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Journal of Hospital Medicine Nov 2023Midline catheters (midlines) are increasingly used in patients with advanced chronic kidney disease (CKD).
BACKGROUND
Midline catheters (midlines) are increasingly used in patients with advanced chronic kidney disease (CKD).
OBJECTIVE
This study describes current practice and acute complications associated with midlines in CKD patients.
DESIGNS, SETTING, AND PARTICIPANTS
Trained abstractors at 66 hospitals from the Michigan Hospital Medicine Safety (HMS) Consortium collected data on a sample of patients who received a midline during hospitalization. Patients were classified as having advanced CKD if their estimated glomerular filtration rate was <45 mL/min/1.73 m .
MAIN OUTCOME AND MEASURES
Midline recipients with advanced CKD were compared to those without advanced CKD by patient, provider, and device characteristics, and by the occurrence of acute complications including major (e.g., upper extremity deep vein thrombosis [UE-DVT] and catheter-related bloodstream infection [CRBSI]) or minor (e.g., catheter occlusion, catheter dislodgement, infiltration, superficial thrombophlebitis, and leaking at insertion site) events. Multivariable mixed effects logistic regression was used to evaluate the association between catheter-related complications and stage of CKD.
RESULTS
Of 21,415 midline recipients, 5272 (24.6%) had advanced CKD, while 16,143 (75.4%) did not. Most midlines were single lumen (90.5%) and remained in place for a median of 6 days. A major or minor midline complication occurred in 804 (15.3%) patients with and 2239 (14.4%) patients without advanced CKD (adjusted odds ratios = 1.04; 95% confidence interval: 0.94-1.14). Among patients with advanced CKD, CRBSI occurred in 13 patients (0.2%) and UE-DVT occurred in 65 patients (1.2%). The proportion of advanced CKD among midline recipients and the frequency of midline-related complications varied across hospitals (interquartile range [IQR] = 19.2% to 29.8% [median = 25.0%] and IQR = 11.0%-18.9% [median = 15.4%], respectively).
Topics: Humans; Catheterization, Central Venous; Catheters; Thrombophlebitis; Patients; Renal Insufficiency, Chronic; Postoperative Complications
PubMed: 37771294
DOI: 10.1002/jhm.13209 -
The Journal of Dermatology Jul 2022Behçet's disease (BD) has a heterogeneous spectrum of disease manifestations featuring the involvement of different organs and can be characterized with different...
Behçet's disease (BD) has a heterogeneous spectrum of disease manifestations featuring the involvement of different organs and can be characterized with different symptoms depending on the clinical department in charge. We retrospectively reviewed BD patients seen at our hospital and investigated the presence of neutrophils producing neutrophil extracellular traps (NET) in those patients. Immunolabeling of myeloperoxidase and histone citrullination proteins was performed on skin biopsies from three BD patients who had skin biopsy-proven superficial vein thrombophlebitis in their erythema nodosum-like lesions. We observed a higher proportion of female patients and a higher incidence of acne-like eruptions among BD patients seen at our dermatology department, while there was a higher incidence of ocular and gastrointestinal involvement among BD patients treated in other departments. We suggest that sex statistical trends could lead to the co-development of different manifestations and may help clinicians choose the best therapeutic approaches, tailoring them to the specific phenotype of the patient rather than one based on single disease manifestations. NET were found in neutrophils of panniculitis concurrent with superficial vein thrombophlebitis. We suggest that the pathogenesis of BD-related thrombosis could be associated with neutrophil activation and NET are released in the panniculitis of affected skin lesions, erythema nodosum-like lesions.
Topics: Behcet Syndrome; Erythema Nodosum; Extracellular Traps; Female; Humans; Retrospective Studies; Thrombophlebitis; Venous Thrombosis
PubMed: 35434809
DOI: 10.1111/1346-8138.16391 -
Journal of Vascular Surgery. Venous and... Nov 2020Insurance approval for saphenous vein ablation is generally limited to junctional reflux involving the great saphenous vein (GSV) or small saphenous vein. This study was... (Comparative Study)
Comparative Study
BACKGROUND
Insurance approval for saphenous vein ablation is generally limited to junctional reflux involving the great saphenous vein (GSV) or small saphenous vein. This study was designed to investigate prevalence and disease severity of anterior accessory GSV (AAGSV) compared with GSV disease in patients presenting to dedicated outpatient vein centers.
METHODS
Deidentified data were pulled from the American Vein & Lymphatic Society PRO Venous Registry for first and second patient encounters. Variables included age, sex, and body mass index (BMI); clinical class of Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification; revised Venous Clinical Severity Score (rVCSS); and duplex ultrasound values for each limb. Data were further scrutinized according to duplex ultrasound findings. Patients with normal findings on duplex ultrasound examination or evidence of acute or chronic thrombosis were excluded. Patients were further characterized into two groups. The primary group had no prior vein treatment vs the progressive group, in which patients have had a superficial venous intervention at some point in the past.
RESULTS
There were 6836 unique patients with duplex ultrasound patterns of either AAGSV or GSV above the knee or both AAGSV and GSV in either group. This pool contained 2604 patients with recorded CEAP class and rVCSS, representing 2664 patient limbs in the final data set. In comparison to limbs in the progressive group, AAGSV reflux was more common in the primary group (78/563 vs 209/2101; P < .01). Demographic features of the groups demonstrated no significant difference. The primary group demonstrated a significantly higher rVCSS (6.95 vs 6.10; P < .01) than the progressive group. Patients in the primary group also demonstrated a significantly higher incidence of more advanced disease (CEAP class C4 and above; 43.1% vs 24.8%; P < .0001) than those in the progressive group. The primary group demonstrated no significant differences in age, sex proportions, or mean BMI. The mean rVCSS for GSV of these patients (7.22) was significantly higher than that of AAGSV patients (5.63; P < .01). The incidence of superficial vein thrombosis for the AAGSV patients (6.41%) was significantly higher than that of the GSV patients (2.17%; P < .05) in the progressive group. Patients in the progressive group demonstrated no significant difference in age, sex proportions, mean BMI, or average rVCSS. The proportion of AAGSV limbs with superficial thrombosis events (37/287 [12.9%]) was significantly higher than that for GSV (59/2214 [2.7%]; P < .01).
CONCLUSIONS
AAGSV reflux is common and carries similar morbidity to GSV reflux. It is manifested with an alarming presence of superficial vein thrombosis.
Topics: Ambulatory Care; Disease Progression; Female; Humans; Incidence; Male; Middle Aged; Prevalence; Registries; Retrospective Studies; Saphenous Vein; Severity of Illness Index; Thrombophlebitis; Ultrasonography, Doppler, Duplex; Venous Insufficiency; Venous Thrombosis
PubMed: 32205127
DOI: 10.1016/j.jvsv.2020.02.010 -
BMC Veterinary Research Sep 2022Although the jugular vein is a major important blood vessel in equine, the literature lacks this vessel's normal B-mode and Doppler ultrasonographic examinations in...
BACKGROUND
Although the jugular vein is a major important blood vessel in equine, the literature lacks this vessel's normal B-mode and Doppler ultrasonographic examinations in donkeys. Therefore, this study aimed to determine the reference ranges of B-mode and Doppler ultrasonographic indices of jugular veins in healthy adult donkeys (Equus asinus) and the possible effect of examination side (left and right), gender, and body condition on the ultrasonographic measurements of this vessel. B-mode and Doppler ultrasound imaging of the external jugular vein was conducted on 20 adult healthy donkeys of both sexes.
RESULTS
In all donkeys, the jugular vein was 4.01 to 8.1 mm from the body surface. The longitudinal and transverse venous diameters ranged from 3.94 to 10.5 mm and from 0.88 to 1.9 cm, respectively. Moreover, the vein areas varied from 0.61 to 2.83 cm. The reference values of superficial and deep wall thickness (SWT and DWT) were 0.56 ± 0.2 and 0.6 ± 0.13 mm, respectively. The blood velocity, blood follow rate, and congestion index of the external jugular vein can be expected in adult healthy donkeys as a range value from 8.4 to 13.5 cm/sec, from 0.33 to 1.78 ml/min, and from 0.06 to 0.27 cm.sec, respectively. Generally, the vein showed laminar monophasic waveforms. The examination side and gender have no significant effect on the ultrasound measurements of the vein (P > 0.05). Donkeys with a body condition score (BCS) ≥ 3 revealed increases in the depth of the vein (P < 0.05).
CONCLUSIONS
The results of this study can be used as reference values and provide a basis for comparison when evaluating donkeys with diseases that affect blood flow in the external jugular vein.
Topics: Animals; Equidae; Female; Horses; Jugular Veins; Male; Ultrasonography; Ultrasonography, Doppler, Color
PubMed: 36104788
DOI: 10.1186/s12917-022-03441-y -
Journal of the European Academy of... Feb 2023
Topics: Humans; Tattooing; Thrombophlebitis; Lower Extremity
PubMed: 35993749
DOI: 10.1111/jdv.18551 -
Clinical Case Reports Nov 2019Penile Mondor's disease or thrombophlebitis of the superficial dorsal penile vein is a rare disorder of the penis. Reported cases in the literature are mostly focal...
Penile Mondor's disease or thrombophlebitis of the superficial dorsal penile vein is a rare disorder of the penis. Reported cases in the literature are mostly focal thrombus. We present clinical and sonographic images of an extensive superficial dorsal penile vein thrombosis.
PubMed: 31788306
DOI: 10.1002/ccr3.2469 -
Obesity Pillars Dec 2023This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians with an overview on obesity, thrombosis, venous disease,...
BACKGROUND
This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians with an overview on obesity, thrombosis, venous disease, lymphatic disease, and lipedema.
METHODS
The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.
RESULTS
Topics in this CPS include obesity, thrombosis, venous disease, lymphatic disease, and lipedema. Obesity increases the risk of thrombosis and cardiovascular disease via fat mass and adiposopathic mechanisms. Treatment of thrombosis or thrombotic risk includes healthful nutrition, physical activity, and the requisite knowledge of how body weight affects anti-thrombotic medications. In addition to obesity-related thrombotic considerations of acute coronary syndrome and ischemic non-hemorrhagic stroke, this Clinical Practice Statement briefly reviews the diagnosis and management of clinically relevant presentations of deep vein thromboses, pulmonary embolism, chronic venous stasis, varicose veins, superficial thrombophlebitis, lipodermatosclerosis, corona phlebectatica, chronic thromboembolic pulmonary hypertension, iliofemoral venous obstruction, pelvic venous disorder, post-thrombotic syndrome, as well as lymphedema and lipedema - which should be included in the differential diagnosis of other edematous or enlargement disorders of the lower extremities.
CONCLUSIONS
This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on obesity, thrombosis, and venous/lymphatic disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.
PubMed: 38125656
DOI: 10.1016/j.obpill.2023.100092 -
Radiology Case Reports Aug 2022On December 2020, the US Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of coronavirus disease 2019...
On December 2020, the US Food and Drug Administration issued the first emergency use authorization for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report development of superficial thrombophlebitis in the ipsilateral breast of a 43-year-old female 7 days after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. Given that this is the first case of superficial thrombophlebitis in the breast shortly after mRNA vaccination for COVID-19 reported to our knowledge, we suggest that this may be a rare vaccine-related event.
PubMed: 35711742
DOI: 10.1016/j.radcr.2022.05.018 -
West African Journal of Medicine Dec 2023Promethazine is a phenothiazine derivative that possesses antihistamine, anti-dopaminergic and anticholinergic properties. It is commonly used to treat motion sickness,...
INTRODUCTION
Promethazine is a phenothiazine derivative that possesses antihistamine, anti-dopaminergic and anticholinergic properties. It is commonly used to treat motion sickness, allergic conditions, nausea and vomiting, in addition to its use as a sedative. Promethazine has vesicant properties and is highly caustic to the intima of blood vessels and surrounding tissues. Intravenous administration may result in thrombophlebitis, unintentional intra-arterial administration, perivascular extravasation and tissue necrosis. To the best of our knowledge there is no previous published report of promethazine-induced thrombophlebitis from sub- Saharan Africa.
CASE REPORT
A 29-year-old Nigerian male was admitted at our hospital on account of malaria with acute gastroenteritis. Due to persistent vomiting, he was administered 25 mg of promethazine injection via a size 22G intravenous cannula which was inserted the previous day on the anteromedial aspect of his right forearm and maintained with continuous intravenous crystalloid infusion. Upon administration of promethazine, he experienced intense burning and erythema. The cannula was removed immediately, another cannula was inserted on the contralateral arm, and promethazine was replaced with ondansetron. Subsequently, he developed a tender, subcutaneous cord-like swelling extending from the middle-third of the anteromedial aspect of his right forearm, corresponding with the site of previous venous cannulation. Ultrasonography revealed a hypoechoic, non-compressible basilic vein, with no flow on colour Doppler interrogation, in keeping with superficial thrombophlebitis. He was treated with a topical anti-inflammatory agent, and the pain and redness subsided after four weeks.
CONCLUSION
The preferred parenteral route of administration of promethazine is deep intramuscular injection. Recommendations to prevent promethazine-induced thrombophlebitis include: use of large and patent veins, use of lower doses, drug dilution and slow administration, use of alternative therapies, and patient education. Promethazine-induced tissue injury is under-reported in this part of the world. Creating awareness through this case report would help reduce the morbidity following promethazine administration.
Topics: Humans; Male; Adult; Promethazine; Ondansetron; Vomiting; Nausea; Thrombophlebitis
PubMed: 38070188
DOI: No ID Found