Thromboembolic events during neoadjuvant chemotherapy in muscle invasive bladder cancer – any correlation to the central venous access? A clinical practice article

Patients with muscle invasive bladder cancer have a generally known 5-year overall survival of approximately 58% with neoadjuvant chemotherapy (NAC). During the last decades, addition of Cisplatinum-based NAC in fit patients prior to radical cystectomy (RC), has significantly improved OS, compared to RC only. However, some published studies following NAC addition, describe an intermediate risk increase of thromboembolic events (TEEs). Placement of central venous access (CVA) before NAC has also been suggested as being a potential risk factor for thrombosis. We present a combination of images and cases from the Northern Swedish health region where three patients developed venous TEE after CVA placement for NAC-administration and found that the time until curable RC was prolonged circa one month each, with an addition of one RC cancelled. These are serious events and to our knowledge, there are no current guidelines on prevention of TEE before RC. The aim with this report was to provide examples of these events and conclude that further prospective trials are warranted on prevention and future guidelines regarding venous anticoagulant treatment for TEE that occur pre-RC in NAC-patients.

Hybrid Management of Acute Portal Vein Thrombosis Complicated by Mesenteric Ischemia

Treatment for portal vein thrombosis complicated by mesenteric ischemia can be treated in the operating room following a hybrid approach. This allows for efficient care of the patient, avoids the need for transhepatic cannulation for obtaining a venogram and placing a thrombolysis catheter, and obviates the need to obtain percutaneous venous access.

PORT-A-CATH catheter rupture: case report

Introduction: The modern management of cancer treatment requires access to the venous system repeatedly for the passage of drugs, fluids and blood components. Peripheral veins are rapidly damaged by repeated punctures and by fluids that pass through them. To solve this problem, long-term vascular accesses avoid repeated punctures. One type of long-term venous access is the Port-A-Cath, which is an implantable device usually in the chest with a central venous catheter. Case report: Next, the case of a 34-year-old female with a diagnosis of breast cancer in the right breast is presented. It is treated with a radical mastectomy, and after the procedure a port-a-cath is placed in the left subclavian route for future treatments. The first cycle of chemotherapy is performed, later the patient reports pain at the catheter placement site with increased volume and progressive increase in pain. The patient goes to her health center for an evaluation, they decide to take a chest X-ray showing the migration of the catheter. The management used was through the seldinger technique at the femoral puncture site with a 6 Fr Amplatz GooseNeck Snare Guide, with which it was possible to extract the foreign body at the level of the left brachiocephalic vein. Conclusion: The implantation of a Port-A-Cath catheter is associated with some risks in the process. Catheter and patient care should be maintained to decrease the incidence of complications.

Safety of immediate use of totally implantable venous access ports in adult patients with cancer: a retrospective single-center study

Purpose: Totally implantable venous access ports (TIVAPs) can be used long-term for safe administration of intravenous drugs. TIVAP complications include catheter-related infections, venous thrombosis, extravasation, TIVAP migration, and pain. The relationship between the timing of the first chemotherapy administration after port implantation and complications is controversial. This study aimed to investigate the safety of immediate use of TIVAPs and the associated risk factors for complications.Methods: Between January 2016 and December 2018, 305 patients (median age, 53 years; 256 women) who underwent TIVAP placement at our institution were included. Chemotherapy was administered within 2 days of implantation. A retrospective analysis of patients’ clinical data was performed to investigate catheter days and complications of TIVAPs.Results: Overall, 305 patients were evaluated over 57,324 catheter days (median, 168 catheter days; interquartile range, 105). The median interval between placement and first use of TIVAPs was 0.98 days. The overall morbidity rate was 2.95%. Nine complications occurred in nine patients, including TIVAP-related infection (4), pain (2), port occlusion (1), thrombosis (1), and scar disunion (1), of which five required port removal (1.64%). The median number of catheter days before complications occurred was 61 (range, 10–457 days; interquartile range, 51). No complications occurred within 7 days of implantation. Body mass index was an independent risk factor for TIVAP-related complications in the Cox proportional hazards model (multivariable analysis: hazard ratio, 1.221; 95% confidence interval, 1.054–1.414; P = 0.008).Conclusion: This study suggests the safe long-term use of TIVAPs following their immediate chemotherapy administration within 2 days of implantation.

Drug therapy and vascular devices used by patients hospitalized for COVID-19: a descriptive study / Terapia medicamentosa e dispositivos vasculares utilizados por doentes hospitalizados para a COVID-19: um estudo descritivo

To describe drug therapy and types of vascular access adopted in the treatment of patients with COVID-19 and admitted to the clinical wards of a university hospital, a referential institution for COVID-19 in Rio de Janeiro, Brazil. Descriptive, retrospective documentary study with a quantitative approach. The sample consisted of 243 electronic medical records from hospitalized patients with a laboratory-confirmed diagnosis of COVID-19, between April and June 2020. The selection of participants took place by intentional non-probabilistic sampling. Peripheral venous access was the mostly applied in 83.5% of the patients. The mostly used classes of drugs were analgesics, (81.9%), followed by antiemetics (70.4%), and antihypertensives (51.9%). For medications directed to COVID-19, azithromycin, oseltamivir, ceftriaxone, and hydroxychloroquine stands out with 67.5%, 58.8%, 50.2% and 27.2%, respectively. Regarding the treatment directed to COVID-19, the medications mostly taken were azithromycin and hydroxychloroquine, justified to a large extent by being recommended by the Ministry of Health in the treatment, according to signs and symptoms (Brazil, 2020). Patients treated with the medications described had good recovery from the clinical condition. Thus, studies based on randomized clinical trials are suggested to prove the efficacy of drug therapies, including their combination.

Complications Associated With Totally Implanted Venous Access Devices in the Arm Versus the Chest: A Short-Term Retrospective Study

Purpose: To retrospectively compare complications for totally implanted venous access devices (TIVADs or ports) in the arm vs. the chest. One participating institution implanted all TIVADs in the arm, whereas the other institution implanted them in the chest. Methods: Subjects were consecutive patients > 18 years with a device inserted between July 2017 and January 2019 at either Hospital A, where all devices were implanted in the arm, or at Hospital B, where all devices were implanted in the chest. Complications (rates/1,000 catheter-days and frequencies) were compared between the arm and chest locations. Results: 201 arm devices (71% female, mean age 59.4 years) and 203 chest devices (66% female, mean age 61.5 years) were assessed. Overall complication rates did not differ between the arm and chest [arm: 30 complications per 56,938 catheter-days (0.530/1,000 catheter-days) vs. chest: 47 complications per 63,324 catheter-days (0.742/1,000 catheter-days), p-value 0.173]. Periprocedural complications and mechanical malfunction also did not differ. Although prophylactic antibiotic use was higher in the chest (79.3% vs. 1.50%, p-value < 0.0001), infection rates did not differ. Arm venous thrombosis was significantly higher in the arm cohort (0.205 vs. 0.017/1,000 catheter-days, p-value 0.003) and pulmonary thromboembolism in the chest cohort (0.269 vs 0.056/1,000 catheter-days, p-value 0.002). Conclusions: While arm venous thrombosis was higher in the arm and pulmonary thromboembolism in the chest cohort, other complications were similar. Antibiotic use was more frequent in the chest cohort, while infection rates remained similar in both cohorts.

‘Pinholes in my arms’: The vicious cycle of vascular access

Background: Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). Aims: To explore how patients make sense of living with a CVAD. Methods: This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. Findings: Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. Conclusion: Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually ‘embodied’ by them.