Comparing catheter related bloodstream infection rate between cuffed tunnelled and non-cuffed tunnelled peripherally inserted central catheter

2021 ◽  
pp. 112972982098737
Author(s):  
Teoh Sze Yong ◽  
Anushya A/P Vijayanathan ◽  
Eric Chung ◽  
Wei Lin Ng ◽  
Nur Adura Yaakup ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Related Complication ◽  
Time Of Infection ◽  
The Mean ◽  
Mean Time ◽  
Crbsi Rate

Objective: To compare catheter related blood stream infection (CRBSI) rate between cuffed tunnelled and non-cuffed tunnelled PICC. Methods: We prospectively followed 100 patients (50:50 cuffed and non-cuffed PICC) and compared CRBSI rate between these groups. Daily review and similar catheter care were performed until a PICC-related complication, completion of therapy, death or defined end-of-study date necessitate removal. CRBSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of infection and from peripheral blood cultures. Results: A total of 50 cuffed PICC were placed for 1864 catheter-days. Of these, 12 patients (24%) developed infection, for which 5 patients (10%) had a CRBSI for a rate of 2.7 per 1000 catheter-days. Another 50 tunnelled non-cuffed PICCs were placed for 2057 catheter-days. Of these, 7 patients (14%) developed infection, for which 3 patients (6%) had a CRBSI. for a rate of 1.5 per 1000 catheter-days. The mean time to development of infection is 24 days in cuffed and 19 days in non-cuffed groups. The mean duration of utilization was significantly longer in non-cuffed than in cuffed group (43 days in non-cuffed vs 37 days in cuffed group, p = 0.008). Conclusions: Cuffed PICC does not further reduce the rate of local or bloodstream infection. Tunnelled non-cuffed PICC is shown to be as effective if not better at reducing risk of CRBSI and providing longer catheter dwell time compared to cuffed PICC.

Blood sampling from peripherally inserted central catheter is effective and safe for patients with head and neck cancers

2020 ◽  
pp. 112972982094345
Author(s):  
Yuejiao Zhang ◽  
Shoude Zhang ◽  
Jinhua Chen ◽  
Ruiyi Zhao
Keyword(s):  
Head And Neck ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Blood Sampling ◽  
Peripherally Inserted Central Catheter ◽  
Test Results ◽  
Central Catheter ◽  
Blood Samples ◽  
Numerical Rating ◽  
Analogue Scales

Objective: To evaluate the validity of laboratory tests for blood sampling from a peripherally inserted central catheter. Methods: A total of 22 patients diagnosed with head and neck cancers were enrolled. In total, 101 paired blood samples were taken both via venipuncture and peripherally inserted central catheter for hematology and biochemistry testing. Paired t tests and linear correlation analysis were used to evaluate the results. Blood sampling–related pain was recorded by visual analogue scales and numerical rating scales. Infusion occlusion, hemolysis, and catheter-related blood stream infection were also recorded. Results: The peripherally inserted central catheter–associated test results were slightly lower than those with venipuncture. Some parameters differed more than others. However, the degree of difference was less than 5% for every pair. There was a high correlation between the test results with two methods of blood sampling with the representative equation approximately being “y = x.” According to visual analogue scales and numerical rating scale analysis, the pain degree with peripherally inserted central catheter was significantly lower than that of the venipuncture (p < 0.001). No case of infusion occlusion, catheter-related blood stream infection was reported with both methods. Hemolysis rate in blood samples from peripherally inserted central catheter (1/101) was much lower than that seen with venipuncture (11/101) with significant difference (p = 0.0056). Conclusion: Blood sampling via peripherally inserted central catheter and venipuncture showed equivalent reliability in laboratory testing. Compared with venipuncture, blood sampling via peripherally inserted central catheter causes less pain and is safer. Blood sampling via peripherally inserted central catheter is strongly recommended for clinical use.

scholarly journals Comparison of the Quality of Life of Patients with Breast or Colon Cancer with an Arm Vein Port (TIVAD) Versus a Peripherally Inserted Central Catheter (PICC)

2021 ◽  
Vol 28 (2) ◽  
pp. 1495-1506
Author(s):  
Brent Burbridge ◽  
Hyun Lim ◽  
Lynn Dwernychuk ◽  
Ha Le ◽  
Tehmina Asif ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Well Being ◽  
Venous Access ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Access Device ◽  
The Mean ◽  
Venous Access Device

Introduction: Venous access is a crucial element in chemotherapy delivery. It remains unclear whether cancer patients prefer a port to a peripherally inserted central catheter (PICC). Our study aimed to assess cancer patients’ satisfaction with their venous access device and to compare the quality of life (QoL) of subjects with a PICC to those with a port. Methods: In this prospective cohort study, EORTC QLQ-C30, and a locally developed quality of life survey (QLAVD), designed to assess satisfaction with venous access devices, were administered to breast or colorectal cancer patients over a one-year period following the device insertion. Mixed effects models were used to assess changes on mean scores at different time points. Results: A total of 101 patients were recruited over a three-year period, (PICC group, n = 50; port group, n = 51). Survey response rates for months one and three were 72% and 48%, respectively. Overall, no significant differences were noted between the two groups in relation to EORTC QOL. At three months, the mean pain scores were 3.5 ± 2.3 for the port and 1.3 ± 0.75 for PICC (<0.001). The mean score for a negative effect of the venous access device on psychosocial well-being was 6.0 ± 4.1 for PICC and 3.0 ± 2.7 for the port (p = 0.005). Complications related to PICCs occurred in 38% patients versus 41% with a port (p > 0.24). Conclusions: Although subjects with a port experienced more pain during the device insertion or access for chemotherapy, it had a smaller negative impact on psychosocial scores than the PICC. No significant differences in complications rates were observed between the two devices.

scholarly journals 250. Blood Stream Infections (BSI) in Pediatric Neuroblastoma High Risk: Emphasis on Viridans Group Streptococci (VGS) Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S124-S125
Author(s):  
Muayad Alali ◽  
Joseph Hageman
Keyword(s):  
High Risk ◽  
Solid Tumors ◽  
Induction Chemotherapy ◽  
Blood Stream Infection ◽  
Lymphoblastic Leukemia ◽  
Blood Stream ◽  
High Risk Group ◽  
Related Complication ◽  
High Risk Factors ◽  
Viridans Group Streptococci

Abstract Background Febrile neutropenia’s (FN) literature has focused on acute leukemia and undergoing allogeneic stem cell transplantation (SCT) as high risk factors for microbiological documented infection (MDI) and blood stream infection (BSI). Comprehensive studies on in pediatric Neuroblastoma high risk (NB-HR) who receive highly myelosuppressive therapy are lacking. Methods We conducted a retrospective medical record review of pediatric patients who received any oncology care at UCM Comer Children’s Hospitals.with a diagnosis of FN who had at least 1 blood culture obtained and one of the following underlying diagnoses (AML, lymphoblastic leukemia ALL), NB-HR, and other solid tumors (ST). SCT patients were excluded from study. We reviewed pathogens isolated from blood cultures (BCx) and determined whether they were pathogens or contaminants using IDSA guidelines. Comparative analyses of BSI rates between NB-HR and other underlying diagnoses were done. Results A total of 560 FN episodes (FNEs) were identified in 230 patients. FNEs occurred in NB-HR were 102 in 77 patients. Fifty-seven percent of patients developed one or more BSI or MDI during induction chemotherapy. The mean age was 11.0 (SD=6.5) years. True BSI occurred in 138 (24.6%) of FN episodes. The organisms that were most frequently isolated from were viridans group streptococci (VGS) (25%). The highest rate of BSI occurred among FNEs with AML (44/115, 37%) followed by NB-HR 26/110 (25%) Table1. Overall BSI rate in NB-HR group is higher than other solid tumors (25 vs 17%, P=0.03). In subset analysis, VGS bacteremia was highest among FNEs with AML and NB-HR compared with ALL (8.7 and 8.8 % vs 6%) P&lt; 0.04 and P=0.02 respectively. Notably, the gram positive/ gram negative (GP/GN ratio) in NB-HR compared with ST was significantly higher (OR =2.26, CI 95% 1.5–7.8, P&lt; 0.01), this was likely due to a higher VGS rate (8.8% vs 2%, OR=4.2, P &lt; 0.01). Rate of GN-BSI are same in each of ALL,HR-NB and ST. Conclusion Our large Neuroblastoma cohort showed that NB-HR during induction chemotherapy are higher risk for VGS bacteremia, compared with other solid tumors. Further prospective studies are needed to investigate infection related complication in this high risk group and possible improved morbidity and mortality. Disclosures All Authors: No reported disclosures

scholarly journals Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals

2021 ◽  
pp. bmjqs-2021-013015
Author(s):  
Vineet Chopra ◽  
Megan O'Malley ◽  
Jennifer Horowitz ◽  
Qisu Zhang ◽  
Elizabeth McLaughlin ◽  
...  
Keyword(s):  
Central Line ◽  
Hospital Performance ◽  
Policy Implications ◽  
Change Point Analysis ◽  
Absolute Difference ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Appropriateness Criteria ◽  
Mean Frequency ◽  
The Mean

BackgroundThe Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.MethodsA quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).ResultsAmong 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p<0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95% CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95% CI 0.21 to 0.29), CLABSI (OR 0.61, 95% CI 0.46 to 0.81) and VTE (OR 0.40, 95% CI 0.33 to 0.47, all p<0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95% CI 0.98 to 0.99, p<0.001).ConclusionsImplementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

2020 ◽  
Vol 21 (5) ◽  
pp. 732-737
Author(s):  
Chunli Liu ◽  
Dingbiao Jiang ◽  
Tao Jin ◽  
Chuanyin Chen ◽  
Ruchun Shi ◽  
...  
Keyword(s):  
Upright Position ◽  
Body Posture ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Posture Change ◽  
Body Change ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Chinese Cancer Patients

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p = 0.009) and height ( p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

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