References:
General Hematology/Oncology
- Böll, B et al. Central Venous Catheter-Related Infections in Hematology and Oncology: 2020 Updated Guidelines on Diagnosis, Management, and Prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) Ann Hematol 2021
- Guidelines developed by a multi-disciplinary panel of 20 experts. Guidelines address definition, diagnosis, management, and prevention of central venous catheter-related infections.
- daCosta ACC. et al. Interventions to Obstructive Long-Term Central Venous Catheter in Cancer Patients: A Meta-Analysis. Support Care Cancer 2019.
- A systematic review and meta-analysis of 15 observational studies and clinical trials evaluating the drugs used to treat obstructive catheter events in cancer patients. The most common interventions used to treat thrombotic catheter occlusion in cancer patients were urokinase and alteplase. No evidence was found about the treatment for non-thrombotic occlusion.
- Farge, D et al. 2019 International Clinical Practice Guidelines For the Treatment and Prophylaxis of Venous Thromboembolism in Patients with Cancer. Lancet Oncol 2019.
- These guidelines were developed by The International Initiative on Thrombosis and Cancer, an independent academic working group aimed at establishing a global consensus for the treatment and prophylaxis of VTE in patients with cancer.
- Jiang, M. et al. Risk of Venous Thromboembolism Associated with Totally Implantable Venous Access Ports in Cancer Patients: A Systematic Review and Meta-Analysis. J Thromb Haemost 2020.
- A systematic review and meta-analysis of 80 studies with 39,148 patients with a totally implantable venous access port (TIVAP) being used for chemotherapy. Current evidence suggests that patients with cancer with TIVAP are less likely to develop VTE compared with external CVCs. This should be considered when choosing the indwelling intravenous device for chemotherapy. However, more attention should be paid when choosing upper-extremity veins as the insertion site.
- Jones, M. et al. Catheter Associated Bloodstream Infection in Patients with Cancer: Comparison of Left- and Right-Sided Insertions. J Hosp Infect 2021.
- Exploratory randomized control trial of 634 CVADs placed in patients aged >14 years with cancer. There were 141 CABSIs; analysis showed strong evidence of right-side allocated insertions having an increased risk of early infection by 2.5 times (95% confidence interval (CI): 1.3-4.7); however, there was no evidence of increased risk for late infection (hazard ratio: 1.06; 95% CI: 0.71-1.59).
- Lafuente Cabrero, E. et al. Risk Factors of Catheter-Associated Bloodstream Infection: Systematic Review and Meta-Analysis. PloS One 2023.
- A systematic review and meta-analysis of 23 studies (17 were included in the meta-analysis) that assessed the risk factors predisposing patients to CLABSI. The risk factors found to increase the probability of developing CLABSI were TPN (total parenteral nutrition), multi-lumen devices, chemotherapy treatment, immunosuppression, and the number of days of catheterization. Single lumen devices presented a lower likelihood of triggering CLABSI.
- Lv, Y. et al. Risk Associated With Central Catheters for Malignant Tumor Patients: A Systematic Review and Meta-Analysis. Oncotarget 2018.
- A systematic review and meta-analysis of patients with PICCs and central catheters for malignant tumors, which found that PICCs are associated with a raised risk of deep vein thrombosis (DVT), and pharmacological DVT prophylaxis drugs are a beneficial factor in decreasing the incidence of thrombosis, while warfarin may decrease the risk of mortality of malignant tumor patients with central catheters.
- Shengmiao, M. et al. Clinical Factors of PICC-RVT in Cancer Patients: A Meta-Analysis. Support Care Cancer 2023.
- A systematic review and meta-analysis of 19,824 patients in 19 articles. Patients included in this study had cancer and an indwelling PICC. This study systematically evaluated the clinical factors of catheter-related venous thrombosis in cancer patients with indwelling PICC, and the results showed that history of chemotherapy, tumor type, tumor stage, metastasis, use of fluorouracil, etoposide, platinum drugs, and taxane were risk factors for PICC-related catheter thrombosis in these patients. These patients should be monitored with greater care. Radiotherapy cannot be considered to be related to the formation of PICC-RVT (related venous thromboembolism).
- Wang, P. et al. Risk of VTE Associated with PORTs and PICCs in Cancer Patients: A Systematic Review and Meta-Analysis. Thromb Res 2022.
- This study included 22 studies with 11,940 adult patients with cancer. This study compared the rates of PORT-related VTE vs. PICC-related VTE. PORTs are associated with a lower risk of VTE than PICCs in cancer patients. The risk of VTE and benefits should be considered when selecting PORTs or PICCs for cancer patients.
- Wang, TF. et al. Management of Catheter-Related Upper Extremity Deep Vein Thrombosis in Patients with Cancer: A Systematic Review and Meta-Analysis. J Thromb Haemost 2024.
- This study evaluated 29 studies with 2,836 cancer patients. This study systematically evaluated the rates of recurrent VTE and bleeding in patients with cancer and catheter-related upper extremity DVT. The study reported a relatively low rate of recurrent VTE and moderate rate of major bleeding events within the first 3 months in these patients.
- Wu, S. et al. Comparison of Complications Between Peripheral Arm Ports and Central Chest Ports: A Meta-Analysis. J Adv Nurs 2018.
- A meta-analysis of 3,524 patients in 15 articles. Study systematically evaluated complications of arm ports compared with complications in chest ports in patients with cancer and found that arm ports are a safe option beside chest ports for adult patients with malignancy, especially in patients with head-neck cancer or breast cancer. Patients should be well informed of the advantages and disadvantages of different vascular access devices and provided a choice.
Solid Tumor Malignancy
- Capozzi, VA. et al. Peripherally Inserted Central Venous Catheters (PICC) versus totally implantable venous access device (PORT) for chemotherapy administration: A Meta-Analysis on Gynecological Cancer Patients. Acta Biomed 2021.
- A meta-analysis of observational studies in epidemiology (n = 1,320); 794 receiving PORTs and 526 receiving PICCs. PORTs had fewer thrombotic complications and fewer malfunction problems than PICC devices. Unless there are specific contraindications, PORTS can be preferred for systemic treatment in gynecological cancer patients.
- Meng, F. et al. Incidence and Risk Factors of PICC-Related Thrombosis in Breast Cancer: A Meta-Analysis. Jpn J Clin Oncol 2024.
- A meta-analysis of 15 articles involving 8,635 patients who underwent PICC placement for breast cancer. The incidence rate of PICC-related thrombosis in breast cancer patients was 7.0% (12.9% after correction for estimation of the specific number of missing studies). Body mass index ≥25, D-dimer >500 ng/ml, elevated fibrinogen, elevated platelet count, and catheter malposition were risk factors for PICC-related thrombosis in breast cancer patients.
- Taxbro, K. et al. Clinical Impact of Peripherally Inserted Central Catheters vs Implanted Port Catheters in Patients with Cancer: An Open-Label, Randomised Two-Centre Trial. Br J Anaesth 2019.
- This randomized clinical trial evaluated the incidence of catheter-related deep venous thrombosis in 399 adult patients with cancer receiving chemotherapy through either a PICC or a PORT. PICCs are associated with higher risk for catheter-related deep venous thrombosis and other adverse events when compared with PORTs. This increased risk should be considered when choosing a vascular access device for chemotherapy, especially in patients with solid malignancy.