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Los accesos venosos centrales son técnicas de uso regular en el ámbito hospitalario, es por ello que la investigación tiene como Objetivo: Establecer la incidencia de complicaciones asociadas a la colocación de accesos venosos centrales en pacientes atendidos en el Hospital Militar Universitario "Dr. Carlos Arvelo". Métodos: estudio prospectivo, de selección intencional de pacientes en el ámbito hospitalario que presenten complicaciones asociadas a la canalización de accesos venosos centrales; a los cuales se les aplicó un cuestionario donde se registraron, además de datos demográficos y clínicos, los resultados del funcionamiento del acceso venoso central. Al séptimo día se retiró o se recambió el acceso venoso central y se tomó muestra para cultivo y antibiograma de la punta de catéter. Los datos fueron tabulados, analizados en gráficos y tablas. Resultados: Uno de los principales hallazgos fueron las complicaciones infecciosas en un 65.93 % y producto de complicaciones mecánicas un 34.05 % del grupo de estudio. Las complicaciones infecciosas fueron atribuibles en su mayoría a Staphylococcus aureus (27,39 %), Pseudomona sp (21,91 %), Stenotrophomonas maltophilia (16,44%), Burkholderia cepacia (10,95 %) y Klebsiella pneumonia (5,48 %). En cuanto al porcentaje de éxito de las intervenciones se encontró que el promedio de intentos fue de 5 con una desviación estándar de ± 3 intentos y una duración promedio menor a 30 minutos en 90 de los casos representando el 76,27 % y duración mayor de 30 minutos en 28 casos representando 23,7 %. Conclusiones: Los accesos venosos yugulares internos fueron los procedimientos más frecuentes seguido de los accesos subclavios, sin predilección de lateralidad alguna. Al revisar los hallazgos se puede evidenciar que la punción arterial se convierte en la complicación mecánica más frecuente produciendo hematomas y equimosis con un alto porcentaje de intentos superiores a 30 minutos o un número de intentos mayores a tres, así como las complicaciones infecciosas generadas por el Staphylococcus aureus y sin que dichas complicaciones se encontraran asociadas al tipo de abordaje estudiado, tiempo de intervención u otros factores de carácter demográfico(AU)

Central venous accesses are a technique of regular use in the hospital environment, that is why the objective of this research is: to establish the incidence of complications treated at the University Military Hospital "Dr. Carlos Arvelo". Methods: prospective study, of intentional selection of patients in the hospital setting who present complications associated to the cannulation of central venous accesses; to whom a questionnaire was applied where, in addition to demographic and clinical data, the results of the central venous access operation were registered. On the seventh day, the central venous access was removed or replaced and a sample was taken for culture and antibiogram of the catheter tip. Data were tabulated, analyzed in graphs and tables. Results: One of the main findings was infectious complications in 65.93 % and mechanical complications in 34.05 % of the study group. Infectious complications were mostly attributable to Staphylococcus aureus (27.39 %), Pseudomona sp (21.91 %), Stenotrophomonas maltophilia (16.44 %), Burkholderia cepacia (10.95 %) and Klebsiella pneumonia (5.48 %). Regarding the percentage of success of the interventions, it was found that the average number of attempts was 5 with a standard deviation of ± 3 attempts and an average duration of less than 30 minutes in 90 of the cases representing 76.27 % and duration greater than 30 minutes in 28 cases representing 23.7 %. Conclusions: Internal jugular venous accesses were the most frequent procedures followed by subclavian accesses, with no predilection for laterality. When reviewing the findings, it can be evidenced that arterial puncture becomes the most frequent mechanical complication producing hematomas and ecchymosis with a high percentage of attempts longer than 30 minutes or a number of attempts longer than three, as well as infectious complications generated by Staphylococcus aureus and without these complications being associated to the type of approach studied, time of intervention or other demographic factors(AU)

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Introducción: Las bacteriemias relacionadas con el uso de catéter (BRC) en pacientes con enfermedad renal crónica avanzada (ERCA) representan un importante problema sanitario. Objetivos: Estimar la incidencia de BRC en pacientes con ERCA en el Hospital Ciro Redondo García, Artemisa, Cuba; y describir su relación con el tipo de acceso vascular (AV), así como la conducta médica que se adopta después del diagnóstico. Métodos: Se realizó un estudio descriptivo entre mayo-octubre del 2019, en el que se incluyó el total de los pacientes (n = 78) de la unidad de hemodiálisis del hospital. Se recogió información acerca del tipo y tiempo de uso del AV. Ante un episodio sugerente de bacteriemia, se obtuvo una muestra de sangre para hemocultivo. Se informó la incidencia de BRC según los criterios de Bouza (2004). Resultados: La tasa de incidencia de BRC se estimó buena (1,18/1 000 días-catéter). Para las producidas por Staphylococcus aureus y por bacterias gramnegativas (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.) las tasas fueron excelentes: 0,44 y 0,88/1 000 días-catéter, respectivamente. Los catéteres venosos centrales se constataron como los AV predominantes. Se verificó que se impuso tratamiento empírico ante signos de probable BRC y este se modificó tras el diagnóstico etiológico específico, acompañado de la retirada del AV siempre que las condiciones clínicas lo permitieron. Conclusiones: Se mantienen en el servicio de hemodiálisis buenas prácticas clínicas para la prevención de BRC. Los agentes etiológicos demostrados obligan a mantener la indicación de tratamiento empírico con antibióticos de amplio espectro(AU)

Introduction: Catheter-related bacteremias (CRB) in patients with advanced chronic kidney diseases represent a major health problem. Objective: To estimate the incidence of CRB in patients with advanced chronic kidney diseases at Ciro Redondo García Hospital, Artemisa, Cuba; and to describe its relationship with the type of vascular access (VA), as well as the medical protocol adopted after diagnosis. Methods: A descriptive study was conducted between May and October 2019. All patients (n=78) in the hospital hemodialysis unit were included. Information about the type and duration of VA was collected. In the presence of an episode suggestive of bacteremia, a blood sample was obtained for blood culture. The incidence of CRB was informed according to Bouza´s criteria (2004). Results: The incidence rate of CRB was estimated good (1.18/1 000 1000 catheter-days). For those caused by Staphylococcus aureus and by gram-negative bacteria (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.), the rates were excellent: 0.44 and 0.88/1000 catheter -days, respectively. Central venous catheters were the predominant VAs. It was confirmed that empirical treatment was initiated in the presence of signs of a probable CRB, which was modified after specific etiological diagnosis, together with the withdrawal of the VA whenever the clinical conditions allowed it. Conclusions: Good clinical practices for the prevention of CBR are maintained at the hemodialysis service. The confirmed etiological agents make it necessary to continue with the indication of empirical treatment with broad-spectrum antibiotics(AU)

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BACKGROUND AND OBJECTIVES: The aim of this study was to analyze risk factors for failure of subclavian vein catheterization. METHODS: A retrospective analysis of 1562 patients who underwent subclavian vein puncture performed by the same experienced operator at Peking University Cancer Hospital from January 1, 2016 to January 1, 2019 was conducted. The success or failure of subclavian vein catheterization was registered in all cases. Various patient characteristics, including age, gender, body mass index (BMI), preoperative hemoglobin, preoperative hematocrit, preoperative mean corpuscular hemoglobin concentration (MCHC), preoperative albumin, preoperative serum creatinine, puncture needles from different manufacturers and previous history of subclavian vein catheterization were assessed via univariate and multivariate analyses. RESULTS: For the included patients, landmark-guided subclavian vein puncture was successful in 1476 cases and unsuccessful in 86 cases (success rate of 94.5%). Successful subclavian vein catheterization was achieved via right and left subclavian vein puncture in 1392 and 84 cases, respectively. In univariate analyses, age and preoperative hemoglobin were associated with failure of subclavian vein catheterization. In a multivariate analysis, aged more than 60 years was a risk factor while the central venous access with Certofix® was associated with an increased rate of success (p-values of 0.001 and 0.015, respectively). CONCLUSIONS: This study has demonstrated that patient aged more than 60 years was a risk factor for failure of subclavian vein catheterization while the central venous access with Certofix® was associated with an increased rate of success.

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RESUMEN La fractura y embolización de un catéter implantable con reservorio es una complicación infrecuente, pero potencialmente grave. El síndrome pinch-off fue descripto en los accesos venosos subclavios, cuando la sección del catéter se produce por la compresión intermitente entre la primera costilla y la clavícula. Informamos el caso de una paciente oncológica a quien se le colocó un catéter implantable con reservorio por acceso percutáneo ecoguiado y control radioscópico en la vena subclavia. Luego de varias sesiones de quimioterapia comenzó con mal funcionamiento del catéter; la radiografía de tórax evidenció la fractura completa del catéter a nivel del espacio costoclavicular con embolia de un fragmento a las cavidades cardíacas. Se realizó la extracción endovascular del catéter fracturado me diante lazo de nitinol por acceso percutáneo femoral, sin complicaciones. Se analizan la incidencia, los factores de riesgo y las medidas para prevenir el síndrome de pinch- off en los catéteres implantables con reservorio.

ABSTRACT Fracture and migration of totally implantable venous access devices is a rare but potentially serious complication. Pinch-off syndrome was described in subclavian venous accesses when the intermittent compression of the catheter between the first rib and the clavicle produces catheter fracture. The report the case of a patient with cancer who underwent implantation of a totally implantable venous access device through the subclavian vein under ultrasound and radioscopy guidance. After several cycles of chemotherapy, the patient started with malfunctioning of the device. The chest X-ray showed a complete fracture of the catheter at the level of the costoclavicular space with migration of a fragment of the catheter to the right cardiac chambers. The fractured catheter was percutaneously removed via the right femoral vein using nitinol gooseneck snare without complications. The incidence of the pinch-off syndrome, risk factors and prevention measures in totally implantable venous access devices are analyzed.

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PURPOSE: Cancer patients require implantation of venous access devices to meet their personalized therapeutic needs, which are often complex due to the nature of the medication and the disease status. Therefore, it is essential to have standardized protocols that guarantee the best results in health and patient safety. METHODS: To learn about the availability of protocols and aspects related to safety in clinical practice and to detect possible opportunities for improvement, a survey has been conducted in various Spanish hospitals, in addition to a review of the evidence regarding the various devices available and complications associated with the administration of chemotherapy. RESULTS: As a result of both analyses, the Foundation for Excellence and Quality in Oncology (ECO), the Spanish Society of Medical Oncology (SEOM), and the Spanish Society of Oncology Nursing (SEEO) have developed a catheter selection algorithm based on patient characteristics and treatment to facilitate the clinical decision-making process, as well as some recommendations aimed at ensuring patient safety and rational use of available resources. CONCLUSIONS: In conclusion, both the venous access catheter selection algorithm and the proposed recommendations aim to respond to the needs revealed in clinical practice and to become an integrable tool in electronic prescription systems to offer homogeneous criteria for action in cancer patients that require venous access, optimizing the use of available health resources with the highest safety and quality of life for the patient.

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OBJECTIVE: The objective of this study was to determine the demographics and subjective rationale for failure to present for retrieval of patients who had an inferior vena cava (IVC) filter placed. METHODS: Between January 1, 2010, and September 12, 2017, there were 242 patients who had retrievable IVC filters placed. Demographics and indications for filter placement were retrospectively analyzed. All patients who failed to have the filter retrieved were contacted by Institutional Review Board-approved telephone survey to delineate the reason that the filter was not removed. RESULTS: Of 242 patients with IVC filters placed, 53 (22%) patients presented for filter retrieval at Abington-Jefferson Health. Patients who presented for filter retrieval were statistically younger (46 years vs 65 years; P < .001). The most common indication for filter placement in both groups was preoperative placement for bariatric surgery, but this percentage was higher in the group that presented for filter retrieval (70% [37/53] in the retrieved group vs 47% [88/189] in the nonretrieved group; P = .018). After telephone survey that reached 146 patients, it was determined that 46 (32%) patients who did not return for filter retrieval were told to keep the filter in place secondary to comorbidities, 28 (19%) did not remember being instructed to follow up for retrieval, and 18 (12%) did not want another procedure. Twenty-four patients were deceased at the time of telephone survey (16%). The remainder of the patients had the filter removed at an outside institution or gave another reason. CONCLUSIONS: Our study documented a disappointingly low rate of filter retrieval. Patients with IVC filters who failed to present for retrieval were more likely to be older and frequently did not understand the complications of leaving a filter in place and the need to have the filter retrieved. Patient education should be increased to better capture patients with IVC filters and to improve retrieval rates, but our study showed that a significant percentage of patients do not have filters retrieved because of comorbidities or they do not want another procedure.

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BACKGROUND/PURPOSE: While many children with renal tumors require long term venous access (VA) for adjuvant chemotherapy, certainly not all do. This study develops and tests a VA decision tree (DT) to direct the placement of VA in patients with renal tumors. METHODS: Utilizing data readily available at surgery a VADT was developed. The VADT was tested retrospectively by 2 independent reviewers on a historic cohort. The ability of the VADT to appropriately select which patients would benefit from VA placement was tested. RESULTS: 160 patients underwent renal tumor surgery between 2005 and 2018. 70 (43.8%) patients met study criteria with median age of 45.1 months (range 1.1-224); 73% required VA. Using the VADT, VA placement was "needed" in 67.1% of patients and "deferred" in 32.9%. Interrater reliability was very high (kappa = 0.97, 95% CI 0.91-1, p < 0.001). The sensitivity and specificity of the VADT to correctly decide on VA placement were 0.92 (0.8-0.98) and 1 (0.79-1). Using the VADT, no patient would have undergone unnecessary VA placement. In reality, 4.3% of patients had an unnecessary VA placed which required a subsequent removal. CONCLUSIONS: These preliminary data support the continued study of this VADT to guide intraoperative decisions regarding VA placement in patients with renal tumors. LEVEL OF EVIDENCE: III - Study of diagnostic test.

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Introducción: Staphylococcus aureus resistente a meticilina constituye la causa principal de bacteriemia relaciona a catéter en pacientes con enfermedad renal crónica avanzada en hemodiálisis. Objetivos: Estimar la tasa de incidencia de bacteriemia relaciona con catéter por Staphylococcus aureus resistente a meticilina en pacientes con enfermedad renal crónica avanzada en el Hospital General Freyre de Andrade, Cuba, y vigilar los valores de concentración mínima inhibitoria de vancomicina frente a los aislados recuperados de bacteriemia. Métodos: El estudio se realizó entre mayo 2017 y febrero 2018, el cual incluyó 64 pacientes con Staphylococcus aureus resistente a meticilina (total de los atendidos en hemodiálisis). De cada uno se recogió información acerca de tipo de acceso vascular y tiempo de uso; de los que desarrollaron un episodio sugerente de bacteriemia se obtuvieron muestras de sangre para hemocultivo. Se informó bacteriemia relacionada con catéter utilizando los criterios de Bouza y otros 2004 y estas se confirmaron debidas a Staphylococcus aureus resistente a meticilina tras determinar la concentración mínima inhibitoria de oxacilina, empleando el método de microdilución en caldo y los criterios del CLSI 2017. Asimismo se evaluó la concentración mínima inhibitoria de vancomicina. Resultados: Las tasas de incidencia de bacteriemia relaciona con catéter por S. aureus y Staphylococcus aureus resistente a meticilina fueron de 0,66 y 0,59/1000 días-catéter, respectivamente. Predominaron las bacteriemia relacionada con catéter en los pacientes con accesos vasculares temporales. No se observó incremento en la concentración mínima inhibitoria de vancomicina (1 y 2 (g/mL) para los aislados responsables de bacteriemia a repetición y persistente. Conclusiones: La tasas de incidencia de bacteriemia relacionada con catéter indican que en la unidad de hemodiálisis se mantienen buenas prácticas clínicas. Los valores de concentración mínima inhibitoria de vancomicina sugieren una reducción en la eficacia de la droga en el tratamiento(AU)

Introduction: Methicillin-resistant Staphylococcus aureus is the leading cause of catheter-related bacteremia in patients with advanced chronic kidney disease undergoing hemodialysis. Objective: Estimate the incidence rate of catheter-related bacteremia by methicillin-resistant Staphylococcus aureus in patients with advanced chronic kidney disease from General Freyre de Andrade Hospital in Cuba, and survey the vancomycin minimum inhibitory concentration values for isolates obtained from bacteremia. Methods: A study was conducted of 64 patients with methicillin-resistant Staphylococcus aureus (total of those undergoing hemodialysis) from May 2017 to February 2018. For each one of them, information was collected about vascular access type and time of use. Blood culture samples were obtained from patients who developed an episode suggesting bacteremia. Catheter-related bacteremia was reported using Bouza et al (2004) criteria, and it was confirmed as due to methicillin-resistant Staphylococcus aureus after determining oxacillin minimum inhibitory concentration by broth microdilution and CLSI 2017 criteria. Vancomycin minimum inhibitory concentration was also evaluated. Results: The incidence rates for catheter-related bacteremia by S. aureus and methicillin-resistant Staphylococcus aureus were 0.66 and 0.59/1000 catheter-days, respectively. A predominance was found of catheter-related bacteremia in patients with temporary vascular accesses. No increase was observed in vancomycin minimum inhibitory concentration (1 and 2 g/mlL for the isolates responsible for recurrent and persistent bacteremia. Conclusions: The incidence rates for catheter-related bacteremia show that good clinical practices are maintained in the hemodialysis unit. Vancomycin minimum inhibitory concentration values suggest a decrease in the efficacy of the drug during treatment(AU)

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RESUMEN Introducción: La cateterización percutánea por punción de una vena de gran calibre y flujo sanguíneo conocido como catéter venoso central ―CVC― es un procedimiento que no deja de ser invasivo, por lo tanto no está exento de potenciales complicaciones que pueden generar un riesgo para la vida de los pacientes como lo es el neumotórax iatrogénico secundario. Objetivo: Establecer la incidencia de neumotórax secundario iatrogénico como complicación inmediata post inserción de catéter venoso central. Materiales y métodos: Se trata de un estudio prospectivo-descriptivo y observacional de las historias clínicas de los pacientes entre 15 y 60 años de edad, de ambos sexos, que ingresaron a los diferentes servicios de hospitalización del hospital Dr. Adolfo Pons del Instituto Venezolano de los Seguros Sociales ―IVSS― (Maracaibo, Venezuela), durante el período comprendido entre enero de 2016 y junio de 2017; los cuales ameritaron inserción de un catéter percutáneo para el abordaje venoso central como indicación para manejo terapéutico o de constantes fisiológicas. Resultados: Se incluyeron 140 pacientes, en el 15,6 % (22) se identificó la presencia de neumotórax secundario en los controles radiológicos post procedimiento cuando el abordaje era la vena subclavia. Conclusiones: Se debe tener en cuenta que el neumotórax secundario representa la complicación mecánica más común en la cateterización venosa central, la cual puede poner en riesgo la integridad del paciente. Este conocimiento es fundamental para detectar esa complicación por el médico operador y poder darle la solución más acorde y adecuada para evitar las complicaciones y lograr así una medicina de mejor calidad.

ABSTRACT Introduction: Percutaneous catheterization by puncture of a large caliber vein and blood flow known as the central venous catheter (CVC), is a non-invasive procedure and, therefore, it is not free of potential complications that may generate a risk for the life of patients, as it is the secondary iatrogenic pneumothorax. Objective: To establish the incidence of secondary iatrogenic pneumothorax as an immediate complication secondary to the insertion of a CVC. Materials and methods: This is a prospective, descriptive, observational study of the medical records of patients between 15-60 years of age of both sexes, who were admitted in the different hospitalization services at Dr. Adolfo Pons Hospital from the Social Insurance Institute of Venezuela ―IVSS for its acronym in Spanish― (Maracaibo, Venezuela) during the period between January 2016 and June 2017, patients who required the insertion of a percutaneous catheter for the central venous approach, as an indication for therapeutic management or physiological constants. Results: A total of 140 patients were included; in 15.6% (22) the presence of secondary pneumothorax was identified in radiological controls when the subclavian vein was approached. Conclusions: It should be considered that secondary pneumothorax represents the most common mechanical complication in central venous catheterization that can put the integrity of the patient at risk. This knowledge is essential to detect this complication by the attending physician and can give the most adequate and appropriate solution to avoid complications and thus achieve better quality medicine.

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La necesidad de un rápido y eficaz tratamiento por vía intravenosa a pacientes críticamente enfermos y con imposibilidad de tratamiento por otras vías ha hecho imperioso el acceso a través de las vías venosas centrales (CVC), se ha asociado con eventos adversos que prolongan la estancia hospitalaria, aumentan los costos hospitalarios, pueden agregar morbilidad e incluso mortalidad al paciente. Objetivo: analizar complicaciones de los pacientes con acceso vascular central hospitalizados en los servicios de Urgencias, Terapia Intensiva Pediátrica, Cirugía General y Cuidados Intensivos Neonatales del Hospital de Niños "J.M. de los Ríos", en el período marzo-agosto 2016. Método: Estudio retrospectivo, longitudinal y descriptivo con seguimiento de la evolución según registros de la historia clínica de cada paciente. Se registraron características demográficas, diagnóstico, criterios de indicación, características de los catéteres y su localización, complicaciones infecciosas y no infecciosas, duración y tipo de manipulación del CVC. Resultados: Se estudiaron 54 pacientes en total con CVC determinando que no existe diferencia importante en cuanto al sexo, 52 % masculino frente a 48,1 % femenino. La localización más frecuente fue a nivel de la vena yugular interna derecha en 56 % de casos. En un 41 % no se cumplieron con los criterios de colocación. Se identificó un 37 % de complicaciones de las cuales 22 % fueron de causa no infecciosa destacando la obstrucción como causa más frecuente y un 15 % de etiología infecciosa siendo la bacteriemia la principal causa en un 56 %. Conclusiones: se obtuvo con mayor frecuencia aislamiento de K. pneumoniae y P. aeruginosa. La permanencia de la mayoría de CVC fue mayor de 7 días. No se cumplen con los bundles de inserción ni de mantenimiento. Al analizar los diferentes factores de riesgo para complicación infecciosa, se obtuvo que la duración del catéter incrementa el riesgo de infección.

The need for rapid and effective intravenous treatment of critically ill patients who are unable to treat by other means has made access through the central venous pathways (CVC) imperative, has been associated with adverse events that prolong hospital stay, increase hospital costs, can add morbidity and even mortality to the patient. Objective: To analyze complications of patients with central vascular access hospitalized in the Emergency Services, Pediatric Intensive Care, General Surgery and Neonatal Intensive Care of Children's Hospital "J.M. de Los Rios, in the period March-August 2016. Method: Retrospective, longitudinal and descriptive study with follow-up of the evolution according to records of the clinical history of each patient. Patient demographics, diagnosis, indication criteria, catheter characteristics and location, infectious and noninfectious complications, duration and type of CVC manipulation were recorded. Results: A total of 54 patients with CVC were studied, determining that there is no significant difference in sex, 52 % male versus 48.1 % female. The most frequent localization was at the level of the right internal jugular vein in 56 % of cases. In 41 %, the placement criteria were not met. 37 % of complications were identified, of which 22 % were of non-infectious cause, the most frequent cause being obstruction and 15 % of infectious etiology, with bacteremia being the main cause in 56 %. Conclusions: Among the isolated microorganisms K. pneumoniae and P. aeruginosa were most frequently found. The permanence of the majority of CVC was greater than 7 days. Insertion and maintenance bundles are not met. When analyzing the different risk factors for infectious complication, it was obtained that the duration of the catheter increases the risk of infection.

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Las infecciones fúngicas asociadas a biofilms en dispositivos biomédicos son refractarias al tratamiento antifúngico y habitualmente se requiere del retiro oportuno del dispositivo, así como la administración de antifúngicos sistémicos. Presentamos el caso de una paciente mujer de 36 años que recibe terapia para el dolor administrada por dispositivo intravascular de larga permanencia, catéter Port-A-Cath, y que desarrolló candidemia y endocarditis por Candida parapsilosis asociada al catéter; el cual tuvo que ser retirado mediante toracotomía por persistencia de la infección a pesar de la terapia antifúngica sistémica. Se evidenció extenso biofilm rodeando al catéter, con aislamiento de Candida parapsilosis y se completaron seis semanas de tratamiento antifúngico con evolución clínica favorable

Fungal infections associated with biofilms in biomedical devices are refractory to antifungal treatment and usually require the timely removal of the device, as well as the administration of systemic antifungals. We present the case of a 36-year- old female patient who received pain therapy administered by a Port-A-Cath long-term central venous access device. She developed catheter-related candidemi a and endocarditis caused by Candida parapsilosis. The catheter had to be removed by thoracotomy due to persistent infection despite the systemic antifungal therapy. An extensive biofilm surrounding the catheter was observed and Candida parapsilosis was isolated. Six weeks of antifungal treatment with a favorable clinical evolution were completed

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Resumen: Introducción: Este estudio tuvo por objetivo valorar las diferencias entre el tipo de fluidoterapia ini cial utilizada (sueros isotónicos o hipotónicos) en el desarrollo de hiponatremia, valores de cloro y to lerancia de las vías venosas. Pacientes y Método: Estudio retrospectivo de cohortes en una Unidad de Cuidados Intensivos Pediátricos (UCIP) de un hospital terciario. Se incluyeron niños menores de 15 años ingresados durante el primer semestre de los años 2010 y 2013, que recibieron fluidoterapia in travenosa, excluyéndose los sometidos a cirugía cardiaca, trasplantados renales y aquellos con ingreso inferior a 24 h. Se recogieron datos epidemiológicos, de comorbilidad y relacionados con el ingreso, tipo de suero recibido, valores de sodio y cloro en las primeras 72 h y la incidencia de extravasaciones de vías periféricas. Resultados: Se incluyeron 111 niños: 68 (61,3%) recibieron líquidos hipotónicos y 43 (38,7%) isotónicos. No hubo diferencias respecto a la patología y gravedad, ni tampoco en el volumen de líquidos recibido. Entre los pacientes que recibieron sueros hipotónicos, 28 (41,2%) pre sentaron hiponatremia, siendo esta moderada (Na <130 mEq/kg) en 11 de ellos, en comparación con 8 niños (18,6%) entre los que recibieron sueros isotónicos, registrando hiponatremia moderada solo en un caso (p=0,027). No se registró ningún caso de hipernatremia, ni hubo diferencias en los valores de cloro plasmático. Tampoco se objetivó mayor frecuencia de pérdida del acceso venoso utilizando la fluidoterapia isotónica (4,7% vs. 7,4%, p=0,704). Conclusión: El uso de líquidos iniciales isotóni cos en niños hospitalizados en UCIP se asocia con menor incidencia y gravedad de hiponatremia, sin cambio en la cloremia y es bien tolerado por las vías venosas periféricas.

Abstract: Introduction: The objective of this study was to evaluate the association between the type of initial fluid therapy used (isotonic or hypotonic solutions) and the development of hyponatremia, the plas ma chlorine values and the tolerance of venous access. Patients and Method: Retrospective cohort study in a Pediatric Intensive Care Unit (PICU) of a high complexity hospital. There were included children younger than 15 years old hospitalized during the first semester of 2010 and 2013 who recei ved intravenous maintenance fluid therapy, excluding patients undergoing cardiac surgery, kidney transplant and admissions that lasted less than 24 hours. Epidemiological, comorbidity and admis sion-related data were collected, including type of solution received, sodium and chlorine values in the first 72 hours of hospitalization and the incidence of extravasation of peripheral intravenous lines. Results: 111 children were included; 68 children (61.3%) were treated with hypotonic solutions and 43 (38.7%) with isotonic solutions. There were no differences in pathology and severity, and also in the volume of fluid received. Among the patients who received hypotonic solutions, 28 (41.2%) de veloped hyponatremia, wich was moderate (Na <130 mEq/Kg) in 11 cases, compared with 8 children (18.6%) who received isotonic solutions, with only one case of moderate hyponatremia (p = 0.027). No cases of hypernatremia were recorded, and there were no differences in plasma chlorine values. There was also no increased frequency of venous access loss in patients treated with isotonic solutions (4.7% versus 7.4%, p = 0.704). Conclusion: Treatment with initial isotonic solutions in children hos pitalized in PICU is associated with a lower incidence and severity of hyponatremia, without changes in the plasma chlorine values and it is well tolerated by peripheral intravenous lines.

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Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.

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The 2015 meeting of the Intestinal Transplant Association was held in Buenos Aires, Argentina. This was the 14th International Small Bowel Transplant Symposium, and it was the first meeting organized as a joint venture of the Transplantation Society, the Intestinal Transplant Association, and the Argentinean Transplant Society (Sociedad Argentina de Trasplantes). Innovative aspects of the classic meeting format included workshops sessions, debates, and multicenter studies. This report highlights the most prominent scientific contributions and results of the first such symposium in a Latin American country.

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Na medicina veterinária, o acesso venoso tem diversas finalidades e é amplamente utilizado devido à facilidade de manuseio, tolerância da maioria dos pacientes e baixo custo. O mais frequente é se empregar os cateter periféricos venosos e para sua utilização deve-se considerar o tipo e calibre do cateter, tempo de permanência e tipo de fluido a ser administrado. Realizada a antissepsia, deve-se fazer o garroteamento para facilitar a localização do vaso. Ao penetrar no lúmen vascular, o cateter deve ser avançado em direção à veia. Por fim, retira-se a agulha, conecta-se o equipo e fixa-se o cateter para mantê-lo estável e viável por até 72 horas. A falha na colocação do cateter pode prolongar o período de internação hospitalar. Dentre as complicações estão o extravasamento de fluidos, impedimento do fluxo sanguíneo, dores, hematomas, hemorragias, flebites, infecções, trombos, endocardite bacteriana e septicemia. Sendo assim, apesar ser amplamente utilizado, o acesso venoso necessita de cuidados inerentes ao seu uso e manutenção, que são fundamentais para diminuir a incidência de complicações imediatas e tardias. Desde que a implantação e manutenção dos cateteres sejam objetos de atenção do clínico responsável, não haverá prejuízos ao bem-estar do paciente.

In veterinary medicine, venous access has several purposes and is widely used because of it’s practical handling, tolerance of most patients and low cost. The most frequent is to use the venous peripheral catheters and for their use it should be considered the type and caliber of the catheter, period of catheterization and type of fluid to be administered. After the antisepsis is done, the tourniquet should be made to facilitate the location of the vessel. When penetrating the vascular lumen, the catheter should be advanced toward the vein. Finally, the needle is withdrawn, the equipment is connected and the catheter is fixed to keep it stable and viable for up to 72 hours Failure to insert the catheter may prolong the period of hospitalization. Complications include fluid leakage, impaired blood flow, pain, hematoma, hemorrhage, phlebitis, infections, thrombi, bacterial endocarditis, and septicemia. Therefore, although it is widely used, venous access requires care that is inherent in its use and maintenance, which are fundamental for reducing the incidence of immediate and late complications. Provided that the implantation and maintenance of the catheters are objects of attention of a responsible clinician, there will be no damages to the health of the patient.

Assuntos

RESUMO

Na medicina veterinária, o acesso venoso tem diversas finalidades e é amplamente utilizado devido à facilidade de manuseio, tolerância da maioria dos pacientes e baixo custo. O mais frequente é se empregar os cateter periféricos venosos e para sua utilização deve-se considerar o tipo e calibre do cateter, tempo de permanência e tipo de fluido a ser administrado. Realizada a antissepsia, deve-se fazer o garroteamento para facilitar a localização do vaso. Ao penetrar no lúmen vascular, o cateter deve ser avançado em direção à veia. Por fim, retira-se a agulha, conecta-se o equipo e fixa-se o cateter para mantê-lo estável e viável por até 72 horas. A falha na colocação do cateter pode prolongar o período de internação hospitalar. Dentre as complicações estão o extravasamento de fluidos, impedimento do fluxo sanguíneo, dores, hematomas, hemorragias, flebites, infecções, trombos, endocardite bacteriana e septicemia. Sendo assim, apesar ser amplamente utilizado, o acesso venoso necessita de cuidados inerentes ao seu uso e manutenção, que são fundamentais para diminuir a incidência de complicações imediatas e tardias. Desde que a implantação e manutenção dos cateteres sejam objetos de atenção do clínico responsável, não haverá prejuízos ao bem-estar do paciente.(AU)

In veterinary medicine, venous access has several purposes and is widely used because of its practical handling, tolerance of most patients and low cost. The most frequent is to use the venous peripheral catheters and for their use it should be considered the type and caliber of the catheter, period of catheterization and type of fluid to be administered. After the antisepsis is done, the tourniquet should be made to facilitate the location of the vessel. When penetrating the vascular lumen, the catheter should be advanced toward the vein. Finally, the needle is withdrawn, the equipment is connected and the catheter is fixed to keep it stable and viable for up to 72 hours Failure to insert the catheter may prolong the period of hospitalization. Complications include fluid leakage, impaired blood flow, pain, hematoma, hemorrhage, phlebitis, infections, thrombi, bacterial endocarditis, and septicemia. Therefore, although it is widely used, venous access requires care that is inherent in its use and maintenance, which are fundamental for reducing the incidence of immediate and late complications. Provided that the implantation and maintenance of the catheters are objects of attention of a responsible clinician, there will be no damages to the health of the patient.(AU)

Assuntos

RESUMO

RESUMEN Introducción: los catéteres venosos centrales son sondas intravasculares que se insertan en los grandes vasos venosos del tórax y abdomen. La técnica comúnmente realizada es la guiada por reparos anatómicos basada en la presunción de la ubicación de los vasos del cuello al identificar estructuras anatómicas externas. El uso de la ultrasonografía ha sido promovido como un método para reducir el riesgo de complicaciones durante la cateterización venosa central. Objetivos: comparar la eficacia de la técnica de inserción de catéteres venosos yugulares internos guiado por ecografía con la realizada por reparos anatómicos. Metodología: estudio experimental realizado en varones y mujeres, mayores de 18 años, en quienes estaba indicada la colocación de acceso venoso central yugular interno en forma programada, internados en las Cátedras de Clínica Médica, Unidad de Cuidados Intermedios y Unidad de Cuidados Intensivos del Hospital de Clínicas y en la Unidad de Cuidados Intensivos del Sanatorio Británico (Asunción). En cada caso fueron medidas las siguientes variables: tasa de éxito de colocación, número de intentos, tiempo de realización y complicaciones (hematomas, punción arterial y neumotórax). Resultados: 149 pacientes fueron considerados en este estudio, realizándose 90 vías venosas yugulares con guía ecográfica y 59 por la técnica habitual por reparos anatómicos. El tiempo de realización y el número de punciones en el grupo con guía ecográfica fue menor (p<0,001). No hubo diferencias estadísticamente significativas en éxito del procedimiento entre ambos grupos pero el realizado con guía ecográfica tuvo menor proporción de complicaciones: hematomas (p<0,01) y punción arterial (p 0,01). No se registró neumotórax en ninguno de los dos grupos. Conclusiones: la colocación de vía venosa central bajo guía ecográfica es superior sobre la técnica por reparos anatómicos considerando la menor proporción de complicaciones, la reducción en el número de intentos y menor tiempo de realización. Aunque el éxito del procedimiento sea similar, las implicancias para llegar a dicho objetivo bajo la técnica a ciegas se traducen en un incremento directo en las otras variables ya citadas en detrimento del paciente. Por lo tanto, siempre que esté disponible tanto el equipamiento necesario como el operador capacitado ésta será la técnica de elección.

ABSTRACT Introduction: The central venous catheters are intravascular tubes that are inserted in the major vessels of the thorax and abdomen. The commonly performed technique is the external anatomical landmarks technique based on the presumption of the location of the neck vessels when identifying external anatomical structures. The use of ultrasound has been promoted as a method to reduce the risk of complications during the central venous catheterization. Objectives: To compare the effectiveness of the ultrasound-guided insertion technique of internal venous catheters versus the surface anatomy landmark technique. Methodology: This experimental study was carried out in adult men and women in whom the insertion of an internal jugular central venous access was indicated and programmed. They were hospitalized in the Services of Medical Clinic, Intermediate Care Unit and Intensive Care Unit of the Hospital de Clínicas and the Intensive Care Unit of the Sanatorio Británico (Asunción). The following variables were measured: the rate of successful insertions, the number of attempts, the duration of catheterization (from puncture of EJV to external fixation of the catheter) and the complications (hematomas, arterial puncture and pneumothorax). Results: One hundred forty nine patients were included in this study, 90 ultrasound-guided jugular vein catheterizations were made and 59 using the external anatomical landmarks technique. The time of performance and the number of punctures were lower in the ultrasound-guided group (p<0.001). There were no statistically significant differences between the groups regarding the success rates but the ultrasound-guided group had less proportion of complications: hematomas (p<0.01) and arterial puncture (p<0.01). Pneumothorax was not registered in any groups. Conclusions: The ultrasound-guided central venous catheterization is superior to the one made using the surface anatomy landmark technique considering the lower proportion of complications, the reduction of the number of attempts and the shorter duration. Although the success of both procedures was similar, the implications for reaching the aim using the surface anatomy landmark technique turned into a direct increase of the above mentioned variables at the expense of the patient. Therefore, whenever both the necessary equipment and a trained operator are available, the ultrasound-guided technique will be the technique of choice.

RESUMO

BACKGROUND: Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. PROCEDURE: A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients. Sociodemographic, clinical, and TIVAP insertion-related variables were evaluated, with the endpoint being the first CLABSI. A Kaplan-Meier analysis was performed to determine CLABSI-free catheter survival. RESULTS: Overall, 188 children were evaluated over 77,541 catheter days, with 94 being diagnosed with CLABSI (50%). Although coagulase-negative staphylococci were the pathogens most commonly isolated, Gram-negative microorganisms (46.8%) were also prevalent. In the multivariate analysis, factors that increased the risk for CLABSI were TIVAP insertion prior to chemotherapy (risk ratio [RR] = 1.56; P < 0.01), white blood cell count less than 1,000 mm-3 on the day of implantation (RR = 1.64; P < 0.01), and chronic malnutrition (RR = 1.41; P < 0.05). Median time without CLABSI following TIVAP insertion was 74.5 days. CONCLUSIONS: Risk factors for CLABSI in pediatric cancer patients with a TIVAP may be related to the severity of the child's condition at catheter insertion. Insertion of the catheter before chemotherapy and unfavorable conditions such as malnutrition and bone marrow aplasia can increase the risk of CLABSI. Protocols must be revised and surveillance increased over the first 10 weeks of treatment.

Assuntos