Term Central Venous Catheters Research Articles

Dalbavancin in catheter-related bloodstream infections: a pilot study.

Catheter-related bloodstream infections (CRBSI) represent a frequent complication of vascular catheterization, with high morbidity, mortality, and associated costs. Most infections are caused by Gram-positive bacteria; thus dalbavancin, a new long-acting lipoglicopeptide, may have a role in early patient discharge strategies optimizing treatment and reducing overall costs. In this small pilot feasibility study, we assessed the efficacy and safety of a "single step" treatment strategy combining dalbavancin administration (1500 mg IV single dose), catheter removal, and early discharge in adult patients admitted to medical wards in a three-year period. We enrolled sixteen patients with confirmed Gram-positive CRBSI, with a mean age of 68 years and relevant comorbidities (median Charlson Comorbidity index=7). The most frequent causative agents were staphylococci, with 25% of methicillin-resistant strains, and the majority of infected devices were short term central venous catheter (CVC) and peripherally inserted central catheter (PICC). Ten out of sixteen patients had been treated empirically before dalbavancin administration. The mean time from dalbavancin administration to discharge was 2 days; none of the patients had adverse drug-related reactions; at 30- and 90-day follow-up, no patients have been readmitted to the hospital due to bacteraemia recurrence. Our results indicate that single-dose dalbavancin is highly effective, well-tolerated, and cost-saving for Gram-positive CRBSI.

POS-566 CATHETER RELATED BLOODSTREAM INFECTION (CRBSI) IN A MIDDLE-EASTERN COHORT OF HEMODIALYSIS PATIENTS: AN ANALYSIS OF 5 YEARS OF FOLLOW UP DATA

Bloodstream infections (BSI) are the second commonest cause of morbidity and mortality in end stage renal failure (ESRF) patients. Dialysis catheters are believed to be the most common contributors to BSI in this cohort. Therefore, patients who are receiving hemodialysis via long term central venous catheters (CVC) are at significantly high risk of CRBSI and its associated morbidity and mortality. Although there are several studies on CRBSI from different cohorts around the world, long-term follow up data are scarce particularly from middle eastern cohorts. We aim to fill this knowledge gap as well as to develop an antibiogram and antibiotic stewardship for this unique cohort of patients. This is a single center retrospective longitudinal study of a middle eastern cohort receiving three times a week regular hemodialysis via permanent CVC in a large out-patient setting. We analyzed all the data from December 2015 to November 2020. Data on incidents of CRBSI, etiology, antimicrobial susceptibility, CRBSI risk factors, and comorbidities were collected. For the sake of our study, we defined CRBSI with the isolation of the same microorganism from the CVC and peripheral blood culture without any other apparent source. The incidence of CRBSI was expressed as incidence per 1000 catheter days. A total of 39 incidents of CRBSI were identified during these 5 years study period. Of the reported cases, 94% grew a single organism while 6% grew polymicrobial. Of the multitude of organisms isolated, 39% were gram positives while the rest were gram negatives. Staphylococcus aureus and enterococcus were predominant gram positives while pseudomonas and klebsiella were the predominant gram negatives. No case of MRSA or fungi were isolated. The distribution of organisms is illustrated in the bar chart below. Interestingly only 70% of cases presented with the typical triad of fever, rigors, and exit site exudates, while around 20% presented with only hypotension. 10% of the cases were completely asymptomatic and were only incidental findings. The incidence of CRBSI per 1000 catheter days was calculated for every month and as illustrated by the graph below, the CRBSI rates seem quite variable throughout this study period. However, interestingly, since the beginning of the COVID19 pandemic outbreak, the CRBSI rates are conspicuously low. This might be explainable by enhanced focus on hand hygiene by both the staff and the patients themselves during this pandemic. CRBSI incidences were higher among patients with longer duration of catheter use, previous bacteremia, old age, diabetes mellitus, and recent hospitalization.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The incidence of CRBSI reported from our center seems to be comparable to other international centers around the world. The causative microorganisms and their antibiotic susceptibilities also seem to be in concordance with the rest of the world despite variations in geography, climate, and ethnicity. We conclude, that irrespective of the differences in the geographical location and study cohorts, strict adherence and attention to hand hygiene and infection control practices by both the staff and the patients are the keys to keeping CRBSI low.

Superior Vena Cava Syndrome in End Stage Renal Disease Patients on Long Term Central Venous Catheters: A Report of Two Cases

Superior Vena Cava Syndrome in End Stage Renal Disease Patients on Long Term Central Venous Catheters: A Report of Two Cases

Taurolidine, an antiseptic for the prevention of central venous catheter-related infections

Taurolidine is a broad-spectrum antiseptic used as lock therapy solution in adult and pediatric patients with long term central venous catheters (CVC) for the prevention of catheter related bloodstream infections (CRBSI). Taurolidine doesn't induce the resistant development and has only minor and brief side effects, which makes it an alternative both as a lock therapy and for the prevention of CRBSI in this group of patients.

Role of serial ultrasound screening of venous thrombosis in oncologic children with central lines

ObjectivePediatric oncology patients are more likely to develop venous thromboembolic events related to central venous catheter (CVC). Study aim was to determine the incidence of catheter related thrombosis (CRT) in a cohort of pediatric oncology patients using vascular ultrasound (US). MethodsConsecutive children of a single cancer referral center, requiring medium to long term CVC implantation, were screened for CRT, using serial ultrasound exams. Measurements and main resultsUS examinations were taken 15, 30 and 90 days after CVC implantation. A total of 113 catheters were studied in 103 patients (median age 10.5 years old). Ultrasound screening was completed in 80.5% patients. Apart from three subjects, US investigations were well tolerated. Patients were followed for a median of 87 days. No symptomatic CRT was recorded throughout. Three cases of asymptomatic thrombosis were identified with early US screening; incidence of CRT events for 1000 catheter-days was 0.11. The presence of previous catheter-related infection and an history of one or more previous CVC placement were identified as risk factors. ConclusionsIn our pediatric patients the incidence of CRT is low. Ultrasound monitoring is well tolerated and allows detecting asymptomatic CRT. Patients with previous CVC infection or insertion seem to have a higher risk of CRT (p =0.003 and p = 0.043 respectively).

Current Management of Difficult Central Venous Access in Pediatric Patients

The central venous catheter (CVC) has become an integral part of various long term parenteral therapies including chemotherapy and parenteral nutrition. In pediatric patients with a long term CVC, multiple repeated accesses and catheter-related complications may lead to difficulty in reestablishment of a line. Strategies in CVC management in these patients should begin with choosing an appropriate catheter according to its purpose, choosing the right access site and prompt treatment of potential complications, especially catheter-related thrombosis. In patients with severe restriction of the superior vena cava and its tributaries, end-stage central venous access is diagnosed. Management of this situation requires a multidisciplinary team and alternative routes of venous access including access through small collateral veins, or through an unusual vein such as the hepatic vein or a gonadal vein, and/or use of alternative surgical techniques. This article provides a comprehensive review regarding the current approach and surgical options in pediatric patients with end-stage central venous access.

A RARE CAUSE OF CONFUSION AND SYNCOPE: THROMBOSIS OF DIALYSIS CATHETER. CASE PRESENTATION AND REVIEW OF CURRENT LITERATURE

Ponte Academic JournalDec 2018, Volume 74, Issue 12 A RARE CAUSE OF CONFUSION AND SYNCOPE: THROMBOSIS OF DIALYSIS CATHETER. CASE PRESENTATION AND REVIEW OF CURRENT LITERATURE Author(s): Mustafa begenc Tascanov ,M. Emre ErkusJ. Ponte - Dec 2018 - Volume 74 - Issue 12 doi: 10.21506/j.ponte.2018.12.5 Abstract:A Rare Cause of Confusion and Syncope: Thrombosis of Dialysis Catheter. Case Presentation and Review of Current Literature SUMMARY Superior vena cava (SVC) syndrome is a complete or partial obstruction of SVC and is occured an emergency situation. While currently 80% of the etiologies are consisted of malignant disorders, in recent years there is an increase in iatrogenic causes such as pacemaker wires and long term central venous catheters. Here we presented a case of SVC syndrome caused by right subclavian vein catheter for two years for dialysis treatment due to chronic renal insufficiency and review of the literature. Keywords: Dialysis Catheter, Vena cava syndrome ,Confusion Download full text:Check if you have access through your login credentials or your institution Username Password

Normal saline versus heparin for patency of central venous catheters in adult patients - a systematic review and meta-analysis

BackgroundHeparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients.MethodsWe searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs. HS to maintain the permeability of CVCs among adult patients were included in our meta-analysis. References of relevant papers were reviewed manually. No language restriction was applied. Non-human studies were excluded. Pooled relative risk (RR) was calculated using a Mantel-Haenszel random-effects model. We also performed subgroup analysis examining the effect of the duration of catheter placement on the outcome. All statistical tests were two-sided using a significance level of 0.05.ResultsTen RCTs involving 7875 subjects (with analysis at patient, catheter, lumen and line access level) were included in this meta-analysis. Whether in terms of pooled or local analysis (RR with 95% confidence interval spans 1), NS can be equally, if not more effective, in keeping the CVCs open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection), heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs long term CVC placement was consistent with the main outcome partly and in particular for maintenance of catheter patency in patients with a long-term placement i.e. >30 days, the RR was 0.97 (n = 6589; 95% CI = 0.76 to 1.23; P = 0.796). However, for patients in whom the catheter was in place for <30 days, the RR was 1.52 (n = 1286; 95% CI = 1.02 to 2.27; P = 0.041).ConclusionsBased on the results of this meta-analysis, HS is not superior to NS in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to NS for flushing catheters from a statistical point of view.

Incidence and Outcomes of Catheter Related Thrombosis in Acute Leukemia: Single Centre Experience

▪IntroductionCatheter related thrombosis (CRT) is a common complication of central venous catheters (CVCs) in patients with hematological and solid organ cancers. However, little is known about the incidence of CRT in acute leukemia patients and the optimal approach to anticoagulant therapy especially in the presence of concurrent and often prolonged thrombocytopenia. Some of these patients might receive sub-therapeutic anticoagulation with a potentially higher risk of recurrent CRT, device failure and thromboembolic events.MethodWe conducted a retrospective chart review of adult patients with newly diagnosed acute leukemia at Vancouver General Hospital (VGH), Canada from January 2014 to December 2014. The study aimed to determine the incidence of CRT and review the current practice of CRT management. The outcomes were symptomatic thrombotic and bleeding events, catheter complications (e.g. infection), and blood product use. Only objectively confirmed CRT cases were included. The follow up period was from CRT diagnosis to last known date of follow-up.ResultsA total of 151 patients were identified, of whom 116 received CVC insertion. Eleven patients (78.5%) received more than one CVC (median 2, range 1-4). Fourteen patients (12%) were diagnosed with symptomatic CRT (table). All CRT events occurred within 30 days (range 4-30 days) after CVC insertion and 85.7% within the first 6 months (range 0.26-6 months) after their diagnosis of acute leukemia. Median follow up of these 14 patients was 447 patient-days (range 13-759). Two patients were lost to follow-up at 13 and 23 days due to transfer of care to other hospitals. Three out of 14 patients died during follow up (at 72, 86 and 372 days, respectively) due to leukemia.Eleven patients (78.5%) were treated with therapeutic anticoagulation using low molecular weight heparin (LMWH). Three untreated patients had CRT confined to basilic vein. Nine out of 11 patients required LMWH dose reduction due to thrombocytopenia according to our local protocol (1). Full dose weight-based LMWH was administered if platelet count could be maintained above 50 × 109/L (with or without platelet transfusion in acute phase, i.e. within 1 month of CRT diagnosis). For platelet counts between 20 and 50 × 109/L, half-dose LMWH was administered with close monitoring. LMWH was withheld if platelet count was lower than 20 x 109/L in subacute phase, i.e. after 1 month. No patient had recurrent CRT or pulmonary embolism during anticoagulation and follow up.Bleeding events occurred in 3 (27%) patients during anticoagulation. There was one major bleeding (spontaneous retroperitoneal hematoma), one clinically relevant non-major bleeding (adenovirus induced cystitis and hematuria requiring hospital admission) and one minor bleeding (bruise) event. Catheter-related infection was documented in 4 (36%) patients. No deaths occurred due to CRT or its treatment.Patients were treated for a minimum of 3 months or longer if the implicated catheter was still in situ. Median treatment time was 3 months (range 2 weeks-7 months). Three patients stopped anticoagulation prior to 3 months (palliation and lost follow-up). None of the CVC was removed as a result of CRT, but 4 were removed for infection, 3 for the completion of chemotherapy, 2 non tunnelled catheters were replaced with long term CVCs, 1 was accidentally dislodged and 1 was removed for logistic reason. The median CVC dwell time was 30 days (range 4-173).Among the 11 treated patients, 8 patients received platelet transfusions during treatment with LMWH. Eighty seven doses of pooled platelets (or its equivalent) and 64 packed red cells were transfused. Sixteen doses (18%) of platelet transfusions were given to keep platelet count above 20-50 for anticoagulation during the first month of CRT; the remainder were given for clinical indications. Only 4 units (6%) of packed red cells were transfused for major bleeding in one patient while 60 units were used for routine support when hemoglobin was <80 g/L.ConclusionTwelve percent of newly diagnosed acute leukemia patients developed CRT. Anticoagulation with LMWH using a dose reduction approach for thrombocytopenia appeared safe and effective with no recurrent VTE events and few bleeding events.1) Lee AY, Peterson EA. Treatment of cancer-associated thrombosis. Blood. 2013 Oct 3; 122:2310-7 [Display omitted] DisclosuresLee:LEO: Consultancy, Honoraria; Bristol Myers-Squibb: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria.

Peripherally Inserted Central Catheters (PICCs) Implantation in the Clinical Management of Oncohematologic Patients: Results of a Large Multicenter, Retrospective Study of the REL Group (Rete Ematologica Lombarda - Lombardy Hematologic Network, Italy)

Background: PICCs are vascular devices inserted from a peripheral vein of the upper third of the arm under ultrasound guide, and provide a central venous access (CVA) with an intermediate duration between short term central venous catheters (CVCs), such as jugular or subclavian CVCs, and long term ones (port-a-caths).PICC insertion is ease and safe with no pneumothorax or hemothorax risk. Their extremity reaches a central vein, and can be used for cytostatic drugs, hyperosmolar solutions, and antibiotics infusion. Furthermore, patients (pts) at high risk of hemorrhage for thrombocytopenia or coagulopathy are eligible for PICC insertion.Nevertheless, some concern exists about the risk of infectious and thrombotic complications associated with PICC use in immunocompromised cancer pts characterized by a prothrombotic state.In particular, few clinical data from large oncohematologic pts series are available on PICCs' implants and their complications.Aims: To analyze the results of a large multicenter, retrospective study of the REL group (Rete Ematologica Lombarda-Lombardy Hematologic Network, Italy) aimed at clinically characterizing PICC use in oncohematologic patients management.Methods: Four REL Hematology Centers participate to the study. The clinical data of 453 implanted PICCs from January 2010 to June 2015, were retrospectively collected, for a total of 44,577 catheter days.Pts median age was 61 yrs (range 10-88).Patients' diagnoses were 197 non-Hodgkin's lymphoma, 10 chronic lymphocytic leukemia, 105 acute myeloid leukemia, 45 acute lymphoblastic leukemia, 33 Hodgkin's lymphoma, 39 multiple myeloma, 12 myelodysplastic/myeloproliferative syndrome, 6 miscellaneous.All pts received intravenous chemotherapy, long term anti infectious drugs (antibiotics and antifungals), and hypertonic solutions.PICCs were inserted by ultrasound-guided puncture of a peripheral vein of the arm, by microintroducer technique, under strict asepsis.Chest X-ray was performed to verify correct tip location (ideally in the proximity of cavo-atrial junction).Data on PICCs' lumen number are available in 423 cases: 292 (69%) were single-lumen and 131 were double-lumen (31%).Results: Median PICC life-span was 90 days (range 1-760, Kaplan-Meier method). No major insertion-related complications were observed.Late complications occurred in 172/453 PICCs (38%, 3.8/1000 catheter days): 93 infectious (20%, 2/1000 catheter days), 38 thrombotic (8%, 0.8/1000 catheter days), 37 mechanical (8%, 0.8/1000 catheter days), 5 (1%, 0.1/1000 catheter days) miscellaneous complications (patient intolerance, local pain and hematoma).Among infectious complications, we reported 24 cases (5%, 0.5/1000 catheter days) of fever of unknown origin (FUO) and 69 (15%, 1.5/1000 catheter days) catheter-related bloodstream infections.Mechanical complications consisted of 3 (1%) catheter dislocations, 19 accidental removals (4%), 16 (3%) lumen occlusions and 3 (1%) breakages of the external section of PICC.In 376/453 (83%) cases PICC was removed due to end of intravenous therapy in 160 patients (35%), death in 98 (22%) and to various complications in 118 (26%) cases. Specifically, FUO lead to PICC removal in 10 (2%), infection in 40 (9%), venous thrombosis in 25 (5%) cases, catheter dislocation or accidental removal in 22 (5%), lumen occlusion in 13 (3%), breakage of the external section of PICC in 2 (0,5%), other mechanical complication in 4 (1%), local pain and miscellaneous 2 (0,5%) each.In the case of a complication occured, the incidence of PICC removal was 68% (118/172): FUO/infections represented the removal cause in 50/172 (29%), mechanical complications in 40/172 (23%), thrombosis in 25/172 (14%) cases.Conclusions: Traditional CVCs are associated with significant complications, reported at varying frequencies in highly heterogeneous oncohematologic pts series: infections are reported from 4.6 to 23% and thromboses from 1.2 to 30.2% of the cases.We have clinically characterized a large series of PICCs in oncohematologic patients. Our data suggest that their implant, as an alternative to traditional CVCs, is a safe and effective way to provide oncohematologic patients at high risk of hemorrhagic and infective complications with a CVA. PICCs compare favorably with traditional CVCs reported complications, and facilitate the proper management of complex and prolonged therapeutic programs. DisclosuresNo relevant conflicts of interest to declare.

Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children.

Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and different frequency of flushes reported. In addition, not all studies reported on all outcomes. The quality of the evidence ranged from low to very low because there was no blinding, heterogeneity and inconsistency between studies was high and the confidence intervals were wide. CVC occlusion was assessed in all three trials (243 participants). We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). The duration of catheter placement was reported to be similar between the two study arms, in one study (203 participants). The review found that there was not enough evidence to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.

Peripherally Inserted Central Venous Catheters Are Associated With High Complication Rates in Patients With Inflammatory Bowel Disease

Introduction: Patients with inflammatory bowel disease (IBD) develop perforating complications and utilize total parenteral nutrition (TPN) as a form of treatment. Central venous catheter (CVC) placement is needed to administer TPN and/or antibiotics. The aim of this study was to identify factors associated with complications in IBD patients undergoing CVC placement. Methods: IBD patients that underwent long-term (>14 days) CVC placement from 2004 until 2013 were identified. Clinical information was extracted from a data repository and review of the medical record. CVC were categorized as ports, Hickman catheters (HC), and peripherally inserted central catheters (PICC). Modifications including antiseptic coatings, cuffs, tunneling and antibiotic/anticoagulant flushes were recorded. Development of CVC-related complications was recorded. Results: 93 patients underwent CVC placement. 74% were Caucasian, 70% were women, and 83% had CD. 47, 36, and 17% of CD patients had ileocolonic, ileal, and colonic disease location. 28% had perianal disease and 74% had perforating behavior. 77% of UC patients had pancolitis. 48 underwent HC, 45 underwent PICC, and none had a port. 24 (26%) developed a complication, including 20 line infections, 3 thrombotic events, and 1 septic thrombosis. 2 patients died. 96% of patients with complications underwent CVC placement to receive TPN. 19 (31%) patients undergoing PICC placement had a complication compared to 5 (19%) patients undergoing HC placement (p < 0.18). Modifications to CVC placement did not decrease the rate of CVC-complications. Patients with an abscess or treated with antibiotics at admission and those that developed post-operative infections were more likely to develop complications (p < 0.05). Methotrexate (MTX) was associated with complications (p < 0.05); however the number of patients treated with MTX was small (n=6). 13 (72%) patients with a history of MRSA, VRE, or CRE developed complications compared to 18% of patients without resistant bacteria (p=0.03). A history of prior CVC-related infection was associated with complications (56 vs. 19%, p=0.001). Patients with peripheral vascular disease and connective tissue diseases were more likely to develop complications (p=0.02). Conclusion: Providers should advocate strongly for HC placement if considering long term CVC use in IBD patients, especially if concurrent infection, prior CVC-related infection, or a history of resistant organisms is present.

Abstracts from the 3rd International Conference on Prevention and Infection Control (ICPIC 2015).

Although infection risk associated with central venous catheters (CVC) has reduced in recent years, the use of CVC are still associated with relatively large number of infections, leading to increased patient morbidity and healthcare costs. A major source of microbial colonisation and infection of short term CVC is the patients’ endogenous skin microorganisms located at the catheter insertion site.

PTH-202 Evaluation of the percussive pop technique to restore patency to long term central venous catheters in patients on home parenteral nutrition

<h3>Introduction</h3> Functioning central venous catheters (CVC) are essential for the delivery of home parenteral nutrition (HPN). Occluded CVC result in delayed treatment and increased risk of infection. Various techniques to restore patency have been described in this patient group, however the percussive POP technique has not been evaluated. The POP technique generates shock waves through the CVC loosening the obstruction, allowing it to be extracted, rather than introduced into the patient.¹This study aimed to evaluate the technique in patients on HPN. <h3>Method</h3> Occlusions between January 2012 and December 2014 were recorded. Total occlusion indicated the CVC could not be flushed, partial indicated resistance. Techniques used to salvage the CVC and outcomes were recorded. 1st line techniques were clearing the hub of any physical matter with a 21G needle and POP technique where a 2.5 ml Luer lock syringe with 1ml 0.9% sodium chloride was attached directly to the CVC hub (tip pointing down). The plunger was then pulled up 1 ml and released. This was repeated until blood backflow or debris was seen in the syringe. 2nd line involved Urokinase 10,000 units or 70% alcohol. Primary outcome was catheter salvage. Other outcomes were CVC rupture, “ballooning” (where the CVC becomes permanently stretched), bacteraemia or recurrence of occlusion within 30 days of intervention. <h3>Results</h3> There were 39 occlusions (30 total, 9 partial) in 27 patients; occlusion rate 0.1 per 1000 CVC days. 25 patients had CVC, 2 patients ports. Patency was restored in 38 (97%) episodes. The 1 unsuccessful episode was a total occlusion in a port resistant to all methods. The 30 total occlusions occurred in 19 patients; 17 patients CVC, 2 patients port. Patency restored on 29 (97%) occasions. Hub clearout used in 5 (17%) episodes, in 2(7%) this was the only method used. POP technique used for 28 (93%) episodes, 3(10%) following hub clearout. Urokinase used in 4 (13%) episodes. In 2 cases patency was restored by the POP technique but with some residual resistance. Urokinase was instilled using the POP technique on 1 occasion. Alcohol was only used once and was unsuccessful. Of the 9 partial occlusions, patency was restored in all. Hub clearout alone was used in 7(78%) occasions. POP technique used in 2(22%) episodes and once with Urokinase (11%). There were no catheter ruptures, “ballooning” or bacteraemia. There was 1 recurrence of total occlusion in a patient on a trial off HPN who was non compliant with weekly CVC flushing. <h3>Conclusion</h3> The results indicate that restoring patency using the percussive POP technique is safe and effective. In addition, it is simple and inexpensive. Urokinase may have an additional role alongside non pharmaceutical methods, but is not often required. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Stewart D. <i>Care of the critically ill</i>2001;17(3)

PTH-217 Spinal infections among patients with long term central venous catheters for home parenteral nutrition: a descriptive case series

<h3>Introduction</h3> Long-term central venous catheters for home parenteral nutrition (HPN) carry a risk of recurrent bacterial colonisation and catheter related sepsis (CRS).¹Spinal infections following an episode of CRS are uncommon but may be underreported or overlooked due to the high incidence of osteoporotic fractures in this cohort.²We aimed to determine the frequency and describe cases of spinal infections in HPN patients at our institution. <h3>Method</h3> We performed a retrospective review of all spinal infections presenting in our HPN patients between January 2010 and October 2013, a cohort of approximately 270 patients. Data were extracted on basic demographics, indication for and duration of HPN, means of venous access, history of presentation and management. <h3>Results</h3> The CRS rate was 0.9 per 1000 catheter days. Six patients were identified (mean age 65 years, 5 male) with spinal infection, a rate of 0.02 per 1000 catheter days. Duration with current CVC ranged from 5 months to 2 years. All patients presented with spinal pain; 5/6 cervical, 1/6 thoracic. All patients had a normal white cell count and differential, and in only 1 case was the CRP elevated. In 4 cases an organism was isolated at the time of presentation from blood cultures taken centrally and/or peripherally – commonly staphylococcal species. All patients had contrast-enhanced magnetic resonance imaging (MRI) with features compatible with spinal infection and in two patients a repeat MRI demonstrated resolution of changes. In three patients a disc biopsy was performed yielding one negative culture, one microbiological correlation with blood cultures and a single positive culture (unknown isolate). All patients received three months of intravenous antibiotic therapy augmented with surgery or conservative management on a case-by-case basis. The CVC was removed in 4/6 patients at presentation, with salvage in the remaining two. <h3>Conclusion</h3> Spinal infections associated with long-term CVC for HPN should be considered in patients presenting with spinal pain. They are often of insidious onset and may present with normal inflammatory markers which may contribute to delayed or missed diagnoses that together with differences in the definition of CRS¹may partially explain the poor representation in the current HPN-related literature.³Gold-standard imaging is with contrast-enhanced MRI with formal biopsy decided on an individual basis. Management should involve prolonged antibiotics and liaison with microbiology and neurosurgery. Multidisciplinary discussion on CVC salvage is important especially in cases of difficult vascular access. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Reimund JM, <i>et al.</i><i>Clin Nutr.</i>2002;21(2):33–38 Haderslev KV, <i>et al.</i><i>JPEN</i>2004;28(5):289–294 Huard G, <i>et al.</i><i>J Clin Med Res.</i>2014;6(4):272–277

PTH-135 Osteomyelitis In Adult Patients On Long-term Parenteral Nutrition

IntroductionOsteomyelitis (OM) has rarely been reported in association with central venous catheter (CVC) use, but there are no reported data on the prevalence of OM in patients with intestinal failure...

Diagnosis of central venous catheter-related bloodstream infection without catheter removal: A prospective observational study

BackgroundCatheter-related bloodstream infections (CRBSI) resulting from bacterial colonisation of an intravascular catheter are the leading cause of nosocomially acquired sepsis contributing significantly towards in-hospital morbidity and mortality. Suspicion of central venous CRBSI leads frequently to catheter withdrawal but not all infection requires the catheter to be withdrawn; therefore, diagnosis of central venous CRBSI without catheter withdrawal is a necessity. MethodsThe study was prospectively performed in a cohort of adult patients who had short term central venous catheter use. The samples collected from each patients included, skin swab from insertion site, swab from catheter hub, paired blood samples from catheter and from the peripheral vein for quantitative blood culture collected within 15 min of each other and catheter-tip sample by cutting off the tip (distal 5-cm segment). All samples were processed immediately. Results50 episodes of clinical sepsis involving 100 patients occurred in the study population. 28 of the episodes were confirmed as CR-BSI (56%). Blood culture from the central venous catheter had the highest sensitivity (71.43%) and the greatest negative predictive value (86.67%). However, the peripheral blood culture was most specific and had the highest positive predictive value (specificity75%; positive predictive value 50%). The most accurate technique was differential quantitative blood cultures (accuracy 72%), followed by semiquantitative superficial cultures (accuracy 68%), although there were no statistically significant differences between values. ConclusionWe recommend combining semiquantitative cultures and peripheral blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique.

Pediyatrik olgularda venöz port implantasyonunda yeni teknik: Tek insizyon çift cep yöntemi

Objective: In general intravenous access might be essential in patients with increased length of hospital stay for obtaining blood samples and for administration of intravenous fluid solutions, medications and total intravenous nutrition solutions. Extended length of use and repeated usage may worsen the peripheral intravenous access. In these conditions long term central venous catheters and implantable chest ports eases the clinicians’ duty. With single incision double pocket technique, two subcutaneous pockets were done with surgical technique just above and below the incision; catheter was placed when the reservoir is in the upper pocket and then fixed at the lower pocket. We think that this technique will decrease the complications related with implantable chest ports placement in pediatric patients. In this study sigle incision double pocket technique was evaluated. Material and Methods: Single-incision two pocket technique has been practiced since January 2011 in our clinic. A total of 32 pediatric venous port placement patient in our hospital were evaluated retrospectively. In retrospective, demographic information, notes regarding the interventional process, pathology, microbiology and laboratory results and clinical observations were recorded, and the data obtained from the notes reported as a descriptive case serie. Results: At the age of 1 month to 132 months, with an average 47.3 months, a total of 32 patients (16 female, 16 male) were included in this study. Complications associated with intervention and port dysfunction was not occurred any of our patients. Venous port related infection was observed in only one of our patients (3.1%). Conclusion: Single incision double pocket technique is feasible and facilitating the process eases the procedure. Low rate of dysfunction might be an alternative for conventional technique.

Safety, Feasibility and Cost Of Hematopoietic Stem Cell Transplantation Management By Peripheral Inserted Central Catheter (PICC): A Phase II Prospective Study

BackgroundThe management of high dose chemotherapy followed by autologous or allogeneic hemopoietic stem cell transplantation requires an intravenous line for administrations of high-dose chemotherapy, blood and platelet transfusions, antibiotics and parenteral nutrition. In this context a safe central venous access is a basic tool for patients management. The aim of our phase II prospective study is to evaluate feasibility, safety and cost of the use of peripherally inserted central catheters (PICC) for the management of hemopoietic stem cell transplantation. MethodsInclusion criteria included inpatient who needed program of autologous and allogenic hematopoietic stem cell transplantation regardless the underlined hematological disease or white cells and platelets counts. All patients were submitted to a preliminary evaluation of arms vascular anatomy by ultrasonography. All implantation procedures has been done under ultrasound guide with radiographic control after insertion. The PICC cost analysis was performed on the cost of devices, insertion and daily management and compared with a historical cohort of patients with short term central venous catheter (CVC). The study was approved by institutional review board. All patients provided a written informed consent. ResultsFrom March 2007 to July 2013 76 consecutive PICC have been implanted in 74 patients for autologous or allogenic stem cell transplantations. There were 37 male and 37 females. Median age was 55 years, range 22-70. With regard to disease, 11 patients (15%) had Hodgkin Lymphoma, 13 (17.5%) non Hodgkin lymphoma, 9 (12%) acute lymphoblastic leukemia, 35 (47%) multiple myeloma, 4 (5.5%) acute myelogenous leukemia, and 2 (3%) other hematological disease. Fifty-five PICC (72%) have been used for single autologous stem cell transplantation, 10 (13%) for double autologous stem cell transplantation and 11 (15%) for allogenic transplantation. Catheter insertion was successful in all instances. PICC median life was 119 days (1-457) for a total of 10877 days of implanted PICC. At the time of this analysis 4 out of 76 PICC (5%) are still “in situ” and in use and 72 (95%) have been removed. Reason for removal was end of therapy in 58 instances (80.5%), accidental withdrawal in 8 (11%), patient death in 1 (1.5%) and catheter related complication in 5 (7%). Catheter related complications were the following: 2 occlusions, 3 suspected PICC-related sepsis. Only 1 episode of confirmed PICC-related septicemia (0.1/1000 days/PICC) was recorded and S.Aureus was isolated. There were only 2 cases (2.6%) of symptomatic PICC-related thrombotic complications which has requested conservative management. Twenty-five of 76 PICC (33%) were power PICC. No patients presented the need for a additional central venous access. Regarding the economic aspect, the actual daily cost of PICC was 1.98 €/day versus 3.40 €/day of the short term CVC (45% lower). ConclusionsThese data encourage the use of PICC in the autologous and allogenic stem cell transplantation because of insertion easiness, duration of life, cost and low rate complication. Disclosures:Off Label Use: Bendamustine.

Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture

Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneumothorax (PNX) in children. Aim: To construct a baseline value before the introduction of systematic use of ultrasound guidance, which requires specific training and equipment. Background: Anesthesia Service and Pediatric Oncology of the Italian National Cancer Center; patients were children (age ≤ 18 years) with solid tumors, needing long-term central venous catheters (Groshong or Port-a-Cath). Materials/Methods: Catheter placement was performed, mostly under general anesthesia, utilizing a micropuncture 5-7 Fr needle and fluoroscopy. In the study period ultrasound was used only in case of previously failed attempts. Relevant data were collected retrospectively. Results: From August 2008 to December 2011, 452 catheters were implanted to our patients. The prevalent approach was from subclavian vein (left 85.7%, right 9.7%); in few cases internal jugular vein was chosen (right 2.4%, left 2.2%). Pneumothorax occurred in 14 patients (3.1%; 95%CI 1.9-5.1). In 4/14 children the PNX was considered minimal and not treated. In 10 patients the PNX was drained. In 7 cases a traditional, surgical thoracostomy was performed, while in 3 children a 14-Ga polyurethane catheter (Arrow International&#174) was inserted over a wire guide in the pleural space by anaesthetists. Conclusions: In our centre rates of PNX are the same as those described in literature and are expected to lower when ultrasound guidance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.