un conto è essere un infermiere che usa l'ecografo
un altro è essere un infermiere che usa l'ecografia
sabato 5 gennaio 2013
DURATA DEI CATETERI IN ECOGUIDA
Artticolo recente a riguardo della durata dei cateteri periferici applicati in ecoguida che conclude che la migliore "sopravvivenza" dei catetri è determinata dall'accuratezza della scelta del vaso da incannulare.
Alcune osservazioni: non ho visto riportato la tipologia di terapia utilizzata (continua vs discontinua), la tipologia delle infusioni, il rapporto tra diametro vena e diametro catetere, il numero di tentativi per l'impianto, concomitanza o meno di fenomeni infettivi.
Am J Emerg Med. 2012 Sep;30(7):1134-40. doi: 10.1016/j.ajem.2011.07.027. Epub 2011 Nov 10.
The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity.
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA. email@example.com
Ultrasound-guided peripheral intravenouscatheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity.
A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed.
After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely, 24% (36/151) had been removed for routine reasons, and 44% (67/151) remained in working condition yielding a survival probability of 0.63 (95% confidence interval [CI], 0.53-0.70). Survival probability was perfect (1.00) when placed in shallow vessels (<0.4 cm), moderate (0.62; 95% CI, 0.51-0.71) for intermediate vessels (0.40-1.19 cm), and poor (0.29; 95% CI, 0.11-0.51) for deep vessels (≥1.2 cm); P < .0001. Intravenous survival probability was higher when placed in the antecubital fossa or forearm locations (0.83; 95% CI, 0.69-0.91) and lower in the brachial region (0.50; 95% CI, 0.38-0.61); P = .0002. The impact of vessel depth and location was significant after 3 hours and 18 hours, respectively. Vessel diameter did not affect USGPIV longevity.
Cannulation of deep and proximal vessels is associated with poor USGPIV survival. Careful selection of target vessels may help improve success of USGPIV placement and durability.