Symptoms and signs of port-related infections in oncology patients related to the offending pathogens

Adverse events associated with home blood transfusion: A retrospective cohort study

AIMS AND OBJECTIVES

To determine the rate of individual and system adverse events associated with blood transfusion at home.

BACKGROUND

Home or residential care facility based blood transfusion is beneficial for individuals requiring transfusion due to reduced disruption to daily life and the comfort of a familiar environment. However, blood transfusion may result in serious adverse events. There is a lack of research in this area, and there is a need to identify rates of adverse events and evaluate the system used for this service.

DESIGN

Retrospective cohort study.

METHODS

Existing data routinely collected for clinical care were used to determine client and system adverse events of medically stable adults with a chronic disease who underwent blood transfusion in a home setting provided by a nurse-led service. A STROBE EQUATOR checklist was used for this study (see Appendix S1).

RESULTS

There were 1790 episodes of care involving 533 participants, with 13 cases of transfusion reaction (incident rate [IR] 0.7%; 95% CI 0.43-1.25). Only five of these were severe, resulting in the cessation of the blood transfusion and further medical review or hospital admission (IR 0.28%; 95% CI 0.12-0.68). There were no cases of tampered blood packaging, expired or visually damaged blood products. There were 10 cases of incorrect paperwork (0.6%) and nine cases of incorrect temperature (0.5%). There were 153 cases of vascular access device adverse events (IR 8.5% 95% CI 7.3-9.9), most commonly, difficulty cannulating the individual (n = 82, 54%).

CONCLUSIONS

A nurse-led home blood transfusion service was associated with low rates of both individual and system adverse events. Further research is needed to explore the perception of those using this service and supports required to improve the experience.

RELEVANCE TO CLINICAL PRACTICE

Blood transfusions may be associated with increased risk of morbidity and mortality. This risk may be increased in a home setting due to the distance from an acute care facility. This study has demonstrated that a nurse-led home blood transfusion service is safe (<1% adverse event rate) for those with a medically stable, chronic condition. There were few failures in the system used to provide this service. Adverse events associated with the vascular access device were the most common complication and the reason for most blood product wastage. Mainly, this was due to difficulty inserting the short-term peripheral intravenous catheter (PIVC). RNs should consider ultrasound to aid PIVC insertion to facilitate treatment provision and enhance the experience of the individual.

Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli

BACKGROUND

Implantable venous access port (IVAP)-related blood stream infections (BSIs) are one of the most common complications of implantable venous ports. The risk factors and pathogens for IVAP-related BSIs are still controversial.

METHODS

We retrospectively reviewed all patients who received IVAPs at a Hospital in Taiwan from January 1, 2011 to June 31, 2014. Two types of venous port, BardPort® 6.6 fr (Bard port) and Autosuture Chemosite® 7.5 fr (TYCO port) were used. All patients with clinically proven venous port-related BSIs were enrolled.

RESULTS

A total of 552 patients were enrolled. There were 34 episodes of IVAP-related BSIs during the study period for a total incidence of 0.177 events/1000 catheter days. Port type (TYCO vs. Bard, HR = 7.105 (95% confidence interval (CI), 1.688-29.904), p = 0.0075), age > 65 years (HR = 2.320 (95 % CI, 1.179-4.564), p = 0.0148), and lung cancer (HR = 5.807 (95% CI, 2.946-11.447), p < 0.001) were risk factors for port infections. We also found that no local sign of infection was significantly associated with the growth of gram-negative bacilli (p = 0.031).

CONCLUSIONS

TYCO venous ports, age > 65 years, and lung cancer were all significant risk factors for IVAP-related BSIs, and no sign of infection was significantly associated with the growth of gram-negative bacilli.

Incidence and risk factors for central venous access port-related infection in Chinese cancer patients

BACKGROUND/PURPOSE

Cytotoxic chemotherapy via central venous access ports is an important part of the standard treatment for most cancers, but it is accompanied with the risk of infections. This study aimed to analyze the incidence and risk factors for central venous access port-related infection (CPI) among Chinese patients receiving cytotoxic chemotherapy.

METHODS

Between January 1, 2002 and December 31, 2005 a total of 1391 cancer patients with 1449 totally implantable central venous access ports were evaluated. The log-rank test and Cox proportional hazards model were used for the analyses of risk factors.

RESULTS

The overall CPI incidence rate was 0.21 per 1000 catheter-days. Hematological malignancies and head and neck cancer were associated with an increased risk of CPI (hazard ratio 4.00 and 4.11, respectively, both p < 0.001) and less infection-free catheter longevity (p < 0.001) compared with other cancer types. Chemotherapy in an adjuvant setting was associated with a lower risk of infection than for patients in a nonadjuvant setting (p < 0.001). The most common pathogens isolated from CPI were Pseudomonas aeruginosa and Candida.

CONCLUSION

Infection remains to be a challenging issue for totally implantable central venous ports. Implementation of an insertion bundle for the prevention of central line-associated bloodstream infections is warranted, especially for those patients with hematological and head and neck cancers, as well as for patients receiving chemotherapy in the metastatic settings.

Non-cephalosporin-susceptible, glucose non-fermentative Gram-negative bacilli meningitis in post-neurosurgical adults: clinical characteristics and therapeutic outcome

OBJECTIVE

The clinical and laboratory characteristics of non-cephalosporin-susceptible (non-CS) glucose non-fermentative Gram-negative (G(-)) infections in adults with postneurosurgical meningitis are rarely examined solely in the literature.

METHODS

The data of 28 post-neurosurgical adults meningitis with glucose non-fermentative G(-) infections, collected during a study period of 5 years (2006-2010), were reviewed. The clinical and laboratory data between the non-cephalosporin-susceptible groups and the cephalosporin-susceptible groups were compared.

RESULTS

A total of 30 G(-) strains were collected from the 28 enrolled cases. Among the implicated glucose non-fermentative G(-) strains, 18 strains, belonging to 17 cases, were non-CS. Among the 18 non-cephalosporin-susceptible strains, Acinetobacter spp. (39%, 7/18) was the most common, followed by Pseudomonas spp. (22%, 4/18), Stenotrophomonas maltophilia (22%, 4/18) and Elizabethkingia meningoseptica (11%, 2/18). With a comparative analysis, there were no significant difference between the non-cephalosporin-susceptible and cephalosporin-susceptible glucose non-fermentative G(-) groups. The clinical and laboratory data were also of no statistical significance between the fatal (n=4) and non-fatal (n=13) non-cephalosporin-susceptible groups.

CONCLUSION

Sixty percent (18/30) of implicated glucose non-fermentative G(-) strains of post-NS meningitis in adults are non-cephalosporin-susceptible. Among the non-cephalosporin-susceptible glucose non-fermentative G(-) strains, Acinetobacter spp., Pseudomonas spp., S. maltophilia and E. meningoseptica are the commonly implicated pathogens, and their emergence in this specific group of meningitis has caused a therapeutic dilemma. The clinical manifestations of non-cephalosporin-susceptible glucose non-fermentative G(-) meningitis were not unique; therefore, only bacterial culture and antimicrobial susceptibility test are the methods for identification confirmation.

Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients

BACKGROUND

The purpose of this study is to characterize the risk factors of bloodstream infection (BSI) associated with the use of permanent implantable venous ports (Port-A) in solid cancer patients.

METHODS

Solid cancer patients implanted with a Port-A were prospectively observed for the occurrence of Port-A-associated BSI (PABSI), defined as BSI without other identifiable infection foci. A PABSI risk score was developed using the Cox proportional hazards model.

RESULTS

A total of 415 patients were registered; 88 PABSI episodes occurred in 58 patients (incidence1.05 per 1000 catheter-days). All but one patient had stage IV cancer. Independent predictors of PABSI occurrence included neutropenia, total parenteral nutrition (TPN), chronic steroid use, invasive procedures, postoperative antibiotics, and preoperative antibiotics. A PABSI risk score with a cut-off value of 0 (sensitivity 88.5%, specificity 64.3%) was defined for stage IV cancer patients as follows: neutropenia, +1.350; TPN, +1.256; chronic steroid use, +1.947; preoperative antibiotics, -0.970; postoperative antibiotics, +0.959; and invasive procedures, +1.098. The median PABSI-free survival was 4.47 months for patients with scores ≥ 0 but not reached for patients with scores <0 (P < 0.0001).

CONCLUSION

The PABSI risk score can assist in identifying high-risk solid cancer patients and may assist in designing future preventive strategies.

Central venous port-related infection in patients with malignant tumors: an observational study

PURPOSE

We evaluated the characteristics of central venous port (CVP)-related infection with microbiological assessments in patients with malignant tumors.

MATERIALS AND METHODS

In a prospective setting, patients with CVP for the treatment of malignant tumors were enrolled in this study. The incidence of CVP-related infection during three months was determined. Microbiological surveillance from skin swab was performed before and after CVP placement.

RESULTS

Fifty-nine patients were enrolled in this study, and 60 CVPs were implanted. Thirty-six (61%) patients had head and neck malignancies. Access route was subclavian vein in 43 (71.7%) CVPs and forearm vein in 17 (28.3%). CVP-related infection was observed in three (5.1%) patients: port-pocket infection in one and probable CVP-related infection in two patients, respectively. No definitive CVP-related bloodstream infection was observed. Before the placement of CVP, colonization at the insertion site was observed in ten subclavian CVP patients, while no colonization was observed in the forearm CVP patients. At 1 and 4 weeks, detection rates of colonization were also higher in subclavian CVP patients. No definitive relationship was demonstrated between skin colonization and clinical development of CVP-related infection.

CONCLUSION

The rate of CVP-related infection in this prospective evaluation in patients with malignant tumors was comparable to previous studies. Colonization of the skin was more prominent in the subclavian site than in the forearm site. Although skin colonization was not proven to be a risk factor of infection, these results may draw attention to the adequate maintenance of CVP. (

TRIAL REGISTRATION

UMIN000003664).

[Percutaneous implantable port-related infection and thrombosis: diagnostic and management]

Taking care of patients in oncology needs safety venous access, as percutaneous implantable port. These venous devices are sometimes responsible for serious adverse events. Infection and thrombosis are the two main complications that can occur early or be delayed. Clinical examination and especially, evaluation of the severity are very important keys to manage the patients. They both can lead to the ablation of the central venous device, which is an option to keep always in mind. However, whatever the clinical situation is, the oncologic context such as life expectancy and the need for a venous access is also a data to counterbalance.

Anesthetic considerations for the pediatric oncology patient--part 3: pain, cognitive dysfunction, and preoperative evaluation

In part three of this three-part review, we continue with discussion of the effects of tumor and its therapy as they impact neurocognitive functioning, psychosocial issues of the patient and family, and the mechanisms and experience of pain in the child with cancer. A discussion of preanesthetic testing and evaluation in this patient population is next presented for the reader, focusing on the factors which pose the commonest and greatest risks to the child undergoing surgery. Lastly, an algorithmic approach to evaluating and managing key components of the medical history of pediatric patients is presented.