Becton, Dickinson And Company · NYSE:BDX
Becton, Dickinson And — MDS20 (April 2020)
28 slides from Becton, Dickinson And's conference presentation, April 2020
Slide 1: Presenter views disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: Acute Complications during CICC placements
Acute Complications during CICC placements Big vessels dammages
Slide 3: It does not happen only to the others!
It does not happen only to the others!…
Slide 4: Mary
Mary • Self examination, small mass, mammography • Breast tumor, • Partial mastectomy, axillary node -, → adjuvant chemotherapy • Port a cath in jugular vein • Michele. Junior Resident. Few months before the end of her education of gynecologic surgeon.
Slide 5: Ponction with US
Ponction with US : ral seal ' s us
Slide 6: Introducer advanced with small resistance, pulsatile red flow
• Introducer advanced with only a small resistance, • Discovery of pulsatil red flow • Ask to the nurse in operating room to call senior surgeon • Unfrequent problem but not really important • Remove devices and compress • Mary does not answer any more to Michele’s questions • Mary breath with diffi
Slide 7: Anesthesia Closed Claims USA
Anesthesia Closed Claims USA 1970-1994 Anesthesiology 2004; 100:1411–8
Slide 8: Closed Claims USA: Central Line Complications
Closed Claims USA Most Common Central Line Complications ™ 1995-2009 (n=92) * p=0.05 1970-1994 (n=96) * Carotid artery Hemothorax Catheter/wire Pneumothorax Cardiac PA rupture cannulation/ embolus tamponade puncture 3 i} <= uv a vu £ =] = a £ oJ o = i) x 1. Domino et al. Anesthesiology 2004; 100:141
Slide 9: Claims against NHS 1995-2009
Claims against NHS 1995-2009 26 claims Arterial punctures: 14 20 severe; 10 deaths Hemopericardium: 4 Pneumothorax: 2 14 arterial punctures, Hemothorax: 1 8 carotid punctures; 3 canulations Nerve injury: 1 5 deaths, 3 brain damages Non arterial injury: 1 Non trauma: 5
Slide 10: Acta Anaesthesiol Scand 2019 claims
Acta Anaesthesiol Scand. 2019;00:1–6. 87 claims Non tunelled CVC , int jug Bleeding US in 20% of cases 0.2% serious mecanical complications 20 acc/year
Slide 11: 1743 vital accidents
• 1743 vital accidents • 50 with vascular access; – 27 between 2005 and 2009; 23 between 2010 and 2014 • 14 DL; 6 SC, 17 int Jug • 13 arterial placements; 2 recognised during the placement; 4 X-Ray nl • 6 guide embolies • 8 secondary dislodgements (hypotension, 2 arrêts cardiaques) • 14 majors bleed
Slide 12: 15 centers, CVC with US
15 centers, CVC with US, Recherche des complications durant les 4 premières semaines
Slide 13: 487 CVC complications
• 487 CVC , 430 acute CVC • Placed by anesthesiologist with US • 3.1% complications: – 1.4% failures – 0.2%pneumothorax – 0.2% hemothorax – 0.2% artérial cannulation – 1,1% others: carotid punctures without cannulation, bad placement needed replacement
Slide 14: Arterial trauma during central venous catheter insertion
Arterial trauma during central venous catheter insertion Guilbert MC, Elkouri S, Bracco D, et al J Vasc Surg 48:918-925, 2008 13 cases in Universary Hospital of Montreal Proposed algorithm
Slide 15: Vascular Complications of Central Venous Catheter Placement
Vascular Complications of Central Venous Catheter Placement: Evidence-Based Methods for Prevention and Treatment Andrew Bowdle, MD, PhD Journal of Cardiothoracic and Vascular Anesthesia, Vol 28, No 2 (April), 2014: pp 358-368
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Slide 17: Brachiocephalic Vein Perforation During Cannulation
Brachiocephalic Vein Perforation During Cannulation of Internal Jugular Vein: A Case Report Atsushi Kainuma, MD,* Keiichi Oshima, MD,* Chiho Ota, MD,§ Yu Okubo, MD,+ Naoto Fukunaga, MD, d on Hak Suh, MD*
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Slide 19: Journal c
Journal c
Slide 20: Management of Arterial Trauma from Central Venous Catheterization
Management of Arterial Trauma or Injury Arising from Central Venous Catheterization 78 cases
Slide 21: Results: management methods and success rate
TABLE II - Management methods employed and success rate Removal and Endovascular compression Surgery No complications (n) Complications (n) Complication types Success rate (%) 1 17 2 5 failure to control 1 failure to haemorrhage control 1 haemothorax haemorrhage 1 cerebral 1 left lung collapse embol
Slide 22: Suggested management of inadvertent arterial cannulation
Suggested management of inadvertent arterial cannulation during central venous catheterisation Arterial injury suspected Confirm arterial injury e.g. pulsatile flow, haematoma formation, arterial pressureAvaveform, blood gas analysis, imaging Observe patient for problems with airway and breathing Ex
Slide 23: Venous damages series 2008-2014
• 2008-2014 • 20 catheterismes 21 venous damages • 5 vena cava, 6 right innominate vein, 10 left innominate vein. • 17 opérators remmembers to push completely the dilatator or radiologic documentation. • Venous damages. No arterial damage in this serie. • 17 death, 19 claims
Slide 24: Take home message
Take home message • Prevention of these injuries is paramount. Use ultrasound in real time to puncture veins.
Slide 25: Take home message
Take home message Prevention of these injuries is paramount. Wires and dilators must never be advanced against any resistance. Guidewire should be repeatedly checked to ensure it moves freely throught the dilatator, to ensure no distortion Dilators should only be advanced far enough to enter the vei
Slide 26: Take home message
Take home message • Shorter dilators should be provided in the insertion kits so that they only are used to dilate the skin, subcutaneous tissue, muscle, and entry in to the vein. • A decisional tree must be immediately available in your hospital, in your operating room
Slide 27: Proposition de CAT lors d'une ponction ou canulation artérielle
Proposition de CAT lors Lésion artérielle suspectée: à confirmer: Flux pulsatile de sang rouge, Formation d’une ponction ou rapide d’un hematome, valeurs et forme canulation artérielle lors de la courbe de pression arterielle, Gaz du de VVC sang, imagerie Y a-t-il des problèmes d’airway ou neurologi
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