Interventions to obstructive long-term central venous catheter in cancer patients: a meta-analysis

Costa, Ana Cristina Carvalho da; Ribeiro, Jéssica Marques; Vasques, Christiane Inocêncio; Canto, Graziela De Luca; Porporatti, André Luís; Reis, Paula Elaine Diniz dos

doi:10.1007/s00520-018-4500-y

Cited by 16 publications

(14 citation statements)

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“…Al tenerse en consideración la utilización de soluciones, un metaanálisis con 15 estudios identificó los principales medicamentos utilizados en la desobstrucción y restauración de la permeabilidad del CVC de larga permanencia. Las sustancias destacadas son: Uroquinase (53,3%), Alteplase (20%), Tenecteplase (13,3%), Uroquinase recombinantes (6,7%), Reteplase (6,7%) y Estafiloquinase (6,7%) (22) .…”

Section: Cuidados Establecidos En La Desobstrucción Del Cvc-tiunclassified

“…De acuerdo con los resultados, la Uroquinase y Tenecteplase demostraron una eficacia en la desobstrucción de aproximadamente 84%, en cuanto la Alteplase se puso en evidencia el éxito en 92% de los casos relatados (22) .…”

Section: Cuidados Establecidos En La Desobstrucción Del Cvc-tiunclassified

“…Al evaluar los datos del análisis cualitativo, se observó una tendencia de superioridad en eficacia del Activador del Plasmogenio Tecidual (TPA) en relación a Uroquinase. Sin embargo, cuando los datos del metaanálisis fueron evaluados, la frecuencia general de restauración de la permeabilidad encontrada es similar entre los medicamentos, con discreta superioridad de la Alteplase en relación a las otras intervenciones (22) .…”

Section: Cuidados Establecidos En La Desobstrucción Del Cvc-tiunclassified

“…No obstante, la mayoría de los estudios incluidos tenían sesgos relacionados principalmente con la población estudiada, como la ausencia de aleatorización, doble ciego y grupo control; además de la alta heterogeneidad entre las dosis utilizadas y los tiempos de infusión. Por lo tanto, las evidencias encontradas tiende a confirmar el éxito de la terapia trombolítica en general, pero, no hay suficientes datos para estandarizar los procedimientos y medicamentos mencionados (22) .…”

Section: Cuidados Establecidos En La Desobstrucción Del Cvc-tiunclassified

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Estratégias de prevenção da obstrução em cateteres centrais totalmente implantados em pacientes oncológicos

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Objetivo: Analizar las producciones científicas que abordan las estrategias de prevención y atención en la obstrucción de los catéteres venosos centrales totalmente implantados en pacientes con cáncer.Material y método: Esta es una revisión bibliográfica integradora, que se realizó en las bases de datos MEDLINE, LILACS, CINAHL y EMBASE, del 20 de julio de 2019 al 31 de julio de 2019, utilizando los siguientes descriptores: Cateterización venosa central; Obstrucción del catéter y oncología, más el uso de términos libres: catéter completamente implantado y neoplasia.Resultados: En total, se seleccionaron e incluyeron 10 estudios. Después del análisis, surgieron las siguientes categorías de análisis: Estrategias para prevenir la obstrucción en CVC-TI y Atención establecidas en el despacho de CVC-TI; teniendo como principales temas abordados: la comparación entre la eficacia en el uso de heparina y solución salina para el mantenimiento y el intervalo de tiempo entre ellos; métodos de despacho y evaluación de permeabilidad CVC-IT.Conclusión: A pesar de la aparición de nuevas formas posibles de prevención de obstrucciones y estrategias de atención en la eliminación de CVC-IT, la literatura no presenta consenso sobre el uso de soluciones con o sin heparina y el intervalo de tiempo entre el mantenimiento para la efectividad de permeabilidad de estos dispositivos en pacientes con cáncer. Objective: To analyze scientific productions that address prevention and care strategies in the obstruction of central venous catheters that are fully implanted in cancer patients.Material and Method: This is an integrative literature review, which took place on the MEDLINE, LILACS, CINAHL and EMBASE databases, from 20 July 2019 to 31 July 2019, using as descriptors: Central venous catheterization; Catheter obstruction and Oncology, in addition to the use of free terms: Catheter fully implanted and Neoplasia.Results: In total, 10 studies were selected and included. After the analysis, the following analysis categories emerged: Strategies for preventing obstruction in CVC-TI and Care established in clearing the CVC-TI; having as main subjects approached: the comparison between the effectiveness in the use of heparin and saline solution for maintenance and time interval between them; unblocking methods and permeability assessment of CVC-TI.Conclusion: Despite the emergence of new possible ways of preventing obstruction and care strategies for clearing CVC-TI, the literature does not have a consensus on the use of solutions with or without heparin and the time interval between maintenance for the effectiveness of the permeability of these devices in cancer patients. Objetivo: Analisar produções científicas que abordem a prevenção e estratégias de cuidado na obstrução de cateteres venosos centrais totalmente implantados em pacientes oncológicos.Material e Método: Trata-se de uma revisão integrativa da literatura, que ocorreu nas bases de dados MEDLINE, LILACS, CINAHL e EMBASE, no período 20 de Julho de 2019 a 31 de Julho de 2019, utilizando-se como descritores: Cateterismo venoso central; Obstrução de cateter e Oncologia, além do uso dos termos livres: Cateter totalmente implantado e Neoplasia.Resultados: Ao total, 10 estudos foram selecionados e incluídos. Após a análise, emergiram as seguintes categorias de análise: Estratégias de prevenção da obstrução em CVC-TI e Cuidados estabelecidos na desobstrução do CVC-TI; tendo então como principais assuntos abordados: a comparação entre a eficácia no uso da heparina e solução salina para manutenções e tempo de intervalo entre as mesmas; métodos de desobstrução e avaliação de permeabilidade dos CVC-TI.Conclusão: Apesar do surgimento de novas formas possíveis de prevenção de obstrução e estratégias de cuidado na desobstrução dos CVC-TI, a literatura não apresenta consenso sobre o uso de soluções com ou sem heparina e o tempo de intervalo entre as manutenções para a efetividade da permeabilidade desses dispositivos em pacientes oncológicos.

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Section: Cuidados Establecidos En La Desobstrucción Del Cvc-tiunclassified

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Estratégias de prevenção da obstrução em cateteres centrais totalmente implantados em pacientes oncológicos

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“…Recently, da Costa et al 15 have conducted a systematic review of the interventions used to treat obstructive events in long-term CVCs in cancer patients. They found drugs used to restoration of catheter function were urokinase (53.3%), alteplase (20%), tenecteplase (13.3%), reteplase (6.7%), recombinant urokinase (6.7%) and streptokinase (6.7%).…”

Section: Literature Reviewmentioning

confidence: 99%

Prospective Audit to Study urokinaSe use to restore Patency in Occluded centRal venous caTheters in haematology and oncology patients (PASSPORT 2)

et al. 2020

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Background: Central venous catheter dysfunction may be associated with intraluminal clots, drug precipitates and lipid residues or extra luminal causes such as fibroblastic sleeve, tip malposition, pinch-off syndrome and venous thrombosis at the tip of central venous catheter. Failure to restore patency after addressing these causes, empirical treatment with thrombolytic agents should be considered. Urokinase is used widely as a thrombolytic agent but very few outcome studies have been published. Methods: A multicentre group conducted a prospective audit of management of central venous catheter dysfunction after exclusion of common causes using in centre standardised doses of urokinase from September 2017 to February 2018 in haematology and oncology units. Data of catheter blood flow were collected anonymously following administration of 5000- to 25,000-IU urokinase in dysfunctional central venous catheter. Results: A total of 117 patients were recruited from eight centres, 54 females and 63 males, median age was 60 (46–68). In total, 53% presented as partial withdrawal occlusion and 47% total occlusion. In partial withdrawal occlusion, patency was restored in 80% of interventions, in 82% of interventions using push lock and in 76% using dwell lock. In total occlusion, patency was restored in 88% of the interventions. The central venous catheter clearance rate was dose dependent; patency was restored in 83% of central venous catheter with 5000 IU, 89% with 10,000 IU and 92% with high dose of 25,000 IU. No adverse events were recorded. Conclusion: In this study, treatment of dysfunctional central venous catheter using standardised urokinase doses was safe and effective in restoring patency when no other mechanical causes could account for central venous catheter dysfunction.

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Venöse Zugänge in der Onkologie

Behlendorf¹,

Wit²

2020

Springer Reference Medizin

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Interventions to obstructive long-term central venous catheter in cancer patients: a meta-analysis

Cited by 16 publications

References 31 publications

Estratégias de prevenção da obstrução em cateteres centrais totalmente implantados em pacientes oncológicos

Estratégias de prevenção da obstrução em cateteres centrais totalmente implantados em pacientes oncológicos

Prospective Audit to Study urokinaSe use to restore Patency in Occluded centRal venous caTheters in haematology and oncology patients (PASSPORT 2)

Venöse Zugänge in der Onkologie

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