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Peritoneal dialysis is a renal replacement therapy modality used in patients with end-stage chronic kidney disease. Peritoneal dialysis catheters can present complications such as infections, leaks, catheter kinking, and mechanical obstruction. The obstruction can be caused by fibrin, adhesions, or entrapment of intraperitoneal organs; among them, the most frequent is the omentum. Entrapment of the fallopian tube fimbriae is an extremely rare complication, requiring early surgical attention. We present the case of a 65-year-old woman with chronic kidney disease on home peritoneal dialysis, who had a Tenckhoff catheter placed three months earlier. She presented to the Emergency Department with abdominal pain and decreased outflow from her catheter. An abdominal CT scan showed a catheter located in the right iliac fossa, mechanical obstruction was suspected, and open abdominal surgery was performed. During the surgery, the fimbriae of the right fallopian tube were found to be trapped in the Tenckhoff catheter. The fallopian tube was freed, and the catheter was adequately repositioned. The patient evolved satisfactorily; peritoneal dialysis was reestablished after two weeks, with no recurrence of long-term entrapment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gómez-Arciniega et al.)

Background: Quality improvement (QI) programs require significant financial investment. The authors evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central catheter (PICC) use., Methods: The authors used an economic evaluation from a health care sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score-matched observations across two time periods for complications (venous thromboembolism [VTE], central line-associated bloodstream infection [CLABSI], and catheter occlusion): preintervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the health care costs avoided due to having lower complication rates., Results: Across 35 hospitals, this study sampled 17,418 PICCs placed preintervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all p < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over seven years, and the average cost-offset per complication averted was $2,614 (95% CI [confidence interval] $2,314-$3,003)., Conclusion: A large-scale, multihospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications., (Copyright © 2024 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Introduction: Cannulation with a central venous catheter (CVC) is a common procedure used in critical care. One of the main complications is occlusion, which can lead to delayed treatment, prolonged hospital stay, and increased health care costs., Objective: The aim of this project was to promote evidence-based practice for nurses caring for patients with a CVC in a Spanish intensive care unit. The project also aimed to reduce CVC occlusion and ensure CVC patency., Methods: This project was guided by the JBI Model of Evidence-based Healthcare and the JBI Evidence Implementation Framework. Seven phases were followed using evidence-based auditing and feedback. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to support data collection, data analysis, and implementation planning., Results: After project implementation, the following results were obtained. Criterion 1 (assessing the CVC, flushing, and aspirating) reached 100% compliance in both audits. Criterion 2 (occlusion documentation) showed a modest improvement, rising from 13.33% to 36.67%. Improvement for Criterion 3 (the need for a policy and protocol) was excellent, rising from 0% at baseline to 100% following implementation. Criterion 4 (rapid instillation of an appropriate thrombolytic agent if a CVC is occluded) remained at 0% compliance in both audits. Criterion 5 (continuing education for health care professionals) improved from 10% to 60%. Criterion 6 (flushing and locking before procedures) improved from 90% to 100%., Conclusion: The project objectives were largely met and resulted in a protocol, which has been shared with other departments within the hospital. The implementation of best clinical practice will be continued, including the use of thrombolytic agents., Spanish Abstract: http://links.lww.com/IJEBH/A200., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 JBI. Unauthorized reproduction of this article is prohibited.)

Background: Peripherally inserted central catheters (PICCs) facilitate diagnostic and therapeutic interventions in health care. PICCs can fail due to infective and non-infective complications, which PICC materials and design may contribute to, leading to negative sequelae for patients and healthcare systems., Objectives: To assess the effectiveness of PICC material and design in reducing catheter failure and complications., Search Methods: The University of Queensland and Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the WHO ICTRP and ClinicalTrials.gov trials registers to 16 May 2023. We aimed to identify other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, as well as relevant systematic reviews, meta-analyses, and health technology assessment reports. We contacted experts in the field to ascertain additional relevant information., Selection Criteria: We included randomised controlled trials (RCTs) evaluating PICC design and materials., Data Collection and Analysis: We used standard Cochrane methods. Our primary outcomes were venous thromboembolism (VTE), PICC-associated bloodstream infection (BSI), occlusion, and all-cause mortality. Secondary outcomes were catheter failure, PICC-related BSI, catheter breakage, PICC dwell time, and safety endpoints. We assessed the certainty of evidence using GRADE., Main Results: We included 12 RCTs involving approximately 2913 participants (one multi-arm study). All studies except one had a high risk of bias in one or more risk of bias domain. Integrated valve technology compared to no valve technology for peripherally inserted central catheter design Integrated valve technology may make little or no difference to VTE risk when compared with PICCs with no valve (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.19 to 2.63; I² = 0%; 3 studies; 437 participants; low certainty evidence). We are uncertain whether integrated valve technology reduces PICC-associated BSI risk, as the certainty of the evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Integrated valve technology may make little or no difference to occlusion risk when compared with PICCs with no valve (RR 0.86, 95% CI 0.53 to 1.38; I² = 0%; 5 studies; 900 participants; low certainty evidence). We are uncertain whether use of integrated valve technology reduces all-cause mortality risk, as the certainty of evidence is very low (RR 0.85, 95% CI 0.44 to 1.64; I² = 0%; 2 studies; 473 participants). Integrated valve technology may make little or no difference to catheter failure risk when compared with PICCs with no valve (RR 0.80, 95% CI 0.62 to 1.03; I² = 0%; 4 studies; 720 participants; low certainty evidence). We are uncertain whether integrated-valve technology reduces PICC-related BSI risk (RR 0.51, 95% CI 0.19 to 1.32; I² = not applicable; 2 studies (no events in 1 study); 542 participants) or catheter breakage, as the certainty of evidence is very low (RR 1.05, 95% CI 0.22 to 5.06; I² = 20%; 4 studies; 799 participants). Anti-thrombogenic surface modification compared to no anti-thrombogenic surface modification for peripherally inserted central catheter design We are uncertain whether use of anti-thrombogenic surface modified catheters reduces risk of VTE (RR 0.67, 95% CI 0.13 to 3.54; I² = 15%; 2 studies; 257 participants) or PICC-associated BSI, as the certainty of evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces occlusion (RR 0.69, 95% CI 0.04 to 11.22; I² = 70%; 2 studies; 257 participants) or all-cause mortality risk, as the certainty of evidence is very low (RR 0.49, 95% CI 0.05 to 5.26; I² = not applicable; 1 study; 111 participants). Use of anti-thrombogenic surface modified catheters may make little or no difference to risk of catheter failure (RR 0.76, 95% CI 0.37 to 1.54; I² = 46%; 2 studies; 257 participants; low certainty evidence). No PICC-related BSIs were reported in one study (111 participants). As such, we are uncertain whether use of anti-thrombogenic surface modified catheters reduces PICC-related BSI risk (RR not estimable; I² = not applicable; very low certainty evidence). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces the risk of catheter breakage, as the certainty of evidence is very low (RR 0.15, 95% CI 0.01 to 2.79; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Antimicrobial impregnation compared to non-antimicrobial impregnation for peripherally inserted central catheter design We are uncertain whether use of antimicrobial-impregnated catheters reduces VTE risk (RR 0.54, 95% CI 0.05 to 5.88; I² = not applicable; 1 study; 167 participants) or PICC-associated BSI risk, as the certainty of evidence is very low (RR 2.17, 95% CI 0.20 to 23.53; I² = not applicable; 1 study; 167 participants). Antimicrobial-impregnated catheters probably make little or no difference to occlusion risk (RR 1.00, 95% CI 0.57 to 1.74; I² = 0%; 2 studies; 1025 participants; moderate certainty evidence) or all-cause mortality (RR 1.12, 95% CI 0.71 to 1.75; I² = 0%; 2 studies; 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter failure (RR 1.04, 95% CI 0.82 to 1.30; I² = not applicable; 1 study; 221 participants; low certainty evidence). Antimicrobial-impregnated catheters probably make little or no difference to PICC-related BSI risk (RR 1.05, 95% CI 0.71 to 1.55; I² = not applicable; 2 studies (no events in 1 study); 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter breakage (RR 0.86, 95% CI 0.19 to 3.83; I² = not applicable; 1 study; 804 participants; low certainty evidence)., Authors' Conclusions: There is limited high-quality RCT evidence available to inform clinician decision-making for PICC materials and design. Limitations of the current evidence include small sample sizes, infrequent events, and risk of bias. There may be little to no difference in the risk of VTE, PICC-associated BSI, occlusion, or mortality across PICC materials and designs. Further rigorous RCTs are needed to reduce uncertainty., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background & Aims: Loss of venous access is threatening for patients with intestinal failure (IF) under long-term parenteral nutrition (PN). We aimed to identify the incidence of central venous catheter (CVC) complications, compare different devices, and analyze interventional recanalizing procedures to restore the patency of occluded CVCs., Methods: For this retrospective cohort study, patient data from a prospective IF database spanning 16 years was analyzed at a tertiary referral center. Catheter dwell times (CDTs) were distinguished by Kaplan-Meier survival analysis and subgroup analyses were performed for different CVC types (tunneled/port catheters). Specific complications (occlusion, catheter-related infection (CRI), displacement, and material defect) were analyzed. Explantation rates and CDTs were compared., Results: Overall, 193 CVCs in 77 patients with IF under PN could be enrolled (62.524 "CVC-days"). Broviac type "B" was found to be significantly superior to type "A" regarding occlusion, CRI, and material defects (log-rank test: p = 0.05; p = 0.026; p = 0.005 respectively). Port catheters were displaying the highest incidence of CRI (2.13 events/1000 catheter days). Interventional catheter recanalization was performed 91 times and significantly increased the CDT from a median of 131 days (IQR: 62; 258) to 389 days (IQR: 262; 731) (Mann-Whitney-U-test: p= <0.001) without increasing complications., Conclusions: Different complication rates and CDT were seen depending on CVC type. Tunneled catheters were significantly superior concerning CRI. Interventional catheter recanalization is a viable alternative to fibrinolytics to restore CVC patency, but long-term patency data is scarce., Competing Interests: Conflict of interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction and Objectives: A central venous catheter (CVC)-a type of central venous access device (CVAD)-is the most common intervention for critical illnesses. Obstruction of the CVC can lead to fatal consequences. Thus, it is critical to maintain catheter lumen patency. The CVC occlusion rate in a hospital in Taiwan was 33%. This project aimed to decrease the CVC occlusion rate in acute care., Methods: This project was conceptually informed by the JBI Evidence-Based Model of Healthcare, in particular, the conceptualization of evidence implementation as inclusive of context analysis, implementation, and evaluation of outcomes using evidence-based quality indicators. As part of the seven-phase implementation process, we used audit and feedback in a pre- and post-test design to measure baseline compliance. Based on the initial audit, we developed an implementation strategy responsive to the identified gaps in compliance. We then undertook a final audit to measure changes in compliance to evaluate our implementation effects. The JBI software, PACES, and the situational analysis software, GRiP, were used for data collection and implementation planning. There were six evidence-based criteria, with a sample size of 30 nurses for each criterion. The team carried out the project from September 2022 to January 2023., Results: Post-implementation audit compliance rates increased to 100% for the following criteria: the organization had a standardized flushing and locking solution protocol (0%), the CVAD lumen was locked upon completion of the final flush (10%), a single-dose system was used for flushing and locking the CVAD (60%), and preservative-free 0.9% sodium chloride was used to flush the CVAD (60%). Furthermore, the CVC occlusion rate decreased from 33% to 5%., Conclusions: The project successfully decreased the rate of CVC occlusion and increased the competence of nurses in acute care settings. The implementation of best practices in clinical care should focus on leadership, cross-department coordination, education, and innovation., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the University of Adelaide, JBI.)

Objective: The aim of this study was to explore how clinical factors, including the number of lifetime revision surgeries and the duration of implantation, affect the degree of obstruction and failure rates of ventricular catheters (VCs) used to manage hydrocephalus., Methods: A total of 343 VCs and their associated clinical data, including patient demographics, medical history, and surgical details, were collected from 5 centers and used for this analysis. Each VC was classified by the degree of obstruction after macroscopic analysis. Univariate, multivariate, and binned analyses were conducted to test for associations between clinical data and degree of VC obstruction., Results: VCs from patients with 0 to 2 lifetime revisions had a larger proportion of VC holes obstructed than VCs from patients with 10 or more revisions (p = 0.0484). VCs implanted for less than 3 months had fewer obstructed holes with protruding tissue aggregates than VCs implanted for 13 months or longer (p = 0.0225). Neither duration of implantation nor the number of lifetime revisions was a significant predictor of the degree of VC obstruction in the regression models. In the multinomial regression model, contact of the VCs with the ventricular wall robustly predicted the overall obstruction status of a VC (p = 0.005). In the mixed-effects model, the age of the patient at their first surgery emerged as a significant predictor of obstruction by protruding tissue aggregates (p = 0.002). VCs implanted through the parietal entry site were associated with more holes with nonobstructive growth and fewer empty holes than VCs implanted via other approaches (p = 0.001)., Conclusions: The number of lifetime revisions and duration of implantation are correlated with the degree of VC obstruction but do not predict it. Contact of the VC with the ventricular wall and the age of the patient at their first surgery are predictors of the degree of VC obstruction, while the entry site of the VC correlates with it.

Background: Burr hole evacuation is a well-established treatment for symptomatic cases with chronic subdural hematoma (cSDH). Routinely postoperative catheter is left in the subdural space to drain the residual blood. Drainage obstruction is commonly seen, and it can be related to suboptimal treatment., Methods: Two groups of patients submitted to cSDH surgery were evaluated in a retrospective non-randomized trial, one group that had conventional subdural drainage (CD group, n ​= ​20) and another group that used an anti-thrombotic catheter (AT group, n ​= ​14). We compared the obstruction rate, amount of drainage and complications. Statistical analyses were done using SPSS (v.28.0)., Results: For AT and CD groups respectively (median ​± ​IQR), the age was 68.23 ​± ​26.0 and 70.94 ​± ​21.5 (p ​> ​0.05); preoperative hematoma width was 18.3 ​± ​11.0 ​mm and 20.7 ​± ​11.7 ​mm and midline shift was 13.0 ​± ​9.2 and 5.2 ​± ​8.0 ​mm (p ​= ​0.49). Postoperative hematoma width was 12.7 ​± ​9.2 ​mm and 10.8 ​± ​9.0 ​mm (p ​< ​0.001 intra-groups compared to preoperative) and MLS was 5.2 ​± ​8.0 ​mm and 1.5 ​± ​4.3 ​mm (p ​< ​0.05 intra-groups). There were no complications related to the procedure including infection, bleed worsening and edema. No proximal obstruction was observed on the AT, but 8/20 (40%) presented proximal obstruction on the CD group (p ​= ​0.006). Daily drainage rates and length of drainage were higher in AT compared to CD: 4.0 ​± ​1.25 days vs. 3.0 ​± ​1.0 days (p ​< ​0.001) and 69.86 ​± ​106.54 vs. 35.00 ​± ​59.67 ​mL/day (p ​= ​0.074). Symptomatic recurrence demanding surgery occurred in two patients of CD group (10%) and none in AT group (p ​= ​0.230), after adjusting for MMA embolization, there was still no difference between groups (p ​= ​0.121)., Conclusion: The anti-thrombotic catheter for cSDH drainage presented significant less proximal obstruction than the conventional one and higher daily drainage rates. Both methods demonstrated to safe and effective for draining cSDH., Competing Interests: Dr. Alkhachroum is supported by an institutional KL2 Career Development Award from the Miami 10.13039/100006975CTSI 10.13039/100006108NCATS UL1TR002736 and by the 10.13039/100000065National Institute of Neurological Disorders and Stroke of the 10.13039/100000002National Institutes of Health under Award Number K23NS126577. All other authors don't have conflicts of interest to declare.All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. This study doesn't have funding support., (© 2023 The Authors.)

Aim: To investigate the safety and feasibility of extending the flushing interval for the totally implantable venous access port (TIVAP) during the non-treatment stage in patients with breast cancer (BC) by retrospectively analyzing the patients' clinical data, including the incidence of TIVAP-related complications., Methods: This single-center retrospective study included patients with BC who underwent TIVAP implantation at our hospital between January 2018 and March 2021 during their non-treatment phase and visited the hospital regularly for TIVAP flushing. Among the 1013 patients with BC who received TIVAP implantation, 617 patients were finally included on the basis of the inclusion and exclusion criteria and divided into three groups according to the length of the flushing interval: group 1 (≤30 days, n = 79), group 2 (31-90 days, n = 66), and group 3 (91-120 days, n = 472). The basic characteristics of patients in each group and the incidence of TIVAP-related complications (catheter obstruction, infection, and thrombosis) were analyzed., Results: No significant intergroup differences were observed in age, body mass index (BMI), tumor stage, pathological staging, implantation approach, chemotherapy regimen, duration of treatment, and TIVAP-related blood return rate (P > 0.05). Among patients from all three groups, 11 cases of catheter pump-back without blood and eight cases of TIVAP-related complications such as infection, thrombosis, and catheter obstruction were recorded. However, no significant differences in TIVAP-related complications were observed among the three groups (P > 0.05)., Conclusion: Extending the TIVAP flushing interval beyond three months during the non-treatment stage in BC patients is safe and feasible and did not increase the incidence of TIVAP-related complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Tian, Chen, Zhang, Wang, Fan, Zhang, Qi, Hu and Yang.)

Purpose: Central line complications remain a problem in critical care patient populations. Various interventions to prevent or treat complications, such as central line-associated bloodstream infection and occlusion, have been the focus of recent research. Although alternative catheter locking solutions have been shown to be effective in other patient populations, their applicability to the critical care setting remains unclear. Due to the high acuity of critical care patients, it is uncertain whether their central lines remain locked for a duration long enough for alternative locking solutions to provide any effect., Methods: This single-centre, prospective, observational study aimed to gather information about the length of time central line lumens remain in a locked state in the average critical care patient. Baseline rates of various central line complications were also tracked., Results: Results of this study indicate that the majority of central lines will have at least one lumen locked for an average of 36.6% of their time in situ., Conclusions: It is anticipated that this length of time provides enough exposure for alternative locking solutions to potentially make a difference in central line complications in this patient population. Results of this study can be used for planning future multi-centre, randomized controlled trials investigating the efficacy of novel central line locking solutions to prevent central line complications in critically ill patients.

Objectives: to estimate incidence and free time of peripherally inserted central catheter obstruction in newborns undergoing red blood cell transfusion in the first 24 hours after the procedure., Methods: a longitudinal study, carried out with neonates in Neonatal Intensive Care Unit at a teaching hospital in Paraná, between January and July 2019. The sample consisted of 46 transfusion events performed in neonates through a peripherally inserted central catheter. Analysis performed according to descriptive statistics., Results: thirty-one catheters were analyzed, inserted in 24 neonates, through which 46 red blood cell transfusions were performed. Most neonates were male, gestational age <32 weeks, weight <1,500 grams, hospitalized mainly for prematurity. Among the 31 catheters, one (3.2%) presented obstruction after transfusion., Conclusions: The occurrence of obstructions immediately after transfusion was low and the catheters remained complication free for the next 24 hours.

Background: Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce., Aims: This study aimed to evaluate off-label use of alteplase for midline catheter occlusions., Method: Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study. The primary outcome was restoration of infusion or withdrawal function from at least one lumen of a treated midline catheter., Findings: Following alteplase administration, withdrawal function was restored in 47% (25/53) of occlusion events, infusion function was restored in 65% (11/17) of complete occlusion events, and infusion or withdrawal function was restored in 58% (31/53) of occlusion events. Only 34% (17/50) of catheters were replaced because of malfunction. Local bleeding was documented in 9% ( n =5) of occlusion events after alteplase administration., Conclusion: Most midline catheter occlusions treated with alteplase demonstrated restoration of infusion or withdrawal function.

Although central venous catheter (CVC)-related thrombosis (CRT) is a severe complication of home parenteral nutrition (HPN), the amount and quality of data in the diagnosis and management of CRT remain low. We aimed to describe current practices regarding CVC management in French adult and pediatric HPN centers, with a focus on CVC obstruction and CRT. Current practices regarding CVC management in patients on HPN were collected by an online-based cross-sectional survey sent to expert physicians of French HPN centers. We compared these practices to published guidelines and searched for differences between pediatric and adult HPN centers' practices. Finally, we examined the heterogeneity of practices in both pediatric and adult HPN centers. The survey was completed by 34 centers, including 21 pediatric and 13 adult centers. We found a considerable heterogeneity, especially in the responses of pediatric centers. On some points, the centers' responses differed from the current guidelines. We also found significant differences between practices in adult and pediatric centers. We conclude that the management of CVC and CRT in patients on HPN is a serious and complex situation for which there is significant heterogeneity between HPN centers. These findings highlight the need for more well-designed clinical trials in this field.

Objective: to evidence the use of flushing to prevent complications from intravenous therapy., Methods: an integrative review in databases, using descriptors and selection criteria. Data were collected in 12 articles using an instrument and later classified, summarized and aggregated for knowledge synthesis., Results: it was evident that: the pre-filled syringe resulted in a lower occurrence of catheter obstruction; irregular flushing frequency caused advanced phlebitis; the use of Venous Arterial Blood Management Protection (VAMP) generated a lower incidence of blood infection; heparinized solution did not result in a lower central catheter failure rate; flushing volume and frequency were not predictors of catheter failure; flushing practice was not shown to be incorporated among professionals., Conclusion: there are disagreements about the volume, frequency, solution and devices used in flushing. New technologies can reduce complications such as obstruction and infection.

Background: The totally implanted vascular access device (TIVAD) is commonly used in patients with malignant tumors requiring chemotherapy or long-term intravenous infusion and those with difficulty placing peripheral venous catheters. It could also be used to draw blood in pediatric patients. Thus, how to maintain the patency and longevity of TIVAD is always emphasized., Methods: In this prospective study, TIVAD was randomly infused in patients under 18 years with three different concentrations of heparinized solutions: 10 mL with 100 U/mL heparin, 20 mL with 10 U/mL heparin, and 30 mL with 10 U/mL heparin., Results: A total of 81 patients (46 males and 35 females) were enrolled in this study from August 2, 2013 to February 1, 2017. The mean age of those who received TIVAD implantation was 7.2 ± 5.3 years, and the mean duration of using TIVAD was 1027.6 ± 369.1 days. Patients without catheter occlusion events experienced significantly shorter hospitalizations, fewer admissions, and fewer punctures than those with catheter occlusion events (p < 0.05). The administration and frequency of blood transfusions, history of bacteremia, and medication history did not increase the risk of catheter occlusion, but puncture frequency increased this risk. In patients with catheter occlusion events (38/81, 46.9%), catheter patency was restored after instillation of urokinase solution., Conclusion: In this study, the risk of TIVAD catheter occlusion was only related to puncture frequency regardless of the heparin flush composition or patient characteristics. A high puncture frequency of TIVAD during the 3.5-year study period significantly increased the risk of catheter occlusion. Besides, flushing and locking solutions for TIVAD using heparin at 10 U/mL was effective as using heparin at 100 U/mL regardless of the flushing volume of 10, 20, or 30 mL., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2021, the Chinese Medical Association.)

Introduction: Intraluminal thrombolytic therapy is the first step treatment of thrombotic malfunction of tunneled hemodialysis catheters (THC). The factors that affect catheter restoration and also catheter survival following thrombolytic therapy are not well described. In this study, we aimed to reveal the predictors that affect the success of the procedure and also present post-restoration catheter patency after intraluminal thrombolytic administration., Method: This retrospective study included 62 patients with tunneled THC thrombosis treated with alteplase between 2017 and2020 in the study center. Age, comorbidities, the use of antiplatelet and anticoagulants, a history of catheter thrombosis, time on dialysis, the duration of the catheter were investigated as possible predictors of procedural success. The independent predictive factors for procedural success were evaluated by using backward stepwise likelihood ratio logistic regression analysis. Primaryand assisted patencieswere presented with Kaplan-Meier graphs., Results: Thrombolityc was administered to 62 patients 102 times. The median primary patency from the first thrombolytic administration to a second catheter thrombosis was 9 months (range 1-20 months). The overall median patency was 12 months (range 2-23 months). The overall procedural success rate was 79.4% (81/102).Multivariate analyses revealed that a history of prior catheter thrombosis was the only risk factor for procedural success (OR: 0.49; 95% CI: 0.26-0.91; p = 0.004). The need for a second dwell time among patients with prior history of thrombolysis was significantly higher compared to patients without a history of catheter thrombosis (12/26 patients, 46.2% and 6/55 patients, 10.9%; respectively; p = 0.001)., Conclusion: The success of thrombolysis in subsequent de novo THC thrombosis decreases in patients who previously required intraluminal thrombolytic administration. Identifying patient subgroups with a high risk for THC thrombosis may be useful to investigate effective secondary prevention strategies.

Background: Subclavian vein (SV) catheterization is a method for the delivery of fluids, drugs, and blood products, venous blood sampling, and central vein pressure monitoring in cardiac surgery. Catheter occlusion is a serious complication of SV catheterization during cardiac surgery, especially after sternal retractor expansion., Methods: In this observational study, 303 patients who had successful right infraclavicular SV catheterization from September 2019 to April 2020 were enrolled to determine the incidence of catheter occlusion. After catheterization, the lumens of all catheters were checked for the ability to infuse and withdraw blood from the catheter before and after sternal retractor expansion. The patients' characteristics, cannulation approach, on-pump or off-pump technique, occlusion of the catheter and its lumens, and any associated complications were recorded. The data were analyzed using IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA)., Results: Of the 303 patients studied, 205 were male (67.7%) and 98 were female (32.3%). Catheter occlusion occurred in 11 patients with on-pump cardiopulmonary bypass (CPB) (227 patients) and 4 patients with off-pump CPB (76 patients) (p=0.863). The incidence of catheter occlusion was 4.95% (15 of 303 patients) with no cases of simultaneous 3-lumen occlusion in a catheter. The most commonly occluded lumen was the distal lumen (57.92%). Simultaneous 2-lumen occlusion occurred in 4 patients. Catheter occlusion was found in 3 of 13 malpositioned catheters (23.07%)., Conclusion: The current study showed that malpositioning of the catheter tip was a risk factor for catheter occlusion and that the distal lumen of a triple-lumen catheter was the most commonly occluded lumen.

Continuous intraperitoneal insulin infusion, from an implanted insulin pump connected to a catheter that delivers insulin directly to the peritoneal cavity has many clinical advantages for patients with Type 1 diabetes. However, the ongoing incidence of catheter obstructions remains a barrier to the widespread use of this therapy. To date, the root cause of these obstructions remains unknown. Here, a two-year clinical investigation was conducted, along with the development of an animal model to enable a mechanistic investigation into this issue. This novel animal model was able to mimic the catheter obstructions that occur in patients and, fortuitously, at an accelerated rate. This model allowed for independent assessment of each potential cause associated with catheter obstructions to help identify the root cause. Both macroscopic and microscopic analysis were conducted with regards to the onset and progression of catheter obstructions, along with monitoring of insulin delivery. Interestingly, although insulin aggregation occurs in insulin pumps and insulin aggregates were found in some catheter obstructions, insulin is unlikely to be the root cause, since obstructions also occurred in the control groups where only diluent (no insulin) was administered to the animals. Inflammatory cells, different phenotypes of fibroblasts, as well as collagen were observed in all obstructed catheters explanted from the patients and the animals. The presence of these cells and collagen is indicative of a typical foreign body reaction. In addition, the dynamic change in the fibroblasts with respect to morphology, phenotype, and spatial distribution suggests that tissue irritation-mediated epithelial to mesenchymal transition plays a role in catheter obstructions., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Children with intestinal failure (IF) require parenteral nutrition (PN) at home, delivered through a central venous catheter (CVC) to support growth. CVC-related complications including infection, breakage, and blockage are the most common cause of readmission to the hospital. The objective of this study was to evaluate the use of instructional videos as part of the caregiver home PN-teaching program to reduce CVC-related complications., Methods: Caregivers of children with IF requiring home PN were surveyed to assess skill confidence and interest in instructional videos for skill acquisition. Videos were then created using a smartphone and free video-editing software. Input from stakeholders (families, care providers) was incorporated in video production. Families were given access to the videos, and CVC-related complications were compared for 2 years prior to and 1 year following video introduction with Welch t-test analysis., Results: After obtaining ethics approval, 11 caregivers were surveyed. Thirty percent reported feeling underconfident in their skills at the time of discharge. After viewing the videos, 100% of caregivers reported that these videos were useful. Catheter-related complication rates significantly decreased in the year following the video introduction from 7.88 to 2.65 complications per 1000 catheter days (P = .046). This included reductions in catheter-related infections, catheter occlusions, and breakages., Conclusions: Children with IF receiving home PN are at high risk for CVC-related complications, and caregivers are the first line of defense for catheter care. Instructional videos were low-cost to create, were well received by all families, and may contribute to reduced catheter-related complications., (© 2021 American Society for Parenteral and Enteral Nutrition.)

Background: Up to 50% of all long-term catheterized individuals experience recurrent episodes of urinary catheter infections and blockages, leading to urine retention, pyelonephritis and septicaemia if the catheter is left in situ. We have previously reported the synergistic activity of weak organic acid (WOA) combinations against nosocomial uropathogens., Aim: To investigate the efficacy of selected WOAs, citric acid and propionic acid, alone and in combination, on prevention of crystalline biofilm formation and catheter blockages., Methods: Static crystallization assays and dynamic in vitro bladder model assays, with scanning electron microscopy, were performed for determination of bacterial viability, urinary pH and time to catheter blockage., Findings: The rate of encrustation around the catheter eyeholes was reduced in the presence of the citric acid/propionic acid combination, extending the time to blockage three-fold., Conclusion: Synergistic WOA combinations identified herein represent promising alternatives to antibiotics to combat the global healthcare burden of catheter-associated urinary tract infections and related blockages., (Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Central venous occlusive disease (CVOD) is a prevalent problem in patients with end-stage renal disease (ESRD) and can lead to access malfunction or ligation for symptomatic relief. The purpose of this study is to evaluate the efficacy of the TriForce® Peripheral Crossing Set (Cook Medical), a novel reinforced telescoping catheter set designed to provide additional support for crossing difficult central venous occlusions., Methods: This is a single-center retrospective study from a quaternary referral center. We identified 37 patients over a 17-month period who underwent 56 attempts at endovascular recanalization for the treatment of central venous occlusion. Technical success rates, procedural data, and outcomes were compared between those undergoing recanalization using traditional wire/catheter sets versus the TriForce catheter set., Results: Average age was 48 ± 2 years. Comorbidities were similar between the two cohorts and included ESRD (61%), deep venous thrombosis (30%), and May-Thurner syndrome (7%). Forty attempts were made with traditional wire/catheter sets and 16 attempts with the TriForce catheter set to treat 2.1 ± 0.2 and 1.9 ± 0.3 occluded venous segments, respectively (P = 0.74). Technical success rates were significantly higher for the group undergoing recanalization using the TriForce catheter (69% versus 38%, P = 0.04) and 4 patients were successfully recanalized using the TriForce catheter set after a failed attempt with traditional wire/catheter sets. Mean fluoroscopy time and radiation dose were 13 ± 3 min and 14,623 ± 2,775 μGy∗m 2 for traditional techniques versus 30 ± 6 min and 30,408 ± 10,433 μGy∗m 2 for the novel telescoping catheter set (P = 0.01 and 0.09, respectively). Freedom from reintervention at 1 year was 60% for the TriForce cohort versus 44% for the traditional wire/catheter cohort (P = 0.25)., Conclusions: The novel TriForce reinforced telescoping catheter set is a useful adjunct that may improve recanalization rates of CVOD compared with traditional wire/catheter sets., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Intravenous (IV) catheter insertion may cause adverse reactions. It is necessary to investigate optimal methods for reducing blood return and extending the usage time of IV catheter by existing technologies. We investigated the efficacy of the PosiFlow regulator with an infusion clip for preventing IV catheter plugging due to venous blood return., Methods: From January 2017 to August 2017, 960 patients requiring IV catheterization were recruited and by using the block randomization method randomly allocated to 4 groups (n=240 in each group): a control group receiving IV catheter with infusion clip; experimental group A receiving IV catheter without infusion clip; experimental group B receiving an IV catheter with the PosiFlow regulator; and experimental group C receiving an IV catheter with a PosiFlow regulator and infusion clip. The rates of catheter plugging and blood return were compared among groups., Results: In different reasons for needle pulling, The rates of catheter plugging and blood return in experimental group C (Received IV catheterization with an infusion clip and PosiFlow regulato) were the lowest among all groups (P<0.05). In different puncture sites, forearm puncture further reduced IV catheter plugging in all groups compared to other puncture sites., Conclusions: Catheter plugging and blood return can be significantly reduced by combining the PosiFlow regulator and an infusion clip, resulting in reduced medical costs and patient distress from catheter reinsertion.

Aims: The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications., Design: This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies., Data Sources: The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019., Review Methods: Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models., Results: Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter-related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department-inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies., Conclusion: Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi-specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced., Impact: Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters., (© 2020 John Wiley & Sons Ltd.)

Catheter obstruction is a major cause of dialysate flow problems in peritoneal dialysis (PD). It will lead to PD technique failure, when its conservative management such as vigorous instillation of dialysate occasionally fails to salvage the catheter potency. In this report, we present two cases of catheter obstruction caused by intraluminal clots of PD catheter. The clots, which could not be removed by the conservative management, were removed by a new technique using an angiographic guidewire. The technique could be an option to resolve PD catheter obstruction.

Introduction: Central or peripheral vascular access devices have been in use for many decades. However, despite adequate care and maintenance, complete occlusion may occur, and its impact cannot be overlooked. A new procedure using a percussion technique has been published and referred as 'the POP technique'., Methods: A hydrodynamic bench was used permitting both the recording of the movement of the piston with a fast camera and the pressure variations in the polyurethane and silicone catheters while connected to 2- and 3-piece syringes., Results: The results are twofold. First the upward movement of the piston leads to the installation of a saturation vapour pressure in the body of the syringe. During this sequence, the clot is submitted to a force of aspiration. Then the release of the plunger leads to a pulse pressure whose dynamics and intensity are dependent of the types of syringes and catheters., Conclusions: The experiments bring to light the importance of practical features such as the orientation of the syringe and the nature of the polyurethane or silicone catheters. Then the analysis enables the definition of practical rules for safe practice of the POP technique. This study will impact clinicians as many may be tempted to use the technique in hope to resolve the occlusion safely, in a timely manner.

Central venous catheter (CVC) dysfunction is often associated with thrombosis, which in turn has been linked with poorer survival outcomes in cancer patients. Our objective was to examine the association of tissue plasminogen activator (tPA) administration as a surrogate measure of CVC dysfunction with survival in pediatric cancer patients. The present study uses data from a population-based retrospective cohort of pediatric oncology patients from the Canadian Maritime provinces treated between 2000 and 2017 at the IWK Health Centre, Halifax, NS. Demographics, diagnosis, date of death or date of last visit, and tPA use for CVC dysfunction were obtained from clinical databases and the provincial Cancer in Young People in Canada registry. The association between tPA administration and survival was examined using a Cox regression model adjusted for sex, age at diagnosis, cancer type, thrombosis, CVC duration, diagnosis era, and treatment modalities. Out of 821 patients, 206 received one or more doses of tPA during upfront therapy. The death rate was 21% and 15% respectively in patients who did and did not receive tPA. In the adjusted regression model, after receiving one or more doses of tPA, children had significantly poorer survival as compared to those that did not receive tPA (HR: 1.496, 95% CI: 1.019, 2.197). CVC dysfunction may be associated with a poorer prognosis in pediatric cancer patients. Future studies should corroborate these findings in other populations, examine the influence of other potential confounders, and determine the role of CVC dysfunction in prognostic models of cancer survival.

Objective: to analyze the evidence available in the literature about the lowest necessary dose of heparin to maintain the patency of the totally implanted central venous catheter in adult cancer patients., Method: an integrative literature review, carried out in the following databases: Literatura Latino-Americana e do Caribe em Ciências de Saúde, Sciverse Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, including thirteen studies., Results: the evidence showed that the dose of heparin (300 IU/ml) is the most used in maintaining the patency of the totally implanted central venous catheter., Conclusion: according to the selected studies, the lowest dose of heparin found in maintaining the patency of the totally implanted central venous catheter in cancer patients was 10 UN/ml with a volume of 5 ml of the heparin solution.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a disorder of aging that is characterized by enlarged cerebral ventricles, gait apraxia, dementia, and urinary incontinence. iNPH is frequently misdiagnosed, in part because the symptoms resemble other neurological disorders, and because other associated symptoms have not been fully characterized. Importantly, iNPH has not previously been associated with stuttering, and shunting has not been shown to alleviate the symptom of stuttering., Case Descriptions: Here, we report 2 cases of patients with iNPH presenting with stuttering that resolved after ventriculoperitoneal (VP) shunt placement. Each patient presented with gait difficulty, incontinence, cognitive impairment, and stuttering. Lasting improvements of the symptoms (including stuttering) were seen in both patients after cerebrospinal fluid (CSF) drainage procedures that included lumbar puncture, extended lumbar CSF drainage, placement of a VP shunt, and VP shunt revision., Conclusions: These findings suggest that iNPH can present with stuttering or dysarthria. The significant improvement in stuttering and dysarthria, along with the improvements in gait difficulty, incontinence, and cognitive impairment that occurred after CSF drainage, suggests that the motor apraxia observed in iNPH can affect speech production. Practitioners should be aware that iNPH can present with stuttering, and that CSF drainage can improve stuttering in select circumstances., (Copyright © 2019 Elsevier Inc. All rights reserved.)

At present, central venous access devices (CVADs) are widely used in clinical practice. The reasons for CVAD obstruction caused by precipitated medication or lipids are increasingly complex. However, there is no clear treatment program for CVAD obstruction caused by precipitated medication or lipids. The target of this study was to analyze data regarding obstruction caused by precipitated medication or lipids in CVADs and to calculate the efficacy of different treatment methods. A systematic review with meta-analysis was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The PubMed, Web of Science, EMBASE, Cochrane Library, CINAHL, and China National Knowledge Internet databases were searched for original research published before 2018. There were 1356 publications initially screened, with one additional study identified through snowballing. Seven studies met the inclusion criteria. The reasons for obstruction, except for clot formation, primarily included the following: mechanical complications; lipid deposition; mineral deposition; or drug precipitation. Meta-analysis showed that sodium hydroxide resulted in the highest recanalization rate in lipid deposition, followed by ethanol, and the difference was significant. The efficacy analysis revealed that hydrochloric acid and l-cysteine have similar effects on mineral deposition and drug precipitation. According to this review, the most effective methodology was shown to be the intravenous perfusion of sodium hydroxide in several treatments when the obstruction is caused by lipid deposition. In contrast, mineral deposition and drug deposition are best treated with l-cysteine to recover the patency of central venous access devices.

Background: Prophylactic laparoscopic omentopexy is a safe technique to prevent catheter obstruction during peritoneal dialysis (PD). Here we described a technique through which the omentopexy was accomplished by Hem-o-loks before PD catheter insertion., Methods: The procedures of omentopexy were described. To evaluate the efficiency of this surgical method, a retrospective review of PD catheter insertion cases and their follow-ups were performed, covering 10 consecutive patients with end-stage renal disease., Results: All patients showed no intraoperative events. No catheter flow obstruction, migration, exit-site infection appeared during the follow-up., Conclusion: Laparoscopic PD catheter insertion using omentopexy can decrease catheter obstruction and migration.

Background: Invention of peritoneal dialysis (PD) has opened new windows for patients under dialysis due to its fewer time requirement and being ambulatory in comparison to hemodialysis. Open surgery and laparoscopic technique have been utilized for peritoneal catheter embedding; however, data about the superior technique are controversial. This study aimed to assess the outcomes of open surgery versus laparoscopic technique and compare their complications in those with survival of over and less than a year in patients who need PD for the first time., Materials and Methods: This randomized clinical trial study was conducted on 121 cases admitted for PD. Patients were randomly divided into two groups undergoing either open or laparoscopic surgery for embedding PD catheter. Patients' demographics, as well as PD function and complications, were followed for a 12-month duration and compared between the two groups., Results: Catheter survival for over 12 months occurred in 39 patients (65%) underwent laparoscopic surgery, and 45 (73.8%) patients underwent open surgery ( P = 0.09). Complications, including catheter obstruction, leak, abdominal hernia, and peritonitis, were not statistically different between the two techniques over 12 months of survival ( P > 0.05). Complications among the catheters with less than a year survival, including obstruction, leak, catheter displacement, hernia, and peritonitis, were not significantly different comparing open surgery with laparoscopic technique ( P > 0.05)., Conclusion: Considering complications, PD catheter implantation through laparoscopic surgery was not statistically different from open surgery, neither for those with less than 12 months of survival nor for those with over a year., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Research in Medical Sciences.)

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

Purpose/Aim : In developing a novel peritoneal oxygenation therapy, catheters implanted into the peritoneal cavity became obstructed with omental tissue and prevented the infusion and removal of fluid from the peritoneal cavity. The obstruction of peritoneal catheters is a significant failure in researching various peritoneal treatments as further fluid administration is no longer possible. The purpose of this preliminary study was to determine the most effective catheter design for infusion and removal of fluid into the peritoneal cavity of rats. Materials and Methods : Four types of catheters were tested including the Jackson-Pratt, round fluted drain, flat fluted drain, and an original design. Three of each catheter type were surgically placed into the peritoneal cavity of rats ( n = 12). In order to test the efficacy of each catheter, saline was infused and extracted twice daily. Catheters were scored on a weighted scale based on the amount of time they remained patent, the subjective force needed for extraction/infusion, and the amount of saline removed. Results : The round and flat fluted drain catheters remained patent for the full duration of the study (12 days) compared to the other models which failed after 7 days. These catheters also yielded a high average for extracted saline volume and an easy extraction/infusion. Conclusions : The round and flat fluted drain catheters were recognized as viable options to be used in rats for peritoneal drain studies of up to 12 days.

The prevalence rate and the incidence rate of hemodialysis and functioning kidney transplant recipients have continuously increased; on the contrary, those of peritoneal dialysis have continuously decreased since 2006. Dialysis patients have been getting older and have been maintained on dialysis longer. Diabetic nephropathy was the leading cause of end stage renal disease. The type of hemodialysis vascular access has been stable during the last 5 years (arteriovenous fistulas 76%, arteriovenous grafts 16%, central venous catheters 8% at 2016). Peritoneal dialysis catheter was mostly inserted surgically (67%), and swan neck straight tip peritoneal dialysis catheter was the most commonly used (48%). Vascular access was managed by radiologists and surgeons, and the management was fragmented among them in the past. However, since the nephrologists became interested in and knowledgeable about the vascular access, they began to play roles in vascular access management. Vascular access has been mostly created by vascular surgeons (≈60%); tunneled central venous hemodialysis catheter insertion and endovascular intervention such as percutaneous transluminal angioplasty (PTA) and thrombectomy have been mostly performed by radiologists (≈70%). Tunneled hemodialysis catheter insertion and endovascular intervention by nephrologists have slowly but consistently increased. Recently, the number of central venous hemodialysis catheter insertion has decreased, and tunneled hemodialysis catheter has been inserted more than non-tunneled hemodialysis catheter, indicating that vascular access has been created timely and the vascular access team has been educated about and following international guidelines.

Two major complications of indwelling urinary catheterisation include infection and mineral encrustation of the catheter. Our antimicrobial urinary catheter (AUC) impregnated with rifampicin, triclosan, and sparfloxacin has demonstrated long-term protective activity against major uropathogens. This study aimed to firstly assess the ability of the AUC to resist mineral encrustation in the presence and absence of bacteria. Secondly, it aimed to investigate the AUC's anti-biofilm activity against multi-drug resistant organisms. There was no difference in surface roughness between AUC and control segments. In a static and a perfusion model, phosphate deposition was significantly reduced on AUCs challenged with P. mirabilis. Furthermore, none of the AUCs blocked during the 28 day test period, unlike controls. The AUC prevented colonisation by methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, extended-spectrum beta-lactamase producing E. coli, and carbapenemase-producing E. coli for 12 consecutive weekly challenges. All three drugs impregnated into the catheter continued to exert protective activity throughout 12 weeks of constant perfusion. The drugs appear to migrate into the crystalline biofilm to continually protect against bacteria not it direct contact with the catheter surface. In conclusion, the AUC reduces mineral encrustation and may increase time to blockage in the presence of P. mirabilis, and does not predispose to mineral deposition under other conditions. It also offers 12 weeks of protection against multi-drug resistant bacteria. STATEMENT OF SIGNIFICANCE: Infection and associated mineral encrustation of urinary catheters are two serious complications of indwelling urinary catheters. Others have attempted to address this through various technologies such as coatings, dips, and surface modifications to prevent infection and/or encrustation. However, all current 'anti-infective' urinary catheter technologies are limited to short-term use. Some patients with spinal injuries, multiple sclerosis, stroke survivors and others use long-term catheters for 4-12 weeks at a time with multiple catheterisation possibly throughout the rest of their life. We present a urinary catheter for long-term use that is impregnated with three antimicrobials by a patient-protected process to prevent infection and encrustation for up to 12 weeks, the maximum lifetime of a long-term catheter before it is changed., (Copyright © 2019 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

To determine micro-organisms attached to removed urethral catheters and relate this to patient-specific information. Indwelling urethral catheters were collected from patients at a UK teaching hospital. The balloon and lumen were sonicated, and micro-organisms were enumerated. Catheter specimen urine results were retrospectively reviewed. Escherichia coli and Enterococcus faecalis were the most common isolates from 61 catheters. 19.7% of patients received antibiotics and 25 % of those had a multi-drug-resistant (MDR) organism in the lumen. Only 2.04% of catheters from patients not receiving antibiotics had a MDR organism. All lumens were colonized irrespective of antibiotic use. Symptom presentation did not correlate with numbers of colonizing organisms or species. Despite heavy colonization, only 8/61 patients were symptomatic. Indwelling urinary catheters in place for ≥10 days were universally colonized and there was no correlation with symptom presentation. Symptom presentation remains the most important factor for defining catheter-associated urinary tract infection.

For patients receiving home parenteral nutrition (HPN), vascular access with a central venous catheter (CVC) is essential to safely administer parenteral nutrition (PN) to meet their nutrition and hydration needs. Unfortunately, despite rigorous training and prevention strategies, CVCs are susceptible to complications such as infection, occlusion, thrombosis, and mechanical failure. Much of the published research on CVC complications focuses on infections; however, catheter occlusions and mechanical failures also contribute significantly to catheter dysfunction and loss. Frequent CVC exchanges put HPN patients at risk of loss of vascular access, making it essential that any strategies that can salvage the CVC be implemented prior to removal. CVC repair is 1 technique that can be utilized to avoid CVC exchanges in certain situations. CVC repairs can be performed in the office or on the ward and are cost effective when compared with CVC replacement. When performed by trained clinical staff, the procedures are highly successful and associated with low risk., (© 2019 American Society for Parenteral and Enteral Nutrition.)

Purpose: To determine the frequency of luminal obstruction on appendiceal graded compression sonography (US) in patients with uncomplicated appendicitis and test the hypothesis that this frequency is similar to the failure rates of primary antibiotic therapy for uncomplicated appendicitis when treatment selection is based on CT findings., Methods: Sonograms of 150 consecutive patients with appendicitis diagnosed on ultrasound (US) and proven histopathologically were retrospectively evaluated; 114 (76.0%) had uncomplicated appendicitis, that is, appendicitis without gangrene or perforation, and were evaluated for appendicolithiasis and lymphoid hyperplasia using previously published sonographic criteria, and for luminal obstruction., Results: Of the 114 patients with uncomplicated appendicitis, US demonstrated no luminal obstruction in 74 (64.9%) and luminal obstruction in 40 (35.1%, P = .018), the latter including 16 (40.0%) with lymphoid hyperplasia and 24 (60.0%, P = .074) with appendicolithiasis., Conclusions: US demonstrated luminal obstruction in 35.1% of patients with uncomplicated appendicitis, similar to the published failure rates of antibiotic therapy when treatment selection is based on CT. This confirms the hypothesis, supporting the possibility that undiagnosed luminal obstruction may account for treatment failures when patients are selected by CT for primary antibiotic therapy, and suggests a role for US in selecting patients without luminal obstruction for antibiotic therapy., (© 2018 Wiley Periodicals, Inc.)

Background:: There are few data to inform decisions about the optimal management of occluded tunneled cuffed hemodialysis catheters with thrombolytic locking solutions. The effect of dose, dwell-time, and number of administrations remains controversial., Methods:: In this retrospective single-center review of tunneled cuffed catheters used between 2010 and 2014, restoration of blood flow as well as pre- and post-pump pressures after either short (30 min) or prolonged (48-72 h) administration of 100,000 IU of urokinase locking solution was evaluated in all thrombotic dysfunctions. We also assessed if multiple urokinase locks for the same thrombotic dysfunction event were more efficient to restore catheter performance than single administration., Results:: Data on 773 thrombotic events in 148 patients (236 catheters) were collected during observation period. After urokinase treatment, blood flow and pre-pump pressure improved (median of 50 mL/min and 20 mmHg) whereas post-pump pressure decreased (median of 15 mmHg) (all P < 0.0001). The short thrombolytic procedure, used in more severely dysfunctional catheters, resulted in significantly larger improvements in catheter function than the long procedure. Multiple administrations for the same thrombotic event further improved access function in case of persisting dysfunction after first lock but had no added beneficial effect if blood flow and/or pump pressures were normalized after first urokinase lock., Conclusion:: Both short and prolonged administration of urokinase locks were efficient in restoring blood flow and pre- and post-pump pressures in dialysis catheters with thrombotic dysfunction. Multiple urokinase locks provide added benefit on these outcomes only in case of persisting dysfunction after the first lock.

Aim: The aim of this study was to compare peripheral arm ports versus central chest ports in complication rates., Background: Late complications of arm ports versus chest ports, including catheter-related infection, venous thrombosis and catheter obstruction, remain controversial., Design: A meta-analysis conducted following the Cochrane handbook., Data Sources: Studies published between 1950-August 2017 were searched through Pubmed, Embase, Web of science and Cochrane library., Review Methods: Two authors independently searched the eligible studies and extracted the data. Studies reporting complications of arm ports compared with chest ports, published in full texts and abstracts, were included. The quality of the studies was assessed with the Newcastle-Ottawa Scale. We did subgroup analyses according to cancer type, age, follow-up and anticoagulant. Relative ratios were calculated with different models., Results: A total of 15 articles covering 3,524 tumour patients met the eligibility criteria. There was no difference in catheter-related infection and catheter obstruction between arm ports and chest ports. After reducing the high heterogeneity, no difference was observed in thrombosis overall; however, arm ports had a lower thrombosis rate than chest ports in patients with head and neck cancer, while a higher thrombosis rate was observed in patients <60 years old or follow up ≥1 year. Further studies are needed in venous thrombosis., Conclusions: Arm ports are a safe option beside chest ports for adult patients with malignancy, especially in patients with head-neck cancer or breast cancer. Patients should be well informed of the advantages and disadvantages of different vascular access devices and provided a choice., (© 2018 John Wiley & Sons Ltd.)

Central venous occlusive disease is frequently observed in patients with end-stage renal disease. Venography remains the gold standard for diagnosis, but intravascular ultrasound is a potentially beneficial adjunct that may positively influence intervention., Competing Interests: Conflict of Interest Disclosure: The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.