Comparison of ultrasound-guided internal jugular vein and supraclavicular subclavian vein catheterization in critically ill patients: a prospective, randomized clinical trial

 

by Becem Trabelsi, Zied Hajjej, Dhouha Drira, Azza Yedes, Iheb Labbene, Mustapha Ferjani and Mechaal Ben Ali 

 

Annals of Intensive Care volume 12, Article number: 91 (2022) 

 

Background

The aim of this study was to compare the effectiveness and safety of ultrasound-guided out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSCV) catheterization in adult intensive care unit.

Methods

A total of 250 consecutive patients requiring central venous catheterization, were randomly assigned to undergo either ultrasound-guided OOP-IJV or IP-SSCV cannulation. All catheterizations were carried out by three physicians. The primary outcome was the first attempt success rate. Ultrasound scanning time, venous puncture time, insertion time, overall access time, number of puncture attempts, number of needle redirections, success rate, guidewire advancing difficulties, venous collapse and adverse events were also documented.

Results

The first attempt success rate was significantly higher in IP-SSCV group (83.2%) compared to OOP-IJV group (63.2%) (p = 0.001). The IP-SSCV group was associated with a longer ultrasound scanning time (16.54 ± 13.51 vs. 5.26 ± 4.05 s; p < 0.001) and a shorter insertion time (43.98 ± 26.77 vs. 53.12 ± 40.21 s; p = 0.038). In the IP-SCCV group, we recorded a fewer number of puncture attempts (1.16 ± 0.39 vs. 1.47 ± 0.71; p < 0.001), needle redirections (0.69 ± 0.58 vs. 1.17 ± 0.95; p < 0.001), difficulties in guidewire advancement (2.4% vs. 27.4%; p < 0.001), venous collapse (2.4%, vs. 18.4%; p < 0.001) and adverse events (8.8% vs. 13.6%; p = 0.22).

Conclusions

The IP-SSCV approach is an effective and a safe alternative to the classic OOP-IJV catheterization in critical adult patients.

 

 

 

Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study

 

by Yiyue Zhong, Liehua Deng, Limin Zhou, Shaoling Liao, Liqun Yue, Shi Wu Wen, Rihua Xie, Yuezhen Lu, Liangqing Zhang, Jing Tang and Jiayuan Wu 

 

Annals of Intensive Care volume 12, Article number: 38 (2022) Published: 07 May 2022

Background

Central venous catheter (CVC) insertion complications are a prevalent and important problem in the intensive care unit (ICU), and source control by immediate catheter removal is considered urgent in patients with septic shock suspected to be caused by catheter-related bloodstream infection (CRBSI). We sought to determine the impact of immediate reinsertion of a new catheter (IRINC) on mortality among patients after CVC removal for suspected CRBSI.

Methods

A propensity score-matched cohort of patients with suspected CRBSI who underwent IRINC or no IRINC in a 32-bed ICU in a university hospital in China from January 2009 through April 2021. Catheter tip culture and clinical symptoms were used to identify patients with suspected CRBSI. The Kaplan–Meier method was used to analyse 30-day mortality before and after propensity score matching, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality in the matched cohort were estimated with Cox proportional hazards models.

Results

In total, 1,238 patients who had a CVC removed due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. Among 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan–Meier analysis found that IRINC was associated with the risk of mortality both before matching (P = 0.00096) and after matching (P = 0.018). A competing risk analysis confirmed the results of the propensity score-matched analysis. The attributable risk associated with bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) among patients with suspected CRBSI in terms of 30-day mortality compared with that associated with other infections.

Conclusions

In this cohort study, IRINC was associated with higher 30-day mortality compared to delayed CVC or no CVC among patients with suspected CRBSI. A large-sample randomized controlled trial is needed to define the best management for CVC in cases of suspected CRBSI because IRINC may also be associated with noninfectious complications.

Reassessment of the Accuracy of Cardiac Doppler Pulmonary Artery Pressure Measurements in Ventilated ICU Patients: A Simultaneous Doppler-Catheterization Study*

Reassessment of the Accuracy of Cardiac Doppler Pulmonary Artery Pressure Measurements in Ventilated ICU Patients: A Simultaneous Doppler-Catheterization Study*

by Mercado, Pablo; Maizel, Julien; Beyls, Christophe; Kontar, Loay; Orde, Sam; Huang, Stephen; McLean, Anthony; Tribouilloy, Christophe; Slama, Michel  

Critical Care Medicine: January 2019 - Volume 47 - Issue 1 - p 41–48

Objectives: Doppler echocardiography is a well-recognized technique for the noninvasive evaluation of pulmonary artery pressure; however, little information is available concerning patients receiving mechanical ventilation. Furthermore, recent studies have debatable results regarding the relevance of this technique to assess pulmonary artery pressure. The aim of our study was to reassess the accuracy of Doppler echocardiography to evaluate pulmonary artery pressure and to predict pulmonary hypertension.

Design: Prospective observational study. Setting: Amiens ICU, France. Patients. ICU patients receiving mechanical ventilation. Interventions: In 40 patients, we simultaneously recorded Doppler echocardiography variables (including tricuspid regurgitation and pulmonary regurgitation) and invasive central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, and mean pulmonary artery pressure.

Measurements and Main Results: Systolic pulmonary artery pressure assessed from the tricuspid regurgitation derived maximal pressure gradient added to the central venous pressure demonstrated the best correlation with the invasive systolic pulmonary artery pressure (r = 0.87) with a small bias (–3 mm Hg) and a precision of 9 mm Hg. A Doppler echocardiography systolic pulmonary artery pressure greater than 39 mm Hg predicted pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mm Hg) with 100% sensitivity and specificity. Tricuspid regurgitation maximal velocity greater than 2.82 m/s as well as tricuspid regurgitation pressure gradient greater than 32 mm Hg predicted the presence of pulmonary hypertension. Pulmonary regurgitation was recorded in 10 patients (25%). No correlation was found between pulmonary regurgitation velocities and either mean pulmonary artery pressure or diastolic pulmonary artery pressure. Pulmonary acceleration time less than 57 ms and isovolumic relaxation time less than 40 ms respectively predicted pulmonary hypertension 100% of the time and had a 100% negative predictive value. Conclusions: Tricuspid regurgitation maximal velocity pressure gradient added to invasive central venous pressure accurately estimates systolic pulmonary artery pressure and mean pulmonary artery pressure in ICU patients receiving mechanical ventilation and may predict pulmonary hypertension.

Arterial Catheter Use in the ICU: A National Survey of Antiseptic Technique and Perceived Infectious Risk

Arterial Catheter Use in the ICU: A National Survey of Antiseptic Technique and Perceived Infectious Risk


Critical Care Medicine: November 2015 - Volume 43 - Issue 11 - p 2346–2353


Cohen, David M. et al


Objectives: Recent studies have shown that the occurrence rate of bloodstream infections associated with arterial catheters is 0.9–3.4/1,000 catheter-days, which is comparable to that of central venous catheters. In 2011, the Centers for Disease Control and Prevention published new guidelines recommending the use of limited barrier precautions during arterial catheter insertion, consisting of sterile gloves, a surgical cap, a surgical mask, and a small sterile drape. The goal of this study was to assess the attitudes and current infection prevention practices used by clinicians during insertion of arterial catheters in ICUs in the United States. Design: An anonymous, 22-question web-based survey of infection prevention practices during arterial catheter insertion. Setting: Clinician members of the Society of Critical Care Medicine. Subjects: Eleven thousand three hundred sixty-one physicians, nurse practitioners, physician assistants, respiratory therapists, and registered nurses who elect to receive e-mails from the Society of Critical Care Medicine. Interventions: None. Measurements and Main Results: There were 1,265 responses (11% response rate), with 1,029 eligible participants after exclusions were applied. Only 44% of participants reported using the Centers for Disease Control and Prevention–recommended barrier precautions during arterial catheter insertion, and only 15% reported using full barrier precautions. The mean and median estimates of the incidence density of bloodstream infections associated with arterial catheters were 0.3/1,000 catheter-days and 0.1/1,000 catheter-days, respectively. Thirty-nine percent of participants reported that they would support mandatory use of full barrier precautions during arterial catheter insertion. Conclusions: Barrier precautions are used inconsistently by critical care clinicians during arterial catheter insertion in the ICU setting. Less than half of clinicians surveyed were in compliance with current Centers for Disease Control and Prevention guidelines. Clinicians significantly underestimated the infectious risk posed by arterial catheters, and support for mandatory use of full barrier precautions was low. Further studies are warranted to determine the optimal preventive strategies for reducing bloodstream infections associated with arterial catheters.

Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates

Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates: A report from 13 years of service. Critical care medicine, March 2014, Vol. 42(3), p.536-43.

Alexandrou, E., et al.

http://journals.lww.com/ccmjournal/Abstract/2014/03000/Central_Venous_Catheter_Placement_by_Advanced.6.aspx

To report procedural characteristics and outcomes from a central venous catheter placement service operated by advanced practice nurses.

Understanding changes in established practice: Pulmonary artery catheter use in critically ill patients

Understanding changes in established practice: Pulmonary artery catheter use in critically ill patients. Critical care medicine, Dec 2013, Vol. 41(12), p.2667-76.

Gershengorn, H.B., and Wunsch, H.

http://journals.lww.com/ccmjournal/Abstract/2013/12000/Understanding_Changes_in_Established_Practice__.1.aspx

Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of “uptake” of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use.

The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections

Critical Care Medicine Feb 2009

Section: Review Articles
Pages: 702-712
The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections: A systematic review

Authors: Juliet C. Hockenhull, MSc; Kerry M. Dwan, MSc; Godfrey W. Smith, MD;
Carrol L. Gamble, PhD; Angela Boland, PhD; Tom J. Walley, MD; Rumona C.
Dickson, MHSc

Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study.

pp. 2185-2193
Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study.
Garnacho-Montero, J.; Aldabó-Pallás, T.; Palomar-Martínez, M.; Vallés, J.; Almirante, B.; Garcés, R.; Grill, F.; Pujol, M.; Arenas-Giménez, C.; Mesalles, E.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN240539030&field=zid

Infection Control and Hospital Epidemiology

SHEA/APIC GUIDELINE
785–814
SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility
Philip W. Smith, MD; Gail Bennett, RN, MSN, CIC; Suzanne Bradley, MD; Paul Drinka, MD; Ebbing Lautenbach, MD; James Marx, RN, MS, CIC; Lona Mody, MD; Lindsay Nicolle, MD; Kurt Stevenson, MD

ORIGINAL ARTICLE
815–819
Effect of Nurse-Led Multidisciplinary Rounds on Reducing the Unnecessary Use of Urinary Catheterization in Hospitalized Patients
Mohamad G. Fakih, MD, MPH; Cathleen Dueweke, RN; Susan Meisner, RN; Dorine Berriel-Cass, RN, MA; Ruth Savoy-Moore, PhD; Nicole Brach, RN; Janice Rey, MT(ASCP); Laura DeSantis, RN, MSN; Louis D. Saravolatz, MD

COMMENTARY
820–822
Indwelling Urinary Catheters in Hospitalized Patients: When in Doubt, Pull It Out
Paul B. Cornia, MD; Benjamin A. Lipsky, MD

ORIGINAL ARTICLE 823–828
Rising Economic Impact of Clostridium difficile–Associated Disease in Adult Hospitalized Patient Population
Xiaoyan Song, PhD, MD, MSc; John G Bartlett, MD; Kathleen Speck, MPH; April Naegeli, MPH; Karen Carroll, MD; Trish M. Perl, MD, MSc

COMMENTARY
829–831
Preventing Clostridium difficile–Associated Disease: Is It Time to Pay the Piper?
Eli N. Perencevich, MD, MS; Kerri A. Thom, MD, MS

ORIGINAL ARTICLE
832–839
Poor Functional Status as a Risk Factor for Surgical Site Infection Due to Methicillin-Resistant Staphylococcus aureus
Deverick J. Anderson, MD, MPH; Luke F. Chen, MBBS, FRACP; Kenneth E. Schmader, MD; Daniel J. Sexton, MD; Yong Choi, RN, BSN; Katherine Link, RN, BSN; Rick Sloane, MPH; Keith S. Kaye, MD, MPH

COMMENTARY
840–841
Debility and the Risk for Surgical Site Infection: Defining the Next Steps
Preeti N. Malani, MD, MSJ

ORIGINAL ARTICLE
842–846
Automated Surveillance for Central Line–Associated Bloodstream Infection in Intensive Care Units
Keith F. Woeltje, MD, PhD; Anne M. Butler, MS; Ashleigh J. Goris, MPH; Nhial T. Tutlam, MPH; Joshua A. Doherty, BS; M. Brandon Westover, MD; Vicky Ferris, RN; Thomas C. Bailey, MD

847–853
Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients
J. Vallés, MD; I. Fernández, RN; D. Alcaraz, RN; E. Chacón, RN; A. Cazorla, RN; M. Canals, RN; D. Mariscal, MD; D. Fontanals, PharmD; A. Morón, PharmD

854–858
Reprocessing and Reuse of Single-Use Medical Devices Used During Hemodynamic Procedures in Brazil: A Widespread and Largely Overlooked Problem
Jorge M. Buchdid Amarante, MD, MsC; Cristiana M. Toscano, MD, PhD; Michele L. Pearson, MD; Virginia Roth, MD; William R. Jarvis, MD; Anna S. Levin, MD, PhD

859–865
Outbreak of Invasive Methicillin-Resistant Staphylococcus aureus Infection Associated With Acupuncture and Joint Injection
R. J. Murray, MBBS, FRACP; J. C. Pearson, BSc; G. W. Coombs, BApplSc; J. P. Flexman, MBBS, FRCPA; C. L. Golledge, MBBS, FRCPA; D. J. Speers, MBBS, FRACP; J. R. Dyer, MBBS, FRACP; D. G. McLellan, MBBS, FRACP; M. Reilly, MHlthSc; J. M. Bell, BSc, BA; S. F. Bowen, MBBS, FRACP; K. J. Christiansen, MBBS, FRCPA

871–877
Three-Year Prospective Study to Improve the Management of Blood-Exposure Incidents
Paul Th. L. van Wijk; Marianne Pelk-Jongen; Clementine Wijkmans, MD; Andreas Voss, MD, PhD; Peter M. Schneeberger, MD, PhD

878–886
Discordant QuantiFERON-TB Gold Test Results Among US Healthcare Workers With Increased Risk of Latent Tuberculosis Infection: A Problem or Solution?
Nira R. Pollock, MD, PhD; Antonio Campos-Neto, MD, PhD; Suely Kashino, PhD; Danielle Napolitano, PhD; Samuel M. Behar, MD, PhD; Daniel Shin, BS; Alex Sloutsky, PhD; Swati Joshi, PhD; Jasmine Guillet, MPH; Michael Wong, MD; Edward Nardell, MD

CONCISE COMMUNICATION
887–889
Rates of Clostridium difficile Infection in Patients Discharged From Spanish Hospitals, 1997–2005
Pilar Soler, MD; Francisco Nogareda, MD; Rosa Cano, MD

890–893
Risk Factors for Methicillin-Resistant Staphylococcus aureus Surgical Site Infection
Stephan Harbarth, MD; Benedikt Huttner, MD; Pascal Gervaz, MD; Carolina Fankhauser, MS; Marie-Noelle Chraiti, RN; Jacques Schrenzel, MD; Marc Licker, MD; Didier Pittet, MD

894–897
Pilot Trial of N-acetylcysteine and Tigecycline as a Catheter-Lock Solution for Treatment of Hemodialysis Catheter–Associated Bacteremia
Saima Aslam, MD; Barbara W. Trautner, MD, PhD; Venkat Ramanathan, MD; Rabih O. Darouiche, MD