Risk of Thrombosis with Different Approaches to Central Venous Access During Acquired Asparaginase Related Antithrombin Deficiency in Children with Leukemia.

Abstract Abstract 2241 Background Children with acute lymphoblastic leukemia (ALL) have several risk factors for thrombosis including asparaginase related acquired antithrombin (AT) deficiency and central venous catheters (CVCs). Both external tunneled and internal CVCs (tunneled, fully implantable devices known as ports) are used to provide reliable venous access. After introduction of a new ALL protocol with prolonged continuous asparaginase treatment aiming at approximately 30 weeks depletion of asparagine more symptomatic thromboses than expected were observed at the Children's Hospital, Helsinki University Central Hospital, Finland. To ensure asparaginase treatment and prevent thromboses an on-demand AT substitution regimen was adopted. Previous studies have described AT substitution during ALL induction; this is the first description and evaluation of on-demand AT substitution over a longer period of time in children. Aim The aim of this study is to describe the prolonged on-demand AT substitution practice in Helsinki during depletion of asparagine from the blood with PEG-ASP and to compare experiences from two Nordic pediatric oncology centers (Children's Hospital in Helsinki and the Astrid Lindgren Children's Hospital Karolinska University Hospital, in Stockholm, Sweden) with the same leukemia protocol but different approaches to central venous access. Procedure All Finnish children with ALL and external tunneled CVCs diagnosed at Children's Hospital in Helsinki between May 2008 and November 2011 (n=38) were compared with Swedish children with ALL and internal CVCs treated concurrently with the same ALL protocol (n=39). Children treated in Helsinki according to the standard or intermediate risk NOPHO-ALL 2008 protocol after initiation of the AT substitution regiment received AT concentrate when their AT level decreased below 55% (the intervention group, n=25). The thrombosis rate and laboratory parameters were compared with children treated earlier in the same unit (the control group, n=10). Results In Helsinki, 2/10 (20%) children in the control group had 3 symptomatic thromboses and 2/25 (8%) children in the intervention group with on-demand AT substitution had one symptomatic thrombotic event each. Both thromboses in the intervention group were associated with concomitant steroid treatment. In the intervention group 14/25 (56%) received AT concentrate (median number of infusions 3, range 1–17). Altogether, 4/38 Finnish patients with external CVCs and 0/39 Swedish patients with internal CVCs had thromboses (Mann Whitney U test, p=0.039) in spite of similar exposure to asparaginase and low antithrombin. A significant difference was also observed in the use of tissue plasminogen activator (tPA): 28/38 Swedish patients had received tPA at least once to restore dysfunctional CVCs (usually loss of the ability to withdraw blood) compared to 2/38 Finnish patients (Mann Whitney U test, p≤0.001). Conclusions Most children are exposed to low AT levels during ASP treatment predisposing to thrombosis especially with concomitant steroids. Larger studies are needed to evaluate the benefit of prophylactic antithrombin treatment. Internal CVCs and tPA may be beneficial in preventing symptomatic thrombosis during leukemia treatment. Disclosures: No relevant conflicts of interest to declare.

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Risk factors for unsuccessful removal of central venous access ports implanted in the forearm of adult oncologic patients

Japanese Journal of Radiology ◽

10.1007/s11604-021-01214-5 ◽

2021 ◽

Author(s):

Mitsuhiro Kinoshita ◽

Shoichiro Takao ◽

Junichiro Hiraoka ◽

Katsuya Takechi ◽

Yoko Akagawa ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Independent Risk Factor ◽

Central Venous Access ◽

Univariate Analysis ◽

Venous Access ◽

Central Venous ◽

Significant Difference ◽

Oncologic Patients

Abstract Purpose To evaluate the risk factors for unsuccessful removal of a central venous access port (CV port) implanted in the forearm of adult oncologic patients. Materials and methods This study included 97 adult oncologic patients (51 males, 46 females; age range, 30–88 years; mean age, 63.7 years) in whom removal of a CV port implanted in the forearm was attempted at our hospital between January 2015 and May 2021. Gender, age at removal, body mass index, and diagnosis were examined as patient characteristics; and indwelling period, indwelling side, and indication for removal were examined as factors associated with removal of a CV port. These variables were compared between successful and unsuccessful cases using univariate analysis. Then, multivariate analysis was performed to identify independent risk factors for unsuccessful removal of a CV port using variables with a significant difference in the univariate analysis. A receiver-operating characteristics (ROC) curve was drawn for significant risk factors in the multivariate analysis and the Youden index was used to determine the optimum cut-off value for predicting unsuccessful removal of a CV port. Results Removal of CV ports was successful in 79 cases (81.4%), but unsuccessful in 18 cases (18.6%) due to fixation of the catheter to the vessel wall. Multivariate logistic regression analysis showed that the indwelling period (odds ratio 1.048; 95% confidence interval 1.026–1.070; P < 0.0001) was a significant independent risk factor for unsuccessful removal of a CV port. ROC analysis showed that the cut-off value for successful removal was 41 months, and 54% of cases with an indwelling period > 60 months had unsuccessful removal. Conclusion The indwelling period is an independent risk factor for unsuccessful removal of a CV port implanted in the forearm of adult oncologic patients, with a cut-off of 41 months.

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Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study

PLoS ONE ◽

10.1371/journal.pone.0242727 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242727

Author(s):

Amine Souadka ◽

Hajar Essangri ◽

Imad Boualaoui ◽

Abdelilah Ghannam ◽

Amine Benkabbou ◽

...

Keyword(s):

Retrospective Study ◽

Intraoperative Complications ◽

Central Venous Access ◽

Venous Access ◽

Demographic Characteristics ◽

Success Rates ◽

Central Venous ◽

Chemotherapy Administration ◽

Significant Difference ◽

Ultrasonographic Guidance

Introduction The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). Material and methods This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. Results Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. Conclusion In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.

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Care Practices in Gaucher Disease: Results of a French Study.

Blood ◽

10.1182/blood.v114.22.4441.4441 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4441-4441

Author(s):

Belmatoug Nadia ◽

Nathalie Guffon ◽

Jérôme Stirnemann ◽

Christine Serratrice ◽

Alain Robert ◽

...

Keyword(s):

Gaucher Disease ◽

Central Venous Access ◽

Venous Access ◽

Infusion Time ◽

Mineral Density ◽

Central Venous ◽

Significant Difference ◽

The Mean ◽

Care Practices ◽

At Home

Abstract Abstract 4441 Introduction Gaucher Disease (GD) management is well defined but little is known about the management of patients in routine practice. To describe it, this multicentre retrospective survey was proposed to all French Hospital Departments in whom Gaucher patients are monitored. Demographic and clinical data were collected, and therapeutic regimens were detailed. Results In 2008, 118 patients were enrolled in 54 centres, including 111 type 1 (GD1) and 7 type 3 (GD3). 90% of patients were adults at inclusion. At time of diagnosis 40% of GPS patients were less than 16 years. Glucocerebrosidase activity assay and bone marrow aspiration were part of the diagnosis in 80% and 51% of patients, respectively. A family survey has been performed in all children and overall in 85 % of patients, with positive results in 44% of cases. 54% of patients are managed by the physician who diagnosed the GD and the mean annual number of visits at hospital is 10 and 4 for children and adults, respectively. In patients diagnosed after the age of 16 years, 20.7% were splenectomised at time of inclusion. On average, hemogram and chitotriosidase are assessed twice a year, as bone mineral density and skeletal MRI are performed every 2 years. Ninety-six patients are treated with imiglucerase, 3 patients with miglustat and 2 patients with a combination of both. Adult patients were treated on average for 87.6 months versus 53 months for children. The mean Imiglucerase dose is 54 U/kg by infusion for GD1 with no significant difference regarding infusions frequencies, and 96 U/kg for GD3 and The treatment is infused every two weeks in 74% of the patients, and every 3 weeks in 18% of them, using a gravity infusion in 57 % of the cases. Only 7.8% of the GPS population is infused using a central venous access with similar rates in adults and children. Infusions are administered at hospital in 60% of cases and at patient's home in 40% of cases. A central venous access is used in 11% of patients who are treated at home. Infusion time is less than 2 hours in 55% of patients and is slightly longer at home compared to hospital. Observance is good or excellent in more than 95% of cases. Conclusion This is the first large national survey about Care Practices in GD patients. The clinical and biological follow-up is globally in line with French Guidelines. Treatment with imiglucerase is administered on average at the recommended dose and frequency, but with an infusion time often longer than that recommended. Patients should be more frequently treated at home, and thus quality of life studies and encouragement of home infusions organisation should be performed in France. Disclosures: Off Label Use: Cerezyme (imiglucerase) : enzymatic replacement therapy for Gaucher disease patients. The aim of imiglucerase is to replace glucocerebrosidase deficiency; The dose of treatment initiation is 60u/kg/2 weeks.. Bruno:Genzyme: Employment.

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GLUCOCORTICOSTEROID DURING PATCH APPLICATION TO IMPROVE SCAR OUTCOME AFTER CENTRAL VENOUS CATHETER. A RANDOMIZED TRIAL

10.22541/au.161185647.75777799/v1 ◽

2021 ◽

Author(s):

Ida Bo Nissen ◽

Mette Møller Handrup ◽

Karen Bang ◽

Henrik Hasle

Keyword(s):

Placebo Group ◽

Central Venous Catheter ◽

Fusidic Acid ◽

Intervention Group ◽

Venous Catheter ◽

Control Group ◽

Neoplastic Disease ◽

Central Venous ◽

Silicone Gel ◽

Significant Difference

Introduction: Children treated for cancer with a central venous catheter are often bothered by scarring. We studied whether glucocorticosteroid during patch occlusion has a beneficial effect on scar outcome in children and adolescents treated for neoplastic disease. Methods: A double-blinded placebo-controlled randomized clinical trial was performed. The main outcome was the Vancouver Scar Scale (VSS). Secondary outcomes were scar width and scar quality measured using the Patient and observer scar assessment (POSAS). The patients were divided into an intervention groups and a control group. The intervention group was randomized into two groups; Active and placebo group. The active treatment consisted of cream with glucocorticosteroid and fusidic acid. The placebo treatment consisted of cream with fusidic acid. Both groups were also treated with a silicone gel patch for three months after central venous catheter removal. The control group did not receive any specific skin care. Results: Assessment at 6 months were completed for 44 in the intervention group (21 in the active and 23 in the placebo group) and 47 in the comtrol group. The intervention group had a significantly lower VSS and a smaller scar compared to the control group (p = 0.00, p = 0.02). The POSAS by the patients and the study nurse showed no significant difference between the intervention and control groups (p = 0.84, p= 0.36). Conclusions: Silicone gel sheet alone or in combination with application of glucocorticosteroid during sheet occlusion improved scar outcome after removal of central venous catheter in children treated for neoplastic diseases.

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Performance of 3 mL versus 5 mL Discarded Volume for Blood Sampling from Central Venous Access Device

Journal of Laboratory Physicians ◽

10.1055/s-0041-1726669 ◽

2021 ◽

Author(s):

HT Lalthanthuami ◽

MJ Kumari ◽

R Venkateswaran ◽

PR Lakshmi ◽

Lakshmi Ramamoorthy

Keyword(s):

Critical Care ◽

Blood Loss ◽

Central Venous Access ◽

Intraclass Correlation ◽

Venous Access ◽

Blood Sampling ◽

Central Venous ◽

Blood Samples ◽

Serum Parameters ◽

Significant Difference

Abstract Background Central venous access devices (CVAD) are an essential part of safe practices in critical care, which enable effective venous access and help in avoiding repeated venipuncture. Discard method is widely practiced for blood sampling. A single occasion of blood sampling may cause minimal blood loss; however, the cumulative volume sequential sampling may become clinically signiﬁcant. The study aims to reduce diagnostic blood loss, ensuring that the subsequent blood sample is not diluted or contaminated by residual intraluminal ﬂuid. Patients and Methods Within-subjects comparative design was adopted for 64 adult patients in the medical intensive care unit of a tertiary hospital. Two blood samples, using 3 mL and 5 mL discarded volume methods, were collected from each patient. Six serum parameters were measured on each of the paired samples and compared. Statistical Analysis Used Paired t-test and Wilcoxon signed rank test were used for comparing the two methods. Bland–Altman plot analysis and intraclass correlation were used for clinically meaningful analysis. Results When tested for fixed bias, there is no statistically significant difference between the methods. Potassium and creatinine levels showed significant proportional bias. The agreement limits of sodium, potassium, creatinine, and direct bilirubin were outside the clinically accepted interval, but the proportion of samples outside these intervals was less than 10%. All serum parameters showed excellent reliability, except for sodium which demonstrated good reliability. Conclusions The practice of discarding 3 mL of blood for discard method is suggested, instead of the standard 5 mL to reduce iatrogenic blood loss. Thus, nurses in critical care are uniquely positioned to limit the diagnostic blood loss while obtaining blood samples.

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Intranasal Mupirocin does not Prevent Exit-Site Infections in Children Receiving Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080302300309 ◽

2003 ◽

Vol 23 (3) ◽

pp. 267-269 ◽

Cited By ~ 7

Author(s):

Yoshinori Araki ◽

Hiroshi Hataya ◽

Masahiro Ikeda ◽

Kenji Ishikura ◽

Masataka Honda

Keyword(s):

Peritoneal Dialysis ◽

Control Group ◽

Study Group ◽

Exit Site ◽

Tokyo Metropolitan ◽

Children's Hospital ◽

Significant Difference ◽

Children’S Hospital ◽

Intranasal Mupirocin ◽

Mupirocin Ointment

← Objective Exit-site infections (ESI) in patients receiving peritoneal dialysis (PD) often progress to tunnel infections and peritonitis, sometimes requiring PD catheter removal. Staphylococcus aureus (SA) is the commonest cause of ESI. In this study, we evaluated the efficacy of mupirocin nasal ointment in preventing ESI in children receiving PD. ← Design A single-center study. ← Setting Tokyo Metropolitan Kiyose Children's Hospital. ← Patients 47 outpatients [33 males; age 11.7 ± 4.9 years (mean ± SD)] participated in this study between April 1998 and March 1999 at Tokyo Metropolitan Kiyose Children's Hospital. The total study period comprised 399 patient-months. Nasal cultures were performed every month. Nasal carriers of SA applied intranasal mupirocin ointment twice per day for 7 days. We compared the incidence of ESI in the intervention group to 77 historical controls (48 males; age 7.6± 5.1 years); the total control period comprised 2802 patient-months. ← Results 32 patients were identified as SA nasal carriers on one or two occasions (32/47 or 68%). The total period of SA nasal carriage was 95 patient-months (95/399 or 24%). The incidence of ESI caused by SA among all ESI cases was 20/28 (71%) in the study group and 115/151 (76%) in the control. There was no significant difference. The incidence of peritonitis caused by SA among all peritonitis cases was 3/6 (50%) in the study group and 17/42 (40%) in the control group, showing no significant difference. There was no significant difference in the overall incidence of ESI, peritonitis, or replacement of PD catheters between the study group and the control group. ← Conclusion Intranasal mupirocin ointment did not prevent ESI. Further study is needed to develop an effective method of preventing ESI in pediatric PD patients.

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