Removal of totally implanted venous access ports for suspected infection in the intensive care unit: a multicenter observational study

Abstract

BackgroundWhile no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis.MethodsDuring this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections.ResultsOne hundred and fifty-one patients (58 ± 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8–0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1–15.6), p = 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p = 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05–0.5), p < 0.01].ConclusionsTIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0383-9) contains supplementary material, which is available to authorized users.

Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study

“…We used bloodstream infections in general as an independent risk factor for attributed mortality risk in the subgroup and sensitivity analyses. These bloodstream infections may be associated with a good prognosis compared to other infections, and we may have overestimated the mortality risk of CRBSI among all patients with sepsis [ 4 , 6 , 7 ]. However, given that this study was an exploratory study based on hypotheses and that this association was apparent, we need to be cautious because of the risk of a lack of a causal relationship due to the inherent limitations of the observational study.…”

Bloodstream infections in critically ill patients: an expert statement

“…An important body of the literature argues for a systematic catheter removal in case of catheter-related BSI in critically ill patients [87][88][89]. However, the device is actually the source of sepsis in less than half of those with a suspected catheter-related infection [90]. The systematic removal should thus be balanced with a more conservative attitude in the absence of septic shock but remains the rule in case of septic shock, immune suppression, or persistent bacteremia under appropriate antimicrobial therapy.…”

Complications associated with implantation and use of totally implantable venous access port in pediatric and adult patients

“…Infections due to TIVAPS usage and management are rare; however, they can cause serious life-threatening conditions [3]. Local signs of the infection are evident in only 18% of patients [33]. Sepsis is suspected if the patient has a fever, hypothermia, tachycardia, tachypnea, or other relevant clinical symptoms [34].…”

“…Catheter-related bloodstream infection is a serious complication that increases the risk for patient morbidity and mortality [12], prolongs hospitaliza-tion in an average of 13 days, and increases treatment costs [12]. Parenteral nutrition is more frequently used in patients with TIVAPS related infections [33]. It is evident from the literature analysis that the most frequent infections are TI-VAPS pocket infections, TIVAPS infections, catheter infections, bloodstream infections, undetermined infections, undetermined inflammations, and inflammatory syndromes.…”

“…Research shows that TIVAPS insertion into vein subclavia and use of shorter length catheters [22]. Lecronier et al [33] note that TIVAPS infections can often cause preterm removal of TI-VAPS, delay of chemotherapy administration or difficulties in specific treatments.…”