A scoping review of Clinical Studies, Hospital Group Reports and National Strategic Documents on vascular access devices in cancer patients

Introduction: The extent of vascular/venous access device (VAD) research output from the Island of Ireland is unknown. The identification of the papers available is important to create a future research agenda. Objectives: The main objective of this study is to answer three questions: What is the number and descriptive quality of reported Vascular Access Device literature from the Island of Ireland? Is the reporting of Catheter Related Infection rates for cancer patients common in Irish Hospital Groups, National Cancer Reports and Publication Outputs? What are the implications for future research in this area? Methods: We used a scoping review and searched selected databases, grey literature and hospital regulatory bodies websites following the Joanna Briggs Institute Guidelines 2017. A data charting form was developed based on a template from the Joanna Briggs Institute and this was used to extract data from the included reports. Results: A total of 660 reports were screened. Sixty-one full text articles were reviewed from which 20 reports were included for data extraction. Of the reports included the following designs were used: nine retrospective study designs, four guidelines, two prospective study designs, two literature reviews and one of the following; survey, case study and cross sectional analysis designs. We did not identify any randomised controlled trials, systematic reviews, meta-analysis, meta-synthesis and scoping reviews. Five studies included catheter related infection rates. Gaps in the research include the collection of data sets and the need to establish a VAD registry; develop core outcomes for VADs; assessment and evaluation of VAD care bundles among cancer patients; and, the inclusion of public and patient involvement in future VAD research. Conclusion: The reporting of VAD outcomes in published literature regarding cancer patients receiving treatment in Ireland is inconsistent and varied with no interventional studies addressing vascular access complications in cancer care.

Taurolidine lock in the treatment of colonization and infection of totally implanted venous access devices in cancer patients

Background: Taurolidine lock is known to be effective in preventing catheter-related infections in a variety of venous access devices, including long term venous access devices for chemotherapy. Though, literature about the use of taurolidine for treating catheter colonization or catheter-related blood stream infection is scarce. Method: We have retrospectively reviewed the safety and efficacy of 2% taurolidine lock for treatment of catheter-colonization and of catheter-related bloodstream infection in cancer patients with totally implanted venous access devices. Diagnosis of colonization or catheter-related infection was based on paired peripheral and central blood cultures, according to the method of Delayed Time to Positivity. Results: We recorded 24 cases of catheter-related infection and two cases of colonization. Taurolidine lock—associated with systemic antibiotic therapy—was successful in treating all cases of catheter-related infection, with disappearance of clinical symptoms, normalization of laboratory values, and eventually negative blood cultures. Taurolidine lock was also safe and effective in treating device colonization. No adverse effect was reported. Conclusion: In our retrospective analysis, 2% taurolidine lock was completely safe and highly effective in the treatment of both catheter-colonization and catheter-related bloodstream infection in cancer patients with totally implanted venous access devices.

Factors influencing plasma galectin-3 concentrations in catheter-bearing hospitalized patients

Introduction: Catheters are an integral part of modern medicine although their use is not without complications. Catheter-related infection triggers a strong inflammatory reaction and has been associated with high morbidity, mortality, and healthcare costs. The clinical diagnosis of catheter-related infection is made difficult by non-specific symptoms. Investigating the alterations in biochemical parameters related to infec-tious and inflammatory processes in these patients constitute an active line of re-search. The aim of this study was to investigate factors influencing the plasma concen-tration of galectin-3 in catheter-bearing patients and to explore its potential usefulness as an index for catheter-related infections. Methods: Circulating concentrations of galectin-3, chemokine (C-C) motif ligand 2, pro-calcitonin and C-reactive protein were measured in 110 patients with a central venous catheter, 165 patients with a urinary catheter, and 72 control subjects. Results: Catheter-bearing patients had significantly higher concentrations of galectin-3 and the other markers than the control group. We identified chronic kidney disease as an independent determinant of plasma galectin-3 concentrations in patients with a central catheter, and serum creatinine concentration, cardiovascular disease and the number of days the catheter was indwelling as determinants in urinary catheter pa-tients. We also found that measuring galectin-3 in urinary catheter patients with a catheter-related infection was more accurate for diagnosis than the other parameters. At galectin-3 = 15 ng/mL, sensitivity was 90%. Conclusion: We conclude that measurement of galectin-3 concentration may be useful for assessing the inflammatory status of catheter-bearing patients and may contribute to the diagnosis of catheter-related infection in those with a urinary catheter.