Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis.

Importance: Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions. Objective: To summarize current rates of CVC-associated complications. Data Sources: MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023. Study Selection: This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded. Data Extraction and Synthesis: Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated. Main Outcomes and Measures: Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed. Results: Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters). Conclusions and Relevance: Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.

The Accuracy of In-State Prescription Monitoring Program Database and Electronic Medical Records Compared to Urine Toxicology Screening in Total Joint Arthroplasty Preoperative Evaluation.

Preoperative narcotic use is associated with poor postoperative pain management and worse outcomes after total joint arthroplasty (TJA). Therefore, identifying controlled substance use preoperatively is necessary. Electronic medical records (EMRs), prescription monitoring programs (PMP), or urine toxicology screening (UTS) are most commonly used. This study aims to compare the accuracy of EMR and PMP versus UTS to determine whether UTS should be implemented as standard of care in TJA preoperative assessment. Preoperative UTS was performed for primary or revision TJA from November 1, 2018, to March 31, 2019. Patient demographics, medical history, prescription history, and UTS results were retrospectively recorded. Prescription monitoring program and EMR were queried for prescription history in the past 2 years. The accuracy of EMR and PMP compared with UTS was calculated. Multivariable logistic regression analysis was performed to identify patient predictors associated with UTS+. Thirty of 148 patients had UTS+. Positive urine toxicology screening was more common in patients younger than 58 years, White race, and undergoing revision surgery. Electronic medical record and PMP documentation had the highest sensitivity (73.3%), specificity (92.4%), positive predictive value (71.0%), and negative predictive value (93.2%). Patients with higher odds of UTS+ include current/former smokers, those with a history of alcohol abuse, drug abuse, hepatitis C diagnosis, and mental illness. For patients without any risk factors for having a UTS+, the use of EMR and PMP may be sufficient to evaluate for controlled substance use; however, UTS should be considered in patients who present with one of the risk factors for UTS+.

Effects of filling techniques on the regional bond strength to lateral walls in Class I cavities.

OBJECTIVES: Using the push-out technique, this study compared the influence of different composite insertion techniques in Class I cavities on the regional shear bond strength to lateral walls. MATERIALS AND METHOD: Standardized Class I cavities were prepared on the occlusal surface of 60 freshly extracted third molars, which were randomly assigned to one of five groups (n = 10). The cavities were bonded with the self-etch adhesive AdheSE and restored with Tetric Ceram resin composite by one of five techniques: G1, incremental technique (four oblique layers); G2, flowable composite as liner and bulk technique; G3, bulk technique and G4, light cone technique. The total-etch adhesive (Single Bond) and incremental technique were used as the control procedure. Each specimen was sectioned perpendicular to the long axis of the tooth in 1 mm-thick dentin slices. A push-out test was performed to measure regional bond strengths and identify the type of failure. Two additional teeth per group were prepared for the morphological interface study using scanning electron microscopy. RESULTS: Differences between the groups were tested by one-way ANOVA and Scheffé post hoc test (F = 29.635, p < 0.001). The highest shear bond strength values were obtained with the incremental technique, regardless of the adhesive used. Significant differences in bond strength to superficial and deep dentin were only found when a total-etch adhesive was used (Single Bond). CONCLUSIONS: Use of the incremental technique with total-etch or self-etch adhesives is the most effective method of inserting resin-based composites in large Class I cavities.

Comparison of regional bond strength in root thirds among fiber-reinforced posts luted with different cements.

AIM: To compare regional bond strength in different thirds of the root canal, among glass fiber-reinforced (FRC) endodontic posts luted with different cements, using the push-out test. MATERIAL AND METHODS: Sixty extracted human anterior teeth were endodontically treated with gutta-percha and AH Plus sealer. The crown portion was removed, and a dowel space was prepared. Prepared teeth were randomly assigned to one of six groups (n = 10) for luting glass FRC Postec posts, with one of the six cement systems (Ketac Cem Aplicap, Relyx Unicem Aplicap, Variolink II/Excite DCS, Panavia F/ED Primer, C&B cement/All-Bond 2, and Multilink/Multilink Primer A/B), using an alignment technique. Specimens were embedded in resin, and each root was sectioned into six 1-mm thick serial slices. A push-out test was performed to measure regional bond strengths and to identify the type of failure. RESULTS: The highest bond strength values were found in the cervical third and the lowest in the apical third. Highest values were obtained using Variolink II, Panavia F, and Multilink resin cements followed by C&B resin cement and Relyx Unicem ionomer resin cement; Ketac-cem ionomer cement showed the lowest value. CONCLUSION: Highest bond strength values were obtained in the cervical third and with resin cements.