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Objective:To investigate the feasibility of using body surface marker localization method to determine the correct position of catheter tip (lower 1/3 of the superior vena cava or the junction of superior vena cava and right atrium) in totally implantable venous access port (TIVAP) implantation via internal jugular vein approach.Methods:The clinical data of 220 patients who underwent TIVAP implantation in Beijing Tongren Hospital, Capital Medical University from June 2019 to June 2021 were retrospectively analyzed. Among them, 168 patients used the internal jugular vein approach. According to the method implemented for determining the length of central venous catheter (CVC) during the operation, the patients were divided into two groups: 136 patients using the body surface marker localization method were defined as the study group; and the remaining 32 cases treated by the intraoperative X-ray fluoroscopic localization method were defined as the control group. The difference in the excellent or good rate of CVC tip position immediately after implantation and the time of implantation was compared between the two groups. In addition, the correlation between the length of CVC indwelling, height, age, and the distance between the catheter tip and tracheal carina was analyzed for the patients with right and left internal jugular vein catheterization. Kolmogorov-Smirnov test was used for statistical distribution of measurement data. Normal distribution of measurement data was expressed as mean ± standard deviation ( ± s), independent sample t-test was used for comparison between groups. Chi-square test was used for comparison between counting data. With TIVAP catheter indenture length as dependent variable and height as independent variable, Pearson correlation analysis was performed, the relationship equation between ideal catheter indenture length and patient height was analyzed by unitary linear regression. Results:When the CVC tip was located at the second intercostal space, the third sternocostal joint and the third intercostal space, the corresponding probability of being in the correct position was 34.8%, 83.3% and 95.0% respectively. The third sternocostal joint or the third intercostal space had a higher probability of correct CVC tip location than the second intercostal space, and the difference were statistically significant ( P<0.001). Furthermore, there was no significant difference in the possibility of the CVC tip located in the correct position between the third sternocostal joint and the third intercostal space ( P=0.149). Compared with the control group (before adjusting catheter position), the proportion of excellent or good CVC position in the study group was significantly improved (94.1% vs 46.9%), and the difference was statistically significant ( χ2=41.99, P<0.001); while the total operation time was significantly shortened [(33.04±6.69) min vs (42.50±5.54) min], and the difference was statistically significant ( P<0.05). There was a linear correlation between the length of CVC insertion and height. Indwelling catheter length via right internal jugular vein approach (cm) =0.159× height (cm)-1.284 ( r=0.597, r2=0.356, P<0.001); length of catheter indwelling through the left approach (cm) =0.097× height (cm) + 12.139 ( r=0.322, r2=0.104, P=0.020). Conclusions:The third sternocostal joint or the third intercostal space would be the corresponding correct surface landmark of the CVC tip when the body surface marker localization method was adopted during the TIVAP implantation via the internal jugular vein approach. Compared with the intraoperative X-ray fluoroscopy localization, the operation time is significantly shortened with the application of the body surface marker localization method. This technique is simple and easy to master and has high reliability in determining the length of catheter and the position of CVC tip.
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This article aims to study the factors affecting the flexibility of the tip of an epidural anesthesia catheter. The flexibility of the tip of the epidural anesthesia catheter was tested with a softness tester from four aspects:raw materials, tip structure, tip processing technology, and the outer diameter of the catheter. Highly flexible and malleable polymer material with a smooth tip, the tip softening process and the proper outer diameter can effectively improve the tip flexibility of the epidural anesthesia catheter.
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Anesthesia, Epidural , Catheterization , Catheters , Epidural SpaceABSTRACT
Introduction: Patients with end-stage renal disease (ESRD) are treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Aims and objectives: Our aim was to study the non-infectious complications in patients of ESRD on CAPD and to study the impact of the non-infectious complications in the survival of CAPD catheters. Materials and Methods: A prospective study has been conducted at Regional institute of medical science, Imphal in a total of 71patients of ESRD who are already on CAPD or newly diagnosed ESRD who have undergone CAPD catheter implantation. Their detailed history, clinical examination and relevant laboratory investigations were done and the different non-infectious complications were identified and analysed. Result: Out of the 71 patients studied 39 patients had complications like hypokalemia (15 patients), omental wrap (10 patients), catheter tip migration (6 patients), haemoperitonium (2 patients), hydrothorax (2patients), exit site leak(2patients), abdominal wall edema (1patient), catheter block(1patient). Conclusion: In our study the most common non-infectious complication was hypokalemia followed by omental wrap and catheter tip migration. Knowledge about the common prevalent non-infectious complications of CAPD alerts the treating doctor to take up the specific corrective steps at an earlier stage, thus preventing the morbidity associated with the same. We conclude that the majority of non-infectious complications in these patients were treatable and did not interfere with the catheter survival.
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Objective Catheter tip displacement (CTD) after ultrasound-guided umbilical vein catheterization (UVC) in neonates may influence the effect of treatment .This study was to investigate the risk factors for CTD . Methods This study included 159 neonates undergoing ultrasound -guided UVC in our hospital between January 2015 and June 2017.We recorded the one-time suc-cess rate of UVC and the numbers of cases of CTD and non -CTD at 7 days after UVC, and analyzed the risk factors for CTD by univari -ate and multivariate logistic regression analyses . Results Ultrasound-guided UVC was successfully performed in 106 (66.67％) of the neonatal patients, who underwent ultrasonography and thoracic and abdominal X -ray examinations 7 days later.CTD was observed in 19 (17.93％) of the 106 neonates, including 5 cases of upward shift (4.72％) and 14 cases of downward shift (13.21％), while the other 87 ( 82.07％) were non-CTD cases.Statistically significant differences were found between the CTD and non -CTD groups in the gestational age, body mass, catheter external fixation, restlessness, catheter-tending time, and catheter shifting (P<0.05).Multivariate analysis showed that the gestational age (OR =-1.315, P =0.015),body mass (OR=-1.214, P=0.019), catheter external fixation (OR =2.164, P =0.007), restlessness (OR =1.354, P =0.014), catheter-tending time (OR=1.458, P=0.012), and catheter shifting (OR=2.016, P=0.010) were the risk factors for CTD after ul-trasound-guided UVC. Conclusion There are quite a few risk factors for CTD after ultrasound -guided UVC, which can be reduced by relevant preventive measures .
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Objective To explore a new method which could detect the misplacement of peripherally inserted central catheter (PICC).Methods The action of coughing was applied to 252 patients and observing the changes in dripping speed.Results The accuracy rate of this new method was 100.00％ (252/252).The success rate of first PICC in these patients was also 100.00％ (252/252).Conclusions It suggests that the new method Should be effective and convenient in the assessment of PICC misplacement and it can be applied to detect the misplacement occurred in and after the process of PICC.
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BACKGROUND: The diagnosis of catheter-related bloodstream infection (CRBSI) should demonstrate catheter colonization of the same organism as the isolate from peripheral blood cultures, by catheter tip culture or by differential time to positivity (DTP) of catheter-drawn blood cultures versus peripheral blood cultures. The purpose of this study was to compare the sonication and the roll-plate methods of catheter tip culture. METHODS: One hundred and sixty-one catheter tips from 122 patients were submitted for catheter tip culture. Distal segments of the catheter were first inoculated using a roll-plate, and then inoculated by sonication. Sonication was performed using a BactoSonic device (Bandelin GmbH, Germany). A total of 1,018 sets of blood cultures from 7 days before to 1 day after catheter removal were analyzed for isolated organisms and DTP. Cutoffs of catheter colonization were > or =15 CFU for the roll-plate method, > or =100 CFU for sonication, and > or =2 h for DTP. RESULTS: Twenty-four catheter tips (14.9%) showed colonization with at least one of the two methods: 21 (13.0%) with the roll-plate method and 22 (13.7%) with sonication. The positivity rates for the two methods showed no significant difference, and the concordance rate for the two methods was 96.9% (k=0.866, P<0.001). Blood culture was positive in 56 episodes in 44 patients, and 14 episodes of CRBSI were diagnosed in 12 patients: 10 by tip culture (two by sonication only) and 8 by DTP. Of the 122 specimens that were negative according to both methods, 4 were from the episodes of CRBSI diagnosed by DTP. CONCLUSION: Roll-plate and sonication methods are comparable in diagnostic sensitivity for catheter colonization. The roll-plate and sonication catheter tip culture methods and DTP are complementary for diagnosis of CRBSI.
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Humans , Catheters , Central Venous Catheters , Colon , Diagnosis , SonicationABSTRACT
Objective The intracardiac electrocardiogram (ecg) positioning technology in the clinical appli -cation of PICC catheter tip to locate effect were discussed .Methods 115 cases of our department in October 2013-2014 December PICC placement of patients admitted to the study .All patients completed according to uniform pro -cedures catheter, and the use of intracardiac electrocardiogram positioning technology in the catheterization process PICC catheter tip positioning, again catheter positioning X -ray film.Results Intracardiac electrocardiogram PICC tip into the superior vena cava sensitivity of 93.03%, and the situation is a total of seven cases no P wave changes , the rest of the patient P or T wave changes .X -ray showed 108 cases of catheter tip is located on the within the vena cava, and two cases in the subclavian vein (intravenously to two cases of circular motion , resulting in a circular mo-tion intravenous catheter insufficient length , which does not reach the superior vena cava ), and two cases in the inter-nal jugular vein, three cases in the brachial vein .Conclusion PICC catheter tip positioning taking intracardiac elec -trocardiogram positioning technology , with high sensitivity and specificity , which can be clinical application .
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Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.
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OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common types of intra-cranial hemorrhages usually associated with trauma. Surgical treatment is the treatment of choice and burr hole trephination (BHT) is widely performed. The recurrence rate in the patients with CSDH is 3.7-30%. This study investigated the risk factors associated with the recurrence of patients with CSDH who underwent BHT. METHODS: One hundred twenty-five patients with CSDH underwent BHT. Eight of 125 patients (6.4%) underwent reoperation for recurrent CSDH. We retrospectively analyzed demographic, clinical and radiological findings, catheter tip location and drainage duration as the risk factors for the recurrence of CSDH. RESULTS: Recurrence of CSDH in the high- or mixed-density groups was significantly higher than those in the low- or iso-density groups (p<0.001). Placement of catheter tip at the temporoparietal area was associated with a significantly higher recurrence rate of CSDH than placement at the frontal area (p=0.006) and the brain re-expansion rate (BRR) was much lower than placement at the frontal area (p<0.001). CONCLUSION: The operation may be delayed in high- and mixed-density groups, unless severe symptoms or signs are present. In addition, placing the catheter tip at the frontal area helps to reduce the incidence of postoperative recurrence of CSDH and to increase the BRR.
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Humans , Brain , Butylated Hydroxytoluene , Catheters , Drainage , Hematoma, Subdural, Chronic , Hemorrhage , Incidence , Recurrence , Reoperation , Retrospective Studies , Risk Factors , TrephiningABSTRACT
OBJECTIVE: A variety of factors are known to have an influence on the recurrence of chronic subdural hematoma (CSDH). In this study, the authors investigated the influential factors for recurrence of CSDH after burr hole drainage. METHODS: 45 patients with unilateral CSDH were treated with one-burr hole trephination and closed drainage in our hospital during last 6 years, whom the drainage catheter tip was randomly located and checked on postoperative computed tomography (CT). The clinical status of patients, thickness of hematoma, midline displacement of before and after surgery, amount of subdural air collection, drainage catheter tip location were estimated and the relationship of those factors with the recurrence was analyzed. RESULTS: Patients with located catheter tip in frontal had a better clinical and radiological result. And the recurrence of CSDH was lower who has lesser amount of subdural air collection in postoperative CT. CONCLUSION: The recurrence rate of unilateral CSDH is influenced by the location of drainage catheter tip and the amount of subdural air collection.
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Humans , Catheters , Displacement, Psychological , Drainage , Hematoma , Hematoma, Subdural, Chronic , RecurrenceABSTRACT
OBJECTIVE: The authors analyzed the postoperative radiological changes in chronic subdural hematoma (CSDH) after operation and its relation to the recurrence. METHODS: After reviewing the postoperative imagings of CSDH patients (90 cases, 70 patients), we classified them into 4 types according to the radiological changes in the hematoma area and calculated the prevalence of recurrence respectively. We also reviewed the preoperative images of the same patients and classified them into 4 types according to hematoma density and internal structure and investigated the prevalence of recurrence after operation respectively. RESULTS: The low density area in postoperative computerized tomography (CT) showed the same Hounsfield unit and signal intensity in magnetic resonance imaging (MRI) with the CSF in ventricles. The recurrence of CSDH was lower if the hematoma was totally replaced with CSF (Type III) or the brain re-expanded completely with total hematoma drainage (Type IV) on postoperative imagings (p<0.05). The location of catheter tip can be used as a valuable indicator of the boundary of newly collected CSF and residual hematoma. CONCLUSION: The low-density area found on postoperative CT medial to the residual hematoma in CSDH is filled with CSF and it can be a helpful factor in reducing the recurrence. The catheter tip location can be used as a good index and we can remove the catheter immediately after confirming the tip location on the inner surface of the skull.
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Humans , Brain , Catheters , Drainage , Hematoma , Hematoma, Subdural, Chronic , Magnetic Resonance Imaging , Prevalence , Recurrence , SkullABSTRACT
BACKGROUND: Catheter-related sepsis (CRS) has become an important cause of nosocomial infections and the major complication with the intravenous central venous catheter (CVC) use. In this paper, we present the culture results of two years from Chonnam National University Hospital on the etiologic agents of CRS. METHODS: We reviewed the culture results for the most recent two years (July 1999 to June 2001) including semiquantitative CVC tip cultures (n=622) and differential quantitative blood cultures (n=149), as well as hospital records to determine clinical correlates of CRS. CRS was defined as a positive blood culture and catheter culture with the same organism in conjunction with a CVC tip >or=15 CFU or a central-to-peripheral blood culture colony count ratio of >or=5 :1. RESULTS: Forty-two (6.8%) of 622 CVC tip cultures and 13 (8.7%) of 149 differential quantitative blood cultures were associated with CRS. A total of 48 (32.0%) of 150 patients with bacteremia or candidemia were confirmed as having CRS, using semiquantitative tip cultures (30.9%, 42 of 136) and/or differential quantitative blood cultures (27.1%, 13 of 48). Twenty-one (48.8%) of 43 candidacies patients were associated with CRS and were more frequent than bacteremia due to Gram-positive cocci (27.3%, 18 of 66), and Gram-negative bacilli (23.1%, 9 of 39)(P<0.05). In 48 cases with proven CRS, Candida parapsilosis (29.2%) and Staphylococcus aureus (25.0%) were the most common etiologic agents, followed by coagulase negative Staphylococcus (10.4%), and Acinetobacter baumannii (8.3%). CONCLUSIONS: In culture proven cases of CRS, C. parapsilosis and S. aureus were the predominant causative organisms, and candidemia was more frequently associated with CRS than was bacteremia.
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Humans , Acinetobacter baumannii , Bacteremia , Candida , Candidemia , Catheters , Central Venous Catheters , Coagulase , Cross Infection , Gram-Positive Cocci , Hospital Records , Prevalence , Sepsis , Staphylococcus , Staphylococcus aureusABSTRACT
BACKGROUND: The peritoneal catheter of the continuous ambulatory peritoneal dialysis(CAPD) is patients' lifeline. A significant number of complications and catheter failures in CAPD are due to mechanical problems. We describe our retrospective experience with CAPD focusing on the rate of catheter displacement and survival according to the site of catheter tip placement in 70 cases of CAPD in Kyunghee University Hospital between November 1994 and February 2000. METHODS: We describe our retrospective experience with CAPD focusing on the rate of catheter displacement and survival according to the site of catheter tip placement in 70 cases of CAPD in Kyunghee University Hospital between November 1994 and February 2000. RESULTS: Among 70 cases of CAPD, 46 cases were right pelvic cavity tip placement and 24 cases were left. Causes of chronic renal failure(CRF) were diabetes mellitus in 29 cases(63%), hypertension in 13 cases (28%), glomerulonephritis in 4 cases(9%) in right pelvic cavity catheter tip placement and diabetes mellitus in 13(54%), hypertension in 10(42%), renal tuberculosis in 1 case(4%) left pelvic cavity catheter tip. There were no difference in causative diseases of CRF between both groups. Incidence of CAPD catheter tip displacement were 17.4%(8/46) at right and 4.2%(1/24) at left catheter(p=0.01). Methods for treatment of displacement were fluoroscopic brushing, laparoscopic manipulation and operation. Of the 9 cases, 5 case were received fluoroscopic brushing, 3 case were laparoscopic manipulation and 1 case was received operation. Other complication were peritonitis, catheter obstruction, hernia, death. Overall survival of catheter were 65%(30/46) at right and 71 %(17/24) at left catheter(p=NS). CONCLUSION: The incidence of CAPD catheter tip displacement was higher with catheter tip at the right pelvis than left(p=0.01). But there is no difference in the catheter survival.
Subject(s)
Catheter Obstruction , Catheters , Diabetes Mellitus , Glomerulonephritis , Hernia , Hypertension , Incidence , Pelvis , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Retrospective Studies , Tuberculosis, RenalABSTRACT
BACKGROUND: The peritoneal catheter of the continuous ambulatory peritoneal dialysis(CAPD) is patients' lifeline. A significant number of complications and catheter failures in CAPD are due to mechanical problems. We describe our retrospective experience with CAPD focusing on the rate of catheter displacement and survival according to the site of catheter tip placement in 70 cases of CAPD in Kyunghee University Hospital between November 1994 and February 2000. METHODS: We describe our retrospective experience with CAPD focusing on the rate of catheter displacement and survival according to the site of catheter tip placement in 70 cases of CAPD in Kyunghee University Hospital between November 1994 and February 2000. RESULTS: Among 70 cases of CAPD, 46 cases were right pelvic cavity tip placement and 24 cases were left. Causes of chronic renal failure(CRF) were diabetes mellitus in 29 cases(63%), hypertension in 13 cases (28%), glomerulonephritis in 4 cases(9%) in right pelvic cavity catheter tip placement and diabetes mellitus in 13(54%), hypertension in 10(42%), renal tuberculosis in 1 case(4%) left pelvic cavity catheter tip. There were no difference in causative diseases of CRF between both groups. Incidence of CAPD catheter tip displacement were 17.4%(8/46) at right and 4.2%(1/24) at left catheter(p=0.01). Methods for treatment of displacement were fluoroscopic brushing, laparoscopic manipulation and operation. Of the 9 cases, 5 case were received fluoroscopic brushing, 3 case were laparoscopic manipulation and 1 case was received operation. Other complication were peritonitis, catheter obstruction, hernia, death. Overall survival of catheter were 65%(30/46) at right and 71 %(17/24) at left catheter(p=NS). CONCLUSION: The incidence of CAPD catheter tip displacement was higher with catheter tip at the right pelvis than left(p=0.01). But there is no difference in the catheter survival.