ABSTRACT
Insertion of central venous catheters in the cervico-thoracic area is potentially associated with the risk of immediate/early untoward events, some of them negligible (repeated punctures), some relevant (accidental arterial puncture), and some severe (pneumothorax). Furthermore, different strategies adopted during insertion may reduce or increase the incidence of late catheter-related complications (infection, venous thrombosis, dislodgment). This paper describes a standardized protocol (S.I.C.: Safe Insertion of Centrally Inserted Central Catheters) for the systematic application of seven basic beneficial strategies to be adopted during insertion of central venous catheters in the cervico-thoracic region, aiming to minimize immediate, early, or late insertion-related complications. These strategies include: preprocedural evaluation, appropriate aseptic technique, ultrasound guided insertion, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and adequate coverage of the exit site.
Subject(s)
Catheterization, Central Venous , Catheterization, Peripheral , Central Venous Catheters , Humans , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Risk Factors , Ultrasonography, Interventional , Catheterization, Peripheral/methods , Postoperative ComplicationsABSTRACT
The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.
Subject(s)
Catheterization, Central Venous , Central Venous Catheters , Humans , Catheters, Indwelling , Femoral Vein/diagnostic imaging , PuncturesABSTRACT
Insertion of Peripherally Inserted Central Catheters (PICCs) is potentially associated with the risk of immediate/early adverse events, some of them minimal (repeated punctures) and some relevant (accidental arterial puncture or nerve-related injury). Several strategies adopted during the insertion process may minimize the risk of such events, including late complication risks such as infection, venous thrombosis, or catheter dislodgment and/or malposition. This paper describes an update version of the SIP protocol (Safe Insertion of PICCs), an insertion bundle which includes eight effective strategies that aims to minimize immediate, early, or late insertion-associated complications. These strategies include: preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; appropriate skin antiseptic technique; choice of appropriate vein, adoption of the Zone Insertion Method™; clear identification of the median nerve and brachial artery; ultrasound-guided puncture; ultrasound-guided tip navigation; intra-procedural assessment of tip location; correct securement of the catheter, and appropriate protection of the exit site. This updated version of the SIP protocol includes several novelties based on the most recent evidence-based scientific literature on PICC insertion, such as the clinical relevance of the tunneling technique, the use of ultrasound for intra-procedural tip navigation and tip location, and the new technologies for the protection of the exit site (cyanoacrylate glue) and for the securement of the catheter (subcutaneous anchorage).
Subject(s)
Disinfection/methods , Equipment Contamination/prevention & control , Infection Control/methods , Infusions, Intravenous/instrumentation , Infusions, Intravenous/nursing , Catheter-Related Infections/etiology , Catheter-Related Infections/prevention & control , Clinical Protocols , Equipment Design , Guideline Adherence , Humans , Infusions, Intravenous/adverse effects , Nurse's Role , Practice Guidelines as TopicSubject(s)
Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Disinfection/methods , Equipment Contamination/prevention & control , Sepsis/prevention & control , Anti-Infective Agents, Local/administration & dosage , Benchmarking , Catheter-Related Infections/etiology , Catheterization, Central Venous/nursing , Clinical Protocols , Equipment Contamination/statistics & numerical data , Equipment Design , Equipment Failure , Humans , Infection Control/methods , Risk Factors , Sepsis/etiologyABSTRACT
DNA and RNA oligomers are used in a myriad of diverse biological and biochemical experiments. These oligonucleotides are designed to have unique biophysical, chemical and hybridization properties. We have created an integrated set of bioinformatics tools that predict the properties of native and chemically modified nucleic acids and assist in their design. Researchers can select PCR primers, probes and antisense oligonucleotides, find the most suitable sequences for RNA interference, calculate stable secondary structures, and evaluate the potential for two sequences to interact. The latest, most accurate thermodynamic algorithms and models are implemented. This free software is available at http://www.idtdna.com/SciTools/SciTools.aspx.
