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2.
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
3.
Surg Innov ; 28(2): 231-235, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-913988

ABSTRACT

Background. The SARS-CoV-2 novel coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to urban health centers across the United States. Many hospitals are reallocating resources to best handle the influx of critical patients. Methods. At our New York City hospital, we developed the ancillary central catheter emergency support service (ACCESS), a team for dedicated central access staffed by surgical residents to assist in the care of critical COVID-19 patients. We conducted a retrospective review of all patients for whom the team was activated. Furthermore, we distributed a survey to the critical care department to assess their perceived time saved per patient. Results. The ACCESS team placed 104 invasive catheters over 10 days with a low complication rate of .96%. All critical care providers surveyed found the service useful and felt it saved at least 30 minutes of procedural time per patient, as patient to critical care provider ratios were increased from 12 patients to one provider to 44 patients to one provider. Conclusions. The ACCESS team has helped to effectively redistribute surgical staff, provide a learning experience for residents, and improve efficiency for the critical care team during this pandemic.


Subject(s)
COVID-19 , Catheterization, Central Venous , Catheterization, Peripheral , Emergency Service, Hospital/organization & administration , Health Personnel/organization & administration , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/statistics & numerical data , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/statistics & numerical data , Hospital Units , Humans , New York City , Retrospective Studies , SARS-CoV-2 , United States
4.
JBJS Case Connect ; 10(3): e2000377, 2020.
Article in English | MEDLINE | ID: covidwho-789018

ABSTRACT

CASE: A 58-year-old man presented with acute respiratory distress syndrome and coagulopathy secondary to COVID-19. He developed acute compartment syndrome (ACS) of the left hand. He underwent a bedside 10-compartment decompression of the hand with volar forearm and carpal tunnel release while in the ICU. This report adds to the scarce body of literature regarding orthopaedic complications related to COVID-19. CONCLUSION: Coagulopathy secondary to COVID-19 can be a risk factor for the development of ACS. Frequent examinations of lines, restraints, and extremities are recommended. The COVID-19 pandemic presents unique challenges, necessitating clinical adjustments to best care for patients.


Subject(s)
Catheterization, Peripheral/adverse effects , Compartment Syndromes/etiology , Coronavirus Infections/complications , Hand/blood supply , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Compartment Syndromes/surgery , Coronavirus Infections/therapy , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , SARS-CoV-2
5.
J Vasc Access ; 21(4): 408-410, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-175837

ABSTRACT

The 2020 COVID pandemic has forced everyone to update the usual medical procedures and adapt them to a new situation characterized by a high risk of contamination of the health operator. The placement of a venous access device is no exception. In the experience of the vascular access team of our hospital, hit by the COVID epidemic in March 2020, the safety of both the patient and the staff can be ensured by an insertion bundle of few smart strategies, which include choice of long dwelling peripheral catheters (midline catheters) rather than short venous cannulas; use of power injectable peripherally inserted central catheters in the COVID patients in intensive care unit requiring a central line; use of wireless probes-easy to carry, easy to clean-for ultrasound guided venipuncture; avoidance of x-rays, using alternative methods for tip location such as intracavitary electrocardiography or trans-thoracic echocardiography; strict adoption of the barrier precautions recommended by the international guidelines.


Subject(s)
Betacoronavirus/pathogenicity , Catheterization, Central Venous , Catheterization, Peripheral , Coronavirus Infections/virology , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Exposure/prevention & control , Pneumonia, Viral/virology , COVID-19 , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/instrumentation , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Humans , Occupational Exposure/adverse effects , Occupational Health , Pandemics , Patient Safety , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Protective Factors , Risk Assessment , Risk Factors , SARS-CoV-2 , Virulence
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