Is immediate chest radiograph necessary after central venous catheter placement in a surgical intensive care unit?

BACKGROUND: Current standard of care dictates that central venous catheter (CVC) insertion should be followed by an immediate chest radiograph to confirm appropriate position and rule out complications. We hypothesized that a subset of monitored intensive care unit patients exists that is at low risk for complications and might safely have radiographic evaluation of line placement deferred until the next scheduled radiograph. METHODS: Data regarding patient and procedural characteristics were obtained prospectively for 184 CVC placed between March 1, 1998, and June 30, 1999. Retrospective data regarding complications were obtained by chart review for an additional 174 CVC placed during the study period but for which data sheets were not completed. All procedures were followed by chest radiography. RESULTS: We documented a complication rate of 9% with the vast majority (25 of 31, 81%) of complications consisting of incorrect positioning. The number of needle passes was greater in the group suffering pneumothorax and arterial puncture than the uncomplicated group (5.6 versus 1.9, P = 0.008). "Straightforward" operator gestalt (P = 0.04) and number of needle passes <3 (P = 0.03) were factors correlating with the absence of complications. These factors had negative predictive values of 94% and 96%, respectively. CONCLUSION: Placement of CVC is safe in experienced hands. In monitored intensive care unit patients who undergo a "straightforward" procedure with <3 needle passes, chest radiograph can be safely deferred until the next scheduled examination.

[Computer-assisted urino-diagnosis of kidney diseases using open-type biochemical analyzers]. / Komp'iuternaia urinodiagnostika zabolevanii pochek s ispol'zovaniem biokhimicheskikh analizatorov otkrytogo tipa.

Computer-aided urinodiagnosis of renal diseases consists in collection of a series of urinary portions in fixed periods at rest, during exercise and drug loading with assessment in each of these portions of protein, urea nitrogen, creatinine, phosphorus, and potassium. Concentrations of all elements are determined by open auto-analyzers using special programs; protein content is measured by two methods, sulfosalicylic acid test and Biuret method. Two data sets are formed including, respectively, information on protein content obtained by the said methods; these data are processed using special programs to reveal the regularities typical of various renal diseases. The method helps diagnose various morphologic types of glomerulonephritis and renal amyloidosis, chronic pyelonephritis and renal tuberculosis, permits assess the risk of oncological diseases of the kidneys and the type of changes in various parts of the nephron and mechanisms of proteinuria.

Detection of latent bacteriuria in patients with chronic pyelonephritis.

Diagnostic possibilities of selective examination of renal urine particularly collected under medicamentous polyuria conditioned by the administration of Lazix were studied in latent bacteriuria. By means of separate collection of renal urine against the background of polyuria it was possible additionally to detect bacteriuria in 1/3 of the patients, to record increase in the intensity of the index in almost half of the patients with renal bacteriuria and, in 1/4 of them to detect, in renal urine, the aetiological agent absent from bladder urine. The latter circumstance not only has a diagnostic significance but also plays a certain role in the selection of medicamentous therapy in chronic pyelonephritis. In addition to traditional bacteriological methods, filtration through membrane filters was used to isolate and identify microflora in the urine. By means of this method it is possible to detect extremely low bacteriuria which cannot be established by any other method.

[Bacteriologic study of the urine of pyelonephritis patients following administration of saluretics]. / Bakteriologicheskoe issledovanie mochi bol'nykh pielonefritom pri vvedenii saluretikov.

The qualitative and quantitative bacteriological study of renal urine samples selectively taken from pyelonephritis patients before and after the administration of lasix was made. This study revealed that simultaneously with plyuria the increased frequency of colony growth occurring after inoculations from urine samples and the greater degree of bacteriuria were observed. The qualitative analysis of microflora in the selectively taken samples of renal urine revealed the presence of additional etiological agents which were absent in the samples of bladder urine. These findings indicate that the bacteriological study of renal urine samples simultaneously with the administration of lasix allows to obtain additional information useful for the diagnostics of pyelonephritis and for the choice of rational schemes of antibacterial therapy.