A six-year study of complications related to peripherally inserted central catheters: A multi-center retrospective cohort study in China.

OBJECTIVE: Peripherally inserted central catheters (PICCs), the most frequent central venous catheter, are used to provide medical treatments, although long-term PICC-related adverse outcomes are unknown in China. This study systematically investigated PICC-related complications in four Chinese hospitals. METHODS: Between January 2014 and January 2020, we analyzed the results of 3550 patients with PICC who were referred to four Chinese hospitals. All patients underwent PICC treatment in four Chinese hospitals. Patient-reported signs and symptoms of a putative PICC-related complication or functional were studied. Long-term outcomes and hospitalization costs were also evaluated. RESULTS: An aggregate of 3285 patients were enrolled in the analytic cohort. 58.6% were females and 41.4% were males. The most common reasons for PICC placement included oncologic malignancy and critically ill patients. The majority of PICCs had valved systems (90.7%) and were implanted in the right side (85.5%) and into the basilic vein (87.7%). At least one potential PICC-related problem or adverse effects (AEs) was reported by 67.3% of patients. Central line-associated bloodstream infection (28.1%) and symptomatic deep vein thrombosis (20.7%) were the most common complications. The majority of PICCs were removed for causes other than AEs, with just 723 reported AEs accounting for 22.0% of all PICC removals. The most reasons for PICCs removal were occlusion (425, 12.9%) and exit-site infections (189, 5.8%). CONCLUSIONS: This study is the first retrospective study in our country to explore PICC-related complications. While living with a PICC, more than 67.3% of patients report signs and symptoms of at least one PICC-related problem or adverse impacts, such as difficulties with PICC use and poor effects on physical and social function. In this group, PICCs are safe and effective, although the danger of PICC-related problems should not be disregarded.

Dexmedetomidine potential in attenuating postoperative delirium in elderly patients after total hip joint replacement.

OBJECTIVE: This study aims to evaluate the effectiveness of dexmedetomidine in reducing the occurrence of postoperative delirium in elderly patients after total hip joint replacement. METHODS: Patients who have undergone total hip joint replacement and who were admitted to the hospital from August 1, 2017, to August 1, 2020, were included in this study. After initial screening, 327 out of 385 patients were selected and randomly assigned to either dexmedetomidine (0.1 µg/kg/h, n=163) or placebo (n=164) groups. The occurrence of delirium was examined twice a day for one week by using the Confusion Assessment Method. Furthermore, 30-day all-cause mortality, hospitalization duration and costs, and the presence of any postoperative complications were also evaluated. RESULTS: The postoperative delirium incidence was significantly lower in the dexmedetomidine group compared to that in the placebo group (13.8 vs. 29.3%, p<0.01). The hospitalization duration (17.2±6.3 vs. 15.6±4.2, p=0.006) and cost (4.5±0.9 vs. 4.9±1.1, p=0.001) in the dexmedetomidine group were also lower than those in the placebo group. Meanwhile, no significant difference between the 30-day all-cause mortality of the two groups was observed (p=0.60). In terms of safety, no significant differences between the occurrence of hypotension and bradycardia were also observed. CONCLUSION: Our findings show that the dexmedetomidine medication can reduce the postoperative delirium incidence in older total hip joint replacement patients and can subsequently decrease the related hospitalization duration and cost of these patients.

Dexmedetomidine potential in attenuating postoperative delirium in elderly patients after total hip joint replacement

SUMMARY OBJECTIVE: This study aims to evaluate the effectiveness of dexmedetomidine in reducing the occurrence of postoperative delirium in elderly patients after total hip joint replacement. METHODS: Patients who have undergone total hip joint replacement and who were admitted to the hospital from August 1, 2017, to August 1, 2020, were included in this study. After initial screening, 327 out of 385 patients were selected and randomly assigned to either dexmedetomidine (0.1 μg/kg/h, n=163) or placebo (n=164) groups. The occurrence of delirium was examined twice a day for one week by using the Confusion Assessment Method. Furthermore, 30-day all-cause mortality, hospitalization duration and costs, and the presence of any postoperative complications were also evaluated. RESULTS: The postoperative delirium incidence was significantly lower in the dexmedetomidine group compared to that in the placebo group (13.8 vs. 29.3%, p<0.01). The hospitalization duration (17.2±6.3 vs. 15.6±4.2, p=0.006) and cost (4.5±0.9 vs. 4.9±1.1, p=0.001) in the dexmedetomidine group were also lower than those in the placebo group. Meanwhile, no significant difference between the 30-day all-cause mortality of the two groups was observed (p=0.60). In terms of safety, no significant differences between the occurrence of hypotension and bradycardia were also observed. CONCLUSION: Our findings show that the dexmedetomidine medication can reduce the postoperative delirium incidence in older total hip joint replacement patients and can subsequently decrease the related hospitalization duration and cost of these patients.

Effects of Melatonin for Delirium in Elderly Acute Heart Failure Patients: A Randomized, Single-Center, Double-Blind, and Placebo-Controlled Trial.

BACKGROUND: Delirium is a common, life-threatening, typical clinical syndrome with the main clinical manifestations of temporary organic mental disorder without specific drug treatment. The aim of the study was to explore the benefits of melatonin for the treatment of delirium after acute heart failure in elderly patients. METHODS: This was a randomized, double-blind, and placebo-controlled trial. This study enrolled patients aged more than 60 years after acute heart failure. A computer-generated randomization sequence (in a 1:1 ratio) was used to randomly assign patients to receive either melatonin (3 mg/day, 7 days) or placebos. The primary endpoint was the incidence of delirium, assessed twice daily with the Confusion Assessment Method during the first 7 days. Analyses were performed by intention-to-treat and safety populations. RESULTS: Between October 2015 and October 2019, 584 patients were assessed. A total of 497 patients randomly were assigned to receive either placebo (N = 249) or melatonin (N = 248). The incidence of delirium was significantly lower in the melatonin group than in the placebo group (27.0% vs. 36.9%, P = 0.021). Regarding safety, the occurrence of rhabdomyolysis and abnormal hepatic function did not differ between the two groups. CONCLUSION: The current study (clinical trial registered number: CHWX-904-201511) suggests that acute melatonin treatment can reduce the incidence of delirium for elderly acute heart failure. It also can reduce the time of hospital stays and hospitalization costs. The therapy was safe and worth spreading.