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Hu Z, He R, Zhao Y, Luo M, Fan Y, Li J. Risk assessment models for PICC-related venous thrombosis in adult patients with cancer: A network meta-analysis. Thromb Res 2024; 239:109030. [PMID: 38735166 DOI: 10.1016/j.thromres.2024.05.003] [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: 01/15/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES This review aims to compare the performance of available risk assessment models (RAMs) for predicting peripherally inserted central catheter-related venous thrombosis (PICC-RVT) in adult patients with cancer. METHODS A systematic search was conducted across ten databases from inception to October 20, 2023. Studies were eligible if they compared the accuracy of a RAM to that of another RAM for predicting the risk of PICC-RVT in adult patients with cancer. Two reviewers independently performed the study selection, data extraction and risk of bias assessments. A Bayesian network meta-analysis (NMA) was used to evaluate the performance of the RAMs. RESULTS A total of 1931 studies were screened, and 7 studies with 10 RAMs were included in the review. The most widely used RAMs were the Caprini (4 studies), Padua prediction score (3 studies), Autar (3 studies), Michigan risk score (2 studies) and Seeley score (2 studies). The sensitivity, specificity and accuracy varied markedly between the models. Notably, the Caprini score achieved higher sensitivity than 4 RAMs (Wells, Revised Geneva, modified MRS, MRS). The Michigan risk score had greater specificity than did the other 6 RAMs (Caprini, Autar, Padua, Seeley, the novel RAM, Wells). The predictive accuracy of the MRS is significantly greater than that of the Caprini and Autar RAM. CONCLUSION The MRS could be the most accurate RAM for identifying patients at high risk of PICC-RVT. However, as limited studies are available, more rigorous studies should be conducted to examine the accuracy of the Michigan risk score for PICC-RVT in different contexts.
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Affiliation(s)
- Zeyin Hu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Ruoying He
- Peking University Shenzhen Hospital, Shenzhen 518035, PR China
| | - Yu Zhao
- Peking University Shenzhen Hospital, Shenzhen 518035, PR China
| | - Mengna Luo
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Yuying Fan
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
| | - Jia Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.
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2
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McManus C, Mifflin N, Rivera R, Vause S, Tran T, Ostroff M, Harrowell L, Frost S, Alexandrou E. Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study. BMJ Open 2024; 14:e081749. [PMID: 38760049 PMCID: PMC11103188 DOI: 10.1136/bmjopen-2023-081749] [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: 11/06/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities. DESIGN A propensity-score matched cohort study. SETTING A 980-bed tertiary referral hospital in South West Sydney, Australia. PARTICIPANTS In-patients referred to the hospital central venous access service for the insertion of a central venous access device. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT). RESULTS The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00). CONCLUSION There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.
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Affiliation(s)
- Craig McManus
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Nicholas Mifflin
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Renz Rivera
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Sophie Vause
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ton Tran
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew Ostroff
- St Joseph's Health and Medical Centre, Emerson, New Jersey, USA
| | - Lorenza Harrowell
- Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Steven Frost
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Evan Alexandrou
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
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3
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Yin Q, Zheng X, Han L, Huang X, Wang Y, Song Y, Zhang Y, Bian Y. Outcome of antithrombotic therapy in cancer patients with catheter-related thrombosis: a systematic review. Front Cardiovasc Med 2023; 10:1290822. [PMID: 38162134 PMCID: PMC10756912 DOI: 10.3389/fcvm.2023.1290822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The guidelines' recommendations for anticoagulation in cancer patients with catheter-related thrombosis are unclear. The aim of this systematic review was to assess anticoagulation management in cancer patients with catheter-related thrombosis (CRT) based on previously published studies. Methods As of June 10, 2023,we searched databases including PubMed, Embase, and Cochrane and included 11 observational studies that met the criteria. We evaluated 770 adults with active cancer and objectively confirmed patients with CRT who were using drugs including warfarin, LMWH, and new oral anticoagulants as antithrombotic therapy. Results We extracted outcome data, including thrombosis recurrence, catheter dysfunction, major bleeding, and death, and performed a meta-analysis. Discussion In this study we found that the risk of VTE recurrence was higher with rivaroxaban, the risk of bleeding and death appeared to be greater with warfarin, and although the risk of catheter dysfunction due to LMWH is a concern, it is still a more reasonable option for cancer patients with catheter-related thrombosis. Systematic Review Registration http://www.clinicaltrials.gov, identifier (CRD42022367979).
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Affiliation(s)
- Qinan Yin
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xingyue Zheng
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lizhu Han
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuefei Huang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yueyuan Wang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yujie Song
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Bian
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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4
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Ray-Barruel G, Horowitz J, McLaughlin E, Flanders S, Chopra V. Barriers and facilitators for implementing peripherally inserted central catheter (PICC) appropriateness guidelines: A longitudinal survey study from 34 Michigan hospitals. PLoS One 2022; 17:e0277302. [PMID: 36331967 PMCID: PMC9635738 DOI: 10.1371/journal.pone.0277302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Peripherally inserted central catheters (PICCs) are prevalent devices for medium-to-long-term intravenous therapy but are often associated with morbid and potentially lethal complications. This multi-center study sought to identify barriers and facilitators of implementing evidence-based appropriateness criteria to improve PICC safety and patient outcomes in a pay-for-performance model. Participating hospitals received an online toolkit with five recommendations: establishing a vascular access committee; implementing a clinical decision tool for PICC appropriateness; avoiding short-term PICC use (≤5 days); increasing use of single-lumen PICCs; and avoiding PICC placement in patients with chronic kidney disease. Longitudinal online surveys conducted biannually October 2014–November 2018 tracked implementation efforts. A total of 306 unique surveys from 34 hospitals were completed. The proportion of hospitals with a dedicated committee overseeing PICC appropriateness increased from 53% to 97%. Overall, 94% of hospitals implemented an initiative to reduce short-term and multi-lumen PICC use, and 91% integrated kidney function into PICC placement decisions. Barriers to implementation included: achieving agreement from diverse disciplines, competing hospital priorities, and delays in modifying electronic systems to enable appropriate PICC ordering. Provision of quarterly benchmarking reports, a decision algorithm, access to an online toolkit, and presence of local champion support were cited as crucial in improving practice. Structured quality improvement efforts including a multidisciplinary vascular access committee, clear targets, local champions, and support from an online education toolkit have led to sustained PICC appropriateness and improved patient safety.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
- Herston Infectious Diseases Institute, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- * E-mail:
| | - Jennifer Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, United States of America
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
| | - Elizabeth McLaughlin
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, United States of America
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
| | - Scott Flanders
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, United States of America
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
| | - Vineet Chopra
- The Michigan Hospital Medicine Safety Consortium, Ann Arbor, Michigan, United States of America
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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5
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van den Bosch CH, Spijkerman J, Wijnen MHWA, Hovinga ICLK, Meyer-Wentrup FAG, van der Steeg AFW, van de Wetering MD, Fiocco M, Morsing IE, Beishuizen A. Central venous catheter-associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice. Support Care Cancer 2022; 30:8069-8079. [PMID: 35776186 PMCID: PMC9512752 DOI: 10.1007/s00520-022-07256-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/23/2022] [Indexed: 01/28/2023]
Abstract
Purpose The purpose of this study was to determine the most optimal central venous catheter (CVC) for pediatric patients with Hodgkin lymphoma (HL) in terms of complications. Methods A retrospective study including patients diagnosed with HL from 2015 to 2021 at the Princess Máxima Center was performed. Patients were followed from CVC insertion until removal or 06–2021, whichever came first. The primary outcome was the CVC-related complication incidence rate (IR) per 1000 CVC-days. Furthermore, the incidence rate ratio (IRR) was calculated by comparing complication IRs between peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP). Additionally, risk factors for central venous thrombosis (CVT) were identified. Results A total of 98 patients were included. The most frequently observed complications were local irritation/infections (18%; IR 0.93), malfunctions (15%; IR 0.88), and CVC-related CVTs (10%; IR 0.52). Single lumen PICCs were associated with a higher risk of complications (49% vs. 26%; IRR 5.12, CI95% 2.76–9.50), severe complications (19% vs. 7%; IRR 11.96, CI95% 2.68–53.42), and early removal (18% vs. 7%; IRR 9.96, CI95% 2.18–45.47). A single lumen PICC was identified as a risk factor for CVC-related CVT when compared to TIVAPs (12% vs. 7%, IRR 6.98, CI95% 1.45–33.57). Conclusion The insertion of a TIVAP rather than a PICC should be recommended for pediatric patients with HL, especially in the presence of CVT-related risk factors. Future trials should evaluate the efficacy and safety of direct oral anticoagulants for the primary prevention of CVT in pediatric patients with a PICC and other CVT-related risk factors. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07256-3.
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Affiliation(s)
| | - Judith Spijkerman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Idske C L Kremer Hovinga
- Van Creveldkliniek University Medical Centre Utrecht, Thrombosis and Hemostasis, Benign Hematology, Utrecht, The Netherlands
| | | | | | | | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Mathematical Institute, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - Indra E Morsing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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6
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Perek S, Khatib A, Izhaki N, Khalaila AS, Brenner B, Horowitz NA. A prediction model for central venous catheter-related thrombosis in patients with newly-diagnosed acute myeloid leukemia: A derivation cohort analysis. Eur J Intern Med 2022; 101:68-75. [PMID: 35527180 DOI: 10.1016/j.ejim.2022.04.025] [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: 03/21/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Catheter-related thrombosis (CRT) is a common complication in cancer patients, that may lead to chemotherapy deferral, elevated risk for systemic infections and pulmonary embolism. This study aimed to assess CRT incidence and risk factors in newly-diagnosed acute myeloid leukemia (AML) patients and create predictive models potentially allowing to decrease CRT occurrence in this population. METHODS This retrospective single-center analysis included all AML patients treated at the Rambam Health Care Campus between 2006 and 2019. Patient clinical and laboratory data were collected to evaluate thrombosis occurrence and time from AML diagnosis to CRT development. Multivariate classification models were created using logistic regression (LR) and competing risk analyzes. RESULTS The final analysis included 632 newly-diagnosed AML patients (mean age 54 ± 15 years). CRT incidence was 10.1% [confidence interval (CI) 7.7-12.9%], median time from AML diagnosis to CRT was 12.5 days [interquartile range 6-30]. In an LR multivariate model, prior history of venous thromboembolism [adjusted odds ratio (AOR) 12.046, p < 0.0001], acute promyelocytic leukemia (APL) (AOR 2.824, p = 0.015), a high body mass index and initial platelet counts <100 × 10E9/L (AOR 1.059 and 0.546; p = 0.011 and 0.040, respectively) were significantly associated with high CRT risk. Analysis of 587 non-APL patients demonstrated comparable results, with CRT incidence of 9.3% (CI 7.0%-12.1%) and emergence of chronic obstructive pulmonary disease (COPD) as a novel significant co-factor (AOR 34.491, p = 0.004). In both models, the area under curve (AUC) was ≥70%. CONCLUSIONS Significant CRT risk factors defined using the created model could be used for identification of high-risk newly-diagnosed AML patients requiring CRT prophylaxis.
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Affiliation(s)
- Shay Perek
- Department of Internal Medicine A, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel; Department of Emergency Medicine, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel
| | - Alaa Khatib
- Department of Emergency Medicine, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
| | - Niv Izhaki
- Department of Internal Medicine A, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
| | - Ali Sleman Khalaila
- Department of Internal Medicine, Nazareth Hospital EMMS, 1611, Al Wadi Al Jawani, Nazareth 16100, Israel
| | - Benjamin Brenner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel
| | - Netanel A Horowitz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, 1, Efron St, Haifa 3109601, Israel; Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8, Ha'Aliya Street, Haifa 3109601, Israel.
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7
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Study on the Correlation Factors of Tumour Prognosis after Intravascular Interventional Therapy. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6940056. [PMID: 34745508 PMCID: PMC8566042 DOI: 10.1155/2021/6940056] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022]
Abstract
Noninvasive or minimally invasive interventional surgery was selected, and the complications were less and had no significant impact on the quality of life of patients. Tumour patients are often accompanied by cerebrovascular diseases, metabolic diseases, and other basic diseases, which more or less adversely affect the surgical efficacy of tumour. In this paper, endovascular remobilization was used to treat tumour; the basic condition of patients before operation and the interventional operation plan were introduced. Through the analysis of clinical data and prognosis evaluation results of tumour patients receiving intravascular interventional therapy, the patients were divided into good prognosis group and poor prognosis group according to the modified Rankin scale score at discharge. The relationship between gender, age, history of hypertension, tumour width, tumour size, preoperative Hunt-Hess grade, interventional surgery method, and prognosis related to intravascular interventional therapy was explored. The results showed that intravascular interventional therapy for tumour patients can obtain a good prognosis, which provides a reference for the future preoperative assessment of treatment risk and possible prognosis and provides a theoretical basis for the formulation of treatment plan to improve prognosis.
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8
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Debourdeau P, Lamblin A, Debourdeau T, Marcy PY, Vazquez L. Venous thromboembolism associated with central venous catheters in patients with cancer: From pathophysiology to thromboprophylaxis, areas for future studies. J Thromb Haemost 2021; 19:2659-2673. [PMID: 34363736 DOI: 10.1111/jth.15487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
Symptomatic catheter related thrombosis (CRT) occurs in 4%-8% of cancer patients. The mean incidence of CRT, detected either by echography or Doppler ranges between 12 and 14% with a high negative predictive value of about 95%, allowing the subsequent occurrence of CRT (symptomatic and asymptomatic) to be safely excluded. Despite its frequency and its medico-economic consequences, no thromboprophylaxis has been validated to date. In most patients, CRT occurs immediately after catheter insertion, most often within the first week and almost all within the first month after insertion. Meta analyses show a reduction of asymptomatic and symptomatic CRT incidence by about 55%-60% using either vitamin K antagonists or low molecular weight heparins without an increased risk of major bleeding. This pharmacological prophylaxis is only effective when started before the central venous catheter insertion at prophylactic doses and thereafter continued at subtherapeutic doses. Since no population at high risk of CRT has been identified, this review focuses on pathophysiology, epidemiology and clinical supportive data that could lead to a new CRT prophylaxis strategy.
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Affiliation(s)
| | | | | | - Pierre Yves Marcy
- Department of Diagnosis & Interventional Imaging, Polyclinics Les Fleurs, Ollioules, France
| | - Léa Vazquez
- Supportive Care Unit, Sainte Catherine Institute, Avignon, France
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9
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Yuen HLA, Zhao J, Tran H, Chunilal S. Development of a risk score to predict peripherally inserted central catheter thrombosis in active cancer. Intern Med J 2021; 52:1733-1740. [PMID: 34613657 DOI: 10.1111/imj.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripherally inserted central catheter (PICC) thrombosis is common. OBJECTIVES To explore the prevalence of symptomatic PICC thrombosis and pulmonary embolism/deep vein thrombosis (PE/DVT) in cancer and non-cancer cohorts. In active cancer we assessed the Khorana and Michigan Risk Score (KRS, MRS) for predicting PICC thrombosis and modifications to improve discriminative accuracy. METHODS We reviewed consecutive cancer patients receiving chemotherapy through a PICC inserted April 2017 to July 2018. For each case, we identified a contemporaneous non-control. RESULTS Among 147 cancer patients, median age 64 years, PICC duration 70 days (range, 2-452), 7% developed PICC thrombosis (95%CI 3.6-12.2) and 4%(95%CI 2-9) PE/DVT. Among 147 controls, median age 68 years, PICC duration 18.3 days (range, 0.5-210), 0.7%(95%CI 0-4) developed PICC thrombosis and 2%(95%CI 0.4-6) PE/DVT. In our cancer cohort, no KRS<1 patients developed PICC thrombosis (95%CI 0-11) compared to 9% (95%CI 5-16) in KRS≥1, p=0.12. PICC thrombosis occurred in 4.7% (95%CI 1.5-11.7) MRS3 compared to 10.9% (95%CI 4.1-22.2) MRS>3, p=0.32. The addition of thrombocytosis, a variable from KRS, to MRS (modified MRS, mMRS) improved discriminative value for PICC thrombosis (c-statistic MRS 0.63 [95%CI 0.44-0.82], mMRS 0.72 [95%CI 0.58-0.85]). PICC thrombosis occurred in 1.4% (95%CI 0-8.3) mMRS3 and 11.8% (95%CI 6.1-21.2) mMRS>3, p=0.02. More patients were categorized as low risk using mMRS3 (47%) than KRS<1 (22%). CONCLUSION Cancer patients had longer PICC durations and higher PICC thrombosis rates than those without (7% vs 0.7%). mMRS more accurately classified low PICC thrombosis risk than KRS<1(47% versus 22%). Prospective validation of mMRS is warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hiu Lam Agnes Yuen
- Monash Haematology, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Jessie Zhao
- Monash Haematology, Monash Health, Melbourne, Australia
| | | | - Sanjeev Chunilal
- Monash Haematology, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
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10
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Sharp R, Carr P, Childs J, Scullion A, Young M, Flynn T, Kirker C, Jackson G, Esterman A. Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study. BMJ Open 2021; 11:e045895. [PMID: 34226216 PMCID: PMC8258560 DOI: 10.1136/bmjopen-2020-045895] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group. DESIGN Retrospective cohort study. SETTING 4 tertiary hospitals in Australia and New Zealand. PARTICIPANTS Adults who had undergone PICC insertion. PRIMARY OUTCOME MEASURE Symptomatic thrombus of the limb in which the PICC was inserted. RESULTS 2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions. CONCLUSIONS Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.
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Affiliation(s)
- Rebecca Sharp
- Clinical and Health Sciences/Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Alliance for Vascular Access Teaching and Research (AVATAR), Griffith University, Nathan, Queensland, Australia
| | - Jessie Childs
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew Scullion
- Vascular Access Team, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Mark Young
- Peri-Operative Services, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Tanya Flynn
- Cancer Services, St George Hospital, Sydney, New South Wales, Australia
| | - Carolyn Kirker
- Department of Anaesthesia and Pain Management, Capital and Coast District Health Board, Wellington, New Zealand
| | - Gavin Jackson
- Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adrian Esterman
- Clinical and Health Sciences/Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
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11
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Ammann KR, Hossainy SFA, Hossainy S, Slepian MJ. Hemocompatibility of polymers for use in vascular endoluminal implants. J Appl Polym Sci 2021. [DOI: 10.1002/app.51277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kaitlyn R. Ammann
- Department of Medicine College of Medicine, University of Arizona Tucson Arizona USA
- Sarver Heart Center, Arizona Health Sciences Center University of Arizona Tucson Arizona USA
| | - Syed F. A. Hossainy
- Department of Bioengineering College of Engineering, University of California Berkeley Berkeley California USA
| | - Sahir Hossainy
- Sarver Heart Center, Arizona Health Sciences Center University of Arizona Tucson Arizona USA
| | - Marvin J. Slepian
- Department of Medicine College of Medicine, University of Arizona Tucson Arizona USA
- Sarver Heart Center, Arizona Health Sciences Center University of Arizona Tucson Arizona USA
- Department of Biomedical Engineering College of Engineering, University of Arizona Tucson Arizona USA
- Department of Materials Science and Engineering College of Engineering, University of Arizona Tucson Arizona USA
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12
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Fletcher J, Woodham D, Cooper SC. Repair of central venous access devices in intestinal failure patients is safe and cost-effective: A retrospective single centre cohort study. Clin Nutr 2021; 40:4263-4266. [PMID: 33551216 DOI: 10.1016/j.clnu.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/11/2020] [Accepted: 01/17/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with chronic intestinal failure (IF) require home parenteral nutrition (HPN). Central venous access is needed for prolonged use of PN, usually via a long term central venous access device (CVAD). Post insertion there may be mechanical complications with a CVAD such as catheter rupture or tear. Repair of damaged CVADs is possible to avoid risks associated with catheter replacement in patients with IF. However, catheter related blood stream infections (CRBSI) are a concern when CVAD's are accessed or manipulated. AIMS To investigate the success of repair of CVADs in patients with IF on HPN, related to repair longevity and incidence of CRBSI following repair. METHOD Nutrition team records of CVAD repairs carried out in patients with IF were reviewed retrospectively for the period April 2015 to March 2019. RESULTS Nutrition Clinical Nurse Specialists carried out 38 repairs in 27 patients. Male n = 5, female n = 22; mean age 55 years. Catheter longevity before first repair (n = 27): median 851 days, IQR 137-1484 days. 30/38 (78.9%) of repairs were successful lasting ≥30days. Hospital admission was avoided in 76% of cases. 4 patients in the failed repair group underwent catheter re-insertion where 4 had a further, subsequently successful, repair, an overall success rate of 89.4% (34/38). 30-day CRBSI rate was 0.09/1000 catheter days in repaired catheters. In comparing costs, there is a potential cost saving of 2766GBP for repair compared to replacement of damaged CVADs. CONCLUSION Repair of tunnelled CVADs in patients with IF is successful and safe with no increased risk of CRBSI. Significant cost savings may be made.
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Affiliation(s)
- Jane Fletcher
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2GW, UK.
| | - Diane Woodham
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2GW, UK
| | - Sheldon C Cooper
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2GW, UK
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13
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Wang TF, Billett HH, Connors JM, Soff GA. Approach to Cancer-Associated Thrombosis: Challenging Situations and Knowledge Gaps. Oncologist 2020; 26:e17-e23. [PMID: 33275323 DOI: 10.1002/onco.13570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Malignancy is a significant risk factor for venous thromboembolism (VTE). It is estimated that up to 20% of patients with cancer may develop VTE at some time in their cancer journey. Cancer-associated VTE can lead to hospitalizations, morbidity, delayed cancer treatment, and mortality. The optimal prevention and management of cancer-associated thrombosis (CAT) is of utmost importance. Direct oral anticoagulants have been recommended as first-line therapy for VTE treatment in the general population and their efficacy has recently been demonstrated in the cancer population, leading to increased use. However, patients with cancer have unique challenges and comorbidities that can lead to increased risks and concerns with anticoagulation. Herein we will discuss commonly encountered challenges in patients with CAT, review available literature, and provide practice suggestions. IMPLICATIONS FOR PRACTICE: This article aims to specifically address cancer-associated thrombosis issues for which there is limited or absent evidence to guide best practice, for circumstances that pose unique challenges for clinicians, and for directions when the literature is conflicting. It reviews pertinent data for each selected topic and provides guidance for patient management based on the best available evidence and experiences from the panel.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Henny H Billett
- Division of Hematology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Jean M Connors
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald A Soff
- Hematology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Chen P, Wan G, Zhu B. Incidence and risk factors of symptomatic thrombosis related to peripherally inserted central catheter in patients with lung cancer. J Adv Nurs 2020; 77:1284-1292. [PMID: 33249623 DOI: 10.1111/jan.14666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/14/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
AIMS To determine the incidence and risk factors associated with peripherally inserted central catheter-related thrombosis (PICC-RT) in patients with lung cancer. DESIGN A retrospective cross-sectional design. METHODS Patients with lung cancer receiving PICC insertion during 1 March 2014-31 May 2019 at a tertiary hospital in Shanghai, China were enrolled (N = 748). Symptomatic PICC-RT was confirmed by Doppler ultrasonography in the presence of clinical symptoms and signs. Univariate and multivariate logistic regression analyses were performed to identify risk factors of symptomatic PICC-RT. RESULTS Among the patients (mean age, 60.7 years; males, 67.1%), 55 (7.35%) had symptomatic PICC-RT. Based on the multivariate analysis, history of smoking [OR 2.49 (1.13-5.46), p < .05], use of Carboplatin [OR 2.23 (1.19-4.17), p < .05] or Docetaxel [OR 7.23 (1.65-31.56), p < .05], PICC size [OR 3.52 (1.78-6.99), p < .001], and level of D-dimer [OR 5.32 (2.39-11.83), p < .001] were significant risk factors of PICC-RT. CONCLUSION Several modifiable factors (e.g., PICC size and level of D-dimer) were related to PICC-RT. In the future, prospective studies are warranted to examine whether those factors could increase the risk of PICC-RT. Meanwhile, healthcare professionals are recommended to perform a comprehensive assessment of the patients receiving PICC insertion. Close attention should be paid to those at risk for PICC-RT. IMPACT Identification of risk factors associated with PICC-RT is an important step towards individualizing the care plan for patients receiving PICC. Our findings provided evidence for the management of PICC-RT in patients with lung cancer. In clinical practice, nurses could deliver appropriate interventions against modifiable risk factors to reduce the risk of PICC-RT.
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Affiliation(s)
- Pei Chen
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Guangming Wan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Haggstrom L, Parmar G, Brungs D. Central Venous Catheter Thrombosis in Cancer: A Multi-Centre Retrospective Study Investigating Risk Factors and Contemporary Trends in Management. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2020; 14:1179554920953097. [PMID: 32943968 PMCID: PMC7466879 DOI: 10.1177/1179554920953097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
Objectives: Central venous access is needed to facilitate chemotherapy for many cancer patients. Central venous catheter-related thrombosis (CVCT) is a major complication that can cause significant morbidity and mortality. We sought to explore the rate of CVCT in a general cancer population in Australia and to identify factors associated with increased risk of thrombosis. Design: This is a multi-centre retrospective cohort study. Setting and participants: We analysed key patient, treatment, and cancer-related factors for 317 patients with cancer and central venous catheters inserted for systemic therapy. Main outcome measures: Symptomatic CVCT confirmed with imaging and management of patients with CVCT. Results: A total of 402 cases of central line insertion were analysed. Central venous catheter-related thrombosis occurred in 24 patients (6.0%). Having a peripherally inserted central catheter (PICC; HR = 3.78, 95% CI = 1.28-11.19, P = .02) compared with an implantable port and a body mass index of ⩾25.0 kg/m2 (HR = 3.60, 95% CI = 1.31-9.85, P = .01) were independently associated with increased risk of thrombosis. Central venous catheter-related thrombosis was managed mostly with removal of the catheter (19 of 24 cases) and anticoagulation, including direct-acting oral anticoagulants in 5 patients. Conclusions: This work explored rates of CVCT in a general cancer population, observing increased rates in those with PICCs or increased body mass index.
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Affiliation(s)
- Lucy Haggstrom
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, NSW, Australia
- Lucy Haggstrom, Department of Medical Oncology, The Wollongong Hospital, Loftus St, Wollongong, NSW 2500, Australia.
| | - Gurdeep Parmar
- Department of Haematology, The Wollongong Hospital, Wollongong, NSW, Australia
| | - Daniel Brungs
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, NSW, Australia
- Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
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