Background: One of the most important strategies to prevent of Central line associated bloodstream infection (CLABSI) is to minimize the duration of central venous catheterization (CVC). We built a medical team consisting of doctors, nurses and pharmacists to discuss whether patients needed CVC, and recommend catheter removal to attending physicians every day. The purpose of this study was to evaluate whether our team-based approach could shorten the total duration of catheterization and reduce the onset of CLABSI.

Methods: This was a retrospective historical control study in the Intensive Care Units of a tertiary care hospital in Japan. Every patients admitted to the ICU during the study period were eligible if they were inserted CVC. Patients were divided into following two groups: Conventional group and Interventional group. We set the primary endpoint as onset of CLABSI. The secondary endpoints included the duration of CVC, inhospital mortality etc.

Results: We included 311 in the Conventional group and 324 in the Interventional group. The reduced tendency of CLABSI was significantly observed in the Interventional group [Odds ratio, 0.262 (95% confidence interval, 0.074-0.929; p=0.030)]. The Interventional group was significantly associated with reduced duration of central venous catheterization (4 days vs 6 days; p<0.001). No differences were observed for secondary endpoints.

Conclusion: The team-based approach to assess CVC necessity could shorten the duration of central venous catheterization and might reduce CLABSI.

A 63-year-old man with a medical history of arterial fibrillation was transferred to our emergency department secondary to right hemiparesis and dysarthria. On admission, the patient was observed to have non-palpable left radial artery pulse and left dorsalis pedis artery pulse. Computed tomography angiography revealed top of the basilar artery occlusion (BAO) caused by cardiogenic embolism, but no aortic dissection. At that time, left brachial and ulnar arteries embolization was concluded. Mechanical thrombectomy for BAO was successfully achieved with good recanalization. Subsequently, diagnostic angiography was performed for left upper and lower extremities artery occlusion. Thereafter, mechanical thrombectomy was successfully achieved. Although diagnosis and treatment delay for acute extremity artery occlusion may lead to a poor outcome, assessment by physicians is sometimes difficult in primary stroke care. It is important to require vascular examination by palpation of arterial pulses of the extremities for a differential diagnosis. If a pulse is non-palpable, clinical physicians should recognize that non-palpable arteries in extremities is a reliable indication for sudden-onset extremities ischemia in patients with embolic stroke.

A 47-year-old man with a history of mycosis fungoides was transported to our hospital in a state of shock, indicated by evaluation of his vital signs on admission. We suspected tumor collapse syndrome and septic shock and administered steroids for management of septic shock-induced relative adrenal insufficiency. The patient’s circulatory status rapidly improved; however, he subsequently developed two episodes of circulatory failure following steroid discontinuation. Detailed medical history obtained from the family revealed long-term topical steroid use. We suspected steroid withdrawal syndrome and re-initiated steroid therapy. The patient’s general condition improved, although he developed progressive pneumonia and septic shock and multiorgan failure during the course of treatment and died of these complications. Autopsy revealed significant thinning of the adrenal glands. Interpretation of the results of random serum cortisol levels may be inaccurate in emergency and intensive care settings. Clinicians should include steroid withdrawal syndrome secondary to discontinuation of topical steroids as well as oral medications in the differential diagnosis of shock.