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Sherwood SJ, Tak C, Bhakta ZN, Packer K, Jacobs H, Liou TG, Young DC. A comparison of aminoglycoside antibiotic serum concentrations collected by peripheral veins and peripherally inserted central catheters in adults with cystic fibrosis. Pediatr Pulmonol 2024; 59:1740-1746. [PMID: 38501330 DOI: 10.1002/ppul.26986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND People with cystic fibrosis (PwCF) are frequently hospitalized for treatment of pulmonary exacerbation. The Cystic Fibrosis Foundation Pulmonary Guidelines support the use of intravenous aminoglycosides with therapeutic drug monitoring for the treatment of pulmonary exacerbation due to Pseudomonas aeruginosa. Serum intravenous tobramycin concentrations are commonly collected by peripheral venipuncture (PV). Discomfort associated with collection of samples by PV prompts collection via PICC, but the accuracy of intravenous tobramycin serum levels collected by PICC has not been documented in adult PwCF. The primary study objective was to evaluate the difference between intravenous tobramycin serum levels collected by PV and PICC in adult PwCF. METHODS The authors conducted a prospective case-control study of adult PwCF admitted to University of Utah Health for a pulmonary exacerbation receiving tobramycin by a single lumen PICC. The authors compared tobramycin peak and random serum levels collected by PV and PICC using a detailed flush and waste protocol. RESULTS The authors analyzed a total of 19 patients with peripheral and PICC samples. The mean tobramycin peak collected by PV (27.2 mcg/mL) was similar to the mean peak collected by PICC (26.9 mcg/mL) (paired samples Wilcoxon signed-rank test, p = .94). The correlation coefficient was 0.88 (95% CI = 0.85-0.91, p < .001). CONCLUSION Tobramycin serum samples collected by PICC appear to be similar in value to PV collections. Collecting aminoglycoside levels by PICC rather than PV may reduce patient discomfort and improve quality of life. Additional multicenter studies are needed to confirm these results.
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Affiliation(s)
- Sabrina J Sherwood
- The Cystic Fibrosis Center of Idaho, St. Luke's Health System, Boise, Idaho, USA
| | - Casey Tak
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Department of Pharmacotherapy, The University of North Carolina at Chapel Hill, Asheville, North Carolina, USA
| | - Zubin N Bhakta
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
| | - Kristyn Packer
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Hollyann Jacobs
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
| | - Theodore G Liou
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David C Young
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
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Tumelty H, Shenton G, Brodlie M. Are trough tobramycin concentrations taken from a central venous catheter accurate enough to safely use? Arch Dis Child 2022; 107:512-514. [PMID: 35210219 DOI: 10.1136/archdischild-2022-323836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Hannah Tumelty
- General Paediatrics, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Geoff Shenton
- Paediatric Oncology and Haematology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne, UK
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Peck Palmer OM, Dasgupta A. Review of the Preanalytical Errors That Impact Therapeutic Drug Monitoring. Ther Drug Monit 2021; 43:595-608. [PMID: 33928931 DOI: 10.1097/ftd.0000000000000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Preanalytical errors comprise the majority of testing errors experienced by clinical laboratories and significantly impact the accuracy of therapeutic drug monitoring (TDM). METHODS Specific preanalytical factors in sample timing, collection, transport, processing, and storage that lead to errors in TDM were reviewed. We performed a literature search using several scientific databases including PubMed, ScienceDirect, Scopus, Web of Science, and ResearchGate for human studies published in the English language from January 1980 to February 2021, reporting on TDM and the preanalytical phase. RESULTS Blood collection errors (ie, wrong anticoagulant/clot activator used, via an intravenous line, incorrect time after dosing) delay testing, cause inaccurate results, and adversely impact patient care. Blood collected in lithium heparin tubes instead of heparin sodium tubes produce supertoxic lithium concentrations, which can compromise care. Specimens collected in serum separator gel tubes cause falsely decreased concentrations due to passive absorption into the gel when samples are not processed and analyzed quickly. Dried blood spots are popular for TDM as they are minimally invasive, allowing for self-sampling and direct shipping to a clinical laboratory using regular mail. However, blood collection techniques, such as trauma to the collection site, filter paper fragility, and hematocrit (Hct) bias, can adversely affect the accuracy of the results. Volumetric absorptive microsampling is a potential alternative to dried blood spot that offers fast, volume-fixed sampling, low pain tolerance, and is not susceptible to Hct concentrations. CONCLUSIONS The identification of preanalytical factors that may negatively impact TDM is critical. Developing workflows that can standardize TDM practices, align appropriate timing and blood collection techniques, and specimen processing will eliminate errors.
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Affiliation(s)
- Octavia M Peck Palmer
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, Texas
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Cefepime therapeutic drug monitoring: Evaluation of agreement between peripheral and central venous blood sampling. Clin Chim Acta 2020; 510:450-454. [PMID: 32795542 DOI: 10.1016/j.cca.2020.08.015] [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: 04/08/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Therapeutic drug monitoring for cefepime is increasingly being performed because of the potential relation between exposure and neurotoxicity. An in vitro pilot study suggested significant carryover of cefepime from central venous catheters when blood sampling is carried out via the same catheter used for administration of cefepime. Therefore, the aim of this study was to evaluate carryover of cefepime in a real-life clinical setting. METHODS A prospective single-center study was conducted at the hematology department of the University Hospitals Leuven. Patients treated with cefepime, and having a central venous catheter, were included. Cefepime trough samples were taken simultaneously via the central venous catheter and peripheral venepuncture. RESULTS Twenty-four patients were included in this study, resulting in 28, 11 and 5 paired samples for tunnelled catheters, implantable port catheters and peripherally inserted central catheters, respectively. No statistically nor clinically significant difference was found between cefepime concentrations measured in centrally versus peripherally obtained blood samples, overall and for all three types of central venous catheters separately. Of note, four paired samples showed a difference larger than 10%, with lower central concentrations probably reflecting a dilution error. CONCLUSION There was no significant carryover of cefepime from long-term central venous catheters. Cefepime samples can be drawn reliably via the central venous catheter, after flushing and discarding the first blood sample. Although, flushing and discard volumes should be standardized to avoid potential dilution errors.
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Complete Blood Count Collected Via Venipuncture Versus Peripherally Inserted Central Catheter in Hematological Patients: A Comparison of 2 Methods. Cancer Nurs 2020; 45:E36-E42. [PMID: 32769376 DOI: 10.1097/ncc.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of peripherally inserted central catheters (PICCs) in cancer care is increasing over traditional central venous catheters. Nurses frequently collect blood by venipuncture when a PICC is inserted, as there is no available evidence to confirm the reliability of blood tests collected through PICCs in adults. OBJECTIVE The aim of this study was to assess the reliability of blood samples for complete blood count (CBC) obtained through PICCs as an alternative to venipuncture. METHODS A cross-sectional design was used to recruit adult hematological patients. The blood samples were collected within 5 minutes of each other by a specialist nurse. Hemoglobin, hematocrit, and platelet count were evaluated. To determine method comparison, Passing-Bablok regression, test of linearity, Pearson product-moment correlation coefficient, and Bland-Altman plots were used. RESULTS Thirty paired blood samples were collected in 29 hematological patients with a mean age of 66.8 years. A statistical difference was found for hemoglobin (P = .001) and hematocrit (P = .001) levels, but no clinical difference. The regression models revealed no systematic differences and no proportional differences with a linear relationship between the methods. Bland-Altman plots highlighted a good agreement between methods. CONCLUSION Blood samples for CBC drawn by PICCs are as reliable as those collected via venipuncture. Blood sampling via PICC could be recommended in people with hematological malignancies in needs of frequent blood tests. IMPLICATIONS FOR PRACTICE Sampling through a PICC provides reliable laboratory results for CBC, and it could reduce patients' discomfort and increase the safety of professionals reducing the risk of accidental percutaneous needlestick injuries.
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Lichliter RL, Tremewan LE, Shonka NM, Mehnert JE, Brennan L, Thrasher JM, Hernandez TL. Therapeutic antibiotic serum concentrations by two blood collection methods within the pediatric patient: A comparative effectiveness trial. J SPEC PEDIATR NURS 2018; 23:e12212. [PMID: 29461683 DOI: 10.1111/jspn.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/04/2018] [Accepted: 01/19/2018] [Indexed: 11/26/2022]
Abstract
Repeated venipunctures and fingersticks to confirm serum drug concentrations cause pain and dissatisfaction for pediatric patients and their families. In many organizations, the standard of care to obtain therapeutic serum drug concentrations by peripheral venipuncture or capillary fingerstick, even when the patient has an existing peripheral intravenous catheter (PIV) or central venous catheter (CVC). The primary objective of this study was to assess agreement between serum tobramycin/vancomycin concentrations collected from a CVC or PIV, versus venipuncture or fingerstick. Among hospitalized pediatric patients (age 3 months to 22 years), 36 paired blood samples were collected. Serum trough vancomycin and random tobramycin concentrations were compared between peripheral intravenous or CVC samples, and venipuncture or fingerstick samples within the same patient. A strict sampling protocol for obtaining the samples was followed, that included collection of the CVC/PIV sample before the venipuncture or fingerstick, less than 2 min between collections of samples from the different sites, and a strict volume-based flush and waste protocol. Concordant correlation coefficients demonstrated substantial agreement between CVC/PIV and venipuncture/fingerstick concentrations for vancomycin (n = 17) and tobramycin (n = 19) (Rc = 0.982 for both). Bland-Altman analyses demonstrated good overall between-method agreement within subjects and minimal bias. Consequently, using a lumen volume-based flush and waste protocol, children with indwelling catheters may not require additional venipunctures and/or fingersticks for confirmation of drug concentrations while hospitalized, improving the quality of care and patient satisfaction.
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Affiliation(s)
| | | | | | | | | | | | - Teri L Hernandez
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
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Qi HJ, Yang WW, Zhang LD, Shi XJ, Li QY, Ye T. Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters. Ann R Coll Surg Engl 2017; 99:358-362. [PMID: 28462656 PMCID: PMC5449693 DOI: 10.1308/rcsann.2017.0004] [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] [Accepted: 12/02/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intravenous calcium supplements are often required following parathyroidectomy to avoid postoperative hypocalcaemia. The aim of this study was to compare application effect of a femoral central venous catheter (CVC) and peripherally inserted central catheter (PICC) on intravenous calcium supplements after parathyroidectomy. METHODS We retrospectively reviewed the hospital records of 73 patients with secondary hyperparathyroidism who underwent a successful parathyroidectomy at the Huashan Hospital attached to Fudan University between 1 April 2011 and 1 February 2016. RESULTS Of the 73 study participants, 39 (53.4%) had a PICC and 34 (46.6%) had a CVC, respectively. Patients in the CVC group needed 6-7 days of intravenous calcium supplements, while patients in PICC group needed only 2-3 days to achieve normal serum calcium concentration (2.2-2.6 mmol/L). Furthermore, the duration of calcium supplementation was 71.62 ± 4.48 hours in PICC group and 100.4 ± 5.43 hours in CVC group (P < 0.05). Of the patients in PICC group, the incidence of catheter occlusion, operation failure and hypocalcaemia was 0%, which was significantly lower than those in CVC group (2.56%, 7.69% and 7.69%, respectively). CONCLUSIONS PICC is a safe and efficient alternative in contrast to CVC for providing venous access for calcium supplementation in surgical patients after parathyroidectomy.
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Affiliation(s)
- H J Qi
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - W W Yang
- General Surgery Unit, Huashan Hospital, Fudan University , Shanghai , China
| | - L D Zhang
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - X J Shi
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - Q Y Li
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - T Ye
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
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Green ME, Sullivan KJ, Wells S, Board R, Feldman HA, McCabe M. A Comparison of Antibiotic Serum Concentrations Drawn Simultaneously from Peripherally Inserted Central Catheters and Peripheral Veins in Children with Respiratory Infection. J Pediatr Nurs 2015; 30:868-76. [PMID: 26382967 DOI: 10.1016/j.pedn.2015.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
The purpose of the study was to evaluate serum concentration of antibiotics drawn from a peripherally inserted central catheter (PICC) compared with a peripheral venipuncture. This prospective comparative study included patients with ages 1month to 21years admitted with a respiratory infection requiring IV vancomycin or IV tobramycin via a newly placed PICC. The difference between the antibiotic levels from the venipuncture and PICC samples was statistically significant for both the peak and trough levels. However, the difference in values was not enough to impact antibiotic dosing and therefore was not clinically significant.
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Affiliation(s)
| | | | | | | | - Henry A Feldman
- Clinical Research Center, Boston Children's Hospital, Boston, MA
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