• MeSH
• Vascular Access Devices trends   MeSH
• Hospitals, Teaching MeSH
• Catheterization, Peripheral methods   standards   nursing   trends   MeSH
• Patient Care Team MeSH
• Catheters, Indwelling standards   trends   MeSH

BACKGROUND: PICC is routinely inserted with assistance of ultrasonography and/or ECG navigation (RI- routine insertion). Only in a minority of patients the insertion of a PICC is difficult and fluoroscopic visualization with introduction of special guidewire is necessary for the success of the procedure (DI-difficult insertion). The aim of the study was to evaluate whether DI can be predicted and associated with a risk of complications during follow-up. METHODS: The study included patients who had a PICC insertion in 2022. The number of patients with RI and DI was recorded and the significance of selected parameters during insertion and the frequency of complications during 1 month follow-up was compared. RESULTS: About 1404 patients had successful PICC insertion in 2022, RI in 1360 (96.8%) and DI in 44 patients (3.2%). There was no significant effect of age, gender, selected vein, its size, insertion site, and tunneling on the course of PICC insertion. However the number of punctures for needle insertion was higher in DI. The complication rate during 1 month follow-up in DI was 9 (20.4%) versus 101 patients (7.4%) in RI (p = 0.002). CONCLUSION: PICC insertion was successful in both RI and DI patients. Of the analyzed parameters, the number of needle punctures was associated with DI, and complications during the 1-month follow-up were more frequently noted in the DI group.

• MeSH
• Time Factors MeSH
• Adult MeSH
• Risk Assessment MeSH
• Radiography, Interventional adverse effects   MeSH
• Ultrasonography, Interventional * MeSH
• Catheterization, Central Venous adverse effects   instrumentation   MeSH
• Middle Aged MeSH
• Humans MeSH
• Catheterization, Peripheral * adverse effects   MeSH
• Punctures * MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PICC-port představuje nový druh dlouhodobého žilního přístupu, který je indikován čím dál častěji z důvodu snížení rizika komplikací při zavádění a výborného estetického efektu ve srovnání s porty hrudními. Jedná se o další generaci portů, která nahradila historicky zaváděné pažní nebo brachiální porty, kdy nevhodně prováděná implantace nevedla k rozšíření jejich používání pro vysoký výskyt komplikací. Při dodržení moderních doporučení se stává PICC-port ve specifických klinických situacích žilním vstupem první volby.

The PICC-port is a novel type of long-term venous access device that is increasingly indicated for use because of the reduced risk of complications during insertion and excellent aesthetic effect when compared with a chest port. It is the next generation of ports that has replaced the previously inserted arm or brachial ports in which inappropriate implantation hindered their widespread use due to high rates of complications. When modern recommendations are followed, the PICC-port can become the first-choice venous access in specific clinical situations.

• MeSH
• Vascular Access Devices MeSH
• Infusions, Intravenous methods   MeSH
• Humans MeSH
• Neoplasms drug therapy   MeSH
• Catheterization, Peripheral * methods   MeSH
• Antineoplastic Agents administration & dosage   MeSH
• Check Tag
• Humans MeSH

Kontext: Akutní končetinová ischemie (acute limb ischemia, ALI) je v dětské populaci vzácné, avšak závažné postižení s významnou celoživotní morbiditou nebo mortalitou. Zpravidla se jedná o posttraumatický stav nebo je příčina iatrogenní. Výsledky: V této studii bylo retrospektivně vyšetřeno 127 novorozenců s invazivním monitorováním hodnot arteriální krve na naší jednotce intenzivní péče v letech 2019–2021. Monitorování se provádělo na horních končetinách u 83 pacientů a na dolních končetinách u 44 pacientů. Akutní končetinová ischemie byla zjištěna u tří (6 %) pacientů s monitorováním dolní končetiny a u osmi (9 %) s monitorováním horní končetiny. Primárně se u pacientů provádělo zahřívání končetiny, infuze heparinu (10 μ/kg/h) i infuze perlinganitu (glycerol-trinitrátu) (0,5 μg/kg/h). Pokud to stav pacienta dovolil, neaplikovaly se vazokonstriktory (adrenalin, noradrenalin atd.). Všichni pacienti reagovali na farmakoterapii a konzervativní léčbu, takže ani v jednom případě nebylo nutno volit chirurgické řešení. U žádného pacienta ani nebylo nutno provést amputaci, protože se krevní oběh v končetinách postupně obnovil. Závěry: Časná a správně zvolená a provedená intervence může významně snížit mortalitu a morbiditu ALI, která se ve skupině novorozenců vyskytuje vzácně. Stále se ještě vyvíjejí různé strategie léčby a množství zkušeností je omezené. I když se zdá, že chirurgické řešení je častější u dospělých pacientů, pozitivních výsledků u akutní končetinové ischemie – vzhledem k technické obtížnosti chirurgického výkonu a odlišné základní patofyziologii dětské popul

Background: Acute limb ischemia (ALI) is a rare but serious condition that can cause significant lifetime morbidity or mortality in the pediatric population. It is usually post-traumatic or iatrogenic. Results: In the study, 127 newborns who were followed up with arterial monitoring in our intensive care unit between 2019-2021 were screened retrospectively. Invasive arterial monitoring was performed on the upper extremities in 83 patients and the lower extremities in 44 patients. Acute extremity ischemia was observed in three (6%) patients who underwent lower extremity monitoring and eight (9%) patients with upper extremity ischemia. Primarily, extremity warming, heparin infusion (10 μ/kg/h), perliganit (Glycerol Trinitrate) infusion (0.5 μg/kg/h) were applied to the patients. Vasoconstrictor agents (adrenaline, noradrenaline etc.) have been avoided in patients whenever possible. All of the patients responded to medical and conservative treatment, and no surgical treatment was applied. Amputation was not applied to any of the patients, and their limb circulations were gradually restored. Conclusions: Early and correct intervention can significantly reduce mortality and morbidity in ALI, which is rare in the newborn group. Management strategies are still evolving and experience is limited. Although the surgical approach seems to be more prominent in adult patients, positive results can be obtained in newborn acute limb ischemia with close clinical follow-up and medical approach due to technical difficulties and different underlying pathophysiology in the pediatric population.

• MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Peripheral Arterial Disease epidemiology   etiology   drug therapy   blood   MeSH
• Catheterization, Peripheral * adverse effects   MeSH
• Statistics as Topic MeSH
• Heart Defects, Congenital * complications   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Clinical Study MeSH

OBJECTIVE: This study aimed to evaluate the safety and performance of PowerPICC catheters in a real-world setting. DESIGN: Prospective, observational, multicentre study. SETTING: Nine European countries, involving 14 centres. PARTICIPANTS: General patient population. INTERVENTION: PowerPICC catheter inserted by the clinician as standard of care with routinely collected outcomes followed through device removal or 180 days postinsertion. PRIMARY AND SECONDARY OUTCOMES MEASURES: Safety and performance outcomes were assessed for PowerPICC, PowerPICC SOLO 2 and PowerGroshong PICC. The primary safety endpoint was the incidence of symptomatic venous thrombosis (VT), and secondary safety endpoints included phlebitis, extravasation, vessel laceration, vessel perforation local infection, accidental dislodgment and catheter-related bloodstream infection (CRBSI). The primary performance endpoint was the percentage of patients whose PowerPICC device remained in place through the completion of therapy. The secondary performance endpoints included catheter patency, placement success in a single attempt and usability. RESULTS: The enrolled patients (N=451) received either PowerPICC, PowerPICC SOLO 2 or PowerGroshong PICC catheters. Across all devices, 1.6% of patients developed symptomatic VT, and CRBSI occurred in 1.6% of patients. There were no cases of phlebitis or extravasation and only three cases of vein laceration or vein perforation. The catheters showed high success rates in completing therapy (81.8%), maintaining patency (93.9%) and achieving successful placement in a single attempt (90.4%). Clinicians overwhelmingly agreed that both the guidewire and stylet (93.3% and 94.4%, respectively) were easy or very easy to use. CONCLUSIONS: This study demonstrates the safety and performance of PowerPICC catheters across diverse settings and patient cohorts in real-world hospital settings across Europe. The findings indicate that these catheters are safe and can be effectively used in the general patient setting and when inserted by a variety of clinicians. The low incidence of complications and high success rates further support the clinical utility of these catheters. TRIAL REGISTRATION NUMBER: NCT04263649.

• MeSH
• Central Venous Catheters adverse effects   MeSH
• Adult MeSH
• Phlebitis etiology   epidemiology   MeSH
• Catheterization, Central Venous adverse effects   instrumentation   methods   MeSH
• Catheter-Related Infections * epidemiology   prevention & control   MeSH
• Middle Aged MeSH
• Humans MeSH
• Catheterization, Peripheral adverse effects   instrumentation   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Catheters, Indwelling adverse effects   MeSH
• Venous Thrombosis epidemiology   etiology   prevention & control   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Geographicals
• Europe MeSH

Starostlivosť o intravenózne vstupy je jednou zo základných intervencii, ktoré vykonáva sestra v rámci ústavnej, ale aj domácej starostlivosti. K pacientom, u ktorých bývajú najčastejšie indikované, patria polymorbídni a krehkí seniori. Príčinou môže byť komplikácia chronického ochorenia alebo akútny problém. U seniorov sa však stretávame s mnohými rizikami, ktoré komplikujú zavedenie vstupu a starostlivosť oň. Sú to zmeny súvisiace s procesom starnutia, ale aj predchádzajúcou parenterálnou aplikáciou liečiv. Často sa stáva, že sestra, ale najmä pacient sú traumatizovaní opakovanými pokusmi o zavedenie kanyly. Z uvedených dôvodov je pri výbere vhodného intravenózneho vstupu nevyhnutné brať do úvahy stav ciev, vlastnosti podávaných liekov- ph a osmolaritu. Výber správneho druhu intravenózneho vstupu (periférny, centrálny), miesta zavedenia a vlastnosti liekov má zároveň veľký vplyv na vznik komplikácii, ktorým môže sestra predchádzať svojimi vedomosťami a zručnosťami, ako prezentujeme v texte.

Taking care of intravenous access is one of the basic interventions performed by a nurse as part of institutional care, as well as home care.The patients for whom they are most often indicated are multimorbid and frail seniors. The cause may be a complication of a chronic disease or an acute problem. However, in the case of seniors, we encounter many risks that complicate the introduction of the input and its care.These are changes related to the aging process, but also to the previous parenteral application of drugs.It often happens that the nurse, but especially the patient, are traumatized by repeated attempts to insert the cannula.For the above reasons, it is necessary to take into account the state of the blood vessels, the properties of the administered drugs-ph. and osmolarity when choosing a suitable intravenous access. The choice of the right type of intravenous access (peripheral, central), the place of introduction and the properties of the drugs also has a great impact on the emergence of complications, which the nurse can prevent with her knowledge and skills, as presented in the article.

• Keywords
• intervence sestry,
• MeSH
• Vascular Access Devices MeSH
• Geriatric Nursing MeSH
• Catheterization, Central Venous nursing   MeSH
• Catheterization, Peripheral nursing   MeSH
• Aged MeSH
• Check Tag
• Aged MeSH

OBJECTIVES: Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable. DESIGN: A retrospective cohort study based on the Extracorporeal Life Support Organization registry. SETTING: ECMO centers worldwide included in the Extracorporeal Life Support Organization registry. PATIENTS: All adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020. INTERVENTIONS: Unilateral or bilateral femoral cannulation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the occurrence of limb ischemia defined as a composite endpoint including the need for a distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy. Secondary endpoints included bleeding at the peripheral cannulation site, need for vessel repair, vessel repair after decannulation, and in-hospital death. Propensity score matching was performed to account for confounders. Overall, 19,093 patients underwent peripheral venoarterial ECMO through unilateral ( n = 11,965) or bilateral ( n = 7,128) femoral cannulation. Limb ischemia requiring any intervention was not different between both groups (bilateral vs unilateral: odds ratio [OR], 0.92; 95% CI, 0.82-1.02). However, there was a lower rate of compartment syndrome/fasciotomy in the bilateral group (bilateral vs unilateral: OR, 0.80; 95% CI, 0.66-0.97). Bilateral cannulation was also associated with lower odds of cannulation site bleeding (bilateral vs unilateral: OR, 0.87; 95% CI, 0.76-0.99), vessel repair (bilateral vs unilateral: OR, 0.55; 95% CI, 0.38-0.79), and in-hospital mortality (bilateral vs unilateral: OR, 0.85; 95% CI, 0.81-0.91) compared with unilateral cannulation. These findings were unchanged after propensity matching. CONCLUSIONS: This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.

• MeSH
• Femoral Artery MeSH
• Adult MeSH
• Ischemia etiology   MeSH
• Compartment Syndromes * MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   MeSH
• Hospital Mortality MeSH
• Catheterization, Peripheral * methods   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic vs. subclavian/axillary vs. femoral artery) to evaluate if each ECLS configuration is associated with different rates of neurologic complications. METHODS: This retrospective, multicenter (34 centers), observational study included adults requiring post-cardiotomy ECLS between January 2000 and December 2020 present in the Post-Cardiotomy Extracorporeal Life Support (PELS) Study database. Patients with Aortic, Subclavian/Axillary and Femoral cannulation were compared on the incidence of a composite neurological end-point (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes were overall in-hospital mortality, neurologic complications as cause of in-hospital death, and post-operative minor neurologic complications (seizures). Association between cannulation and neurological outcomes were investigated through linear mixed-effects models. RESULTS: This study included 1897 patients comprising 26.5% Aortic (n = 503), 20.9% Subclavian/Axillary (n = 397) and 52.6% Femoral (n = 997) cannulations. The Subclavian/Axillary group featured a more frequent history of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease and previous stroke. Neuro-monitoring was used infrequently in all groups. Major neurologic complications were more frequent in Subclavian/Axillary (Aortic: n = 79, 15.8%; Subclavian/Axillary: n = 78, 19.6%; Femoral: n = 118, 11.9%; p < 0.001) also after mixed-effects model adjustment (OR 1.53 [95% CI 1.02-2.31], p = 0.041). Seizures were more common in Subclavian/Axillary (n = 13, 3.4%) than Aortic (n = 9, 1.8%) and Femoral cannulation (n = 12, 1.3%, p = 0.036). In-hospital mortality was higher after Aortic cannulation (Aortic: n = 344, 68.4%, Subclavian/Axillary: n = 223, 56.2%, Femoral: n = 587, 58.9%, p < 0.001), as shown by Kaplan-Meier curves. Anyhow, neurologic cause of death (Aortic: n = 12, 3.9%, Subclavian/Axillary: n = 14, 6.6%, Femoral: n = 28, 5.0%, p = 0.433) was similar. CONCLUSIONS: In this analysis of the PELS Study, Subclavian/Axillary cannulation was associated with higher rates of major neurologic complications and seizures. In-hospital mortality was higher after Aortic cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results encourage vigilance for neurologic complications and neuromonitoring use in patients on ECLS, especially with Subclavian/Axillary cannulation.

• MeSH
• Aorta * MeSH
• Femoral Artery * MeSH
• Subclavian Artery MeSH
• Adult MeSH
• Cardiac Surgical Procedures adverse effects   methods   MeSH
• Catheterization methods   adverse effects   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   adverse effects   statistics & numerical data   MeSH
• Hospital Mortality trends   MeSH
• Nervous System Diseases etiology   epidemiology   MeSH
• Catheterization, Peripheral methods   adverse effects   statistics & numerical data   MeSH
• Postoperative Complications epidemiology   etiology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

Limb ischaemia is a clinically relevant complication of venoarterial extracorporeal membrane oxygenation (VA ECMO) with femoral artery cannulation. No selective distal perfusion or other advanced techniques were used in the past to maintain adequate distal limb perfusion. A more recent trend is the shift from the reactive or emergency management to the pro-active or prophylactic placement of a distal perfusion cannula to avoid or reduce limb ischaemia-related complications. Multiple alternative cannulation techniques to the distal perfusion cannula have been developed to maintain distal limb perfusion, including end-to-side grafting, external or endovascular femoro-femoral bypass, retrograde limb perfusion (e.g., via the posterior tibial, dorsalis pedis or anterior tibial artery), and, more recently, use of a bidirectional cannula. Venous congestion has also been recognized as a potential contributing factor to limb ischaemia development and specific techniques have been described with facilitated venous drainage or bilateral cannulation being the most recent, to reduce or avoid venous stasis as a contributor to impaired limb perfusion. Advances in monitoring techniques, such as near-infrared spectroscopy and duplex ultrasound analysis, have been applied to improve decision-making regarding both the monitoring and management of limb ischaemia. This narrative review describes the evolution of techniques used for distal limb perfusion during peripheral VA ECMO.

• MeSH
• Femoral Artery * MeSH
• Adult MeSH
• Ischemia prevention & control   etiology   MeSH
• Catheterization methods   MeSH
• Extremities blood supply   MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   MeSH
• Perfusion methods   MeSH
• Catheterization, Peripheral methods   adverse effects   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: There are several types of LPC (long peripheral catheters) that vary in length, size, insertion method, and cost. The aim of the study was to evaluate whether ultrasonography can be useful for the selection of the suitable LPC in DIVA (difficult intravenous access) patients. METHODS: Based on the ultrasonographic examination, a long peripheral catheter was selected. A 6.4 cm LPC into a vein at a depth of up to 0.5 cm, a 8.5 cm LPC into a vein at a depth up to 1.5 cm, and a 9.8 cm catheter at a depth up to 2 cm using the cannula over needle method. A 12 cm catheter was inserted into the deeper veins using the direct Seldinger method. The catheter diameter was no more than 33% vein diameter. Dwell time and the number of complications of four vascular devices were recorded and compared. RESULTS: One thousand one hundred fifty-six patients, average age 76 years (19-102), 501 men and 655 women, were included in the study. Average dwelling time was 10 days (1-30), there were 136 complications (11.7%). A catheter 6.4 cm long was inserted in 346 (29.8%), 8.5 cm in 140 (12.1%), 9.8 cm in 320 (27, 5%), and 12 cm in 356 (30.6%) patients. There were no significant differences in dwelling time, rate, and type of complications among the four catheters used. CONCLUSION: Our results confirm that ultrasound examination can be useful for the selection of the suitable long peripheral catheter in DIVA patients.

• MeSH
• Time Factors MeSH
• Vascular Access Devices MeSH
• Equipment Design * MeSH
• Adult MeSH
• Ultrasonography, Interventional * MeSH
• Clinical Decision-Making MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Catheterization, Peripheral * instrumentation   adverse effects   MeSH
• Predictive Value of Tests * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Catheters, Indwelling * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH