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Zhu L, Li K, He Q, Liu L. Psychological experiences and needs of tumor patients with implanted intravenous infusion ports: a qualitative study. Front Oncol 2024; 14:1392416. [PMID: 38817894 PMCID: PMC11137243 DOI: 10.3389/fonc.2024.1392416] [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: 02/27/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
Background There are many problems of psychological burden in patients with tumor implanted in port of intravenous infusion. However, more attention is paid to its complications in the literature, and psychological problems are seldom concerned. The purpose of this study was to explore the psychological state and needs of tumor patients after implantation of an intravenous infusion port and provide valuable references for psychological interventions. Method A semi-structured interview was conducted with 11 patients with intravenous infusion ports. Colaizzi's 7-step analysis was used to analyze the interview data. Results According to the primary information, four themes and nine sub-themes were extracted: (1) lack of self-worth, (2) multiple emotional experiences (guilt, doubt, worry, and gain). (3) Poor self-management and self-maintenance awareness (over-reliance on medical staff, unchanged family roles, lack of related knowledge). (4) Expectations and suggestions for the future (inner expectations, suggestions for infusion ports). Conclusion The patient's psychological state should be carefully monitored during tube implantation, to relieve the patient's tension and anxiety and improve nursing satisfaction and patient outcomes.
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Affiliation(s)
- Lan Zhu
- 1Department of Nursing, Jiangxi Provincial People’s Hospital ,The First Affiliated Hospital of Nanchang Medical Collage, Nanchang, Jiangxi, China
| | - Kun Li
- Department of Neurology, Nanchang People’s Hospital, Nanchang, Jiangxi, China
| | - Qiu He
- Department of Nursing, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Liu
- 1Department of Nursing, Jiangxi Provincial People’s Hospital ,The First Affiliated Hospital of Nanchang Medical Collage, Nanchang, Jiangxi, China
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Suzuki T, Michimoto K, Hasumi J, Kisaki S, Hasegawa Y, Fujimori A, Yoshimatsu L, Ashida H, Ojiri H. Silver-Mixed Port Reduces Venous Access Port Related Infection Rate Compared to Non-Silver-mixed Port: A Single-center Retrospective Analysis. Cardiovasc Intervent Radiol 2023; 46:1696-1702. [PMID: 37902854 PMCID: PMC10695883 DOI: 10.1007/s00270-023-03583-y] [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: 03/09/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE Totally implantable venous access ports (TIVAPs) are increasingly used as safe and convenient central venous access devices. However, several TIVAP-related complications occur, with port/catheter infection being most common. Silver-mixed ports have recently been introduced in anticipation of reducing TIVAP infection. This study aimed to investigate the efficacy of this device in reducing port infection by examining groups with and without silver-mixed devices. MATERIALS AND METHODS From April 2017 to July 2022, silver-mixed ports (S group) and non-silver-mixed port group (NS group) were reviewed at our institution. The incidence of TIVAP-related infections, patient characteristics, and bacteriological data were evaluated. Univariate and multivariate analyses were used to evaluate risk factors for TIVAP-related infection. RESULTS A total of 607 patients (S group, n = 203; NS group, n = 404) were enrolled. The rates of TIVAP-related infection were 3.0% (n = 6) and 7.7% (n = 31) in the S and NS groups, respectively. The incidence of total infection per 1000 catheter-days were 0.114 and 0.214 the S and NS groups, respectively. In the entire group, the rates of infection were 6.1% (n = 37) and the incidence of total infection per 1000 catheter-days was 0.187. Univariate and multivariate analyses revealed a significantly lower TIVAP-related infection rate in S group than NS group (p = 0.0216, odds ratio = 2.88 confidence interval: 1.17-7.08). No gram-negative rods were detected in the S group as port infection. CONCLUSION Silver-mixed port may be feasible in preventing port infection. LEVEL OF EVIDENCE Level 3, Local non-random sample.
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Affiliation(s)
- Takayuki Suzuki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Kenkichi Michimoto
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Yasuaki Hasegawa
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Ayako Fujimori
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo, 125-8506, Japan
| | - Lynn Yoshimatsu
- Department of Radiology, The Jikei University Daisan Hospital, 4-11-1, Izumihonchou, Komae-shi, Tokyo, 201-8601, Japan
| | - Hirokazu Ashida
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, The Jikei University of Second Building 14F, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan
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Rosenthal VD, Jin Z, Valderrama-Beltran SL, Gualtero SM, Linares CY, Aguirre-Avalos G, Mijangos-Méndez JC, Ibarra-Estrada MÁ, Jiménez-Alvarez LF, Reyes LP, Alvarez-Moreno CA, Zuniga-Chavarria MA, Quesada-Mora AM, Gomez K, Alarcon J, Millan-Oñate J, Aguilar-de-Moros D, Castaño-Guerrero E, Córdoba J, Sassoe-Gonzalez A, Millán-Castillo CM, Leyva-Xotlanihua L, Aguilar-Moreno LA, Bravo-Ojeda JS, Gutierrez-Tobar IF, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Flores-Sánchez BM, Cano-Medina YA, Chapeta-Parada EG, Gonzalez-Niño RA, Villegas-Mota MI, Montoya-Malváez M, Cortés-Vázquez MÁ, Medeiros EA, Fram D, Vieira-Escudero D, Dueñas L, Carreazo NY, Salgado E, Yin R. Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries. Am J Infect Control 2023; 51:1114-1119. [PMID: 36921694 DOI: 10.1016/j.ajic.2023.03.006] [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: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, FL, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Miguel Ángel Ibarra-Estrada
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Freire MP, Assis DB, Carlesse F, Belizario JDC, Germano PCP, Virolli JM, Turdo AC, Rodrigues BQ, Maciel ALP, Goncalves P, Boszczowski I, Abdala E, Levin AS. A surveillance program for long-term central venous access-associated infections in outpatient chemotherapy services. Infect Control Hosp Epidemiol 2023; 44:1555-1561. [PMID: 37039458 DOI: 10.1017/ice.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE In this study, we described the first results of a surveillance system for infections associated with long-term central venous catheters (LT-CVC) in patients under outpatient chemotherapy. DESIGN This was a multicentric, prospective study. SETTING Outpatient chemotherapy services. PARTICIPANTS The study included 8 referral cancer centers in the State of São Paulo. INTERVENTION These services were invited to participate in a newly created surveillance program for patients under chemotherapy. Several meetings were convened to share previous experiences on LT-CVC infection surveillance and to define the surveillance method. Once the program was implemented, all bloodstream infection (LT-CVC BSIs), tunnel infection, and exit-site infections associated with LT-CVC were reported. Data from January to May 2021 were analyzed. The median monthly number of chemotherapy sessions per clinic was 925 (IQR, 270-5,855). We used Poisson regression to analyze the association of rates with the characteristics of the services. RESULTS In total, 107 LT-CVC infections were reported, of which 95% were BSIs, mostly associated with totally implantable devices (76%). Infections occurred a median of 4 days after the last catheter manipulation and 116 after the LT-CVC insertion. Also, 102 microorganisms were isolated from LT-CVC BSIs; the most common pathogen was Staphylococcus epidermidis, at 22%. Moreover, 44 infections (44%) fulfilled the criteria for CVC-related LT-CVC BSI and 27 infections (27%) met the criteria for mucosal barrier injury. The 1-year cumulative LT-CVC BSI rate was 1.94 per 1,000 CVC days of use. The rates were higher in public hospitals (IRR, 6.00; P < .001) and in hospitals that already had in place surveillance for LT-CVC infections (IRR, 2.01; P < .01). CONCLUSION Our study describes an applicable surveillance method for infections in cancer outpatients using LT-CVC.
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Affiliation(s)
- Maristela P Freire
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
- Infection Control Service, Cancer Institute of São Paulo State, São Paulo, Brazil
| | - Denise Brandão Assis
- Division of Hospital Infections, Center for Epidemiologic Surveillance "Prof. Alexandre Vranjac," Center for Disease Control, São Paulo State Health Department, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Icaro Boszczowski
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Edson Abdala
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
- Infection Control Service, Cancer Institute of São Paulo State, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious Diseases, Universidade de Sao Paulo, School of Medicine Hospital das Clínicas, São Paulo, Brazil
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Rosenthal VD, Yin R, Myatra SN, Memish ZA, Rodrigues C, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Afeef Al-Ruzzieh M, Aguirre-Avalos G, Guclu E, Gan CS, Jiménez Alvarez LF, Chawla R, Hlinkova S, Arjun R, Agha HM, Zuniga Chavarria MA, Davaadagva N, Lai YH, Gomez K, Aguilar-de-Moros D, Tai CW, Sassoe Gonzalez A, Aguilar Moreno LA, Sandhu K, Janc J, Aleman Bocanegra MC, Yildizdas D, Cano Medina YA, Villegas Mota MI, Omar AA, Duszynska W, El-Kholy AA, Alkhawaja SA, Florin GH, Medeiros EA, Tao L, Tumu N, Elanbya MG, Dongol R, Mioljević V, Raka L, Dueñas L, Carreazo NY, Dendane T, Ikram A, Kardas T, Petrov MM, Bouziri A, Viet-Hung N, Belskiy V, Elahi N, Salgado E, Jin Z. Multinational prospective study of incidence and risk factors for central-line-associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years. Infect Control Hosp Epidemiol 2023:1-11. [PMID: 37114756 DOI: 10.1017/ice.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify central-line (CL)-associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). DESIGN From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. SETTING The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PATIENTS In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. METHODS For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). RESULTS The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03-1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03-1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03-1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23-1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31-4.01; P <.0001) or at a teaching hospital (aOR, 2.91; 95% CI, 2.22-3.83; P < .0001), hospitalization in a middle-income country (aOR, 2.41; 95% CI, 2.09-2.77; P < .0001). The ICU type with highest risk was adult oncology (aOR, 4.35; 95% CI, 3.11-6.09; P < .0001), followed by pediatric oncology (aOR, 2.51;95% CI, 1.57-3.99; P < .0001), and pediatric (aOR, 2.34; 95% CI, 1.81-3.01; P < .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01; 95% CI, 2.71-3.33; P < .0001), followed by femoral (aOR, 2.29; 95% CI, 1.96-2.68; P < .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48; 95% CI, 1.02-2.18; P = .04). CONCLUSIONS The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
- INICC Foundation, International Nosocomial Infection Control Consortium, Miami, Florida, United States
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Camilla Rodrigues
- Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Chin Seng Gan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Ruzomberok, Slovakia
- Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | | | | | | | | | - Yin Hoong Lai
- International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | | | | | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | | | | | | | | | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Wieslawa Duszynska
- Wroclaw Medical University. Department of Anesthesiology and Intensive Therapy, Wroclaw, Poland
| | | | | | - George Horhat Florin
- University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
- Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua, New Guinea
| | | | | | | | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Tala Kardas
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | | | | | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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Lee J, Hur SM, Kim Z, Lim CW. Safety of immediate use of totally implantable venous access ports in adult patients with cancer: a retrospective single-center study. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:104-110. [PMID: 36945672 PMCID: PMC9942755 DOI: 10.14216/kjco.21016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023]
Abstract
Purpose Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications. Methods Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients' clinical data was performed to investigate catheter days and complications of TIVAPs. Results Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10-457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054-1.414; P=0.008). Conclusion This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.
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Affiliation(s)
- Jisu Lee
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Mo Hur
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Cheol Wan Lim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Li J, Chen W, Zhao W, Zhang H, Huang Z, Zhang S, Li Y. Surface measurement, intracardiac electrocardiogram and tracheal bifurcation techniques for locating the catheter tips of totally implantable venous access port. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105238. [PMID: 31862623 DOI: 10.1016/j.cmpb.2019.105238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The purpose of our study is to compare the reliability and consistency of three commonly used techniques, which are surface measurement, intracardiac electrocardiogram (IECG) and tracheal bifurcation methods in measuring the tip location of totally implantable venous access port (TIVAP) in the same patient. METHODS The thirty-five patients scheduled for implantation of TIVAP were included and right subclavian vein was selected for venous access. We used surface measurement method (Group L) to estimate the length and position of catheter before catheterization, and then we used IECG method (Group E) to confirm the position of catheter during catheterization and after catheterization used tracheal bifurcation method by CT (Group T) for measurement. The differences of catheter length measured by three methods were compared by non-parametric Kruskal-Wallis test. Intraclass correlation coefficient (ICC) was used to evaluate the reliability of three methods and Bland-Altman chart was used to evaluate consistency. RESULTS There are no difference in the length of TIVAP catheter between L and T groups (P > 0.05), but they have significant differences comparing with E group (P < 0.05). The three positioning methods have a good consistency (ICC = 0.886, P < 0.05).Through linear regression analysis, the regression equation are: catheter length (mm) = 77.32 + 0.66 × height (cm), 36.25 + 0.81 × height (cm) and 68.82 + 0.70 × height (cm). The distances from catheter tip to the junction of superior vena cava and right atrium measured by IECG (Group E) was closer to the target value. CONCLUSIONS All three methods can be used to measure the length of TIVAP catheter, and IECG method is the most accurate. And similar to most studies, returning the catheter 20 mm after positioning can avoid catheter entering the right atrium, but we found that 10 mm is a sufficient length to achieve this.
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Affiliation(s)
- Jun Li
- Department of Anesthesiology, Shulan Hospital, No. 848 Dongxin Road, Xiacheng District, Hangzhou 310022, China
| | - Wei Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Wenli Zhao
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Hu Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Zeyong Huang
- Department of Anesthesiology, Shulan Hospital, No. 848 Dongxin Road, Xiacheng District, Hangzhou 310022, China
| | - Shuping Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China
| | - Yuebing Li
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, China.
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Virulence genes profile and biofilm formation ability of Acinetobacter baumannii strains isolated from inpatients of a tertiary care hospital in southwest of Iran. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Beh HN, Sieunarine K. Arterio-venous fistula-expanding role for venous access in mastocytosis patients. J Surg Case Rep 2019; 2019:rjz053. [PMID: 30800282 PMCID: PMC6380077 DOI: 10.1093/jscr/rjz053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 01/17/2023] Open
Abstract
Long-term central venous access is increasingly common as there are growing number of patients suffering from conditions that require repeated infusions for various indications. However, central venous access has its downside where there is a risk of infection and thrombosis (F Pinelli, E Cecero, D Del'Innocenti, V Selmi, R Giua, G Villa et al., 'Infection of totally implantable venous access devices: a review of literature,' J Vasc Access 2018;19: 230-42.). Arterio-venous (AV) fistula is traditionally used for haemodialysis, however in patients requiring repeated access or long-term central venous access it can be considered as an unconventional solution. We report a case where 61-year-old male who has a history of systemic mastocytosis. He presents frequently to the Emergency Department with anaphylactic reaction requiring intravenous adrenaline, antihistamine and steroids. He had multiple issues with central lines as well as ports including line sepsis and thrombosis. On further discussion, an arterio-venous fistula was considered and surgically created to allow the AV fistula to be cannulated directly or under ultrasound guidance with its advantage it can be accessed rapidly in emergency setting.
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Affiliation(s)
- Han Nien Beh
- Department of Vascular Surgery, Joondalup Health Campus, Joondalup, WA, Australia
| | - Kishore Sieunarine
- Department of Vascular Surgery, Joondalup Health Campus, Joondalup, WA, Australia
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10
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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria. Antimicrob Agents Chemother 2018; 62:AAC.00569-18. [PMID: 29987150 DOI: 10.1128/aac.00569-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022] Open
Abstract
The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.
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11
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Lecronier M, Valade S, Bigé N, de Prost N, Roux D, Lebeaux D, Maury E, Azoulay E, Demoule A, Dres M. Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study. Ann Intensive Care 2018; 8:41. [PMID: 29594891 PMCID: PMC5874227 DOI: 10.1186/s13613-018-0383-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/08/2018] [Indexed: 12/29/2022] Open
Abstract
Background While no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis. Methods During this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections. Results One hundred and fifty-one patients (58 ± 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8–0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1–15.6), p = 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p = 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05–0.5), p < 0.01]. Conclusions TIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection. Electronic supplementary material The online version of this article (10.1186/s13613-018-0383-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Lecronier
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.
| | - Sandrine Valade
- Service de Réanimation médicale, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand-Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naike Bigé
- Service de Réanimation médicale, Groupe Hospitalier Est Parisien, Hôpital Saint-Antoine Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas de Prost
- Service de Réanimation médicale, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Damien Roux
- Service de Réanimation médico-chirurgicale, Groupe Hospitalier Paris Nord, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eric Maury
- Service de Réanimation médicale, Groupe Hospitalier Est Parisien, Hôpital Saint-Antoine Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elie Azoulay
- Service de Réanimation médicale, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand-Widal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Demoule
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.,INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Martin Dres
- Service de Pneumologie et Réanimation Médicale (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.,INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
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12
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Devrim İ, Oruç Y, Demirağ B, Kara A, Düzgöl M, Uslu S, Yaşar N, Aydın Köker S, Töret E, Bayram N, Vergin C. Central line bundle for prevention of central line-associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients. J Vasc Access 2018; 19:358-365. [PMID: 29926785 DOI: 10.1177/1129729818757955] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The clinical impact of central line bundle programs for central line-associated bloodstream infections has been well demonstrated in intensive care units. However, the experience of central line bundle programs in totally implantable venous access devices (ports) in pediatric-hematology patients was limited. METHODS A retrospective study was designed to compare and evaluate the clinical impact of implementing a central line bundle for a 2-year 5-month period, including 10 months of prebundle period, 11 months of central line bundle (that includes needleless split-septum devices), and finally 8 months of central line bundle period in which single-use prefilled flushing devices were added to the previous central line bundle. RESULTS During the prebundle period, the rate of 14.5 central line-associated bloodstream infections per 1000 CL-days had decreased to 5.49 CLABSIs per 1000 CL-days in the first bundle period. The incidence rate ratio with these two groups was 0.379, indicating a relative risk reduction of 62% ( p = 0.005). By the addition of single-use prefilled flushing devices to the first bundle program, the central line-associated bloodstream infection rate decreased to 2.63 per 1000 CL-days. Port removal rate due to central line-associated bloodstream infections was 0.46 per 1000 catheter days in the bundle period, which was significantly lower than in the prebundle period in which port removal rate was 4.5 per 1000 catheter days ( p < 0.001). CONCLUSION Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates, improving patients' quality of life by preventing ports removal due in pediatric cancer patients.
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Affiliation(s)
- İlker Devrim
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Yeliz Oruç
- 2 Department of Infection Control Committee, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Bengü Demirağ
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ahu Kara
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Mine Düzgöl
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Selma Uslu
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Nevbahar Yaşar
- 2 Department of Infection Control Committee, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Sultan Aydın Köker
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Ersin Töret
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Nuri Bayram
- 1 Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Canan Vergin
- 3 Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
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Pinelli F, Cecero E, Degl'Innocenti D, Selmi V, Giua R, Villa G, Chelazzi C, Romagnoli S, Pittiruti M. Infection of totally implantable venous access devices: A review of the literature. J Vasc Access 2018; 19:230-242. [PMID: 29512430 DOI: 10.1177/1129729818758999] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient's quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients' morbidity and mortality-both in the hospital or outpatient setting-and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device-related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device-related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device-related infections.
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Affiliation(s)
- Fulvio Pinelli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elena Cecero
- 2 Department of Health Science, University of Florence, Florence, Italy
| | | | - Valentina Selmi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rosa Giua
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Gianluca Villa
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Cosimo Chelazzi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- 4 Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Viana Taveira MR, Lima LS, de Araújo CC, de Mello MJG. Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study. Pediatr Blood Cancer 2017; 64:336-342. [PMID: 27666952 DOI: 10.1002/pbc.26225] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Totally implantable venous access ports (TIVAPs) are used for prolonged central venous access, allowing the infusion of chemotherapy and other fluids and improving the quality of life of children with cancer. TIVAPs were developed to reduce the infection rates associated with central venous catheters; however, infectious events remain common and have not been fully investigated in pediatric oncology patients. PROCEDURE A retrospective cohort was formed to investigate risk factors for central line-associated bloodstream infection (CLABSI) in pediatric cancer patients. Sociodemographic, clinical, and TIVAP insertion-related variables were evaluated, with the endpoint being the first CLABSI. A Kaplan-Meier analysis was performed to determine CLABSI-free catheter survival. RESULTS Overall, 188 children were evaluated over 77,541 catheter days, with 94 being diagnosed with CLABSI (50%). Although coagulase-negative staphylococci were the pathogens most commonly isolated, Gram-negative microorganisms (46.8%) were also prevalent. In the multivariate analysis, factors that increased the risk for CLABSI were TIVAP insertion prior to chemotherapy (risk ratio [RR] = 1.56; P < 0.01), white blood cell count less than 1,000 mm-3 on the day of implantation (RR = 1.64; P < 0.01), and chronic malnutrition (RR = 1.41; P < 0.05). Median time without CLABSI following TIVAP insertion was 74.5 days. CONCLUSIONS Risk factors for CLABSI in pediatric cancer patients with a TIVAP may be related to the severity of the child's condition at catheter insertion. Insertion of the catheter before chemotherapy and unfavorable conditions such as malnutrition and bone marrow aplasia can increase the risk of CLABSI. Protocols must be revised and surveillance increased over the first 10 weeks of treatment.
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Affiliation(s)
| | - Luciana Santana Lima
- Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, Pernambuco, Brazil
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