Catheter-related bloodstream infections in palliative care patients receiving parenteral nutrition by medical home care

Schedin, Anna; Goodrose-Flores, Charlotte; Bonn, Stephanie E; Björkhem‐Bergman, Linda

doi:10.1136/bmjspcare-2020-002331

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…Thirty-three articles were excluded during the first stage of screening, including seven review articles or guidelines without descriptions of any patient data, twelve articles for non-palliative intent, four articles with peripheral catheters and ten articles without details of CVAD-related complications. After screening the abstracts, eight publications were chosen to proceed with full-text review and two papers were excluded due to incomplete data retrieval [17,18]. A paper studying PORTs was excluded due to the administration of chemotherapy in a palliative care setting [19].…”

Section: Search Strategy Resultsmentioning

confidence: 99%

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Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

Wong,

Choi,

Lee

2023

Cancers

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(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27–19.10) was higher than that for central lines (1.44%, 95% CI 0.30–4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00–9.62) was also higher than that with central lines (0.96%, 95% CI 0.12–3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00–12.22) compared to central lines (0.48%, 95% CI 0.01–2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.

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Section: Search Strategy Resultsmentioning

confidence: 99%

“…chosen to proceed with full-text review and two papers were excluded due to incomplete data retrieval [17,18]. A paper studying PORTs was excluded due to the administration of chemotherapy in a palliative care se ing [19].…”

Section: Search Strategy Resultsmentioning

confidence: 99%

Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

Wong,

Choi,

Lee

2023

Cancers

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“…According to the literature [19] , PN's use appears to be a risk factor for the onset of CRBSI. It has been reported [20][21][22] that PN can increase the risk of CRBSI by three to ten times. Our study demonstrated that the duration of PN increased one day, the risk of fungal colonization in PICC tips was increased by 28%.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Clinical Analysis for PICC Related Fungal Colonization in Premature Infants

Zhang

Yang

Dong

et al. 2021

Preprint

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Objective: The present study aimed to analyze the risk factors for positive peripherally inserted central catheter (PICC) related fungal colonization in preterm infants. Methods: A retrospective study was conducted in a tertiary hospital in southwest China between January 1, 2018 and December 31, 2020. The enrolled infants who underwent ultrasound-guided PICC insertion during hospitalization were born at < 32 weeks gestation or birth weight < 1500 grams. The demographics, the PICC related characteristics, the use of antibiotic, glucocorticoid and parenteral nutrition (PN) were collected from the medical record. Univariate and multivariate analyses were performed to investigate risk factors for PICC-related fungal colonization. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value by calculating the Yoden index. Results: A total of 124 premature infants underwent ultrasound-guided PICC insertion. Among them, 19 patients had positive results of fungi at PICC tips.PN infusion duration (OR 1.37, 95%CI 1.05-1.79) and postnatal glucocorticoid exposure(OR 9.19, 95%CI 1.04-81.65) were independent risk factors for fungal colonization in PICC. The optimal cut-off value was 15days,28days, respectively. Conclusion: PICC tips fungal colonization is affected by postnatal glucocorticoid exposure and PN infusion duration. Appropriate clinical management should be adopted to avoid fungal colonization and fungemia.

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High-protein home parenteral nutrition in malnourished oncology patients: a systematic literature review

Cotogni,

Shaw,

Jimenez-Fonseca

et al. 2023

Support Care Cancer

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Introduction Up to 83% of oncology patients are affected by cancer-related malnutrition, depending on tumour location and patient age. Parenteral nutrition can be used to manage malnutrition, but there is no clear consensus as to the optimal protein dosage. The objective of this systematic literature review (SLR) was to identify studies on malnourished oncology patients receiving home parenteral nutrition (HPN) where protein or amino acid delivery was reported in g/kg bodyweight/day, and to compare outcomes between patients receiving low (< 1 g/kg bodyweight/day), standard (1–1.5 g/kg/day), and high-protein doses (> 1.5 g/kg/day). Methods Literature searches were performed on 5th October 2021 in Embase, MEDLINE, and five Cochrane Library and Centre for Reviews and Dissemination databases. Searches were complemented by hand-searching of conference proceedings, a clinical trial registry, and bibliographic reference lists of included studies and relevant SLRs/meta-analyses. Results Nineteen publications were included; sixteen investigated standard protein, two reported low protein, and one included both, but none assessed high-protein doses. Only one randomised controlled trial (RCT) was identified; all other studies were observational studies. The only study to compare two protein doses reported significantly greater weight gain in patients receiving 1.15 g/kg/day than those receiving 0.77 g/kg/day. Conclusion At present, there is insufficient evidence to determine the optimal protein dosage for malnourished oncology patients receiving HPN. Data from non-HPN studies and critically ill patients indicate that high-protein interventions are associated with increased overall survival and quality of life; further studies are needed to establish whether the same applies in malnourished oncology patients.

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Catheter-related bloodstream infections in palliative care patients receiving parenteral nutrition by medical home care

Cited by 5 publications

References 17 publications

Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

Risk Factors and Clinical Analysis for PICC Related Fungal Colonization in Premature Infants

High-protein home parenteral nutrition in malnourished oncology patients: a systematic literature review

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