Arterial trauma is a rare, but potentially life-threatening complication of central venous catheter insertion, with limited evidence to guide its prevention and management. We aimed to identify incidents from two national databases of incident reports to better characterise this complication and its consequences.

We extracted and analysed reports from the National Reporting and Learning System and the Strategic Executive Information System over a 10-year period, including incidents involving arterial insertion of a dilator or catheter. Arterial puncture by needle or guidewire was included if moderate or severe harm resulted.

We identified 241 arterial trauma incidents including diverse device types, settings and insertion techniques. Arterial trauma occurred despite the reassuring visual appearance of blood in 35 (15%) incidents and despite guidewire visualisation by ultrasound in 53 (22%) incidents. After catheter insertion, a chest radiograph was the most common method which failed to identify arterial cannulation in 20 (27%) cases of delayed recognition. Outcomes included 24 (10%) strokes and 10 (4%) deaths. After excluding femoral and peripherally-inserted catheters, stroke was associated with delayed diagnosis (RR 3.57, 95%CI 2.04-6.24) and arterial drug administration (RR 2.67, 95%CI 1.48-4.82). However, stroke (eight, 6%) and death (three, 2%) still occurred despite immediate recognition of arterial trauma, underscoring the dangers of arterial dilatation.

Whilst some incidents involved potential risk factors (e.g. operator inexperience, landmark technique, paediatric lines and emergent insertion) arterial trauma nevertheless occurs when experienced operators undertake seemingly routine procedures. Our findings complement previous research on serious harm from this complication and support the need for robust and objective pre-dilatation checks. It is essential that these findings inform the perception, discussion and mitigation of risk associated with central venous catheter insertion to prevent avoidable patient harm.

This study evaluated the impact of choosing the right versus left internal jugular vein (IJV) for initial central venous catheter (CVC) placement on hemodialysis catheter-related outcomes in critically ill patients.

Medical records from the University of Maryland Medical Center were reviewed for adult critical care patients who received an IJV CVC between January 1, 2019, and December 31, 2022, and later required an additional temporary hemodialysis catheter.

The study included 214 patients, with 100 (46.7 %) receiving the primary CVC in the right IJV and 114 (53.3 %) in the left IJV. The right IJV group had higher hemodialysis catheter re-insertion rates (40 % vs. 2.6 % in the left IJV group, P < 0.001) related to using a different site other than the right IJV for the initial hemodialysis catheter (85 % for the right IJV group vs. 1.75 % for the left IJV group). Hemodialysis catheters were exchanged over a guidewire in 23 % of the right IJV group vs. 0.9 % in the left IJV group (P < 0.001). Additionally, 38 % of patients in the right IJV group required three venous access interventions, with 14 % needing four or more, versus only 2.6 % requiring three interventions in the left IJV group.

Initiating CVC placement in the right IJV in critically ill patients is associated with a higher risk of hemodialysis catheter re-catheterization related to the use of veins other than the right IJV for hemodialysis catheter placement and an increased need for venous access interventions compared to placement in the left IJV.

To investigate whether tissue adhesive (TA, 2-octyl blended with n-butyl cyanoacrylate) application to centrally/femorally inserted central catheters (CICCs/FICCs) exit sites could reduce the occurrence of central line-associated bloodstream infection (CLABSI).

This retrospective review with historical controls was conducted in three tertiary care institutions. The TA group was established from December 2021 to July 2022 with the simultaneous initiation of TA application to the exit site of CICCs/FICCs. Patients in the control group received CICCs/FICCs before TA application between February 2021 and November 2021. Adverse event (AE) rates, including CLABSI, oozing, dislocation, and skin problems, were compared between groups. Risk factors were analysed using inverse probability of treatment weighting (IPTW)-adjusted Cox analysis.

The TA group comprised 1,061 patients (median age=62 years; interquartile range [IQR], 51-72; men=549), while the control group included 1,049 patients (median age=61 years; IQR, 50-72; men=516). The CLABSI rate was significantly lower in the TA group (1.84/1,000 catheter-day) compared with the control group (3.66/1,000 catheter-days), with a rate ratio of 0.5 (95% confidence interval, 0.28-0.87; p=0.01). Dislocation rates were not significantly different in the two groups (p=0.45). Pruritus and blisters at the exit-site occurred slightly more often in the TA group (TA=36, control=25, p=0.16), whereas the oozing rate was significantly lower (TA=120, control=158, p=0.01). IPTW-adjusted analysis revealed TA as risk-reducing factor (p=0.003), while age (p=0.04) and triple-lumen (p=0.04) were significant risk factors for CLABSI.

TA application at CICCs/FICCs exit sites could significantly lower CLABSI rates without serious AEs.

Background: Central line-associated bloodstream infections (CLABSIs) represent a significant healthcare challenge due to their association with increased morbidity, mortality, and financial burden. Current guidelines discourage the use of the femoral vein (FV) for central venous catheter (CVC) placement due to a perceived higher infection risk compared to the internal jugular vein (IJV) or subclavian (SCV) sites. However, recent evidence questions this assumption and suggests that femoral CVCs may carry similar risks to other sites, emphasizing the need for updated analyses. Objective: The goal of this study was to address the misconception that femoral CVCs have a higher associated risk for developing CLABSI compared to other central line sites. This study evaluates risk for CLABSI across FV, IJV, and SCV sites. Methods: Using the TriNetX Research Network to conduct a retrospective cohort analysis, initial queries identified 99,216 patients who were encountered between 2014 and 2025 for CVC placement. Following propensity score matching, 65,265 of these patients were retained for statistical analysis. Patients were categorized based on anatomic CVC placement sites into IJV, SCV, and FV cohorts. CLABSI incidence was determined using ICD-10-CM codes within 1 day to 1 month post-CVC insertion. Sensitivity analyses were conducted for the 2014-2025 period, as well as for the 2014-2019 and 2019-2025 periods to assess overall risk and evaluate for changes in CLABSI risk by anatomic site over time. Outcomes were compared using risk percentages, risk ratios, and odds ratios with 95% confidence intervals to compare differences in risk for CLABSI across different sites. Results: Overall, femoral CVCs were not associated with a statistically significant higher risk of CLABSI compared to IJV or FV CVCs from the overall period of 2014-2025. Only the risk difference between IJV and SCV CVCs over 2014-2025 showed a statistically significant difference. IJV CVCs were associated with a higher risk of CLABSI compared with SCV CVCs, with a risk difference of 0.089% (95% CI: 0.006%, 0.171%, Z = 2.11, p=0.0348), a risk ratio of 1.708 (95% CI: 1.033, 2.826), and an odds ratio of 1.71 (95% CI:1.033, 2.831). Over the 2014-2019 period, there was no statistically significant risk difference between the IJV and FV cohorts (risk difference 0.09%, 95% CI: -0.035%, 0.215%, Z = 1.415, p=0.1569). Comparing the IJV to SCV CLABSI rates for the 2014-2019 period, the risk difference was 0.112% (95% CI: -0.009%, 0.234%, Z = 1.81, p=0.07). For the 2019-2025 period between the IJV and FV cohorts, the risk difference was -0.077% (higher risk in the FV cohort), which was not a statistically significant difference (95% CI: -0.193%, 0.04%, Z = -1.289, p=0.1974). Comparing the IJV to SCV CLABSI rates for the 2019-2025 period, the risk difference was 0.117% (95% CI: = -0.006%, 0.24%, Z = 1.861, p=0.0627), which was not a statistically significant difference. Conclusions: This study challenges the prevailing assumption that femoral CVCs carry a higher risk of CLABSI compared to IJV and SCV sites, showing no significant difference in risk. These findings suggest that avoidance of the FV for CVC placement out of concern for infection may unnecessarily limit clinical options without improving patient outcomes. Emphasizing site-specific risks like technical complications and anatomical considerations over infection concerns could simplify decision-making and enhance personalized care in CVC placement.

The administration of home parenteral nutrition improves quality of life for patients with intestinal failure, thus fostering their will to actively participate to social activities. Nevertheless, sports participation can be risky for patients with a central venous catheter (CVC). Despite literature thoroughly proving the positive impact of sports on motor-psychosocial development, no consistent evidence assessing its role on central-line complications is available. This study aimed to report the European centers' approach to children with intestinal failure on home parenteral nutrition and interested in playing sports, further assessing complications and how to prevent them.

A questionnaire focusing on children with intestinal failure regarding physical activity was circulated to 20 centers. Questions assessed the centers' policy for CVC management, the sports-related recommendations for patients on home parenteral nutrition and complication rates.

Sixteen (80%) centers filled in the questionnaire. Twelve centers reported not to have a standardized formal protocol for catheter care during sports. All centers encouraged patients to perform mild/moderate exercise, whereas high-contact sports were allowed by one center only. Specific dressings were suggested to protect the vascular access device, especially for water sports. Only one sports-related complication (rupture) was reported.

This survey emphasizes that sports should not be restricted in patients with intestinal failure and represents a blueprint for sports-related recommendations for these patients. Prospective studies assessing complication rates are advisable to ensure an improved access to sports for these patients.

Emergent central line (CL) insertion may be associated with a higher risk of central line-associated blood stream infection (CLABSI). We hypothesized that CLs placed emergently within 2 hours of arrival to the emergency department (ED) for critical trauma patients are associated with a higher risk of CLABSI compared with CLs placed outside the ED. We additionally hypothesized that femoral ED-CLs are associated with a higher risk of CLABSI compared with internal jugular (IJ) vein ED-CLs.

The 2017-2019 Trauma Quality Improvement Program database was queried for critical trauma patients admitted to the intensive care unit or operating suite from the ED who underwent CL insertion. Patients who were transferred, died < 72 hours, or hospitalized <2 days were excluded. A total of 27,981 patients met inclusion criteria and 169 of these patients met criteria for a CLABSI. Patients receiving an ED-CL within 2 hours of arrival were compared with patients receiving a CL outside of the ED (non-ED-CL). We performed a subanalysis of only ED-CL patients for risk of CLABSI dependent on insertion site. A multivariable logistic regression analysis was performed.

Of 27,981 patients, 7908 (28.3%) received an ED-CL mostly in the subclavian vein (51.5%). After adjusting for risk factors, ED-CL patients had a similar risk of CLABSI (odds ratio [OR], 0.75; CI, 0.51-1.11; P = .15), compared with non-ED-CL patients. Among ED-CL patients, insertion of a subclavian CL (OR, 0.40; CI, 0.18-0.87; P = .02) was associated with a lower risk of CLABSI compared with an IJ CL, whereas femoral and IJ CLs had a statistically nonsignificant difference in risk of CLABSI (OR, 0.46; CI, 0.20-1.05; P = .06).

Insertion of ED-CLs within 2 hours of arrival is not associated with a higher risk of CLABSI compared with insertion of a non-ED-CLs. The subclavian vein is the most common site for emergent CL insertion in the ED. For ED-CLs, the subclavian line is associated with the lowest risk of CLABSI and should be considered the optimal site for insertion in critically ill trauma patients with no known history of chronic kidney disease.

In this Society for the Advancement of Transplant Anesthesia (SATA) white paper, experts in abdominal transplant anesthesia and critical care reviewed the current literature and practice behaviors to create a comprehensive review of the utilization of point-of-care ultrasound (PoCUS) in abdominal organ transplantation (AOT) and to provide evidenced-based recommendations for clinicians to utilize perioperative PoCUS to improve patient outcomes in real time. Organized by phase of care-preoperative, intraoperative, and postoperative-this paper includes a discussion of transthoracic, pulmonary, gastric, and transesophageal echocardiography. Part I of this paper focuses on preoperative and intraoperative PoCUS while the upcoming Part II focuses on utilizing PoCUS in the immediate postoperative and intensive care setting to guide fluid management, identify venous congestion, identify causes of shock, and estimate hemodynamics in AOT patients.

Cancer-associated thrombosis (CAT) is a common clinical problem in the treatment of cancer patients posing some unique challenges. These include the need to balance between the risk of recurrent thromboembolic events and bleeding complications in the individual cancer patient. A frequently encountered dilemma is the need for long-term anticoagulation in the setting of active malignancy. Until now, optimal duration, intensity, and type of anticoagulation in cancer patients remain an area of ongoing debate. In this case-based review, we present several challenging clinical scenarios and provide guidance on management. For optimal treatment results, CAT generally requires a multidisciplinary approach including specialists for thrombosis and hemostasis as well as hematology and oncology. Individual patient preferences should always be taken into account, especially in clinical situations with weak treatment evidence.

Despite diligent efforts, complications continue to occur during the placement of central venous catheters (CVCs). Healthcare Failure Mode and Effect Analysis has been promoted as a process improvement tool and this review describes the strategic application of Failure Mode and Effects Analysis (FMEA) to CVC placement. The objective is to demonstrate the utility of FMEA first as a tool for identifying quality or safety issues and second for guiding mitigation efforts.

Background: Despite significant prevention efforts, the incidence of central line-associated bloodstream infection (CLABSI) in intensive care units (ICUs) is rising at an alarming rate. CLABSI contributes to increased morbidity, mortality, prolonged hospital stays and elevated healthcare costs. This study aimed to determine the incidence rate of CLABSI, compliance with the central venous catheter (CVC) care bundle and risk factors associated with CLABSI among ICU patients. Method: This prospective observational study was conducted in one university hospital and two public hospitals in Malaysia between October 2022 to January 2023. Adult ICU patients (aged > 18 years) with CVC and admitted to the ICU for more than 48 h were included in this study. Data collected included patient demographics, clinical diagnosis, CVC details, compliance with CVC care bundle and microbiological results. All data analyses were performed using SPSS version 23. Results: A total of 862 patients with 997 CVCs met the inclusion criteria, contributing to 4330 central line (CL) days and 18 CLABSI cases. The overall incidence rate of CLABSI was 4.16 per 1000 CL days. The average of overall compliance with CVC care bundle components was 65%. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (78.3%), followed by Gram-positive bacteria (17.4%) and Candida spp. (2.0%). Multivariate analysis identified prolonged ICU stay (adjusted odds ratio (AOR): 1.994; 95% confidence interval (CI): 1.092-3.009), undergoing surgery (AOR: 2.02, 95% CI: 1.468-5.830) and having had multiple catheters (AOR: 3.167, 95% CI: 1.519-9.313) as significant risk factors for CLABSI. Conclusions: The findings underscore the importance of robust surveillance, embedded infection-control and -prevention initiatives, and strict adherence to the CVC care bundle to prevent CLABSI in ICUs. Targeted interventions addressing identified risk factors are crucial to improve patient outcomes and reduce healthcare costs.

In the past 5 years, non-dialysis femoral venous access has changed in terms of indications, techniques of insertion, and expected incidence of complications. To the traditional non-emergency indication for femoral catheters-obstruction of the superior vena cava-many other indications have been added, both in intensive and non-intensive care. The insertion technique has evolved, thanks to ultrasound guided venipuncture, tunneling, and ultrasound based intraprocedural tip location. Insertion of femorally inserted central catheters may be today regarded as a procedure with an extremely low intraprocedural and post-procedural risk. The risk of infection is reduced by the possibility of the exit site at mid-thigh, by the use of cyanoacrylate glue for sealing the exit site, and by appropriate intraprocedural strategies of infection prevention. The risk of catheter-related thrombosis is low, due to several concomitant strategies: a proper match between vein diameter and catheter caliber; an accurate intraprocedural assessment of tip location by ultrasound and/or intracavitary ECG; the consistent use of ultrasound guided venipuncture and micro-introducer kits; an adequate stabilization of the catheter at the exit site. The risk of mechanical complications and the risk of lumen occlusion are minimized when using polyurethane, power injectable catheters. All these novelties have brought a revolution in the field of femoral venous access, so that this route may be considered as safe and effective as other approaches to central venous catheterization.

Venous stenosis secondary to central venous access is a well-recognized complication. However, in patients without kidney disease or those not undergoing hemodialysis, central venous stenosis is less frequently reported, suggesting that while the condition is documented in these specific populations, it may be underreported in the general population with other characteristics. This study describes a 69-year-old patient with a history of thrombophilia due to MTHRF 677 gene heterozygous mutation, who developed left subclavian vein stenosis two weeks after the use of central vascular access, leading to left upper extremity edema, development of collateral venous network, and pain and dyspnea. Endovascular treatment was performed with recanalization and angioplasty of the subclavian vein, with favorable outcomes, improving symptoms in the immediate post-operative period and continuing through six-month follow-up with monthly consultation and phlebography control. The adequate response to this type of clinical situation with endovascular management and monotherapy with anticoagulant factor Xa inhibitor (apixaban) confirms this approach as another alternative within the field of vascular surgery.

It is well-known that infectious complications after central venous catheterisation are associated with increased mortality, length of hospital stay and costs. However, there are limited data regarding such associations for immediate insertion-related complications. Therefore, the aim of this study was to investigate whether major immediate insertion-related complications are associated with mortality, length of hospital stay and costs.

This was a preplanned substudy to the CVC-MECH trial on immediate insertion-related complications after central venous catheterisation in the ultrasound-guided era. Patients receiving central venous catheters at Skåne University Hospital from 2 March 2019 to 31 December 2020 were prospectively included. Patient characteristics, clinical data and costs were automatically collected from medical journals and the patient administration system. Associations between major immediate insertion-related complications and mortality, length of hospital stay and costs were studied by multivariable logistic and linear regression analyses.

In total, 6671 patients were included, of whom 0.5% suffered major immediate insertion-related complications. Multivariable analyses, including surrogates for general morbidity, showed associations between major immediate insertion-related complications and 30-day (odds ratio 2.46 [95% CI 1.05-5.77]), 90-day (2.90 [1.35-6.21]) and 180-day (2.26 [1.05-4.83]) mortality. There were no associations between major immediate insertion-related complications and increased length of hospital stay or costs.

This study showed that major immediate insertion-related complications, although not directly responsible for any death, were associated with increased 30-day, 90-day and 180-day mortality. These findings clearly demonstrate the importance of using all possible means to prevent avoidable insertion-related complications after central venous catheterisation.

Tunneled dialysis catheters (TDCs) are typically the vascular access of choice for critically ill patients in need of urgent dialysis for prolonged periods of time. The standard of practice is to insert these catheters under fluoroscopic guidance to ensure proper catheter placement in the cavo-atrial junction or right atrium. However, there is increasing interest in bedside placement of TDCs without fluoroscopic guidance in patients deemed too critically ill to be transported to the fluoroscopy suite or operating room. Our aim was to systematically review the literature on bedside placement of TDCs and to calculate the pooled prevalence rates of technical success, favorable clinical outcomes, and overall complications. We searched PubMed and Google Scholar for articles on bedside insertion of TDCs without setting a specific timeframe. We stratified the articles based on the risk of publication bias. Data on technical success, favorable clinical outcomes and complications were collected. A total of 22 articles were included, comprising 1546 TDCs inserted at bedside. The technical success rate was found to be 97.2% [95% CI: 94.6 - 98.9%; I2 = 77.5%]; LFK index = -0.72 and favorable clinical outcome was reported in 97.6% [95% CI: 94.5-99.5%; I2 = 84.8%]; LFK index = -1.62. The pooled prevalence of complications was found to be 6.98% [95% CI: 3.12 - 12.1%; I2 = 87.8%]; LFK index = 0.95, most of which were mechanical in nature. Our findings suggest that bedside placement of TDCs is a technically feasible procedure with high favorable clinical outcomes and comparable complication rates to the conventional method of TDC insertion under fluoroscopic guidance. Several non-fluoroscopic techniques have also been suggested to confirm the proper positioning of the catheter in the right atrium. These findings may challenge the gold standard of utilizing fluoroscopic guidance for TDCs.

Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.

Multisite parallel group, superiority, randomized controlled trial.

Four metropolitan Australian ICUs.

Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.

Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).

The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.

MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.

The precautions brought on by the COVID-19 pandemic led to the growing practice of bundling lines in patients requiring intubation. Our study aims to examine the effect of immediate bundled lines (IBL) on traumatic injuries. We hypothesized that severely injured patients may benefit from IBL.

A retrospective review of all intubated trauma patients (1/2015-12/2020) at a Level I Trauma Center was conducted. Patients ≤18 years and those who died or were transferred prior to intensive care unit (ICU) admission were excluded. IBL was defined as placement of central venous catheter (CVC) and arterial line (AL) ≤4 hours after intubation. Delayed lines were any lines placed >4 hours after intubation. Primary outcome was time from intubation to CVC and AL.

728 patients were included. The majority received CVC and/or AL with 17.7% in a delayed fashion. Severe head injury (AIS ≥3) most often had immediate AL or delayed bundled lines (P < 0.001). IBL were more common with gunshot wounds (GSW) (P < 0.001) and blood transfusions (P < 0.001). IBL were associated with significantly lower GCS (P = 0.018) and higher median ISS. Multivariate logistic regression revealed severe/profound ISS, GSW, and pedestrian struck were predictive of IBL.

Intubated trauma patients who presented with certain mechanisms (GSW, pedestrian struck), received blood transfusions, or exhibited severe/profound ISS may be more likely to receive IBL. IBL is not superior to either immediate AL or to no lines in terms of mortality. No lines had a significant effect on ICU LOS or hospital LOS, except in the setting of severe head injury.

A panel of experts convened by the International Society for Infectious Diseases (ISID) has reviewed and consolidated current recommendations for preventing vascular catheter infections, particularly central line-associated bloodstream infections (CLABSIs). This review provides healthcare professionals with insights into key issues such as the rates of CLABSI in high-income countries and low- and middle-income countries, the attributable extra length of stay, cost and mortality, and risk factors. This position paper highlights evidence-based strategies for preventing infections, applicable to both high-income and low- and middle-income countries.

A rising incidence of septic shock as well as recommendations for early vasopressor initiation has increased the number of patients eligible for norepinephrine (NE). Traditionally, NE has been administered through central lines, in intensive care units, due to the risk of extravasation in peripheral lines. The aim of the current study is to determine the rate of complications and patient outcomes when NE is administered through midline catheters (MCs) in intermediary care units (IMCUs).

Retrospective cohort study.

Three IMCUs in southern Sweden PARTICIPANTS: Patients with septic shock who received NE through a MC from September 2020 through March 2023.

The primary outcome was a major complication to treatment, defined as extravasation of NE, catheter-associated venous thromboembolism and catheter-associated bloodstream infection (BSI). Secondary outcomes included patient outcomes after intermediary care (either deceased, discharged to regular ward care or intensive care) and the need for additional central lines.

Of 474 eligible patients, 472 were included, with a median (IQR) age of 73.5 (65-80) years, with 281 (60%) men. The median (IQR) duration of NE infusion was 21 (9-38) hours, with a median (IQR) dosage of 0.12 (0.08-0.20) µg/kg/min. Major complications occurred in 12 cases (2.5%), with one suspected extravasation, seven thromboembolic events and four catheter-related BSIs. After intermediary care, 334 patients (71%) were discharged to regular ward care, 66 patients (14%) were escalated to intensive care and 72 (15%) died in intermediary care, of whom 69 had a documented ceiling of care decision. 100 patients (21%) received a central line.

NE administration in MCs was associated with a low rate of short-term complications and could decrease the need for central lines. MCs can enable the initial management of circulatory failure outside intensive care, but more studies are needed to determine the long-term value of IMCUs.

NCT06121115.

Although the implantation of the totally implantable venous access ports globally is increasingly sophisticated, there is still a dearth of absolute standardization in the technical choice of each surgical step, with numerous technologies demonstrating significant applicability. This review comprehensively summarizes the diverse choices of implantation procedural techniques related to the pocket location, vein access, port specification, catheterization method, puncture guidance, single-incision technique, catheter tip positioning method, port fixation, skin closure, and first-use period. The aim is to provide surgeons with alternative options when they encounter different problems in each procedure due to the diverse clinical characteristics of patients during venous port implantation.

Short bowel syndrome (SBS) is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). During the intestinal rehabilitation process, patients may need parenteral support for months or years, parenteral nutrition (PN), or hydration/electrolyte supplementation, as a bridge for the desired enteral autonomy.

Several classification criteria have been highlighted to reflect different perspectives in CIF. The management of CIF-SBS in adults is a multidisciplinary process that aims to reduce gastrointestinal secretions, slow transit, correct/prevent malnutrition, dehydration, and specific nutrient deficiencies, and prevent refeeding syndrome. The nutritional support team should have the expertise to take care of these complex patients: fluid support; oral, enteral, and PN; disease/PN-related complications; pharmacologic treatment; and surgical prevention/treatment.

CIF-SBS is a complex disease with undesired consequences, if not adequately identified and managed. A comprehensive approach performed by a multidisciplinary team is essential to reduce PN dependence, promote enteral independence, and improve quality of life.

Hospital-acquired infections, including central line associated bloodstream infections (CLABSI), are an ongoing source of cost, morbidity, and mortality worldwide. This article presents a summary of the impact of the recent SARS-CoV-2 pandemic on CLABSI incidence, an overview of current standard-of-care practices for reduction of CLABSI, and a look toward future changes in bacteremia metrics and challenges in prevention.

Objective Proper preparation is necessary before performing certain procedures on a patient. Recently, videos created using social media content have been used as a preparation method. This has become particularly important in medical education since the COVID-19 pandemic. Central venous catheter placement is an important procedure performed in critically ill patients. This study assessed the quality of videos about central venous catheter placement available on YouTube. Methods A search was conducted on YouTube with the keyword "central venous catheter placement" on June 1, 2024. The review process involved two independent medical experts who comprehensively assessed the relevance and content of each video. To assess the quality of the videos, the DISCERN score, mDISCERN score, Global Quality Score (GQS), and American Medical Association Journal (JAMA) rating scale were used as evaluation tools. Results Top 41 English-language videos deemed most relevant were evaluated, each with over 25,000 views. Analysis of the video sources revealed that 36.6% of the videos were uploaded by doctors. Moreover, 87.8% of the videos were audio narrations accompanied by real patients or mannequins, and the remaining videos comprised audio narration with animated images. The mean JAMA score of the videos was 1.73, the mean mDISCERN score was 2.66, the mean DISCERN score was 40.46, and the mean GQS score was 3.8. A statistically significant difference was observed between the mDISCERN scores of videos containing real visual content and those containing animated visual content (p = 0.038). Moreover, the same two groups also exhibited higher quality scores in the GQS (p = 0.029). Conclusion The quality of information related to central venous catheter placement on YouTube is highly variable. Specifically, videos that provide valuable information and those that have the potential to mislead viewers do not have a noticeable difference in terms of views and popularity. For a medical practitioner or physician seeking reliable information, a useful and safe approach is preferring videos uploaded by medical professionals. It is important to prioritize the professional identity of the content creator rather than the video's popularity or the number of comments it has received.

Classic teaching in neurocritical care is to avoid jugular access for central venous catheterization (CVC) because of a presumed risk of increasing intracranial pressure (ICP). Limited data exist to test this hypothesis. Aneurysmal subarachnoid hemorrhage (aSAH) leads to diffuse cerebral edema and often requires external ventricular drains (EVDs), which provide direct ICP measurements. Here, we test whether CVC access site correlates with ICP measurements and catheter-associated complications in patients with aSAH.

In a single-center retrospective cohort study, patients with aSAH admitted to Emory University Hospital between January 1, 2012, through December 31, 2020, were included. Patients were assigned by the access site of the first CVC placed. The subset of patients with an EVD were further studied. ICP measurements were analyzed using linear mixed effect models, with a binary comparison between internal-jugular (IJ) versus non-IJ access.

A total of 1577 patients were admitted during the study period with CVC access: subclavian (SC) (887, 56.2%), IJ (365, 23.1%), femoral (72, 4.6%), and peripheral inserted central catheter (PICC) (253, 16.0%). Traumatic pneumothorax was the most common with SC access (3.0%, p < 0.01). Catheter-associated infections did not differ between sites. Catheter-associated deep venous thrombosis was most common in femoral (8.3%) and PICC (3.6%) access (p < 0.05). A total of 1220 patients had an EVD, remained open by default, generating 351,462 ICP measurements. ICP measurements, as compared over the first 24-postinsertion hours and the next 10 days, were similar between the two groups. Subgroup analysis accounting for World Federation of Neurological Surgeons grade on presentation yielded similar results.

Contrary to classic teaching, we find that IJ CVC placement was not associated with increased ICP in the clinical context of the largest, quantitative data set to date. Further, IJ access was the least likely to be associated with an access-site complication when compared with SC, femoral, and PICC. Together, these data support the safety, and perhaps preference, of ultrasound-guided IJ venous catheterization in neurocritically ill patients.

During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique.

A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed.

Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53-0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49-0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41-0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48-0.87).

US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.

We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort.

This study was conducted using the healthcare-associated infection surveillance cohort "REA-REZO" involving 193 intensive care units (ICUs). All CVC inserted and removed during the same ICU stay between January 1st 2018 and December 31st 2022 were eligible but only those whose tips were sent for microbiological analysis were included. Primary objective was to describe CVC insertion sites and subsequent catheter-related bloodstream infection (CRBSI).

Out of 126,997 CVCs, 71,314 were not sent for tip culture, and only 55,663 CVCs were included, (30,548 in internal jugular [IJ], 14,423 in femoral and 10,692 in subclavian [SC] sites). The incidence of CRBSI was 0.7 [0.6-0.8] in the IJ site, 0.7 [0.6-0.9] in the femoral site, and 0.6 [0.4-0.7] CRBSI per 1000 CVC days in the SC site (p = 0.248). The multivariable Poisson regression model showed no differences of CRBSI incidence rates between the three insertion sites. Microorganisms observed in CRBSI were coagulase-negative Staphylococci (27.9%), Enterobacterales (27.5%), non-fermenting Gram-negative Bacilli (10.4%), Candida sp. (16.9%), and Staphylococcus aureus (16.9%).

Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded.

Central venous catheters are among the most used medical devices in hospitals today. Despite advances in modern medicine, catheter infections remain prevalent, causing significant morbidity and mortality worldwide. Here, SteriGel is reported, which is a multifunctional hydrogel engineered to prevent and treat central line-associated bloodstream infections (CLABSI). The mechanical properties of SteriGel are optimized to ensure appropriate gelation kinetics, bio-adhesiveness, stretchability, and recoverability to promote durability upon application and to provide persistent protection against infection. In vitro assays demonstrated that SteriGel exhibits long-term antimicrobial efficacy and has bactericidal effects against highly resistant patient-derived pathogens known to be frequently associated with CLABSI. SteriGel outperformed Biopatch, which is a clinically used device for CLABSI, in ex vivo cadaver studies that simulate clinical scenarios. Furthermore, SteriGel has biocompatible, pro-healing, and anti-inflammatory properties in vitro and in a rat subcutaneous injection model, suggesting a potential synergistic effect in the prevention and treatment of CLABSI. SteriGel is a multifunctional adherent biomaterial with potent antimicrobial effects for sustained sterility while promoting healing of the catheter incision site to protect against infection.

Venous catheters inserted in superficial femoral vein and with mid-thigh exit site have emerged as a feasible and safe technique for central or peripheral tip's venous access, especially in agitated, delirious patients. The spread of multidrug-resistant bacterial (MDR) strains is an emerging clinical problem and more and more patients are being colonized by these types of bacteria. The aim of this study is to evaluate the incidence of central line associated bloodstream infections (CLABSI) or catheter related bloodstream infections (CRBSI) in mid-thigh catheters in patients with positive rectal swabs to evaluate the safety of this procedure and the real infection risk.

In this retrospective observational study, we analyzed data on patients with mid-tight catheters inserted from May 2021 to November 2022. All surveillance rectal swabs were recorded. In addition, to collect data on CLABSI and CRBSI, the results of all blood and catheter tip cultures performed during the hospital stay were acquired.

Six hundred two patients were enrolled, 304 patients (50.5%) had a rectal swab; 128 (42.1%) swabs were positive for MDR. Nine CLABSI (only two in patients with a positive rectal swab) and three CRBSI were detected. No statistical difference in the absolute number of CLABSI and CRBSI and in the number of infections per 1000 catheter days emerged between the overall population and patients with positive rectal swabs (respectively p = 0.45 and p = 0.53). Similarly, no statistical difference in the number of CLABSI and CRBSI was found among patients with a negative swab and patients with a positive one (respectively p = 0.43 and p = 0.51).

According to our data, cannulation of the superficial femoral vein represents a safe location in patients with positive rectal swabs.

Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines.

We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018, to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes.

Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 5.08%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. On multivariable regression analysis, we identified autoimmune disease, dialysis frequency of > 3 × per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including B. cepacia complex, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug-resistant organisms (MDROs) comprised almost half of the isolates (n = 89, 44.5%), with Coagulase-negative Staphylococcus species having the highest proportion among gram-positive organisms and Acinetobacter spp. among gram-negative isolates.

Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve hemodialysis patients' outcomes and reduce the CRBSI burden in our institution.

Although ultrasound can be considered an assistant method, successful placement of a central venous catheter (CVC) in infants is still challenging. The incidence of CVC placement-related complications is still high. Therefore, this systematic review aimed to synthesize evidence to assess the effects of ultrasound-guided CVC placement on adverse outcomes in infants and neonates aged <12 months.

PubMed, Ovid, EMBASE, and the Cochrane Library were searched to identify potentially relevant studies. The main outcome was the incidence of adverse events, which included inadvertent arterial puncture, hematoma, pneumothorax and hemothorax, catheter kinking, threading, and malpositioning problems, venous thrombosis, catheter-related infection, phlebitis, and cardiac tamponade.

Eleven studies involving 2097 patients were included in the final analysis. The odds of inadvertent arterial puncture, and catheter kinking, threading, and malpositioning problems were lower in the ultrasound group than in the control group. No significant difference was detected in the incidence of hematoma or venous thrombosis between the control and ultrasound groups. Other complications, such as pneumothorax, hemothorax, phlebitis, and cardiac tamponade, rarely occurred.

Ultrasound-guided CVC placement can improve the safety of punctures in neonates and infants. CVC punctures should be guided in real-time by ultrasound.

The use of peripherally inserted central venous catheters (PICCs) has increased worldwide in the last decade. However, PICCs are associated to catheter-related thrombosis (CRT) and central line-associated bloodstream infections (CLABSIs). We describe the characteristics of patients requiring a PICC, estimate the incidence rate, and identify potential risk factors of PICC-related complications.

All adult patients requiring a PICC at our institution (Fundación Santa Fe de Bogotá, Bogota, Colombia) from September 2022 to May 2024 were included in the analysis. The database from active PICC monitoring collected demographic and PICC-related information. The incidence rate of CLABSI and CRT, and crude odds ratios (cORs) were estimated.

Overall, 1936 individuals were included in the study. The median age was 67 years (IQR: 50-78 years), and 51.5% were females. The median duration of PICC lines was 10 days (IQR: 4-17). Seventy-nine patients had catheter-related complications, mostly in the Intensive Care Unit (ICU). The CLABSI and CRT institutional incidence rates per 1000 catheter-days were 2.03 (2.96 in the ICU) and 0.58 (0.61 in the ICU), respectively. Prolonged catheter use (≥ 6 days), PICC insertion in the intensive care unit, and postoperative care after cardiac surgery were identified as potential risk factors for CLABSI, while a catheter insertion into the brachial vein was associated with CRT.

Daily PICC assessment, particularly in patients with prolonged catheter use, PICC insertion into the brachial vein, or in postoperative care after cardiac surgery may significantly reduce CLABSI and CRT cases. Implementing Vascular Access Teams, venous catheter care bundles, and institutional insertion protocols optimize clinical outcomes.

Thromboembolism (TE) complicates the course of pediatric cancer in a considerable number of cases. Cancer-related TE is attributed to an interaction of the underlying malignancy, the effects of therapy, and a possible thrombophilia predisposition. More specifically, recognized risk factors include a very young age and adolescence, non-O blood group, type and site of cancer, inherited thrombophilia, presence of central venous catheter, and type of chemotherapy. TE in children with cancer most commonly occurs in their extremities. In the absence of evidence-based guidelines for the management of thrombotic complications in pediatric oncology patients, TE management follows general recommendations for the management of pediatric TEs. Given the limitations of conventional anticoagulant therapy, direct oral anticoagulants could provide an alternative; however, their safety and efficacy in children with cancer remain to be seen. As for thromboprophylaxis, numerous studies have been conducted, albeit with conflicting results. Although the survival of pediatric oncology patients has significantly improved in recent years, morbidity due to cancer-related TE remains, underlying the need for large multicenter trials investigating both TE management with currently available agents and primary prevention.

Incidence of central venous catheter (CVC)-related thrombosis in critically ill patients remains ambiguous and its association with potential hazardous sequelae unknown. The primary aim of the study was to evaluate the epidemiology of CVC-related thrombosis; secondary aims were to assess the association of catheter-related thrombosis with catheter-related infection, pulmonary embolism and mortality.

This was a single-center, prospective observational study conducted at a tertiary intensive care unit (ICU) in the Netherlands. The study population consisted of CVC placements in adult ICU patients with a minimal indwelling time of 48 h. CVC-related thrombosis was diagnosed with ultrasonography. Primary outcomes were prevalence and incidence, incidence was reported as the number of cases per 1000 indwelling days.

173 CVCs in 147 patients were included. Median age of patients was 64.0 [IQR: 52.0, 72.0] and 71.1 % were male. Prevalence of thrombosis was 0.56 (95 % CI: 0.49, 0.63) and incidence per 1000 indwelling days was 65.7 (95 % CI: 59.0, 72.3). No association with catheter-related infection was found (p = 0.566). There was a significant association with pulmonary embolism (p = 0.022). All 173 CVCs were included in the survival analysis. Catheter-related thrombosis was associated with a lower 28-day mortality risk (hazard ratio: 0.39, 95 % CI: 0.17, 0.87).

In critically ill patients, prevalence and incidence of catheter-related thrombosis were high. Catheter-related thrombosis was not associated with catheter-related infections, but was associated with pulmonary embolism and a decreased mortality risk.

Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors (RF) in Asia.

From 03/27/2004 to 02/11/2022, we conducted a multinational multicenter prospective cohort study in 281 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam). For estimation of CLABSI rate we used CL-days as denominator and number of CLABSI as numerator. To estimate CLABSI RF for we analyzed the data using multiple logistic regression, and outcomes are shown as adjusted odds ratios (aOR).

A total of 150,142 patients, hospitalized 853,604 days, acquired 1514 CLABSIs. Pooled CLABSI rate per 1000 CL-days was 5.08; per type of catheter were: femoral: 6.23; temporary hemodialysis: 4.08; jugular: 4.01; arterial: 3.14; PICC: 2.47; subclavian: 2.02. The highest rates were femoral, temporary for hemodialysis, and jugular, and the lowest PICC and subclavian. We analyzed following variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization ratio, CL-type, tracheostomy use, hospitalization type, ICU type, facility ownership and World Bank classifications by income level. Following were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 4% daily (aOR = 1.04; 95% CI = 1.03-1.04; p < 0.0001); number of CL-days before CLABSI acquisition, rising risk 5% per CL-day (aOR = 1.05; 95% CI 1.05-1.06; p < 0.0001); medical hospitalization (aOR = 1.21; 95% CI 1.04-1.39; p = 0.01); tracheostomy use (aOR = 2.02;95% CI 1.43-2.86; p < 0.0001); publicly-owned facility (aOR = 3.63; 95% CI 2.54-5.18; p < 0.0001); lower-middle-income country (aOR = 1.87; 95% CI 1.41-2.47; p < 0.0001). ICU with highest risk was pediatric (aOR = 2.86; 95% CI 1.71-4.82; p < 0.0001), followed by medical-surgical (aOR = 2.46; 95% CI 1.62-3.75; p < 0.0001). CL with the highest risk were internal-jugular (aOR = 3.32; 95% CI 2.84-3.88; p < 0.0001), and femoral (aOR = 3.13; 95% CI 2.48-3.95; p < 0.0001), and subclavian (aOR = 1.78; 95% CI 1.47-2.15; p < 0.0001) showed the lowest risk.

The following CLABSI RFs are unlikely to change: country income level, facility-ownership, hospitalization type, and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, and tracheostomy; using subclavian or PICC instead of internal-jugular or femoral; and implementing evidence-based CLABSI prevention recommendations.

Central venous access devices are essential for the management of critically ill patients, but they are potentially associated with many complications, which may occur during or after insertion. Many evidence-based documents-consensus and guidelines-suggest practical recommendations for reducing catheter-related complications, but they have some limitations. Some documents are not focused on critically ill patients; other documents address only some special strategies, such as the use of ultrasound; other documents are biased by obsolete concepts, inappropriate terminology, and lack of considerations for new technologies and new methods. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to offer an updated compendium of the main strategies-old and new-that should be adopted for minimizing catheter-related complications in the adult critically ill patient. The project has been planned as a consensus, rather than a guideline, since many issues in this field are relatively recent, and few high-quality randomized clinical studies are currently available, particularly in the area of indications and choice of the device. Panelists were chosen between the Italian vascular access experts who had published papers on peer-reviewed journals about this topic in the last few years. The consensus process was carried out according to the RAND/University of California at Los Angeles (UCLA) Appropriateness Methodology, a modification of the Delphi method, that is, a structured process for collecting knowledge from groups of experts through a series of questionnaires. The final document has been structured as statements which answer to four major sets of questions regarding central venous access in the critically ill: (1) before insertion (seven questions), (2) during insertion (eight questions), (3) after insertion (three questions), and (4) at removal (three questions).

To compare the outcomes of fluoroscopic versus portable placement of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) in pediatric patients.

This is a single-center, retrospective review of 346 upper-extremity PICC placements (286 fluoroscopic and 60 portable; mean age, 9.83 years [SD ± 5.58]; 49.1% female) and 138 tunneled femoral CVC placements (56 fluoroscopic and 82 portable; mean age, 0.23 years [SD ± 0.36]; 57.0% female). Portable placements used mobile plain-film radiography. All lines were placed by board-certified interventional radiologists.

Fluoroscopic PICC placements had a lower procedure time (43.9 vs 57.9 minutes; P < .001), radiation dosage (342 vs 590 mGy·cm2; P < .001), incidence of technical failure (0% vs 3.3%; P = .029), and incidence of catheter malfunction (1.7% vs 12.1%; P < .001) compared with portable PICC placements. Fluoroscopic CVC placements had a lower procedure time (42.6 vs 54.8 minutes; P < .001) and radiation dosage (63.8 vs 405 mGy·cm2; P < .001) compared with portable CVC placements. No technical failures were found in either CVC groups and the difference was nonsignificant for catheter malfunction (0% vs 7.3%; P = .081). Fluoroscopic placements of PICCs and CVCs had a lower incidence rate of central line-associated bloodstream infection compared with portable placements (0.71 vs 2.22 cases per 1,000 line-days; P = .046). Overall, fluoroscopic placements of PICCs and CVCs had fewer adverse events compared with portable placements (3.2% vs 14.8%; P < .001). Portable procedure setting was the only significant factor associated with adverse events (odds ratio, 33.77; 95% CI, 4.56-757.01).

Fluoroscopic placements of PICCs and CVCs are associated with lower procedure time, radiation dose, and risk of adverse events compared with portable placements in pediatric patients.