Microbial Biofilms
Chaminda Jayampath Seneviratne in Microbial Biofilms, 2017
Catheters are medical devices which are inserted into the body to deliver or drain medications, fluids or gasses. These catheters provide a binding surface for microorganisms to adhere. Under favourable conditions, adhered microorganisms may develop biofilms on catheters, leading to chronic BAI. The catheter invades through the skin insertion site and invariably comes in contact with the patient’s endogenous skin microflora. However, the first contact of microorganisms with the catheter surface does not lead to biofilm formation. The chances of biofilm formation become higher when the catheter is placed for an extended period of time. Biofilms can be formed on the extraluminal as well as the interluminal surfaces of the catheter, which have considerable differences in terms of source and composition. Some common examples of catheter-associated biofilm infections are discussed in the paragraphs that follow.
Invasive hemodynamic monitoring in obstetrics
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
In addition to mechanical complications, catheter-related infections pose a significant risk to the patient. Infection of the CVC may occur locally at the insertion site, from hub colonization and subsequent infection through the catheter lumen, or through hematogenous seeding of the catheter (5). The Centers for Disease Control and Prevention recommend the subclavian vein as the site of choice to reduce the risk of catheter-related sepsis (9). The Institute for Healthcare Improvement recommends five steps to reduce central-line infections: hand washing, maximal barrier precautions, chlorhexidine skin antisepsis, selection of an optimal catheter site, and prompt removal of the CVC when no longer needed. Antiseptic-containing hubs (chlorhexidine) and antimicrobial-impregnated catheters (minocycline and rifampin) have been shown to decrease the rate of catheter-related bloodstream infections when compared with non-impregnated catheters and should be considered in all CVC insertions when the institutional infection rate exceeds 2% (4,5).
Vascular access in the newborn
Prem Puri in Newborn Surgery, 2017
The most common complication of any central catheter is infection. Historically, rates of central line–associated blood stream infection (CLABSI) as high as 29% have been seen in neonates, with smaller infants at greatest risk. 12,16 Differences in infection rates can be attributed to differences in patient populations and practice guidelines.12 CLABSI has received a lot of attention in the past 10 years, which has resulted in a significant decrease in the infection rate. Particularly, creation of care “bundles” to standardize care and enforce best practice policies has been shown to decrease CLABSI rates even in high-risk infants.17 Coagulase-negative staphylococci continue to be the most common cause of central line infection and bacteremia. Numerous other bacteria including gram-negatives, anaerobes, and Candida species can cause line infection, especially in the postsurgical neonate. Although many authors advocate treatment with antibiotics for the clearance of central line infection, removal of the foreign body (CVC) associated with the infection may be needed in refractory cases. PICC lines can be inserted as a bridge to replacement of more permanent access during antibiotic treatment of the bacteremia. Insertion site infections can generally be treated with antibiotics alone and do not require removal of the catheter unless bacteremia is documented. With careful guidelines for the placement and maintenance of these catheters, very low infection rates can be achieved.
Steerable catheters for minimally invasive surgery: a review and future directions
Published in Computer Assisted Surgery, 2018
Xiaohua Hu, Ang Chen, Yigang Luo, Chris Zhang, Edwin Zhang
Minimally invasive surgery (MIS) utilizes image-guided procedures to diagnose and treat diseases in nearly every organ system, and MIS has revolutionized surgery in the last two decades. By minimizing the physical trauma to the patient, MISs can reduce infection rate and recovery time considerably and it can also allow shortening a hospital stay of the patients. One of the common tools used in MIS, in interventional radiology in particular, is the catheter which is a long, thin and flexible tube or wire. The catheter is inserted into the vascular system, gastrointestinal tract and airway for both diagnosis and treatment. Currently, the majority of MIS procedures are performed manually with the so-called deflectable or conventional catheters. Such catheters have a limited range of motion and flexibility and much rely on the operators’ skill and experience to maneuver the catheter tip to reach and interact the target site in a stable manner. The complexity of the anatomy of the pathway and target site and the lack of information of the contact force are responsible for some difficulty in the operation of catheters in terms of dexterity, safety and stability (inappropriately leading to failures of the operation).
Evaluation of the Macy Catheter®: a rectal catheter for rapid medication and fluid administration
Published in Expert Review of Medical Devices, 2018
Kim Marie C. Macygin, Erik Kulstad, Robert K. Mokszycki, Morgan Goldsmith
A variety of patients in different care settings need an alternative delivery route for fluid and medication when the oral route is compromised and venous access is not practical, not warranted, or difficult to obtain.The Macy Catheter is the first FDA indicated rectal catheter for on-going administration of fluid and medications. It can remain in place for up to 28 days. Insertion of the catheter is a quick, painless, non-sterile procedure, which can be performed by a trained healthcare provider.The simplicity, speed and versatility of the Macy Catheter make the rectal route a viable first line alternative for fluid and medication delivery when the oral route is compromised. The Macy Catheter can be used for a variety of patient conditions across the entire lifespan.
The Effects of Acute Intracranial Pressure Changes on the Episcleral Venous Pressure, Retinal Vein Diameter and Intraocular Pressure in a Pig Model
Published in Current Eye Research, 2021
Deepta Ghate, Sachin Kedar, Shane Havens, Shan Fan, William Thorell, Carl Nelson, Linxia Gu, Junfei Tong, Vikas Gulati
The lumbar cistern was accessed using a 14-gauge Touey needle advanced in the inter-spinous space between L3-L4 or L4-L5 vertebrae. If the lumbar cistern was not accessed with three attempts using this technique, the intervertebral lamina was exposed through skin incision and direct visualization cannulation was performed after (three animals). The accurate placement was confirmed by clear cerebrospinal fluid backflow. The lumbar catheter was advanced cephalad in the subarachnoid space through the needle for approximately 2–3 spinal levels above the insertion line. Once secured to the overlying skin, the catheter was attached to a normal saline bag using IV tubing with adjustable flow. Baseline readings were obtained with the system closed off at the level of the spine using a 3-way stopcock to ensure a closed system.
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