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Risk factors for chest port complications in oncologic patients
JVIR
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Scientific e-Posters
S235
Abstract No. 552 Risk factors for chest port complications in oncologic patients J. DeRaddo1, K. Kobayashi1, T. Blackburn1, P. Skummer2, M. Jawed1, D. Zhang1, M. Karmel1; 1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University Hospital, Syracuse, NY Purpose: To retrospectively investigate the incidence of chest port (port) complications in over 1,000 ports and to elucidate the risk factors. Materials: Between January 2013 and December 2015, a total of 1,033 chest ports were placed in 995 patients with cancer (Male/Female: 494/501, median age: 59 years). Medical records and imaging studies were reviewed to identify port complications requiring removal or treatment. The complications were classified as infection (local or systemic), mechanical failure (such as catheter malposition), thrombosis, and port site skin issue. Medical records and imaging studies were reviewed to record patients’ demographics (age, gender, body mass index, diabetes, HIV, cancer type, presence of recurrence, prior port), laboratory data at placement (CBC, albumin, INR), medications (steroids, anticoagulants/platelets, bevacizumab), and port characteristics (lumen count, laterality, in/out patient placement). Risk factors for complications were elucidated using univariate and multivariate logistic regressions. Results: A total of 311,434 catheter-days (median per patient: 244 catheter days) were observed. A total of 133 patients (13.4%, 0.043/100 days) had a complication including 74 infections (7.4%, 0.024/100 days), 18 mechanical failure (1.8%, 0.006/100 days), 25 thromboses (2.5%, 0.008/100 days), and 23 skin issues (2.3%, 0.007/100 days). Leukocytosis (WBC411,000/mL; OR 1.88 95% CI 1.19-2.98, p ¼ .007), thrombocytopenia (plateletso150,000/mL; OR 1.77 95% CI 1.10-2.87, p ¼ .02), history for prior port (OR 2.94 95% CI 1.37-6.34, p ¼ .006), and patients under the age of 60 (OR 1.53 95% CI 1.03-2.26, p ¼ .03) all had a significantly increased risk for complications in multivariate logistic regression. Other variables were not statistically significant for port-related complications in multivariate analysis. Conclusions: Patients with a history of prior port appear to have almost 3 times higher chance of complications compared to those without this history. Alternative vascular access methods should be explored in this patient population, especially when leukocytosis and/or thrombocytopenia are present.
Abstract No. 553
M. Groenwald1, I. Latich1, T. Friedman2, D. Silin3; 1Yale University, New Haven, CT; 2Weill Cornell Medicine, New York, NY; 3N/A, Cheshire, CT Purpose: Preoperative antibiotics are often given prior to port placement. There are conflicting data whether a single
Abstract No. 554 Managing tunneled/implanted central venous access devices in patients with bacteremia: a comparative analysis across two institutions J. Dombrowski1, R. Ogilvie1, B. Glaenzer1, C. Molvar1, T. Ozga2, M. Borge1, A. Malamis1, P. Amin1; 1Loyola University Medical Center, Maywood, IL; 2Gottlieb Memorial Hospital, Melrose Park, IL Purpose: To compare the efficacy of exchange versus removal of implanted/tunneled central venous access devices in patients with bacteremia, evaluating for microorganism recurrence. Materials: Retrospective search from 7/2015 to 7/2016 yielded 82 patients with bacteremia referred to IR for management of implanted/tunneled central venous access devices. 44 patients underwent removal and 38 patients underwent exchange. Recurrence rates after bacteremia clearance through 30 days were obtained. Blood cultures from device were considered “matched” if peripheral blood cultures grew same organism. Negative catheter tip culture rates were obtained. Results: See chart.
Scientific e-Posters
Effectiveness of single-dose preprocedural antibiotics prior to port placement: A singleinstitution retrospective review
prophylactic dose prevents port site infection and systemic bacteremia within the first month following placement. Materials: Single institution IRB approved retrospective review of adult patients presenting for port placement. Procedure date, MRN, antibiotic agent, number of lumens, indication, age, and gender were documented. Ports placed and removed within 30 days were investigated. If infection was indication for removal, the following was documented: site infection on removal, bacteremia, cultured agents, and source of culture (blood stream, port site, other). Incidence rates were calculated and compared between the antibiotic vs. no-antibiotic arms. Chi-squared analysis was used for comparison. Results: 5967 port placements were included, of which 61.4% were in women. The mean age of patients undergoing port placement was 59.3 years (SD ⫾ 14 years). 52% Of removed ports were from women (p ¼ 0.1741), at a mean age of 55.3 years. 67% (3978) received antibiotics while 33% (1989) did not. 52 ports were removed within 30 days, 29% within the first two weeks and 71% within the last two weeks. 50 of these were due to infection concern, 35 in the antibiotic arm vs 15 in the no-antibiotic arm. Incidence of removal was 0.87% in the antibiotic arm vs 0.75% in the no-antibiotic arm (p ¼ 0.629). There was evidence of site infection on removal in 0.301% of antibiotic arm cases vs 0.298% in the no-antibiotic arm (p ¼ 0.9840). 53.3% patients with ports removed from the no-antibiotic arm (8/15) had bacteremia with a skin agent compared with 48.5% (17/35) in the antibiotic arm (p ¼ 0.7581). Notably, 26% of removed ports were in patients with primary lymphoma or liquid dyscrasia, compared with 13% incidence of these in the total population (p ¼ 0.0067). Otherwise no association was seen between infection rates and placement indication. Conclusions: Single dose of pre-procedural antibiotics does not prevent against immediate post-procedural local infection or associated skin agent bacteremia. The incidence of infection is higher in patients with lymphoma and/or liquid dyscrasias.
’
Scientific e-Posters
S235
Abstract No. 552 Risk factors for chest port complications in oncologic patients J. DeRaddo1, K. Kobayashi1, T. Blackburn1, P. Skummer2, M. Jawed1, D. Zhang1, M. Karmel1; 1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University Hospital, Syracuse, NY Purpose: To retrospectively investigate the incidence of chest port (port) complications in over 1,000 ports and to elucidate the risk factors. Materials: Between January 2013 and December 2015, a total of 1,033 chest ports were placed in 995 patients with cancer (Male/Female: 494/501, median age: 59 years). Medical records and imaging studies were reviewed to identify port complications requiring removal or treatment. The complications were classified as infection (local or systemic), mechanical failure (such as catheter malposition), thrombosis, and port site skin issue. Medical records and imaging studies were reviewed to record patients’ demographics (age, gender, body mass index, diabetes, HIV, cancer type, presence of recurrence, prior port), laboratory data at placement (CBC, albumin, INR), medications (steroids, anticoagulants/platelets, bevacizumab), and port characteristics (lumen count, laterality, in/out patient placement). Risk factors for complications were elucidated using univariate and multivariate logistic regressions. Results: A total of 311,434 catheter-days (median per patient: 244 catheter days) were observed. A total of 133 patients (13.4%, 0.043/100 days) had a complication including 74 infections (7.4%, 0.024/100 days), 18 mechanical failure (1.8%, 0.006/100 days), 25 thromboses (2.5%, 0.008/100 days), and 23 skin issues (2.3%, 0.007/100 days). Leukocytosis (WBC411,000/mL; OR 1.88 95% CI 1.19-2.98, p ¼ .007), thrombocytopenia (plateletso150,000/mL; OR 1.77 95% CI 1.10-2.87, p ¼ .02), history for prior port (OR 2.94 95% CI 1.37-6.34, p ¼ .006), and patients under the age of 60 (OR 1.53 95% CI 1.03-2.26, p ¼ .03) all had a significantly increased risk for complications in multivariate logistic regression. Other variables were not statistically significant for port-related complications in multivariate analysis. Conclusions: Patients with a history of prior port appear to have almost 3 times higher chance of complications compared to those without this history. Alternative vascular access methods should be explored in this patient population, especially when leukocytosis and/or thrombocytopenia are present.
Abstract No. 553
M. Groenwald1, I. Latich1, T. Friedman2, D. Silin3; 1Yale University, New Haven, CT; 2Weill Cornell Medicine, New York, NY; 3N/A, Cheshire, CT Purpose: Preoperative antibiotics are often given prior to port placement. There are conflicting data whether a single
Abstract No. 554 Managing tunneled/implanted central venous access devices in patients with bacteremia: a comparative analysis across two institutions J. Dombrowski1, R. Ogilvie1, B. Glaenzer1, C. Molvar1, T. Ozga2, M. Borge1, A. Malamis1, P. Amin1; 1Loyola University Medical Center, Maywood, IL; 2Gottlieb Memorial Hospital, Melrose Park, IL Purpose: To compare the efficacy of exchange versus removal of implanted/tunneled central venous access devices in patients with bacteremia, evaluating for microorganism recurrence. Materials: Retrospective search from 7/2015 to 7/2016 yielded 82 patients with bacteremia referred to IR for management of implanted/tunneled central venous access devices. 44 patients underwent removal and 38 patients underwent exchange. Recurrence rates after bacteremia clearance through 30 days were obtained. Blood cultures from device were considered “matched” if peripheral blood cultures grew same organism. Negative catheter tip culture rates were obtained. Results: See chart.
Scientific e-Posters
Effectiveness of single-dose preprocedural antibiotics prior to port placement: A singleinstitution retrospective review
prophylactic dose prevents port site infection and systemic bacteremia within the first month following placement. Materials: Single institution IRB approved retrospective review of adult patients presenting for port placement. Procedure date, MRN, antibiotic agent, number of lumens, indication, age, and gender were documented. Ports placed and removed within 30 days were investigated. If infection was indication for removal, the following was documented: site infection on removal, bacteremia, cultured agents, and source of culture (blood stream, port site, other). Incidence rates were calculated and compared between the antibiotic vs. no-antibiotic arms. Chi-squared analysis was used for comparison. Results: 5967 port placements were included, of which 61.4% were in women. The mean age of patients undergoing port placement was 59.3 years (SD ⫾ 14 years). 52% Of removed ports were from women (p ¼ 0.1741), at a mean age of 55.3 years. 67% (3978) received antibiotics while 33% (1989) did not. 52 ports were removed within 30 days, 29% within the first two weeks and 71% within the last two weeks. 50 of these were due to infection concern, 35 in the antibiotic arm vs 15 in the no-antibiotic arm. Incidence of removal was 0.87% in the antibiotic arm vs 0.75% in the no-antibiotic arm (p ¼ 0.629). There was evidence of site infection on removal in 0.301% of antibiotic arm cases vs 0.298% in the no-antibiotic arm (p ¼ 0.9840). 53.3% patients with ports removed from the no-antibiotic arm (8/15) had bacteremia with a skin agent compared with 48.5% (17/35) in the antibiotic arm (p ¼ 0.7581). Notably, 26% of removed ports were in patients with primary lymphoma or liquid dyscrasia, compared with 13% incidence of these in the total population (p ¼ 0.0067). Otherwise no association was seen between infection rates and placement indication. Conclusions: Single dose of pre-procedural antibiotics does not prevent against immediate post-procedural local infection or associated skin agent bacteremia. The incidence of infection is higher in patients with lymphoma and/or liquid dyscrasias.