To gain additional experience in ultrasound-guided procedures, interventional radiology (IR)-bound surgical preliminary interns at an urban community hospital established a difficult intravenous access (DIVA) consult service. This study evaluates the efficacy, safety, and educational value for such a team. The first year of DIVA team results were followed from May 2019 to April 2020. The value of the experience for IR-bound residents vs. categorical general surgery residents (GS) was compared. 239 patients were evaluated by the DIVA team for a total of 4.3 consults per week. General surgery residents performed an additional estimated 2.5 consults per week. For IR residents, 218/230 (94.8%) PIV and 8/9 (88.9%) midline attempts were successful. There were no technical complications that required additional procedural interventions. All residents found educational value in participating in DIVA team. Residents designated to enter IR found participating in the DIVA team to be significantly more beneficial for overall educational value learning identification/access of vessels under ultrasound guidance ( P < .01). Interventional radiology residents had a higher mean number of procedures (average 60 vs. 24) before diminishing educational value was noted ( P < .05). 100% of GS and IR residents noted that upon entering PGY 2 they felt more adept than their peers at performing ultrasound-guided vascular access and all believed their experience working with DIVA team would benefit them throughout their careers. Establishment of an intern-directed difficult IV access team is beneficial to resident education as well as patient care. Monitoring of case load to avoid service over education is recommended.
Background Vascular prosthetic graft infections are rare but associated with high morbidity and mortality. Treatment involves removal of the infected graft requiring arteriotomy closure. Previously this was performed with autologous graft, but bovine tissue has increasingly been used. The objective of this paper is to review the community hospital experience with bovine tissue repair in an infected vascular field. Materials and Methods A retrospective review of all cases performed by a single surgeon in a community hospital for infected prosthetic grafts was completed. Sixteen cases were included where bovine tissue was used for repair. Presentation, location of graft, and causative organism were reviewed, and outcomes including reoperation and mortality were recorded. Results Of the 16 patients, 15 (94%) had positive cultures of the graft. Methicillin-Resistant Staph Aureus was the most commonly isolated organism (50%). There were 3 unplanned reoperations including a revision from below to above knee amputation, drainage of a hematoma, and a wound debridement within the first year. Over the 1 year follow up period, 3 patients died for a mortality of 19%. There were no reinfections during follow-up. Discussion Prosthetic graft infection is a rare but serious vascular surgery complication. The causative organism has shifted in the last few years to become increasingly drug resistant. Treatment requires excision, and bovine tissue has been demonstrated to provide a safe and durable method of repair.
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