John J. Crowley

Long-term central venous access in pediatric patients at high risk: conventional versus antibiotic-impregnated catheters.

PURPOSE To study selective use of antibiotic-impregnated catheters in children at increased risk of venous catheter-related infections (CRIs). MATERIALS AND METHODS From December 2008 to June 2009, 428 peripherally inserted central catheters (PICCs) were placed by the interventional radiology service of a large metropolitan childrens hospital. This retrospective study analyzed demographic and outcome data for the 125 patients in this group at high risk for venous CRI. Patients at high risk were those with active systemic infection, previous complicated central venous access, intensive care unit (ICU) admission, intestinal failure, transplantation, complex congenital heart disease, or renal failure. Patients (age, 7.6 y ± 7.0; 73 male and 52 female) received a conventional or antibiotic-impregnated PICC, with 17 receiving more than one catheter. RESULTS Of the 146 of 428 qualifying patient encounters (34%), 53 patients received an antibiotic-impregnated PICC and 93 received a conventional PICC, representing 5,080 total catheter-days (CDs). The rates of CRIs per 1,000 CDs, including catheter exit site infections and catheter-related bloodstream infections, were 0.86 for antibiotic-impregnated PICCs and 5.5 for conventional PICCs (P = .036). A propensity-based model predicts 15-fold greater infection-free survival over the lifetime of the catheter in patients who receive an antibiotic-impregnated PICC (P < .001). Antibiotic-impregnated PICC recipients with active infection or ICU admission at the time of insertion had no catheter-associated infections, compared with 3.42 and 9.46 infections per 1,000 CDs, respectively, for patients who received conventional PICCs. Patients with intestinal failure had 1.49 and 10 infections per 1,000 CDs with antibiotic-impregnated versus conventional PICCs, respectively. CONCLUSIONS Antibiotic-impregnated long-term PICCs significantly improve infection-free catheter survival in pediatric patients at high risk.

Neurofibromas With Imaging Characteristics Resembling Vascular Anomalies

OBJECTIVE Although neurofibromas are rare, their initial clinical and imaging presentation can mimic those of vascular anomalies, particularly if the characteristic clinical features of neurofibromatosis are not present. The diagnostic challenges encountered in five cases of histologically proven neurofibromas, initially diagnosed as vascular anomalies, are reviewed and discussed. CONCLUSION The clinical and imaging differences between neurofibromas and vascular anomalies are detailed with the histopathologic features to better understand why some neurofibromas are diagnosed as vascular anomalies.

Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology

Monzer A. Chehab, MD, Avnesh Thakor, MD, PhD, Sheryl Tulin-Silver, MD, Bairbre L. Connolly, MB, MCh, FRCPC, FRCSI, Anne Marie Cahill, MD, Thomas J. Ward, MD, Siddharth A. Padia, MD, Maureen P. Kohi, MD, Mehran Midia, MD, Gulraiz Chaudry, MBChB, FRCR, Joseph J. Gemmete, MD, Jason W. Mitchell, MD, MPH, MBA, Lynn Brody, MD, John J. Crowley, MD, Manraj K.S. Heran, MD, Jeffrey L. Weinstein, MD, Boris Nikolic, MD, MBA, Sean R. Dariushnia, MD, Alda L. Tam, MD, MBA, and Aradhana M. Venkatesan, MD

Quality improvement guidelines for pediatric abscess and fluid drainage

Mark J. Hogan, MD, Francis E. Marshalleck, MD, Manrita K. Sidhu, MD, Bairbre L. Connolly, MD, Richard B. Towbin, MD, Wael A. Saad, MD, Ann Marie Cahill, MD, John Crowley, MD, Manraj K. S. Heran, MD, FRCPC, Eric J. Hohenwalter, MD, Derek J. Roebuck, MB, BS, Michael J. Temple, MD, FRCP, T. Gregory Walker, MD, John F. Cardella, MD, and Members from the Society of Interventional Radiology Standards of Practice Committee and Society for Pediatric Radiology Interventional Radiology Committee