Catheter-related thrombosis in a neonatal intensive care unit: a case-control study

Introduction: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. Objective: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. Methods: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. Results: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. Conclusion: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

Study on the application of different-length peripheral intravenous catheters in patients undergoing metabolic and bariatric surgery:a randomized clinical trial / 中华护理杂志

Objective To investigate the appropriate venous access for obese patients undergoing metabolic and bariatric surgery by comparing the clinical outcomes of different lengths of peripheral intravenous catheters.Methods Inpatients who underwent bariatric surgery in a tertiary hospital in Zhejiang from August 2022 to December 2022 were selected as the study population using a fixed-point continuous convenience sampling method.A stratified block randomisation method was used to divide the group into an experimental group 1(mini-midline catheters),an experimental group 2(midline catheters)and a control group(short peripheral intravenous catheters,Short PIVCs).The incidence of catheter-related complications,the rate of extubation due to complications,the duration of catheter retention,the time to first catheter-related complication were compared in the 3 groups.Results A total of 186 patients were included,with 62 patients in each group.The overall incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 25.81％,8.06％,and 58.06％.The extubation rates due to complications were 19.35％,4.84％,and 41.94％,and the duration of catheter retention was 7.00(6.00,7.00)d,7.00(6.00,7.00)d,6.00(3.00,6.25)d.The differences were statistically different(P＜0.05)when comparing the 3 groups.Among them,the differences in the overall incidence of catheter-related complications and the rate of extubation due to complications were statistically significant when comparing experimental group 1 with the control group,experimental group 2 with the control group,and experimental group 1 with experimental group 2(P＜0.017);the duration of catheter retention in both experimental group 1 and experimental group 2 were higher than it in the control group,and the differences were statistically different(P＜0.017).Conclusion The complication rate of mini-midline catheters and midline catheters is lower than that of short ones,and the indwelling time is consistent with the perioperative period of metabolic and bariatric surgery,which is suitable for use in patients undergoing metabolic and bariatric surgery.

Prevention of complications related to peripherally inserted central catheter insertion techniques in newborns: systematic review and network meta-analysis / Prevención de complicaciones asociadas con las técnicas de inserción de catéter central de inserción periférica en recién nacidos: revisión sistemática y metaanálisis en red / Prevenção de complicações relacionadas a técnicas de inserção do cateter central de inserção periférica em recém-nascidos: revisão sistemática e metanálise em rede

Objective: to analyze the effectiveness of peripherally inserted central catheter insertion techniques in preventing the occurrence of complications related to this device in newborns. Method: a paired and network systematic literature review and meta-analysis, with its search carried out in seven databases and in the Grey Literature, including randomized and non-randomized clinical trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 and Risk of Bias In Non-randomized Studies of Interventions tools. Certainty of the evidence was assessed by means of the Grading of Recommendations Assessment, Development and Evaluation. A meta-analysis was carried out with the aid of the R statistical program. Results: eight studies with 1,126 newborns were included and six insertion techniques were identified: intracavitary electrocardiogram; intracavitary electrocardiogram associated with ultrasound; ultrasound; formula; anatomical landmark; and modified anatomical landmark. Five techniques significantly decreased primary tip malpositioning when compared to the control ( p <0.05). Intracavitary electrocardiogram significantly and more effectively reduced arrhythmias, general complications and phlebitis; the technique that used a formula also reduced general complications. Infection, infiltration, secondary tip malpositioning, catheter rupture, thrombosis, occlusion and catheter-associated skin lesion were not significantly preventable events. Conclusion: intracavitary electrocardiogram and use of the formula were the most effective techniques in reducing complications.

Objetivo: analizar la efectividad de las técnicas de inserción de catéter central de inserción periférica en la prevención de la aparición de complicaciones asociadas con este dispositivo en recién nacidos. Método: revisión sistemática de la literatura y metaanálisis pareado y en red, la búsqueda se realizó en siete bases de datos y en la literatura gris, se incluyeron ensayos clínicos aleatorizados y no aleatorizados. El riesgo de sesgo se evaluó mediante las herramientas Cochrane Risk of Bias 2 y Risk of Bias In Non-randomized Studies of Interventions . La certeza de la evidencia a través de la Grading of Recommendations Assessment, Development and Evaluation . Se realizó un metaanálisis con ayuda del programa estadístico R. Resultados: se incluyeron ocho estudios, con 1126 recién nacidos, y se identificaron seis técnicas de inserción: electrocardiograma intracavitario, electrocardiograma intracavitario asociado a ultrasonido, ultrasonido, fórmula, punto anatómico de referencia y punto anatómico de referencia modificado. Cinco técnicas redujeron significativamente el mal posicionamiento primario de la punta en comparación con el control (p<0,05). El electrocardiograma intracavitario redujo de manera significativa y más efectiva las arritmias, las complicaciones generales y la flebitis; la técnica que utilizó una fórmula también redujo las complicaciones generales. La infección, la infiltración, el mal posicionamiento secundario de la punta, la rotura del catéter, la trombosis, la oclusión y las lesiones de la piel asociadas con el catéter son eventos que no se revinieron significativamente. Conclusión: el electrocardiograma intracavitario y el uso de la fórmula fueron las técnicas más efectivas para reducir las complicaciones.

Objetivo: analisar a efetividade das técnicas de inserção de cateter central de inserção periférica na prevenção da ocorrência de complicações relacionadas a este dispositivo em recém-nascidos. Método: revisão sistemática da literatura e metanálise pareada e em rede, com busca realizada em sete bases de dados e na literatura cinzenta, inclusão de ensaios clínicos aleatorizados e não aleatorizados. O risco de viés foi avaliado pelas ferramentas da Cochrane Risk of Bias 2 e o Risk of Bias In Non-randomised Studies of Interventions. A certeza da evidência pelo Grading of Recommendations Assessment, Development and Evaluation. Realizou-se metanálise com auxílio do programa estatístico R. Resultados: oito estudos, com 1126 recém-nascidos, foram incluídos e seis técnicas de inserção identificadas: eletrocardiograma intracavitário, eletrocardiograma intracavitário associado à ultrassonografia, ultrassonografia, fórmula, marco de referência anatômico e marco de referência anatômico modificado. Cinco técnicas diminuíram significativamente o mau posicionamento primário da ponta quando comparadas com o controle ( p <0,05). O eletrocardiograma intracavitário diminuiu arritmias, complicações gerais e flebite de forma significativa e mais efetiva; a técnica que utilizou uma fórmula também reduziu complicações gerais. Infecção, infiltração, mau posicionamento secundário da ponta, ruptura do cateter, trombose, oclusão e lesão de pele associada ao cateter não foram eventos prevenidos significativamente. Conclusão: eletrocardiograma intracavitário e uso da fórmula foram as técnicas mais efetivas na redução de complicações.

Intervenção educativa para melhorar o manejo do dispositivo de acesso vascular totalmente implantado / Intervención educativa para mejorar el manejo del dispositivo de acceso vascular totalmente implantado / Educational intervention to improve management of totally implanted vascular access device

Resumo Objetivo Avaliar o efeito de uma intervenção educativa para enfermeiros para aumentar o conhecimento e as habilidades práticas de manejo de dispositivos de acesso vascular totalmente implantados. Métodos Estudo quase-experimental realizado em um hospital universitário. A intervenção incluiu exposição a um manual de procedimentos seguida de treinamento teórico-prático sete dias depois. Oitenta e um enfermeiros foram avaliados no início do estudo, após autoexposição ao manual e após receberem treinamento teórico-prático. Os participantes foram avaliados quanto ao seu conhecimento e habilidades práticas no gerenciamento de dispositivos de acesso vascular totalmente implantados. Estatísticas descritivas foram realizadas para todas as variáveis. O teste t pareado foi utilizado para examinar se a pontuação média mudou desde a linha de base até a primeira e segunda avaliações de conhecimento, acesso, desacesso e manutenção do cateter. O nível de significância foi definido como 0,05. Resultados Os aumentos médios nas pontuações após a exposição dos enfermeiros ao manual foram de 18,2 pontos para conhecimento, com 16,5 pontos para técnica de acesso, 15,5 para técnica de desacesso e 24,2 para técnica de manutenção do cateter. Após o treinamento teórico-prático, observamos aumento médio de 4,2 pontos para acesso, com 3,9 para desacesso e 4,2 para manutenção do cateter. Conclusão A intervenção educativa para enfermeiros aumentou os escores médios de conhecimentos e habilidades práticas. Ao final da intervenção, 75% dos enfermeiros atingiram pelo menos 33 pontos de 38 para conhecimento e 77%, 77% e 78% obtiveram escores perfeitos para acesso, desacesso e manutenção, respectivamente. A intervenção educativa foi eficaz na melhoria do conhecimento e das habilidades práticas para manejo de dispositivos de acesso vascular totalmente implantados.

Resumen Objetivo Evaluar el efecto de una intervención educativa para enfermeros para aumentar los conocimientos y las habilidades prácticas de manejo de dispositivos de acceso vascular totalmente implantados. Métodos Estudio cuasi experimental realizado en un hospital universitario. La intervención incluyó la exposición a un manual de procedimientos, seguida de una capacitación teórico-práctica siete días después. Se evaluó a 81 enfermeros al comienzo del estudio, después de la autoexposición al manual y después de recibir la capacitación teórico-práctica. Los participantes fueron evaluados respecto a sus conocimientos y habilidades prácticas en la gestión de dispositivos de acceso vascular totalmente implantados. Se realizaron estadísticas descriptivas para todas las variables. Se utilizó el test-t pareado para examinar si el puntaje promedio cambió desde la línea basal hasta la primera y segunda evaluación de conocimientos, acceso, desacceso y mantenimiento del catéter. El nivel de significación fue definido como 0,05. Resultados El aumento promedio de los puntajes después de la exposición de los enfermeros al manual fue de 18,2 puntos en el conocimiento, con 16,5 puntos en la técnica de acceso, 15,5 en la técnica de desacceso y 24,2 en la técnica de mantenimiento del catéter. Después de la capacitación teórico-práctica, observamos un aumento promedio de 4,2 en el acceso, 3,9 en el desacceso y 4,2 en el mantenimiento del catéter. Conclusión La intervención educativa para enfermeros aumentó el puntaje promedio de conocimientos y habilidades prácticas. Al final de la intervención, el 75 % de los enfermeros alcanzó por lo menos 33 puntos de 38 en el conocimiento y el 77 % obtuvo puntaje perfecto en el acceso y en el desacceso y el 78 % en el mantenimiento. La intervención educativa fue eficaz en la mejora de los conocimientos y habilidades prácticas para el manejo de dispositivos de acceso vascular totalmente implantados.

Abstract Objective To evaluate the effect of an educational intervention for nurses to increase knowledge and practical skills of management of totally implanted vascular access devices. Methods A quasi-experimental study conducted in a teaching hospital. The intervention included exposure to a manual of procedures followed by a theoretical-practical training seven days later. Eighty-one nurses were evaluated at baseline, after self-exposure to the manual, and after receiving the theoretical-practical training. Participants were evaluated on their knowledge and practical skills of totally implanted vascular access device management. Descriptive statistics were performed for all variables. Paired t test was used to examine whether the mean score changed from the baseline to first and second assessments of knowledge, access, de-access and maintenance of catheter. Significance level was set to 0.05. Results Mean increases in scores after nurses were exposed to the manual were: 18.2 points for knowledge, 16.5 points for access technique, 15.5 for de-access technique, and 24.2 for catheter maintenance technique. After the theoretical-practical training, we observed a mean increase of 4.2 points for access, 3.9 for de-access and 4.2 for catheter maintenance. Conclusion The educational intervention for nurses increased mean scores of knowledge and practical skills. At the end of the intervention, 75% of the nurses reached at least 33 points out of 38 for knowledge, and 77%, 77%, and 78% had perfect scores for access, de-access, and maintenance, respectively. The educational intervention was effective in improving knowledge and practical skills for management of totally implanted vascular access devices.

Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis

Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.

Nivel de conocimiento de Enfermería sobre manejo del catéter implantable del Hospital Pediátrico, Chaco 2022 / Level of nursing knowledge about the managementof the implantable catheter at the Pediatric Hospital, Chaco 2022

Introducción: el catéter implantable en pacientes pediátricos es uno de los elementos más usados e importantes, utilizados en tratamientos por plazos extendidos. Estos dispositivos son de incumbencia del área de enfermería en cuanto a su mantenimiento y cuidado, con su dominio se brinda confort y mayor seguridad al paciente. Objetivo: determinar el nivel de conocimiento del profesional de enfermería sobre el manejo del catéter implantable en servicios de internación de un Hospital Pediátrico, Chaco, año 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional; población en estudio la totalidad del personal de enfermería del servicio de internación; se usó como instrumento de recolección de datos un cuestionario escrito, que contenía las variables sociodemográficas y de conocimientos de aspectos generales, conocimientos en la habilitación y mantenimiento del catéter implantable. Resultados: los resultados obtenidos en la investigación manifiestan un nivel regular de conocimientos en aspectos generales del catéter implantable, sin embargo, el nivel en cuanto a la habilitación y mantenimiento del dispositivo se apreció que fue bueno, con respecto al nivel de conocimiento en la habilitación y mantenimiento del catéter implantable según formación académica alcanzada del personal que trabajan en los servicios de internación, se observó que los licenciados en enfermería y especialista obtuvieron un mayor porcentaje en conocimiento bueno. Conclusión: se concluye que existen aspectos generales sobre el manejo del catéter implantable que requieren un refuerzo en los conocimientos por parte del personal de enfermería en pos de la mejora continua en el cuidado [AU]

Introduction: the implantable catheter in pediatric patients is one of the most used and important elements, used in treatments for extended periods. These devices are the responsibility of the nursing area in terms of their maintenance and care, with their control comfort and greater safety are provided to the patient. Objective: To determine the level of knowledge of the nursing professional on the management of the implantable catheter in hospitalization services of a Pediatric Hospital, Chaco, year 2022. Methodology: quantitative, descriptive, cross-sectional and observational study; study population the entire nursing staff of the hospitalization service. A written questionnaire was used as a data collection instrument, which contained the sociodemographic variables and knowledge of general aspects, knowledge in the habilitation and maintenance of the implantable catheter. Results: the results obtained in the investigation show a regular level of knowledgein general aspects of the implantable catheter, however, the level[AU]

Introdução: o cateter implantável em pacientes pediátricos é um dos elementos mais utilizados e importantes, sendo utilizado em tratamentos por períodos prolongados. Esses aparelhos são de responsabilidade da área de enfermagem quanto a sua manutenção e cuidados, com seu controle seja proporcionado conforto e maior segurança ao paciente. Objetivo: determinar o nível de conhecimento do profissional de enfermagem sobre o manejo do cateter implantável nos serviços de internação de um Hospital Pediátrico, Chaco, ano 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional; população do estudo toda a equipe de enfermagem do serviço de internação. Como instrumento de coleta de dados foi utilizado um questionário escrito, que continha as variáveis sociodemográficas e conhecimentos sobre aspectos gerais, conhecimentos na habilitação e manutenção do cateter implantável. Resultados: os resultados obtidos na investigação mostram um nível regular de conhecimento em aspectos gerais do cateter implantável, no entanto, o nível quanto à qualificação e manutenção do dispositivo foi avaliado como bom, no que diz respeito ao nível de conhecimento na qualificação e manutenção do cateter implantável de acordo com a formação acadêmica alcançada pela equipe que atua nos serviços de internação, observouse que os graduados em enfermagem e especialistas obtiveram maior percentual de bom conhecimento. Conclusão: concluise que existem aspectos gerais sobre o manejo do cateter implantável que requerem um reforço de conhecimento por parte da equipe de enfermagem em busca da melhoria contínua na assistência[AU]

Predictors of early catheter replacement after HoLEP. Results from a high-volume laser center

ABSTRACT Introduction: The aim of the study was to investigate clinical and surgical factors associated with early catheter replacement in patients treated with Holmium Laser Enucleation of the Prostate (HoLEP). Materials and Methods: Data of patients treated with HoLEP at our Institution by a single surgeon from March 2017 to January 2021 were collected. Preoperative variables, including non-invasive uroflowmetry and abdominal ultrasonography (US), were recorded. Bladder wall modifications (BWM) at preoperative US were defined as the presence of single or multiple bladder diverticula or bladder wall thickening ≥5 mm. Clinical symptoms were assessed using validated questionnaires. Only events occurred within the first week after catheter removal were considered. Results: Overall, 305 patients were included, of which 46 (15.1%) experienced early catheter replacement. Maintenance of anticoagulants/antiplatelets (AC/AP) therapy at surgery (p=0.001), indwelling urinary catheter (p=0.02) and the presence of BWM (p=0.001) were more frequently reported in patients needing postoperative re-catheterization. Intraoperative complications (p=0.02) and median lasing time (p=0.02) were significantly higher in this group. At univariate analysis, indwelling urinary catheter (p=0.02), BWM (p=0.01), ongoing AC/AP therapy (p=0.01) and intraoperative complications (p=0.01) were significantly associated with early catheter replacement. At multivariate analysis, indwelling urinary catheter (OR: 1.28; p=0.02), BWM (OR: 2.87; p=0.001), and AC/AP therapy (OR: 2.21; p=0.01) were confirmed as independent predictors of catheter replacement. Conclusions: In our experience the presence of indwelling urinary catheter before surgery, BWM and the maintenance of AC/AP therapy were shown to be independent predictors of early catheter replacement after HoLEP.

Clinical-epidemiological characterization of patients submitted to hemodialysis according to the national kidney foundation, the kidney disease outcomes quality initiative ­ KDOQI in a hemodialysis reference center in the metropolitan region of São Paulo, Brazil

Introduction: hemodialysis is a treatment that helps in the survival of patients with renal failure, through an established cardiopulmonary bypass to carry out blood filtration, as a result, there is a need for a feasible, lasting and effective vascular access. There are two types of vascular access, arteriovenous fistulas, using autogenous veins or prostheses, and venous catheters. The indications for choosing the type of vascular access are related to the characteristics and restriction of use of each patient.Objective: to analyze the epidemiological, demographic and clinical profile of patients undergoing hemodialysis in two reference services in the metropolitan region of São Paulo, Brazil, and compare the clinical-surgical processes with those defined by the Kidney Guidelines disease Outcomes Quality Initiative (KDOQI).Methods: data were collected in two public hospitals, with patients undergoing hemodialysis, through registration forms and medical records, from August to December 2016. The volunteers were informed about the procedures and objectives of the study and, after agreeing, they signed a consent form. The variables age, gender, weight, height, body mass index, hemodialysis time, types of accesses already used , complications related to the accesses and underlying disease were analyzed. Patients with chronic renal failure undergoing hemodialysis of both genders, with no age restriction, were included. Patients not able to perform one of the techniques, arteriovenous fistula or catheter, were excluded . The collected data were compared with the Kidney guidelines disease Outcomes Quality Initiative (KDOQI).Results: a total of 252 individuals were included, of which 182 are patients undergoing reference hospital treatment in the city of São Bernardo do Campo, SP and 70 patients at the State University Hospital Mário Covas, a State reference in the clinical management of patients undergoing hemodialysis care.Conclusion: chronic kidney disease is highly prevalent with progression to end-stage chronic kidney failure (dialysis). The definition of the epidemiological profile of the population undergoing treatment, as well as the journey of venous accesses for hemodialysis (catheters and fistulas), are fundamental for the multidisciplinary team's learning curve about complications throughout the course of the disease/treatment. Furthermore, the clinical-surgical management of this population is in line with the guidelines of the National Kidney Foundation. The treatment performed in these hemodialysis centers is efficient and in line with what the KDOQI recommends.

Patrulla de catéteres: Análisis de la implementación de un equipo de colocación de catéteres percutáneos como estrategia menos invasiva para la terapia intravenosa / Catheter patrol: analysis of the implementation of a percutaneous catheter placement team as a less invasive strategy for intravenous therapy

En el año 2008 se creó el equipo de patrulla de catéteres para la colocación de catéteres percutáneos por punción directa para pacientes pediátricos en el Hospital de Pediatría Juan P. Garrahan, como estrategia para el cumplimiento de la terapia intravenosa. Diseño: Cohorte retrospectiva. Objetivo: evaluar resultados de la implementación de la patrulla de catéteres entre 2009 y 2013. Se analizaron factores asociados a complicaciones. Criterios de inclusión: catéteres colocados en unidades de cuidados intermedios por Enfermería de patrulla de catéteres en niños con edad entre 31 días a 17 años. Resultados: 2121 catéteres, 1,6 catéteres/paciente, edad mediana 6 años (r 1m- 17 años), permanencia mediana 9 días (7-12). Complicaciones más frecuentes: obstrucción 27,19%, desplazamiento 25,94%,ruptura 11,76%, traccionado por el paciente 11,08%, bacteriemia asociada a catéter 1,62 a 2,80 por 1000 días /catéter. La tasa de incidencia de complicaciones en los menores de 1 año fue 39,92 días catéter mientras que en los mayores de 1 año 31,14 días catéter; p=0,002, diámetro en fr y relación con complicaciones: 4fr 12,17 días/catéter, 3fr 24,25 días/catéter y 2fr 42,27dias/catéter, (p=0,000), no hubo diferencias según cantidad de lúmenes. Conclusiones: los resultados de este estudio sugieren que la edad del paciente, el tipo de cuidado y contención inciden en las complicaciones. Los dispositivos de aseguramiento deberán estar acordes a las necesidades y características del niño (AU)

In 2008, the catheter patrol team was created for the placement of percutaneous catheters by direct puncture for pediatric patients at Hospital de Pediatría Juan P. Garrahan, as a strategy to increase compliance with intravenous therapy. Design: Retrospective cohort study. Objective: to evaluate the results of the implementation of a catheter patrol between 2009 and 2013. Factors associated with complications were analyzed. Inclusion criteria: catheters placed in intermediate care units by catheter patrol nurses in children aged 31 days to 17 years. Results: 2121 catheters, 1.6 catheters/patient, median age 6 years (r 1m- 17 years), median stay 9 days (7-12). Most frequent complications: obstruction 27.19%, displacement 25.94%, rupture 11.76%, accidental pull-out by the patient 11.08%, catheter-associated bacteremia 1.62 to 2.80 per 1000 catheter-days. The incidence rate of complications in children under 1 year of age was 39.92 catheter-days while in those older than 1 year it was 31.14 catheter-days (p=0.002). Relationship between fr diameter and complications: 4fr 12.17 catheter-days, 3fr 24.25 catheter-days, and 2fr 42.27 catheter-days (p=0.000); there were no differences according to the number of lumens. Conclusions: the results of this study suggest that the age of the patient, the type of care, and containment have an impact on complications. Securement devices should be in agreement with the needs and characteristics of the child (AU)

Ocorrência de pneumotórax como evento adverso relacionado assistência à saúde / Ocorrência de pneumotórax como evento adverso relacionado assistência à saúde / Presence of pneumorax as an adverse event related to health care

Introdução: O acesso venoso central é definido como a colocação de um cateter com sua extremidade posicionada na veia cava ou no átrio direito, tendo diversas funções no manejo do paciente em estado crítico. Pneumotórax causado durante a inserção do cateter é um incidente que resulta em dano ao paciente, sendo assim considerado um evento adverso relacionado à assistência médica. Objetivo: Analisar a ocorrência de pneumotórax como evento adverso relacionado à assistência à saúde após a inserção de um cateter venoso central. Método: Trata-se de um estudo quantitativo, transversal e analítico. Depois de realizar o cálculo amostral para obtenção da amostra, pacientes submetidos à inserção de cateter venoso central na instituição pesquisada no período de abril até setembro de 2022 foram incluídos na pesquisa, a coleta de dados utilizou dados secundários. Resultados: Uma amostra de 103 pacientes foi obtido, dos quais 10 (9,7%) dos pacientes apresentaram pneumotórax relacionado à inserção de cateter venoso central. de pneumotórax. A ocorrência de pneumotórax e o fato de o profissional que inseriu o cateter ser residente. A ocorrência de pneumotórax teve associação significativa (p 0,03) levando ao aumento do tempo de internação. Conclusão: O os resultados encontrados demonstram uma significativa ocorrência do evento adverso relacionado à assistência à saúde pneumotórax, após a inserção do Cateter Venoso Central (CVC). Estratégias voltadas para a segurança do paciente são fundamentais e devem ser perseguidas constantemente.

Introduction: Central venous access is defined as the placement of a catheter with its end positioned in the superior vena cava or in the right atrium, having several functions in the management of the patient in critical condition. Pneumothorax caused during catheter insertion is an incident that results in harm to the patient, thus considered an adverse event related to health care. Objective: To analyze the occurrence of pneumothorax as adverse events related to health care after insertion of a central venous catheter. Method: This is a quantitative, cross-sectional, analytical study. After performing the sample calculation to obtain the sample, patients who underwent insertion of a central venous catheter at the researched institution from April to September 2022 were included in the research, data collection used secondary data. Results: A sample of 103 patients was obtained, of which 10 (9.7%) of the patients had pneumothorax related to the insertion of a central venous catheter. of pneumothorax. The occurrence of pneumothorax and the fact that the professional who inserted the catheter was a resident. The occurrence of pneumothorax had a significant association (p 0.03) leading to increased length of stay. Conclusion: The results found demonstrate a significant occurrence of the adverse event related to pneumothorax health care, after the insertion of the Central Venous Catheter (CVC). Strategies aimed at patient safety are fundamental and must be pursued constantly.(AU)

Introducción: El acceso venoso central se define como la colocación de un catéter con su extremo posicionado en la vena cava superior o en la aurícula derecha, teniendo varias funciones en el manejo del paciente en estado crítico. El neumotórax causado durante la inserción del catéter es un incidente que resulta en daño para el paciente, por lo que se considera un evento adverso relacionado con la atención a la salud. Objetivo: Analizar la ocurrencia de neumotórax como eventos adversos relacionados con la atención a la salud después de la inserción de un catéter venoso central. Método: Se trata de un estudio cuantitativo, transversal, analítico. Después de realizar el cálculo de la muestra para la obtención de la muestra, se incluyeron en la investigación los pacientes que se sometieron a la inserción de un catéter venoso central en la institución investigada de abril a septiembre de 2022, la recolección de datos utilizó datos secundarios. Resultados: Se obtuvo una muestra de 103 pacientes, de los cuales 10 (9,7%) de los pacientes presentaron neumotórax relacionado con la inserción de un catéter venoso central. La ocurrencia de neumotórax y el hecho de que el profesional que insertó el catéter fuera residente. La ocurrencia de neumotórax tuvo una asociación significativa (p 0,03) que condujo a una mayor duración de la estancia. Conclusión: Los resultados encontrados demuestran una ocurrencia significativa del evento adverso relacionado con la atención de salud del neumotórax, después de la inserción del Catéter Venoso Central (CVC). Las estrategias dirigidas a la seguridad del paciente son fundamentales y deben ser seguidas constantemente.(AU)

Tratamiento mínimamente invasivo del catéter doble J calcificado

Introducción: La calcificación del catéter doble J puede encontrarse en el 13 % de los colocados y aumenta proporcionalmente al tiempo que permanezca en contacto con la orina. Los investigadores coinciden en que el catéter doble J calcificado es una complicación compleja de resolver. Se realizó una revisión bibliográfica, de 2011 a 2021. Se utilizaron las bases de datos SciELO, EBSCO, Elsevier y PubMed, con los descriptores: litiasis, catéteres, procedimientos quirúrgicos mínimamente invasivos y complicaciones intraoperatorias y posoperatorias. Objetivo: Describir el papel de la cirugía mínimamente invasiva para el tratamiento del catéter doble J calcificado. Desarrollo: Los factores de riesgo relacionados a catéter doble J calcificados son clínico-terapéuticos y sociodemográficos, como la infección urinaria, antecedentes de litiasis, embarazo, enfermedad renal crónica, anomalías metabólicas o congénitas. Los de poliuretano presentan mayores tasas de calcificación. La litotricia extracorpórea por ondas de choque puede emplearse hasta en 70,7 % de los pacientes. Métodos multimodales como ureteroscopía, previa cistolitotricia transuretral, se han aplicado entre 6 % y 17,9 %, la nefrolitotomía percutánea y ureteroscopía, previa cistolitotricia o no, en el 7,7 % al 20 %. Las complicaciones más frecuentes se informan durante el posoperatorio (20 %): fiebre, dolor, vómitos, hematuria, pielonefritis, sepsis, urinoma, migración espontánea del nuevo catéter colocado y daño renal agudo, entre otras. Conclusiones: La cirugía mínimamente invasiva en la actualidad es el pilar fundamental, del tratamiento de los pacientes con catéter doble J calcificado.

Introduction: The calcification of the double J catheter can be found in 13% of those placed and increases proportionally to the time it remains in contact with urine. The researchers agree that the calcified double J catheter is a complex complication to resolve. A bibliographic review was carried out, from 2011 to 2021. The resources of the SciELO, EBSCO, Elsevier and PubMed databases were used in relation to the descriptors lithiasis, catheters, minimally invasive surgical procedures and intraoperative and postoperative complications. Objective: To describe the role of minimally invasive surgery for the treatment of calcified double J catheter. Development: The risk factors related to calcified double J are clinical-therapeutic and sociodemographic, such as urinary tract infection, history of lithiasis, pregnancy, chronic kidney disease, metabolic or congenital anomalies. Those made of polyurethane have higher rates of calcification. Extracorporeal shock wave lithotripsy can be used in up to 70.7% of patients. Multimodal methods such as ureteroscopy prior to transurethral cystolithotripsy have been applied between 6-17.9%, percutaneous nephrolithotomy and ureteroscopy prior cystolithotripsy or not in 7.7%-20%. The most frequent complications are reported during the postoperative period (20%): fever, pain, vomiting, hematuria, pyelonephritis, sepsis, urinoma, spontaneous migration of the newly placed catheter, and acute kidney injury, among others. Conclusions: Minimally invasive surgery is currently the cornerstone of treatment for patients with calcified double-J catheters.

Qualitative systematic review of the safety and feasibility of early mobilization in critically ill patients with femoral catheters / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety and feasibility of early mobilization in critically ill patients with femoral catheters, and to provide reference for guiding clinical rehabilitation training. Methods    The literature on the safety and feasibility of early mobilization in critically ill patients with femoral catheters included in PubMed, EMbase, OVID, Springer-link, Wiley Online Library, and Web of Science up to June 2021 was searched, and relevant data were extracted for analysis. Results    Seventy-two papers were initially screened, and 12 papers that met the criteria were finally included, covering 1 056 patients, and 489 patients had femoral catheters. Patients underwent 6 495 sessions of physical therapy, and a total of 62 patients had adverse events, including 14 (2.86%, 14/489) patients with catheter-related adverse events. Conclusion    Although early mobilization in critically ill patients with femoral catheters may lead to adverse catheter-related events, the incidence is low. Therefore, the associated risks and benefits should be weighed in clinical practice, and femoral catheter is not recommended as a contraindication for early mobilization in critically ill patients.

Complications of central venous catheterization and risk factors in Pediatric Intensive Care Unit of Xi 'an Children's Hospital / 中国基层医药

Objective:To analyze the incidence of complications of central venous catheterization and risk factors in the Pediatric Intensive Care Unit of Xi'an Children 's Hospital.Methods:The clinical data of 310 children who underwent central venous catheterization in the Pediatric Intensive Care Unit of Xi 'an Children's Hospital from June 2020 to February 2021 were retrospectively analyzed. The incidence of complications of central venous catheterization and risk factors were analyzed.Results:A total of 334 central venous catheters were used in 310 chidren. Among the 310 children who underwent central venous catheterization, 102 children (30.54%) had complications related to central venous catheterization. The complications related to central venous catheterization included catheter infection (13.17%), catheter malposition (8.38%), exudation at the puncture site (4.79%), catheter occlusion (2.99%), accidental removal (0.60%), and central venous thrombosis (0.60%). Central venous catheters were removed in 82 children (24.55%) because of complications. There was a significant difference in the incidence of central venous thrombosis among three surgical approaches: femoral vein, internal jugular vein, and subclavian vein ( χ2 = 7.06, P = 0.029). Longer time for catheterization resulted in a higher incidence of complications, including catheter-related infection ( χ2 = 7.17, P = 0.028), puncture point exudation and obstruction ( χ2 = 8.59, P = 0.014), central venous thrombosis ( χ2 = 6.78, P = 0.034). Regression analysis showed that suture shedding and bleeding at the insertion sites were the main risk factors for catheter-related complications (suture shedding OR = 4.85, P = 0.001; bleeding at the insertion sites OR = 1.83, P = 0.008). Conclusion:The most common complications of central venous catheterization in the Pediatric Intensive Care Unit of Xi'an Children's Hospital include catheter-related infection, catheter malposition, and puncture site exudation. Risk factors for complications during catheter retention include suture shedding and bleeding at the insertion sites.

Establishment of contralateral arteriovenous fistula by using the waste vein on the side of central venous lesion: a case report / 中华肾脏病杂志

Central venous lesion is a difficult problem in the vascular access complications of hemodialysis, which can cause serious clinical symptoms and affect the quality of hemodialysis and life of patients. We established arteriovenous fistula of the contralateral graft blood vessel with the used vein on the diseased side of the central vein of the patient. The arteriovenous fistula of the graft blood vessel was successfully punctured and hemodialysis was performed 2 weeks later. In this way, we not only solved the problem of venous hypertension and subsequent vascular access in the patient, but also reserved more vascular resources.

Clinical experience of REcanalisation and balloon-oriented puncture for Re-insertion of long- term dialysis catheter in nonpatent central veins / 中华肾脏病杂志

It is difficult to insert long-term dialysis catheters after severe stenosis or occlusion of the internal jugular vein and innominate vein. We used REcanalisation and balloon-oriented puncture for Re-insertion of dialysis catheter in nonpatent central veins (REBORN) in seven patients with severe central venous lesions, and all patients were inserted with long-term dialysis catheters successfully. None had severe complications such as pneumothorax, hemothorax, or pulmonary embolism during operation. All catheters functioned well after postoperative follow-up of 2 months. REBORN provides a novel approach to establish difficult dialysis pathways.

Incidence and related factors of umbilical venous catheter tip migration / 中华围产医学杂志

Objective:To analyze the incidence and the related factors of umbilical vein catheter (UVC) tip migration within 7 d after umbilical vein catheterization.Methods:This prospective study involved neonates who were successfully indwelled with UVCs in the Department of Neonatology of Gansu Provincial Women and Child-care Hospital from June 2020 to December 2021. The position of the UVC tip, length of umbilical stump, body weight, and abdominal circumference were recorded after the UVCs were inserted successfully, and the changes in these four data at 2, 24, 48, 72 h, and 7 d after catheterization were analyzed and compared. All the subjects were divided into the non-migrate group, inward migration group, and outward migration group. Chi-square test, Mann-Whitney U test, or Kruskal Wallis H test were used for statistical analysis. Results:A total of 157 newborns were enrolled, with 51 cases in the inward migration group, 62 cases in the outward migration group, and 44 cases in the non-migrate group. There were no significant differences among the three groups regarding gestational age, birth weight, gender, born through cesarean section, age at the time of catheterization, use of sedation, and feeding modes (all P>0.05). The migration rates of UVCs tip at 2, 24, 48, 72 h, and 7 d after catheterization were 0, 27.4% (43/157), 27.2% (31/114), 25.3% (21/83), and 29.0% (18/62), respectively. The cumulative migration rates at 24, 48, 72 h, and 7 d were 27.4% (43/157), 47.1% (74/157), 60.1% (95/157), and 72.0% (113/157), respectively. Compared with the non-migrate group, the inward migration group had a shorter umbilical cord stump at 24 and 48 h [0.5 cm (0.4-0.5 cm) vs 0.6 cm (0.5-0.8 cm); 0.4 cm (0.3-0.5 cm) vs 0.5 cm (0.5-0.6 cm), Z=－5.55 and －3.69, both P<0.05], less abdominal circumference increment at 48 and 72 h [0.6 cm (0.5-1.0 cm) vs 0.9 cm (0.7-1.2 cm); 0.6 cm (0.3-0.9 cm) vs 0.9 cm (0.7- 1.3 cm), Z=－2.03 and －2.09, both P<0.05)], and more weight loss percentage [－4.7% (－6.0%-－3.6%) vs －3.1% (－3.7%-－2.2%); －6.0% (－7.5%-－5.0%) vs －3.9% (－5.1%-－2.4%), Z=－3.75 and －2.96, both P<0.05]. The abdominal circumference increased more in the outward migration group at 24, 48, 72 h, and 7 d than those in the non-migrate group [1.6 cm (0.9-1.9 cm) vs 0.7 cm (0.5-0.9 cm); 1.5 cm (1.2-1.8 cm) vs 0.9 cm (0.7-1.2 cm); 1.7 cm (1.3-1.9 cm) vs 0.9 cm (0.7-1.3 cm); 1.6 cm (1.1-1.9 cm) vs 0.9 cm (0.6-1.3 cm), Z=－4.82, －4.79, －3.74, and －3.09, all P<0.05]. Conclusion:The incidence of UVC tip migration is high, which could be affected by dryness and retraction of the umbilical cord stump and the change in neonatal abdominal circumference and body weight.

Clinical application of PET automatic drug infusion system combined with power peripherally inserted central catheter in 18F-FDG PET/CT imaging / 中华核医学与分子影像杂志

Objective:To evaluate the feasibility of PET automatic drug infusion system combined with power peripherally inserted central catheter (PICC) for 18F-FDG injection and PET/CT imaging. Methods:Fifty patients with malignant neoplasms who underwent 18F-FDG PET/CT imaging in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine between December 2021 to July 2022 were prospectively enrolled. They were equally divided into power PICC group and peripheral venipuncture group. PET automatic drug infusion system was respectively connected with the pre-established channels of power PICC and peripheral venipuncture for 18F-FDG injection. Each patient underwent a routine PET/CT imaging at 1 h post-injection. The blood glucose, body weight, prescription dose and injection dose were recorded, and SUV max in the liver and cavoatrial junction were measured in both groups. The independent-sample t test was performed to compare the differences between 2 groups. The power PICC tip positions after 18F-FDG injection in power PICC group were observed. Results:The liver SUV max in the power PICC group and peripheral group were 2.54±0.50 and 2.57±0.31 ( t=0.37, P=0.716), and the SUV max of cavoatrial junction in the 2 groups were 1.68±0.25 and 1.63±0.22 ( t=-0.78, P=0.441), respectively. No significant differences were found in blood glucose, body weight, prescription dose and injection dose between the 2 groups ( t values: 0.00-0.13, all P>0.05). The ratios of injection dose to prescription dose in the 2 groups were 0.998 3±0.007 3 and 0.997 6±0.016 5, respectively, indicating high injection accuracy of the injection methods. No obvious drug residue was displayed at the end of catheter, resulting in good imaging quality. All the tip positions after injection were between T5 and T8, in line with the standardization management of power PICC. Conclusion:PET automatic drug infusion system combined with power PICC can be safely used for 18F-FDG injection and PET/CT imaging with less injection puncture.

Álbum seriado para enfermeiros sobre prevenção de infecção de cateter venoso central em crianças* / Álbum seriado para enfermeros sobre prevención de infección de catéter venoso central en niños / Flip chart for nurses about the prevention of central venous catheter infections in children

Objetivo: construir um álbum seriado para enfermeiros sobre prevenção de infecção de cateter venoso central totalmente implantado (CVC-TI) em crianças onco-hematológicas. Método: estudo metodológico, realizado em duas etapas: revisão integrativa de literatura e produção do álbum seriado. Resultados: o álbum seriado contém fichas roteiros e ilustrações voltados para o profissional como forma de orientação e fácil acessibilidade, no momento do cuidado ao CVC-TI na criança onco-hematológica, apresentando 6 ilustrações, juntamente com a capa. Conclusão: acredita-se que o produto em questão se constitui como uma ferramenta importante que possibilita o aprendizado para os enfermeiros, contribuindo assim, para qualidade da assistência.

Objective: To build a flip chart for nurses about the prevention of subcutaneous port central venous catheter (SP-CVC) infections in children with blood cancer. Method: Methodological study carried out in two stages: integrative literature review and production of the flip chart. Results: The flip chart includes forms, scripts, and figures that aim to be an easily accessible tool to guide health workers in regard to providing SP-CVC related care to children with blood cancers, presenting a total of 6 images, including its cover. Conclusion: We believe that the product at hand is an important tool for the education of nurses, thus contributing to the quality of care.

Objetivo: elaborar un álbum seriado para enfermeros sobre la prevención de infección de catéter venoso central totalmente implantado (CVC-TI) en niños onco-hematológicos. Método: estudio metodológico, realizado en dos etapas: revisión bibliográfica integradora y elaboración del álbum seriado. Resultados: el álbum seriado contiene fichas, guiones y figuras ilustrativas dirigidas a los profesionales como forma de orientación y de fácil accesibilidad en el cuidado del CVC-TI en niños onco-hematológicos, presentando 6 ilustraciones junto con la portada. Conclusión: Se considera que el producto en cuestión es un instrumento importante que posibilita el aprendizaje de los enfermeros, contribuyendo así para la calidad de los cuidados.

Nursing protocols to reduce urinary tract infection caused by indwelling catheters: an integrative review / Protocolos de enfermería para reducir la infección del tracto urinario causada por catéteres permanentes: revisión integradora / Protocolos de enfermagem para redução de infecção urinária por cateteres de demora: revisão integrativa

ABSTRACT Objectives: to analyze the production of knowledge in research articles about the effectiveness of nursing protocols for reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection rate in hospitalized adult and older patients. Methods: an integrative review of three full articles, available in the MEDLINE Complete - EBSCO, Scopus and Web of Science databases, from 01/01/2015 to 04/26/2021. Results: the three protocols reduced infection rates, and from the review/synthesis of their knowledge, a level IV body of evidence emerged to compose the nursing care process aimed at reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection. Final Considerations: this process gathers scientific evidence to support the elaboration of nursing protocols and, consequently, the conduction of clinical trials on its effectiveness in reducing urinary tract infection by indwelling urinary catheter.

RESUMEN Objetivos: analizar la producción de conocimiento a partir de artículos de investigación sobre la efectividad de los protocolos de enfermería para reducir la estancia de una sonda vesical y la tasa de infección del tracto urinario relacionada con el catéter en adultos y ancianos hospitalizados. Métodos: revisión integradora de tres artículos completos, en las bases de datos MEDLINE Complete (EBSCO), Scopus y Web of Science, del 01/01/2015 al 26/04/2021. Resultados: los tres protocolos redujeron las tasas de infección y, de la revisión/síntesis de sus conocimientos, surgió un cuerpo de evidencia de nivel IV para componer el proceso de atención de enfermería, con el objetivo de reducir la permanencia de sonda vesical y la infección asociada. Consideraciones Finales: este proceso reúne evidencias científicas para apoyar la elaboración de protocolos de enfermería y, consecuentemente, la realización de ensayos clínicos sobre su efectividad en la reducción de la infección por sonda vesical permanente.

RESUMO Objetivos: analisar a produção do conhecimento de artigos de pesquisas acerca da efetividade de protocolos de enfermagem para redução do tempo de permanência de sonda vesical de demora e da taxa de infecção do trato urinário relacionada ao cateter em pacientes adultos e idosos hospitalizados. Métodos: revisão integrativa de três artigos na íntegra, nas bases de dados MEDLINE Complete (EBSCO), Scopus e Web of Science, no período de 01/01/2015 a 26/04/2021. Resultados: os três protocolos reduziram as taxas de infecção, e, da revisão/síntese de seu conhecimento, emergiu um corpo de evidências de nível IV para compor o processo de cuidar de enfermagem, visando à redução da permanência do cateter e da infecção associada. Considerações Finais: esse processo reúne evidências científicas para subsidiar a elaboração de protocolos de enfermagem e, consequentemente, a condução de ensaios clínicos sobre sua eficácia na redução de infecção do trato urinário por sonda vesical de demora.