Rate Of Catheter-related Complications Research Articles

Complication Rates of Peripherally Inserted Central Catheters in Oncologic Versus Non-Oncologic Patients

ObjectivesPeripherally inserted central catheters are commonly used in cancer patients and provide vascular access for the administration of chemotherapy, antibiotics, or parenteral nutrition. Besides many advantages, they represent a source of possible complications such as catheter related blood stream infection, catheter occlusion, or thrombosis. In this study, the catheter-related complication rate between oncologic and non-oncologic patients was compared. MethodsThis retrospective cohort-study included 411 patients who underwent their first catheter placement at the Vienna General Hospital—Medical University of Vienna from January 2013 to June 2018. Patient demographics and catheter-related parameters were collected and statistically analyzed using a competing risk model. ResultsMean catheter dwell time was 27.75 days. The overall complication rate was 7.54% (2.72 per 1000 catheter days). Underlying malignant disease (hazard ratio: 0.351, 95% confidence interval [CI]: 0.133-0.929, P = .035) and chemotherapy administration (hazard ratio: 2.837, 95% CI: 1.088-7.394, P = .033) were significantly associated with the occurrence of any kind of complication. Catheter related blood stream infection was observed among 11 (2.68%) patients and again significantly associated with chemotherapy administration (hazard ratio: 4.545, 95% CI: 1.178-17.539; P = .028). Thrombosis was found in 7 (1.70%) patients and occlusion in 13 (3.16%) cases. Conclusions and implications for nursing practiceChoice of venous access is an interdisciplinary decision with emphasis on patient participation. In oncologic patients, our data suggests that the benefits of peripherally inserted central catheters regarding costs, invasiveness, and accessibility might be outweighed by the higher rate of complications associated with the device. This becomes even more important in a community care setting, where standardized handling procedures and patient education play a pivotal role in device safety.

Safety and Efficacy of Midline vs Peripherally Inserted Central Catheters Among Adults Receiving IV Therapy

Midline catheters (MCs) are widely used, but safety and efficacy compared with peripherally inserted central catheters (PICCs) has not been adequately evaluated. To compare the safety and efficacy of MCs with PICCs among adult patients with an anticipated intravenous therapy lasting from 5 to 28 days. This parallel, 2-group, open-label, randomized clinical trial (RCT) was conducted in Denmark from October 2018 to February 2022 at a single academic tertiary care center. Adult inpatients and outpatients were consecutively randomized. Patients were randomized in a 1:1 ratio to either the MC group or the PICC control group. The primary outcome was catheter-related bloodstream infection (CRBSI), analyzed using the Fisher exact test. Secondary outcomes were symptomatic catheter-related thrombosis and catheter failure, including mechanical cause, phlebitis, infiltration, pain in relation to drug or fluid administration, and leaking from the puncture site. Incidence rate ratios (IRRs) were calculated to assess between-group failure rates over device dwell time using Poisson regression. An intention-to-treat analysis was performed. A total of 304 patients (mean [SD] age, 64.6 [13.5] years; 130 [42.8%] female) were included in the analysis, and 152 patients were allocated to each catheter group. The incidence of CRBSI was low, with 0 in the MC group and 1 in the PICC control group (P > .99). The MC group had a higher catheter-related complication rate (20 [13.2%] vs 11 [7.2%]), and an IRR of 2.37 (95% CI, 1.12-5.02; P = .02) for complications compared with the PICC control group. In a post hoc analysis stratified by catheter dwell time, no significant difference in complication rate (IRR, 1.16; 95% CI, 0.50-2.68; P = .73) was found between the 2 groups for catheters used less than 16 days. In this RCT with patients who received medium- to long-term intravenous therapy, the incidence of CRBSI was low, with no difference between MCs and PICCs. The use of MCs resulted in a higher incidence of catheter-related complications compared with use of PICCs. This finding should be balanced in the decision of type of catheter used at the individual patient level. ClinicalTrials.gov Identifier: NCT04140916.

Midline and Extended Dwell Catheters for IV Antibiotics


 Midline catheters may be associated with longer uncomplicated indwelling time and a lower overall risk of catheter-related complications than extended dwell catheters.
 The rates of catheter-related complications were low across different peripheral catheter types.
 Midline catheters may have a lower proportion of catheter-related bloodstream infections, drug leakage from the exit site, and complete catheter occlusion, but a higher proportion of catheter-related thrombosis events compared with extended dwell catheters.
 The findings were derived from 1 retrospective cohort study with imbalanced baseline characteristics of patients, and the limitations of the study may have favoured midline catheters; future studies are needed to confirm our findings.
 We did not find any systematic reviews, health technology assessments, randomized controlled trials, or evidence-based guidelines that met our inclusion criteria.

The safety of peripherally inserted central venous catheters in critically ill patients: A retrospective observational study.

Centrally inserted central venous catheters (CICCs) are commonly placed in critically ill patients who require a central venous catheter (CVC). Recently, peripherally inserted central venous catheters (PICCs) have been widely used on general wards. However, the safety of PICCs in critically ill patients remains unclear. We conducted a retrospective observational study at a mixed intensive care unit (ICU). Adult patients (⩾18 years) who were emergently admitted to the ICU and underwent CVC insertion between April 2019 and March 2021 were enrolled. We compared the safety of PICCs and CICCs. The primary outcome was the overall rate of catheter-related complications, including bloodstream infections, thrombosis, insertional trauma, catheter malfunction, and accidental removal. We used a stabilized inverse probability weighting (sIPW) model to estimate the effects of PICC use. A total of 239 CVCs (PICCs, 53; CICCs, 186) were inserted into 229 patients. Although the severity of illness did not differ significantly between the groups, the length of hospital stay and mean indwelling catheter duration were significantly longer in the PICC group. There was no significant intergroup difference in the overall rate of catheter-related complications (PICC: 9.4% vs CICC: 3.8%; odds ratio [OR]: 2.65; 95% confidence interval [CI]: 0.63-10.2, p = 0.145), and there were 7.7 and 9.0 complications per 1000 catheter days in the PICC and CICC groups, respectively (hazard ratio [HR]: 0.61; 95% CI: 0.14-2.65, p = 0.513). After adjustment using the sIPW model, PICC use was not found to be associated with a reduction in catheter-related complications (adjusted OR: 3.10; 95% CI: 0.90-10.7; adjusted HR: 0.53; 95% CI: 0.14-1.97). We found no significant differences in catheter-related complications between patients treated using CICCs and those treated using PICCs after emergency ICU admission. Our findings imply that PICCs may be an alternative to CICCs in critically ill patients.

Proper Depth of Percutaneous Central Venous Catheter via the Great Saphenous Vein for Very Low Birth Weight Infants: A Single-Center, Prospective Cohort Study.

A proper depth of percutaneous central venous catheter (PCVC) is very important to reduce procedural time and prevent various complications in very low birth weight (VLBW) infants who require minimal handling or have a sensitive skin. The objective of this study was to suggest a formula for faster and proper insertion of PCVC in VLBWIs to prevent unintended consequences of patients' conditions. Prospective data of VLBW infants admitted from June 2015 to January 2018 who had PCVC inserted via the great saphenous vein within seven days after birth were analyzed. Correlations of length of inserted PCVC with body weight, body length, and postmenstrual age at the date of PCVC insertion were determined with a linear regression analysis. Using results of this analysis, a formula to determine the optimal insertion length of PCVC was derived. Coefficient of determination was used to assess how well outcomes were replicated by the formula. The formula to predict the proper insertion length of PCVC via the great saphenous vein at popliteal crease level was obtained as follows: Optimal Length (cm) = 3.8 × Body Weight (kg) + 11.1. With everyday movements such as flexion and extension of the lower extremities, the mean difference in catheter tip position was 7.0 ± 3.9 mm, which was not significant enough to escalate the risk of catheter tip displacement. The rate of catheter-related complications was as low as 4.9% in this study. The formula derived from this study to predict the optimal PCVC insertion length could benefit VLBW infants by reducing procedural time and lowering the risk of complications.

Ultrasound to guided epicutaneo-caval catheter insertion in newborn infants.

Recently, ultrasound (US) has been increasingly used for epicutaneo-caval catheter (ECC) tip positioning; however, the selection of blood vessels for ECC still depends on the operator's subjective judgment. This study aimed to explore the value of US in decision-making regarding the great saphenous vein (GSV), tip navigation, and tip location of ECC. Catheterization through the GSV of the lower extremity was selected. The running condition of the GSV was assessed by using US, and the angle between the GSV and the femoral vein was observed and measured. We selected the GSV with a smaller angle to the femoral vein for ECC catheterization. ECC catheterization under ultrasound guidance increased the success rate at the time of catheterization from 82.5% to 100% (increased by 17.5%) and shortened the catheterization time from 56.1 ± 5.30 min to 31.5 ± 2.58 min on average (shortened by 44%). The incidence rate of catheter-related complications decreased by 58.2% catheter days from 6.80/1,000 to 2.84/1,000. ECC insertion under the guidance of US has numerous advantages, including significantly improving the success rate of one-time catheterization, shortening the time of catheterization, and reducing catheter-related complications.

Surgical complications of intrathecal baclofen in children: A single centre, 20-year retrospective cohort study.

Complications of intrathecal baclofen treatment (ITB) with an implanted pump can be severe and require surgery. Surgical implantation techniques and catheter materials for continuous ITB treatment have improved over the past years with the aim to reduce complications. To assess: 1) the type and rate of complications of ITB that require surgical intervention, 2) which risk factors influence the occurrence of complications, and, specifically, 3) whether complication rate is influenced by type of catheter used. A retrospective cohort study was conducted including all children (<18 years old) in one university medical center with pump implantation between 2001 and 2017. All complications requiring surgery were recorded. Risk factors for surgical intervention were determined using multiple logistic regression analysis. Catheter related complications between two types of catheters (silicone vs coated) were compared. In total, 88 complications of ITB treatment requiring surgery were found in 47 (36.2%) out of 130 children. These included catheter-related complications (55.7% of all complications), infections (21.6%), cerebrospinal fluid leakage (14.8%), and pump-related complications (7.9%). The silicone catheter type, used until 2012, was found to be a significant risk factor for complications (Odds Ratio 3.75; 95% CI: 1.30-10.83). Since the introduction of the coated catheter type, in 2012, the rate of catheter-related complications decreased, from 0.15 to 0.10 complications per pump year. The rate of surgical complications of intrathecal baclofen in children is high, and most frequently catheter-related. The number of complications decreased since the introduction of a new, coated, catheter in 2012. This study helps to inform children and their caregivers about the risk of possible complications of ITB, and to identify directions for future improvement of ITB care.

A Simplified Technique of Rectus Sheath Tunneling in Open Peritoneal Dialysis Catheter Insertion

Background: Peritoneal dialysis (PD) is the preferred treatment for patients with chronic kidney disease (CKD), however, complications associated with PD catheter placement often result in a patient transferring to hemodialysis (HD). Rectus sheath tunneling is a relatively new technique for laparoscopic PD catheter insertion, aimed at reducing these complications. We examined the outcomes of open PD catheter insertion with rectus sheath tunneling (R-PD) to assess whether the technique decreases these kinds of complications and improves the quality of treatment for CKD patients. Materials and Methods: A retrospective review was undertaken of 40 CKD patients who had undergone R-PD catheter insertion. The details of R-PD catheter insertion technique, along with a summary of the outcomes, including catheter-related complications and survival time, were reported. Results: Forty CKD patients were 19 women and 21 men, ranging from ages 24 to 88. Mean operative time for R-PD insertion was 28 minutes (SD, 11.9). Three patients experienced minor abdominal wall bleeding and no patients had iatrogenic visceral organ injury. Catheter dysfunction was found in 3 patients (7.5%). Median catheter survival time was 23 months. Number of functioning catheters at 12 and 24 months were 16 and 14. Cumulative catheter survival rate at 12 and 24 months were 50% and 44%, respectively. Conclusion: Comparable outcomes were found between R-PD insertion technique and others. Although further research is necessary to ensure that these findings apply over a large group of patients, our results suggest that R-PD insertion is as straightforward, effective, and reproducible as other techniques while offering lower rates of catheter-related complications. Keywords: Peritoneal dialysis; Open catheterization; Rectus sheath tunneling; Retrospective studies; End stage renal disease

Complications of tunneled peripherally inserted and tunneled-cuffed central catheters in home parenteral nutrition

ObjectivesWe sought to compare complications associated with tunneled peripherally inserted central catheters (tPICCs) and tunneled-cuffed centrally inserted central catheters (tCICCs) in adult home parenteral nutrition (HPN). MethodsThe study (2017–2019) identified 257 people with type III chronic intestinal failure requiring HPN. The data were analyzed for tPICC- and tCICC-related complications. The rate of catheter-related complications was recorded as the number of complications analyzed per 1000 d of catheter use, and rates were compared using the Mann–Whitney Wilcoxon test. ResultsA total of 273 venous access devices were included to the analyses: 150 (55%) non-cuffed tPICCs and 123 (45%) tCICCs. In-dwelling time for tPICCs and tCICCs were 23 045 and 43 789 catheter d, respectively. Median (interquartile range) catheter days and duration of HPN, for tPICCs and tCICCs, were respectively 119 (166) and 324 (314) d and 108 (159) and 324 (322) d. The overall complication rates per 1000 catheter d for tPICCs and tCICCs were 1.52 and 0.8, respectively (P = 0.565). On analysis, there was no statistical difference between complication rates per 1000 catheter d. The removal rate and conversion ratio due to complications were similar for tPICCs and tCICCs. ConclusionsBoth tPICCs and tCICCs have similar complication rates per 1000 d. This study highlights that tCICCs, the preferred and currently used venous access devices in HPN, can be effectively and safely replaced by tPICCs, depending on the indications.

ECG-guided PICC insertion using a new silicon catheter with a conductive tip: A retrospective clinical study.

Safety and efficacy of ECG-guided PICC insertion using a new silicon catheter with a conductive tip was evaluated in daily practice. A retrospective study was conducted on 1659 patients who accepted successful tip-conductive PICC placement and clinically followed-up until the catheter removal between January 2018 and April 2019. Baseline of patient characteristics, catheter placement characteristics, date of dressing changes as well as records of catheter-related complications were extracted from a special designed mobile APP. The first-attempt success (success of placing catheter tip to the ideal position by primary indwelling operation) rate of PICC placement was 99.3%. The average duration of PICC placement was 128.7 ± 39.5 days and 1535 patients (92.5%) reached the therapy end-point without any complications and removed the catheter normally. The cumulative rates of total complications were 7.5%, including exit site infection (2.5%), phlebitis (0.9%), DVT (1.0%), catheter malposition (1.1%), catheter breakage (0.1%), and liquid extravasation (1.8%). In multivariable logistic regression analyses, hyperlipidemia, diabetes mellitus, lung cancer, stomach cancer, and lymphoma were significantly associated with increased risk of complications, as the independent risk factors. This retrospective clinical study demonstrates that ECG-guided insertion of a new tip-conductive PICC is associated with a high rate of first-attempt success and low rate of catheter related complications.

Use of instructional videos to reduce central venous catheter complications in children with intestinal failure receiving home parenteral nutrition.

Children with intestinal failure (IF) require parenteral nutrition (PN) at home, delivered through a central venous catheter (CVC) to support growth. CVC-related complications including infection, breakage, and blockage are the most common cause of readmission to the hospital. The objective of this study was to evaluate the use of instructional videos as part of the caregiver home PN-teaching program to reduce CVC-related complications. Caregivers of children with IF requiring home PN were surveyed to assess skill confidence and interest in instructional videos for skill acquisition. Videos were then created using a smartphone and free video-editing software. Input from stakeholders (families, care providers) was incorporated in video production. Families were given access to the videos, and CVC-related complications were compared for 2 years prior to and 1 year following video introduction with Welch t-test analysis. After obtaining ethics approval, 11 caregivers were surveyed. Thirty percent reported feeling underconfident in their skills at the time of discharge. After viewing the videos, 100% of caregivers reported that these videos were useful. Catheter-related complication rates significantly decreased in the year following the video introduction from 7.88 to 2.65 complications per 1000 catheter days (P = .046). This included reductions in catheter-related infections, catheter occlusions, and breakages. Children with IF receiving home PN are at high risk for CVC-related complications, and caregivers are the first line of defense for catheter care. Instructional videos were low-cost to create, were well received by all families, and may contribute to reduced catheter-related complications.

Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days.

Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.

P1164INTERVENTIONAL NEPHROLOGY SERVICE ENHANCES PERITONEAL DIALYSIS UTILISATION AND UPTAKE: EXPERIENCE FROM A SINGLE CENTRE IN SINGAPORE

Abstract Background and Aims Interventional nephrology (IN) is not having a well-defined role in peritoneal dialysis (PD) service provision. Impact to PD catheter outcomes, PD utilisation and uptake on integrated care approach under IN service was not known. Here we report the experience and outcomes of IN practice in PD service from a single centre in Singapore. Method We postulated an IN-led, multidisciplinary collaborative model of care for end stage renal failure patients, who transited through a seamless care pathway from pre-dialysis counselling to insertion of PD catheter, could improve utilisation and increase uptake of PD as dialysis modality of choice. This approach was based on: 1. Interventional nephrologist-led PD catheter insertion service, 2. coordination of care (figure 1) and 3. early start of PD. Outcomes of IN involvement in PD access management and coordination of care were included in this study. Results From January 2015 to May 2019, a total of 140 PD catheter insertions were performed by interventional nephrologist (table 1). The prevalence of PD patients in our program was increased by 217% after initiation of IN service (figure 2). Annually, incident ESRF patients who chose PD as dialysis modality increased from 10% to 28% (figure 3). We had a very low PD catheter-related complication rate in reference to international standards (table 2). Catheter adjustment-free survival was 94% and 83% at 12 months and 36 months respectively (figure 4). Conclusion The multifaceted and holistic role of IN in PD translated into remarkable outcomes on PD utilisation and uptake. It also confirms the safety and efficacy of IN procedures in PD when performed by appropriately trained nephrologists.

Impact of arm choice for peripherally inserted central catheter (PICC) insertion on patients: a cross-sectional study

Background: Arm choice for peripherally inserted central catheter (PICC) insertion is often determined by PICC nurses. Objectives: To explore the impact of arm choice (dominant or non-dominant) on the rate of catheter-related complications and degree of comfort in patients with PICCs. Design: A cross-sectional study. Methods: We used questionnaires and scales to collect 255 patients’ general information, catheter-related complications and comfort degree. They were divided into two groups (PICC inserted in the dominant or non-dominant arm). Results: There were significant differences in the rate of PICC occlusion and insertion site bleeding (χ 2 = 9.829, P < 0.05; χ 2 = 6.502, P < 0.05), both were lower in the non-dominant group than in the dominant group. Patients in the non-dominant group had a higher degree of comfort (Z = −10.166, P < 0.01). Conclusion: Inserting into non-dominant arms is related to the lower rate of catheter-related complications and higher degree of comfort for patients. Impact statement: These findings provide practical evidence for nurses to make a better choice.

Peritoneal dialysis catheter removal at the time of renal transplantation: Choosing the optimal candidate.

Concurrent peritoneal dialysis (PD) catheter removal during renal transplantation is controversial, with limited evidence supporting this practice. Our objective was to determine the rate of delayed graft function (DGF) in patients on preoperative PD. Additionally, we sought to identify which patients can safely have their PD catheter removed during transplantation due to a low risk of DGF. We conducted a retrospective observational study between June 2011 and December 2015. The primary outcome was the diagnosis of DGF, defined as the need for dialysis within the first week of transplantation. Clinical and transplant factors, including graft type and donor criteria, were assessed for association with the primary outcome. Catheter-related complication rates were also compared between post-transplant PD and hemodialysis (HD). Of our cohort of 567 patients, 145 patients (25.6%) developed DGF. Obesity (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.00-1.11; p=0.04) and increased perioperative blood loss (OR 1.002; 95% CI 1.000-1.003; p=0.03) were predictors of DGF. Protective factors included living donor (LD) grafts (OR 0.15; 95% CI 0.05-0.49; p=0.002) and intraoperative graft urine production (OR 0.39; 95% CI 0.23-0.65; p<0.001). In our PD cohort, only LD grafts demonstrated lower DGF rates (0 LD vs. 20.8% deceased donor; p=0.003). In terms of post-transplant renal replacement therapy, patients on PD and HD had similar duration of temporary dialysis (one day PD vs. two days HD; p=0.48) and catheter-related complication rates (4.5% PD vs. 2.6% HD; p=0.30). Carefully selected patients, such as those receiving LD grafts, may benefit from concurrent PD catheter removal.

Short-term results of continuous venovenous haemodiafiltration versus peritoneal dialysis in 40 neonates with inborn errors of metabolism

Several recent studies have reported that toxic metabolites accumulated in the body as a product of inborn errors of metabolism (IEM) are eliminated more rapidly with continuous venovenous hemodiafiltration (CVVHDF) than with peritoneal dialysis (PD). However, there is still uncertainty about the impacts of dialysis modalities on the short-term outcome. Here, it was aimed to investigate the effects of dialysis modalities on the short-term outcome. This retrospective study included 40 newborn infants who underwent PD (29 patients) or CVVHDF (11 patients) due to inborn errors of metabolism at a tertiary centre, between June 2013 and March 2018. The outcomes and the potential effects of the dialysis modality were evaluated. Of 40 patients, 21 were urea cycle defect, 14 were organic academia, and 5 were maple syrup urine disease. The median 50% reduction time of toxic metabolites were shorter in patients treated with CVVHDF (p < 0.05). Catheter blockage was the most common complication observed in PD group (24.1%), whereas in CVVHDF group hypotension and filter blockage were more common. There was no significant difference in mortality between dialysis groups (38% vs. 45.4%, p > 0.05). In patients with hyperammonaemia, duration of plasma ammonia > 200μg/dL was the most important factor influencing mortality (OR 1.05, CI 1.01-1.09, p = 0.007).Conclusion: This study showed that CVVHDF is more efficient than PD to rapidly eliminate toxic metabolites caused by IEM in newborn infants, but not in improving survival. What is Known: •Toxic metabolites are eliminated more rapidly with CVVHDF than with PD. •Higher complication rates were reported with rigid peritoneal catheters in PD and catheter blockage in CVVHDF. What is New: •Prolonged duration of plasma ammonia levels above a safe limit (200 μg/dL) was associated with increased mortality. •Lower catheter-related complication rates may have been associated with the use of Tenckhoff catheters in PD and the use of right internal jugular vein in CVVHDF.

A comparison between two types of indwelling pleural catheters for management of malignant pleural effusions

Malignant pleural effusion (MPE) is a common cause of quality of life deterioration in patients with advanced cancer. Management options include chemical pleurodesis with a sclerosing agent such as doxycycline or talc powder, surgery, and also the placement of tunneled indwelling pleural catheters (IPCs). Two different IPC types are mostly used in the USA. We conducted a single-center retrospective study with the objective to compare the efficacy and safety profiles of two IPC systems. Patients with a diagnosis of malignancy, who received IPCs by the interventional radiology department of our hospital from January 2013 to March 2015, were identified in the local database and a chart review was performed to record characteristics and outcomes. Patients without a diagnosis of malignancy or with pleural effusions of cardiac origin were excluded from the study. We identified 27 patients with a median age of 59.0 years. Eighty patients received Aspira catheter while nine patients received PleurX catheter, and seven patients achieved spontaneous pleurodesis. The median length of stay (LOS) was 9 days for the Aspira group (AG), as compared to 13 days for the PleurX group (PG) (overall median LOS was 10 days; range, 2-62 days). The rate of catheter-related complications (pain, obstruction, loculations, infection, hemorrhage) was 39% (seven patients) for the AG and 33% (three patients) for the PG (overall ten patients, 37%). In our study, outcomes and safety were similar for patients receiving either type of IPC, Aspira or PleurX.

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.

Dahiliye Hastalarında Terapötik Plazma Değişimi Endikasyonları, Komplikasyonları ve Yanıtları; Tek Merkez, Retrospektif Analiz Sonuçları

Therapeutic plasma exchange (TPE) is a process that allows high molecular weight substances to be removed from plasma. Therapeutic plasma exchange is widely used in many diseases in the practice of internal medicine. Current guidelines on this process have been published in recent years due to increased awareness and accessibility. The most common and most comprehensive of these is the American Apheresis Society (ASFA) guideline. In this study, we retrospectively determined the demographic data, underlying diseases, biochemical parameters, volume and type of replacement fluid, complications developed during and after the procedure, additional treatments, need for dialysis, and the number of sessions for patients who underwent therapeutic plasma exchange for any reason in the internal medicine clinic aimed to reveal aspects that can be improved in clinical practice. In the study, 117 patients between 2007 and 2016 were evaluated retrospectively. Of all cases, 63 (53.8%) were female. At the time of diagnosis, the mean age of the patients was 52.15 ± 16.8 (20-88) years. The most common indications for TPE were thrombotic thrombocytopenic purpura (TTP) and ANCA-associated vasculitis. Fresh frozen plasma and albumin were the most commonly used replacement fluids. Catheter related complication rate was 5.1%. The rate of complication related to TPE during TPE was 19.6%. No fatal reactions to TPE treatment were observed. There was a significant relationship between alkaline phosphatase (ALP) and mortality when the relationship between the laboratory data and the mortality rate of the patients with TTP was considered (p = 0.002). There was a significant correlation between chlorine and hematocrit and mortality in ANCA-associated vasculitis patients (p = 0.029 and p= 0.037, respectively). For the purpose of estimating mortality, further work is needed to confirm the validity of these laboratory data. As a result; TPE is a useful, easy and effective life saving treatment with few side effects.

Parenteral therapy and complications in patients with intestinal failure in a regional unit

Objective: To describe a cohort of patients with intestinal failure (IF) and tunnelled catheters in a regional IF unit, treatment and catheter-related complication rates, and to compare the quality of care with previously published results from specialised IF centres in Denmark.Methods: A retrospective chart review of an adult IF patient cohort receiving parenteral therapy through tunnelled catheters in a regional IF unit from 2005 to 2014. Demographics, indication, type and frequency of parenteral therapy, dwell time, cause of removal and complications were recorded.Results: Parenteral therapy was provided to 78 patients with a median age of 64 (25–86) years. Numbers increased from seven patients in 2005 to 40 in 2014. The cause of IF was surgical complications (33%), cancer (28%), inflammatory bowel disease (IBD, 15%) and other causes (24%). The median duration of parenteral therapy was 453 days (range: 16–3651 days). One hundred and forty-two tunnelled catheters were inserted. The incidence of catheter-related blood stream infection (CRBSI) was 1.51/1000 days (95% CI: 1.20–1.90) and the incidence of thrombosis was 0.10/1000 days (0.04–0.25). Seventy-two episodes of CRBSI occurred with 89 microorganisms cultured, the most common being coagulase-negative Staphylococcus (n = 25, 28%).Conclusion: The rate of CRBSI did not differ from larger centres in Denmark but the rate of thrombotic events was higher than expected. Parenteral therapy can safely and effectively be offered to patients with IF in smaller centres.