Insertion Of Central Venous Access Devices Research Articles

Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal?

PurposeTo assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal for infection either within the first 30 days or between 30 and 90 days after CVAD insertion. Materials and MethodsOne hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. ResultsPatients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. ConclusionsFever at diagnosis in patients with leukemia is not a predictor of CVAD removal for infection.

Enhancing Clinical Safety and Cancer Patient Experience Through Comprehensive eLearning on Central Venous Access Devices.

Health practitioners often insert and maintain central venous access devices (CVADs) as part of cancer care. One in four CVADs prematurely fail, which is associated with increased mortality, morbidity and a negative impact on quality of life. To support implementation of updated guidelines, eviQ Education developed a comprehensive, peer-reviewed, evidence-based CVADs eLearning package. An evaluation indicated that the eLearning supported clinicians' practice and increased knowledge and clinical competency in CVAD insertion and management.

Pacemaker leads as a potential source of problems in patients who might need a central venous access port.

Lead-dependent venous occlusion may impede the insertion of a central venous access device (CVAD). The aim of this retrospective, cohort study was to assess the chance of implantation of CVAD in patients with cardiac implantable electronic devices (CIEDs). We reviewed and analyzed 3,075 venograms of patients with CIEDs undergoing transvenous lead extraction (TLE) between June 2008 and July 2021. Relationship between venous patency and the chance of CVAD placement was estimated. In 2,318 (75.38%) patients, venography showed no potential obstacles to venous port implantation on the ipsilateral side. In patients with leads on the left side, significant narrowing more often affected the subclavian vein than the brachiocephalic vein [1,595 (55.29%) vs. 830 (28.63%), respectively] or the superior vena cava (SVC) [21 (0.73%) cases]. Furthermore, the subclavian and brachiocephalic veins on the opposite side were also narrowed [35 (2.35%) and 27 (1.24%), respectively]. The chances of port insertion were assessed as easy on CIED side or opposite side in 2,318 (75.38%) and 2,291 (97.91%) patients, respectively), as difficult insertion/questionable performance in 246 (8.00%) and 22 (0.94% patients) and doubtful or impossible insertion/questionable performance in 511 (16.62%)/27 (1.15%) patients with CIED. (I) Varying degrees of lead-dependent venous obstruction (LDVO) is a frequent finding in patients with CIEDs; (II) the major thoracic veins on the opposite side of the chest may also be significantly narrowed; (III) venography should be considered before attempted CVAD insertion in patients with long lead dwell times or in patients after CIED removal, including planned contralateral port placement.

Facilitators and barriers to evidence-based practice in central venous access device insertion and management in an intensive care unit: A qualitative study

IntroductionResearch evidence and clinical practice guidelines exist on preventing central line-associated bloodstream infections. However, there is limited knowledge about the barriers and facilitators to evidence-based central venous access device care. AimThe aim of this study was to investigate the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting. MethodThis exploratory qualitative study involved focus groups and interviews with registered nurses and physicians involved in central venous access device insertion and management in a tertiary Australian intensive care unit. Purposive sampling was used to recruit staff (n = 26) with varying years of clinical experience and clinical positions. Six focus groups and three individual interviews were conducted. Interviews were audio recorded, transcribed verbatim and analysed using content analysis. ResultsThree overarching categories emerged: work structures to support optimal performance; processes to optimise quality of care, and factors influencing staff members’ behaviour. Perceived facilitators to optimal central venous access device care included explicit language use in procedure documents, work-system integrated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation. ConclusionTo bring about effective improvement in central venous access device care, future interventions should be tailored to address identified barriers, including integrating audit and feedback into clinicians’ work processes. Additionally, future research is needed to explore the role of patients and their families in central venous access device care. Implications for clinical practiceWhen developing practice policies or procedure manuals, it is important to use explicit language to ensure clear communication of evidence-based recommendations to clinicians. Strategies integrated into work processes can enhance adherence to evidence-based practice. Large departments with limited educators should explore innovative methods like online education to ensure optimal central venous access device care.

How to Prepare for Advancement to Central Venous Access Device Insertion Beyond Peripherally Inserted Central Catheters: Socially Relevant

How to Prepare for Advancement to Central Venous Access Device Insertion Beyond Peripherally Inserted Central Catheters: Socially Relevant

Decreasing the incidence of central line-associated bloodstream infection in a medical intensive care unit: a best practice implementation project.

Bloodstream infections are common in critically ill patients using central venous access devices (CVAD) in intensive care units (ICU). This project aimed to decrease the incidence of central line-associated bloodstream infections (CLABSI) by using evidence-based strategies. The project applied the JBI audit and feedback methods. Thirty-two nurses and five resident physicians from the medical ICU of a medical center participated in the project. Preintervention compliance was measured for the 11 key evidence-based criteria (six audit criteria of central venous catheter insertion and five audit criteria of dressing and catheter securement). Strategies were implemented to overcome the barriers identified in the baseline assessment. Impact evaluation and sustainability were conducted to change the CLABSI rate and the competence of healthcare professionals in providing CVAD care. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for the data collection, analysis, and implementation planning. Barriers included insufficient knowledge among nurses and physicians, poor compliance with the standard CVAD insertion procedure by physicians, inadequate cooperation among the CVAD care team members, and lack of CVAD-related equipment. The strategies included education and training in CVAD care, the establishment of a team resource management program, and the provision of appropriate equipment. Following project implementation, the CLABSI rate decreased from 8.38 to 3.9 BSIs/1000 CVAD-days. The project successfully decreased the CLABSI rate and increased the competence of healthcare professionals. Implementation of best practices in clinical care should focus on leadership, team resource management, education, monitoring, and innovation.

Evaluation of extended-length cannula inserted using ultrasound guidance in patients with difficult IV access.

Historically, gaining peripheral intravenous (IV) access for patients with difficult intravenous access (DIVA) has been problematic and associated with increased complications, central venous access device insertion and reduced patient satisfaction. Consequently, extended-length peripheral intravenous catheters (PIVCs) have been developed, but to date no real-world data exploring their effectiveness with NHS patients has been published. This article reports on the results of introducing extended-length PIVCs, inserted using ultrasound guidance in patients with DIVA by a vascular access team. This began in 2019, across an adult tertiary hospital setting in the NHS with about 750 beds. The specialties at this hospital include, but are not limited to, emergency medicine; head and neck; vascular; diabetes and endocrinology; respiratory; care of the older person; stroke services; gastroenterology; and trauma and orthopaedics. The vascular access team recorded 1485 individual insertions between 2019 to 2022, with a mean dwell time of 6 days, a first attempt success rate of 91%, and a therapy completion rate of 75 and 78% for inpatient and outpatients respectively. Indications included administration of IV fluids, medication, blood products and access for investigations or procedures. Obtaining reliable IV access in patients with DIVA prevents treatment delays, cancelled or delayed procedures, both of which benefit patients and the healthcare organisation. The data presented in this study support the use of extended-length PIVCs in patients with DIVA and has led to the development of new referral pathways.

Revisiting the Anatomical Landmark-Guided Central Venous Access Device Insertion: A Retrospective Cohort Study.

Ultrasound (USG) guidance is superior to blind and open cut-down techniques for accurate puncture of the internal jugular vein (IJV) or subclavian vein, but it increases the cost and duration of the procedure. Here, we report our experience with the reliability and consistency of anatomic landmark-guided technique for Central Venous Access Device (CVAD) insertion in a low-resource setting. A retrospective analysis of the prospectively maintained database of patients undergoing CVAD insertion through one of the jugular veins was performed. Central venous access was achieved using a standardized anatomic insertion landmark (apex of Sedillot's triangle). Ultrasonography (USG) and/or fluoroscopy assistance was taken as and when required. Over 12months (October 2021 to September 2022), a total of 208 patients underwent CVAD insertion. Central venous access was successfully achieved using anatomic landmark-guided technique in all but 14 patients (6.7%), in whom USG guidance or C-arm was used. Eleven out of 14 patients who needed guidance for CVAD insertion had body mass index (BMI) of more than 25, one had thyromegaly while the remaining two had an arterial puncture during cannulation. CVAD insertion-related complications included deep vein thrombosis (DVT) in five, extravasation of chemotherapeutic agent in one, spontaneous extrusion related to a fall in one, and persistent withdrawal-related occlusion in seven patients. Anatomical landmark-guided technique of CVAD insertion is safe and reliable, and can reduce the need for USG/C-arm in 93% of the patients.

CATERPILLAR-study protocol: an assessor-blinded randomised controlled trial comparing taurolidine-citrate-heparin to heparin-only lock solutions for the prevention of central line-associated bloodstream infections in paediatric oncology patients

IntroductionThe efficacy of taurolidine containing lock solutions for the prevention of central line-associated bloodstream infections (CLABSI) in paediatric oncology patients is still unknown. If the taurolidine-citrate-heparin lock appears to decrease...

Central venous access device practice across haematology and oncology centres in Australia and New Zealand: a cross-sectional survey.

Central venous access devices (CVADs) are commonly used in malignancies. We conducted an online, anonymous cross-sectional survey of practice regarding CVAD management in haematology centres among clinicians in Australia and New Zealand. We identified variation in clinical practice regarding CVAD selection, insertion, management and removal. These findings highlight research gaps in CVAD care.

Current practice, education and recommendations for training of central line insertion for trainees and fellows in adult intensive care units across Australia and New Zealand.

Central venous access device (CVAD) is a common procedure in ICU which, although generally safe, can lead to acute and delayed complications. Training and accreditation process for its insertion vary worldwide. The objective of this study was to explore variability in existing training and accreditation processes for central venous access device (CVAD) insertion among different intensive care units (ICU), current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement. A prospective cross-sectional web-based survey was sent through email and CICM e-newsletter to intensivists and directors of ICU across ANZ. All responses were tabulated, post-hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarised. A total of 115 responses was received from various public and private ICU from all states of ANZ; 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICU, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools and ultrasound training to improve training and assessment. Thirty-five percent of the participants inserted 0-5 CVAD and more than half of the intensivists had inserted <10 CVAD in a 1-year period. Two-thirds of the respondents recommended inserting between 6 and 20 CVAD each year to maintain competence. The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion among intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICU.

A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement

Background: Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. Methods: Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG ( n = 172) or traditional ( n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. Results: Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9–24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference–19.9 min (95% CI–14.6 to −34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. Conclusions: Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. Trial registration: This trial is registered at the Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au ). The registration number is ACTRN12620000919910.

Anticoagulants decrease the risk for catheter-related venous thrombosis in patients with chronic intestinal failure: A long-term cohort study.

BackgroundCatheter‐related venous thrombosis (CRVT) is a severe complication of home parental nutrition. Although primary prevention of CRVT is crucial, there is no consensus on anticoagulant use to prevent this adversity. The aim was to compare CRVT risk in patients with chronic intestinal failure (CIF) in the presence or absence of anticoagulants, and to identify CRVT risk factors.MethodsThis retrospective cohort study comprised adult patients with CIF with a central venous access device (CVAD) between 2010 and 2020 that were treated at our national CIF referral center. Analyses were performed at a CVAD level.ResultsOverall, 1188 CVADs in 389 patients were included (540.800 CVAD days). Anticoagulants were used in 403 CVADs. In total, 137 CRVTs occurred in 98 patients, resulting in 0.25 CRVTs/1000 CVAD days (95% CI, 0.22–0.29). Anticoagulant use was associated with a decreased CRVT risk (odds ratio [OR] = 0.53; 95% CI, 0.31–0.89; P = 0.02). Left‐sided CVAD insertion (OR = 2.00; 95% CI, 1.36–2.94), a history of venous thrombosis (OR = 1.73; 95% CI, 1.05–2.84), and a shorter period postinsertion (OR = 0.78; 95% CI, 0.65–0.92) were independently associated with an increased CRVT risk.ConclusionAnticoagulants decreased the CRVT risk. In addition, we identified left‐sided vein insertion, a history of venous thrombosis, and a shorter period post‐CVAD insertion as CRVT risk factors. Further prospective studies should provide guidance whether prophylactic anticoagulant use, especially in higher‐risk patients with a left‐sided CVAD or a history of venous thrombosis, is justified.

Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram.

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.

Catheter-Associated Bloodstream Infections (CA-BSI) in Adults with Cancer: A Prospective Randomized Controlled Trial

Background: Central venous access devices (CVADs) are essential in the modern management of patients with haematological malignancies and solid tumors. An often serious complication is catheter-associated bloodstream infection (CA-BSI) which is a major cause of morbidity and mortality. We have previously demonstrated (JHI 2011;78:26) in a retrospective study of 1127 CVADs that insertion of lines on the right side of the body was associated with increased risk of CA-BSI (HR 1.60, 95%CI 1.05-2.44). We hypothesized that this finding related to the predominance of right-handedness in the patient (as for the general) population, which may result in greater movement and thus associated bacterial contamination of the catheterised limb.Methods: We performed a prospective randomised controlled, non-blinded study at two centres to determine whether the side of CVAD insertion influences the incidence of CA-BSI with consenting patients randomly allocated to either dominant or non-dominant-side CVAD insertion. Any in- or out-patient >14yrs with cancer requiring a CVAD was eligible. Patients had to have both sides of the body available for CVAD insertion so patients with contraindications to CVAD insertion on one particular side of the body were excluded. The primary end-point of the study was the number of line days until CA-BSI, determined in a blinded fashion by two specialists according to standard Australia Council of Healthcare Standards definitions. Secondary end-points included catheter-related blood stream infection (CR-BSI, a stricter definition of line-related infection requiring a positive line tip culture or differential time to positivity of ≥ 2hrs between line and peripheral cultures) and CA-BSI restricted to patients with peripherally inserted central catheters (PICC lines). Analysis was by intent-to-treat.Results: 640 CVADs were randomised to dominant (n=322) or non-dominant (n=318) side of insertion. Five subjects were subsequently excluded (dominant side n=2, non-dominant side n=3) leaving 635 for final analysis. 34% were female, median age was 56yrs and 9.3% were left handed. 60% had hematological malignancies and 40% had solid tumors. The CVAD type was a PICC line (67%), tunnelled Hickman line (23%) and non-tunnelled line (10%); 85% were double and 13% triple lumen lines. Baseline characteristics were all well balanced between randomization arms.22% of CVADs were complicated by CA-BSI. The rate of CA-BSI per 1000 line days was 3.49 vs 3.66 in the non-dominant vs dominant group (HR 0.91; 95%CI, 0.65-1.28; p=0.602; Fig 1A). By multivariate analysis, the rate of CA-BSI was increased by: use of tunnelled Hickman lines compared to PICC lines (HR 2.05, 95%CI 1.45-2.91); having a haematological malignancy needing intensive chemotherapy or transplantation compared to non-GI solid tumors (HR 5.56; 95%CI 2.47-12.5); but not non-dominant compared to dominant side of line insertion (HR 0.94, 95%CI 0.69-1.36).2.5% of CVADs were complicated by CR-BSI. The rate of CR-BSI per 1000 line days was 0.26 vs 0.55 in the non-dominant vs dominant group (HR 0.46; 95%CI, 0.15-1.34; p=0.153; Fig 1B). By multivariate analysis, the rate of CR-BSI was increased by use of tunnelled Hickman lines compared to PICC lines (HR 5.39, 95%CI 1.78-16.33) and there was a trend to increased CR-BSI in patients with the CVAD inserted in the dominant side (HR 0.37, 95%CI 0.12-1.15, p=0.084). There was no impact of patient diagnosis on CR-BSI. In analysis confined to PICC lines, there was no impact of side of insertion on CA-BSI or CR-BSI.Because the trial design also allowed a randomized comparison between right and left side of insertion (as opposed to non-dominant vs dominant side) we examined if a right sided CVAD affected outcomes (Fig 2A&B). In multivariate analysis right sided line placement was associated with a non-significant trend for increased CA-BSI (HR 1.40, 95%CI 0.99-1.96, p=0.055) and CR-BSI (HR 2.93, 95%CI 0.93-9.24), p=0.066).Conclusion: In a randomized controlled trial the rate of CA-BSI was not impacted by whether CVAD insertion was on the dominant or non-dominant side. There is a suggestion, however, that a right sided line insertion may increase both CA-BSI and CR-BSI but a larger study would be required to properly assess this hypothesis. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Abstract P861: The Perception of Missed Nursing Care in Patients With Acute Stroke

Background: “ Missed nursing care” is a unique type of error known as medical underuse. These errors of omission are related to events, such as patient falls, nosocomial infections, and pressure injuries, associated with increased stroke mortality and morbidity. This study aimed to measure the phenomena of missed care in patients with stroke from the perspective of staff RNs working on a stroke unit and neuro intensive care unit at a Comprehensive Stroke Center. Methods: A Missed Care Survey was developed. Building on the work by Kalisch, the new Missed Care Survey focused entirely on nurse-sensitive measures and related evidence-based bundle steps. Two versions of the 25- question ordinal survey were developed, differing only in how the responses were worded. One asked how often care was missed [never missed (5), rarely missed (4), occasionally missed (3), frequently missed (2), always missed (1)]. and the other how frequently care was completed [always completed (5),usually completed (4), etc.).Descriptive statistics were used to evaluate results. Staff volunteered to take the survey during an annual stroke review class, rating their perception of care over the last 30-days. The IRB determined that the human subject regulation did not apply. Results: Completion rate was 93% (n=140). Differences between the two surveys were minimal with the overall summary score being the same (4.1; range 3.5-4.5). Individual scores ranged from 2.6 to 5. Items most frequently described as never missed included timely administration of pre-operative antibiotics and use of barrier precautions with central venous access device insertion. Care most missed included bathing and peri-care (with/without indwelling catheter), mobility, incentive spirometry, and the prevention of loops in urinary drainage catheter tubing. There were minor changes in rankings between the two survey versions. Conclusions: Scores reflect that known interventions to prevent iatrogenic complications are frequently or occasionally missed (or only usually and occasionally completed). Next steps include validation with real time observations. When missed care is not addressed, it can become routine, known as normalization of deviance, negatively impacting patient outcomes and the quality of care.

Radiation dose during fluoroscopically guided central venous access device insertion: Retrospective observational study

IntroductionCentral venous access devices (CVADs) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5pps and 4pps. Material and methodsA retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n=24) and 7.5 pps (n=33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye. ResultsThe results show that the median dose area product (DAP) for CVAD insertion is 0.7Gycm2 and 0.3Gycm2 for procedures done at 7.5pps and 4pps, respectively. This corresponded to an effective dose of 0.22mSv and 0.1mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36μSv, 0.1μSv and 0.05μSv when 7.5pps was utilised and 0.13μSv, 0.03μSv and 0.02μSv when 4pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1μSv, 1.4μSv, and 0.6μSv in the 7.5pps studies and 0.7μSv, 0.5μSv, and 0.2μSv when 4pps was used. ConclusionThe patient effective dose was estimated to be 0.1–0.22mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.

Peripheral parenteral nutrition: An evaluation of utility and complications

Rationale: Peripheral parenteral nutrition (PPN) may negate the need for central venous access device insertion in a subset of patients requiring short-term parenteral nutrition. Previous studies have reported adverse complications of up to 50% with PPN.1 This study aimed to evaluate the use of PPN at a tertiary referral centre where the therapy is initiated and overseen by a dedicated nutrition support team.

Catheter-associated bloodstream infections in adults with cancer: a prospective randomized controlled trial

A common complication of central venous access devices (CVADs) is catheter-associated bloodstream infection (CABSI). We previously demonstrated that insertion of CVADs on the right side was associated with increased risk of CABSI, and hypothesized that this related to the predominance of right-handedness in the patient population, resulting in greater movement and bacterial contamination. To perform a prospective randomized, controlled, non-blinded study to determine whether the side of CVAD insertion influenced the incidence of CABSI. Adult cancer patients were randomly allocated to either dominant or non-dominant side CVAD insertion. The primary endpoint of the study was the number of line-days until CABSI, determined in a blinded fashion by two assessors. In all, 640 CVADs were randomized to dominant (N= 322) or non-dominant (N= 318) side of insertion, 60% had haematological malignancies, and 40% solid tumours. CVADs were a peripherally inserted central catheter line (67%), tunnelled CVAD (23%), and non-tunnelled CVAD (10%). Twenty-two percent of CVADs were complicated by CABSI. The rate of CABSI per 1000 line-days was 3.49 vs 3.66 in the non-dominant vs dominant group (hazard ratio (HR): 0.91; 95% confidence interval (CI): 0.65-1.28). By multivariable analysis, the rate of CABSI was increased by: use of tunnelled CVADs compared to peripherally inserted central venous catheter lines (HR: 2.05; 95% CI: 1.45-2.91); having a haematological malignancy compared to non-gastrointestinal solid tumours (5.55; 2.47-12.5); but not dominant compared to non-dominant side of CVAD (0.97; 0.69-1.36). CABSI in adult patients with cancer was not impacted by whether CVAD insertion was on the dominant or non-dominant side.

PRO105 COMPLICATIONS ASSOCIATED WITH CENTRAL VENOUS ACCESS DEVICES IN PATIENTS WITH HEMOPHILIA A (PWHA): A SECONDARY CLAIMS-BASED ANALYSIS

To evaluate incidence of complications associated with central venous access devices (CVADs) in PwHA. This retrospective cohort study was conducted using claims data from MarketScan Commercial Research Database from 07.01.2005–03.31.2019. The study cohort comprised PwHA and included CVAD cases (≥1 CVAD insertion claim), and controls with no CVAD insertion claim through the study period. Patients were required to have continuous enrollment for 6 months pre- and at least 3 months post-index date. Index date was defined as the first date of port insertion for CVAD cases and first hemophilia A (HA) diagnosis for controls during the study period. HA was identified using a previously validated claims-based algorithm. CVAD use and complications (all-cause infections, thrombosis and hematoma) were identified using ICD-9-CM/ICD-10-CM diagnosis/procedure and CPT codes. Patients were followed until first outcome, plan switch or over a 2-year post-index period. Incidence and rates of complications among CVAD cases and controls were evaluated using Cox proportional-hazards models (adjusted for age, region, comorbidity score, and insurance type). The study cohort comprised 862 PwHA; 61 (7%) had evidence of CVAD use. CVAD cases were significantly younger than controls (mean age ± SD: 4.7±5.3 years vs. 25.9±17.5 years, p<0.001) and had a significantly higher Elixhauser comorbidity score (mean ± SD: 0.9±0.6 vs. 0.5±0.8, p<0.001). In the post-index period, a significantly higher proportion of CVAD cases (vs. controls) had all-cause infections (44.3% vs. 26.7%, p<0.001) and thrombosis (13.1% vs. 1.1%, p<0.001). No CVAD cases had evidence of hematoma; it occurred in 1.5% of controls. Cox models revealed that CVAD cases had 2.3 times (95%CI: 1.5–3.6) and 9.2 times (95%CI: 2.4–35.6) higher rate of all-cause infections and thrombosis, respectively. CVAD use in HA is associated with higher rates of complications, underscoring the need for novel non-intravenous treatments which remove the need for CVADs.