Central Venous Catheter Research Articles

Improved Sixty-Day Mortality in Candidemia with Antifungal Treatment Within 72 Hours of Fever Onset: A Single-Center Retrospective Study in Rural Japan

Introduction: Prognostic factor investigations for candidemia have been conducted in large-scale facilities, leading to significant evidence, including early administration of echinocandin antifungal agents and removal of central venous catheters (CVCs). In departments that provide aggressive chemotherapy or transplantation, candidiasis markers are regularly evaluated, and preemptive treatments may be initiated. However, in resource-limited facilities, candidemia detection largely relies on vital signs like fever and blood cultures. This study assessed whether evidence from large-scale facilities applies to such settings. Additionally, while prior studies indicate that early antifungal treatment is based on positive blood cultures, no established criteria exist for early administration based on fever as an indicator. Methods: This study analyzed cases of candidemia from blood cultures at Fukui General Hospital (2014–2024). Patients aged 18 or older with at least one positive blood culture for Candida species and clinical signs of infection were included, while contamination cases were excluded. The patients were categorized into survival and death groups based on 60-day survival from fever onset. The variables collected included age, gender, duration from admission to fever onset, time from fever onset to blood culture collection and antifungal treatment initiation, antifungal treatment within 72 h, serum albumin levels, history of cancer, diabetes, empiric echinocandin treatment, CVC insertion, duration of CVC insertion until fever onset, use of total parenteral nutrition, broad-spectrum antibiotic use, and sequential organ failure assessment (SOFA) score. Fever was defined as a body temperature of 38.0 °C or higher, guiding blood culture collection. Results: Of 30 candidemia cases, 29 were analyzed. Survival was significantly associated with younger age (average 73.3 ± 13.3 vs. 83.1 ± 9.1 years, p = 0.038) and antifungal treatment within 72 h of fever onset (9 vs. 3, p = 0.025). CVC use was of marginal significance (8 vs. 13, p = 0.108). There was a significant difference in the duration (in days) of CVC insertion until fever onset (median [IQR]: 15.5 [11.75–19.5] vs. 30.0 [19.0–39.0], p = 0.027). Logistic regression identified early antifungal treatment (OR = 0.065, p = 0.035) and CVC use (OR = 21.8, p = 0.024) as independent predictors of mortality. Conclusions: Early antifungal treatment within 72 h of fever onset and CVC use were independent predictors of mortality in candidemia. The importance of early antifungal treatment was reaffirmed even in smaller facilities. The impact of CVC insertion on 60-day survival cannot be readily generalized due to the limited sample size. Further research is needed to clarify the impact of fever-based antifungal initiation and CVC use on 60-day survival.

Bacteremia in Pediatric Solid Organ Transplant Recipients within 1 Year of Transplant.

Bacteremia is a major cause of morbidity and mortality in immunocompromised children, yet there are limited data in children who have undergone solid organ transplantation (SOT). We retrospectively reviewed bloodstream infections (BSI) in 581 recipients of heart, liver, or kidney transplants over a 14-year period. Overall 1-year incidence in this population was 8.4%, and was highest in recipients of liver transplants compared to heart or kidney. Younger age, transplantation earlier in the time period studied, need for repeat surgery within 30 days of transplant, and prior diagnosis of diabetes or tumor were associated with an increased risk of BSI. Most BSI occurred within 90 days of transplant, and most were associated with central venous lines. Coagulase-negative staphylococci and enteric commensals were commonly isolated. Multiple BSI within the year after transplant were uncommon. Although overall mortality was not increased in patients with BSI compared to those without, patients with BSI had more total hospitalizations and more days spent in the hospital in the year following SOT. In a large pediatric SOT population, overall BSI rates were significant but decreased over time. Identifying factors which contribute to BSI after SOT may direct interventions that can impact inpatient care requirements for these patients.

Abstract 4988: Port flushes in oncology - Does frequency matter?

Abstract Background: Ports, a type of central venous access device, are frequently used for the administration of intravenous medications, such as chemotherapy. These devices can remain in place for extended periods of time, from several months to years. To reduce the risk of complications, manufacturers recommend routine maintenance, often through monthly heparin flushes which leads to frequent visits to health care settings, adding to the burden and cost of care for both the patient and the healthcare system. The COVID-19 pandemic necessitated decreasing the frequency of port flushes to every 3 months when possible. The aim of this study was to evaluate if extending the interval between heparin flushes impacted safety outcomes. Methods: A retrospective chart review study was performed utilizing patient data from a single cancer center. Medical records were abstracted for patients with the following characteristics; a diagnosis of malignancy, ≥ 18 years of age, not on current chemotherapy, port placement greater than 30 days prior to enrollment, at least 6 months of follow-up data, and at least one successful port flush within the 6-month study period. The control group (CG) consisted of patients with a standard port flush interval of 4 weeks vs the experimental group (EG) that received an extended interval of every 12 weeks. The primary outcome was port removal, and the secondary outcome was complications of any kind (discomfort, erythema, use of tPA, thrombus, and infection). Descriptive statistics were used to summarize data, with Pearson’s chi-square or Fisher’s exact tests utilized to calculate group differences. Results: Of the 1,162 patients who were initially screened for eligibility, 215 patients were included in the analysis: 69 in the CG and 146 in the EG. The average port flush interval was 30.97 days in the CG and 86.21 days in the EG. In the CG, 4 patients (5.8%) required port removal due to complications, compared to 3 patients (2.05%) in the EG (p=0.21). Twelve (17.4%) patients in the CG had port-related complications as compared to 3 patients (2.05%) in the EG (p=0.001). The complications evaluated were discomfort (n=1 in CG), erythema (n=1 in CG, n=1 in EG), infection (n=1 in CG), port malfunction (n=5 in CG, n=2 in EG), thrombus (n=2 in CG), and use of tPA (n=5 in CG). Conclusion: Our findings suggest that extending the interval between port maintenance flushes from 4 to 12 weeks may lead to lower port-related complications. While the results are promising, the study was limited by the relatively small sample size due to strict inclusion and exclusion criteria. Adopting a 12-week flushing interval may improve the quality of life of cancer patients by reducing the frequency of clinic visits and may also lower healthcare costs for patients and hospitals alike. This extended interval approach is a promising step towards patient-centered care, improving overall healthcare efficiency while maintaining safety. Citation Format: Shabbir Haiderbhai, Julia Parrish, Grace Lavandowska, Megan Kelly, Aarabhi Gurumoorthy, Anu Gaba. Port flushes in oncology - Does frequency matter [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4988.

Hemodialysis Central Venous Catheter Use and Infections Before and After the COVID-19 Pandemic: Data from a National Dialysis Provider.

Hemodialysis Central Venous Catheter Use and Infections Before and After the COVID-19 Pandemic: Data from a National Dialysis Provider.

Extra-anatomic aorto-right subclavian bypass after complicated insertion of permanent dialysis catheter

Central venous dialysis catheters are the first line of choice to start on hemodialysis. They could be a bridge to establish another dialysis access. Dialysis catheters are essential of two types: temporary (non-tunnelled) and permanent (tunnelled). Insertion of a dialysis catheter is a ubiquitous procedure in renal medicine. One of the rare but serious complications is vascular erosion. We report on a case of a 68-year-old female patient with acute kidney injury who needed emergency hemodialysis. A permanent dialysis catheter was inserted into her right subclavian vein. There was not good flow in the dialysis catheter’s afferent and efferent lumens. The nephrologist performed a contrast chest roentgenoscopy, which showed that the dialysis catheter followed an abnormal course by passing into the ascending aorta. Emergency surgical extraction of the dialysis catheter was initiated using median sternotomy and supraclavicular incision to identify the entry point of the catheter into the subclavian artery. Due to the dissection of the subclavian artery, we performed an extra-anatomic aorto-subclavian bypass with a saphenous vein graft. The dialysis catheter was inserted through open access into the right subclavian vein.

Recurrent Thrombosis and Major Bleeding in Children Treated for VTE.

Risk factors for recurrent venous thromboembolism (VTE) in children are poorly understood, and concerns about risks of anticoagulant therapy in children remain. This single-center, cohort with nested case-control study aimed to determine the incidence rate of recurrent thrombosis and associated risk factors and the incidence of major bleeding in children with VTE on therapeutic anticoagulation. We identified 632 patients managed for VTE between January 1, 2015 and December 31, 2022. There was a VTE recurrence rate of 13.7 per 100 person-years. Univariate analysis showed the presence of a central venous catheter (P=0.02), inflammatory bowel disease (P=0.02), and intestinal failure (P=0.03) were significant risk factors for recurrent VTE. In multivariate logistic regression, significant risk factors for recurrence were anatomic venous abnormality (OR 2.8 with 95% CI 1.37, 5.59), the presence of a central venous catheter (OR 2.0 with 95% CI of 1.21, 3.26), and inflammatory bowel disease (OR 3 with 95% CI 1.18, 7.98). Major bleeding on anticoagulation occurred at a rate of 2.2 per 100 person-years. These data demonstrate that this heterogeneous cohort of children had a high risk of VTE recurrence. The overall major bleeding risk with anticoagulation was low. While each patient with VTE needs to be considered individually, these data support the view that perceived bleeding risk should generally not be a major barrier to anticoagulation in the pediatric setting. Moreover, secondary or extended anticoagulation may be considered in children at high risk for recurrence.

Risk factors for upper extremity deep vein thrombosis after esophagectomy for esophageal cancer in retrosternal reconstruction.

Upper extremity deep vein thrombosis (UEDVT) is a fatal postoperative complication that can cause pulmonary embolism (PE). There have been few reports on the relationship between esophageal cancer and UEDVT. The aim of this study is to analyze the risk factors for UEDVT in esophageal cancer. Seventy-five cases of thoracic esophageal cancer who underwent one-stage curative resection and reconstructive surgery from May 2019 to June 2022 were included. The stomach or ileocolon was selected as the reconstructive graft. All cases requiring chemotherapy were treated with a peripheral central venous catheter (PICC). To evaluate the width of the retrosternal space, the retrosternal ratio and the cross-sectional area of the graft intestine were measured at the level of the left brachiocephalic vein. UEDVT was observed in 11 patients (14.7%) and occurred only with gastric tube reconstruction (p = 0.02). The width of the retrosternal space was significantly different between the UEDVT and non-UEDVT groups (p = 0.002). The cross-sectional area of reconstructive organ was larger in the stomach than in the ileocolon (p < 0.01). Patients with a history of PICC insertion from the left side had a higher incidence of UEDVT (p = 0.025). In esophagectomy, gastric tube reconstruction, a retrosternal ratio less than 0.16, and history of PICC insertion from the left side are risk factors for UEDVT.

Electrochemical Catheter Hub Operated by a Wearable Micropotentiostat Prevents Acinetobacter baumannii Infection In Vitro.

Intraluminal infection of central venous catheters, used for long-term treatment, can result in central line-associated bloodstream infection (CLABSI). These infections can be challenging to prevent and treat due to formation of biofilms within catheter lumens, which shield bacteria from the human immune response and conventional antimicrobial therapies. Preventing bacterial colonization of catheter hubs is a strategy to prevent CLABSI. To address this, we developed a nonantibiotic, animal-ready electrochemical catheter hub (e-catheter hub), operated by a wearable, battery-powered micropotentiostat (MP), that internally generates tunable hypochlorous acid (HOCl) for preventing intraluminal infection. The design evaluated three different electrode materials-titanium, platinum, and gold-for HOCl generation and biocidal activity, using working and counter electrodes of the same materials and a silver/silver chloride-plated wire as a quasi-reference electrode. e-catheter hubs operated by MPs at 1.5 VAg/AgCl for 3 h generated HOCl, reducing Acinetobacter baumannii ATCC-17978 below the detection limit (average reduction of 4.40 ± 0.05 log10 CFU/mL). The efficacy of e-catheter hubs operated by MPs in generating HOCl and achieving biocidal activity is comparable to that of a commercial potentiostat. This study represents the first step in developing a localized, nonantibiotic strategy to mitigate CLABSI risk.

In vitro safety of power injection of contrast media through central venous hemodialysis catheters.

Central venous catheters (CVCs) provide direct access to the central circulatory system, commonly used in hemodialysis and intensive care units for drug administration. Although uncertified for the procedure, CVCs are sometimes used for power injection of contrast medium (CM) during CT scans to avoid peripheral intravenous catheter placement. Previous studies suggest this practice is safe, but incidents are reported. This study aims to measure intraluminal pressure during CM injection through CVCs and assess its impact on the luminal surface to guide responsible clinical use. An experimental in vitro test setup was developed. Four samples each of three different types of unused CVCs were used. Strain gauges were applied to the exterior walls of either the inflow or outflow lumen of the CVC. These gauges measured material deformation due to intraluminal pressure during CM injections at rates of 4.5 and 8 mL/s, each performed five times. Strain data were calibrated against known pressures in a static system. Three CVCs of each type were then pressurized until bursting, and one was subjected to microscopic analysis of the luminal surfaces. Intraluminal pressures measured (97-545 kPa or 14-79 PSI) were below the burst pressure (779-1248 kPa or 113-181 PSI) in all instances. Strain regression analysis shows a statistically significant (p < 0.01) trend over 10 injections in all CVCs tested except one, indicating material fatigue. Surface microscopy revealed surface micro-cracks from repeated injections, suggesting material damage. The intraluminal pressures from power injections of CM are sufficiently low to prevent CVC bursting. While incidental use for CM injection appears safe, repeated use may cause material damage.

Candida Bloodstream Infections and Associated Risk Factors in Pediatric Cardiac Intensive Care

Background: Candida infections have become a significant cause of morbidity and mortality in pediatric cardiac intensive care units following congenital heart surgery, ranking among the most common causes of complications in this patient population. There is a paucity of information available regarding the epidemiology, clinical features, and risk factors associated with candidemia in this patient population. The present study evaluates the incidence of Candida bloodstream infections in pediatric cardiac intensive care units. Methods: The study was conducted retrospectively on cases of patients under the age of 18 who were admitted to the pediatric cardiac intensive care unit between 1 January 2021 and 1 January 2024. The isolated pathogens were recorded. A reanalysis was conducted on 36 patients with Candida bloodstream infections, with data pertaining to age, weight, cardiac pathologies, duration of mechanical ventilation, length of hospital stay, and antibiotic use being subjected to further examination. Each case was matched with two control patients based on age and date of surgery. The results were analyzed statistically. Results: A total of 36 cases of candidemia were identified and matched with 72 control cases. The incidence of candidemia was found to be 21.8 episodes per 1000 hospital admissions. The median age of patients with candidemia was four months. Candida species were identified in the blood cultures of 36 out of 1650 patients (0.21%). Candida albicans (n = 12, 33.3%), Candida parapsilosis (n = 16, 44.4%), Candida glabrata (n = 2, 5.5%), and other non-albicans Candida species (n = 6, 16.6%) were isolated. The mortality rate associated with Candida bloodstream infections was 61.1% (22/36). The following independent risk factors were identified as being associated with candidemia: a birth weight of less than 2500 g (OR: 3.2; 95% confidence interval (CI): 2.5–5; p = 0.009), a RACHS-1 score of 4 or above (OR: 2.1; 95% CI: 1.3–6; p = 0.01), cumulative antibiotic exposure of seven days or more (OR: 2.5; 95% CI: 2–10; p &lt; 0.001), duration of central venous catheterization (CVC) of ≥14 days (OR: 6.1; 95% CI: 4–18; p &lt; 0.001), mechanical ventilation dependency of ≥10 days (OR: 4.2; 95% CI: 3–11; p = 0.01), a requirement for total parenteral nutrition (OR: 9; 95% CI: 6–24; p &lt; 0.001), and delayed sternal closure of ≥2 days (OR: 1.8; 95% CI: 1–4; p = 0.04). Conclusions: Postoperative candidemia represents a significant complication in pediatric patients with congenital heart disease (CHD), with different Candida species identified as a potential cause. The primary risk factors that contribute to the likelihood of a Candida bloodstream infection in these cases are a low birth weight, a high RACHS-1 score, dependence on mechanical ventilation, prolonged exposure to antibiotics, prolonged central venous catheter duration, delayed sternal closure, and total parenteral nutrition.

Minimally Invasive Management of Subclavian Artery Catheter Misplacement: The New Standard?

Background: The accidental puncture of the supra-aortal arteries during central venous catheterization is a rare but potentially life-threatening complication. Traditional management often requires open surgical repair, which is associated with significant morbidity. This study evaluates an endovascular approach for managing such cases using an Angio-Seal™ vascular closure device (Terumo Medical Corporation, Somerset, NJ, USA). Methods: Between January 2010 and December 2024, 47 patients with misplaced catheters in supra-aortal arteries were treated at our institution. Of these, 37 cases involving subclavian artery catheter misplacements were managed using a standardized algorithm and form the focus of this study. Additional interventions, such as stent graft placement or balloon inflation, were performed as needed. Results: Primary technical success was achieved in 86.5% of cases. Four patients required stentgrafts and one balloon inflation for persistent extravasations. One patient developed a small subclavian pseudoaneurysm, which resolved spontaneously. Primary assisted technical success and clinical success rates were both 100%. Conclusions: This study demonstrates the efficacy and safety of our minimally invasive endovascular approach for managing subclavian artery catheter misplacements. With a high success rate, low complication rate, and the avoidance of open surgery, this algorithm offers a promising alternative for treating this rare but serious complication of central venous catheterization.

Management of Malpositioned Central Venous Catheters in the Subclavian Artery: Case-series and Systematic Review of Literature.

Malposition of central venous catheter is a notable technical complication and often need retrieval to avoid further complications. We present a retrospective assessment of case series and literature review of the safety and efficacy of open and endovascular procedures performed to retrieve malpositioned central venous catheters in the subclavian artery. PubMed/Medline, Ovid and Embase.Case series and review Methods:A retrospective analysis was conducted of the clinical data of seven patients referred to our hospital between 2014 and 2023, in whom malpositioned central venous catheters were incidentally inserted within the subclavian artery and were retrieved. A systematic literature review was undertaken according to PRISMA guidelines to evaluate the efficacy and safety of the reported ways of management. Two investigators independently performed case series and case reports screening in the literature to reveal and evaluate the efficacy of open and endovascular treatment of malpositioned central venous catheterization. Technical success in safe removal of the misplaced catheter was achieved in all cases. Out of the seven patients, 6 patients (85.7%) were treated endovascularly (four of them (66.6%) treated by ANGIO-SEAL® closure device (Terumo) and two of them (33.3%) were treated with adjunct VIABAHN® covered stent (GORE®), while only one patient was managed by open surgery. All the patients went through uneventful recovery, with mean hospital stay of 3.67 days for the endovascular-treated patients, while the open surgery-treated patient stayed for 12 days. Literature review identified 21 cases of malpositioned central venous catheter, 13 cases were managed by ANGIO-SEAL® closure device (Terumo), three cases were managed by StarClose SE™ (Abbott), two cases were managed by EXOSEAL™ (Cordis), two cases were managed by VIABAHN® ENDOPROTHESIS (GORE®), and one case was treated by open surgical repair. Twenty cases showed no postoperative complications, and only one case showed postoperative pseudoaneurysm which was treated by ultrasound-guided compression. Closure devices, with ANGIO-SEAL (Terumo) being the commonest method, can be safely and effectively utilized for endovascular closure of the subclavian artery following removal of malpositioned central venous catheters. The endovascular options are also accompanied by short hospital stay and lower morbidities. Open surgery should be reserved for patients in whom endovascular options fail.Clinical ImpactThis patient case series and the literature review provided a safe and efficient intervention for treatment of malpositioned central venous catheters in arterial access using Angioseal closure devices, Despite using it out of its IFUs, but it proved to be a proper solution for such complication apart from the known open surgical intervention which accompanied by long hospital stay and morbidity.

Gas aspiration after cannulating a central venous port catheter. How can that happen?

Gas aspiration after cannulating a central venous port catheter. How can that happen?

The third extinct representative of the genus Europs Wollaston, 1854 (Coleoptera: Nitiduloidea: Monotomidae) in Baltic amber

The third fossil minute-clubbed beetle of the extant genus Europs Wollaston, 1854 (Coleoptera: Monotomidae), E. carsteni sp. nov., is described, diagnosed and illustrated from Eocene Baltic amber. This Palaeogene species can be distinguished from the known Eocene congeners by triangular femoral lines with long longitudinal linear extension produced beyond the middle of abdominal ventrite 1 and by the finely setose dorsum.

Use of 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection during central catheter insertion in premature neonates.

2% Chlorhexidine gluconate in 70% isopropyl alcohol (2% CHG in 70% IPA) is the recommended skin antiseptic for adult and children during central venous catheter (CVC) insertion but neonatal data are limited. We assessed skin toxicity of 2% CHG in 70% IPA for vascular catheter site preparation in preterm neonates using sterile disposable pre-measured devices. Monocentric, retrospective, observational study conducted in tertiary level NICU on 146 neonates less than 32 weeks gestational age (GA) and younger than 15 days. Infants were stratified in Group I (GA ⩽ 28 weeks) and Group II (GA = 29-32 weeks) and received skin disinfection with 2% CHG in 70% IPA for either umbilical venous catheters or epicutaneous caval catheters. We evaluated the incidence of skin lesions in preterm neonates who received skin disinfection 2% CHG in 70% IPA with the Neonatal Skin Condition Score. Numeric thresholds ⩽5, 5-7, and >7 were used to define mild, moderate, and severe skin infection respectively. The rate of central line associated bloodstream infection (CLABSI) was also calculated. Two hundred implanted catheters (100 per group) from 146 neonates were reviewed. While two cases of severe skin lesions occurred locally on the abdomen of two 24 weeks babies, no lesion was reported in Group II infants. We found a CLABSI rate of 16% with a rate of 17 infections per 1000 catheter days. The use of 2% CHG in 70% IPA for skin disinfection during CVC implantation in preterm infants over 24 weeks GA does not lead to severe skin lesions.

Hemodynamic Collapse Due to Unrecognized Hemothorax Following Central Venous Catheter Insertion in a Resource-Limited Setting: A Case Report

Hemodynamic Collapse Due to Unrecognized Hemothorax Following Central Venous Catheter Insertion in a Resource-Limited Setting: A Case Report

Venous Thromboembolic Risk Does Not Increase After a Third Dose of SARS-CoV-2 mRNA-BNT162b2 Vaccine in Cancer Patients Receiving Active Systemic Therapies: Updated Results from the Vax-On-Third-Profile Study

(1) Background: Clinical evidence has raised concerns regarding a potential link between COVID-19 mRNA-based vaccines and the occurrence of thromboembolic events. So far, no research has explored the effects of this possible interaction in cancer patients undergoing active treatment. We leveraged prospective monitoring from the Vax-On-Third-Profile study to examine the development of venous thromboembolism (VTE) after the third dose of mRNA-BNT162b2 (tozinameran) and its association with antibody and lymphocyte responses. (2) Methods: Patients who had received a third dose of tozinameran and had not experienced any VTE in the previous 30 days were eligible. A serological evaluation was conducted before the booster vaccination (timepoint-1) and four weeks thereafter (timepoint-2) to measure antibody titers against the SARS-CoV-2 spike protein, as well as to determine the absolute counts of T-helper cells, T-cytotoxic cells, B cells, and NK cells. Data were acquired from November 2021 to October 2022 and analyzed from November 2022 to October 2023. (3) Results: The present study involved 429 patients who were given a third dose of tozinameran from 26 September to 30 October 2021. Among the active treatments of interest, 109 (25.4%) patients received targeted therapy, 111 (25.9%) received cytotoxic chemotherapy, 39 (9.1%) received immune checkpoint inhibitors, 21 (4.9%) received endocrine therapy, and 30 (7.0%) received a combination of chemotherapy and targeted agents in the eight weeks preceding the booster dosing. In addition, 119 (27.7%) patients who had discontinued any systemic therapy for at least 12 weeks accounted for the reference subgroup. After a median follow-up time of 10.6 (95% CI 8.1–11.7) months, we observed 31 venous thromboembolic events in the general population, for an overall incidence rate of 7.2% (95% CI 5.0–10.1). The median time to VTE development after booster immunization was 99 (95% CI 85–112) days. In a univariate comparison, patients exposed to targeted therapies (11.3% [95% CI 6.0–18.9]; p = 0.030) or immune checkpoint inhibitors (16.2% [95% CI 6.2–32.0]; p = 0.012) had a significantly higher incidence of VTE than the reference cohort (3.4% [95% CI 0.9–8.5]). Univariate analysis of immune responses showed that only dynamic changes pertaining to NK cell distributions correlated significantly with VTE occurrence. Multivariate regression analysis confirmed only a high-level NK cell response (OR 6.10 [9% CI 2.16–17.21]; p = 0.001), a history of thromboembolic events (OR 9.81 [3.99–24.13]; p &lt; 0.001), and the presence of a central venous catheter (OR 5.02 [95% CI 1.84–13.67]; p = 0.002) as independently associated with an increased risk of VTE. (4) Conclusions: This prospective cohort study provides unprecedented evidence that cancer patients have no increased risk of developing VTE after the third dose of tozinameran, regardless of the type of active therapy. The specific pattern of lymphocyte response appears to increase thromboembolic risk, underlying immune dysregulation as a causal cofactor. These findings emphasize the need for additional monitoring after periodic COVID-19 vaccination in cancer patients.

Extending the interval for changing flushing solutions for central venous and arterial line systems in the intensive care unit: An evidence-based quality improvement project.

Central venous lines (CVLs) and arterial lines (ALs) are commonly used for patients in the intensive care units (ICUs) to facilitate the administration of medications and haemodynamic monitoring. In an ICU in Queensland, Australia (AU), saline (sodium chloride 0.9%) flush bags used for these lines were routinely changed every 24 h following organizational policy that all intravenous fluid bags are to be changed within a 24-h period. This quality improvement (QI) project aimed to evaluate current practice guided by the Plan-Do-Study-Act (PDSA) model of QI and implementation science. Benchmarking practices with other ICUs was conducted. A narrative literature review focused on evaluating the safe interval for changing flush solutions every 24 h was performed using EBSCO Medline, CINAHL, Cochrane Library, Embase and Google Scholar databases for citations up to November 2022. Bloodstream infection rates attributed to CVLs and/or ALs were monitored. Economic analysis was performed. End-user feedback was sought. A change of practice was implemented for a 1-year study period (March 2023 - March 2024) to extend dwell times of flushing solutions for CVLs and ALs from every 24 h to every 96 h. One-year post-implementation, no bloodstream infections were linked to CVLs or ALs. A simplified economic analysis was performed based on costs of 0.9% sodium chloride 500-mL fluid bags, which revealed that changing the fluid bags once every 96 h resulted in a per patient saving of AU$3.21 for any individual AL or CVL and up to AU$6.42 per patient where both an AL and CVL are in situ, based on fluid bag cost at AU$1.07 per bag. This saving excludes potential savings from reduced nursing time, infection-related costs and recycling costs. A sustainable practice change based on evidence was implemented in the local ICU. The use of the PDSA model of the QI process and the principles of implementation science strengthened the buy-in and implementation of the project. This practice change was examined through lenses of evidence-based practice, environmental sustainability (minimizing environmental footprint by limiting plastic bag usage), patient safety, cost minimization, and reduced nursing workload.

Case Report: Endovascular therapy for an iatrogenic vertebrojugular arteriovenous fistula and pseudoaneurysm induced by multiple vascular procedures

Vertebrojugular arteriovenous fistula (VJAVF) and vertebral artery pseudoaneurysm (VAPA) are usually caused by iatrogenic and penetrating traumas. The concurrence of these two entities originating from different ostia of the vertebral artery (VA) is extremely rare. The history of repeated open-heart surgery and the application of central venous catheterization during anesthesia increased the risk of VA injuries and its complications of the VJAVF and VAPA. The patient, who complained of dizziness, was initially diagnosed with bradycardia and aortic paravalvular leak. However, the symptoms persisted even after permanent pacemaker implantation and transcatheter closure of the aortic paravalvular leak. Ultrasonography, CT angiography, and intraoperative right subclavian arteriography showed a VJAVF originating from the right VA and draining into the right internal jugular vein. A VAPA originated from another ostium of the right VA without a drainage vessel. Using the endovascular technique, a 4 mm stent graft was deployed in a 3.6 mm VA to cover both the VJAVF and the VAPA ostia. The symptoms of dizziness disappeared. The VJAVF and VAPA were completely sealed without recurrence at the 6-month follow-up.

Central line-associated bloodstream infections (CLABSI) in critical care: understanding incidence, and risk factors in Palestine

IntroductionCentral line-associated bloodstream infections (CLABSIs) represent a major source of morbidity and mortality, particularly in developing countries. Central venous catheters (CVCs) are an essential part of managing critically ill patients. This study seeks to describe the epidemiology of central line-associated bloodstream infections CLABSI among ICU patients in Palestine and to identify the specific organism involved.MethodsThis retrospective descriptive study included 323 ICU patients with 490 central venous catheters. The electronic medical records were reviewed to identify patients with CLABSIs hospitalized from January 2018 through December 2021. Comparative analysis was conducted to assess associations between various variables and the incidence of CLABSI.ResultA total of 19 CLABSI episodes in 323 patients yielded an incidence of CLABSI of approximately 5.9%, with a rate of 8.91 per 1,000 device days. CLABSI patients had significantly more CVC utilization ratio and insertions compared to non-CLABSI patients. No significant differences were observed in age, gender, or overall mortality. The most predominant bacteria was Acinetobacter baumannii (21%).ConclusionThis study highlights the importance of minimizing CVC use and limiting the number of insertions to reduce CLABSI risk. Effective management strategies should focus on reducing CVC duration and frequency.