Talk:Central venous catheter

message: Hi Veronica, 
*This webpage about CLABSI from CDC: http://www.cdc.gov/hicpac/BSI/01-BSI-guidelines-2011.html
*This patient level page from MedlinePlus: https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000474.htm OR (has images, although not great images..)  https://www.nlm.nih.gov/medlineplus/ency/imagepages/19861.htm
*This page as IDSA has some guidelines which might be worth a look: http://www.idsociety.org/Other_Guidelines/
Whit
Emwhitaker (talk) 15:43, 12 November 2015 (UTC)
thread_title: Potential sources

message: Hi All! I will be editing the "Central venous catheter" page for medical accuracy and understandability. My focus will be in the following areas:
Distractors:
* The 13 Elements of Performance (EPs) to decrease CLABSI- not completely filled in and don’t think necessary
* Information on quatitative blood cultures-what are they? Why was it mentioned?
* Implanting ports: “Huber” needles-? Needed?  
Inaccurate Citations:
* 1:doesn’t work (where a lot of the citation/medical use is from)
* 2:doesn’t give a direct link and is from 2002
* 4: doesn’t make sense
* 5: doesn’t work
Out of Date Information:
 
* Re-ordering of medical uses to comply with why central lines are placed the majority of the time (right now CVP is #1, but not placed for monitoring CVP very often now)
* Information from 2002
Three Potential Sources:
* Smith Reston N, Nolan Jerry P. Central venous catheters 2013; 347 :f6570
* Fosh, B., Canepa, M., Eaton, M., Long-term venous access insertion: ‘the learning curve.’ ANZ J Surg. 2015 Oct 29. doi: 10.1111/ans.13338. [Epub ahead of print]
* Rosen BT, Wittnebel K. Chapter 115. Central Line Placement. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com.ucsf.idm.oclc.org/content.aspx?bookid=496&Sectionid=41304091.
VeronicaNicole88 (talk) 00:02, 5 November 2015 (UTC)
thread_title: Student Edits

message: I work in the Renal ward of my local hospital and thought I should point out we use Internal Jugular and Femoral lines as temporary access, along with Tunnel Neck Lines (Sub-clavian) as a more permanent solution.  This is usually until a fistula can be created as this has a lower risk of infection.  Perhaps someone with more medical knowledge (i'm just a Health Care Assistant) could add to the page ?
Cheers —The preceding unsigned comment was added by 82.39.202.88 (talk) 22:05, 11 January 2007 (UTC)
thread_title:  Haemodialysis 

message: This section would benefit from general quality and style improvements. It has a very strong US focus and seems to be overly promoting the work of Dr Pronovost, using superlatives "tremendous amount of work", missing references "some literature has suggested", overly specific based on a single study ("38% of people"), style "myriad of recommendations". The bullet list of CDC guidelines should be summarized or removed. The reference to Barash book can be replaced with the actual CDC recommendations.  — Preceding unsigned comment added by FlaxorDeLux (talk • contribs) 10:31, 28 February 2020 (UTC)
thread_title: Bloodstream infections

message: It's been known for some time that chlorhexidine is better than povidone-iodine tincture for cleaning. It now turns out that it can prevent 50% of all catheter colonisations - http://archinte.ama-assn.org/cgi/content/abstract/167/19/2066?etoc ; we will need to mention this or some other study soon. JFW | T@lk 05:48, 26 October 2007 (UTC)
replies: text: I've just added this to the text, under "Infection:Treatment". Please check if I have formatted the reference correctly. Thanks. --Kyoko 07:24, 26 October 2007 (UTC)
thread_title: Chlorhexidine

message: In the UK, people commonly refer to the NICE "guideline" on the use of ultrasound. The reference is:
* National Institute for Clinical Excellence. Guidance on the use of ultrasound  locating devices for placing central venous catheters. NICE Technical report  number 49. September 2002.
This should probably be mentioned, although the evidence is present only in potentially difficult lines. JFW | T@lk 09:16, 5 March 2008 (UTC)
thread_title:  NICE guideline 

message: Once again, in an emergency medicine setting only a single good study shows that ultrasound reduces complications doi:10.1136/emermed-2012-201230 JFW | T@lk 14:59, 12 April 2013 (UTC)
thread_title:  Ultrasound 

message: https://www.youtube.com/watch?v=vr4uTinST2E&list=PL1spZk8R2sxGqvkNG6WVC1oERAogXqv2D&index=5
fought a clip demonstration is this the CVC surgery?  — Preceding unsigned comment added by 36.225.100.147 (talk) 15:32, 29 October 2015 (UTC)
thread_title:  is THIS CVC? 

message: CVC: central venous catheter 
CVP: central venous pressure 
 So need to insert CVC before CVP can be measured  — Preceding unsigned comment added by Composcompos12 (talk • contribs) 11:34, 8 November 2015 (UTC)
thread_title:  CVC & CVP compare 

message: The organization of the lead is clear in addressing definition, placement, and use. It lays out a framework for the remainder of the article and uses lay terms first but further uses medical terms, such as defining the internal jugular vein but only after referring to it as a “vein in the neck.” I do not think that changes need to be made to the lead, as it is both concise and clear. The links are also appropriate, and the picture of the central venous catheter is also easy to understand. 
Although I like the medical uses section, I do believe certain parts are written in a way that is less understandable to the lay-person (I bring this up mainly because when I asked my non-medical friends and family for feedback, they did not understand plasmapheresis, peripheral blood stem cell collections, and some of the younger readers at a high school level did not know the word caustic). Even though there are links to these terms that can be clicked on for further reading, by clicking on the links for definitions it can interrupt the readability. If you would like, you could consider including parenthesis next to plasmapharesis and including the definition from the link, such as (removal, treatment, and return of (components of) blood plasma from blood circulation.)
For the complications section, there is medical jargon that is defined by links but not in the article itself, such as pneumothorax. It may be helpful to define this term to prevent the need of clicking on links throughout the article, then needing to return to the CVC article afterward. While the term jugular was defined early in the lead, for a lay-person, when you refer to “jugular lines,” under the bloodstream infections section, it may interrupt the readability and could rather be written as “Infection risks were initially thought to be less in lines placed in the neck veins…” I think the bloodstream infections section was well written regarding organization and was very thorough, including information that is important to both health care professionals as well as non-health care professionals. I think the thrombosis section is great in defining thrombosis, explaining why it occurs, and how it is treated/prevented. The misplacement section is also easily readable and understood by non-medical professionals. For the “other complications” section, medical jargon such as “Trendelenburg positioning” is appropriately linked and I believe this is acceptable rather than defining it in this article, as it would be too long and would interrupt the readability of the article rather than improve it.
The insertion section is more directed towards health professionals (based on my non-medical friends telling me that they had difficulty imagining how to place a central venous catheter), but I find this appropriate as it is not easy to describe and would more appropriately target medical professionals anyways. 
The “Types” section was well received by my non-medical friends, and it was easily understandable in my opinion as well. The tunneled vs non-tunneled portion was well defined with links to the different catheters if further reading were desired. The implanted ports section was also well written with an appropriate picture accompanying the section. The PICC line section was concise and appropriate, and I liked the inclusion of the pronunciation of the term so that people are able to bring it up in conversations with their health care providers. I think it could be helpful to include why a PICC line would be used, as you explained the reason for port placement in the previous section. It could be very concise and even just include that it may be indicated “In those who require more than 2 weeks of intravenous treatment.” as it is stated in the PICC Wikipedia page link.
I think this is a very good article! At times, there are terms or parts of the article that are a little more difficult for non-medical readers, but most of it is understandable by both people of the medical and non-medical community!  — Preceding unsigned comment added by Bangabullet90 (talk • contribs) 20:20, 18 November 2015 (UTC)
thread_title:  Peer Review for Wikipedia Elective for VeronicaNicole88 

message: Hello, I have a photo of the central line that was placed in my neck after emergency surgery due to complications from child birth. 
You can clearly see the sutures holding it in place. I'm not sure if it would be a helpful addition to the article (currently have a drawing of sutures) but I'm happy to share it for the page. --Red minx (talk) 10:08, 15 May 2018 (UTC)
thread_title:  Photograph 

message: Dear all, 
I’m a 4th year medical student. Over the next month I will be making some edits to this article and hope to achieve the following: 
Introduction – Continue to develop and expand section. Hoping to highlight the importance of these devices by briefly covering incidence of use (millions placed each year), common indications, and rationale for placement. 
Types of catheters – Expand section on non-tunneled and tunneled catheters, adding pictures, clinical uses for each, benefits/drawbacks. 
Insertion – add section detailing the various sites of insertions and the advantages/disadvantages of each approach 
Complications – Include incidences, update data/guidelines re: central line associated blood infections (CLABSI), address risk of arrhythmias, vascular injury. Talk about ways to avoid complications. 
Management – Add brief sections on the management of catheters after placement – e.g. prevention of infection and thrombosis, managing mechanistic complications. 
I welcome any feedback.  — Preceding unsigned comment added by Phalliday47 (talk • contribs) 05:35, 6 March 2020 (UTC)
thread_title:  Medical student proposed work plan  

message: Lead
* I like the broad overview of the scope of central venous catheters that you provide
* I wonder if breaking up the Lead paragraph will make it more visibly digestible to the reader
* Great job on going through a large amount information in a concise manner
Medical uses section
* Impressive job on entirely reworking a large paragraph
* I liked the way you display the information in a list format. It helps to easily visualize the information
* I suggest adding in more hyperlinks to other wikipedia articles in this section as there are a large number of complex medical terminology
* Tone is neutral and balanced
Catheter Flow section
* Great job on identifying a need for a new section
* I like how you summarize the equation in a descriptive paragraph including the rationale for central catheter design and function, placing the equation in context.
* I would consider breaking down the last sentence in the section into several sentences for clarity.
Peripherally Inserted Central Catheters (PICC) section
* Great idea including this section in the article, as PICC lines are a very important and closely related topic
* I like how you describe the pitfalls and indications for PICC lines in a clear and concise manner, incorporating previous topics like catheter flow
* I would consider breaking up this paragraph into 2-3 sections for ease of visualization
Maryhan17 (talk) 04:50, 23 March 2020 (UTC)
thread_title:  Peer review