Peripherally inserted central catheter-related complications in cancer patients: a prospective study of over 50,000 catheter days

2017 ◽  
Vol 18 (2) ◽  
pp. 153-157 ◽  
Author(s):  
Junren Kang ◽  
Wei Chen ◽  
Wenyan Sun ◽  
Ruibin Ge ◽  
Hailong Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Multivariable Logistic Regression Analysis ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Multicenter Cohort Study ◽  
Related Factors

Purpose To evaluate incidence and risk factors of peripherally inserted central catheter (PICC)-related complications in cancer patients. Methods A prospective, multicenter, cohort study of cancer patients with PICC insertion was performed from February 1, 2013 to April 24, 2014. All patients were monitored in clinic until PICCs were removed. The primary endpoint was PICC removal due to complications. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression analysis to identify significant independent risk factors for PICC-related complications. Results There were 477 cancer patients included, for a total of 50,841 catheter-days. Eighty-one patients (17.0%) developed PICC-related complications, with an incidence of 1.59 per 1000 catheter days. Thirty-six (7.5%) PICCs were removed because of complications. The most common complications were skin allergy (4.6%), catheter occlusion (3.4%) and accidental withdrawal (2.3%). Nine (1.9%) patients developed symptomatic upper extremity deep venous thrombosis (UEDVT) and central line associated bloodstream infection (CLABSI) was shown in six (1.3%) PICCs with an infection rate 0.12 per 1000 catheter days. In multivariable analysis, body mass index (BMI) >25 (odds ratio, 2.09; 95% confidence interval, 1.26-3.47, p = 0.004) was shown to be a significant risk factor for PICC complications. Conclusions Cancer patients with BMI greater than 25 were more likely to have PICC complications.

Preoperative in-hospital mortality in neonates with critical CHD

2021 ◽  
pp. 1-7
Author(s):  
Dennis R. Delany ◽  
Shahryar M. Chowdhury ◽  
Corinne Corrigan ◽  
Jason R. Buckley
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Patient Care ◽  
Multivariable Analysis ◽  
Health Information System ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Interrupted Aortic Arch ◽  
Administrative Dataset ◽  
Care Improvement

Abstract Objective: Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. Study design: The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. Results: Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0–20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8–2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0–4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2–2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. Conclusion: Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.

scholarly journals No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma

2015 ◽  
Vol 97 (8) ◽  
pp. 584-588 ◽  
Author(s):  
I Phang ◽  
R Sivakumaran ◽  
MC Papadopoulos
Keyword(s):  
Risk Factors ◽  
Subdural Haematoma ◽  
Early Stage ◽  
Significant Risk ◽  
Working Hours ◽  
Significant Risk Factor ◽  
Chronic Subdural Haematoma ◽  
Timing Of Surgery ◽  
Related Factors ◽  
Burr Holes

Introduction Neurosurgical trainees should achieve competency in chronic subdural haematoma (CSDH) drainage at an early stage in training. The effect of surgeon seniority on recurrence following surgical drainage of CSDH was examined. Methods All CSDH cases performed at St George’s Hospital in London between March 2009 and March 2012 were analysed. Recurrence was defined as clinical deterioration with computed tomography evidence of CSDH requiring reoperation within six months. The following risk factors were considered: seniority of primary and supervising surgeons, timing of surgery (working hours, outside working hours), patient related factors (age, antiplatelets, warfarin) and operative factors (general vs local anaesthesia, burr holes vs craniotomy, drain use). For recurrent cases, we examined the distance of the cranial opening from the thickest part of the CSDH. Results A total of 239 patients (median age: 79 years, range: 33–98 years) had 275 CSDH drainage operations. The overall recurrence rate was 13.1%. The median time between the initial procedure and reoperation was 16 days (range: 1–161 days). The only statistically significant risk factor for recurrence was antiplatelets (odds ratio: 2.62, 95% confidence interval: 1.13–6.10, p<0.05). Warfarin, grade of surgeon, timing of surgery, type of anaesthesia, type of operation and use of drains were not significant risk factors. In 26% of recurrent CSDH cases, the burr holes or craniotomy flaps were placed with borderline accuracy. Conclusions CSDH drainage is a suitable case for neurosurgical trainees to perform without increasing the chance of recurrence.

scholarly journals Analysis of Factors Causing Skin Damage in the Application of Peripherally Inserted Central Catheter in Cancer Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Luan Tian ◽  
Xinxin Yin ◽  
Yuxin Zhu ◽  
Xin Zhang ◽  
Congcong Zhang
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Chemotherapy Cycle ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Skin Damage ◽  
Related Factors

Objective. To investigate the related factors of skin damage caused by peripherally inserted central catheter (PICC) in cancer patients. Methods. It was a retrospective analysis of 202 cancer patients admitted to our hospital from February 2014 to July 2019. 50 cases of PICC-related skin damage and 152 cases of non-skin damage were studied. In addition, multivariate logistic regression analysis was used to determine independent risk factors for PICC-related skin damage, including cancer patients with catheter-related skin damage and patients without skin damage. Results. 50 patients with PICC skin damage (19 males and 31 females) and 152 patients without skin damage (62 males and 90 females) were retrospectively analyzed. The skin damage rate was 24.8%. The analysis of variance results showed that many factors are related to PICC catheter-related skin damage, including hormones (χ2/Z = 4.468, P < 0.05 ), body mass index (BMI) (χ2/Z = −2.443, P < 0.05 ), days with tube (χ2 = 26.230, P < 0.05 ), chemotherapy cycle (χ2/Z = 25.638, P < 0.05 ), and self-care ability (χ2/Z = −1.968, P < 0.05 ). Logistic regression analysis showed that hormones (odds ratio (OR) = 3.896, P = 0.045 ), BMI (OR = 1.129, P = 0.017 ), days with tube (OR = 0.419, P = 0.013 ), and chemotherapy cycle (OR = 3.302, P = 0.028 ) are independent factors affecting PICC-related skin damage. Conclusion. The independent influencing factors of skin damage during PICC catheterization are hormones, BMI, number of days with tube, and chemotherapy cycle.

scholarly journals Complications of biliary-enteric anastomoses

2017 ◽  
Vol 99 (3) ◽  
pp. 210-215 ◽  
Author(s):  
RS Kadaba ◽  
KA Bowers ◽  
S Khorsandi ◽  
RR Hutchins ◽  
AT Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Late Complications ◽  
Biliary Reconstruction ◽  
Tertiary Referral Centre ◽  
Younger Age

INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.

scholarly journals Peripherally Inserted Central Catheter-Related Vein Thrombosis in Patients With Lung Cancer

2016 ◽  
Vol 23 (2) ◽  
pp. 181-186 ◽  
Author(s):  
Jun Ren Kang ◽  
Li Hai Long ◽  
Sun Wen Yan ◽  
Wang Wei Wei ◽  
Han Zhi Jun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Advanced Disease ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Related Factors ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Logistic Analysis ◽  
Independent Risk Factors

Background: Peripherally inserted central venous catheters (PICCs) are widely used in patients with cancer. Catheter usage is one of the risk factors for venous thromboembolism. We aimed to scrutinize the incidence and risk factors for PICC-related upper extremity venous thrombosis (UEVT) in patients with lung cancer receiving chemotherapy. Patients and Methods: We performed a retrospective cohort study of patients with lung cancer with PICC insertion undergoing chemotherapy. Symptomatic PICC-UEVT was diagnosed by ultrasound. The relationship between chemotherapeutic agent exposure and PICC-UEVT was evaluated. Patient-, catheter-, and insertion-related factors were analyzed in univariable and multivariable logistic regression to identify significant independent risk factors for PICC-UEVT in patients with lung cancer. Results: A total of 328 patients with lung cancer having PICC undergoing chemotherapy were included, for a total of 34 895 catheter days. Seventeen (5.2%) patients developed PICC-related UEVT, with an incidence of 0.49 per 1000 catheter days. In multivariable logistic analysis, advanced disease was shown to be a significant risk factor for PICC-UEVT (odds ratio [OR]: 4.9; 95% confidence interval [CI]: 1.4-16.7; P = .011). Patients treated with etoposide had a higher risk of PICC-related UEVT (OR: 3.6; 95% CI: 1.1-12.1; P = .042). Patients were followed up after PICC removal for a median duration of 246 days. None of the patients developed pulmonary embolism. Conclusion: Patients with lung cancer harboring an advanced disease or treating with etoposide were at higher risk of PICC-UEVT.

High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)

Blood ◽  
2008 ◽  
Vol 112 (7) ◽  
pp. 2703-2708 ◽  
Author(s):  
Cihan Ay ◽  
Ralph Simanek ◽  
Rainer Vormittag ◽  
Daniela Dunkler ◽  
Guelay Alguel ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Plasma Levels ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cumulative Probability ◽  
Increased Risk ◽  
Soluble P

Abstract Cancer patients are at high risk for venous thromboembolism (VTE). Laboratory parameters with a predictive value for VTE could help stratify patients into high- or low-risk groups. The cell adhesion molecule P-selectin was recently identified as risk factor for VTE. To investigate soluble P-selectin (sP-selectin) in cancer patients as risk predictor for VTE, we performed a prospective cohort study of 687 cancer patients and followed them for a median (IQR) of 415 (221-722) days. Main tumor entities were malignancies of the breast (n = 125), lung (n = 86), gastrointestinal tract (n = 130), pancreas (n = 42), kidney (n = 19), prostate (n = 72), and brain (n = 80); 91 had hematologic malignancies; 42 had other tumors. VTE occurred in 44 (6.4%) patients. In multivariable analysis, elevated sP-selectin (cutoff level, 53.1 ng/mL, 75th percentile of study population) was a statistically significant risk factor for VTE after adjustment for age, sex, surgery, chemotherapy, and radiotherapy (hazard ratio = 2.6, 95% confidence interval, 1.4-4.9, P = .003). The cumulative probability of VTE after 6 months was 11.9% in patients with sP-selectin above and 3.7% in those below the 75th percentile (P = .002). High sP-selectin plasma levels independently predict VTE in cancer patients. Measurement of sP-selectin at diagnosis of cancer could help identify patients at increased risk for VTE.

Methicillin-ResistantStaphylococcus aureus(MRSA) Nasal Carriage in Residents of Veterans Affairs Long-Term Care Facilities: Role of Antimicrobial Exposure and MRSA Acquisition

2012 ◽  
Vol 33 (6) ◽  
pp. 551-557 ◽  
Author(s):  
Nimalie D. Stone ◽  
Donna R. Lewis ◽  
Theodore M. Johnson ◽  
Thomas Hartney ◽  
Doris Chandler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Care Facility ◽  
Significant Risk Factor ◽  
Nasal Carriage ◽  
Veterans Affairs ◽  
Term Care

Objective.To identify risk factors associated with methicillin-resistantStaphylococcus aureus(MRSA) acquisition in long-term care facility (LTCF) residents.Design.Multicenter, prospective cohort followed over 6 months.Setting.Three Veterans Affairs (VA) LTCFs.Participants.All current and new residents except those with short stay (<2 weeks).Methods.MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE).Results.Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1–28.6];P= .002). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers.Conclusions.MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions.

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