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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Gonzalez-Vargas JM, Sinz E, Moore JZ, Miller SR. Clinical Outcomes of Standardized Central Venous Catheterization Simulation Training: A Comparative Analysis. JOURNAL OF SURGICAL EDUCATION 2024; 81:444-455. [PMID: 38278722 PMCID: PMC10922709 DOI: 10.1016/j.jsurg.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE A standardized ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) using online- and simulation-based training was first designed and then large-scale deployed at a teaching hospital institution to improve CVC surgical education. To understand the impact that the standardized training might have on patient complications, this study focuses on identifying the impact of the integration of an iteratively designed US-IJCVC training on clinical complications at a teaching hospital. DESIGN AND PARTICIPANTS A comparative study was conducted using TriNetX, a global health research network. Using Current Procedural Terminology (CPT) codes and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified the total number of patients with a CVC and mechanical, infectious, and thrombosis complications with and without billable ultrasound between July 1 to June 30 in 2016, 2017, and 2022. SETTING A teaching hospital institution in Pennsylvania. RESULTS Results showed a correlation between years and complications indicating, (1) mechanical complications billable ultrasound, (2) infectious complications billable ultrasound, and (3) thrombosis complications billable ultrasound were significantly lower with the large-scale deployment. Results also showed that (4) mechanical, infectious, and thrombosis complications with and without billable ultrasound are within the range that prior work has reported. CONCLUSION These results indicate that there has been a decrease in mechanical, infectious, and thrombosis complications, which correlates with the US-IJCVC training large-scale deployment.
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Affiliation(s)
| | - Elizabeth Sinz
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jason Z Moore
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, Pennsylvania
| | - Scarlett R Miller
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, Pennsylvania; School of Engineering Design, Technology, and Professional Programs, Penn State, University Park, Pennsylvania
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Wang F, Wang Y, Liu J. Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34924. [PMID: 37773817 PMCID: PMC10545263 DOI: 10.1097/md.0000000000034924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/03/2023] [Indexed: 10/01/2023] Open
Abstract
To explore the risk factors for peripherally inserted central venous catheter (PICC)-related complications in children. This retrospective study analyzed data collected from electronic medical records. A total of 584 patients with indwelling PICC treated between January 2019 and August 2021 were included in this study. According to the occurrence of PICC-related complications, the patients without PICC-related complications were included in the control group (n = 538) and those with PICC-related complications were included the observation group (n = 46). The risk factors for PICC-related complications were analyzed. Of the 584 patients with PICCs, 46 (7.88%) had PICC-related complications. Univariate analysis revealed significant differences in venipuncture (P < .001), oozing of blood from the puncture point (P < .001), indwelling time (P < .001), intravenous nutrient solution (P < .001), and catheter type (P = .003). Complications were used as dependent variables. The independent variables were vein puncture, blood oozing at the puncture point, indwelling time, intravenous nutrient solution, and catheter type. Multivariate logistic regression analysis revealed that the vein puncture (odds ratio [OR] 10.115, 95% confidence interval [CI] 5.034-20.323, P < .001), puncture point blood oozing (OR 9.217, 95% CI 3.860-22.004, P < .001), indwelling time (OR 6.390, 95% CI 3.527-10.972, P = .005), intravenous nutrient solution (OR 2.593, 95% CI 1.675-4.015, P < .001), and catheter type (OR 8.588, 95% CI 2.048-19.095, P = .013) were all risk factors for PICC-related complications in children. Venipuncture, oozing of blood from the puncture point, indwelling time, intravenous nutrient solution, and catheter type are risk factors for PICC-related complications in children. Significant attention should be paid to whether the puncture point is bleeding, the presence or absence of an intravenous nutrient solution, duration of catheterization, type of catheterization, and venipuncture. Additionally, preventive nursing measures should be implemented as soon as possible to reduce the risk of complications related to peripheral PICC.
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Affiliation(s)
- Fang Wang
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Yu Wang
- Department of Nuclear Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Jingzhen Liu
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
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Picardi M, Giordano C, Della Pepa R, Pugliese N, Esposito M, Abagnale DP, Giannattasio ML, Lisi D, Lamagna M, Grimaldi F, Muccioli Casadei G, Ciriello M, Persico M, Gargiulo G, Pane F. Intravascular Complications of Central Venous Catheterization by Insertion Site in Acute Leukemia during Remission Induction Chemotherapy Phase: Lower Risk with Peripherally Inserted Catheters in a Single-Center Retrospective Study. Cancers (Basel) 2023; 15:cancers15072147. [PMID: 37046808 PMCID: PMC10093126 DOI: 10.3390/cancers15072147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The basilic/brachial (BBV), internal jugular (IJV), and subclavian veins (SCV) are commonly used as central venous catheter (CVC) sites. A BBV approach [peripherally inserted central catheter (PICC)] is increasingly used for short- to intermediate-term CVCs for acute leukemias undergoing cytotoxic intensive regimens. In this retrospective study, the catheterization of the BBV, IJV, and SCV in patients with previously untreated acute leukemia was assessed. The primary outcome was the composite incidence of catheter-related symptomatic deep-vein thrombosis (sDVT) and bloodstream infection (BSI) from catheterization up to 30 days later. In a 10-year period, 336 CVC were inserted in the BBV (n = 115), IJV (n = 111), and SCV (n = 110) in 336 patients suffering from AML (n = 201) and ALL (n = 135) and undergoing induction chemotherapy. The primary outcome events were 8, 20, and 27 in the BBV, SCV and IJV cohorts (2.6, 6.9, and 9.6 per 1000 catheter-days, respectively; p = 0.002). The primary outcome risk was significantly higher in the IJV-cohort than in the BBV-cohort (HR, 3.6; 95% CI, 1.6 to 7.9; p = 0.001) and in the SCV-cohort than in the BBV-cohort (HR, 2.6; 95% CI, 1.2 to 5.9; p = 0.02). PICC was a valid CVC for the induction chemotherapy of acute leukemia for the lowest risk of sDVT and BSI.
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Affiliation(s)
- Marco Picardi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Claudia Giordano
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Roberta Della Pepa
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Novella Pugliese
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Esposito
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Davide Pio Abagnale
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Luisa Giannattasio
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Dario Lisi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Martina Lamagna
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Francesco Grimaldi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giada Muccioli Casadei
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Mauro Ciriello
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Marcello Persico
- Department of General Surgery, Endocrinology, Orthopaedics, and Rehabilitations, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Gianpaolo Gargiulo
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Fabrizio Pane
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
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Hentrich M, Böll B, Teschner D, Panse J, Schmitt T, Naendrup JH, Schmidt-Hieber M, Neitz J, Fiegle E, Schalk E. Impact of the insertion site of central venous catheters on central venous catheter-related bloodstream infections in patients with cancer: results from a large prospective registry. Infection 2023:10.1007/s15010-023-02029-4. [PMID: 37016194 DOI: 10.1007/s15010-023-02029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Overall, insertion of central venous catheter (CVC) into femoral veins (FV) has been shown to be associated with a higher risk of infection compared with subclavian and internal jugular (IJV/SCV) CVC, but no data are available on the impact of the FV insertion site on the CVC-related bloodstream infections (CRBSI) risk in patients with cancer. The objective of the study is to compare CRBSI rates and incidences of FV with those of internal jugular and subclavian vein (IJV/SCV CVC) as observed in the prospective SECRECY registry. METHODS SECRECY is an ongoing observational, prospective, clinical CRBSI registry active in six departments of hematology/oncology in Germany. Each case of FV CVC was matched at a ratio of 1:1 to a case with IJV/SCV CVC. The propensity score was estimated using a multivariable logistic regression model adjusting for age, sex, cancer type, and duration of indwelling catheter. RESULTS Of 4268 CVCs included in this analysis, 52 (1.2%) were inserted into the FV and 4216 (98.8%) into the IJV/SCV. 52 cases of FV CVC were matched with 52 IJV/SCV CVC. There was no significant difference in the CRBSI rate (3.8% vs. 9.6%), the CRBSI incidence (5.7 vs. 14.2/1000 CVC days), and the median CVC time (5.5 vs. 5 days) between the FV and the IJV/SCV group. CONCLUSION Based on this data, inserting FV CVCs in patients with cancer does, at least in the short-term, not appear to be associated with an increased risk of CRBSI as compared to IJV/SCV CVC.
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Affiliation(s)
- Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, University of Munich, Nymphenburger Str. 163, 80634, Munich, Germany.
| | - Boris Böll
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Daniel Teschner
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Panse
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Timo Schmitt
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the, Johannes Gutenberg University Mainz, Mainz, Germany
- Hamm Hospital Nahetal, Bad Kreuznach, Germany
| | - Jan-Hendrik Naendrup
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, Pneumology and Nephrology, Carl-Thiem Hospital Cottbus, Cottbus, Germany
| | - Julia Neitz
- Department of Hematology and Oncology, Red Cross Hospital Munich, University of Munich, Nymphenburger Str. 163, 80634, Munich, Germany
| | - Eva Fiegle
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Center, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
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Chen L, Li C, Bai H, Li L, Chen W. Use of modeling and simulation to predict the influence of triazole antifungal agents on the pharmacokinetics of zanubrutinib and acalabrutinib. Front Pharmacol 2022; 13:960186. [PMID: 36299883 PMCID: PMC9588929 DOI: 10.3389/fphar.2022.960186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Bruton’s tyrosine kinase (BTK) inhibitors are commonly used in the targeted therapy of B-cell malignancies. It is reported that myelosuppression and fungal infections might occur during antitumor therapy of BTK inhibitors, therefore a combination therapy with triazole antifungals is usually required. Objective: To evaluate the influence of different triazoles (voriconazole, fluconazole, itraconazole) on the pharmacokinetics of BTK inhibitors (zanubrutinib, acalabrutinib) and to quantify the drug-drug interactions (DDIs) between them. Methods: The physiologically-based pharmacokinetic (PBPK) models were developed based on pharmacokinetic parameters and physicochemical data using Simcyp® software. These models were validated using clinically observed plasma concentrations data which based on existing published studies. The successfully validated PBPK models were used to evaluate and predict potential DDIs between BTK inhibitors and different triazoles. BTK inhibitors and triazole antifungal agents were simulated by oral administration. Results: Simulated plasma concentration-time profiles of the zanubrutinib, acalabrutinib, voriconazole, fluconazole, and itraconazole are consistent with the clinically observed profiles which based on existing published studies, respectively. The exposures of BTK inhibitors increase by varying degrees when co-administered with different triazole antifungals. At multiple doses regimen, voriconazole, fluconazole and itraconazole may increase the area under plasma concentration-time curve (AUC) of zanubrutinib by 127%, 81%, and 48%, respectively, and may increase the AUC of acalabrutinib by 326%, 119%, and 264%, respectively. Conclusion: The PBPK models sufficiently characterized the pharmacokinetics of BTK inhibitors and triazole antifungals, and were used to predict untested clinical scenarios. Voriconazole exhibited the greatest influence on the exposures of BTK inhibitors. The dosage of zanubrutinib or acalabrutinib need to be reduced when co-administered with moderate CYP3A inhibitors.
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Affiliation(s)
- Lu Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Chao Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Hao Bai
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Lixian Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Wanyi Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing University, Chongqing, China
- *Correspondence: Wanyi Chen,
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Schalk E, Biehl LM, Böll B. Jugular vein inserted central venous catheters (CVC) and the risk of CVC-related bloodstream infections in patients with hematological malignancies. Am J Hematol 2022; 97:E336-E340. [PMID: 35713556 DOI: 10.1002/ajh.26633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/21/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Enrico Schalk
- Otto-von-Guericke University Magdeburg, Medical Center, Department of Hematology and Oncology, Magdeburg, Germany
| | - Lena M Biehl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Centre for Infection Research, Bonn-Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Cologne, Germany
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