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Thapa S, Terry PB, Kamdar BB. Hemodialysis catheter-associated superior vena cava syndrome and pulmonary embolism: a case report and review of the literature. BMC Res Notes 2016; 9:233. [PMID: 27107813 PMCID: PMC4842288 DOI: 10.1186/s13104-016-2043-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemodialysis (HD) catheters are frequently inserted into the superior vena cava (SVC), and can lead to thrombotic complications. However, to our knowledge, HD catheter-related thrombosis leading to subsequent SVC syndrome, bacteremia, and pulmonary emboli has not been described. CASE PRESENTATION A 28-year-old dialysis-dependent woman with IgA nephropathy developed facial swelling, head pressure, headache, nausea, dizziness and fever 6 weeks after right internal jugular (IJ) HD catheter placement. Chest and neck imaging demonstrated a non-occlusive thrombus surrounding the HD catheter and extending from the SVC to the junction of the right IJ and right subclavian veins, confirming thrombosis-associated SVC syndrome. Intravenous (IV) anticoagulation was initiated, as well as IV vancomycin for Staphylococcus epidermidis bacteremia. Despite prompt intravenous anticoagulation, 9 and 12 days after initial presentation she developed catheter-associated pulmonary embolism (PE) and PE-associated pulmonary infarction, respectively. Hypercoagulable workup was negative. The HD catheter was eventually replaced, HD resumed, and the patient was transitioned from intravenous to oral anticoagulation and discharged. Nine months later, she underwent successful renal transplantation. CONCLUSION SVC syndrome and pulmonary embolism are potential consequences of HD catheter-related thrombosis. Given the frequency of HD catheter placement, physicians should be aware of these potential complications in any patient with HD catheter-related thrombosis.
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Affiliation(s)
- Sritika Thapa
- />Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL Bldg, West Tower 6th Floor CIMS Suite, Baltimore, MD 21224 USA
| | - Peter B. Terry
- />Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Biren B. Kamdar
- />Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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Ren H, Colletta A, Koley D, Wu J, Xi C, Major TC, Bartlett RH, Meyerhoff ME. Thromboresistant/anti-biofilm catheters via electrochemically modulated nitric oxide release. Bioelectrochemistry 2015; 104:10-6. [PMID: 25588885 PMCID: PMC4480771 DOI: 10.1016/j.bioelechem.2014.12.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/07/2014] [Accepted: 12/17/2014] [Indexed: 01/25/2023]
Abstract
Inexpensive nitric oxide (NO) release strategies to prevent thrombosis and bacterial infections are desirable for implantable medical devices. Herein, we demonstrate the utility of electrochemically modulated NO release from a catheter model using an inner copper wire working electrode and an inorganic nitrite salt solution reservoir. These catheters generate NO surface fluxes of >1.0 × 10(-10)mol min(-1) cm(-2) for more than 60 h. Catheters with an NO flux of 1.1 × 10(-10)mol min(-1) cm(-2) are shown to significantly reduce surface thrombus formation when implanted in rabbit veins for 7h. Further, the ability of these catheters to exhibit anti-biofilm properties against bacterial species commonly causing bloodstream and urinary catheter infections is examined. Catheters releasing NO continuously during the 2d growth of Staphylococcus aureus exhibit a 6 log-unit reduction in viable surface bacteria. We also demonstrate that catheters generating NO for only 3h at a flux of 1.0 × 10(-10)mol min(-1) cm(-2) lower the live bacterial counts of both 2d and 4d pre-formed Escherichia coli biofilms by >99.9%. Overall, the new electrochemical NO-release devices could provide a cost-effective strategy to greatly enhance the biocompatibility and antimicrobial properties of intravascular and urinary catheters, as well as other implantable medical devices.
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Affiliation(s)
- Hang Ren
- Department of Chemistry, University of Michigan, 930 N. University, Ann Arbor, MI 48109-1055, USA
| | - Alessandro Colletta
- Department of Chemistry, University of Michigan, 930 N. University, Ann Arbor, MI 48109-1055, USA
| | - Dipankar Koley
- Department of Chemistry, Oregon State University, 153 Gilbert Hall, Corvallis, OR 97331-4003, USA
| | - Jianfeng Wu
- Department of Environmental Health Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Terry C Major
- Department of Surgery, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI 48109-5686, USA
| | - Robert H Bartlett
- Department of Surgery, University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI 48109-5686, USA
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, 930 N. University, Ann Arbor, MI 48109-1055, USA.
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A 69-year-old woman with lymphoma and chylothorax. Looking beyond the usual suspect. Ann Am Thorac Soc 2015; 11:1490-3. [PMID: 25423001 DOI: 10.1513/annalsats.201406-251cc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fallouh N, McGuirk HM, Flanders SA, Chopra V. Peripherally Inserted Central Catheter-associated Deep Vein Thrombosis: A Narrative Review. Am J Med 2015; 128:722-38. [PMID: 25697969 DOI: 10.1016/j.amjmed.2015.01.027] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/12/2015] [Accepted: 01/19/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although common, little is known about factors associated with peripherally inserted central catheter-related deep vein thrombosis (PICC-DVT). To better guide clinicians, we performed a comprehensive literature review to summarize best practices for this condition. METHODS A systematic search of the literature for studies reporting epidemiology, diagnosis, treatment, and prevention of PICC-DVT was conducted. Algorithms for diagnosis and management were compiled using available evidence. RESULTS The incidence of PICC-DVT varied between 2% and 75% according to study population, testing modality and threshold for diagnosis. Studies evaluating the diagnostic utility of clinical symptoms suggested that these were neither sensitive nor specific for PICC-DVT; conversely, ultrasonography had excellent sensitivity and specificity and is recommended as the initial diagnostic test. Although more specific, contrast venography should be reserved for cases with high clinical probability and negative ultrasound findings. Centrally positioned, otherwise functional and clinically necessary PICCs need not be removed despite concomitant DVT. Anticoagulation with low-molecular-weight heparin or warfarin for at least 3 months represents the mainstay of treatment. The role of pharmacologic prophylaxis and screening for PICC-DVT in the absence of clinical symptoms is unclear at this time. CONCLUSIONS PICC-DVT is common, costly and morbid. Available evidence provides guidance for diagnosis, treatment and prevention of this condition.
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Affiliation(s)
- Nabil Fallouh
- Department of General Medicine, University of Michigan Health System, Ann Arbor
| | - Helen M McGuirk
- Department of General Medicine, University of Michigan Health System, Ann Arbor; Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and the Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Mich
| | - Scott A Flanders
- Department of General Medicine, University of Michigan Health System, Ann Arbor
| | - Vineet Chopra
- Department of General Medicine, University of Michigan Health System, Ann Arbor; Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and the Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Mich.
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Sriskandarajah P, Webb K, Chisholm D, Raobaikady R, Davis K, Pepper N, Ethell ME, Potter MN, Shaw BE. Retrospective cohort analysis comparing the incidence of deep vein thromboses between peripherally-inserted and long-term skin tunneled venous catheters in hemato-oncology patients. Thromb J 2015; 13:21. [PMID: 26113804 PMCID: PMC4480444 DOI: 10.1186/s12959-015-0052-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background The introduction of central venous catheters has advanced medical care, particularly in hemato-oncology. However these can be associated with an increased thrombotic risk. Previous studies have compared the rate of thrombotic events between peripherally- inserted (PICCs) and long term skin tunneled catheters (LTSTCs) noting fewer complications associated with the latter, though this has rarely translated into clinical practice. The objectives of our study was to compare the cumulative incidence of thrombotic events between peripherally-inserted and long term skin tunneled venous catheters. Patients/methods We performed a retrospective, single center cohort analysis of patients with hematological malignancies who had either a PICC or LTSTC line inserted between January 2010 through January 2013. Cumulative incidences of thrombotic events were compared between the two groups, and post-thrombotic complications were also examined. Results 346 patients had a PICC inserted with cumulative incidence of symptomatic thrombosis of 5.8%, while 237 patients had a LTSTC inserted with a cumulative incidence of 1.7% (p = 0.003). Post-thrombotic complication rates, particularly infection, were higher in the PICC group compared to the LTSTC group (p = 0.597). Conclusions Our study showed that the incidence of thrombotic events in hemato-oncology patients was significantly lower in those who had a LTSTC compared to PICC line. As the use of central venous lines increases in hemato-oncology patient care, a randomized trial comparing PICCs and LTSTCs is necessary to address which venous access is most appropriate in this cohort of patients, with minimal risk of morbidity and mortality.
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Affiliation(s)
- Priya Sriskandarajah
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Katharine Webb
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - David Chisholm
- Department of Anesthetics, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Ravi Raobaikady
- Department of Anesthetics, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Kim Davis
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Natalie Pepper
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Mark E Ethell
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Mike N Potter
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
| | - Bronwen E Shaw
- Department of Haem-Oncology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT UK
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A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis. J Vasc Surg Venous Lymphat Disord 2015; 3:243-50.e1. [PMID: 26992301 DOI: 10.1016/j.jvsv.2015.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/01/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few studies have investigated the treatment and the outcomes of patients with catheter-related thrombosis (CRT). METHODS The RIETE registry (Registro Informatizado de Enfermedad TromboEmbólica [Computerized Registry of Patients with Venous Thromboembolism]) is a prospective international registry of consecutive patients with objectively confirmed venous thromboembolism (VTE). We analyzed the characteristics, treatment, and outcomes of patients with CRT. RESULTS Of 558 patients with CRT, 45 (8%) presented with a pulmonary embolism (PE) concomitantly. More patients had central line-associated thrombosis compared with port systems, but catheter type did not influence the risk of presenting with a PE. Patients with only CRT were more often prescribed low-molecular-weight heparin for the duration of their anticoagulant treatment compared with patients presenting with concomitant PE. VTE recurrences and major bleeding events occurred frequently during treatment with anticoagulation (7 per 100 patient-years and 8.9 per 100 patient years, respectively). The rates of fatal PE recurrences (1.85 per 100 patient-years) and fatal bleeding (2.32 per 100 patient-years) were similar. Patients with an additional transient risk factor for VTE had the lowest risk for VTE recurrences (odds ratio [OR], 0.07; 90% confidence interval [CI], 0.01-0.45) compared with patients with CRT and no additional transient risk factors. PE at presentation increased the risk of recurrent thrombosis by 2.4 times. Renal insufficiency was also an independent predictor of recurrent thrombosis (OR, 3.93; 90% CI, 2.0-7.7). The odds of recurrent thrombosis was decreased by 77% in patients who received anticoagulation therapy for >90 days compared with patients with a shorter treatment (OR, 0.23; 90% CI, 0.1-0.56). CONCLUSIONS Concomitant PE occurs less frequently in CRT than lower extremity deep venous thrombosis, but it is associated with a worse outcome. CRT occurs in high-risk patients, and duration of anticoagulation must be predicated on balancing these risks.
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Aggarwal SK, McCauley W. Tunnelled central venous catheter–induced thrombosis: a rare case of superior vena cava syndrome. CAN J EMERG MED 2015; 7:273-7. [PMID: 17355686 DOI: 10.1017/s1481803500014433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThrombotic venous obstruction in patients with a tunnelled central venous catheter is a cause of superior vena cava syndrome that is not routinely encountered by emergency physicians. Diagnosis requires identifying patients at risk (e.g., those under treatment for cancer and those who have a tunnelled central venous catheter), recognizing the signs and symptoms of superior vena cava syndrome, usually dyspnea and dilated neck or thoracic veins, and imaging the venous obstruction using computer tomography or sonography. Management involves anticoagulation and local thrombolytic administration. We report the case of a 28-year-old woman who presented with a 2-day history of face, chest and bilateral arm swelling who had been receiving maintenance chemotherapy for acute lymphoblastic leukemia through a Hickman® catheter. This case demonstrates the need to be vigilant for thrombus formation in patients with long-term, indwelling central venous catheters.
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Affiliation(s)
- Sandeep K Aggarwal
- Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
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Santos PK, Fernandes AM, Figueiredo V, Janeiro S. Superior vena cava syndrome associated with longstanding implantable central venous port. BMJ Case Rep 2015; 2015:bcr-2014-206643. [PMID: 25628316 DOI: 10.1136/bcr-2014-206643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bassil N, Rostaing L, Mengelle C, Kallab S, Esposito L, Guitard J, Cardeau-Desangles I, Weclawiak H, Izopet J, Kamar N. Prospective monitoring of cytomegalovirus, Epstein-Barr virus, BK virus, and JC virus infections on belatacept therapy after a kidney transplant. EXP CLIN TRANSPLANT 2015. [PMID: 24907721 DOI: 10.6002/ect.2013.0252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Few data regarding viral replication in patients receiving belatacept are available. The aim of this single-center study was to compare the incidence of viral infections (cytomegalovirus, Epstein Barr virus, BK virus, and JC virus), in 62 de novo kidney transplant patients enrolled in the BENEFIT studies, receiving either belatacept (n=42) or cyclosporine (n=20). MATERIALS AND METHODS By means of polymerase chain reaction, belatacept-treated patients were tested for cytomegalovirus, Epstein-Barr virus, BK virus, and JC virus infections monthly for 36 months, monthly for the first 6 months, and then quarterly for 36 months in cyclosporine-treated patients. Additional samples were obtained when a viral infection was suspected. RESULTS The number of positive cytomegalovirus, BK virus, or JC virus viremias over the number of polymerase chain reactions performed through all 3 years was similar in both groups. Conversely, over the 3-year study, the number of positive Epstein-Barr virus viremias over the number of Epstein-Barr virus polymerase chain reactions performed was significantly higher in the belatacept group (76% vs 50%; P = .047). The number of Epstein-Barr virus primary infection was similar in both groups, while the number of Epstein-Barr virus reactivation was higher in the belatacept group. CONCLUSIONS Epstein-Barr virus replication occurs more often in patients receiving belatacept, than it does in those receiving cyclosporine.
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Affiliation(s)
- Nadine Bassil
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France
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Lee SJ, Kim NC. Risk Factors Associated with Venous Thromboembolism in Cancer Patients. ASIAN ONCOLOGY NURSING 2015. [DOI: 10.5388/aon.2015.15.3.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Su Jung Lee
- Graduate School of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Nam Cho Kim
- College of Nursing, The Catholic University of Korea, Seoul, Korea
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Pulletikurthi C, Munroe N, Stewart D, Haider W, Amruthaluri S, Rokicki R, Dugrot M, Ramaswamy S. Utility of magneto-electropolished ternary nitinol alloys for blood contacting applications. J Biomed Mater Res B Appl Biomater 2014; 103:1366-74. [DOI: 10.1002/jbm.b.33317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 10/02/2014] [Accepted: 10/18/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Chandan Pulletikurthi
- Department of Mechanical and Materials Engineering; Florida International University; Miami Florida
| | - Norman Munroe
- Department of Mechanical and Materials Engineering; Florida International University; Miami Florida
| | - Danique Stewart
- Tissue Engineered Mechanics; Imaging and Materials Laboratory (TEMIM Lab); Department of Biomedical Engineering; Florida International University; Miami Florida
| | - Waseem Haider
- Department of Mechanical Engineering; University of Texas - Pan American; Edinburg Texas
| | - Sushma Amruthaluri
- Department of Mechanical and Materials Engineering; Florida International University; Miami Florida
| | | | | | - Sharan Ramaswamy
- Tissue Engineered Mechanics; Imaging and Materials Laboratory (TEMIM Lab); Department of Biomedical Engineering; Florida International University; Miami Florida
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Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction. Cardiovasc Intervent Radiol 2014; 38:642-50. [DOI: 10.1007/s00270-014-0968-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/22/2014] [Indexed: 11/25/2022]
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Berea-Baltierra R, Rivas-Ruiz R, Vela-Martinez E, Sevilla-Gonzalez MDLL, Talavera-Pina JO, Valencia-Jimenez E, Perez-Franco I, Escobedo-Hernandez L. Risk factors for subclavian vein thrombosis in cancer patients with total parenteral nutrition. J Clin Med Res 2014; 6:345-53. [PMID: 25110538 PMCID: PMC4125329 DOI: 10.14740/jocmr1862w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2014] [Indexed: 11/13/2022] Open
Abstract
Background There are few reports on total parenteral nutrition (TPN) and its possible prothrombotic effect. The purpose of this study was to identify risk factors for subclavian vein thrombosis (SVT) in patients receiving TPN. Method Cancer patients with indwelling subclavian catheters and TPN were followed in a cohort study. Doppler ultrasound examination was performed 8 and 30 days after catheter placement. Results One hundred twenty-one patients were included, with a mean of 61 (± 11.8) years of age. We detected 36 SVT events at day 8 (29.8%) and 47 (38.8%) at day 30 after central catheter placement. Mean length of subclavian catheterization was 17.2 (± 8.2) days. Fifty-three point three percent of patients receiving ≥ 3,050 mOsm TPN in 24 hours developed SVT (relative risk (RR) = 2.01, 95% CI, 1.14 - 3.57; P = 0.016) at day 8 and 60% (RR = 1.67, 95% CI, 1.30 - 2.71; P = 0.038) at day 30 post-catheter placement. Protein administration of > 97.5 g/day was shown to be a risk factor for early thrombosis with a mean of 16.88 days for the development of SVT (95% CI, 10 - 23.7) versus 27.8 days (95% CI, 25.8 - 29.9) in the group with nutritional protein content < 97.5 g/day (P = 0.000). Conclusion High-osmolarity and high-protein nutrition formulas were shown to be risk factors for SVT in cancer patients receiving TPN.
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Affiliation(s)
- Ricardo Berea-Baltierra
- Department of Internal Medicine and Nutritional Support, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | - Rodolfo Rivas-Ruiz
- Department of Pediatrics, Pediatric Hospital, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elpidia Vela-Martinez
- Department of Internal Medicine and Nutritional Support, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | | | - Juan Osvaldo Talavera-Pina
- Centro de Adiestramiento en Investigacion Clinica, Coordinacionde Investigacion en Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elena Valencia-Jimenez
- Department of Radiology, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | - Irene Perez-Franco
- Department of Radiology, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | - Laura Escobedo-Hernandez
- Department of Radiology, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico City, Mexico
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Biffi R, Toro A, Pozzi S, Di Carlo I. Totally implantable vascular access devices 30 years after the first procedure. What has changed and what is still unsolved? Support Care Cancer 2014; 22:1705-14. [DOI: 10.1007/s00520-014-2208-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 03/09/2014] [Indexed: 11/25/2022]
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Devoogdt N, Pans S, De Groef A, Geraerts I, Christiaens MR, Neven P, Vergote I, Van Kampen M. Postoperative Evolution of Thickness and Echogenicity of Cutis and Subcutis of Patients With and Without Breast Cancer-Related Lymphedema. Lymphat Res Biol 2014; 12:23-31. [DOI: 10.1089/lrb.2013.0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Steven Pans
- Department of Radiology, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Rose Christiaens
- Department of Oncology, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Surgical Oncology, Multidisciplinary Breast Clinic, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Oncology, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ignace Vergote
- Department of Oncology, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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Butros SR, Walker TG, Salazar GM, Kalva SP, Oklu R, Wicky S, Ganguli S. Direct translumbar inferior vena cava ports for long-term central venous access in patients with cancer. J Vasc Interv Radiol 2014; 25:556-60. [PMID: 24507994 DOI: 10.1016/j.jvir.2013.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the indications, complications, and long-term results of translumbar port placements to the inferior vena cava for long-term central venous access in a single tertiary center. MATERIALS AND METHODS This retrospective study included all patients with cancer who underwent translumbar port placement from January 2000 to July 2012; 31 patients (all women) with an average age of 53.1 years ± 11.1 (range, 30-77 y) were included in the study. Of these patients, 26 (81%) had breast cancer, 3 had lung cancer, 1 had ovarian cancer, and 1 had rectal cancer. Indications included central venous occlusion in 9 patients (29%) and bilateral mastectomy and lymph node dissection in 22 patients (71%). RESULTS All procedures were technically successful. The overall 30-day complication rate was 9.7% (n = 3). Average catheter use was 14.1 months ± 21 (range, 0.75-108 mo). Thirteen (41.9%) ports were removed because they were no longer needed; 4 (12.9%) ports required removal for port malfunction; 12 (38.7%) patients died with their ports still in place; 2 (6.5%) ports remain in use. Three (9.7%) ports required delayed secondary intervention to remain functional. One patient had a systemic infection attributed to the port, resulting in an overall infection rate of 0.08 per 1,000 catheter days. CONCLUSIONS Translumbar inferior vena cava port placement is a technically feasible and safe alternative method for long-term central venous access.
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Affiliation(s)
- Selim R Butros
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114.
| | - T Gregory Walker
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Gloria M Salazar
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Sanjeeva P Kalva
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Rahmi Oklu
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Stephan Wicky
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
| | - Suvranu Ganguli
- Department of Imaging, Section of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 290, Boston, MA 02114
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67
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Abstract
Central venous catheters (CVCs) may be used for treatment of critically and chronically unwell patients in hospital or in their homes. Complications can occur and should be resolved promptly so they do not result in increased lengths in hospital stay or readmission for patients receiving intravenous therapy at home. This article defines CVCs and the types of central venous access device that are in use in the U.K.; describes how to prevent occlusion and maintain the patency of CVCs; describes the types of occlusions that may occur; and discusses how to assess each type of occlusion and how they may be managed.
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68
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Ahn DH, Illum HB, Wang DH, Sharma A, Dowell JE. Upper extremity venous thrombosis in patients with cancer with peripherally inserted central venous catheters: a retrospective analysis of risk factors. J Oncol Pract 2013; 9:e8-12. [PMID: 23633980 DOI: 10.1200/jop.2012.000595] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Peripherally inserted central catheters (PICCs) are often used in place of mediport catheters because of cost and lack of operating room time and to prevent delays in therapy. One common complication associated with their use is upper extremity venous thrombosis (UEVT). The purpose of this study was to ascertain risk factors associated with an increased risk of PICC-associated UEVT in patients with cancer. METHODS Retrospective analysis identified 237 patients with cancer who received PICCs at the Dallas Veterans Affairs Medical Center from 2006 to 2009. We analyzed many risk factors, including PICC infection (PI), use of erythropoiesis-stimulating agents (ESAs), antiplatelet agents (APAs), treatment dose anticoagulation (TDA), and bevacizumab. RESULTS Of 237 patients, 36 (15%) were found to have UEVT. Stepwise logistic regression analysis showed risk factors positively associated with UEVT were use of ESAs (odds ratio [OR], 10.66; 95% CI, 2.25 to 50.49), hospitalization (OR, 2.38; 95% CI, 1.05 to 5.39), PI (OR, 2.46; 95% CI, 1.03 to 5.86), and TDA (OR, 8.34; 95% CI, 2.98 to 23.33), whereas patients receiving APAs had a lower risk of UEVT (OR, 0.25; 95% CI, 0.07 to 0.92). CONCLUSION Specific factors significantly increase the risk of UEVT in patients with cancer with PICCs, whereas use of APAs seems to have a protective effect against UEVT. These results may aid in the development of a predictive model for identifying patients at high risk of UEVT who may benefit from APAs, as well as in determining preventive strategies for reducing the risk of PICC-associated UEVT.
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Affiliation(s)
- Daniel H Ahn
- University of Texas Southwestern Medical Center, Department of Palliative Care, Dallas, TX 75390-8889, USA.
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69
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Abstract
Central venous catheters are commonly used in haematology departments for the administration of chemotherapy, blood products and parenteral nutrition in patients with haematological malignancy. Thrombosis is a recognized complication of such devices especially in oncology patients. Catheter-related thrombi (CRT) may lead to pulmonary embolism and infection, as well as catheter failure and potential delays in treatment. The vast majority of CRT are asymptomatic, thus a high index of suspicion is required in making the diagnosis. Doppler ultrasound or venography may be employed to identify CRT. Once confirmed, the initiation of treatment is a balance between the risks of anticoagulation against potential complications of CRT. A number of risk factors for CRT are discussed along with an overview of catheter types, their appropriate choice and intravascular positioning.
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Affiliation(s)
- Jim Murray
- Haemophilia and Thrombosis Centre, University Hospital of Wales, Cardiff, UK
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70
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Gaddh M, Antun A, Yamada K, Gupta P, Tran H, El Rassi F, Kim HS, Khoury HJ. Venous access catheter-related thrombosis in patients with cancer. Leuk Lymphoma 2013; 55:501-8. [PMID: 23772637 DOI: 10.3109/10428194.2013.813503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with cancer are at high risk for developing venous thromboembolism (VTE), and the presence of a central venous catheter (CVC) further increases this risk. CVC-related VTE has serious implications related to the loss of vascular access, development of pulmonary embolism, recurrent VTE, infections and post-thrombotic syndrome. The pathogenesis of CVC-related VTE is complex and multifactorial, with risk factors associated with the catheter, the vessel selected for insertion and the underlying cancer as well as the anti-cancer therapy. Clinical presentation of CVC-related VTEs is often non-specific, and ultrasonography is the most commonly used radiological diagnostic test. Management of CVC-related VTE in patients with cancer requires a balance between the need for venous access, the risk of VTE recurrence and the risk of bleeding from treatment-induced thrombocytopenia. Effective VTE prophylaxis methods have yet to be defined. Ongoing studies are evaluating the role of newer oral antithrombotic agents and alternative interventional strategies for the prevention and treatment of CVC-related VTE in patients with cancer.
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Affiliation(s)
- Manila Gaddh
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University , Atlanta, GA , USA
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71
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Thornsberry LA, LoSicco KI, English JC. The skin and hypercoagulable states. J Am Acad Dermatol 2013; 69:450-62. [PMID: 23582572 DOI: 10.1016/j.jaad.2013.01.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/19/2013] [Accepted: 01/25/2013] [Indexed: 11/19/2022]
Abstract
Hypercoagulable states (HS) are inherited or acquired conditions that predispose an individual to venous and/or arterial thrombosis. The dermatologist can play a vital role in diagnosing a patient's HS by recognizing the associated cutaneous manifestations, such as purpura, purpura fulminans, livedo reticularis, livedo vasculopathy (atrophie blanche), anetoderma, chronic venous ulcers, and superficial venous thrombosis. The cutaneous manifestations of HS are generally nonspecific, but identification of an abnormal finding can warrant a further workup for an underlying thrombophilic disorder. This review will focus on the basic science of hemostasis, the evaluation of HS, the skin manifestations associated with hypercoagulability, and the use of antiplatelet and anticoagulant therapy in dermatology.
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Affiliation(s)
- Laura A Thornsberry
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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72
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Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis. J Thromb Thrombolysis 2013; 37:97-101. [DOI: 10.1007/s11239-013-0914-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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73
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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: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [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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74
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75
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Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68:529-44. [PMID: 23415017 DOI: 10.1016/j.crad.2012.10.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 11/23/2022]
Abstract
Central venous catheters (CVCs) provide valuable vascular access. Complications associated with the insertion and maintenance of CVCs includes pneumothorax, arterial puncture, arrhythmias, line fracture, malposition, migration, infection, thrombosis, and fibrin sheath formation. Image-guided CVC placement is now standard practice and reduces the risk of complications compared to the blind landmark insertion technique. This review demonstrates the imaging of a range of complications associated with CVCs and discusses their management with catheter salvage techniques.
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76
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Debourdeau P, Farge D, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Büller HR, Bounameaux H. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost 2013; 11:71-80. [PMID: 23217208 DOI: 10.1111/jth.12071] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. OBJECTIVES To establish common international Good Clinical Practices Guidelines (GCPG) for the management of CRT in cancer patients. METHODS An international working group of experts was set up to develop GCPG according to an evidence-based medicine approach, using the GRADE system. RESULTS For the treatment of established CRT in cancer patients, we found no prospective randomized studies, two non-randomized prospective studies and one retrospective study examining the efficacy and safety of low-molecular-weight heparin (LMWH) plus vitamin K antagonists (VKAs). One retrospective study evaluated the benefit of CVC removal and two small retrospective studies were on thrombolytic drugs. For the treatment of symptomatic CRT, anticoagulant treatment (AC) is recommended for a minimum of 3 months; in this setting, LMWHs are suggested. VKAs can also be used, in the absence of direct comparisons of these two types of anticoagulants in this setting [Guidance]. The CVC can be kept in place if it is functional, well-positioned and non-infected and there is good resolution under close surveillance; whether the CVC is kept or removed, no standard approach in terms of AC duration has been established [Guidance]. For the prophylaxis of CRT in cancer patients, we found six randomized studies investigating the efficacy and safety of VKA vs. placebo or no treatment, one on the efficacy and safety of unfractionnated heparin, six on the value of LMWH, one double-blind randomized and one non randomized study on thrombolytic drugs and six meta-analyses of AC and CVC thromboprophylaxis. Type of catheter (open-ended like the Hickman(®) catheter vs. closed-ended catheter with a valve like the Groshong(®) catheter), its position (above, below or at the junction of the superior vena cava and the right atrium) and method of placement may influence the onset of CRT on the basis of six retrospective trials, four prospective non-randomized trials, three randomized trials and one meta-analysis. In light of these data: use of AC for routine prophylaxis of CRT is not recommended [1A]; a CVC should be inserted on the right side, in the jugular vein, and distal extremity of the CVC should be located at the junction of the superior vena cava and the right atrium [1A]. CONCLUSION Dissemination and implementation of these international GCPG for the prevention and treatment of CRT in cancer patients at each national level is a major public health priority, needing worldwide collaboration.
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77
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Mastroianni CM, Viscomi C, Ceniti S, De Simone R, Filice A, Gadaleta Caldarola G, Infusino S, Manfredi C, Rea A, Sandomenico C, Turano S, Serranò F, Condemi G, Cortese C, Prantera T, Palazzo S. Preferences of patients with advanced colorectal cancer for treatment with oral or intravenous chemotherapy. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 1:181-7. [PMID: 22272925 DOI: 10.2165/1312067-200801030-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND In recent years, patient-reported outcomes such as health-related quality of life have become important areas of clinician focus in general cancer management. Patients' preferences for, and/or satisfaction with, oral versus intravenous (IV) chemotherapy schedules may have a major impact on such outcomes. OBJECTIVE To evaluate preferences for oral or IV chemotherapy in patients with advanced colorectal cancer. METHODS A multicenter, randomized, crossover trial was conducted in 12 hospitals in Southern Italy, in which 22 patients with advanced colorectal cancer received one cycle of oral capecitabine ± irinotecan or oxaliplatin, followed by one cycle of an IV de Gramont or similar regimen (arm A), or the same regimens in reverse order (arm B). Patients were aged 50-70 years and 21% had a higher level of education (graduate or similar). Patients received oral capecitabine 3500 mg/m/day for 7 days (± irinotecan 180 mg/m or oxaliplatin 85 mg/m on day 1 only), followed by an IV de Gramont regimen ± irinotecan (FOLFIRI) or oxaliplatin (FOLFOX); or the two schedules administered in reverse order.The main outcome measure was patients' preferences for oral versus IV chemotherapy, as determined by a pre- and post-treatment therapy preference questionnaire (TPQ). RESULTS Before treatment, 75% of patients preferred oral therapy. Characteristics that patients considered to be important were that treatment should not interfere with daily activities (100% of patients) and should not cause fatigue (95%), diarrhea (76%), or painful mouth ulcers (76%); other factors considered important were the risk of infection and nausea (90%), and that treatment could be administered at home (65%). After receiving both chemotherapy schedules, only 45% of patients preferred oral therapy, while 55% preferred IV therapy. Among the latter, the most important characteristics influencing treatment choice were less nausea (66%), fewer mood effects (65%), the safety of hospital IV treatment (62%), less interference with family relationships (55%), less vomiting (55%), less interference with daily activities (50%), and less diarrhea (50%). Although the order in which patients received therapy did not influence treatment preference, significantly fewer patients with a lower rather than higher educational level preferred oral therapy (47% vs 80%; chi-square test = 9.9; p = 0.002). CONCLUSION These results suggest that there may be a correlation between educational level and the preference of patients with advanced colorectal cancer for oral or IV chemotherapy.
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Affiliation(s)
- Candida M Mastroianni
- 1 Mariano Santo Hospital, Cosenza, Italy 2 Siderno Hospital, Siderno, Italy 3 San Giovanni di Dio Hospital, Crotone, Italy
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78
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Smith RS, Zhang Z, Bouchard M, Li J, Lapp HS, Brotske GR, Lucchino DL, Weaver D, Roth LA, Coury A, Biggerstaff J, Sukavaneshvar S, Langer R, Loose C. Vascular Catheters with a Nonleaching Poly-Sulfobetaine Surface Modification Reduce Thrombus Formation and Microbial Attachment. Sci Transl Med 2012; 4:153ra132. [DOI: 10.1126/scitranslmed.3004120] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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79
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Daneshpour N, Collighan R, Perrie Y, Lambert P, Rathbone D, Lowry D, Griffin M. Indwelling catheters and medical implants with FXIIIa inhibitors: A novel approach to the treatment of catheter and medical device-related infections. Eur J Pharm Biopharm 2012; 83:106-13. [PMID: 23022540 DOI: 10.1016/j.ejpb.2012.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/03/2012] [Accepted: 09/04/2012] [Indexed: 11/18/2022]
Abstract
Central venous catheters (CVCs) are being utilized with increasing frequency in intensive care and general medical wards. In spite of the extensive experience gained in their application, CVCs are related to the long-term risks of catheter sheath formation, infection, and thrombosis (of the catheter or vessel itself) during catheterization. Such CVC-related-complications are associated with increased morbidity, mortality, duration of hospitalization, and medical care cost [1]. The present study incorporates a novel group of Factor XIIIa (FXIIIa, plasma transglutaminase) inhibitors into a lubricious silicone elastomer in order to generate an optimized drug delivery system whereby a secondary sustained drug release profile occurs following an initial burst release for catheters and other medical devices. We propose that the incorporation of FXIIIa inhibitors into catheters, stents, and other medical implant devices would reduce the incidence of catheter sheath formation, thrombotic occlusion, and associated staphylococcal infection. This technique could be used as a local delivery system for extended release with an immediate onset of action for other poorly aqueous soluble compounds.
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Affiliation(s)
- Nooshin Daneshpour
- Medicines Research Unit, School of Life and Health Sciences, Aston University, Birmingham, UK
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80
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Abstract
Cardiac toxicities from cancer therapy can become evident many years after treatment, and these late cardiac effects can have a profound impact on cancer survivors. There are a myriad of potential cardiovascular complications from cancer therapy, but these can be grouped into three main categories. First, vascular conditions including atherosclerosis, thrombosis, and hypertension predominate. Second, cardiac structural problems, especially valvular degeneration, can have a dramatic impact long term. Lastly, and most importantly, cardiac dysfunction and heart failure are potentially common late cardiac effects and can certainly be prevented or detected early during active cancer therapy to result in optimal outcomes. Future research on late cardiac effects in cancer survivors needs to include advanced cardiac imaging techniques, novel cardiac biomarkers, and genetic determinants of response to cancer treatment.
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Affiliation(s)
- Daniel J Lenihan
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, TN 37232-8802, USA.
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81
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Arone KMB, de Oliveira CZ, Garbin LM, dos Reis PED, Galvão CM, Silveira RCDCP. Thrombotic obstruction of the central venous catheter in patients undergoing hematopoietic stem cell transplantation. Rev Lat Am Enfermagem 2012; 20:804-12. [PMID: 22990167 DOI: 10.1590/s0104-11692012000400022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 03/27/2012] [Indexed: 11/21/2022] Open
Abstract
This is an integrative literature review with the aim of summarizing the prevention measures and treatment of thrombotic obstruction of long-term semi-implanted central venous catheters, in patients undergoing hematopoietic stem cell transplantation. The sample consisted of seven studies, being two randomized controlled clinical trials, three cohort studies and two case series. Regarding the prevention measures, one single study demonstrated effectiveness, which was a cohort study on the oral use of warfarin. In relation to the treatment measures, three studies evidenced effectiveness, one highlighted the efficacy of streptokinase or urokinase, one demonstrated the benefit of using low-molecular-weight heparin and the other treated the obstruction with heparin or urokinase. Catheter patency research shows a restricted evolution that does not follow the evolution of transplantations, mainly regarding nursing care.
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82
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Aw A, Carrier M, Koczerginski J, McDiarmid S, Tay J. Incidence and predictive factors of symptomatic thrombosis related to peripherally inserted central catheters in chemotherapy patients. Thromb Res 2012; 130:323-6. [DOI: 10.1016/j.thromres.2012.02.048] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/22/2012] [Accepted: 02/28/2012] [Indexed: 12/11/2022]
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83
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Abstract
Thrombosis is a common complication in patients with acute leukemia. While the presence of central venous lines, concomitant steroids, the use of Escherichia coli asparaginase and hereditary thrombophilic abnormalities are known risk factors for thrombosis in children, information on the pathogenesis, risk factors, and clinical outcome of thrombosis in adult patients with acute lymphoid leukemia (ALL) or acute myeloid leukemia (AML) is still scarce. Expert consensus and guidelines regarding leukemia-specific risk factors, thrombosis prevention, and treatment strategies, as well as optimal type of central venous catheter in acute leukemia patients are required. It is likely that each subtype of acute leukemia represents a different setting for the development of thrombosis and the risk of bleeding. This is perhaps due to a combination of different disease-specific pathogenic mechanisms of thrombosis, including the type of chemotherapy protocol chosen, the underlying patients health, associated risk factors, as well as the biology of the disease itself. The risk of thrombosis may also vary according to ethnicity and prevalence of hereditary risk factors for thrombosis; thus, it is advisable for Latin American, Asian, and African countries to report on their specific patient population.
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Affiliation(s)
- Erick Crespo-Solís
- Clínica de Leucemia Aguda, Departamento de Hematología y Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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84
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Efficacy of Normal Saline Versus Heparinized Saline Solution for Locking Catheters of Totally Implantable Long-Term Central Vascular Access Devices in Adult Cancer Patients. Cancer Nurs 2012; 35:E35-42. [DOI: 10.1097/ncc.0b013e31823312b1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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85
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Kyriazi V. Breast cancer as an acquired thrombophilic state. J Breast Cancer 2012; 15:148-56. [PMID: 22807931 PMCID: PMC3395737 DOI: 10.4048/jbc.2012.15.2.148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 03/27/2012] [Indexed: 11/30/2022] Open
Abstract
Cancer is an acquired thrombophilic condition manifested by increased incidence of venous and arterial thromboembolic complications. Despite progress that has been achieved in treatments over the recent years, thromboembolism remains a major complication in patients with breast cancer; it is accompanied by significant morbidity and mortality. Approximately, 1% of breast cancer patients develop venous thromboembolism within 2 years with the highest incidence occurring in the 6 months post diagnosis. Metastatic disease and their comorbidities are the strongest predictors of the development of thrombotic event. The diagnosis of venous thromboembolism is associated with a higher risk of death within 2 years of diagnosis. Thromboembolic events in cancer patients range from abnormal laboratory coagulation tests without specific symptoms to massive thomboembolism and disseminated intravascular coagulation. The underlying pathophysiology is complex and includes the prothrombotic properties of cancer cells, which can be enhanced by anticancer treatment modalities, such as surgery, hormonal agents, and chemotherapy. Primary thromboprophylaxis in cancer patients should be individualized according to risk. For secondary prevention, several clinical studies have shown that low molecular weight heparin has improved patients' compliance, cancer outcomes and overall survival. This review summarizes the available data on the pathogenesis and clinical approach of hemostatic changes in breast cancer.
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Affiliation(s)
- Vasiliki Kyriazi
- Hematological Department, Central Polyclinic, Institution of Social Insurance, Thessaloniki, Greece
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86
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Heran MKS, Burrill J. Vascular pediatric interventional radiology. Can Assoc Radiol J 2012; 63:S59-73. [PMID: 22658372 DOI: 10.1016/j.carj.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/20/2011] [Accepted: 12/09/2011] [Indexed: 12/13/2022] Open
Abstract
Interventional radiology procedures are increasingly in demand in both the adult and pediatric populations. Pediatric procedures mirror many of the adult procedures but with increased complexity due to many considerations, notably patient size. This article reviews the various vascular pediatric interventional procedures. The aim is to provide a greater exposure to the possible treatment options for pediatric patients and to facilitate understanding of the success and complications rates related to various interventions.
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Affiliation(s)
- Manraj K S Heran
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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87
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Ge X, Cavallazzi R, Li C, Pan SM, Wang Y, Wang F. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012; 2012:CD004084. [PMID: 22419292 PMCID: PMC6516884 DOI: 10.1002/14651858.cd004084.pub3] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Central venous access (CVA) is widely used. However, its thrombotic, stenotic and infectious complications can be life-threatening and involve high-cost therapy. Research revealed that the risk of catheter-related complications varied according to the site of CVA. It would be helpful to find the preferred site of insertion to minimize the risk of catheter-related complications. This review was originally published in 2007 and was updated in 2011. OBJECTIVES 1. Our primary objective was to establish whether the jugular, subclavian or femoral CVA routes resulted in a lower incidence of venous thrombosis, venous stenosis or infections related to CVA devices in adult patients.2. Our secondary objective was to assess whether the jugular, subclavian or femoral CVA routes influenced the incidence of catheter-related mechanical complications in adult patients; and the reasons why patients left the studies early. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2011, Issue 9), MEDLINE, CINAHL, EMBASE (from inception to September 2011), four Chinese databases (CBM, WANFANG DATA, CAJD, VIP Database) (from inception to November 2011), Google Scholar and bibliographies of published reviews. The original search was performed in December 2006. We also contacted researchers in the field. There were no language restrictions. SELECTION CRITERIA We included randomized controlled trials comparing central venous catheter insertion routes. DATA COLLECTION AND ANALYSIS Three authors assessed potentially relevant studies independently. We resolved disagreements by discussion. Dichotomous data on catheter-related complications were analysed. We calculated relative risks (RR) and their 95% confidence intervals (CI) based on a random-effects model. MAIN RESULTS We identified 5854 citations from the initial search strategy; 28 references were then identified as potentially relevant. Of these, we Included four studies with data from 1513 participants. We undertook a priori subgroup analysis according to the duration of catheterization, short-term (< one month) and long-term (> one month) defined according to the Food and Drug Administration (FDA).No randomized controlled trial (RCT) was found comparing all three CVA routes and reporting the complications of venous stenosis.Regarding internal jugular versus subclavian CVA routes, the evidence was moderate and applicable for long-term catheterization in cancer patients. Subclavian and internal jugular CVA routes had similar risks for catheter-related complications. Regarding femoral versus subclavian CVA routes, the evidence was high and applicable for short-term catheterization in critically ill patients. Subclavian CVA routes were preferable to femoral CVA routes in short-term catheterization because femoral CVA routes were associated with higher risks of catheter colonization (14.18% or 19/134 versus 2.21% or 3/136) (n = 270, one RCT, RR 6.43, 95% CI 1.95 to 21.21) and thrombotic complications (21.55% or 25/116 versus 1.87% or 2/107) (n = 223, one RCT, RR 11.53, 95% CI 2.80 to 47.52) than with subclavian CVA routes. Regarding femoral versus internal jugular routes, the evidence was moderate and applicable for short-term haemodialysis catheterization in critically ill patients. No significant differences were found between femoral and internal jugular CVA routes in catheter colonization, catheter-related bloodstream infection (CRBSI) and thrombotic complications, but fewer mechanical complications occurred in femoral CVA routes (4.86% or 18/370 versus 9.56% or 35/366) (n = 736, one RCT, RR 0.51, 95% CI 0.29 to 0.88). AUTHORS' CONCLUSIONS Subclavian and internal jugular CVA routes have similar risks for catheter-related complications in long-term catheterization in cancer patients. Subclavian CVA is preferable to femoral CVA in short-term catheterization because of lower risks of catheter colonization and thrombotic complications. In short-term haemodialysis catheterization, femoral and internal jugular CVA routes have similar risks for catheter-related complications except internal jugular CVA routes are associated with higher risks of mechanical complications.
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Affiliation(s)
- Xiaoli Ge
- Xinhua Hospital, Shanghai Jiao Tong University School of MedicineEmergency Department1665 Kong Jiang RoadShanghaiChina200092
| | - Rodrigo Cavallazzi
- Department of Medicine, University of LouisvilleDivision of Pulmonary, Critical Care and Sleep MedicineA3R27, Health Science CenterAmbulatory Care Building, 550 S. Jackson StreetLouisvilleKYUSA40202
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Psychotic Disorders600 Wan Ping Nan RoadShanghaiChina
| | - Shu Ming Pan
- Xinhua Hospital, Shanghai Jiao Tong University School of MedicineEmergency Department1665 Kong Jiang RoadShanghaiChina200092
| | - Ying‐Wei Wang
- Huashan Hospital, Fudan UniversityDepartment of AnaesthesiologyNo. 12 Wulumuqi RoadShanghaiChina200040
| | - Fei‐Long Wang
- Xinhua Hospital, Shanghai Jiao Tong University School of MedicineEmergency Department1665 Kong Jiang RoadShanghaiChina200092
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88
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Falanga A, Marchetti M. Anticancer treatment and thrombosis. Thromb Res 2012; 129:353-9. [DOI: 10.1016/j.thromres.2011.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/21/2011] [Accepted: 10/24/2011] [Indexed: 12/21/2022]
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89
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Falanga A, Russo L. Epidemiology, risk and outcomes of venous thromboembolism in cancer. Hamostaseologie 2011; 32:115-25. [PMID: 21971578 DOI: 10.5482/ha-1170] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/11/2011] [Indexed: 12/16/2022] Open
Abstract
Cancer is associated with a fourfold increased risk of venous thromboembolism (VTE). The risk of VTE varies according to the type of malignancy (i. e. pancreatic cancer, brain cancer, lymphoma) and its disease stage and individual factors (i. e. sex, race, age, previous VTE history, immobilization, obesity). Preventing cancer-associated VTE is important because it represents a significant cause of morbidity and mortality. In order to identify cancer patient at particularly high risk, who need thromboprophylaxis, risk prediction models have become available and are under validation. These models include clinical risk factors, but also begin to incorporate biological markers. The major American and European scientific societies have issued their recommendations to guide the management of VTE in patients with cancer. In this review the principal aspects of epidemiology, risk factors and outcome of cancer-associated VTE are summarized.
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Affiliation(s)
- A Falanga
- Division of Immunohematology and Transfusion Medicine, Department Oncology-Hematology, Ospedali Riuniti, Bergamo, Italy.
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90
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Vos FJ, Donnelly JP, Oyen WJG, Kullberg BJ, Bleeker-Rovers CP, Blijlevens NMA. 18F-FDG PET/CT for diagnosing infectious complications in patients with severe neutropenia after intensive chemotherapy for haematological malignancy or stem cell transplantation. Eur J Nucl Med Mol Imaging 2011; 39:120-8. [PMID: 21947022 PMCID: PMC3227801 DOI: 10.1007/s00259-011-1939-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 09/07/2011] [Indexed: 11/28/2022]
Abstract
Purpose Between 30 and 50% of febrile neutropenic episodes are accounted for by infection. C-reactive protein (CRP) is a nonspecific parameter for infection and inflammation but might be employed as a trigger for diagnosis. The aim of the study was to evaluate whether 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT can be used to detect inflammatory foci in neutropenic patients with elevated CRP and whether it helps to direct treatment. Methods Twenty-eight consecutive patients with neutropenia as a result of intensive chemotherapy for haematological malignancies or myeloablative therapy for haematopoietic stem cell transplantation were prospectively included. 18F-FDG PET/CT was added to the regular diagnostic workup once the CRP level rose above 50 mg/l. Results Pathological FDG uptake was found in 26 of 28 cases despite peripheral neutrophil counts less than 0.1 × 10−9/l in 26 patients: in the digestive tract in 18 cases, around the tract of the central venous catheter (CVC) in 9 and in the lungs in 7 cases. FDG uptake in the CVC tract was associated with coagulase-negative staphylococcal bacteraemia (p < 0.001) and deep venous thrombosis (p = 0.002). The number of patients having Streptococcus mitis bacteraemia appeared to be higher in patients with grade 3 oesophageal FDG uptake (p = 0.08). Pulmonary FDG uptake was associated with the presence of invasive fungal disease (p = 0.04). Conclusion 18F-FDG PET/CT scanning during chemotherapy-induced febrile neutropenia and increased CRP is able to detect localized foci of infection and inflammation despite the absence of circulating neutrophils. Besides its potential role in detecting CVC-related infection during febrile neutropenia, the high negative predictive value of 18F-FDG PET/CT is important for avoiding unnecessary diagnostic tests and therapy.
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Affiliation(s)
- Fidel J Vos
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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91
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Lim BG, Kim YM, Kim H, Lim SH, Lee MK. Internal jugular vein thrombosis associated with venous hypoplasia and protein S deficiency revealed by ultrasonography. J Anesth 2011; 25:930-4. [PMID: 21931986 DOI: 10.1007/s00540-011-1233-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 09/01/2011] [Indexed: 10/17/2022]
Abstract
A 41-year-old woman, who had no thrombotic risk factors and past history except congenital scoliosis, underwent central venous catheterization (CVC) before correction of the scoliosis. When internal jugular vein (IJV) catheterization using the anatomical landmark technique failed, CVC under ultrasound guidance was tried. As a consequence, thrombosis and hypoplasia of the right IJV were incidentally detected by ultrasonography. Central venous catheters were then successfully placed in other veins under ultrasound guidance. Also, after examinations to rule out the possibility of pulmonary embolism and to clarify the causes of the IJV thrombosis, the patient was found to have protein S deficiency. CVC under ultrasound guidance should be recommended to prevent the failure of cannulation and complications such as thromboembolism in patients who could possibly have anomalies of vessels as a result of anatomical deformities caused by severe scoliosis, even if patients do not have thrombotic risk factors such as a history of central catheter insertion or intravenous drug abuse, cancer, advanced age, cerebral infarction, and left ventricular dysfunction. Also, if venous thrombosis is found in patients without predisposing risk factors, one should ascertain the cause of the hypercoagulable state, for example protein S deficiency, and perform appropriate treatment and prevention of venous thromboembolism.
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Affiliation(s)
- Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 97, Gurodong-Gil, Guro-Gu, Seoul, 152-703, Korea
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92
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Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K, Neven P, Van Kampen M. Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related to breast cancer: randomised controlled trial. BMJ 2011; 343:d5326. [PMID: 21885537 PMCID: PMC3164214 DOI: 10.1136/bmj.d5326] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to breast cancer. DESIGN Randomised single blinded controlled trial. SETTING University Hospitals Leuven, Leuven, Belgium. PARTICIPANTS 160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed. Randomisation was done independently from recruitment and treatment. Baseline characteristics were comparable between the groups. INTERVENTION For six months the intervention group (n = 79) performed a treatment programme consisting of guidelines about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group (n = 81) performed the same programme without manual lymph drainage. MAIN OUTCOME MEASURES Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in arm volume of 200 mL or more in the value before surgery. RESULTS Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P = 0.45). The time to develop arm lymphoedema was comparable between the two group during the first year after surgery (hazard ratio 1.3, 0.6 to 2.5; P = 0.49). The sample size calculation was based on a presumed odds ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as (presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30). CONCLUSION Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in the short term. Trial registration Netherlands Trial Register No NTR 1055.
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Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy, University Hospitals Leuven, Leuven, Belgium.
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93
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Identification of Risk Factors for Catheter-Related Thrombosis in Patients with Totally Implantable Venous Access Ports in the Forearm. J Vasc Access 2011; 13:79-85. [DOI: 10.5301/jva.5000003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose To identify risk factors for the development of catheter-related thrombosis (CRT) in patients with totally implant-able venous access ports (TIVAP) in the forearm, and to analyze the effect of prophylaxis and treatment. Methods We retrospectively identified 200 patients (94 men, 106 women, mean age 57.7 +/-14 y) with TIVAP implantation in the forearm between 3/2010 and 11/2010. Type, number of punctures and sonographically defined diameter of the accessed vein were analyzed. Chemotherapy administered prior to the implantation procedure and history of thrombo-embolic events were assessed. Thrombo-embolic prophylaxis (TEP) following port implantation and treatment as well as course of CRT were analyzed. Results Twenty-one patients (10.5%) were diagnosed with CRT. Accessed vessels and mean diameter were basilic (n=150, 3.7 mm), brachial (n=39, 3.5 mm) and cephalic (n=11, 3.5 mm) vein. Neither type nor vessel diameter had effect on CRT development (P>.05). Implantation in the left forearm resulted in a significantly higher rate of CRT (P=.04). Ninety-five patients (47.5%) received chemotherapy and 30 patients (15.0%) had a history of thrombosis prior to implantation; both had no effect on development of CRT. Low molecular weight heparin (LMWH) was prescribed in 94/200 patients (47.0%) and had no effect on development of CRT (P>.05). Therapeutic anticoagulation with LMWH resulted in clinical improvement in 12/21 patients (57.4%). Conclusions TIVAPs of the forearm may be associated with a certain rate of early and late CRT. The simplest vein to puncture should be selected for vascular access. Thrombo-embolic prophylaxis appears to be rather ineffective for prevention of CRT.
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94
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Varona Porres D, Andreu Soriano J, Pallisa Núñez E, Persiva Morenza O, Roque Pérez A. Patología vascular torácica en pacientes oncológicos. RADIOLOGIA 2011; 53:335-48. [DOI: 10.1016/j.rx.2011.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 11/15/2022]
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Varona Porres D, Andreu Soriano J, Pallisa Núñez E, Persiva Morenza O, Roque Pérez A. Thoracic vascular disease in oncologic patients. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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96
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Anaissie EJ, Coleman EA, Goodwin JA, Kennedy RL, Lockhart KD, Stewart CB, Coon SK, Bailey C, Barlogie B. Prophylactic recombinant erythropoietin therapy and thalidomide are predictors of venous thromboembolism in patients with multiple myeloma: limited effectiveness of thromboprophylaxis. Cancer 2011; 118:549-57. [DOI: 10.1002/cncr.26302] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 02/02/2011] [Accepted: 03/15/2011] [Indexed: 11/10/2022]
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97
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Kwaan HC, Huyck T. Thromboembolic and bleeding complications in acute leukemia. Expert Rev Hematol 2011; 3:719-30. [PMID: 21091148 DOI: 10.1586/ehm.10.71] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of both thromboembolic and bleeding complications is high in acute leukemia. This double hazard has a significant negative impact on the morbidity and mortality of patients with this disease. The clinical manifestations of both complications show special features specific to the form of acute leukemia. Recognition of these characteristics is important in the diagnosis and management of acute leukemia. In this article, several additional issues are addressed, including the features of bleeding and thrombosis in acute promyelocytic leukemia, the current understanding of the leukostasis syndrome and the iatrogenic complications including catheter-associated thrombosis, and the adverse effects of therapeutic agents used in acute leukemia. As regards the bleeding complications, thrombocytopenia is a major cause. Corrective measures, including recent guidelines on platelet transfusions, are provided.
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Affiliation(s)
- Hau C Kwaan
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, 710 Fairbanks Court, Chicago, IL 60611, USA.
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98
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O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39:S1-34. [PMID: 21511081 DOI: 10.1016/j.ajic.2011.01.003] [Citation(s) in RCA: 714] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/03/2011] [Accepted: 02/04/2011] [Indexed: 12/14/2022]
Affiliation(s)
- Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland 20892, USA.
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DiPasco PJ, Misra S, Koniaris LG, Moffat FL. Thrombophilic state in cancer, Part I: Biology, incidence, and risk factors. J Surg Oncol 2011; 104:316-22. [DOI: 10.1002/jso.21925] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 03/14/2011] [Indexed: 12/21/2022]
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100
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O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52:e162-93. [PMID: 21460264 DOI: 10.1093/cid/cir257] [Citation(s) in RCA: 1223] [Impact Index Per Article: 94.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
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