Central Venous Catheter Placement Research Articles

Iatrogenic Carotid Injury Following Jugular Vein Cannulation: A Case Report

Central Venous Catheterization (CVC) through the internal jugular vein is a routine procedure conducted in critically ill patients for hemodynamic monitoring, medication administration, and fluid management both in preparation for and during major surgery and for possible dialysis therapy. We present a case of an 80-year-old patient who went to hospital due to a sudden increase in creatinine levels. Subjected to an attempted CVC placement procedure, she suffered damage to the right common carotid artery with perforation and hemorrhage of the carotid artery. Taken immediately to the operating room, it was decided to repair the common carotid artery endovascularly using a covered stent with an immediate stop to the bleeding.

Post-procedural Brachial Neuritis: Clinical, Electrodiagnostic and Neuroimaging features.

Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis is common. Imaging is important to confirm the diagnosis of post-procedural brachial neuritis and exclude other etiologies. Clinical, electrodiagnostic, and neuroimaging features of patients with post-procedural brachial neuritis from a single quaternary care institution were identified and analyzed. Six (2 female) patients were identified with median age 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1-day to 2-weeks. The initial symptom for 5/6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root, and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions of these nerves were seen in 3/6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. Post-procedural brachial neuritis is an underrecognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of hourglass constrictions in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings. HGC = hourglass constriction; EDX = electrodiagnostic; IRB = Institutional Review Board; ACDF = anterior cervical discectomy and fusion; NRS = Numerical Rating Scale; MUAP = motor unit action potential.

Accidental Subclavian Artery Catheterization After Central Venous Catheter Placement

Accidental Subclavian Artery Catheterization After Central Venous Catheter Placement

Prior central venous catheter placement and age are associated with earlier intervention after permanent hemodialysis access creation.

Arteriovenous fistulas (AVFs) and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease. However, complications and access failure often necessitate re-intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures. This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision. A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders. Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision.

Central Venous Catheter Use in Burn Patients: Complications and Preventive Measures

Summary: The use of a central venous catheter (CVC) is essential in the management of burn patients, especially due to the difficulty of venous access, the length of hospitalization, and the need for routine fluid replenishment and medication administration, particularly antibiotics. Aim of the study: The aim of this study is to identify the rate of complications associated with central venous catheters in the context of burn patients to discuss its indications and the benefit/risk ratio. Methods: This descriptive retrospective study was conducted in the Plastic Surgery Department of CHU Mohamed VI in Marrakech, involving patients who received a central venous catheter during their admission to the burn unit from March 2023 to March 2024. Data collection included basic demographic data, comorbidities, burn mechanism, burn depth, percentage of burned body surface area (BSA), central catheter location (subclavian, femoral, jugular), the site (healthy/burned), the duration of catheter placement, complications (infection and venous thrombosis), detection of germs during culture, and the length of hospital stay. Results: Infection and venous thrombosis were identified as the most frequent complications of CVC use. Further research is needed to evaluate the role of regular CVC changes (every 10 to 15 days after insertion) in preventing infections and to establish a clear anticoagulation protocol for preventing deep vein thrombosis (DVT). Conclusion: While CVCs can be a valuable resource in the treatment of burn patients, they are associated with significant risks, some of which may be life-threatening. The duration of CVC placement should be minimized, and blood cultures (preferably from the CVC tip) should be systematically sent after 10 days or at the first suspicion of complications to reduce the incidence and severity of CVC-related infections.

Safety of Peripherally Infused Sympathomimetic Vasopressors in the Intensive Care Unit and Emergency Department.

Sympathomimetic vasopressors may be administered through a peripheral catheter, but there are limited data available on the safety of peripheral use. The purpose of this study was to analyze the safety of peripherally infused sympathomimetic vasopressors. A multicenter, retrospective observational study was conducted to evaluate patients who received peripheral vasopressors. The study's primary outcome was to assess the incidence of extravasation during the administration of peripheral vasopressors. Secondary outcomes include avoidance of central venous catheter (CVC) placement and institution protocol deviations. There were 198 patients included in the study, of which 142 patients received norepinephrine, 48 patients received phenylephrine, and 8 patients received epinephrine peripherally. Extravasation events occurred in 11 (5.6%) patients. Seven patients required a pharmacologic antidote and 10 patients required a warm compress. No significant differences were seen in characteristics of patients who extravasated compared with those who did not. Protocol deviations identified during the study included 24 (12.1%) patients receiving doses above the protocol maximum, 19 (9.6%) with a body mass index above the protocol maximum, and 45 (22.7%) patients receiving peripheral vasopressor over 24 hours. The majority of patients were able to avoid CVC placement (59.1%). Peripherally infused sympathomimetic vasopressors are safe to administer up to 24 hours with a low incidence of extravasation events while avoiding CVC placement in the majority of patients.

Risk factors for central line-associated bloodstream infection in the pediatric intensive care setting despite standard prevention measures.

Identify risk factors for central line-associated bloodstream infections (CLABSI) in pediatric intensive care settings in an era with high focus on prevention measures. Matched, case-control study. Quaternary children's hospital. Cases had a CLABSI during an intensive care unit (ICU) stay between January 1, 2015 and December 31, 2020. Controls were matched 4:1 by ICU and admission date and did not develop a CLABSI. Multivariable, mixed-effects logistic regression. 129 cases were matched to 516 controls. Central venous catheter (CVC) maintenance bundle compliance was >70%. Independent CLABSI risk factors included administration of continuous non-opioid sedative (adjusted odds ratio (aOR) 2.96, 95% CI [1.16, 7.52], P = 0.023), number of days with one or more CVC in place (aOR 1.42 per 10 days [1.16, 1.74], P = 0.001), and the combination of a chronic CVC with administration of parenteral nutrition (aOR 4.82 [1.38, 16.9], P = 0.014). Variables independently associated with lower odds of CLABSI included CVC location in an upper extremity (aOR 0.16 [0.05, 0.55], P = 0.004); non-tunneled CVC (aOR 0.17 [0.04, 0.63], P = 0.008); presence of an endotracheal tube (aOR 0.21 [0.08, 0.6], P = 0.004), Foley catheter (aOR 0.3 [0.13, 0.68], P = 0.004); transport to radiology (aOR 0.31 [0.1, 0.94], P = 0.039); continuous neuromuscular blockade (aOR 0.29 [0.1, 0.86], P = 0.025); and administration of histamine H2 blocking medications (aOR 0.17 [0.06, 0.48], P = 0.001). Pediatric intensive care patients with chronic CVCs receiving parenteral nutrition, those on non-opioid sedative infusions, and those with more central line days are at increased risk for CLABSI despite current prevention measures.

Optimizing Catheter Verification

Purpose Accurate detection of central venous catheter (CVC) misplacement is crucial for patient safety and effective treatment. Existing artificial intelligence (AI) often grapple with the limitations of label inaccuracies and output interpretations that lack clinician-friendly comprehensibility. This study aims to introduce an approach that employs segmentation of support material and anatomy to enhance the precision and comprehensibility of CVC misplacement detection. Materials and Methods The study utilized 2 datasets: the publicly accessible RANZCR CLiP dataset and a bespoke in-house dataset of 1006 annotated supine chest x-rays. Three deep learning models were trained: a classification network, a segmentation network, and a combination of both. These models were evaluated using receiver operating characteristic analysis, area under the curve, DICE similarity coefficient, and Hausdorff distance. Results The combined model demonstrated superior performance with an area under the curve of 0.99 for correctly positioned CVCs and 0.95 for misplacements. The model maintained high efficacy even with reduced training data from the local dataset. Sensitivity and specificity rates were high, and the model effectively managed the segmentation and classification tasks, even in images with multiple CVCs and other support materials. Conclusions This study illustrates the potential of AI-based models in accurately and reliably determining CVC placement in chest x-rays. The proposed method shows high accuracy and offers improved interpretability, important for clinical decision-making. The findings also highlight the importance of dataset quality and diversity in training AI models for medical image analysis.

Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum.

The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school. Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores. Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively. Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

Successful placement of a chest wall venous infusion port via persistent left superior vena cava: A case report.

Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly occurring in approximately 0.3% to 0.5% of the population. The presence of PLSVC complicates central venous catheter placement, increasing procedural risks. This case report describes the successful placement of a chest wall venous infusion port in a patient with PLSVC, offering valuable insights for managing similar cases and ensuring safer clinical outcomes. A 51-year-old female, 3 weeks post-right breast cancer surgery, was admitted for her first adjuvant hemotherapy session. She requested the placement of a venous infusion port due to the prolonged duration of chemotherapy. Imaging studies suggested the presence of PLSVC. Echocardiography revealed a dilated coronary sinus, and subsequent chest computed tomography and angiography confirmed the presence of PLSVC. A chest wall venous infusion port was inserted via the left internal jugular vein. Due to the PLSVC, the catheter was adjusted to ensure proper placement. The patient successfully completed chemotherapy without any complications or discomfort associated with the venous port. Imaging studies, including chest X-ray and computed tomography, confirmed proper port function and catheter positioning, with no evidence of thrombosis, infection, or other related issues. The patient remained in good overall condition throughout the treatment. Detailed preoperative evaluations, intraoperative imaging guidance, and postoperative follow-ups are crucial for the safe and effective management of PLSVC patients undergoing central venous catheter placement.

Providing very low-birth-weight infants with fast enteral feeding reduced how long they needed a central venous catheter.

To determine the impact of the protocol change from slow to fast enteral feeding progression on duration of central venous catheter placement, and the rates of late-onset sepsis and necrotising enterocolitis. We compared the evolution of all very low-birth-weight infants admitted on their first postnatal day in neonatal intensive care unit during a 12-month period, before (2021 Cohort) and after (2022 Cohort) implementation of a new feeding protocol. Linear regression model was used to adjust for confounding factors. A total of 343 VLBW infants were included (median gestational age ± SD 28.3 ± 1.7 weeks; median birth weight ± SD 980 ± 300 g). Median initial duration of central venous catheter was 5 days in 2022 cohort compared with 9 days in 2021 cohort (unadjusted p = 0.006, adjusted p = 0.001). Median time to achieve full enteral feeding was 8 days versus 12 days, p < 0.001, with no significant difference in late-onset sepsis or necrotising enterocolitis rates. The change from slow to fast enteral feeding progression for very low-birth-weight infants significantly decreased the central venous catheter duration with no adverse outcomes. This is consistent with recent randomised study results and supports the safe implementation in neonatal intensive care units.

Procedural Complications of Central Venous Catheter Placement in Pediatric Oncology Practice (a Clinical Case Series)

The availability of central venous access is the cornerstone of contemporary pediatric oncology and hematology. As a result, the percentage of pediatric patients receiving infusion chemotherapy who require a central line remains high. Central venous catheter insertion can be associated with procedural complications, including life-threatening ones.Aim — to investigate the potential factors leading to complications during central venous catheterization in order to develop preventive strategies.Materials and methods. The study included 1,512 original cases of patients aged 1 month to 20 years treated at the D. Rogachev National Research Medical Center between 2019 and 2022. The following 10 complications were examined: failed first venipuncture attempt, guidewire/catheter malpositioning, guidewire knotting, lifethreatening arrhythmias, guidewire entrapment in the trabecular network of the right ventricle, arterial puncture, pneumothorax, hemothorax, puncture of lung parenchyma, Horner's syndrome. In addition, four rare complications were noted, including phrenic nerve injury, cardiac tamponade, alveolar hemorrhage, and arterial pseudoaneurysm.Results. The primary cause of all complications was direct mechanical injury to anatomical structures by a needle or guidewire/catheter. When inadvertent vascular injury and bleeding occur, the resulting hematoma may lead to further damage by compressing soft tissues. Excessively deep insertion of the guidewire may cause its knotting or cardiac arrhythmias. Adequate physician training and strict adherence to procedural protocols are essential to avoid these complications.Conclusion. Central venous catheterization remains a procedure with potential complications. Although ultrasound guidance does not eliminate all risks, it increases the likelihood of successful venipuncture at the first attempt, thereby reducing complication rates. Recognizing the potential causes of procedural complications during central venous access placement, including uncommon ones, facilitates early diagnosis and appropriate medical intervention.

Challenges in central venous catheter placement due to thoracic venous anomaly in an infant - A case report.

Challenges in central venous catheter placement due to thoracic venous anomaly in an infant - A case report.

Systematic review of ultrasound-guided central venous catheter placement-related complications in neonates and infants aged

Although ultrasound can be considered an assistant method, successful placement of a central venous catheter (CVC) in infants is still challenging. The incidence of CVC placement-related complications is still high. Therefore, this systematic review aimed to synthesize evidence to assess the effects of ultrasound-guided CVC placement on adverse outcomes in infants and neonates aged <12 months. PubMed, Ovid, EMBASE, and the Cochrane Library were searched to identify potentially relevant studies. The main outcome was the incidence of adverse events, which included inadvertent arterial puncture, hematoma, pneumothorax and hemothorax, catheter kinking, threading, and malpositioning problems, venous thrombosis, catheter-related infection, phlebitis, and cardiac tamponade. Eleven studies involving 2097 patients were included in the final analysis. The odds of inadvertent arterial puncture, and catheter kinking, threading, and malpositioning problems were lower in the ultrasound group than in the control group. No significant difference was detected in the incidence of hematoma or venous thrombosis between the control and ultrasound groups. Other complications, such as pneumothorax, hemothorax, phlebitis, and cardiac tamponade, rarely occurred. Ultrasound-guided CVC placement can improve the safety of punctures in neonates and infants. CVC punctures should be guided in real-time by ultrasound.

Augmented reality visualization for ultrasound-guided interventions: a pilot randomized crossover trial to assess trainee performance and cognitive load

BackgroundAugmented reality (AR) technology involving head-mounted displays (HMD) represents a significant innovation in medical education, particularly for training in guided invasive procedures. Novice physicians often face challenges in simultaneously identifying anatomical landmarks and performing procedures when learning point-of-care ultrasound (POCUS). Our primary objective was to determine the effectiveness of AR in enhancing physician training for ultrasound-guided interventions using AR visual overlays. The secondary objective was to compare cognitive load between traditional ultrasound training settings and AR-assisted training settings.MethodsThis randomized crossover study, conducted from 2021 to 2022, compared performance and cognitive load of trainees attempting accurate central venous catheter (CVC) placement using an AR-HMD to display ultrasound images (AR-US), compared with standard ultrasound without visual overlay (S-US). We enrolled 47 trainees, including 22 final-year undergraduate medical students and 25 postgraduate physicians (years 1–4) from three hospitals in Taiwan. All participants had basic training in US-guided CVC placement but lacked AR-US experience. Performance and cognitive load were assessed using time measurements and NASA Task Load Index (NASA-TLX), covering the dimensions of Mental-, Physical- and Temporal Demand, and Performance, Effort and Frustration.ResultsWe found AR technology reduced the time required for critical steps in CVC placement, while minimizing users’ neck strain. Female and junior trainees using AR-US identified anatomy and localized veins faster than those using S-US. Using AR-US, female trainees significantly outperformed males in anatomical identification [mean difference (MD): -10.79 s (95% CI: -2.37 to -19.21)]. The NASA-TLX cognitive load assessment showed mental workload trending lower in all dimensions except performance while using AR-US, compared to S-US. Similarly, junior trainees’ effort- and frustration scores were lower [MD: -2.73 (95% CI: -5.04 to -0.41) and -2.41 (95% CI: -4.51 to -0.31), respectively], as were female trainees’ effort scores [MD: -3.07 (95% CI: -6.10 to -0.03)] when using AR-US, compared to S-US, whereby these differences were statistically significant.ConclusionsAR technology helped improve trainee performance and reduced cognitive load during ultrasound-guided CVC placement. These findings support the application of AR technology to enhance physician training in ultrasound-guided interventional procedures, suggesting that AR-HMDs could be a valuable tool in medical education.Trial registrationThe trial was registered with Clinicaltrials.gov on 20/09/2023 as a clinical trial, under the identifier NCT 06055400.

A Study to Assess the Effectiveness of Informative Booklet Regarding Knowledge, Attitude and Practice Among Intensive Care Unit (ICU) Staff Nurses Regarding Prevention of Central Line Associated Blood Stream Infection (CLABSI)

Background: Nurses in Intensive Care Units (ICU) have a vital role in reducing Central line associated blood stream infections (CLABSI) if they are well educated to use strategies to decrease Central line associated blood stream infections (CLABSI) rate which are based on the center for disease control and prevention guidelines (CDC) to improve patient’s outcomes. Health-care-associated infections are a huge concern in the intensive care units (ICUs) across the globe. Nearly 90% of catheter-related bloodstream infections are caused by central venous catheters (CVCs). Central venous catheters (CVC) are commonly inserted in critically ill patients and play an important role for hemodynamic monitoring and delivery of crucial treatments. Central line-associated bloodstream infection (CLABSI) is a laboratory confirmed bloodstream infection occurring in a patient with a CVC in place for &gt;48 hours that is not related to an infection at any other site. Preventing nosocomial infections pose a great challenge in ICU, because of the multi-drug resistant organisms treated with broad-spectrum antibiotics. Clinical practice guidelines from various organizations are available for prevention of vascular catheter related infections. The Institute for Healthcare Improvement has introduced a “central line bundle” that includes the five best evidence-based practices to prevent CLABSI. This bundle includes hand hygiene, maximal barrier precautions during catheter insertion, skin antisepsis with chlorhexidine, optimal selection of the catheter site, with avoidance of the femoral vein and a daily assessment of line necessity, including the removal of an unnecessary line. Of these components, “hand hygiene” (HH) is the most convenient and cost effective to follow. “Hand Hygiene” HH prevents the transmission of pathogens and is a universal strategy to prevent all nosocomial infections. The World Health Organization has proposed a multimodal strategy; which includes five elements called the “Five Moments for Hand Hygiene”, as an evidence-based approach to prevent hospital-acquired infections. The five moments include, before touching the patient, before performing any a clean/aseptic procedure, after exposure/risk of body fluid, after touching the patient and after touching the patient surroundings. Therefore, the researcher was curious to know the effectiveness of informative booklet regarding knowledge, attitude and practice of intensive care unit staff nurses regarding prevention of central line associated blood stream infection (CLABSI).

Acute Venous Occlusion in Two Infants Following Central Venous Catheter Placement.

Acute Venous Occlusion in Two Infants Following Central Venous Catheter Placement.

Optimising central venous catheter placement by comparing cavoatrial junction position to chest X-ray landmarks: Across-sectional study using CT chest reconstruction.

Central venous catheter (CVC) tip placement guided by chest X-ray (CXR) landmarks is currently prone to inconsistency and malpositioning. This study aims to better define the relationship between the cavoatrial junction (CAJ) and selected X-ray landmarks. Chest CTs of 100 patients were retrospectively assessed. CT images were converted to a 'virtual CXR' using a digital workstation, enabling simultaneous localisation of the CAJ and evaluation of CXR landmarks. Vertical distances between the CAJ and selected landmarks were measured for each patient. Measurements were assessed for correlation with age and compared between age groups and sexes. The mean vertical distance of the following landmarks above the CAJ was found: the carina (46.2 mm), the intersection of the bronchus intermedius and the right heart border (7.6 mm) and the superior inflection of the right heart border (Sup-RHB) (13.0 mm). The maximum lateral bulge of the right heart border (Lat-RHB) was 18.4 mm below the CAJ. A new landmark: the mid-superior right heart border, defined as the mid-point between the Sup-RHB and Lat-RHB, was the closest to the CAJ, lying 2.6 mm below the CAJ. We propose that the CVC tip can be placed at the mid-superior right heart border landmark.

A Local Experience of Antibiotic Lock Therapy as an Adjunctive Treatment for Central Venous Catheter-Related Bloodstream Infections in Pediatric Oncology and Hematology Patients.

One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology-hematology ward. a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology-hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259-0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects.

The clinical impact of primary granulocyte-colony stimulating factor prophylaxis in children with acute lymphoblastic leukemia who underwent induction chemotherapy

BackgroundData describing the risk factors for the occurrence of severe infections in acute lymphoblastic leukemia (ALL) patients following induction chemotherapy and the role of prophylactic granulocyte-colony stimulating factor (G-CSF) in the era of antimicrobials prophylaxis are limited. MethodsThis study enrolled 188 children aged ≤18 years with newly diagnosed ALL who received Taiwan Pediatric Oncology Group ALL-2002 and 2013 treatments between January 1, 2010 and June 30, 2021. Prophylactic G-CSF was administered when a patient continues neutropenia after achieving the first bone marrow remission since June 1, 2015. Clinical factors were assessed for their association with severe infections. ResultsFrom January 2010 to May 2015, 80 children experienced a total of 11 (13.5%) episodes of severe infections; while 10 (9.2%) episodes were reported to occur in 108 patients who received prophylactic G-CSF. Reduction of severe infections occurrence did not achieve statistical significance during prophylactic G-CSF administration in ALL patients. Compared with ALL-high risk (HR) and very high risk patients with no G-CSF prophylaxis, the use of G-CSF prophylaxis significantly reduced episodes of febrile neutropenia. Occurrence of grade III-IV intestinal ileus, grade II-III oral mucositis, prolonged neutropenia, central venous catheter (CVC) placement, or the requirement insulin therapy for hyperglycemia were associated with higher risk of bloodstream infections. ConclusionsALL-HR patients with G-CSF prophylaxis were associated with reduction of febrile neutropenia episodes. Occurrence of severe ileus, oral mucositis, hyperglycemia, CVC placement, or prolonged neutropenia were associated with severe infections in ALL patients receiving induction chemotherapy.