• Journal of Technology Innovation
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• v.8 no.2
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• pp.1-17
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• 2000

Recently, due to the primary emphasis of health industry and to the restriction of budget, setting the priorities for effective and efficient investment on the medical device and material products has been one of the critical issues in the government sector. This paper shows how an Analytic Hierarchy Process (AHP) model can be used for assessing selected medical device and material products for grant of the Ministry of Health & Welfare. The final results show that unabsorbable suture is the most attractive medical device product among 88 evaluated products, followed by IV cannula, central venous catheter.

• Neonatal Medicine
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• v.28 no.3
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• pp.116-123
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• 2021

Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU). Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed. Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P=0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004). Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.276-280
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• 2023

Fungal thrombophlebitis of the central vein is a rare, life-threatening disease associated with significant morbidity and mortality. It requires immediate central venous catheter removal and intravenous antifungal therapy, combined in some cases with either anticoagulation or aggressive surgical debridement. A 70-year-old male patient injured by a falling object weighing 1,000 kg was transferred to our hospital. A contained rupture of the abdominal aorta with retroperitoneal hematoma was treated with primary aortic repair, and a small bowel perforation with mesenteric laceration was treated with resection and anastomosis. After a computed tomography scan, the patient was diagnosed with thrombophlebitis of the left internal jugular vein and brachiocephalic vein. Despite antifungal treatment, fever and candidemia persisted. Therefore, emergency debridement and thrombectomy were performed. After the operation, the patient was treated with an oral antifungal agent and direct oral anticoagulants. During a 1-year follow-up, no signs of candidemia relapse were observed. There is no optimal timing of surgical treatment for relapsed fungal central thrombophlebitis. Surgical treatment should be considered for early recovery.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1359-1362
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• 2008

The most effective treatment strategy for patients with hemophilia is replacement therapy with FVIII or FIX concentrates, which usually requires long-term, uncomplicated venous access. However, central venous access device (CVADs, ports) insertion requires inpatient admission and general anesthesia, and presents some problems regarding health insurance coverage. Peripherally inserted central catheters (PICCs) were inserted in two severe hemophilia patients aged 7 and 11 years with high titers of inhibitors. They experienced frequent bleeding episodes and required replacement therapy, which eventually resulted in difficulty in acquiring venous line access. Factor VIII activity was below 1%, and inhibitor titers were 160 and 26.3 BU/ml. In an outpatient setting, PICC lines are easily placed by radiological guidance and require local anesthesia alone. PICC has been feasible, in particular, for hemophilia patients with frequent bleeding episodes.

• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.389-396
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• 2005

Background : Central venous catheters(CVCs) area major source of nosocomial infection. Chlorhexidine-silver sulfadiazine coated catheters (CHSS) were developed to reduce the rate of CVC infection. However, the clinical effectiveness of CHSS in comparison wth non-coated catheter (NCC) remains to be evaluated. Methods : From January 2004 to December 2004 in medical intensive care unit (ICU) of Asan Medical Center, CVCs were inserted in 446 cases. We retrospectively analyzed characteristics of patients and catheterization,the catheter-related infection rate and colonization, microbiologic findings, and insertion sites (subclavian, jugular, femoral) according to the type of inserted CVCs (NCC: 187 cases, CHSS: 259 cases). Catheter related infection is defined as catheter related bacteremia and catheter related non-bacteremic sepsis. Results : 1) The mean age of the patients in each group was $62{\pm}16$ years, $63{\pm}15$ years (p=0.42), and sex ratio 94:50, 141:69 (p=0.9) in NCC and CHSS. Duration of ICU admission ($29{\pm}37$, $26{\pm}44$ p=0.42), duration of mechanical ventilation ($17{\pm}22$, $15{\pm}19$ p=0.17), and APACHE III score at the time of CVC insertion ($81{\pm}34$, $82{\pm}37$ p=0.61) were not different between both groups. 2) Mean duration of catheterization was 118 in NCC and 119 in CHSS (p=0.98). Number of catheter-days was 2176 days in NCC and 3035 days in CHSS. Catheter-related infection occurred in 9 (4.8%) cases receiving NCC and 4 cases (1.5%) receiving CHSS. Catheterrelated infection incidence per 1000 catheter-days was 4.1 and 1.3, respectively (p=0.04). CHSS was associated with a significant reduction of infection in jugular catheters regarding to insertion sites (p=0.01). 3) Microorganisms causing infection were Staphylococcus aureus (n=3), Candida (n=3), coagulase-negative Staphylococci (n=2), and Klebsiella (n=1) in NCC, and Candida species (n=2), coagulase-negative Staphylococci (n=2), Proteus (n=1) in CHSS. Conclusion : CHSS has significantly reduced the episodes of infection compared to NCC in jugular catheterization in medical ICU.

• Journal of Korean Biological Nursing Science
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• v.6 no.1
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• pp.33-42
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• 2004

Background : Intravenous(IV) access is becoming an increasingly important part of health care today. The current drive for clinical effectiveness and cost-effective health care serves to increase the need for reliable vascular access. Venous access devices were developed to overcome problems associated with limited peripheral access and frequent venipuncture in patients with long-term therapy. Although the peripherally inserted central catheter(PICC) have become popular during recent years in USA, its procedure is rare in Korea. Purpose : The goal of this study was to analyze the PICC inserted patient data by IV CNS intervention. Method : A Total of 62 PICCs were inserted into 51 patients by the IV CNS during a 10-month period form November, 14, 2002, to October 2, 2002. Data was obtained retrospectively through chart review. Result : The patient population included 34(54.8%) men and 28(45.2%) women, with a mean age 50.6 years. The main indication for PICC placement was to access vein in poor peripheral venous status(40.3%). The mean served interval for PICC insertions was 16.7 days(range, $2{\sim}61$ days). The reasons for removal were completed therapy in 18 cases(29.0%), patient death in 13 cases(21.0%), and mechanical or functional PICC problem in 10cases(16.1%). The three PICCs removed for presumed infection, and one had only positive tip cultures(0.2%). Conclusion : PICCs are rapidly growing popularity and required an extended course of IV therapy.

• Clinical and Experimental Pediatrics
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• v.63 no.9
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• pp.361-367
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• 2020

Background: Length of stay is a significant indicator of care effectiveness and hospital performance. Owing to the limited number of healthcare centers and facilities, it is important to optimize length of stay and associated factors. Purpose: The present study aimed to investigate factors associated with neonatal length of stay in the neonatal intensive care unit (NICU) using parametric and semiparametric models and compare model fitness according to Akaike information criterion (AIC) between 2016 and 2018. Methods: This retrospective cohort study reviewed 600 medical records of infants admitted to the NICU of Bandar Abbas Hospital. Samples were identified using census sampling. Factors associated with NICU length of stay were investigated based on semiparametric Cox model and 4 parametric models including Weibull, exponential, log-logistic, and log-normal to determine the best fitted model. The data analysis was conducted using R software. The significance level was set at 0.05. Results: The study findings suggest that breastfeeding, phototherapy, acute renal failure, presence of mechanical ventilation, and availability of central venous catheter were commonly identified as factors associated with NICU length of stay in all 5 models (P<0.05). Parametric models showed better fitness than the Cox model in this study. Conclusion: Breastfeeding and availability of central venous catheter had protective effects against length of stay, whereas phototherapy, acute renal failure, and mechanical ventilation increased length of stay in NICU. Therefore, the identification of factors associated with NICU length of stay can help establish effective interventions aimed at decreasing the length of stay among infants.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.5
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• pp.1873-1875
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• 2012

Objective: To compare the complications of peripherally inserted central catheters (PICC) by a modified Seldinger technique under ultrasound guidance or the conventional (peel-away cannula) technique. Methods: From February to December of 2010, cancer patients who received PICC at the Department of Chemotherapy in Jiangsu Cancer Hospital were recruited into this study, and designated UPICC if their PICC lines were inserted under ultrasound guidance, otherwise CPICC if were performed by peel-away cannula technique. The rates of successful placement, hemorrhage around the insertion area, phlebitis, comfort of the insertion arm, infection and thrombus related to catheterization were analyzed and compared on days 1, 5 and 6 after PICC and thereafter. Results: A total of 180 cancer patients were recruited, 90 in each group. The rates of successful catheter placement between two groups differed with statistical significance (P <0.05), favoring UPICC. More phlebitis and finger swelling were detected in the CPICC group (P <0.05). From day 6 to the date the catheter was removed and thereafter, more venous thrombosis and a higher rate of discomfort of insertion arms were also observed in the CPICC group. Conclusion: Compared with CPICC, UPICC could improve the rate of successful insertion, reduce catheter related complications and increase comfort of the involved arm, thus deserving to be further investigated in randomized clinical studies.

• Journal of radiological science and technology
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• v.34 no.1
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• pp.35-41
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• 2011

Total implanted central venous port (TIAP, Chemoport) is widely used in oncology patients because it does not require external dressing and restricts patient activity. Chemoport only requires monthly flushes of heparinized saline to keep the patency of the catheter and probably less prone to infectious complications than tunneled catheter. Despite the extensive use of permanent central venous access in oncology patients, there are only few reports about clinical experience of the Groshong catheter. The purpose of this study is to compare the complication rate between the traditional open-ended (non-valved) chemoports and valved chemoports (Groshong catheter connected to TIAP). During 5 years (Jan 2006 to May 2010), 438 patients received chemoport insertion procedure in our interventional radiology department. Among them 30 patients was referred to our department for problematic chemoports. We compared the cause of problematic chemoports between two types of chemoports (valved, vs. non-valved). Valved chemoports had higher referral rates than non-valved chemoports. When there is a need to insert valved port, different method of insertion and maintenance procedure seems to be necessary. More than 20 ml of flusing with heparinized saline after blood sampling could be a good suggestion. Adequate care of chemoport is essential for long patency. Also following the guideline from the manufacturing company is necessary.

• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.24-31
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• 2010

Purpose: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. Methods: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. Results: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). Conclusion: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.