Introduction: Peripherally Inserted Central Catheters (PICCs) are commonly used in medium or long-term infusion therapy. This study aims to assess the costs associated with PICCs and its determinants. Methods: A retrospective cohort of patients with PICCs inserted at the Hospital for Sick Children between Jan.1, 2008 and Dec.31, 2008, were reviewed and followed until their PICCs were removed. Cost analysis, theoretical cost comparison with peripheral intravenous therapy (PIV), and multiple linear regressions were applied from the societal perspective. Findings: The average total cost is $2763.75/catheter/day, including inpatient ward cost. Age, male, ward, home care, catheter dwell days, and complications were found to be significant factors influencing the total cost. PICCs can become a cost saving device, compared to PIV, but is affected by several factors. Conclusion: Information gleaned from this study will inform decision makers maximizing the benefits of better resource allocation.

Introduction: Peripherally Inserted Central Catheters (PICCs) are commonly used in medium or long-term infusion therapy. This study aims to assess the costs associated with PICCs and its determinants. Methods: A retrospective cohort of patients with PICCs inserted at the Hospital for Sick Children between Jan.1, 2008 and Dec.31, 2008, were reviewed and followed until their PICCs were removed. Cost analysis, theoretical cost comparison with peripheral intravenous therapy (PIV), and multiple linear regressions were applied from the societal perspective. Findings: The average total cost is $2763.75/catheter/day, including inpatient ward cost. Age, male, ward, home care, catheter dwell days, and complications were found to be significant factors influencing the total cost. PICCs can become a cost saving device, compared to PIV, but is affected by several factors. Conclusion: Information gleaned from this study will inform decision makers maximizing the benefits of better resource allocation.

SAMMANFATTNING Bakgrund Medelåldern i Sverige ökar, och så även behovet av avancerad hemsjukvård då många är sjuka eller svårt sjuka sista tiden i livet. Tillgång till avancerad hemsjukvård kommer främja palliativa patienters rätt till autonomi, varför en ständig utveckling är nödvändig. Syfte Att observera PICC-lineinläggning i två olika vårdmiljöer i syfte att upptäcka eventuella likheter och skillnader vad gäller vårdmiljön och patientens upplevelser. Metod Strukturerad icke-deltagande observationsstudie med en deskriptiv design. I de fall det var möjligt utfördes kortare intervjuer med patienten efter PICC-lineinläggningens slutförande. Den insamlade datan analyserades kvalitativt. Resultat Båda observationstillfällen resulterade i en lyckad PICC-lineinläggning. När tekniska svårigheter uppstod vid inläggningen, var det i sjukhusmiljö enkelt att tippa sjukhussängen bakåt för att underlätta införandet, medan det var svårare att utföra samma åtgärd i hemmet. Där fick sjuksköterskorna nöja sig med att ta bort kuddar och lägga patienten helt plant i sängen. Patienten som mottog PICC-line på sjukhuset uttryckte missnöje och besvikelse över bristen på assistans från sjuktransporten till sjukhuset, medan patienten i hemmet uttryckte tacksamhet över att inte behöva åka in till sjukhuset för att få en PICC-line. Det fanns ingen skillnad i teknik eller grad av sterilt utförande. Slutsats Båda patienter genomgick en PICC-lineinläggning med lyckat resultat, och inläggningen kunde utföras enligt samma rutin både i hemmet och på sjukhus. Oförutsedda händelser och komplikationer löstes således, men det är värt att notera att förutsättningarna för att lösa dem skiljde sig i patientens hem jämfört med på sjukhus, främst på grund av skillnader i utbud av extramaterial. Medtagandet av ytterligare material så som en extra PICC-line skulle ytterligare eliminera risken för en misslyckad PICC-lineinläggning i hemmet. Tacksamheten över att inte behöva komma in till sjukhuset var överväldigande hos patienten som fick PICC-line i hemmet, vilket går helt i linje med den svenska vårdens strävan att hjälpa patienter uppnå autonomi. Fortsatt forskning och utveckling skulle kunna innebära att PICC-line inläggning i hemmet kan erbjudas även till patienter som är svårt sjuka men som ännu inte trätt in i ett palliativt skede. Nyckelord PICC-line, hemsjukvård, palliativ vård, autonomi / ABSTRACT Background The average age of Swedish people is rising, and so is the need for advance health care since a lot of people are poorly or very poorly during the last period of their lives. Access to advanced health care will support dying patients right to autonomy. Therefore it is necessary to constantly develop this area. Aim To observe PICC-line insertion in two different environments of care with the aim to discover any possible similarities or differences with regards to the environment of care and experiences of the patient. Method Structured Non-Participant Observational study with a descriptive design. When possible, short interviews were conducted with the patient after the PICC-lineinsertion. The collected data was analysed qualitatively. Results Both observations resulted in a successful PICC-lineinsertion. When technical difficulties occurred during the insertion, it was easy to tip the hospital bed backwards to make the insertion easier, while it was more difficult to perform the same action in the home environment. There the possible measures were reduced to removing pillows and placing the patient completely flat on the bed. The patient who received a PICC-line in the hospital expressed discontent and disappointment over the lack of assistance during the transport to the hospital, while the patient in the home expressed gratitude over not having to go to the hospital to have the PICC-line inserted. Conclusion Both patients went through a PICC-lineinsertion with a successful result, and the insertion could be performed according to the same routine both in the home and the hospital. Unforeseen events and complications were solved, but it’s worth noting that the conditions for solving them differs between the home and hospital environment, mainly due to differences in availability to extra material. To bring extra material, such as an extra PICC- line, would further eliminate risks of an unsuccessful PICC-lineinsertion in the home. The gratitude shown towards not having to come in to the hospital was overwhelming from the patient who received a PICC-line in the home, something that resonates well with the swedish health care systems desire to help patients uphold their autonomy. Continued research and development could mean that PICC-lineinsertion in the home can also be offered to patients who are very sick but have not yet entered the palliative phase. Keywords PICC-line, home care, palliative care, autonomy

SAMMANFATTNING Bakgrund: PICC är en central infart som används inom vården för att kunna ge kärlretande läkemedel. Komplikationer vid användning av PICC kan vara infektion, trombos, tromboflebit eller stopp i katetern.  Syfte: Syftet med studien är att undersöka förekomsten av komplikationer av PICC hos onkologiska patienter samt för att se om det finns några skillnader mellan olika diagnosgrupper och behandlingar med avseende på förekomsten av djupa ventromboser (DVT) och infektioner. Syftet är också att ta reda på hur länge en PICC sitter och hur vanligt det är att en PICC felplaceras.  Metod: Metoden som används är en retrospektiv, deskriptiv, kvantitativ undersökning. I studien ingår alla onkologpatienter som fått en PICC år 2009-2011 (n=677). Data samlades in med hjälp av journalgranskning.  Resultat: Förekomsten av DVT var 5,6 %. Patienter som fick behandling med Capecitabin hade statistiskt signifikant mer DVT jämfört med andra behandlingar. Patienter som fick behandling med R-CHOP hade statistiskt signifikant mindre DVT jämfört med andra behandlingar. Antalet infektioner var 3 %. Stopp i katetern drabbade 1,8 % av patienterna, 17 % hade besvär med rodnad under förbandet, 12 % av alla katetrar åkte ut 4 cm eller mer och 2,5 % av katetrarna felplacerades vid inläggningen. En PICC var insatt i medelvärde 92 dagar, median 105 dagar.  Slutsats: Förekomsten av komplikationer av PICC var låg hos onkologiska patienter med undantag för hudbesvär som förekom hos var sjätte patient. Behandlingar innehållande Capecitabin förefaller öka risken för DVT men fler studier behövs för att öka kunskaperna om detta. PICC är en säker venös infart vid behandling med cytostatika. / ABSTRACT Background: PICC (peripherally inserted central catheter) is a central line used in healthcare to provide vascular irritant drugs. Complications with PICC can be infection, thrombosis, thrombophlebitis or occlusion of the catheter.  Aim: The aim of the study is to examine the incidence of complications of PICC in oncology patients and to see if there are any differences between diagnostic groups and treatments for the presence of deep venous thrombosis (DVT) and infection. The aim is also to find out for how long time a PICC is inserted and how common it is for a PICC misplaced.  Method: The method used is a retrospective, descriptive, quantitative survey. The study includes all oncology patients who received a PICC years 2009-2011 (n=677). Data were collected through medical record review.  Results: The incidence of DVT was 5,6 %. Patients treated with Capecitabin had statistically significantly more DVT compared with other treatments. Patients treated with R-CHOP had statistically significantly less DVT compared with other treatments. The incidence of infections was 3 %. Occlusion of the catheter affected 1,8 % of patients, 17 % had problems with redness under the dressing, 12 % of all catheters went out four cm or more and 2,5 % of the catheters were misplaced at insertion. A PICC was inserted in mean 92 days, median 105 days.  Conclusion: The complication rate of PICC was low in oncology patients with the exception of skin problems that occurred in every sixth patient. Treatments containing Capecitabin appears to increase the risk of DVT but more studies are needed to raise awareness of this. PICC is a safe venous access for chemotherapy.

Bakgrund: Perifert insatt central venkateter (PICC-line) är en medicinteknisk produkt som används till bland annat provtagning, nutrition och infusioner. Det blir allt vanligare att patienter får PICC-line som central infart och att dessa patienter får sin omvårdnad på vanliga vårdavdelningar. Det saknas studier om hur sjuksköterskor på vårdavdelningar upplever förändringen av ett ökat antal patienter med PICC-line och hur väl de anser sig vara förberedda och utbildade för att kunna ge säker vård. Syfte: Syftet med studien är att beskriva sjuksköterskors erfarenhet av att ge omvårdnad när en patient har PICC-line. Metod: Empirisk intervjustudie med kvalitativ ansats som analyserades med konventionell innehållsanalys beskriven av Hsieh och Shannon. Resultat: Resultatet visade att sjuksköterskorna hade olika erfarenhet av att ge omvårdnad till patienter när de har PICC-line, vilket de beskrev ur flera olika synvinklar. I analysen framkom tre av dessa speciellt tydligt, vilka utgjorde kategorierna. De tre kategorierna benämndes som ”påverkar arbetsbelastningen”, ”påverkar säkert handhavande” och ”påverkar omvårdnaden”. Slutsats: Enligt sjuksköterskornas erfarenhet påverkades arbetsbelastningen när en patient hade PICC-line. Den beskrevs främst kunna vara tidssparande och förenklande men också stressande då problem uppstod. Sjuksköterskorna kunde uppleva osäkerhet vid handhavandet av PICC-line relaterat till bristande utbildning och förberedelse, men upplevde samtidigt teamarbetet och stödet från kollegor som betryggande. PICC-line kunde resultera i minskat lidande för patienten, men beskrevs också som begränsande för patienten.

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Home parenteral nutrition is a treatment enabling the patients with intestinal failure to live their lifes in their home environment. The possibility to commence and practise home parenteral nutrition requires not only a medical and pharmaceutical team, but also paramedical staff, which plays a signifiant part mainly in education of the patient and his close relatives. The study's aim was to characterize the patients involved in the home parenteral nutrition programme (HPN) and catheters used for this purpose and as well to analyze complication rate of the long term catheters related to their use and subsequent care. Into the retrospective quantitative study were included patiens treated with home parenteral nutrition since january 2009 to september 2015 within one nutrition care center. Data collection was realized by research in medical documentation. Altogether 135 patients were included in the study (93 female and 42 male), who have hade 227 catheters inserted in total (114 portcatheters, 73 Broviac catheters and 40 PICC) with 86 187 catheter days. The most frequent basic disease was cancer (36%) and the most prevalent indication to HPN was a short bowel syndrome (50%). Overall complication rate was 2,12/1000 catheter days (1,62 catheter sepsis, identically local infections and thrombotic...

(EN) Home parenteral nutrition (DPV) has become a routine part of patients care whose oral intake is reduced or completely eliminated. An integral part of the application of DPV is also the permanent or temporary need for functioning vascular access. Catheter complications negatively affect the quality of life, morbidity and in case of catheter sepsis the patient mortality. In addition it also brings increased costs for therapy and the need for patients re-hospitalization. The main objective of our study is to analyze catheter-related complications and to determine whether use of catheter plugs like TauroLock and TauroLock Hep and Tegaderm CHG antimicrobial dressing affect the incidence of catheter complications with DPV, and whether the incidence of complications is affected by a person who treated the catheter. The secondary objective is to characterize patients with served DPV and types of catheter used for this purpose.The method chosen is a retrospective observational cohort study. The study contains 52 patients with 72 catheters (39 Broviac, 18 PICC and 15 ports). The monitored number of catheter- days in total was 33,875. We conclude that the use TauroLock Hep is effective in the prevention of catheter complications and significantly reduces the overall incidence of all complications (p =...

Hospital-acquired infections (HAIs) pose a significant and increasing threat to global health. One primary cause of this threat is increasing antibiotic resistance. As traditional antibiotics continue to grow less effective, there is an urgent need for novel antimicrobial strategies. This work explores the potential of ceragenins, also known as cationic steroid antimicrobials (CSAs), as a promising alternative to combat HAIs. Specifically, we investigated potential roles that CSAs can play in the context of multiple medical device coatings in healthcare settings. Ceragenins are synthetic mimic of antimicrobial peptides (AMPs) which exhibit broad-spectrum antimicrobial activity against many common pathogens that have been cited as high priority by global health organizations. Unlike traditional antibiotics, which rely on specificity to bacterial enzymes or processes, ceragenins disrupt microbial membranes generally. This mechanism of action allows ceragenins to bypass many of the related antibiotic resistance mutations of bacteria and fungi. As microbial membranes are a highly conserved and fundamental structure of these pathogens, it is much more difficult for microbes to develop mutations that prevent CSA binding. Additionally, ceragenins are resistant to both host and pathogenic proteolytic degradation and are cost-effective to produce, which place CSAs as an attractive alternative to traditional antibiotics. This research investigates the integration of ceragenins into various medical devices to prevent HAIs. Specifically, we investigated silicone tissue expanders, peripherally inserted central catheter (PICC) lines, and adhesive devices which include both polyacrylate and silicone scar tape. These studies include the development of coating techniques to maximize appropriate antimicrobial activity while maintaining stability and biocompatibility across these different base materials. Our experimental results demonstrate that ceragenin-coated devices significantly reduce microbial colonization and biofilm formation. We considered the length of antimicrobial activity needed and developed coatings that would be appropriate for those use cases. This reduction in harmful pathogenic colonization demonstrates their potential to improve patient outcomes and reduce healthcare costs associated with HAIs. Further research and development could facilitate the continued adoption of ceragenin-based coatings in medical devices, which can reduce the incidence of HAIs while contributing to the broader fight against antibiotic-resistant infections worldwide.