J Vasc Interv Radiol

How long should peripherally inserted central catheterization be delayed in the context of recently documented bloodstream infection?

May 052012

How long should peripherally inserted central catheterization be delayed in the context of recently documented bloodstream infection?

J Vasc Interv Radiol. 2012 Jan;23(1):123-5

Authors: Daneman N, Downing M, Zagorski BM

Abstract
The risk of relapsing bacteremia was assessed retrospectively among a cohort of 348 patients who underwent peripherally inserted central catheter (PICC) insertion within 6 weeks of a documented bacteremia. The overall risk of relapsing bacteremia was low (three of 348; 0.9%) when PICC insertion was performed in the context of a recent bloodstream infection. The relapse risk was higher when PICCs were inserted within 2 days (two of 31; 6.5%) versus at least 3 days (one of 317; 0.3%) after documentation of bacteremia (P = .02).

PMID: 22221476 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Percutaneous Cholecystostomy for Acute Cholecystitis: Ten-Year Experience.

J Vasc Interv Radiol Start a Discussion »

Dec 052011

Percutaneous Cholecystostomy for Acute Cholecystitis: Ten-Year Experience.

J Vasc Interv Radiol. 2011 Nov 29;

Authors: Joseph T, Unver K, Hwang GL, Rosenberg J, Sze DY, Hashimi S, Kothary N, Louie JD, Kuo WT, Hofmann LV, Hovsepian DM

Abstract
PURPOSE: To review the clinical course of patients with acute cholecystitis treated by percutaneous cholecystostomy, and to identify risk factors retrospectively that predict outcome. MATERIALS AND METHODS: A total of 106 patients diagnosed with acute cholecystitis were treated by percutaneous cholecystostomy during a 10-year period. Seventy-one (67%) presented to the emergency department (ED) specifically for acute cholecystitis, and 35 (23%) were inpatients previously admitted for other conditions. Outcomes of the two groups were compared with respect to severity of illness, leukocytosis, bile culture, liver function tests, imaging features, time intervals from onset of symptoms to medical and percutaneous intervention, and whether surgical cholecystectomy was later performed. RESULTS: Overall, 72 patients (68%) showed an improvement clinically, whereas 34 (32%) showed no improvement or a clinically worsened condition after cholecystostomy. Patients who presented to the ED primarily with acute cholecystitis fared better (84% of patients showed improvement) than inpatients (34% showed improvement; P < .0001). Gallstones were identified in 54% of patients who presented to the ED, whereas acalculous cholecystitis was more commonly diagnosed in inpatients (54%). Patients with sepsis had worse outcomes overall (P < .0001). Bacterial bile cultures were analyzed in 95% of patients and showed positive results in 52%, with no overall effect on outcome. There was no correlation between the time of onset of symptoms until antibiotic therapy or cholecystostomy in either group. Long-term outcomes for both groups were better for those who later underwent cholecystectomy (P < .0001). CONCLUSIONS: Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness.

PMID: 22133709 [PubMed - as supplied by publisher]

Link to Article at PubMed

Short-term infection in cuffed versus noncuffed small bore central catheters: a randomized trial.

J Vasc Interv Radiol Start a Discussion »

Apr 172010

Short-term infection in cuffed versus noncuffed small bore central catheters: a randomized trial.

J Vasc Interv Radiol. 2010 Feb;21(2):203-11

Authors: Trerotola SO, Patel AA, Shlansky-Goldberg RD, Solomon JA, Mondschein JI, Stavropoulos SW, Soulen MC, Itkin M, Chittams J

PURPOSE: To determine if a polyester cuff offered benefit in jugular small-bore central catheters (SBCCs). MATERIALS AND METHODS: Eighty-four patients were randomly assigned to receive a 5-F single- or 6-F dual-lumen SBCC with (n = 42) or without (n = 42) a polyester cuff. Follow-up was performed at 2 weeks, 1 month, and 3 months or at catheter removal, whichever came first. At scheduled follow-up, catheter function, patient satisfaction, and infection were determined. At catheter removal, tip culture was performed to determine colonization and jugular vein patency was determined with ultrasonography (US). RESULTS: The overall infection rate was 0.4 per 1,000 catheter days. There was one clinical infection (noncuffed catheter). Colonization occurred in two noncuffed catheters and one cuffed catheter. There was one catheter dislodgment in the noncuffed group and none in the cuffed group. Cuffed catheters were no more difficult to insert but took slightly longer to remove (6 minutes +/- 4.7 vs 5 minutes +/- 3, P = .39) and often required local anesthesia for removal, whereas noncuffed catheters did not (41% vs 0%, P = .001). Partial (two cuffed, 0 noncuffed) or complete (two cuffed, one noncuffed) jugular thrombosis was seen on five of 58 completion US studies (8.6%). CONCLUSIONS: A polyester cuff on a SBCC confers no significant benefit in short-term colonization rates. Infection in SBCCs is uncommon. Despite their small diameters, SBCCs can result in jugular thrombosis, an important consideration in any patient requiring long-term venous access.

PMID: 20036147 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions.

J Vasc Interv Radiol Start a Discussion »

Oct 222009

Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions.

J Vasc Interv Radiol. 2009 Aug;20(8):1066-9

Authors: Zuckerman DA, Reed MF, Howington JA, Moulton JS

PURPOSE: To assess the feasibility and effectiveness of intrapleural recombinant tissue-type plasminogen activator (r-tPA) in the treatment of loculated parapneumonic effusions (PPEs). MATERIALS AND METHODS: A single-arm prospective study of 25 consecutive patients with loculated PPEs was analyzed. All patients received 6-mg doses of intrapleural r-tPA on a defined schedule via a thoracostomy tube. The volume of output from the tubes was recorded and analysis of the fluid composition performed. Follow-up was both clinical and radiographic, with all patients undergoing pre- and postprocedural computed tomography. RESULTS: Eighteen of the 25 patients (72%) required no additional intervention and had a complete clinical and radiographic response with the fibrinolytic therapy. Seven patients (28%) were treated with video-assisted thoracoscopic surgery, but no patient required thoracotomy for total decortication. There were no hemorrhagic complications. CONCLUSIONS: Intrapleural r-tPA is effective in the treatment of loculated PPEs. It can be performed safely and in some patients may avoid the need for additional surgical intervention.

PMID: 19560940 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Single-incision technique for tunneled central venous access.

J Vasc Interv Radiol Start a Discussion »

Oct 222009

Single-incision technique for tunneled central venous access.

J Vasc Interv Radiol. 2009 Aug;20(8):1052-8

Authors: Contractor SG, Phatak TD, Klyde D, Gonzales S, Sadowski S, Bhagat N

PURPOSE: To describe the authors' experience in using a single-incision technique for placing implantable chest ports and tunneled dialysis catheters. MATERIALS AND METHODS: Implantable chest ports and tunneled dialysis catheters were placed in 130 consecutive unselected patients aged 18 to 81 years over a 6-month period. A micropuncture needle bent into a C shape was used to access the internal jugular vein (IJV) from an infraclavicular access under real-time ultrasonographic (US) guidance. A microwire and sheath were then passed into the superior vena cava; this was followed by placement of the tunneled catheter either through a peel-away sheath (implantable chest port) or de novo over the wire (tunneled dialysis catheter). Technical success of procedure performance, total US and procedure times, and adverse procedural outcomes were documented for each case. Follow-up for infections and catheter outcomes was performed, with an average follow-up of 2 months. RESULTS: One hundred thirty of the 131 placements were successful. Fifty-eight implantable chest ports and 72 tunneled dialysis catheters were placed. Four implantable chest ports and 16 tunneled dialysis catheters were placed via the left IJV; the remainder were placed via the right IJV. There were no procedure-related complications. The average US and total procedure times were the same as those for a conventional technique. The lack of a second incision in the lower neck improved the cosmetic result. CONCLUSIONS: The single-incision technique for tunneled central venous access is feasible and safe. Total US and procedure times are within the range of those with a conventional technique. Cosmetically, this technique is superior to the conventional technique.

PMID: 19647183 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy.

J Vasc Interv Radiol Start a Discussion »

Feb 132009

Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy.

J Vasc Interv Radiol. 2008 Dec;19(12):1723-31

Authors: Courtney A, Nemcek AA, Rosenberg S, Tutton S, Darcy M, Gordon G

PURPOSE: To prospectively assess the safety of the PleurX catheter in the management of recurrent ascites in patients with advanced abdominal malignancy and the consequent quality of life among these patients. MATERIALS AND METHODS: This was a multicenter, prospective study of PleurX catheters implanted between March 2004 and April 2005 for control of nonhepatic abdominal ascites associated with malignancy. A total of 34 subjects were included (age range, 40-81 years; mean age, 64.3 y) who underwent 440 drainage sessions. Subjects kept records of volume and frequency of ascites drainage and recorded any difficulties encountered with use of the device. Subjects assessed symptoms before device insertion and weekly for as long as 12 weeks. Serum laboratory values reflecting overall volume status were tracked. RESULTS: All catheter insertions were successful without major procedural complications. Twenty-nine (85%) required no catheter intervention or separate therapeutic paracentesis during 12 weeks observation or until the patient's death. Three needed a total of 13 interventions to restore catheter function. Before 12 weeks, 26 subjects died. Five discontinued catheter use as a result of catheter function despite the presence of ascites. Ascites resolved in five patients. Bloating and abdominal discomfort were significantly reduced at 2 and 8 weeks (P < .05). At weekly follow-up, 83%-100% of subjects reported their ascites to be well controlled. There were no significant changes in blood chemistry results between baseline and 12 weeks. One case of peritonitis at 10 weeks resolved with antibiotic treatment. CONCLUSIONS: In terminally ill patients, PleurX catheter use resulted in improvement of ascites-related discomfort and was associated with low rates of serious adverse clinical events and catheter failure.

PMID: 18951041 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Older Entries