Insertion rates and complications of central lines in the UK population: A pilot study

Background

Central venous catheters are inserted ubiquitously in critical care and have roles in drug administration, fluid management and renal replacement therapy. They are also associated with numerous complications. The true number of central venous catheters inserted per year and the proportion of them associated with complications are unknown in the UK.

Methods

We performed a prospective audit at five hospitals, as a feasibility pilot for a larger, nationwide audit. Using a novel secure online data collection platform, developed earlier and adapted for this project, all central venous catheters inserted for patients admitted to the Intensive Care Units were documented at five pilot sites across the UK.

Results

A total of 117 data collection forms were submitted. Users found the electronic data collection system easy to use. All data fields were ready for analysis immediately after data input. Out of the 117 central venous catheters, 17 were haemodialysis catheters and five pulmonary artery introducers. Experienced practitioners (at least three years' experience) inserted 85% of the central venous catheters. The site of insertion was the internal jugular vein for 80%, femoral for 12% and subclavian for 8% of central venous catheters. Most central venous catheters were inserted in ICU (49%) or theatres (42%). Ultrasound was used for 109 (93%) of central venous catheter insertions and its use was not associated with fewer complications. In 15 cases venopuncture was attempted more than once (all with ultrasound) and this was associated with significantly increased risk of complications. There were eight immediate complications (6.8%): five related to venopuncture and inability to pass a guidewire, two carotid artery punctures and one associated with significant arrhythmia.

Conclusion

This study demonstrates the ease and feasibility of collecting detailed descriptive data on central line insertion and its immediate complications in the UK over two weeks. In our proposed nationwide audit, organisation-level data on local policies and standard operating procedures is required to complete the picture on this important aspect of intensive care practice.

Developing a digital data collection platform to measure the prevalence of sepsis in Wales

OBJECTIVE

To develop a secure, efficient, and easy-to-use data collection platform to measure the prevalence of sepsis in Wales over 24 hours.

MATERIALS AND METHODS

Open Data Kit was used on Android devices with Google App Engine and a digital data collection form.

RESULTS

A total of 184 students participated in the study using 59 devices across 16 hospitals, 1198 datasets were submitted, and 97% of participants found the Open Data Kit form easy to use.

DISCUSSION

We successfully demonstrated that by combining a reliable Android device, a free open-source data collection framework, a scalable cloud-based server, and a team of 184 medical students, we can deliver a low-cost, highly reliable platform that requires little training or maintenance, providing results immediately on completion of data collection.

CONCLUSION

Our platform allowed us to measure, for the first time, the prevalence of sepsis in Wales over 24 hours.

P5-22-01: Feasibility and Patient Safety of Serial Biopsies (bx) in Metastatic HER2−Positive Breast Cancer (BC) To Evaluate Alterations in Molecular Biomarkers (BM): Preliminary Results of SHERsig (Study of HER2 Signature in Metastatic Breast Cancer) a Prospective Phase II Study

Background

The use of trastuzumab (H)-based therapy for HER2−positive BC has significantly altered outcomes. Yet up to 64% of metastatic patients (pts) fail to respond (Robert JCO 2006) and most pts will progress within 24–42 months (m) following an initial response for metastatic disease. Preclinical data suggest several in vitro resistance mechanisms but confirmatory in vivo data are lacking, preventing optimal personalized care. This ongoing proof-of-concept study examines serial bx in pts with HER2−positive metastatic BC in order to assess BM profiles across multiple lines of treatment.

Methods: Key eligibility criteria include: centrally confirmed HER2 status, minimum of 1 disease site considered suitable for serial bx, normal coagulation profile and cardiac function, prior adjuvant/neoadjuvant taxane and H completed ≥12 m and ≥6 m respectively, ECOG ≤2. Pts receive q3wk H with clinician choice of taxane (docetaxel 75–100 mg/m2 q21, paclitaxel 80 mg/m2 weekly or 175 mg/m2 q21 [TH]). At the time of progressive disease, pts receive capecitabine (X) and H. Two core bx and 1 optional fine needle aspirate are performed at the following times: baseline (after 3 weeks [w] of TH), at 6 w, at time of first progression prior to XH, and at the time of progression on XH. Tumor assessments are performed at 6 w, then 9 w intervals, with cardiac assessment every 6 m. Primary endpoint aims to explore and potentially define BM signatures that could alter during HER2−targeted therapy and predict for decreased or increased sensitivity to H-based treatment. Secondary endpoints include bx safety, ORR and TTP. At time of baseline bx, pts have the option to complete a pt satisfaction questionnaire.

Results: Between August 2009 and June 2011, 58 pts were screened; 29 enrolled. The other 29 pts were screen failures, with 3 pts (5%) specifically declining entry due to the requirement for serial bx. Median age is 53 y (range 37–86), with 9 and 20 pts having recurrent or de novo metastatic disease. Eight pts received adjuvant systemic treatment, including H in 4 pts. Baseline bx performed in the breast, n (%): 15 (52), bone: 6 (21), liver: 4 (14), and lymph nodes: 4 (14); 14 and 27 pts underwent bx at 3 and 6 w respectively. After a median of 34 w of treatment 11 pts progressed on TH and 7 pts underwent planned bx. There were 12 SAEs, none related to bx. Most AEs were grade 1/2 (95%) with 3% grade 3 and 1 death due to intercurrent illness. From a total of 43 bx, 12 (27%) grade 1/2 AEs (hematoma 2, transient hypotension 2, mild pain 8) were reported, with resolution in all instances. Fifteen pts consented to the pt satisfaction substudy.

Conclusions: Preliminary results of the first reported serial bx study in metastatic BC demonstrated 95% pt acceptance of this approach. Evaluation of BM profiles will be conducted following planned recruitment of 50 pts. To date, the feasibility and safety of obtaining serial bx in metastatic BC is supported by the current safety profile and patient uptake. Updated recruitment data will be presented.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-22-01.

Impact of neutropenia on delivering planned chemotherapy for solid tumours

The ability to deliver the planned dose and intensity of chemotherapy (the amount of drug administered/unit of time) is important for tumour control and survival. In clinical practice, neutropenic events are the main limiting factors towards achieving this aim. We assessed the impact of neutropenic events [defined as either hospital admission due to febrile neutropenia (FN), dose delay > or =7 days due to neutropenia or dose reduction of > or =15% due to neutropenia] on dose intensity (DI) in a random sample of 50 patients with various solid tumours. Fifty patients who received systemic chemotherapy for solid tumours were assessed as part of this study. Using a pre-programmed data collection tool via computer, retrospective data were collected. The neutropenic events were defined before data collection. The patient characteristics are as follows: breast 26 patients (stage I-6; II-3; III-17), colorectal 16 patients (stage I-6; II-3; III-7) and others 8 patients [small cell lung cancer (SCLC), ovarian, peritoneal and oesophageal cancers]. The chemotherapy regimens used are Flourouracil, Epirubicin, cyclophosphamide (FEC) 14 patients (28%); 5 Flourouracil/folinic acid (5FU/FA) 12 patients (24%); Adriamycin, cyclophosphamide (AC) 11 patients (22%); other 13 patients (26%). Neutropenic events occurred in a significant proportion of patients (overall 40%; breast 26%; colorectal 56%; others 25% of patients) and in a significant number (21%) of chemotherapy cycles. Overall, dose delay was the most common neutropenic event, occurring in 30% of patients (breast 32%; colorectal 31%; others 25%% of patients). Dose reduction due to neutropenia was noted in 20% of patients (breast 12% colorectal 38% others 13%% of patients). Hospitalizations due to FN affected 8% of patients. Only two patients had granulocyte colony-stimulating factor (GCSF) as treatment for two cycles. Relative dose intensity (RDI) in patients with neutropenic events was 81% compared with 92% in patients without an event and the results were consistent for different cancers. In total, 65% of patients who experienced one neutropenic event were likely to experience subsequent events. In conclusion neutropenic events have a significant impact on the ability to deliver planned DI. Hence, proactive use of GCSF has the potential to improve adherence to the planned schedule of chemotherapy.