Lock terapia na prevenção e tratamento da infecção da corrente sanguínea associada ao cateter vascular: revisão integrativa / Terapia de bloqueo en la prevención y tratamiento de infecciones del torrente sanguíneo asociadas al catéter vascular: revisión integradora / Lock therapy in prevention and treatment of catheter-associated bloodstream infection: integrative review

Resumo Objetivo Sintetizar o conhecimento sobre o uso da lock terapia na prevenção e no tratamento da infecção da corrente sanguínea associada ao dispositivo de acesso vascular central de longa permanência em pacientes adultos e idosos hospitalizados. Métodos Revisão integrativa com busca nas bases de dados CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus e Web of Science, no período de 1º janeiro de 2010 a 28 de setembro de 2021 sem restrições de idioma. Os dados foram analisados de forma descritiva. Resultados Foram identificados 16 estudos sendo seis (37,5%) sobre o uso da lock terapia como prevenção de infecção associada ao dispositivo de acesso vascular central e dez (62,5%) sobre tratamento. Os artigos sobre prevenção relataram o uso de soluções não antibióticas. Nove dos dez estudos que abordaram a lock terapia como tratamento, utilizaram soluções antibióticas. Dois estudos avaliaram a eficácia da lock terapia em curta duração (de três a quatro dias), sete em maior duração (entre 10 e 14 dias) e um não especificou a duração. Cada estudo descreveu uma técnica de intervenção e o tempo de permanência da solução intraluminal. Em relação ao risco de viés, foram avaliados como baixo risco: cinco ensaios clínicos randomizados, dois ensaios clínicos sem randomização e oito estudos observacionais. Apenas um estudo observacional foi classificado como risco moderado. Conclusão Na prevenção, identificou-se o uso de soluções não antibióticas como o etanol. Para o tratamento, foi utilizada a daptomicina endovenosa. Enquanto os estudos incluídos nessa revisão sobre prevenção não demonstraram evidência estatística, os dez estudos sobre tratamento demonstraram que a lock terapia é um complemento eficaz ao tratamento sistêmico, apresentando boas taxas de salvamento do cateter.

Resumen Objetivo Sintetizar el conocimiento sobre el uso de la terapia de bloqueo en la prevención y tratamiento de infecciones del torrente sanguíneo asociadas al dispositivo de acceso vascular central de larga permanencia en pacientes adultos y adultos mayores hospitalizados. Métodos Revisión integradora con búsqueda en las bases de datos CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus y Web of Science, en el período del 1 de enero de 2010 al 28 de septiembre de 2021 sin restricción de idioma. Los datos fueron analizados de forma descriptiva. Resultados Se identificaron 16 estudios, de los cuales seis (37,5 %) trataban sobre el uso de la terapia de bloqueo como prevención de infecciones asociadas al dispositivo de acceso vascular central y diez (62,5 %) sobre tratamiento. En los artículos sobre prevención se relató el uso de soluciones no antibióticas. En nueve de los diez estudios que abordaban la terapia de bloqueo como tratamiento, se utilizaron soluciones antibióticas. En dos estudios se evaluó la eficacia de la terapia de bloqueo de corta duración (de tres a cuatro días), siete de mayor duración (entre 10 y 14 días) y uno sin especificar la duración. En cada estudio se describió una técnica de intervención y el tiempo de permanencia de la solución intraluminal. Con relación al riesgo de sesgo, fueron evaluados con riesgo bajo: cinco ensayos clínicos aleatorizados, dos ensayos clínicos no aleatorizados y ocho estudios observacionales. Solo un estudio observacional fue clasificado con riesgo moderado. Conclusión Para la prevención, se identificó el uso de soluciones no antibióticas como el etanol. Para el tratamiento, se utilizó la daptomicina intravenosa. Aunque los estudios incluidos en esta revisión sobre prevención no hayan demostrado evidencia estadística, los diez estudios sobre tratamiento demostraron que la terapia de bloqueo es un complemento eficaz para el tratamiento sistémico y presentó buenos índices de salvamento del catéter.

Abstract Objective To synthesize knowledge on the use of lock therapy for prevention and treatment of long-term central vascular access devices-associated bloodstream infection in hospitalized adult and elderly patients. Methods Integrative review conducted in CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus, and Web of Science databases, from January 1st, 2010 to September 28th, 2021, without language restrictions. Data were analyzed descriptively. Results Sixteen studies were identified, six (37.5%) on the use of lock therapy for prevention of bloodstream infection associated with central vascular access devices, and ten (62.5%) on treatment. The articles on prevention reported the use of non-antibiotic solutions. Nine of the ten studies that addressed lock therapy as treatment used antibiotic solutions. Two studies assessed the effectiveness of lock therapy in a short duration (three to four days), seven in a longer duration (between 10 and 14 days), and one did not specify the length of time. Each study described an intervention technique and the length of stay of the intraluminal solution. Regarding the risk of bias, five randomized clinical trials, two non-randomized clinical trials, and eight observational studies were rated as low risk. Only one observational study was classified as moderate risk. Conclusion The use of non-antibiotic solutions such as ethanol was identified for prevention of bloodstream infection. For treatment, intravenous daptomycin was used. While the studies included in this review on prevention did not show statistical evidence, the ten studies on treatment demonstrated that lock therapy is an effective complement to systemic treatment, showing good catheter salvage rates.

Cine­picc: satisfaction and knowledge following a video and hands-on training on peripherally inserted central catheter

Introduction: This study assessed the knowledge and satisfaction of a nursing staff regarding peripherally inserted central catheter (PICC) care before and after a combined training strategy consisting of a video and hands-on practice.Methods: A cross-sectional and prospective study with data collection held at a public university hospital from March 2018 to May 2018 and in March 2019. Participants answered a pre-test about PICC lines, watched a video on PICC care and maintenance, attended hands-on sessions, and answered a post-test.Results: A total of 520 professionals participated in the study, of which 87.4% were from the nursing staff. The pre-test was answered by 211 individuals and the post-test questions were answered by 203 people. The satisfaction research showed 97% of satisfied respondents.Conclusions: Our results indicate that a change from the traditional training model to an active educational approach reached more participants, representing an innovative pedagogical tool in the training of critical and reflexive professionals.

Activated platelets in central venous catheters: a flow cytometry and numerical simulation approach

The central venous catheter that is inserted in patients undergoing hemodialysis can cause hemodynamic instability and trigger complications such as thrombus formation. The objective of this study was to investigate hemostatic and numerical influences on thrombus formation in patients undergoing hemodialysis with a central venous catheter. Participants were assigned to three groups: I: clinical and laboratorial healthy individuals matched by sex and age (controls); II: participants after one month of insertion of the catheter and III: participants after 4 months of insertion of the catheter. Platelet activation was investigated by GPIIb/IIIa and p-selectin expressions using flow cytometry. A three-dimensional model of the catheter was constructed in the numerical simulation for the calculation of partial differential equation of a platelet activation model. A significant difference was detected by the expression of p-selectin comparing the group I (33.42 ± 4.74), group II (40.79 ± 5.54) and group III(51.00 ± 7.21) (p < 0.0001). The median values for GPIIb/IIIa were 10426 (10029-10721), 13921 (13412-15652) and 19946 (18714-21815) after catheter insertion (p < 0.0001), for groups I, II and III, respectively. Excluding the first arterial orifice, venous orifices tend to have greater platelet activation when compared to the other arterial orifices. The results of this study showed the influence of arterial and venous lateral orifices in stimulating the development of thrombi associated with the activation of platelet markers the longer the catheter was used.

Translumbar hemodialysis long-term catheters: an alternative for vascular access failure / Cateter translombar para hemodiálise: uma alternativa para falência de acesso vascular

Abstract Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.

Resumo Introdução: O acesso vascular (AV) para hemodiálise (HD) é crucial para os pacientes portadores de doença renal crônica (DRC) estágio V. Infelizmente, com o passar dos anos, um percentual não desprezível desses enfermos evolui para falência de AV por diversos motivos, o que impossibilita a confecção de novas fístulas arteriovenosas (FAV) ou o implante de cateteres venosos centrais nos sítios de punções tradicionais. Nesse cenário, o implante de cateteres translombares para hemodiálise (CTLHD) em veia cava inferior ganha destaque como medida salvadora. Objetivos: Relatar uma série de 12 casos de implante de CTLHD, sua técnica de implante, patência e complicações. Métodos: Estudo retrospectivo que analisou 12 implantes de CTLHD por radiologista intervencionista no setor de hemodinâmica do Hospital Universitário da Universidade Federal do Rio Grande do Norte (UFRN), no período de janeiro/2016 a outubro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxa de sucesso, complicações observadas, sobrevida dos pacientes, patência do cateter e desfechos clínicos. Resultados: Todos os 12 CTLHD foram implantados e utilizados com sucesso; ocorreram apenas 2 complicações associadas ao procedimento (sangramento e falha na extubação); 41,6% dos pacientes apresentaram infecção relacionada ao cateter após 98 ± 72,1 dias (6-201 dias), mas não houve necessidade de remoção; e a patência foi de 315,5 cateteres-dia (65-631 dias). Conclusão: O CTLHD é uma opção para pacientes com falência de acesso vascular, prolongando a sobrevida dos pacientes e atuando como ponte para o transplante renal.

Tecnovigilância no Brasil: panorama das notificações de eventos adversos e queixas técnicas de cateteres vasculares / Postmarketing surveillance in Brazil: vascular catheters - an overview of notifications of adverse events and technical complaints

Resumo O objetivo deste artigo é identificar, quantificar e categorizar a ocorrência de notificações de eventos adversos e queixas técnicas relacionados ao uso de cateter vascular recebidas pelo sistema NOTIVISA no período de janeiro de 2007 a junho de 2016. Estudo descritivo, retrospectivo, documental, com abordagem quantitativa. Os dados solicitados e fornecidos pela Anvisa foram analisados e apresentados na forma de gráficos e tabelas. Fizeram parte do estudo 4682 notificações de queixas técnicas e 671 de eventos adversos. Houve aumento progressivo das notificações no período estudado. Quanto ao tipo de queixa técnica, a maioria delas se referiu a 'produto com suspeita de desvio de qualidade' sendo em maior quantidade o motivo 'rompimento do cateter durante o procedimento'. O evento adverso mais notificado foi 'Cateter rompeu na veia e migrou para outra parte do corpo'. Destaca-se que no período estudado ocorreram 4 notificações de óbitos, a forma mais grave de evento adverso. O estudo permitiu visualizar a importância da vigilância pós-comercialização dos cateteres vasculares além de fornecer um panorama de seu uso, o que pode apoiar ações de Tecnovigilância e subsidiar as políticas públicas voltadas a esse produto.

Abstract This article identifies, quantifies and categorizes adverse event notifications and technical complaints related to the use of vascular catheters, received by the Notivisa system in the period from January 2007 to June 2016. It is a descriptive, retrospective, documental study with a quantitative approach. Data requested and supplied by Anvisa were analyzed and presented in the form of charts and tables. The study covered 4,682 notifications of technical complaints, and 671 adverse events. There was a progressive increase in notifications during the period studied. As to the type of technical complaint, the majority referred to 'suspected quality failings', the largest component being due to 'catheter rupture during procedure'. The adverse event most notified was 'catheter broke in the vein and migrated to another part of the body'. In the period studied there were four notifications of deaths, the most severe level of adverse event. The study made it possible to visualize the importance of after-sales surveillance of vascular catheters, as well as supplying a wide-ranging overview of their use. Provision of this overview could support technical surveillance activities and serve as input for public policies relating to this product.

Research progress of blood collection by central vascular access device / 中国实用护理杂志

Blood collection taken from the central vascular access device can avoid the risk of anxiety,pain,nerve injury and hematoma.This paper from the center of vascular access device of blood collection method,under the condition of infusion via central vascular access device and blood sampling were collected by the center of vascular access related considerations of these three aspects are reviewed, lay the foundation for the future as soon as possible to establish checklist of blood collection by central vascular access device.

Analysis of the reason and handling measures of catheter fracture of the implantable vascular access device / 中国实用护理杂志

Objective To analyze the reasons of catheter fracture of implantable vascular access devices and to explore the prevention and handling measures. Methods A retrospective analysis was carried in 3 887 adult patients with implantable vascular access devices and 13 had catheter fracture. The clinical features and causes were analyzed and the successful handling measures were summarized. Results Of 3 887 cases, a total of 13 (0.33%) catheter fracture occurred. The incidence rate of catheter fracture via subclavian jugular venipuncture was 3.70%,(6/162) , via internal jugular venipuncture was 0.18% (7/3 725), via internal jugular venipuncture was significantly lower than that via the subclavian venipuncture (χ2=47.505,P=0.000). There had no statistical differences between the left and right of the two puncture ways(P=0.707,0.682). Conclusions Catheter fracture is one of the serious complications in the process of use and maintenance of implantable vascular access device. Choosing appropriate surgical method, strengthen maintenance education, specificating the operation procedure, closing observation and other measures can not only reduce the occurrence of the catheter fracture, but also can dealt with catheter fracture in time, which could ensure the safety of patients' life.

Comprehensive understanding of atrial septal defects by imaging studies for successful transcatheter closure / 소아과

Transcatheter closure of atrial septal defects has become a popular procedure. The availability of a preprocedural imaging study is crucial for a safe and successful closure. Both the anatomy and morphology of the defect should be precisely evaluated before the procedure. Three-dimensional (3D) echocardiography and cardiac computed tomography are helpful for understanding the morphology of a defect, which is important because different defect morphologies could variously impact the results. During the procedure, real-time 3D echocardiography can be used to guide an accurate closure. The safety and efficiency of transcatheter closures of atrial septal defects could be improved through the use of detailed imaging studies.

Complications of a Totally Implanted Vascular Access Device (Chemoport) in Children with Malignancy

BACKGROUND: Carefully using a totally implanted vascular access device and regular check-up of its condition in children who suffer with malignancy is very important. This study was performed to determine the complications related to using this device, according to the patient's age, gender and diagnosis, and the time from port insertion. METHODS: We retrospectively studied 77 patients with malignancy (46 males and 31 females, age: 0.1~18 years, mean age: 7.8 years) and they were treated with a totally implanted vascular access device (chemoport) from January 1996 to May 2007 in Kyungpook National University Hospital, Korea. We assessed the symptoms and radiologic findings, conducted blood tests and doppler USG; we found several complications and compared them according the patients' age, gender and diagnosis. RESULTS: Among the 77 cases with a totally implanted vascular access device (chemoport), 14 cases had complications related to the chemoport. Infections were detected in 8 cases. 6 of them had infections related to the chemoport after 4~7 months from the port-insertion. After port removal and treatment with broad spectrum antibiotics, their symptoms such as fever and swelling were improved. Disconnection of the port was detected in 2 cases after 2 months and 22 months from port-insertion, respectively. These ports were successfully removed by cardiac catheterization. Rotation of the port was detected in one case after 9 months from port-insertion: the rotated port was removed. Obstruction with thrombus was detected in 3 cases, after 7~16 months from port-insertion: this condition was treated with thrombolytic agents such urokinase and t-PA (tissue plasminogen activator), or surgical removal of the blood clot in the port site. CONCLUSION: To reduce the complications related to the totally implanted vascular access (device), such as infection, thrombosis and disconnection, we should carefully use this device and also regularly check its function and position. After completion of chemotherapy, removal of the port as soon as possible should be considered. If a complication is detected, then we should manage it immediately.

Disconnection and Migration of Totally Implanted Vascular Access Devices in Three Pediatric Oncology Patients / 대한소아혈액종양학회지

Totally implanted vascular access devices are excellent for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter disconnection and migration are rare but potentially serious complications of these widely used devices. Retrieval of the migrated fragment is generally indicated but may not be possible. We hereby report three cases of catheter disconnection and migration of totally implanted vascular access devices into the heart along with the review of literatures.