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Brian R Jacobs - One of the best experts on this subject based on the ideXlab platform.
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the impact of needleless connector device design on central venous Catheter Occlusion in children a prospective controlled trial
Journal of Parenteral and Enteral Nutrition, 2006Co-Authors: Susan Schilling, Darcy Doellman, Nancy Hutchinson, Brian R JacobsAbstract:Background: Intraluminal Occlusion is common in children with central venous Catheters (CVCs). Although multiple factors predispose CVCs to Occlusion, reflux of blood is frequently implicated. We hypothesized that use of either a single-valve or positive-pressure-valve needleless connector device would reduce CVC Occlusion rates in comparison to a standard device. We further hypothesized that saline would be as effective as heparinized saline flush in preventing Occlusion and infection. Methods: CVC lumens were prospec- tively capped with 1 of 3 needleless connector devices in a 4-group design. Group 1 lumens were capped with a standard device, group 2 with a single-valve device, group 3 with a positive-pressure-valve device flushed with heparinized saline, and group 4 with a positive-pressure-valve device flushed with saline. Data were obtained regarding Occlusion and infection rates and user satisfaction. Results: Three hun- dred sixty children with 599 CVC lumens completed the study. Complete Occlusion occurred in 19/150 (12.7%) lumens in group 1 in comparison to 2/150 (1.3%) in group 2, 5/149 (3.4%) in group 3, and 6/150 (4%) in group 4 (p .05). There was a trend toward a 2-fold greater infection rate in group 4. User satisfaction was higher in groups 2, 3, and 4 than group 1( p .05). Conclusions: CVCs capped with a single-valve or positive-pressure-valve needleless connector device have lower complete Catheter Occlusion rates than those capped with a standard device. Heparinized saline flush affords no advantages over saline in reducing Occlusion rate; however, there was a trend toward lower infection rate with the use of heparinized saline. ( Journal of Parenteral and Enteral Nutrition 30:85-90, 2006) Central venous Catheters have become essential in the management of adults and children with acute and chronic diseases. Though these devices are clearly ben- eficial, they are not without risks. One of the most frequent complications associated with the use of these devices is Occlusion, which occurs in up to 25% of central venous Catheters. 1,2 Historical prospective data at Cincinnati Children's Hospital Medical Center (CCHMC) revealed a 12% Catheter Occlusion rate (internal data). Catheter Occlusion can lead to re- stricted Catheter use and delay or discontinuation of patient therapy, thus compromising the quality of care. In addition, the resulting inability to obtain blood sam- ples through these malfunctioning devices can result in the need for peripheral venipuncture that is often dif- ficult and traumatic in children. Characteristics that contribute to Catheter Occlusion include Catheter com- position, Catheter size, various patient factors, infusate composition, local Catheter use protocols, and the use of connector devices. 3-5 A variety of needleless connector
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central venous Catheter Occlusion a prospective controlled trial examining the impact of a positive pressure valve device
Journal of Parenteral and Enteral Nutrition, 2004Co-Authors: Brian R Jacobs, Susan Schilling, Darcy Doellman, Nancy Hutchinson, Melissa Rickey, Shannen NelsonAbstract:Background Central venous Catheter (CVC) Occlusion occurs frequently in children. This problem is often associated with disruption of intravascular therapy and monitoring. Multiple factors may predispose to Catheter Occlusion, but reflux of blood into the Catheter lumen is a common factor. We hypothesized that use of a positive pressure valve device would reduce the incidence of Catheter Occlusion. Methods In phase I of this sequential study design, newly placed CVCs were capped with a standard device. In Phase II, CVCs were capped with a positive-pressure valve device. Data collected included patient demographics, type of Catheter, infusate, Catheter duration, and complications. Partial and complete Catheter Occlusions were delineated. A user satisfaction survey was conducted. Results There were 153 children (mean age 48.0 +/- 7.7 months) with 312 CVC lumens enrolled in the study. Mean Catheter duration was 9.4 +/- 0.9 days. There were fewer complete Occlusions in CVCs capped with the positive pressure valve device than with the standard device [6/161 (3.7%) vs 18/151 (11.9%) Occlusions, respectively; p = .012)]. There were no significant differences in partial Occlusions, phlebitis, or Catheter-related bloodstream infection between the 2 groups. Conclusions CVCs with a positive-pressure valve cap device have a lower incidence of complete Catheter Occlusion than those with a standard cap device.
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central venous Catheter Occlusion and thrombosis
Critical Care Clinics, 2003Co-Authors: Brian R JacobsAbstract:: Central venous Catheters are widely used in children with critical illness and chronic disease. These devices are often essential in the delivery of medications and intravenous fluids and in hemodynamic monitoring. Central venous Catheter Occlusion and thrombosis are common problems in patients using these devices. This article reviews the background, pathophysiology, and incidence of Catheter Occlusion and Catheter-related thrombosis. Diagnostic, preventive, and treatment strategies, along with future research directions, are addressed.
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recombinant tissue plasminogen activator in the treatment of central venous Catheter Occlusion in children
The Journal of Pediatrics, 2001Co-Authors: Brian R Jacobs, Mary Haygood, John HinglAbstract:Abstract Tissue plasminogen activator was used to treat 228 children with 320 central venous Catheter (CVC) Occlusion events. Patency was restored in 91% of CVCs after 1 to 3 treatments, with no adverse events. Tissue plasminogen activator is effective in restoring patency to occluded CVCs and is a viable alternative to CVC removal or urokinase treatment. (J Pediatr 2001;139:593-6)
Joshua Wolf - One of the best experts on this subject based on the ideXlab platform.
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monitoring central venous Catheter resistance to predict imminent Occlusion a prospective pilot study
PLOS ONE, 2015Co-Authors: Joshua Wolf, Li Tang, Jeffrey E. Rubnitz, Rachel C. Brennan, David R. Shook, Dennis C. Stokes, Paul MonagleAbstract: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
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Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study
PLOS ONE, 2015Co-Authors: Joshua Wolf, Nigel Curtis, Li Tang, Jeffrey E. Rubnitz, Rachel C. Brennan, David R. Shook, Dennis C. Stokes, Paul Monagle, Leon J. Worth, Kim J. AllisonAbstract: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
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ethanol lock therapy in pediatric hematology and oncology
Pediatric Blood & Cancer, 2013Co-Authors: Joshua Wolf, Vanessa Clifford, Patricia M. Flynn, Jerry L. Shenep, Nigel CurtisAbstract:Central venous Catheters are essential for treatment of cancer and hematologic disorders in children. Central line-associated bloodstream infection (CLABSI) is the most common important complication and can lead to serious sequelae. Conventional antibiotic treatment is often unsuccessful. Ethanol lock therapy (ELT) has been shown to prevent CLABSI in various patient groups and might also be beneficial as adjunctive treatment for active infection. Efficacy and safety have not been adequately studied in the pediatric hematology/oncology population. Catheter Occlusion and intraluminal clots have been reported. Routine use of ELT should not be recommended in this population until more data are available. Pediatr Blood Cancer 2013; 60: 18–25. © 2012 Wiley Periodicals, Inc.
John Hingl - One of the best experts on this subject based on the ideXlab platform.
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recombinant tissue plasminogen activator in the treatment of central venous Catheter Occlusion in children
The Journal of Pediatrics, 2001Co-Authors: Brian R Jacobs, Mary Haygood, John HinglAbstract:Abstract Tissue plasminogen activator was used to treat 228 children with 320 central venous Catheter (CVC) Occlusion events. Patency was restored in 91% of CVCs after 1 to 3 treatments, with no adverse events. Tissue plasminogen activator is effective in restoring patency to occluded CVCs and is a viable alternative to CVC removal or urokinase treatment. (J Pediatr 2001;139:593-6)
Paul Monagle - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study
PLOS ONE, 2015Co-Authors: Joshua Wolf, Nigel Curtis, Li Tang, Jeffrey E. Rubnitz, Rachel C. Brennan, David R. Shook, Dennis C. Stokes, Paul Monagle, Leon J. Worth, Kim J. AllisonAbstract: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
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monitoring central venous Catheter resistance to predict imminent Occlusion a prospective pilot study
PLOS ONE, 2015Co-Authors: Joshua Wolf, Li Tang, Jeffrey E. Rubnitz, Rachel C. Brennan, David R. Shook, Dennis C. Stokes, Paul MonagleAbstract: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
Jeffrey E. Rubnitz - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study
PLOS ONE, 2015Co-Authors: Joshua Wolf, Nigel Curtis, Li Tang, Jeffrey E. Rubnitz, Rachel C. Brennan, David R. Shook, Dennis C. Stokes, Paul Monagle, Leon J. Worth, Kim J. AllisonAbstract: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
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monitoring central venous Catheter resistance to predict imminent Occlusion a prospective pilot study
PLOS ONE, 2015Co-Authors: Joshua Wolf, Li Tang, Jeffrey E. Rubnitz, Rachel C. Brennan, David R. Shook, Dennis C. Stokes, Paul MonagleAbstract: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