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Vieira LG, Schneider G, Margatho AS, Braga FTMM, Vasques CI, Møller T, Ferreira EB, Silveira RCDCP. Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review. Semin Oncol Nurs 2024:151650. [PMID: 38705798 DOI: 10.1016/j.soncn.2024.151650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices. DATA SOURCES This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530). CONCLUSION The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates. IMPLICATIONS FOR NURSING PRACTICE This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.
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Affiliation(s)
- Leticia Genova Vieira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Guilherme Schneider
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Tom Møller
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Takematsu Y, Shibasaki S, Tanaka T, Hiro J, Takahara T, Matsuoka H, Uyama I, Suda K. The safe implementation of peripherally inserted central catheters by nurse practitioners for patients with gastroenterological diseases in Japan: a single-center retrospective study. Surg Today 2024; 54:487-495. [PMID: 37731133 DOI: 10.1007/s00595-023-02748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE As a safe and reliable alternative to central venous catheters (CVCs), peripherally inserted central catheters (PICCs) are commonly used in clinical practice. However, the insertion of PICCs by nurse practitioners (NPs), especially in Japan, has not been reported extensively. Thus, we investigated the safety and efficiency of PICC insertions by NPs. METHODS The participants were 1322 patients who underwent PICC insertion by NPs at Fujita Health University Hospital (FNPs). The basilic vein in the brachium was the preferred vein for insertion; the brachial vein was the alternative. Patients were monitored from the time of PICC insertion until its removal. Ultrasonography-guided puncture was used for all catheter insertions, and the catheter tip was replaced into the superior vena cava under fluoroscopic imaging with maximal sterile barrier precautions. The outcomes of the PICC insertions by the FNPs were evaluated retrospectively. RESULTS Overall, 23 FNPs inserted a collective total of 1322 PICCs, which remained in place for a collective total of 23,619 catheter days. The rate of successful PICC insertion was 99% (1310 patients). The median time taken for PICC insertion was 12 min (interquartile range, 10-15 min). Intraoperative complications occurred in two patients (0.2%). The confirmed incidence of central line-associated bloodstream infection was 3.4% (45 patients), and these infections occurred on 1.9 per 1000 catheter days. The median duration of PICC placement was 15 days (range, 10-23 days). CONCLUSION PICC insertion by NPs is safe and a potential alternative to CVC insertion by surgeons.
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Affiliation(s)
- Yuriko Takematsu
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Tsuyoshi Tanaka
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Junichiro Hiro
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Takeshi Takahara
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Gan W, Hu L, Luo Y, Tang M. Impact of peripherally inserted central venous catheter-associated phlebitis in neonate guided by intracavitary electrocardiogram: A systematic review and meta-analysis of randomised controlled trials. Int Wound J 2023; 20:1130-1138. [PMID: 36220149 PMCID: PMC10031215 DOI: 10.1111/iwj.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
Because the application of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) in the treatment of neonates is controversial in terms of phlebitis reduction compared with traditional X-ray positioning technique, a systematical evaluation is needed on the impact of IC-ECG on this common complication following PICC. Literature retrieval was conducted on large databases including PubMed, Google Scholar, Cochrane library, and CNKI. Randomised controlled trials (RTCs) of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in the treatment of neonates up to July 7, 2022, were collected. Then indicators of included studies were compared and analysed by two researchers. Meta-analysis was performed on the STATA 17.0 software. After excluding invalid trials, 11 out of 316 randomised controlled trials were included for further analysis. Meta-analysis results showed that compared with the control group, IC-ECG-guided PICC could decrease the incidence of phlebitis (I2 = 0.00%, P = 0.76, OR = 0.33, 95% CI 0.19-0.56) and that no significant difference was observed between preterm neonates and term neonates (P = 0.74). Meanwhile, total complications were decreased in neonates (I2 = 0.00%, P = 0.00 OR = 0.23, 95% CI 0.16-0.33). IC-ECG-guided PICC could also improve the accuracy of optimal tip location (I2 = 0.00%, P = 0.53, OR = 5.37, 95% CI 3.80-7.59). IC-ECG-guided PICC could achieve reduced phlebitis incidence and total complications in the treatment of neonates, as well as increased accuracy of optimal tip location, no matter if those neonates were preterm or not. This study was registered in inplasy.com with No. INPLASY202280012 (DOI: 10.37766/inplasy2022.8.0012).
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Affiliation(s)
- Wenyi Gan
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Hu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yulan Luo
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Menglin Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Milczarek S, Kulig P, Zuchmańska A, Baumert B, Osękowska B, Bielikowicz A, Wilk-Milczarek E, Machaliński B. Safety of Cryopreserved Stem Cell Infusion through a Peripherally Inserted Central Venous Catheter. Cancers (Basel) 2023; 15:cancers15041338. [PMID: 36831679 PMCID: PMC9954289 DOI: 10.3390/cancers15041338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The management of patients undergoing stem cell transplantation requires a multipurpose central venous catheter (CVC) to facilitate drug administration, parenteral nutrition, transfusion of blood products, and collection of blood samples. Peripherally inserted central venous catheters (PICCs) appear to meet these requirements but are rarely used for stem cell infusion. We aimed to retrospectively assess the safety and feasibility of stem cell infusion through PICC and to evaluate its impact on transplantation kinetics. We retrospectively analyzed the outcomes of peripheral blood stem cell (PBSC) transplantation in patients receiving cryopreserved autologous or allogeneic PBSC by PICCs and compared the results with patients receiving transplants through a conventionally inserted central venous catheter (CICC). Despite statistically significant differences in CD34+ dose, infusion rate, and total length of administration, the clinical outcomes of transplantation, exemplified by platelet and neutrophil engraftment, along with the length of hospitalization, were not affected by the prolonged infusion time and lower infusion velocity in the PICC group. Our study showed that the clinical outcomes of PBSC transplantation did not differ between the PICC and CICC groups, suggesting that both types of catheters can be implemented in a PBSC transplantation setting.
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Affiliation(s)
- Sławomir Milczarek
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Piotr Kulig
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Alina Zuchmańska
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Bartłomiej Baumert
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Bogumiła Osękowska
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Anna Bielikowicz
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Wilk-Milczarek
- Department of General and Dental Radiology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland
- Department of Hematology and Transplantology, Pomeranian Medical University, 71-252 Szczecin, Poland
- Correspondence:
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Caris MG, de Jonge NA, Punt HJ, Salet DM, de Jong VMT, Lissenberg-Witte BI, Zweegman S, Vandenbroucke-Grauls CMJE, van Agtmael MA, Janssen JJWM. Indwelling time of peripherally inserted central catheters and incidence of bloodstream infections in haematology patients: a cohort study. Antimicrob Resist Infect Control 2022; 11:37. [PMID: 35177128 PMCID: PMC8851849 DOI: 10.1186/s13756-022-01069-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to assess whether longer indwelling time of peripherally inserted central catheters (PICC) increases risk of central line associated bloodstream infections (CLABSI) in haematology patients.
Methods
Multicentre retrospective cohort study among haematology patients receiving PICCs between 2013 and 2015. Occurrence of CLABSI based on CDC definitions was assessed. We calculated incidence rates, determined risk factors for CLABSI and used Poisson regression models to assess the risk of developing CLABSI as a function of PICC dwell time. We compared diagnoses and treatment characteristics between 2013–2015 and 2015–2020.
Results
455 PICCs placed in 370 patients were included, comprising 19,063 catheter days. Median indwelling time was 26 days (range 0–385) and CLABSI incidence was 4.0 per 1000 catheter days, with a median time to CLABSI of 33 days (range 18–158). Aplastic anaemia (AA) was associated with an increased risk of CLABSI; patients undergoing autologous stem cell transplantation (SCT) were less likely to develop CLABSI. In the unadjusted analysis, PICCs with an indwelling time of 15–28 days, 29–42 days, 43–56 days and > 56 days each had an increased CLABSI incidence rate ratio of 2.4 (1.2–4.8), 2.2 (0.95–5.0), 3.4 (1.6–7.5) and 1.7 (0.9–3.5), respectively, compared to PICCs in place for < 15 days. However, after adjusting for AA and SCT, there was no significant difference in incidence rates between dwell times (p 0.067).
Conclusions
Our study shows that risk of CLABSI does not appear to increase with longer PICC indwelling time. Routine replacement of PICCs therefore is unlikely to prevent CLABSI in this population.
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Ban T, Fujiwara SI, Murahashi R, Nakajima H, Ikeda T, Matsuoka S, Toda Y, Kawaguchi SI, Ito S, Nagayama T, Umino K, Minakata D, Nakano H, Morita K, Ashizawa M, Yamamoto C, Hatano K, Sato K, Ohmine K, Kanda Y. Risk Factors for Complications Associated with Peripherally Inserted Central Catheters During Induction Chemotherapy for Acute Myeloid Leukemia. Intern Med 2022; 61:989-995. [PMID: 34511570 PMCID: PMC9038473 DOI: 10.2169/internalmedicine.8184-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Peripherally inserted central catheters (PICCs) are widely used in patients with hematologic malignancies. However, the risks of PICC-related complications during chemotherapy for acute myeloid leukemia (AML) are not fully understood. Methods We conducted a retrospective review of 128 adult patients with AML who received induction therapy by way of PICC insertion between 2012 and 2019. Results The median duration of PICC insertion was 30 days. The incidence rate of catheter-related bloodstream infection (CRBSI) was 2.4% at 30 days, and women were more likely to suffer from CRBSI than men. Local reactions at the insertion site were observed in 56 patients; however, these events did not predict CRBSI. The incidence rates of catheter-related thrombosis (CRT) were 1.6% at 30 days. Obesity put patients at an increased risk for CRT. Unexpected PICC removal occurred in 59 patients, and women were at a higher risk of catheter removal than men. Conclusion Low PICC-related complication rates, possibly associated with high rates of catheter removal, were observed during intensive chemotherapy for AML. Women and obese patients require careful monitoring of their PICC. Procedures to achieve appropriate PICC removal without increasing the complication rate need to be considered.
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Affiliation(s)
- Tetsuaki Ban
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Shin-Ichiro Fujiwara
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Japan
| | - Rui Murahashi
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Hirotomo Nakajima
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Sae Matsuoka
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | | | - Shoko Ito
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Japan
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Akhtar N, Lee L. Utilization and Complications of Central Venous Access Devices in Oncology Patients. Curr Oncol 2021; 28:367-377. [PMID: 33435136 PMCID: PMC7903275 DOI: 10.3390/curroncol28010039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.
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Affiliation(s)
- Narmeen Akhtar
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada;
- Department of Oncology, Niagara Health, St. Catharines, ON L2S 0A9, Canada
| | - Linda Lee
- Department of Oncology, Niagara Health, St. Catharines, ON L2S 0A9, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
- Correspondence: ; Tel.: +1-905-682-6451; Fax: +1-905-685-3391
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Utsu Y, Masuda S, Watanabe R, Arai H, Nakamura A, Matsui S, Izumi S, Aotsuka N. Changes in Central Venous Catheter Use in the Hematology Unit with the Introduction of Ultrasound Guidance and a Peripherally Inserted Central Venous Catheter. Intern Med 2021; 60:2765-2770. [PMID: 34470985 PMCID: PMC8479208 DOI: 10.2169/internalmedicine.7119-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective A central venous catheter (CVC) is often needed to treat hematologic diseases, but it is accompanied by many complications. Ultrasound guidance (USG) or a peripherally inserted central venous catheter (PICC) can reduce such complications. Meterials We collected data of patients with attempted CVC placement in our hematology unit in 2012 (before introduction of USG and PICC) and 2018 (after introduction) and compared both periods. Results In total, 187 CVC insertions were attempted in 2018 and 198 in 2012. USG was used 154 times (82%) in 2018 and 4 times (2%) in 2012 (p<0.001). The success rates of insertion were 95% in 2018 and 89% in 2012 (p=0.063). The incidence of acute complications was 4.3% in 2018 and 9.1% in 2012 (p=0.069). The incidence of CVC removal owing to delayed complications was 26% in 2018 and 21% in 2012 (p=0.327). The sites of approach in 2018 and 2012 were the internal jugular in 42 (22%) and 54 (27%), subclavian in 52 (28%) and 128 (65%), brachial (PICC) in 89 (48%) and 14 (7%), and femoral in 4 (2%) and 2 (1%), respectively (p<0.001). Conclusion USG has become commonplace since its introduction. The landmark-based subclavian approach was largely replaced by PICC with USG in 2018. USG and PICC can help improve success rates and safety profiles.
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Affiliation(s)
- Yoshikazu Utsu
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shinichi Masuda
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Reiko Watanabe
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Hironori Arai
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Ayako Nakamura
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shinichirou Matsui
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shintarou Izumi
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Nobuyuki Aotsuka
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
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Corti F, Brambilla M, Manglaviti S, Di Vico L, Pisanu MN, Facchinetti C, Dotti KF, Lanocita R, Marchianò A, de Braud F, Ferrari LAM. Comparison of outcomes of central venous catheters in patients with solid and hematologic neoplasms: an Italian real-world analysis. Tumori 2020; 107:17-25. [PMID: 32529962 DOI: 10.1177/0300891620931172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other. METHODS We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs). RESULTS A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; p = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs (p = 0.013). No significant differences in terms of catheter-related thromboses (p = 0.676) or catheter-related infections (p = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort (p = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128-0.536; p < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018-0.372; p < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135-0.553; p < 0.0001). CONCLUSIONS This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk-benefit assessment, patient preferences, and compliance.
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Affiliation(s)
- Francesca Corti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Sara Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Di Vico
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Maria Neve Pisanu
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Claudia Facchinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Katia Fiorella Dotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rodolfo Lanocita
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alfonso Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy
| | - Laura Anna Maria Ferrari
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bruzzese A, Chistolini A, Morano SG, Fegatelli DA, Micozzi A. Peripherally inserted central catheter in patients with acute myeloid leukemia: incidence and risk factors for premature removal. Leuk Lymphoma 2020; 61:2265-2267. [PMID: 32436407 DOI: 10.1080/10428194.2020.1762880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Antonella Bruzzese
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Antonio Chistolini
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | | | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Micozzi
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
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11
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Xiao AQ, Sun J, Zhu LH, Liao ZY, Shen P, Zhao LL, Latour JM. Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study. Eur J Pediatr 2020; 179:439-446. [PMID: 31788740 DOI: 10.1007/s00431-019-03524-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 12/19/2022]
Abstract
This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.
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Affiliation(s)
- Ai-Qing Xiao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Jing Sun
- Nursing school, Hunan University of Chinese Medicine, Changsha, Hunan Province, China.,Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Zhen-Yu Liao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Ping Shen
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Lin-Lin Zhao
- Division of Neonatal Medicine, Xiangtan Central Hospital, Xiangtan, Hunan Province, China
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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12
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Mariggiò E, Iori AP, Micozzi A, Chistolini A, Latagliata R, Berneschi P, Giampaoletti M, La Rocca U, Bruzzese A, Barberi W, Foà R, Morano SG. Peripherally inserted central catheters in allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer 2020; 28:4193-9. [PMID: 31900609 DOI: 10.1007/s00520-019-05269-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. METHODS We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. RESULTS The median duration of PICC placement was 117 days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. CONCLUSIONS PICC are a safe and reliable long-term venous access in allo-HSCT recipients.
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13
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Nailon RE, Rupp ME. Surveillance of home health central venous catheter care outcomes: Challenges and future directions. Am J Infect Control 2019; 47:1382-7. [PMID: 31676067 DOI: 10.1016/j.ajic.2019.04.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data are available regarding central venous catheter (CVC)-related complications that occur in home care. A practical out-of-hospital surveillance mechanism is needed. METHODS Home health/infusion agencies in 4 states submitted monthly data from January 2011 through March 2015. Data were collected by patient age and included number of patients on service with a CVC, device days, central line-associated bloodstream infection (CLABSI), CVC-occlusions, doses of fibrinolytics administered, and number of patients receiving fibrinolytics. RESULTS Ten agencies from 4 states contributed data across the study period. A total of 913 occlusions and 73 CLABSIs occurred during the 51-month surveillance period. The CLABSI rates per 1,000 device days per year across the study surveillance period ranged from 0-0.40 for pediatric and from 0-0.37 for adult patients, whereas occlusion rates per 1,000 device days ranged from 0.26-1.59 for pediatric and from 2.59-33.29 for adult patients. Doses of fibrinolytic agents administered per 1,000 device days ranged from 0.26-1.80 in pediatric and 3.53-33.85 in adult patients. CONCLUSIONS Opportunities exist to further expand efforts to quantify the presence of CVCs in home settings to enable improvements with measuring and tracking patient outcomes as they relate to CVC care. Exploration of continued sustainability of surveillance and data validation are warranted to optimize home health/infusion care practices and outcomes.
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14
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Liu S, Zhang F, Xie L, Wang Y, Xiang Q, Yue Z, Feng Y, Yang Y, Li J, Luo L, Yu C. Machine learning approaches for risk assessment of peripherally inserted Central catheter-related vein thrombosis in hospitalized patients with cancer. Int J Med Inform 2019; 129:175-83. [DOI: 10.1016/j.ijmedinf.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/04/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022]
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15
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Scrivens N, Sabri E, Bredeson C, McDiarmid S. Comparison of complication rates and incidences associated with different peripherally inserted central catheters (PICC) in patients with hematological malignancies: a retrospective cohort study. Leuk Lymphoma 2019; 61:156-164. [PMID: 31387422 DOI: 10.1080/10428194.2019.1646908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with hematological malignancies (HM) or undergoing hematopoietic cell transplantation (HCT) require reliable vascular access. Peripherally inserted central catheters (PICC) meet this need, however, studies suggest these patients have higher rates of PICC-associated complications. This retrospective cohort study evaluates the influence of PICC type on the rates and incidences of complications. Four hundred and eighty-five dual lumen PICCs were inserted into 469 complex patients with HM or undergoing HCT: 161 Groshong®, 60 PowerPICC® Solo, 165 BioFlo®, and 99 Arrow®. The rates and incidences of complications differed significantly across the PICC types. The overall rate of complication ranged from 7.40 to 26.4/1000 catheter days (CDs). The rate of deep vein thrombosis (0.31-1.48/1000 CDs) and occlusion differed across the PICC types, while the rate of central line-associated bloodstream infection (0.53-0.74/1000 CDs) did not. Following multivariate adjustment, PICC type was associated with complication rate. This highlights that PICC type should be considered in clinical decisions.
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Affiliation(s)
| | - Elham Sabri
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher Bredeson
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.,The University of Ottawa, Ottawa, ON, Canada
| | - Sheryl McDiarmid
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
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16
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Abstract
Patients are increasingly receiving therapy at home via central vascular access devices (CVADs). Limited data exist regarding patients' experiences with outpatient CVADs. This study characterized outpatient CVAD care via 14-day patient diaries. Information included location, frequency, and purpose of CVAD access episodes and who performed CVAD care. Across all patients, 77% of care was provided in the patient's home compared with other sites. Home care was provided via self-care (48%), by a family member/caregiver (25%), or by a nurse (27%). Flushing the device was the most frequent reason for device access (52%). An occlusion rate of 9.57 per 1000 device days was also noted. Further examination of CVAD maintenance and patient/care provider education is warranted.
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17
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Takezawa Y, Izumi K, Kamijima T, Machioka K, Shima T, Iwamoto H, Nohara T, Shigehara K, Kadono Y, Seto C, Mizokami A. Effectiveness of Synthetic Polymer-coated Peripherally Inserted Central Catheter in Patients With Advanced Cancer. In Vivo 2019; 33:877-880. [PMID: 31028211 DOI: 10.21873/invivo.11553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM A peripherally inserted central catheter (PICC) is recommended for the safe administration of anticancer agents. The effectiveness of synthetic polymer-coated and non-coated PICCs was compared. PATIENTS AND METHODS Patients with advanced cancers who had indwelling PICCs were reviewed using their medical records. Three types of PICCs were compared in terms of complications and catheter failure. RESULTS A total of 90 patients were retrospectively analyzed, including 31 with Groshong PICCs, 30 with Argyle PICC kit, and 29 with Argyle PICC kit II. The incidence of catheter failure for Groshong PICC, Argyle PICC kit, and Argyle PICC kit II per 1,000 PICC days was 4.4614, 5.6617, and 0.8658, respectively. Catheter failure-free survival in the Argyle PICC kit II group was significantly better than that in the Argyle PICC kit group (p=0.0339). CONCLUSION Argyle PICC kit II, a synthetic polymer-coated PICC, may render longer patency and prevention of catheter failure than non-coated PICCs.
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Affiliation(s)
- Yuta Takezawa
- Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan.,Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Taiki Kamijima
- Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kazuaki Machioka
- Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Takashi Shima
- Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Chikashi Seto
- Department of Urology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
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18
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Ahrari A, Al-Ani F, Wang YP, Lazo-Langner A. Treatment of venous thromboembolism in acute leukemia: A systematic review. Thromb Res 2019; 178:1-6. [PMID: 30921533 DOI: 10.1016/j.thromres.2019.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety and efficacy of venous thromboembolism (VTE) treatment in patients with acute leukemia (AL) are not well understood and the optimal treatment strategy is unclear. METHODS We conducted a systematic review of the literature aiming to identify observational studies and randomized trials describing treatment of VTE in the setting of AL including, acute myeloid leukemia (AML), acute promyelocytic leukemia (APL), and acute lymphoblastic leukemia (ALL). Due to the heterogeneity of findings, no meta-analysis was attempted. RESULTS A total of 13 observational studies (11 cohorts and 2 case-control) totaling 5359 participants were included. The number of patients with VTE among the total population was 304 (5.7%; 95% CI 5.1-6.3). In patients with VTE, 221 patients received treatment with anticoagulation using either of low-molecular-weight heparin, unfractionated heparin, and/or vitamin K antagonists. Most studies adjusted the anticoagulant dose based on platelet count. The reported recurrence rate ranged from 0 to 29% among different studies and varied according to the duration of anticoagulant treatment and follow up. Bleeding events were not uniformly reported but the total number was low among anti-coagulated patients. CONCLUSION There is a significant lack of data in this area with a high degree of heterogeneity in the choice of anticoagulant, dose adjustments for thrombocytopenia, and duration of anticoagulation. Further studies are required to develop guidelines and suggestions for treatment of VTE in AL.
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Affiliation(s)
- Azin Ahrari
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada
| | - Fatimah Al-Ani
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada
| | - Yimin Pearl Wang
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
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19
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Song Y, Liu S, Lou T, Ma Y, Wang N, Yong Q, Cong L, Xiao Z, Liu G. Risk factors associated with peripherally inserted central catheter-related venous thrombosis in hospitalized patients of advanced age. J Int Med Res 2019; 48:300060518820744. [PMID: 30632436 PMCID: PMC7140210 DOI: 10.1177/0300060518820744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective This study was performed to determine the risk factors associated with
peripherally inserted central catheter (PICC)-related venous thrombosis in
patients of advanced age (>65 years). Methods In total, 549 hospitalized patients aged 66 to 104 years who were undergoing
PICC placement from January 2008 to December 2014 were enrolled. Symptomatic
venous thrombosis was confirmed by B-mode or Doppler ultrasonography in the
presence of clinical signs. Logistic regression analysis was performed on
the variables of interest to identify the risk factors for thrombosis. Odds
ratios (ORs) with the corresponding 95% confidence intervals were
generated. Results Of the 549 patients with PICC placement, 106 (19.3%) developed
PICC-associated venous thrombosis, 84 cases of which were symptomatic. The
logistic regression results revealed that PICC-related venous thrombosis was
associated with a history of venous thrombosis (OR, 6.745 [3.237–14.056]),
number of lumens (OR, 1.934 [1.362–2.572] and OR, 3.762 [1.672–5.932] for
dual and triple lumens, respectively), and PICC gauge (OR, 1.821
[1.256–2.537] and OR, 3.864 [1.367–8.251] for 5-Fr and 6-Fr,
respectively). Conclusions A history of thrombosis, high number of lumens, and large-gauge catheters
were strong risk factors for patients aged >65 years undergoing PICC
placement.
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Affiliation(s)
- Yang Song
- Center of Clinical Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, China.,Department of Clinical Microbiology, Chinese PLA General Hospital, Beijing, China
| | - Shuang Liu
- Center of Clinical Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Ting Lou
- Medical Records Management Section of Geriatric Ward, Chinese PLA General Hospital, Beijing, China
| | - Yuxiu Ma
- National Clinical Research Center for Geriatric Disease, Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Na Wang
- Outpatient Comprehensive Treatment Area, Chinese PLA General Hospital, Beijing, China
| | - Qinge Yong
- National Clinical Research Center for Geriatric Disease, Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Lin Cong
- Center of Clinical Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Zheng Xiao
- Center of Clinical Laboratory, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Gao Liu
- National Clinical Research Center for Geriatric Disease, Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
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20
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Picardi M, Della Pepa R, Cerchione C, Pugliese N, Mortaruolo C, Trastulli F, Giordano C, Grimaldi F, Zacheo I, Raimondo M, Chiurazzi F, Pane F. A Frontline Approach With Peripherally Inserted Versus Centrally Inserted Central Venous Catheters for Remission Induction Chemotherapy Phase of Acute Myeloid Leukemia: A Randomized Comparison. Clin Lymphoma Myeloma Leuk 2019; 19:e184-94. [PMID: 30704933 DOI: 10.1016/j.clml.2018.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The incidence of peripherally inserted central catheter (PICC)-related adverse events has been uncertain in the setting of acute myeloid leukemia (AML) compared with the incidence of centrally inserted central catheter (CICC) adverse events. PATIENTS AND METHODS We conducted a monocentric, randomized trial of patients with previously untreated AML. Of the 93 patients, 46 had received a PICC and 47 had received a CICC as frontline intravascular device. Thereafter, all patients underwent intensive chemotherapy for hematologic remission induction. The primary endpoint was catheter-related (CR)-bloodstream infection (BSI) and venous thrombosis (VT) rate. The secondary endpoints catheter malfunction, catheter removal, and patient overall survival. RESULTS The CR-BSI and CR-VT rate in the PICC and CICC groups was 13% and 49%, respectively, with a difference of 36 percentage points (relative risk for CR-BSI or CR-VT, 0.266; P = .0003). The CR-BSI incidence was 1.4 and 7.8 per 1000 catheters daily in the PICC and CICC groups, respectively. Among the CR thromboses, the symptomatic VT rate was 2.1% in the PICC group and 10.6% in the CICC group. In the CICC group, 16 of the 47 patients (34%) had the catheter removed for BSI (n = 5), septic thrombophlebitis (n = 4), VT (n = 2), or malfunction (n = 5) a median of 7 days after insertion. In the PICC group, only 6 of the 46 patients (13%) required catheter removal for VT (n = 2) or malfunction (n = 4). At a median follow-up of 30 days, 6 patients in the CICC group died of CR complications versus none of the patients in the PICC group (P = .012). Using PICCs, the reduction in BSI and symptomatic VT decreased mortality from CR infection and venous thromboembolism. In contrast, the CICC approach led to early catheter removal mostly for difficult-to-treat infectious pathogens. CONCLUSION Our data have confirmed that BSI and symptomatic VT are the major complications affecting frontline central intravascular device-related morbidity in the leukemia setting. The use of a PICC is safer than that of a CICC and maintains the effectiveness for patients with AML undergoing chemotherapy, with an approximate fourfold lower combined risk of infection or thrombosis at 30 days.
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21
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Li A, Jiao J, Zhang Y, Tian L, Miao J, Hao X, Sun Z, Sun Q. A randomized controlled study of bedside electrocardiograph-guided tip location technique & the traditional chest radiography tip location technique for peripherally inserted central venous catheter in cancer patients. Indian J Med Res 2018; 147:477-483. [PMID: 30082572 PMCID: PMC6094514 DOI: 10.4103/ijmr.ijmr_1120_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background & objectives: The peripherally inserted central catheter (PICC) has the advantages of higher safety, lower infection rate and longer retention time than peripherally inserted catheter. This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique. Methods: Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and after the procedure; medical cost and incidence of complications at one week, three months and six months after PICC insertion. Results: Accurate tip location was achieved in 99.30 per cent in the ECG test group vs 92.30 per cent in the control group (P <0.001). At 24 h after the procedure, the anxiety level was significantly lower in the ECG test group. The presence of thrombogenesis was significantly lower in the ECG test group at both three months and six months after the procedure (P=0.04 and P=0.03, respectively). Interpretation & conclusions: The ECG-guided PICC tip location technique was accurate and caused fewer procedure-related complications and less anxiety in patients compared to chest radiography tip location technique. Radiographic confirmation of PICC tip position may not be needed when ECG guidance is used and thus it can help avoid radiation exposure.
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Affiliation(s)
- AiMin Li
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - JianGuo Jiao
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ying Zhang
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Li Tian
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - JinHong Miao
- Comprehensive Medical Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - XiaoLi Hao
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - ZhenChang Sun
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - QiaoZhi Sun
- Department of Oncology, Lymphoma Diagnosis & Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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22
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Rushton C, Jackson A, Goddard K, Alfred A. A case review of a patient experience of photopheresis using a peripherally inserted central catheter. J Clin Apher 2018; 34:73-74. [PMID: 30414332 DOI: 10.1002/jca.21674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/26/2018] [Accepted: 10/18/2018] [Indexed: 11/05/2022]
Abstract
Extracorporeal photopheresis (ECP) is a cell based immunomodulatory therapy in which the patient is attached intravenously to a cell separating machine. During ECP a patient's blood is collected via either a central venous access device (CVAD) or a peripherally inserted 16G arterial venous fistula needle in either one or both antecubital fossa. However, patients presenting for ECP with GVHD repeatedly present a challenge to the ECP team due to poor venous access resulting from previous therapies and skin changes. The use of peripherally inserted central venous catheters (PICCs) offers an alternative route of vascular access for this cohort of patients. Here we present a case report of a patient successfully treated with ECP following the insertion of a PICC line.
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Affiliation(s)
- Cherie Rushton
- Photopheresis, Rotherham Foundation Trust, Rotherham, United Kingdom
| | - Andrew Jackson
- Vascular Access, Rotherham Foundation Trust, Rotherham, United Kingdom
| | - Kathryn Goddard
- Photopheresis, Rotherham Foundation Trust, Rotherham, United Kingdom
| | - Arun Alfred
- Photopheresis, Rotherham Foundation Trust, Rotherham, United Kingdom
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23
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Sylvia CJ, Wagel MA, Giare-Patel K, Spangler TA, Breznock EM, Gupta N. Chlorhexidine-coated peripherally inserted central catheters reduce fibroblastic sleeve formation in an in vivo ovine model. J Vasc Access 2018; 19:644-650. [DOI: 10.1177/1129729818769033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: This study compared an antimicrobial and anti-thrombogenic peripherally inserted central catheter treated with a chlorhexidine-based technology, a peripherally inserted central catheter with bulk distributed fluoro-oligomers, and a poly 2-methoxyethyl acrylate–based peripherally inserted central catheter to an untreated peripherally inserted central catheter (control) in an ovine model at 14 and 30 days post-implant. Methods: One of four types of peripherally inserted central catheters was surgically implanted into the left jugular vein of each of 18 sheep for 14 or 30 days. Blood analysis consisted of complete blood counts, serum chemistries, and coagulation (fibrinogen, prothrombin time, and partial thromboplastin time) profiles. Sheep were sacrificed to examine the vein and thorax. Histological analysis was performed on serial catheter sections using standard microscopy on hematoxylin and eosin–stained tissues. Results: All catheters developed fibroblastic sleeves at both 14 and 30 days. The chlorhexidine-peripherally inserted central catheter showed a 64% lower mean fibroblastic sleeve weight and a 66% shorter mean fibroblastic sleeve length compared to the untreated control at 14 days. By 30 days, compared to untreated control, the chlorhexidine-peripherally inserted central catheter showed 81% lower mean fibroblastic sleeve weight with 75% shorter mean fibroblastic sleeve length, the fluoro-oligomer-peripherally inserted central catheter showed 54% lower mean sheath weight with 40% shorter mean fibroblastic sleeve length, and the poly 2-methoxyethyl acrylate-peripherally inserted central catheter had 41% lower mean fibroblastic sleeve weight with 57% lower fibroblastic sleeve length. Conclusion: Among the three anti-thrombogenic peripherally inserted central catheter technologies, the chlorhexidine-peripherally inserted central catheter had the smallest fibroblastic sleeves, followed by the fluoro-oligomer-peripherally inserted central catheter, poly 2-methoxyethyl acrylate-peripherally inserted central catheter, and control peripherally inserted central catheter.
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Affiliation(s)
| | | | | | - Taylor A Spangler
- VDx Veterinary Diagnostics and Preclinical Research Services, Davis, CA, USA
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Zhao H, He Y, Huang H, Ling Y, Zhou X, Wei Q, Lei Y, Ying Y. Prevalence of medical adhesive-related skin injury at peripherally inserted central catheter insertion site in oncology patients. J Vasc Access 2018; 19:23-7. [PMID: 29148003 DOI: 10.5301/jva.5000805] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: The aim of our study was to identify the prevalence and risk factors of medical adhesive-related skin injuries (MARSI) at peripherally inserted central catheters (PICC) insertion site in oncology patients. Methods: A cross-sectional observational study lasting two weeks was carried out in four inpatient departments. Skin assessment data and photographs of skin were collected during PICC maintenance. Other related information came from medical records. The skin injuries were classified by dermatologists and PICC specialized nurses. MARSI prevalence was calculated and the associated factors were analyzed statistically. Results: All 419 patients were included. The prevalence of total MARSI at PICC insertion site was 125, (29.83%), including mechanical skin injury (73, 17.42%), contact dermatitis (CD) (39, 9.31%), moisture-associated skin damage (11, 2.63%), folliculitis (2, 0.48%). Multivariate analysis identified two independent risk factors for MARSI including age ≥50 y (p = 0.031, odds ratio [OR] = 4.521, 95% confidence interval [CI] [1.389, 20.620]) and hematologic malignancies (p = 0.000, OR = 2.514, 95% CI [1.590,3.97]. Oxaliplatin and arsenic trioxide infusion through PICC, history of skin allergies was associated with CD, with p = 0.020, OR = 3.492, 95% CI (1.220, 9.990); p = 0.003, OR = 4.565, 95% CI (1.661,12.547); p = 0.000, OR = 12.333, 95% CI (3.669, 41.454), respectively. Conclusions: MARSI at PICC insertion site is a frequent event among oncology patients. Epidemiological data and independent risk factors are presented in our study, which provide a basis for future study in this area.
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Fracchiolla NS, Todisco E, Bilancia A, Gandolfi S, Orofino N, Guidotti F, Mancini V, Marbello L, Assanelli A, Bernardi M, Santoro A, Cairoli R, Consonni D, Cortelezzi A. Clinical management of peripherally inserted central catheters compared to conventional central venous catheters in patients with hematological malignancies: A large multicenter study of the REL GROUP (Rete Ematologica Lombarda - Lombardy Hematologic Network, Italy). Am J Hematol 2017; 92:E656-E659. [PMID: 28891226 DOI: 10.1002/ajh.24903] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Sara Gandolfi
- Hematology Unit; Humanitas Cancer Center; Rozzano Italy
| | - Nicola Orofino
- Hematology Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Francesca Guidotti
- Hematology Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Valentina Mancini
- Department of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Laura Marbello
- Department of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplantation Unit; San Raffaele Hospital Scientific Institute; Milan Italy
| | - Massimo Bernardi
- Hematology and Bone Marrow Transplantation Unit; San Raffaele Hospital Scientific Institute; Milan Italy
| | | | - Roberto Cairoli
- Department of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Dario Consonni
- Epidemiology Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Agostino Cortelezzi
- Hematology Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
- University of Milan; Milan Italy
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Abstract
The purpose of this study was to examine the efficacy of using an electronic tablet to provide patient education for flushing peripherally inserted central catheters (PICCs) as a way to reduce the incidence of occlusion. Eleven patients, newly diagnosed with cancer, participated in a pilot study that used a video on PICC flushing and remote coaching using FaceTime (Apple, Cupertino, CA) to teach patients how to maintain their PICCs in their homes. At the end of the 6-week intervention, no adverse outcomes (occlusions or infections) were noted among the patients who participated in the study.
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Hao N, Xie X, Zhou Z, Li J, Kang L, Wu H, Guo P, Dang C, Zhang H. Nomogram predicted risk of peripherally inserted central catheter related thrombosis. Sci Rep 2017; 7:6344. [PMID: 28740162 PMCID: PMC5524883 DOI: 10.1038/s41598-017-06609-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/14/2017] [Indexed: 12/24/2022] Open
Abstract
The use of peripherally inserted central catheters (PICCs) is increasing rapidly worldwide. A number of patient-related, clinical-related and device-related characteristics might be risk factors for PICC-related thrombosis. We retrospectively reviewed a database of 320 consecutive patients who underwent PICC insertion between December 2014 and December 2015 at the First Affiliated Hospital of Xi’an Jiaotong University to explore the potential associations between risk factors and PICC-associated thrombosis. A novel nomogram for predicting risk was developed based on the data. The nomogram prediction model included ten risk factors that were derived from different relevant estimates. The nomogram prediction model showed good discriminatory power (Harrell’s C-index, 0.709) and a high degree of similarity to actual thrombosis occurring after calibration. Furthermore, principal component analysis was performed to identify the factors that most influence PICC-related thrombosis. Our novel nomogram thrombosis risk prediction model was accurate in predicting PICC-related thrombosis. Karnofsky performance scores, D-dimer and blood platelet levels and previous chemotherapy were principal components. Our findings might help clinicians predict thrombosis risk in individual patients, select proper therapeutic strategies and optimize the timing of anticoagulation therapy.
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Affiliation(s)
- Nan Hao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xin Xie
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Zhangjian Zhou
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jieqiong Li
- Department of Nurse, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Li Kang
- Department of Thoracic Surgery Ward 2, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Huili Wu
- Department of Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Pingli Guo
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Chengxue Dang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Hao Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 227W Yanta Road, Xi'an, 710061, Shaanxi, China.
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McDiarmid S, Scrivens N, Carrier M, Sabri E, Toye B, Huebsch L, Fergusson D. Outcomes in a nurse-led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open 2017; 5:E535-E539. [PMID: 28676535 PMCID: PMC5621949 DOI: 10.9778/cmajo.20170010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) provide enormous benefit to patients. However, recent publications have highlighted relatively high PICC-associated complication rates. We report on patient and device outcomes from a nurse-led program. METHODS We performed a retrospective analysis of a prospective cohort of consecutive patients undergoing PICC insertion at The Ottawa Hospital between Jan. 1, 2013 and Dec. 31, 2014. Of the 8314 BioFlo PASV PICCs inserted, we randomly selected a sample of 700 and obtained a complete data set for 656. We measured the cumulative incidence of major complications (catheter-related bloodstream infections and deep vein thrombosis) and use of a thrombolytic to alleviate occlusions. RESULTS The total number of catheter days was 58 486, and the median dwell time 45 days. We observed 4 cases of catheter-related bloodstream infection (0.6% [95% CI 0.17%-1.55%]) (0.07/1000 catheter days). Ten patients (1.5% [95% CI 0.83%-2.78%]) (0.17/1000 catheter days) had catheter-related deep venous thrombosis. At least 1 dose of thrombolytic was required in 75 catheters (11.4% [95% CI 8.61%-13.39]), 31 (7.1%) of the 436 single-lumen catheters and 113 (25.7%) of the 440 lumina of dual-lumen catheters (p < 0.001). INTERPRETATION We attribute our low rates of major complications to a nurse-led expert insertion team, standardized care and maintenance protocols, high insertion volumes, novel catheter material and continuous quality-improvement initiatives that are implemented and evaluated regularly. We conclude that the considerable benefits PICCs provide to patients are attained with a low risk of major complications.
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Affiliation(s)
- Sheryl McDiarmid
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
| | - Nicholas Scrivens
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
| | - Marc Carrier
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
| | - Elham Sabri
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
| | - Baldwin Toye
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
| | - Lothar Huebsch
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
| | - Dean Fergusson
- Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont
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Xie J, Xu L, Xu X, Huang Y. Complications of peripherally inserted central catheters in advanced cancer patients undergoing combined radiotherapy and chemotherapy. J Clin Nurs 2017; 26:4726-4733. [PMID: 28334494 DOI: 10.1111/jocn.13825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jun Xie
- Department of Hematology; Wuxi People's Hospital Affiliated to Nanjing Medical University; Wuxi Jiangsu China
| | - Linjie Xu
- Department of Hematology; Wuxi People's Hospital Affiliated to Nanjing Medical University; Wuxi Jiangsu China
| | - Xiaomin Xu
- Department of Hematology; Wuxi People's Hospital Affiliated to Nanjing Medical University; Wuxi Jiangsu China
| | - Yunjuan Huang
- Department of Hematology; Wuxi People's Hospital Affiliated to Nanjing Medical University; Wuxi Jiangsu China
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Chen MH, Hwang WL, Chang KH, Chiang LCJ, Teng CLJ. Application of peripherally inserted central catheter in acute myeloid leukaemia patients undergoing induction chemotherapy. Eur J Cancer Care (Engl) 2016; 26. [PMID: 28029197 DOI: 10.1111/ecc.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
Increasingly, peripherally inserted central catheters (PICC) are applied in patients with haematological malignancies. The feasibility and safety of PICC for induction chemotherapy in acute myeloid leukaemia (AML) remain unclear. Medical records of 89 newly diagnosed adult de novo AML patients, who achieved complete remission, were retrospectively reviewed (PICC group, n = 43; intravenous [IV] line group, n = 46). Patients' clinical characteristics and the number of blind punctures for blood sampling were compared between these two groups, and risk factors associated with bacteraemia were identified by univariate analysis. Patients in the PICC group experienced significantly fewer blind punctures than those in the IV line group (3.3 ± 3.6 vs. 14.4 ± 6.0; p = .000); 20.9% of PICC patients had bacteraemia, compared with 23.9% in the IV line group (p = .803). Most patients (76.7%) removed their PICC because treatment was completed. PICC increased the quality of life in AML patients undergoing chemotherapy induction by reducing the number of blind blood punctures required. Bacteraemia in PICC patients was comparable to that in IV line patients. PICC is, therefore, a feasible and safe central venous device for use in AML patients.
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Affiliation(s)
- M-H Chen
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - W-L Hwang
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - K-H Chang
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| | - L C J Chiang
- School of Nursing, HungKuang University, Taichung, Taiwan
| | - C L J Teng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Life Science, Tunghai University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Keller EJ, Semaan E, Lee J, Aragona E, Molina H, Salem R, Resnick SA, Chrisman H, Collins JD. The Direct and Indirect Costs of Ultrasound-Guided Peripherally Inserted Central Catheter Repositioning at a Large Academic Medical Center. ACTA ACUST UNITED AC 2016; 21:230-6. [DOI: 10.1016/j.java.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AbstractBackground: To assess the technical success of ultrasound (US)-guided peripherally inserted central catheter (PICC) placement at a large academic medical center and evaluate the direct and indirect costs associated with malpositioned catheters.Methods: This retrospective chart review consisted of 250 consecutive inpatients and 150 consecutive outpatients (N = 400, aged 58 ± 17 years, 225 men and 175women) who underwent US-guided PICC placement at a single center. Repositioning rates were compared between high-complexity (inpatient) and low-complexity (outpatient) groups using a χ2 test and phi coefficient. Initial and final catheter tip position was assessed by radiography. Direct costs of repositioning were estimated using Medicare reimbursement rates. Indirect costs, including additional staff time, imaging, and delays in treatment, were assessed via a survey of PICC nurses and chart reviews.Results: Initial PICC placement resulted in an optimal tip position in 34% of patients and an optimal or acceptable position in 84% of patients. Repositioning rates were significantly higher for inpatients with a low to moderate association between inpatient PICC placement and the need for repositioning (χ2 = 9.603, P = .002; σ = 0.155, P = .002). In total, 77 catheters required repositioning, costing on average an additional $186.03 and 50 minutes of staff time per catheter as well as delaying catheter use in 23 patients for at least 24 hours.Conclusions: PICC malpositioning is a significant source of inefficiency, especially for inpatient services, that should be addressed to reduce expenditures and maximize patients' perceptions of quality health care.
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Barbour ME, Maddocks SE, Grady HJ, Roper JA, Bass MD, Collins AM, Dommett RM, Saunders M. Chlorhexidine hexametaphosphate as a wound care material coating: antimicrobial efficacy, toxicity and effect on healing. Nanomedicine (Lond) 2016; 11:2049-57. [DOI: 10.2217/nnm-2016-0084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aim: In this study, chlorhexidine hexametaphosphate (CHX-HMP) is investigated as a persistent antimicrobial coating for wound care materials. Materials & methods: CHX-HMP was used as a wound care material coating and compared with chlorhexidine digluconate materials with respect to antimicrobial efficacy, toxicity and wound closure. Results: Antimicrobial efficacy at day 1, 3 and 7 was observed with experimental and commercial materials. CHX-HMP coated materials had less toxic effect on human placental cells than commercial chlorhexidine dressings. CHX-HMP in pluronic gel did not delay healing but reduced wound colonization by E. faecalis. Conclusion: CHX-HMP could become a useful component of wound care materials with sustained antimicrobial efficacy, lower toxicity than chlorhexidine digluconate materials, and reduction in wound colonization without affecting closure.
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Affiliation(s)
- Michele E Barbour
- Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, UK
| | | | - Helena J Grady
- Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, UK
- Bristol Centre for Functional Nanomaterials, University of Bristol, UK
| | | | - Mark D Bass
- Centre for Membrane Interactions & Dynamics, Department of Biomedical Science, University of Sheffield, UK
| | - Andrew M Collins
- Bristol Centre for Functional Nanomaterials, University of Bristol, UK
| | | | - Margaret Saunders
- Bioengineering, Innovation & Research Hub (BIRCH), University Hospitals Bristol, UK
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Zhao R, Chen C, Jin J, Sharma K, Jiang N, Shentu Y, Wang X. Clinical evaluation of the use of an intracardiac electrocardiogram to guide the tip positioning of peripherally inserted central catheters. Int J Nurs Pract 2015; 22:217-23. [PMID: 26617329 DOI: 10.1111/ijn.12409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of peripherally inserted central catheters (PICCs) provides important central venous accesses for clinical treatments, tests and monitoring. Compared with the traditional methods, intracardiac electrocardiogram (ECG)-guided method has the potential to guide more accurate tip positioning of PICCs. This study aimed to clinically evaluate the effectiveness of an intracardiac ECG to guide the tip positioning by monitoring characteristic P-wave changes. In this study, eligible patients enrolled September 2011 to May 2012 according to the inclusion and exclusion criteria received the catheterization monitored by intracardiac ECG. Then chest radiography was performed to check the catheter position. The results revealed that, with 117 eligible patients, all bar one patient who died (n = 116) completed the study, including 60 males and 56 females aged 51.2 ± 15.1 years. Most (n = 113, > 97%) had characteristic P-wave changes. The intracardiac ECG-guided positioning procedure achieved correct placement for 112 patients (96.56%), demonstrating 99.12% sensitivity and 100% specificity. In conclusion, the intracardiac ECG can be a promising technique to guide tip positioning of PICCs. However, since the sample size in this study is limited, more experience and further study during clinical practice are needed to demonstrate achievement of optimal catheterization outcomes.
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Affiliation(s)
- Ruiyi Zhao
- Department of Nursing, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Chunfang Chen
- Department of Nursing, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Komal Sharma
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Nan Jiang
- Department of Nursing, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Yingqin Shentu
- Department of Nursing, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Xingang Wang
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
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