1
|
Hashimoto K, Nawata S, Wada S, Hamaguchi S, Tanabe K, Mimura H. Assessment of the deformation rate of venous diameter during internal jugular vein puncture using a newly developed thin-tip three-dimensional needle. J Vasc Access 2024:11297298241260904. [PMID: 39091113 DOI: 10.1177/11297298241260904] [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: 08/04/2024] Open
Abstract
BACKGROUND The internal jugular vein (IJV) is one of the most used sites for central venous access. Some authors revealed the association of a higher deformation rate of the IJV wall with posterior wall penetration, which may cause a hemorrhagic complication. A newly developed thin-tip needle (three-dimensional (3D) needle) reduced the deformation rate in an ex vivo study. Therefore, we conducted a clinical study to investigate its efficacy in reducing vessel deformity during IJV puncture. METHODS This study retrospectively enrolled 80 adult patients who received central venous port (CVP) implantation via the IJV from April 1, 2022, to November 10, 2023, in our institution. Traditional needle-and-catheter was used for ultrasound (US)-guided IJV puncture (usual group) for the former 40 patients before July 18, 2023. Afterward, the 3D needle was used for the latter 40 patients (3D needle group). US images were stored and analyzed to calculate the deformation rate. RESULTS The deformation rate was 58.6% (13.2-100) for the usual needle and 41.8% (10.6-100) for the 3D needle (p = 0.0034). Patients who required several punctures included 2 for the usual needle and 12 for the 3D needle, respectively (p = 0.0032). All patients and the usual needle group demonstrated a weak negative correlation between the deformation rate and pre-puncture vessel diameter (r = 0.24 and 0.41, respectively), with no correlation in the 3D needle group. CONCLUSION The deformation rate of the IJV wall was smaller in the 3D needle group than in the usual needle group. The use of a 3D needle would be safer when puncturing the IJV.
Collapse
Affiliation(s)
- Kazuki Hashimoto
- Department of Diagnostic Radiology and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shintaro Nawata
- Department of Diagnostic Radiology and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinji Wada
- Department of Diagnostic Radiology and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shingo Hamaguchi
- Department of Diagnostic Radiology and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenichiro Tanabe
- Department of Frontier Medicine, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hidefumi Mimura
- Department of Diagnostic Radiology and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| |
Collapse
|
2
|
Siddiqui MT, Coughlin KL, Koenen B, Al-Yaman W, Bestgen A, Regueiro M, Kirby DF. Association between tunneled catheter placement and catheter-associated deep venous thrombosis in adults with inflammatory bowel disease receiving home parenteral nutrition: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:562-570. [PMID: 38949827 DOI: 10.1002/jpen.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of thrombosis. They often need parenteral nutrition (PN) requiring intravenous access for prolonged periods. We assessed the risk of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs) and tunneled catheters for patients with IBD receiving home PN (HPN). METHODS Using the Cleveland Clinic HPN Registry, we retrospectively studied a cohort of adults with IBD who received HPN between June 30, 2019 and January 1, 2023. We collected demographics, catheter type, and catheter-associated DVT (CADVT) data. We performed descriptive statistics and Poisson tests to compare CADVT rates among parameters of interest. We generated Kaplan-Meier graphs to illustrate longevity of CADVT-free survival and a Cox proportional hazard model to calculate the hazard ratio associated with CADVT. RESULTS We collected data on 407 patients, of which, 276 (68%) received tunneled catheters and 131 (32%) received PICCs as their initial catheter. There were 17 CADVTs with an overall rate of 0.08 per 1000 catheter days, whereas individual rates of DVT for PICCs and tunneled catheters were 0.16 and 0.05 per 1000 catheter days, respectively (P = 0.03). After adjusting for age, sex, and comorbidity, CADVT risk was significantly higher for PICCs compared with tunneled catheters, with an adjusted hazard ratio of 2.962 (95% CI=1.140-7.698; P = 0.025) and adjusted incidence rate ratio of 3.66 (95% CI=2.637-4.696; P = 0.013). CONCLUSION Our study shows that CADVT risk is nearly three times higher with PICCs compared with tunneled catheters. We recommend tunneled catheter placement for patients with IBD who require HPN infusion greater than 30 days.
Collapse
Affiliation(s)
- Mohamed Tausif Siddiqui
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathleen L Coughlin
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Koenen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Wael Al-Yaman
- Department of Gastroenterology and Hepatology, St. Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Ashley Bestgen
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
McManus C, Mifflin N, Rivera R, Vause S, Tran T, Ostroff M, Harrowell L, Frost S, Alexandrou E. Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study. BMJ Open 2024; 14:e081749. [PMID: 38760049 PMCID: PMC11103188 DOI: 10.1136/bmjopen-2023-081749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities. DESIGN A propensity-score matched cohort study. SETTING A 980-bed tertiary referral hospital in South West Sydney, Australia. PARTICIPANTS In-patients referred to the hospital central venous access service for the insertion of a central venous access device. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT). RESULTS The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00). CONCLUSION There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.
Collapse
Affiliation(s)
- Craig McManus
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Nicholas Mifflin
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Renz Rivera
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Sophie Vause
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ton Tran
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew Ostroff
- St Joseph's Health and Medical Centre, Emerson, New Jersey, USA
| | - Lorenza Harrowell
- Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Steven Frost
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Evan Alexandrou
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| |
Collapse
|
4
|
Trebuian CI, Marza AM, Cindrea AC, Petrica A, Onea S, Sutoi D, Barsac C, Crintea-Najette I, Popa D, Chioibas R, Mederle OA. Risk Assessment of Venous Thromboembolism among Septic Shock Patients: Single versus Concurrent Insertion of Central Venous Catheters. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:785. [PMID: 38792968 PMCID: PMC11123159 DOI: 10.3390/medicina60050785] [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: 03/30/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Thrombosis is a serious complication experienced by some hospitalized patients. While concurrent placement of two catheters (CVCs) in the same central vein offers several benefits in clinical settings, we aimed to investigate the role of this procedure in relation to the risk of thrombosis. Materials and Methods: Over a two-year retrospective analysis, we examined 114 patients with septic shock caused by a pulmonary infection, who underwent the insertion of one or more central lines into a central vein during their ICU stay. Logistic regression models were employed to assess the correlation between the Caprini risk score, the placement of two CVCs in the same vein, COVID-19 infection and the risk of venous thromboembolism (VTE). Results: In total, 53% of the patients underwent the concurrent insertion of two CVCs. The placement of two CVCs in the same vein appears to elevate the VTE risk by 2.5 times (95% CI: 1.03-6.12). Logistic regression analysis indicated that hemodialysis catheters amplify the VTE risk by nearly five times, even when accounting for a series of factors (95% CI: 1.86-12.31). Conclusions: Our study suggests that the elevated risk of VTE is likely associated with the insertion of the hemodialysis catheters rather than solely the presence of two concurrent catheters.
Collapse
Affiliation(s)
- Cosmin Iosif Trebuian
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Department of Anesthesia and Intensive Care, Emergency County Hospital, 320210 Resita, Romania
| | - Adina Maria Marza
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Alexandru Cristian Cindrea
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Alina Petrica
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania
| | - Stefania Onea
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania;
| | - Dumitru Sutoi
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania;
| | - Claudiu Barsac
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Clinic of Anesthesia and Intensive Care, “Pius Brinzeu” Emergency Clinical County Hospital, 300736 Timisoara, Romania;
| | - Iulia Crintea-Najette
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Daian Popa
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| | - Raul Chioibas
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
| | - Ovidiu Alexandru Mederle
- Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.I.T.); (A.C.C.); (A.P.); (D.S.); (C.B.); (I.C.-N.); (D.P.); (R.C.); (O.A.M.)
- Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania
| |
Collapse
|
5
|
Dicks AB, Moussallem E, Stanbro M, Walls J, Gandhi S, Gray BH. A Comprehensive Review of Risk Factors and Thrombophilia Evaluation in Venous Thromboembolism. J Clin Med 2024; 13:362. [PMID: 38256496 PMCID: PMC10816375 DOI: 10.3390/jcm13020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality worldwide. There are many factors, both acquired and inherited, known to increase the risk of VTE. Most of these result in increased risk via several common mechanisms including circulatory stasis, endothelial damage, or increased hypercoagulability. Overall, a risk factor can be identified in the majority of patients with VTE; however, not all risk factors carry the same predictive value. It is important for clinicians to understand the potency of each individual risk factor when managing patients who have a VTE or are at risk of developing VTE. With this, many providers consider performing a thrombophilia evaluation to further define a patient's risk. However, guidance on who to test and when to test is controversial and not always clear. This comprehensive review attempts to address these aspects/concerns by providing an overview of the multifaceted risk factors associated with VTE as well as examining the role of performing a thrombophilia evaluation, including the indications and timing of performing such an evaluation.
Collapse
Affiliation(s)
- Andrew B. Dicks
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Elie Moussallem
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Marcus Stanbro
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Jay Walls
- Department of Hematology, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA;
| | - Sagar Gandhi
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| | - Bruce H. Gray
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine—Greenville, Greenville, SC 29601, USA; (E.M.); (M.S.); (S.G.); (B.H.G.)
| |
Collapse
|
6
|
Alemu T, Adule A, Sorato MM, Borsamo A. Incidence and factors associated with deep vein thrombosis among hospitalized adult patients at Hawassa university comprehensive specialized hospital Hawassa city, Sidama, Ethiopia: retrospective cohort study. J Thromb Thrombolysis 2024; 57:164-174. [PMID: 37704907 DOI: 10.1007/s11239-023-02889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Deep vein thrombosis is a public health problem with substantial morbidity and mortality globally. In Ethiopia, death due to complications of DVT is very significant however its incidence, risk factors, and preventive methods are not well studied. To assess the incidence and factors associated with deep vein thrombosis among hospitalized adult patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. METHOD Intuitional-based retrospective study design was employed in July1-August 30, 2022 in 660 randomly selected patients' record cards. The patients' record cards were reviewed from 2012 to 2014 at Hawassa University Compressive Specialized Hospital. The data entry and analysis were done by using Epi Info and SPSS version 24. After adjusting covariates at a 95% confidence interval, an independent variable with a P value < 0.05 was declared significantly associated with deep vein thrombosis. An odds ratio was calculated to measure the strength of the relationship independent variable and deep vein thrombosis. RESULTS The overall incidence of DVT was 10.6% [95% CI: 8.5%, 13.1%]. After adjusting for covariates, orthopedic trauma; AOR = 2.6 (95% CI (1.2-5.4), corona virus; AOR = 2.5 (95%CI (1.07-5.1), and hospital stay > 15 days; AOR = 2.2 (95% CI (1.25-3.94) were significantly associated with deep vein thrombosis. CONCLUSION DVT incidence is high among hospitalized patients. An orthopedic trauma, a recent infection of the coronavirus, and a hospital stay above 15 days were a risk to acquire deep vein thrombosis. Early identification and detection of patients at high risk of developing DVT and provision of prophylaxis are recommended.
Collapse
Affiliation(s)
- Tsegaye Alemu
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Aklilu Adule
- Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | - Mende Mensa Sorato
- Department of Pharmacy, School of Medicine, Komar University of Science and Technology, Qularaisi, Sulaimaniyah, KRI, Iraq.
| | - Asfaw Borsamo
- Department of Human Anatomy, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
7
|
Marshall S, Tsveybel K, Boukedes S, Chepuri R, Coppolino A, El-Chemaly S, Hartigan P, Kennedy J, Keshk M, Klibaner-Schiff E, Lee S, Mallidi H, Sharma N, Thaniyavarn T, Young J, Townsend K, Goldberg H. Limited Effect of Prevention Strategies on Incidence of Clinically Detectable Venous Thromboembolism After Lung Transplantation. Transplant Proc 2023; 55:2191-2196. [PMID: 37802745 DOI: 10.1016/j.transproceed.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/02/2023] [Accepted: 06/30/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Thromboembolic complications are common post-lung transplant, leading to significant morbidity. We instituted multiple interventions because of an observed 36.8% incidence of venous thromboembolism (VTE) (Incidence rate (IR) 5.74/1000 pt days) in our recipients. METHODS Our initiative commenced January 2015 with enoxaparin initiation within 6-8 hours of intensive care unit arrival and continuation for 4-6 weeks. We evaluated the IR of VTE in lung transplant recipients within 90 days of transplant. In 2017, the protocol was modified to extend the time to initiation of prophylaxis to within 72 hours of ICU arrival. In 2019, we further amended our intraoperative vascular access strategy. RESULTS Eighteen of 26 lung transplant recipients (LTR) met inclusion criteria in the 2015 cohort. Six of 18 (33.3%) developed VTE, 50% of which were upper extremity (UE), line associated. Fifty two of 75 LTR were eligible for enoxaparin prophylaxis in the 2017 cohort. Fifteen of 52 subjects (28.8%) developed VTE, 77.8% of which were UE and line associated. Despite improved adherence in 2017, there was little change in VTE IR (3.90/1000 pt days compared with 3.85/1000 pt days). Twenty six of 43 LTR met protocol inclusion criteria in the 2019 cohort. Ten subjects (38.5%) developed VTE, 67% of which were UE and line associated (IR 5.18/1000 pt days). CONCLUSION Our prospective study found that LTR remain at high risk for VTE despite aggressive prophylaxis with 4-6 weeks of enoxaparin and adjustment of vascular access approach. Alternative interventions should be investigated to minimize VTE development in this vulnerable population.
Collapse
Affiliation(s)
- Shirley Marshall
- Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts
| | - Karen Tsveybel
- Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts
| | - Steve Boukedes
- Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts
| | - Rasika Chepuri
- Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Antonio Coppolino
- Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Souheil El-Chemaly
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Philip Hartigan
- Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - John Kennedy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mohamed Keshk
- Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Stefi Lee
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Hari Mallidi
- Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Nirmal Sharma
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Tany Thaniyavarn
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - John Young
- Division of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Thoracic Surgery, Veterans Affairs Boston Health care System, Boston, Massachusetts
| | - Keri Townsend
- Lung Transplant Program, Brigham & Women's Hospital, Boston, Massachusetts
| | - Hilary Goldberg
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
8
|
Amarneh M, Carney B, Davis TW. The Use of the Internal Thoracic Vein for Placement of Large-Bore Tunneled Catheters. J Vasc Interv Radiol 2023; 34:2038-2040. [PMID: 37437803 DOI: 10.1016/j.jvir.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Mohammad Amarneh
- Vascular and Interventional Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242.
| | - Brendan Carney
- Vascular and Interventional Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242
| | - Trent W Davis
- Vascular and Interventional Radiology, St Joseph's Hospital and Medical Center, Creighton University, Omaha, NE
| |
Collapse
|
9
|
Abbruzzese C, Guzzardella A, Consonni D, Turconi G, Bonetti C, Brioni M, Panigada M, Grasselli G. Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study. Ann Intensive Care 2023; 13:106. [PMID: 37858003 PMCID: PMC10587047 DOI: 10.1186/s13613-023-01206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Catheter-related thrombosis (CRT) incidence, rate, and risk factors vary in literature due to differences in populations, catheters, diagnostic methods, and statistical approaches. The aim of this single-center, prospective, observational study was to assess incidence, incidence rate (IR), cumulative incidence, and risk factors by means of IR ratio (IRR) of asymptomatic CRT in a non-oncologic Intensive Care Unit (ICU) population. CRT development was assessed daily by means of ultrasound screening. The proportions of patients and catheters developing CRT and CRT incidence rates, expressed as the number of events per catheter-days (cd), were calculated. Kalbfleisch and Prentice's method was used to estimate the cumulative incidence of CRTs. Univariate and multivariable Poisson regression models were fitted to calculate IRR in risk factors analysis. RESULTS Fifty (25%, 95% CI 19-31) out of 203 included patients, and 52 (14%, 95% CI 11-18) out of 375 catheters inserted developed CRT [IR 17.7 (13.5-23.2) CRTs/1000*cd], after 5 [3-10] days from insertion. Forty-six CRTs (88%) were partial thrombosis. All CRTs remained asymptomatic. Obesity and ECMO support were patient-related protective factors [IRR 0.24 (0.10-0.60), p = 0.002 and 0.05 (0.01-0.50), p = 0.011, respectively]. The internal jugular vein had higher CRT IR than other sites [20.1 vs. 5.9 CRTs/1000*cd, IRR 4.22 (1.22-14.63), p = 0.023]. Pulmonary artery catheter and left-side cannulation were catheter-related risk factors [IRR 4.24 (2.00-9.00), p < 0.001 vs. central venous catheters; IRR 2.69 (1.45-4.98), p = 0.002 vs. right cannulation, respectively]. No statistically significant effect of the number of simultaneously inserted catheters [IRR 1.11 (0.64-1.94), p = 0.708] and of the catheterization length [IRR 1.09 (0.97-1.22), p = 0.155] was detected. The ICU length of stay was longer in CRT patients (20 [15-31] vs. 6 [4-14] days, p < 0.001), while no difference in mortality was observed. CONCLUSIONS CRTs are frequent but rarely symptomatic. This study suggests that obesity and ECMO are protective factors, while pulmonary artery catheter, internal jugular vein and left-side positioning are risk factors for CRT.
Collapse
Affiliation(s)
- Chiara Abbruzzese
- Department of Anaesthesiology, Critical Care and Emergency, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Amedeo Guzzardella
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Gloria Turconi
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Claudia Bonetti
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Matteo Brioni
- Department of Anaesthesiology, Critical Care and Emergency, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Mauro Panigada
- Department of Anaesthesiology, Critical Care and Emergency, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Giacomo Grasselli
- Department of Anaesthesiology, Critical Care and Emergency, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| |
Collapse
|
10
|
Pironi L, Cuerda C, Jeppesen PB, Joly F, Jonkers C, Krznarić Ž, Lal S, Lamprecht G, Lichota M, Mundi MS, Schneider SM, Szczepanek K, Van Gossum A, Wanten G, Wheatley C, Weimann A. ESPEN guideline on chronic intestinal failure in adults - Update 2023. Clin Nutr 2023; 42:1940-2021. [PMID: 37639741 DOI: 10.1016/j.clnu.2023.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND & AIMS In 2016, ESPEN published the guideline for Chronic Intestinal Failure (CIF) in adults. An updated version of ESPEN guidelines on CIF due to benign disease in adults was devised in order to incorporate new evidence since the publication of the previous ESPEN guidelines. METHODS The grading system of the Scottish Intercollegiate Guidelines Network (SIGN) was used to grade the literature. Recommendations were graded according to the levels of evidence available as A (strong), B (conditional), 0 (weak) and Good practice points (GPP). The recommendations of the 2016 guideline (graded using the GRADE system) which were still valid, because no studies supporting an update were retrieved, were reworded and re-graded accordingly. RESULTS The recommendations of the 2016 guideline were reviewed, particularly focusing on definitions, and new chapters were included to devise recommendations on IF centers, chronic enterocutaneous fistulas, costs of IF, caring for CIF patients during pregnancy, transition of patients from pediatric to adult centers. The new guideline consist of 149 recommendations and 16 statements which were voted for consensus by ESPEN members, online in July 2022 and at conference during the annual Congress in September 2022. The Grade of recommendation is GPP for 96 (64.4%) of the recommendations, 0 for 29 (19.5%), B for 19 (12.7%), and A for only five (3.4%). The grade of consensus is "strong consensus" for 148 (99.3%) and "consensus" for one (0.7%) recommendation. The grade of consensus for the statements is "strong consensus" for 14 (87.5%) and "consensus" for two (12.5%). CONCLUSIONS It is confirmed that CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for the underlying gastrointestinal disease and to provide HPN support. Most of the recommendations were graded as GPP, but almost all received a strong consensus.
Collapse
Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Center for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Center for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Cora Jonkers
- Nutrition Support Team, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Željko Krznarić
- Center of Clinical Nutrition, Department of Medicine, University Hospital Center, Zagreb, Croatia
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
| |
Collapse
|
11
|
Zhang GH, Xia JM, Lai DP, Cheng YR, Lv SJ. Establishment of risk nomogram prediction model for venous catheter thrombosis. Ir J Med Sci 2023; 192:2285-2290. [PMID: 36637678 DOI: 10.1007/s11845-022-03272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Venous catheters are widely used in clinical practice, but a drawback of their usage is the increased risk of thrombosis. AIMS The current study explored the risk factors affecting the formation of thrombosis following venous catheterization and establishes a risk nomogram prediction model for catheter-related thrombosis. METHODS Univariate and multivariate logistic regression analyses were carried out to identify the independent factors involved in venous catheter thrombosis. These factors were included in the construction of a nomogram. Finally, the C-index and calibration curves were used to validate the nomogram. RESULT A total of 146 cases were included in the sample, of which 36 were cases of thrombosis. The results of the univariate logistic regression analysis showed that the following were significant factors: age, Acute Physiology and Chronic Health Evaluation scoring system (APACHE II) score, white blood cell (WBC), hematocrit (HCT), international normalized ratio (INR), fibrinogen (FIB), and D-dimer. Multivariate logistic regression analysis was performed, which confirmed that the factors of age (AUC: 0.677, 95% CI: 0.564-0.790), APACHE II score (AUC: 0.746, 95% CI: 0.656-0.837), INR (AUC: 0.743, 95% CI: 0.636-0.849), and D-dimer (AUC: 0.826, 95% CI: 0.750-0.902) were independent variables. Next, a nomogram was constructed using these independent variables for predicting venous catheter thrombosis. Favorable results with C-indexes (0.816; 95% CI: 0.780-0.882) and calibration curves closer to ideal curves indicated the accurate predictive ability of this nomogram. CONCLUSION The individualized nomogram demonstrated effective prognostic prediction for patients with venous thrombosis.
Collapse
Affiliation(s)
- Guo-Hu Zhang
- Emergency Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Jin-Ming Xia
- Emergency Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Deng-Pan Lai
- Emergency Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Yong-Ran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, 311300, China.
| | - Shi-Jin Lv
- Emergency Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China.
| |
Collapse
|
12
|
Wong CCH, Choi HCW, Lee VHF. Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4712. [PMID: 37835406 PMCID: PMC10571956 DOI: 10.3390/cancers15194712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27-19.10) was higher than that for central lines (1.44%, 95% CI 0.30-4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00-9.62) was also higher than that with central lines (0.96%, 95% CI 0.12-3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00-12.22) compared to central lines (0.48%, 95% CI 0.01-2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.
Collapse
Affiliation(s)
| | - Horace Cheuk-Wai Choi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, Centre of Cancer Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
13
|
Asymptomatic pulmonary thromboembolism due to hemodialisys catheter thrombosis: case series and literature review. CEN Case Rep 2022. [PMID: 36574198 PMCID: PMC10393924 DOI: 10.1007/s13730-022-00757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Right atrial thrombus is commonly associated to catheters. Catheter-related right atrial thrombus (CRAT) in hemodialysis patients frequently presents as pulmonary embolism. Although CRAT is sometimes asymptomatic, even in these cases it is associated with worse prognosis. The management strategy for CRAT is not well established, however, along with catheter removal, anticoagulation, thrombolysis, and surgical thrombectomy may be performed. Suspicion of asymptomatic pulmonary embolism associated to CRAT is important in order to perform proper treatment. The authors of this article report two cases of asymptomatic pulmonary thromboembolism due to CRAT in hemodialysis patients and perform a review of the literature.
Collapse
|
14
|
Wang L, Jia L, Jiang A. Pathology of catheter-related complications: what we need to know and what should be discovered. J Int Med Res 2022; 50:3000605221127890. [PMID: 36268763 PMCID: PMC9597033 DOI: 10.1177/03000605221127890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the considerable efforts made to increase the prevalence of autogenous fistula in patients on hemodialysis, tunneled cuffed catheters are still an important access modality and used in a high percentage of the hemodialysis population. However, because of the conundrum posed by tunneled cuffed catheters, patients can develop a multitude of complications, including thrombosis, infections, formation of a fibrin sheath, and central vein stenosis, resulting in increased morbidity and mortality as well as placing a heavy burden on the healthcare system. However, with an increasing number of studies now focusing on how to manage these catheter-related complications, there has been less translational research on the pathology of these complications. This review of the most recent literature provides an update on the pathological aspects of catheter-related complications, highlighting what we need to know and what is yet to be discovered. The future research strategies and innovations needed to prevent these complications are also addressed.
Collapse
Affiliation(s)
- Lihua Wang
- Lihua Wang, Department of Kidney Disease
and Blood Purification Centre, 2nd Hospital of Tianjin Medical University, 23rd
Pingjiang Road, Hexi District, Tianjin 300211, PR China.
| | | | | |
Collapse
|
15
|
Gillis VELM, van Houdt T, Wouters Y, Wanten GJA. Anticoagulants decrease the risk for catheter-related venous thrombosis in patients with chronic intestinal failure: A long-term cohort study. JPEN J Parenter Enteral Nutr 2022; 46:1677-1685. [PMID: 34967025 PMCID: PMC9542651 DOI: 10.1002/jpen.2323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Catheter-related venous thrombosis (CRVT) is a severe complication of home parental nutrition. Although primary prevention of CRVT is crucial, there is no consensus on anticoagulant use to prevent this adversity. The aim was to compare CRVT risk in patients with chronic intestinal failure (CIF) in the presence or absence of anticoagulants, and to identify CRVT risk factors. METHODS This retrospective cohort study comprised adult patients with CIF with a central venous access device (CVAD) between 2010 and 2020 that were treated at our national CIF referral center. Analyses were performed at a CVAD level. RESULTS Overall, 1188 CVADs in 389 patients were included (540.800 CVAD days). Anticoagulants were used in 403 CVADs. In total, 137 CRVTs occurred in 98 patients, resulting in 0.25 CRVTs/1000 CVAD days (95% CI, 0.22-0.29). Anticoagulant use was associated with a decreased CRVT risk (odds ratio [OR] = 0.53; 95% CI, 0.31-0.89; P = 0.02). Left-sided CVAD insertion (OR = 2.00; 95% CI, 1.36-2.94), a history of venous thrombosis (OR = 1.73; 95% CI, 1.05-2.84), and a shorter period postinsertion (OR = 0.78; 95% CI, 0.65-0.92) were independently associated with an increased CRVT risk. CONCLUSION Anticoagulants decreased the CRVT risk. In addition, we identified left-sided vein insertion, a history of venous thrombosis, and a shorter period post-CVAD insertion as CRVT risk factors. Further prospective studies should provide guidance whether prophylactic anticoagulant use, especially in higher-risk patients with a left-sided CVAD or a history of venous thrombosis, is justified.
Collapse
Affiliation(s)
- Veerle E. L. M. Gillis
- Department of Gastroenterology and HepatologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Thijs van Houdt
- Department of Gastroenterology and HepatologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Yannick Wouters
- Department of Gastroenterology and HepatologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Geert J. A. Wanten
- Department of Gastroenterology and HepatologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| |
Collapse
|
16
|
Suh J, Lee SW. Preoperative prediction of the need for arterial and central venous catheterization using machine learning techniques. Sci Rep 2022; 12:11948. [PMID: 35831346 PMCID: PMC9279292 DOI: 10.1038/s41598-022-16144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
Some surgical patients require an arterial or central venous catheterization intraoperatively. This decision relied solely on the experience of individual anesthesiologists; however, these decisions are not easy for clinicians who are in an emergency or inexperienced. Therefore, applying recent artificial intelligence techniques to automatically extractable data from electronic medical record (EMR) could create a very clinically useful model in this situation. This study aimed to develop a model that is easy to apply in real clinical settings by implementing a prediction model for the preoperative decision to insert an arterial and central venous catheter and that can be automatically linked to the EMR. We collected and retrospectively analyzed data from 66,522 patients, > 18 years of age, who underwent non-cardiac surgeries from March 2019 to April 2021 at the single tertiary medical center. Data included demographics, pre-operative laboratory tests, surgical information, and catheterization information. When compared with other machine learning methods, the DNN model showed the best predictive performance in terms of the area under receiver operating characteristic curve and area under the precision-recall curve. Operation code information accounted for the largest portion of the prediction. This can be applied to clinical fields using operation code and minimal preoperative clinical information.
Collapse
Affiliation(s)
- Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
17
|
Home Parenteral and Enteral Nutrition. Nutrients 2022; 14:nu14132558. [PMID: 35807740 PMCID: PMC9268549 DOI: 10.3390/nu14132558] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
While the history of nutrition support dates to the ancient world, modern home parenteral and enteral nutrition (HPEN) has been available since the 1960s. Home enteral nutrition is primarily for patients in whom there is a reduction in oral intake below the amount needed to maintain nutrition or hydration (i.e., oral failure), whereas home parenteral nutrition is used for patients when oral-enteral nutrition is temporarily or permanently impossible or absorption insufficient to maintain nutrition or hydration (i.e., intestinal failure). The development of home delivery of these therapies has revolutionized the field of clinical nutrition. The use of HPEN appears to be increasing on a global scale, and because of this, it is important for healthcare providers to understand all that HPEN entails to provide safe, efficacious, and cost-effective support to the HPEN patient. In this article, we provide a comprehensive review of the indications, patient requirements, monitoring, complications, and overall process of managing these therapies at home. Whereas some of the information in this article may be applicable to the pediatric patient, the focus is on the adult population.
Collapse
|
18
|
Yeow M, Soh S, Yap R, Tay D, Low YF, Ning Goh SS, Yeo CS, Lo ZJ. A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy. J Vasc Surg Venous Lymphat Disord 2022; 10:1184-1191.e8. [PMID: 35367407 DOI: 10.1016/j.jvsv.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Ensuring reliable central venous access with the least complications is vital for cancer patients receiving chemotherapy. A systematic review and network meta-analysis was conducted to compare the safety, quality of life (QoL) and cost effectiveness of different types of central venous access device (CVAD) for patients receiving chemotherapy. METHODS PubMed, EMBASE and Cochrane were searched from inception to 20th August 2021 for randomized controlled trials comparing the various CVADs [non-tunnelled central venous catheter (non-tunnelled catheter), peripherally inserted central venous catheter (PICC), totally implantable ports (PORT), and tunnelled catheter]. RESULTS A total of 11 eligible RCTs comprising 2585 patients were identified. PORT was associated with lower odds of overall complications, device removal due to complications, thrombotic and mechanical complications compared to PICC [(Odds Ratio (OR) 0.54, 95% CI 0.43 - 0.69), (OR 0.49, 95% CI 0.26 - 0.93), (OR 0.37, 95% CI 0.23 - 0.62) and (OR 0.35, 95% CI 0.13 - 0.95) respectively]. Tunnelled catheter was associated with higher odds of overall complication rate, device removal due to complications and infective complications compared to PORT [(OR 1.68, 95% CI 1.30 - 2.17), (OR 2.52, 95% CI 1.34 - 4.73), (OR 2.11, 95% CI 1.14 - 3.90) respectively]. Ranking probability based on SUCRA values indicated that PORT had the lowest probability of overall complications, removal due to complications, and thrombotic complications. CONCLUSION PORT is superior in terms of complications, QoL compared to other CVADs without compromising on cost effectiveness and should be considered the standard of care in patients receiving chemotherapy.
Collapse
Affiliation(s)
- Marcus Yeow
- Yong Loo Lin School of Medicine, National University of Singapore.
| | - Shauna Soh
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Ryan Yap
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Desiree Tay
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Yi Fen Low
- Yong Loo Lin School of Medicine, National University of Singapore
| | | | | | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| |
Collapse
|
19
|
Ashcraft M, Douglass M, Garren M, Mondal A, Bright LE, Wu Y, Handa H. Nitric Oxide-Releasing Lock Solution for the Prevention of Catheter-Related Infection and Thrombosis. ACS APPLIED BIO MATERIALS 2022; 5:1519-1527. [PMID: 35343228 PMCID: PMC9680935 DOI: 10.1021/acsabm.1c01272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although frequently used, venous catheters are often associated with serious complications such as infection and thrombosis. Lock solution therapies are clinically used to deter these issues but generally address only infection or thrombosis with limited success. Here, we report the development of a dual-functional lock therapy using nitric oxide (NO) donor molecule, S-nitrosoglutathione (GSNO). NO is a potent, broad-spectrum antimicrobial agent that also temporarily inhibits platelet activation, preventing thrombosis. Furthermore, NO has antibiofilm actions, an ability that traditional antibiotic lock solutions lack, thus limiting their efficacy. In this work, different concentrations of GSNO were characterized via NO analysis to determine a range of NO-releasing lock solution (NOreLS) concentrations to investigate and to demonstrate prolonged potential efficacy. Tested against clinically used vancomycin and gentamicin lock solutions, GSNO-based NOreLS repeatedly outperformed in models of different stages of catheter infections. NOreLS also prevented clot formation when exposed to whole blood, showing increased efficacy compared to a heparin lock solution. Moreover, NOreLS was demonstrated to be biocompatible via hemolysis and cytotoxicity assays. NOreLS has excellent potential for safely and effectively preventing infection and thrombosis related to catheter usage.
Collapse
Affiliation(s)
- Morgan Ashcraft
- Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Mark Garren
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Arnab Mondal
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Lori Estes Bright
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Yi Wu
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States.,School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| |
Collapse
|
20
|
Dodson MW, Cirulis MM, Li H, Yue Z, Brown LM, Elliott CG. Frequency of Thrombotic Risk Factors in Patients with Chronic Thromboembolic Pulmonary Hypertension and Acute Pulmonary Embolism: A Case-Control Study. Clin Appl Thromb Hemost 2022; 28:10760296211073277. [PMID: 35000431 PMCID: PMC8744163 DOI: 10.1177/10760296211073277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of acute pulmonary embolism (PE) which remains underdiagnosed. A better understanding of risk factors for CTEPH would improve our ability to predict which PE survivors are at risk. Several medical conditions-including malignancy, splenectomy, thyroid hormone supplementation, the presence of an intravascular device, inflammatory bowel disease, osteomyelitis, and non-O blood group-have been associated with increased risk of CTEPH, primarily in studies comparing patients with CTEPH to individuals with non-thrombotic conditions. Because many of these conditions increase thrombosis risk, it remains unclear whether their association with CTEPH reflects a general effect on thrombosis risk, or a specific effect on the risk of developing CTEPH as an outcome of thrombosis. We performed a case-control study comparing the frequencies of these conditions in patients with CTEPH versus patients with acute PE who did not develop CTEPH. The conditions studied were equally frequent in the CTEPH and PE cohorts, although there was a trend towards an increased frequency of splenectomy and non-O blood group among the CTEPH cohort. Thus, other than the possible exceptions of splenectomy and non-O blood group, the investigated medical conditions do not appear likely to increase the risk of CTEPH as an outcome of acute PE, and thus are unlikely to be useful in predicting CTEPH risk among PE survivors.
Collapse
Affiliation(s)
- Mark W Dodson
- 7061Intermountain Medical Center, Murray, Utah, USA.,14434University of Utah, Salt Lake City, Utah, USA
| | - Meghan M Cirulis
- 7061Intermountain Medical Center, Murray, Utah, USA.,14434University of Utah, Salt Lake City, Utah, USA
| | - Haojia Li
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Zhang Yue
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lynette M Brown
- 7061Intermountain Medical Center, Murray, Utah, USA.,14434University of Utah, Salt Lake City, Utah, USA
| | - C Gregory Elliott
- 7061Intermountain Medical Center, Murray, Utah, USA.,14434University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
21
|
Diagnosis of deep vein thrombosis of the upper extremity: a systematic review and meta-analysis of test accuracy. Blood Adv 2021; 4:2516-2522. [PMID: 32511715 DOI: 10.1182/bloodadvances.2019001409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/30/2020] [Indexed: 11/20/2022] Open
Abstract
Upper extremity deep vein thrombosis (UEDVT) accounts for ≤10% of DVT and can be associated with morbidity and mortality. Accurate diagnosis and treatment are necessary for safe and effective patient management. We systematically reviewed the accuracy of D-dimer and duplex ultrasonography (US) for the evaluation of suspected first-episode UEDVT. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and PubMed for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included prospective cross-sectional and cohort studies that evaluated test accuracy. Two investigators independently screened and collected data. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 9 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.96 (95% confidence interval [CI], 0.87-0.99) and 0.47 (95% CI, 0.43-0.52), respectively. The pooled estimates for duplex US sensitivity and specificity were 0.87 (95% CI, 0.73-0.94) and 0.85 (95% CI, 0.72-0.93), respectively. Certainty of evidence was moderate. In this review, we summarized the test accuracy (sensitivity and specificity) of D-dimer and duplex US for this indication. The sensitivity and specificity of the tests found in the present review should be considered in the context of whether they are used alone or in combination, which is dependent on the prevalence of disease in the population, the clinical setting in which the patient is being evaluated, cost, potential harms, and patient outcomes. This study was registered at PROSPERO as Systematic Review Registration Number CRD42018098488.
Collapse
|
22
|
Hanumunthadu B, Breathnach A. Antibiotic adverse events on an outpatient parenteral antibiotic service: a retrospective cohort study. Eur J Hosp Pharm 2021. [DOI: 10.1136/ejhpharm-2019-002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
23
|
Sharma T, Kunkes J, O'Sullivan D, Fernandez AB. Elevated risk of venous thromboembolism in patients undergoing therapeutic hypothermia after cardiac arrest. Resuscitation 2021; 162:251-256. [PMID: 33766667 DOI: 10.1016/j.resuscitation.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Targeted Temperature Management (TTM) reduces mortality and improves neurological outcomes after cardiac arrest. Cardiac arrest is considered a pro-thrombotic state. Endovascular cooling catheters may increase the risk of thrombosis. Targeted Temperature Management, however, increases fibrinolysis. The net outcome of these opposing effects remains largely unexplored. Moreover, the exact rate of venous thromboembolism (VTE) is uncertain in these patients. We sought to determine the incidence and potential predictors of VTE in patients undergoing TTM. METHODS Single center retrospective analysis. Participants were age ≥18 years old, admitted with out-of-hospital or in-hospital cardiac arrest, underwent TTM between January 1, 2007 and April 30, 2019 with endovascular cooling catheter. A total of 562 patients who underwent TTM (Study group) were compared to 562 patients treated for ARDS (control group). This control group was based on presumed similarities in factors affecting VTE: intensive care setting, immobility, length of stay and likely presence of central venous catheters. RESULTS Patients who underwent TTM had a significantly higher rate of VTE (6.6% vs 2.3%, p = 0.006) and deep vein thrombosis (DVT) (4.6% vs 1.3%, p = 0.011) when compared to control group. In multivariate analysis age, gender, race and hospital length of stay were not associated with development of VTE in the study group. CONCLUSION Patients undergoing TTM after cardiac arrest have statistically higher incidence of VTE and DVT compared to patients with ARDS. This risk is independent of age, gender, race or length of stay.
Collapse
Affiliation(s)
- Toishi Sharma
- Department of Internal Medicine, University of Connecticut, Farmington, CT, United States
| | - Jordan Kunkes
- Division of Cardiology, Hartford Hospital, Hartford, CT, United States
| | - David O'Sullivan
- Research Administration, Hartford Healthcare, Hartford, CT, United States
| | - Antonio B Fernandez
- Division of Cardiology, Hartford Hospital, Hartford, CT, United States; University of Connecticut School of Medicine, Farmington, CT, United States.
| |
Collapse
|
24
|
Johansen M, Classen V, Muchantef K. Long-term IV access in paediatrics - why, what, where, who and how. Acta Anaesthesiol Scand 2021; 65:282-291. [PMID: 33147351 DOI: 10.1111/aas.13729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
Establishment of long-term central venous access imposes the risk of procedural adverse events (air embolism, pneumothorax, accidental arterial cannulation of the great vessels, tricuspid valve damage and cardiac tamponade) as well as the risk of increased morbidity and mortality due to catheter related blood stream infections, vessel stenosis, deep vein thrombosis and the often high risk anaesthetic management of syndromic children. This narrative review aims to provide a historical and clinical background for the development and use of CVADs (central venous access devices), origin and management of the most common complications (catheter related thrombosis, infections and persistent withdrawal occlusion) and present the reader with an update on the "why, what, where, who and how" in paediatric long-term central venous access. Finally, we will present the reader with a clinical method for applying a retrograde inserted tunnelled and cuffed catheter using the left brachiocephalic vein access.
Collapse
Affiliation(s)
- Mathias Johansen
- Department of Paediatric Anaesthesia Montreal Children's Hospital Montreal Canada
| | - Volker Classen
- Department of Paediatric Anaesthesia Rigshospitalet Copenhagen Denmark
| | - Karl Muchantef
- Department of Interventional Radiology Montreal Children's Hospital Montreal Canada
| |
Collapse
|
25
|
Tse B, Lim G, Sholzberg M, Pavenski K. Describing the point prevalence and characteristics of venous thromboembolism in patients with thrombotic thrombocytopenic purpura. J Thromb Haemost 2020; 18:2870-2877. [PMID: 33448602 DOI: 10.1111/jth.15027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/18/2020] [Accepted: 07/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Arterial thromboembolic events are relatively common and well-described in patients with thrombotic thrombocytopenic purpura (TTP). However, the literature describing venous thromboembolism (VTE) in TTP is scarce. METHODS Single-institution retrospective chart review was conducted in TTP patients over a 10-year period to describe the point prevalence of VTE. Data were analyzed using descriptive statistics. RESULTS We identified 77 consecutive patients with 123 episodes of TTP. Of these patients, 14 (18%) experienced 16 VTEs (6 pulmonary embolisms, 6 deep vein thromboses, 4 superficial vein thromboses [SVT]). Excluding SVT, the point prevalence of VTE was 14%. All were acute and associated with admission for acute TTP. All patients were treated with plasma exchange (PLEX); 6/8 patients on concurrent PLEX at VTE diagnosis were exchanged with solvent-detergent plasma (SDP). Platelet and lactate dehydrogenase levels at time of VTE diagnosis had largely normalized from presentation values (median 175 × 109 U/L [interquartile range 130.75, 250] and 232 U/L [interquartile range 178.75, 263.5], respectively). Most VTEs (9/16) occurred while patients were not on pharmacologic thromboprophylaxis. All but one VTE was treated with anticoagulation. No VTEs were fatal or massive. CONCLUSIONS Our data provide additional evidence that TTP patients may be at risk for VTE. It is possible that SDP exerted a prothrombotic effect. TTP-associated VTEs may be pathophysiologically distinct from arterial thromboses because they occur following hematological recovery. VTE thromboprophylaxis was not commonly used. Our findings suggest the need to implement VTE thromboprophylaxis earlier in hospitalized patients with TTP.
Collapse
Affiliation(s)
- Brandon Tse
- Division of Hematology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gloria Lim
- Division of Hematology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Division of Hematology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Division of Hematology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Abdelaal Ahmed Mahmoud M Alkhatip A, Yassin HM, Farag E, Hamza MK, Bahr MH, Ahmed AG, El Emady MF, Sallam AM, Elayashy M, Abdelhaq M, Kamal AM, Elramely MA. Antistasis Retrograde Flow Vascular Catheter: A Novel Solution to Thrombogenicity: A Computational Fluid Dynamics Study. Anesth Analg 2020; 131:1281-1290. [PMID: 32925349 DOI: 10.1213/ane.0000000000004782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Catheter-related thrombosis (CRT) is a serious complication of vascular catheters. Retrograde catheter insertion has been shown to decrease pericatheter hemostasis and thrombosis, but it is technically challenging. The current in silico trial is an analytical approach to evaluating different approaches to designing retrograde flow into a vascular catheter. METHODS The novel catheter design aims to provide antistasis retrograde flow (ASRF) of fluid through multiple backward-directed side openings, with a self-closing terminal opening to facilitate standard insertion. Four different models of the catheter were evaluated by computational fluid dynamic studies, with retrograde-angled openings of 15°, 30°, 45°, and 60° to the long axis of the catheter. RESULTS ASRF successfully reduced the areas of fluid stagnation in models with 15° and 30° openings. Models with 45° and 60° did not significantly reduce stagnation. ASRF is reversed by the main bloodstream after a few millimeters. The novel catheter design achieved a slightly higher saline flow rate compared with the standard catheter (89.75, 91.72, 94.13, and 94.26 mL/min for 15°, 30°, 45°, and 60° designs, respectively, versus 86.93 mL/min for the standard catheter). CONCLUSIONS The novel ASRF vascular catheter reduces pericatheter fluid stasis and has the potential to reduce CRT. Further in vitro and in vivo trials are warranted to validate these findings and evaluate clinical efficacy.
Collapse
Affiliation(s)
- Ahmed Abdelaal Ahmed Mahmoud M Alkhatip
- From the Department of Anesthesia, Beni Suef University Hospital and Faculty of Medicine, Beni Suef University, Beni-Suef, Egypt
- Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Hany M Yassin
- Department of Anaesthesia, Fayoum University Hospital and Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ehab Farag
- From the Department of Anesthesia, Beni Suef University Hospital and Faculty of Medicine, Beni Suef University, Beni-Suef, Egypt
| | - Mohamed K Hamza
- Department of Anesthesia, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud H Bahr
- From the Department of Anesthesia, Beni Suef University Hospital and Faculty of Medicine, Beni Suef University, Beni-Suef, Egypt
| | - Ahmed Goda Ahmed
- From the Department of Anesthesia, Beni Suef University Hospital and Faculty of Medicine, Beni Suef University, Beni-Suef, Egypt
| | - Mohamed Farid El Emady
- Department of Anesthesia, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr M Sallam
- Department of Anesthesia, Ain Shams University Hospital and Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt
| | - Mohamed Elayashy
- Department of Anesthesia, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abdelhaq
- Department of Anesthesia, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Kamal
- Department of Anesthesia, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Elramely
- Department of Anesthesia, National Cancer Institute, Cairo University, Cairo, Egypt
| |
Collapse
|
27
|
Drakos P, Ford BC, Labropoulos N. A systematic review on internal jugular vein thrombosis and pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2020; 8:662-666. [DOI: 10.1016/j.jvsv.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/09/2020] [Indexed: 11/26/2022]
|
28
|
Cohen JB, Comer DM, Yabes JG, Ragni MV. Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study. TH OPEN 2020; 4:e51-e58. [PMID: 32435723 PMCID: PMC7234833 DOI: 10.1055/s-0040-1710506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction
Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear.
Methods
We performed a retrospective analysis of discharge data from the National Inpatient Sample between 2009 and 2014, using International Disease Classification codes to identify IBD and non-IBD patients with or without thrombosis. We used NIS-provided discharge-level weights to reflect prevalence estimates. Categoric variables were analyzed by Rao-Scott Chi-square test, continuous variables by weighted simple linear regression, and covariates associated with thrombosis by weighted multivariable logistic regression.
Results
Thrombosis prevalence in IBD was significantly greater than in non-IBD, 7.52 versus 4.54%,
p
< 0.0001. IBD patients with thrombosis were older and more likely to be Caucasian than IBD without thrombosis, each
p
< 0.001. Thrombosis occurred most commonly in the mesenteric vein. Thrombotic risk factors in IBD include surgery, ports, malignancy, dehydration, malnutrition, and steroids at 53.7, 13.2, 13.1, 12.4, 8.9, and 8.2%, respectively. Those with thrombosis had greater severity of illness, 1.42 versus 0.96; length of stay, 7.7 versus 5.5 days; and mortality, 3.8 versus 1.5%; all
p
< 0.0001. Adjusting for age and comorbidity, odds ratios for predictors of thrombosis included ports, steroids, malnutrition, and malignancy at 1.73, 1.61, 1.34, and 1.13, respectively, while Asian race, 0.61, was protective, each
p
< 0.001.
Conclusion
Thrombosis prevalence is 1.7-fold greater in IBD than non-IBD patients. Adjusting for age and comorbidity, the odds ratio for thrombosis in IBD was 73% higher with ports, 61% higher with steroids, 34% with malnutrition, and 13% with malignancy. Whether long-term anticoagulation would benefit the latter is unknown.
Collapse
Affiliation(s)
- Jessica B Cohen
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center and Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, United States.,University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Diane M Comer
- University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, Pennsylvania, United States
| | - Jonathan G Yabes
- University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, Pennsylvania, United States
| | - Margaret V Ragni
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center and Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, United States.,University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
29
|
Katyal N, Korzep A, Newey C. Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke. J Neurosci Rural Pract 2019; 9:155-158. [PMID: 29456363 PMCID: PMC5812144 DOI: 10.4103/jnrp.jnrp_460_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Central venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed. He was found to have a right frontal ischemic stroke on computed tomography (CT). CT angiography noted that the catheter was arterial and had a thrombosis around it. He was started on a low-dose heparin infusion. A combination of cardiothoracic surgery and interventional cardiology was required to safely remove the catheter. Central arterial catheterization is an unusual cause for acute ischemic stroke and presents management challenges.
Collapse
Affiliation(s)
- Nakul Katyal
- Department of Neurology, University of Missouri, Columbia 63511, MO, USA
| | - Amanda Korzep
- Department of Emergency Medicine, University of Missouri, Columbia 63511, MO, USA
| | - Christopher Newey
- Department of Neurology, University of Missouri, Columbia 63511, MO, USA
| |
Collapse
|
30
|
Badheka A, Bloxham J, Schmitz A, Freyenberger B, Wang T, Rampa S, Turi J, Allareddy V, Auslender M, Allareddy V. Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience. BMJ Open 2019; 9:e026031. [PMID: 31444177 PMCID: PMC6707696 DOI: 10.1136/bmjopen-2018-026031] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme. DESIGN Retrospective cohort study. SETTING Single-centre, large quaternary children's hospital. PARTICIPANTS Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI. CONCLUSIONS The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.
Collapse
Affiliation(s)
- Aditya Badheka
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | - Jodi Bloxham
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | - April Schmitz
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | | | - Tong Wang
- Management Sciences, University of Iowa Henry B Tippie College of Business, Iowa City, Lowa, USA
| | - Sankeerth Rampa
- Health Care Administration, Rhode Island College, Providence, Rhode Island, USA
| | - Jennifer Turi
- Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | | | - Marcelo Auslender
- Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA
| | | |
Collapse
|
31
|
Kalisz K, Enzerra M, Ansari-Gilani K. Cardiovascular findings on cross-sectional imaging: spectrum of incidental and critical findings and clinical relevance for the abdominal radiologist. Abdom Radiol (NY) 2019; 44:1161-1180. [PMID: 30737548 DOI: 10.1007/s00261-019-01922-7] [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: 10/27/2022]
Abstract
Although not the primary focus of the exams, cardiovascular structures are included to some extent on all abdominal or whole-body cross-sectional studies. Cardiovascular findings often present incidentally and may range from chronic to acute and emergent pathologies. Among the most common cardiovascular findings are the presence of cardiac calcifications, most commonly coronary, which correlate with the presence of coronary artery and valvular disease. Signs of myocardial ischemia, both acute and chronic, and its complications may also be visualized. Cardiac filling defects most commonly represent thrombus and are associated with systemic arterial embolic complications. Pericardial findings often manifest as effusion or thickening, which may lead to hemodynamic consequences visible at imaging. Incidental pulmonary emboli and systemic venous thrombi may be incidentally detected, particularly in hospitalized and oncologic patients, and warrant immediate attention. This review will highlight the appearance of common and important incidental cardiovascular findings and related pitfalls and discuss reporting and follow-up recommendations relevant to the abdominal radiologist.
Collapse
Affiliation(s)
- Kevin Kalisz
- Department of Radiology, Duke University Medical Center, Durham, NC, USA.
| | - Michael Enzerra
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
32
|
Badger J. Long peripheral catheters for deep arm vein venous access: A systematic review of complications. Heart Lung 2019; 48:222-225. [PMID: 30660325 DOI: 10.1016/j.hrtlng.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Long peripheral catheters (LPCs) offer a quick, simple and cost-effective alternative for venous access in intensive care patients with difficult venous access, but the decision to use them must be balanced against an assessment of harm. The aim of this systematic review was to synthesise reports of complications associated with LPCs. METHODS The electronic databases MEDLINE, EMBASE and CINAHL were searched systematically for randomised controlled trials, cohort studies and case control studies published in the period 1966 to 24th July 2018 reporting LPC associated occlusion, catheter related blood stream infections, phlebitis and infiltration. Study quality was assessed using the Methodological Index for Non-Randomised Studies. The studies were described and participant characteristics; type of catheter; setting; average dwell time; and rates of occlusion, catheter related blood stream infection, phlebitis and infiltration were extracted as summary measures. RESULTS Five cohort studies and one randomised controlled study, comprising a total of 350 participants, fulfilled the inclusion criteria. Dwell time ranged from 1 to 15days and the reported complication rate was 3-14%. The most common complication was catheter occlusion (4%), followed by phlebitis (1%), infiltration (0.9%), and catheter related blood stream infection (0.3%). Significant heterogeneity, particularly in identification and reporting of complications, means results should be interpreted with caution. CONCLUSION There is a lack of intervention specific and adequately powered randomised controlled trials investigating LPCs in an intensive care setting. Until the results of such studies are available, LPCs should be used as an alternative to ultrasound-guided PVCs in well monitored acute care environments.
Collapse
Affiliation(s)
- James Badger
- Honorary Academic Research Trainee, University of Southampton NHS Trust, University of Southampton, University Road, Southampton, SO171BJ, United Kingdom.
| |
Collapse
|
33
|
Shatzel JJ, O'Donnell M, Olson SR, Kearney MR, Daughety MM, Hum J, Nguyen KP, DeLoughery TG. Venous thrombosis in unusual sites: A practical review for the hematologist. Eur J Haematol 2018; 102:53-62. [PMID: 30267448 DOI: 10.1111/ejh.13177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/13/2022]
Abstract
Thrombosis of unusual venous sites encompasses a large part of consultative hematology and is encountered routinely by practicing hematologists. Contrary to the more commonly encountered lower extremity venous thrombosis and common cardiovascular disorders, the various thromboses outlined in this review have unique presentations, pathophysiology, workup, and treatments that all hematologists should be aware of. This review attempts to outline the most up to date literature on cerebral, retinal, upper extremity, hepatic, portal, splenic, mesenteric, and renal vein thrombosis, focusing on the incidence, pathophysiology, provoking factors, and current recommended treatments for each type of unusual thrombosis to provide a useful and practical review for the hematologist.
Collapse
Affiliation(s)
- Joseph J Shatzel
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Matthew O'Donnell
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon
| | - Sven R Olson
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Matthew R Kearney
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon
| | - Molly M Daughety
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Justine Hum
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon
| | - Khanh P Nguyen
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Oregon
| | - Thomas G DeLoughery
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
34
|
Parisi L, Toffoli A, Ghiacci G, Macaluso GM. Tailoring the Interface of Biomaterials to Design Effective Scaffolds. J Funct Biomater 2018; 9:E50. [PMID: 30134538 PMCID: PMC6165026 DOI: 10.3390/jfb9030050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 12/21/2022] Open
Abstract
Tissue engineering (TE) is a multidisciplinary science, which including principles from material science, biology and medicine aims to develop biological substitutes to restore damaged tissues and organs. A major challenge in TE is the choice of suitable biomaterial to fabricate a scaffold that mimics native extracellular matrix guiding resident stem cells to regenerate the functional tissue. Ideally, the biomaterial should be tailored in order that the final scaffold would be (i) biodegradable to be gradually replaced by regenerating new tissue, (ii) mechanically similar to the tissue to regenerate, (iii) porous to allow cell growth as nutrient, oxygen and waste transport and (iv) bioactive to promote cell adhesion and differentiation. With this perspective, this review discusses the options and challenges facing biomaterial selection when a scaffold has to be designed. We highlight the possibilities in the final mold the materials should assume and the most effective techniques for its fabrication depending on the target tissue, including the alternatives to ameliorate its bioactivity. Furthermore, particular attention has been given to the influence that all these aspects have on resident cells considering the frontiers of materiobiology. In addition, a focus on chitosan as a versatile biomaterial for TE scaffold fabrication has been done, highlighting its latest advances in the literature on bone, skin, cartilage and cornea TE.
Collapse
Affiliation(s)
- Ludovica Parisi
- Centro Universitario di Odontoiatria, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Andrea Toffoli
- Centro Universitario di Odontoiatria, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Giulia Ghiacci
- Centro Universitario di Odontoiatria, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Guido M Macaluso
- Centro Universitario di Odontoiatria, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.
| |
Collapse
|
35
|
Dolmatch BL, Gurley JC, Baskin KM, Nikolic B, Lawson JH, Shenoy S, Saad TF, Davidson I, Baerlocher MO, Cohen EI, Dariushnia SR, Faintuch S, d’Othee BJ, Kinney TB, Midia M, Clifton J. Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction: Endorsed by the American Society of Diagnostic and Interventional Nephrology (ASDIN), British Society of Interventional Radiology (BSIR), Canadian Interventional Radiology Association (CIRA), Heart Rhythm Society (HRS), Indian Society of Vascular and Interventional Radiology (ISVIR), Vascular Access Society of the Americas (VASA), and Vascular Access Society of Britain and Ireland (VASBI). J Vasc Access 2018; 20:114-122. [DOI: 10.1177/1129729818791409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bart L Dolmatch
- Department of Interventional Radiology, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - John C Gurley
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Kevin M Baskin
- Department of Radiology, Advanced Interventional Institute, Pittsburgh, PA, USA
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, NY, USA
| | - Jeffrey H Lawson
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC, USA
| | - Surendra Shenoy
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Theodore F Saad
- Department of Radiology, St. Francis Hospital, Nephrology Associates, Wilmington, DE, USA
| | - Ingemar Davidson
- Department of Radiology, Tulane University, New Orleans, LA, USA
| | - Mark O Baerlocher
- Department of Interventional Radiology, Royal Victoria Hospital, Barrie, ON, Canada
| | - Emil I Cohen
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, GA, USA
| | - Salomão Faintuch
- Division of Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Thomas B Kinney
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Mehran Midia
- Department of Interventional Radiology, McMaster University, Hamilton, ON, Canada
| | | | | |
Collapse
|
36
|
Ulrych J, Kvasnicka T, Fryba V, Komarc M, Malikova I, Brzezkova R, Kvasnicka Jr J, Krska Z, Briza J, Kvasnicka J. The impact of hereditary thrombophilia on the incidence of postoperative venous thromboembolism in colorectal cancer patients: a prospective cohort study. Eur Surg 2018. [DOI: 10.1007/s10353-018-0534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Premuzic V, Perkov D, Smiljanic R. The development of central venous thrombosis in hemodialyzed patients is associated with catheter tip depth and localization. Hemodial Int 2018; 22:454-462. [PMID: 29722112 DOI: 10.1111/hdi.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of our work was to analyze the incidence of tunneled hemodialysis catheters-related thrombosis in hemodialyzed patients depending on catheter tip depth and position and to evaluate the impact of other established risk factors responsible for development of central venous thrombosis. METHODS The presence of central vein thrombosis, location, and the depth of the catheter tip was reviewed by two experienced radiologists. All patients with suspected central venous thrombosis had factor V Leiden, lupus anticoagulant, and cardiolipin antibodies checked (acIgM and acIgG) and were evaluated with cat-scan venography. FINDINGS A total of 68 tunneled hemodialysis catheters were analyzed with CT venography for central venous thrombosis. There were no signs of central venous thrombosis when catheter tips were placed in the right atrium. There was significantly higher number of catheter tips located on the vein wall than located centrally in patients with central venous thrombosis. Higher percentage of central venous thrombosis, smaller number of tips placed in the right atrium, higher values of IgM cardiolipin antibodies, and higher number of patients with positive factor V Leiden mutation were found in group of patients with catheter tips located on vein wall. DISCUSSION Higher incidence of central venous thrombosis in patients with the catheter tip placed on the vein wall is a consequence of a catheter tip depth proximal of the right atrium. Increased factor V Leiden mutation and acIgM values in these patients should be observed as a result of the vein stasis caused by inappropriate catheter tip depth and localization.
Collapse
Affiliation(s)
- Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Drazen Perkov
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ranko Smiljanic
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| |
Collapse
|
38
|
Nañez-Terreros H, Jaime-Perez JC, Muñoz-Espinoza LE, Camara-Lemaroy CR, Ornelas-Cortinas GE, Ramos-Dena RD, Gonzalez-Guerrero JF, Nangullasmu-Plasencia T, Gonzalez-Escamilla M, Chipuli-Lopez O. D-dimer from central and peripheral blood samples in asymptomatic central venous catheter-related thrombosis in patients with cancer. Phlebology 2018; 34:52-57. [DOI: 10.1177/0268355518772171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the usefulness of a negative D-dimer in peripheral or central venous blood to screen for asymptomatic catheter-related thrombosis in cancer patients. Methods D-dimer was measured in blood from central venous catheter and peripheral venous samples in 48 patients with cancer. Asymptomatic catheter-related thrombosis was identified via Doppler ultrasound. Bland and Altman’s limits of agreement analysis was used to compare sample sites. Sensitivity and specificity of D-dimer was calculated. Results Overall, 33 of the central samples and 32 of the peripheral samples had D-dimer levels below the cutoff (≥0.3 mg/l). Mean central D-dimer was 0.31 ± 0.35 mg/l; peripheral 0.24 ± 0.22 mg/l (p = 0.5). Bland–Altman plot showed that the two sample sites were not equivalent. Catheter-related thrombosis was demonstrated in five patients, and there were three false negatives. Peripheral D-dimer had a negative predictive value of 90.9%. Conclusions A negative D-dimer may be useful for screening asymptomatic catheter-related thrombosis in patients with cancer, but the central and peripheral sample sites are not equivalent.
Collapse
Affiliation(s)
- Homero Nañez-Terreros
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jose C Jaime-Perez
- Hemathology Service, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Linda E Muñoz-Espinoza
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Carlos R Camara-Lemaroy
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Gerardo E Ornelas-Cortinas
- Radiology Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Ricardo D Ramos-Dena
- Radiology Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Juan F Gonzalez-Guerrero
- Oncology and Radiotherapy Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Tomas Nangullasmu-Plasencia
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Moises Gonzalez-Escamilla
- Oncology and Radiotherapy Department, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Osvaldo Chipuli-Lopez
- Internal Medicine Department Research Team, Faculty of Medicine and Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| |
Collapse
|
39
|
Latest Innovations in the Treatment of Venous Disease. J Clin Med 2018; 7:jcm7040077. [PMID: 29641492 PMCID: PMC5920451 DOI: 10.3390/jcm7040077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 12/16/2022] Open
Abstract
Venous disease is more common than peripheral arterial disease. Pathophysiologically, venous disease can be associated with obstruction, reflux, or both. A common feature in chronic venous disease is ambulatory venous hypertension. Inflammatory and pro-thrombotic mechanisms can be activated. The current therapies, including compression, ablation, and recanalization are discussed.
Collapse
|
40
|
Dolmatch BL, Gurley JC, Baskin KM, Nikolic B, Lawson JH, Shenoy S, Saad TF, Davidson I, Baerlocher MO, Cohen EI, Dariushnia SR, Faintuch S, Janne d’Othee B, Kinney TB, Midia M, Clifton J, Baerlocher MO, Baskin K, Clifton J, Dalley A, Dariushnia S, Davidson I, Dolmatch B, Gurley J, Haskal Z, Journeycake J, Lawson J, McLennan G, Nikolic B, Ramsburg D, Ross J, Saad T, Shenoy S, Spencer B, Thompson D, Walker TG, Walser E. Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction. J Vasc Interv Radiol 2018; 29:454-460.e3. [DOI: 10.1016/j.jvir.2017.12.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 10/17/2022] Open
|
41
|
Kim JH, Kim JE, Hong YS, Kim SY, Kim KP, Choi KE, Shin JH, Kim TW. Increased incidence of chemoport-related thrombosis in patients with colorectal cancer receiving bevacizumab: A single-institutional experience. Chin J Cancer Res 2018; 30:460-467. [PMID: 30210226 PMCID: PMC6129570 DOI: 10.21147/j.issn.1000-9604.2018.04.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Chemoport-related thrombosis (CRT) is a serious complication that causes morbidities and interrupts administration of intravenous cancer therapy. We investigated the incidence and risk of CRT in colorectal cancer (CRC) patients treated with bevacizumab (BEV). Methods We retrospectively reviewed 1,534 CRC patients who received chemotherapy with or without BEV using a chemoport between 2014 and 2016. Results The participants had a median age of 58 (18−85) years, and 60.3% were male. All participants were stratified into three groups: adjuvant chemotherapy (AC) (n=670), palliative chemotherapy (PC) without BEV (n=356), and PC with BEV (n=508). The median follow-up was 20.19 (interquartile range, 14.07−27.19) months. CRT occurred in 3.8% of all patients; incidence of symptomatic and asymptomatic CRT was 2.9% and 0.9%, respectively. CRT occurred more in patients with BEV (5.7%) than in patients without BEV (2.9%, P=0.008). The cumulative incidence of CRT in patients administered PC with BEV was significantly higher than that in those administered AC (P=0.011) and there was a trend toward increased CRT in patients administered PC with BEV compared with those administered PC without BEV (P=0.044). Multivariate analysis found that BEV treatment was the only variable that was significantly associated with CRT (hazard ratio, 2.06; 95% confidence interval, 1.24−3.43; P=0.006). Conclusions BEV treatment was significantly associated with increased incidence of CRT in CRC patients.
Collapse
Affiliation(s)
- Jwa Hoon Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Jeong Eun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Kyu-Pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Ki Eun Choi
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
| |
Collapse
|
42
|
Moir D, Bodenham A. A narrative review of long-term central venous access devices for the intensivist. J Intensive Care Soc 2017; 19:236-246. [PMID: 30159016 DOI: 10.1177/1751143717741249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Long-term central venous access devices are increasingly prevalent and consequently often encountered by intensivists. This review introduces the different types of long-term central venous access devices, outlines their potential utility, examines potential complications associated with their use and outlines an approach to the management of these complications.
Collapse
Affiliation(s)
- David Moir
- Anaesthesia and Intensive Care Medicine, Leeds Teaching Hospital, Leeds, UK
| | - Andrew Bodenham
- Anaesthesia and Intensive Care Medicine, Leeds Teaching Hospital, Leeds, UK
| |
Collapse
|
43
|
Wallace A, Albadawi H, Patel N, Khademhosseini A, Zhang YS, Naidu S, Knuttinen G, Oklu R. Anti-fouling strategies for central venous catheters. Cardiovasc Diagn Ther 2017; 7:S246-S257. [PMID: 29399528 DOI: 10.21037/cdt.2017.09.18] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs.
Collapse
Affiliation(s)
- Alex Wallace
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Nikasha Patel
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences, University of California-Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.,Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA, USA.,California NanoSystems Institute (CNSI), University of California-Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Grace Knuttinen
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
44
|
Point-of-Care Ultrasound Identification of Internal Jugular Vein Thrombosis in Newly Diagnosed Lymphoma. Pediatr Emerg Care 2017; 33:800-802. [PMID: 29095387 DOI: 10.1097/pec.0000000000001333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a child who presented with neck swelling and was ultimately diagnosed with lymphoma after an internal jugular vein thrombosis was discovered by point-of-care ultrasound. The use of point-of-care ultrasound enabled thrombus detection, which prompted further evaluation and treatment.
Collapse
|
45
|
Incidence of Cannula-Associated Deep Vein Thrombosis After Veno-Venous Extracorporeal Membrane Oxygenation. ASAIO J 2017; 63:588-591. [DOI: 10.1097/mat.0000000000000539] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
|
46
|
Crespo-Burillo J, Alarcia-Alejos R, Capablo-Liesa J. Superior vena cava syndrome as a complication of intravenous immunoglobulin treatment. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
47
|
Síndrome de vena cava superior como complicación del tratamiento con inmunoglobulinas intravenosas. Neurologia 2017; 32:202-204. [DOI: 10.1016/j.nrl.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/13/2015] [Accepted: 05/24/2015] [Indexed: 11/20/2022] Open
|
48
|
Petridis C, Nitschke M, Lehne W, Smith E, Goltz J, Lehnert H, Meier M. Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate. Eur J Vasc Endovasc Surg 2017; 53:262-267. [DOI: 10.1016/j.ejvs.2016.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
|
49
|
Asfaw AB, Punzalan RC, Yan K, Hoffmann RG, Hanson SJ. Screening Guidelines for Venous Thromboembolism Risk in Hospitalized Children Have Low Sensitivity for Central Venous Catheter-Associated Thrombosis. Hosp Pediatr 2016; 7:39-45. [PMID: 27965360 DOI: 10.1542/hpeds.2016-0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Local pediatric screening guidelines for venous thromboembolism (VTE) are developed from incomplete pediatric data and extrapolated from adult data in which immobility is a major risk factor. We hypothesized that screening guidelines centered on immobility are inadequate for identifying children at risk of central venous catheter (CVC)-associated VTE. METHODS This retrospective case-control (4:1) study at an academic, quaternary-level, free-standing children's hospital applied screening guidelines for VTE risk to all cases of VTE from July 2012 to April 2014. Cases and controls were classified as "at risk" or "not at risk" of VTE by guideline criteria. These guidelines assessed VTE risk factors, including CVC, as reported in the pediatric literature. RESULTS VTE prevalence was 0.5 per 100 admissions. Sixty-nine of 114 patients with radiographically confirmed VTE were classified as being "at risk" by the guidelines, with a sensitivity of 61%, specificity of 90.8%, a positive predictive value of 2.4%, and negative predictive value of 99.8%. There was no difference in screening guidelines sensitivity for identifying CVC-associated VTE versus non-CVC-associated VTE. Half of the 45 patients with VTE who were not captured as being "at risk" did not have decreased mobility, the entry point to the algorithm, and 80% of these patients had a CVC. CONCLUSIONS Screening guidelines have low sensitivity for identifying hospitalized children at increased risk of both CVC-associated and other VTE events. Decreased mobility is not a requirement for CVC-associated VTE. Risk factors extrapolated from adult data are insufficient for identifying children at risk of VTE.
Collapse
Affiliation(s)
- Asfawossen B Asfaw
- Grand Strand Regional Medical Center, Children's Healthcare Services of South Carolina, Myrtle Beach, South Carolina
| | - Rowena C Punzalan
- Divisions of Hematology and.,Children's Hospital and Health System, Milwaukee, Wisconsin; and
| | - Ke Yan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Raymond G Hoffmann
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sheila J Hanson
- Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin;
| |
Collapse
|
50
|
An overview of hematopoietic stem cell transplantation related thrombotic complications. Crit Rev Oncol Hematol 2016; 107:149-155. [DOI: 10.1016/j.critrevonc.2016.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/19/2016] [Accepted: 09/21/2016] [Indexed: 02/07/2023] Open
|