Central venous device-related infection and thrombosis in patients treated with moderate dose continuous-infusion interleukin-2

Eastman, Michael; Khorsand, Masoud; Maki, Dennis G.; Williams, Eliot C.; Kim, KyungMann; Sondel, Paul M.; Schiller, Joan H.; Albertini, Mark R.

doi:10.1002/1097-0142(20010215)91:4<806::aid-cncr1068>3.0.co;2-k

Cited by 31 publications

(8 citation statements)

References 44 publications

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“…In a separate study, 5 of 28 (18%) patients with CVCs with clots had clinical infections versus 0 of 10 (0%) patients with CVCs without clots [40]. The odds ratio for infection related to thrombosis was 4.1 (confidence interval 1.5-11.4) [32], and prophylactic heparin/vancomycin/ciprofloxacin or heparin/vancomycin flushes resulted in a threefold lower incidence of blood infection compared with heparin alone [52]. This is not a surprising finding, since almost all cannulated blood vessels contain a fibrin sheath that is seeded with adherent cocci [17][18][19].…”

Section: Infection Of Cvcsmentioning

confidence: 89%

“…In those that are symptomatic, symptoms include arm/neck/head swelling or pain, headache, numbness of the extremity, erythema of the extremity, phlegmasia, venous distention, and jaw pain. Table 3 lists the studies in which patients with CVCs developed symptoms and then had clots in the affected blood vessel documented by venogram or ultrasound [22,25,[27][28][29][30][31][32][33][34][35][36][37][38][39]. On average, 12% of all patients with CVCs developed symptomatic thrombi but there was a wide range, from 5%-41% of all CVC insertions.…”

Section: Cvc-related Blood Vessel Thrombosis (Dvt)mentioning

confidence: 99%

“…In a nonrandomized study of 160 patients with melanoma or renal cell cancer being treated with interleukin-2, 1 mg/day warfarin did not reduce the CVC thrombosis rate [32]. In a nonblinded study of patients with hematological malignancies, Heaton et al randomized 88 patients with double-lumen subclavian Hickman CVCs to receive either 1 mg/day warfarin or no therapy [39].…”

Section: The Use Of Low Dose Warfarin To Prevent Cvc-related Thrombosismentioning

confidence: 99%

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Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with lowmolecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

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Section: Infection Of Cvcsmentioning

confidence: 89%

Section: Cvc-related Blood Vessel Thrombosis (Dvt)mentioning

confidence: 99%

Section: The Use Of Low Dose Warfarin To Prevent Cvc-related Thrombosismentioning

confidence: 99%

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Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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“…However, studies after 2000 began recommending against routine anticoagulation, 10,28,37,45,53,54 and in 2004, the journal Chest reversed its 2001 prophylaxis recommendation. However, studies after 2000 began recommending against routine anticoagulation, 10,28,37,45,53,54 and in 2004, the journal Chest reversed its 2001 prophylaxis recommendation.…”

Section: Discussionmentioning

confidence: 99%

Central Venous Catheter-Related Thrombosis

Yacopetti¹

2008

Journal of Infusion Nursing

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Thrombosis related to central venous catheters is often underappreciated and misdiagnosed, despite its incidence and impact on patient morbidity and mortality. The purpose of this article is to offer a review of the literature, investigate the pathophysiology of the condition, and summarize the key points. Recommendations for the treatment and prevention of this complication are explored to help guide clinical practice.

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“…A retrospective review of 160 consecutive patients with metastatic melanoma or renal cell carcinoma was conducted to determine the incidence of central catheter bloodstream infection and thrombosis while receiving moderate-dose, continuous-infusion interleukin-2 (Eastman et al, 2001). All of the patients had implanted central catheters (mostly tunneled catheters), and 84 patients received 1 mg warfarin daily to prevent thrombosis.…”

Section: Vascular Endothelial Damagementioning

confidence: 99%

Venous Thromboembolism in Patients With Cancer Part I: Survey of Oncology Nurses' Attitudes and Treatment Practices for Ambulatory Settings

Viale¹,

Schwartz²

2004

Clinical Journal of Oncology Nursing

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Patients with cancer have a higher incidence of venous thromboembolism (VTE). Little information currently exists on VTE and the understanding and beliefs of oncology nurses. Therefore, the attitudes and treatment practices of ambulatory oncology nurses were surveyed to determine the current knowledge base of VTE in patients with cancer. Survey results are presented along with a thorough literature review of thromboembolism and the unique risk factors for this frequent complication in patients with cancer. The causes of VTE in this patient population often are multifactorial and include hypercoagulability, stasis, and vascular endothelial damage from procedures or the neoplastic process itself. In particular, chemotherapy administration can increase the risk of thrombosis considerably. New therapies, including thalidomide, require oncology nurses caring for these patients to have heightened awareness of the potential for thrombogenic complications. This is the first of two articles that address the problem of thromboembolism in patients with cancer, including the survey results. (See part II on page 465.) Oncology nurses are essential in the care of VTE in patients with cancer and can help with patient identification, treatment, and compliance for improved patient outcomes.

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Central venous device-related infection and thrombosis in patients treated with moderate dose continuous-infusion interleukin-2

Cited by 31 publications

References 44 publications

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Central Venous Catheter-Related Thrombosis

Venous Thromboembolism in Patients With Cancer Part I: Survey of Oncology Nurses' Attitudes and Treatment Practices for Ambulatory Settings

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