Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

Ultrasound-Guided Central Venous Catheterization: A Protocol to Be Followed in Pediatrics?

Objective: To investigate the effectiveness of ultrasound-guided central venous catheterization when compared to the conventional procedure. Method: A prospective cohort study was carried out over a 9-month period from February to October 2016 involving 144 inpatients at PICU of Irmandade da Santa Casa de Sao Paulo Hospital, undergoing central venous catheterization. The patients were matched in pairs of identical patients according to the levels of potentially intervening variables (age, nutritional status, puncture site, professional experience), differing only as to the CVC technique: ultrasound-guided (USG-CVC) or conventional (C-CVC). Discarding data from non-paired patients, the remaining did forming 47 pairs, matched as two related samples: USG-CVC and C-CVC groups. Success parameters: number of puncture attempts;time spent at CVC;success rate and complications. Results: In the USG-CVC group, the number of attempts (mean = 2.04) and the time spent at catheterization (mean = 11.89 minutes) were lower (t = 2.34, df = 46, t 0.95 = 2.02, p t = 3.07, df = 46, t 0.95 = 2.02, p < 0.05), respectively, when compared to the results obtained for the control group (C-GVC), (mean = 3.21) and (mean = 28.26 minutes), respectively. As to success, there was observed a significant difference (F (1, 46) = 16.6;Q (1) = 12.5, p < 005) when considering only one trial (USG -CVC = 27/47;C-CVC = 9/47), but no significant difference (F (1, 46) = 3.76;Q (1) = 3.56, p > 0.05) when considering several attempts. Complications were found less frequently in the USG-CVC group (3/47) than in the CVC-C (13/47), (F (1, 46) = 8.24;Q (1) = 7.14, p < 0.05). Conclusion: USG-CVC was found to be more effective than the conventional technique, especially regarding success at the first puncture attempt.

Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study

BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese patients.METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above.RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups.CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

Multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report

BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.

Impact of central venous port implantation method and access choice on outcomes

BACKGROUND Although the number of patients who need central venous ports for permanent vascular access is increasing,there is still no“gold standard”for the implantation technique.AIM To identify the implantation technique that should be favored.METHODS Two hundred central venous port-implanted patients in a tertiary hospital were retrospectively evaluated.Patients were assigned into two groups according to the access method.The first group comprised patients whose jugular veins were used,and the second group comprised patients whose subclavian veins were used.Groups were evaluated regarding age,sex,application side,primary diagnosis,active follow-up period in the hospital,chemotherapy agents administered,number of complications,and the Clavien-Dindo severity score.The distribution of the variables was tested with the Kolmogorov-Smirnov test and the Mann-Whitney U test.Theχ^(2) test was used to analyze the variables.RESULTS There was no statistically significant difference between the groups regarding age,sex,side,number of chemotherapy drugs,and duration of port usage(P>0.05).Only 2 patients in group 1 had complications,whereas in group 2 we observed 19 patients with complications(P<0.05).No port occlusion was found in group 1,but the catheters of 4 patients were occluded in group 2.One port was infected in group 1 compared to three infected ports in group 2.Two port ruptures,two pneumothorax,one revision due to a mechanical problem,one tachyarrhythmia during implantation,and four suture line problems were also recorded in group 2 patients.We also showed that it would be sufficient to evaluate and wash ports once every 2 mo.CONCLUSION Our results robustly confirm that the jugular vein route is safer than the subclavian vein approach for central venous port implantation.

Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration

Background A simple measurement of central venous pressure(CVP)-mean by the digital monitor display has become increasingly popular.However,the agreement between CVP-mean and CVP-end(a standard method of CVP measurement by analyzing the waveform at end-expiration)is not well determined.This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude(ΔCVP=CVPmax-CVPmin)during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.Methods In total,291 patients were included in the study.CVP-mean and CVP-end were obtained simultaneously from each patient.CVP measurement difference(|CVP-mean-CVP-end|)was defined as the difference between CVP-mean and CVP-end.TheΔCVP was calculated as the difference between the peak(CVPmax)and the nadir value(CVPmin)during the respiratory cycle,which was automatically recorded on the monitor screen.Subjects with|CVP-mean-CVP-end|≥2 mm Hg were divided into the inconsistent group,while subjects with|CVP-mean-CVP-end|2 mm Hg were divided into the consistent group.ResultsΔCVP was significantly higher in the inconsistent group[7.17(2.77)vs.5.24(2.18),P0.001]than that in the consistent group.There was a significantly positive relationship betweenΔCVP and|CVP-mean-CVP-end|(r=0.283,P 0.0001).Bland-Altman plot showed the bias was-0.61 mm Hg with a wide 95%limit of agreement(-3.34,2.10)of CVP-end and CVP-mean.The area under the receiver operating characteristic curves(AUC)ofΔCVP for predicting|CVP-mean-CVP-end|≥2 mm Hg was 0.709.With a high diagnostic specificity,usingΔCVP3 to detect|CVP-mean-CVP-end|lower than 2mm Hg(consistent measurement)resulted in a sensitivity of 22.37%and a specificity of 93.06%.UsingΔCVP8 to detect|CVP-mean-CVPend|8 mm Hg(inconsistent measurement)resulted in a sensitivity of 31.94%and a specificity of 91.32%.Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios.ΔCVP during the respiratory period is related to the variation of the two CVP methods.A highΔCVP indicates a poor agreement between these two methods,whereas a lowΔCVP indicates a good agreement between these two methods.

Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients

Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.

Central Venous Catheter-related Thrombosis in Senile Male Patients: New Risk Factors and Predictors

Central venous catheterization（CVC）-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases（6.17%） of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization（P〈0.01） and that in internal jugular vein catheterization（P〈0.05）. No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization（P〉0.05）. Previous venous thrombosis history（P〈0.01）, high lactate dehydrogenase level（P〈0.01）, low high-density lipoprotein（HDL） level（P〈0.05）, and low albumin level（P〈0.05） were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

BACKGROUND:Low central venous pressure(CVP) affects hemodynamic stability and tissue perfusion.This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma(HCC).METHODS:Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection.The systolic blood pressure(SBP) was maintained,if possible,at 90 mmHg or higher.Hepatitis B surface antigen was positive in 90 patients(92.8%) and cirrhosis in 84 patients(86.6%).Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes.The average clamp time was 21.4±8.0 minutes.These patients were divided into 5 groups based on the CVP:group A:0-1 mmHg;B:1.1-2 mmHg;C:2.1-3 mmHg;D:3.1-4 mmHg and E:4.1-5 mmHg.The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed.RESULTS:With active fluid load,a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A(95% CI:10.8%-26.3%);39.2% in group B(95% CI:29.5%-48.9%);72.2% in group C(95% CI:63.2%-81.1%);89.7% in group D(95% CI:83.6%-95.7%);and 100% in group E(95% CI:100%-100%).The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP.Compared to groups D and E,blood loss in groups A,B and C was significantly less(analysis of variance test,P【0.05).Compared with the baseline,the blood oxygenation decreased significantly when the CVP was reduced.Base excess and HCO 3-in groups A and B were significantly decreased compared with those in groups C,D and E(P【0.05).CONCLUSION:In consideration of blood loss,SBP,base excess and HCO 3-,a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.

Hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model

BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 O.CONCLUSION: The optimal CVP for hepatic resection is 2to 3 cmH2O.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Simpli?ed point-of-care ultrasound protocol to con?rm central venous catheter placement:A prospective study

BACKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(CVC) placement is with plain ? lm chest radiography(CXR). We hypothesized that a simple point-of-care ultrasound(POCUS) protocol could effectively con? rm placement and reduce time to con? rmation.METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8%(95%CI 77.1%–93.5%) and speci? city of 100%(95%CI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes(IQR 10–29) and 32 minutes(IQR 19–45), respectively.CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a con? rmatory CXR.

Correlation of Inferior Vena Cava Respiratory Variability Index with Central Venous Pressure and Hemodynamic Parameters in Ventilated Pigs with Septic Shock

Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.

Viabahn Stent Graft for Inadvertent Insertion of a Central Venous Catheter in the Subclavian Artery

Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.

Effect of positive end-expiratory pressure ventilation on central venous pressure and intraoperative blood loss in patients undergoing laparoscopic hepatectomy

Objective:Tto investigate the effects of positive end-expiratory pressure(PEEP)ventilation on central venous pressure(CVP)and intraoperative blood loss in patients undergoing laparoscopic hepatectomy.Methods:46 cases of patients undergoing laparoscopic hepatectomy,25 cases of male,female 21 cases,ASAⅠ~Ⅲlevel,were randomly divided into two groups.In group A tidal volume was set to 6 ml/kg(Predicted Body Weight,PBW)and PEEP was set to 0 cmH2O.The tidal volume of group B was set as group A,PEEP was set to 8 cmH2O.CVP,MAP,and Ppeak were recorded in the supine position after intubation(T0),supine position after pneumoperitoneal(T1),anti-trendelenberg position after pneumoperitoneal(T2),supine position after surgery(T3),and Ddyn was calculated.The amount of nitroglycerin and the amount of blood loss were recorded.Results:Compared with group A,the CVP of group B was significantly increased at T1 and T2(P<0.05).Compared to T2 with T1 in group A and group B,CVP was decreased significantly(P<0.05).At T3,Cdyn in group B was significantly higher than that in group A(P<0.05).The amount of nitroglycerin in group B was significantly higher than that in group A(P<0.05).There was no significant difference in intraoperative fluid rehydration and blood loss between the two groups(P>0.05).Conclusion:PEEP with 8cmH2O can improve Ddyn in patients undergoing laparoscopic hepatectomy,but increased CVP.It requires more use of controlled low central venous pressure techniques to reduce intraoperative blood loss.

Emergency service results of central venous catheters:Single center,1042 patients,10-year experience

BACKGROUND Central venous catheterization is currently an important procedure in critical care.Central catheterization has important advantages in many clinical situations.It can also lead to different complications such as infection,hemorrhage,and thrombosis.It is important to investigate critically ill patients undergoing catheterization.AIM To evaluate the characteristics,such as hospitalization,demographic characteristics,post-catheterization complications,and mortality relationships,of patients in whom a central venous catheter was placed in the emergency room.METHODS A total of 1042 patients over the age of 18 who presented to the emergency department between January 2005 and December 2015 were analyzed retrospectively.The patients were divided into three groups,jugular,subclavian,and femoral,according to the area where the catheter was inserted.Complications related to catheterization were determined as pneumothorax,guidewire problems,bleeding,catheter site infection,arterial intervention,and sepsis.Considering the treatment follow-up of the patients,three groups were formed as outpatient treatment,hospitalization,and death.RESULTS The mean age of the patients was 60.99±19.85 years;423(40.6%)of them were women.Hospitalization time was 11.89±16.38 d.There was a significant correlation between the inserted catheters with gender(P=0.009)and hospitalization time(P=0.040).Also,blood glucose,blood urea nitrogen,creatinine,and serum potassium values among the biochemical values of the patients who were catheterized were significant.A significant association was observed in the analysis of patients with complications that develop according to the catheter region(P=0.001)and the outcome stage(P=0.001).In receiver operating characteristic curve analysis of hospitalization time and mortality area under curve was 0.575,the 95%confidence interval was 0.496-0.653,the sensitivity was 71%,and the specificity was 89%(P=0.040).CONCLUSION Catheter location and length of stay are important risk factors for catheter-borne infections.Because the risk of infection was lower than other catheters,jugular catheters should be preferred at entry points,and preventive measures should be taken by monitoring patients closely to reduce hospitalization infections.

Prevention of central venous catheter-related infection in ICU with cluster nursing intervention: a meta-analysis

Objective:To systematically evaluate the clinical effects of cluster nursing intervention in preventing central venous catheter-related infection in intensive care unit.Methods:A randomized controlled study was searched from China National Knowledge Internet(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),Chinese Biomedical Literature Service System(SinoMed),PubMed,Embase and Cochrane library databases from the establishment to May 1,2020.Two reviewers independently evaluated and cross checked the quality of the study.Revman 5.3 was used to conduct the meta-analysis.Results:A total of 21 randomized controlled trials with 6,030 patients were included.Meta-analysis showed that the incidence of central venous catheter-related infection(relative risk(RR)=0.29,95%confidence interval(CI)[0.23,0.37]),the incidence of catheter plugging(RR=0.25,95%CI[0.16,0.39])and catheter prolapse(RR=0.18,95%CI[0.11,0.29])were significantly different between the two groups.Conclusion:Cluster nursing intervention could prevent central venous catheter-related infection in intensive care unit.

Clinical Course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcutaneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235 - 627) and 563 (95% confidence interval, 368 - 728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.

Venous Catheterization Experimental Model in Rabbits:Histological Alterations in the Catheter Region

Central venous access is one of the most common surgery procedures worldwide, especially in pediatric surgery. Local and regional complications as the result of venous catheter permanence time are frequently described as: thrombosis, infection, edema and local cellulite, movement and loss of the catheter. Other severe complications such as endocardiac and hemorrhagic lesions are also described and considered the cause of catheter early removal. In the literature few studies have addressed vascular and perivascular lesions and complications as the result of central venous access to peripheral veins, given the difficulty of setting up venous catheterization experimental models to study blood vessels and perivascular tissue alterations after catheterization. In the present venous catheterization experimental model, rabbits were divided into two groups based on the time that the venous catheters were maintained in their veins. Group a composed of 7 New Zealand male rabbits was submitted to a 15-day treatment;and the 6 New Zealand male rabbits of group B were treated during 90 days. Both groups presented similar inflammatory conditions since there was no significant difference between groups. Therefore, the results may well suggest that the endothelial inflammatory reaction could have developed at an early initial short period and by maintaining the catheter, the inflammatory reactions would have decreased or disappeared. Aimed at studying these vascular and perivascular alterations in venous catheterization, the present study proposes an experimental rabbit model that allows the analysis of differences in local vascular and perivascular histological variations and compares histological differences between both venous catheterization groups each of them with different periods of treatment.