Academic literature on the topic 'Intravenous catheterization Complications'

There are approximately 2 million cardiac catheterizations that occur every year in the United States and with an aging population this number continues to rise. Adverse events due to this procedure occur at low rates and include stroke, arrhythmia, and myocardial infarctions. Due to the high volume of procedures there are a growing number of adverse events. Stroke after cardiac catheterization (SCC) has an incidence between 0.27 and 0.5% and is one of the most debilitating complications leading to high rates of mortality and morbidity. Given the relatively uncommon clinical setting of stroke after cardiac catheterization, treatment protocols regarding the use of IV or IA thrombolysis have not been adequately developed. Herein, we describe a case of a 39-year-old male who developed a stroke following a cardiac catheterization where IV thrombolysis was utilized although the patient was on heparin prior to cardiac catheterization.

Backgrounds and Objectives: Although most problems of peripheral intravenous catheterization are inconsiderable and easily treated, some are dangerous and require rapid management. This study aimed to explore peripheral intravenous catheter-related com-plications and the quality of nursing care for dressing sites of peripheral intravenous catheterization among the pediatric population. Methods: The study was conducted at Raparin Teaching Hospital for Children inpatient units in Erbil City/Iraq, using an observational study design. A purposive sample from 296 hospitalized children with peripheral intravenous catheterization was chosen for this study. The data was collected using a special check List (PIVC-miniQ) developed for checking the signs and symptoms and the quality of care for the catheter insertion site. Furthermore, the obtained data on peripheral intravenous catheterization problems was evaluated for exploring grades of phlebitis using the Phlebitis Scale developed by the Infusion Nursing Society in 2011. The data was processed and analyzed using SPSS using descriptive statistical analysis (frequency, percentage) and inferential statistical tests (Chi-squared, contingency coefficient). The probability value of ≤0.05 was regarded as statistically significant. Results: Most (82.4%) of patients were recruited in the emergency unit, with the highest percentage (36.8%) were toddlers. More than two-thirds (72.3%) of participants were assessed within the first peripheral catheter insertion. Regarding overall grades of patients’ peripheral intravenous catheterization complications (PIVC), less than a quarter (21.6%) were within the first grade, indicating being at risk for complications, and 6.8% were within the second grade, indicating slight phlebitis. Regarding the nursing care for PIVC site care, 62.5% of participants received fair care, and 22.3% received poor care. Conclusions: A quarter of observed children were at risk for having phlebitis and less than ten percent had slight phlebitis. About a quarter of patients received poor nursing care for the catheter insertion site. Most participants have not a documentation of peripheral intravenous catheter insertion date on the dressing and on the patient's chart.

Background: Peripheral Intravenous Catheterization (PIVC) related complication is a common and significant problem in clinical practices. The aim of the study was to see the pattern of complication developed by PIVC and to find out the associated risk factors. Materials & methods: A prospective study was conducted amongst 300 patients and 420 PIVCs were observed. Results: 76 (18.09%) patients developed phlebitis and among the phlebitis patients 55.26% were grade 2 and 22.37% grade 3. Hypertonic fluid infusion and some antibiotics were found as risk factors for phlebitis. Amongst the antibiotics flucloxacilin (60%), amikacin (50%), amoxicillin + clavulanic acid were most common antibiotics responsible for development of phlebitis. Conclusions: Catheterization site and use of antibiotics and potassium chloride with associated co-morbidities are predisposing factors for phlebitis. Better insertion technique may be sought to lower the incidence of PIVC related complications. J MEDICINE JUL 2019; 20 (1) : 29-33

Despite widespread use pulmonary artery catheterization has not been proven to reduce complications or mortality. One study supported the use of routine preoperative pulmonary artery catheterization in moderate-risk vascular surgery patients; several other studies have reported that pulmonary artery catheterization is not efficacious. Our goal was to scrutinize the data using meta-analysis. This is a systematic review of the literature. MEDLINE was searched for all articles on pulmonary artery catheterization, optimization, oxygen delivery, and preoperative preparation of vascular surgery patients. Data from papers judged appropriate for inclusion were analyzed using a computer program, Easy MA. Complications were defined as only those that could have reasonably have been prevented by or resulted from pulmonary artery catheterization. Of hundreds of possible papers only four were found to be adequate randomized prospective studies with similar exclusions, therapeutic endpoints, and interpretable complication and mortality rates. Controls included 174 patients versus 211 in the protocol group. Power analysis showed that the combined sample sizes were adequate. The meta-analysis demonstrates that the studies are homogeneous. The use of a pulmonary artery catheter does not prevent morbidity or mortality. Of the studies providing data on the amount of intravenous fluid administered three reported that statistically significantly more fluid was given to patients who underwent pulmonary artery catheterization. Meta-analysis indicates that in moderate-risk vascular surgery patients routine preoperative pulmonary artery catheterization is not associated with improved outcomes.

A NUMBER OF SERIOUS COMPLICATIONS can arise from malpositioned central venous catheters (CVCs), including cardiac tamponade and perforation, pleural effusions, and infusion into the vertebral venous system anywhere along the spinal column. Figure 1 is an x-ray of a premature infant taken after insertion of a 2.0 Silastic peripherally inserted central catheter (PICC), demonstrating the catheter entering the left ascending lumbar vein (ALV). Routine contrast injection of 0.3 mL of iothalamate meglumine 60 percent (Conray, Covidien Imaging Solutions, Hazelwood, Missouri) at the time of the PICC-placement film demonstrated that the contrast material extended into the vertebral venous plexus. The catheter was immediately withdrawn before intravenous fluid was administered, and the infant experienced no complications.

ABSTRACT Objectives The advantages of using a peripherally inserted central catheter (PICC) in hospitalized patients make this device very important for intravenous therapy. This study describes the use of PICCs at the Institute of Orthopedics and Traumatology at the Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo over the last 10 years. Methods This retrospective study analyzed 1,057 medical records and included 1,023 medical files with complete information on the punctured vein, diagnosis, duration of catheterization, complications, and catheter tip positioning. Results Seven hundred and twenty PICCs (70.4%) were considered successfully positioned, and mean duration of catheterization was 34.3 days. The basilic vein was used in 528 (51.6%) patients, while 157 (15.4%) catheters were removed due to complications. No cases of catheter-related thrombosis or infection were found. Eight hundred and sixty-six (84.6%) patients completed their treatment with PICC in place. Conclusion PICC is a safe intravenous device that can be successfully utilized for medium- and long-course intravenous therapy in hospitalized and discharged orthopedic patients. Level of Evidence IV; Case series.

AbstractWhile the numerous complications of intravenous hyperalimentation (IVH) are well recognized, we encountered a unique one. A 60-year-old man developed a sore throat, neck pain and fever seven days after catheterization of the subclavian vein to provide post-operative nutrition. Marked swelling was visible at the right posterior wall of his oropharynx and hypopharynx. X-ray of the neck revealed that the tip of the catheter was positioned in the internal jugular vein, not the subclavian vein as intended. The acute pharyngitis, diagnosed as due to phlebitis of the internal jugular vein due to the malpositioned catheter, subsided within two days of catheter removal.

Introduction: To propose a novel cannulation technique for difficult urethral catheterization procedures. Technique: The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. Results: The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. Conclusions: This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.

The HannaH study showed that neoadjuvante-adjuvant subcutaneous and intravenous trastuzumab have similar efficacy and tolerability in patients with early HER2-positive breast cancer. The analysis of the results of the subcutaneous and intravenous trastuzumab usage in Russian population showed the favorable association between tpCR anf EFS. tpCR achiviement is associated with clinical benefit in HER2 positive breast cancer. For patients with difficult venous access who do not require intravenous chemotherapy currently, Subcutaneous trastuzumab allows to receive effective treatment without the risk of complications, which involves catheterization of a Central vein.

INTRODUCTION: TAVI has settled as the standard of care of AS for inoperable, high-risk, and selected intermediate-risk patients undergoing aortic valve replacement. Vascular and bleeding complications are related to worst outcomes. HYPOTHESES: a. The reduction and early recognition of vascular and bleeding complications might improve clinical outcomes in patients treated with TAVI. b. A full percutaneous transfemoral approach for TAVI is related to a lower rate of major bleedings in comparison to the surgical cut-down approach. c. The development of post-TAVI thrombocytopenia has a prognosis value in short-term clinical outcomes. d. The kinetics of drop platelet count (DPC) after TAVI are different according to the type of valve implanted. MATERIALS AND METHODS: Sub-project 1: “Comparison of complications between percutaneous puncture or surgical cut-down for transfemoral access in TAVI” Data from the Spanish TAVI Registry were analyzed. Patients undergoing transfemoral TAVI in 41 Spanish centers from January 2010 to July 2015 were included. Subjects were divided into percutaneous puncture (PG) and cut-down group (CG). A propensity-matched comparison was performed to avoid selection bias. Vascular and bleeding complications were evaluated at 30-days and mid-term follow-up. Sub-project 2: “Study of Thrombocytopenia after TAVI” a. Patients from 2 Spanish centers between 2012 to 2016 were included. Subjects with severe baseline thrombocytopenia (<100x109/L) and peri-procedural death were excluded. Laboratory analyses were performed. Two groups were created according the DPC: ≤30% or >30%. Clinical, procedural characteristics and outcomes were collected retrospectively. b. Patients treated with transfemoral TAVI in a French high-volume center from 2008 to 2016 were included. Exclusion criteria were non-transfemoral approach, severe baseline thrombocytopenia and peri-procedural death. The study protocol was like the previous study. RESULTS: Sub-project 1 A total of 2,465 transfemoral TAVI patients were included. The PG had 1,833 patients (74,3%) and the CG had 632 patients (25,6%). Propensity matching score resulted in 615 pairs. Vascular complications at 30-days were significantly higher in the PG (RR 2,66; IC95% [1,85-3,64], p = <0,001) mainly driven to minor vascular complications. In contrast, the bleeding complications were higher in the CG (RR 0,45; IC95% [0,26-0,78], p = 0,003). At a mean follow-up of 323 days, the rates remained similar. Higher rates of vascular complications in the PG: 15% vs. 5,1% (HR 2,23; IC95% [1,6-3,11]; p = <0,001) and higher rates of major bleedings in the CG: 3,4% vs. 1,6% (HR 0,57; IC95% [0,35-0,95], p = 0,03). Sub-project 2 a) The analyzed population included 195 patients: 100 (52,2%) treated with self-expanding valves (SEV) and 95 (48,8%) with balloon-expandable valves (BEV). The mean percentage of DPC was 31,9±15,3%. The DPC was significantly higher in the BEV population in comparison to SEV (36,3±15,1% vs 27,7±14,4, p<0,001). After multivariate analysis, the use of BEV was independently associated to a DPC>30% (67,4% vs. 36,0%; OR 3,4; 95% CI, 1,42-8,16). AT 30-days, the DPC>30% was associated to a higher rate of major and life-threatening bleedings, vascular complications, sepsis, and death. At 1-year there were no differences in mortality. (6,35% vs. 10,0%; HR 1,54; 95% CI, 0,56-4,25). b) A total of 609 were included. The mean DPC was 32,5±13,9%. The DPC was higher in the BEV group (33.9±14.2 vs 30.7±13.4%, p=0.006), and the nadir was reached significantly later in comparison with the SEV group. (3,0±1,3 vs 2,5±1,1 days, p<0,001). After the multivariate analysis, the factors related to a DPC>30% were the use of BEV, known coronary disease and preserved left ventricle ejection fraction. At 30-days the DPC>30% was associated to a higher rate of major and life-threatening bleedings (6,8 vs 2,1%, p=0.009) and death (3,5 vs 0,8%, p=0.036). At 1-year there were no differences in mortality CONCLUSIONS: 1. The reduction and early recognition of vascular and bleeding complications is associated to an improvement in clinical outcomes in patients treated with TAVI. 2. The completely percutaneous approach of transfemoral TAVI yielded lower rate of major bleedings and higher rate of minor vascular complications in comparison to the surgical cut-down and closure. 3. A post-procedural DPC>30% is related with worse clinical outcomes at 30-days after TAVI. 4. The use of balloon-expandable valves seems to be associated with a higher risk of drop on platelet counts after TAVI.
El Implante Transcatéter de Válvula Aórtica (TAVI) se ha consolidado como el tratamiento de elección en pacientes inoperables, de alto y seleccionados con intermedio riesgo quirúrgico. Las complicaciones vasculares y hemorrágicas están asociadas a peores resultados clínicos y a mayor estancia intrahospitalaria. Subproyecto 1: “Comparación entre las complicaciones de la punción percutánea y disección quirúrgica en el Implante Transfemoral de Válvula Aórtica” Análisis retrospectivo del Registro Nacional TAVI. Se incluyeron pacientes tratados con TAVI transfemoral en 41 centros españoles desde enero 2010 hasta julio 2015. Se evaluaron la complicaciones vasculares y hemorrágicas a los 30 días y a medio término. Asimismo, se evaluó la frecuencia de ictus, daño renal agudo, infarto del miocardio y muerte. Para reducir el sesgo de selección se realizó un “score de propensión”. Subproyecto 2: “Estudio de la Trombocitopenia después del Implante Transcatéter de Válvula Aórtica” a) Se incluyeron pacientes tratados con TAVI en 2 centros españoles entre enero 2012 y diciembre 2016. Se excluyeron pacientes con plaquetopenia severa basal (<100x109/L) y con muerte peri-procedimiento. Se realizaron analíticas seriadas durante el ingreso. El seguimiento clínico se realizó a los 30 días, 3 meses y 1 año posterior al procedimiento. Se recogieron las características basales, del procedimiento y los eventos clínicos en una base de datos. Se crearon 2 grupos de acuerdo con el porcentaje de caída de plaquetas: ≤30% y >30%. b) Se incluyeron pacientes tratados con TAVI transfemoral en un centro francés de alto volumen de TAVI, entre enero 2008 y diciembre 2016. Se excluyeron los pacientes con acceso no transfemoral, con plaquetopenia severa pre-procedimiento y con muerte peri-procedimiento. El protocolo del estudio fue similar al del estudio previo. La disminución y el reconocimiento temprano de complicaciones vasculares y hemorrágicas permite mejores resultados clínicos en pacientes tratados con TAVI. El abordaje completamente percutáneo de la TAVI se asoció a una tasa menor de sangrados mayores y a una mayor tasa de complicaciones vasculares menores en comparación con el abordaje quirúrgico. La caída en el porcentaje de plaquetas >30% se relaciona con peores resultados clínicos a los 30 días post-TAVI. El uso de las prótesis balón-expandibles parece asociarse a un mayor riesgo de disminución de plaquetas.

Initially always lethal, the prognosis of infective endocarditis (IE) has been revolutionized by antibacterial therapy and valve surgery. Nevertheless, it remains one of the deadliest infectious diseases, with ≥30% of patients dying within a year of diagnosis. Its incidence has also remained stable at 25–50 cases per million per year, and results predominantly from a combination of bacteraemia and a predisposing cardiac condition, including endocardial lesions and/or intracardiac foreign material. While antibiotic prophylaxis is recommended by various learned societies to cover healthcare procedures with the potential of causing bacteraemia in at-risk patients, there is no evidence to support this strategy. Even though the benefits are hypothetical, national guidelines should still be followed to avoid medico-legal issues. General preventive measures, such as education of clinicians and at-risk patients appear to be more crucial. Invasive procedures, especially intravenous catheterization, should be kept to the minimum possible. The severity of IE mandates a multidisciplinary and standardized approach to treatment, with involvement of dedicated surgeons within specialist centres. Standardized antibiotic protocols have produced dramatic reductions in hospital and 1-year mortality in reference centres. Most deaths now result from complications that constitute definite surgical indications, so optimization of surgical management and avoidance of delay will clearly improve prognosis. This disease has now entered an ‘early surgery’ era, with a more aggressive surgical approach showing promising results. Conditions such as septic shock, sudden death, and vancomycin-resistant staphylococcal endocarditis still constitute therapeutic and research challenges, and justify an important role for specialist centres.

This chapter covers specialized services that are provided by pediatric hospitalists such as caring for patients with behavioral and mental health conditions, newborns, and children with medical complexity. It also includes core procedural skills within the scope of pediatric hospital medicine including the indications, contraindications, alternatives, risks, benefits, and complications of each. These procedures include lumbar punctures (LP), vascular access (arterial, intraosseous, umbilical, intravenous catheters), incision and drainage, feeding tube placement or replacement (nasogastric, gastric), airway management (tracheostomy tube change, bag mask ventilation, intubation, LMA placement), needle thoracentesis, bladder catheterization, procedural sedation, and neonatal circumcision. These questions encompass domains 2-5 of the American Board of Pediatrics exam content specifications.

Thirty-four patients with acute myocardial infarction were treated prospectively using a new strategy of pre-hospital intravenous streptokinase given by a physician-operated mobile intensive care unit. Prehospital treated patients who had experienced no previous myocardial infarction were compared to a similar group treated with streptokinase in-hospital. All patients underwent cardiac catheterization on day 6.Patients receiving streptokinase in the pre-hospital phase of acute myocardial infarction had smaller infarcts and better residual myocardial function than the group given streptokinase in-hospital in terms of peak creatine phosphokinase (900 v.1298 IU, p=0.023), ejection fraction (62 v. 55%, p=0,004), computer-derived dysfunction index (427 v. 727, p=0.003), and electrocardiographic QRS score (4.1 v. 6.4, p=0.001). The only difference between these groups at baseline was the duration of pain prior to initiation of streptokinase therapy (1.0 ± 0.4 hours vs. 1.9 ± 0.9 hours). There were no major complications related to pre-hospital administration of streptokinase.Pre-hospital stretokinase infusion is feasible, safe and practical. It reduces ischemia time because treatment is not delayed until hospital arrival and therapy limits infarct size. Thrombolytic therapy for acute myocardial infarction can be initiated at home and should not be limited to hospitalized patients.