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Evaluation of catheter infection rates in patient after conversion of temporary to tunneled dialysis catheters versus de novo placement
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Posters and Exhibits
with a review of the literature on fluoroscopy times for these procedures. Materials and Methods: The double Kumpe technique, which utilizes two Kumpe catheters in tandem to facilitate navigation through the pylorus, will first be described. In addition to technique illustration, an institutional database search was performed for gastrostomy, gastrojejunostomy, and conversion gastrojejunostomy procedures from the last 12 months (n¼319). Fluoroscopy times, procedural times, and radiation doses (mGy) were recorded and averaged according to each procedure. Comparison will be made with values cited in the current limited literature. Results: Average fluoroscopy time and radiation dose for gastrostomy to gastrojejunostomy conversion were 18.4 minutes and 430.6 mGy, respectively. Utilizing the double Kumpe technique resulted in a 2/3 reduction in fluoroscopy time and radiation dose on average. Average institutional fluoroscopy times and radiation doses for primary gastrostomies and gastrojejunostomies were 6.6 minutes and 374.3 mGy (gastrostomy), and 17 minutes and 627.4 mGy (gastrojejunostomy). Conclusion: The double Kumpe technique for gastrostomy to gastrojejunostomy conversion can assist in lowering fluoroscopy times by utilizing traditional techniques. The provided fluoroscopy time and dosages provided are representative of clinical practice at our institution and can be added to the current limited literature on these commonly performed procedures.
Abstract No. 322 Effect of irreversible electroporation (IRE) on liver function tests following treatment of primary and metastatic liver tumors: a single center retrospective analysis
Posters and Exhibits
G. Narayanan, R. Suthar, K.J. Barbery, J. Yrizarry; Radiology, Division of Vascular/Interventional Radiology, University of Miami, Miami, FL Purpose: Retrospective evaluation of the effects of IRE on liver function tests (LFT), following treatment of hepatocellular carcinoma (HCC) and metastatic liver tumors. Materials and Methods: Between Jan 2010 and Dec 2011, the LFT’s of 60 patients that had 74 IRE treatments in liver with the Nanoknife (angiodynamics, NY) were reviewed. Twenty eight patients had primary HCC and 32 patients had metastatic liver tumors. Age range was between 40-83 years, with a mean of 61 years (males-38, females-22). Total Bilirubin, AST (aspartate aminotransferase), ALT (alanine transaminase) and ALKP (alkaline phosphatase) levels were analyzed at baseline, 24-48 hour and 1-8 weeks post IRE. Wilcoxon signed rank test was performed using the SPSS 20.0 to assess the significance of differences in pre and 24-48 hour post procedure lab values. All lab values were categorized into normal, grade 1, grade 2, grade 3 and grade 4 according to CTCAE criteria 4.03. Results: Bilirubin values increased after 54(75%) of 72 procedures (p¼0.00) at 24-48 hour post-IRE (mean increase: 0.6 mg/dl, range: 0.1-3.9 mg/dl). In 43 (79.6%) of the 54 procedures with an increase, the bilirubin values still remained in the normal range. Out of 74 procedures, AST values increased significantly in 73 (98.7%) procedures (p¼0.00) and exceeded the baseline AST grade in 70 (94.6%) procedures at 24-48 hour post-IRE (mean increase: 553.9 U/L, range: 16-2068 U/L). At 1-8 week follow-up AST values were available for 32 procedures, of which 26
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(81.3%) returned to baseline. The ALT values increased significantly in all procedures (p¼0.00) and exceeded the baseline grade in 67 (90.5%) procedures at 24-48 hour post-IRE (mean increase: 355 U/L, range: 2-1469 U/L). At 1-8 week time point, ALT values were available for 32 procedures, of which 23 (71.8%) returned to baseline. ALKP values decreased significantly in 57 (77%) of 74 procedures (p¼0.00) at 24-48 hour post-IRE (mean decrease 39 U/L, range: 3-140U/L). Conclusion: IRE treatments in the liver are associated with transient changes in LFT values that trend back to baseline over 1-8 weeks. Limitations of our study include the retrospective nature and unavailability of some of the values at certain time points.
Abstract No. 323 Evaluation of catheter infection rates in patient after conversion of temporary to tunneled dialysis catheters versus de novo placement J.M. Criddle, S.B. White, P. Patel, E.J. Hohenwalter, S.M. Tutton, W.S. Rilling, R.A. Hieb; Vascular/ Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI Purpose: Prior studies have reported infection rates of converting non tunneled dialysis catheters (NTDC) to tunneled dialysis catheters (TDC) vs. de novo placement of TDCs while using povidone-iodine as the sterilization agent. Chlorhexidine, as per the CDC guidelines, has been exclusively used as our sterilizing agent since 2005. Therefore, our study aims to determine whether there is a difference in infection rates between conversion and de novo placement when utilizing chlorhexidine. Materials and Methods: A retrospective analysis of adult patients was performed evaluating a cohort of patients who underwent placement of a NTDC which was subsequently converted to a TDC and a second cohort who underwent de novo TDC placement from 1/1/2009 to 8/10/2012. To assess the rate of infection, the following data points were collected: date of procedure(s), indication, outcomes, site of catheter insertion, lab values pre and post procedure, imaging, complications, infection rates within the life of the initially placed catheter, length of catheter use before exchange (catheter days) and survival. Catheter-related infections were defined as any patient with an indwelling catheter that had positive blood cultures, positive tip cultures, or documented pus at the insertion site of the catheter. Results: The conversion cohort was composed of 205 patients, 141 of which were lost to follow-up, leaving 64 patients within this group. (A majority of our patients receive dialysis at outside facilities, which accounts for the high number of patients lost to follow-up.) The de novo cohort included 60 randomly selected patients. Of the 64 patients who underwent conversion, 24 developed a catheter related infection, with a calculated infection rate of .27 events per 100 catheter days. Of the 60 de novo catheter events, 19 developed infection with a calculated infection rate of .26 events per 100 catheters days. Conclusion: In this series, there is no difference in infection rates between conversion of NTDCs to TDCs vs. de novo TDC placement when utilizing chlorhexidine as the sterilzation agent. However, these infection rates are superior to those reported when using povidone-iodine.
Posters and Exhibits
with a review of the literature on fluoroscopy times for these procedures. Materials and Methods: The double Kumpe technique, which utilizes two Kumpe catheters in tandem to facilitate navigation through the pylorus, will first be described. In addition to technique illustration, an institutional database search was performed for gastrostomy, gastrojejunostomy, and conversion gastrojejunostomy procedures from the last 12 months (n¼319). Fluoroscopy times, procedural times, and radiation doses (mGy) were recorded and averaged according to each procedure. Comparison will be made with values cited in the current limited literature. Results: Average fluoroscopy time and radiation dose for gastrostomy to gastrojejunostomy conversion were 18.4 minutes and 430.6 mGy, respectively. Utilizing the double Kumpe technique resulted in a 2/3 reduction in fluoroscopy time and radiation dose on average. Average institutional fluoroscopy times and radiation doses for primary gastrostomies and gastrojejunostomies were 6.6 minutes and 374.3 mGy (gastrostomy), and 17 minutes and 627.4 mGy (gastrojejunostomy). Conclusion: The double Kumpe technique for gastrostomy to gastrojejunostomy conversion can assist in lowering fluoroscopy times by utilizing traditional techniques. The provided fluoroscopy time and dosages provided are representative of clinical practice at our institution and can be added to the current limited literature on these commonly performed procedures.
Abstract No. 322 Effect of irreversible electroporation (IRE) on liver function tests following treatment of primary and metastatic liver tumors: a single center retrospective analysis
Posters and Exhibits
G. Narayanan, R. Suthar, K.J. Barbery, J. Yrizarry; Radiology, Division of Vascular/Interventional Radiology, University of Miami, Miami, FL Purpose: Retrospective evaluation of the effects of IRE on liver function tests (LFT), following treatment of hepatocellular carcinoma (HCC) and metastatic liver tumors. Materials and Methods: Between Jan 2010 and Dec 2011, the LFT’s of 60 patients that had 74 IRE treatments in liver with the Nanoknife (angiodynamics, NY) were reviewed. Twenty eight patients had primary HCC and 32 patients had metastatic liver tumors. Age range was between 40-83 years, with a mean of 61 years (males-38, females-22). Total Bilirubin, AST (aspartate aminotransferase), ALT (alanine transaminase) and ALKP (alkaline phosphatase) levels were analyzed at baseline, 24-48 hour and 1-8 weeks post IRE. Wilcoxon signed rank test was performed using the SPSS 20.0 to assess the significance of differences in pre and 24-48 hour post procedure lab values. All lab values were categorized into normal, grade 1, grade 2, grade 3 and grade 4 according to CTCAE criteria 4.03. Results: Bilirubin values increased after 54(75%) of 72 procedures (p¼0.00) at 24-48 hour post-IRE (mean increase: 0.6 mg/dl, range: 0.1-3.9 mg/dl). In 43 (79.6%) of the 54 procedures with an increase, the bilirubin values still remained in the normal range. Out of 74 procedures, AST values increased significantly in 73 (98.7%) procedures (p¼0.00) and exceeded the baseline AST grade in 70 (94.6%) procedures at 24-48 hour post-IRE (mean increase: 553.9 U/L, range: 16-2068 U/L). At 1-8 week follow-up AST values were available for 32 procedures, of which 26
’
JVIR
(81.3%) returned to baseline. The ALT values increased significantly in all procedures (p¼0.00) and exceeded the baseline grade in 67 (90.5%) procedures at 24-48 hour post-IRE (mean increase: 355 U/L, range: 2-1469 U/L). At 1-8 week time point, ALT values were available for 32 procedures, of which 23 (71.8%) returned to baseline. ALKP values decreased significantly in 57 (77%) of 74 procedures (p¼0.00) at 24-48 hour post-IRE (mean decrease 39 U/L, range: 3-140U/L). Conclusion: IRE treatments in the liver are associated with transient changes in LFT values that trend back to baseline over 1-8 weeks. Limitations of our study include the retrospective nature and unavailability of some of the values at certain time points.
Abstract No. 323 Evaluation of catheter infection rates in patient after conversion of temporary to tunneled dialysis catheters versus de novo placement J.M. Criddle, S.B. White, P. Patel, E.J. Hohenwalter, S.M. Tutton, W.S. Rilling, R.A. Hieb; Vascular/ Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI Purpose: Prior studies have reported infection rates of converting non tunneled dialysis catheters (NTDC) to tunneled dialysis catheters (TDC) vs. de novo placement of TDCs while using povidone-iodine as the sterilization agent. Chlorhexidine, as per the CDC guidelines, has been exclusively used as our sterilizing agent since 2005. Therefore, our study aims to determine whether there is a difference in infection rates between conversion and de novo placement when utilizing chlorhexidine. Materials and Methods: A retrospective analysis of adult patients was performed evaluating a cohort of patients who underwent placement of a NTDC which was subsequently converted to a TDC and a second cohort who underwent de novo TDC placement from 1/1/2009 to 8/10/2012. To assess the rate of infection, the following data points were collected: date of procedure(s), indication, outcomes, site of catheter insertion, lab values pre and post procedure, imaging, complications, infection rates within the life of the initially placed catheter, length of catheter use before exchange (catheter days) and survival. Catheter-related infections were defined as any patient with an indwelling catheter that had positive blood cultures, positive tip cultures, or documented pus at the insertion site of the catheter. Results: The conversion cohort was composed of 205 patients, 141 of which were lost to follow-up, leaving 64 patients within this group. (A majority of our patients receive dialysis at outside facilities, which accounts for the high number of patients lost to follow-up.) The de novo cohort included 60 randomly selected patients. Of the 64 patients who underwent conversion, 24 developed a catheter related infection, with a calculated infection rate of .27 events per 100 catheter days. Of the 60 de novo catheter events, 19 developed infection with a calculated infection rate of .26 events per 100 catheters days. Conclusion: In this series, there is no difference in infection rates between conversion of NTDCs to TDCs vs. de novo TDC placement when utilizing chlorhexidine as the sterilzation agent. However, these infection rates are superior to those reported when using povidone-iodine.