Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates / 中国当代儿科杂志

OBJECTIVES@#To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI.@*METHODS@#A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates.@*RESULTS@#A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05).@*CONCLUSIONS@#CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.

A review in emergency central venous catheterization / 中华创伤杂志(英文版)

Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and techniques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate.

The Effect of Head Rotation and Leg Elevation on Skin Depth, Diameter and Relative Position of the Internal Jugular Vein, and its Implications

PURPOSE: The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA). METHODS: A total of 20 volunteers were enrolled in this study. In a supine position with/without 30degrees head rotation to the left, and with/without 30degrees leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180degrees to +180degrees. The measurements observed in each position were compared. RESULTS: As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter. CONCLUSION: Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.

The Effect of Head Rotation and Leg Elevation on Skin Depth, Diameter and Relative Position of the Internal Jugular Vein, and its Implications

PURPOSE: The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA). METHODS: A total of 20 volunteers were enrolled in this study. In a supine position with/without 30degrees head rotation to the left, and with/without 30degrees leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180degrees to +180degrees. The measurements observed in each position were compared. RESULTS: As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter. CONCLUSION: Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.

Hemoptysis after Left Subclavian Central Venous Catheterization during Anesthesia Induction for Open Heart Surgery : Two cases report / 대한마취과학회지

Central venous catheters allow a measurement of the hemodynamic variables that cannot be measured accurately by noninvasive means, and allow the delivery of medications and nutritional support that cannot be administered safely through peripheral venous catheters. Unfortunately, the use of central venous catheters is associated with adverse events that are hazardous to patients. Hemoptysis is a significant clinical presentation in respiratory medicine. Often a life threatening emergency, it mandates a prompt assessment and intervention. Fiberoptic bronchoscope is useful and essential for investigating the cause of hemoptysis as well as for managing airway hygiene. We report two cases of hemoptysis after left subclavian central venous catheterization along with the use of a fiberoptic bronchoscope for hemoptysis.

Ten-Year Study of Bacteremia in Hemodialysis Patients in a Single Center / 대한신장학회잡지

BACKGROUND: The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. METHODS: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication and mortality of bacteremia. We compared clinical factors, morbidity and mortality between arteriovenous fistula and central venous catheter groups. RESULTS: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%) and staphylococcus aureus was most common. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n=4), aspiration pneumonia (n=2), hypoxic brain injury (n=1), gastrointestinal bleeding (n=1), and rupture of aortic pseudoaneurysm. Central venous catheter group (n= 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p<0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p=0.042) than arteriovenous group. CONCLUSION: This data showed that bacteremia caused high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.

Preventing of Sterile Phlebitis by Infrared Irradiation after Peripherally Inserted Central Catheterization / 中华医院感染学杂志

OBJECTIVE To study the clinical effect of preventing and treating sterile phlebitis(abacterial phlebitis,SP) by infrared irradiation after peripherally inserted central catheterization(PICC).METHODS Totally 122 inpatients from the Zhejiang Provincial People′s Hospital were divided into two groups randomly,the control group and the experimental group.The control group was only treated with usual care after PICC,while the experimental group with both infrared irradiation and usual care.The incidence rate of SP and its correlation factor were compared between the two groups.RESULTS None in the experimental group got SP.Nevertheless,the control group got a 21.9%incidence rate.The development of SP mostly own to impassable intubation or repeating intubation.CONCLUSIONS For those patients with impassable intubation or repeating intubation during PICC operation,infrared irradiation shows greatly helpful and can obviously prevent the SP and diminish patients′ fee.