Background: Hospitalized patients may require central venous access devices (CVADs) for inadequate intravenous (IV) access. CVADs have known complications, including peri-procedural trauma and central line associated bloodstream infections (CLABSI). CLABSI is of concern for patients and hospital systems, as it is largely preventable and used as a quality measure. A CVAD alternative is a short [...]

Background: The Michigan PICC-DVT Risk Score (MRS) identified five predictors for deep venous thrombosis (DVT) associated with peripherally inserted central catheters (PICCs): presence of another central venous catheter (CVC) when device is placed, white blood cell (WBC) count at time of insertion, active cancer, number of catheter lumens, and history of venous thromboembolism (VTE)1. We [...]

Background: Medicine procedure services (MPS) increasingly perform bedside procedures such as lumbar puncture (LP). While rates of major complications are low, success rates in the literature are widely variable and dependent on patient body habitus, patient positioning, operator experience, and use of ultrasound guidance.1 Many trainees report discomfort with their skill in performing and supervising [...]

Background: Gabapentinoids (gabapentin and pregabalin) are commonly prescribed medications typically used to treat neuropathic pain. They are often prescribed off label with varying degrees of evidence to treat a variety of other conditions such as non-neuropathic pain, post-operative pain, and alcohol use disorder. Due to emerging evidence, in 2019 the FDA put out a warning [...]

Background: Hypoglycemia is common and potentially life-threatening for diabetic patients, often iatrogenic from diabetes treatments. It is important to be able to accurately study rates of hypoglycemia when evaluating the inpatient treatment of diabetes at a systems-level. Discharge diagnosis codes show promise as a tool in the surveillance of hypoglycemic events in large administrative databases [...]

Background: Poorly controlled pain in hospitalized patients is common and may lead to excessive opioid administration and adverse events. Ketamine is a reversible, non-competitive NMDA receptor antagonist which blocks glutamate excitatory transmission and provides analgesia with minimal respiratory effects. Dosing for procedural sedation and induction of general anesthesia ranges from 1-4.5 mg/kg. Consensus guidelines for [...]

Background: Almost three-quarters of hospitals with 50 or more beds have a palliative care program, and the percentage of annual hospital admissions receiving an initial palliative care consultation is more than 5%. Methylnaltrexone (MNTX) is a peripherally acting µ-opioid receptor antagonist indicated for opioid-induced constipation (OIC) in patients with advanced illness who are receiving palliative [...]

Background: The placement of peripherally inserted central catheters (PICCs) is increasingly performed primarily by vascular access nurses (VAN) in United States hospitals1. Despite the increased use of these specially trained clinicians, little is known about the patient and device characteristics of the PICCs they placed compared to those placed by interventional radiology (IR) providers. While [...]

Background: Recent work by the authors showed that over half of the incidences of hypoglycemia in hospitalized diabetics involved patients with CKD, and that 18% of patients with diabetes and end-stage renal disease (ESRD) had a hypoglycemic episode while hospitalized. The importance of reducing inpatient hypoglycemia is reflected in the Centers for Medicare and Medicaid [...]

Background: Patent Foramen Ovale (PFO) is a common abnormality that affects between 25% and 34% of the general population. For most people, it is a benign finding; however, in some, the PFO can be wider, allowing a paradoxical embolus to transit from the venous to the arterial circulation, which is associated with cryptogenic stroke, migraine, [...]