Upper Extremity Impedance Plethysmography in Patients with Venous Access Devices

1994 ◽  
Vol 72 (04) ◽  
pp. 540-542 ◽  
Author(s):  
McDonald K Horne ◽  
Donna Jo Mayo ◽  
Richard Alexander ◽  
Elizabeth P Steinhaus ◽  
Richard C Chang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Central Venous Access ◽  
Venous Access ◽  
Impedance Plethysmography ◽  
Venous Obstruction ◽  
Central Venous ◽  
Venous Outflow ◽  
Complete Obstruction ◽  
Venous Access Devices

SummaryCentral venous access devices (VADs) are often associated with thrombotic obstruction of the axillary-subclavian venous system. To explore the accuracy of impedance plethysmography (IPG) in identifying this complication we performed IPG on 35 adult cancer patients before their VADs were placed and approximately 6 weeks later. At the time of the second IPG the patients also underwent contrast venography of the axillary-subclavian system. The venograms revealed partial venous obstruction in 12 patients (34%) and complete obstruction in two (5.7%). Although the IPG results from venographically normal and abnormal patients overlapped extensively, mean measurements of venous outflow were significantly lower in the patient population with abnormal venograms (P = 0.052 for Vo; P = 0.0036 for Vo/Vc). In our hands, therefore, upper extremity IPG cannot be used to make clinical decisions about individual patients with VADs, but it can distinguish venographically normal and abnormal populations.

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

A Psychometric Validation of the Decisional Conflict Scale in Italian Cancer Patients Scheduled for Insertion of Central Venous Access Devices

2020 ◽  
Vol 40 (10) ◽  
pp. 5583-5592
Author(s):  
MARIA ROSARIA ESPOSITO ◽  
ASSUNTA GUILLARI ◽  
FRANCESCO GIANCAMILLI ◽  
TERESA REA ◽  
MICHELA PIREDDA ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Decisional Conflict ◽  
Psychometric Validation ◽  
Central Venous ◽  
Decisional Conflict Scale ◽  
Venous Access Devices ◽  
Conflict Scale

Subcutaneously implanted central venous access devices in cancer patients

Cancer ◽  
1997 ◽  
Vol 79 (8) ◽  
pp. 1635-1640 ◽  
Author(s):  
Roderich E. Schwarz ◽  
Jeffrey S. Groeger ◽  
Daniel G. Coit
Keyword(s):  
Cancer Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Venous Access Devices

Infection Related to Implantable Central Venous Access Devices in Cancer Patients: Epidemiology and Risk Factors

2013 ◽  
Vol 34 (7) ◽  
pp. 671-677 ◽  
Author(s):  
Maristela P. Freire ◽  
Ligia C. Pierrotti ◽  
Antônio E. Zerati ◽  
Pedro H. X. N. Araújo ◽  
J. M. Motta-Leal-Filho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Multidisciplinary Team ◽  
Neutropenic Patient ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Venous Access ◽  
Central Venous ◽  
Venous Access Devices

Objective.To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections.Design.Prospective cohort study.Setting.Referral hospital for cancer in São Paulo, Brazil.Patients.We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death.Methods.Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections.Results.During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days (P < .001). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use.Conclusions.Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.

scholarly journals ONLINE Special Article Managing central venous access devices in cancer patients: A practice guideline

2008 ◽  
Vol 18 (2) ◽  
Author(s):  
Esther Green ◽  
Gail Macartney ◽  
Caroline Zwaal ◽  
Patricia Marchand ◽  
Lia Kutzscher ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Practice Guideline ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Venous Access Devices

scholarly journals Catheter‐related thrombosis incidence and risk factors in adult cancer patients with central venous access devices

2020 ◽  
Vol 50 (12) ◽  
pp. 1475-1482 ◽  
Author(s):  
Marc L. Ellis ◽  
Satomi Okano ◽  
Andrew McCann ◽  
Angela McDowall ◽  
Rosita Van Kuilenburg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Venous Access Devices ◽  
Catheter Related Thrombosis

A prospective audit evaluating use of urokinase in oncology patients with occluded central venous access devices

2019 ◽  
Vol 28 (19) ◽  
pp. S30-S36
Author(s):  
Karen Harrold ◽  
Annette Martin ◽  
Neel Bhuva
Keyword(s):  
Cancer Patients ◽  
Best Practice ◽  
Central Venous Access ◽  
Effective Means ◽  
Venous Access ◽  
Treatment Schedule ◽  
Prospective Audit ◽  
Central Venous ◽  
Total Occlusion ◽  
Venous Access Devices

This article reports the results of a single-site prospective audit evaluating the safety and effectiveness of urokinase (Syner-Kinase®) to restore patency in central venous access devices (CVADs) for cancer patients. CVADs are routinely inserted to allow the safe and timely administration of systemic anti-cancer therapies; therefore, catheter dysfunction can interrupt the treatment schedule and adversely affect patient outcome. The aim was to contribute to the development of evidence-based, standardised, best practice guidelines. Prospective data were collected from all patients (n=22) identified with an occluded CVAD, requiring use of Syner-Kinase to manage a persistent withdrawal occlusion or total occlusion, over a 6-month period. Findings revealed a single administration of Syner-Kinase for catheter occlusion clearance to be effective in 92% of cases. Results suggest that use of the thrombolytic agent is well-tolerated and an effective means of restoring patency for long-term CVADs in cancer patients.

Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

2019 ◽  
Vol 14 (1) ◽  
pp. 47-49
Author(s):  
Basant K. Puri ◽  
Anne Derham ◽  
Jean A. Monro
Keyword(s):  
Bloodstream Infection ◽  
Antibiotic Treatment ◽  
Central Venous Access ◽  
Case Series ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Host Cells ◽  
Central Venous ◽  
Intravenous Antibiotic ◽  
Venous Access Devices

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.

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