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Hara Y, Sumida Y, Yamazaki S, Takei D, Yamashita M, Fukuda A, Hisanaga M, Tanaka T, Wakata K, Miyazaki T, Araki M, Yano H, Nakamura A. Risk factors for infection of totally implantable central venous access ports among patients requiring port removal. J Vasc Access 2024:11297298231225808. [PMID: 38316617 DOI: 10.1177/11297298231225808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Totally implantable central venous access ports, are required for various purposes, ranging from chemotherapy to nutrition. Port infection is a common complication. In many patients with port infection, the ports are removed because antibiotics are ineffective. We evaluated the risk factors associated with port removal due to port infection. METHODS By retrospective chart review, we collected data of 223 patients who underwent port removal for any reason. Port infection was defined as infection symptoms, such as fever; elevated white blood cell counts or C-reactive protein levels; or redness at the port site, in the absence of other infections, which improved with port removal. The characteristics of patients with or without port infection were compared using univariate (chi-squared test, t-test) and multivariate logistic regression analyses. RESULTS We compared 172 patients without port infection to 51 patients with port infection. Univariate analysis identified sex (p = 0.01), body mass index (BMI) ⩽20 kg/m2 (p = 0.00004), diabetes mellitus (p = 0.04), and purpose of use (p = 0.0000003) as significant variables. However, male sex (p = 0.03, 95% confidence interval [CI]: 0.01-0.23), BMI ⩽20 kg m2 (p = 0.002, 95% CI: 0.06-0.29), and purpose of use (total parenteral nutrition (TPN); p = 0.000005, 95% CI: 0.31-0.76) remained significant using multivariate analysis. Moreover, the patients with short bowel syndrome and difficulty in oral intake tended to be infected easily. Additionally, Staphylococcus species were the most common microbes involved in port infection. CONCLUSIONS Male sex, BMI ⩽20 kg/m2, and purpose of use as a TPN were risk factors for port infection. Ports should not be used for long duration of TPN or used only in exceptional cases.
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Affiliation(s)
- Yuki Hara
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Yorihisa Sumida
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Shoto Yamazaki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Daiki Takei
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Manpei Yamashita
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Akiko Fukuda
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Makoto Hisanaga
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Takayuki Tanaka
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Koki Wakata
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Hiroshi Yano
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Akihiro Nakamura
- Department of Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
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Moriyama K, Ando T, Kotani M, Tokumine J, Nakazawa H, Motoyasu A, Yorozu T. Risk factors associated with increased incidences of catheter-related bloodstream infection. Medicine (Baltimore) 2022; 101:e31160. [PMID: 36281147 PMCID: PMC9592381 DOI: 10.1097/md.0000000000031160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have implemented several preventive measures to reduce central line-associated bloodstream infection (CLABSI) in the general intensive care unit (ICU) of a university hospital in Japan. Here, we analyzed the factors associated with CLABSI in patients with central venous catheter (CVC) insertions and evaluated the effects of our implemented preventive measures. From July 2013 to June 2018, data was collected from the medical records of 1472 patients with 1635 CVC insertions, including age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of ICU stay, duration of catheter insertion, insertion site, and mechanical ventilation status. During weekly conferences, a surveillance team comprising intensive care and infection control doctors and nurses determined the patients' CLABSI status. The analyzed factors were compared between CLABSI and central line patients without bloodstream infection. Multivariate analysis revealed three factors associated with CLABSI. Adjusted odds ratios with 95% confidence intervals were as follows: duration of ICU stay, 1.032 (1.019-1.044); duration of catheter insertion, 1.041 (1.015-1.066); and APACHE II score, 1.051 (1.000-1.105). The prominent risk factors were associated with the severity of the initial condition and exacerbation of the clinical condition of the patients during their stays in the ICU. Further strategies to reduce CLABSI must be developed.
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Affiliation(s)
- Kiyoshi Moriyama
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadao Ando
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mariko Kotani
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akira Motoyasu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
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Epidemiology and outcome of occult bacteremia in patients discharged from emergency departments or ambulatory units: one-year study. Eur J Clin Microbiol Infect Dis 2022; 41:649-655. [PMID: 35150380 DOI: 10.1007/s10096-022-04419-2] [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: 11/08/2021] [Accepted: 02/04/2022] [Indexed: 11/03/2022]
Abstract
Microbiological diagnosis of bloodstream infection (BSI) is made several hours after blood culture sampling. This delay could be critical in ambulatory clinics, emergency departments, and hospital day care units, as the patient may be discharged prior to blood culture positivity. Our aim was to evaluate the clinical outcome (including the number of readmissions) of patients diagnosed with BSI after discharge. We prospectively included all adult patients with positive blood culture for BSI that was confirmed after discharge from our center (Grenoble-Alpes University Hospital) in 2016. Patients were contacted about their blood culture results, and their clinical status was controlled via an external consultation or their family physician, with hospital readmission if necessary. Clinical outcome, accuracy of initial diagnosis, microbiological epidemiology, and antibiotic prescription were assessed. In 2016, 1433 episodes of positive blood culture were detected in our hospital, with 50 (3.5%) occurring after patient discharge. Clinically relevant bacteria were determined in 32/50 cases (64%), while other positive blood culture results were considered to be contaminants. Clinical reevaluation was performed in 45 patients (90%). The diagnosis was changed during the clinical reassessment of 24/49 patients (49%). Antibiotics were prescribed prior to discharge for 24/50 patients (48%), modified during follow-up for 15/45 (33%), and initiated for 13/45 (29%) at the reevaluation. Overall, 24/45 (53%) patients were readmitted to hospital units after reevaluation. The clinical follow-up of patients with positive blood culture after discharge led to diagnostic changes and hospital readmission in around half of patients.
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Grossi F, Jaśkiewicz P, Ferreira M, Czyżewicz G, Kowalski D, Ciuffreda L, Garcia-Gomez R, Caruso S, Bosch-Barrera J, Gautier S, Ta Thanh Minh C, Henriet S, de Castro G. Oral vinorelbine and cisplatin as first-line therapy for advanced squamous NSCLC patients: a prospective randomized international phase II study (NAVoTrial 03). Ther Adv Med Oncol 2021; 13:17588359211022905. [PMID: 34349841 PMCID: PMC8287271 DOI: 10.1177/17588359211022905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: The study investigated the efficacy and safety of oral vinorelbine-cisplatin (OV-CDDP) and gemcitabine-cisplatin (GEM-CDDP) in patients with squamous non-small cell lung cancer (sq-NSCLC). Patients and methods: This was an open-label, prospective, multicenter, international phase II study that enrolled untreated patients with advanced sq-NSCLC. Patients were randomized to receive 3-week cycles of either 60–80 mg/m2 OV days 1 and 8 in combination with 80 mg/m2 CDDP day 1 (arm A) or 1250 mg/m2 GEM days 1 and 8 in combination with 75 mg/m2 CDDP day 1 (arm B). After four cycles, patients without disease progression continued maintenance dose of OV or GEM until progression or unacceptable toxicity. The primary objective was disease control rate (DCR). Secondary objectives included progression-free survival (PFS), time to treatment failure (TTF), overall survival (OS), safety, and quality of life (QoL). Results: A total of 114 patients with sq-NSCLC were randomized, and 113 were treated (57 in arm A and 56 in arm B). DCR was high in both arms: 73.7% (95%CI: 62.4–100.0) in arm A and 75.0% (95%CI: 63.7–100.0) in arm B. Median PFS and TTF were similar in arm A and B 4.2 and 2.8 months, and 4.3 and 3.1 months, respectively. Even though the difference was not significant, the OS was 10.2 for arm A and 8.4 months for arm B. The safety profiles were consistent with the current knowledge of adverse events. QoL results revealed an improvement in patients under OV treatment. Conclusion: The OV-CDDP combination showed comparable efficacy to GEM-CDDP with acceptable safety profile and enhanced patients’ QoL. Trial registration: The study was registered under EudraCT number 2012-003531-40.
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Affiliation(s)
- Francesco Grossi
- UOC Oncologia Medica, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Piotr Jaśkiewicz
- Lung Cancer and Chest Tumours Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | - Dariusz Kowalski
- Lung Cancer and Chest Tumours Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Libero Ciuffreda
- Oncology Department, AOU S. Giovanni Battista - Molinette, Turin, Italy
| | - Ramon Garcia-Gomez
- Oncology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Salvatore Caruso
- Oncology Department,VAR, CH de la Dracenie - Draguignan, Draguignan, France
| | - Joaquim Bosch-Barrera
- Oncology Department, Catalan Institute of Oncology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | | | | | | | - Gilberto de Castro
- Clinical Oncology, ICESP - Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Fatal Infections Among Cancer Patients: A Population-Based Study in the United States. Infect Dis Ther 2021; 10:871-895. [PMID: 33761114 PMCID: PMC8116465 DOI: 10.1007/s40121-021-00433-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Cancer patients are prone to infections, but the mortality of fatal infections remains unclear. Understanding the patterns of fatal infections in patients with cancer is imperative. In this study, we report the characteristics, incidence, and predictive risk factors of fatal infections among a population-based cancer cohort. Methods A total of 8,471,051 patients diagnosed with cancer between 1975 and 2016 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) program. The primary outcome was dying from fatal infections. Mortality rates and standardized mortality ratios (SMRs) adjusted for age, sex, race, and calendar year were calculated to characterize the relative risks of dying from fatal infections and to compare with the general population. Furthermore, cumulative mortality rates and the Cox regression models were applied to identify predictive risk factors of fatal infections. Results In cancer patients, the mortality rate of fatal infections was 260.1/100,000 person-years, nearly three times that of the general population [SMR, 2.92; 95% (confidence interval) CI 2.91–2.94]. Notably, a decreasing trend in mortality rate of fatal infections was observed in recent decades. SMRs of fatal infections were highest in Kaposi sarcoma (SMR, 162.2; 95% CI 159.4–165.1), liver cancer (SMR, 30.9; 95% CI 30.0–31.8), acute lymphocytic leukemia (SMR, 19.1; 95% CI 17.0–21.4), and acute myeloid leukemia (SMR, 13.3; 95% CI 12.4–14.3). Patients aged between 20 and 39 years old exhibited a higher cumulative mortality rate in the first few years after cancer diagnosis, whereas the cumulative mortality rate of those > 80 years old was rapidly increasing and became the highest approximately 3 years post-cancer diagnosis. Predictive risk factors of dying from fatal infections in cancer patients were the age of 20–39 or > 80 years, male sex, black race, diagnosed with cancer before 2000, unmarried status, advanced cancer stage, and not receiving surgery and radiotherapy, but receiving chemotherapy. Conclusion Cancer patients were at high risks of dying from infectious diseases. Certain groups of cancer patients, including those aged between 20 and 39 or > 80 years, as well as those receiving chemotherapy, should be sensitized to the risk of fatal infections. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00433-7.
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Böll B, Schalk E, Buchheidt D, Hasenkamp J, Kiehl M, Kiderlen TR, Kochanek M, Koldehoff M, Kostrewa P, Claßen AY, Mellinghoff SC, Metzner B, Penack O, Ruhnke M, Vehreschild MJGT, Weissinger F, Wolf HH, Karthaus M, Hentrich M. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2021; 100:239-259. [PMID: 32997191 PMCID: PMC7782365 DOI: 10.1007/s00277-020-04286-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.
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Affiliation(s)
- Boris Böll
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, Magdeburg, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Oncology, University Medicine Göttingen, Georg-August-University, Göttingen, Germany
| | - Michael Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Til Ramon Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Kostrewa
- Department of Hematology and Oncology, Campus Fulda, Philipps-University Marburg, Fulda, Germany
| | - Annika Y Claßen
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd Metzner
- Department of Hematology and Oncology, University Hospital Oldenburg, Oldenburg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Hematology and Oncology, Helios Klinikum Aue, Aue, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Weissinger
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department III of Internal Medicine, Hematology, Oncology and Hemostaseology, Südharzklinikum, Nordhausen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
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Oliveira TB, Mesía R, Falco A, Hsieh JCH, Yokota T, Saada-Bouzid E, Schmitz S, Elicin O, Giacomelli L, Bossi P. Defining the needs of patients with recurrent and/or metastatic head and neck cancer: An expert opinion. Crit Rev Oncol Hematol 2020; 157:103200. [PMID: 33321152 DOI: 10.1016/j.critrevonc.2020.103200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/08/2023] Open
Abstract
The clinical and biological heterogeneity of head and neck cancer (HNC) is paralleled by a plethora of different symptoms that affect the patient's quality of life. These symptoms include, for instance, pain, fatigue, nutritional issues, airways obstruction, voice alterations and psychological distress. In addition, patients with HNC are prone to a high risk of infection, and may also suffer from acute complications, such as hypercalcemia, spine compression by bone metastasis or bleeding. Prolonging survival is also an inherent expectation for all patients. Addressing the above needs is crucial in all patients with HNC, and especially in those with recurrent and/or metastatic (RM) disease. However, research on how to address patients' needs in RM-HNC remains scarce. This paper defines patients' needs for RM HNC and presents an Expert Opinion on how to address them, proposing also some lines of research.
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Affiliation(s)
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Barcelona, Spain
| | - Agustin Falco
- Medical Oncology Department, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, 333, Taiwan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - Sandra Schmitz
- Departments of Medical Oncology and Head and Neck Surgery, Institut Roi Albert II, Institut de Recherche Clinique et Expérimentale (Pole MIRO), Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Woluwe-Saint-Lambert, Belgium
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Luca Giacomelli
- Polistudium srl, Milan, Italy; Department of Surgical Sciences and Integrated Diangostics, University of Genoa, Genoa, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, 25123, Brescia, Italy.
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Ye F, Liu Y, Yu P, Li N, Wang Y, Xie X, Tang J. Intraoperative ipsilateral subclavian port catheter implantation in resectable breast cancer patients: A novel, safe, and convenient clinical practice. Cancer Med 2020; 9:8970-8978. [PMID: 33145946 PMCID: PMC7724495 DOI: 10.1002/cam4.3595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Port catheter (PC) is a classical route of administering chemotherapy for breast cancer patients. We established a standard operating procedure (SOP) of intraoperative ipsilateral subclavian PC implantation in selected resectable breast cancer patients. Methods We conducted a prospective clinical study to assess its safety and complications. A total of seventy six resectable breast cancer patients were included for intraoperative ipsilateral subclavian PC implantation. Thirty patients receiving conventional percutaneous contralateral PC implantation under local anesthesia at the same period were recruited as control group. The time consuming of implantation, and PC‐related complications were recorded. Visual analog scale questionnaires were used to assess patients’ satisfaction. Results Compared with conventional contralateral PC implantation under local anesthesia, SOP for intraoperative ipsilateral subclavian PC implantation significantly shortens the time consuming (11.6 vs. 28.6 min, p < 0.001). With a median retention time of 6.3 months, the overall incidence rate of PC‐related complications is 21%, of which the most common complications are infections and venous thromboembolism (7.9% for each). Most patients (86.8%) with intraoperative ipsilateral subclavian PC implantation have completed the whole chemotherapy successfully. Due to the general anesthesia and shorter time consuming, intraoperative implantation gains significantly more patients' satisfaction. Conclusions In the present study, we develop a SOP for intraoperative ipsilateral subclavian PC implantation in resectable breast cancer patients, which is noval, convenient, and safe. In selected breast cancer patients with indications for adjuvant chemotherapy, this practice could significantly shorten the time consuming of PC implantation and improve the degree of patients' satisfaction.
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Affiliation(s)
- Feng Ye
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ping Yu
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Na Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yan Wang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jun Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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Nair RM, Maroo A. The concoction of cancer, catheter, and intracardiac clot: a case report describing a potential treatment strategy. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33204995 PMCID: PMC7649519 DOI: 10.1093/ehjcr/ytaa360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/27/2020] [Accepted: 09/10/2020] [Indexed: 11/21/2022]
Abstract
Background Patients with cancer often pose a unique challenge to anticoagulation, as they have a higher risk of bleeding and clotting than the general population. Patients with cancer and catheter-related intracardiac thrombus are a very specific subset of people who do not have specific recommendations guiding their treatment. This article aims to address the existing knowledge gaps in this scenario and provide a possible treatment approach for these patients. Case summary We describe the case of a 46-year-old lady with invasive breast cancer, who was on chemotherapy through a central venous catheter and was found to have a right atrial thrombus on routine echocardiography. Due to the paucity of data in this scenario and because the patient requested an oral anticoagulant which did not need frequent monitoring, we started her on apixaban for a total of 3 months. Echocardiogram was repeated at 4 and 8 weeks. In the 8-week echocardiogram, the right atrial thrombus was no longer visualized. Discussion Malignancy and central venous catheters significantly increase the risk of thrombosis. Although low molecular weight heparin is the preferred anticoagulant to manage thrombosis in patients with cancer, direct oral anticoagulants have been proven to be non-inferior. In patients with catheter-related intracardiac thrombus, anticoagulation should be continued for at least 3 months or until the catheter is removed, whichever is longer.
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Affiliation(s)
- Raunak Mohan Nair
- Department of Internal medicine, Cleveland Clinic Fairview Hospital, 18101 Lorain Ave, Cleveland, OH 44111, USA
| | - Anjli Maroo
- Section of Cardiology, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
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10
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Yu XY, Xu JL, Li D, Jiang ZF. Late complications of totally implantable venous access ports in patients with cancer: Risk factors and related nursing strategies. Medicine (Baltimore) 2018; 97:e12427. [PMID: 30235721 PMCID: PMC6160048 DOI: 10.1097/md.0000000000012427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to assess the incidence rate and the risk factors for late complications associated with use of central totally implanted venous access devices (TIVAPs) in patients with cancer, and to devise nursing strategies to minimize late complications.This retrospective study included 500 patients with TIVAPs from 2012 to 2015. Multivariable logistic regression analysis was performed to assess the effect of sex, age, primary diagnosis, duration of surgery, and the length of hospital stay on the incidence of late complications of TIVAP.The cumulative maintenance period of TIVAP was 159,605 days. Late complications included catheter-related obstruction (n = 14; 2.8%), infection (n = 3; 0.6%), drug extravasation (n = 1; 0.2%), and catheter exposure (n = 1; 0.2%). Multivariate analyses revealed that age, breast cancer, lung cancer, and gastric cancer were risk factors for the late complications associated with TIVAP.There was a low incidence of late complications with TIVAP use. Catheter-related obstruction is the most frequent late complication of TIVAP. Risk factors for TIVAP-associated late complications include age and certain cancers, such as breast cancer, lung cancer, and gastric cancer.
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Puri BK, Derham A, Monro JA. Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices. Rev Recent Clin Trials 2018; 14:47-49. [PMID: 30117400 DOI: 10.2174/1574887113666180817125036] [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: 06/21/2018] [Revised: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. OBJECTIVE We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. METHOD A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. RESULTS There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. CONCLUSION It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.
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Affiliation(s)
- Basant K Puri
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Anne Derham
- Breakspear Medical Group, Hemel Hempstead, Hertfordshire, United Kingdom
| | - Jean A Monro
- Breakspear Medical Group, Hemel Hempstead, Hertfordshire, United Kingdom
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12
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Pliakos EE, Andreatos N, Ziakas PD, Mylonakis E. The Cost-effectiveness of Antimicrobial Lock Solutions for the Prevention of Central Line–Associated Bloodstream Infections. Clin Infect Dis 2018; 68:419-425. [DOI: 10.1093/cid/ciy511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Elina Eleftheria Pliakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
| | - Nikolaos Andreatos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
| | - Panayiotis D Ziakas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
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13
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Right or left? Side selection for a totally implantable vascular access device: a randomised observational study. Br J Cancer 2017; 117:932-937. [PMID: 28787431 PMCID: PMC5625671 DOI: 10.1038/bjc.2017.264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/11/2017] [Accepted: 07/17/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Totally implantable vascular access device (TIVAD)-related complications interfere in the anticancer treatment and increase medical expenses. We examined whether the implantation side of central line TIVADs is associated with the occurrence of thrombotic or occlusion events. METHODS We enrolled patients with cancer who required central line TIVADs and randomised them to receive the TIVAD implantation on either the left or right side. The primary endpoint was the occurrence of catheter-related thrombotic or occlusion events. RESULTS We randomised 240 patients, of which 235 received TIVAD implantation according to the protocol. In the per-protocol cohort, 117 and 118 patients received implantation on the left and right sides, respectively. Catheter-related thrombotic or occlusion events occurred in 9 (4%) patients, accounting for 0.065 events per 1000 catheter-days. Between the patients with left- and right-sided implantations, the occurrence rates (P=0.333) and the time from catheter implantation to the occurrence of thrombotic or occlusion events (P=0.328) were both similar. In the multivariate analysis, the side of implantation remained unassociated with the occurrence of thrombotic or occlusion events. CONCLUSIONS The side of central line TIVAD implantation was not associated with the occurrence of catheter-related thrombotic or occlusion events in patients with cancer.
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Abstract
Pancreatic cancer is more common in older adults, who are underrepresented in clinical trials and frequently under treated. Chronological age alone should not deter clinicians from offering treatment to geriatric patients, as they are a heterogeneous population. Geriatric assessment, frailty assessment tools, and toxicity risk scores help clinicians select appropriate patients for therapy. For resectable disease, surgery can be safe but should be done at a high-volume center. Adjuvant therapy is important; though there remains controversy on the role of radiation, chemotherapy is well studied and efficacious. In locally advanced unresectable disease, chemoradiation or chemotherapy alone is an option. Neoadjuvant therapy improves the chances of resectability in borderline resectable disease. Chemotherapy extends survival in metastatic disease, but treatment goals and risk-benefit ratios have to be clarified. Adequate symptom management and supportive care are important. There are now many new treatment strategies and novel therapies for this disease.
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Patel PA, Boehm S, Zhou Y, Zhu C, Peterson KE, Grayes A, Peterson LR. Prospective observational study on central line-associated bloodstream infections and central venous catheter occlusions using a negative displacement connector with an alcohol disinfecting cap. Am J Infect Control 2017; 45:115-120. [PMID: 27499191 DOI: 10.1016/j.ajic.2016.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Major complications of central venous catheter (CVC) use include bloodstream infection and occlusion. We performed a prospective, observational study to determine the rate of central line-associated bloodstream infection (CLABSI) and CVC occlusion using a negative displacement connector with an alcohol disinfecting cap. METHODS Patients were followed from the time of CVC insertion through 2 days after removal, at the time of hospital discharge if there was no documentation of removal, or 90 days after the insertion of the CVC if it was not removed. CLABSI was defined using National Healthcare Safety Network criteria. Data for evidence of lumen occlusions were extracted from the electronic health record. Direct observations were performed to assess adherence to hospital policy regarding CVC insertion practice. RESULTS A total of 2,512 catheters from 2,264 patients were enrolled for this study. There were 21 CLABSIs (0.84%; 95% confidence interval [CI], 0.48%-1.19%; 0.62 per 1,000 line days) and 378 occlusions (15.05%; 95% CI, 13.65%-16.45%; 11.23 per 1,000 line days). Eighty-five direct observations demonstrated insertion protocol adherence in 881 of 925 (95.24%; 95% CI, 93.87%-96.61%) measured criteria. CONCLUSIONS Lines placed following a standardized protocol using a negative displacement connector with an alcohol cap have low rates of infection compared with historically published findings. We also established that the occlusion rate is >15-fold the CLABSI rate.
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Affiliation(s)
| | - Susan Boehm
- NorthShore University Health System, Evanston, IL
| | - Ying Zhou
- NorthShore University Health System, Evanston, IL
| | | | | | | | - Lance R Peterson
- NorthShore University Health System, Evanston, IL; University of Chicago Pritzker School of Medicine, Chicago, IL
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16
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Carry-Littles K, Nguyen K, Rowe T, Johnston PA, Brassil K. Symptom word documentation: A novel approach to identifying and managing hospital-acquired infections. Am J Infect Control 2016; 44:1424-1426. [PMID: 27112369 DOI: 10.1016/j.ajic.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 11/16/2022]
Abstract
An interprofessional team developed a symptom word documentation tool based on surveillance definitions for specific types of infections published by the Centers for Disease Control and Prevention. Nursing documentation was monitored pre- and postimplementation of the tool, revealing increased compliance with symptom documentation. Although symptom word documentation does not reduce the number of infections, it may impact the central line-associated bloodstream infection (CLABSI) rate by better differentiating CLABSI from other infection sources, as was observed in this institution.
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Affiliation(s)
- Kim Carry-Littles
- The Division of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Kim Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, TX; The Department of Infection Control, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Todd Rowe
- The Division of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Patricia A Johnston
- The Division of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly Brassil
- The Division of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Diaz JA, Rai SN, Wu X, Chao JH, Dias AL, Kloecker GH. Phase II Trial on Extending the Maintenance Flushing Interval of Implanted Ports. J Oncol Pract 2016; 13:e22-e28. [PMID: 28084883 DOI: 10.1200/jop.2016.010843] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retrospective studies suggest that it may be safe to extend the maintenance flushing interval of implanted ports from once every month, as recommended by the manufacturer, to once every 3 months, but no prospective cohort studies have been done specifically assessing the safety and feasibility of this intervention. METHODS This was a phase II study in oncologic patients who retained a functional port after completion of systemic chemotherapy. Patients enrolled in the study had their port flushed once every 3 months and were observed until completion of five scheduled flushes (one on enrollment and four additional flushes, one every 3 months) or development of any port-related complication, including infections, thrombosis, and occlusions. The primary end points were frequency of port-related complications and port failure requiring removal. RESULTS A total of 87 patients were enrolled in the study. The median follow-up time was 308 days, accounting for a total of 24,202 catheter-days. There were 10 port-related complications (11.49%; 95% CI, 4.85% to 18.14%). No infection or symptomatic thrombosis occurred. The mean time to port-related complication was 184 days. No patients developed port failure while on protocol, but on subsequent medical record review, four patients developed a complication that required port removal or port revision within 30 days of being removed from the trial (4.6%; 95% CI, 0.4% to 8.8%; 0.17/1,000 catheter-days). CONCLUSION Extending the maintenance flushes of implanted ports in adult oncologic patients to once every 3 months is safe, effective, and likely to increase patient adherence and satisfaction while decreasing the associated cost.
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Affiliation(s)
- Jorge A Diaz
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Shesh N Rai
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Xiaoyoung Wu
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Ju-Hsien Chao
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Ajoy L Dias
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
| | - Goetz H Kloecker
- University of Louisville James Graham Brown Cancer Center, Louisville, KY
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18
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Wang Z, Shen M, Qiao M, Zhang H, Tang Z. Clinical factors and incidence of prolonged fever in neurosurgical patients. J Clin Nurs 2016; 26:411-417. [PMID: 27240113 DOI: 10.1111/jocn.13409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 01/13/2023]
Abstract
AIMS AND OBJECTIVES To describe the incidence of prolonged fever in patients admitted to the neurosurgery department, and the corresponding risk indicators. BACKGROUND Prolonged fever was defined as a temperature higher than 38·3°C lasting more than five days. Prolonged fever is a common phenomenon and could lead to worsened outcomes in specific patient groups, especially for those with brain injury. However, the studies on prolonged fever in neurosurgical patients are limited and insufficient. DESIGN A retrospective observational study. METHODS Retrospective data were collected from 1 January 2014 to 31 December 2014, at the neurosurgical department of a large teaching hospital. We performed univariate and multivariate analyses to identify independent indicators for prolonged fever vs. short-term fever. RESULTS Among 2845 patients, prolonged fever occurred in 466 (16%). The older patients were associated with longer duration of mechanical ventilation and hospital stay. It predominantly occurred in patients with subarachnoid haemorrhage (SAH) and traumatic brain injury. Patients receiving antibiotic treatment tended to manifest prolonged fever more frequently. Multivariate analysis revealed that the use of antibiotics, central venous catheter and prolonged mechanical ventilation were independent risk predictors for prolonged fever. Patients diagnosed with brain tumour seemed to be not associated with prolonged fever. CONCLUSIONS Prolonged fever is the common complication in neurosurgical patients. The risks of prolonged fever in patients are attributed to antibiotic therapy, use of central venous catheter and prolonged mechanical ventilation. Indicators of prolonged fever are helpful for better identification of high-risk patients and fever control. RELEVANCE TO CLINICAL PRACTICE A better reveal on the epidemiology and predictable factors of prolonged fever in neurosurgical patients will provide a better understanding on those patients who are most at risk, and therefore contribute to fever control and better outcome.
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Affiliation(s)
- Zhuo Wang
- School of Nursing, Medical College of Huzhou University, Huzhou, China
| | - Meifen Shen
- School of Nursing, Medical College of Soochow University, Suzhou, China.,Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meizhen Qiao
- Department of Infection Control, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiyin Zhang
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zaixiang Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
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Ma LI, Liu Y, Wang J, Chang Y, Yu L, Geng C. Totally implantable venous access port systems and associated complications: A single-institution retrospective analysis of 2,996 breast cancer patients. Mol Clin Oncol 2016; 4:456-460. [PMID: 26998304 DOI: 10.3892/mco.2016.726] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022] Open
Abstract
Totally implantable venous access port systems (TIVAPS) are widely used in breast cancer patients. However, complications are frequent and may necessitate device replacement or removal, resulting in additional patient stress and treatment delays. The aim of this study was to investigate possible risk factors for complications. A total of 2,996 consecutive female breast cancer patients, with a median age of 50.2 years (range, 21.2-85.5 years) were enrolled in this observational, single-centre study between December, 2008 and April, 2014. TIVAPS implantation was principally performed using local anaesthesia and the blind puncture or Seldinger technique through internal jugular or subclavian vein access. A retrospective chart review was conducted to obtain information associated with TIVAPS and patient data. Insertion performed by blind puncture and Seldinger technique had a success ratio of 96.34 and 99.80%, respectively (χ2=29.905, P<0.001). However, the success ratio of the puncture technique group was 99.76% when the TIVAPS was implanted in the right internal jugular vein. The most common complications were late complications, with an overall incidence rate of 5.41% (162/2,996) during the entire device duration. The most common late complications included fibrin formation (1.84%, 55/2,996), port-related bacteraemia (1.44%, 43/2,996) and deep vein thrombosis (0.63%, 19/2,996). No patient died during the study. Our results demonstrated that insertion of TIVAPS by blind puncture or the Seldinger technique through internal jugular or subclavian vein access is convenient, and insertion by the Seldinger technique through the right internal jugular vein is the preferred method. Therefore, TIVAPS is safe for continuous infusional chemotherapy regimens for breast cancer patients.
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Affiliation(s)
- L I Ma
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Jianxin Wang
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yuan Chang
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Long Yu
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Cuizhi Geng
- Breast Disease Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
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Sousa B, Furlanetto J, Hutka M, Gouveia P, Wuerstlein R, Mariz JM, Pinto D, Cardoso F. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol 2015; 26 Suppl 5:v152-68. [PMID: 26314776 DOI: 10.1093/annonc/mdv296] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- B Sousa
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | | | - M Hutka
- St George's University Hospitals, NHS Foundation Trust, London, UK
| | - P Gouveia
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - R Wuerstlein
- CCC of LMU, Breast Center, University Hospital Munich, Munich, Germany
| | - J M Mariz
- Department of Haematology, Instituto Português de Oncologia do Porto- Francisco Gentil, Oporto, Portugal
| | - D Pinto
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal
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Abstract
BACKGROUND Identifying unwarranted variation in health care can highlight opportunities to reduce harm. One often discretionary process in oncology is use of implanted ports to administer intravenous chemotherapy. While there are benefits, ports carry risks. This study's objective was to assess provider-driven variation in port use among cancer patients receiving chemotherapy. RESEARCH DESIGN Retrospective assessment using population-based SEER-Medicare data to assess differences in port use across health care providers of older adults with cancer. Participants included over 18,000 patients ages 66 and older diagnosed with breast, colorectal, lung, or pancreatic cancer in 2005-2007, treated by approximately 2900 providers. We identified port use for patients receiving treatment from hospital outpatient facilities versus physicians' offices. Our main analysis assessed the likelihood of a patient receiving a port given port use by the provider's last patient. For a subset of high-use providers, we examined individual provider-level variation by estimating the risk-adjusted likelihood of insertion. RESULTS Patients receiving chemotherapy in hospital outpatient facilities were significantly less likely to receive a port than those treated in physicians' offices, with adjusted odds ratios (AOR) varying from 0.50 to 0.75 across cancer sites. Implanting a port was associated with increased likelihood of port insertion in the provider's next patient (AOR varied from 1.71 to 2.25). Significant between-provider variation was found among providers with at least 10 patients. CONCLUSIONS Our findings support the idea that there is provider-driven variation in the use of ports for chemotherapy administration. This variation highlights an opportunity to standardize practice and reduce unnecessary use.
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Lipitz-Snyderman A, Ma Q, Pollack MF, Barron J, Elkin EB, Bach PB, Malin JL. Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer. J Oncol Pract 2015; 11:505-10. [PMID: 26265170 DOI: 10.1200/jop.2015.004796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite some advantages to their use, long-term central venous catheters (CVCs) are associated with complications for patients who require chemotherapy. Understanding of these risks in commercially insured populations is limited. This information can inform medical policies that ensure the appropriate use of venous access devices. This study's objectives were to assess the extent of variation in use of long-term CVCs in a cohort of commercially insured women with breast cancer, and to assess risks of associated complications. METHODS Retrospective cohort analysis was conducted using health insurance claims between January 2006 and October 2013. The cohort included commercially insured women age ≥ 18 years diagnosed with breast cancer who received infusion chemotherapy (N = 31,047). We conducted matched and case-mix adjusted Cox proportional hazard modeling to assess differences in bloodstream infections and thrombovascular complications between patients using long-term CVCs and those using temporary intravenous catheters. RESULTS Approximately two thirds of the cohort had a long-term CVC, although rates varied across regions (57% to 75%), health plans (65% to 70%), and insurance coverage (63% to 68%). After propensity score matching, the adjusted hazard ratio for infection was 2.70 (95% CI, 2.31 to 3.16) and thrombovascular complications, 2.61 (95% CI, 2.33 to 2.93) in patients with long-term CVCs compared with those with temporary intravenous catheters. CONCLUSION Although long-term CVCs may have benefits, they are associated with increased morbidity. Regional and health plan variation in long-term CVC insertion suggests that some of their use reflects provider- or institution-driven variation in practice. Evidence-based guidelines and tools may help decrease discretionary use of long-term CVCs.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Qinli Ma
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Michael F Pollack
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - John Barron
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Elena B Elkin
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Jennifer L Malin
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
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23
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Piredda M, Biagioli V, Giannarelli D, Incletoli D, Grieco F, Carassiti M, De Marinis MG. Improving cancer patients' knowledge about totally implantable access port: a randomized controlled trial. Support Care Cancer 2015. [PMID: 26201750 DOI: 10.1007/s00520-015-2851-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Providing patients with written information about totally implantable access ports (TIAPs) is recommended during the pre-implantation period to reduce anxiety and to help recalling information. No study tested the effectiveness of information about TIAP neither with oral communication nor with booklets. This study aimed at evaluating the effectiveness of an information booklet, alone or together with answers to clarification questions, both in improving patients' short- and long-time knowledge about TIAP and in decreasing patients' physiological indicators of anxiety immediately after TIAP implantation. METHODS This is a randomized controlled trial with three parallel groups: group A (n = 34) receiving only the booklet, group B (n = 34) receiving the booklet with answers to clarification questions, and group C (n = 37) receiving routine care. RESULTS After 3 months, pair comparisons revealed a significant improvement in knowledge of TIAP in each group (p < 0.001), together with a significant difference in group C compared with groups A (p < 0.001) and B (p < 0.001), similar to each other. Physiological indicators of anxiety decreased in the intervention groups compared to control group immediately after TIAP implantation. CONCLUSIONS The interventions provided resulted effective in decreasing patients' physiological indicators of anxiety immediately after TIAP implantation and improving patients' knowledge about TIAP immediately and at 3 months. Adding answers to clarification questions to the booklet was not more effective than the booklet alone. A well-designed booklet with attention both to scientific content and to communication techniques is useful in improving patients' knowledge about TIAP and reducing anxiety.
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Affiliation(s)
- Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21-00128, Rome, Italy.
| | - Valentina Biagioli
- School of Nursing, Faculty of Medicine, Department of Biomedicine and Prevention, Tor Vergata University, Via Montpellier, 1-00133, Rome, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, Via Elio Chianesi, 53-00144, Rome, Italy
| | - Daniele Incletoli
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Francesca Grieco
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Massimiliano Carassiti
- Department of Anesthesia Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 21-00128, Rome, Italy
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21-00128, Rome, Italy
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