Comparison of outcomes of central venous catheters in patients with solid and hematologic neoplasms: an Italian real-world analysis

2020 ◽  
pp. 030089162093117
Author(s):  
Francesca Corti ◽  
Marta Brambilla ◽  
Sara Manglaviti ◽  
Laura Di Vico ◽  
Maria Neve Pisanu ◽  
...  
Keyword(s):  
Real World ◽  
Multivariable Analysis ◽  
Central Venous Catheters ◽  
Cancer Center ◽  
Central Venous ◽  
Free Survival ◽  
Treatment Type ◽  
Risk Benefit Assessment ◽  
Oncologic Patients

Introduction: Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other. Methods: We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs). Results: A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; p = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs ( p = 0.013). No significant differences in terms of catheter-related thromboses ( p = 0.676) or catheter-related infections ( p = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort ( p = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128–0.536; p < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018–0.372; p < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135–0.553; p < 0.0001). Conclusions: This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk–benefit assessment, patient preferences, and compliance.

Tunneled internal jugular catheters in adult patients: comparison of outcomes in hemodialysis versus infusion catheters

2007 ◽  
Vol 48 (6) ◽  
pp. 613-619 ◽  
Author(s):  
B. Peynircioglu ◽  
F. Ozkan ◽  
M. Canyigit ◽  
B. E. Cil ◽  
F. Balkanci
Keyword(s):  
Adult Population ◽  
Infectious Complications ◽  
Central Venous Catheters ◽  
Catheter Removal ◽  
Central Venous ◽  
Technical Success Rate ◽  
Infusion Group ◽  
Oncologic Patients ◽  
Long Term Follow Up

Background: Tunneled central venous catheters placed by interventional radiologists are now widely used for hemodialysis and infusion therapies throughout the world. However, complications such as infections and malfunctions still remain a major concern in oncology and hemodialysis patients. Purpose: To evaluate the long-term follow-up results of tunneled central venous catheters in an adult population in terms of infectious complications and malfunction rates in dialysis and oncology patients. Material and Methods: We retrospectively reviewed the hospital charts and our electronic database for 434 tunneled internal jugular catheters in 335 consecutive patients between December 2002 and March 2006. Mean patient age was 57 years (range 23–86 years) in the hemodialysis group and 45 years (range 18–83 years) in the infusion group. A total of 224 hemodialysis catheters were placed in 168 patients (68 females, 100 males) and 210 infusion catheters in 167 patients (48 females, 119 males). Results: Technical success rate was 100%. Mean duration of catheter use was 86 days (1–652 days) and 60 days (2–686 days) for hemodialysis and infusion catheters, respectively. A total of 107 hemodialysis (47%) and 95 infusion catheters (45%) were electively removed due to completion of therapy and resolution of need for dialysis. Revisions were performed 0.22 and 0.11 per 100 catheters days in the hemodialysis and infusion groups, respectively. Our total infection rate was 0.10 episodes per 100 catheter days, and the rate of infections necessitating catheter removal was 0.05 episodes per 100 catheter days in the hemodialysis group, which is lower than that reported in other big series. However, in the infusion group, the rate of infections necessitating catheter removal was 0.28 episodes per 100 catheter days. Conclusion: Long-term central venous accesses using tunneled internal jugular catheters appeared to be safe and effective for both hemodialysis and long-term infusion therapies, with relatively higher infection rates in oncologic patients.

scholarly journals Transanal total mesorectal excision: short- and long-term results of the first hundred cases of a certified colorectal cancer center in Germany

2021 ◽  
Author(s):  
Vinzenz Völkel ◽  
Sabine Schatz ◽  
Teresa Draeger ◽  
Michael Gerken ◽  
Monika Klinkhammer-Schalke ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Tumor Resection ◽  
Operation Time ◽  
Cancer Center ◽  
Transanal Total Mesorectal Excision ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Short And Long Term

Abstract Background Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. Patients and methods Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan–Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. Results During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien–Dindo 3–4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. Conclusion TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.

Alkylating agent rechallenge in metastatic pancreatic neuroendocrine tumours

2021 ◽  
Author(s):  
Ophelie De Rycke ◽  
Thomas Walter ◽  
Marine Perrier ◽  
Olivia Hentic ◽  
Catherine Lombard-Bohas ◽  
...  
Keyword(s):  
Neuroendocrine Tumours ◽  
Objective Response ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Free Survival ◽  
Mgmt Expression ◽  
Pancreatic Neuroendocrine Tumours

A rechallenge is common after initial efficacy of alkylating-based chemotherapy (ALK) in pancreatic neuroendocrine tumors (PanNET). High MGMT expression seems associated with lower response to ALK. We aimed to evaluate the efficacy and toxicity of ALK rechallenge in PanNET. Secondly, to assess the evolution of MGMT expression under ALK. All consecutive patients with advanced PanNETs who received initial ALK (achieving tumor control) followed by a pause > 3 months, then an ALK rechallenge (ALK2) upon progression were retrospectively studied (Cohort A). Primary endpoint was progression-free survival under ALK2 (PFS2). The MGMT expression was retrospectively assessed by immunohistochemistry (H-score) in consecutive PanNET surgically resected following ALK (Cohort B). We foud that cohort A included 62 patients (median Ki67 8%), for which ALK1 followed by pause achieved an objective response rate of 55%, and a PFS1 of 23.7 months (95% IC, 19.8-27.6). ALK2 achieved no objective response, and stability in 62% of patients. The median PFS2 was 9.2 months (IC 95% 7.1-11.3). At multivariable analysis, a hormonal syndrome (p=0.032) and a pause longer than 12 months (p=0.041) were associated with a longer PFS2. In the cohort B (17 patients), the median MGMT H-score increased from 45 (IQR 18-105) before ALK, to 100 (IQR 56-180) after ALK (p=0.003). We conclude that after initial efficacy of ALK treatment, a pause followed by ALK rechallenge might be appropriate to prolong tumor control, improve quality of life and limit long-term adverse events. Increased MGMT expression under ALK might explain low efficacy of ALK rechallenge.

The retrograde tunnel: a method for the fixation of central venous catheters in the military environment

1991 ◽  
Vol 77 (2) ◽  
pp. 75-77
Author(s):  
R. A. Wheeler ◽  
T. J. W. Spalding ◽  
J. A. Thomas ◽  
G. A. Carss
Keyword(s):  
Central Venous Line ◽  
Central Venous Catheters ◽  
Patient Transfer ◽  
Central Venous ◽  
Medical Facilities ◽  
Subcutaneous Tunnel ◽  
Paediatric Practice ◽  
The Military

AbstractCentral venous catheters (CVCs) are prone to accidental removal during patient transportation. Of the casualties who require transfer between medical facilities, those with CVC in situ require additional vigilance to prevent loss of the CVC, which continues to occur despite various methods of fixation. The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters. Several methods have been described, but the long-term CVCs in paediatric practice pose special problems, particularly that of the patients continually testing the CVCs fixation. Using a new polyurethane CVC, a retrograde tunnelling technique has been developed which affords immediate and secure fixation. We propose that this CVC, together with the technique of retrograde tunnelling, is the solution to inadvertent central venous line removal during patient transfer.

scholarly journals Infections associated with the central venous catheters

2014 ◽  
Vol 142 (3-4) ◽  
pp. 261-266
Author(s):  
Biljana Draskovic ◽  
Izabella Fabri ◽  
Anna Uram-Benka ◽  
Goran Rakic
Keyword(s):  
Intensive Care ◽  
Critically Ill Patients ◽  
Venous Access ◽  
Health Condition ◽  
Central Venous Catheters ◽  
Maintenance Period ◽  
Central Venous ◽  
Prevention Of Infection ◽  
Catheter Infections

Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient?s health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

scholarly journals Risk factors for unplanned removal of central venous catheters in hospitalized children with hematological and oncological disorders

2020 ◽  
Author(s):  
Moe Miyagishima ◽  
Hamada Motoharu ◽  
Yuji Hirayama ◽  
Hideki Muramatsu ◽  
Takahisa Tainaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Subdistribution Hazard ◽  
Significant Difference

Background: Central venous catheters (CVCs) have been essential devices for the treatment of children with hematological and oncological disorders. Only few studies investigated the complications and selections of different types of CVCs in these pediatric patients. This study aimed to compare risk factors for unplanned removal of two commonly used CVCs, i.e., peripherally inserted central catheters (PICCs) and tunneled CVCs, and propose better device selection for the patient. Procedure: This retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC. Results: Between January 1, 2013, and December 31, 2015, 89 patients inserted with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total 9,177 catheter-days) were followed up until the catheter removal. The median duration of catheterization was 88 days in PICCs and 186 days in tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas no significant difference was observed in the cumulative incidence of central line-associated bloodstream infection (11.8% vs. 2.3%, p = 0.664). Multivariable analysis identified younger age (<2 years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI, 1.48–5.02) were independent risk factors for unplanned removal. Conclusion: Our results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

scholarly journals Population-Based Study of Docetaxel or Abiraterone Effectiveness and Predictive Markers of Progression Free Survival in Metastatic Castration-Sensitive Prostate Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Juan Briones ◽  
Maira Khan ◽  
Amanjot K. Sidhu ◽  
Liying Zhang ◽  
Martin Smoragiewicz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Predictive Factors ◽  
Real World ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Predictive Markers ◽  
Age At Diagnosis ◽  
Free Survival ◽  
Significant Difference

BackgroundBoth Docetaxel (DOC) and Abiraterone (ABI) improve the survival of men with metastatic, castration sensitive prostate cancer (mCSPC). However, the outcome among mCSPC patients is highly variable, while there is a lack of predictive markers of therapeutic benefit. Furthermore, there is limited data on the comparative real-world effectiveness of adding DOC or ABI to androgen deprivation therapy (ADT).MethodsWe conducted a retrospective analysis of 121 mCSPC patients treated at Odette Cancer Centre (Toronto, ON, Canada) between Dec 2014 and Mar 2021 (DOC n = 79, ABI n = 42). The primary endpoint studied was progression free survival (PFS), defined as the interval from start of ADT to either (i) biochemical, radiological, or symptomatic progression, (ii) start of first-line systemic therapy for castration-resistant prostate cancer (CRPC), or (iii) death, whichever occurred first. To identify independent predictive factors for PFS in the entire cohort, a Cox proportional hazard model (stepwise selection) was applied. Overall survival (OS) was among secondary endpoints.ResultsAfter a median follow-up of 39.6 and 25.1 months in the DOC and ABI cohorts, respectively, 79.7% of men in the DOC and 40.5% in the ABI group experienced a progression event. PFS favored the ABI cohort (p = 0.0038, log-rank test), with 78.0% (95%CI 66.4–91.8%) of ABI versus 67.1% (57.5–78.3%) of DOC patients being free of progression at 12 months. In univariate analysis superior PFS was significantly related to older age at diagnosis of mCSPC, metachronous metastatic presentation, low-volume (CHAARTED), and low-risk (LATITUDE) disease, ≥90% PSA decrease at 3 months (PSA90), and PSA nadir ≤0.2 at 6 months. Age (HR = 0.955), PSA90 (HR = 0.462), and LATITUDE risk stratification (HR = 1.965) remained significantly associated with PFS in multivariable analysis. OS at 12 months was 98.7% (96.3–100%) and 92.7% (85.0–100%) in the DOC and ABI groups (p = 0.97), respectively.ConclusionsIn this real-world group of men undergoing treatment intensification with DOC or ABI for mCSPC, we did not find a significant difference in OS, but PFS was favoring ABI. Age at diagnosis of mCSPC, PSA90 at 3 months and LATITUDE risk classification are predictive factors of PFS in men with mCSPC.

scholarly journals Incidence rates of bloodstream infections in children with long-term central venous catheters at Instituto Nacional do Câncer, Brazil (1995 to 2001)

2002 ◽  
Vol 6 ◽  
pp. S29
Author(s):  
Marcelo Schirmer ◽  
Eduardo Velasco ◽  
Carlos A.S. Martins ◽  
Leda M. Dias ◽  
Vânia M.S.C. Gonçalves ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Incidence Rates ◽  
Central Venous Catheters ◽  
Central Venous

Catheter-related deep venous thrombosis in children with hemophilia

Blood ◽  
2001 ◽  
Vol 98 (6) ◽  
pp. 1727-1731 ◽  
Author(s):  
Janna M. Journeycake ◽  
Charles T. Quinn ◽  
Kim L. Miller ◽  
Joy L. Zajac ◽  
George R. Buchanan
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Central Venous Catheters ◽  
Catheter Placement ◽  
Central Venous ◽  
Radiographic Evidence ◽  
Catheter Dysfunction ◽  
The Mean ◽  
Clinical Problems

Abstract Central venous catheters (CVCs) are a common adjunct to hemophilia therapy, but the risk of CVC-related deep venous thrombosis (DVT) in hemophiliacs is not well defined. In a previous study, 13 patients with CVCs had no radiographic evidence of DVT. However, recent abstracts and case studies demonstrate that DVT does occur. Therefore, this study sought to determine the frequency of DVT in children with hemophilia and long-term CVCs and to correlate venographic findings with clinical features. All hemophilia patients with tunneled subclavian CVCs in place for 12 months or more were candidates for evaluation. Patients were examined for physical signs of DVT and questioned about catheter dysfunction. Contrast venograms were obtained to identify DVT. Fifteen boys with severe hemophilia were evaluated, including 9 from the initially studied group of 13. Eight patients had evidence of DVT, 5 of whom previously had normal venograms. Five of 15 patients had clinical problems related to the CVC, all of whom had DVT. Four of 15 patients had suggestive physical signs; 3 had DVT. The mean duration of catheter placement for all patients was 57.5 months (range, 12-102 months). For patients with DVT, the mean duration was 66.6 ± 7.5 months, compared to 49.5 ± 7.2 months for patients without DVT (P = .06). No patient whose CVC was in place fewer than 48 months had an abnormal venogram. Many hemophilia patients with CVCs develop DVT of the upper venous system, and the risk increases with duration of catheter placement.

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