Days Of Catheter Placement Research Articles

Catheters linked thrombosis in neonates: a single center observational study

BackgroundCentral venous catheters (CVCs) are the major risk factors for neonatal thrombosis that might negatively affect morbidity and mortality in neonates. The aim of the present work was to estimate the incidence of CVC-linked thrombosis, among neonates in the NICU of Alexandria University Maternity Hospital, Egypt, over 1year, and to determine its possible risk factors.MethodsThis observational cohort study involved 134 newborn infants born from July 2020 to July 2021with CVCs insertion during their hospital stay. Patients who had congenital anomalies, had thrombosis unrelated to the implantation of CVCs or died before 7 days of catheter placement were excluded from the analysis. The 134 neonates who met the study’s eligibility requirements had 142 CVCs inserted. Serial ultrasound and Doppler scans on site of venous insertion of catheters were performed.ResultsSeventeen patients with catheter’s thrombosis (12%) were found during the placement of 142 catheters or 1615 CVCs’ days, resulting in an overall rate of 10.5 thrombotic events per 1000 catheters’ days. We constructed a logistic regression model to identify risk factors behind CVC-linked thrombosis. In univariate analysis, femoral central venous lines (CVLs), catheter dwell-time, sepsis, packed red cells (PRBCs) transfusions and low platelet count were risk factors for CVC-linked thrombosis. Nevertheless, only PRBCs transfusion was significant in the multivariate analysis, with OR and 95% confidence level 5.768 (1.013–32.836).ConclusionMany factors should be considered in prediction of patients at risk of thrombosis including sepsis, femoral line insertion, low platelet count and PRBCs-transfusions. In our analysis, PRBCs-transfusion through peripheral intravenous lines (PIVs) was the strongest factor associated with CVC-linked thrombosis.

Correlation between Duration of Placement of Non-tunneled Hemodialysis Catheter and Positive Bacterial Culture Incidence in Hemodialysis Patients

Non-tunneling hemodialysis catheter is one of the most convenient vascular accesses for hemodialysis in End Stage Kidney Disease (ESRD) patients. However, these catheters have the highest morbidity among all available accesses. Current guidelines recommend that non-tunneled hemodialysis catheters be placed for no more than 2 weeks to prevent bacterial contamination. This study was conducted in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, throughout January-December 2021. A correlation test with a prospective observational analysis design was applied to find the link between the duration of non-tunneled hemodialysis catheter placement and the incidence of positive bacterial culture on the catheter. Pearson correlation test was used to see the strength of the correlation, with a significance limit of 0.05. This study involved 28 subjects. The most common location for catheter placement was in the jugular vein, and laboratory examinations showed no correlation between leukocyte values and positive bacterial culture results. Hypertension and diabetes mellitus were not significant risk factors (p-value 0.887). At ≤14 days of catheter placement, only 1 (6.7%) of the subjects presented a positive culture result. Most of the positive bacterial culture results were found at a duration of 15-30 days of placement, (n=8; 53.3%). The results of the Pearson test showed a p-value of 0.036 and an r-value of 0.399, indicating a significant result with a strong correlation between the two variables. The duration of placement of hemodialysis catheters has a positive correlation with the incidence of positive bacterial cultures, which can increase the risk of systemic infection associated with hemodialysis catheters.

A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan.

This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications. Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest. Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines. PD catheter placement in Japan was proven to be safe and appropriate.

P-067 PREHABILITATION IN A LOSS OF DOMAIN BILATERAL INGUINOSCROTAL HERNIA: USE OF BOTULINUM TOXIN AND PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM

Abstract Aim Describe the use of botulinum toxin A (BT) and preoperative progressive pneumoperitoneum (PPP) in a loss of domain inguinoscrotal hernia following our hospital's protocol. Material and methods Single case report of a 60-year-old male, with loss of domain bilateral inguinoscrotal hernia. We performed prehabilitation with respiratory physiotherapy (RP), BT and PPP. We applied BT 30 days before surgery, injecting a total of 500U in 12 sites of abdominal wall: 4 in the lateral abdominal muscle and 2 of them in each rectus abdominis. We calculated, using the Tanaka index, the ratio between the abdominal cavity volume (ACV) and the hernia volume (HV), which was 32%, as well as the amount of pneumoperitoneum to insufflate, which according to our protocol is HV x3 + 100cc. The PPP catheter was placed 10 days before repair, insufflating a total of 6.900cc within seven consecutive days of catheter placement. Results With the application of prehabilitation (BT, RP, PPP) we achieve a lengthening of 18.5 cm and a decrease of 27 mm of the thickness as well as an increase in the volume of the abdominal cavity of×4.200cc. Afterwards, a hernioplasty with Stoppa and bilateral Litchenstein technique was performed. as well as a scrotoplasty and circumcision for the patient's phimosis in collaboration with Plastic and Urology services. The surgical procedure was performed without complications. After 7 months there is no hernia recurrence. Conclusions BT and PPP help to repair the inguinoscrotal hernia, avoiding the mayor surgical techniques like component separation diminishing morbidity.

Peritoneal access – a pressing problem

In Portugal, as well as in Europe, peritoneal dialysis (PD) use remains low. Reorganization of PD units including a well -structured peritoneal access management protocol are fundamental to improve the take -up of this therapy. We analyzed the procedure and outcomes in a PD unit, addressing two key quality questions: at which level of estimated glomerular filtration rate (eGFR) were patients referred to peritoneal catheter placement and whether if it was timely placed. We retrospectively evaluated all patients submitted to catheter placement between 2017 and June 2020. We analyzed the patient journey from Kidney Replacement Therapies (KRT) Option Appointment, until PD start, as well as demographic and clinical variables, including eGFR at four time points (KRT Options Appointment, PD unit evaluation, catheter placement, and PD start). To explore the adequacy of catheter placement schedule, we compared the characteristics of the patients who started PD within 90 days of catheter placement (Early group), and of those who started after the first 90 days (Late group). We analyzed 48 patients in the Early and 27 in the Late group. The Early group presented a lower eGFR on KRT Options Appointment, with timely intervention: eGFR at catheter placement averaged 8.0 ± 2.1 mL/min/1,72m2. PD start occurred at 7.0 ± 1.9 and 8.0 ± 2.4 mL/min/1.72m2, in the Early and Late group, respectively. None of the patients suffered an urgent transition to HD by CVC. Four patients started PD less than 15 days after catheter placement, all of them without complications. PD patients’ admission involves specific tasks. Administrative tools or indicators to evaluate those processes are lacking. A peritoneal access clinic would allow the formalization of this circuit, allowing a quality and equitable approach to dialysis access. We suggest a structured pathway for peritoneal access management.

Dynamic Curve Analysis of Indicators Related to Lumbar Cistern Drainage for Postoperative Meningitis

To analyze the dynamic curve of cerebrospinal fluid (CSF)-related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with lumbar cistern drainage (LCD). We conducted a retrospective study of LCD placement in 51 patients. Primary outcomes measured included dynamic changes of body temperature before and after intervention and cerebrospinal fluid biochemical parameters over the course of 13 days of catheter placement. We also assessed the bivariate correlation between white blood cell (WBC) count changes, polykaryocyte percentage, body temperature, and daily cerebrospinal fluid drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on WBC count change curves. After LCD, there was a statistically significant difference (P < 0.01) between the WBC count before drainage and on the fourth day of drainage. There was a negative correlation between the change curve of the WBC count and the change curve of daily drainage volume (r=-0.56). When the daily drainage volume was 250-300 mL/day, the change curve pattern of the WBC count was consistent with the overall trend, and there was no significant difference in the curve of the WBC count between different surgical sites (P > 0.05). The WBC count can decrease significantly by day 4 after drainage, and placement of the LCD for 6-7 days is ideal. An average drainage volume of 250-300 mL/day is safe and effective.

Antibiotic Sensitivity Patterns of Urine and Biofilms in Patients with Indwelling Urinary Catheter in Denden Hospital, Asmara, Eritrea

The intricate infections leading to long-term morbidity of catheterized patients are due to the presence of a covering and blocking the lumen of urinary catheters by biofilms which have increased ability of resistance to host immune system and antibiotic treatment. The biofilm mode of growth is a basic survival strategy implemented by bacteria in a wide range of settings such as environmental, industrial and clinical aquatic settings. Bacterial growth on the inner surface of the catheter with biofilm formation is frequent and may occur within days of catheter placement. This study investigated the formation of biofilm inside catheter lumen of patients from Denden hospital, Asmara, Eritrea. And also, it assessed the antimicrobial sensitivity pattern of biofilm isolates and compared it with urine isolates. Resistance to antibiotics was observed in biofilm isolates more than urine isolates. E. coli was the most frequently isolated organism in both biofilm and urine samples.

4:12 PM Abstract No. 69 Tunneled peritoneal drainage catheter for refractory ascites: a single-center experience of 480 patients

To evaluate the efficacy, safety, and complications of tunneled peritoneal catheters for the treatment of refractory ascites, and to assess for association between tumor type and catheter-related complications. A single-center, HIPPA-compliant, IRB-approved retrospective review of the interventional radiology division quality assurance database and electronic medical records of tunneled peritoneal catheters placed from 04/01/2006 to 03/31/2016. 480 patients were reviewed (203 males, 277 females) in whom 489 catheters were placed (472 received 1, 7 received 2, and 1 received 3). Most patients (477; 97.5%) had malignant ascites. 25 patients were lost to follow-up. Malignant ascites was associated with an average catheter duration of 58.4 days compared to non-malignant ascites with average catheter duration of 83.4 days. Pancreatic (16.5%), ovarian (14.2%), breast (12.1%), and peritoneal carcinomatosis of unknown primary (8.4%) make up the majority of the causes of malignant ascites. Technical success rate was 100%. A total of 103 (20.2%) complications were identified, including access site leak (4.1%), catheter occlusion (3.5%), peritonitis (3.0%), inadequate drainage (2.8%), and cellulitis (2.6%). Pancreatic cancer has lower catheter duration (mean 40.7 days versus mean 61.3 days) among the 4 largest represented categories of malignancies. Rates of catheter related complications are relatively similar among malignancies frequently associated with ascites. 230 subjects died within 30 days of catheter placement (47.9%), and 363 died within 90 days of placement (75.6%). Tunneled peritoneal catheters are advantageous for home drainage of patients with refractory ascites, but almost half of our subjects, most of whom had malignancy as the etiology of their ascites, died within 30 days of placement. Adverse events after placement are not uncommon, but most can be treated conservatively.

Comparison Of Ultrasound Versus Magnetic Resonance Venography For Diagnosis Of Catheter-Related Thrombosis In Children: A Multicenter Multinational Study

BackgroundVenous thrombotic events (VTE) in children are related to central venous catheters and occur predominantly in the upper venous system. In routine clinical practice, ultrasound (US) is the most frequently used imaging technique for diagnosis of VTE in children because of its ease of use and non-invasiveness. However, US is known to be relatively insensitive for detection of VTE in the central upper venous system. Magnetic resonance venography (MRV) is a promising alternative as MRV can comprehensively image the central venous system, is minimally invasive and does not involve radiation. However, MRV involves high technical and logistic demands, and requires sedation in young children. ObjectivesTo compare the feasibility and diagnostic accuracy of US and MRV for diagnosis of central venous catheter related VTE in children. MethodsStudy Design: Cross-sectional diagnostic study. Study population: Children 0-<18 years of age with a central venous catheter in place for any reason were recruited prospectively and consisted of i) children who are asymptomatic for VTE: children who were screened for central venous catheter-related VTE within 20-60 days of catheter placement ii) children who are symptomatic for VTE: children presenting with signs and symptoms of central venous catheter related VTE within 7 days of symptom onset (all study-related imaging tests were completed within this time period). Children were excluded in case of i) systemic anticoagulant or antiplatelet therapy, and ii) inability to undergo contrast MRV. Imaging tests: Each participant had three imaging tests performed i) Doppler compression US ii) MRV without contrast iii) MRV with gadolinium contrast. All imaging studies were performed within 48 hours of each other. Data collection included clinical and demographic information on each subject, imaging and video documentation of each US and MRV. Central Adjudication Committee: All imaging studies were blinded and independently reviewed and interpreted by a central adjudication committee for the presence or absence of VTE. Outcomes: The two main study outcomes were 1) Feasibility of performing each test: assessed by a) the number of children who completed each diagnostic study and b) the number of evaluable studies; and 2) Diagnostic accuracy of each diagnostic test: assessed by the proportion of VTE identified by the respective test in relation to the total number of VTE identified by any imaging modality. ResultsA total of 152 children were enrolled from 24 centers in 9 countries: Argentina, Brazil, Mexico, United States, Canada, United Kingdom, Netherlands, Austria and Germany. The median age (range) for children was 11 years (2 months to 17 years). Fourteen (9.2%) children had clinical symptoms of VTE. One hundred and thirty three (88%) children had US completed, 113 (74%) had MRV without contrast and 113 (74%) had MRV with contrast. 18 subjects withdrew from the study before any test was performed for various reasons. Adjudication and analysis are ongoing, and will be completed by October 14th, 2013. Therefore, final results regarding the feasibility and diagnostic accuracy of each test will be available at the time of presentation. ConclusionWe have completed the largest and most comprehensive study to date comparing the feasibility and diagnostic accuracy of currently available non-invasive imaging modalities for detecting central venous catheter related VTE in children. Ultrasound demonstrated better feasibility than MRV, however, MRV still proved feasible in nearly three-quarters of pediatric subjects and was performed without sedation in individuals as young as 2 months old. The overall feasibility and diagnostic accuracy of each test will be reported after final adjudication and analysis are complete. The study findings will be used to formulate an effective pediatric diagnostic algorithm for diagnosis of central venous catheter-related VTE. The algorithm will be used as guidance for clinical practice as well as outcome assessments for clinical trials of antithrombotic agents in children. Disclosures:Male:Bristol Myer Squibb: Consultancy. Yee:Bristol Myer Squibb: Research Funding. Loewe:Bristol Myer Squibb: Consultancy. Krishnamurthy:Koninklijke Philips NV: Research Funding; Bristol Myer Squibb: Consultancy. Chalmers:Bristol Myer Squibb: Consultancy. Newburger:Merck: Consultancy; Janssen Pharmacutical: Consultancy; Bristol Myer Squibb: Consultancy. Ramirez:Bristol Myer Squibb: Employment. Portman:Bristol Myer Squibb: Employment. Mitchell:Bristol Myer Squibb: Consultancy; Eisai: Consultancy; Boehringer Ingelheim: Consultancy.

Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis

BackgroundCentral venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement.MethodsPatients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association’s Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter–related complications (MCRCs).ResultsThirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter–related complications were most frequently seen in patients 16 years or younger.ConclusionsThe risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters. Data provided in this study can be applied toward improving patient care.

Abstract P4-15-02: Timing of infectious complications following breast conserving therapy with catheter-based accelerated partial breast irradiation

Abstract Background: Accelerated partial breast irradiation (APBI) has been introduced as an alternative to whole breast irradiation as part of breast conserving therapy for selected patients. The long-term outcomes remain under investigation. Previous publications have emphasized early postoperative infections with APBI with less focus on delayed infection. In the current study, we evaluated patients enrolled on a prospective registry trial for infectious complications after treatment with catheter-based APBI. Methods: Patients who underwent single-entry catheter-based APBI were identified from a single-institution prospective registry from 2009 to 2011. Data regarding treatment, patient comorbidities, complications, and outcomes were obtained from registry and retrospective chart review. Infectious complications were assessed from the date of APBI catheter insertion and were classified as early (≤30 days) or delayed (&amp;gt;30 days). All patients were maintained on oral antibiotics while the catheter was in place. Results: A total of 91 patients with 92 cases of primary breast cancer were enrolled on a prospective registry at a comprehensive cancer center between 2009 and 2011 and treated with single-entry catheter-based APBI. The median follow-up time was 76.2 weeks. A temporary catheter was placed at the time of initial operation in 40 cases (43.5%) and left in place a median of 6 days prior to definitive catheter insertion. There were 20 patients (21.7%) who required re-excision. Overall, breast infection occurred in 13 (14.1%) patients. Three (3.3%) patients had infection within 30 days of catheter placement and 10 (10.9%) occurred more than 30 days after catheter insertion (median 112.5 days, interquartile range 51–154). Eight patients were managed with oral antibiotics alone on an outpatient basis. The remainder required a combination of admission, intravenous antibiotics, and aspiration of abscess. One patient underwent operative drainage. Conclusion: We found an overall infection rate of 14.1% in patients treated with catheter-based APBI. This is consistent with other reports; however, we found that the majority of infections occurred more than 30 days after definitive catheter placement. Vigilance for infectious complications must continue beyond the immediate treatment period in patients undergoing catheter-based APBI. Most infections following APBI can be managed on an outpatient basis without operative intervention. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-15-02.

Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single center experience and review of the literature

Experiences with minimally invasive techniques for peritoneal dialysis (PD) catheter placement are being increasingly described. Percutaneous placement of catheters using ultrasound and fluoroscopic guidance has reduced the risk of complications and has led to successful long-term catheter function. An interventional radiology catheter placement capability was established at our facility and it serves as the basis for this report.We performed a retrospective analysis of patients in a tertiary care center in Northern California who required PD between July 2005 and October 2008. Patients underwent PD catheter placement in an interventional radiology suite by the radiologist using a percutaneous Seldinger technique that was guided by fluoroscopy.Sixty-four patients between the ages of 25 and 90 were referred for fluoroscopic PD catheter placement by an interventional radiologist. If clinically indicated, PD was initiated within days of catheter placement. Minor complications were noted: four with minor bleeding, three with catheter migration, and one with temporary exit-site leakage. No bowel or bladder perforations were encountered.Fluoroscopically guided PD catheter placement by interventional radiologists can be a safe and cost-effective strategy to initiate acute or chronic PD. This approach could reduce the need for temporary vascular access and expedite the initiation of PD therapy by eliminating the delays in catheter placement often associated with surgical consultation and operating room scheduling.

Incidence and risk factors of catheter-related deep vein thrombosis in a pediatric intensive care unit: a prospective study.

To estimate the incidence and to characterize risk factors for central venous catheter (CVC)-related deep vein thrombosis (DVT) in a pediatric intensive care unit. Consecutive children admitted to a pediatric intensive care unit who required a CVC for more than 48 hours were examined by Doppler ultrasonography of the catheterized vein at days 2, 4, 6, or 7 after insertion and weekly thereafter until CVC removal. The incidence of CVC-related DVT was 18.3% (17 of 93) (95% confidence interval = 10.2% to 25.8%). Thromboses were diagnosed within the first 4 days of catheter placement for 15 of 17 CVC-related thromboses. Multivariate analysis showed that risk factors most predictive of CVC-related DVT were presence of a cancer (odds ratio = 17.23, 95% confidence interval = 1.5 to 194) and young age (odds ratio for age = 0.72, 95% confidence interval = 0.54 to 0.96). The frequency of CVC-related DVT is substantial in pediatric intensive care units. Risk is highest during the 4 days after insertion and decreases thereafter. The clinical impact, optimal prevention, and therapy of these thromboses remain to be determined.

Peripherally inserted central catheters: experience in 523 children.

To evaluate prospectively the use of peripherally inserted central catheters in a large pediatric population. During a 3-year period, data were collected prospectively on 523 consecutive attempts to place peripherally inserted central catheters in children. Patients underwent radiologically guided placement because attempts were unsuccessful on the inpatient units or a patient request was made. Fluoroscopy with use of contrast material and venography were used to place catheters and document the position of the catheter tip. Follow-up data were collected until treatment cessation or catheter removal. Among 523 attempts, 486 (92.9%) catheters were successfully placed. In the 37 (7.1%) unsuccessful cases, more than half of these children were younger than 24 months of age or weighed less than 5 kg. Ages of patients in whom 523 placement attempts were made ranged from 3 weeks to 18 years (mean, 6.9 years). Catheters were in place from 1 to 390 days (mean, 20 days). Frequency of infection was 1.9% (nine cases); incidence of infection was 0.93 per 1,000 catheter-placement days. There were two cases (0.4%) of central venous thrombosis. Most patients were discharged within 2 days of catheter placement. Fluoroscopically guided placement of peripherally inserted central catheters is a safe and effective method for establishing intermediate- and long-term central venous access in the pediatric population.

The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections

To determine the appropriate time for removal or replacement of peripheral and pulmonary arterial catheters in critically ill cancer patients, we prospectively studied 71 peripheral arterial catheters and 71 pulmonary artery (Swan-Ganz) catheters from 110 consecutive cancer patients. All catheters were cultured semiquantitatively, by the roll-plate culture technique. Of the 71 peripheral arterial catheters, 11 (15%) produced local infections (⩾15 colonies) and four (5·5%) produced catheter-related septicaemia. Ten of the 11 local infections and all four septicaemias occurred after 4 days of catheter placement ( P < 0·05). Likewise, of the 71 Swan-Ganz catheters, 12 (17%) produced local infection and four (5·6%) led to septicaemia. Swan-Ganz catheter-related septicaemia occurred at rates of 2% and 16%, before and after 7 days of catheter placement, respectively ( P = 0·056). Duration of piacement was a risk factor for the development of catheter infections, independent of the patient's neutropenic status, administration of antibiotics such as vancomycin during catheterization, and the presence of concurrent central venous catheters. Life-table analysis showed that the cumulative risks of developing a catheter infection increased from 7% to 17% after 6 days of peripheral arterial catheter placement and from 9% to 18% after 4 days of placement of the Swan-Ganz catheter. We conclude that in the critically ill cancer patient in our unit, peripheral arterial catheters should be changed to a new site every 4–6 days and pulmonary artery catheters every 4–7 days.

Local thrombolytic therapy for hepatic artery thrombosis following chemotherapy infusion catheter placement.

Nine patients with hepatic artery thrombosis subsequent to catheter placement (four surgical and five percutaneous) for hepatic arterial infusion chemotherapy were treated with local thrombolytic therapy. The thromboses were located in the common hepatic, proper hepatic and hepatic arteries. Thrombolytic therapy was instituted within seven days of catheter placement, at a rate of 5,000 to 20,000 units/hour (streptokinase) or 5,000 to 15,000 units/hour (urokinase) for 15 to 64 hours. All patients had repeat angiography and 99mTc-MAA hepatic artery perfusion scintigraphy after the infusion. In eight of the patients, thrombolytic therapy resulted in dissolution of the thrombus and recanalization of the hepatic artery. In three of these patients, rethrombosis occurred within a few days, and was attributed to underlying arterial abnormalities. The other five had documented continued hepatic arterial patency allowing completion of the chemotherapy course. The patient who did not respond to the lytic therapy had developed extensive collateral flow through the gastroduodenal artery to the liver.