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Peer kidney care initiative 2014 report: dialysis care and outcomes in the United States.
Weinhandl E, Constantini E, Everson S, Gilbertson D, Li S, Solid C, Anger M, Bhat JG, DeOreo P, Krishnan M, Nissenson A, Johnson D, Ikizler TA, Maddux F, Sadler J, Tyshler L, Parker T, Schiller B, Smith B, Lindenfeld S, Collins AJ
(2015) Am J Kidney Dis 65: Svi, S1-140
MeSH Terms: Catheterization, Central Venous, Health Status Disparities, Hospitalization, Humans, Infection, Kidney Failure, Chronic, Mortality, Outcome Assessment (Health Care), Quality Improvement, Renal Dialysis, United States
Added August 5, 2015
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11 MeSH Terms
Are peripherally inserted central catheters associated with increased risk of adverse events in status 1B patients awaiting transplantation on continuous intravenous milrinone?
Haglund NA, Cox ZL, Lee JT, Song Y, Keebler ME, DiSalvo TG, Maltais S, Lenihan DJ, Wigger MA
(2014) J Card Fail 20: 630-7
MeSH Terms: Academic Medical Centers, Cardiotonic Agents, Catheter-Related Infections, Catheterization, Central Venous, Catheterization, Peripheral, Female, Heart Failure, Heart Transplantation, Heart-Assist Devices, Hemorrhage, Humans, Infusions, Intravenous, Intensive Care Units, Male, Middle Aged, Milrinone, Regression Analysis, Retrospective Studies, Tennessee, Venous Thromboembolism, Waiting Lists
Show Abstract · Added February 19, 2015
BACKGROUND - Peripherally inserted central catheters (PICCs) are used to deliver continuous intravenous (IV) milrinone in stage D heart failure (HF) patients awaiting heart transplantation (HT).
METHODS - We retrospectively analyzed PICC adverse events (AEs) and associated cost in 129 status 1B patients from 2005 to 2012. End points were HT, left ventricular assist device (LVAD), and death. Regression analysis was used to identify AE risk factors.
RESULTS - Fifty-three PICC AEs occurred in 35 patients (27%), consisting of 48 infections, 4 thromboses, and 1 bleeding event. Median duration of PICC support was 63 (interquartile range [IQR] 34-131) days, and median time to first PICC infection was 44 (IQR 14-76) days. Among PICC infections, 9% required defibrillator removal and 30% were inactivated on the HT list for a mean of 23 ± 17 days. Rate of HT, LVAD, or death was similar between groups (P > .05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (hazard ratio 7.59, 95% CI 1.97-29.23; P = .003). Median cost per PICC infection was $10,704 (IQR $7,401-$26,083).
CONCLUSIONS - PICC infections were the most frequent AEs. PICCs with >1 lumen were associated with increased risk of infection. PICC AEs accounted for increased intensive care unit admissions, HT list inactivations, and overall cost.
Copyright © 2014 Elsevier Inc. All rights reserved.
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21 MeSH Terms
Hemodialysis patient preference for type of vascular access: variation and predictors across countries in the DOPPS.
Fissell RB, Fuller DS, Morgenstern H, Gillespie BW, Mendelssohn DC, Rayner HC, Robinson BM, Schatell D, Kawanishi H, Pisoni RL
(2013) J Vasc Access 14: 264-72
MeSH Terms: Age Factors, Aged, Aged, 80 and over, Australia, Canada, Catheterization, Central Venous, Central Venous Catheters, Cross-Sectional Studies, Cultural Characteristics, Europe, Female, Health Care Surveys, Health Knowledge, Attitudes, Practice, Healthcare Disparities, Humans, Japan, Logistic Models, Male, Middle Aged, Multivariate Analysis, New Zealand, Odds Ratio, Patient Preference, Practice Patterns, Physicians', Renal Dialysis, Sex Factors, United States
Show Abstract · Added August 21, 2013
PURPOSE - Catheters are associated with worse clinical outcomes than fistulas and grafts in hemodialysis (HD) patients. One potential modifier of patient vascular access (VA) use is patient preference for a particular VA type. The purpose of this study is to identify predictors of patient VA preference that could be used to improve patient care.
METHODS - This study uses a cross-sectional sample of data from the Dialysis Outcomes and Practice Patterns Study (DOPPS 3, 2005-09), that includes 3815 HD patients from 224 facilities in 12 countries. Using multivariable models we measured associations between patient demographic and clinical characteristics, previous catheter use and patient preference for a catheter.
RESULTS - Patient preference for a catheter varied across countries, ranging from 1% of HD patients in Japan and 18% in the United States, to 42% to 44% in Belgium and Canada. Preference for a catheter was positively associated with age (adjusted odds ratio per 10 years=1.14; 95% CI=1.02-1.26), female sex (OR 1.49; 95% CI=1.15-1.93), and former (OR=2.61; 95% CI=1.66-4.12) or current catheter use (OR=60.3; 95% CI=36.5-99.8); catheter preference was inversely associated with time on dialysis (OR per three years=0.90; 95% CI=0.82-0.97).
CONCLUSIONS - Considerable variation in patient VA preference was observed across countries, suggesting that patient VA preference may be influenced by sociocultural factors and thus could be modifiable. Catheter preference was greatest among current and former catheter users, suggesting that one way to influence patient VA preference may be to avoid catheter use whenever possible.
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27 MeSH Terms
Peritransplant gastrointestinal symptoms in familial amyloidotic polyneuropathy.
Ohya Y, Isono K, Obayashi K, Hayashida S, Lee KJ, Yamamoto H, Takeichi T, Asonuma K, Ando Y, Inomata Y
(2013) Exp Clin Transplant 11: 327-31
MeSH Terms: Adult, Amyloid Neuropathies, Familial, Body Mass Index, Catheterization, Central Venous, Female, Gastrointestinal Diseases, Hospitals, University, Humans, Japan, Length of Stay, Liver Transplantation, Living Donors, Male, Middle Aged, Nutritional Status, Nutritional Support, Recovery of Function, Retrospective Studies, Time Factors, Treatment Outcome
Show Abstract · Added February 11, 2015
OBJECTIVES - Gastrointestinal dysfunction is a common complication in familial amyloidotic polyneuropathy, and gastrointestinal symptoms are associated with a patient's nutritional status. The object of this study was to evaluate changes in peritransplant gastrointestinal symptoms and the nutritional status of familial amyloidotic polyneuropathy patients using the modified body mass index following a living-donor liver transplant.
MATERIALS AND METHODS - In a retrospective analysis, we compared 17 Japanese familial amyloidotic polyneuropathy patients who underwent living-donor liver transplant in Kumamoto University Hospital between 2000 and 2009 with a control group of 28 patients with chronic liver disease. We analyzed the peritransplant gastrointestinal symptoms, nutritional status, duration of central venous catheterization, and postoperative hospital stay. The Mann-Whitney U test and Fisher exact test were used to analyze relations between the familial amyloidotic polyneuropathy group and control group, and the Wilcoxon signed-rank test, to analyze the relation of perioperative modified body mass index, with a value for P < .05 considered statistically significant.
RESULTS - The duration of central venous catheterization and postoperative hospital stay were significantly longer in the familial amyloidotic polyneuropathy group than they were in the control group. There was no significant difference between modified body mass index preoperatively and 1 year after living-donor liver transplant. Although gastrointestinal symptoms were typically mild before living-donor liver transplant, the familial amyloidotic polyneuropathy group experienced a temporary deterioration in gastrointestinal symptoms after receiving the living-donor liver transplant but recovered after approximately 2 months.
CONCLUSIONS - Although familial amyloidotic polyneuropathy patients experienced temporary exacerbations of gastrointestinal symptoms, their nutritional status was not affected during the peritransplant period, and they generally recovered within 2 months.
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20 MeSH Terms
Critical and honest conversations: the evidence behind the "Choosing Wisely" campaign recommendations by the American Society of Nephrology.
Williams AW, Dwyer AC, Eddy AA, Fink JC, Jaber BL, Linas SL, Michael B, O'Hare AM, Schaefer HM, Shaffer RN, Trachtman H, Weiner DE, Falk AR, American Society of Nephrology Quality, and Patient Safety Task Force
(2012) Clin J Am Soc Nephrol 7: 1664-72
MeSH Terms: Anti-Inflammatory Agents, Non-Steroidal, Catheterization, Central Venous, Cost Savings, Cost-Benefit Analysis, Evidence-Based Medicine, Guideline Adherence, Health Care Costs, Health Promotion, Health Services Misuse, Hematinics, Humans, Mass Screening, Nephrology, Patient Safety, Physician-Patient Relations, Practice Guidelines as Topic, Professional-Family Relations, Program Development, Quality Indicators, Health Care, Renal Dialysis, Renal Insufficiency, Chronic, Societies, Medical, United States
Show Abstract · Added February 25, 2014
Estimates suggest that one third of United States health care spending results from overuse or misuse of tests, procedures, and therapies. The American Board of Internal Medicine Foundation, in partnership with Consumer Reports, initiated the "Choosing Wisely" campaign to identify areas in patient care and resource use most open to improvement. Nine subspecialty organizations joined the campaign; each organization identified five tests, procedures, or therapies that are overused, are misused, or could potentially lead to harm or unnecessary health care spending. Each of the American Society of Nephrology's (ASN's) 10 advisory groups submitted recommendations for inclusion. The ASN Quality and Patient Safety Task Force selected five recommendations based on relevance and importance to individuals with kidney disease.Recommendations selected were: (1) Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; (2) do not administer erythropoiesis-stimulating agents to CKD patients with hemoglobin levels ≥10 g/dl without symptoms of anemia; (3) avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD of all causes, including diabetes; (4) do not place peripherally inserted central catheters in stage 3-5 CKD patients without consulting nephrology; (5) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.These five recommendations and supporting evidence give providers information to facilitate prudent care decisions and empower patients to actively participate in critical, honest conversations about their care, potentially reducing unnecessary health care spending and preventing harm.
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23 MeSH Terms
Cardiac-gated bright blood MR imaging to determine retrieval feasibility of a chronic foreign body.
Baghdanian A, Cohn JR, Mitchell DG, Adamo RD, Brown DB
(2012) J Vasc Interv Radiol 23: 151-2
MeSH Terms: Angiography, Cardiac-Gated Imaging Techniques, Catheterization, Central Venous, Contrast Media, Device Removal, Female, Foreign Bodies, Humans, Magnetic Resonance Imaging, Interventional, Middle Aged, Pulmonary Artery
Added March 5, 2014
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Frequency of peripherally inserted central catheter complications in children.
Barrier A, Williams DJ, Connelly M, Creech CB
(2012) Pediatr Infect Dis J 31: 519-21
MeSH Terms: Anti-Bacterial Agents, Catheter-Related Infections, Catheterization, Central Venous, Catheterization, Peripheral, Child, Child, Preschool, Female, Humans, Immunocompetence, Infant, Infusions, Parenteral, Male, Risk Factors, Thrombosis
Show Abstract · Added February 3, 2014
This study examined the frequency and types of complications with peripherally inserted central catheters (PICCs) placed in immunocompetent pediatric patients for parenteral antimicrobial therapy. It also sought to determine risk factors associated with those complications. Complications occurred at a frequency of 19.3/1000 PICC days, and greater than 30% of PICCs developed at least one complication. Risk factors for complication include double-lumen PICCs, PICCs placed in the femoral vein, younger age, and greater number of daily doses.
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14 MeSH Terms
Early outcomes among those initiating chronic dialysis in the United States.
Chan KE, Maddux FW, Tolkoff-Rubin N, Karumanchi SA, Thadhani R, Hakim RM
(2011) Clin J Am Soc Nephrol 6: 2642-9
MeSH Terms: Aged, Arteriovenous Shunt, Surgical, Blood Vessel Prosthesis Implantation, Catheterization, Central Venous, Female, Hospitalization, Humans, Kidney Failure, Chronic, Male, Middle Aged, Peritoneal Dialysis, Renal Dialysis, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States
Show Abstract · Added May 20, 2014
BACKGROUND AND OBJECTIVES - Approximately one million Americans initiated chronic dialysis over the past decade; the first-year mortality rate reported by the U.S. Renal Data System was 19.6% in 2007. This estimate has historically excluded the first 90 days of chronic dialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - To characterize the mortality and hospitalization risks for patients starting chronic renal replacement therapy, we followed all patients initiating dialysis in 1733 facilities throughout the United States (n = 303,289). Mortality and hospitalizations within the first 90 days were compared with outcomes after this period, and the results were analyzed. Standard time-series analyses were used to depict the weekly risk estimates for each outcome.
RESULTS - Between 1997 and 2009, >300,000 patients initiated chronic dialysis and were followed for >35 million dialysis treatments; the highest risk for morbidity and mortality occurred in the first 2 weeks of treatment. The initial 2-week risk of death for a typical dialysis patient was 2.72-fold higher, and the risk of hospitalization was 1.95-fold higher when compared to a patient who survived the first year of chronic dialysis (week 53 after initiation). Similarly, over the first 90 days, the risk of mortality and hospitalization remained elevated. Thereafter, between days 91 and 365, these risks decreased considerably by more than half. Surviving these first weeks of dialysis was most associated with the type of vascular access. Initiating dialysis with a fistula was associated with a decreased early death risk by 61%, whereas peritoneal dialysis decreased the risk by 87%.
CONCLUSIONS - The first 2 weeks of chronic dialysis are associated with heightened mortality and hospitalization risks, which remain elevated over the ensuing 90 days.
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17 MeSH Terms
A silver-alginate-coated dressing to reduce peripherally inserted central catheter (PICC) infections in NICU patients: a pilot randomized controlled trial.
Hill ML, Baldwin L, Slaughter JC, Walsh WF, Weitkamp JH
(2010) J Perinatol 30: 469-73
MeSH Terms: Administration, Cutaneous, Alginates, Anti-Bacterial Agents, Bandages, Catheterization, Central Venous, Catheters, Indwelling, Female, Glucuronic Acid, Hexuronic Acids, Humans, Infant, Newborn, Male, Pilot Projects, Polysaccharides, Sepsis, Silver, Treatment Outcome
Show Abstract · Added February 27, 2014
OBJECTIVE - Our aim was to evaluate the safety of a silver-alginate-containing dressing to reduce peripherally inserted central catheter (PICC) infections in neonatal intensive care unit (NICU) patients.
STUDY DESIGN - Patients were randomized 3:1 to receive a patch containing silver, alginate and maltodextrin or standard of care. Patches were placed under the regular transparent retention dressing at the PICC exit site at insertion and were replaced with every dressing change at least every 2 weeks until PICC discontinuation. All study infants were monitored for adverse skin reactions.
RESULT - A total of 100 infants were followed up for 1922 person-days, including 75 subjects with 89 PICCs who received the patch. The median birth weight (1330 g) and median gestational age (30 weeks) was lower in the patch group when compared with the controls (P=0.001 and 0.005, respectively). Study patients received the patch with their PICC at a median age of 5 days; the patch stayed in place for a median of 13 days. We noted no adverse skin reactions and found no evidence that the patch alters the microbiology of PICC-associated infections.
CONCLUSION - This pilot trial suggests that silver-alginate-coated dressings are skin safe and their inclusion in future trials aimed at reduction of PICC-associated bloodstream infections in the NICU should be considered.
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The "right" of passage: surviving the first year of dialysis.
Wingard RL, Chan KE, Lazarus JM, Hakim RM
(2009) Clin J Am Soc Nephrol 4 Suppl 1: S114-20
MeSH Terms: Arteriovenous Shunt, Surgical, Biomarkers, Blood Vessel Prosthesis Implantation, Case-Control Studies, Catheterization, Central Venous, Drug Utilization, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Hemoglobins, Hospitalization, Humans, Kidney Failure, Chronic, Male, Middle Aged, Patient Education as Topic, Phosphorus, Program Evaluation, Proportional Hazards Models, Renal Dialysis, Retrospective Studies, Risk Assessment, Risk Factors, Serum Albumin, Time Factors, Treatment Outcome, United States, Vitamin D
Show Abstract · Added May 20, 2014
Mortality risk for dialysis patients is highest in the first year. We previously showed a 41% mortality benefit associated with a pilot case management program for incident hemodialysis patients (n = 918). The RightStart Program (RSP) provided prompt medical management and self-management education and was recently expanded to more facilities. We conducted a matched cohort analysis to validate the expanded program's continued effectiveness. Death risk was reduced for RS patients (n = 4308) versus matched controls (C; n = 4308) by 34% (hazard ratio = 0.66, P < 0.0001) at 120 d and 22% at 1 yr (hazard ratio = 0.78, P < 0.0001). RS patients had lower hospitalization during the first year (RS = 15.5 days per patient year versus C = 16.9, P < 0.01). At 120 d, more RS patients achieved hemoglobin 11 to 12 g/dl (RS = 22.4% versus C = 19.7%, P < 0.01), eKt/V > or = 1.2 (RS = 66% versus C = 53.5%, P < 0.01), albumin > or = 4.0 g/dl (RS = 26% versus C = 22%, P < 0.01), and phosphorus 3.5 to 5.5 mg/dl (RS = 52.4% versus C = 45.4%). At 120 d, RS patients had a greater reduction in catheter use (RS = 32% versus C = 25%, P < 0.01) and more vitamin D orders (RS = 60% versus C = 55%, P < 0.01). Expansion of RS to a larger incident patient population results in significant reduction of morbidity and mortality associated with improvement of intermediate outcomes.
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28 MeSH Terms