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Introduction
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...
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Background
Cancer indeed represents a significant public health challenge, and unplanned extubation of peripherally inserted central catheter (PICC-UE) is a critical concern in patient safety. Identifying independent risk factors and implementing high-quality assessment tools for early detection in high-risk populations can play a crucial role in r...
Objective
The novel ultrasound magnetic needle navigation technique can visualize the entire needle and identify its projected trajectory. We hypothesized that this technique increases the first-attempt success rate of central venous puncture by novice learners compared with the conventional needle navigation technique.
Methods
This prospective, r...
Prolonged antibiotic therapy is often recommended for the treatment of spinal infections. This study aimed to evaluate the efficacy and safety of outpatient intravenous (IV) antibiotic therapy for spinal neurosurgery patients with spondylodiscitis. We carried out a retrospective study involving 67 patients who were administered peripherally inserte...
Introduction: Prolonged antibiotic therapy is often recommended for the treatment of spinal infections. This study aimed to evaluate the efficacy and safety of outpatient intravenous (IV) antibiotic therapy for spinal neurosurgery patients with spondylodiscitis.
Methods: We carried out a retrospective study involving 67 patients who were administer...
Citations
... A secondary outcome measure is the rate of bacterial colonization (The persistent adherence and proliferation of microbial communities on the inner surface of the catheter. Laboratory microbiological examinations reveal positive bacterial or fungal cultures from peripheral venous blood, or the cultivation of identical species and drug susceptibility results from both the catheter segment and peripheral blood, indicating the presence of pathogenic organisms [19]). The exclusion criteria for this meta-analysis are delineated as follows: non-Chinese and non-English language literature, and conference abstracts or review articles. ...
Background
The prevention of catheter-related bloodstream infections (CRBSI) is a critical priority in the clinical management of central venous catheters (CVCs). This meta-analysis aims to evaluate the efficacy of chlorhexidine gluconate antibacterial dressings in the context of CVC care.
Methods
A systematic literature search was performed in PubMed, Web of Science, Embase et al. databases up to May 28, 2024. The search targeted randomized controlled trials (RCTs) that investigated the impact of chlorhexidine gluconate antibacterial dressings on CVC-related outcomes. The meta-analysis was conducted using RevMan 5.3 software.
Results
The final analysis included 14 RCTs involving a total of 8920 patients with CVCs, with participants divided into a chlorhexidine antibacterial dressing group (n = 4731) and a control group (n = 4189). The chlorhexidine dressing group demonstrated a statistically significant reduction in the incidence of CRBSI compared to the control group, with a relative risk (RR) of 0.48, 95% confidence interval (CI) 0.36–0.64, P < 0.001. The chlorhexidine dressing group also showed a significant decrease in bacterial colonization, with an RR of 0.46, 95% CI 0.38–0.55, P < 0.001. Assessment of publication bias through funnel plot asymmetry and Egger’s test revealed no significant bias in the included studies (all P > 0.05).
Conclusions
There is a notable reduction in the incidence of CRBSI and bacterial colonization in patients with CVCs through the application of chlorhexidine gluconate dressings. Given the compelling evidence, the integration of these dressings into standard nursing care protocols for the management of CVCs is advocated.
... Femorally inserted central catheters (FICC) are often an alternative option in ALS patients, when insertion of a PICC or a CICC is potentially challenging or overtly contraindicated. 2 Recent studies have shown that FICCs inserted by cannulation of the superficial femoral vein at mid-thigh in non-paretic lower limbs carry a low risk of thrombosis or infection. 2,3 Though, there are no clinical studies on the incidence of thrombosis when FICCs are inserted by cannulation of the superficial femoral vein in patients with paraplegia or tetraplegia, such as ALS patients. ...
Background: Central venous catheterization may be required in patients with amyotrophic lateral sclerosis (ALS) for parenteral nutrition, antibiotic treatment, or blood sampling. Different venous access devices can be taken into consideration—centrally inserted central catheters (CICC), peripherally inserted central catheters (PICC), and femorally inserted central catheters (FICCs)—depending on the clinical conditions of the patients. Regardless of the type of access, the presence of paraplegia or tetraplegia is commonly considered a risk factor for catheter-related thrombosis (CRT). Method: This retrospective study analyzes the rate of CRT and other non-infectious complications associated with central venous access in a cohort of 115 patients with paraplegia or tetraplegia, most of them affected by ALS (n = 109). Results: In a period of 34 months, from January 2021 to October 2023, we inserted 75 FICCs, 29 CICCs, and 11 PICCs. PICCs were inserted only in patients with preserved motility of the upper limbs. All devices were inserted by trained operators adopting appropriate insertion bundles. We had no immediate or early complication. Though antithrombotic prophylaxis was adopted only in 61.7% of patients, we had no symptomatic CRT. Other non-infectious complications were infrequent (4 out of 115 patients).
Conclusion: These results suggest (a) that the presence of paraplegia or tetraplegia is not necessarily associated with an increased risk of CRT, (b) that the adoption of well-designed insertion bundles plays a key role in minimizing non-infectious complications, and (c) that the insertion of FICCs by direct cannulation of the superficial femoral vein at mid-thigh in paraplegic/tetraplegic patients may have the same advantages which have been described in the general population.
... Similarly, a feasibility study that assessed the safety and utility of tFICCs reported a CLABSI rate of 1.28 per 1000line days. 19 43 We reported near negligible symptomatic DVT rates in the matched group. While asymptomatic thrombosis cannot be discounted, no catheters required removing for symptomatic DVT in the tFICC group and only two in the PICC group (0.5%, 0.11/1000-line days). ...
Objectives
To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities.
Design
A propensity-score matched cohort study.
Setting
A 980-bed tertiary referral hospital in South West Sydney, Australia.
Participants
In-patients referred to the hospital central venous access service for the insertion of a central venous access device.
Primary and secondary outcome measures
The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT).
Results
The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference −0.63/1000 catheter days, 95% CI −2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI −6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI −0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference −0.11 per 1000 catheter days, 95% CI −0.26 to 0.04, p=1.00).
Conclusion
There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.
... The optimal results of our experience (no insertion complication, no infection, only three late complications) are also due the adoption of a bundle of effective strategies: use of ultrasound throughout the procedure (for appropriate choice of the vein, venipuncture, tip navigation, and tip location); access to the SFV, less invasive than the access to the common femoral vein; use of 5 Fr catheters inserted in veins of 6-8 mm diameter, a strategy which reduces the risk of catheter-related thrombosis; use of micro-introducer kits (21 G needles and 0.018″ guidewires), which reduces the invasiveness of the maneuver; adoption of intra-procedural tip location, as recommended by the current international guidelines 1,2,22 ; placement of the reservoir at mid-thigh, in an area where the device can be easily accessed and where the bacterial contamination is lower if compared to the groin. 30 A special consideration deserves the choice of the location of the tip and the method of intra-procedural tip location. ...
Background
Femoral ports are used in patients with indication to a totally implanted venous access device but with contraindication to chest-ports and brachial ports because of obstruction of the superior vena cava. In the last three decades, femoral ports have been implanted almost exclusively by cannulation of the common femoral vein at the groin, while the position of the tip has been assessed by X-ray.
Methods
We report our experience with a new approach to femoral ports, which includes recent methods and techniques developed in the last few years. These novel femoral ports, which we call “FICC-ports,” are characterized by (a) long femoral 5 Fr polyurethane catheter inserted by ultrasound-guided puncture of the superficial femoral vein at mid-thigh; (b) intraprocedural location of the tip in the sub-diaphragmatic inferior vena cava, using ultrasound visualization by the transhepatic and/or the subcostal view; (c) low-profile or very low-profile reservoir implanted above the quadriceps muscle, at mid-thigh.
Results
In the last 3 years, we have implanted 47 FICC-ports in young adults with mediastinal lymphoma compressing the superior vena cava. We had no immediate/early complication, and only three late complications (one kinking of the catheter in the subcutaneous tissue; one tip migration with secondary venous thrombosis; one persistent withdrawal occlusion due to fibroblastic sleeve).
Conclusion
If there is indication to a femoral port, the implantation of a “FICC-port”—as described above—is to be strongly considered in terms of safety, effectiveness, and cost-effectiveness: no immediate-early complications, minimal late complications, no X-ray exposure, low invasiveness, low cost.
... This is likely because the puncture site is separate from the exit site, and the subcutaneous route provides additional protection from contamination. Moreover, the exit site could be positioned through tunneling in a less contaminated bacterial area, as even recently reported in the Femoral Inserted Central Catheter with an exit site in the mid-thigh area [37,38]. tPICCs seem to be safer than cPICCs in terms of CRT, which has been identified as one of the most relevant complications of PICC implantation in previous studies [2,39]. ...
Introduction: Situations involving increased workloads and stress (i.e., the COVID-19 pandemic) underline the need for healthcare professionals to minimize patient complications. In the field of vascular access, tunneling techniques are a possible solution. This systematic review and meta-analysis aimed to compare the effectiveness of tunneled Peripherally Inserted Central Catheters (tPICCs) to conventional Peripherally Inserted Central Catheters (cPICCs) in terms of bleeding, overall success, procedural time, and late complications. Methods: Randomized controlled trials without language restrictions were searched using PUBMED®, EMBASE®, EBSCO®, CINAHL®, and the Cochrane Controlled Clinical Trials Register from August 2022 to August 2023. Five relevant papers (1238 patients) were included. Results: There were no significant differences in overall success and nerve or artery injuries between the two groups (p = 0.62 and p = 0.62, respectively), although cPICCs caused slightly less bleeding (0.23 mL) and had shorter procedural times (2.95 min). On the other hand, tPICCs had a significantly reduced risk of overall complications (p < 0.001; RR0.41 [0.31–0.54] CI 95%), catheter-related thrombosis (p < 0.001; RR0.35 [0.20–0.59] IC 95%), infection-triggering catheter removal (p < 0.001; RR0.33 [0.18–0.61] IC 95%), wound oozing (p < 0.001; RR0.49 [0.37–0.64] IC 95%), and dislodgement (p < 0.001; RR0.4 [0.31–0.54] CI 95%). Conclusions: The tunneling technique for brachial access appears to be safe concerning intra-procedural bleeding, overall success, and procedural time, and it is effective in reducing the risk of late complications associated with catheterization.
... In the in vitro model we chose a high load of bacterial contamination, in order to reproduce the worst clinical settings. The use of femoral catheters, mainly with mid-thigh exit site, is becoming increasingly common in hospitals, particularly in bedridden patients with psychomotor agitation, delirium, and dementia [21][22]. These patients are, among others, those at greater risk of bacterial skin colonization; indeed, many of them live in nursing homes, have had several hospital admissions and undergo bed hygiene [21]. ...
... The use of femoral catheters, mainly with mid-thigh exit site, is becoming increasingly common in hospitals, particularly in bedridden patients with psychomotor agitation, delirium, and dementia [21][22]. These patients are, among others, those at greater risk of bacterial skin colonization; indeed, many of them live in nursing homes, have had several hospital admissions and undergo bed hygiene [21]. During this cleaning procedure, it is common to get the catheter's hub dirty and contaminated with a high bacterial load (>0. ...
Background: Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality among hospitalized patients. Different studies suggest that the use of disinfectant caps (DCs) significantly reduces the rate of CRBSIs. The first purpose of this study is to analyze, through an in-vitro-model, the antiseptic effect of DCs produced by two manufacturers; the second aim is to assess potential differences in terms of effectiveness between the two manufacturers' products. Methods: A know concentration of thirteen different microorganisms was incubated with the sponge drenched in antimicrobial fluid inside DCs and cultured through several assays to investigate the disinfectant effectiveness of some commercially available caps. Disinfectant properties were evaluated under two different conditions: baseline (DCs placed on the needle-free connec-tors (NFCs) and stress test (DCs directly applied to the catheter hub).
... (c) Non-tunneled FICCs with exit site at mid-thigh: as discussed above, ultrasound guided puncture of the superficial femoral vein at mid-thigh is associated with an exit site in an area which usually at low risk of contamination 26 ; the risk of thrombosis and the risk of dislodgment also appear to be reduced; this approach is more and more utilized in both hospitalized and non-hospitalized patients with relative or absolute contraindications to the placement of a PICC or a CICC 58 (Figure 8). The ideal location of the tip should be in the subdiaphragmatic inferior vena cava (ultrasound visualization of the tip in the tract of vena cava between renal veins and hepatic veins, using a transhepatic view with "bubble test") or in right atrium ( Figure 6) (tip location by intracavitary ECG or by ultrasound visualization of the tip using a subcostal or apical view with "bubble test"). ...
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.
