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Purpose Indwelling central venous catheters (CVCs) have been increasingly used to enable delivery of intravenous chemotherapy. We aimed to compare the safety and cost of two commonly used CVCs, peripherally inserted central venous catheter (PICCs) and ports, in the delivery of chemotherapy in patients with non-haematological malignancies. Methods Seventy patients were randomly assigned to receive either a PICC or a port. The primary endpoint was occurrence of major complications, which required removal of the CVC and secondary endpoints included occurrence of any complications. Results Port devices were associated with fewer complications compared with PICC lines (hazard ratio of 0.25, CI, 0.09–0.86, P  = 0.038). Major complication rate was lower in the port arm compared to the PICC arm (0.047 versus 0.193 major complications/100 catheter days, P  = 0.034) with 6 versus 20 % of patients experiencing major complications, respectively. Thrombosis, the most common complication, was significantly higher in the PICC arm compared to the port arm (25 versus 0 %, P  = 0.013). Quality of life and cost estimates did not differ significantly between the two arms. Conclusions Port devices are associated with a lower risk of complications, with no difference in cost, compared to PICC lines in patients with non-haematological malignancies receiving intravenous chemotherapy.

•Peripherally inserted central catheter (PICC) is crucial in treating preterm neonates.•The effectiveness of heparin for reducing PICC occlusion is controversial.•Scanning electron microscopy is used for first time for judging catheter obstruction.•Adding heparin may be unnecessary for the maintaining of PICC in preterm neonates. This study aimed to assess the need for adding heparin to parenteral nutrition (PN) on reducing catheter intraluminal obstruction based on scanning electron microscopy (SEM) of peripherally inserted central catheter (PICC) in preterm neonates. In this randomized controlled blinded non-inferiority trial, neonates with gestational age <32 weeks requiring PICC to receive PN were enrolled and randomly divided into two groups. In the heparin group, 0.5 IU/mL heparin was added to PN for continuous infusion through PICC; while in the no-heparin group, there was no heparin added. All catheter tips were collected for SEM of catheter intraluminal obstruction. The primary outcome was the ratio of intraluminal obstructed area at catheter tip calculated by SEM. A non-inferiority margin of 0.1 was chosen. The duration of catheter patency, incidence of catheter-related complications, and heparin-related side effects were analyzed. Between June 1, 2021, and May 31, 2022, 91 neonates (gestational age of 28.17 ± 1.77 weeks) were ultimately enrolled. In the intention-to-treat analysis, the average ratio of intraluminal obstructed area at catheter tip indicated by SEM in no-heparin group was 0.313, and 0.362 in the heparin group (95% confidence intervals of the differences was –0.028 to 0.147). The lower bound of the one-side 95% confidence intervals was greater than –0.1, indicating non-inferiority. No statistically significant differences existed in the duration of catheter patency, the incidence of catheter-related complications between two groups. PN without heparin was non-inferior to the addition of 0.5 IU/mL heparin to PN during infusion on reducing catheter intraluminal obstruction based on SEM of PICC in preterm neonates. These findings could reduce the unnecessary exposure to heparin in preterm neonates.

When clinicians need to administer a vasopressor infusion, they are faced with the choice of administration via either peripheral intravenous catheter (PIVC) or central venous catheter (CVC). Vasopressor infusions have traditionally been administered via central venous catheters (CVC) rather than Peripheral Intra Venous Catheters (PIVC), primarily due to concerns of extravasation and resultant tissue injury. This practice is not guided by contemporary randomised controlled trial (RCT) evidence. Observational data suggests safety of vasopressor infusion via PIVC. To address this evidence gap, we have designed the \"Vasopressors Infused via Peripheral or Central Access\" (VIPCA) RCT. The VIPCA trial is a single-centre, feasibility, parallel-group RCT. Eligible critically ill patients requiring a vasopressor infusion will be identified by emergency department (ED) or intensive care unit (ICU) staff and randomised to receive vasopressor infusion via either PIVC or CVC. Primary outcome is feasibility, a composite of recruitment rate, proportion of eligible patients randomised, protocol fidelity, retention and missing data. Primary clinical outcome is days alive and out of hospital up to day-30. Secondary outcomes will include safety and other clinical outcomes, and process and cost measures. Specific aspects of safety related to vasopressor infusions such as extravasation, leakage, device failure, tissue injury and infection will be assessed. VIPCA is a feasibility RCT whose outcomes will inform the feasibility and design of a multicentre Phase-3 trial comparing routes of vasopressor delivery. The exploratory economic analysis will provide input data for the full health economic analysis which will accompany any future Phase-3 RCT.

Background Maintaining venous access is of great clinical importance. Running a slow continuous infusion to keep the vein open (KVO) is often used in peripheral intravenous catheters (PIVCs). Previous studies have compared the effects of intermittent flushing and continuous infusion via peripherally inserted central catheters (PICCs). In this study, we applied KVO to central venous catheters (CVCs) and compared the occlusion rate of this technique with that of the intermittent flushing technique. Method This is a randomized controlled trial of 14 hospitals in China. A total of 250 patients will be recruited in this study, and they will be randomized at a 1:1 ratio. After study inclusion, patients who will undergo CVC insertion will receive intermittent flushing with prefilled saline syringes (control group) or KVO infusion with elastic pumps (test group). All the catheters will be checked for patency by scoping Catheter Injection and Aspiration (CINAS) Classification on Days 3 and 7. The primary outcome is the rate of catheter occlusion in 7 days. Patients will be followed up until 9 days after CVC insertion, catheter occlusion, or catheter removal. The secondary outcomes are the rate of catheter occlusion in 3 days, nurse satisfaction, cost-effectiveness, adverse event rate, catheter-related bloodstream infection rate, catheter-related thrombosis rate, extravasation rate, phlebitis rate, and catheter migration. Discussion We expect that the trial will generate findings that can provide an evidence-based basis for the improvement and optimization of clinical catheter flushing techniques. Trial registration Chinese Clinical Trial Registry, ChiCTR2200064007. Registered on 23 September 2022. https://www.chictr.org.cn/showproj.html?proj=177311 .

Central venous access devices (CVADs) are integral to cancer treatment. However, catheter-related thrombosis (CRT) poses a considerable risk to patient safety. It interrupts treatment; delays therapy; prolongs hospitalisation; and increases the physical, psychological and financial burden of patients. Our study aims to construct and validate a predictive model for CRT risk in patients with cancer. It offers the possibility to identify independent risk factors for CRT and prevent CRT in patients with cancer. We prospectively followed patients with cancer and CVAD at Xiangya Hospital of Central South University from January 2021 to December 2022 until catheter removal. Patients with CRT who met the criteria were taken as the case group. Two patients with cancer but without CRT diagnosed in the same month that a patient with cancer and CRT was diagnosed were selected by using a random number table to form a control group. Data from patients with CVAD placement in Qinghai University Affiliated Hospital and Hainan Provincial People’s Hospital (January 2023 to June 2023) were used for the external validation of the optimal model. The incidence rate of CRT in patients with cancer was 5.02% (539/10 736). Amongst different malignant tumour types, head and neck (9.66%), haematological (6.97%) and respiratory (6.58%) tumours had the highest risks. Amongst catheter types, haemodialysis (13.91%), central venous (8.39%) and peripherally inserted central (4.68%) catheters were associated with the highest risks. A total of 500 patients with CRT and 1000 without CRT participated in model construction and were randomly assigned to the training ( n  = 1050) or testing ( n  = 450) groups. We identified 11 independent risk factors, including age, catheterisation method, catheter valve, catheter material, infection, insertion history, D-dimer concentration, operation history, anaemia, diabetes and targeted drugs. The logistic regression model had the best discriminative ability amongst the three models. It had an area under the curve (AUC) of 0.868 (0.846–0.890) for the training group. The external validation AUC was 0.708 (0.618–0.797). The calibration curve of the nomogram model was consistent with the ideal curve. Moreover, the Hosmer–Lemeshow test showed a good fit ( P  > 0.05) and high net benefit value for the clinical decision curve. The nomogram model constructed in this study can predict the risk of CRT in patients with cancer. It can help in the early identification and screening of patients at high risk of cancer CRT.

Objective To compare the incidence of central line associated blood stream infections (CLABSI) with the use of umbilical venous catheters (UVC) or peripherally inserted central cathethers (PICC) as primary vascular access in preterm neonates. Method This was an open-label, two parallel-arm, randomized controlled trial which included hospitalized neonates with birth weight <1250g who required a central venous access on day 1 of life. The neonates were randomized to either UVC or PICC groups and evaluated for the incidence of CLABSI. Results Of the total 238 eligible neonates, 128 and 110 neonates were randomized to the UVC and PICC groups, respectively. The baseline characteristics were comparable in both groups. There was no significant difference in the incidence of CLABSI among the UVC and PICC groups (21.1% vs 18.2%; P = 0.57). Neonates in the PICC group needed multiple attempts at insertion compared to those in the UVC group (43% vs 12%, P = 0.01); more time was needed for PICC line insertion [median (IQR) 20 (15, 40) vs 10 (5, 15) minutes], but had longer duration of the primary line [7 (4, 10) vs 5 (3, 7) days]. Early removal of the line for leakage was higher in the UVC group and local signs of inflammation were higher in the PICC group. The overall incidence of complications was similar between the groups (53% vs 45%, P = 1.00). Conclusion In preterm infants with a birth weight of less than 1250g, the incidence of CLABSI was similar in the UVC and PICC groups when used as a primary central line. The overall complication rates were comparable in the UVC and PICC groups.

ObjectiveTo explore the impact of the terminal tip location of silicone midline catheter (MC, a type of intravenous catheter measuring 20–30 cm in length and inserted into upper arm veins using a modified Seldinger technique) in the subclavian vein group versus axillary vein group on catheter-related complications and indwelling duration.DesignThis is a randomised controlled study.SettingTwenty-seven tertiary hospitals in China.ParticipantsBetween September 2022 and October 2023, 2307 patients underwent MC placement and were randomly assigned to either the axillary vein group (n=1124) or the subclavian vein group (n=1183).Outcome measuresThere were two outcome measures: one was to compare the incidence of catheter-related complications (eg, catheter-related thrombosis, infection, catheter occlusion, etc.) between the two groups, and the other was to compare the indwelling duration between the groups.ResultsThe total observed incidence of catheter-related complications in the axillary vein group and subclavian vein group was 1.0% (11/1124) and 0.8% (10/1183), respectively. There was no statistically significant difference in the total incidence of catheter-related complications. The median indwelling duration (median (IQR)) of the two groups was 10 days (7, 15) and 10 days (7, 15), respectively. The two groups had no statistical difference in the indwelling duration.ConclusionsOur findings suggested that the terminal tip of silicone MC in the subclavian vein would not increase the incidence of catheter-related complications. Silicone MC was a safe catheter for the low incidence of catheter-related complications and could be popularised in clinical practice.Trial registration numberChiCTR2200058942; Chinese Clinical Trial Registry.

The aim of the study was to assess the influence of music on anxiety levels compared to standard patient care in patients undergoing venous catheter placement procedures. This prospective randomized controlled trial included patients undergoing placement procedures for peripherally inserted central venous catheters (PICC), ports and central venous catheters (CVC). Patients were randomly assigned to a music intervention group (MIG) and a control group (CTRL). State and trait anxiety levels were assessed as primary outcome using the state-trait anxiety inventory (STAI) before and after the procedures. Secondary outcomes comprised averaged heart rate for all participants and time of radiological surveillance for port placement procedures exclusively. 72 participants were included into the final analysis (MIG n  = 40; CTRL n  = 32). All procedures were successful and no major complications were reported. Mean levels for post-interventional anxieties were significantly lower in the MIG compared to the CTRL (34.9 ± 8.9 vs. 44 ± 12.1; p  < 0.001). Mean heart rate in the MIG was significantly lower than in the CTRL (76.1 ± 13.7 vs. 93 ± 8.9; p  < 0.001). Procedure time for port implantation was significantly longer in the MIG by 3 min 45 s ( p  = 0.031). Music exposure during central venous catheter placement procedures highly significantly reduces anxiety and stress levels and can be used to improve patients’ overall experience in the angio suite.