Would you discharge a patient with a substance use disorder home with a peripherally inserted central catheter?
0%Yes
0%No
0%It depends!
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General Critical Care
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Researchers conducted a systematic review and meta-analysis of 130 observational and randomized studies spanning from 2015 to 2023 to estimate the complication rate associated with central venous catheters (CVCs) in adult inpatients. The study excluded peripherally inserted central venous catheters, dialysis catheters, long-term tunneled catheters, and catheters placed by radiologists.
The analysis revealed that the three most common complications related to CVC insertions were placement failure (20.4 events per 1000 catheters placed), arterial puncture (16.2 events per 1000 catheters placed), and pneumothorax (4.4 events per 1000 catheters placed). The composite outcome of four serious complications (arterial cannulation, pneumothorax, infection, and deep venous thrombosis) from a CVC placed for 3 days was estimated to occur at a rate of 30 events per 1000 catheters placed, translating to approximately…
A 49-year-old male noted an enlarged lymph node in his right axilla. He had no constitutional symptoms. The node was firm and moveable and slightly tender to palpation. The rest of his exam was unremarkable except for multiple small, healing, linear scratches on both hands that he said were from a new kitten, and a 2 mm papular lesion on the dorsum of his right hand which he hadn’t noticed. A CBC and chest x-ray were normal.
Because of his anxiety about a possible malignancy, the node was resected. Pathology demonstrated granulomas with neutrophilic abscesses in granuloma centers and was read as consistent with “necrotizing granulomatous lymphadenitis.”
Two months before he noticed the axillary node, he visited East Africa where he ate local food, cut his right hand on a plant leaf, and trailed his right hand in river water while in a canoe. He is an avid gardener who…
Which one of the following is the most likely cause of his axillary node enlargement?
0%Mycobacterium marinum
0%Sporothrix schenckii
0%Nocardia brasiliensis
0%Bartonella henselae
In Disseminated Intravascular Coagulation (DIC), patients may present with both necrotic and hemorrhagic skin lesions, reflecting the complex and severe nature of this condition. The necrotic lesions arise from widespread microthrombi formation in small blood vessels, leading to impaired blood flow and subsequent tissue death, manifesting as purplish, black, or red patches on the skin. Concurrently, hemorrhagic lesions occur due to the significant depletion of platelets and clotting factors, a result of the excessive clotting process, leading to spontaneous bleeding under the skin. These may appear as petechiae, purpura, or ecchymoses, scattered across various parts of the body.
@Everyone
Right upper lobe consolidation with a very nice air bronchogram on CT scan of the chest!
Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis
Individuals on single or combined antithrombotic therapy with high or very high cardiovascular risk have an elevated susceptibility to severe infections and related complications, both in the short and long term. When infection and sepsis is associated with coagulopathy, adjustments to antithrombotic therapy is often necessary based on underlying cardiovascular conditions, treatment indications, clinical status, and patient prognosis:
If the platelet count falls below 100 × 10^9/L in patients already on oral anticoagulation (OAC), heparins should be utilized; heparins should be discontinued if the platelet count drops below 30 × 10^9/L.
Individuals on dual antiplatelet therapy (DAPT) should transition to single antiplatelet therapy (SAPT) using a P2Y12 inhibitor or low-dose acetylsalicylic acid…
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- Hussain Al-shabib
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Can I Safely Discharge a Patient with a Substance Use Disorder Home with a Peripherally Inserted Central Catheter? | NEJM Evidence
The rising incidence of serious injection-related infections, such as endocarditis and skin infections, among people who use drugs (PWUD) presents a clinical challenge, particularly regarding the safe discharge of these patients with peripherally inserted central catheters (PICCs) for prolonged outpatient parenteral antibiotic therapy (OPAT). This review evaluates the complications associated with PICC use in PWUD, explores combined infection and substance use disorder treatment models, and discusses risk assessment tools to guide clinical decisions. Despite limited high-quality evidence, data suggest that some PWUD can safely complete OPAT with a PICC, highlighting the importance of patient-centered care and shared decision-making to mitigate stigma and ensure the provision of gold-standard treatment.