Randomized Trial of Prevention of Catheter-Related Bloodstream Infection by Continuous Infusion of Low-Dose Unfractionated Heparin in Patients With Hematologic and Oncologic Disease
ABSTRACT Infection is a serious complication of central venous catheters in immunocompromised patients. Catheter-related infection may be caused by fibrin deposition associated with catheters. Interventions designed to decrease fibrin deposition have the potential to reduce catheter-related infections. The purpose of this study was to evaluate the role of low-dose unfractionated heparin in preventing catheter-related bloodstream infection in patients with hemato-oncological disease.
This study was a randomized, controlled trial in which patients with nontunneled catheters were randomly assigned to receive either intravenous unfractionated heparin (continuous infusion of 100 U/kg per day) or 50 mL/day of normal saline solution as a continuous infusion (control group). Heparin was continued until the day of discharge. Catheter-related bloodstream infection was defined according to Infectious Disease Society of America guidelines.
Two hundred and eight patients were randomly assigned. Four patients were excluded after assignment. Ultimately, 204 patients were analyzed. Catheter-related bloodstream infection occurred in 6.8% (7 of 102 catheters) of those in the heparin group (2.5 events per 1,000 days) and in 16.6% (17 of 102 catheters) of those in the control group (6.4 events per 1,000 days) (P = .03). No other risk factors were found for the development of catheter-related bloodstream infection. Four and five patients experienced severe bleeding in the heparin and control groups, respectively (P = .2). We did not observe heparin-induced thrombocytopenia.
The use of continuous infusion of low-dose unfractionated heparin (100 U/kg per day) can be a practical and economical approach to the prevention of catheter-related bloodstream infection in patients with hemato-oncological disease.
- SourceAvailable from: Adriano Venditti
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- "Therefore we have hypothesized that LMWH prophylaxis during CVC insertion and removal could be a reasonable option to prevent CRT. In randomized studies , the use of a continuous infusion of low-dose unfractionated heparin (100 U/Kg per day) was able to decrease the rate of CVC bloodstream infection and CRT in patients with hematological malignancies . In our experience the adjunct of an unconventional dose of LMWH for 7 days after CVC insertion and removal did not reduce the risk of CRT. "
ABSTRACT: Central venous catheters (CVC) related thrombosis (CRT) represents a well known complication in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy but the efficacy of antithrombotic prophylaxis still remains controversial. We analyzed 71 consecutive AML patients whose CVC was inserted before each chemotherapy cycle for an overall number of 106 CVC placements. In 47/106 insertions, a prophylaxis with 100IU/kg/day low molecular weight heparin (LMWH) was administered for 7days after CVC insertion and additional 7 after CVC removal. This unconventional dose of LMWH, although higher than usual, appeared adequate for a short-course approach. LMWH was delivered regardless of the platelet (PLT) count once provided that it should have been maintained above 20x10(9)/L by transfusions. Of 106 insertions, we observed 19 (18%) episodes of CRT, 58 (54%) of sepsis and 50 (47%) infections of CVC-exit site with no difference between LMWH and no-LMWH group. Occurrence of CRT was significantly associated with CVC-exit site infections (14/19, p=0.01) and sepsis (16/19, p=0.005) with no difference between LMWH and no-LMWH group. In multivariate analysis, both CVC-exit site infections and sepsis were confirmed to be independent risk factors for CRT development. Our retrospective study, although based on a small sample size, suggests that the occurrence of CVC-exit site infections and neutropenic sepsis following chemotherapy significantly increases the risk of CRT in AML, independently from the use of LMWH prophylaxis.Thrombosis Research 08/2013; 132(5). DOI:10.1016/j.thromres.2013.08.007 · 2.43 Impact Factor
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ABSTRACT: L’infection liée aux cathéters veineux centraux, événement grave en grande partie évitable, est la principale cause de bactériémie nosocomiale. Les bactériémies associées aux cathéters et liées aux cathéters doivent être bien distinguées. En l’absence de signes locaux patents, de sepsis sévère, d’immunodépression ou de matériel prothétique en place, la réalisation d’hémocultures qualitatives comparatives par le cathéter et en périphérie peut faire le diagnostic d’implication du cathéter sans obliger à son ablation. Des taux de bactériémies liées aux cathéters (définition du consensus français) supérieurs à 1 pour 1000 journéescathéters doivent être considérés comme inacceptables. La mise en place d’un programme de prévention en réanimation est réalisable et le plus souvent efficace pour faire diminuer les taux d’infections, motiver et restructurer les équipes de soins. Si les taux d’infections sont élevés, la mise en place de mesures simples (renforcement de l’hygiène des mains, asepsie chirurgicale à la pose, solutions antiseptiques contenant de l’alcool, voie sous-clavière préférentielle, procédure d’entretien des cathéters et des lignes de perfusion, réfection immédiate des pansements souillés ou décollés, ablation des cathéters inutiles) et adaptées au mode de fonctionnement du service sont efficaces. Une gouvernance claire et une rétroinformation sont indispensables au succès de ces programmes d’amélioration de la qualité des soins. Si les taux restent élevés, ou si l’on veut aller plus loin, les pansements imprégnés de chlorhexidine permettent de diminuer encore le risque d’infection. L’utilisation des cathéters imprégnés d’agents antimicrobiens doit être limitée aux situations d’échec de la politique globale de prévention.Réanimation 07/2013; 22(4). DOI:10.1007/s13546-013-0685-8
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ABSTRACT: Bioassays involve multi-stage sample processing and fluidic handling, which are generally labor-intensive and time-consuming. Using microfluidic technology to integrate and automate all these steps in a single chip device is highly desirable in many practical applications such as clinical diagnostic and in-field environmental testing. We have developed self-contained and fully integrated biochip systems for immunoassay and DNA analysis. These microfluidic biochip devices can perform detection of multiple bioagents (including antigens and DNA) using electrochemical detection methods. Microfluidic mixer, valves, pumps, channels, chambers, and Combimatrix microelectrode array are integrated to perform parallel immunoassays to detect infectious particles (viruses and bacteria) from complex biological samples in a single, fully automated biochip device. All microfluidic components use very simple and inexpensive approaches in order to reduce chip complexity. Back-end detection is accomplished using an enzyme-based electrochemical detection method that has many advantages including high sensitivity ( approximately fM) and simple apparatus. The sensor is a miniaturized array of individually addressable microelectrodes controlled by active CMOS circuitry. Pathogenic bacteria and DNA detections are both demonstrated. The devices with capabilities of on-chip sample processing and detection provide a cost-effective solution to direct sample-to-answer biological analysis for point-of-care genetic analysis, disease diagnosis, and in-field bio-threat detection.Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 02/2004; 7:5394. DOI:10.1109/IEMBS.2004.1404507