Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: Wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure

Gidaro, Antonio; Samartin, Federica; Salvi, Emanuele; Casella, Francesco; Cogliati, Chiara; Giustivi, Davide; Lugli, Francesca; Trione, Chiara; Melchionda, Chiara; Bartoli, Arianna; Foschi, Antonella; Schiavini, Monica; Schiuma, Marco; Castelli, Roberto; Calloni, Maria Vittoria

doi:10.1177/11297298221085450

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…This evolution improved the approach through the common femoral vein (CFV) and offered the possibility of moving the exit site away from the inguinal crease by tunneling the catheter at the mid-thigh. 3 At the same time, US guided venipuncture allowed to approach the superficial femoral vein (SFV) at mid-thigh, as recently reported by Annetta et al 4 and Gidaro et al 5 During COVID 19 pandemic, the femoral approach was recommended and widely used due to the distance from the patient's airways, the lower risk of dislocation than CICCs during pronation manoeuvres and the absence of interaction with the CPAP helmet, often used in the treatment of COVID 19 pneumonia. [5][6][7][8] Since 2020, Nurses of an Italian tertiary hospital Vascular Access Team (VAT), started using femoral approach in CVAD positioning as alternative to PICCs, when the veins of the arm were unavailable and a CICC was not indicated or the intraprocedural risks of CICC positioning were too high.…”

Section: Introductionmentioning

confidence: 75%

Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization

et al. 2022

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Background: Femorally inserted central catheters are increasingly used, especially after the COVID-19 pandemic, also thanks to widespread of tunneling techniques that allow the exit site to be moved away from the groin. Methods: In this retrospective observational study, femorally inserted catheters, with exit site at mid-thigh and the tip in Inferior vena cava or in Inferior vena cava at the junction with right atrium, have been observed and complications have been analyzed. All catheters were inserted by trained Nurses of a tertiary hospital Vascular Access Team. Results: In 142 catheters (126 inserted via common femoral vein and 16 inserted via superficial femoral vein) and 3060 catheter days, we observed an infection rate of 1.3 events/1000 catheter days (all of them in oncologic patients and up to 30 days of catheterization), 2 cases of thrombotic events (1.41%) and 17 cases of accidental removal (11.97%). Other rare complications, as primary malposition, tip migration, arterial pseudoaneurysm, have been recorded. The average length of catheters inserted, from the exit site to the tip, was 47.6 ± 2.4 cm. Conclusion: The attention to the correct position of the tip, the exit site at mid-thigh and the new techniques during insertion make these femoral catheters as safe as other central vascular access devices. For this kind of central access device, a catheter at least 50 cm long is needed.

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Section: Introductionmentioning

confidence: 75%

Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization

et al. 2022

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“…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].…”

Section: N Resultsmentioning

confidence: 99%

Disinfectant caps in vitro effectiveness

2023

Infez Med

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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 connectors (NFCs) and stress test (DCs directly applied to the catheter hub).Results: Both manufacturers overcame the basal tests (fourteen different assays). Regarding stress tests: the only significant bacterial load was found for Serratia marcescens (10 4 CFU/mL in ICU Medical™), both at 90 and 180 minutes after incubation; due to the low load, MDR Acinetobacter baumannii was not considered significant (<10 3 CFU/mL in BD PureHub™). Conclusions: Our results confirm what was reported in BD PureHub™ datasheet and add data not previously shown by ICU Medical™. Moreover, no difference was observed between the two manufacturers products: the use of both DCs on NFCs was able to reclaim the catheter lumen. These findings support the routine use of DCs with NFCs, as part of a structured bundle of interventions, to reduce the incidence of CRBSIs.

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“… 27 Despite the lack of available data on this phenomenon, there is a consensus on avoiding the use of armpit straps in the presence of peripherally inserted venous catheters. 11 Recently the implantation of midline catheters in the superficial femoral vein has been proposed as a possible solution with promising results, 28 however additional data is needed to confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

Effects of positive airway pressure on basilic vein diameter and venous flow velocity in healthy volunteers

et al. 2022

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Introduction: The placement of vascular catheters of adequate size in accordance to catheter-to-vein ratio (CVR) recommendations represents one of the cornerstones of catheter-related upper vein thrombosis prevention. However there is scarcity of data on its effect on the venous dynamics of the basilic vein, a common site for long-term catheter placement. This study investigates the effects of the application of positive airway pressure on the diameter and blood flow velocity of basilic vein. We also measured the effects of under-armpit straps, a device commonly used to keep continuous positive airway pressure (CPAP) helmets in place. Methods: We enrolled 28 healthy volunteers. Basilic vein diameter and minimum/maximum blood flow velocity, according to respiratory venous flow oscillation, were measured by ultrasound on the midpoint of their dominant arm during spontaneous breathing and during breathing in a CPAP helmet with 10 cm H2O of airway pressure applied, with the helmet kept in place either through armpit straps or by tying the helmet to the bed. Results: The application of 10 cm H2O of positive airway pressure significantly increased basilic vein diameter by 0.9 ± 0.2 mm, while reducing minimum blood flow velocity by 1.8 ± 0.4 cm/s. These effects were amplified by the application of under armpit straps. Conclusions: Breathing with positive airway pressure increases basilic vein diameter while reducing blood flow-velocity. This phenomenon might lead to an incorrect assessment of CVR, misleading the operator into choosing improperly large catheters.

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Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: Wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure

Cited by 10 publications

References 27 publications

Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization

Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization

Disinfectant caps in vitro effectiveness

Effects of positive airway pressure on basilic vein diameter and venous flow velocity in healthy volunteers

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