Stratification of Risk Factors of Complications Associated with Peritoneal Dialysis Catheter Placement.

Background: Peritoneal dialysis (PD) is a frequent method for renal replacement therapy in pediatric population. However, PD is associated with a high incidence of early and late complications. Thus, this study aims to evaluate the perioperative factors associated with these complications. Methods: Clinical records of patients who had peritoneal dialysis catheter (PDC) placement between January 2013 and June 2016 were retrospectively analyzed. Sociodemographic and perioperative variables were recorded and analyzed. Results: A total of 92 patients required PDC insertion. Primary PDC failure occurred in 21.74% of cases, and 17.39% required reoperation. The most common complication was occlusion (13.04%), followed by leak (8.7%). Age younger than 1 year and weight less than 10 kg were significant risk factors for catheter dysfunction, reoperation, leak, PDC occlusion, hernia, and death. The open technique was associated with higher risks of operation, leak, and peritonitis than the laparoscopic technique. Placement of the catheter by the laparoscopic technique reduced the odds of occlusion by 38%. Conclusions: Patients younger than 1 year and weighing less than 10 kg have an increased risk of complications and death, regardless of the technique used. The most frequent complication is catheter failure; however, the laparoscopic technique appears to reduce this complication.

Traqueotomía percutánea guiada por ultrasonografía en tiempo real. Revisión de la literatura / Literature Review. Real-time ultrasonography-guided percutaneous tracheotomy

La traqueotomía percutánea por dilatación es un procedimiento que se realiza en las unidades de paciente crítico, implica la disección roma de los tejidos pretraqueales, seguida de la dilatación de la tráquea sobre la guía y la inserción de la cánula traqueal mediante la técnica de Seldinger. En las últimas décadas, la evidencia sugiere que, en manos de médicos capacitados, es al menos tan segura como la traqueotomía quirúrgica, con similar incidencia de complicaciones. La selección adecuada de pacientes y el uso de herramientas de seguridad complementarias, como broncoscopio o ultrasonido, disminuyen las tasas de falla y complicaciones. Siendo contraindicaciones absolutas para traqueotomía percutánea por dilatación una anatomía anormal, tumor maligno en el sitio de traqueostomía, coagulopatías o vía aérea difícil. La guía mediante broncoscopia permite la evaluación de la profundidad del tubo endotraqueal, confirma la posición de la aguja en el eje de la tráquea y la adecuada inserción del cable guía y dilatador. Entre sus desventajas destacan que, el sitio de punción está sujeto a sesgo y no puede guiar con precisión la aguja en la penetración de la tráquea. La traqueotomía percutánea guiada por ultrasonido es una alternativa validada en unidades, donde no se cuente con broncoscopia. Es un método rápido, seguro, que permite la identificación de estructuras anatómicas, vasculatura cervical, permite identificar el sitio de la punción y guía la inserción de la aguja en la tráquea. Esta técnica presenta altas tasas de éxito al primer intento, reduciendo significativamente el número de punciones.

Percutaneous dilation tracheostomy is a procedure performed in critical patient units. It involves blunt dissection of the pretracheal tissues followed by dilation of the trachea over the guidewire and insertion of the tracheal cannula using the Seldinger technique. In recent decades, evidence suggests that in the hands of trained physicians it is at least as safe as surgical tracheostomy, with a similar incidence of complications. The proper selection of patients and the use of complementary safety tools such as bronchoscope or ultrasound reduce failure rates and complications. Being absolute contraindications for PDT abnormal anatomy, malignant tumor at the tracheostomy site, coagulopathies, or difficult to treat airway. Bronchoscopy guidance allows evaluation of the depth of the endotracheal tube, confirms the position of the needle in the axis of the trachea and the proper insertion of the guide wire and dilator. Among its disadvantages are that the puncture site is subject to slant and cannot accurately guide the needle into the trachea. In addition, it requires Critical Patient Units with bronchoscope and trained personnel. Ultrasound-guided percutaneous tracheotomy is a validated alternative in units where bronchoscopy is not available. It is a fast, safe method that allows the identification of anatomical structures, cervical vasculature, identifies the puncture site and guides the insertion of the needle into the trachea. With high first-attempt success rates, significantly reducing the number of punctures.

Accidental guide wire migration and late percutaneous externalization after central venous catheterization.

A 70-year-old man was admitted to the emergency department with recent spontaneous externalization of a metallic device from his right inner thigh. He had been experiencing mild local pain for 2 weeks and had a recent hospitalization due to cardiogenic hemodynamic instability, requiring a central venous catheter placement in his right internal jugular vein 3 months earlier. Doppler ultrasound confirmed the intravascular foreign body hypothesis as a guidewire was identified inside the right femoral vein, associated with femoropopliteal venous thrombosis. The guidewire was successfully removed percutaneously through simple manual traction guided by radioscopy. The patient was discharged the following day on oral anticoagulation with rivaroxaban. On outpatient follow-up 4 weeks post discharge, he had no complaints in the right lower limb except for slight swelling. Central venous catheterization is a common invasive procedure that, although unquestionably safe and well stablished in medical practice, can lead to serious complications when performed without proper technique.

Complicaciones por accesos venosos centrales en pacientes adultos / Complications due to central venous access in adult patients

Los accesos venosos centrales son técnicas de uso regular en el ámbito hospitalario, es por ello que la investigación tiene como Objetivo: Establecer la incidencia de complicaciones asociadas a la colocación de accesos venosos centrales en pacientes atendidos en el Hospital Militar Universitario "Dr. Carlos Arvelo". Métodos: estudio prospectivo, de selección intencional de pacientes en el ámbito hospitalario que presenten complicaciones asociadas a la canalización de accesos venosos centrales; a los cuales se les aplicó un cuestionario donde se registraron, además de datos demográficos y clínicos, los resultados del funcionamiento del acceso venoso central. Al séptimo día se retiró o se recambió el acceso venoso central y se tomó muestra para cultivo y antibiograma de la punta de catéter. Los datos fueron tabulados, analizados en gráficos y tablas. Resultados: Uno de los principales hallazgos fueron las complicaciones infecciosas en un 65.93 % y producto de complicaciones mecánicas un 34.05 % del grupo de estudio. Las complicaciones infecciosas fueron atribuibles en su mayoría a Staphylococcus aureus (27,39 %), Pseudomona sp (21,91 %), Stenotrophomonas maltophilia (16,44%), Burkholderia cepacia (10,95 %) y Klebsiella pneumonia (5,48 %). En cuanto al porcentaje de éxito de las intervenciones se encontró que el promedio de intentos fue de 5 con una desviación estándar de ± 3 intentos y una duración promedio menor a 30 minutos en 90 de los casos representando el 76,27 % y duración mayor de 30 minutos en 28 casos representando 23,7 %. Conclusiones: Los accesos venosos yugulares internos fueron los procedimientos más frecuentes seguido de los accesos subclavios, sin predilección de lateralidad alguna. Al revisar los hallazgos se puede evidenciar que la punción arterial se convierte en la complicación mecánica más frecuente produciendo hematomas y equimosis con un alto porcentaje de intentos superiores a 30 minutos o un número de intentos mayores a tres, así como las complicaciones infecciosas generadas por el Staphylococcus aureus y sin que dichas complicaciones se encontraran asociadas al tipo de abordaje estudiado, tiempo de intervención u otros factores de carácter demográfico(AU)

Central venous accesses are a technique of regular use in the hospital environment, that is why the objective of this research is: to establish the incidence of complications treated at the University Military Hospital "Dr. Carlos Arvelo". Methods: prospective study, of intentional selection of patients in the hospital setting who present complications associated to the cannulation of central venous accesses; to whom a questionnaire was applied where, in addition to demographic and clinical data, the results of the central venous access operation were registered. On the seventh day, the central venous access was removed or replaced and a sample was taken for culture and antibiogram of the catheter tip. Data were tabulated, analyzed in graphs and tables. Results: One of the main findings was infectious complications in 65.93 % and mechanical complications in 34.05 % of the study group. Infectious complications were mostly attributable to Staphylococcus aureus (27.39 %), Pseudomona sp (21.91 %), Stenotrophomonas maltophilia (16.44 %), Burkholderia cepacia (10.95 %) and Klebsiella pneumonia (5.48 %). Regarding the percentage of success of the interventions, it was found that the average number of attempts was 5 with a standard deviation of ± 3 attempts and an average duration of less than 30 minutes in 90 of the cases representing 76.27 % and duration greater than 30 minutes in 28 cases representing 23.7 %. Conclusions: Internal jugular venous accesses were the most frequent procedures followed by subclavian accesses, with no predilection for laterality. When reviewing the findings, it can be evidenced that arterial puncture becomes the most frequent mechanical complication producing hematomas and ecchymosis with a high percentage of attempts longer than 30 minutes or a number of attempts longer than three, as well as infectious complications generated by Staphylococcus aureus and without these complications being associated to the type of approach studied, time of intervention or other demographic factors(AU)