Simultaneous Rapid Saline Flush to Correct Catheter Malposition: A Clinical Overview

2015 ◽  
Vol 20 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Elizabeth Natividad ◽  
Todd Rowe
Keyword(s):  
Interventional Radiology ◽  
Clinical Outcomes ◽  
Vascular Access ◽  
Vena Cava ◽  
Cost Savings ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Quality Outcomes ◽  
Catheter Malposition ◽  
And Migration

Abstract Central venous catheters and peripherally inserted central catheters are fundamental in the delivery of pharmacologic and nutrition therapies to patient populations, including individuals with cancer. Malposition and migration of these catheters outside of the superior or inferior vena cava can contribute to delays in therapy as individuals await repositioning, and in some cases replacement of the catheter. Traditional repositioning using overwire or interventional radiology techniques can be costly and may delay care. The placement and management of these catheters has increasingly become the domain of specially trained vascular access nurses. A team of specially trained vascular access nurses, in collaboration with interventional radiologists at a National Cancer Institute-designated comprehensive cancer center developed a procedure for catheter repositioning using a simultaneous rapid saline flush technique (SRSFT). We present this procedure, along with implications for cost and clinical outcomes. Clinical outcomes suggest that 68% of catheters have been successfully repositioned using this technique with no adverse events associated with the procedure noted to date. In addition, the use of the SRSFT represents a cost savings of up to 90% compared with traditional repositioning procedures. The SRSFT is identified as safe, timely, cost-conscious, and therapeutically effective, although further research is needed to formally evaluate the efficacy of repositioning using this technique compared with overwire and interventional-radiology-guided repositioning, including complications and quality outcomes.

scholarly journals Characteristics and Clinical Outcomes of Individuals at High Risk for Pancreatic Cancer: A Descriptive Analysis from a Comprehensive Cancer Center

2018 ◽  
Vol 1 (1) ◽  
pp. 106-119
Author(s):  
Griffin McNamara ◽  
Karla Ali ◽  
Shraddha Vyas ◽  
Tri Huynh ◽  
Monica Nyland ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Clinical Outcomes ◽  
Genetic Risk ◽  
Incidental Findings ◽  
The United States ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pancreatic Cysts ◽  
Sporadic Cases

Pancreatic cancer (PC), a leading cause of cancer-related deaths in the United States, is typically diagnosed at an advanced stage. To improve survival, there is an unmet need to detect pre-malignant lesions and early invasive disease. Prime populations to study for early detection efforts include cohorts of high risk individuals (HRI): those with increased risk to develop pre-malignant pancreatic cysts and PC because of a familial or hereditary predisposition to the disease and those in the general population of sporadic cases who are incidentally found to harbor a pre-malignant pancreatic cyst. The objective of this study was to describe the characteristics and clinical outcomes of cohorts of HRI identified at Moffitt Cancer Center. We set out to determine the uptake of screening, the prevalence and characteristics of solid and cystic pancreatic lesions detected via screening or as incidental findings, and the age at which lesions were detected. Of a total of 329 HRI, roughly one-third were found to have pancreatic lesions, most of which constituted pre-malignant cysts known as intraductal papillary mucinous neoplasms. Individuals with the highest genetic risk for PC were found to have smaller cysts at a much earlier age than sporadic cases with incidental findings; however, many individuals at high genetic risk did not have abdominal imaging reports on file. We also identified a subset of HRI at moderate genetic risk for PC that were found to have cystic and solid pancreatic lesions as part of a diagnostic work-up rather than a screening protocol. These findings suggest the pancreatic research community should consider expanding criteria for who should be offered screening. We also emphasize the importance of continuity of care between cancer genetics and gastrointestinal oncology clinics so that HRI are made aware of the opportunities related to genetic counseling, genetic testing, and screening.

Differences in clinical outcomes in young-onset colorectal cancer based on ethnicity in an NCI designated comprehensive cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3605-3605
Author(s):  
Benjamin David Fangman ◽  
Stephen Haff ◽  
Shannon Scielzo ◽  
Aravind Sanjeevaiah ◽  
Udit N. Verma ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Clinical Outcomes ◽  
Safety Net ◽  
Stage Ii ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Young Onset ◽  
Hispanic Ethnicity ◽  
Black Patients

3605 Background: Ethnic disparities can impact clinical outcomes of young-onset colorectal cancer (CRC) patients. We aimed to determine if differences in outcomes based on ethnicity exist in young–onset CRC treated at an NCI-designated comprehensive cancer center program. Methods: A retrospective chart review for stage II – IV young-onset CRC patients ≤45 years old diagnosed between 04/2011 and 11/2015. Patients had to undergo treatment at safety-net Parkland Hospital (PH) or at the Simmons Comprehensive Cancer Center (SCCC) in Dallas, TX. Demographic data, dates of surgery, adjuvant chemotherapy, recurrence or death were obtained. Results: Of 123 patients that met inclusion criteria, 15 were excluded due to incomplete information. Of the remaining 108 patients, 36 (33%) and 72 patients (67%) were treated at SCCC and PH, respectively. Sixty (55%) were non-Hispanic vs 48 (44.4%) Hispanic. There were more Stage IV patients at SCCC vs Parkland (58.3% vs 30.6%, p < 0.01) but there was no difference regarding ethnicity. Also, no significant difference was seen between non-Hispanic White (NHW), Hispanic, and Black patients in median days to colectomy (1 vs 13 vs 0; p = .402) or adjuvant chemotherapy (55.5 vs 53.0 vs 64.0 days, p = .820). Hispanic patients had significantly better overall survival (OS) than Black or NHW patients (p = 0.025). The OS benefit was driven by improved 5-year OS in stage II/III Hispanic vs NHW vs Black patients (95% vs 62% vs 60%; p = 0.06). Multivariate Cox Regression analysis showed stage II/III (p < 0.001) and Hispanic ethnicity (p < 0.001) were independently associated with improved outcomes. Conclusions: In young-onset CRC treated at an NCI-designated comprehensive cancer center, Hispanic ethnicity had better OS than other ethnicities and this was largely due to better outcomes in stage II and III CRC. The causes for these ethnic differences in young-onset CRC patients needs further exploration. [Table: see text]

scholarly journals Data Unit, Translational Research, and Registries

2021 ◽  
pp. 157-165
Author(s):  
Fazal Hussain ◽  
Saud Alhayli ◽  
Mahmoud Aljurf
Keyword(s):  
Translational Research ◽  
Core Competencies ◽  
Care Facility ◽  
Standards Of Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Quality Outcomes ◽  
Therapeutic Modalities ◽  
Quality Cancer Care ◽  
Academic Standing

AbstractResearch is the only way to challenge the existing standards of care; a dynamic and multidimensional process encompassing innovative therapeutic modalities, techniques, and interventions to optimize outcomes and quality of life of cancer patients. Cancer research has emerged as one of the core competencies for the standardization, accreditation, and academic standing of any comprehensive cancer center. Data unit is the center of gravity and the hub of research and development (databases, registries, translational research, randomized control trials) in a quality cancer care facility. Quality assurance, ethical conduct, and monitoring of research are the hallmarks of a center of excellence in galvanizing the research efforts and optimizing the quality outcomes.

scholarly journals A rare complication following internal jugular vein catheterization to malposition: acute Budd Chiari syndrome

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Sumeyra Koyuncu ◽  
Nevzat Herdem ◽  
Cihan Uysal ◽  
Guven Kahriman ◽  
Ismail Kocyigit ◽  
...  
Keyword(s):  
Vascular Access ◽  
General Condition ◽  
Rare Complication ◽  
Vena Cava ◽  
Sudden Onset ◽  
Health Expectancy ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Catheter Malposition

Abstract Background Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition. Case presentation After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient’s general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization. Conclusion Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications.

scholarly journals Demonstrating value: association of cost and quality outcomes with implementation of a value-driven oncology-hospitalist inpatient collaboration for patients with lung cancer

2019 ◽  
Vol 8 (1) ◽  
pp. e000381 ◽  
Author(s):  
Joanna-Grace Manzano ◽  
Anne Park ◽  
Heather Lin ◽  
Suyu Liu ◽  
Josiah Halm
Keyword(s):  
Lung Cancer ◽  
Quality Of Care ◽  
Cost Savings ◽  
Initial Study ◽  
Cancer Center ◽  
Medical Problems ◽  
Readmission Rates ◽  
Quality Outcomes ◽  
Adjusted Cost

The hospitalist model of care has gained favour in many hospital systems for the value, cost-effectiveness and quality of care that hospitalists provide. Hospitalists are experts in high-acuity medical problems of patients and they are intimately knowledgeable about hospital operations that enable efficiency of patient care. This results in tremendous cost-savings for institutions especially since hospitalists are also obligated to be involved in quality and practice improvement initiatives. The University of Texas MD Anderson Cancer Center employs oncology-hospitalists for many of their patients with cancer needing inpatient services. This physician team has expertise in both cancer-related and comorbidity-related reasons for hospitalisation. In September 2015, the thoracic and head and neck medical oncology team started a collaboration with the Oncology Hospitalist team whereby a proportion of patients with thoracic malignancies were directly admitted to hospitalists for inpatient care. To determine the value of this collaboration, a pre- and post- implementation study was done to compare quality outcomes such as readmission rates and length of stay (LOS) between the two groups. Adjusted outcomes showed that readmission rates were similar for both physician groups both at baseline and after implementation of the collaborative (p=0.680 and p=0.840, respectively). Median LOS was similar for both groups at baseline (4 days) and was not significantly different post-implementation (4vs5 days, p=0.07). The adjusted cost of a hospitalisation was also similar for hospitalist encounters and thoracic oncology encounters. This initial study showed that quality of care remained comparable for patients with lung cancer who were admitted to either service. With possibly shorter LOS but comparable readmission outcomes and adjusted cost for patients discharged from the hospitalist service, there is a strong value benefit for the implemented Thoracic Oncology-Hospitalist inpatient collaborative.

Acute palliative care unit in a comprehensive cancer center (CCC): Financial and clinical outcomes

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20518-e20518 ◽  
Author(s):  
A. F. Elsayem ◽  
D. Hui ◽  
Z. Li ◽  
M. Flores ◽  
W. A. Atkinson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Symptom Control ◽  
Health Care Facilities ◽  
Comprehensive Cancer Center ◽  
Rank Test ◽  
Cancer Center ◽  
Major Barrier ◽  
Cancer Centers

e20518 Background: Acute palliative care units (APCU) in CCCs improves symptom control for advanced cancer patients and supports their families. However, these services are not available in the majority of cancer centers. Concerns regarding financial reimbursements represent a major barrier for establishing APCUs. The purpose of this study is to report the clinical outcomes and compare the financial outcomes of our APCU as compared to other services at our CCC. Methods: We reviewed all admissions to the APCU over the last 5 fiscal years for demographic information, length of stay, discharges, survival, hospital billings and collection of charges, and compared these to the rest of the institution. Results: 2,510 unique patients were admitted to the APCU. Median age was 59 years (19–101) and 51% were female. The median length of stay in APCU was 8 days (Q1-Q3 6–10). Median survival of patients discharged home, to health care facilities and hospice were 53, 22, and 13 days, respectively (p<0.001, log rank test), with 6 month survival of 20%, 4%, and 2%, respectively. Professional collections ranged from 42–47% of charges for APCU, vs. 32–38% for rest of the CCC and were stable over the 5 year period. Hospital collections were 47–51% of charges for APCU, vs. 55–57% for the rest of the CCC. The payer mix included commercial 1155 (46%), Medicare 755 (30%), Medicaid 126 (5%), mixed 127 (5%), indigent 198 (8%), and others 149 (6%). Conclusions: The ACPU has reimbursement outcomes consistent with the American acute care model and comparable to the rest of the CCC for last 5 years. The APCU is as viable as any other clinical programs in our institution. Further research is needed to investigate possible reasons for lack of APCU in cancer centers. No significant financial relationships to disclose.

The financial implications of a conversion from enoxaparin to dalteparin as the LMWH of choice at a comprehensive cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17566-e17566
Author(s):  
S. G. Patterson ◽  
P. Johnson ◽  
B. Bradbury ◽  
J. Tata ◽  
R. Quilitz ◽  
...  
Keyword(s):  
Low Molecular Weight Heparin ◽  
Cost Savings ◽  
Fiscal Year ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Low Molecular Weight ◽  
Significant Cost ◽  
Order Sets ◽  
The One ◽  
Full Class

e17566 Background: To assess the financial implications of a conversion from enoxaparin to dalteparin as the low molecular weight heparin (LMWH) of choice at a large, comprehensive cancer center. Methods: A full class review of LMWH's was conducted in September of 2007 resulting in dalteparin replacing enoxaparin as the LMWH of choice. The Pharmacy and Therapeutics Committee approved automatic substitution with notification of the prescribing physician. The one exception to the policy was conversion if the patient was on enoxaparin at home, the policy would allow for continuation of therapy. Once the policy was approved, laminated dosing conversion cards and pre-printed order sets were developed. Multiple in-services were held prior to the official conversion date of October 15, 2007, to address any issues and to facilitate the conversion. Cost comparisons were made within individual settings adjusting for utilization levels. Results: In the fiscal year prior to the conversion from enoxaparin to dalteparin the cancer center purchased nearly $360,000 of enoxaparin for the inpatient and infusion center settings. In the year following the LMWH change, the total projected cost for LMWHs is $244,000, resulting in a 32% cost savings of $115,000. Conclusions: The change from enoxaparin to dalteparin resulted in significant cost savings for the cancer center. Additional studies are underway to examine the clinical outcomes of the LMWH change. No significant financial relationships to disclose.

Optimization of intravenous immune globulin use at a comprehensive cancer center

2019 ◽  
Vol 76 (Supplement_4) ◽  
pp. S102-S106 ◽  
Author(s):  
Bradley S Figgins ◽  
Samuel L Aitken ◽  
Laura K Whited
Keyword(s):  
Body Weight ◽  
Immune Globulin ◽  
Cost Savings ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Waste Reduction ◽  
Intravenous Immune Globulin ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Diverse Range

Abstract Purpose Intravenous immune globulin (IVIG) is a high-cost medication used in a diverse range of settings. At many institutions, IVIG is dosed using total body weight (TBW). Recent evidence suggests that alternative dosing weights reduce waste without compromising clinical outcomes. The objective of this study was to quantify the waste reduction potential generated through the use of alternative IVIG dosing weights. Methods We performed a retrospective analysis of all IVIG doses administered from January 2011 through January 2016 to adults (≥18 years). TBW and height at the time of administration were used to calculate prescribed dose (g/kg), ideal body weight (IBW), and adjusted body weight (AdjBW). Three dosing methods were analyzed, as follows: use of AdjBW if TBW is >120% IBW (method 1), AdjBW for all doses (method 2), and IBW for all doses (method 3). Outcomes included potential IVIG use averted, direct drug cost savings, and reductions in outpatient infusion times for each method. Results A total of 9,918 doses were administered to 2,564 patients over 5 years, representing an average usage of 75,994 g/year. If dosing methods 1, 2, and 3 had been used, the annual use of IVIG would have decreased by 21.9% (16,658 g/year, p < 0.001), 24.2% (18,371 g/year, p < 0.001), and 35.9% (27,252 g/year, p < 0.001), respectively. This translates into average annual cost differences of $2.37 million, $2.62 million, and $3.89 million and average annual outpatient infusion time savings of 841 hours, 920 hours, and 1,366 hours, respectively. Conclusion IVIG dosing optimization through use of alternative dosing weights represents a significant source of waste reduction and cost reduction.

Sign in / Sign up

Export Citation Format

Share Document