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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

Receiver operating characteristic analysis for maximal change from Last Visit to predict catheter occlusion within 10 days.(A) Any occlusion event and (B) an occlusion event requiring TPA therapy.
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pone.0135904.g006: Receiver operating characteristic analysis for maximal change from Last Visit to predict catheter occlusion within 10 days.(A) Any occlusion event and (B) an occlusion event requiring TPA therapy.

Mentions: ROC analysis showed that a maximal change of 8.8% from Last Visit best predicted occlusion within 10 days (p<0.01; sensitivity, 75%; specificity, 67%; AUC = 0.71) (Fig 6A). A higher cut-off of 19.2% best predicted occlusion events requiring treatment with TPA within 10 days (p = 0.01; sensitivity, 64%; specificity, 83%; AUC = 0.73) (Fig 6B). When the change of pressure from Last Visit was greater than 8.8%, the odds ratio of occlusion within 10 days was 6.2 (95% CI, 1.8–21.5).


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)

Receiver operating characteristic analysis for maximal change from Last Visit to predict catheter occlusion within 10 days.(A) Any occlusion event and (B) an occlusion event requiring TPA therapy.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0135904.g006: Receiver operating characteristic analysis for maximal change from Last Visit to predict catheter occlusion within 10 days.(A) Any occlusion event and (B) an occlusion event requiring TPA therapy.
Mentions: ROC analysis showed that a maximal change of 8.8% from Last Visit best predicted occlusion within 10 days (p<0.01; sensitivity, 75%; specificity, 67%; AUC = 0.71) (Fig 6A). A higher cut-off of 19.2% best predicted occlusion events requiring treatment with TPA within 10 days (p = 0.01; sensitivity, 64%; specificity, 83%; AUC = 0.73) (Fig 6B). When the change of pressure from Last Visit was greater than 8.8%, the odds ratio of occlusion within 10 days was 6.2 (95% CI, 1.8–21.5).

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