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Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study.

Wolf J, Tang L, Rubnitz JE, Brennan RC, Shook DR, Stokes DC, Monagle P, Curtis N, Worth LJ, Allison K, Sun Y, Flynn PM - PLoS ONE (2015)

Bottom Line: When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar." Ten patients attended 113 catheter-resistance monitoring visits.Participants rated catheter-resistance monitoring as highly acceptable.Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

ABSTRACT

Background: Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed.

Methods: We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar."

Results: Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8-21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0-22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable.

Conclusions: In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy.

Trial registration: Clinicaltrials.gov NCT01737554.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of CRM results and clinical outcomes.Per the STARD (STAndards for Reporting Diagnostic accuracy studies) initiative, the design of the study and flow of the patients are diagrammed [14]. The reasons for inconclusive CRM included first visit (n = 10), previous visit R2 was less than 85% (n = 7), TPA since previous visit (n = 10), and abnormal CVC function (n = 1). “CRM normal” indicates that the change in resistance was less than 8.8%. “CRM abnormal” indicates that either the change in resistance was at least 8.8% or the R2 was less than 85%. Clinical outcomes are also noted.
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pone.0135904.g001: Flow diagram of CRM results and clinical outcomes.Per the STARD (STAndards for Reporting Diagnostic accuracy studies) initiative, the design of the study and flow of the patients are diagrammed [14]. The reasons for inconclusive CRM included first visit (n = 10), previous visit R2 was less than 85% (n = 7), TPA since previous visit (n = 10), and abnormal CVC function (n = 1). “CRM normal” indicates that the change in resistance was less than 8.8%. “CRM abnormal” indicates that either the change in resistance was at least 8.8% or the R2 was less than 85%. Clinical outcomes are also noted.

Mentions: The following baseline data were obtained for each participant: demographic details, characteristics of primary disease, and CVC specifics (i.e., type, size, anatomic location, insertion date, and previous complications). Additional data were prospectively collected weekly for as long as 15 weeks: attendance at study visits, reasons for missed visits, clinically apparent occlusion or administration of tissue plasminogen activator (TPA) for CVC occlusion, and occurrence of all other clinically significant CVC-related complications [i.e., catheter fracture, central line–associated bloodstream infection (CLABSI), or venous thrombosis]. Investigators collecting data about these outcomes were not blind to CRM results, but clinicians who diagnosed clinical events and prescribed therapy were blind to CRM results. This report uses the format of the Standards for Reporting Diagnostic Accuracy Initiative (Fig 1).


Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study.

Wolf J, Tang L, Rubnitz JE, Brennan RC, Shook DR, Stokes DC, Monagle P, Curtis N, Worth LJ, Allison K, Sun Y, Flynn PM - PLoS ONE (2015)

Flow diagram of CRM results and clinical outcomes.Per the STARD (STAndards for Reporting Diagnostic accuracy studies) initiative, the design of the study and flow of the patients are diagrammed [14]. The reasons for inconclusive CRM included first visit (n = 10), previous visit R2 was less than 85% (n = 7), TPA since previous visit (n = 10), and abnormal CVC function (n = 1). “CRM normal” indicates that the change in resistance was less than 8.8%. “CRM abnormal” indicates that either the change in resistance was at least 8.8% or the R2 was less than 85%. Clinical outcomes are also noted.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555832&req=5

pone.0135904.g001: Flow diagram of CRM results and clinical outcomes.Per the STARD (STAndards for Reporting Diagnostic accuracy studies) initiative, the design of the study and flow of the patients are diagrammed [14]. The reasons for inconclusive CRM included first visit (n = 10), previous visit R2 was less than 85% (n = 7), TPA since previous visit (n = 10), and abnormal CVC function (n = 1). “CRM normal” indicates that the change in resistance was less than 8.8%. “CRM abnormal” indicates that either the change in resistance was at least 8.8% or the R2 was less than 85%. Clinical outcomes are also noted.
Mentions: The following baseline data were obtained for each participant: demographic details, characteristics of primary disease, and CVC specifics (i.e., type, size, anatomic location, insertion date, and previous complications). Additional data were prospectively collected weekly for as long as 15 weeks: attendance at study visits, reasons for missed visits, clinically apparent occlusion or administration of tissue plasminogen activator (TPA) for CVC occlusion, and occurrence of all other clinically significant CVC-related complications [i.e., catheter fracture, central line–associated bloodstream infection (CLABSI), or venous thrombosis]. Investigators collecting data about these outcomes were not blind to CRM results, but clinicians who diagnosed clinical events and prescribed therapy were blind to CRM results. This report uses the format of the Standards for Reporting Diagnostic Accuracy Initiative (Fig 1).

Bottom Line: When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar." Ten patients attended 113 catheter-resistance monitoring visits.Participants rated catheter-resistance monitoring as highly acceptable.Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

ABSTRACT

Background: Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed.

Methods: We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar."

Results: Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8-21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0-22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable.

Conclusions: In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy.

Trial registration: Clinicaltrials.gov NCT01737554.

No MeSH data available.


Related in: MedlinePlus