Indian Journal of Critical Care Medicine December 2014 Vol 18 Issue 12
bacteria isolated in various samples. L. monocytogenes, S. pneumoniae and Group B Streptococcus were also isolated from blood culture. In conclusion, BACTEC™ automated culture has higher isolation rate of pathogenic bacteria and lesser time for identification even with less bacterial load or count in the sterile body fluid sample. It also helps in guiding antimicrobial therapy especially in critically ill patients and eventually affecting patient’s outcome.
outcome without hepatic transplantation.[1] In fact, hepatic dysfunction is an important, but forgotten complication of dengue.[2] The management of dengue hepatitis is usually supportive and symptomatic treatment. The use of NAC might be useful. However, it should be noted that dengue hepatitis can be self-limited.[3,4] To manage dengue hepatitis, with or without hepatic dysfunction, the critical concept is optimal fluid replacement therapy.[5]
Viroj Wiwanitkit1,2,3
Uttam Udayan, Meena Dias
Department of Microbiology, Fr Muller Medical College, Mangalore, Karnataka, India
Hainan Medical University, China, 2Faculty of Medicine, University of Nis, Serbia, 3 Joseph Ayobabalola University, Nigeria
Correspondence: Dr. Meena Dias, S-3, Casa Leila, S.L Mathias Road, Falnir, Mangalore - 575 002, Karnataka, India. E-mail: [email protected]
Correspondence: Prof. Viroj Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand. E-mail: [email protected]
1
References
References
1.
1.
2. 3.
4.
5.
Collee JG, Marr W. Culture of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney: Practical Medical Microbiology. 14 th ed. New Delhi: Reed Elsevier; 2008. p. 124. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Document M100-S21.Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Alberts B, Johnson A, Lewis J, Raf M, Roberts K, Walter P. Molecular Biology of the Cell. 4th ed. New York: Garland Science; 2002. Available from: http://www.ncbi.nlm.nih.gov/books/NBK21054/. [Last accessed on 2013 Jul 25]. Velay A, Schramm F, Gaudias J, Jaulhac B, Riegel P. Culture with BACTEC Peds Plus bottle compared with conventional media for the detection of bacteria in tissue samples from orthopedic surgery. Diagn Microbiol Infect Dis 2010;68:83-5. Daur AV, Klimak F Jr, Cogo LL, Botão GD, Monteiro CL, Dalla Costa LM. Enrichment methodology to increase the positivity of cultures from body fluids. Braz J Infect Dis 2006;10:372-3.
2.
3.
4. 5.
Habaragamuwa BW, Dissanayaka P. N-acetylcystein in dengue associated severe hepatitis. Indian J Crit Care Med 2014;18:181-2. Mourão MP, Lacerda MV, Bastos Mde S, Albuquerque BC, Alecrim WD. Dengue hemorrhagic fever and acute hepatitis: A case report. Braz J Infect Dis 2004;8:461-4. Wiwanitkit V. Liver dysfunction in dengue infection: An analysis of the previously published Thai cases. J Ayub Med Coll Abbottabad 2007;19:10-2. Suh SJ, Seo YS, Ahn JH, Park EB, Lee SJ, Sohn JU, et al. A case of imported Dengue fever with acute hepatitis. Korean J Hepatol 2007;13:556-9. Wiwanitkit V. Updates on clinical pharmacology of dengue. Indian J Pharmacol 2013;45:105.
Access this article online Quick Response Code: Website: www.ijccm.org
Access this article online Quick Response Code: Website:
DOI: 10.4103/0972-5229.146335
www.ijccm.org
DOI: 10.4103/0972-5229.146331
N-acetylcystein in dengue hepatitis Sir, The recent report on N-acetylcystein (NAC) in dengue hepatitis is very interesting. [1] Habaragamuwa and Dissanayaka they found that NAC resulted in a good 830
Coiling of central venous catheter in right internal jugular vein Sir, We read with interest the article written by Goyal et al.[1] describing a case of coiling of central venous catheter (CVC) in left subclavian vein. The authors have reported it as a rare complication, and we do not agree with this statement. Malatinský et al.[2] in 1976 presented a
Indian Journal of Critical Care Medicine December 2014 Vol 18 Issue 12
series of 378 radiographically controlled CVC placements and reported pure loop formations (coiling) in 2.9% of the cases. Supraclavicular subclavian approach was used in the majority of the patients and the authors explain this as a reason for relatively low incidence rates in their series as compared to other studies.[2] We report a case of coiling of central venous catheter in right internal jugular vein (IJV) in a 36-year-old patient admitted postoperatively in intensive care unit (ICU) following evacuation of large extradural hematoma. The CVC was placed in the operation theatre under ultrasound guidance. Intraoperatively the waveform was damped, and the flow of fluids was slow, but it was considered secondary to rotation of the neck and labeled as “positional”. Just after admission to the ICU a “flush test” was performed, and it was positive; 5–10 mL of normal saline was injected with force using a syringe and fluid thrill was felt in the ipsilateral neck region with the palmer aspect of the hand.[3] Subsequent chest X-ray confirmed coiling of CVC in right IJV [Figures 1a and b]. Factors predisposing to coiling and catheter malpositions are: a. Retrograde venous flow secondary to IJV valve incompetence in patients with chronic obstructive pulmonary disease, primary pulmonary hypertension and prior cannulations and catheterizations of the IJV[4,5] b. Retrograde venous flow in patients with high intrathoracic and intrabdomical pressures c. Seldinger technique: The catheter is inserted over the guidewire and placed in the central vein. During this procedure sometimes the guidewires are removed before the CVC are properly positioned in the superior vena cava. Resistance encountered in inserting the CVC then leads to excessive pressure applications, which then predisposes to malpositioning. Common sites of resistance are the junction of first rib and clavicle for the subclavian vein and the junction of
a
b
Figure 1: (a) Chest X-ray anteroposterior view with coiled central venous catheter in right internal jugular vein, (b) Coiled central venous catheter after removal
venous tributaries for the IJV and brachiocephalic vein.
Tanvir Samra, Vikas Saini
Departments of Anaesthesia, and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence: Dr. Vikas Saini, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India. E-mail: [email protected]
References 1. 2. 3.
4. 5.
Goyal V, Sahu S. Coiling of central venous catheter in the left subclavian vein, a rare complication. Indian J Crit Care Med 2014;18:105-6. Malatinský J, Kadlic T, Májek M, Sámel M. Misplacement and loop formation of central venous catheters. Acta Anaesthesiol Scand 1976;20:237-47. Toshniwal GR, Rath GP, Bithal PK. Flush test: A new technique to assess the malposition of subclavian central venous catheter position in the internal jugular vein. J Neurosurg Anesthesiol 2006;18:268-9. Doepp F, Bähr D, John M, Hoernig S, Valdueza JM, Schreiber SJ. Internal jugular vein valve incompetence in COPD and primary pulmonary hypertension. J Clin Ultrasound 2008;36:480-4. Wu X, Studer W, Erb T, Skarvan K, Seeberger MD. Competence of the internal jugular vein valve is damaged by cannulation and catheterization of the internal jugular vein. Anesthesiology 2000;93:319-24.
Access this article online Quick Response Code: Website: www.ijccm.org
DOI: 10.4103/0972-5229.146337
A case of guidewire embolism during central venous catheterization: Better safe than sorry! Sir, Central venous catheterization (CVC) is a routine procedure in intensive care unit as well as in surgical patients requiring monitoring of hemodynamic variables, for medications and parentral nutrition, hemodialysis etc. The incidence of complications ranges from 5% to 29%[1] such as arterial puncture, hemothorax, pneumothorax, nerve injury, air embolism or dysrthythmias. Guidewire embolism during CVC is a rare iatrogenic complication.[2] The Seldinger technique is commonly used to cannulate the vessels.[3] We report a case of lost guidewire following 831
Copyright of Indian Journal of Critical Care Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
bacteria isolated in various samples. L. monocytogenes, S. pneumoniae and Group B Streptococcus were also isolated from blood culture. In conclusion, BACTEC™ automated culture has higher isolation rate of pathogenic bacteria and lesser time for identification even with less bacterial load or count in the sterile body fluid sample. It also helps in guiding antimicrobial therapy especially in critically ill patients and eventually affecting patient’s outcome.
outcome without hepatic transplantation.[1] In fact, hepatic dysfunction is an important, but forgotten complication of dengue.[2] The management of dengue hepatitis is usually supportive and symptomatic treatment. The use of NAC might be useful. However, it should be noted that dengue hepatitis can be self-limited.[3,4] To manage dengue hepatitis, with or without hepatic dysfunction, the critical concept is optimal fluid replacement therapy.[5]
Viroj Wiwanitkit1,2,3
Uttam Udayan, Meena Dias
Department of Microbiology, Fr Muller Medical College, Mangalore, Karnataka, India
Hainan Medical University, China, 2Faculty of Medicine, University of Nis, Serbia, 3 Joseph Ayobabalola University, Nigeria
Correspondence: Dr. Meena Dias, S-3, Casa Leila, S.L Mathias Road, Falnir, Mangalore - 575 002, Karnataka, India. E-mail: [email protected]
Correspondence: Prof. Viroj Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand. E-mail: [email protected]
1
References
References
1.
1.
2. 3.
4.
5.
Collee JG, Marr W. Culture of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney: Practical Medical Microbiology. 14 th ed. New Delhi: Reed Elsevier; 2008. p. 124. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Document M100-S21.Wayne, PA: Clinical and Laboratory Standards Institute; 2009. Alberts B, Johnson A, Lewis J, Raf M, Roberts K, Walter P. Molecular Biology of the Cell. 4th ed. New York: Garland Science; 2002. Available from: http://www.ncbi.nlm.nih.gov/books/NBK21054/. [Last accessed on 2013 Jul 25]. Velay A, Schramm F, Gaudias J, Jaulhac B, Riegel P. Culture with BACTEC Peds Plus bottle compared with conventional media for the detection of bacteria in tissue samples from orthopedic surgery. Diagn Microbiol Infect Dis 2010;68:83-5. Daur AV, Klimak F Jr, Cogo LL, Botão GD, Monteiro CL, Dalla Costa LM. Enrichment methodology to increase the positivity of cultures from body fluids. Braz J Infect Dis 2006;10:372-3.
2.
3.
4. 5.
Habaragamuwa BW, Dissanayaka P. N-acetylcystein in dengue associated severe hepatitis. Indian J Crit Care Med 2014;18:181-2. Mourão MP, Lacerda MV, Bastos Mde S, Albuquerque BC, Alecrim WD. Dengue hemorrhagic fever and acute hepatitis: A case report. Braz J Infect Dis 2004;8:461-4. Wiwanitkit V. Liver dysfunction in dengue infection: An analysis of the previously published Thai cases. J Ayub Med Coll Abbottabad 2007;19:10-2. Suh SJ, Seo YS, Ahn JH, Park EB, Lee SJ, Sohn JU, et al. A case of imported Dengue fever with acute hepatitis. Korean J Hepatol 2007;13:556-9. Wiwanitkit V. Updates on clinical pharmacology of dengue. Indian J Pharmacol 2013;45:105.
Access this article online Quick Response Code: Website: www.ijccm.org
Access this article online Quick Response Code: Website:
DOI: 10.4103/0972-5229.146335
www.ijccm.org
DOI: 10.4103/0972-5229.146331
N-acetylcystein in dengue hepatitis Sir, The recent report on N-acetylcystein (NAC) in dengue hepatitis is very interesting. [1] Habaragamuwa and Dissanayaka they found that NAC resulted in a good 830
Coiling of central venous catheter in right internal jugular vein Sir, We read with interest the article written by Goyal et al.[1] describing a case of coiling of central venous catheter (CVC) in left subclavian vein. The authors have reported it as a rare complication, and we do not agree with this statement. Malatinský et al.[2] in 1976 presented a
Indian Journal of Critical Care Medicine December 2014 Vol 18 Issue 12
series of 378 radiographically controlled CVC placements and reported pure loop formations (coiling) in 2.9% of the cases. Supraclavicular subclavian approach was used in the majority of the patients and the authors explain this as a reason for relatively low incidence rates in their series as compared to other studies.[2] We report a case of coiling of central venous catheter in right internal jugular vein (IJV) in a 36-year-old patient admitted postoperatively in intensive care unit (ICU) following evacuation of large extradural hematoma. The CVC was placed in the operation theatre under ultrasound guidance. Intraoperatively the waveform was damped, and the flow of fluids was slow, but it was considered secondary to rotation of the neck and labeled as “positional”. Just after admission to the ICU a “flush test” was performed, and it was positive; 5–10 mL of normal saline was injected with force using a syringe and fluid thrill was felt in the ipsilateral neck region with the palmer aspect of the hand.[3] Subsequent chest X-ray confirmed coiling of CVC in right IJV [Figures 1a and b]. Factors predisposing to coiling and catheter malpositions are: a. Retrograde venous flow secondary to IJV valve incompetence in patients with chronic obstructive pulmonary disease, primary pulmonary hypertension and prior cannulations and catheterizations of the IJV[4,5] b. Retrograde venous flow in patients with high intrathoracic and intrabdomical pressures c. Seldinger technique: The catheter is inserted over the guidewire and placed in the central vein. During this procedure sometimes the guidewires are removed before the CVC are properly positioned in the superior vena cava. Resistance encountered in inserting the CVC then leads to excessive pressure applications, which then predisposes to malpositioning. Common sites of resistance are the junction of first rib and clavicle for the subclavian vein and the junction of
a
b
Figure 1: (a) Chest X-ray anteroposterior view with coiled central venous catheter in right internal jugular vein, (b) Coiled central venous catheter after removal
venous tributaries for the IJV and brachiocephalic vein.
Tanvir Samra, Vikas Saini
Departments of Anaesthesia, and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence: Dr. Vikas Saini, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India. E-mail: [email protected]
References 1. 2. 3.
4. 5.
Goyal V, Sahu S. Coiling of central venous catheter in the left subclavian vein, a rare complication. Indian J Crit Care Med 2014;18:105-6. Malatinský J, Kadlic T, Májek M, Sámel M. Misplacement and loop formation of central venous catheters. Acta Anaesthesiol Scand 1976;20:237-47. Toshniwal GR, Rath GP, Bithal PK. Flush test: A new technique to assess the malposition of subclavian central venous catheter position in the internal jugular vein. J Neurosurg Anesthesiol 2006;18:268-9. Doepp F, Bähr D, John M, Hoernig S, Valdueza JM, Schreiber SJ. Internal jugular vein valve incompetence in COPD and primary pulmonary hypertension. J Clin Ultrasound 2008;36:480-4. Wu X, Studer W, Erb T, Skarvan K, Seeberger MD. Competence of the internal jugular vein valve is damaged by cannulation and catheterization of the internal jugular vein. Anesthesiology 2000;93:319-24.
Access this article online Quick Response Code: Website: www.ijccm.org
DOI: 10.4103/0972-5229.146337
A case of guidewire embolism during central venous catheterization: Better safe than sorry! Sir, Central venous catheterization (CVC) is a routine procedure in intensive care unit as well as in surgical patients requiring monitoring of hemodynamic variables, for medications and parentral nutrition, hemodialysis etc. The incidence of complications ranges from 5% to 29%[1] such as arterial puncture, hemothorax, pneumothorax, nerve injury, air embolism or dysrthythmias. Guidewire embolism during CVC is a rare iatrogenic complication.[2] The Seldinger technique is commonly used to cannulate the vessels.[3] We report a case of lost guidewire following 831
Copyright of Indian Journal of Critical Care Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
