ABSTRACT
Introduction: Tracheomegaly (TM) is a very rare and often unrecognized phenomenon defined radiologically as an abnormal enlargement of the diameter of the trachea exceeding 21 mm in women and 25 mm in men. In most cases it is congenital, while possible causes of acquired TM include diseases of the connective tissue (Mounier-Kuhn and Ehlers-Danlos syndrome), various inflammatory conditions (chronic bronchitis, pulmonary and cystic fibrosis), smoking, and prolonged mechanical ventilation with increased cuff pressure. There are few papers in the literature addressing TM, mainly case reports and some case series. Material(s) and Method(s): We retrospectively analyzed chest x-rays of all patients who were mechanically ventilated from April 1, 2020, to January 31, 2021. The occurrence of TM was determined by measuring the diameter of the trachea before intubation and by continuously measuring the diameter of the trachea in the cuff area after intubation, from which we calculated the cuff-to-trachea diameter ratio (C/T ratio). Result(s): The study included 1015 patients divided into three groups: 383 patients treated in the intensive care unit with mechanical ventilation, 132 patients treated with high-flow oxygen ventilation, and 500 randomly selected patients treated with nasal catheter oxygen therapy. Among the patients studied, we observed radiologically visible TM in the cuff area in 18.54% of patients, whereas the percentage of TM in patients with prolonged MV was 90.6%. A C/T ratio >1.5 was observed in 12.53% of patients. Respiratory complications, a total of 16.71% of them (pneumomediastinum, pneumothorax, tracheoesophageal fistula, subcutaneous emphysema, tracheomalacia) showed a significant association with C/T ratio. Using ROC analysis, C/T ratio is considered a reliable potential prognostic factor for respiratory complications. Conclusion(s): The results of our study demonstrate the importance of early detection and prevention of TM in MV patients with COVID-19 by chest X-ray and measurement of C/T ratio and promote understanding of the development of this rare phenomenon.
ABSTRACT
Introduction: - Recurrent exit site infection and peritonitis are major causes of PD catheter removal and PD failure - 1/3 lead to hospitalizations - 5-10% lead to mortality - Reported rate in Australia is 0.6 episode/patient-year - Our first hypothesis is that implementing these prophylactic measures should lead to lower rates of PD peritonitis, PD catheter failure and mortality from 2017 onwards - Our second hypothesis is reduction in the impact of these prophylactic interventions during the covid pandemic Methods: - The aim of this study is to assess the impact of prophylactic interventions that were implemented in 2017 at Gosford hospital, particularly looking at the rates of PD peritonitis, PD catheter failure, transition to HD and mortality - The second aim of this project is to assess the effect of covid pandemic on these interventions Inclusion criteria - Adult (ages 18+) - Patients on peritoneal dialysis in the central coast renal unit - Duration from 2013-2022 - Intervention: Prophylactic antibiotic therapy during PD catheter insertion, prophylactic anti-fungal therapy while on antibiotic therapy, nursing, and patient education - Exposure(s) - Prophylactic antibiotic and antifungal therapies, nursing, and patient education - Confounders - Covid pandemic - Primary outcome - Reduction in PD peritonitis - Secondary outcome(s) - PD catheter failure, transition to haemodialysis, mortality Results: - Our data demonstrates reduction in the rate of PD peritonitis and PD catheter failure following the implementation of prophylactic interventions. - There is no significant difference in the rate of PD peritonitis between the pre and post covid pandemic periods, as the prophylactic measures were still being implemented adequately as per hospital policy. Conclusion(s): - Administration of prophylactic antibiotic and antifungal therapies in PD patients is thought to reduce the rate of PD peritonitis, PD catheter failure and mortality based on our current guidelines. - Our research project has been designed to assess the clinical effectiveness of these prophylactic interventions, in addition to the impact of covid pandemic on these outcomes. No conflict of interestCopyright © 2023
ABSTRACT
The proceedings contain 13 papers. The topics discussed include: are citizens involved in vascular access research? a scoping review protocol;nursing care to prevent peripherally inserted central catheter (PICC) related complications: a systematic review;clothing constraints in maintaining vascular access;supporting Portuguese nurses' evidence-based practice related to peripheral intravenous catheterization: a Delphi consensus study;aseptic techniques for peripherally inserted central catheters: a scoping review protocol;unusual placement of a fully implantable catheter into the internal thoracic vein;relationship between nutritional status and catheter-related infection in COVID-19 patients;comparison of two methods for evaluation of the tip position in totally implantable venous access device (TIVAD);and best practice in the insertion and maintenance of removal of peripheral intravenous catheters (PIVC): contributions to nursing care.
ABSTRACT
Objective: Describe and compare dwell time and the causes of removal of midline and mini-midline catheters in two cohorts: COVID-19 and non-COVID-19 patients. Method(s): Observational, retrospective and cohort study conducted in the Vall d'Hebron University Hospital in Barcelona, consulting the medical records of patients from March 1 to May 15, 2020 by the venous access nursing team. Result(s): 344 Catheters were inserted in 305 patients. In the Covid-19 cohort there were 88 patients and 96 catheters were placed, of which 84 were mini-midline and 12 midline. In the non-Covid-19 cohort, 248 catheters were placed in 217 patients, of which 217 were mini-midline and 31 midline. The mean duration of catheters inserted in the Covid-19 patient cohort was 12 days for mini-midline and midline and 11 days for mini-midline and 12 days for midline in the noncovid group. The main cause of removal in both groups was the end of treatment, significantly higher in non-Covid-19 patients. The second was decease in the Covid patient cohort and catheter occlusion in the non-Covid group, both with a statistically significant difference. Conclusion(s): Correct maintenance and care with adequate nursing staff rates might be keys to better preserve midline and mini-midline despite patient related characteristics.