Free fibular bone grafting is an effective treatment for early osteonecrosis of the femoral head in young patients. However, recipient vessels are often small rendering microvascular anastomosis difficult. We have developed a novel technique using retrograde flow through the branches of the lateral circumflex femoral artery to use the proximal end of the artery as the recipient vessel. A vessel diameter of up to 5 mm is obtained providing a good match with the peroneal vessels. We used this technique to perform vascularized bone grafting of the femoral head in 10 patients with Ficat grade 2 and 3 osteonecrosis. Pulsatile retrograde flow from the lateral circumflex femoral artery was observed in each case. Retrospective review gave a median follow up of 52 months (range 17-99). Symptoms improved in all 10 cases. There was no radiological deterioration over the period of follow-up in eight cases. One patient underwent conversion to a total hip replacement 24 months after surgery. These results compare favorably with other studies. The lateral circumflex femoral artery turnover technique is a reliable and useful technique in vascularized bone grafting of the femoral head.

We performed a quality improvement project to decrease utilization of multilumen peripherally inserted central catheters (PICCs) in favor of single-lumen PICCs and midline catheters. Through optimization of electronic orders, education and decision support, we decreased utilization of multilumen PICCs, changed provider ordering patterns, and showed a downward trend in CLABSIs.

Studies have demonstrated that a dedicated peripherally inserted central catheter (PICC) team can reduce costs, lead to efficient use of staff time, improve patient outcomes, and improve organizational performance. A dedicated, nurse-driven PICC team at the authors' facility has demonstrated excellence through teamwork. Over the past three years, the PICC team has made significant strides in the quality of service provided to patients. The goals of the team consisted of (1) improving PICC-placement success rates; (2) developing an electronic database to track patient outcomes; (3) constructing protocols and guidelines to improve efficiency, appropriate use of PICC lines, and patient safety; and (4) pursuing collaborative research projects, publications, and presentations at the local and national level.

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