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Fernandez-Fernandez I, Parra-García G, Blanco-Mavillard I, Carr P, Santos-Costa P, Rodríguez-Calero MÁ. Vascular access specialist teams versus standard practice for catheter insertion and prevention of failure: a systematic review. BMJ Open 2024; 14:e082631. [PMID: 38969373 PMCID: PMC11227807 DOI: 10.1136/bmjopen-2023-082631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE Billions of vascular access devices (VADs) are inserted annually for intravenous therapy worldwide. However, their use is not without challenges. Facilitating the process and enhancing results, hospital authorities have created vascular access specialist teams (VASTs) with advanced competencies in the evaluation, insertion, care and management of VADs. The objective is to compare the effectiveness of VASTs versus standard practice regarding cannulation success and vascular access maintenance in hospitalised adults. DESIGN Systematic review, using the Mixed Methods Appraisal Tool. DATA SOURCES We conducted a structured data search on Cochrane Library, MEDLINE, Web of Science, Scopus and EBSCOhost up to 31 May 2023. We did not impose a time limit regarding the date of publication. ELIGIBILITY CRITERIA Studies were eligible for inclusion in the review if they were randomised and non-randomised trials and observational studies. DATA EXTRACTION AND SYNTHESIS We included studies that described or evaluated the activity of VASTs compared with clinical practitioners. The outcomes analysed were the success of the cannulation and the incidence of associated adverse effects. RESULTS The search strategy produced 3053 papers published between 1984 and 2020, from which 12 were selected for analysis. VASTs are heterogeneously described among these studies, which mainly focus on insertions, frequently for patients with difficult intravenous access. Some patients presented with specific needs or requirement for specific insertion technique or catheter type. Compared with usual practice, these studies indicate that the involvement of a VAST is associated with a higher effectiveness in terms of first attempt insertions and insertion success rates, and a reduction in catheter-associated adverse events. However, meta-analyses confirming this trend are not currently possible. CONCLUSIONS It seems apparent that VASTS contribute to improving the health of patients during the administration of intravenous. VASTs seem to increase the effectiveness of VAD insertion and care and reduce complications. PROSPERO REGISTRATION NUMBER CRD42021231259.
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Affiliation(s)
| | | | - Ian Blanco-Mavillard
- Healthcare Implementation and Research Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma de Mallorca, Spain
- Care, Chronicity and Evidence in Health Research Group, Health research institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing (UICISA: E), Higher School of Nursing of Coimbra, Coimbra, Portugal
- Portuguese Association for Vascular Access (APoAVa), Coimbra, Portugal
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Teja B, Bosch NA, Diep C, Pereira TV, Mauricio P, Sklar MC, Sankar A, Wijeysundera HC, Saskin R, Walkey A, Wijeysundera DN, Wunsch H. Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:474-482. [PMID: 38436976 DOI: 10.1001/jamainternmed.2023.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions. Objective To summarize current rates of CVC-associated complications. Data Sources MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023. Study Selection This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated. Main Outcomes and Measures Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed. Results Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters). Conclusions and Relevance Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.
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Affiliation(s)
- Bijan Teja
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicholas A Bosch
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V Pereira
- Clinical Trial Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paolo Mauricio
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashwin Sankar
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Refik Saskin
- ICES Central, University of Toronto, Toronto, Ontario, Canada
| | - Allan Walkey
- Division of Health Systems Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- ICES Central, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Wunsch
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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3
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Nakao M, Inagaki Y, Hata T, Morioka Y, Otsuki H, Arashi H, Yamaguchi J, Hagiwara N. Clinical outcomes of endovascular therapy with vascular stents for central venous obstruction in hemodialysis patients. J Cardiol 2022; 80:469-474. [PMID: 35850891 DOI: 10.1016/j.jjcc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/19/2022] [Accepted: 06/09/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Symptomatic central venous obstruction (CVO) is sometimes observed in patients undergoing hemodialysis. Angioplasty is generally performed for salvage purposes, and stent implantation is performed as a last resort to prevent permanent venous occlusion. However, published reports about the clinical outcomes of stenting for CVO have been limited by the small number of included patients and the relatively old generation of analyzed stents. This study aimed to clarify the safety and efficacy of endovascular therapy (EVT) using stents for symptomatic CVO in contemporary practice. METHODS This retrospective review was performed between May 2012 and August 2021. We retrospectively analyzed consecutive 31 lesions (31 patients, 64 ± 10.7 years old) treated with a vascular stent for elastic recoil after balloon angioplasty or recurrent stenosis <3 months after angioplasty. The primary outcome was primary patency, defined as freedom from target lesion revascularization. The secondary outcome was assisted primary patency, defined as freedom from permanent occlusion of the target stents. RESULTS In all cases, stents were successfully deployed on the target lesions. No EVT-related complications were observed. Self-expandable and balloon-expandable stents were used in 26 and 5 lesions, respectively. The median follow-up period was 18 months (interquartile range, 7-40). Kaplan-Meier analysis revealed that the primary patency rates were 66.1 % at 6 months, 61.7 % at 12 months, and 38.4 % at 24 months after EVT. The assisted primary patency rate was 70.3 % 24 months after EVT. In the multivariate analysis, younger age was the only independent predictor of target lesion revascularization (hazard ratio: 0.92, 95 % CI: 0.85-0.99, p = 0.04). CONCLUSIONS Stent implantation for CVO that is resistant to standard angioplasty seems safe and effective.
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Affiliation(s)
- Masashi Nakao
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Yusuke Inagaki
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Takehiro Hata
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuta Morioka
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisao Otsuki
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
| | - Nobuhisa Hagiwara
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
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Thiel K, Kalmbach S, Maier G, Wichmann D, Schenk M, Königsrainer A, Thiel C. Standardized procedure prevents perioperative and early complications in totally implantable venous-access ports-a complication analysis of more than 1000 TIVAP implantations. Langenbecks Arch Surg 2022; 407:3755-3762. [PMID: 36070032 PMCID: PMC9722872 DOI: 10.1007/s00423-022-02656-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Since their invention 40 years ago, totally implantable venous-access ports (TIVAPs) have become indispensable in cancer treatment. The aim of our study was to analyze complications under standardized operative and perioperative procedures and to identify risk factors for premature port catheter explantation. METHODS A total of 1008 consecutive TIVAP implantations were studied for success rate, perioperative, early, and late complications. Surgical, clinical, and demographic factors were analyzed as potential risk factors for emergency port catheter explantation. RESULTS Successful surgical TIVAP implantation was achieved in 1005/1008 (99.7%) cases. No intraoperative or perioperative complications occurred. A total of 32 early complications and 88 late complications were observed leading to explantation in 11/32 (34.4%) and 34/88 (38.6%) cases, respectively. The most common complications were infections in 4.7% followed by thrombosis in 3.6%. Parameters that correlated with unplanned TIVAP explantation were gender (port in situ: female 95% vs. male 91%, p = 0.01), underlying disease (breast cancer 97% vs. gastrointestinal 89%, p = 0.004), indication (chemotherapy 95% vs. combination of chemotherapy and parenteral nutrition 64%, p < 0.0001), and type of complication (infection 13.4% vs. TIVAP-related complication 54% and thrombosis 95%, p < 0.0001). CONCLUSION Standardized operative and perioperative TIVAP implantation procedures provide excellent results and low explantation rate.
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Affiliation(s)
- Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
| | - Sarah Kalmbach
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Gerhard Maier
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Dörte Wichmann
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Martin Schenk
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Alfred Königsrainer
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Christian Thiel
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
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Lasagni D, Nosadini M, Molinari AC, Saracco P, Pelizza MF, Piersigilli F, Putti MC, Gaffuri M, Giordano P, Lorenzoni G, Francavilla A, Trapani S, Luciani M, Suppiej A, Tufano A, Tormene D, Martinato M, Gregori D, Sartori S, Simioni P. Systemic Catheter-Related Venous Thromboembolism in Children: Data From the Italian Registry of Pediatric Thrombosis. Front Pediatr 2022; 10:843643. [PMID: 35402350 PMCID: PMC8984174 DOI: 10.3389/fped.2022.843643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Central venous catheters (CVCs) represent one of the main risk factors for venous thrombotic events (VTEs) in children. METHODS We studied the Italian Registry of Pediatric Thrombosis (RITI) with regard to systemic radiologically confirmed CVC-related VTEs (CVC-VTEs) occurred during 6.5 years in children aged 29 days to 18 years. RESULTS A total of 78 CVC-VTEs were included, which occurred in 76 patients (40/76, 53% males). CVC-VTEs comprised 67 non-cardiac VTEs (86%) and 11 intracardiac thrombotic events (ICTEs) (14%); the median age at onset was 19 and 17 months, respectively. The most frequent reason for CVC insertion was supportive therapy. The catheters were placed percutaneously in 85% of cases (56/66) and surgically in the remaining 15% (10/66). Peripherally inserted central catheters (PICCs) were used in 47% (31/66) cases, partially implanted catheters in 42% (28/66), non-implantable catheters in 7% (5/66), and totally implanted catheters (Port) in 2% (1/66). CVC-VTEs were symptomatic in 77% of cases (60/78), while in the remaining 23%, they were incidentally detected on the imaging performed for the underlying condition. The median time between CVC insertion and the onset of symptoms was 10 days in non-cardiac VTEs and 39 days in ICTEs. Doppler ultrasound was the diagnostic technique most frequently used. The venous compartment most frequently affected was the veins of the lower extremities (52%, 43/73). Anti-thrombotic treatment was administered in 96% of CVC-VTEs (75/78). About 2.6% (2/76) of patients experienced a second thrombotic event. At discharge, post-thrombotic syndrome was reported in 13.5% (5/37) events with available data, CVC replacement in 10.8% (4/47), and ischemic necrosis with toe finger amputation in 2.7% (1/37). Three patients died due to an underlying condition; no CVC-VTE-related deaths were reported. CONCLUSIONS We have carried out a registry-based study on CVC-VTEs in the children in Italy, providing the data that may help improve the detection and management of this CVC-related complication.
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Affiliation(s)
- Donatella Lasagni
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | | | - Paola Saracco
- Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | | | - Maria Caterina Putti
- Department of Oncology and Hematology, University Hospital of Padua, Padua, Italy
| | | | - Paola Giordano
- Pediatric Hematology and Oncology, University of Bari, Bari, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Sandra Trapani
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Matteo Luciani
- Department of Hematology and Oncology and Transfusional Medicine, IRCCS Pediatric Hospital Bambin Gesù, Rome, Italy
| | - Agnese Suppiej
- Department of Medical Sciences-Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy
| | - Daniela Tormene
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, University of Padua Medical School, Padua, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, University of Padua Medical School, Padua, Italy
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Sebuhyan M, Crichi B, Deville L, Le Maignan C, Bonnet C, Marjanovic Z, Rueda J, Bensaoula O, Ndour A, Frere C, Madeleine I, Farge D. Patient education program at the forefront of cancer-associated thrombosis care. JOURNAL DE MEDECINE VASCULAIRE 2021; 46:215-223. [PMID: 34862015 DOI: 10.1016/j.jdmv.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Treatment of cancer-associated thrombosis (CAT) requires specific approaches, although it is well codified in most cases. Current national and international (International Initiative on Cancer and Thrombosis, ITAC) Clinical Practice Guidelines (CPG) recommend the use of low-molecular-weight heparin (LMWH) over 6 months as first treatment option, and anticoagulation should be maintained thereafter as long as cancer is active. Since compliance improves when patients understand their disease and related treatments, we created a dedicated patient education program (PEP) for CAT, aiming to improve quality of care. METHODS Retrospective analysis of all patients who voluntarily joined the PEP for CAT from 2014 to 2020. RESULTS In total, 182 cancer patients (median age, 64.9 years) were included, 53.3% with metastatic disease. A total of 528 PEP sessions (median, 3 per patient) were delivered. After PEP completion, the rate of self-injections or those performed at home by a relative had increased from 49.1% to 59.8% (P=0.05). Quality of life had improved significantly (P=0.025) and 90.0% of patients reported adhering to anticoagulant therapy. CONCLUSION Implementation of a structured and personalized PEP for CAT is feasible, allowing to improve cancer patient empowerment, adherence to CAT treatment and quality of life. The Groupe francophone et cancer (GFTC) members aim at facilitating access to CAT-PEP for both patients and caregivers and use of the multi-language ITAC-CPG mobile app (free access: www.itaccme.com) to improve the care and quality of life of patients with CAT.
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Affiliation(s)
- M Sebuhyan
- Groupe francophone thrombose et cancer, Paris, France; Department of Clinical Physiology, Lariboisière Hospital, AP-HP, Paris, France.
| | - B Crichi
- Groupe francophone thrombose et cancer, Paris, France; Department of Internal Medicine (UF 04), CRMR MATHEC, maladies auto-immunes et thérapie cellulaire, Saint-Louis Hospital, AP-HP, Paris, France
| | - L Deville
- Pharmacy Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - C Le Maignan
- Groupe francophone thrombose et cancer, Paris, France; Department of Internal Medicine (UF 04), CRMR MATHEC, maladies auto-immunes et thérapie cellulaire, Saint-Louis Hospital, AP-HP, Paris, France
| | - C Bonnet
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Z Marjanovic
- Groupe francophone thrombose et cancer, Paris, France; Department of Hematology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - J Rueda
- Groupe francophone thrombose et cancer, Paris, France; Department of Internal Medicine, Hospital Universitario Rey-Juan-Carlos, Madrid, Spain
| | - O Bensaoula
- Groupe francophone thrombose et cancer, Paris, France; Department of Medical Oncology CLCC Curie Institute, centre Rene-Huguenin, Saint Cloud, France
| | - A Ndour
- Groupe francophone thrombose et cancer, Paris, France; Department of Internal Medicine (UF 04), CRMR MATHEC, maladies auto-immunes et thérapie cellulaire, Saint-Louis Hospital, AP-HP, Paris, France
| | - C Frere
- Groupe francophone thrombose et cancer, Paris, France; Inserm UMRS_1166, Department of Hematology, Institute of Cardiometabolism And Nutrition, GRC 27 GRECO, Pitié-Salpêtrière Hospital, Sorbonne université, AP-HP, Paris, France
| | - I Madeleine
- Pharmacy Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - D Farge
- Groupe francophone thrombose et cancer, Paris, France; Department of Internal Medicine (UF 04), CRMR MATHEC, maladies auto-immunes et thérapie cellulaire, Saint-Louis Hospital, AP-HP, Paris, France; EA 3518, institut universitaire d'hématologie, université de Paris, Paris, France.
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7
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Lascano D, Kelley-Quon LI. Management of Postoperative Complications Following Common Pediatric Operations. Surg Clin North Am 2021; 101:799-812. [PMID: 34537144 DOI: 10.1016/j.suc.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review discusses complications unique to pediatric surgical populations. Here the authors focus primarily on five of the most common procedures performed in children: appendectomy, central venous catheterization, pyloromyotomy, gastrostomy, and inguinal/umbilical hernia repair.
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Affiliation(s)
- Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
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8
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Streiff MB, Abutalib SA, Farge D, Murphy M, Connors JM, Piazza G. Update on Guidelines for the Management of Cancer-Associated Thrombosis. Oncologist 2020; 26:e24-e40. [PMID: 33275332 DOI: 10.1002/onco.13596] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022] Open
Abstract
Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in patients with cancer. Over the past 2 decades, enormous advances have been made in the management of CAT. The growing evidence base informing practice has led to the publication of a number of guidelines and guidance documents on the diagnosis and treatment of CAT. The goal of this review is to examine the latest versions of evidence-based guidelines, highlighting the differences and similarities in their methodology, their disease-specific content, and recommendations for management. Our analysis shows that for most clinical topics, the different guidelines provide roughly similar management advice. However, there are a number of important clinical topics in CAT that are not currently covered by the existing guidelines. We think inclusion of these topics in future versions of the guidelines will facilitate ongoing efforts to optimize the care of patients with CAT. IMPLICATIONS FOR PRACTICE: Cancer-associated thrombosis (CAT) is a common complication in patients with cancer. This review examines the differences and similarities of the current CAT guidelines methods and recommendations. Current guidelines largely agree on many aspects of CAT management. However, there are a number of topics in CAT that are not currently included in guidelines where evidence-based guidance would be very helpful for clinicians. Coverage of these topics in future guidelines is encouraged to optimize clinical practice.
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Affiliation(s)
- Michael B Streiff
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Dominique Farge
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, Paris, France.,Department of Medicine, McGill University Health Center, Montreal, Canada
| | - Martina Murphy
- Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
| | - Jean M Connors
- Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Medicine Division at the Brigham and Women's Hospital, Boston, Massachusetts, USA.,Brigham and Womens Hospital and Dana-Farber Cancer Institute, Boston Massachusetts, USA
| | - Gregory Piazza
- Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular Medicine Division at the Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
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9
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Pinelli F, Balsorano P, Mura B, Pittiruti M. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access 2020; 22:501-508. [PMID: 32772785 DOI: 10.1177/1129729820947594] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Catheter-related thrombosis represents one of the most common complications following central venous access insertion. Despite the amount of available studies, many aspects surrounding catheter-related thrombosis remain controversial. Thirteen years ago, the Italian Study Group for Long Term Central Venous Access (GAVeCeLT) developed a nationwide Consensus in order to clarify some key aspects on this topic. Despite most of them still remain valid, however, knowledge around catheter-related thrombosis has greatly evolved over the last decade, with a natural evolution in terms of catheter technologies, insertion techniques, and management bundles. Aims of this editorial are to readdress conclusions of the 2007 GAVeCeLT Consensus in the light of the new relevant evidences that have been added in the last 13 years and to analyze some unsolved issues that still remain debated.
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Paolo Balsorano
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Benedetta Mura
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
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10
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Cotogni P, Mussa B, Degiorgis C, De Francesco A, Pittiruti M. Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days. JPEN J Parenter Enteral Nutr 2020; 45:768-776. [PMID: 32511768 DOI: 10.1002/jpen.1939] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). METHODS We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. RESULTS We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. CONCLUSION PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.
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Affiliation(s)
- Paolo Cotogni
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy
| | - Baudolino Mussa
- Central Venous, Access Team, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Claudia Degiorgis
- Central Venous, Access Team, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
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11
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Cotogni P, Caccialanza R, Pedrazzoli P, Bozzetti F, De Francesco A. Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients. Healthcare (Basel) 2020; 8:healthcare8020183. [PMID: 32585965 PMCID: PMC7348909 DOI: 10.3390/healthcare8020183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022] Open
Abstract
Current guidelines recommend home parenteral nutrition (HPN) for cancer patients with chronic deficiencies of dietary intake or absorption when enteral nutrition is not adequate or feasible in suitable patients. HPN has been shown to slow down progressive weight loss and improve nutritional status, but limited information is available on the monitoring practice of cancer patients on HPN. Clinical management of these patients based only on nutritional status is incomplete. Moreover, some commonly used clinical parameters to monitor patients (weight loss, body weight, body mass index, and oral food intake) do not accurately reflect patient’s body composition, while bioelectrical impedance analysis (BIA) is a validated tool to properly assess nutritional status on a regular basis. Therefore, patient’s monitoring should rely on other affordable indicators such as Karnofsky Performance Status (KPS) and modified Glasgow Prognostic Score (mGPS) to also assess patient’s functional status and prognosis. Finally, catheter-related complications and quality of life represent crucial issues to be monitored over time. The purpose of this narrative review is to describe the role and relevance of monitoring cancer patients on HPN, regardless of whether they are receiving anticancer treatments. These practical tips may be clinically useful to better guide healthcare providers in the nutritional care of these patients.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-338-7018496
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine and Medical Therapy, Università degli Studi di Pavia, 27100 Pavia, Italy;
| | | | - Antonella De Francesco
- Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, 10126 Turin, Italy;
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12
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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13
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Zhou X, Lin X, Shen R, Qu Y, Mo C, Li Y, Chen Q, Wu G, Chen Z, Huang K. A retrospective analysis of risk factors associated with catheter-related thrombosis: a single-center study. Perfusion 2020; 35:806-813. [PMID: 32419612 DOI: 10.1177/0267659120915142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catheter-related thrombosis may lead to catheter infections and failure, further deep venous thrombosis, and pulmonary embolism. Recognizing the risk factors for catheter-related thrombosis is extremely important to inform the development of catheter care guidelines. METHODS Data were collected from a total of 1,532 patients who had undergone venous catheterization, including indwelling catheterization from 19 March 2019 to 30 March 2019 in the Sun Yat-sen Memorial Hospital. The factors for which data were to be collected included the patients' physical characteristics, catheter-related factors, and catheter care-related factors. Logistic regression analysis, the chi-squared test, Fisher's exact test, and the t-test were used to analyze the data. RESULTS Of the 1,532 patients studied, 28 developed intraductal thrombi, and of the factors analyzed, malignancy, a catheterization history, a history of thrombophilia, surgery during the week before catheterization, the catheterization duration, and anticoagulant therapy were significant risk factors associated with catheter-related thrombosis (all p < 0.05). There were no significant associations between the catheter brand, the number of lumens, the insertion direction, or the factors associated with catheter care and catheter-related thrombosis (all p > 0.05). CONCLUSION Our study incorporated clear and systematic risk factors associated with catheter-related thrombosis. Malignancy, history of thrombophilia, history of catheterization, surgery during the week before catheterization, and catheterization duration were associated with increased risks of catheter-related thrombosis. Prophylactic anticoagulation was effective for preventing and treating catheter-related thrombosis.
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Affiliation(s)
- Xuezhen Zhou
- Department of Nursing, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Runnan Shen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yingying Qu
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chunling Mo
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- Venous Catheter Nursing Clinic, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qinchang Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guitao Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Zhenhong Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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14
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Couturaud F, Girard P, Laporte S, Sanchez O. [What duration of anticoagulant treatment for PE/proximal DVT?]. Rev Mal Respir 2019; 38 Suppl 1:e99-e112. [PMID: 31711819 DOI: 10.1016/j.rmr.2019.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- F Couturaud
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; EA3878-GETBO, CIC Inserm1412, département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne occidentale, 29200 Brest, France
| | - P Girard
- Institut du thorax-Curie-Montsouris, l'institut mutualiste Montsouris, 75014 Paris, France
| | - S Laporte
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; SAINBOIS U1059 équipe DVH, Unité de recherche clinique, Inserm, innovation, pharmacologie, CHU de Saint-Étienne, université Jean-Monnet, université de Lyon, hôpital du Nord, 42000 Saint-Étienne, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service de pneumologie et soins intensifs, université de Paris, AH-HP, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Innovations thérapeutiques en hémostase, Inserm UMRS 1140, 75006 Paris, France.
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15
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Li G, Zhang Y, Ma H, Zheng J. Arm port vs chest port: a systematic review and meta-analysis. Cancer Manag Res 2019; 11:6099-6112. [PMID: 31308748 PMCID: PMC6613605 DOI: 10.2147/cmar.s205988] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background Two prevailing, totally implantable venous access ports are routinely utilized in oncology: chest port or arm port. This systematic review with meta-analysis was conducted to compare safety and efficiency of the two techniques. Methods We performed evidence acquisition intensively from PubMed, Embase, and Cochrane Library. Available comparative studies that evaluated both techniques were identified. The outcomes of interest included total complication events, procedure-related infections, thrombosis, intra-operative complications, mechanical complications, conversion rate, early port removal, and operating time. Results Thirteen comparative studies including 3,896 patients (2,176 for chest ports, and 1,720 for arm ports) were identified. The present study showed that arm port was associated with higher procedure conversion rate (2.51% in chest port group and 8.32% in arm port group; odd ratios [OR] 0.27, 95% confidence interval [CI] 0.15-0.46; p<0.001), but lower incidence of intra-operative complications (1.38% in chest port group and 0.41% in arm port group; OR 2.38, 95% CI 1.07-5.29; p=0.03). There were no between-group differences with respect to total complication events, procedure-related infections, thrombosis, mechanical complications, early port removal, and operating time. Subgroup analysis of patients under 60 years revealed that no significant difference was detected in intra-operative events (1.19% in chest port group and 0.02% in arm port group, OR 2.59, 95% CI 0.74-9.08; p<0.14), indicating that age may be a risk factor for intra-operative events. Sensitivity analysis did not change conclusions of all endpoints of interest. Conclusion Arm port is associated with higher procedure conversion rate, but lower incidence of intra-operative complications, and age may be a risk factor for intra-operative events.
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Affiliation(s)
- Guanhua Li
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, People's Republic of China
| | - Yu Zhang
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, People's Republic of China
| | - Hongmin Ma
- Department of Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, People's Republic of China
| | - Junmeng Zheng
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, People's Republic of China
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16
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Li H, Jiang G. [Perioperative Venous Thromboembolism (VTE) Prophalaxis
in Thoracic Cancer Patients: Chinese Experts Consensus]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 21:739-752. [PMID: 30309425 PMCID: PMC6189026 DOI: 10.3779/j.issn.1009-3419.2018.10.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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17
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Duwadi S, Zhao Q, Budal BS. Peripherally inserted central catheters in critically ill patients - complications and its prevention: A review. Int J Nurs Sci 2019; 6:99-105. [PMID: 31406874 PMCID: PMC6608659 DOI: 10.1016/j.ijnss.2018.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 01/16/2023] Open
Abstract
Peripherally inserted central catheter (PICC) is extensively used in critical care settings, because it plays a vital role in providing safe central venous entry. However, PICC is associated with several complications, which should be detected to shorten the duration of patients' improvement, reduce health care cost, and lessen the incidence of various PICC-related complications. Therefore, this study aimed to outline current literature on PICC procedures, potential complications, and measures for prevention. Understanding evidence-based guidelines regarding insertion technique, early detection of complications, and care bundle of PICC is significant in complication prevention. Implementation of education, training, and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications. Thus, the strict care of indwelling PICC lines, the targeted and reasonable PICC-associated complication prevention, and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.
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Affiliation(s)
- Sona Duwadi
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Birendra Singh Budal
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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18
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Liang YJ, Tang LQ, Sun XS, Fan YY, Yan JJ, Du YY, Guo SS, Liu LT, Xie HJ, Liu SL, Tang QN, Li XY, Mai HQ, Chen QY. Symptomatic venous thromboembolism associated with peripherally inserted central catheters predicts a worse survival in nasopharyngeal carcinoma: results of a large cohort, propensity score-matched analysis. BMC Cancer 2018; 18:1297. [PMID: 30594171 PMCID: PMC6310996 DOI: 10.1186/s12885-018-5213-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing use, symptomatic venous thromboembolism (VTE) associated with peripherally inserted central catheter (PICC) is a common complication in nonmetastatic nasopharyngeal carcinoma (NPC) patients. METHODS A total of 3012 nonmetastatic NPC patients were enrolled in this retrospective study, and we applied Cox regression and log-rank tests to assess the association between PICC-VTE and survival using the propensity score method (PSM) to adjust for gender, age, radiotherapy technique, tumor stage, node stage, UICC clinical stage and pre-treatment EBV DNA. RESULTS 217 patients developed PICC-VTE, with an incidence of 7.20%. PSM identified 213 patients in the cohort with VTE and 852 in that without. Patients who developed PICC-VTE had a shorter 5-year PFS (77.5% vs 87.6%, p < 0.001), DMFS (85.0% vs 91.2%, p < 0.001), LRRFS (93.9% vs 97.7%, p < 0.001) and OS (85.4% vs 87.6%, p < 0.001). Subgroup analyses indicated that no significant survival difference was found between PICC-related superficial venous thrombosis and deep vein thrombosis, nor did different anticoagulant treatment methods. CONCLUSIONS PICC-VTE was associated with a worse survival outcome in nonmetastatic NPC patients. A prospective randomized clinical trial is required to verify the results.
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Affiliation(s)
- Yu-Jing Liang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Lin-Quan Tang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xue-Song Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yu-Ying Fan
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jin-Jie Yan
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yu-Yun Du
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Shan-Shan Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Li-Ting Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Hao-Jun Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Sai-Lan Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Qing-Nan Tang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xiao-Yun Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Hai-Qiang Mai
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Qiu-Yan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
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19
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Li H, Jiang G, Bölükbas S, Chen C, Chen H, Chen K, Chen J, Cui X, Fang W, Gao S, Gilbert S, Fu J, Fu X, Hida Y, Li S, Li X, Li Y, Li H, Li Y, Liu D, Liu L, He J, He J, Marulli G, Oizumi H, de Perrot M, Petersen RH, Shargall Y, Sihoe A, Tan Q, Wang Q, Xu S, Yang M, Yang Y, Yu Z, Zhang L, Zhang X, Zhao H, Zhi X. The Society for Translational Medicine: the assessment and prevention of venous thromboembolism after lung cancer surgery. J Thorac Dis 2018; 10:3039-3053. [PMID: 29997971 PMCID: PMC6006068 DOI: 10.21037/jtd.2018.05.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/20/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Servet Bölükbas
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Cancer Hospital, Fudan University, Shanghai 200032, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing University Cancer Center, Beijing 100142, China
| | - Jun Chen
- Department of Thoracic Surgery, Genernal Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Xiangli Cui
- Department of Pharmacology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University Medical School, Shanghai 200030, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jianhua Fu
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yasuhiro Hida
- Cardiovascular and Thoracic Surgery, Hokkaido University, Sapporo, Japan
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100005, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an 710000, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijing Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yongjun Li
- Department of Vascular Surgery, Beijing Hospital, Beijing 100730, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Giuseppe Marulli
- Department of Cardiologic, Thoracic and Vascular Sciences, Division of Thoracic Surgery, University of Padova, Padova, Italy
| | - Hiroyuki Oizumi
- Department of Surgery II (Cardiovascular, Thoracic and Pediatric Surgery), Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, 9N-961, University Health Network, Toronto, Canada
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University and Service of Thoracic Surgery, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Alan Sihoe
- Department of Surgery, The University of Hong Kong Division of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen 518054, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Mei Yang
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, San Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University Medical School, Shanghai 200030, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
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20
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Desruennes E, Gomas F. [Central venous access for cancer chemotherapy]. Presse Med 2018; 47:320-330. [PMID: 29567048 DOI: 10.1016/j.lpm.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 11/28/2022] Open
Abstract
The tip of a long term central venous access should be located at the junction of the superior vena cava with the right atrium in order to reduce the incidence of dysfunction and venous thromboses. Picc-lines have their place for treatments of less than 6 months with obvious advantages in terms of discretion and comfort. Long-term sequential chemotherapy is an indisputable indication of an implantable port, while long-term parenteral nutrition is an indication of a tunneled cuffed catheter. In case of mediastinal compression, the risk-benefit ratio favors femoral access. Catheter related venous thrombosis or infection do not necessarily require the withdrawal of the device. A device that is no longer used should be removed when the likelihood of recurrence of the disease is low or too far.
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Affiliation(s)
- Eric Desruennes
- Gustave Roussy Cancer Campus, département d'anesthésie, rue Édouard-Vaillant, 94800 Villejuif, France; CHRU, hôpital Jeanne-de-Flandre, clinique d'anesthésie pédiatrique, avenue Eugène-Avinée, 59000 Lille, France.
| | - Frédéric Gomas
- Gustave Roussy Cancer Campus, département d'anesthésie, rue Édouard-Vaillant, 94800 Villejuif, France
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21
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Kim JH, Park JH, Cho J, Kong TY, Lee JH, Beom JH, Joo YS, Ko DR, Chung HS. Simulated internal jugular vein cannulation using a needle-guiding device. Am J Emerg Med 2018; 36:1931-1936. [PMID: 29467087 DOI: 10.1016/j.ajem.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Using a two-dimensional ultrasound-guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound-guided internal jugular vein cannulation of a simulated internal jugular vein. METHODS Eighty-eight participants were randomized to perform needle insertion for internal jugular vein cannulation of a phantom using the ultrasound-guided approach with (case group) or without (control group) this new device. The primary outcome was the success rate of the first attempt. The secondary outcome was the frequency of mechanical complications such as arterial puncture and posterior wall puncture, procedure time, and level of difficulty. RESULTS Among 44 participants using the device, 33 (75.0%) achieved successful cannulation on the first attempt. However, only 12 (27.3%) of the 44 participants not using the device recorded success during the first attempt (risk difference, 0.477; 95% confidence interval [CI] 0.294-0.661; P<0.001). The number of attempts was significantly lower (risk difference, -3.955; 95% CI, -5.014 to -3.712; P<0.001) when participants performed cannulation with the device (1.63±1.71) than without the device (5.59±5.78). Our study also showed that participants were comfortable when performing the ultrasound-guided approach with the new device (risk difference, -1.955; 95% CI, -2.016 to -1.493; P<0.0001). CONCLUSIONS The new disposable device was effective for successful first attempts at needle insertion during ultrasound-guided internal jugular vein cannulation. Future clinical trials are needed to assess the effectiveness of this device.
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Affiliation(s)
- Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul 03722, Republic of Korea
| | - Junho Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Tae Young Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jin Ho Beom
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Young Seon Joo
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Dong Ryul Ko
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
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22
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Benzidia I, Connault J, Solanilla A, Michon-Pasturel U, Jamelot M, Nguessan MK, Hij A, Le Maignan C, Farge D, Frère C. [New international guidelines for curative treatment and prophylaxis for venous thromboembolism (VTE) in cancer patients and the dedicated smartphone application]. JOURNAL DE MEDECINE VASCULAIRE 2017; 42:375-383. [PMID: 29203044 DOI: 10.1016/j.jdmv.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/17/2017] [Indexed: 06/07/2023]
Abstract
Venous thromboembolism (VTE) is a frequent and serious complication in cancer patients, and the second leading cause of death in this setting. Cancer patients are also more likely to present recurrent VTE and major bleeding while taking anticoagulants. Management of VTE in these patients is always challenging and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME) released international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis, based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. An update of these ITAC-CME consensus guidelines, including the use of direct oral anticoagulants, was recently published. In this review, we summarize these updated guidelines. Better adherence to the international guidelines, involving an adequate educational and active implementation strategies, will substantially decrease the burden of VTE and allow to increase survival in cancer patients.
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Affiliation(s)
- I Benzidia
- UF04 maladies auto-immunes et pathologie vasculaire, service de médecine interne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J Connault
- Service de médecine interne, CHU de Nantes, 44000 Nantes, France
| | - A Solanilla
- Service de médecine vasculaire, hôpital Saint-André, 33076 Bordeaux, France
| | - U Michon-Pasturel
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - M Jamelot
- Service d'oncologie médicale, centre Henri-Becquerel, rue d'Amiens, 76000 Rouen, France
| | - M K Nguessan
- Département de médecine interne et gériatrie, centre hospitalier universitaire de Treichville, université Félix Houphouet Boigny d'Abidjan, Abidjan, Côte d'Ivoire
| | - A Hij
- UF04 maladies auto-immunes et pathologie vasculaire, service de médecine interne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Le Maignan
- Service d'oncologie médicale, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Farge
- UF04 maladies auto-immunes et pathologie vasculaire, service de médecine interne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Frère
- Service d'hématologie biologique, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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23
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Marchena P, Nieto J, Guil M, García-Bragado F, Rabuñal R, Boccalon H, Trujillo-Santos J, Monreal M. Long-term therapy with low-molecular-weight heparin in cancer patients with venous thromboembolism. Thromb Haemost 2017; 107:37-43. [DOI: 10.1160/th11-06-0423] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/14/2011] [Indexed: 12/13/2022]
Abstract
SummaryLong-term therapy with low-molecular-weight heparin (LMWH) is the treatment of choice for cancer patients with venous thromboembolism (VTE). However, the ideal doses of LMWH have not been thoroughly studied. We used the RIETE Registry data to assess the influence of the daily LMWH dosage on outcome during the first three months after VTE. We used propensity score-matching to compare patients who received <150 vs. those receiving ≥150 UI/kg/day LMWH. Up to July 2010, 3,222 cancer patients with VTE received long-term therapy with fixed doses of LMWH. Of these, 1,472 (46%) received <150 IU/kg/day (mean, 112 ± 28), and 1,750 received ≥150 IU/kg/day (mean, 184 ± 32). Results of the propensity score matching involved 1269 matched pairs. During follow-up, the incidence of pulmonary embolism (PE) recurrences was similar (1.2% vs. 1.9%), but patients receiving <150 IU/kg/day LMWH had a lower incidence of fatal PE than those treated with ≥150 IU/kg/day (0.2% vs. 1.0%; p=0.004). Multivariate analysis confirmed that patients receiving <150 IU/kg/day LMWH had a lower risk for fatal PE (odds ratio [OR]: 0.2; 95% confidence interval [CI]: 0.06–0.8) and for major bleeding (OR: 0.6; 95% CI: 0.3–1.0) than those treated with ≥150 IU/kg/day. In real life, one in every two cancer patients with VTE received lower doses of LMWH than those used in randomised trials, with large variations from patient to patient. Unexpectedly, patients treated with <150 IU/kg/day LMWH had fewer fatal PE cases and fewer major bleeding events than those receiving ≥150 IU/kg/day LMWH. This finding, however, should be validated in prospective clinical trials.
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24
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Frere C, Farge D. Clinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients. Thromb Haemost 2017; 116:618-25. [DOI: 10.1160/th16-04-0302] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/12/2016] [Indexed: 11/05/2022]
Abstract
SummarySymptomatic venous thromboembolism (VTE) occurs 4-7 times more frequently in cancer patients as compared to non-cancer patients. A significant number of risk factors, which can be subcategorised as patient-, cancer- or treatment-related, have been shown to influence the risk of VTE during malignancy and further incorporated in risk-assessment models. Safe and efficient thromboprophylaxis regimens allow substantial decreased in VTE rates, since VTE is most often a largely preventable disease, but thromboprophylaxis remains underused in cancer compared to non-cancer patients. If thromboprophylaxis is warranted in cancer patients undergoing surgery or hospitalised for acute medical illness or with a lower mobility in the absence of contraindications to anticoagulants, its benefit remains controversial in outpatients and may be limited to locally advanced or metastatic pancreatic or lung cancer treated with chemotherapy. The International Initiative on Thrombosis and Cancer-CME free mobile app (ios and android), based on the International Clinical Practice Guidelines (CPG), facilitates their implementation and dissemination of knowledge worldwide so as to improve VTE treatment and prophylaxis in cancer patients.
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25
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Debourdeau P, Espié M, Chevret S, Gligorov J, Elias A, Dupré PF, Desseaux K, Kalidi I, Villiers S, Giachetti S, Frere C, Farge D. Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study. Cancer Med 2017; 6:2732-2744. [PMID: 28980454 PMCID: PMC5673948 DOI: 10.1002/cam4.1201] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/16/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022] Open
Abstract
Previous epidemiologic studies investigating central venous catheter (CVC)‐related venous thromboembolism (CRT) were conducted in heterogenous cancer populations and data in breast cancer (BC) remain limited. To investigate the Doppler ultrasound (DUS)‐CRT incidence, risk factors and outcomes in BC, we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double‐blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow‐up. Symptomatic DUS‐CRT were treated by anticoagulants. D‐Dimers, thrombin generation, and platelet‐derived microparticles were measured before and 2 days after CVC placement. In DUS‐CRT patients, a nested case–control study analyzed the role of thrombophilia. Among 524 patients, the DUS‐CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient‐months). Ten/14 symptomatic DUS‐CRT were detected on double‐blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS‐CRT. Age >50 years (OR, 1.80; 95% CI, 1.01–3.22), BMI >30 kg/m² (OR, 2.64; 95% CI, 1.46–4.76) and comorbidities (OR, 2.05; 95% CI, 1.18–3.56) were associated with DUS‐CRT. No biomarkers was found to predict DUS‐CRT. In multivariate analysis, BMI >30 kg/m² (OR, 2.66; 95%CI, 1.46–4.84) and lobular carcinoma histology (OR, 2.56; 95%CI, 1.32–4.96) remained the only significant DUS‐CRT risk factors. Thrombophilia did not account for DUS‐CRT. Only clinical parameters identified high risk DUS‐CRT patients who may be considered for thromboprophylaxis.
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Affiliation(s)
| | - Marc Espié
- Breast Cancer Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Paris Diderot, Paris, France
| | - Sylvie Chevret
- University Paris Diderot, Paris, France.,Biostatistic Department and Medical Informatics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joseph Gligorov
- Medical Oncology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Francilian Breast Intergroup, APREC, IUC-UPMC Sorbonne University, Paris, France
| | - Antoine Elias
- Department of Vascular Medicine, Sainte Musse Hospital, Toulon, France
| | | | - Kristell Desseaux
- University Paris Diderot, Paris, France.,Biostatistic Department and Medical Informatics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Issa Kalidi
- Department of Biology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stephane Villiers
- Department of Anesthesiology and Reanimation, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvie Giachetti
- Breast Cancer Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Paris Diderot, Paris, France
| | - Corinne Frere
- Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, UMR_S 1166, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France
| | - Dominique Farge
- University Paris Diderot, Paris, France.,Internal Medicine Unit: Autoimmune and Vascular Diseases, UF 04, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
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26
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Mahé I, Scotté F, Rey JB, Elalamy I, Lamblin A, Mayeur D, Pernod G. Prevention and treatment of cancer-associated thrombosis in France: A national survey among vascular disease and supportive care specialists. JOURNAL DE MEDECINE VASCULAIRE 2017; 42:255-262. [PMID: 28964384 DOI: 10.1016/j.jdmv.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND/AIM Long-term use of low-molecular-weight heparins (LMWH) for the treatment of cancer-associated thrombosis (CAT) has been well-established. Conversely, the use of thromboprophylaxis in patients with cancer remains controversial in the absence of homogeneous guidelines. Our aim was to assess the awareness of treatment guidelines and the management of patients with CAT in daily clinical practice. METHODS A national survey based on an open questionnaire developed by a panel of health professionals including specialists in vascular medicine, oncology, supportive care and pharmacy, was proposed on line to 2104 specialists experts in the management of CAT with the objective to collect at least 400 answers. Clinical practice assessment included the treatment of lung adenocarcinoma-associated thrombosis, the use of thromboprophylaxis and factors influencing the management of patients with CAT. RESULTS A total of 401 questionnaires were completed by specialists of vascular medicine (68%), oncology (12%) and other (20%). LMWH was the preferred option for over 90% of the participants for the treatment of recent overt proximal pulmonary embolism or deep-vein thrombosis. Up to 70% of the participants considered treatment duration for 6 months and more than 12 months in case of active malignancy. Patient management in the setting of incidental VTE and thromboprophylaxis were heterogeneous in the absence of clear guidance while VTE risk scores would be used by only 14% of participants. CONCLUSION Patients with CAT are properly managed based on clear and consistent guidelines. Patient care is heterogeneous regarding treatment duration beyond 6 months and thromboprophylaxis while VTE risk scores are misused. Identification of referent health care professionals for CAT management and more clear guidelines are required.
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Affiliation(s)
- I Mahé
- EA 7334, Internal Medicine, Louis-Mourier Hospital, Paris 7 University, AP-HP, 92700 Colombes, France.
| | - F Scotté
- Medical Oncology and Supportive Care Unit, Hôpital Européen Georges-Pompidou, 75908 Paris cedex 15, France
| | - J-B Rey
- Pharmacie, Institut de Cancérologie Jean-Godinot, 51100 Reims, France
| | - I Elalamy
- Inserm U938, Biological Hematology, Tenon University Hospital, 75970 Paris cedex 20, France
| | - A Lamblin
- LEO Pharma, 78960 Voisins-le-Bretonneux, France
| | - D Mayeur
- Medical Oncology and Supportive Care Unit, Hôpital Mignot, 177, rue Versailles, 78150 Le Chesnay, France
| | - G Pernod
- Vascular Medicine, CHU de Grenoble site Nord, 38700 La Tronche, France
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27
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Macdougall L, Hanley J, Mountford C, Thompson NP. UK practice in the prevention of central venous catheter-associated thrombosis in adults on home parenteral nutrition. Frontline Gastroenterol 2017; 8:163-166. [PMID: 28839904 PMCID: PMC5558273 DOI: 10.1136/flgastro-2015-100665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Maintaining central access is imperative for the delivery of home parenteral nutrition (HPN) in those with intestinal failure. Methods to reduce central venous catheter infection are well recognised; however, the prevention of line thrombosis is less well studied. METHODS This paper reviews the current evidence and reports a survey of current practice within the UK. Using an electronic survey, respondents were asked to detail their use of anticoagulation in different patient groups and the type of anticoagulation used. RESULTS 41 replies were received from 31 centres. Only one responder used low-dose warfarin routinely; 80% however anticoagulated those with a previous line thrombosis and 65% anticoagulated those that had any deep vein thrombosis or pulmonary embolus. The most commonly used anticoagulant was dose-adjusted warfarin aiming for an international normalised ratio of 2-3. CONCLUSIONS The evidence from the current literature in both HPN and the wider field is that there is no clear evidence that anticoagulation is either beneficial or harmful in the prevention of line thrombosis. This survey suggested that practice is varied across the UK likely reflecting the lack of evidence within the current literature.
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Affiliation(s)
- L Macdougall
- Deptartment of Gastroenterology, Newcastle upon Tyne Hospitals FT, Newcastle-upon-Tyne, UK
| | - J Hanley
- Department of HaematologyNewcastle upon Tyne Hospitals FT, Newcastle-upon-Tyne, UK
| | - C Mountford
- Deptartment of Gastroenterology, Newcastle upon Tyne Hospitals FT, Newcastle-upon-Tyne, UK
| | - N P Thompson
- Deptartment of Gastroenterology, Newcastle upon Tyne Hospitals FT, Newcastle-upon-Tyne, UK
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28
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Shapiro DR, Dudek CJ, Ho JG. A Toddler With Central Venous Catheter Develops Tachycardia. Clin Pediatr (Phila) 2017; 56:496-499. [PMID: 27466077 DOI: 10.1177/0009922816661331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Douglas Ryan Shapiro
- 1 Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | - Christopher J Dudek
- 1 Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | - Jason G Ho
- 2 Pediatric Cardiology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville
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29
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Wu S, Huang J, Jiang Z, Huang Z, Ouyang H, Deng L, Lin W, Guo J, Zeng W. Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies. BMC Cancer 2016; 16:747. [PMID: 27658952 PMCID: PMC5034477 DOI: 10.1186/s12885-016-2791-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background A totally implantable venous access device (TIVAD) provides reliable, long-term vascular access and improves patients’ quality of life. The wide use of TIVADs is associated with important complications. A meta-analysis was undertaken to compare the internal jugular vein (IJV) with the subclavian vein (SCV) as the percutaneous access site for TIVAD to determine whether IJV has any advantages. Methods All randomized controlled trials (RCTs) and cohort studies assessing the two access sites, IJV and SCV, were retrieved from PubMed, Web of Science, Embase, and OVID EMB Reviews from their inception to December 2015. Random-effects models were used in all analyses. The endpoints evaluated included TIVAD-related infections, catheter-related thrombotic complications, and major mechanical complications. Results Twelve studies including 3905 patients published between 2008 and 2015, were included. Our meta-analysis showed that incidences of TIVAD-related infections (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.48–1.04, P = 0.081) and catheter-related thrombotic complications (OR 0.76, 95 % CI 0.38–1.51, P = 0.433) were not significantly different between the two groups. However, compared with SCV, IJV was associated with reduced risks of total major mechanical complications (OR 0.38, 95 % CI 0.24–0.61, P < 0.001). More specifically, catheter dislocation (OR 0.43, 95 % CI 0.22–0.84, P = 0.013) and malfunction (OR 0.42, 95 % CI 0.28–0.62, P < 0.001) were more prevalent in the SCV than in the IJV group; however, the risk of catheter fracture (OR 0.47, 95 % CI 0.21–1.05, P = 0.065) were not significantly different between the two groups. Sensitivity analyses using fixed-effects models showed a decreased risk of catheter fracture in the IJV group. Conclusion The IJV seems to be a safer alternative to the SCV with lower risks of total major mechanical complications, catheter dislocation, and malfunction. However, a large-scale and well-designed RCT comparing the complications of each access site is warranted before the IJV site can be unequivocally recommended as a first choice for percutaneous implantation of a TIVAD.
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Affiliation(s)
- Shaoyong Wu
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Jingxiu Huang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Zongming Jiang
- Department of Anesthesiology, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
| | - Zhimei Huang
- Department of Minimal Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Handong Ouyang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Li Deng
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenqian Lin
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Jin Guo
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Weian Zeng
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, People's Republic of China.
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Woller SC, Stevens SM, Evans RS. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) initiative: A summary and review of peripherally inserted central catheter and venous catheter appropriate use. J Hosp Med 2016; 11:306-10. [PMID: 26662622 DOI: 10.1002/jhm.2525] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/05/2015] [Accepted: 11/15/2015] [Indexed: 11/07/2022]
Abstract
Peripherally inserted central catheters (PICCs) are being selected for venous access more frequently today than ever before. Often the choice of a PICC, when compared with other vascular access devices (VADs), is attractive because of perceived safety, availability, and ease of insertion. However, complications associated with PICCs exist, and there is a paucity of evidence to guide clinician choice for PICC selection and valid use. An international panel with expertise in the arena of venous access and populations associated with these devices was convened to clarify approaches for the optimal use of PICCs and VADs. Here we present for the busy hospital-based practitioner the methodology, key outcomes, and recommendations of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) panelists for the appropriate use of VADs.
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Affiliation(s)
- Scott C Woller
- Department of Medicine, Intermountain Medical Center, Murray, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Scott M Stevens
- Department of Medicine, Intermountain Medical Center, Murray, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - R Scott Evans
- Medical Informatics, Intermountain Healthcare, Biomedical Informatics, University of Utah, Salt Lake City, Utah
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Lee AY, Peterson EA, Wu C. Clinical practice guidelines on cancer-associated thrombosis: a review on scope and methodology. Thromb Res 2016; 140 Suppl 1:S119-27. [DOI: 10.1016/s0049-3848(16)30110-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mahé I, Puget H, Buzzi JC, Lamuraglia M, Chidiac J, Strukov A, Helfer H, Perozziello A. Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study. Support Care Cancer 2016; 24:3369-77. [DOI: 10.1007/s00520-016-3164-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
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Mori Y, Nagayama S, Kawamura JI, Hasegawa S, Tanaka E, Okabe H, Takeuchi M, Sonobe M, Matsumoto S, Kanai M, Muto M, Chiba T, Sakai Y. A retrospective analysis on the utility and complications of upper arm ports in 433 cases at a single institute. Int J Clin Oncol 2015; 21:474-82. [PMID: 26507141 PMCID: PMC4901144 DOI: 10.1007/s10147-015-0917-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
Background We have employed upper arm central venous ports (UACVPs) since 2006 for long-term intravenous chemotherapy (CTx) or fluid supplementation. We evaluated the long-term availability of CVPs implanted in the upper arm to determine whether UACVPs could be one of the treatment options besides chest CVPs in terms of CVP-related complications. Methods We reviewed the medical records of all patients who underwent subcutaneous implantation of UACVPs at Kyoto University Hospital from 1 April, 2006 to 30 June, 2009. We assessed the indwelling duration of the UACVPs and the incidences of early and late UACVP-related complications. Results A total of 433 patients underwent subcutaneous implantation of UACVPs during this time period. The cumulative follow-up period was 251,538 catheter days, and the median duration of UACVP indwelling was 439.0 days (1–2, 24). There was no UACVP-related mortality throughout the study period. A total of 83 UACVP-related complications occurred (19.2 %), including 43 cases of infection (9.9 %, 0.17/1000 catheter days), ten cases of catheter-related thrombosis (2.3 %, 0.040/1000 catheter days), ten cases of occlusion (2.3 %, 0.040/1000 catheter days), nine cases of catheter dislocation (2.0 %, 0.036/1000 catheter days), five cases of port leakage (1.2 %, 0.019/1000 catheter days), four cases of skin dehiscence (0.9 %, 0.015/1000 catheter days) and two cases of port chamber twist (0.5 %, 0.008/1000 catheter days). The removal-free one-year port availability was estimated at 87.8 %. Conclusions UACVPs were of long-term utility, with complication rates comparable to those of chest CVPs previously reported.
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Affiliation(s)
- Yukiko Mori
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoshi Nagayama
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Jun-Ichiro Kawamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Suguru Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Eiji Tanaka
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Okabe
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Megumi Takeuchi
- Department of Breast Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto University, Yoshidahonmachi, Sakyo Ward, Kyoto, Kyoto, 606-8501, Japan
| | - Shigemi Matsumoto
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masashi Kanai
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Muto
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsutomu Chiba
- Department of Clinical Oncology, Kyoto University Hospital Cancer Center, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Gastroenterology and Hepatology, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Large Cohort Study of Central Venous Catheter Thrombosis during Intravenous Antibiotic Therapy. Antimicrob Agents Chemother 2015; 60:36-43. [PMID: 26459894 DOI: 10.1128/aac.00700-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022] Open
Abstract
The frequency and risk factors for central venous catheter-related thrombosis (CRT) during prolonged intravenous (i.v.) antibiotic therapy have rarely been reported. The primary objective of this study was to evaluate the frequency, incidence, and risk factors for CRT among patients being treated with prolonged i.v. antibiotic therapy. The secondary objective was to describe the clinical manifestations, diagnostic evaluation, and clinical management. This cohort study was conducted between August 2004 and May 2010 in a French referral center for osteoarticular infections. All patients treated for bone and joint infections with i.v. antimicrobial therapy through a central venous catheter (CVC) for ≥2 weeks were included. Risk factors were identified using nonparametric tests and logistic regression. A case-control study investigated the role of vancomycin and catheter malposition. A total of 892 patients matched the inclusion criteria. CRT developed in 16 infections occurring in 16 patients (incidence, 0.39/1,000 catheter days). The median time to a CRT was 29 days (range, 12 to 48 days). Local clinical signs, fever, and secondary complications of CRT were present in 15, 8, and 4 patients, respectively. The median C-reactive protein level was 95 mg/liter. The treatment combined catheter removal and a median of 3 months (1.5 to 6 months) of anticoagulation therapy. The outcome was good in all patients, with no recurrence of CRT. Three risk factors were identified by multivariate analysis: male sex (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.1 to 26.6), catheter malposition (OR, 5.3; 95% CI, 1.6 to 17.9), and use of vancomycin (OR, 22.9; 95% CI, 2.8 to 188). Catheter-related thrombosis is a rare but severe complication in patients treated with prolonged antimicrobial therapy. Vancomycin use was the most important risk factor identified.
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Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 163:S1-40. [PMID: 26369828 DOI: 10.7326/m15-0744] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.
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Affiliation(s)
- Vineet Chopra
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A. Flanders
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Saint
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott C. Woller
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomi P. O'Grady
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nasia Safdar
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott O. Trerotola
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajiv Saran
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Moureau
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Wiseman
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mauro Pittiruti
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie A. Akl
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Y. Lee
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Courey
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi Swaminathan
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack LeDonne
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol Becker
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L. Krein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J. Bernstein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
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Ge BH, Copelan A, Scola D, Watts MM. Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management. Semin Intervent Radiol 2015; 32:108-22. [PMID: 26038619 DOI: 10.1055/s-0035-1549375] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist.
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Affiliation(s)
- Benjamin H Ge
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Copelan
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Dominic Scola
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Micah M Watts
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Proper Tip Position of Central Venous Catheter in Pediatric Patients. J Vasc Access 2015; 16:399-402. [DOI: 10.5301/jva.5000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/20/2022] Open
Abstract
Background In this study, we analyzed the thin-section pulmonary computed tomographic (CT) angiogram scans of pediatric patients to determine the normative length of superior vena cava (SVC) and the distance between carina and cephalad of SVC or cavocatrial junction. Methods Consecutive child patients, under 13 years of age in whom the central catheters were inserted under ultrasound guidance from December 2004 to April 2005 were evaluated retrospectively. Results In the 14 cases, the mean age was 7.2 ± 4.21 years. The mean length and diameter of the SVC in the pediatric patients were 45.6 ± 23.03 and 13.7 ± 3.62 mm, respectively. The distance from the carina to the cavoatrial junction was 22.0 ± 9.98 mm. The mean distance from the superior margin of the SVC to the carina was 23.7 ± 16.70 mm. The mean distance from the carina to the catheter tip was 38.9 ± 18.60 mm. In no case was the cavoatrial junction cephalad with respect to the carina. Carina to cavoatrial junction junction was significantly associated with age, height, and weight, respecitively (r = 0.750; p = 0.005, r = 0.763; p = 0.004; r = 0.777; p = 0.003). Conclusions The carina is a good landmark for the upper border of the cavoatrial junction. Length of carina to cavoaterial juction was associated with age. The rates of malposition and re-intervention and the patient's exposure to radiation can be reduced by using ultrasound during the catheter insertion.
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Chew TW, Gau CS, Wen YW, Shen LJ, Mullins CD, Hsiao FY. Epidemiology, clinical profile and treatment patterns of venous thromboembolism in cancer patients in Taiwan: a population-based study. BMC Cancer 2015; 15:298. [PMID: 25925555 PMCID: PMC4414299 DOI: 10.1186/s12885-015-1200-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 03/17/2015] [Indexed: 01/02/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a clinically significant complication that is well documented among Caucasian cancer patients. However, evidence regarding VTE incidence and treatment among Asian cancer patients is very limited. The objective of this study is to investigate the incidence, risk factors and management of VTE among Taiwanese cancer patients. Methods Using Taiwan’s National Health Insurance Research Database, we identified 43,855 newly diagnosed cancer patients between 2001 and 2008. Two alternative algorithms for identifying VTE event were explored to better quantify a range of incidence rates of VTE in our cancer patients. Multivariable logistic regression models were used to explore VTE risk factors. Results The incidence rates of VTE were 9.9 (algorithm 1) and 3.4 (algorithm 2) per 1,000 person-years, respectively. The incidence rates were higher in certain cancers, particularly liver, pancreas, and lung. Significant risk factors for VTE were site of cancer, prior history of VTE, chemotherapy and major surgeries. Long-term anticoagulant therapy was initiated in 64.1% patients with VTE and 72.2% of them received warfarin alone. Approximately two-thirds of patients with VTE received ≤ 3 months of anticoagulant therapy. Conclusion Incidence of cancer-related VTE is lower among Taiwanese compared to Caucasian populations. Nevertheless, risk factors for cancer-related VTE found in our study were consistent with current literature.
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Affiliation(s)
- Tan-Wei Chew
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, R220, 33, Linsen S. Road, Taipei, 10050, Taiwan.
| | - Churn-Shiouh Gau
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, R220, 33, Linsen S. Road, Taipei, 10050, Taiwan. .,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Center for Drug Evaluation, Taipei, Taiwan.
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan.
| | - Li-Jiuan Shen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, R220, 33, Linsen S. Road, Taipei, 10050, Taiwan. .,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
| | | | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, R220, 33, Linsen S. Road, Taipei, 10050, Taiwan. .,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 2015; 1:CD006962. [PMID: 25575244 PMCID: PMC6517109 DOI: 10.1002/14651858.cd006962.pub2] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Central venous catheters (CVCs) can help with diagnosis and treatment of the critically ill. The catheter may be placed in a large vein in the neck (internal jugular vein), upper chest (subclavian vein) or groin (femoral vein). Whilst this is beneficial overall, inserting the catheter risks arterial puncture and other complications and should be performed with as few attempts as possible. Traditionally, anatomical 'landmarks' on the body surface were used to find the correct place in which to insert catheters, but ultrasound imaging is now available. A Doppler mode is sometimes used to supplement plain 'two-dimensional' ultrasound. OBJECTIVES The primary objective of this review was to evaluate the effectiveness and safety of two-dimensional (imaging ultrasound (US) or ultrasound Doppler (USD)) guided puncture techniques for insertion of central venous catheters via the internal jugular vein in adults and children. We assessed whether there was a difference in complication rates between traditional landmark-guided and any ultrasound-guided central vein puncture.Our secondary objectives were to assess whether the effect differs between US and USD; whether the effect differs between ultrasound used throughout the puncture ('direct') and ultrasound used only to identify and mark the vein before the start of the puncture procedure (indirect'); and whether the effect differs between different groups of patients or between different levels of experience among those inserting the catheters. SEARCH METHODS We searched the Central Register of Controlled Trials (CENTRAL) (2013, Issue 1), MEDLINE (1966 to 15 January 2013), EMBASE (1966 to 15 January 2013), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 15 January 2013 ), reference lists of articles, 'grey literature' and dissertations. An additional handsearch focused on intensive care and anaesthesia journals and abstracts and proceedings of scientific meetings. We attempted to identify unpublished or ongoing studies by contacting companies and experts in the field, and we searched trial registers. We reran the search in August 2014. We will deal with identified studies of interest when we update the review. SELECTION CRITERIA We included randomized and quasi-randomized controlled trials comparing two-dimensional ultrasound or Doppler ultrasound with an anatomical 'landmark' technique during insertion of internal jugular venous catheters in both adults and children. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data on methodological quality, participants, interventions and outcomes of interest using a standardized form. A priori, we aimed to perform subgroup analyses, when possible, for adults and children, and for experienced operators and inexperienced operators. MAIN RESULTS Of 735 identified citations, 35 studies enrolling 5108 participants fulfilled the inclusion criteria. The quality of evidence was very low for most of the outcomes and was moderate at best for four of the outcomes. Most trials had an unclear risk of bias across the six domains, and heterogeneity among the studies was significant.Use of two-dimensional ultrasound reduced the rate of total complications overall by 71% (14 trials, 2406 participants, risk ratio (RR) 0.29, 95% confidence interval (CI) 0.17 to 0.52; P value < 0.0001, I² = 57%), and the number of participants with an inadvertent arterial puncture by 72% (22 trials, 4388 participants, RR 0.28, 95% CI 0.18 to 0.44; P value < 0.00001, I² = 35%). Overall success rates were modestly increased in all groups combined at 12% (23 trials, 4340 participants, RR 1.12, 95% CI 1.08 to 1.17; P value < 0.00001, I² = 85%), and similar benefit was noted across all subgroups. The number of attempts needed for successful cannulation was decreased overall (16 trials, 3302 participants, mean difference (MD) -1.19 attempts, 95% CI -1.45 to -0.92; P value < 0.00001, I² = 96%) and in all subgroups. Use of two-dimensional ultrasound increased the chance of success at the first attempt by 57% (18 trials, 2681 participants, RR 1.57, 95% CI 1.36 to 1.82; P value < 0.00001, I² = 82%) and reduced the chance of haematoma formation (overall reduction 73%, 13 trials, 3233 participants, RR 0.27, 95% CI 0.13 to 0.55; P value 0.0004, I² = 54%). Use of two-dimensional ultrasound decreased the time to successful cannulation by 30.52 seconds (MD -30.52 seconds, 95% CI -55.21 to -5.82; P value 0.02, I² = 97%). Additional data are available to support use of ultrasound during, not simply before, line insertion.Use of Doppler ultrasound increased the chance of success at the first attempt by 58% (four trials, 199 participants, RR 1.58, 95% CI 1.02 to 2.43; P value 0.04, I² = 57%). No evidence showed a difference for the total numbers of perioperative and postoperative complications/adverse events (three trials, 93 participants, RR 0.52, 95% CI 0.16 to 1.71; P value 0.28), the overall success rate (seven trials, 289 participants, RR 1.09, 95% CI 0.95 to 1.25; P value 0.20), the total number of attempts until success (two trials, 69 participants, MD -0.63, 95% CI -1.92 to 0.66; P value 0.34), the overall number of participants with an arterial puncture (six trials, 213 participants, RR 0.61, 95% CI 0.21 to 1.73; P value 0.35) and time to successful cannulation (five trials, 214 participants, each using a different definition for this outcome; MD 62.04 seconds, 95% CI -13.47 to 137.55; P value 0.11) when Doppler ultrasound was used. It was not possible to perform analyses for the other outcomes because they were reported in only one trial. AUTHORS' CONCLUSIONS Based on available data, we conclude that two-dimensional ultrasound offers gains in safety and quality when compared with an anatomical landmark technique. Because of missing data, we did not compare effects with experienced versus inexperienced operators for all outcomes (arterial puncture, haematoma formation, other complications, success with attempt number one), and so the relative utility of ultrasound in these groups remains unclear and no data are available on use of this technique in patients at high risk of complications. The results for Doppler ultrasound techniques versus anatomical landmark techniques are also uncertain.
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Affiliation(s)
- Patrick Brass
- HELIOS Klinikum KrefeldDepartment of Anaesthesiology, Intensive Care Medicine, and Pain TherapyLutherplatz 40KrefeldGermany47805
- Witten/Herdecke UniversityIFOM ‐ The Institute for Research in Operative Medicine, Faculty of Health, Department of MedicineOstmerheimer Str. 200CologneGermany51109
| | - Martin Hellmich
- University of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneNRWGermany50937
| | - Laurentius Kolodziej
- Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Klinik für Intensivmedizin und RespiratorentwöhnungRuhrlandklinikTüschener Weg 40EssenGermany
| | - Guido Schick
- Medizinisches Zentrum StädteRegion AachenKlinik für Anästhesie, Intensivmedizin und NotfallmedizinMauerfeldchen 25WürselenGermany
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev 2015; 1:CD011447. [PMID: 25575245 PMCID: PMC6516998 DOI: 10.1002/14651858.cd011447] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Central venous catheters can help with diagnosis and treatment of the critically ill. The catheter may be placed in a large vein in the neck (internal jugular vein), upper chest (subclavian vein) or groin (femoral vein). Whilst this is beneficial overall, inserting the catheter risks arterial puncture and other complications and should be performed in as few attempts as possible.In the past, anatomical 'landmarks' on the body surface were used to find the correct place to insert these catheters, but ultrasound imaging is now available. A Doppler mode is sometimes used to supplement plain 'two-dimensional' ultrasound. OBJECTIVES The primary objective of this review was to evaluate the effectiveness and safety of two-dimensional ultrasound (US)- or Doppler ultrasound (USD)-guided puncture techniques for subclavian vein, axillary vein and femoral vein puncture during central venous catheter insertion in adults and children. We assessed whether there was a difference in complication rates between traditional landmark-guided and any ultrasound-guided central vein puncture.When possible, we also assessed the following secondary objectives: whether a possible difference could be verified with use of the US technique versus the USD technique; whether there was a difference between using ultrasound throughout the puncture ('direct') and using it only to identify and mark the vein before starting the puncture procedure ('indirect'); and whether these possible differences might be evident in different groups of patients or with different levels of experience among those inserting the catheters. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 1), MEDLINE (1966 to 15 January 2013), EMBASE (1966 to 15 January 2013), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 15 January 2013), reference lists of articles, 'grey literature' and dissertations. An additional handsearch focused on intensive care and anaesthesia journals and abstracts and proceedings of scientific meetings. We attempted to identify unpublished or ongoing studies by contacting companies and experts in the field, and we searched trial registers. We reran the search in August 2014. We will deal with any studies of interest when we update the review. SELECTION CRITERIA Randomized and quasi-randomized controlled trials comparing two-dimensional ultrasound or Doppler ultrasound versus an anatomical 'landmark' technique during insertion of subclavian or femoral venous catheters in both adults and children. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data on methodological quality, participants, interventions and outcomes of interest using a standardized form. We performed a priori subgroup analyses. MAIN RESULTS Altogether 13 studies enrolling 2341 participants (and involving 2360 procedures) fulfilled the inclusion criteria. The quality of evidence was very low (subclavian vein N = 3) or low (subclavian vein N = 4, femoral vein N = 2) for most outcomes, moderate for one outcome (femoral vein) and high at best for two outcomes (subclavian vein N = 1, femoral vein N = 1). Most of the trials had unclear risk of bias across the six domains, and heterogeneity among the studies was significant.For the subclavian vein (nine studies, 2030 participants, 2049 procedures), two-dimensional ultrasound reduced the risk of inadvertent arterial puncture (three trials, 498 participants, risk ratio (RR) 0.21, 95% confidence interval (CI) 0.06 to 0.82; P value 0.02, I² = 0%) and haematoma formation (three trials, 498 participants, RR 0.26, 95% CI 0.09 to 0.76; P value 0.01, I² = 0%). No evidence was found of a difference in total or other complications (together, US, USD), overall (together, US, USD), number of attempts until success (US) or first-time (US) success rates or time taken to insert the catheter (US).For the femoral vein, fewer data were available for analysis (four studies, 311 participants, 311 procedures). No evidence was found of a difference in inadvertent arterial puncture or other complications. However, success on the first attempt was more likely with ultrasound (three trials, 224 participants, RR 1.73, 95% CI 1.34 to 2.22; P value < 0.0001, I² = 31%), and a small increase in the overall success rate was noted (RR 1.11, 95% CI 1.00 to 1.23; P value 0.06, I² = 50%). No data on mortality or participant-reported outcomes were provided. AUTHORS' CONCLUSIONS On the basis of available data, we conclude that two-dimensional ultrasound offers small gains in safety and quality when compared with an anatomical landmark technique for subclavian (arterial puncture, haematoma formation) or femoral vein (success on the first attempt) cannulation for central vein catheterization. Data on insertion by inexperienced or experienced users, or on patients at high risk for complications, are lacking. The results for Doppler ultrasound techniques versus anatomical landmark techniques are uncertain.
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Affiliation(s)
- Patrick Brass
- HELIOS Klinikum KrefeldDepartment of Anaesthesiology, Intensive Care Medicine, and Pain TherapyLutherplatz 40KrefeldGermany47805
- Witten/Herdecke UniversityIFOM ‐ The Institute for Research in Operative Medicine, Faculty of Health, Department of MedicineOstmerheimer Str. 200CologneGermany51109
| | - Martin Hellmich
- University of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneNRWGermany50937
| | - Laurentius Kolodziej
- Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Klinik für Intensivmedizin und RespiratorentwöhnungRuhrlandklinikTüschener Weg 40EssenGermany
| | - Guido Schick
- Medizinisches Zentrum StädteRegion AachenKlinik für Anästhesie, Intensivmedizin und NotfallmedizinMauerfeldchen 25WürselenGermany
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014; 3:80-94. [PMID: 25374804 PMCID: PMC4220141 DOI: 10.5492/wjccm.v3.i4.80] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
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Farge-Bancel D, Bounameaux H, Brenner B, Büller HR, Kakkar A, Pabinger I, Streiff M, Debourdeau P. Implementing thrombosis guidelines in cancer patients: a review. Rambam Maimonides Med J 2014; 5:e0041. [PMID: 25386357 PMCID: PMC4222430 DOI: 10.5041/rmmj.10175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.
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Affiliation(s)
- Dominique Farge-Bancel
- Assistance Publique-Hôpitaux de Paris, Internal Medicine and Vascular Disease Unit, Saint-Louis Hospital; Sorbonne Paris Cité, Paris 7 Diderot University, Paris, France
| | - Henri Bounameaux
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - Ajay Kakkar
- Thrombosis Research Institute and Queen Mary University of London, London, UK
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
| | - Michael Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jasti N, Streiff MB. Prevention and treatment of thrombosis associated with central venous catheters in cancer patients. Expert Rev Hematol 2014; 7:599-616. [DOI: 10.1586/17474086.2014.954541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cotogni P, Barbero C, Garrino C, Degiorgis C, Mussa B, De Francesco A, Pittiruti M. Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study. Support Care Cancer 2014; 23:403-9. [PMID: 25120012 PMCID: PMC4289011 DOI: 10.1007/s00520-014-2387-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 08/04/2014] [Indexed: 01/29/2023]
Abstract
Purpose Few prospective follow-up studies evaluating the use of peripherally inserted central catheters (PICCs) to deliver chemotherapy and/or home parenteral nutrition (HPN) have focused exclusively on oncology outpatients. The aim of this prospective study was to assess the reliability and the safety of PICCs over a 5-year use in non-hospitalized cancer patients requiring long-term intravenous therapies. Methods Since June 2008, all adult oncology outpatient candidates for PICC insertion were consecutively enrolled and the incidence of catheter-related complications was investigated. The follow-up continued until the PICC removal. Results Two hundred sixty-nine PICCs in 250 patients (98 % with solid malignancies) were studied, for a total of 55,293 catheter days (median dwell time 184 days, range 15–1,384). All patients received HPN and 71 % received chemotherapy during the study period. The incidence of catheter-related bloodstream infections (CRBSIs) was low (0.05 per 1,000 catheter days), PICC-related symptomatic thrombosis was rare (1.1 %; 0.05 per 1,000 catheter days), and mechanical complications were uncommon (13.1 %; 0.63 per 1,000 catheter days). The overall complication rate was 17.5 % (0.85 per 1,000 catheter days) and PICCs were removed because of complications only in 7 % of cases. The main findings of this study were that, if accurately managed, PICCs can be safely used in cancer patients receiving chemotherapy and/or HPN, recording a low incidence of CRBSI, thrombosis, and mechanical complications; a long catheter life span; and a low probability of catheter removal because of complications. Conclusions Our study suggests that PICCs can be successfully utilized as safe and long-lasting venous access devices in non-hospitalized cancer patients.
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Affiliation(s)
- Paolo Cotogni
- Anesthesiology and Intensive Care, Unit of Parenteral Nutrition in Oncology, Department of Medicine, S. Giovanni Battista Hospital, University of Turin, Via Giovanni Giolitti 9, 10123, Turin, Italy,
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Moran J, Colbert CY, Song J, Mathews J, Arroliga AC, Varghees S, Hull J, Reddy S. Screening for novel risk factors related to peripherally inserted central catheter-associated complications. J Hosp Med 2014; 9:481-9. [PMID: 24911379 DOI: 10.1002/jhm.2207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm. METHODS A case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and risk factors for complications. One hundred seventy cases of inpatients who experienced PICC-related complications were identified. Age- and gender-matched controls were randomly selected among patients who underwent PICC placement without documented complications during this time. RESULTS A total of 1444 PICCs were placed, with a complication rate of 11.77% (95% confidence interval: 10.11%-13.44%). Complications included catheter-associated thrombosis (3%), mechanical complications (4%), catheter-associated bloodstream infections (2%), and cellulitis (1%). In multivariable logistic regression analyses, malnutrition and after-hours placement were significantly associated with increased risk of complications, as was body mass index (BMI) >30 after adjusting for anticoagulation and time of placement. In a secondary multivariable logistic regression analysis, after-hours placement and malnutrition were significantly associated with increased risk of nonmechanical complications. Additionally, in conditional univariate analyses, length of stay, malnutrition, and after-hours placement were associated with increased risk of catheter-associated thrombosis. In our multivariable logistic regression analyses, use of anticoagulation/antiplatelet agents was associated with decreased risk of all-cause complications, nonmechanical complications, and catheter-associated thrombosis. CONCLUSIONS Screening of patients undergoing PICC placement with attention to malnutrition, BMI >30, and length of stay may reduce the risk of PICC-associated complications. Use of anticoagulation/antiplatelet agents and avoiding after-hours placement may reduce complications and enhance patient safety.
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Affiliation(s)
- Jennifer Moran
- Department of Medicine, Baylor Scott & White Health, Temple, Texas; Texas A & M University System Health Science Center College of Medicine, College Station, Texas
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Pires NN, Vasques CI. Nurses' knowledge regarding the handling of the totally-implanted venous access device. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014000830013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the light of nurses' questions regarding the handling of the totally-implanted venous access device, this study aimed to evaluate these professionals' knowledge. This is a descriptive study with a qualitative approach, whose sample was made up of 28 nurses working on the Internal Medicine ward and in the Emergency Room. The study was undertaken in two stages: interviewing, to evaluate knowledge regarding the handling of the implanted port; and an integrative review to clarify the doubts identified. The results indicated that the nurses' knowledge was inadequate regarding when to use the implanted port, its purpose, the puncture technique, maintenance and handling. It is concluded that the knowledge of the subjects evaluated is inadequate, and that it is necessary for these professionals' clinical skills to be standardized and for them to receive theoretical-practical training.
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Mezouar S, Mege D, Darbousset R, Farge D, Debourdeau P, Dignat-George F, Panicot-Dubois L, Dubois C. Involvement of Platelet-Derived Microparticles in Tumor Progression and Thrombosis. Semin Oncol 2014; 41:346-58. [DOI: 10.1053/j.seminoncol.2014.04.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Frere C, Debourdeau P, Hij A, Cajfinger F, Onan MN, Panicot-Dubois L, Dubois C, Farge D. Therapy for Cancer-Related Thromboembolism. Semin Oncol 2014; 41:319-38. [DOI: 10.1053/j.seminoncol.2014.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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[Cancer-associated venous thromboembolic recurrence: disregard of treatment recommendations]. Bull Cancer 2014; 101:295-301. [PMID: 24691192 DOI: 10.1684/bdc.2014.1907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Low-molecular-weight heparins (LMWH) are the reference curative treatment of venous thromboembolism (VTE) in patients with cancer. All international guidelines recommend the long-term use of LMWH given their demonstrated superiority compared to vitamin-K antagonists (VKA) in reducing VTE recurrence in this patient population without increased risk of bleeding. However, several studies consistently show a lack of adherence to treatment recommendations, which are applied at the very best in 50% of cases. This results in a loss of chance for patients with fragile prognosis and in whom VTE represents the second cause of death. Given the expected benefit and the increased VTE prevalence in patients with cancer, full awareness is necessary to implement programs aiming at improving the therapeutic management of cancer-associated VTE. This requires multidisciplinary consideration by qualified physicians involved in the management of patients with cancer-associated VTE such as oncologists, internists and those specialized in vascular disease and hemostasis.
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