Analysis of the relationship between deep venous catheter-related infection and post-operative complications in patients receiving minimally invasive esophagectomy

Objective The aim of the study was to evaluate catheter-related infection rate(CRIR)for patients receiving minimally invasive esophagectomy(MIE),to identify the optimal catheterization approach and relationship between CRIR and post-operative complications.Methods In total,168 patients with esophageal carcinoma and undergoing MIE combined with preoperative deep venous catheterization(DVC)were analyzed in our institution(Qingdao Municipal Hospital,China),from 2014 to 2018.After completing DVC,catheter-tips together with intraductal venous blood samples were sent to the microbiology lab for bacterial strain culture.CRIR was statistically evaluated for the following clinical variables:gender,age,smoking status,drinking status,past history,tumor location,histologic grade,pathological T,N,and M category,anastomotic location,anastomotic leakage,anastomotic stricture,chylothorax,pneumonia,recurrent laryngeal nerve(RLN)injury,reflux esophagitis,catheterization site,and catheter-locking days.Results Among the 144 patients recruited in our study,105 catheters were inserted into the jugular vein and 39 catheters into the subclavian vein.The median age of these patients was 63 years(range:42–79 years),and the median catheter-locking period was seven days(range:4–21 days).Four catheters were identified with three types of strain colonizations,including Staphylococcus epidermidis,Staphylococcus aureus and Blastomyces albicans.Statistical data showed that patients diagnosed with catheter-related infection were likely to incur anastomotic leakage(66.67%,P<0.001)and pneumonia(27.27%,P<0.001);features such as tumors located in the upper esophagus(13.6%,P=0.003),and over seven catheterlocking days(10.00%,P<0.001)were attributed to a high CRIR.Conclusion Although both jugular and subclavian veins can be catheterized for patients with MIE,DVC is associated with more than seven catheter-locking days and upper esophagectomy,due to high CRIR.Furthermore,catheter-related infection is related to anastomotic leakage and pneumonia.

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.

Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients

Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.

风险管理在预防深静脉导管相关血流感染的应用探讨

目的探究分析在预防深静脉导管相关血流感染中采取风险管理的效果。方法从2017年10月—2018年10月该院接受深静脉导管的患者中抽选86例,列为对照组,接受常规护理管理。再从2018年11月—2019年11月该院接受深静脉导管的患者中抽选86例,列为实验组,接受风险管理,对比两组深静脉导管相关血流感染预防情况。结果实验组患者深静脉导管相关血流感染发生率(4.65%)、细菌培养阳性率(2.33%)均明显低于对照组(15.12%、10.47%),非计划性拔管概率(3.49%)、导管堵塞概率(2.33)均明显小于对照组(13.95%、11.63%),护理满意度评分、生活质量评分均明显高于对照组,差异有统计学意义(P<0.05)。结论在预防深静脉导管相关血流感染中采取风险管理效果显著,能够降低深静脉导管相关血流感染发生率,提高患者的生活质量。

老年恶性肿瘤患者深静脉导管相关性血流感染影响因素与预防

目的分析老年恶性肿瘤患者深静脉导管相关性血流感染的影响因素,及预防深静脉导管相关性感染的对策。方法选择2015年1月-2016年12月医院收治的老年恶性肿瘤深静脉置管患者489例为研究对象,统计深静脉导管相关性血流感染的病原菌与药敏情况,分析患者性别、年龄、合并疾病、肿瘤部位、治疗方式等资料,归纳老年恶性肿瘤患者深静脉导管相关性血流感染的影响因素。结果老年恶性肿瘤静脉置管患者导管相关性血流感染率为13.70%(67/489);共培养分离病原菌83株,其中革兰阳性菌34株占40.96%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主;革兰阴性菌45株占54.22%,以大肠埃希菌、肺炎克雷伯菌为主;真菌4株占4.82%。主要革兰阳性菌对奈替米星和阿米卡星较敏感;主要革兰阴性菌对美罗培南、亚胺培南和头孢哌酮/舒巴坦较敏感。股静脉置管、置管时间、三腔导管、院外维护、恶性肿瘤晚期是老年恶性肿瘤患者导管相关性血流感染的影响因素(P<0.05)。结论老年恶性肿瘤置管患者并发深静脉导管相关性血流感染率较高,病原菌对临床常用抗菌药物具有一定的耐药性,应针对患者个体情况结合影响因素制定个性化医护措施,降低深静脉导管相关性血流感染率。

TLR9信号通路在深静脉穿刺致全身性炎症感染患者外周血中的表达及意义

目的 分析Toll样受体9(TLR9)信号通路在深静脉穿刺致全身性炎症感染患者外周血中的表达及意义。方法 选取宁波市医疗中心李惠利医院东部院区2018年2月-2019年12月192例中心静脉导管(CVC)置管术后疑似导管相关性血流感染(CRBSI)患者为研究对象,其中54例根据血培养确诊为CRBSI(CRBSI组),138例为非CRBSI(非CRBSI组),比较两组患者外周血单个核细胞(PBMCs)中TLR9、核因子-κB(NF-κB)信使核糖核酸(mRNA)表达水平及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,受试者工作特征(ROC)曲线评估上述指标对CVC置管后CRBSI的预测价值。结果 CRBSI组股静脉插管率、CVC置管时间、糖尿病患病率高于非CRBSI组(P<0.05),血清白蛋白水平低于非CRBSI组(P<0.05)。CRBSI组外周血PBMCs中TLR9、NF-κB mRNA表达及血清TNF-α、IL-6水平均高于非CRBSI组(P<0.05),ROC曲线分析结果,外周静脉血PBMCs中TLR9、NF-κB mRNA及血清TNF-α、IL-6检测对CRBSI具有较高预测价值,曲线下面积(AUC)分别为0.944、0.924、0.913、0.882。结论 TLR9信号通路可能参与深静脉穿刺置管所致全身性感染的发生发展,积极监测相关指标对深静脉穿刺致全身性感染诊疗有利。