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Efficacy of biopatch™ in reducing catheter related infections in cuffed, tunneled central venous catheters
JVIR
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Posters and Exhibits
S127
office (1 CHF, 2 bleeding access sites). There were no cases of acute limb loss, stroke, MI, or death within 24 hours. Conclusion: Carefully selected arterial endovascular procedures may be performed in an office-based setting with overall low complication rates.
Abstract No. 286 Efficacy of biopatchTM in reducing catheter related infections in cuffed, tunneled central venous catheters S.K. O’Horo, D. Corson, R.A. Baum; Interventional Radiology, Brigham and Women’s Hospital, Boston, MA Purpose: Catheter related infections (CRIs) are an important cause of morbidity and mortality in immunocompromised patients in need of long term central venous access.1 Chlorhexidine impregnated sponges have been shown to decrease infection rates in nontunneled central venous catheters (CVCs).1 The purpose of this study is to evaluate the efficacy of BiopatchTMwhen used with a tunneled, cuffed CVC to reduce CRIs. Materials and Methods: All large bore tunneled, cuffed CVCs placed in our department between December 1, 2008 and August 31, 2012 were included in this study. HiIQTM is used to track all procedural complications and was queried for occurences of local infection and septicemia/bacteremia for all patients who had catheters placed in this period. Endpoints were clinically based: a local or site infection was generally recognized as an erythematous exit site and septicemia/bacteremia was defined as those cases which required catheter removal due to positive blood cultures. This data was analyzed using a Chi Square test. Results: Between December 1, 2008 and August 31, 2012, 2491 patients had catheters placed. 1348 patients had catheters placed before the intervention and 1237 after. For the 2 years before the intervention, there were 69 episodes of septicemia/bacteremia with an overall prevalence of 5.1%. After BiopatchTM was employed, there were 51 episodes of septicemia/bacteremia for an overall prevalence of 4.1%. This difference was not statistically significant (P¼0.23). With regards to local infection, there were 28 patients who experienced local infection before BiopatchTM and 13 after, for an overall prevalence of 2.0% and 1.0% respectively. This result was statistically significant with a P¼0.03. Conclusion: There is good historical evidence to support the use of BiopatchTM to reduce CRIs in nontunneled CVCs. Based on our results in this retrospective study, BiopatchTM is also useful in reducing local exit site infections in patients who have tunneled, cuffed catheters. Reference 1. Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine impregnated sponges and less frequent dressing changes for prevention of catheterrelated infections in critically ill adults: a randomized controlled trial. JAMA 2009; 301:1231-41.
Ultrasound guided transhepatic permanent dialysis catheter: alternative approach for haemodialysis S.E. Hegab; Radiodiagnosis and intervention radiology, Alexandria university, Alexandria, Egypt
Abstract No. 288 A novel lead-free lightweight material provides greater radiation protection compared to conventional lead M.J. Benenati1, R.T. Gandhi1, C.S. Pena1, H. Uthoff1,2, B.T. Katzen1; 1Baptist Cardiac and Vascular Institute, Miami, FL; 2Angiology, University Hospital Basel, Basel, Switzerland Purpose: To determine whether a thyroid collar (TC) composed of a novel lead-free lightweight material composed of barium sulfate and bismuth oxide (XPF) provides improved radiation protection compared to conventional 0.5 mm lead TC in a realworld interventional clinical setting. A secondary objective of the study is to compare the comfort of the XPF thyroid collars with that of standard TCs. Materials and Methods: A prospective, randomized clinical trial was conducted in which operators were randomized to wear either XPF or standard 0.5 mm lead TCs during 144 fluoroscopic interventions. As many procedures involved more than one operator, a total of 256 measurements were obtained during a 10 month period from October 2011 to July 2012. Following each intervention, radiation dose was measured (via dosimeter placed
Posters and Exhibits
Abstract No. 287
Purpose: Nonconventional image-guided percutaneous catheter placements are the exception and are requested only when traditional access sites are unavailable. They are good alternative routes for permanent venous access and haemodialysis, and with proper technique and care, will be associated with minimal post procedural complications This study highlights the technical aspects of ultrasound-guided transhepatic permanent dialysis catheter in vascular access management. Materials and Methods: For patients dependent on permanent venous catheters for survival, the progressive loss of venous access sites should prompt a systematic approach to alternative sites and techniques to maximize patient survival and minimize complications. Results: This study included 12 patients with exhausted all classical venous access for haemodialysis. They had normal coagulation profile. Conscious sedation was used for all patients. Ultrasound guided was used to access the hepatic vein ( right hepatic vein in 8 patients and middle hepatic vein in 4 patients), using a 16 G teflon coated needle. The subcostal approach was selected in 6 patients and the intercostal anterior axillary line in another 6 patients. Under fluoroscopy, the hydrophilic guide wire 0.0035 inch is introduced through the needle in hepatic vein to reach the superior vena cava. Gradual dilatation of the track was performed until peel away sheath was advanced to the cavo-atrial junction. A subcutaneous tunnel was formed and the permanent haemodialysis catheter was inserted with its tip at the right atrium. Mild right hypochondrial pain was noticed in three patients , with intercostal approach, for few days. Follow up for 6 -12 months, revealed normal functioning haemodialysis catheter in 11 patients and a single sepsis complication. Conclusion: Transhepatic insertion of haemodialysis catheter is a good non-classical alternative access and has same patency rate and incidence of complications as that of classical chest haemodialysis catheter. Interventional radiologists should be familiar with the appropriate use of both conventional and unconventional types of venous access and their associated risks
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Posters and Exhibits
S127
office (1 CHF, 2 bleeding access sites). There were no cases of acute limb loss, stroke, MI, or death within 24 hours. Conclusion: Carefully selected arterial endovascular procedures may be performed in an office-based setting with overall low complication rates.
Abstract No. 286 Efficacy of biopatchTM in reducing catheter related infections in cuffed, tunneled central venous catheters S.K. O’Horo, D. Corson, R.A. Baum; Interventional Radiology, Brigham and Women’s Hospital, Boston, MA Purpose: Catheter related infections (CRIs) are an important cause of morbidity and mortality in immunocompromised patients in need of long term central venous access.1 Chlorhexidine impregnated sponges have been shown to decrease infection rates in nontunneled central venous catheters (CVCs).1 The purpose of this study is to evaluate the efficacy of BiopatchTMwhen used with a tunneled, cuffed CVC to reduce CRIs. Materials and Methods: All large bore tunneled, cuffed CVCs placed in our department between December 1, 2008 and August 31, 2012 were included in this study. HiIQTM is used to track all procedural complications and was queried for occurences of local infection and septicemia/bacteremia for all patients who had catheters placed in this period. Endpoints were clinically based: a local or site infection was generally recognized as an erythematous exit site and septicemia/bacteremia was defined as those cases which required catheter removal due to positive blood cultures. This data was analyzed using a Chi Square test. Results: Between December 1, 2008 and August 31, 2012, 2491 patients had catheters placed. 1348 patients had catheters placed before the intervention and 1237 after. For the 2 years before the intervention, there were 69 episodes of septicemia/bacteremia with an overall prevalence of 5.1%. After BiopatchTM was employed, there were 51 episodes of septicemia/bacteremia for an overall prevalence of 4.1%. This difference was not statistically significant (P¼0.23). With regards to local infection, there were 28 patients who experienced local infection before BiopatchTM and 13 after, for an overall prevalence of 2.0% and 1.0% respectively. This result was statistically significant with a P¼0.03. Conclusion: There is good historical evidence to support the use of BiopatchTM to reduce CRIs in nontunneled CVCs. Based on our results in this retrospective study, BiopatchTM is also useful in reducing local exit site infections in patients who have tunneled, cuffed catheters. Reference 1. Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine impregnated sponges and less frequent dressing changes for prevention of catheterrelated infections in critically ill adults: a randomized controlled trial. JAMA 2009; 301:1231-41.
Ultrasound guided transhepatic permanent dialysis catheter: alternative approach for haemodialysis S.E. Hegab; Radiodiagnosis and intervention radiology, Alexandria university, Alexandria, Egypt
Abstract No. 288 A novel lead-free lightweight material provides greater radiation protection compared to conventional lead M.J. Benenati1, R.T. Gandhi1, C.S. Pena1, H. Uthoff1,2, B.T. Katzen1; 1Baptist Cardiac and Vascular Institute, Miami, FL; 2Angiology, University Hospital Basel, Basel, Switzerland Purpose: To determine whether a thyroid collar (TC) composed of a novel lead-free lightweight material composed of barium sulfate and bismuth oxide (XPF) provides improved radiation protection compared to conventional 0.5 mm lead TC in a realworld interventional clinical setting. A secondary objective of the study is to compare the comfort of the XPF thyroid collars with that of standard TCs. Materials and Methods: A prospective, randomized clinical trial was conducted in which operators were randomized to wear either XPF or standard 0.5 mm lead TCs during 144 fluoroscopic interventions. As many procedures involved more than one operator, a total of 256 measurements were obtained during a 10 month period from October 2011 to July 2012. Following each intervention, radiation dose was measured (via dosimeter placed
Posters and Exhibits
Abstract No. 287
Purpose: Nonconventional image-guided percutaneous catheter placements are the exception and are requested only when traditional access sites are unavailable. They are good alternative routes for permanent venous access and haemodialysis, and with proper technique and care, will be associated with minimal post procedural complications This study highlights the technical aspects of ultrasound-guided transhepatic permanent dialysis catheter in vascular access management. Materials and Methods: For patients dependent on permanent venous catheters for survival, the progressive loss of venous access sites should prompt a systematic approach to alternative sites and techniques to maximize patient survival and minimize complications. Results: This study included 12 patients with exhausted all classical venous access for haemodialysis. They had normal coagulation profile. Conscious sedation was used for all patients. Ultrasound guided was used to access the hepatic vein ( right hepatic vein in 8 patients and middle hepatic vein in 4 patients), using a 16 G teflon coated needle. The subcostal approach was selected in 6 patients and the intercostal anterior axillary line in another 6 patients. Under fluoroscopy, the hydrophilic guide wire 0.0035 inch is introduced through the needle in hepatic vein to reach the superior vena cava. Gradual dilatation of the track was performed until peel away sheath was advanced to the cavo-atrial junction. A subcutaneous tunnel was formed and the permanent haemodialysis catheter was inserted with its tip at the right atrium. Mild right hypochondrial pain was noticed in three patients , with intercostal approach, for few days. Follow up for 6 -12 months, revealed normal functioning haemodialysis catheter in 11 patients and a single sepsis complication. Conclusion: Transhepatic insertion of haemodialysis catheter is a good non-classical alternative access and has same patency rate and incidence of complications as that of classical chest haemodialysis catheter. Interventional radiologists should be familiar with the appropriate use of both conventional and unconventional types of venous access and their associated risks