Risk factors for subclavian vein thrombosis in cancer patients with total parenteral nutrition (original) (raw)
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Introduction: Planning the delivery of parenteral nutrition (PN), the right choice and placement of venous access is a hight important topic in hospitalized patients. Parenteral Nutrition can be administered through peripheral venous access devices, for short time and limited by the PN composition.Evidence suggests chat use of the PICC may be preferable to fewer complications associates to mechanical insertion and reduces integration costs. Method: In order to determinate the incidence of patients with two CVC for PN administration and assess the adequacy of the insertion, and describe the associated complications we improve a prospective study analyzes in patients admitted to the Hospital (January 2011-March 2012), carriers tunnelled catheters with implantable ports of requiring PICC for the administration of PN over6-day treatment. Results: From a total of 506 patients hospitalized we revised PICC carriers,197 set out to the administration of PN, of which a total of 39 oncology patients were carriers of two central venous catheter simultaneously, without any complicationsThe mean duration of PN was 21.2 days. The average stay of two simultaneous central CVC 28.1 days and duration of hospital stay 37.7 days. Discussion & conclusion: We observed that although cancer patients carrying either tunneled CVC (silicone) for administration of chemotherapy and supportive treatment, the PICC high flow polyurethane inserted Unilumen ultrasound will be the choice when NP hospital management because:The PICC catheter tip is placed in the lower third of the superior vena cava, the cave-atrial junction, decreases wrong position and mechanical complications, and CRBSI have not appeared. We justify the concomitant need for both types of catheters to avoid further complications, such as drug interaction risk of obstruction or thrombosis and infection risk associated with explantation of the catheter, in terms of costs and delays of long-term chemotherapy treatment, indispensable in cancer patients.
The Journal of Pediatrics, 1995
ing home total parenteral nutrition at our institution (N = 12). All children (5 months to 17 years of age) were examined with bilateralupper limb venography. All CVLs were flushed daily with heparin (200 units). At the time of evaluation, 49 CVLs had b e e n placed in the 12 children. Of the 39 CVLs removed, 27 (66%) were blocked; venograms had not been previously obtained except of one child. Eight children had clinical evidence of superficial collateral circulation in the upper portion of the chest and the upper extremities; five had intermittent symptoms of superior vena cava obstruction. On venography, 8 of the 12 children had extensive evidence of DVT; two were unilateral and six bilateral.
Central Venous Catheterization for Parenteral Nutrition
Annals of Surgery, 1981
To define the risks associated with central venous catheterization for total parenteral nutrition (TPN) 3291 patient days of this therapy, delivered by an established nutrition support team, were evaluated. One hundred and seventy-five catheters placed in 104 patients were reviewed over an 18 month period. Positive cultures were reported on 11 cannulae for a 6.4% incidence of colonization; five catheters (2.8%) were considered septic. Pleural or mediastinal complications of subclavian or internal jugular venipuncture occurred in eight patients (4.8%). Misdirection of the catheter tip occurred in 11.5% of insertions. Five patients (4.8%) had clinically apparent thrombosis in the superior vena cava, innominate and/or subclavian veins during hospitalization; four others had evidence of thrombosis at autopsy examination, giving an incidence of 8.7% in the entire series. No death directly resulted from the use of this therapy. Compliance with a rigid protocol by an experienced team can allow safe and effective use of central venous catheters and parenteral nutrition therapy. S INCE DUDRICK'S LANDMARK PUBLICATION over a decade ago,1 total parenteral nutrition (TPN) has gained wide acceptance as a valuable adjunct in the care of critically ill patients. A multitude of serious rmietabolic complications can arise from TPN; these are related to the composition of solutions intended to be nutritionally complete, and range from hyperglycemic coma to vitamin or mineral deficiencies.2 Central venous access is a necessity due to the high osmolarity of the TPN solutions, which present problems related to the establishment and maintenance of central venous catheters.
Incidence, Risk Factors, and Outcomes of Catheter-Related Thrombosis in Adult Patients With Cancer
Journal of Clinical Oncology, 2006
Thrombosis of long-term central venous catheters (CVC) is a serious complication that causes morbidity and interrupts the infusion of chemotherapy, intravenous medication, and blood products. We performed a prospective study to examine the incidence, risk factors, and long-term complications of symptomatic catheter-related thrombosis (CRT) in adults with cancer. Patients and Methods Consecutive patients with cancer, undergoing insertion of a CVC, were enrolled and prospectively followed while their catheter remained in place plus 4 subsequent weeks or a maximum of 52 weeks, whichever came first. Patients with symptomatic CRT were followed for an additional 52 weeks from the date of CRT diagnosis. The end points were symptomatic CRT, symptomatic pulmonary embolism (PE), postphlebitic syndrome, and catheter life span. Results Over 76,713 patient-days of follow-up, 19 of 444 patients (4.3%) had symptomatic CRT in 19 of 500 catheters (0.3 per 1,000 catheter-days). The median time to CRT was 30 days and the median catheter life span was 88 days. Significant baseline risk factors for CRT were: more than one insertion attempt (odds ratio [OR] ϭ 5.5; 95% CI, 1.2 to 24.6; P ϭ .03); ovarian cancer (OR ϭ 4.8; 95% CI, 1.5 to 15.1; P ϭ .01); and previous CVC insertion (OR ϭ 3.8; 95% CI, 1.4 to 10.4; P ϭ .01). Nine of the 19 CRT patients were treated with anticoagulants alone, eight patients were treated with anticoagulants and catheter removal, while two patients did not receive anticoagulation. None had recurrent CRT or symptomatic PE. Postphlebitic symptoms were infrequent. Conclusion In adults with cancer, the incidence of symptomatic CRT is low and long-term complications are uncommon.
Thromboprophylaxis in cancer patients with central venous catheters
Thrombosis and Haemostasis, 2008
SummaryIt was the aim of the review to determine the risks and benefits of primary thromboprophylaxis with anticoagulants in cancer patients with central venous devices. Medline, Central and Google Scholar databases were searched for randomized controlled trials (RCTs) in June 2006.Two reviewers extracted data and appraised the quality of RCTs. Results were expressed as relative risk (RR) with 95% confidence intervals (CI) using random effects model for the outcomes of catheter-related thrombosis, bleeding and thrombocytopenia. Eight RCTs (1,428 patients) were included. There was no statistically significant difference in the risk of catheter-related thrombosis for the use of warfarin versus placebo (3 trials, 425 patients, RR 0.75, 95% CI 0.24–2.35,p=0.63),heparin versus placebo (4 trials,886 patients, RR 0.46 95% CI 0.18–1.20, p=0.06) or warfarin, unfractionated heparin or low-molecular-weight heparin versus placebo (7 trials, 1,311 patients, RR 0.59, 95% CI 0.31–1.13, p=0.11). Su...
Thrombosis Journal, 2017
Background: Deep vein thrombosis (DVT) is a common complication of peripherally inserted central catheters (PICCs). PICCs are increasingly utilised in the management of cancer patients, a group which carries both additional risks for vascular thromboembolism as well as for complex morbidity. We analysed a cohort of cancer patients subjected to PICC insertion in a single cancer centre for the incidence of all-type vascular thromboembolism (VTE) and investigated relative risk factors. Methods: In this clinical audit, the records of patients referred for PICC insertion in our centre in the period between 1/1/2011 and 1/4/2014 were retrospectively reviewed. The primary outcomes investigated were a) PICC-related deep vein thrombosis (PRDVT) and b) distant VTE (lower limb DVT and pulmonary embolism). 4Fr single lumen PICCs were placed in all patients. The Kaplan Meier method was used to study time from PICC insertion to PRDVT/VTE. Survival curves were compared using the log rank method. Logistic and Cox regression analyses were used to assess local, distant and combined endpoints. Results: Four hundred ninety patients were included in the analysis of which 27 (5.5%) developed a PRDVT. Statistically significant risk factors for developing PRDVT in multivariate analysis included more than one attempt for insertion (OR 2.61, 95%CI: 1.12-6.05) and the use of fluoropyrimidine containing chemotherapy (OR 4.27, 95%CI 1.3-14.07). Twenty-six patients developed a distant VTE. Male gender was the only significant risk factor for distant VTE. When all-type VTE were considered together fluoropyrimidine containing chemotherapy (OR 4.54, 95% CI 1.63-12.61), male gender (OR 2.03, 95% CI 1.04-3.93) and white cell count (OR 1.12, 95% CI 1.00-1.26) were statistically significant as risk factors in this analysis. Conclusions: This is a large study of VTE following PICC insertion in cancer patients which also looks at the rate of distant VTE. The observed PRDVT incidence is comparable with available literature. Fluoropyrimidine containing chemotherapy and more than one attempt for PICC insertion were independent predictors of PICC-associated VTE whilst the former remained an independent predictor of all-type VTE. Anticoagulation did not prevent thrombotic events in this cohort.
Parenteral Nutrition as a Risk Factor for Central Venous Catheter-Related Infection
Journal of Parenteral and Enteral Nutrition, 2005
Background: The role of parenteral nutrition (PN) therapy as an independent risk factor for central venous catheter (CVC)-related infection in nonselected adult patients is not well established. The aim of this study was to evaluate PN as a risk factor for central venous catheterrelated infection in nonselected adult patients in a general university hospital. Methods: Patients using central venous catheters, exposed or nonexposed to PN, were prospectively followed for development of central venous catheter-related infection. Results: One hundred fifty-three patients were studied; 28 developed central venous catheter-related infection. Patients with central venous catheter-related infection presented higher frequency of PN use than patients without infection (60.7 vs 34.4%; p ϭ .010). Multivariate Cox analysis showed that PN (relative risk (RR) ϭ 3.30; 95% confidence interval [CI], 1.30 -8.34; p ϭ .012) was the only risk factor for central venous catheter-related infection. Malnutrition (RR ϭ 0.45; 95% CI, 0.15-1.34; p ϭ .152), days of hospitalization before central venous catheter insertion (RR ϭ 1.00; 95% CI, 0.98 -1.02; p ϭ .801), and sustained hyperglycemia (RR ϭ 0.49; 95% CI, 0.98 -1.21; p ϭ .091) were not significant in the model. Multiple logistic regression revealed that malnutrition (odds ratio [OR] ϭ 8.05; 95% CI, 1.85-35.03; p ϭ .005), central venous catheter indication for surgical-related pathology (OR ϭ 7.26; 95% CI, 2.51-21.04; p Ͻ .001), sustained hyperglycemia (OR ϭ 4.34; 95% CI, 1.79 -10.52; p ϭ .001)