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Size matters, reducing peripherally inserted central venous access associated thrombosis
JVIR
’
Scientific Session
Wednesday
and gram negative organisms, and each patient received optimized antibiotic therapy based upon cultures and sensitivities. Of the patients with proven bacteremia who underwent an over-the-wire exchange, 6% (n ¼ 5) developed recurrent bacteremia with the same culture-proven organism within 3 months of the exchange compared to 11% (n ¼ 11) of patients who underwent catheter removal with or without replacement after line holiday (P ¼ 0.28). Conclusions: Reinfection rates after over-the-wire tunneled catheter exchanges were lower than in those patients who underwent catheter removal and line holidays despite similar causative organisms and appropriate antibiotic therapy. In the setting of suspected line infection, catheter exchange is as effective as removal for a line holiday.
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PICC-associated VT was the highest with DL catheter because it was the most used catheter. We should be more conservative when choosing the right number of lumens for the PICC that the patient will have for their long term IV therapy and avoid the consequences of PICC-associated VT. References 1. Evans RS, Sharp JH, Linford LH, Lloyd JF, Woller SC, et al. Reduction of peripherally inserted central catheter-associated DVT. Chest 2013; 143 (3):627–633. PubMed PMID: 22878346. 2. Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 2010 Oct; 138(4):803–810. PubMed PMID: 20923799. 3. O’Brien J, Paquet F, Lindsay R, Valenti D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol 2013; 10(11):864–868. PubMed PMID: 24075218.
Reference 1. Tanriover, Bekir, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney International 2000; 57(5): 2151–2155.
8:27 AM
Abstract No. 439
Size matters, reducing peripherally inserted central venous access associated thrombosis F. Kang, K. Wheeler, R. Ryu, D. Johnson; University of Colorado Denver, Aurora, CO.
Abstract No. 440
Chest ports placed in oncologic patients with a history of prior port removal: is there any increased risk for complications? G. Stewart1, K. Kobayashi1, P. Skummer1, J. Patel1, M. Faridnia2, M. Jawed1, D. Zhang3, C. Mendenhall4, M. Karmel5; 1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University, Baldwinsville, NY; 3SUNY Upstate Medical University, Indianapolis, IN; 4SUNY Upstate Medical University, Manlius, NY; 5Upstate Medical University, Syracuse, NY. Purpose: Patients with cancer (oncologic patients) with a history of prior chest port (port) removal may need another port for various reasons including continuation of chemotherapy after port-related complications, recurrent disease, or new cancer. We retrospectively investigated the incidences of port-related complications in oncologic patients with a history of prior port removal and to compare those without the history. Materials: Between January 1, 2012 and May 30, 2014, 832 ports were placed in 809 oncologic patients (M/F: 420/389, mean age: 57). 60 ports had a history of prior port removal (port removal group) and 772 ports were placed for the first time (primary port group). The reasons of prior port removal were completion of prior treatment (n¼17, non-complication group) and complications (n¼43, complication group). The medical records and imaging studies were reviewed to identify port-related complications requiring treatment or port removal. Complications were classified as 1) (local or blood stream) infection, 2) mechanical (such as catheter malpositioning), 3) thrombotic, and 4) port site skin issues (such as erosion). SPSS was used for statistical analyses. Results: 17 ports (27.4%) in port removal group and 95 ports (11.6%) in primary port group were associated with complications (Po0.05). Incidence of infection (10/60 vs 59/772, P o0.05) and that of mechanical complications (4/60 vs 15/772, Po0.05) were significantly higher in port removal group. Incidence of thrombotic complications (3/60 vs 18/772, P¼0.24) and that of port site skin issues (2/60 vs 8/772, P¼0.12) were not significantly different between the two groups. Among port removal group, incidence of complications in complication group were not statistically different from that in non-complication group (5/17 vs 12/43, P¼0.572).
WEDNESDAY: Scientific Sessions
Purpose: Peripherally inserted central catheter (PICC) has become the main modality for the long term intravenous (IV) therapy, and as its popularity increased, so has the PICCassociated venous thrombosis (VT). Often double lumen (DL) or triple lumen (TL) catheters are requested for the ease of IV access despite single lumen (SL) catheter may be sufficient for the patients’ long term IV therapy. During the review of our institutional rate of PICC-associated VT, we noticed an unusually high number of PICC –associated VT in DL catheters. As the number of lumens for PICC may pose as the most modifiable risk for PICC-associated VT, this study was aimed at the difference in the rate of PICC-associated VT among SL, DL, and TL catheters. Materials: We conducted a 2-year retrospective cohort study of all PICC insertion by a certified designated PICC team using highly replicable approach at our institution, which is a 593bed, level I trauma and tertiary referral hospital from 2013 to 2014. During this period, PICC insertions were done with either SL, DL, or TL catheters based on the request from the primary healthcare team, and any patients with PICC insertion who were symptomatic for upper extremity VT were evaluated with Doppler ultrasound for the presence of PICC-associated VT. Results: We identified a total of 5818 UE PICC insertions during the 24-month period. PICC-associated VTs were detected in 41 of 1346 (3.0%) SL catheters, 169 of 3114 (5.4%) DL catheters and 112 of 1358 (8.2%) TL catheters (X2 P o 0.00001). When the rate of PICC-associated VT for TL catheter was compared directly against DL and SL catheters, the rate was significantly higher (P o 0.001, P o 0.00000001), and the rate for DL catheter compared directly to the rate for SL catheter was significantly higher (P o 0.001) as well. Conclusions: TL catheter had the highest rate of PICCassociated VT followed by DL catheter. The number of
8:36 AM
’
Scientific Session
Wednesday
and gram negative organisms, and each patient received optimized antibiotic therapy based upon cultures and sensitivities. Of the patients with proven bacteremia who underwent an over-the-wire exchange, 6% (n ¼ 5) developed recurrent bacteremia with the same culture-proven organism within 3 months of the exchange compared to 11% (n ¼ 11) of patients who underwent catheter removal with or without replacement after line holiday (P ¼ 0.28). Conclusions: Reinfection rates after over-the-wire tunneled catheter exchanges were lower than in those patients who underwent catheter removal and line holidays despite similar causative organisms and appropriate antibiotic therapy. In the setting of suspected line infection, catheter exchange is as effective as removal for a line holiday.
’
S197
PICC-associated VT was the highest with DL catheter because it was the most used catheter. We should be more conservative when choosing the right number of lumens for the PICC that the patient will have for their long term IV therapy and avoid the consequences of PICC-associated VT. References 1. Evans RS, Sharp JH, Linford LH, Lloyd JF, Woller SC, et al. Reduction of peripherally inserted central catheter-associated DVT. Chest 2013; 143 (3):627–633. PubMed PMID: 22878346. 2. Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 2010 Oct; 138(4):803–810. PubMed PMID: 20923799. 3. O’Brien J, Paquet F, Lindsay R, Valenti D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol 2013; 10(11):864–868. PubMed PMID: 24075218.
Reference 1. Tanriover, Bekir, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney International 2000; 57(5): 2151–2155.
8:27 AM
Abstract No. 439
Size matters, reducing peripherally inserted central venous access associated thrombosis F. Kang, K. Wheeler, R. Ryu, D. Johnson; University of Colorado Denver, Aurora, CO.
Abstract No. 440
Chest ports placed in oncologic patients with a history of prior port removal: is there any increased risk for complications? G. Stewart1, K. Kobayashi1, P. Skummer1, J. Patel1, M. Faridnia2, M. Jawed1, D. Zhang3, C. Mendenhall4, M. Karmel5; 1SUNY Upstate Medical University, Syracuse, NY; 2SUNY Upstate Medical University, Baldwinsville, NY; 3SUNY Upstate Medical University, Indianapolis, IN; 4SUNY Upstate Medical University, Manlius, NY; 5Upstate Medical University, Syracuse, NY. Purpose: Patients with cancer (oncologic patients) with a history of prior chest port (port) removal may need another port for various reasons including continuation of chemotherapy after port-related complications, recurrent disease, or new cancer. We retrospectively investigated the incidences of port-related complications in oncologic patients with a history of prior port removal and to compare those without the history. Materials: Between January 1, 2012 and May 30, 2014, 832 ports were placed in 809 oncologic patients (M/F: 420/389, mean age: 57). 60 ports had a history of prior port removal (port removal group) and 772 ports were placed for the first time (primary port group). The reasons of prior port removal were completion of prior treatment (n¼17, non-complication group) and complications (n¼43, complication group). The medical records and imaging studies were reviewed to identify port-related complications requiring treatment or port removal. Complications were classified as 1) (local or blood stream) infection, 2) mechanical (such as catheter malpositioning), 3) thrombotic, and 4) port site skin issues (such as erosion). SPSS was used for statistical analyses. Results: 17 ports (27.4%) in port removal group and 95 ports (11.6%) in primary port group were associated with complications (Po0.05). Incidence of infection (10/60 vs 59/772, P o0.05) and that of mechanical complications (4/60 vs 15/772, Po0.05) were significantly higher in port removal group. Incidence of thrombotic complications (3/60 vs 18/772, P¼0.24) and that of port site skin issues (2/60 vs 8/772, P¼0.12) were not significantly different between the two groups. Among port removal group, incidence of complications in complication group were not statistically different from that in non-complication group (5/17 vs 12/43, P¼0.572).
WEDNESDAY: Scientific Sessions
Purpose: Peripherally inserted central catheter (PICC) has become the main modality for the long term intravenous (IV) therapy, and as its popularity increased, so has the PICCassociated venous thrombosis (VT). Often double lumen (DL) or triple lumen (TL) catheters are requested for the ease of IV access despite single lumen (SL) catheter may be sufficient for the patients’ long term IV therapy. During the review of our institutional rate of PICC-associated VT, we noticed an unusually high number of PICC –associated VT in DL catheters. As the number of lumens for PICC may pose as the most modifiable risk for PICC-associated VT, this study was aimed at the difference in the rate of PICC-associated VT among SL, DL, and TL catheters. Materials: We conducted a 2-year retrospective cohort study of all PICC insertion by a certified designated PICC team using highly replicable approach at our institution, which is a 593bed, level I trauma and tertiary referral hospital from 2013 to 2014. During this period, PICC insertions were done with either SL, DL, or TL catheters based on the request from the primary healthcare team, and any patients with PICC insertion who were symptomatic for upper extremity VT were evaluated with Doppler ultrasound for the presence of PICC-associated VT. Results: We identified a total of 5818 UE PICC insertions during the 24-month period. PICC-associated VTs were detected in 41 of 1346 (3.0%) SL catheters, 169 of 3114 (5.4%) DL catheters and 112 of 1358 (8.2%) TL catheters (X2 P o 0.00001). When the rate of PICC-associated VT for TL catheter was compared directly against DL and SL catheters, the rate was significantly higher (P o 0.001, P o 0.00000001), and the rate for DL catheter compared directly to the rate for SL catheter was significantly higher (P o 0.001) as well. Conclusions: TL catheter had the highest rate of PICCassociated VT followed by DL catheter. The number of
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