Material Failure of Silicone Catheter Lines: A Retrospective Review of Partial and Complete Ruptures in 553 Patients

Delayed onset skin toxicity reaction after peripherally inserted central catheter rupture in lower extremities combined with chemotherapy

Herein, we present a patient who was undergoing chemotherapy for bilateral breast cancer and experienced delayed-onset skin toxicity reactions after rupture of a peripherally inserted central catheter (PICC) in the lower extremities. The objective of this case report is to provide the necessary nursing assessment for the risk awareness of the PICC internal rupture and the occurrence of central venous catheter extravasation, as well as to strengthen the judgment of delayed skin toxicity of chemotherapeutic drugs. Rupture of the PICC in the lower extremities was primarily attributed to the use of a silicone catheter and an excessive puncture angle. The nature of docetaxel and partial catheter rupture caused drug extravasation, leading to delayed skin toxicity. The use of a polyurethane catheter reduces the incidence of catheter rupture; hence, silicon catheters should be avoided. The central venous catheter is also at risk for the extravasation of chemotherapeutic agents. Moreover, docetaxel-induced delayed skin toxicity, which has a high incidence, should be treated as expected. Nurses and clinicians should be aware of PICC internal rupture and central venous catheter extravasation to strengthen the judgment of delayed skin toxicity of chemotherapeutic drugs.

Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review

BACKGROUND

Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation.

METHODS

A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data.

RESULTS

From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies.

CONCLUSION

Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.

Exploring risk factors for totally implantable venous access devices (TIVADs)-related thrombotic occlusion in the off-treatment period

Totally implantable venous access devices (TIVADs) have been widely used for many years in the management of patients suffering from cancer. Thrombotic occlusion is the most common functional complication in the off-treatment period. This study aims to investigate the incidence of and risk factors for TIVADs-related thrombotic occlusion in patients with breast cancer. The clinical data of 1586 eligible patients with breast cancer with TIVADs at the Fourth Affiliated Hospital of Hebei Medical University from 1 January 2019 to 31 August 2021 were analysed. Thrombotic occlusion was confirmed by angiography with signs of partial or total occlusion. Thrombotic occlusion occurred in 96 (6.1%) cases. Multivariable logistic regression analysis showed that the insertion site of the catheter (P = 0.004), size of the catheter (P < 0.001), and indwelling time (P < 0.001) were significant factors for thrombotic occlusion. Insertion in the right internal jugular vein, smaller catheter size and shorter indwelling time can lower the incidence of thrombotic occlusion in breast cancer patients with TIVADs in the off-treatment period.

Cyclic Deformation and Fatigue Failure Mechanisms of Thermoplastic Polyurethane in High Cycle Fatigue

In this study, the main purpose is to analyze the fatigue failure of thermoplastic polyurethane (TPU) plate under tension-tension load control tests (frequency = 5 Hz, stress ratio = 0.1) and consider the change in hydrogen bond content. The results show that the S-N curve of TPU material shows a downward trend before reaching the fatigue limit (10.25 MPa), and the energy is continuously consumed during the cyclic creep process and undergoes three stages of the hard segment and the soft segment changes. The infrared spectrum study shows that the increase in fatigue life will lead to more physical crosslinking, resulting in the reduction of hydrogen bond content, and the increase in microphase separation, leading to the occurrence of fatigue fracture. In addition, the scanning electron microscope and three-dimensional confocal analysis showed that the crack originated from the aggregation of micropores on the surface of the material and was accompanied by the slip of the molecular chain, the crack propagation direction was at an angle of about 45°.

Impact of mechanical stress on flexible tubing used for biomedical applications: Characterization of the damages and impact on the patient's health

Flexible tubing is a key part of a lot of medical devices used in hospital, but may be subjected to a lot of various mechanical stresses that can led to the failure or to complications for the patients. The nature and causes of these mechanical stresses were listed for peristaltic pump tubing, infusion set tubing and catheters. Their consequences in term of tubing damages and particular contamination were reported. The impact of the chemical nature of the tubing, of its size and also the impact of various parameters of the clinical acts were reviewed. Last the consequences for the patient's health were discussed.