The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform
Constantine Theoharis - One of the best experts on this subject based on the ideXlab platform.
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Histologic changes in the human vein wall adjacent to indwelling central venous Catheters.
Journal of vascular and interventional radiology : JVIR, 2003Co-Authors: Andrew R Forauer, Constantine TheoharisAbstract:Central venous catheter dysfunction can be caused by thrombosis (of the catheter or vessel itself), fibrin sheath formation, or infection. These sequelae can lead to costly interventions, loss of the access device, or loss of access sites in as many as one-third of patients. This study examined the histologic changes in the access vein and superior vena cava wall that is adjacent to central venous Catheters in humans. The access vein, brachiocephalic vein, and superior vena cava were excised en bloc at autopsy from six patients with central venous Catheters. The specimens were processed and stained with hematoxylin and eosin. The specimens were examined for histologic changes in the vein wall adjacent to the Catheters, changes in the intima, and the presence of associated thrombus. Three Catheters had been in place <14 days (short term), and three for >90 days (long term). Two microscopic patterns were observed. The short-term Catheters displayed foci of local intimal injury with endothelial denudation and a layer of adherent thrombus. The second pattern, seen in the long-term Catheters, consisted of smooth muscle cell proliferation leading to vein wall thickening. Focal areas of catheter attachment to the vein wall, composed of thrombus in varying stages of organization, collagen, and endothelial cells, were also observed. After short-term catheter placement, focal areas of endothelial injury were seen in the vein wall adjacent to the catheter. Associated thrombus may or may not be present. Long-term Catheters displayed vein wall thickening and bridges from the vein wall to the catheter. These observations represent a progressive reaction of the human vein wall to access devices.
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Histologic changes in the human vein wall adjacent to indwelling central venous Catheters.
Journal of Vascular and Interventional Radiology, 2003Co-Authors: Andrew R Forauer, Constantine TheoharisAbstract:PURPOSE Central venous catheter dysfunction can be caused by thrombosis (of the catheter or vessel itself), fibrin sheath formation, or infection. These sequelae can lead to costly interventions, loss of the access device, or loss of access sites in as many as one-third of patients. This study examined the histologic changes in the access vein and superior vena cava wall that is adjacent to central venous Catheters in humans. MATERIALS AND METHODS The access vein, brachiocephalic vein, and superior vena cava were excised en bloc at autopsy from six patients with central venous Catheters. The specimens were processed and stained with hematoxylin and eosin. The specimens were examined for histologic changes in the vein wall adjacent to the Catheters, changes in the intima, and the presence of associated thrombus. RESULTS Three Catheters had been in place 90 days (long term). Two microscopic patterns were observed. The short-term Catheters displayed foci of local intimal injury with endothelial denudation and a layer of adherent thrombus. The second pattern, seen in the long-term Catheters, consisted of smooth muscle cell proliferation leading to vein wall thickening. Focal areas of catheter attachment to the vein wall, composed of thrombus in varying stages of organization, collagen, and endothelial cells, were also observed. CONCLUSIONS After short-term catheter placement, focal areas of endothelial injury were seen in the vein wall adjacent to the catheter. Associated thrombus may or may not be present. Long-term Catheters displayed vein wall thickening and bridges from the vein wall to the catheter. These observations represent a progressive reaction of the human vein wall to access devices.
Andrew R Forauer - One of the best experts on this subject based on the ideXlab platform.
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Histologic changes in the human vein wall adjacent to indwelling central venous Catheters.
Journal of vascular and interventional radiology : JVIR, 2003Co-Authors: Andrew R Forauer, Constantine TheoharisAbstract:Central venous catheter dysfunction can be caused by thrombosis (of the catheter or vessel itself), fibrin sheath formation, or infection. These sequelae can lead to costly interventions, loss of the access device, or loss of access sites in as many as one-third of patients. This study examined the histologic changes in the access vein and superior vena cava wall that is adjacent to central venous Catheters in humans. The access vein, brachiocephalic vein, and superior vena cava were excised en bloc at autopsy from six patients with central venous Catheters. The specimens were processed and stained with hematoxylin and eosin. The specimens were examined for histologic changes in the vein wall adjacent to the Catheters, changes in the intima, and the presence of associated thrombus. Three Catheters had been in place <14 days (short term), and three for >90 days (long term). Two microscopic patterns were observed. The short-term Catheters displayed foci of local intimal injury with endothelial denudation and a layer of adherent thrombus. The second pattern, seen in the long-term Catheters, consisted of smooth muscle cell proliferation leading to vein wall thickening. Focal areas of catheter attachment to the vein wall, composed of thrombus in varying stages of organization, collagen, and endothelial cells, were also observed. After short-term catheter placement, focal areas of endothelial injury were seen in the vein wall adjacent to the catheter. Associated thrombus may or may not be present. Long-term Catheters displayed vein wall thickening and bridges from the vein wall to the catheter. These observations represent a progressive reaction of the human vein wall to access devices.
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Histologic changes in the human vein wall adjacent to indwelling central venous Catheters.
Journal of Vascular and Interventional Radiology, 2003Co-Authors: Andrew R Forauer, Constantine TheoharisAbstract:PURPOSE Central venous catheter dysfunction can be caused by thrombosis (of the catheter or vessel itself), fibrin sheath formation, or infection. These sequelae can lead to costly interventions, loss of the access device, or loss of access sites in as many as one-third of patients. This study examined the histologic changes in the access vein and superior vena cava wall that is adjacent to central venous Catheters in humans. MATERIALS AND METHODS The access vein, brachiocephalic vein, and superior vena cava were excised en bloc at autopsy from six patients with central venous Catheters. The specimens were processed and stained with hematoxylin and eosin. The specimens were examined for histologic changes in the vein wall adjacent to the Catheters, changes in the intima, and the presence of associated thrombus. RESULTS Three Catheters had been in place 90 days (long term). Two microscopic patterns were observed. The short-term Catheters displayed foci of local intimal injury with endothelial denudation and a layer of adherent thrombus. The second pattern, seen in the long-term Catheters, consisted of smooth muscle cell proliferation leading to vein wall thickening. Focal areas of catheter attachment to the vein wall, composed of thrombus in varying stages of organization, collagen, and endothelial cells, were also observed. CONCLUSIONS After short-term catheter placement, focal areas of endothelial injury were seen in the vein wall adjacent to the catheter. Associated thrombus may or may not be present. Long-term Catheters displayed vein wall thickening and bridges from the vein wall to the catheter. These observations represent a progressive reaction of the human vein wall to access devices.
Marcus C Hermansen - One of the best experts on this subject based on the ideXlab platform.
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intravascular catheter complications in the neonatal intensive care unit
Clinics in Perinatology, 2005Co-Authors: Marcus C HermansenAbstract:Central and peripheral intravascular Catheters serve many important functions for sick neonates; however, the use of these Catheters also carries significant risk of permanent disability or even death. This article examines the risks of catheter-related thromboembolic events, vasospasm, and infection. The article also looks at risks that are specific to umbilical artery Catheters, unbilical vein Catheters, peripherally inserted central Catheters, peripheral artery Catheters, and peripheral intravenous Catheters. Specific recommendations are made to reduce the possiblility of an intravascular catheter-realatd complication.
Oya Kutlay - One of the best experts on this subject based on the ideXlab platform.
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Efficacy of antiseptic-impregnated Catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit.
Journal of Hospital Infection, 2005Co-Authors: S. Osma, Ş.f. Kahveci, F.n. Kaya, Halis Akalin, Cuneyt Ozakin, Emel Yilmaz, Oya KutlayAbstract:Summary This study was conducted to evaluate the impact of central venous Catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter ( N =64) or a standard triple-lumen catheter ( N =69). The mean (SD) durations of catheterization for the antiseptic and standard Catheters were 11.7 (5.8) days (median 10; range 3–29) and 8.9 (4.6) days (median 8.0; range 3–20), respectively ( P =0.006). Fourteen (21.9%) of the antiseptic Catheters and 14 (20.3%) of the standard Catheters had been colonized at the time of removal ( P =0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic Catheters and one case (1.4%) was associated with a standard catheter ( P =0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group ( P =0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group ( P =0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous Catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.
Issam I Raad - One of the best experts on this subject based on the ideXlab platform.
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a comparison of two antimicrobial impregnated central venous Catheters
The New England Journal of Medicine, 1999Co-Authors: Rabih O Darouiche, Stephen O. Heard, Issam I Raad, Andrea Gabrielli, John Thornby, Olivier C Wenker, Johannes Berg, Nancy Khardori, Hend Hanna, Ray Y HachemAbstract:Background The use of central venous Catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated Catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective Catheters. Methods We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous Catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen Catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the Catheters were cultured by both the roll-plate and the sonication ...
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central venous Catheters coated with minocycline and rifampin for the prevention of catheter related colonization and bloodstream infections a randomized double blind trial
Annals of Internal Medicine, 1997Co-Authors: Issam I Raad, Rabih O Darouiche, Jacques Dupuis, Dima Abisaid, Andrea Gabrielli, Ray Y Hachem, Matthew J Wall, Richard Harris, James W Jones, Antonio C BuzaidAbstract:Background: Central venous Catheters are a principal source of nosocomial bloodstream infections, which are difficult to control. Objective: To determine the efficacy of Catheters coated with minocycline and rifampin in preventing catheter-related colonization and bloodstream infections. Design: Multicenter, randomized clinical trial. Setting: Five university-based medical centers. Patients: 281 hospitalized patients who required 298 triple-lumen, polyurethane venous Catheters. Intervention: 147 Catheters were pretreated with tridodecylmethyl-ammonium chloride and coated with minocycline and rifampin. Untreated, uncoated Catheters (n = 151) were used as controls. Measurements: Quantitative catheter cultures, blood cultures, and molecular typing of organisms to determine catheter-related colonization and bloodstream infections. Results: The group with coated Catheters and the group with uncoated Catheters were similar with respect to age, sex, underlying diseases, degree of immunosuppression, therapeutic interventions, and risk factors for catheter infections. Colonization occurred in 36 (26%) uncoated Catheters and 11 (8%) coated Catheters (P < 0.001). Catheter-related bloodstream infection developed in 7 patients (5%) with uncoated Catheters and no patients with coated Catheters (P < 0.01). Multivariate logistic regression analysis showed that coating Catheters with minocycline and rifampin was an independent protective factor against catheter-related colonization (P < 0.05). No adverse effects related to the coated Catheters or antimicrobial resistance were seen. An estimate showed that the use of coated Catheters could save costs. Conclusions: Central venous Catheters coated with minocycline and rifampin can significantly reduce the risk for catheter-related colonization and bloodstream infections. The use of these Catheters may save costs.
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quantitative tip culture methods and the diagnosis of central venous catheter related infections
Diagnostic Microbiology and Infectious Disease, 1992Co-Authors: Issam I Raad, Mouin F Sabbagh, Kenneth H Rand, Robert J SherertzAbstract:The diagnostic usefulness of two quantitative catheter culture methods was compared in a prospective study of central venous and arterial Catheters. The roll-plate method followed by sonication was used to culture 177 Catheters from 85 patients, and the sonication method was used to culture 136 Catheters from 68 patients. All patients were evaluated for catheter-related infections. Catheter-related infections were associated with ≥100 colony-forming units (CFU) isolated from catheter tips by either roll plate (p = 0.01) or sonication (p < 0.001). The sensitivity, specificity, and positive and negative predictive values of ≥103 CFU by roll plate for catheter-related septicemia were 56%, 97%, 63%, and 96% compared with 93%, 95%, 76%, and 99%, respectively, for the same level by sonication. For central venous and arterial Catheters, the sonication method can distinguish infection from contamination and is superior to the roll-plate method in that it may offer a more sensitive and predictive alternative in the diagnosis of catheter-related septicemia.
