Hickman Catheter Research Articles

#1024 Lung ultrasound in 28 versus 8 places and volume status in chronic hemodialysis patients

Abstract Background and Aims Overhydration is considered a significant risk factor for cardiovascular and all-cause mortality in end-stage kidney disease patients. Measurement of total and extracellular water with bioelectrical impedance analysis (BIA), inferior vena cava diameter (IVCd) measurement, and circulating pro-B-type natriuretic peptide (proBNP) levels have previously been tested as possible indicators of volume status in hemodialysis (HD) patients, with BIA showing the most potential. Recently, it has been shown that lung ultrasound (LUS)-guided volume depletion is an effective strategy for relieving lung congestion in chronic HD patients. The aim of our study was to determine whether performing LUS on only 8 places was comparable to the regular 28 places. Method LUS was performed on 29 randomly selected patients before their regular HD procedure in 28 regular places and correlated with 8 places (4 on each side). In addition, BIA with a body composition monitor (BCM) was performed, IVCd was measured using ultrasound and serum NT-proBNP value was determined. Statistical analysis was performed using a commercially available SPSS® for Windows® (version 29.0; Chicago, IL, USA). Spearman's non-parametric test was used to determine a correlation between variables. P-values less than 0.05 were considered statistically significant. Results We included 29 chronic HD patients, 15 male (51.7 %), with a mean age of 66.3 ± 12.5 years and a median dialysis vintage of 53.0 (95% CI (40.9, 100.6)) months. Most patients (96.6 %) had a functional arteriovenous fistula, whereas only one patient (3.4 %) was dialysed using a Hickman catheter. A very strong, directly proportional correlation was found between performing LUS in 28 and 8 places (ρ=0.909; p<0.001). A significant moderate correlation was also found between both LUS in 28 and 8 places and systolic blood pressure (ρ=0.503; p=0.005 and ρ=0.467; p=0.011, respectively) (Table 1). Neither of the LUS methods statistically correlated with other tested volume markers – overhydration, intracellular and extracellular volume measured with BIA, IVCd in inspiration and expiration and IVC index, or serum NT-proBNP levels. Conclusion In our study, we found a very strong, positive, and significant correlation between performing LUS in 28 regular places and 8 places. Both also moderately correlated with systolic blood pressure. However, we did not find a statistically significant correlation between LUS and other tested volume markers.

Breakage and dislocation of the Hickman catheter in pediatric patient

Introduction. The Hickman catheter is a tunneled, open-type catheter often implanted in children for long-term intravenous treatment. Their application can cause numerous complications. Catheter breakage and dislocation of fragments to the intravascular system is a rare but life-threatening condition. When a complication occurs, depending on the patient's clinical condition, the first step is transcutaneous endovascular removal of the catheter's fragment. If this is not possible, surgical thoracotomy is necessary. The objective of this article was to present a case of breakage and dislocation of Hickman catheter in pediatric patient, as well as the diagnostic and therapeutic approach to complications. Case outline. We report a 14-month-old child who had a Hickman catheter because he was undergoing treatment for acute juvenile myelomonocytic leukemia. Due to a malfunction of the catheter, the existing catheter had to be removed. During the surgical procedure, a breakage and dislocation of the catheter fragment occurred. A chest x-ray and an echocardiography confirmed the position of the catheter fragment in the right atrium. A transcutaneous endovascular procedure was successfully performed to remove part of the catheter. Conclusion. Numerous complications can occur during the insertion, management, and removal of long-term catheters. It is necessary to periodically control the catheter's position by chest x-ray and ultrasound of the heart and neck. If a particular complication is detected, an individual approach to treatment with the lowest risk to the patient should be chosen. Dislocated fragments of the Hickman catheter can be safely removed by endovascular transcatheter procedures.

Removal of stuck tunnelled dialysis line requiring cardiopulmonary bypass and venous repair.

Tunnelled central venous dialysis catheters can usually be removed easily. However, their removal can become rarely complicated requiring more invasive techniques. We report a case in which cardiopulmonary bypass and repair of great veins was required for safe removal. A 38-year-old female with end-stage renal failure and a 3-year-old Hickman line inserted into her right internal jugular vein was referred to our cardiac surgical unit following failed attempts of line removal by local vascular surgical team using open vascular surgical techniques. As a result, an MDT decision was made that it was safer to proceed to a cardiothoracic surgical approach rather than other techniques. Investigations showed significant calcification surrounding the line which was adherent to the venous wall. Removal of the retained catheter required median sternotomy and the use of cardiopulmonary bypass as the great veins had to be opened to free the line and allow complete removal. The line was successfully removed with its encircling calcified sheath, and the veins were closed primarily without needing a patch repair. The integrity of the great veins was maintained to meet the on-going need this young patient has for central venous access. The patient made an uneventful recovery. When other measures fail, sternotomy and cardiopulmonary bypass provide a safe option for complete removal of stuck central venous catheters with low risk to the patient.

Review of Blood Cultures Taken From Arterial Lines in James Cook University Hospital: Contamination Analysis And Comparison With Venous Samples

BACKGROUND: Blood cultures are crucial diagnostic tools for identifying and treating bloodstream infections. Traditionally, venous blood is the preferred source for sample acquisition, but arterial lines offer an alternative. However, concerns regarding contamination and diagnostic accuracy have been raised, questioning the reliability of arterial line blood cultures. This study aimed to evaluate the contamination rates of arterial line blood cultures at James-Cook University Hospital (JCUH), UK and compare them with venous samples to understand their clinical utility better. METHODS: A comprehensive retrospective review analysed 17,643 blood culture samples collected between September 2022 and March 2023 at JCUH. Among these, 109 arterial line blood cultures and 785 venous peripheral adult samples were included for data analysis. Contamination rates were calculated as the number of positive blood cultures with contaminants per total positive samples (arterial or venous). The incidence of contamination was defined as the number of total blood cultures reported with contaminants per total samples (arterial or venous). No discrimination was made based on the number of contaminants found. Clinical information accompanying the blood cultures, such as the specification of arterial lines as 'new' samples, was also considered. RESULTS: The overall contamination rate at JCUH was found to be 4.99%. Specifically, the contamination rate for venous samples was 49.26%, while arterial samples had a higher contamination rate of 56.52%. The incidence of contamination from arterial samples was 11.92%, significantly higher than the incidence rate for venous samples at 3.18%. Most arterial samples were requested from intensive care units (ICUs) and highly dependent wards (HDUs), indicating potential areas for targeted interventions to improve blood culture collection practices. CONCLUSION: Arterial blood cultures demonstrated higher contamination rates compared to venous samples, raising concerns about their reliability. Contamination in arterial samples, particularly when collected from critically ill patients in ICUs and HDUs, can lead to inappropriate use of antibiotics, delayed, or missed diagnosis, and suboptimal patient outcomes. The study recommends targeted interventions to improve arterial blood culture collection practices and further training for healthcare workers involved in arterial line care. Encouraging the use of only 'new' arterial lines and implementing standardized protocols can help reduce contamination rates. Furthermore, the study identified certain limitations, such as potential human errors in data analysis and the need for a larger dataset of arterial line cultures. Extending the analysis to compare different sample sources like CVCs, Hickman lines, and central lines could provide a more comprehensive understanding of contamination rates across various culture collection methods. In conclusion, venous samples showed higher clinical favourability with a lower contamination rate, providing increased dependability for accurate diagnosis and management. Although some studies have not shown clear superiority of arterial samples over venous samples, this analysis highlights considerable differences in contamination rates, suggesting a potential inferiority of arterial blood culture samples. While efforts can be made to optimize the consistency of arterial samples and reduce contamination rates, their use should be approached with caution. Implementing the recommended measures is essential for accurate diagnosis, improved patient outcomes, and effective antibiotic management in clinical practice.

Anitmicrobial Susceptibility to Microoranisms in Hematological Malignancies; A Need to Review Institutional Protocols

Abstract Introduction Febrile neutropenia is a medical emergency in patients with hematological malignancies. The severity of neutropenia and the duration of infection have an important implication on primary treatment outcome. Previously assessed institutional review revealed gram negative bacteria to be the most common microorganisms, and leading cause of febrile neutropenia. However, the predominance of gram positive bacteria had also increased in later past years [1]. In high risk patients, infections caused by multidrug resistant bacteria worsen treatment complications and thus at times empirical use of antibiotics like colomycin is required; otherwise the prognosis may be jeopardized [2]. Regular surveillance of local flora and susceptibility pattern of antimicrobial is must to elude the antimicrobial resistance. Objective The study was conducted to evaluate the prevalence of microorganisms and to observe the sensitivity pattern of antimicrobials as an institutional protocol to establish antimicrobial policies. Material and methods A cross sectional study was conducted at National Institute of blood diseases and bone marrow transplantation, PECHS campus from August 2021 - January 2022. Ethical approval was taken from research committee prior to the study and informed consent was taken from the patients. Febrile neutropenia was defined as a single reading of oral temperature of ≥38 °C on two or more occasions in 12 h in the presence of absolute neutrophil count of less than 1000cells/mm. Blood cultures were performed using the BACTEC blood culture system. Organisms were identified according to routine bacteriological procedures and disc diffusion method was used for interpreting antibiotic susceptibility. Data was analyzed by SPSS version 23.0. Frequencies and percentages were calculated for categorical variable and mean (standard deviation) was computed for quantitative variables. Association between categorical variables was observed using the chi-square test or Fisher’s exact test. P value of <0.05 was considered statistically significant. Results A total of 310 cultures taken from blood (37.4%), peripheral line (4.2%), hickman line (8.1%), red line (2.6%), pus (7.1%), sputum (9.7%) and urine (31%) samples were observed. Out of total 213 (69%) were found to be gram negative and 97 (31%) were gram positive. Gram negative were mostly reported in blood cultures 61 (20%) while gram positive was found in urine cultures 80 (26%). E.coli (40.8%) was the most prevalent among the gram negative microorganisms followed Klebsiella pneumonae (16.9%), Pseudomonas species (11.7%), Pseudomonas aeruginosa (11.3%), Burkholderia cepacia (7%), Enterobacter species (3.3%), Moraxella species (3.3%), Proteus mirabilis (2.8%), Salmonella typhi (1.4%), Acinetobacter species (0.9%) and Citrobacter species (0.5%). In gram negative organisms, Acinetobacter species, Burkholderia cepacia, Citrobacter species and Moraxella species were identified substantially which were not previously prevalent. In gram positive microorganisms Staphylococcus epidermidis (55.3%) was more prevalent, followed by Enterococcus species (19%), Micrococcus species (16%), Streptococcus species (6%), Staphylococcus aureus (3.7%), from which Micrococcus species was reported for first time. Sensitivity of meropenem, amikacin and colistin was higher in gram negative while the sensitivity of fosfomycin, and linezolid was found in gram positive isolates The association of sensitivity and resistance with gram negative and positive isolates was found statistically significant with amikacin, vancomycin, fosfomycin and ciprofloxacin (p=<0.05). Conclusion Gram negative isolates were found prevalent in our study. The sensitivity of meropenem, amikacin and colistin was high than other regimens in gram negative while the sensitivity of fosfomycin, and linezolid was found in gram positive isolates. Few emerging isolates were observed in the study as well. The regular review of microbial pattern and susceptibility evaluation is imminent for prevention of microbial resistance and assessment of institutional practices.

Chimaeribacter arupi a new member of the Yersineacea family has the characteristics of a human pathogen.

Chimaeribacter arupi (heterotypic synonym: "Nissabacter archeti") is a facultative anaerobic, newly described Gram-negative rod and belongs to the Yersineacea family. Here, we report the case of a 19-month-old female infant patient who presented to the emergency unit with somnolence and fever. C. arupi was isolated from a positive blood culture, taken via an implanted Broviac catheter, proving a bloodstream infection by the pathogen. The objective of this study was to utilize whole genome sequencing to assess the genes encoding potential virulence associated factors, which may play a role in host tropism, tissue invasion and the subsequent stages in the pathogenesis of a bloodstream infection with C. arupi. The genome of the isolate was completely sequenced employing Illumina MiSeq and Nanopore MinION sequencing and the presumptive virulence associated factors and antimicrobial resistance genes were investigated in more detail. Additionally, we performed metabolic profiling and susceptibility testing by microdilution. The presence of predicted TcfC-like α-Pili suggests that C. arupi is highly adapted to humans as a host. It utilizes flagellar and type IV pili-mediated motility, as well as a number of γ1-pili and a σ-pilus, which may be used to facilitate biofilm formation and adherence to host epithelia. Additionally, long polar fimbriae may aid in tissue invasion. The bacterium possesses antioxidant factors, which may enable temporary survival in phagolysosomes, and a capsule that potentially provides protection from phagocytosis. It may acquire iron ions from erythrocytes through the type 6 secretion system and hemolysins. Furthermore, the isolate exhibits beta-lactamase-mediated penicillin and aminopenicillin resistance. Based on the analysis of the whole genome, we conclude that C. arupi possesses virulence factors associated with tissue invasion and may thus be a potential opportunistic pathogen of bloodstream infections.

In vitro comparison of the effectiveness of various antimicrobial locks with taurolidine in the treatment and prevention of catheter-related bloodstream infections in patients receiving parenteral nutrition

ObjectivesTo evaluate the effectiveness of various taurolidine solutions in the prevention and treatment of catheter-related bloodstream infections (CRBSIs) caused by the entire spectrum of microbes in patients receiving parenteral nutrition in a shorter period of time. MethodsThe in vitro method was used to test for eradication of biofilm. Different locks were used: TauroSept (2%), TauroLock (1.35%), TauroLock half concentration, and 3.5% taurolidine and tested on Staphylococcus (S.) epidermidis, S. aureus, S. hominis, methicillin-resistant S. aureus (MRSA), Pseudomonas (P.) aeruginosa (PSAE), multidrug‐resistant P. aeruginosa (MR PSAE), vancomycin-resistant enterococci, Klebsiella pneumoniae producing carbapenemase (KPC), Klebsiella pneumoniae producing extended-spectrum beta-lactamase (KLPN ESBL), Candida (C.) albicans, and C. glabrata. Broviac catheters were incubated for growth of each organism and then incubated in lock solutions. Colony forming units (CFUs) were then counted after 30 min, 60 min, and 120 min of incubation. ResultsA statistically significant decrease in CFUs was observed after 30 min of taurolidine exposure for S. hominis, PSAE, KLPN ESBL, KLPN KPC, C. albicans, and C. glabrata; after 60 min of exposure for S. epidermidis, PSAE, MR PSAE, KLPN ESBL, KPC, C. albicans, and C. glabrata; and after 120 min of exposure for S. epidermidis, S. hominis, S. aureus, PSAE, MR PSAE, KLPN ESBL, KPC, C. albicans, C. glabrata. ConclusionsThe application of taurolidine is effective in the treatment of CRBSIs. Taurolidine proved to be more effective against Gram-negative microorganisms during a 30-min exposure. Using 0.675% taurolidine is still effective. To achieve the required antimicrobial effect, the catheter must be sanitized for at least 2 h.

Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood monitoring and reliable intravenous fluid and drug administration. Specifically, the tunneled multi-lumen Hickman catheter (HC) is commonly used in swine models due to its lower extrication and complication rates. Despite fewer complications relative to other CVCs, HC-related morbidity presents a significant challenge, as it can significantly delay or otherwise negatively impact ongoing studies. The proper insertion and maintenance of HCs is paramount in preventing these complications, but there is no consensus on best practices. The purpose of this protocol is to comprehensively describe an approach for the insertion and maintenance of a tunneled HC in swine that mitigates HC-related complications and morbidity. The use of these techniques in >100 swine has resulted in complication-free patent lines up to 8 months and no catheter-related mortality or infection of the ventral surgical site. This protocol offers a method to optimize the lifespan of the HC and guidance for approaching issues during use.

Improvement of Broviac catheter-related outcomes after the implementation of a quality management system: A before-and-after prospective observational study

Background: Because of the high rates of Broviac catheter complications, we started an urgent quality process to reduce this morbidity. The aim is to assess the efficiency of the main actions we have taken in enhancing our practice and improving Broviac outcomes. Methods: We included all neonates and young infants requiring surgical central venous access using a Broviac tunneled catheter. We compared the catheters’ outcomes before and after the implementation of a quality program based on a nurse teaching program, patient selection, and catheter management multidisciplinary protocol. The significance threshold was set at p<0.05. Results: We included 94 patients: 51 in the protocol group and 43 in the control group. The complication rate was reduced from 60.3% to 25.5% with p=0.001. The lifetime of the catheter was improved from 11.3 ± 4.3 days to 19.1 ± 9 days with p=0.007. The catheter infection was reduced from 65.3% to 46.1% with p≤0.001. Conclusion: This quality improvement project shows the utility of a quality assurance program based on careful indications and patient selection, a nursing teaching program, and a multidisciplinary catheter management protocol, in reducing Broviac catheter-related morbidity.

Novel Surgical Management of an Extensive Recurrent Hickman Line Thrombosis involving the SVC and Right Atrium

Novel Surgical Management of an Extensive Recurrent Hickman Line Thrombosis involving the SVC and Right Atrium

Venous Thromboembolism Prophylaxis in High-Risk Pediatric Oncology Patients

Introduction Pediatric oncology patients are at increased risk for hospital-acquired venous thromboembolism (HA-VTE), which is associated with increased morbidity in this population. Up to 20% of pediatric oncology patients with central venous catheters (CVC) experience HA-VTE. However, much debate exists over the use of pharmacologic thromboprophylaxis to prevent HA-VTE in the pediatric oncology population, primarily due to lack of evidence regarding safety and efficacy. Pediatric oncology patients have many well-established risk factors for VTE including adolescence, obesity, CVC presence, and receipt of asparaginase chemotherapy. Given the uncertainty regarding prevention strategies in this population, research is needed regarding the use of prophylactic anticoagulation in pediatric oncology patients. Objective: To evaluate the use of prophylactic anticoagulation in pediatric oncology patients at risk for HA-VTE. Methods A retrospective, single center chart review of pediatric oncology patients who received clinical care at a tertiary care children's hospital was performed. Over 1600 patients were captured from a departmental database of all new oncologic diagnoses identified between January 1, 2014 and December 31, 2014. Patients were excluded if they received care at another institution or did not have an additional risk factor for HA-VTE outside of cancer diagnosis. Defined risk factors were age >12 years, body mass index (BMI) >30, CVC placement, receipt of asparaginase, and history of thrombosis. 514 patients met inclusion criteria. Patient age, BMI, history of thrombophilia, type of CVC, cancer type, steroid administration and asparaginase administration were analyzed as potential risk factors for VTE. Logistic regression was used to model odds of thrombus as a function of risk factors. A classification and regression tree (CART) model was also fitted to identify predictors of thrombus. Results Of 514 patients identified as high-risk for VTE, only 19 (3.7%) received prophylaxis. Most patients received enoxaparin for prophylaxis. Almost 15% (75/514) developed VTE during the study period. Of those who developed a VTE, 9% (7/75) were on prophylaxis at the time of VTE. 100% of the patients that developed VTE had a CVC in place. Obese patients were most likely to develop VTE with an odds ratio of 2.2 (95% CI 1-4.3, p 0.032). 28% (18/65) of obese patients developed VTE, yet only 6% (4/65) of obese patients received prophylaxis. Of these obese patients, 50% (2/4) developed VTE despite prophylaxis. Patients age >12 years were more likely to have VTE than those age <12 years (OR 1.1; 95% CI 1-1.1, p 0.023). Patients with Hickman catheters also had twice the odds of developing VTE (OR 2.1; 95% CI 1-4.1, p 0.046). In evaluating VTE occurrence by malignancy type, patients with hepatic tumors had the highest occurrence of thrombosis (8/12; 87%) followed by patients with myeloid leukemia (10/36; 28%), and lymphoblastic leukemia (28/170; 16%). The CART model was able to accurately predict occurrence or non-occurrence of thrombus in 87% of patients in the dataset based on the risk factors of obesity, age, and cancer type. Discussion It is well-established that malignancy is a significant risk factor for the development of VTE in pediatric oncology patients. Yet due to concern for bleeding events in these patients who frequently have thrombocytopenia, pharmacologic prophylaxis may not be used despite additional high-risk factors for VTE. This study demonstrates that pharmacologic prophylaxis is rarely used, even among high-risk pediatric oncology patients. For each risk group, most patients prescribed prophylaxis did not develop thrombus, however VTE still occurred in some. Risk stratification for pediatric oncology patients is essential given potential bleeding risk. We were able to identify additional high-risk features such as obesity, type of CVC, and cancer type. The CART model for high-risk pediatric populations had high specificity (88%) but poor sensitivity (23%). Application of this model could inform appropriate use of thromboprophylaxis in pediatric oncology patients to reduce the incidence of HA-VTE in this population. Further research is needed regarding safety and efficacy of prophylaxis, but this study provides important data to guide future steps.

Efficacy of same venous route Hickman catheter replacement in patients with intestinal failure

Periodical replacement of venous Hickman catheters is required for the nutritional care of patients with intestinal failure. The conventional de novo operation (DN-OP) involves inserting the catheter into a new venous tract in each replacement; however, this could result in fast consumption of functional central vessels in patients with intestinal failure. Recently, same-route operation (SR-OP) has been adopted as an alternative approach for retaining venous access. We conducted a retrospective study to compare the efficacy of Hickman catheters and the survival of venous vessels using two different operative strategies. Overall, 181 catheters were inserted, 109 using DN-OP and 72 using SR-OP. The mean catheter duration was 11.9±8.8 months in the DN-OP group and 10.5±5.6 months in the SR-OP group; the infection rate was 0.74 in the DN-OP group and 0.44 in the SR-OP group. The vein accesses used in these insertions (n=113) were classified: the DN-vein group for veins accessed only by DN-OP (n=75) and the SR-vein group for veins accessed by an initial DN-OP and subsequent SR-OPs (n=38). Mean working duration per vein access was 12.3±10.1 months in the DN-vein group and 28.2±14.8 months in the SR-vein group (p<0.001); mean infection-free duration was 11.4±10.1 months in the DN-vein group and 27.7±15.3 months in the SR-vein group (p<0.001). Application of SR-OP in Hickman catheter replacement significantly extended the working duration of venous access by re-using the same venous route without compromising catheter efficacy in patients with IF having poor venous access.

Necessity of performing a routine chest radiograph following the insertion of tunnelled Hickman catheter under imaging guidance: A single centre experience.

A chest radiograph has traditionally been performed following the insertion of a tunnelled Hickman catheter to immediately exclude rare but potentially serious complications such as pneumothorax and haemothorax and confirm appropriate positioning of the catheter tip. The value of completing the routine chest radiograph has been questioned when fluoroscopic image may be easily obtained in the angiography suite for the same purpose, and the rate of iatrogenic pneumothorax remains extremely low in the Medical literature. We describe our experience of performing Hickman catheter insertion under ultrasound and fluoroscopic guidance and whether routinely performing the chest radiograph is justifiable. A single centre retrospective review was performed of patients who received a tunnelled Hickman catheter and underwent postprocedural chest radiograph in the Interventional Radiology Department during a fifteen-year period from August 2007 to April 2021. Patient demographics and complications were documented. Delayed iatrogenic pneumothorax was diagnosed in one asymptomatic patient (0.06%) on a chest radiograph out of 1735 patients, and they required chest tube insertion. Other complications included two cases of right common carotid artery puncture, one case of right internal jugular vein dissection and one case of left internal jugular perforation. Two patients required a repeat procedure within 24 h due to superior migration of the Hickman catheter on chest radiograph. Given the extremely low rate of iatrogenic pneumothorax, chest radiograph following the insertion of a tunnelled Hickman catheter under ultrasound and fluoroscopic guidance may be an unnecessary investigation unless the patient is symptomatic, or there is sufficient clinical concern.

Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital

Background: Hickman-Broviac catheters have improved the care of young children needing frequent and prolonged venous access, but at the same times it has substantial morbidity, particularly in a resource-constrained setup. Our study aims to describe the experience of a Tunisian hospital and investigate the main risk factors for complications. Methods: In this study, we included all the neonates and infants who underwent Broviac catheter insertion in the pediatric surgery department. The patients were divided into 2 groups according to the presence of complications. We compared these two groups and univariate logistic regression analyses were used to determine the risk factors for complications. Results: Forty-three children were included in the study. The incidence of complicated catheters was 60.4%. The following factors were significantly associated with an increased risk of complications: age 6 months [OR 3.5, 95% CI: 0.6-19.3], weight 6 kg [OR 1.54, 95% CI: 0.46-5.2], emergency circumstances [OR 1.62, 95% CI: 0.8-5.4], and antibiotic-therapy as an indication for Broviac catheter insertion [OR 1.8, 95% CI: 0.5-6.2]. Conclusion: Complications seem to be more frequent in patients younger than 6 months and those with a weight of less than 6Kg. To reduce the morbidity related to the catheters, the indications should be carefully chosen.

Identifying Odds of Bloodstream Infection in Repaired Silastic Central Venous Catheters in a Pediatric Population

Highlights Abstract Background: Silicone central venous catheters (CVCs) that weaken or rupture are reparable using a commercial repair kit. A literature review exploring bloodstream infections in repaired CVCs identified many findings indicating low or no increased risk of infection. This study aimed to understand pediatric patients’ risk of bloodstream infection with repaired Hickman or Broviac catheters. Methods: A matched retrospective case-control study examined central line–associated bloodstream infection (CLABSI) or bacteremia in two separately matched cohorts of patients with silicone-type catheters. Controls were patients with CVCs selected from 2016 to 2019 and were matched to cases based on age group (older or younger than 3 years). Conditional logistic regression models calculated odds ratios (OR), with 95% confidence intervals (CI) representing the odds of a line repair occurring 30 days before an event among cases versus controls. Results: In 61 CLABSI cases and 104 controls, the OR of exposure to a line repair was 0.43; 95% CI, 0.05–3.87, P = 0.45. In comparing 49 bacteremia cases to 109 controls, the OR of exposure to a line repair was 6.69; 95% CI, 0.69–8, P = 0.10. Conclusions: The frequency of CVC repair was relatively low. Associations between repair and infection were not detected in either cohort; however, odds of line repair exposure appeared to be higher in bacteremia cases (a trend not observed in the CLABSI cohort). More extensive studies examining the demographic and clinical characteristics of the CVC repair population will be critical for improving outcomes.

PB2255: ANTIMICROBIAL SUSCEPTIBILITY TO MICROORGANISMS IN HEMATOLOGICAL MALIGNANCIES; A NEED TO REVIEW INSTITUTIONAL PROTOCOLS

Background: Febrile neutropenia is a medical emergency in patients with hematological malignancies. The severity of neutropenia and the duration of infection have an important implication on primary treatment outcome. Previously assessed institutional review revealed gram negative bacteria to be the most common microorganisms, and leading cause of febrile neutropenia. However, the predominance of gram positive bacteria had also increased in later past years. In high risk patients, infections caused by multidrug resistant bacteria worsen treatment complications and thus at times empirical use of antibiotics like colomycin is required; otherwise the prognosis may be jeopardized. Regular surveillance of local flora and susceptibility pattern of antimicrobial is must to elude the antimicrobial resistance. Aims: The study was conducted to evaluate the prevalence of microorganisms and to observe the sensitivity pattern of antimicrobials as an institutional protocol to establish antimicrobial policies. Methods: A cross sectional study was conducted at National Institute of blood diseases and bone marrow transplantation, PECHS campus from August 2021 - January 2022. Febrile neutropenia was defined as a single reading of oral temperature of ≥38 °C on two or more occasions in 12 h in the presence of absolute neutrophil count of less than 1000cells/mm. Blood cultures were performed using the BACTEC blood culture system. Organisms were identified according to routine bacteriological procedures and disc diffusion method was used for interpreting antibiotic susceptibility. Data was analyzed by SPSS version 23.0. Frequencies and percentages were calculated for categorical variable and mean (standard deviation) was computed for quantitative variables. Association between categorical variables was observed using the chi-square test or Fisher’s exact test. P value of <0.05 was considered statistically significant. Results: A total of 310 cultures were observed in 305 patients. The cultures were taken from blood, peripheral line, hickman line, red line, pus, and urine. Out of total, 213 (69%) were found to be gram negative and 97 (31%) were gram positive. The most prevalent gram negative microorganism were Ecoli in 87 (41%) followed by Klebsiella pneumonae 36 (17%), Pseudomonas species 25 (12%) and Pseudomonas aeruginosa in 24(11%) cultures. However, in gram positive; Staphylococcus epidermidis 49 (51%) was more prevalent. Moreover, in gram negative organisms, Acinetobacter species, Burkholderia cepacia, Citrobacter species and Moraxella Species were identified substantially which were not previously previously prevalent. However, in gram positive organisms, Micrococcus species was reported for first time. Gram negative were mostly reported in blood cultures 61 (20%) while gram negative was found in urine cultures 80 (26%). The association of sensitivity and resistance with gram negative and positive isolates was found statistically significant with Amikacin, Vancomycin, Fosfomycin and Ciprofloxacin Summary/Conclusion: Gram negative isolates were found prevalent in our study. The sensitivity of Meropenem, Amikacin and Colistin was high than other regimens in gram negative while the sensitivity of Fosfomycin, and Linezolid was found in gram positive isolates. Few emerging isolates were observed in the study as well. The regular review of microbial pattern and susceptibility evaluation is imminent for prevention of microbial resistance and assessment of institutional practices.

The Evaluation of Central Venous Catheter-related Complications in Pediatric Acute Leukemia Patients: Single Center Experience.

Central venous catheters (CVCs) are important for maintenance of childhood leukemia treatment but CVCs may develop complications. The aim of this study was to retrospectively evaluate the CVC-related complication rate, complication types, and outcome in children with acute leukemia. Complications developing in 310 CVCs (ports n=250, Hickman catheters n=60) inserted in 262 patients were evaluated. A total of 225,296 catheter days were screened. Median (range) CVC in-dwelling time was 661.5 (1 to 2636) days. In total, 157 complications developed of which 91 (58%) were infectious complications, 35 (22.3%) were vascular, 19 (12.1%) were surgical, and 12 (7.6%) were mechanical. Hickman catheters had a higher complication rate and were more prone to mechanical complications ( P <0.01) but there was no difference for other complications. A lower absolute neutrophil count at insertion was observed in children with infectious complications ( P <0.01). Seventy-eight of 136 catheters (57.3%) had to be removed prematurely. The overall complication rate was 0.65 per 1000 catheter days. In multivariate analysis, relapse leukemia, Hickman catheter and low absolute neutrophil count increased complication risk by 4.00, 1.97, and 1.92 times, respectively. Five (1.9%) deaths occurred because of catheter complications. Safe use of CVCs can be improved by early detection of complications and an experienced catheter care team.

Comparison of blood collection tubes for 29 biochemical analytes in pediatric patients with central venous catheters

BackgroundPediatric cancer patients undergoing chemotherapy or radiation therapy generally require a central venous catheter (CVC). However, serum drawn from CVCs has several drawbacks for use in routine chemistry tests. Biochemical analytes were evaluated using heparin plasma instead of serum to maintain turnaround time and to prevent problems caused by micro-clot formation or delayed clotting time. MethodsVenous blood samples from 52 pediatric oncology patients with chemoports or Hickman catheters were collected in serum separating tubes (SSTs) and lithium heparin tubes (LHTs). A total of 29 parameters were analyzed on a Cobas c702 (Roche Diagnostics, Mannheim, Germany). Passing-Bablok regression and Bland-Altman difference plots were used for statistical analyses. ResultsWhen the mean value of each analyte measured from LHT was compared with those from SST, percentage bias was within the desirable bias limit in most of the analytes. However, albumin, potassium, and inorganic phosphorus showed a negative constant bias of −3.0%, −5.3%, and −1.6%, respectively, and total protein showed a positive constant bias of + 3.8%. ConclusionsThe use of LHTs for sample collection from pediatric patients with CVCs could be helpful for routine chemistry analyses. The results of potassium and total protein should be interpreted with consideration of the difference between serum and plasma samples.

Factors affecting mechanical complications of central venous access devices in children

PurposeFactors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications.MethodsRetrospective (2016–2021) review of children (< 18 years old) receiving a CVAD. Data, reported as number of cases (%) and median (IQR), were analysed by Fisher’s exact test, chi-squared test and logistic regression analysis.ResultsIn total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p < 0.0001). Hickman lines had a higher incidence of complications compared to implantable port devices [24/91 (26.3%) vs 30/226 (13.3%); p = 0.008].ConclusionMechanical complications occur in 17% of CVADs at a median of < 6 months after insertion. Risk factors include younger age and lower weight. Implantable port devices have a lower complications rate.Level of evidenceLevel 4: case-series with no comparison group.

Surgical Experience Affects the Outcome of Central Venous Access Catheter Implantation in Children: A Retrospective Cohort Study.

Surgical complications occur in up to third of children, limiting the benefits of tunneled central venous catheters (tCVCs) in children. We aimed to identify risk factors for complications related to catheter implantation. All children and adolescents undergoing tCVC implantation at a single center over a period of 9 years were analyzed. Infection, thrombosis, dislocation, and catheter dysfunction were defined as complications. Both patient-related (ie, age, sex, vessel characteristics, revision surgery) and surgical factors (ie, sex of surgeon, surgical experience) were analyzed for their association with complications. A total of 1024 catheters were inserted, 887 ports and 137 broviac catheters. In terms of patient-related factors, Broviac catheters, and nononcological patients had a higher complication rate. The use of the internal jugular vein and revision surgery was associated with significantly increased complications in patients with port catheters. Experience of the surgeon correlated with various outcome parameters. Implantation performed by an attending were associated with lower complication rates in comparison to those performed by residents. Within the resident group, insertions performed by experienced residents had more complications compared with those performed by residents during their first years. The study suggests that the outcome of tCVCs insertion is affected by the type of catheter used, the utilized vessel and above all by surgical experience. Residents had significantly increased complication rates in comparison to board-certified surgeons and amongst resident's outcome got worse with increasing experience of the residents. The presence of an experienced attending did not compensate for this effect. To improve the outcome of tCVCs, strategies like direct feedback after every procedure to achieve proficiency should be implanted in residency programs.