Analysis of risk factors for central venous catheter-related complications: a prospective observational study in pediatric patients with bone sarcomas.

BACKGROUND: The incidence of central venous catheter (CVC)-related complications reported in pediatric sarcoma patients is not established as reports in available literature are limited. The analysis of risk factors is part of the strategy to reduce the incidence of CVC complications. OBJECTIVE: The objective of this study was to determine the incidence of CVC complications in children with bone sarcomas and if defined clinical variables represent a risk factor. METHODS: During an 8-year period, 155 pediatric patients with bone sarcomas were prospectively followed up for CVC complications. Incidence and correlation with clinical features including gender, age, body mass index, histology, disease stage, and use of thromboprophylaxis with low-molecular-weight heparin were analyzed. RESULTS: Thirty-three CVC complications were recorded among 42 687 CVC-days (0.77 per 1000 CVC-days). No correlation between the specific clinical variables and the CVC complications was found. A high incidence of CVC-related sepsis secondary to gram-negative bacteria was observed. CONCLUSIONS: The analysis of CVC complications and their potential risk factors in this sizable and relatively homogeneous pediatric population with bone sarcomas has led to the implementation of a multimodal approach by doctors and nurses to reduce the incidence and morbidity of the CVC-related infections, particularly those related to gram-negative bacteria. IMPLICATIONS FOR PRACTICE: As a result of this joint medical and nursing study, a multimodal approach that included equipping faucets with water filters, the reeducation of doctors and nurses, and the systematic review of CVC protocol was implemented.

[Effectiveness of the transparent sterile dressing vs standard to fix the peripheral venous catheter (PVC) on the incidence of phlebitis. A randomized controlled trial]. / Efficacia della medicazione sterile trasparente rispetto a quella standard per il fissaggio del catetere venoso periferico (CVP) sull'incidenza delle flebiti.Trial randomizzato e controllato.

UNLABELLED: Effectiveness of the transparent sterile dressing vs standard to fix the peripheral venous catheter (PVC), on the incidence of phlebitis. A randomized controlled trial. INTRODUCTION: The type of dressing could contribute to the incidence of phlebitis, infiltration and accidental removals but the results of the studies are contrasting and samples are limited. AIM: To compare the effectiveness of a transparent polyurethane sterile dressing on the rate of phlebitis associated to peripheral venous catheter (PVC) vs a non sterile sticking plaster in use in current practice (standard dressing). DESIGN: Randomized controlled trial. Participants. 1061 PVCs (703 patients, adults and children) at a research orthopedic hospital in the north of Italy; 540 PVCs allocated to receive the sterile and 521 the standard dressing. RESULTS: 96 PVCs were excluded for phlebitis, 48 (9.6%) in the sterile and 48 (10.1%) in the standard dressing group, RR 0.96 (95%CI 0.697 - 1.335). Accidental removal of the PVCs was more frequent with the sterile dressing (9.6% vs 6.3%) but the number of catheters removed without complications was larger in the standard dressing group (48.9% vs 54.9% P=0.0503). Eighty-five PVCs were replaced for detachment of the dressing (50, 9.2% sterile and 35, 6.7% standard dressing). The cheapest transparent sterile dressing costs 32 cents while the standard 9 cents. CONCLUSIONS: A sticking non sterile plasters is not influential on the rate of phlebitis and ensures an good fix of the PVC compared the transparent sterile dressing to of polyurethane film.

Extravasation of antineoplastic agents: prevention and treatments.

The extravasation of antineoplastic agents is an unwanted and distressing situation that can easily occur. It may cause severe and irreversible local injuries. Left untreated, vesicant chemotherapy extravasation can potentially cause tissue necrosis, functional impairment and permanent disfigurement. This article provides a review of current literature regarding recommendations on the prevention and treatment of extravasation of antineoplastic agents.

[Cohort study of peripheral catheter related complications and identification of predictive factors in a population of orthopedic patients]. / Studio di coorte sulla popolazione ortopedica delle complicanze correlate all'utilizzo del catetere venoso periferico e identificazione dei fattori predittivi.

INTRODUCTION: Peripheral venous catheters (PVC) may cause complications, specifically local. Their management varies across health care workers and wards, and guidelines recommendations are often weak and based on experts' opinion. AIM: To measure the incidence of PVCs phlebitis, occlusions, accidental removal and infiltrations and their predictive factors in an orthopedic population. METHODS: From may 4 2009 to 30, in an orthopedic hospital, data on patients to whom a PVC was inserted were collected: patient's and PVC characteristics, management and securing strategies, until one of the following outcomes: phlebitis, occlusion, accidental removal, infiltration or end of treatment. RESULTS: Overall, 873 patients were recruited and 139 PVCs. The following complications occurred: phlebitis 10.9%; occlusions 16.8%; accidental removals 5.8%, local infiltrations 14.4%; 648 PVCs (46.5%) were removed without complications. The risk for all complications (multivariate analysis) increased with age and for the other complications also with the administration of blood transfusions thorough PVC, irritant drugs and use >3 times/day for phlebitis; small gauge, not using PVC and surgical site infections for occlusions; positioning the PVC in the hand and fixing the PVC with the Chevron method for accidental removals; and female sex, transfusions and thromboembolic therapy for infiltrations. CONCLUSIONS: The incidence of phlebitis is high compared to the gold standard of 5%. Knowing the incidence of main complications is a requirement for any improvement strategy and may favor the abandonment of useless or dangerous practices.