost-effectiveness.
The authors found that the insertion of the device in a sedation room rather than in the operating room was associated with a relevant reduction in costs, with no difference in terms of immediate, early, or late complications. The benefits of this innovative approach include an easier periprocedural management of the patient, less radiation exposure, and more comfortable and welcoming environment for the child and his parents.Authors : Antonio Chiaretti1 , Mauro Pittiruti2 , Giovanni Sassudelli1 , Giorgio Conti3 , Marco Rossi4 , Silvia Maria Pulitano`3 , Aldo Mancino3 , Angela Pusateri4 , Antonio Gatto1 and Federica Tosi4
1 Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
2 Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
3 Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
4 Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, ItalyCorresponding author: Antonio Gatto, Institute of Pediatrics, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Email: antonio.gatto@policlinicogemelli.it
J Vasc Access. 2021 Mar;22(2):184-188.
Epub 2020 Jun 22 -
Catheter salvage strategies in children with central venous catheter-related or -associated bloodstream infections: a systematic review and meta-analysis
Optimal management of central venous catheter-related, or -associated, bloodstream infections (CRBSI or CLABSI) in children is not established.
From 345 identified publications, 19 met inclusion criteria (total of 914 attempted salvage strategies).
To achieve successful catheter salvage, in CRBSI the addition of ALT was superior to systemic antibiotics alone. CRBSI recurrence was less common in studies that used ALT compared with systemic antibiotics alone. Recurrences were low with both antibiotic locks and ethanol lock. No clear benefits of ALT addition compared to systemic antibiotic only were found in CLABSI.
The conclusion in this study is that the addition of an antimicrobial lock solution to systemic antibiotic may be beneficial for successful catheter salvage in paediatric patients with CRBSI, depending on aetiology, whereas no statistically significant difference between systemic antibiotic with or without addition of an antimicrobial lock solution was found regarding CLABSI.
Authors :
D. Buonsenso a,b, c, *, G. Salerno d , G. Sodero d , F. Mariani d , L. Pisapia e , C. Gelormini e , M. Di Nardo f , P. Valentini a , G. Scoppettuolo g , D.G. Biasucci e, **
a Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
b Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universita` Cattolica Del Sacro Cuore, Rome, Italy
c Global Health Research Institute, Istituto di Igiene, Universita` Cattolica Del Sacro Cuore, Rome, Italy
d Institute of Pediatrics, Universita` Cattolica Del Sacro Cuore, Rome, Italy
e Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy f Pediatric Intensive Care Unit, Children’s Hospital Bambino Gesu`, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy g Department of Infectious Diseases, Fondazione Policlinico Universitario ‘A.Gemelli’ IRCCS, Rome, Italy
* Corresponding author. Address: Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, Italy. Tel.: þ39 06 3015 6242; fax: þ39 06 3013450.
** Corresponding author. Address: Intensive Care Unit, Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, Italy. Tel.: þ39 06 3015 6242; fax: þ39 06 3013450. E-mail addresses: danilobuonsenso@gmail.com (D. Buonsenso), danielebiasucci@gmail.com (D.G. Biasucci).
0195-6701/ @2022 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
Available online at http://www.sciencedirect.com Journal of Hospital Infection -
Long peripheral catheters in neonates: filling the gap between short peripheral catheters and epicutaneous-caval catheters?
Non-critically ill neonates at times require venous access to provide peripherally compatible infusions for a limited period (more than 3days). In such a situation, short peripheral cannulas are not appropriate as their average duration is about 2days, while—on the other hand—epicutaneous-caval catheters may be too invasive. In these patients, insertion of long peripheral cannulas may be an effective option.
In the experience of the authors, 2Fr 4–6 cm long peripheral catheters may be a valid option for neonates requiring peripherally compatible infusions for more than 3days. The limits of this study are the necessity of training in the technique of insertion and the small size of our sample. The longest dwell was observed in neonates weighing >2000g at the time of LPC insertion.
Authors : Maria Grazia Romitti* , Carmen Rodriguez Perez* , Elena Pezzotti, Mario Motta and Francesco Maria Risso
Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
*These authors have contributed equally to this work. Corresponding author: Maria Grazia Romitti, Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, n. 1, Brescia, Lombardia 25123, Italy.
Email: mg.romitti8@gmail.com
-
Ultrasound-guided cannulation of the superficial femoral vein for central venous access
In this study, the authors have retrospectively reviewed their experience with central catheters inserted by ultrasound-guided puncture and cannulation of the superficial femoral vein, focusing mainly on indications, technique of venipuncture, and incidence of immediate/early complications.
They concluded that the ultrasound approach to the superficial femoral vein is an absolutely safe technique of central venous access. In their experience, it was not associated with any risk of severe insertion-related complications, even in patients with low platelet count or coagulation disorders. Also, the exit site of the catheter at mid-thigh may have advantages if compare to the exit site in the inguinal area.
Authors : Maria Giuseppina Annetta 1, Bruno Marche 1, Laura Dolcetti 1, Cristina Taraschi 1, Antonio La Greca 1, Andrea Musarò 1, Alessandro Emoli 1, Giancarlo Scoppettuolo 1, Mauro Pittiruti1 1Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy.
PMID: 33749364
DOI: 10.1177/11297298211003745
To consult the study -
Chest-to-arm tunneling: A novel technique for medium/long term venous access devices
Chest-to-arm (CTA) tunneling has been described recently as a technique that allows an optimal exit site at mid-arm even in chronically ill patients with complex clinical issues and challenging problems of vascular access.
The results in the study are very good and they concluded that CTA tunneling is a safe maneuver, with very low risk of complications, and should be considered as an option in patients with complex venous access.
Authors : Maria Giuseppina Annetta 1, Matt Ostroff 2, Bruno Marche 1, Alessandro Emoli 1, Andrea Musarò 1, Davide Celentano 1, Cristina Taraschi 1, Laura Dolcetti 1, Antonio La Greca 1, Giancarlo Scoppettuolo 1, Mauro Pittiruti 1
1 Fondazione Policlinico Universitario “A.Gemelli”, Rome, Italy.
2 St. Joseph’s University Medical Center, Paterson, NJ, USA.
J Vasc Access. 2023 Jan;24(1):92-98.
DOI: 10.1177/11297298211026825. Epub 2021 Jun 19
PMID: 34148390
To consult the study -
Advances in neonatal vascular access
Recently, Dr F. Piersigilli gave a presentation in the Belgian Association of neonatology.
Dr. Piersigilli is member of the advisory board of the NEVAT.
She gave a presentation about all the important things to know about vascular access for neonates.
Authors: Dr. Piersigilli, Neonatologist
Cliniques Universitaires Saint Luc – Brussels, Belgium
-
Taurolidine Lock Solutions for the Prevention of Catheter-Related Bloodstream Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
The results of the analyses suggest that TLS reduced the incidence of CRBSIs without obvious adverse effects and bacterial resistance. There was insufficient evidence to demonstrate a difference in susceptibility to taurolidine between G+ and G-bacteria. As the analyses were limited to studies with small sample sizes, they cannot conclude whether TLS treatment is associated with a higher risk for catheter-associated thrombosis compared to a control heparin lock solution.
In addition, the results must also be treat with caution due to methodological deficiencies of the included studies. More well-designed and adequately powered RCTs are needed to confirm these findings.
Authors : Yong Liu1 *, An-Qiang Zhang2 , Lin Cao1 , Hong-Tao Xia1 , Jun-Jie Ma1
1 Intensive care unit, Suining Central Hospital, Chuanshan District, Suining, Sichuan, China,
2 State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Yuzhong District, Chongqing, China
Liu Y, Zhang A-Q, Cao L, Xia H-T, Ma J-J (2013) Taurolidine Lock Solutions for the Prevention of Catheter-Related Bloodstream Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 8(11): e79417.
