Peripheral Insertion of Pediatric Central Venous Catheters in Adults with Difficult I.V. Access.

BACKGROUND: Difficult intravenous access is a frequent occurrence in critical care and emergency medicine. Prior intravenous access, chemotherapy use, and obesity are a few factors associated with difficult access. Alternatives to peripheral access are often contraindicated, not feasible, or not readily available. OBJECTIVES: To describe the feasibility and safety of peripheral insertion of peripherally inserted pediatric central venous catheters (PIPCVC) in a cohort of adult critical care patients with difficult intravenous access. METHODS: Prospective observational study of adult patients with difficult intravenous access who underwent peripheral insertion of pediatric PIPCVCs at a large university hospital. RESULTS: During a 1-year period, 46 patients were evaluated for PIPCVC; 40 catheters were placed successfully. The median age of the patients was 59 years (range 19-95 years) and 20 (50%) were female. The median body mass index was 27.2 (range 17.1-41.8). The basilic vein was accessed in 25/40 (63%) patients, the cephalic in 10/40 (25%), and the accessed vessel was missing in 5/40 (13%) cases. The PIPCVCs were in place for a median of 8 days (range 1-32). One superficial thrombosis and one deep occurred; pulmonary embolism did not occur. CONCLUSIONS: PIPCVC placement seems to be a feasible option in patients in whom peripheral intravenous access is difficult. The safety of this technique needs to be evaluated in prospective studies.

Reports of Guillain-Barre Syndrome Following COVID-19 Vaccination in the USA: An Analysis of the VAERS Database.

BACKGROUND AND PURPOSE: An association between Guillain-Barre syndrome and its variants (GBS/V) and vaccines has led to hesitancy toward vaccination. COVID-19 vaccines could theoretically provoke GBS/V via immune activation. We analyzed reports of GBS/V after COVID-19 vaccination in the vaccine adverse event reporting system (VAERS). METHODS: The VAERS database is a surveillance system used to report vaccination events in the USA, and is open for consumers and physicians to access. It was queried for reports of GBS/V following COVID-19 vaccination. Reports were reviewed by four neurologists. Modified diagnostic criteria were used to classify reports into definite, possible, and not GBS/V or insufficient data. Descriptive statistics were used to describe the sample, chi-square tests and one-way ANOVAs were used to compare intergroup differences, and t-test were used to compare group means. RESULTS: In 2021, 815 reports of GBS/V were filed. The completion rate for the variables in VAERS was 93.5%. The median age was 55 years (interquartile range [IQR]=5-86 years) and 50% of the subjects were male. The median time of onset was 10 days (IQR=0-298 days), 11% reported onset on the day of vaccination, and 13% reported onset after 6 weeks. Hospitalization was reported by 77%, with a median stay of 7 days (IQR=1-150 days). Lack of recovery, permanent disability, and death constituted 57%, 46%, and 2% of the reports, respectively. Based on GBS/V criteria, 47% of the cases were definite, 16% were possible, and 37% were not GBS/V or insufficient data. An alternate diagnosis was provided in 9% of cases. CONCLUSIONS: GBS/V reports following COVID-19 vaccination were common, but many occurred outside of the expected timelines for GBS/V. Only 47% of cases represented definite GBS/V.