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P018 USEFULNESS OF GROSHONG CATHETERS FOR CENTRAL VENOUS ACCESS VIA THE EXTERNAL JUGULAR VEIN
32 P016 THE SIGNIFICANCE OF ONODERA’S PROGNOSTIC NUTRITIONAL INDEX FOR GASTROSTOMY PATIENTS M. Inukai1 , F. Goda1 , N. Kajitani2 , H. Okuyama3 , T. Himoto3 , H. Masugata3 , S. Senda3 . 1 Cancer Center, Kagawa University Hospital, Kagawa; 2 Department of Surgery, Yoshinaga Hospital, Okayama; 3 Department of Integrated Medicine, Kagawa University School of Medicine, Kagawa, Japan Rationale: Onodera’s Prognostic Nutritional Index (PNI), which calculate from the serum albumin and total lymphocyte account [PNI = 10×Alb (g/dl) + 0.005×Lymphocyte (/mm3 peripheral blood)] is used to the indicator of prognosis for advanced colon cancer. In this study, we evaluated the relevance of PNI as an index to predict the prognosis for gastrostomy patients. Methods: A retrospective analysis of 119 patients underwent Percutaneous Endoscopic Gastrostomy (PEG) from January 2006 to March 2008 was performed. There were 50 men and 71 women with a median age of 84.9 years (range, 58 99 years). PNI of patients was calculated at the time of pre-gastrostomy placement and the discharge from hospital. The patients were divided 2 groups by either higher 35 or lower 35 of PNI. The survival rate was calculated by Kaplan Mayer curves. Results: An average survival was 285.8 days. The survival rate after gastrostomy was 95% at 30 days, 89% at 90 days, and 50% at 665 days. The higher PNI patients at the time of pre-gastrostomy placement and the discharge from hospital were significantly prolonged survival compared lower PNI patients. The value of PNI at the time of the discharge from hospital seemed to be better indicator of prognosis compared with that before gastrostomy. Because some patients were increased the value of PNI after gastrostomy. Conclusion: PNI is a useful predicting prognostic factor of patients with gastrostomy tube feeding. After the gastrostomy tube feeding, PNI can improve some patients, therefore, even if patients with lower PNI are not excluding the indication of PEG placement. Disclosure of Interest: none
P017 EFFECT OF A FISH OIL-BASED NUTRITION SUPPORT ON HEALING OF PRESSURE ULCERS AND EXPRESSION OF ADHESION MOLECULES IN CRITICALLY ILL PATIENTS: PRELIMINARY RESULTS M. Theilla1 , Y. Zimra2 , B. Schwartz3 , R. Anbar1 , H. Shapiro1 , S. Lev1 , J. Cohen1 , P. Singer1 . 1 General Intensive Care Department and Institute for Nutrition Research, 2 Hematology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva; 3 Faculty of Agricultural, Food and Environmental Quality Sciences, School of Nutritional Sciences, Rehovot, Israel Rationale: The inflammatory response after tissue injury incites migration of phagocytes to the injury site, eradicates pathogens, and facilitates tissue reconstruction.The fish oil effects on 1) healing of incident pressure ulcers (PU), 2) expression of adhesion molecules that mediate leukocyte migration and the association
Poster presentations between treatment, healing rates and adhesion molecule expression are analyzed here. Methods: ICU patients suffering from PU grade >2 were randomly allocated to receive the fish oil-based formula or an isocaloric control. Weekly monitoring of ulcer grade (per PUSH tool test) and expression of adhesion molecules per immunohistochemistry and Flow Cytometry was performed for 28 days. TNFalpha;, C-Reactive Protein were also tested. Statistical analysis was performed using: t-test, and ANOVA with repeated measures. Results: Thirteen patients average age was 43.8±13.4. The PUSH TOOL test showed a time-dependent decline in ulcer severity in the intervention group (n = 8), and an increase in the control group (n = 5)(p < 0.001). CD18 granulocytes increased significantly (p < 0.001) in the intervention group from day 1 (22.57±39.20) to day 28 (58.60±35.40) whereas a decrease occurred in the control group (day 1: 79.20±44.20; day 28: 51.60±48.00). CD49b lymphocytes also increased significantly in the fish oil group as opposed to a decrease in the control group. CRP decreased between day 1 and day 28 in the experimental group in contrast to the control group (p < 0.05). There were no significant changes over time or between groups in other adhesion molecules. Conclusion: Fish oil’s anti-inflammatory and PU healing actions are associated to an increase in adhesion molecules that facilitate trans-migration of leukocytes and lymphocytes to the site(s) of injury. Thus, an increase in Adhesion Molecules may be operative in enhanced wound healing seen in critical care patients receiving fish oil. Disclosure of Interest: No disclosure
P018 USEFULNESS OF GROSHONG CATHETERS FOR CENTRAL VENOUS ACCESS VIA THE EXTERNAL JUGULAR VEIN M. Ishizuka1 , H. Nagata1 , K. Takagi1 , T. Horie1 , T. Sawada1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Methods: Central venous access was achieved by insertion of a single-lumen 4.0 Fr. Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVCRBSI) were evaluated from the database, respectively. Results: Two hundred twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (P < 0.01) and period (P < 0.01), a larger number of operations (P < 0.01) and more frequent use of total parenteral nutrition (TPN) (P < 0.01), and less frequent
Critical Care II use of chemotherapy (P < 0.01) than IJV-C. However, there were no significant differences in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C (N.S.). There were no significant differences such complications as malposition (N.S.), oozing or hematoma formation of insertion site (N.S.), arterial bleeding (N.S.), nerve damage (N.S.), pneumothorax (N.S.), and phlebitis (N.S.), between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding and nerve damage. Conclusion: EJV-C using Groshong catheters has no severe complications and same rates of CVC-RBSI as conventional IJV-C for central venous access. References Ishizuka M, Nagata H, Takagi K, Horie T, Furihata M, et al. External jugular Groshong catheter is associated with fewer complications than a subclavian Argyle catheter. Eur Surg Res 2008; 40: 197 202. Disclosure of Interest: No financial support or other potential conflicts of interest exist. All authors have no conflicts to disclose.
P019 EXTERNAL JUGULAR GROSHONG CATHETER IS ASSOCIATED WITH FEWER COMPLICATIONS THAN A SUBCLAVIAN ARGYLE CATHETER M. Ishizuka1 , H. Nagata1 , K. Takagi1 , T. Horie1 , M. Furihata1 , A. Nakagawa1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access. Methods: Central venous access was done by either insertion of a Groshong catheter via the EJV or, a Argyle catheter via the subclavian vein with single puncture. Results: Eighty patients (Group 1) were treated with 146 subclavian venous catheters for 2770 catheter-days and 98 patients (Group 2) were treated with 147 external jugular venous catheters for 2381 catheter-days. Fever appeared in 36.3% (53/146) and 16.3% (24/147) of the patients in Groups 1 and 2, respectively (p < 0.01). The malposition and pneumothorax rates were 17.1% (25/146) and 2.0% (3/147) (p < 0.01), and 2.7% (4/146) and 0% (0/147) (p < 0.05) in the two Groups, respectively. Conclusion: Insertion of a Groshong catheter via an EJV is more acceptable for central venous access than insertion of a conventional subclavian venous catheter. References Mansfield PF, Hohn DC, Fornage BD, et al. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994; 331:1735-1738. Alhimyary A, Fernandez C, Picard M, et al. Safety and efficacy of total parenteral nutrition delivered via a peripherally inserted central venous catheter. Nutr Clin Pract 1996; 11:199 203. Cardella JF, Cardella K, Bacci N, et al. Cumulative experience with 1,273 peripherally inserted central catheters at a single institution. J Vasc Interv Radiol 1996; 7:5 13. Disclosure of Interest: No financial support or other potential conflicts of interest exist. All authors have no conflicts to disclose.
33 P020 A RIGHT-SIDED, RATHER THAN LEFT-SIDED APPROACH IS MORE ACCEPTABLE FOR CENTRAL VENOUS CATHETERIZATION VIA THE INTERNAL JUGULAR VEIN M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To examine whether a right-sided, rather than a left-sided approach is superior for central venous catheter (CVC) insertion via the IJV. Methods: A retrospective study was performed to compare the right IJV with the left in terms of characteristics such as vertical and horizontal diameters, depth from the skin, and the relationship between the IJV and the common carotid artery (CCA) using the same computed tomography axial slice. Results: From April 2006 to September 2008, 100 patients (50 male and 50 female) who underwent CVC insertion via the IJV before surgery for colorectal cancer were enrolled. Vertical and horizontal diameters of the right IJV were significantly larger than those of the left IJV (right: left (cm), 1.51±0.41 vs 1.13±0.34, P < 0.0001, 1.54±0.36 vs 1.08±0.33, P < 0.0001), respectively. The right IJV runs more superficially than the left IJV (right: left (cm), 1.74±0.60 vs 1.87±0.56, P < 0.0001). Conclusion: Because the right IJV has a much wider diameter and runs more superficially than the left IJV, a right-sided approach is more acceptable than a left-sided approach for CVC insertion via the IJV. References Troianos CA, Kuwik RJ, Pasqual JR, Lim AJ, Odasso DP. Internal jugular vein and carotid artery anatomic relation as determined by ultrasonography. Anesthesiology 1996; 85(1):43 8. Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006; 10(6):R162. Hosokawa K, Shime N, Kato Y, Hashimoto S. A randomized trial of ultrasound image-based skin surface marking versus realtime ultrasound-guided internal jugular vein catheterization in infants. Anesthesiology 2007; 107(5):720 4. Disclosure of Interest: No financial support or other potential conflicts of interest exist. All authors have no conflicts to disclose.
P021 FEMORAL VENOUS CATHETERIZATION IS A MAJOR RISK FACTOR FOR CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To disclose the risk factors for catheterrelated bloodstream infection in colorectal surgery. Methods: Catheter-related bloodstream infection was evaluated retrospectively from a database of patients who had undergone colorectal surgery. Results: Three hundred-fifty patients received 423 central venous catheter s for a total of 7760 catheter-days.
P017 EFFECT OF A FISH OIL-BASED NUTRITION SUPPORT ON HEALING OF PRESSURE ULCERS AND EXPRESSION OF ADHESION MOLECULES IN CRITICALLY ILL PATIENTS: PRELIMINARY RESULTS M. Theilla1 , Y. Zimra2 , B. Schwartz3 , R. Anbar1 , H. Shapiro1 , S. Lev1 , J. Cohen1 , P. Singer1 . 1 General Intensive Care Department and Institute for Nutrition Research, 2 Hematology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva; 3 Faculty of Agricultural, Food and Environmental Quality Sciences, School of Nutritional Sciences, Rehovot, Israel Rationale: The inflammatory response after tissue injury incites migration of phagocytes to the injury site, eradicates pathogens, and facilitates tissue reconstruction.The fish oil effects on 1) healing of incident pressure ulcers (PU), 2) expression of adhesion molecules that mediate leukocyte migration and the association
Poster presentations between treatment, healing rates and adhesion molecule expression are analyzed here. Methods: ICU patients suffering from PU grade >2 were randomly allocated to receive the fish oil-based formula or an isocaloric control. Weekly monitoring of ulcer grade (per PUSH tool test) and expression of adhesion molecules per immunohistochemistry and Flow Cytometry was performed for 28 days. TNFalpha;, C-Reactive Protein were also tested. Statistical analysis was performed using: t-test, and ANOVA with repeated measures. Results: Thirteen patients average age was 43.8±13.4. The PUSH TOOL test showed a time-dependent decline in ulcer severity in the intervention group (n = 8), and an increase in the control group (n = 5)(p < 0.001). CD18 granulocytes increased significantly (p < 0.001) in the intervention group from day 1 (22.57±39.20) to day 28 (58.60±35.40) whereas a decrease occurred in the control group (day 1: 79.20±44.20; day 28: 51.60±48.00). CD49b lymphocytes also increased significantly in the fish oil group as opposed to a decrease in the control group. CRP decreased between day 1 and day 28 in the experimental group in contrast to the control group (p < 0.05). There were no significant changes over time or between groups in other adhesion molecules. Conclusion: Fish oil’s anti-inflammatory and PU healing actions are associated to an increase in adhesion molecules that facilitate trans-migration of leukocytes and lymphocytes to the site(s) of injury. Thus, an increase in Adhesion Molecules may be operative in enhanced wound healing seen in critical care patients receiving fish oil. Disclosure of Interest: No disclosure
P018 USEFULNESS OF GROSHONG CATHETERS FOR CENTRAL VENOUS ACCESS VIA THE EXTERNAL JUGULAR VEIN M. Ishizuka1 , H. Nagata1 , K. Takagi1 , T. Horie1 , T. Sawada1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To evaluate the usefulness of central venous access via the external jugular vein (EJV) employing Groshong catheters, and to compare the complications with those of conventional internal jugular venous catheterization. Methods: Central venous access was achieved by insertion of a single-lumen 4.0 Fr. Groshong catheter via the EJV or internal jugular vein (IJV) with a single puncture. Complications associated with insertion and central venous catheter-related bloodstream infection (CVCRBSI) were evaluated from the database, respectively. Results: Two hundred twenty-five patients received 400 catheters for a total period of 5377 catheter-days. Ninety-six patients underwent 201 internal jugular venous catheter (IJV-C) procedures for 2381 catheter-days, and 129 patients underwent 199 external jugular venous catheter (EJV-C) procedures for 2996 catheter-days. Use of EJV-C was associated with a longer catheter insertion length (P < 0.01) and period (P < 0.01), a larger number of operations (P < 0.01) and more frequent use of total parenteral nutrition (TPN) (P < 0.01), and less frequent
Critical Care II use of chemotherapy (P < 0.01) than IJV-C. However, there were no significant differences in complications associated with insertion and CVC-RBSI between IJV-C and EJV-C (N.S.). There were no significant differences such complications as malposition (N.S.), oozing or hematoma formation of insertion site (N.S.), arterial bleeding (N.S.), nerve damage (N.S.), pneumothorax (N.S.), and phlebitis (N.S.), between IJV-C and EJV-C. Moreover, EJV-C was not associated with morbidities such as pneumothorax, arterial bleeding and nerve damage. Conclusion: EJV-C using Groshong catheters has no severe complications and same rates of CVC-RBSI as conventional IJV-C for central venous access. References Ishizuka M, Nagata H, Takagi K, Horie T, Furihata M, et al. External jugular Groshong catheter is associated with fewer complications than a subclavian Argyle catheter. Eur Surg Res 2008; 40: 197 202. Disclosure of Interest: No financial support or other potential conflicts of interest exist. All authors have no conflicts to disclose.
P019 EXTERNAL JUGULAR GROSHONG CATHETER IS ASSOCIATED WITH FEWER COMPLICATIONS THAN A SUBCLAVIAN ARGYLE CATHETER M. Ishizuka1 , H. Nagata1 , K. Takagi1 , T. Horie1 , M. Furihata1 , A. Nakagawa1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access. Methods: Central venous access was done by either insertion of a Groshong catheter via the EJV or, a Argyle catheter via the subclavian vein with single puncture. Results: Eighty patients (Group 1) were treated with 146 subclavian venous catheters for 2770 catheter-days and 98 patients (Group 2) were treated with 147 external jugular venous catheters for 2381 catheter-days. Fever appeared in 36.3% (53/146) and 16.3% (24/147) of the patients in Groups 1 and 2, respectively (p < 0.01). The malposition and pneumothorax rates were 17.1% (25/146) and 2.0% (3/147) (p < 0.01), and 2.7% (4/146) and 0% (0/147) (p < 0.05) in the two Groups, respectively. Conclusion: Insertion of a Groshong catheter via an EJV is more acceptable for central venous access than insertion of a conventional subclavian venous catheter. References Mansfield PF, Hohn DC, Fornage BD, et al. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994; 331:1735-1738. Alhimyary A, Fernandez C, Picard M, et al. Safety and efficacy of total parenteral nutrition delivered via a peripherally inserted central venous catheter. Nutr Clin Pract 1996; 11:199 203. Cardella JF, Cardella K, Bacci N, et al. Cumulative experience with 1,273 peripherally inserted central catheters at a single institution. J Vasc Interv Radiol 1996; 7:5 13. Disclosure of Interest: No financial support or other potential conflicts of interest exist. All authors have no conflicts to disclose.
33 P020 A RIGHT-SIDED, RATHER THAN LEFT-SIDED APPROACH IS MORE ACCEPTABLE FOR CENTRAL VENOUS CATHETERIZATION VIA THE INTERNAL JUGULAR VEIN M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To examine whether a right-sided, rather than a left-sided approach is superior for central venous catheter (CVC) insertion via the IJV. Methods: A retrospective study was performed to compare the right IJV with the left in terms of characteristics such as vertical and horizontal diameters, depth from the skin, and the relationship between the IJV and the common carotid artery (CCA) using the same computed tomography axial slice. Results: From April 2006 to September 2008, 100 patients (50 male and 50 female) who underwent CVC insertion via the IJV before surgery for colorectal cancer were enrolled. Vertical and horizontal diameters of the right IJV were significantly larger than those of the left IJV (right: left (cm), 1.51±0.41 vs 1.13±0.34, P < 0.0001, 1.54±0.36 vs 1.08±0.33, P < 0.0001), respectively. The right IJV runs more superficially than the left IJV (right: left (cm), 1.74±0.60 vs 1.87±0.56, P < 0.0001). Conclusion: Because the right IJV has a much wider diameter and runs more superficially than the left IJV, a right-sided approach is more acceptable than a left-sided approach for CVC insertion via the IJV. References Troianos CA, Kuwik RJ, Pasqual JR, Lim AJ, Odasso DP. Internal jugular vein and carotid artery anatomic relation as determined by ultrasonography. Anesthesiology 1996; 85(1):43 8. Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006; 10(6):R162. Hosokawa K, Shime N, Kato Y, Hashimoto S. A randomized trial of ultrasound image-based skin surface marking versus realtime ultrasound-guided internal jugular vein catheterization in infants. Anesthesiology 2007; 107(5):720 4. Disclosure of Interest: No financial support or other potential conflicts of interest exist. All authors have no conflicts to disclose.
P021 FEMORAL VENOUS CATHETERIZATION IS A MAJOR RISK FACTOR FOR CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION M. Ishizuka1 , H. Nagata1 , K. Takagi1 , K. Kubota1 . 1 Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Japan Rationale: To disclose the risk factors for catheterrelated bloodstream infection in colorectal surgery. Methods: Catheter-related bloodstream infection was evaluated retrospectively from a database of patients who had undergone colorectal surgery. Results: Three hundred-fifty patients received 423 central venous catheter s for a total of 7760 catheter-days.