Prevention of epidural catheter migration: a comparative evaluation of two tunneling techniques

Gautam Sujeet,Agarwal Anil,Das Pravin Kumar,Khuba Sandeep,Kumar Sanjay 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.1

BackgroundEpidural analgesia failure episodes can be reduced by catheter fixation techniques with a lower incidence of catheter migration. In this clinical study, we compared the roles of two epidural catheter tunneling techniques for the prevention of epidural catheter migration.MethodsPatients undergoing major abdominal surgery were randomized into three groups of 50 patients each based on the method used to secure the epidural catheter. In the control group (CG), the epidural catheter was secured without tunneling. Tunneling groups 1 and 2 (TG1 and TG2) were defined as tunneling with and without a catheter loop, respectively. The primary outcome measure was the migration of the epidural catheter, while the secondary outcome measures were the adequacy of analgesia and signs of inflammation. All patients were followed up by the acute pain service team twice daily in the postoperative period until the epidural catheter was removed. The results were analyzed by the one-way analysis of variance (ANOVA), chi-square test, and Fisher’s exact test. P values <0.050 were considered significant.ResultsThe three groups were similar with respect to patient characteristics. Catheter migration was significantly reduced in TG2 (two patients) compared to those in the other two groups, i.e., TG1 (eight patients) (P = 0.045) and CG (17 patients) (P = 0.001). No differences were found amongst the three groups in analgesia adequacy and catheter site inflammation (P > 0.050).ConclusionsCatheter migration was significantly reduced by tunneling without a catheter loop in TG2 as compared to the other two groups. Therefore, we suggest routine use of tunneling without a catheter loop technique in anesthesia practice and look forward to future studies with larger sample sizes.

우측 내경정맥 경로를 이용한 피하터널식 중심정맥도관 삽입술

신성욱,도영수,Sin, Seong-Uk,Do, Yeong-Su 대한영상의학회 2003 대한영상의학회지 Vol.48 No.3

목적: 우측 내경 정맥을 통하여 피하 터널식 중심정맥도관을 삽입한 경우 시술로 인한 합병증과 장기추적 결과를 알아보고자 하였다. 대상과 방법: 2001년 6월에서 2002년 5월 사이에 우측 내경 정맥을 통해 Hickman 도관을 삽입한 654명, 670예를 대상으로 시술과 관련된 합병증을 조사하고 2002년 7월까지의 추적결과를 분석하였다. 결과: 670예 중 669예(99.9%)에서 성공적으로 삽입했고 시술과 관련된 초기 합병증은 8예(1.2%)(기흉 3예, 조기위치 변위 1예, 공기색전증 1예, 도관 손상 1예,도관 꺾임 1예 및 기정맥에 삽입된 1예 등)였다. Hickman 도관의 삽입기간은 1-407일(평균 107.1일)이었다. 추적기간 중 416예에서 Hickman 도관을 제거하였고 이 중 치료의 종료에 의한 경우가 334예, 환자의 치료 거부나 치료약제의 변경 등으로 인한 경우가 16예, 도관 관련 합병증에 의한 경우가 53예, 기타 13예였다. 후기 합병증 53예(8.0%)는 감염 44예(6.6%), 위치 변위 5예(0.8%), 도관 폐쇄 2예(0.3%), 혈전성 정맥염 1예(0.15%), 도관 혈전과 관련한 우심방 혈전1예(0.15%)등이었다. 혈전성 정맥염 1예를 제외하고 증상을 유발하는 정맥혈전이나 협착은 관찰되지 않았다. 결론: 우측 내경 정맥을 통해 Hickman 도관을 삽입할 경우 정맥혈전이나 협착을 유발하는 빈도가 매우 낮으므로 중심정맥 도관을 설치할 경우 우측 내경 정맥이 일차적 경로가 되어야 한다. Purpose: To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. Materials and Methods: Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. Results: The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheters were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted , namely the one case of thrombophlebitis. Conclusion: Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.

Incidence of Catheter-associated Urinary Tract Infection in Hospitals with Less than 300 Beds

박진주,서유빈,김성란,박혜진,엄중식,유현미,천희경 대한의료관련감염관리학회 2019 의료관련감염관리 Vol.24 No.1

Background: Catheter-associated urinary tract infection is a major infection in healthcare facilities. We investigated the urinary catheter utilization ratio and incidence of catheter-associated urinary tract infections in small-sized hospitals with ≤300 beds. Methods: We recruited hospitals via a web-based survey from July 2016 to September 2016. Infection control practitioners provided data about catheter-associated urinary tract infections on the website according to the prescribed form. The urinary catheter utilization ratio was calculated by dividing the number of device-days by the number of patient-days. The incidence of catheter-associated urinary tract infections per 1,000 device-days was calculated by dividing the number of urinary tract infections in patients with indwelling urinary catheter by the number of indwelling device-days and multiplying by 1000. The urinary catheter utilization ratio and incidence of catheter-associated urinary tract infections were compared between hospitals with >200 beds and ≤200 beds.Results: Twenty-seven hospitals were included. The average urinary catheter utilization ratio was 0.4 (0.47 in hospitals with >200 beds and 0.38 in hospitals with ≤200 beds; P=0.1). The incidence of catheter-associated urinary tract infections was 1.59 per 1,000 device-days. There was no significant difference in the incidence of infections according to the number of beds (1.53 in hospitals with >200 beds vs 1.9 in hospitals with ≤200 beds, P=0.421). Conclusion: The incidence of catheter-associated urinary tract infections in small-sized hospitals was considerably high. Efforts must be made to attenuate the infection rates through proper infection control and monitoring.

Catheter-associated urinary tract infections in patients who have undergone radical cystectomy for bladder cancer: A prospective randomized clinical study of two silicone catheters (clinical benefit of antibiotic silicone material)

태범식,오종진,정병창,구자현 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.3

Purpose: The prevalence of catheter-associated urinary tract infections (CAUTIs) varies from 5% to 8.2%, and the risk of infection increases by 5% to 7% per day of primary indwelling. We investigated whether a novel biofilm inhibitory mechanism using an inhibitory silicone urethral catheter (a coated Foley catheter) can reduce CAUTIs compared to conventional non-coated Foley catheters. Materials and Methods: This study prospectively analyzed the difference in the incidence of CAUTIs in patients who underwent radical cystectomy with an orthotopic neobladder for bladder cancer and received a coated or conventional non-coated catheter. Additionally, differences in bacterial colonization between the groups were analyzed using a catheter-tip bacterial culture test. Results: Eighty-five patients were randomized into the “coated Foley catheter” group (abbreviated as “case” group; 41 patients) and a control group (44 patients). The two groups were identical except for their surgical history. The incidence of CAUTIs 2 weeks after radical cystectomy was 21.95% (case) and 27.27% (control), with no significant difference between the two groups. However, when the catheter was removed 2 weeks after surgery, the catheter tip culture test revealed significant bacterial colonies in 25 (60.98%) and 38 (86.36%) patients in the case and control group, respectively. No catheter-related postoperative side effects were observed in either group. Conclusions: The incidence of CAUTIs in the two groups did not differ according to the catheter material. However, the catheter bacterial culture test showed that bacterial colonization was significantly suppressed on the Bi-Fi Free technology catheter, which comparatively inhibited biofilm formation.

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients

( Dong Yeon Ryu ),( Sang Bong Lee ),( Gil Whan Kim ),( Jae Hun Kim ) 대한외상학회 2019 大韓外傷學會誌 Vol.32 No.3

Purpose: To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods: From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results: During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter- days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05). Conclusions: The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

다양한 Balloon catheter의 풍선 확장에 대한 연구

이승민,한진효,윤동욱,김정민 대한인터벤션영상기술학회 2022 대한인터벤션영상기술학회지 Vol.25 No.1

목 적 : 다양한 Balloon catheter에서 표준으로 제시하는 Balloon size와 그에 해당하는 기압을 가했을 때 Balloon catheter의 측정값 간의 차이가 발생하는지 비교해 보고, 더 나아가 초기 상태의 Balloon catheter를 1회 ballooning 하였을 때의 balloon size와 수차례의 Re-ballooning 하였을 때 Balloon catheter의 size 변화에 대해 In-vitro 실험을 통해 분석 및 평가하고자 한다. 대상 및 방법 : PTCA Balloon catheter, PTA Balloon catheter #1, PTA Balloon catheter #2, Non-vascular Balloon catheter 총 4가지 제품으로 규정압력의 절반(1/2 Nominal pressure), 규정압력(Nominal pressure), 정격파열 압력 (Rated burst pressure) 총 3가지 조건을 적용하여 각 조건 당 5번의 실험을 진행하였다. 실험을 통하여 얻게 된 영상으로 Angiography system의 measurement 기능 및 Image-J program 총 2가지 방법을 이용하여 Balloon catheter의 size를 측정하고 각각의 방법을 통해 얻게 된 측정값과 제품에서 제시하는 기준값을 비교 및 분석하였다. 결과 : Nominal pressure 조건에서 각 제품에서 제시된 기준값과 실제 기압을 가했을 때의 Balloon size를 Image J program으로 측정값을 구한 결과, 그 차이는 PTCA Balloon catheter는 1.7%, PTA Balloon catheter #1은 6.41%, PTA Balloon catheter #2는 6.53%, Non-vascular Balloon catheter 7.16%를 나타냈다. 1회 Ballooning을 시행한 Balloon catheter size와 수차례의 Re-ballooning을 한 Balloon catheter size의 측정값 차이는 Nominal pressure 조건에서 Angiography system의 measurement는 PTCA Balloon catheter는 3.86%, PTA Balloon catheter #1은 2.29%, PTA Balloon catheter #2는 4.87%, Non-vascular Balloon catheter 1.07%를 나타냈다. 결론 : 각각의 balloon catheter 제품에 제시된 기준값과 A/M 측정값 간의 차이는 약 8.97 – 15.94% 나타났고, 아울러 1회 ballooning의 balloon size의 측정값과 수차례의 re-ballooning 후 balloon size의 측정값 차이는 약 0.37 – 5.33% 나타났다. 따라서, 위의 제시된 결과를 참고하여 balloon catheter를 이용하는 시술에 적용한다면 더 정확하고 안전한 시술에 도움이 될 것이라 사료된다.

정맥내 카테터 사용과 관련된 합병증 발생에 대한 전향적 조사연구

최선주,정희진,우흥정,김우주,박승철,박창현 대한병원감염관리학회 1998 의료관련감염관리 Vol.3 No.2

Randomized comparison of popliteal-sciatic perineural catheter tip migration and dislocation in a cadaver model using two catheter designs

Lauren Steffel,Steven K. Howard,Edward R. Mariano,Lindsay Borg,Jody C. Leng,T. Edward Kim 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.1

Background: New catheter-over-needle (CON) technology for continuous peripheral nerve blockade has emerged, but its effect on the risk of perineural catheter tip dislocation is unknown. Less flexible catheters may be more likely to migrate away from the nerve with simulated patient movement. In the present study, we evaluated catheter tip migration between CON catheters and traditional catheter-through-needle (CTN) catheters during ultrasound-guided short-axis in-plane (SAX-IP) insertion. Methods: We evaluated the migration of popliteal-sciatic catheters in a prone, unembalmed male cadaver. Thirty catheter placement trials were divided randomly into two groups based on the catheter type: CON or CTN. A single anesthesiology resident placed the catheters by SAX-IP insertion, and the catheters were then examined by ultrasound before and after ipsilateral knee range of motion (ROM) exercises (0o–130o flexion). A blinded expert regional anesthesiologist performed caliper measurements on the ultrasound images before and after the ROM exercises. The primary outcome was the change in distance from the catheter tip to the center of the nerve (cm) between before and after the ROM exercises. Results: The change in the tip-to-nerve distance (median [10th–90th percentile]) was 0.06 (−0.16 to 0.23) cm for the CTN catheter and 0.00 (−0.12 to 0.69) for the CON catheter (P = 0.663). However, there was a statistically significant increase in dislocation out of the nerve compartment for the CON catheter (4/15; 0/15 for CTN) (P = 0.043). Conclusions: Although the use of different catheter designs had no effect on the change in the measured migration distance of popliteal-sciatic catheters, 27% of the CON catheters were dislocated out of the nerve compartment. These results may influence the choice of catheter design when using SAX-IP perineural catheter insertion.

말기 신부전 환자의 혈액투석에서 Tunneled Cuffed Catheter ( Permcath ) 사용 성적에 대한 연구

강영선(Young Sun Kang),이소영(So Young Lee),한상엽(Sang Yup Han),조상경(Sang Kyung Jo),신진호(Jin Ho Shin),차대룡(Dae Ryong Cha),권영주(Young Joo Kwon),조원용(Won Yong Cho),표희정(Heui Jung Pyo),김형규(Hyoung Kyu Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

목적 : 혈액투석을 받는 만성 신부전 환자에게 혈관 접속장치의 확보는 환자의 생명을 유지시키기 위한 중요한 요소이다. 그러나 충분한 사전 준비 없이 시행되는 응급 혈액 투석시 흔히 사용되는 polyurethan teflon double lumen catheter는 비교적 사용기간이 짧으며, 사용 중 여러 가지 중한 합병증을 동반할 수 있다. 따라서 최근 피하에 매몰시킬 수 있는 dacron cuff를 갖고 있는 tunneled cuffed catheter(Permcath®)가 사용 중 합병증이 적고 충분한 기간 동안 사용할 수 있어 동정맥 문합 수술 후 혈관이 성숙되기까지 충분히 기다릴 수 있는 시간이 있고, 반 영구적인 목적으로 사용할 수 있다고 알려져 있다. 이에 이 연구에서는 tunneled cuffed catheter사용의 합병증 및 성적에 대해 조사하였다. 방법 : 1995년 1월부터 1999년 8월까지 환자 86명에 대하여 시행한 총 101예를 대상으로 조사하였으며 86명 중 27명은 다른 병원으로 전원하였다. 86명에 포함되지 않는 8명은 추적이 중단되어 조사대상에서 제외되었으며 전원된 환자는 병원이나 환자를 통한 전화 인터뷰를 시행하였다. 결과 : 전체 환자 86명의 평균 연령은 58세이고 남녀가 각각49명, 37명이었다. 이 중 35명은 당뇨병이 있었다. 대상환자 86명 중 4회 시행이 1명, 3회 시행이 1명, 2회가 10명이 있어 도관삽입은 101예에서 시행되었다. 사용 목적은 동정맥 문합술 후 혈관 성숙을 위해 대기하는 경우가 46%로 가장 많았고 혈관상태가 좋지 않아 혈관 수술을 할 수 없어 시행한 경우가 31%, 복막투석 중 합병증 발생의 경우가 15%였다. 혈관 수술을 위한 경우가 5%였으며 신장이식을 준비하는 경우도 있었다. 합병증은 시술환자 중 51%에서 발생하였으며, 이 중 국소 출혈이 70%로 많았으나 모든 예에서 도관관련 균혈증 가능성(possible catheter-related bacteremia, possible CRB)이 30%, 출구 감염이 14%, 기계적인 합병증이 7%를 차지했다. 카테터를 제거한 이유의 20%에서는 상기한 합병증 때문이었고 54%에서는 사용 목적이 사라져 의도적으로 제거한 경우였다. 내경 정맥 및 쇄골하정맥 등 카테터의 삽입 위치와 당뇨병 유무, 연령, 성별에 따른 전체 합병증의 차이는 없었다. 그리고 각각에 따른 출혈, 균혈증 등의 합병증에도 차이는 없었다. 그러나 출구 감염의 경우 쇄골하 정맥을 사용했을 때 더 흔히 발생하였다. 평균 사용기간은 4.5개월로 가장 긴 기간은 20개월이었다. 결론 : Tunneled cuffed catheter는 혈액투석을 필요로 하는 만성 신부전 환자에서 경한 합병증을 유발하면서 장기간 사용할 수 있어 장기적으로 유지투석을 시행해야 하는 만성 신부전 환자에서 일시적 또는 반영구적 혈관 접속장치로 유용할 것으로 생각되며, 향후 이의 적극적인 시도가 필요하리라 여겨진다. Background : Mortality and morbidity of ESRD patients depend on a maintenance of vascular access for dialysis. Polyurethane teflon double lumen catheters have been used for a temporary vascular access for hemodialysis. But, their use has a high rate of complications and a limited duration. Recently developed tunneled cuffed catheter(Permcath®) have lesser complications and longer durability and it could be an alternative for double lumen polyurethan catheter. This study evaluated the usefulness and complica- tions of a tunneled cuffed catheter as a long-term vascular access at the Korea University Medical Center. Methods: The study was done retrospectively through rnedical chart review and telephone interview to investigate age, sex, the absence or presence of diabetes mellitus, catheter performance, indications for a insertion, complications, causes of catheter removal. 101 catheters were inserted in 86 ESRD patients(80 jugular, 21 subclavian) from February, 1995 to August, 1999. The complication rates and it's association with diabetes mellitus and the location of catheter insertion were reviewed. Results: The rnean age of patients was 58 years (49 men, 37 women). 35 patients were diabetics. The purpose of catheters insertion were : 1) waiting for the maturation of an arteriovenous fistula(46%), 2) no other available vascular access(31%), 3) after a removal or insertion of peritoneal dialysis catheters (15%), 4) waiting for the better vascular access operation(5%). Catheters were removed because of mechanical obstructions(8%), infections(12%), deaths of patients(16%). 51% of patients had catheter related complications. Local bleeding(70%) was the most common complication. Bacteremia and exit site infection rate were 30% and 14% respectively. The complication rates had no association with age, sex, the absence or presence of diabetes mellitus and the location of catheter insertion. However, a subcalvian catheter was more vulnerable to exit site infection than an internal jugular catheter. Conclusions: A tunneled cuffed catheter is safer, and more durable than a polyurethane teflon double lumen catheter. It could be used for a short-term vascular access, or for a permanent vascular access in person otherwise with no other alternatives.

카테터 관련 균혈증 진단을 위한 초음파 파쇄법을 이용한 카테터 정량 배양의 평가

김수경,김현기,고영진,성홍섭,김미나 대한임상미생물학회 2015 Annals of clinical microbiology Vol.18 No.1

Background: The diagnosis of catheter-related bloodstream infection (CRBSI) should demonstrate catheter colonization of the same organism as the isolate from peripheral blood cultures, by catheter tip culture or by differential time to positivity (DTP) of catheterdrawn blood cultures versus peripheral blood cultures. The purpose of this study was to compare the sonication and the roll-plate methods of catheter tip culture. Methods: One hundred and sixty-one catheter tips from 122 patients were submitted for catheter tip culture. Distal segments of the catheter were first inoculated using a roll-plate, and then inoculated by sonication. Sonication was performed using a BactoSonic device (Bandelin GmbH, Germany). A total of 1,018 sets of blood cultures from 7 days before to 1 day after catheter removal were analyzed for isolated organisms and DTP. Cutoffs of catheter colonization were ≥15 CFU for the roll-plate method, ≥100 CFU for sonication, and ≥2 h for DTP. Results: Twenty-four catheter tips (14.9%) showed colonization with at least one of the two methods: 21 (13.0%) with the roll-plate method and 22 (13.7%) with sonication. The positivity rates for the two methods showed no significant difference, and the concordance rate for the two methods w s 96.9% (k=0.866, P<0.001). Blood culture was positive in 56 episodes in 44 patients, and 14 episodes of CRBSI were diagnosed in 12 patients: 10 by tip culture (two by sonication only) and 8 by DTP. Of the 122 specimens that were negative according to both methods, 4 were from the episode of CRBSI diagnosed by DTP. Conclusion: Roll-plate and sonication methods are comparable in diagnostic sensitivity for catheter colonization. The roll-plate and sonication cath ter tip culture methods and DTP are complementary for diagnosis of CRBSI. (Ann Clin Microbiol 2015;18:7-13)