|ECR 2018 / C-1774|
|Venous thrombosis and infection associated with peripherally inserted central catheter|
Methods and materials
METHODS AND MATERIALS
This is a descriptive, observational, longitudinal and retrospective study.
Population: All patients in whom a PICC catheter was placed by the Interventional Radiology service in Tec Salud Hospitals in the period from March 2015 to August 2016. Exclusion criteria: Patients who do not have reference images of the procedure in the PACS system or description of the vessel (name and diameter) in the RIS system. Elimination criteria: Patients who have been discharged from hospital with implanted catheter and the date of catheter removal is unknown. The variables evaluated were: 1) Infection associated to the catheter demonstrated by positive culture with the agent isolated. 2) Thrombosis of the vein in which the catheter was inserted, demonstrated by Doppler ultrasound. 3) Insertion site (name of the vein). 4) Caliber of the vein (measured in millimeters). 5) Catheter duration measured in days.
The PICC catheters that used were 5 and 6 Fr, of 2 or 3 lumens, all provided by the hospital’s supplier. Portable ultrasound was used to perform the guided puncture of the selected blood vessel; temporary storage of images where made in the RIS-PACS system, which was later available in the interpretation rooms of hospitals.
All the PICC's were placed by the interventional Radiology service, which is made up of 3 specialists (FPG, MAC, JSS). Catheters 5 or 6 Fr were used. The catheters were placed only in the upper extremities (Table 2) .
References: Radiology, Instituto Tecnológico y de Estudios Superiores de Monterrey - Monterrey/MX
The choice of the number of lumens and diameter of the catheter was according to the criteria of each interventional physician. The site of insertion of the catheter was determined by performing a venous ultrasound of the upper extremity in order identify the most accessible vein, avoiding as much as possible those veins that were previously accessed and discarding those with previous thrombosis.
The insertion method used by all the interventional radiologists was the same: sterile technique guided by ultrasound ( Fig. 4, Fig. 5, Fig. 6 ). Depending on the patient's status, all these procedures were performed in the either the intensive care unit, the operating room, the hemodynamic room or the emergency room.
During the procedure, images were recorded on the ultrasound with the measurement of the transverse diameter of the vessel with the calipers placed inside the walls of the vessel, as well as the name of the vessel Fig. 7. These images were later available for review in the PACS system and where dictation of the report of the procedure in RIS-PACS was made.
During the procedure, the placement of the catheter inside the vein is confirmed with ultrasound of the accesed vein Fig. 8 Fig. 9 Fig. 10. After completion of procedure the placement of the catheter was confirmed in the cavoatrial junction by portable chest x-ray and in some cases by fluoroscopy. The images were saved in the patient's file.
Catheter Care: Interventional radiologists used standard sterile technique, including sterile barriers such as dressings impregnated with chlorhexidine gluconate. The maintenance and manipulation of the catheter was carried out only by the Department of Catheter Clinic.
Data Collection: The report and/or reference images of the procedure were reviewed in the Radiology Information System and Picture Archiving and Communication System (RIS-PACS) to collect the data on insertion vessel, vein gauge, catheter gauge and lumens; all was recorded and saved on an Excel spreadsheet.
The patient follow-up information was obtained through the files kept by the Department of Catheter Clinic who is under the care of the Epidemiological Surveillance Unit. In the cases where there was a clinical suspicion of infection, information was obtained through their daily log; the number of days the catheter was implanted and the result of the culture were recorded.
The catheters that fell under a clinical suspicion of infection were removed, sent to be cultured in the hospital laboratory. If a positive culture resulted and a successful isolation of the agent were obtained, the corresponding information was recorded.
Doppler ultrasound was used to confirm the clinical suspicion of catheter-associated venous thrombosis, fulfilling at least the following criteria: presence of thrombus, lack of compression of the vessel and lack of venous flow on Doppler examination Fig. 11, Fig. 12, Fig. 13 (1).
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