Central venous access in obese patients: A potential complication

Department of Anesthesia, Stanford University, Palo Alto, California, United States
Anesthesia and analgesia (Impact Factor: 3.42). 05/2006; 102(4):1293-4. DOI: 10.1213/01.ANE.0000199216.28502.1D
Source: PubMed
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    ABSTRACT: Background. Bariatric surgery has increased across America. Venous access is difficult in these patients. Anesthesiologists often utilize valuable operating room (OR) time acquiring reliable intravenous lines. Our objective was to determine if outpatient central venous line (CVL) placement improves OR efficiency and professional reimbursement for CVL insertion. Methods. In our bariatric practice, selected surgery patients have outpatient CVLs placed during prophylactic vena cava filter placement. In a cohort of 268 gastric bypass patients operated between 1/01 and 11/06, we compared time-to-incision between 106 with pre-established CVLs and 162 without. In addition, we determined professional compensation rates for CVLs placed outpatient versus CVLs inserted in the OR. Results. Patients with preoperative (outpatient) CVLs required 35.6 ± 12.5 minutes to skin incision compared with 42.5 ± 13.9 minutes for controls (P < 0.0001), and 34.9% had skin incision in <30 minutes compared with 16.4% of controls. Radiologists collected 28.2% of outpatient billings for CPT code 36556, compared with anesthesiologists who collected <1% when placing CVLs in the OR. Conclusions. Outpatient CVLs prior to gastric bypass improve efficiency in the OR with earlier skin incision. Professional reimbursement is better for outpatient CVLs than intraoperative inpatient CVLs.
    07/2012; 2012:816871. DOI:10.5402/2012/816871
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    ABSTRACT: The prevention of healthcare-associated infections (HCAIs) is a major goal in modern healthcare. Intrinsic, patient-related factors may contribute to the risk of HCAIs. To review the association between obesity and the risk and outcome of HCAIs. A PubMed search of relevant studies on obesity and nosocomial infections and obesity and dosing of antimicrobials. Search terms were: 'obesity', 'infection', 'nosocomial infection', 'surgical site infection', 'critical care unit', 'bacteremia', 'urinary tract infection', 'health care associated infection'. Obesity has been shown to be associated with an increased risk of HCAIs in several studies. The association is most clear in cardiac, vascular, orthopaedic and gastrointestinal surgery. Body mass index (BMI) data are frequently recorded in patients undergoing surgical and invasive procedures. The recording of BMI data is not systematic in the literature and in many studies median BMI of the control group or reference group (normal weight) also indicates overweight or obesity. Thus, clear BMI cut-offs for increased infection risk cannot be determined. Obesity is frequently associated with underdosing of antimicrobials in both prophylaxis and treatment of HCAIs. Studies indicate that obesity affects the pharmacokinetics of antimicrobial drugs. However, there are no dosing recommendations for antimicrobial use in obesity. Obesity increases the risk of nosocomial infections and is frequently associated with underdosing of antimicrobials in both prophylaxis and treatment of HCAIs. A challenge in future hospital hygiene prevention lies in our capacity to combat obesity epidemics.
    The Journal of hospital infection 08/2013; 85(1). DOI:10.1016/j.jhin.2013.06.012 · 2.78 Impact Factor
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    ABSTRACT: Obese patients are a highly specialized population to manage within the health care system. Excess weight contributes to changes in patients' anatomy and physiology. Specialized equipment, including vascular access devices, is required to accommodate their needs. Research has shown that traditional methods of obtaining vascular access can prove unfruitful in the obese patient population. Choosing the most appropriate device in conjunction with practicing the most effective technique will improve vascular access outcomes for obese patients.
    Journal of infusion nursing: the official publication of the Infusion Nurses Society 01/2013; 36(1):52-6. DOI:10.1097/NAN.0b013e31827989d8