Evolution of Antithrombin (AT) and Fibrinogen (Fg) Levels during Induction Chemotherapy with L-Asparaginase (Asp) in Adult Patients with Acute Lymphoblastic Leukemia (ALL) or Lymphoblastic Lymphoma (LBL). Clinical Outcomes and Use of Coagulation Supportive Treatments: The CAPELAL Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4486-4486
Author(s):  
Mathilde Hunault-Berger ◽  
Yves Gruel ◽  
Jean-Luc Harousseau ◽  
Martine Delain ◽  
Abdallah Maakaroun ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Central Venous Access ◽  
Venous Access ◽  
Fresh Frozen Plasma ◽  
Adult Patients ◽  
Cerebral Vein ◽  
Central Venous ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Chromogenic Assay

Abstract The incidence of AT and Fg deficiency and of thrombotic and bleeding events after Asp has been well evaluated in children with ALL, but little is known in adults. In this study, the incidence of these events and the use of coagulation supportive treatments was evaluated in 214 adult patients with ALL (n= 191) or LBL (n=23) included in the GOELAL02 trial (Blood 2004, in press). The induction therapy included steroids (40 mg/m2/d d1-21), vincristine (2 mg d1, 8, 15, 22), idarubicine (5 mg/m2 d1, 8,15, 22) and Asp (7500 UI/m2 d10, 13, 16, 19, 22, 25) delivered through a central venous access. Fresh frozen plasma (FFP), Fg (Clottagen®) and AT (Aclotine®) concentrates were recommended to maintain their levels > 1 g/l and 60%, respectively. If no transfusion, Asp infusion was delayed for 48 hours. Platelets were transfused when < 20 x 109/l. Heparin prophylaxis was left to institutional guidelines. Symptomatic thromboses and significant bleedings were systematically recorded. Active DIC was present in 10.3% of patients on d1. Fg and AT levels were measured 4098 times (20/patient, von Clauss assay) and 1718 times (8/patient, chromogenic assay) respectively, and evolved between d1 and d35 as shown below (mean ± sd). AT nadir was < 60% in 71% of patients with values < 40% in 26% of cases. Fg levels were < 1g/l in 73% of patients with values < 0.5g/l in 9%.Twenty-one thromboses occurred two to 35d after the first Asp infusion (median = 14d) in 20 patients (9.3%), with cerebral vein thrombosis (5), pulmonary embolism (3), upper (5) or lower (8) limb deep vein thrombosis. At the time of event, the median AT level was 48% (mean 60.7) with 12 of 21 thromboses (57%) occurring with AT < 60%. Fourty-two bleedings occurred one to 45d after the first Asp infusion (median = 8d) in 31 patients, with CNS hemorrhage (1), epistaxis (24), central venous access bleeding (8), GI bleeding (1), and large ecchymoses (8). At the time of event, median Fg level was 1.3 g/l. Asp infusions were reduced or delayed in 64% of all patients due to low Fg and/or AT levels. FFP, AT and Fg were infused in 31%, 41% and 52% of patients at mean doses of 5.3 ml/kg/infusion, 31UI/kg/infusion and 7.9 g respectively. AT level increased from 58%±16 (n=79) to 86%±23.2 (n=57) after the first AT infusion but was unchanged after FFP. Fg level increased from 0.9g/l ± 0.3 (n=85) to 1.4g/l ±0.5 (n=69) after Fg infusion but was unmodified after FFP. In conclusion, Fg and AT levels are frequently decreased in adults treated by Asp, with often a less than optimal chemotherapy. Bleeding events were not associated with severe Fg deficiency, but thrombotic events could be favored in some patients by acquired AT deficiency. The benefit of AT concentrates to prevent thrombosis and to reduce delay in Asp infusions could therefore be prospectively assessed in adults treated by Asp. d1 (n) d10-Asp 1 (n) d13-Asp2 (n) d19-Asp 4 (n) d25-Asp 6 (n) AT % - 121±16 (79) 83±16 (125) 65±20 (111) 65±22 (77) Fg g/l 3.2±1.7 (142) 1.9±1.0 (159) 1.4±0.7 (195) 1.1±0.4 (169) 1.4±0.6 (118)

Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

2021 ◽  
Author(s):  
Miguel García-Boyano ◽  
José Manuel Caballero-Caballero ◽  
Marta García Fernández de Villalta ◽  
Mar Gutiérrez Alvariño ◽  
María Jesús Blanco Bañares ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Access Device ◽  
Vein Thrombosis ◽  
Venous Access Device ◽  
Deep Vein

Cannulation of the popliteal vein as an intraoperative emergency access in prone position: A case report

2021 ◽  
pp. 112972982110080
Author(s):  
Tobias Kammerer ◽  
Tobias Brezina
Keyword(s):  
Prone Position ◽  
Central Venous Access ◽  
Venous Catheter ◽  
Venous Access ◽  
Popliteal Vein ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Emergency Situations ◽  
Feasible Alternative

Many surgeries have to be performed in the prone position. Access to central vessels is very limited in this position. This requires forward planning with regard to the placement of a central venous catheter. Emergency situations or unexpected intraoperative events in prone position are challenging, as a conventional central venous access is not possible. We describe the cannulation of the popliteal vein in such a case. We report the case of a patient with severe intracerebral hemorrhage who was transferred to our emergency department where his clinical condition rapidly deteriorated. Due to the surgical approach, a prone position was necessary and preoperative central venous cannulation was not possible. We therefore performed an alternative vascular access in prone position using a ultrasound-guided cannulation of the popliteal vein. The cannulation of the popliteal vein described here can be carried out as a quick and easy feasible alternative in emergency situations in prone position. The ultrasound-guided catheter insertion succeeded without any problems and there was no evidence of a deep vein thrombosis after the intervention.

scholarly journals Deep vein thrombosis risk stratification in intensive care unit patients: a pressing need

2020 ◽  
Vol 8 (2) ◽  
pp. 406
Author(s):  
Viral B. Patel ◽  
Labani M. Ghosh ◽  
Bhalendu Vaishnav
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Risk Stratification ◽  
Central Venous Access ◽  
Venous Access ◽  
P Value ◽  
Central Venous ◽  
Assessment Score ◽  
Vein Thrombosis ◽  
Deep Vein

Background: Risk stratification of deep vein thrombosis in patients admitted to ICU and incorporating DVT risk assessment score as a regular practice were the aim of the present study.Methods: This study was carried out in 67 patients admitted in ICU >18 years of age, over one year. Patients with confirmed DVT, <48 hours of stay, thrombocytopenia, diagnosed coagulation disorders, those who have received DVT prophylaxis in last 1 month and those with active bleeding were excluded. It was a cross sectional observational study. A SMART assessment score and pretest probability scoring card was used. Mechanical or pharmacological prophylaxis was given to those with moderate and high risk for DVT.Results: As per SMART assessment score 4.5%, 41.8%, 6% and 23.9% had no, moderate, high and highest risk of developing DVT. As per the pretest probability scores 76%, 20.9% and 3% were in low, moderate and high-risk group. Both scoring systems are comparable (p=0.001). There was significant association between paralysis (p value was 0.003), central venous access (p value was 0.006), patient bed ridden for >72 hours (p value was 0.009) and risk group.Conclusions: Prolonged bed rest, paralysis and central venous access are the most important contributing conditions for high risk of DVT. Risk stratification should be routinely performed in ICU.  SMART assessment tool and pre-test probability scores are both equally efficacious in identifying high risk patients for DVT. Both mechanical and pharmacological means of DVT prophylaxis are equally effective in preventing DVT.

Safety and Efficacy of Alfimeprase for Restoring Function in Occluded Central Venous Catheters: Interim Results of a Phase 2, Multicenter, Randomized, Double-Blind Study (NuCath).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1768-1768 ◽  
Author(s):  
Steven R. Deitcher ◽  
Stephan Moll ◽  
Howard D. Homesley ◽  
Luigi Bertoli ◽  
Peter Kenyon ◽  
...  
Keyword(s):  
Patency Rate ◽  
Central Venous Access ◽  
Study Drug ◽  
Venous Access ◽  
Double Blind Study ◽  
Phase 2 ◽  
Central Venous ◽  
Bleeding Events ◽  
Double Blind ◽  
Safety And Efficacy

Abstract Alfimeprase, a recombinantly produced 22.6 kilodalton metalloproteinase, is a genetically modified variant of fibrolase. Alfimeprase, like fibrolase, proteolytically cleaves both the alpha and beta chains of fibrin(ogen) independent of plasminogen activation to plasmin and directly dissolves thrombi. Readily abundant alpha-2 macroglobulin acts as an endogenous circulating alfimeprase inactivator, forming a covalent, irreversible bond with alfimeprase which results in an inactive complex. Based on the direct thrombolytic effect of alfimeprase, rapid activity was hypothesized. We performed a Phase 2, randomized, double-blind, controlled, dose-ranging study to compare the safety and efficacy of one or two instillations of three intraluminal doses of alfimeprase (0.3 mg; 1.0 mg; and 3.0 mg) and Cathflo® Activase® (Genentech) 2.0 mg in reestablishing patency to occluded central venous access devices (CVADs). This report describes an interim analysis of 48 patients with CVAD withdrawal occlusion who were enrolled and randomized to treatment. Catheter patency was assessed at 5, 15, 30, and 120 minutes after each dose of study drug. Adverse events including bleeding events were assessed for a 30-day period after exposure to study drug. Cumulative patency rates are shown in the table. All study arms had similar patency rates at 120 minutes after the first dose. The alfimeprase 3.0 mg dose produced the highest patency rate at 120 minutes after the second dose. All three alfimeprase doses were more effective than Cathflo® Activase® during the first 30 minutes of treatment. The alfimeprase 1.0 mg and 3.0 mg doses resulted in ≥ 50% patency restoration rates at 15 minutes compared to 0% for Cathflo® Activase®. No intracranial hemorrhage, major hemorrhagic, or embolic events were reported in any treated patients at 5 days. Efficacy and safety results of this study support further evaluation of alfimeprase doses ranging from 1.0 mg to 3.0 mg for treatment of occluded CVADs. Cumulative Patency Rate (%) Alfimeprase 0.3 Alfimeprase 1 Alfimeprase 3 Cathflo Activase N=13 N=14 N=9 N=12 D=dose; min=minutes after dose Baseline 0 0 0 0 D 1; 5 min 15 14 44 0 D 1; 15 min 15 50 57 0 D 1; 30 min 30 50 57 25 D 1; 120 min 46 50 57 50 D 2; 5 min 46 50 57 58 D 2; 15 min 46 50 57 67 D 2; 30 min 46 50 57 67 D 2; 120 min 46 50 78 67

Central Venous Silicone Elastomer Catheter Placement by Basilic Vein Cutdown in Neonates

PEDIATRICS ◽  
1986 ◽  
Vol 78 (4) ◽  
pp. 636-639
Author(s):  
Joseph Gilhooly ◽  
Jeffrey Lindenberg ◽  
John W. Reynolds
Keyword(s):  
Premature Infants ◽  
Staphylococcus Epidermidis ◽  
Central Venous Access ◽  
Venous Access ◽  
Silicone Elastomer ◽  
Basilic Vein ◽  
Inexpensive Method ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Subcutaneous Tunnel

There is a need for central venous access in small premature infants and other neonates when enteral feeding is not tolerated or is contraindicated. We placed 83 small (0.635-mm od) silicone elastomer catheters by basilic vein cutdown through a subcutaneous tunnel in 79 patients during a 12-month period. Thirty-five patients (44%) weighed &lt;1,000 g. Each patient on whom the procedure was attempted had successful placement of a catheter, and they remained in place a mean of 20 days (range three to 82). Patients had a mean weight gain of 15 g per day of catheter use. Sixty-two catheters (75%) were removed electively, 13 (16%) secondary to complications, six (7%) because of patient deaths (none catheter related), and two (2%) were accidentally dislodged. Two episodes of catheter-related sepsis (0.12 episodes per 100 days of catheter use) caused by Candida albicans and Staphylococcus epidermidis were encountered. Other complications included one subclavian vein thrombosis, eight catheter occlusions, and two local arm inflammations. This technique proved to be a safe, easy, and inexpensive method to administer parenteral nutrition to neonates, especially those weighing &lt;1,000 g.

scholarly journals ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

2021 ◽  
pp. 112972982110443
Author(s):  
Antonio La Greca ◽  
Emanuele Iacobone ◽  
Daniele Elisei ◽  
Daniele Guerino Biasucci ◽  
Vito D’Andrea ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Central Venous Access ◽  
Venous Access ◽  
Adult Patients ◽  
Central Venous ◽  
Promising Tool ◽  
Standardized Protocol ◽  
Venous Catheterization ◽  
Procedural Evaluation ◽  
Venous Access Devices

Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice.

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