Acutely ill hematology/oncology patients with central-line associated bloodstream infections and the impact of timing of catheter removal on outcomes.

BACKGROUND: Hematology/oncology patients are at risk for central line-associated bloodstream infections (CLABSI). The purpose was to determine if infection-related mortality, persistent bacteremia, and recurrent bacteremia were decreased with early central venous catheter (CVC) removal. METHODS: A case-matched, retrospective cohort study was conducted comparing patients with early catheter removal (≤12 hours) to late catheter removal (>12 hours) in hematology/oncology patients with CLABSI from June 1, 2015 to May 31, 2018. Patients were case-matched based on intensive care unit admission and presence of shock to control for severity of illness. RESULTS/DISCUSSION: Of 148 patients meeting study inclusion, 128 (86.5%), had their CVC removed during hospitalization (median 11.8 hours). The majority had a hematologic malignancy (90.5%). Following case-matching, 48 patients remained in each group. The primary outcome of infection-related mortality, persistent bacteremia, or recurrent bacteremia occurred more frequently in the late catheter removal group compared to the early catheter removal group although this was not statistically significant (18.8% vs 8.3%, P = .136). CONCLUSIONS: A lower incidence of infection-related mortality, persistent bacteremia, and recurrent bacteremia was found in patients early catheter removal; however the sample size was not adequate to detect statistical differences. Investigators should continue to evaluate if early catheter removal confers a benefit in a larger patient population.

The differential diagnosis of syncope: a guide for emergency department advanced practice nurses.

Syncope is common in patients presenting in the emergency department, and it is essential that advanced practice nurses (APNs) be able to quickly and efficiently risk-stratify these patients. The importance of a thorough and accurate history and physical examination cannot be understated in diagnosing the pathology of syncope. Although vasovagal syncope is the most common cause of syncope, it is important to rule out the life-threatening causes of syncope first. APNs working in emergency departments can determine what pertinent diagnostic studies need to be ordered and which consults should be considered in patients presenting with syncope. APNs can also decide whether an inpatient admission is warranted or whether the patient can be safely discharged with outpatient follow-up. The importance of the history and physical examination as the best tool that APNs can use has been highlighted. Finally, implications for APNs in treating patients presenting with syncope are discussed.