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Wiesen B, Atwell M, Leavitt C, Clark N, Kessler E, Lam E, Flaig T, Kukreja J, Kim S, Maroni P, Cost NG. Use of Peripheral Intravenous Access in Patients Undergoing Chemotherapy for Testicular Cancer. JCO Oncol Pract 2024; 20:361-369. [PMID: 38127812 DOI: 10.1200/op.23.00580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/27/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Systemic chemotherapy, depending on the regimen, can be administered through peripheral intravenous (pIV) access or through central venous access devices (CVADs). There is no current best practice regarding optimal access for chemotherapy for patients with testicular cancer (TC). We retrospectively evaluated patients undergoing systemic chemotherapy for TC and compared baseline characteristics and complications of patients using pIV versus CVADs. METHODS We included patients with TC who underwent first-line systemic chemotherapy at the University of Colorado Hospitals from 2005 to 2020. Data were collected on demographics, cancer characteristics, type, duration of chemotherapy, pIV or CVAD use, and associated complication rates. We then performed univariate and multivariate regression analyses to compare complication rates and risk factors for each group. RESULTS One hundred fifty-four patients met inclusion criteria. Ninety-two (60%) patients used CVADs, and 62 patients (40%) used pIV for their initial treatment. Only six (9.7%) of 62 patients transitioned from pIV to CVADs during therapy. Similarly, 10 of 92 (10.9%) patients with initial CVAD needed to transition to a different type of CVAD or to pIV (P = .81). There were a greater number of venous access-related complications (48 of 92 patients, 52.2%) and overall thrombotic events (33 of 92 patients, 35.9%) for the CVAD group (P > .001) when compared with the pIV group. We observed an association between the following factors and venous access-related complications during chemotherapy: higher stage TC, increased total chemotherapy cycles, and delayed therapy. CONCLUSION Peripheral IV use for first-line nonvesicant chemotherapy in patients with TC appears to be well tolerated with high rates of therapy completion and lower rates of complications when compared with CVADs. These data support our preferred treatment approach and provide evidence that pIV access is a safe and effective way to deliver chemotherapy for patients with TC.
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Affiliation(s)
- Brett Wiesen
- The University of Colorado, Division of Urology, Aurora, CO
| | - Michael Atwell
- The University of Colorado, Division of Urology, Aurora, CO
| | - Colton Leavitt
- The University of Utah, Department of Urology, Salt Lake City, UT
| | - Nathan Clark
- The University of Colorado, Division of Urology, Aurora, CO
| | - Elizabeth Kessler
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Elaine Lam
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Thomas Flaig
- The University of Colorado, Division of Medical Oncology, Aurora, CO
| | - Janet Kukreja
- The University of Colorado, Division of Urology, Aurora, CO
| | - Simon Kim
- The University of Colorado, Division of Urology, Aurora, CO
| | - Paul Maroni
- The University of Colorado, Division of Urology, Aurora, CO
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Li H, Shan J. Risk Factors of the Totally Implantable Venous Access Device-Related Infection in Patients With Brain Tumors Undergoing Chemotherapy After Surgery. Surg Infect (Larchmt) 2024; 25:133-139. [PMID: 38265425 DOI: 10.1089/sur.2023.266] [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] [Indexed: 01/25/2024] Open
Abstract
Background: The complication of totally implantable venous access device (TIVAD) is an infection, which causes the death of patients. Therefore, it is critical to identify risk factors for TIVAD infection to prevent death. Patients and Methods: The enrolled patients were divided into two groups and subsequently divided into subgroups according to various factors in which the correlation between infection and risk factors was analyzed. Multivariable logistic analysis of odds ratios (ORs) for seven risk factors was performed, meanwhile, the receiver operating characteristic (ROC) curve analysis of neutrophil and serum albumin was conducted for the prediction of TIVAD infection occurrence. Results: Catheter-related blood stream infection was the common infection type, which was dominantly caused by Staphylococcus aureus. Removal of TIVAD and antibiotic therapy were the preferred approaches for the treatment of infection. Seven risk factors were closely associated with the TIVAD infection, however, two risk factors, including age and outpatient, were excluded according to the multivariate logistic analysis of ORs. Receiver operating characteristic curve analysis revealed neutrophil count and serum albumin could predict the occurrence of TIVAD infection. Conclusions: Five risk factors were positively related to TIVAD infection; neutrophil and serum albumin could be used to predict the occurrence of TIVAD infection.
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Affiliation(s)
- Haihong Li
- Department of Neurosurgery 1, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Jing Shan
- Department of Orthopaedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Amroun K, Brugel M, Rhaiem R, Teuma L, Vannieuwenhuyse G, Lipere A, Brenet E, Kianmanesh R, Bouché O. Assessing the time-to-removal of totally implantable venous access devices comparing valved-versus open-ended catheters in patients treated with chemotherapy. J Vasc Access 2024:11297298231223539. [PMID: 38205615 DOI: 10.1177/11297298231223539] [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] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Totally IntraVenous Acess Devices (TIVAD) are used to have long-term bloodstream access. The catheter connected to the subcutaneous chamber may be valved (TIVAD-V) or open-ended (TIVAD-O). Infectious and occlusion complications require the removal of the TIVAD. We compared the two types of catheters (TIVAD-V and TIVAD-O) in terms of time-to-removal and complication rates. METHODS A retrospective study of 636 patients treated for any malignancy using a TIVAD were included. TIVAD complication was defined as the occurrence of infection or occlusion requiring TIVAD removal. Risk factors of complications and time-to-removal of TIVAD were assessed by a Cox proportional hazard analysis. RESULTS A total of 55 TIVADs (8.7%) were removed including 47 for infection and eight for occlusion in 54 months. There was no significant difference in the frequency of complications between TIVAD-V and TIVAD-O. There was no significant difference in time-to-removal between TIVAD-V and TIVAD-O (17.0 months, IQR [10.5-25.0] and 18.4 months, IQR [11.5-22.9], p = 0.345, respectively). CONCLUSION There was no difference between TIVAD with valved and open catheter in terms of complications and time-to-removal in patients treated by chemotherapy.
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Affiliation(s)
- Koceila Amroun
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Mathias Brugel
- Department of Digestive Oncology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Rami Rhaiem
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Lugdivine Teuma
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Geoffrey Vannieuwenhuyse
- Department of Obstetrics and Gynaecology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Audrey Lipere
- Department of Obstetrics and Gynaecology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Esteban Brenet
- Department of Otorhinolaryngology, Head and Neck surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est France
| | - Reza Kianmanesh
- Department of Digestive and Endocrine surgery, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, University of Reims Champagne Ardenne (URCA), Reims, Grand Est, France
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Brandão MÂ, Rodrigues Z, Sampaio S, Acioli J, Sampaio C. Catéter Venoso Totalmente Implantável em 278 Pacientes Oncológicos. Rev Bras Cancerol 2023. [DOI: 10.32635/2176-9745.rbc.2000v46n1.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Os catéteres totalmente implantáveis proporcionam acesso vascular prolongado, baixo risco durante inserção e remoção, fácil manutenção, conforto e segurança para o paciente e baixo índice de complicações. Nosso objetivo é relatar a experiência com 278 catéteres implantados por um único cirurgião. Foram critérios para o implante: diagnóstico histopatológico, expectativa de vida maior que 3 meses, dificuldade de acesso venoso periférico e programa de quimioterapia. Entre março de 1990 e março 1998 foram implantados 278 catéteres em 272 pacientes. Tempo de permanência: 382 dias (5a 2897) totalizando 106.457 dias. Sexo feminino 64.8%. Idade média 50,2 anos. Via de acesso: jugular interna 67,9%, jugular externa 26,5%, safena 2,2%, cefálica 1,7% e subclávia 1.7%. Complicações: #1. Obstrução (0,26/1000 dias) #2. Hematoma 6,11% do total, todos em pacientes leucêmicos. #3. Extravasamento 0,2/1000 dias). #4. Trombose (0,03/1000 dias). #5. Infecção 20 episódios, 0,19/1000 dias), sendo 6 lúmen, 7 peri-port e 7 suspeita clínica de sepses. Foram retirados 34 catéteres, 26 por complicações e 8 ao término do tratamento. Permanecem vivos em uso do cateter 45,2%. Não apresentaram qualquer tipo de complicação 74,5% dos pacientes. Em nossa experiência o número de complicações é baixo. O manuseio é realizado exclusivamente por profissionais treinados. Atenção com pacientes leucêmicos para a formação de hematomas.
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Yeow M, Soh S, Yap R, Tay D, Low YF, Ning Goh SS, Yeo CS, Lo ZJ. A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy. J Vasc Surg Venous Lymphat Disord 2022; 10:1184-1191.e8. [PMID: 35367407 DOI: 10.1016/j.jvsv.2022.03.007] [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: 11/01/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Ensuring reliable central venous access with the least complications is vital for cancer patients receiving chemotherapy. A systematic review and network meta-analysis was conducted to compare the safety, quality of life (QoL) and cost effectiveness of different types of central venous access device (CVAD) for patients receiving chemotherapy. METHODS PubMed, EMBASE and Cochrane were searched from inception to 20th August 2021 for randomized controlled trials comparing the various CVADs [non-tunnelled central venous catheter (non-tunnelled catheter), peripherally inserted central venous catheter (PICC), totally implantable ports (PORT), and tunnelled catheter]. RESULTS A total of 11 eligible RCTs comprising 2585 patients were identified. PORT was associated with lower odds of overall complications, device removal due to complications, thrombotic and mechanical complications compared to PICC [(Odds Ratio (OR) 0.54, 95% CI 0.43 - 0.69), (OR 0.49, 95% CI 0.26 - 0.93), (OR 0.37, 95% CI 0.23 - 0.62) and (OR 0.35, 95% CI 0.13 - 0.95) respectively]. Tunnelled catheter was associated with higher odds of overall complication rate, device removal due to complications and infective complications compared to PORT [(OR 1.68, 95% CI 1.30 - 2.17), (OR 2.52, 95% CI 1.34 - 4.73), (OR 2.11, 95% CI 1.14 - 3.90) respectively]. Ranking probability based on SUCRA values indicated that PORT had the lowest probability of overall complications, removal due to complications, and thrombotic complications. CONCLUSION PORT is superior in terms of complications, QoL compared to other CVADs without compromising on cost effectiveness and should be considered the standard of care in patients receiving chemotherapy.
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Affiliation(s)
- Marcus Yeow
- Yong Loo Lin School of Medicine, National University of Singapore.
| | - Shauna Soh
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Ryan Yap
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Desiree Tay
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Yi Fen Low
- Yong Loo Lin School of Medicine, National University of Singapore
| | | | | | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Beauchemin M, Marshall AF, Ricci AM, Lopez I, Yao Y, Lee A, Jin Z, Sulis ML. Bacteremia in Febrile, Non-neutropenic, and Well-appearing Children With Cancer. J Pediatr Hematol Oncol 2022; 44:e194-e198. [PMID: 34001793 PMCID: PMC8599517 DOI: 10.1097/mph.0000000000002201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/29/2021] [Indexed: 01/03/2023]
Abstract
Fever in a neutropenic pediatric oncology patient requires prompt assessment due to the risk of infectious complications. The appropriate management of fever in non-neutropenic patients, however, is not well-established. We describe the rate of bacteremia in a cohort of non-neutropenic pediatric oncology patients with fever at a large institution. Patients were included if they presented to the emergency department or outpatient clinic between 2009 and 2014 with fever, had a central venous catheter (CVC), and were not neutropenic. Three hundred eighty-six episodes of fever occurring in 159 patients were included in the data analysis. Fifty-nine percent of patients were male, 41% had a diagnosis of acute lymphoblastic leukemia, and 90% had a port-a-cath as CVC. The rate of bacteremia was 3.4%; presence of a port-a-cath was protective against bacteremia whereas a white blood cell count >20,000/mm3 was associated with a higher likelihood of bacteremia. Gram-positive microorganisms were most commonly isolated (64.3%) and frequently resistant to cephalosporins. In summary, in our study, the rate of bacteremia was low among non-neutropenic, well-appearing pediatric cancer patients with a CVC and was not associated with any serious medical complications. Prospective research is needed to determine the most appropriate management of these patients.
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Affiliation(s)
- Melissa Beauchemin
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation. Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Alison Fernbach Marshall
- Pediatric Transplant Center, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Angela M. Ricci
- Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock, Lebanon, NH
| | - Ibis Lopez
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation. Columbia University Irving Medical Center, New York, NY
| | - Yujing Yao
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Alice Lee
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation. Columbia University Irving Medical Center, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Maria Luisa Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
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Wouters Y, Causevic E, Klek S, Groenewoud H, Wanten GJA. Use of Catheter Lock Solutions in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Individual-Patient Data Meta-Analysis. JPEN J Parenter Enteral Nutr 2020; 44:1198-1209. [PMID: 31985068 PMCID: PMC7540581 DOI: 10.1002/jpen.1761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Use of catheter lock solutions (CLSs) as a strategy to prevent catheter-related bloodstream infections (CRBSIs) has been evaluated in recent clinical trials. Our aim was to identify the most effective CLS formulation in patients receiving home parenteral nutrition (HPN). METHODS We conducted a systematic review and individual-patient data meta-analysis (IPDMA). Prospective randomized clinical trials in adult HPN patients using CLS were identified from PubMed, EMBASE, Web of Science, CINAHL, Cochrane library, and ClinicalTrials.gov. Primary outcome was the number of CRBSIs per 1000 catheter days for each CLS. Other outcomes included time to CRBSI and identification of patients with a higher risk for CRBSIs. RESULTS In total, 1107 studies were screened for eligibility, of which three studies comprising 162 HPN patients and 45,695 catheter days were included in the IPDMA. CRBSI rates were significantly decreased in patients using taurolidine (rate 0.13; 95% confidence interval [CI], 0.05-0.32) when compared with saline (rate 0.74; 95% CI, 0.31-1.74; P = .002) or heparin (rate 2.01; 95% CI, 1.03-3.91; P < .001). The cumulative proportion of CRBSI-free patients using taurolidine, saline, and heparin after 1 year was 88%, 56%, and 14%, respectively. Three risk factors for CRBSIs were identified: type of CLS, intestinal dysmotility as underlying condition, and use of central venous catheters. CONCLUSIONS Taurolidine was the most effective CLS formulation in HPN patients for the prevention of CRBSIs. We suggest discussing with patients the benefits and risks when starting taurolidine, especially in patients who are considered to have a higher risk for CRBSIs.
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Affiliation(s)
- Yannick Wouters
- Intestinal Failure UnitDepartment of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Erna Causevic
- Intestinal Failure UnitDepartment of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Stanislaw Klek
- General Surgery UnitStanley Dudrick's Memorial HospitalSkawinaPoland
| | - Hans Groenewoud
- Department of Health EvidenceRadboud University Medical CentreNijmegenthe Netherlands
| | - Geert J. A. Wanten
- Intestinal Failure UnitDepartment of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenthe Netherlands
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Abstract
BACKGROUND There are a limited number of studies that address non-neutropenic fever episodes in children with cancer, and no standard approach exists. METHOD We opt to retrospectively analyze the efficacy of the current clinical approach for management of non-neutropenic fever episodes and the associated risk factors among children with cancer at the Princess Noorah Oncology Center from May 2016 through December 2017. RESULTS A total of 480 non-neutropenic fever episodes were identified in 131 children, of which 62 episodes were triaged as high-risk non-neutropenic fever and 418 as low-risk non-neutropenic fever. Of those 480 non-neutropenic fever, 361 episodes (75.2%) were associated with the presence of central venous catheters. The overall failure rate of ceftriaxone mono-therapy was observed in 75.6% (11.7% in high-risk non-neutropenic fever with a mean C-reactive protein level of 21.1 (±23.2) mmol/L and 63.9% in low-risk non-neutropenic fever with a mean C-reactive protein level of 17.6 (±53.9) mmol/L). The overall bacteremia rate was 14.4%. The type of organisms isolated was mainly high-risk organisms in 59 non-neutropenic fever episodes (85.5%), OR 1.78 (95% CI: 0.45-7.04) p = 0.41. Of note, all bacteremia were associated with the presence of central venous catheter (100%). Of all the examined risk factors of outpatient treatment failure in low-risk non-neutropenic fever, only prolonged fever of more than three days were significantly associated with bacteremia OR 8.107 [95% CI: 1.744-37.691], p = 0.008. Noteworthy is that almost 43% of non-neutropenic fever episodes were associated with respiratory symptoms. This study provides a baseline for future prospective research assessing the pattern of non-neutropenic fever by focusing on associated risk factors.
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Affiliation(s)
- Aeshah AlAzmi
- Department of Pharmaceutical Care Clinical Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Faculty of Medicine, Jeddah, Saudi Arabia
- Department of Pediatrics, Oncology/Hematology/BMT, Princes Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Wasil Jastaniah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Faculty of Medicine, Jeddah, Saudi Arabia
- Department of Pediatrics, Oncology/Hematology/BMT, Princes Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia
| | - Mona AlDabbagh
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Faculty of Medicine, Jeddah, Saudi Arabia
- Department of Pediatrics, Division of Infectious diseases, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Naglla Elimam
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Faculty of Medicine, Jeddah, Saudi Arabia
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Jiang M, Li CL, Pan CQ, Yu L. The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis. Support Care Cancer 2019; 28:361-372. [PMID: 31044308 DOI: 10.1007/s00520-019-04809-x] [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: 01/06/2019] [Accepted: 04/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs). METHODS A systematic search of PubMed, Web of science, Embase, and the Cochrane Library was carried out from inception through Oct 2018, with no language restrictions. Trials examining the risk of CLABSI in cancer patients who received TIVAPs compared with those who received external CVCs were included. Two reviewers independently reviewed, extracted data, and assessed the risk of bias of each study. A random-effect model was used to estimate relative risks (RRs) with 95% CIs. RESULTS In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31-0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22-0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38-0.79]). CONCLUSIONS TIVAP can significantly reduce the risk of CLABSI compared with external CVCs.
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Affiliation(s)
- Meng Jiang
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, 11 Lingjiaohu Avenue, Wuhan, 430015, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Li Yu
- Department of Critical Care Medicine, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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Grözinger G, Grosse U, Syha R, Hoffmann R, Partovi S, Nikolaou K, Stahl S, Königsrainer A, Thiel K, Thiel C. CT-Guided Translumbar Placement of Permanent Catheters in the Inferior Vena Cava: Description of the Technique with Technical Success and Complications Data. Cardiovasc Intervent Radiol 2018; 41:1356-1362. [PMID: 29675773 DOI: 10.1007/s00270-018-1961-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/12/2018] [Accepted: 04/05/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. MATERIALS AND METHODS This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). RESULTS All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4 months (range 3.4-160 months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CONCLUSIONS CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.
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Affiliation(s)
- Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany.
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Sasan Partovi
- Department of Radiology, Section of Interventional Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Stéphane Stahl
- Department for Plastic, Hand and Reconstructive Surgery, Klinikum Lüdenscheid, Paulmannshöher Straße 14, 58515, Lüdenscheid, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
| | - Christian Thiel
- Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany
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Lombardi D, Di Lauro V, Piani B, Scuderi C, Spazzapan S, Magri MD, Crivellari D, Annunziata MA, De Cicco M, Veronesi A. Acceptance of External Infusion Pumps in Patients with Advanced Breast Cancer Receiving Continuous Infusion Fluorouracil. Tumori 2018; 89:488-91. [PMID: 14870769 DOI: 10.1177/030089160308900505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background We investigated the physical and psychological adaptation to a protracted continuous infusion system in a series of patients receiving protracted continuous infusion of 5-fluorouracil for advanced breast cancer. Patients and methods The protracted continuous infusion of 5-fluorouracil was administered by means of a portable elastomeric pump (Baxter Seven-Day Infusor, 0.5 mL/hr) via an indwelling Groshong catheter. Patients were asked to complete a questionnaire exploring the impact of the continuous infusion system upon various aspects of daily life, the overall level of disturbance, the general judgement on its quality, and their willingness to resume the same kind of treatment in the future. All items were graded on a 4-point scale from 0 = not at all, to 4 = very much. Results Seventy-one patients were evaluated. All patients received 5-fluorouracil at the dose of 250 mg/m2/day as a protracted continuous infusion alone (n = 14) or in combination with vinorelbine (n = 45) or Taxol (n = 12). The median duration of the protracted continuous infusion before evaluation was 9 months (3–31). The mean level of disturbance to daily activities was 0.86 points. The activities most frequently disturbed by treatment included daily personal care (mean, 1.76 points) and sexual activity (mean, 1.20 points). Twenty-one patients required medical intervention because of problems related to the protracted continuous infusion system. The overall level of disturbance was rated at a mean level of 0.72 points, whereas the overall merits of the protracted continuous infusion system and the willingness of the patient to resume protracted continuous infusion in the future were rated at a mean level of 2.90 and 2.55 points, respectively. Conclusions The system for the protracted continuous infusion of 5-fluorouracil was well tolerated by the patients, who were able in most cases to perform their daily activities with little or no disturbance, needing only occasional help, and were willing to resume the same treatment modality if necessary.
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Affiliation(s)
- Davide Lombardi
- Division of Medical Oncology C, Centro di Riferimento Oncologico, Aviano, Italy
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Biffi R, Pozzi S, Pace U, Cenciarelli S, Zambelli M, Orsi F, Grasso RF, De Braud F, Andreoni B. Is there a Real Advantage in Utilizing Central Venous Ports in Oncology Surgery? An Analysis of the Cost-Effectiveness Ratio. Tumori 2001; 87:74-5. [DOI: 10.1177/030089160108700438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Biffi R, Pittiruti M, Gillet JP, Fobe D, Hermanne JP, Pescio M, Gourlia A, Collet K, Battelli C, Cenciarelli S. Valved Central Venous Catheter Connected to Subcutaneous Port: A Multicenter Phase IV Study Based on a Cohort of 50 Oncology Patients. J Vasc Access 2018; 3:147-53. [PMID: 17639477 DOI: 10.1177/112972980200300403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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 Since technical aspects and clinical features of central venous valved catheters are far from being completely understood, a multinational group of investigators has decided to assess a new distally-valved catheter connected to a port, in the clinical setting of oncology patients undergoing chemotherapy, in an attempt to verify its safety and viability, while also investigating its practical features. Methods Our project was structured as a phase IV multicenter study. Hospitalized adults (ages 18–80 years) who had solid tumors and were candidate for intravenous chemotherapy met the criteria to enter the study. One single type of port was used (made of titanium, plastic and silicone) connected to a silicone, distally valved catheter (as manufactured by B. Braun Aesculap). A case report form was provided for each treated case; all relevant data regarding implantation and follow-up were entered into the form, mailed to a coordinating center (G. Chevillon, B. Braun Medical, France) and stored in a software database for statistical analysis. Results 50 patients (from 6 participating centers) were included in this study. No major complications occurred at insertion. The most frequent clinical problem during follow-up was inability to draw blood samples (9% during the first chemotherapy cycle; 8% after the second cycle); blood obtained from the device was defined “unsuitable for hematology test” in 9% of the cases at first chemotherapy cycle and in 23% of the cases after the second cycle. No catheter obstruction occurred. Conclusion The distally valved catheter port tested in this study was reliable, safe and practical for long-term treatment of an oncology patients’ population undergoing chemotherapy. As most other reports and clinical trials dealing with other types of distally valved catheters pointed out, inability to draw viable blood samples (so called withdrawal occlusion) is a major concern in their clinical use. Mechanisms underlying this technical problem are still unclear.
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Affiliation(s)
- R Biffi
- Division of General Surgery, European Institute of Oncology, Milano - Italy
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Wu O, Boyd K, Paul J, McCartney E, Ritchie M, Mellon D, Kelly L, Dixon-Hughes J, Moss J. Hickman catheter and implantable port devices for the delivery of chemotherapy: a phase II randomised controlled trial and economic evaluation. Br J Cancer 2016; 114:979-85. [PMID: 27092784 PMCID: PMC4984916 DOI: 10.1038/bjc.2016.76] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the United Kingdom, totally implantable venous access systems (TIVAS) are not routinely used. Compared with Hickman catheters, these devices are more expensive and complex to insert. However, it is unclear whether the higher costs may be offset by perceived greater health benefits. This pilot trial aimed to generate relevant data to inform the design of a larger definitive randomised controlled trial. METHODS This was a phase II prospective, randomised, open trial from two UK oncology centres. The primary end point was overall complication rate. Secondary end points included individual complication rates, time to first complication and quality of life. Analysis was by intention to treat. An economic evaluation was also carried out. RESULTS A total of 100 patients were randomised in a 3 : 1 ratio to receive a Hickman or a TIVAS. Overall, 54% of patients in the Hickman arm suffered one or more complications compared with 38% in the TIVAS arm (one-sided P=0.068). In the Hickman arm, 28% of the devices were removed prematurely due to a complication compared with 4% in the TIVAS arm. Quality of life based on the device-specific questionnaire was greater in the TIVAS arm for 13 of the 16 questions. The economic evaluation showed that Hickman arm was associated with greater mean cost per patient £1803 (95% CI 462, 3215), but similar quality-adjusted life years -0.01 (95% CI -0.15, 0.15) than the TIVAS arm. However, there is much uncertainty associated with the results. CONCLUSIONS Compared with Hickman catheters, TIVAS may be the cost-effective option. A larger multicentre trial is needed to confirm these preliminary findings.
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Affiliation(s)
- Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
| | - Jim Paul
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - Elaine McCartney
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - Moira Ritchie
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
- Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - D Mellon
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - Linda Kelly
- School of Health Nursing and Midwifery, University of West of Scotland, Caird Building, Hamilton ML3 0JB, UK
| | - Judith Dixon-Hughes
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - Jon Moss
- Interventional Radiology Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK
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Esbenshade AJ, Di Pentima MC, Zhao Z, Shintani A, Esbenshade JC, Simpson ME, Montgomery KC, Lindell RB, Lee H, Wallace A, Garcia KL, Moons KG, Debra L. F. Development and validation of a prediction model for diagnosing blood stream infections in febrile, non-neutropenic children with cancer. Pediatr Blood Cancer 2015; 62:262-268. [PMID: 25327666 PMCID: PMC4402108 DOI: 10.1002/pbc.25275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 06/24/2014] [Accepted: 08/20/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] ≥500/µl) is not well defined. PROCEDURE In a retrospective cohort of febrile (temperature ≥38.0° for >1 hr or ≥38.3°) pediatric oncology patients with ANC ≥500/µl, a diagnostic prediction model for BSI was constructed using logistic regression modeling and the following candidate predictors: age, ANC, absolute monocyte count, body temperature, inpatient/outpatient presentation, sex, central venous catheter type, hypotension, chills, cancer diagnosis, stem cell transplant, upper respiratory symptoms, and exposure to cytarabine, anti-thymocyte globulin, or anti-GD2 antibody. The model was internally validated with bootstrapping methods. RESULTS Among 932 febrile episodes in 463 patients, we identified 91 cases of BSI. Independently significant predictors for BSI were higher body temperature (Odds ratio [OR] 2.36 P < 0.001), tunneled external catheter (OR 13.79 P < 0.001), peripherally inserted central catheter (OR 3.95 P = 0.005), elevated ANC (OR 1.19 P = 0.024), chills (OR 2.09 P = 0.031), and hypotension (OR 3.08 P = 0.004). Acute lymphoblastic leukemia diagnosis (OR 0.34 P = 0.026), increased age (OR 0.70 P = 0.049), and drug exposure (OR 0.08 P < 0.001) were associated with decreased risk for BSI. The risk prediction model had a C-index of 0.898; after bootstrapping adjustment for optimism, corrected C-index 0.885. CONCLUSIONS We developed a diagnostic prediction model for BSI in febrile pediatric oncology patients without severe neutropenia. External validation is warranted before use in clinical practice. Pediatr Blood Cancer 2015;62:262-268. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Adam J. Esbenshade
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - M. Cecilia Di Pentima
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA
| | - Zhiguo Zhao
- Vanderbilt Department of Biostatistics, Nashville, TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Ayumi Shintani
- Vanderbilt Department of Biostatistics, Nashville, TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Jennifer C. Esbenshade
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA
| | | | | | | | - Haerin Lee
- Vanderbilt School of Medicine, Nashville, TN, USA
| | - Ato Wallace
- Vanderbilt School of Medicine, Nashville, TN, USA
| | | | - Karel G.M. Moons
- Vanderbilt Department of Biostatistics, Nashville, TN, USA,Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlands
| | - Friedman Debra L.
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Mudan S, Giakoustidis A, Morrison D, Iosifidou S, Raobaikady R, Neofytou K, Stebbing J. 1000 Port-A-Cath ® placements by subclavian vein approach: single surgeon experience. World J Surg 2015; 39:328-34. [PMID: 25245435 DOI: 10.1007/s00268-014-2802-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Totally implantable venous access ports are widely used for the administration of chemotherapy in patients with cancer. Although there are several approaches to implantation, here we describe Port-A-Cath(®) (PAC) placement by percutaneous puncture of the subclavian vein with ultrasonographic guidance. PATIENTS AND METHODS Data on our vascular access service were collected prospectively from June 2004. This service included port-a-caths and Hickman lines. Once 1000 consecutive port-a-caths(®) had been reached the study was closed and data analysed for the port-a-caths(®) alone. The left subclavian vein was the preferred site for venous access, with the right subclavian and jugular veins being the alternative choices if the initial approach failed. Patients were followed up in the short-term, and all the procedures were carried out by a single surgeon at each one of two institutions. RESULTS Venous access by PAC was established in 100 % of the 1,000 cases. Of the 952 patients where the left subclavian vein was chosen for the first attempt of puncture, the success rate of PAC placement was 95 % (n = 904). Pneumothorax occurred in 12 patients (1.2 %), and a wound haematoma occurred in 4 (0.4 %) out of the total 1,000 patients. No infections were recorded during the immediate post-operative period but only in the long-term post-operative use with 8 patients requiring removal of the PAC due to infection following administration of chemotherapy. CONCLUSION This is a very large series of PAC placement with an ultrasound-guided approach for left subclavian vein and X-ray confirmation, performed by a single surgeon, demonstrating both the safety and effectiveness of the procedure.
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Affiliation(s)
- S Mudan
- Department of Academic Surgery, The Royal Marsden NHS Trust, Fulham Road, London, SW3 6JJ, UK
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Alonso-Echanove J, Edwards JR, Richards MJ, Brennan P, Venezia RA, Keen J, Ashline V, Kirkland K, Chou E, Hupert M, Veeder AV, Speas J, Kaye J, Sharma K, Martin A, Moroz VD, Gaynes RP. Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units. Infect Control Hosp Epidemiol 2015; 24:916-25. [PMID: 14700407 DOI: 10.1086/502160] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground:Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.Methods:We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.Results:A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days;P= .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by “float” nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P= .0001), patient cared for by a float nurse for more than 60% of CVC-days (P= .0019), no antibiotics administered to the patient within 48 hours of insertion (P= .0001), and patient unarousable for 70% or more of the duration of the CVC (P= .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P= .0001).Conclusions:Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.
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Affiliation(s)
- Juan Alonso-Echanove
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Biffi R, Pozzi S, Bonomo G, Della Vigna P, Monfardini L, Radice D, Rotmensz N, Zampino MG, Fazio N, Orsi F. Cost effectiveness of different central venous approaches for port placement and use in adult oncology patients: evidence from a randomized three-arm trial. Ann Surg Oncol 2014; 21:3725-31. [PMID: 24841352 DOI: 10.1245/s10434-014-3784-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND No randomized trials have so far investigated the cost effectiveness of different methods for implantation and use of central venous ports in oncology patients. PATIENTS AND METHODS Overall, 403 patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of port, either through a percutaneous landmark access to the internal jugular vein, an ultrasound (US)-guided access to the subclavian vein, or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Insertion and maintenance costs were estimated by obtaining the charges for an average implant and use, while the costs of the management of complications were analytically assessed. The total cost was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any. RESULTS A total of 401 patients were evaluable-132 with the internal jugular vein, 136 with the subclavian vein and 133 with the cephalic vein access. No differences were found for the rate of early complications. The US-guided subclavian insertion site had significantly lower failures. Infections occurred in 1, 3, and 3 patients (internal jugular, subclavian, and cephalic access, respectively; p = 0.464), whereas venous thrombosis was observed in 15, 8, and 11 patients, respectively (p = 0.272). Mean cost for purchase, implantation, diagnosis and treatment of complications in each patient was <euro>2,167.85 for subclavian US-guided, <euro>2,335.87 for cephalic, and <euro>2,384.10 for internal jugular access, respectively (p = 0.0001). CONCLUSION US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.
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Affiliation(s)
- Roberto Biffi
- Division of Abdomino-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Milan, Italy,
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Miao J, Ji L, Lu J, Chen J. Randomized Clinical Trial Comparing Ultrasound-Guided Procedure with the Seldinger’s Technique for Placement of Implantable Venous Ports. Cell Biochem Biophys 2014; 70:559-63. [DOI: 10.1007/s12013-014-9956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kulkarni S, Wu O, Kasthuri R, Moss JG. Centrally Inserted External Catheters and Totally Implantable Ports for the Delivery of Chemotherapy: A Systematic Review and Meta-Analysis of Device-Related Complications. Cardiovasc Intervent Radiol 2014; 37:990-1008. [DOI: 10.1007/s00270-013-0771-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
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Mangum DS, Verma A, Weng C, Sheng X, Larsen R, Kirchhoff AC, Druzgal C, Fluchel M. A comparison of central lines in pediatric oncology patients: Early removal and patient centered outcomes. Pediatr Blood Cancer 2013; 60:1890-5. [PMID: 23868811 DOI: 10.1002/pbc.24687] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/14/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND While there is increasing evidence supporting the choice of subcutaneous ports (SPs) over external venous catheters (EVCs) in pediatric oncology patients, prior conflicting studies exist and little data have been gathered as to which type of central line is preferred from the patient/family perspective. PROCEDURE We performed a single institution, 10 years, retrospective analysis of central lines in pediatric oncology patients (n = 878) to evaluate unplanned early removal and cause of removal while simultaneously obtaining a cross sectional survey of 143 of the primary caretakers/parents of these patients to evaluate their overall satisfaction with the line. RESULTS EVCs have significantly higher odds of unplanned early removal in comparison to SPs (6.7% of SPs vs. 27.3% of EVCs, odds ratio (OR) = 6.3, P < 0.0001 when controlling for age and diagnosis) secondary to increased infection, malfunction and patient preference. Patients with SPs felt like their central line was easier to care for, had less daily impact in their life, and were overall more satisfied with their central line compared to patients with EVCs, even when controlling for early removal (P < 0.0001 for all). SP patients were much more likely to state that they would choose the same type of line again (OR = 15, P < 0.0001) than EVC patients. CONCLUSION SPs demonstrated lower removal rates and greater patient satisfaction than EVCs. These data should be considered when choosing a central line for pediatric cancer patients.
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Affiliation(s)
- David Spencer Mangum
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; Primary Children's Medical Center, Salt Lake City, Utah; Albert Einstein College of Medicine, Bronx, New York
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Celebi S, Sezgin ME, Cakır D, Baytan B, Demirkaya M, Sevinir B, Bozdemir SE, Gunes AM, Hacimustafaoglu M. Catheter-associated bloodstream infections in pediatric hematology-oncology patients. Pediatr Hematol Oncol 2013; 30:187-94. [PMID: 23458064 DOI: 10.3109/08880018.2013.772683] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 11/13/2022]
Abstract
Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.
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Affiliation(s)
- Solmaz Celebi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Uludag University Medical Faculty, Bursa, Turkey.
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Schiffer CA, Mangu PB, Wade JC, Camp-Sorrell D, Cope DG, El-Rayes BF, Gorman M, Ligibel J, Mansfield P, Levine M. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013; 31:1357-70. [PMID: 23460705 DOI: 10.1200/jco.2012.45.5733] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To develop an evidence-based guideline on central venous catheter (CVC) care for patients with cancer that addresses catheter type, insertion site, and placement as well as prophylaxis and management of both catheter-related infection and thrombosis. METHODS A systematic search of MEDLINE and the Cochrane Library (1980 to July 2012) identified relevant articles published in English. RESULTS The overall quality of the randomized controlled trial evidence was rated as good. There is consistency among meta-analyses and guidelines compiled by other groups as well. RECOMMENDATIONS There is insufficient evidence to recommend one CVC type or insertion site; femoral catheterization should be avoided. CVC should be placed by well-trained providers, and the use of a CVC clinical care bundle is recommended. The use of antimicrobial/antiseptic-impregnated and/or heparin-impregnated CVCs is recommended to decrease the risk of catheter-related infections for short-term CVCs, particularly in high-risk groups; more research is needed. The prophylactic use of systemic antibiotics is not recommended before insertion. Data are not sufficient to recommend for or against routine use of antibiotic flush/lock therapy; more research is needed. Before starting antibiotic therapy, cultures should be obtained. Some life-threatening infections require immediate catheter removal, but most can be treated with antimicrobial therapy while the CVC remains in place. Routine flushing with saline is recommended. Prophylactic use of warfarin or low-molecular weight heparin is not recommended, although a tissue plasminogen activator (t-PA) is recommended to restore patency to occluded catheters. CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy.
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Affiliation(s)
- Charles A Schiffer
- Karmanos Cancer Institute, Wayne State UniversitySchool of Medicine, Detroit, MI, USA
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White AD, Othman D, Dawrant MJ, Sohrabi S, Young AL, Squire R. Implantable versus cuffed external central venous catheters for the management of children and adolescents with acute lymphoblastic leukaemia. Pediatr Surg Int 2012. [PMID: 23178960 DOI: 10.1007/s00383-012-3213-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to determine if there is a difference between complications for totally implantable central venous catheters (ports) and tunnelled external central venous catheters (external CVCs) that result in early removal of the central venous catheter (CVC) in children and adolescents with acute lymphoblastic leukaemia (ALL). METHODS All children hospitalised between November 1996 and December 2007 with ALL who had a CVC were included retrospectively. We analysed data regarding the patient's first CVC. RESULTS We included 322 patients. 254 received a port and 68 received an external CVC. There were 102 CVC complications that required removal of the CVC prior to the completion of chemotherapy (65 in patients with ports, 37 in patients with external CVCs). Overall complications requiring CVC removal were significantly less likely to occur in the patient's with ports (p < 0.001). Ports were significantly less likely to require removal prior to the end of treatment overall (p < 0.001) and for specific complications such as infection (p < 0.001) and dislodgement (p = 0.001). However, when adjusted for disease severity there is no difference in premature CVC removal rates. CONCLUSION When patients are risk-stratified for disease severity there is no difference in rates of CVC removal prior to completion of treatment.
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Affiliation(s)
- Alan D White
- Paediatric Surgical Department, Leeds Children's Hospital, Leeds, UK.
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Lebeaux D, Larroque B, Gellen-Dautremer J, Leflon-Guibout V, Dreyer C, Bialek S, Froissart A, Hentic O, Tessier C, Ruimy R, Pelletier AL, Crestani B, Fournier M, Papo T, Barry B, Zarrouk V, Fantin B. Clinical outcome after a totally implantable venous access port-related infection in cancer patients: a prospective study and review of the literature. Medicine (Baltimore) 2012; 91:309-318. [PMID: 23117849 DOI: 10.1097/md.0b013e318275ffe1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Morbidity and mortality after a totally implantable venous access port (TIVAP)-related infection in oncology patients have rarely been studied. We conducted this study to assess the incidence and factors associated with the following outcome endpoints: severe sepsis or septic shock at presentation, cancellation of antineoplastic chemotherapy, and mortality at week 12. We conducted a prospective single-center observational study including all adult patients with solid cancer who experienced a TIVAP-related infection between February 1, 2009, and October 31, 2010. Patients were prospectively followed for 12 weeks. Among 1728 patients receiving antineoplastic chemotherapy during the inclusion time, 72 had an episode of TIVAP-related infection (4.2%) and were included in the study (median age, 60 yr; range, 28-85 yr). The incidence of complications was 18% for severe sepsis or septic shock (13/72 patients), 30% for definitive cancellation of antineoplastic chemotherapy (14/46 patients who still had active treatment), and 46% for death at week 12 (33/72 patients). Factors associated with severe sepsis or septic shock were an elevated C-reactive protein (CRP) level and an infection caused by Candida species; 4 of the 13 severe episodes (31%) were due to coagulase-negative staphylococci (CoNS). Factors associated with death at week 12 were a low median Karnofsky score, an elevated Charlson comorbidity index, the metastatic evolution of cancer, palliative care, and an elevated CRP level at presentation. Hematogenous complications (that is, infective endocarditis, septic thrombophlebitis, septic pulmonary emboli, spondylodiscitis, septic arthritis, or organ abscesses) were found in 8 patients (11%). In conclusion, patients' overall condition (comorbidities and autonomy) and elevated CRP level were associated with an unfavorable clinical outcome after a TIVAP-related infection. Candida species and CoNS were responsible for severe sepsis or septic shock.
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Affiliation(s)
- David Lebeaux
- From the Service de Médecine Interne (DL, JGD, AF, VZ, BF), Unité d'Epidémiologie et de Recherche Clinique (BL), Service de Microbiologie (VLG, SB),Service d'Oncologie Médicale (CD), Service d'Hépatologie et Gastroentérologie (OH), and Service d'Anesthésie-Réanimation (CT), Hôpital Beaujon, AP-HP, Clichy; and Service de Microbiologie (RR), Service d'Hépatologie etGastroentérologie (ALP), Service de Pneumologie (BC, MF), Service de Médecine Interne (TP), and Service d'Oto-rhino Laryngologie (BB), Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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Salamonsen M, Keating D, Whitford H, Bailey M, Miller T, Manterfield C, Williams T. IVI epoprostenol as salvage therapy in pulmonary arterial hypertension: an Australian perspective. Intern Med J 2012; 41:245-51. [PMID: 20681957 DOI: 10.1111/j.1445-5994.2010.02333.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND IVI epoprostenol is the only therapy for pulmonary arterial hypertension (PAH) with a randomized controlled trial demonstrating improved survival, when used as first-line monotherapy. In Australia it is used as salvage therapy for those failing treatment with other targeted therapies or presenting in World Health Organization functional class (FC) IV. AIMS Report experience with IVI epoprostenol, administered as salvage therapy for the treatment of adults with PAH in a single Australian PAH centre. METHODS Retrospective case series of all patients commenced on IVI epoprostenol for PAH, between 2002 and 2010. Review of case notes with collection of data at baseline and after treatment, including FC, 6-min walk test (6MWT), right ventricular systolic pressure (RVSP) on echocardiogram, patient survival and treatment complications. Change in indices was assessed using the Wilcoxon Sign Rank Test and is expressed as median (inter-quartile range). RESULTS A total of 23 patients was included. Treatment was generally well tolerated with few major complications. At the end of the study period, nine patients were successfully bridged to transplant, five had a sustained response to IVI epoprostenol, six had an incomplete response but were clinically stabilized, two died awaiting transplant and one died who was not a candidate for transplantation. Overall, when measured at best level post initiation of IVI epoprostenol, there were significant improvements in FC -1 [0 to -1] (P < 0.0001), 6MWT (m) +117 [70-264] (P= 0.002) and RVSP (mmHg) -7.0 [4.0 to -45] (P= 0.03). CONCLUSION Findings support efficacy of epoprostenol as salvage therapy for patients with PAH.
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Affiliation(s)
- M Salamonsen
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
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Koonings P, Lentz SE. Vascular Access and Other Invasive Procedures. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011; 21:1224-32. [PMID: 21207035 DOI: 10.1007/s00330-010-2045-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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Biffi R, Orsi F, Pozzi S, Maldifassi A, Radice D, Rotmensz N, Zampino MG, Fazio N, Peruzzotti G, Didier F. No impact of central venous insertion site on oncology patients' quality of life and psychological distress. A randomized three-arm trial. Support Care Cancer 2010; 19:1573-80. [PMID: 20803038 DOI: 10.1007/s00520-010-0984-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 08/16/2010] [Indexed: 12/15/2022]
Abstract
PURPOSE Though totally implantable access ports (TIAP) are extensively used, information from randomized trials about the impact of insertion site on patient's quality of life (QoL) and psychological distress is unavailable. PATIENTS AND METHODS Four hundred and three patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of TIAP, either through a percutaneous landmark access to the internal jugular or an ultrasound-guided access to the subclavian or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Patients' QoL and psychological distress were investigated at regular intervals by means of EORTC QLQ-C30 and HADS (Hospital Anxiety and Depression Scale) questionnaires, using univariate and multivariate repeated measure linear mixed models. A post hoc analysis investigated the impact of type of administered chemotherapy (adjuvant vs palliative). RESULTS Three hundred and eighty-four patients (95.2%) were evaluable, 126 with the internal jugular, 132 with the subclavian and 126 with the cephalic vein access. The median follow-up was 361 days (range, 0-1,087). Mean score changes for the items of the EORTC QLQ-C30 scales were significantly associated with type of administered chemotherapy only (P < 0.001), and not with implantation site. Frequency distribution of patients with depression and anxiety score greater than 10 at HADS was not significantly different, with respect either to type of administered chemotherapy or TIAP implantation site. CONCLUSION Central venous insertion sites had no impact on patients' QoL and psychological distress. Patients undergoing palliative therapies showed worse EORTC QLQ-C30 scales.
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Affiliation(s)
- Roberto Biffi
- Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Handrup MM, Møller JK, Frydenberg M, Schrøder H. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2010; 55:309-13. [PMID: 20582964 DOI: 10.1002/pbc.22530] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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: 11/07/2022]
Abstract
BACKGROUND Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter. PROCEDURE All children hospitalized from January 2000 to March 2008 with newly diagnosed ALL and with double-lumen total implantable devices (TIDs) or tunneled external catheters (TEs) were included retrospectively. We only used data related to the patient's first catheter. RESULTS We included 98 children; 35 received a TID and the remaining 63 received a TE. A total number of 29,566 catheter days and 93 catheter-associated blood stream infections (CABSI) was identified. We found a CABSI rate of 3.1/1,000 catheter days (5.4/1,000 catheter days for TEs and 1.4/1,000 catheter days for TIDs, incidence rate ratio (IRR) 3.82 (95% CI 2.37-6.35) P = 0.0001). No difference was found in CABSI between neither early versus later placed TIDs (IRR = 0.99 (95% CI 0.41-2.45) P = 0.98) nor early versus later placed TEs (IRR = 0.81 (95% CI 0.40-1.86) P = 0.54). We found no difference between early and later placed catheters regarding non-elective removal (RR = 0.86 (95% CI 0.72-1.03) P = 0.09). TEs had a higher risk of non-elective removal compared with TIDs (RR = 3.95 (95% CI 1.88-8.29) P < 0.001). CONCLUSIONS The study did not find that children with ALL and with early placed CVCs experienced significantly more complications compared with children with late placed catheters. This study found that children with ALL and TEs experienced more complications than children with TIDs.
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Affiliation(s)
- Mette Møller Handrup
- Department of Pediatrics, Aarhus University Hospital Skejby, Brendstrupgårdsvej, Arhus, Denmark.
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Cortelezzia A, Fracchiolla NS, Maisonneuve P, Moia M, Luchesini C, Ranzi ML, Monni P, Pasquini MC, Lambertenghi-Deliliers G. Central Venous Catheter-related Complications in Patients with Hematological Malignancies: A Retrospective Analysis of Risk Factors and Prophylactic Measures. Leuk Lymphoma 2010; 44:1495-501. [PMID: 14565650 DOI: 10.3109/10428190309178770] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED We retrospectively analyzed the incidence of thrombotic and infectious complications in relation with the use of central venous catheters (CVCs), in a series of patients with hematological malignancies and low platelet and leucocyte counts. PATIENTS AND METHODS 126 patients with hematological malignancies were analyzed. A total of 207 CVCs were implanted: 137 centrally (CICCs) and 70 peripherally (PICCs). The median duration of the CVCs was 19 days for a total of 4051 catheter-days. Antithrombotic prophylaxis was unfractionated heparin (UFH), 2,500 IU daily by 24 h continuous infusion in 169 CVCs, low molecular weight heparin (LMWH), 3,800 IU daily by single bolus intravenous injection (i.v.) in 21 and warfarin in one. No prophylaxis was given in 16 CVCs. Thrombotic complications developed in 15.5% of the CVCs (7.9 events/1000 catheter days), and the frequency of infectious complications was 10.6% (5.2 events/1000 catheter days). On multivariate analysis thromboses were more frequent and earlier with PICCs than CICCs (p = 0.0001), and in patients on UFH (16.6%) than in LMWH prophylaxis (4.7%), but the last difference was not statistically significant. In conclusions the incidence of thrombotic complications in our series was comparable to that observed in non-thrombocytopenic patients and was significantly higher in those carrying PICC than CICC (p = 0.0001). There were fewer thrombotic events in the patients receiving i.v. LMWH prophylaxis than in those receiving i.v. UFH. The use of anticoagulants was safe and not associated with hemorrhages.
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Affiliation(s)
- A Cortelezzia
- Department of Hematology, IRCCS Maggiore Hospital and University of Milan, Milan, Italy.
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Abstract
BACKGROUND We sought to determine the risk of bacteremia in a cohort of outpatient febrile nonneutropenic pediatric oncology patients and to assess clinical characteristics that may influence decisions regarding empiric antibiotic therapy. PROCEDURE A single institution retrospective cohort study was performed of outpatient pediatric oncology patients presenting with fever, a central venous catheter, and an absolute neutrophil count (ANC) of >/=500/microl over a 6-year period. We also collected data regarding the presence of clinically evident infections, antibiotics prescribed, and the sensitivity of bacteria to specific antibiotics. RESULTS There were 29 cases of bacteremia in 459 (6.3%) febrile outpatient visits by 167 patients. Bacteremia was documented in 4.4% of patients with ports and in 16.2% of patients with external catheters. Patients with external catheters had a relative risk of bacteremia of 3.7 (95% CI: 1.8-7.4) times the risk of those with internal catheters (P < 0.0001). A documented source for fever on exam was noted in 21% of patients but in none of the patients with bacteremia (P = 0.004). Empiric treatment with ceftriaxone was administered to 92% of the patients. Of the high-risk bacteremic infections (Gram-negative organisms, Streptococcus pneumoniae, viridans group streptococcus, and Staphylococcus aureus) 94% had at least an intermediate sensitivity to ceftriaxone. CONCLUSIONS Bacteremia is an important issue in febrile nonneutropenic pediatric oncology patients occurring in 6% of the patient visits in this study. The overall sensitivity of high-risk bacteremia to ceftriaxone provides justification for its empiric use in outpatient febrile nonneutropenic pediatric oncology patients.
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Affiliation(s)
- Michael J Kelly
- Department of Pediatric Hematology Oncology, Hasbro Children's Hospital, Providence, RI 02903, USA.
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Abstract
Central venous catheters are widely used in the care of patients with cancer. Indwelling catheters are associated with upper extremity deep venous thrombosis in some patients, and recognition of this entity is an important aspect of treating patients with malignancies. This article will review the incidence, pathogenesis, clinical presentation, diagnosis, treatment, and prophylaxis of catheter-associated thrombosis in patients with malignancy. The care of pediatric patients with malignancy and catheter-associated thrombosis will also be addressed.
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Affiliation(s)
- Sudeep P Shivakumar
- Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Nova Scotia, Canada
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Garcia-Alfonso P, Muñoz-Martin A, Mendez-Ureña M, Quiben-Pereira R, Gonzalez-Flores E, Perez-Manga G. Capecitabine in combination with irinotecan (XELIRI), administered as a 2-weekly schedule, as first-line chemotherapy for patients with metastatic colorectal cancer: a phase II study of the Spanish GOTI group. Br J Cancer 2009; 101:1039-43. [PMID: 19738605 DOI: 10.1038/sj.bjc.6605261] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Combination chemotherapy is standard treatment for metastatic colorectal cancer (MCRC). The aim of this study was to determine the efficacy and safety of capecitabine+irinotecan (2-weekly schedule), as first-line therapy of MCRC. METHODS Patients received irinotecan 175 mg m(-2) on day 1 and oral capecitabine 1000 mg m(-2) twice daily on days 2-8 every 2 weeks. For patients aged > or =65 years, the starting doses of irinotecan and capecitabine were reduced to 140 and 750 mg m(-2), respectively. RESULTS A total of 53 patients were enrolled: 29 (55%) were > or =65 years old. In an intention-to-treat analysis, complete response was achieved in three patients for an overall response rate (ORR) of 32%. The disease control rate (ORR + stable disease) was 66% and the median duration of response was 7.3 months. Median time to progression and overall survival were 9.0 and 19.2 months, respectively. Grade 4 neutropenia was reported in one patient: no other grade 4 toxicities were recorded. Grade 3 diarrhoea occurred in 8 (15%) patients and grade 1-2 hand-foot syndrome in 7 (13%) patients. CONCLUSION Capecitabine and irinotecan, given every 2 weeks, as first-line treatment of MCRC is an active regimen with a manageable toxicity profile, even in older patients.
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Hooda B, Lalani G, Fadoo Z, Billoo G. Implantable Port Devices Are Catheters of Choice for Administration of Chemotherapy in Pediatric Oncology Patients-A Clinical Experience in Pakistan. Ann N Y Acad Sci 2008; 1138:43-6. [DOI: 10.1196/annals.1414.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Spagrud LJ, von Baeyer CL, Ali K, Mpofu C, Fennell LP, Friesen K, Mitchell J. Pain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access. J Pain Symptom Manage 2008; 36:173-84. [PMID: 18400458 DOI: 10.1016/j.jpainsymman.2007.10.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 10/23/2007] [Accepted: 10/31/2007] [Indexed: 11/28/2022]
Abstract
This study examined pain and distress from needles in children undergoing blood sampling as a function of adult-child interaction and type of venous access (i.e., central external venous lines, internalized ports, or peripheral access via venipuncture). Participants were 55 pediatric oncology patients, aged 3-18 years, who were undergoing routine blood work. Pain ratings were obtained using the Faces Pain Scale-Revised (FPS-R) and conversation during the procedure was audio taped for coding using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Children's ratings of pain using the FPS-R were similar in the port (M=2.57/10, standard deviation [SD]=3.46) and peripheral (M=2.56/10, SD=3.24) groups, despite the fact that most children with internal ports were given a topical anesthetic. Similarly, there were no differences between port and peripheral groups in rates of child coping or distress, or parent and nurse observations of child pain. As would be expected, external line access was not associated with pain or distress, even among very young children, suggesting that they appropriately understood the pain rating scale. Results of the transcribed CAMPIS-R data indicate that the influences in adult-child interaction are bidirectional. Support was found for the well-established positive relationship between child distress and adult reassurance and empathy. Implications for intervention and selection of central venous access devices are discussed.
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Affiliation(s)
- Lara J Spagrud
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Allen RC, Holdsworth MT, Johnson CA, Chavez CM, Heideman RL, Overturf G, Lemon D, Hunt WC, Winter SS. Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer 2008; 51:53-8. [PMID: 18266227 DOI: 10.1002/pbc.21497] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [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: 11/07/2022]
Abstract
BACKGROUND Catheter-associated blood stream infections (CABSI) are frequent complications encountered with cancer treatment. In order to understand which factors might predispose to CABSIs in children and young adults, we evaluated risk for infection in association with tumor type, catheter type, and setting of occurrence. METHODS All pediatric oncology patients having a central venous catheter (CVC) with a tunneled external (TE) or totally implantable design (TID) were prospectively followed for the occurrence of a CABSI for 12 months. CABSIs were defined in accordance with the guidelines published by the Centers for Disease Control, and were quantified as the number of occurrences per 1,000 device days. Rates of CABSIs were stratified by tumor histology, type of catheter design, and setting of occurrence. Statistical comparisons were made using the Mantel-Haenzel statistic and the Cox proportional hazard model. RESULTS A total of 58 CABSIs were identified in 139 patients over a period of 35,935 CVC days. The overall CABSI rate was 1.6 infections per 1,000 CVC days (95% CI 1.2, 2.1). Stratified analysis demonstrated increased risk for CABSIs in hospitalized patients having TEs, and while patients with solid tumors were also at higher risk; this association was not supported by the Cox proportional hazard model. CONCLUSION While our baseline CABSI rate was comparatively lower than for other institutions, subset analyses identified that hospitalized cancer patients having TEs are at the highest risk for developing CABSIs. Our findings may help to guide improved methods of anticipating and controlling infections in immunocompromised patients.
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Affiliation(s)
- Rebekah C Allen
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Johansson E, Engervall P, Björvell H, Hast R, Björkholm M. Patients' perceptions of having a central venous catheter or a totally implantable subcutaneous port system-results from a randomised study in acute leukaemia. Support Care Cancer 2008; 17:137-43. [PMID: 18449573 DOI: 10.1007/s00520-008-0449-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 04/03/2008] [Indexed: 11/26/2022]
Abstract
GOALS OF WORK The selection process of type of central venous access device (CVAD) in patients with acute leukaemia (AL) is generally based on appropriate catheter capacity/function and risk of complications in relation to the planned length of therapy. Advantages and disadvantages of the CVAD from the patient's perspective should also be important parts in the selection of type of device. Perceptions on having a CVAD were thus analysed in a series of adult patients with AL included in a prospective randomised study evaluating the use of a double lumen totally implantable subcutaneous port system (PORT) or a double lumen central venous catheter (CVC) regarding survival time and complication rate. MATERIALS AND METHODS Perceptions were registered in 32 patients (median age 68 years, range 24-83 years) on three occasions (T1; the day after placement, T2; 3 weeks after placement and T3 after 12 weeks and/or when the CVAD was removed) with the use of two study specific questionnaires. MAIN RESULTS Overall, many patients reported minor catheter related discomfort, feelings of anxiety and restrictions. Half of the patients (6/11) who experienced a local bleeding after CVAD insertion described the placement procedure as unpleasant. More patients in the CVC group compared with the PORT group stated that they thought of having a CVAD (T3; p = 0.02) and that the CVAD interfered when dressing themselves (T2; p = 0.02 and T3; 0.04) or taking a shower (T3; p = 0.009). CONCLUSION Our findings support the view that the PORT is less restrictive in daily life than the CVC.
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Affiliation(s)
- Eva Johansson
- Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
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Ignatov A, Hoffman O, Smith B, Fahlke J, Peters B, Bischoff J, Costa SD. An 11-year retrospective study of totally implanted central venous access ports: complications and patient satisfaction. Eur J Surg Oncol 2008; 35:241-6. [PMID: 18329836 DOI: 10.1016/j.ejso.2008.01.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 01/19/2008] [Indexed: 10/22/2022] Open
Abstract
AIMS We wanted to assess the factors that predict complications and patient satisfaction of totally implanted central venous access ports (TIAP). METHODS We reviewed 550 patients with breast or gynaecological malignancies who had initial port placement for chemotherapy between 1995 and 2006. We retrospectively assessed all TIAP complications, port duration and follow-up care until the TIAPs were removed (or the last known recorded documentation) or until the death of the patient. TIAP-related patient satisfaction was also assessed via a questionnaire-based survey of 356 patients. RESULTS 561 TIAPs were placed in 550 cancer patients (11 patients received 2 TIAPs during the study period); the median time of port duration was 22.5 months. There were 104 complications in this group. Of these, 81 occurred during chemotherapy treatment that lasted a median time of 182 days. Removal secondary to complication was observed in 48 cases. TIAPs placed on the left chest side, through the subclavian vein or with the catheter tip localized in the peripheral part of superior vena cava demonstrated the highest incidence of complications. Patients with a BMI >28.75 had an increased risk for developing complications. Our follow-up questionnaire revealed a 93% patient satisfaction rate with the TIAP. CONCLUSIONS Patients with left-sided ports, catheter tips lying in the upper part of the superior vena cava and implantation via the subclavian vein are at a higher risk for TIAP-associated complications. Being excessively overweight was assessed as another risk factor for developing complications. TIAPs are highly accepted and further recommended by patients.
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Affiliation(s)
- A Ignatov
- Department of Obstetrics and Gynaecology, Otto-von Guericke University, Magdeburg, Germany
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Karthaus M. Prophylaxis of catheter-related venous thrombosis in cancer patients. Support Care Cancer 2008; 16:787-90. [DOI: 10.1007/s00520-007-0374-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Köhne CH, De Greve J, Hartmann JT, Lang I, Vergauwe P, Becker K, Braumann D, Joosens E, Müller L, Janssens J, Bokemeyer C, Reimer P, Link H, Späth-Schwalbe E, Wilke HJ, Bleiberg H, Van Den Brande J, Debois M, Bethe U, Van Cutsem E. Irinotecan combined with infusional 5-fluorouracil/folinic acid or capecitabine plus celecoxib or placebo in the first-line treatment of patients with metastatic colorectal cancer. EORTC study 40015. Ann Oncol 2007; 19:920-6. [PMID: 18065406 DOI: 10.1093/annonc/mdm544] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study aimed to demonstrate the noninferiority of capecitabine to 5-fluorouracil (5-FU)/folinic acid (FA), in relation to progression-free survival (PFS) after first-line treatment of metastatic colorectal cancer and the benefit of adding celecoxib (C) to irinotecan/fluoropyrimidine regimens compared with placebo (P). PATIENTS AND METHODS Patients were randomly assigned to receive FOLFIRI: irinotecan (180 mg/m(2) i.v. on days 1, 15 and 22); FA (200 mg/m(2) i.v. on days 1, 2, 15, 16, 29 and 30); 5-FU (400 mg/m(2) i.v. bolus, then 22-h, 600 mg/m(2) infusion) or CAPIRI: irinotecan (250 mg/m(2) i.v. infusion on days 1 and 22); capecitabine p.o. (1000 mg/m(2) b.i.d. on days 1-15 and 22-36). Patients were additionally randomly assigned to receive either placebo or celecoxib (800 mg: 2 x 200 mg b.i.d.). RESULTS The trial was closed following eight deaths unrelated to disease progression in the 85 enrolled (629 planned) patients. Response rates were 22% for CAPIRI + C, 48% for CAPIRI + P, 32% for FOLFIRI + C and 46% for FOLFIRI + P. Median PFS and overall survival (OS) times were shorter for CAPIRI versus FOLFIRI (PFS 5.9 versus 9.6 months and OS 14.8 versus 19.9 months) and celecoxib versus placebo (PFS 6.9 versus 7.8 months and OS 18.3 versus 19.9 months). CONCLUSION Due to the small sample size following early termination, no definitive conclusions can be drawn in relation to the noninferiority of CAPIRI compared with FOLFIRI.
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Affiliation(s)
- C-H Köhne
- Department of Oncology and Hematology, Klinikum Oldenburg, Oldenburg, Germany.
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Abstract
Although neutropenia is recognized as a risk factor for infection and compromised wound healing, there are little data regarding the specific impact of neutropenia on morbidity and mortality after placement of implanted central venous catheters (CVC). We conducted a retrospective review of children with a diagnosis of acute lymphocytic leukemia or aplastic anemia who received a CVC over a 5-year period. The absolute neutrophil count immediately before catheter placement was recorded. Three hundred eight catheters were placed in 195 patients with acute lymphocytic leukemia and 15 with aplastic anemia. Absolute neutrophil count was less than 0.5 x 109/L in 105 cases (Group 1). The incidence of CVC removal for all causes and for infection within 100 days in Group 1 was 17.1 per cent and 11.4 per cent, respectively, compared with 7.9 per cent ( P = 0.01) and 1.5 per cent ( P < 0.0001) with absolute neutrophil count 0.5 x 109/L or greater (Group 2). Infections included two cases of mucormycosis with one death. Ports were more likely than Hickman catheters (C. R. Bard Inc., Murray Hill, NJ) to be removed for all causes ( P = 0.01) and for infection ( P = 0.04). The placement of implanted central venous catheters in neutropenic children was associated with substantial infectious morbidity and one death. When possible, CVC, particularly ports, should be avoided in the presence of neutropenia.
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Affiliation(s)
- Arvand Elihu
- Division of Pediatric Surgery, Loma Linda University School of Medicine and Children's Hospital, Loma Linda, California
| | - Gerald Gollin
- Division of Pediatric Surgery, Loma Linda University School of Medicine and Children's Hospital, Loma Linda, California
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Ng F, Mastoroudes H, Paul E, Davies N, Tibballs J, Hochhauser D, Mayer A, Begent R, Meyer T. A comparison of Hickman line- and Port-a-Cath-associated complications in patients with solid tumours undergoing chemotherapy. Clin Oncol (R Coll Radiol) 2007; 19:551-6. [PMID: 17517500 DOI: 10.1016/j.clon.2007.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 03/05/2007] [Accepted: 04/15/2007] [Indexed: 11/19/2022]
Abstract
AIMS To compare the complication rates of Hickman lines and Port-a-Caths in patients undergoing infusional chemotherapy for solid tumours. MATERIALS AND METHODS A single institution retrospective analysis comparing complication rates for 30 Hickman lines and 33 Port-a-Caths inserted for chemotherapy in adults with solid tumours was carried out. RESULTS Patients were well matched in terms of primary site and chemotherapy regimen. In both cases, over 85% were inserted radiologically under local anaesthetic. The total time in situ for Hickman lines and Port-a-Caths was 3539 days (median 83, range 6-585) and 5783 days (median 158, range 20-456), respectively. The complication rate for Hickman lines was 5.09/1000 catheter days, almost five times that for Port-a-Caths, with 1.04/1000 catheter days, a relative risk of 4.9 (confidence interval: 1.9-15.1, P=0.0003). Most (73%) complications occurred within 4 weeks of insertion. However, some arose much later: the range of time to complication was 1-304 days for Hickman lines and 1-132 days for Port-a-Caths. Infection was the most common complication, accounting for nine of 18 Hickman line complications and five of six Port-a-Cath complications, giving an overall infection rate of 2.54/1000 catheter days and 0.86/1000 catheter days, respectively. Additionally, Hickman lines had a 26% leakage rate or displacement rate, which did not occur at all in the Port-a-Cath group. Complications required the removal of 16 Hickman lines and five Port-a-Caths. The rate of removal was five times higher for Hickman lines (Hickman lines=4.52/1000 catheter days, Port-a-Caths=0.86/1000 catheter days, P=0.0027). Overall, the cost of Port-a-Caths was less than that of Hickman lines. CONCLUSION In this study, Port-a-Caths were shown to be both safer and cheaper than Hickman lines for patients requiring infusional chemotherapy.
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Affiliation(s)
- F Ng
- Academic Department of Oncology, Royal Free and University College Medical School, Rowland Hill Street, London, UK
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Voog E, Lazard E, Juhel L. Doit-on prescrire une prophylaxie de la maladie thromboembolique aux patients porteurs d'un cathéter central et/ou recevant unechimiothérapie pour une tumeur solide? Presse Med 2007; 36:225-34. [PMID: 17259031 DOI: 10.1016/j.lpm.2006.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 08/31/2006] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Deep venous thrombosis and pulmonary embolism are well-recognized complications of cancer, especially in patients with a venous access device or receiving chemotherapy. The pathogenic mechanisms of thrombosis in cancer patients involve a complex interaction between the patient's tumor cells and hemostatic system. Chemotherapy and central venous catheters increase the risk of thromboembolism. Prophylactic treatment for these patients remains controversial. METHODS We conducted a systematic literature review using the Medline database and abstract books for meetings of the American Society of Clinical Oncology and the American Society of Hematology since 2000. Our search focused on clinical trials of primary prevention of venous catheter-related thrombosis or prevention of chemotherapy-related venous thromboembolism in cancer patients. RESULTS Ten studies evaluating primary prevention of patients with central catheters were identified, and their results are contradictory. Currently only one study has examined prevention of chemotherapy-related venous thromboembolism, in women with metastatic breast cancer. Its results cannot be extrapolated to other tumors. CONCLUSION Systematic prophylaxis cannot yet be recommended. In the near future we must improve our knowledge of the risk factors of these complications. Prophylaxis should be individualized for each patient. New anticoagulant drugs should be tested in cancer patients.
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Abstract
BACKGROUND Early catheter-related infection is a serious complication in cancer treatment, although risk factors for its occurrence are not well established. The authors conducted a prospective study to identify the risk factors for developing early catheter-related infection. METHODS All consecutive patients with cancer who underwent insertion of a central venous catheter were enrolled and were followed prospectively during 1 month. The study endpoint was occurrence of early catheter-related infection. RESULTS Over 10,392 catheter-days of follow-up, 14 of 371 patients had early catheter-related infections (14 patients in 10,392 catheter-days or 1.34 per 1000 catheter-days). The causative pathogens were gram positive in 11 of 14 patients. In univariate analysis, the risk factors for early catheter-related infection were aged <10 years (P = .0001), difficulties during insertion (P < 10(-6)), blood product administration (P < 10(-3)), parenteral nutrition (P < 10(-4)), and use >2 days (P < 10(-6)). In multivariate analysis, 3 variables remained significantly associated with the risk of early catheter-related infection: age <10 years (odds ratio [OR], 18.4; 95% confidence interval [95% CI], 1.9-106.7), difficulties during insertion procedure (OR, 25.6; 95% CI, 4.2-106), and parenteral nutrition (OR, 28.5; 95% CI, 4.2-200). CONCLUSIONS On the day of insertion, 2 variables were identified that were associated with a high risk of developing an early catheter-related infection: young age and difficulties during insertion. The results from this study may be used to identify patients who are at high risk of infection who may be candidates for preventive strategies.
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Affiliation(s)
- Nicolas Penel
- Department of General Oncology, Oscar Lambret Cancer Center, Lille, France.
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Abstract
AIM Comparison of catheter tip versus port content culture techniques to assess infection in totally implanted vascular access devices (TIVAD). MATERIALS AND METHODS Comparison of pocket swab, catheter-tip and port content cultures after removing the silicon puncture septum in a prospectively collected consecutive series of 102 TIVAD removed for clinical suspicion of infection, between May 2000 and March 2003. RESULTS 102 totally implanted port-catheters in 98 patients, age ranging from 1 to 90 years (median 53 years), were removed 7 to 2616 days after insertion (median 210 days). Infection of the pocket surrounding the port was found in 21 cases, all proven by a positive culture of the pocket swab. Out of the remaining 81 cases without pocket infection, 32 had only a positive catheter tip culture, whereas 56 had a positive port content culture (p = 0.0002). Always the same microorganism was isolated in the 32 patients with positive catheter tip and port content cultures. The main organisms identified within TIVAD were Coagulase Negative Staphylococcus (CNS) (41 cases) and Candida sp (15 cases). Eight out of the 21 pocket infections were caused by Staphylococcus aureus. CONCLUSION In the presence of local signs of infection, taking cultures of the pocket surrounding the port is sufficient for diagnostic purposes. When infection is localized within the device only, port content cultures taken after removal of the silicon septum are more often positive than cultures of the catheter tip, and constitute therefore a more reliable tool for the assessment of TIVAD infection.
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Affiliation(s)
- F Brouns
- Surgical Oncology, University Hospital, Leuven, Belgium.
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Agnelli G, Verso M. Therapy Insight: venous-catheter-related thrombosis in cancer patients. ACTA ACUST UNITED AC 2006; 3:214-22. [PMID: 16596145 DOI: 10.1038/ncponc0458] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 02/08/2006] [Indexed: 11/09/2022]
Abstract
Central venous catheters (CVCs) have improved the management of patients with cancer substantially, by facilitating chemotherapy and supportive therapy. The use of CVCs is associated with complications such as infection and upper-limb deep vein thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to the use of CVCs ranges between 2% and 4%. In the most recent study, the incidence of CVC-related thrombosis, as screened by venography, was approximately 18% in the absence of prophylaxis. In cancer patients with CVC-related UL-DVT, the incidence of clinically overt pulmonary embolism was between 15% and 25%, and the incidence of autopsy-proven pulmonary embolism was up to 50%. Pathogenic factors for CVC-related thrombosis include vessel injury caused by the CVC insertion procedure, venous stasis because of the indwelling CVC, and hypercoagulability associated with cancer. Recent studies have not confirmed a benefit for prophylaxis with antithrombotic agents for CVC-related thrombosis. The recommended treatment for CVC-related thrombosis is based on long-term anticoagulant therapy, with or without catheter removal.
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Masci G, Magagnoli M, Pedicini V, Poretti D, Castagna L, Carnaghi C, Morenghi E, Del Vecchio A, Finotto R, Brambilla G, Santoro A. Long-term, tunneled, noncuffed central venous catheter in cancer patients (Vygon): safety, efficacy, and complications. Support Care Cancer 2006; 14:1141-6. [PMID: 16622649 DOI: 10.1007/s00520-006-0065-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Totally implantable or partially cuffed central venous catheters (CVC) are commonly used in cancer patients, but they are often expensive and may produce complications. To minimize costs, we have been using a low-cost, partially tunneled, silicone elastomer catheter with no Dacron cuff or antireflux valve (Vygon) since 2001. This study is a retrospective investigation of our experience using the Vygon catheter as a long-term CVC in patients with malignancy. MATERIALS AND METHODS A total of 458 Vygon catheters (Nutricath, Vygon) were percutaneously inserted by an interventional radiologist in 302 cancer patients. The median duration of catheter use was 93 days, mean 164.3 days (range 1-789). Main patient characteristics were as follows: number of male/female patients, 166/136; median age, 51 years; hematological/nonhematological patients, 189/113. RESULTS Early complications were pneumothorax in six and hematoma in twelve of 458 implants, respectively. Thirteen out of 302 patients developed a catheter-related thrombosis. One hundred and thirty-five of 458 Vygon catheters required removal because of catheter-related complications: 68 accidental losses, 37 cases of febrile neutropenia suspected to be catheter-related, ten catheter dislodgements, ten catheter malfunctions, four local infections, three thromboses, two catheter ruptures, and one allergic reaction. CONCLUSION Vygon catheters do not seem to induce more early and late complications as compared with other more expensive devices, except for disadvantage of the high incidence rate of accidental losses.
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Affiliation(s)
- Giovanna Masci
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
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Conter C, Carausu L, Martin E, Rubie H, Castex MP, Marec-Berard P. Utilisation des sites veineux implantables dans les chimiothérapies massives en pédiatrie. Arch Pediatr 2006; 13:256-61. [PMID: 16469486 DOI: 10.1016/j.arcped.2005.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/16/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND The feasibility and complication rate of central venous totally implantable access ports (TIAP), used for delivering high-dose chemotherapy (HDC) with autologous stem cell transplantation, have not been fully investigated to date, due to the almost exclusive use of external catheters (EC) in this clinical setting. PATIENTS AND METHODS We retrospectively studied infectious and mechanical complications of 45 TIAP and 19 EC, in 64 children receiving HDC and autologous stem cell transplantation at the Centre Leon-Berard (Lyon) or at the oncology unit of Toulouse children hospital between January 1999 and December 2003. RESULTS From the beginning of intensification to 60 days after bone marrow transplantation, 7 catheter-related bloodstream infections (3/19 EC or 15.8% corresponding to 2.69 infections for 1000 days of observation; 4/45 TIAP or 8.9% corresponding to 1.38 infections for 1000 days of observation) and 2 local infections (1/45 TIAP; 1/19 EC) were reported. Seven cases of reversible obstruction (6/7 with TIAP) and no deep venous thrombosis were detected. In 7 cases, another venous access was required either for accidental removal (2 EC), catheter infection (2 TIAP), or admission to intensive care (2 TIAP, 1 EC). TIAP complication rate does not seem to be influenced by factors such as low weight, massive blood product transfusion or prolonged parenteral nutrition. In 8 children, TIAP were used for collection of hematopoietic progenitor cells. CONCLUSIONS The use of TIAPs appears as a safe and effective option for HDC. We found more mechanical complications but less infectious complications with TIAP than with EC. Nevertheless, results need to be validated prospectively in a larger study cohort.
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Affiliation(s)
- C Conter
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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