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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: Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture.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.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%).

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

Metrics used to report change in resistance.Change in resistance at each visit was described as the proportional change in estimated resistance within each lumen compared to that at Baseline (i.e., enrollment or first CRM visit), Reset (i.e., first CRM visit after TPA administration), or Last Visit (i.e., immediately previous CRM visit). Figure shows data from a single study participant and catheter lumen.
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pone.0135904.g004: Metrics used to report change in resistance.Change in resistance at each visit was described as the proportional change in estimated resistance within each lumen compared to that at Baseline (i.e., enrollment or first CRM visit), Reset (i.e., first CRM visit after TPA administration), or Last Visit (i.e., immediately previous CRM visit). Figure shows data from a single study participant and catheter lumen.

Mentions: A number of metrics were used to describe the change in resistance, including proportional changes in resistance within each lumen compared to that measured in the same lumen at the time of enrollment/first CRM (i.e., Baseline), at the first CRM after TPA administration (i.e., Reset), or at the previous CRM visit (i.e., Last Visit) (Fig 4).


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)

Metrics used to report change in resistance.Change in resistance at each visit was described as the proportional change in estimated resistance within each lumen compared to that at Baseline (i.e., enrollment or first CRM visit), Reset (i.e., first CRM visit after TPA administration), or Last Visit (i.e., immediately previous CRM visit). Figure shows data from a single study participant and catheter lumen.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0135904.g004: Metrics used to report change in resistance.Change in resistance at each visit was described as the proportional change in estimated resistance within each lumen compared to that at Baseline (i.e., enrollment or first CRM visit), Reset (i.e., first CRM visit after TPA administration), or Last Visit (i.e., immediately previous CRM visit). Figure shows data from a single study participant and catheter lumen.
Mentions: A number of metrics were used to describe the change in resistance, including proportional changes in resistance within each lumen compared to that measured in the same lumen at the time of enrollment/first CRM (i.e., Baseline), at the first CRM after TPA administration (i.e., Reset), or at the previous CRM visit (i.e., Last Visit) (Fig 4).

Bottom Line: Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture.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.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%).

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