Use Of Central Venous Devices Research Articles

Lactobacillus bacteremia: Pathogen or prognostic marker?

ObjectiveLactobacillus bacteremia is a rare event and its epidemiology is poorly known. Whether Lactobacillus bacteremia is a contaminant, a risk factor, or a risk marker of death remains an open question. Patients and methodsWe conducted a retrospective study of patients presenting with Lactobacillus bacteremia (LB), between January 2005 and December 2014, at the Grenoble University Hospital. ResultsLB was observed in 38 patients (0.34% of all positive blood cultures). Cancer (40%), immunosuppression (37%), and use of central venous devices (29%) were frequently associated with LB. We observed a significant increase with time in the number of Lactobacillus positive blood cultures among all blood cultures performed (P=0.04). LBs were divided into two clinical-biological presentations: secondary bacteremia with a known portal of entry (n=30) and isolated bacteremia (n=8). Case fatality was 31% at D28, 55.2% at 1 year in the secondary bacteremia group, and 12.5% (both at D28 and 1 year) in the isolated bacteremia group. Secondary bacteremia with a known portal of entry was significantly associated with case fatality after adjustment for age, co-infection, cancer, immunosuppression, diabetes, and sex (OR 14.9 [1.04–216] P=0.047) for fatality at one year, but not for D28 fatality (P=0.14). ConclusionLactobacillus bacteremia may be an important marker of disease severity rather than a pathogen, suggesting comorbidities. It should not be considered a contaminant, but should lead physicians to screen for associated infections and underlying diseases.

Thrombosis and hemostatic abnormalities in hematological malignancies.

There is a paucity of data that pertain to thrombosis in patients with hematological malignancies. Recent studies showed that patients with lymphoma, multiple myeloma, and acute leukemia have an increased thrombotic risk, particularly at the time of diagnosis and during chemotherapy. We searched the PubMed database for articles on thromboembolic complications in patients with hematological malignancies published between 1996 and 2013. The incidence of thrombotic events is variable, and is influenced by the type and the stage of hematological malignancy, the antitumor therapy, and the use of central venous devices. The pathogenesis of thromboembolic disease in hematological malignancies is multifactorial. Tumor cell-derived procoagulant, fibrinolytic, or proteolytic factors, and inflammatory cytokines affect clotting activation, and chemotherapy and immunomodulatory drugs increase the thrombotic risk in patients with lymphoma, acute leukemia, and multiple myeloma. Infections might also contribute to the pathogenesis of the thromboembolic complications: endotoxins from gram-negative bacteria induce the release of tissue factor, tumor necrosis factor and interleukin-1b, and gram-positive organisms can release bacterial mucopolysaccharides that directly activate factor XII. In the setting of plasma cell dyscrasias, hyperviscosity, decreased fibrinolysis, procoagulant autoantibody production, inflammatory cytokines, acquired activated protein C resistance, and the prothrombotic effects of antimyeloma agents might be the cause of thromboembolic complications. Anticoagulant therapy is very complicated because of high risk of hemorrhage. Therefore, an accurate estimate of a patient's thrombotic risk is essential to allow physicians to target thromboprophylaxis in high-risk patients.

Venous thromboembolism in the hematologic malignancies

This review summarizes the current knowledge of the epidemiology, prophylaxis, and treatment of venous thromboembolism (VTE) in patients with lymphoma, multiple myeloma or acute leukemia. Hematologic malignancies are associated with a high risk of thrombotic complications. The incidence of these events is greatly variable and is influenced by many factors, including the type and the stage of disease, antitumor therapies, and the use of central venous device (CVD). Epidemiological data allow an estimate of the incidence of VTE in acute leukemia, lymphomas, and multiple myeloma. The effect of chemotherapy on the incidence of thrombosis is particularly evident in acute leukemia as it causes the exacerbation of the clotting/bleeding syndrome typical of this disease. The role of chemotherapy is also relevant in lymphoma, and in multiple myeloma, in which the use of immunomodulating agents, in combination with chemotherapy and steroids significantly increases the risk of VTE. Thrombotic complications have a significant impact on morbidity and mortality of hematological cancer patients, therefore, in this setting, the issue of thromboprophylaxis to prevent VTE is important. However, no clear recommendation in these conditions is available, with the exception of multiple myeloma. Large prospective randomized clinical trials are needed to establish the best practice for prevention and treatment of VTE in these types of malignant diseases.

Migration of a Port-A-Cath from the Femoral Vein into the Duodenum 10 Months after Implantation

Central venous devices (CVDs) are widely used in patients with long-term venous access demand, such as nutritional support or drug delivery. Advances in medicine have made it possible to prolong the lives of patients with cancer and chronic illnesses, and the need for CVDs is rising.1Heibl C. Trommet V. Burgstaller S. Mayrbaeurl B. Baldinger C. Koplmuller R. et al.Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: a single-centre prospective analysis.Eur J Cancer Care (Engl). 2010; 19: 676-681Crossref PubMed Scopus (38) Google Scholar Generally speaking, the use of a CVD is a safe and convenient modality.2Robinson M.O. Halverson P. Port-A-Cath: a study of complication rates.S D J Med. 1991; 44: 187-190PubMed Google Scholar A 9-year-old girl with a history of ornithine transcarbamylase deficiency, hyperammonemia, cerebral palsy, and epilepsy was referred with fever and bilious vomiting. Percutaneous endoscopic gastrostomy had been performed and a Port-A-Cath catheter (Bard, Salt Lake City, Utah) was implanted via the left femoral vein 10 months before admission. On hospitalization, the patient’s physical findings were unremarkable—a distressed facial expression was observed during drug administration from the Port-A-Cath. Laboratory studies showed leukocyte levels of 2.24 × 109/L and C-reactive protein levels of 11.5 mg/dL. Her abdominal plain film showed visualized the gastrostomy and the Port-A-Cath (Figure, A). Abdominal computed tomography was performed and revealed a right suprarenal cystic lesion and probable dislocation of the Port-A-Cath (Figure, B). Communication of the Port-A-Cath with the duodenum was shown by retrograde venography from the Port-A-Cath (Figure, C). Migration of the Port-A-Cath with penetration into the duodenum was diagnosed, and a hole over the posterior side of the second portion of the duodenum was found during the operation. The Port-A-Cath was intact and patent, without thrombosis inside. The postoperative course was uneventful. The use of CVDs is rising and they have proved to be safe and convenient devices worldwide.3O'Brien S.H. Klima J. Termuhlen A.M. Kelleher K.J. Venous thromboembolism and adolescent and young adult oncology inpatients in US children's hospitals, 2001 to 2008.J Pediatr. 2011; 159: 133-137Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 4Hamilton H.C. Foxcroft D.R. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy.Cochrane Database Syst Rev. 2007; 3: CD004084Crossref PubMed Scopus (59) Google Scholar However, although complications are rare, high alertness must be maintained in patients with indwelling CVDs.5Binnebosel M. Grommes J. Junge K. Gobner S. Schumpelick V. Truong S. Internal jugular vein thrombosis presenting as a painful neck mass due to a spontaneous dislocated subclavian port catheter as long-term complication: a case report.Cases J. 2009; 2: 7991Crossref PubMed Scopus (14) Google Scholar Careful history taking and image reading may provide a clue for early detection, and timely treatment is important in ensuring a good outcome.

Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials

BackgroundSeptic thrombophlebitis is an iatrogenic life-threatening disease associated with use of central venous devices and intravenous (IV) therapy. In cancer patients receiving chemotherapy, vein resection or surgical thrombectomy in large central venous lines is time-consuming, can delay administration of chemotherapy, and therefore can compromise tumor control. Experience with thrombolysis has been published for catheter-related thrombosis but for septic thrombosis, this experience is scarce.ResultsWe describe three patients with cancer and septic thrombophlebitis of central veins caused by Staphylococcus aureus treated with catheter removal, thrombolysis, and intravenous (IV) antibiotics. In our reported cases, an initial bolus of 250,000 international units (IU) of streptokinase administered during the first h followed by an infusion of 20,000–40,000 IU/h for 24–36 h through a proximal peripheral vein was sufficient to dissolve the thrombus. After thrombolyisis and parenteral antibiotic for 4–6 weeks the septic thrombosis due to Staphylococcus aureus solved in all cases. No surgical procedure was needed, and potential placement of a catheter in the same vein was permitted.ConclusionThrombolysis with streptokinase solved symptoms, cured infection, prevented embolus, and in all cases achieved complete thrombus lysis, avoiding permanent central-vein occlusion.

Changing pattern of care of boys with haemophilia in western European centres

Haemophilia management is not uniform among countries, even within western Europe, that have close economic, social and cultural relationship. The European Paediatric Network PedNet aims to share experiences in the field of the care of boys with haemophilia. In 1998, a PedNet survey has shown significant disparities in 20 centres from 16 countries, particularly as regards the implementation of prophylaxis regimen. This survey has been updated in 2003 to describe the current status of haemophilia management in 22 centres and the changing pattern of care of boys with severe haemophilia in western Europe. Regular, continuous long-term prophylaxis is provided in all PedNet centres, more than 50% and 80-100% of boys being treated this way in 20/22 and 15/22 centres respectively. Twenty of the 22 centres (91%) recommend continuous prophylaxis (primary or secondary A) for a new patient. The use of recombinant factor VIII concentrates was already widespread in 1998 and a further expansion of recombinant products has been observed over the last 5 years. Recombinant FVIII is now used exclusively in nine centres and for more than 80% of boys with haemophilia A in nine other centres. The use of recombinant and plasma derived FIX is more balanced: among 18 centres where boys with haemophilia B are treated, 14 use recombinant FIX, and nine administer it to a majority of patients. Other modifications of practice have been stressed in this survey, such as more targeted use of central venous devices in the youngest boys and more extensive characterisation of genetic mutations.

Unexpected Sudden Death from Coronary Sinus Thrombosis. An Unsual Complication of Central Venous Catheterization

Coronary sinus thrombosis is an unusual but potentially serious complication of the use of central venous devices. We report a fatal case of coronary sinus thrombosis in relation to a malpositioned central venous catheter. The death occurred very soon following the beginning of symptoms and the cause could not be suspected. Direct trauma of the catheter on the coronary sinus endothelium seems the most probable cause of the thrombosis.