The use of short-term central venous catheters for optimizing continuous infusion of coagulation factor concentrate in haemophilia patients undergoing major surgical procedures

Haemophilia ◽  
2015 ◽  
Vol 21 (5) ◽  
pp. e364-e368 ◽  
Author(s):  
A. Boban ◽  
C. Lambert ◽  
C. Hermans
Keyword(s):  
Continuous Infusion ◽  
Surgical Procedures ◽  
Coagulation Factor ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Short Term ◽  
Factor Concentrate

The Use of Temporary Central Venous Catheters for Optimizing Continuous Infusion in Hemophilia Patients Undergoing Major Surgical Procedures

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2822-2822
Author(s):  
Ana Boban ◽  
Catherine M Lambert ◽  
Cedric R. Hermans
Keyword(s):  
Continuous Infusion ◽  
Surgical Procedures ◽  
Jugular Vein ◽  
Central Venous Catheters ◽  
Clotting Factor ◽  
Major Surgery ◽  
Peripheral Vein ◽  
Central Venous ◽  
Short Term ◽  
Factor Concentrate

Abstract Introduction: Continuous infusion (CI) of clotting factor concentrate has facilitated surgical procedures and intensive replacement therapy in hemophilia patients. The advantage of CI over bolus infusions is ability to maintain steady-state levels of coagulation factors and moreover, to reduce the total amount of factor concentrate spent. CI is commonly delivered through a peripheral vein. However, a significant number of hemophilia patients have distorted peripheral veins which can compromise continuous flow of factor concentrate needed for successful treatment. Also, thrombophlebitis at the site of venous access, an adverse effect of CI previously reported, can further impair the delivery of factor concentrate in CI and make the future use of the vein for concentrate administration impossible or difficult. Use of central venous catheter can ease the application of CI. By searching the literature, we found only a few case reports describing the use of temporary non-tunneled central venous catheters (CVC) for administrating CI in patients with hemophilia. The aim of this study was to evaluate the efficacy and safety of short-term used non-tunneled CVC for CI during surgical procedures in hemophilia patients. Methods: In this study we have retrospectively studied patients with hemophilia that had temporarily used non-tunneled CVC for CI of factor concentrate during and after major surgery in the Saint-Luc University Hospital in Brussels between August 2000 and April 2014. The indication for CVC usage was a major surgery with anticipated need for CI of factor concentrate longer than 5 days. CVC was inserted by an experienced anesthesiologist in the operating room after the induction of general anesthesia and normalization of APTT. Before the CVC insertion, the patient would have already received bolus of clotting factor concentrate and have the CI started through the peripheral vein. Upon placement, the CI was switched to the CVC. The CVC was kept in place until leaving hospital or cessation of the need for continuous infusion. Results: During the study period, 40 male patients with hemophilia A or B (37 and 3 patients, respectively) underwent 67 major surgical procedures covered by CI of factor concentrate delivered through CVC. Patients, age 21 -81, had severe, mild or moderate disease (33, 5 and 2 patients, respectively). Patients had altogether 65 CVC for 67 surgical procedures. The same catheter was used for 3 surgeries and 16 patients had CVC placed more than once; 14 patients twice, one patient three times and one ten times. Patients underwent orthopedic surgery (79%), gastrointestinal surgery (15%) and cardiovascular surgery (5%) while one patient (1%) had surgery of urinary tract. The CVC were placed in the right jugular vein (58%), the left jugular vein (18%), the left subclavian vein (8%) and right subclavian vein (3%), while the data were missing in 6 patients. Median duration of catheter was 12 days, with range from 5 to 107 days. No CVC was removed prematurely and no malfunctions of catheters were recorded. Moreover, no complications related to the CVC were noted whatsoever. We searched for bleeding at the site of puncture of the catheter, signs of local infection, pneumothorax following placement of CVC, catheter thrombosis, malfunction of the catheter and surgical site infection. Finally, most of the patients reported satisfaction related to the use of CVC for CI of factor concentrate. Conclusions: Based on results of this study, we can conclude that the use of short-term non-tunneled CVC should be considered in patients with hemophilia undergoing major surgery with the need for prolonged CI of factor concentrates. By placing CVC we can ensure undisturbed flow of factor concentrate during CI and preserve peripheral veins for the future concentrate administration. Disclosures No relevant conflicts of interest to declare.

Tunneling short-term central venous catheters to prevent catheter-related infection

1998 ◽  
Vol 26 (8) ◽  
pp. 1452-1457 ◽  
Author(s):  
Adrienne G. Randolph ◽  
Deborah J. Cook ◽  
Calle A. Gonzales ◽  
Christian Brun-Buisson
Keyword(s):  
Central Venous Catheters ◽  
Central Venous ◽  
Short Term ◽  
Catheter Related Infection

Thrombotic complications in patients with hereditary bleeding disorders

2004 ◽  
Vol 92 (08) ◽  
pp. 298-304 ◽  
Author(s):  
Massimo Franchini
Keyword(s):  
Risk Factors ◽  
Gene Mutations ◽  
Coagulation Factor ◽  
Venous Catheter ◽  
Bleeding Tendency ◽  
Bleeding Disorders ◽  
Central Venous ◽  
Prothrombotic Risk Factors ◽  
Thrombotic Complications ◽  
Factor Concentrate

SummaryThromboses in patients with hereditary bleeding disorders are uncommon. However, in some cases, the co-existence of prothrombotic risk factors may increase the likelihood of developing thrombotic complications in such patients. This review summarizes the cases of thrombosis reported in the literature and analyzes the most important risk factors for thrombosis in patients with a congenital bleeding tendency. In particular we focus on central venous catheter (CVC)-associated thrombosis, on the thrombotic complications of coagulation factor concentrate therapy and on the presence of prothrom-botic gene mutations. Data were identified by searches of the published literature, including PubMed, references from reviews and abstracts from the most important meetings on this topic. In conclusion, there is increasing evidence that thrombotic complications in patients with hereditary bleeding disorders have a multifactorial pathogenesis, depending on exogenous (coagulation factor replacement therapy, CVC, HIV infection) and/or endogenous (prothrombotic gene mutations) risk factors.

Clinical evaluation of a chlorhexidine intravascular catheter gel dressing on short-term central venous catheters

2016 ◽  
Vol 44 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Tarja J. Karpanen ◽  
Anna L. Casey ◽  
Tony Whitehouse ◽  
Peter Nightingale ◽  
Ira Das ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Central Venous Catheters ◽  
Intravascular Catheter ◽  
Central Venous ◽  
Short Term

scholarly journals Management of Perioperative Anticoagulation in Patients with VWD

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1100-1100
Author(s):  
Mario Von Depka ◽  
Carsten Detering ◽  
Stefanie Döpke ◽  
Mahnaz Ekhlasi-Hundrieser
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Surgical Procedures ◽  
Thrombotic Event ◽  
Coagulation Factor ◽  
Post Surgery ◽  
Thrombosis Risk ◽  
Perioperative Anticoagulation ◽  
Factor Concentrate ◽  
Von Willebrand

Abstract Objectives: von Willebrand disease (VWD) is the most common hereditary bleeding disorder. This study reviews the management of perioperative anticoagulation in patients with VWD undergoing surgical procedures. Risk factors for VTE with von Willebrand factor (VWF) concentrate use are older age, previous VTE, obesity, surgery, hormone replacement therapy use, antifibrinolytic therapy use and high post infusion FVIII levels. Currently, there are few data from randomized clinical trials assessing efficacy and possible complications of perioperative VTE prophylaxis in VWD patients. Methods: A total number of 116 surgeries were performed (minor: n=64 and major: n=52) in this retrospective, single-centre study. They were divided into groups of perioperative non-anticoagulation (n=54) and perioperative anticoagulation (n=62), who all received coagulation factor concentrate (CFC). Sub-analyses were done according to the type of concentrate used. Anticoagulation was performed using different low molecular weight heparins (LMWH) according to standard protocols or body-weight adapted doses in patients with either elevated body-mass-index or additional thrombosis risk factors. Blood samples had been collected pre- and post-surgery (up to 21 days) to analyse PT, aPTT, PFA, and trough levels of FVIII coagulant activity (FVIII:C), VWF activity (VWF:GPIbM) and antigen (VWF:Ag), respectively. Furthermore, the median doses of CFC/kg and the median total number of infusions were calculated. The rates of clinically overt thrombosis as well as bleeding were assessed during the post-operative phase. Results: The majority of patients suffered from VWD type 1 (104), 9 patients with type 2A, 2 with type 2M and 1 with type 3 VWD. Humate-P (H) was used in 55 patients and 61 patients received Wilate (W). Using W, we found parallel curves for FVIII:C, VWF-antigen and VWF:GPIbM, respectively. Using H, less concordance between VWF:Ag and VWF:GPIbM was visible and FVIII:C tends to increase between D3 to D10 in spite of decreasing VWF:Ag and VWF:GPIbM. This observation was visible in minor as well as major surgical procedures. LMWH (Enoxaparin, Nadroparin and Certaparin) were used in doses between 30 and 100 mg/injection (mean 46.0 ± 18.5 mg/injection) and a mean of 32.2 ± 24.6 injections in total (range: 8-112). In one patient a significant haematoma occurred (1/116; 0.9%), also one thrombotic event was documented in a different patient (1/116; 0.9%). Conclusion: Using standard dose LMWH in patients with no overt increased thrombosis risk as well as body-weight-adapted LMWH in high risk patients seem to be safe and effective in VWD patients receiving coagulation factor concentrate perioperatively. However, prospective randomized comparative studies are required to determine the optimal indication as well as type of anticoagulation according to the CFC treatment regimen in this setting. Disclosures No relevant conflicts of interest to declare.

scholarly journals Construction of a nursing care instrument for patients with central venous catheters

Rev Rene ◽  
2022 ◽  
Vol 23 ◽  
pp. e70967
Author(s):  
Stefhanie Conceição de Jesus ◽  
Kátia Cilene Godinho Bertoncello ◽  
Fernanda Alves Ferreira Gonçalves ◽  
Aline Daiane Colaço ◽  
Geline Nascente Soares Lentz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Care ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Short Term ◽  
Validity Index ◽  
Three Stages ◽  
The Moment ◽  
Final Composition

Objective: to build a nursing care instrument for patients with short-term central venous catheters in an Intensive Care Unit. Methods: a multi-method study in three stages: structuring of the instrument; pre-testing of the instrument; agreement analyses among nurses and final composition of the instrument. Results: the instrument, in its first version, presented three domains related to the moment of insertion (five items), maintenance (15 items) and catheter removal (ten items). Most of the 30 items were assessed as relevant (23/77%) and presented a satisfactory Content Validity Index (28/93%). Ten items were reformulated, 32 new items were included, and three items were deleted. Conclusion: the instrument was constructed, which presented response validity for the care of nurses to patients with central venous catheters in Intensive Care Units, consisting of three domains and 59 items evaluated by nurses and considered appropriate for the moments of insertion, maintenance and removal of the catheter.

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