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Vieira Filho JF, Ribeiro VN, do Nascimento ÁMA, Maria Alves de Melo M. Infections in Children with Cancer Admitted in an Oncology Reference Hospital: A Cross-sectional Study. Curr Microbiol 2023; 80:315. [PMID: 37544971 DOI: 10.1007/s00284-023-03420-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Pediatric oncology patients are usually immunosuppressed due to factors such as the neoplasm and its treatment, making them more susceptible to infections. This article aims to determine the infection profile of pediatric oncology patients admitted to an oncology reference hospital in Natal, Rio Grande do Norte, Brazil. A retrospective and cross-sectional study was conducted, collecting data from patients hospitalized due to infection in a pediatric oncology unit exclusively for the Brazilian public health system, spanning from 2018 to 2021. A total of 168 episodes of infections were identified in 96 patients, resulting in 157 hospitalizations. Among the patients with infections, 62.4% had hematological malignancies, and out of these cases, 74.6% specifically had Acute Lymphoid Leukemia. The Escherichia coli (31.9%) was the most prevalent microorganism isolated from the samples. Multidrug-resistant microorganisms accounted for 52% of all identified microorganisms. Fluoroquinolones and beta-lactam were the most prevalent antibiotic classes in the analyzed antibiograms. Factors such as Sex, type of cancer, chemotherapy in the last 30 days, were found to be associated with the occurrence of infection (p < 0.05). Conducting epidemiological studies regarding infections in pediatric oncology is crucial to development of empirical protocols, and the implementation of strategies to better control future infections.
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Affiliation(s)
- Jonas Fernandes Vieira Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | - Viviane Nunes Ribeiro
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | | | - Menilla Maria Alves de Melo
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil.
- Department of Pharmacy, Pesquisa e Inovação, Instituto de Ensino, Liga Norte Riograndense Contra o Câncer Hospital, Av. Miguel Castro, Nossa Senhora de Nazaré, Natal, 1355, CEP 59062-000, Rio Grande do Norte, Brazil.
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César RM, Lage APD, Wainstein A. Follow up of utility and value of totally implantable chemotherapy catheter in 233 brazilian patients receiving chemotherapy to treat cancer. Rev Col Bras Cir 2023; 50:e20233367. [PMID: 37436280 PMCID: PMC10508678 DOI: 10.1590/0100-6991e-20233367-en] [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: 05/11/2022] [Accepted: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES the present study aims to evaluate cancer patients related to the catheter flow and the general satisfaction of these patients. METHODS we studied 233 individuals diagnosed with cancer who underwent chemotherapy treatment through venous access through portocath between January 2015 and December 2019. RESULTS 97% of the patients consulted had palliative chemotherapy, and 99.1% of patients reported satisfaction with the implantation process and treatment method. Regarding catheter flow according to venous return and drip during drug infusion, 98.7% of individuals presented good flow. CONCLUSIONS the results show that catheter flow was satisfactory in all implant sites observed and emphasize the advantages of using a totally implanted catheter. This benefice happens due to the reduction of emotional factors that cause stress in cancer patients receiving chemotherapy, as well as the reduction of trauma and discomfort experienced by patients during the infusion of peripheral chemotherapy.
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Affiliation(s)
- Rodrigo Melo César
- - Faculdade Ciências Médicas de Minas Gerais, Pós Graduação - Belo Horizonte - MG - Brasil
| | - Ana P Drummond Lage
- - Faculdade Ciências Médicas de Minas Gerais, Pós Graduação - Belo Horizonte - MG - Brasil
| | - Alberto Wainstein
- - Faculdade Ciências Médicas de Minas Gerais, Pós Graduação - Belo Horizonte - MG - Brasil
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Okyere I, Okyere P, Singh S, Brenu SG. Portacath Implantation in Ghana: Initial Experience at the Komfo Anokye Teaching Hospital in Kumasi. Clin Med Insights Case Rep 2022; 15:11795476221087910. [PMID: 35342320 PMCID: PMC8943456 DOI: 10.1177/11795476221087910] [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] [Received: 11/22/2021] [Accepted: 02/24/2022] [Indexed: 12/04/2022] Open
Abstract
Current practice for chemotherapy in most oncology departments is the use of
dedicated venous access for the continuous and frequent delivery of drugs,
fluids and blood products, and the monitoring of the effects of treatment. The
frequent venipuncture of peripheral veins is associated with various
complications and discomfort to the patients. Permanent central venous access is
therefore very important. Totally Implantable Vascular Access Device (TIVAD) is
a type of central venous access that utilizes the central veins; the internal
jugular vein, the subclavian or the femoral veins. It is a kind of permanent
central venous access where a central venous catheter is connected to a
subcutaneously buried port or septum which can be accessed at any time and has
the ability to stay for almost 5 years. They are therefore the preferred form of
long-term central venous access in patients treated by oncology departments. We
share our initial experience of 5 patients in our institution. There were 4
females and one young boy who had been diagnosed with Hemophilia. Three of the
patients had new implantation, one had removal of her 5-year-old TIVAD that had
been implanted in another country and one had the TIVAD accessed when she had
been referred to our hospital for breast surgery after neoadjuvant
chemotherapy.
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Affiliation(s)
- Isaac Okyere
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Anesthesia and Intensive Care, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Perditer Okyere
- Department of Internal Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanjeev Singh
- Department of Anesthesia and Intensive Care, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Santos ÁVD, Barbosa ED, Nunes GV, Cavalcante RDS, Diniz AKF, Freitas GRC, Araújo JFSBD. Inadequate positioning of central venous catheters inserted at intensive care units. EINSTEIN-SAO PAULO 2022; 20:eAO6497. [DOI: 10.31744/einstein_journal/2022ao6497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/10/2021] [Indexed: 11/05/2022] Open
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de Souza Garcia AF, Ribeiro G, de Assis Arantes J, Reginato GM, Xavier NV, Carregaro AB, Silva TJF, Grigoletto R, de Freitas SH, Dória RGS. Evaluation of totally implantable catheters in healthy horses. BMC Vet Res 2021; 17:339. [PMID: 34702265 PMCID: PMC8549289 DOI: 10.1186/s12917-021-03052-z] [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] [Received: 07/26/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device’s placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted into one cephalic vein in ten adult horses (n = 10). Twenty-four hours following placement, IVRLP with contrast was performed via the TIC and evaluated with radiography. Physical examinations, lameness evaluation, hematologic assessment, and the catheter patency tests were performed at scheduled intervals for the duration of catheterization (7–60 days). Results Catheters were implanted without difficulty and allowed for IVRLP 24 h post implantation. Complications resulted in removal of the catheters, with four maintained for 7 days, three in place for 15 days, and three catheters maintained for 60 days. Complications included lameness, limb swelling, catheter kinking, and venous thrombosis. Conclusions The implantation technique of the TIC in the cephalic vein of horses is feasible and requires minimal technical effort. Although TIC allows venous access without the need for repeated venipuncture, its long-term use presents complications. For horses requiring prolonged daily cephalic IVRLP, the use of a TIC could be indicated. However, the high incidence of venous thrombosis may limit clinical application.
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Affiliation(s)
| | - Gesiane Ribeiro
- United Metropolitan Colleges, Rua Ministro Nelson Hungria, 541, Vila Tramontano, São Paulo, São Paulo, 05690-050, Brazil
| | - Julia de Assis Arantes
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Gustavo Morandini Reginato
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Nathalia Villaca Xavier
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Adriano Bonfim Carregaro
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Thiago Jhonatha Fernandes Silva
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Renan Grigoletto
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Silvio Henrique de Freitas
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Renata Gebara Sampaio Dória
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil.
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Facanali CBG, Paixão VS, Sobrado CW, Facanali MR. Spontaneous Knot Formation in a Central Venous Catheter. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932354. [PMID: 34525010 PMCID: PMC8450428 DOI: 10.12659/ajcr.932354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient: Male, 63-year-old
Final Diagnosis: Spontaneous knot formation in central venous catheter
Symptoms: Central venous catheter whit any flow • associated with pain at the insertion site of the access
Medication: —
Clinical Procedure: Central venous catheterization
Specialty: General and Internal Medicine • Surgery
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Affiliation(s)
| | | | - Carlos Walter Sobrado
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Marcio Roberto Facanali
- Department of Gastroenterology, University of São Paulo, School of Medicine, Santos, SP, Brazil
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Kara H, Arikan AE, Dulgeroglu O, Uras C, Icten GE, Tutar B, Parlakkilic UT, Sonmez O. Detachment and embolization of totally implantable central venous access devices: diagnosis and management. Acta Chir Belg 2021; 122:240-247. [PMID: 33645456 DOI: 10.1080/00015458.2021.1896829] [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: 10/22/2022]
Abstract
BACKGROUND Detachment and embolization (DE) is a rare complication of totally implantable central venous access devices (TIVADs). This study aimed to analyze clinical findings, etiology, and treatment options in DE of TIVADs. METHODS Patients who experienced DE between 2010-2019 were included. Indications, implantation techniques, time to diagnosis, patient complaints, diagnostic methods, rupture site, location of embolization, treatment methods, and chest X-rays prior to detachment were analyzed retrospectively. RESULTS DE of TIVAD was detected in 12(1.2%) patients. Eleven patients had breast cancer and one had colon cancer. Mean age at implantation was 45.3 ± 9.6(31-61.3) years. Seven (58%) patients were asymptomatic, four (33.3%) had TIVAD malfunction, and one (8.3%) had pain and swelling at port site after injection. Mean time from implantation to diagnosis was 1149.92(16-2795) days. The etiologies comprised Pinch-off Syndrome (POS) in eight (66%) patients, detachment directly adjacent to the lock mechanism in three (25%) patients, and probable iatrogenic injury during explantation in one (9%) patient. The most common site of embolism was the superior vena cava (25%). While the embolized fragment was removed percutaneously in 11 patients, medical follow-up was treatment choice for one patient. CONCLUSIONS DE is a rare complication with an incidence rate of 1.2% in this study. Since most patients were asymptomatic, chest radiography plays an important role in diagnosis. The most common cause was POS, and it can be prevented by inserting the catheter from lateral third of the clavicle during subclavian vein catheterization. The first-choice treatment was percutaneous femoral retrieval. However, if not technically possible, alternative treatment options are thoracotomy or follow-up with anticoagulant therapy.
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Affiliation(s)
- Halil Kara
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Akif Enes Arikan
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Onur Dulgeroglu
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cihan Uras
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Gul Esen Icten
- Department of Radiology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Burcin Tutar
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | | | - Ozlem Sonmez
- Department of Oncology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Depboylu BC, Yazman S. Do 'Videos' sections of Internet search engines provide accurate and adequate information about totally implantable venous access ports? J Vasc Access 2020; 22:225-231. [PMID: 32597358 DOI: 10.1177/1129729820937094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE After cancer diagnosis, patients often look to Internet to learn more about totally implantable venous access ports which improve compliance with systemic anticancer therapy, as they do not get enough information from healthcare professionals. The aim of this study was to evaluate the video quality on Internet about totally implantable venous access ports using the most used three Internet search engines worldwide. METHODS 'Videos' sections of the most used three Internet search engines were queried using 'Chemotherapy Port', 'Port Catheter' and 'Totally Implantable Venous Access Ports' keywords. First, 50 results of each keyword in each search engine were analysed and evaluated according to a novel scoring system created by authors (totally implantable venous access port video evaluation score), Journal of the American Medical Association score and modified DISCERN score by independent reviewers. Obtained data were analysed by descriptive statistics, Kruskal-Wallis and chi-square tests. RESULTS Of the 450 videos, 229 were evaluated. The total video length was 1394.38 min. The mean video length was 6.08 ± 5.39 min, and the mean video view count was 32,553.71 ± 83,524.23. Mean Journal of the American Medical Association score, modified DISCERN score and totally implantable venous access port video evaluation score were 2.33 ± 0.90, 2.43 ± 1.59 and 3.54 ± 3.47, respectively. According to totally implantable venous access port video evaluation score, of the videos, 1.3% were remarkable, 5.2% were useful, 25.8% were poor and 67.7% were useless. Of the videos, 36.7% have been presented by healthcare professionals. Mean Journal of the American Medical Association score, modified DISCERN score and totally implantable venous access port video evaluation score of these videos were 3.11 ± 0.68, 3.97 ± 0.93 and 4.69 ± 4.25, respectively (p = 0.000, p = 0.000 and p = 0.003, respectively). CONCLUSION Internet search engines' 'Videos' sections have the potential of providing information about totally implantable venous access ports. However, they are vulnerable to providing unreliable information. This study has showed that videos about totally implantable venous access ports are insufficient in terms of reliability and integrity and may mislead patients.
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Affiliation(s)
- Burak Can Depboylu
- Department of Cardiovascular Surgery, Mugla Sıtkı Kocman University, Faculty of Medicine, Mugla, Turkey
| | - Serkan Yazman
- Department of Cardiovascular Surgery, Mugla Sıtkı Kocman University, Faculty of Medicine, Mugla, Turkey
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Gowin E, Świątek-Kościelna B, Mańkowski P, Januszkiewicz-Lewandowska D. The Profile of Microorganisms Responsible for Port-Related Bacteremia in Pediatric Hemato-Oncological Patients. Cancer Control 2020; 27:1073274820904696. [PMID: 32157910 PMCID: PMC7092702 DOI: 10.1177/1073274820904696] [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
Patients with pediatric cancer face an increased risk of infections. In most cases, these infections are associated with the use of a long-term central venous catheter. This study describes the epidemiology of a port-associated bacteremia as well as a profile of microorganisms responsible for port-associated bloodstream infections (PABSIs) in pediatric patients with cancer treated in a single center. The retrospective analysis included patients with cancer who had implanted a port, hospitalized between 2010 and 2015 at the Department of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences. The medical records of patients were reviewed for demographic characteristics, diagnosis, port-related complications, and their management. Data were collected from patients' electronic medical records containing complete information on medical examinations and supplementary tests, diagnosis, timing, and type of port-associated complications. In a study period, 277 ports were inserted to 241 patients. A total of 183 094 catheter days were analyzed. Sixteen patients had more than 1 insertion of a port. The commonest observed complication was PABSI (40.07%) and the incidence density was 0.6 per 1000 port-days. Staphylococcus was the most commonly isolated organisms from patients with PABSI. From all port-associated complications, bloodstream infections and mechanical complications were the most often observed complications. The commonest pathogens responsible for PABSI were coagulase-negative staphylococci. Pathogens resistant to standard antibiotic treatment play an important role in PABSI, with methicillin-resistant Staphylococcus epidermidis being the predominant pathogen. Port-associated bloodstream infections are a common reason for preterm removal of a port.
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Affiliation(s)
- Ewelina Gowin
- Department of Health Promotion, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Przemysław Mańkowski
- Department of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Choksi A, Finnegan K, Etezadi V. Does systemic antibiotic prophylaxis prior to the placement of totally implantable venous access devices reduce early infection? A retrospective study of 1,485 cases at a large academic institution. Am J Infect Control 2020; 48:95-99. [PMID: 31439370 DOI: 10.1016/j.ajic.2019.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To determine if ending the practice of administering prophylactic antibiotics prior to the placement of totally implantable venous access devices (TIVADs) is correlated with an increase in 30-day bloodstream infection-related TIVADs removals. METHODS The practice of administering prophylactic antibiotics prior to the placement of TIVADs ended in July 2013 at our institution. We compiled a list of patients who had TIVADs placed between July 2010 and July 2016 and cross-referenced this list to a list of patients who had TIVADs removed between July 2010 and August 2016 to evaluate the 30-day bloodstream infection-related TIVAD removals. Retrospective chart review of all patients was performed to collect demographic information, indication for placement, and type of antibiotic administered, if applicable. RESULTS Over the study period of 6 years, a total of 1,513 TIVADs were placed, of which 28 cases were excluded because of death within 30 days unrelated to TIVAD placement. Of the remaining 1,485 cases, 733 TIVADs were placed in 709 unique patients with prophylactic antibiotic treatment and 752 TIVADs were placed in 709 unique patients without treatment. A total of 8 patients were identified to have TIVADs removed within 30 days owing to infection, of which 4 patients were treated with prophylactic antibiotics. The odds of infection-related removals without prophylactic treatment compared with prophylactic treatment was 0.97 (95% confidence interval, 0.24-3.91; P = .97). CONCLUSIONS Ending the practice of administrating systemic antibiotic prophylaxis prior to the placement of TIVADs had no effect on the 30-day bloodstream infection-related TIVAD removals rate at our institution. We do not recommend the use of prophylactic antibiotics for the placement of TIVAD.
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Affiliation(s)
- Ankur Choksi
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD
| | - Karen Finnegan
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD
| | - Vahid Etezadi
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD.
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Jesus-Silva SGD, Oliveira JDS, Ramos KTF, Morais LA, Silva MADM, Krupa AE, Cardoso RS. Análise das taxas de infecção e duração de cateteres de hemodiálise de curta e longa permanência em hospital de ensino. J Vasc Bras 2020; 19:e20190142. [PMID: 34290749 PMCID: PMC8276652 DOI: 10.1590/1677-5449.190142] [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: 11/06/2019] [Accepted: 04/24/2020] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto Os cateteres venosos centrais para hemodiálise (CVCH) de curta permanência (CCP) e cateteres tunelizáveis de longa permanência (CTLP) são fundamentais para a terapia hemodialítica. Entretanto, há escassa casuística nacional acerca da incidência de complicações desses dois tipos de cateteres. Objetivos Analisar as complicações e tempo de duração de CVCHs em centro de hemodiálise de hospital de ensino. Métodos Foi feito um estudo unicêntrico, longitudinal e retrospectivo de 115 pacientes consecutivos submetidos a implante de cateteres para hemodiálise (67 CCP e 48 CTLP) em um período de 2 anos, com análise de sobrevida geral, perviedade, perda do acesso e incidência de complicações. Resultados Sessenta por cento eram do sexo masculino e a média de idade foi de 62 anos. O principal sítio de punção foi a veia jugular interna direita. Hipertensão arterial sistêmica estava presente em 95% dos casos. A mediana de permanência do cateter foi de 50 dias (CCP) versus 112 dias (CTLP; p < 0,0001). Não houve diferença na sobrevida global. Infecção relacionada ao cateter apresentou maior incidência nos CCP, sendo Staphylococcus sp. o microrganismo mais encontrado. A taxa de infecção por 1.000 dias foi maior nos CCP em relação aos CTLP (16,7 eventos/1.000 dias versus 7,0 eventos/1.000 dias, respectivamente). Baixa renda foi o único fator relacionado a maior incidência de infecção. Conclusões O tempo de permanência dos CTLP foi significativamente maior que os CCP, porém ainda assim abaixo dos valores relatados na literatura e sem impacto na sobrevida global. Baixa renda foi um fator associado a infecção de cateter.
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Lukito AA, Pranata R, Huang I, Thengker A, Wirawan M. Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619832282. [PMID: 30833817 PMCID: PMC6393817 DOI: 10.1177/1179547619832282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022]
Abstract
Introduction: Totally implantable venous device has a good safety profile, although certain complications may occur. Late mechanical complications include catheter fracture and cardiac migration which are rarely occurring in approximately 0.1% to 1% of patients. Case presentation: A 33-year-old woman referred by the surgical oncologist for port catheter fragment extraction through endovascular approach. She was asymptomatic on presentation and has a history of hypertension and smoking. Chest X-ray showed a port catheter fragment previously thought to be in the right atrium at the level of 8-9 thoracic vertebrae (right heart catheterization showed that the port catheter fragment was in the coronary sinus). Angiography of the right outflow tract indicates that the fragment was not in the outflow tract or pulmonary arteries but posterior to it. It was concluded that the port catheter fragment had migrated deep into the coronary sinus and the snare was unable to pull the fragment. It was deemed unfeasible to remove the fragment through the endovascular approach. Discussion: The port catheter fracture had migrated entirely into the coronary sinus and to the deep of our knowledge; this was the fourth case reported in the current literature. We tried to do a review of previous similar case reports; interestingly, this was the only case where the fragmented catheter was situated deep within the coronary sinus without any part of the fragment projected to the right atrium. This made the retrieval of the fragment much more difficult with a high chance of failure. Conclusions: Migration of totally implantable venous device into coronary sinus is a rare but possible complication and might be difficult to remove if the position is unfavorable.
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Affiliation(s)
- Antonia Anna Lukito
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Ian Huang
- Department of Internal Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Alvin Thengker
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Marco Wirawan
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
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