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Summary Background The millions of peripheral intravenous catheters used each year are recommended for 72–96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement. Methods This multicentre, randomised, non-blinded equivalence trial recruited adults (≥18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before allocation) was to clinically indicated replacement, or third daily routine replacement. Patients, clinical staff, and research nurses could not be masked after treatment allocation because of the nature of the intervention. The primary outcome was phlebitis during catheterisation or within 48 h after removal. The equivalence margin was set at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonisation, infusion failure, catheter numbers used, therapy duration, mortality, and costs. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000445370. Findings All 3283 patients randomised (5907 catheters) were included in our analysis (1593 clinically indicated; 1690 routine replacement). Mean dwell time for catheters in situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13) when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0·41% (95% CI −1·33 to 2·15%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred. Interpretation Peripheral intravenous catheters can be removed as clinically indicated; this policy will avoid millions of catheter insertions, associated discomfort, and substantial costs in both equipment and staff workload. Ongoing close monitoring should continue with timely treatment cessation and prompt removal for complications. Funding Australian National Health and Medical Research Council.

IntroductionPeripheral intravenous catheters (PIVCs) are the most commonly used vascular access device in hospitalised patients. Yet PIVCs may be complicated by local or systemic infections leading to increased healthcare costs. Chlorhexidine gluconate (CHG)-impregnated dressings may help reduce PIVC-related infectious complications but have not yet been evaluated. We hypothesise an impregnated CHG transparent dressing, in comparison to standard polyurethane dressing, will be safe, effective and cost-effective in protecting against PIVC-related infectious complications and phlebitis.Methods and analysisThe ProP trial is a multicentre, superiority, randomised clinical and cost-effectiveness trial with internal pilot, conducted across three centres in Australia and France. Patients (adults and children aged ≥6 years) requiring one PIVC for ≥48 hours are eligible. We will exclude patients with emergent PIVCs, known CHG allergy, skin injury at site of insertion or previous trial enrolment. Patients will be randomised to 3M Tegaderm Antimicrobial IV Advanced Securement dressing or standard care group. For the internal pilot, 300 patients will be enrolled to test protocol feasibility (eligibility, recruitment, retention, protocol fidelity, missing data and satisfaction of participants and staff), primary endpoint for internal pilot, assessed by independent data safety monitoring committee. Clinical outcomes will not be reviewed. Following feasibility assessment, the remaining 2624 (1312 per trial arm) patients will be enrolled following the same methods. The primary endpoint is a composite of catheter-related infectious complications and phlebitis. Recruitment began on 3 May 2023.Ethics and disseminationThe protocol was approved by Ouest I ethic committee in France and by The Queensland Children’s Hospital Human Research Ethics Committee in Australia. The findings will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT05741866.

IgG4-related disease is a protean condition that mimics many malignant, infectious, and inflammatory disorders. This multi-organ immune-mediated condition links many disorders previously regarded as isolated, single-organ diseases without any known underlying systemic condition. It was recognised as a unified entity only 10 years ago. Histopathology is the key to diagnosis. The three central pathology features of IgG4-related disease are lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis. The extent of fibrosis is an important determinant of responsiveness to immunosuppressive therapies. IgG4-related disease generally responds to glucocorticoids in its inflammatory stage, but recurrent or refractory cases are common. Important mechanistic insights have been derived from studies of patients treated by B-cell depletion. Greater awareness of this disease is needed to ensure earlier diagnoses, which can prevent severe organ damage, disabling tissue fibrosis, and even death. Identification of specific antigens and T-cell clones that drive the disease will be the first steps to elucidate the pathogenesis of IgG4-related disease.

Peripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors. A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings.

Phlebitis due to peripheral intravenous cannulation is a common issue in hospitalized patients which leading to serious complications such as deep vein and pulmonary thromboembolism, and septicemia. Understanding the time to phlebitis onset and its predictors is of clinical importance. However, data on its incidence, contributing factors, and time of onset remain limited in Ethiopia. Given the scarcity of compressive studies conducted in Ethiopia and the critical knowledge gap on the incidence, predictors, and timing of phlebitis onset, this study is significant in advancing clinical practice by identifying the time to onset of phlebitis and its predictors among hospitalized patients with peripheral intravenous cannulation. A prospective follow-up study design was conducted on a sample size of 372 participants using structured interviews and observational checklists. Time to phlebitis onset was determined with the Kaplan-Meier method and log-log plots, while predictors were identified using Cox proportional hazards regression. The cumulative incidence of phlebitis was 39.25% (95% CI: 34.25%-44.41%), with a median onset time of 5 days (IQR 4-6 days). Whereas, the significant predictors were female sex (AHR = 1.58, 95% CI: 1.11-2.25), use of an 18-gauge cannula (AHR = 2.02, 95% CI: 1.20-3.41), receipt of a blood transfusion (AHR = 2.11, 95% CI: 1.14-3.91), and administration of potassium chloride (AHR = 1.93, 95% CI: 1.17-3.19) and vancomycin (AHR = 2.89, 95% CI: 1.73-4.83). In this study, the incidence of peripheral intravenous cannula-induced phlebitis was high, with a lower median time of phlebitis onset. The key predictors were female sex, large cannula, receipt of a blood transfusion, and administration of potassium chloride and vancomycin.

This study investigated the risk factors of peripheral intravenous catheter (PIVC)-related phlebitis in critically ill patients according to the duration of catheter dwelling. This was a post-hoc analysis of the AMOR-VENUS study involving 23 intensive care units (ICUs) in Japan. We included patients aged ≥ 18 admitted to the ICU and had PIVCs inserted during ICU admission. The primary outcome measure was phlebitis, and the risk factors of phlebitis were evaluated based on hazard ratios (HR) and 95% confidence intervals (CI). The duration of catheter dwelling was classified as (i) ≤ 24 h; (ii) > 24 h, ≤ 72 h; and (iii) > 72 h. Multivariable marginal Cox regression analysis was performed using the presumed risk factors for each group. In total, 1,335 patients and 3,348 PIVCs were evaluated. Among patients with ≤ 24 h of catheter dwelling, phlebitis occurrence was associated with ICU admission for non-surgical management with ICU admission for elective surgery as the reference, standardized drug administration in the ICU, and dexmedetomidine administration in the ICU. Among those with > 24 h but ≤ 72 h of catheter dwelling, it was associated with male sex with female sex as the reference, tetrafluoroethylene as the catheter material with polyurethane as the reference, nicardipine administration, and noradrenaline administration. Among those with > 72 h of catheter dwelling, it was associated with a catheter size ≥ 18 G and nicardipine administration. The risk factors for phlebitis varied with the duration of catheter dwelling. Individualized catheter management, considering the duration of catheter dwelling, may help avoid phlebitis in patients admitted to the ICU.

In this phase 3 trial, progesterone had no benefit as a neuroprotective agent in patients with blunt traumatic brain injury. Together with a second negative clinical trial of progesterone for acute TBI (SYNAPSE), the findings provide no support for this therapeutic approach. More than 2.4 million emergency department visits, hospitalizations, or deaths are related to traumatic brain injury (TBI) annually, and approximately 5.3 million Americans are living with disability from TBI. The aggregate annual cost of TBI in the United States now approaches $76.5 billion. 1 Survivors of severe TBI typically require 5 to 10 years of intensive therapy and are often left with substantial disability. 2 Despite decades of research, no pharmacologic agent has been shown to improve outcomes after TBI. Progesterone is a potent neurosteroid synthesized in the central nervous system. Preclinical studies in laboratory animals indicated that the early administration of . . .

Intravascular catheters are essential for critically ill patients, enabling safe administration of medications, fluids, and hemodynamic monitoring. However, they pose risks of systemic and localized bloodstream infections. This review examines the types of central venous catheters (CVCs), complications associated with their use, and evidence-based practices for catheter management to prevent infections. Complications range from minor issues like occlusions and unintentional removals to severe problems such as phlebitis, infections, and skin damage. Catheter-related bloodstream infection (CR-BSI) is a serious complication influenced by patient, catheter, and institutional factors, with incidence rates of 1-3.1 per 1,000 patient days in adult intensive care units. In Saudi Arabia, a study found a 39.3% complication rate, with phlebitis being the most common (17.6%). Proper CVC management is crucial, focusing on dressing changes, disinfection, assessing patency, flushing, connector usage, blood sampling, and removal techniques. Adherence to evidence-based guidelines and standardized protocols is essential for preventing complications. Nurses' knowledge and institutional practices play a significant role in reducing catheter-related infections. Further research and consistent implementation of best practices are necessary to minimize the risks associated with intravascular catheters and improve patient outcomes.

Neonatal-short peripheral intravenous catheters (n-SPCs) and neonatal-long peripheral intravenous catheters (n-LPCs) are widely used for short-term vascular access in neonates. A retrospective single-centred cohort study was conducted in the neonatal intensive care unit between 2019 and 2022 to compare the 2 types of catheters. A total of 34,464 catheter insertions were analysed (32,885 n-SPCs, 1,579 n-LPCs). n-LPCs had longer dwell time (48:27 ± 39:08 h versus 34:01 ± 33:31 h, p  < 0.001). Accidental removals were lower in n-LPCs (0.3% versus 2.6%, p  < 0.001). n-LPCs had higher rates of phlebitis (16.1% versus 6.6%, p  < 0.001) and peripheral intravenous infiltration or extravasation (PIVIE) rate (40.0% versus 29.9%). Severe PIVIE (≥ 30% severity) was higher in n-LPCs (8.5% versus 2.8%, p  < 0.001). n-LPCs offer a more stable and effective option for peripheral vascular access in neonates. Their use should be balanced with strategies to reduce the risk of phlebitis and severe PIVIE.