Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central 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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Rates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children

Critical Care Medicine ◽

10.1097/ccm.0000000000004461 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 1

Author(s):

Nital Patel ◽

Tara L. Petersen ◽

Pippa M. Simpson ◽

Mingen Feng ◽

Sheila J. Hanson

Keyword(s):

Venous Thromboembolism ◽

Critically Ill ◽

Central Venous Access ◽

Bloodstream Infections ◽

Venous Access ◽

Central Line ◽

Critically Ill Children ◽

Central Venous ◽

Venous Access Devices

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

Infection Control and Hospital Epidemiology ◽

10.1086/671006 ◽

2013 ◽

Vol 34 (7) ◽

pp. 671-677 ◽

Cited By ~ 10

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.

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The case for using implanted ports

British Journal of Nursing ◽

10.12968/bjon.2019.28.sup14a.s3 ◽

2019 ◽

Vol 28 (Sup14a) ◽

pp. S3-S10 ◽

Cited By ~ 1

Author(s):

Jane Hodson

Keyword(s):

Bloodstream Infection ◽

Vascular Access ◽

Central Venous Access ◽

Venous Access ◽

Low Risk ◽

Central Venous ◽

Different Types ◽

Venous Access Devices ◽

Catheter Related Bloodstream Infection

Uses of central venous access devices (CVADs) include the administration of vital fluids and medications. Implanted ports are a type of CVAD that is used when long-term vascular access is required. The device is discreet and associated with a low risk of catheter-related bloodstream infection. This article describes the different types and components of ports and how to select them. It explains how to insert ports, and provides guidance on accessing and de-accessing them

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Use of Vancomycin-Containing Lock or Flush Solutions for Prevention of Bloodstream Infection Associated with Central Venous Access Devices: A Meta-Analysis of Prospective, Randomized Trials

Clinical Infectious Diseases ◽

10.1086/505976 ◽

2006 ◽

Vol 43 (4) ◽

pp. 474-484 ◽

Cited By ~ 101

Author(s):

N. Safdar ◽

D. G. Maki

Keyword(s):

Bloodstream Infection ◽

Randomized Trials ◽

Meta Analysis ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Venous Access Devices

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Utilization and Complications of Central Venous Access Devices in Oncology Patients

Current Oncology ◽

10.3390/curroncol28010039 ◽

2021 ◽

Vol 28 (1) ◽

pp. 367-377

Author(s):

Narmeen Akhtar ◽

Linda Lee

Keyword(s):

Removal Rate ◽

Central Venous Access ◽

Bloodstream Infections ◽

Venous Access ◽

Central Venous ◽

Oncology Patients ◽

Vascular Access Devices ◽

Entire Cohort ◽

Ambulatory Oncology ◽

Venous Access Devices

Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.

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

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650254 ◽

1996 ◽

Vol 75 (02) ◽

pp. 251-253 ◽

Cited By ~ 264

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.

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