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1.
J Nurs Care Qual ; 37(3): 275-281, 2022.
Article in English | MEDLINE | ID: covidwho-1922418

ABSTRACT

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are an ongoing concern in health care, resulting in increased mortality, morbidity, length of stay, and additional costs to hospitals. LOCAL PROBLEM: Despite intermittent improvements in CLABSI rates within our facility, long-term sustainment has been challenging. METHODS: This was a quality improvement project including a collaborative rounding approach supported by specialty nursing roles. INTERVENTIONS: In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit. RESULTS: High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits. CONCLUSIONS: Despite challenges correlated with COVID-19, a collaborative rounding team promotes and enhances awareness of prevention methods and a culture of safety.


Subject(s)
COVID-19 , Catheter-Related Infections , Catheterization, Central Venous , Cross Infection , COVID-19/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Cross Infection/prevention & control , Hospitals , Humans , Infection Control/methods , Quality Improvement
3.
J Pediatr Nurs ; 65: 29-32, 2022.
Article in English | MEDLINE | ID: covidwho-1796225

ABSTRACT

The failure of the global supply chain became rapidly apparent at the beginning of the COVID-19 pandemic when healthcare organizations were left without supplies needed to care for patients. The supply chain failure is one downstream effect of the pandemic and indirectly impacts patient morbidity and mortality. This column presents a case study of one staff nurse's experience working in a pediatric intensive care unit at a rural children's hospital two years into the pandemic and the toll the global supply chain failure continues to take on patients and healthcare professionals. Central Line Blood Stream Infections (CLABSIs) are used to showcase the severity of the supply chain failure at the point of care. Standardized central line insertion and care bundles have proven to be effective in reducing the incidence of CLABSI; however, they are dependent on the availability of materials and supplies. Health care providers face a "wicked problem" in preventing CLABSIs. The failure of the global supply chain must be examined by healthcare organizations, manufacturers, and government officials so that new systems can be put into place, so we are prepared for a public health emergency.


Subject(s)
COVID-19 , Catheter-Related Infections , Catheterization, Central Venous , Central Venous Catheters , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Central Venous Catheters/adverse effects , Child , Humans , Pandemics/prevention & control
4.
Einstein (Sao Paulo) ; 20: eAO6497, 2022.
Article in English | MEDLINE | ID: covidwho-1789931

ABSTRACT

OBJECTIVE: To evaluate the positioning of the distal tip of central venous catheters and the factors that contributed to inadequate positioning in patients admitted to intensive care. METHODS: This is a cross-sectional study, with a sample of 246 medical records of patients admitted to intensive care units. A catheter position analysis form was used as an instrument for data collection. RESULTS: It was seen that 86.2% of catheters used in intensive care were centrally inserted in the internal jugular veins, 74.4% were double-lumen catheter, and ultrasound was employed for puncture technique in 84.6% of cases. Of the distal ends of the catheters, 53.7% were at the cavoatrial junction (correct position). According to statistical tests, there was a positive correlation between the inadequate positioning of the distal extremity with the central insertion catheter (p=0.012). Patients with presumptive diagnosis associated with COVID-19 showed a positive correlation with inappropriate positioning of the catheter distal tip (p=0.017). CONCLUSION: There are extrinsic factors related to improper positioning of the distal tip of catheters, such as the type of catheter used, the patients' diagnosis and the puncture with insertion in the left jugular vein.


Subject(s)
COVID-19 , Catheterization, Central Venous , Central Venous Catheters , Catheters, Indwelling , Cross-Sectional Studies , Humans , Intensive Care Units , Jugular Veins/diagnostic imaging
5.
World J Surg Oncol ; 20(1): 103, 2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1770547

ABSTRACT

BACKGROUND: Vascular access in cancer patients is of great importance in order to deliver tumour-specific therapy and continues to be so during exceptional conditions. This study aimed to examine the impact of the coronavirus disease 2019 pandemic on the care and complication rates associated with subcutaneous venous port (PORT) insertion in cancer treatment. METHODS: We retrospectively studied all adult cancer patients that received a PORT in 2020 at a Swedish county hospital, including insertion characteristics and in-dwell complication rates for up to 6 months after implantation; these estimates were compared with historic data. RESULTS: Data from 257 patients, of which 56 were haematological patients, were included and compared with those of 168 patients in the control group. The group characteristics were similar, except for the inclusion of haematological patients in the study group. Insertion characteristics showed a shorter waiting time and higher rates of antibiotic and sedative use during the pandemic. The rates of postoperative haematoma and catheter occlusion during the study period were higher than otherwise. The rates of adverse events related to the PORT in the solid tumour group were comparable to those in the control group (18.4% vs. 14.9%). Patients with haematological malignancies were more likely to experience adverse events (37.5% vs. 18.4%) and deep venous thrombosis (7.1% vs. 1.0%) than those with solid tumours. CONCLUSION: In conclusion, the present findings suggest that PORTs remain a safe venous access system even during a pandemic, indicating a robust vascular access service.


Subject(s)
COVID-19 , Catheterization, Central Venous , Neoplasms , Adult , COVID-19/epidemiology , Case-Control Studies , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Humans , Neoplasms/complications , Pandemics , Retrospective Studies
6.
Am J Health Syst Pharm ; 79(13): 1079-1085, 2022 06 23.
Article in English | MEDLINE | ID: covidwho-1758628

ABSTRACT

PURPOSE: The study's purpose was to measure the impact of anti-reflux needleless connector usage in prevention of intraluminal thrombotic occlusions among central venous catheters, as represented by alteplase usage, in a home infusion patient population. METHODS: An18-month before-and-after cohort study of a single home infusion intervention was conducted to compare occlusion outcomes with use of two types of needleless connectors-neutral and anti-reflux-in preventing catheter occlusions, which have been reported to occur in 28% of home infusion patients, resulting in treatment delays, increased nursing encounters and emergency room visits, and higher overall pharmacy costs for supplies and alteplase. RESULTS: A total of 552,707 patient therapy days were studied: 42.5% in the neutral needleless connector group (n = 235,004 therapy days) and 57.5% in the anti-reflux needleless connector group (n = 317,703 therapy days). The rate of alteplase usage with neutral versus anti-reflux needleless connectors was 4.4% versus 2.2% per 1,000 therapy days, with median alteplase use of 112 (95% CI, 89-169) units versus 82 (95% CI, 68-109) units (P < 0.001). Implementation of anti-reflux connectors reduced occlusions and alteplase usage by 48%. CONCLUSION: Statistical evidence demonstrated that use of anti-reflux needleless connectors with central venous access devices reduced the need for alteplase in the study population. Since 10% of patient occlusions were within 7 days after home infusion admission, future research may indicate that placement of anti-reflux needleless connectors at the time of in-hospital insertion can improve patient outcomes. This quality improvement measure reduced central catheter occlusions, alteplase costs, and the number of required nursing and emergency room visits.


Subject(s)
Catheterization, Central Venous , Pharmacy , Catheterization, Central Venous/adverse effects , Cohort Studies , Emergency Service, Hospital , Humans , Quality Improvement , Tissue Plasminogen Activator
7.
Int J Drug Policy ; 96: 103438, 2021 10.
Article in English | MEDLINE | ID: covidwho-1712559

ABSTRACT

BACKGROUND: People who use drugs (PWUD), and especially those who inject drugs, are at increased risk of acquiring bloodborne infections (e.g., HIV and HCV), experiencing drug-related harms (e.g., abscesses and overdose), and being hospitalized and requiring inpatient parenteral antibiotic therapy delivered through a peripherally inserted central catheter (PICC). The use of PICC lines with PWUD is understood to be a source of tension in hospital settings but has not been well researched. Drawing on theoretical and analytic insights from "new materialism," we consider the assemblage of sociomaterial elements that inform the use of PICCs. METHODS: This paper draws on n = 50 interviews conducted across two related qualitative research projects within a program of research about the impact of substance use on hospital admissions from the perspective of healthcare providers (HCPs) and people living with HIV/HCV who use drugs. This paper focuses on data about PICC lines collected in both studies. RESULTS: The decision to provide, maintain, or remove a PICC is based on a complex assemblage of factors (e.g., infections, bodies, drugs, memories, relations, spaces, temporalities, and contingencies) beyond whether parenteral intravenous antibiotic therapy is clinically indicated. HCPs expressed concerns about the risk posed by past, current, and future drug use, and contact with non-clinical spaces (e.g., patient's homes and the surrounding community), with some opting for second-line treatments and removing PICCs. The majority of PWUD described being subjected to threats of discharge and increased monitoring despite being too ill to use their PICC lines during past hospital admissions. A subset of PWUD reported using their PICC lines to inject drugs as a harm reduction strategy, and a subset of HCPs reported providing harm reduction-centred care. CONCLUSION: Our analysis has implications for theorizing the role of PICC lines in the care of PWUD and identifies practical guidance for engaging them in productive and non-judgemental discussions about the risks of injecting into a PICC line, how to do it safely, and about medically supported alternatives.


Subject(s)
Catheterization, Central Venous , HIV Infections , Hepatitis C , Pharmaceutical Preparations , Catheterization, Central Venous/adverse effects , Catheters , HIV Infections/drug therapy , Hepatitis C/drug therapy , Hospitals , Humans , Retrospective Studies , Risk Factors
8.
Clin J Am Soc Nephrol ; 17(3): 429-433, 2022 03.
Article in English | MEDLINE | ID: covidwho-1674203

ABSTRACT

Measures implemented to prevent transmission of severe acute respiratory syndrome coronavirus 2 in outpatient dialysis facilities may also help to prevent catheter-associated bloodstream infections in patients receiving hemodialysis. We used United States Renal Data System data to examine rates of antibiotic administration within dialysis facilities and rates of hospital admission for catheter-associated bloodstream infection from March 2018 through November 2020, and rates of hospitalization for sepsis, to address overall changes in hospitalization during the coronavirus disease 2019 (COVID-19) pandemic. Using logistic regression, we estimated year-over-year adjusted odds ratios of these events in 3-month intervals. During the first 6 months of the pandemic, rates of antibiotic administration were between 20% and 21% lower, and rates of hospitalization for catheter-associated bloodstream infection were between 17% and 24% lower than during corresponding periods in 2019, without significant changes in rates of hospitalization for sepsis. However, rates of catheter-associated events also decreased between 2018 and 2019, driven by reductions in facilities operated by a large dialysis provider. These data suggest that significant reductions in catheter-associated infections occurred during the pandemic, superimposed on nonpandemic-related reductions in some facilities before the pandemic. Even after the pandemic, it may be prudent to continue some COVID-19 mitigation measures to prevent catheter-associated bloodstream infections.


Subject(s)
COVID-19/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Central Venous Catheters/adverse effects , Infection Control , Renal Dialysis/adverse effects , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19/transmission , COVID-19/virology , Catheter-Related Infections/microbiology , Catheter-Related Infections/transmission , Catheterization, Central Venous/instrumentation , Female , Hospitalization , Humans , Male , Middle Aged , Protective Factors , Renal Dialysis/instrumentation , Risk Assessment , Risk Factors , Time Factors , United States
9.
Breast Dis ; 41(1): 1-3, 2022.
Article in English | MEDLINE | ID: covidwho-1604128

ABSTRACT

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Subject(s)
Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , COVID-19/prevention & control , Catheterization, Central Venous/methods , Infection Control/methods , Patient Safety , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/standards , Central Venous Catheters , Chemotherapy, Adjuvant , Critical Pathways , Female , Humans , Infection Control/standards , Mastectomy , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Sentinel Lymph Node Biopsy/standards
10.
Infect Dis Clin North Am ; 35(4): 841-856, 2021 12.
Article in English | MEDLINE | ID: covidwho-1506789

ABSTRACT

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.


Subject(s)
Bacteremia/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Bacteremia/epidemiology , Bacteremia/etiology , COVID-19/epidemiology , Catheter-Related Infections/epidemiology , Catheter-Related Infections/etiology , Catheterization, Central Venous/standards , Clinical Decision-Making , Cross Infection/epidemiology , Cross Infection/etiology , Humans , Patient Care Bundles/standards , Practice Guidelines as Topic , SARS-CoV-2
11.
J Am Soc Nephrol ; 32(11): 2948-2957, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496700

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD. METHODS: We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared with 2017-2019 historical trends, using Centers for Medicare and Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively. RESULTS: Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15-18 (April, incidence rate ratio [IRR], 0.75; 95% CI, 0.73 to 0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR, 0.69; 95% CI, 0.66 to 0.73). Pre-emptive kidney transplantation decreased markedly during weeks 15-18 (IRR, 0.56; 95% CI, 0.46 to 0.67). Mean eGFR at dialysis initiation decreased by 0.33 ml/min per 1.73 m2 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min per 1.73 m2 were highest during weeks 19-22 (May, OR, 1.14; 95% CI, 1.05 to 1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR, 1.24; 95% CI, 1.14 to 1.34) in weeks 11-14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR, 1.30; 95% CI, 1.20 to 1.41). CONCLUSIONS: During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.


Subject(s)
COVID-19/epidemiology , Kidney Failure, Chronic/epidemiology , Adolescent , Adult , Aged , Catheterization, Central Venous/statistics & numerical data , Glomerular Filtration Rate , Humans , Incidence , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Kidney Transplantation/statistics & numerical data , Logistic Models , Middle Aged , Odds Ratio , Procedures and Techniques Utilization , Renal Dialysis/statistics & numerical data , United States , Young Adult
12.
Monaldi Arch Chest Dis ; 92(2)2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1444411

ABSTRACT

Contralateral pneumothorax after percutaneous central venous catheter placement has not been previously reported. Three patients who required intubation and mechanical ventilation for acute respiratory failure due to COVID-19 were identified with a new pneumothorax on routine post-placement chest roentgenogram on the side opposite the catheter placement.  Retrospective review of charts, radiographs, and laboratory studies.  No causative relationship was identified between the percutaneous placement of the central venous catheters and the subsequent pneumothoraces identified on the contralateral side, other than the presence of active COVID-19 viral pneumonia. The timing of the contralateral pneumothoraces were coincidental the placement of the central venous catheters.  We believe these pneumothoraces were a consequence of the pulmonary pathology of the COVID-19 virus.


Subject(s)
COVID-19 , Catheterization, Central Venous , Pneumothorax , COVID-19/complications , Catheterization, Central Venous/adverse effects , Humans , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Respiration, Artificial/adverse effects , Retrospective Studies
13.
J Thromb Thrombolysis ; 53(2): 257-263, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1432597

ABSTRACT

Venous thromboembolism (VTE) is an important complication of coronavirus disease 2019 (COVID-19). To date, few studies have described vascular access device use and VTE risk in this cohort. To examine the use of vascular access devices and incidence of VTE in patients hospitalized with COVID-19. We performed a retrospective, multi-center cohort study of patients hospitalized with COVID-19 who received a midline catheter, peripherally inserted central catheter (PICCs), tunneled or non-tunneled central venous catheter (CVC), hemodialysis (HD) catheter or a port during hospitalization. Mixed-effects multivariable logit models adjusting for VTE risk factors in the Caprini risk score were fit to understand the incremental risk of VTE in patients with vascular access devices vs. those that did not receive devices. Management of VTE was determined by examining anticoagulant use pre- vs. post-thrombosis. Results were expressed using odds ratios (ORs) and associated 95% confidence intervals (CI). A total of 1228 hospitalized COVID-19 patients in 40 hospitals, of which 261 (21.3%) received at least one vascular access device of interest, were included. The prevalence of acute, non-tunneled CVCs was 42.2%, acute HD catheters 18.4%, midline catheters 15.6%, PICCs 15.6%, tunneled CVCs 6.8%, and implanted ports 1.4%. The prevalence of VTE was 6.0% in the study cohort, and 10.0% among patients with vascular access devices. After adjusting for known VTE risk factors, patients that had a vascular access device placed were observed to have a four-fold greater odds of VTE than those that did not (OR 4.17, 95% CI 2.33-7.46). Patients who received multiple different catheters experienced more VTE events compared with patients that received only one type (21.5% vs. 6.1%, p < .001). Among the 26 patients with VTE, only 8 (30.8%) survived to discharge and among these, only 5 were discharged on therapeutic doses of anticoagulation. Hospitalized patients with COVID-19 that receive vascular access devices experienced higher rates of VTE than those that do not. Future studies to evaluate the nexus between COVID-19, vascular device use, and thrombosis appear are warranted.


Subject(s)
COVID-19 , Catheterization, Central Venous , Thrombosis , Vascular Access Devices , Venous Thromboembolism , COVID-19/complications , Catheterization, Central Venous/adverse effects , Hospitals , Humans , Michigan/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Thrombosis/epidemiology , Thrombosis/etiology , Vascular Access Devices/adverse effects , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology
14.
J Am Soc Nephrol ; 32(11): 2948-2957, 2021 11.
Article in English | MEDLINE | ID: covidwho-1430594

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD. METHODS: We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared with 2017-2019 historical trends, using Centers for Medicare and Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively. RESULTS: Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15-18 (April, incidence rate ratio [IRR], 0.75; 95% CI, 0.73 to 0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR, 0.69; 95% CI, 0.66 to 0.73). Pre-emptive kidney transplantation decreased markedly during weeks 15-18 (IRR, 0.56; 95% CI, 0.46 to 0.67). Mean eGFR at dialysis initiation decreased by 0.33 ml/min per 1.73 m2 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min per 1.73 m2 were highest during weeks 19-22 (May, OR, 1.14; 95% CI, 1.05 to 1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR, 1.24; 95% CI, 1.14 to 1.34) in weeks 11-14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR, 1.30; 95% CI, 1.20 to 1.41). CONCLUSIONS: During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.


Subject(s)
COVID-19/epidemiology , Kidney Failure, Chronic/epidemiology , Adolescent , Adult , Aged , Catheterization, Central Venous/statistics & numerical data , Glomerular Filtration Rate , Humans , Incidence , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Kidney Transplantation/statistics & numerical data , Logistic Models , Middle Aged , Odds Ratio , Procedures and Techniques Utilization , Renal Dialysis/statistics & numerical data , United States , Young Adult
15.
Surgery ; 170(6): 1652-1658, 2021 12.
Article in English | MEDLINE | ID: covidwho-1316640

ABSTRACT

BACKGROUND: In surgical training, assessment tools based on strong validity evidence allow for standardized evaluation despite changing external circumstances. At a large academic institution, surgical interns undergo a multimodal curriculum for central line placement that uses a 31-item binary assessment at the start of each academic year. This study evaluated this practice within increased in-person learning restrictions. We hypothesized that external constraints would not affect resident performance nor assessment due to a robust curriculum and assessment checklist. METHODS: From 2018 to 2020, 81 residents completed central line training and assessment. In 2020, this curriculum was modified to conform to in-person restrictions and social distancing guidelines. Resident score reports were analyzed using multivariate analyses to compare performance, objective scoring parameters, and subjective assessments among "precoronavirus disease" years (2018 and 2019) and 2020. RESULTS: There were no significant differences in average scores or objective pass rates over 3 years. Significant differences between 2020 and precoronavirus disease years occurred in subjective pass rates and in first-time success for 4 checklist items: patient positioning, draping, sterile ultrasound probe cover placement, and needle positioning before venipuncture. CONCLUSION: Modifications to procedural training within current restrictions did not adversely affect residents' overall performance. However, our data suggest that in 2020, expert trainers may not have ensured learner acquisition of automated procedural steps. Additionally, although 2020 raters could have been influenced by logistical barriers leading to more lenient grading, the assessment tool ensured training and assessment integrity.


Subject(s)
Catheterization, Central Venous/standards , Educational Measurement/statistics & numerical data , General Surgery/education , COVID-19 , Educational Measurement/standards , General Surgery/standards , Humans
16.
Semin Dial ; 34(5): 360-367, 2021 09.
Article in English | MEDLINE | ID: covidwho-1309792

ABSTRACT

BACKGROUND: Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS-CoV-2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID-19 on MHD in a large cohort of patients from India. METHODS: Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox-regression analysis. RESULTS: Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID-19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID-19 (p = 0.001). Mortality was higher among patients on twice-weekly MHD than thrice-weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26-5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52-8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25-0.99, p = 0.049) had significant effect on mortality. CONCLUSION: The adjusted mortality risk of COVID-19 in MHD patients is high in patients associated with severe COVID-19 and patients having CVC as vascular access.


Subject(s)
COVID-19/mortality , Renal Dialysis , Age Factors , Catheterization, Central Venous/adverse effects , Comorbidity , Female , Hospital Mortality , Hospital Units , Humans , India/epidemiology , Male , Middle Aged , Noninvasive Ventilation , Prospective Studies , Severity of Illness Index
17.
BMJ Open ; 11(4): e042475, 2021 04 14.
Article in English | MEDLINE | ID: covidwho-1186290

ABSTRACT

INTRODUCTION: Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications. METHODS AND ANALYSIS: A multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve); (2) chlorhexidine gluconate-impregnated PICC (with external clamp)) and one control group ((3) conventional polyurethane PICC (with external clamp)). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome is PICC failure, a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication; thrombotic complications; infective complications; adverse events (local or systemic reaction); PICC dwell time; patient/parent satisfaction; and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI. ETHICS AND DISSEMINATION: Ethical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published. TRIAL REGISTRATION NUMBER: ACTRN12619000022167.


Subject(s)
Catheter-Related Infections , Catheterization, Central Venous , Catheterization, Peripheral , Central Venous Catheters , Adult , Australia , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Central Venous Catheters/adverse effects , Child , Humans , Multicenter Studies as Topic , Queensland , Randomized Controlled Trials as Topic , Risk Factors
18.
Medicine (Baltimore) ; 100(7): e24720, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1125772

ABSTRACT

ABSTRACT: The purpose of this study was to explore the management experience of outpatient with totally implantable central venous access Ports (TIVAPs, Ports) during the epidemic, including whether the extension of the irrigation interval will affect the incidence of catheter occlusion, the reasons for the port removal rate, and the corresponding protective treatment strategies during the COVID-19 epidemic.We retrospectively analyzed the Ports evaluation and flushing procedure data between February 3, 2020 and April 3, 2020; the cases were divided into the normal group and delayed group according to the critical point of the maintenance interval of 28 days (4 weeks). We compared the incidence of catheter obstruction between the 2 groups, analyzed the causes of catheter removal events in the 2 groups, and proposed corresponding protective treatment recommendations.During the period, 329 cases were included in the study. There was no significant difference in the incidence of catheter obstruction between the 2 groups. There were 15 patients with catheter removal, 8 cases of infection, 5 cases of catheter obstruction, and 1 case of an ectopic catheter, as well as 1 case of an overturned port. During the epidemic, no hospital infections related to the Ports flushing procedure occurred.The interval of Ports flushing procedures for patients without clinical symptoms can be appropriately extended during the COVID-19 epidemic. However, once the local infection symptoms or other sources of discomfort appear, Ports assessment needs to be performed as soon as possible. Take enhanced protected and isolation measures did not increase cross-infection during outpatient's flushing procedure at non-COVID-19-designated diagnosis and treatment hospitals.


Subject(s)
COVID-19/epidemiology , Catheterization, Central Venous , Outpatients , Device Removal , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
20.
J Intensive Care Med ; 36(3): 373-375, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1067076

ABSTRACT

BACKGROUND: In the setting of the COVID pandemic, many patients falling ill with acute respiratory distress syndrome eventually require prone positioning for gas exchange. Traditionally, central venous catheters are inserted with patient in the supine or Trendelenburg position. However, when a patient cannot tolerate supine position and the need for central venous access is urgent, catheter placement may be considered with the patient in the prone position. CASE SUMMARY: A 69-year-old male with rapidly declining respiratory status secondary to COVID pneumonia quickly developed acute respiratory distress syndrome, was rapidly intubated, and then placed in the prone position. Patient could not tolerate the supine position even briefly and required a central venous catheter insertion for continuous renal replacement therapy. We kept the patient in the prone position and successfully inserted a central venous catheter in such position with real-time ultrasound guidance and using micropuncture technique. CONCLUSION: In the setting of the COVID pandemic, many cases of acute respiratory distress syndrome require patients to be prone in order to improve gas exchange. In the most severe situations, these patients would not be able to tolerate rotating back to the supine position but would still require central venous catheter insertion urgently. We demonstrated feasibility of central venous catheter insertion in the prone position in these severely ill patients.


Subject(s)
COVID-19/therapy , Catheterization, Central Venous/methods , Patient Positioning/methods , Prone Position , Respiratory Distress Syndrome/therapy , Ultrasonography, Interventional/methods , Aged , Humans , Intubation, Intratracheal , Male , Punctures , SARS-CoV-2
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