Background: The American Board of Internal Medicine suggests residents participate in a minimum of five abdominal paracentesis (AP), central venous catheter (CVC) placements, and lumbar punctures to ensure “adequate knowledge and understanding” of procedures performed by practicing internists. Competency in these procedures is poorly defined and difficult to assess. To address the need for well-supervised, [...]

Background: The advent of internal medicine procedure services within academic medical centers has had a profoundly positive impact on patient care, patient safety, and resident training (1-4). In general, these teams focus on performing invasive bedside procedures, including paracenteses, lumbar punctures, central venous catheter placements, thoracenteses, and ultrasound-guided peripheral intravenous catheter placements. Recently, the procedure service at [...]

Background: Venous access is commonly required in hospitalized patients for the administration of intravenous fluids and medications and blood products. Peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) are required for the administration of vasopressors, chemotherapy, or total parenteral nutrition but often they are placed due to difficulty obtaining a peripheral venous catheter [...]

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: Catheter occlusion is one of the most common complications associated with Peripherally Inserted Central Catheter (PICC) insertion, affecting 1 in every 8 PICCs placed. Occlusion may have important consequences for patients including inability to use the device, delays in tests or treatment, or if irreversible the need to remove and replace the device. Based [...]

Background: Long-term central venous access devices (CVADs) are integral to cancer care provision. Despite the high prevalence of CVAD occlusion in children with cancer, strategies to prevent occlusive events are understudied. We aimed to test the safety and feasibility of conducting a randomized controlled trial (RCT) comparing heparinised saline, with normal saline (0.9% sodium chloride) [...]

Case Presentation: A 79-year-old woman with hypertension and rheumatoid arthritis presented with generalized fatigue and decline in her functional status over 6 months. Her symptoms progressed in the month preceding admission to nausea, vomiting, right upper quadrant pain, and intolerance to solids and liquids for several days. An outpatient abdominal ultrasound revealed only hepatic steatosis. [...]