Impact of the COVID-19 Lockdown on Physical Activity Levels and Health Parameters in Young Adults with Cancer.

The lockdown of the COVID-19 pandemic impacted physical activity (PA) levels around the world, affecting health parameters in young adults with cancer (YAC). To our knowledge, there is no evidence of the impact of the lockdown on the Spanish YAC. To analyse the changes in PA levels before, during, and after the lockdown of the YAC and its impact on health metrics in Spain, in this study, we utilized a self-reported web survey. PA levels decreased during the lockdown, and a significant increase in PA was observed after the lockdown. Moderate PA had the largest reduction (49%). Significant increases in moderate PA were noted after the lockdown (85.2%). Participants self-reported more than 9 h of sitting per day. HQoL and fatigue levels were significantly worse during the lockdown. The impact of the COVID-19 pandemic in this cohort of Spanish YAC showed a decrease in PA levels during the lockdown, affecting sedentarism, fatigue and HQoL. After lockdown, PA levels partially recovered, while HQoL and fatigue levels remained altered. This may have long-term physical effects such as cardiovascular comorbidities associated with sedentarism and psychosocial effects. It is necessary to implement strategies such as cardio-oncology rehabilitation (CORE), an intervention that can be delivered online, potentially improving participants' health behaviours and outcomes.

Evidence of exhausted lymphocytes after the third anti-SARS-CoV-2 vaccine dose in cancer patients.

Introduction: Evidence is scant regarding the long-term humoral and cellular responses Q7 triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in cancer patients after repeated booster doses. The possibility of T-cell exhaustion following these booster doses in this population has not yet been fully studied and remains uncertain. Methods: In this single-center prospective observational study, we explored the specific humoral and cellular response to S1 antigen in 36 patients with solid malignancies at baseline, and after the second and third doses of the mRNA-1273 vaccine. Results: A dual behavior was observed: 24 (66.7%) patients showed partial specific IFN-γ response after the second dose that was further enhanced after the third dose; and 11 (30.5%) already showed an optimal response after the second dose and experienced a marked fall-off of specific IFN-γ production after the third (4 patients negativization), which might suggest T cell exhaustion due to repetitive priming to the same antigen. One (2.8%) patient had persistently negative responses after all three doses. Seroconversion occurred in all patients after the second dose. We then studied circulating exhausted CD8+ T-cells in 4 patients from each of the two response patterns, those with increase and those with decrease in cellular response after the third booster. The patients with decreased cellular response after the booster had a higher expression of PD1+CD8+ and CD57+PD1+CD8+ exhausted T cells compared with those with an increased cellular response both in vivo and in vitro. The proportion of PD1+CD8+ and CD57+PD1+CD8+ exhausted T cells inversely correlated with IFN-γ production. Discussion: Our preliminary data show that the two-dose SARS-CoV-2 vaccine regimen was beneficial in all cancer patients of our study. An additional booster seems to be beneficial in suboptimal vaccine seroconverters, in contrast to maximal responders that might develop exhaustion. Our data should be interpreted with caution given the small sample size and highlight the urgent need to validate our results in other independent and larger cohorts. Altogether, our data support the relevance of immunological functional studies to personalize preventive and treatment decisions in cancer patients.

Beneficios, complicaciones y mantenimiento de los catéteres Midline / Benefits, complications and maintenance of Midline catheters

Actualmente, en terapia intravenosa se están buscando alternativas que resuelvan las necesidades de los pacientes minimizando los problemas secundarios asociados a la utilización de catéteres venosos. El catéter venoso medial o Midline (MC) se ha convertido en un dispositivo seguro y eficiente para la administración de tratamientos intravenosos, ya que cada vez existen materiales más vasocompatibles que permiten prolongar su utilización. Sin embargo, existen ciertas limitaciones para su uso con sustancias vesicantes e irritantes. Los catéteres Midline son catéteres periféricos largos que se insertan en venas periféricas del brazo, cuya punta queda situada a nivel axilar, siendo de uso inmediato. Para asegurar la longevidad y el correcto funcionamiento de estos dispositivos, los profesionales enfermeros se deben formar en los cuidados de los sistemas, siendo conscientes de que muchos de los problemas potenciales desaparecerán con la correcta aplicación de protocolos

In the area of intravenous therapy, alternatives are being currently sought in order to cover the needs of patients, reducing as much as possible any secondary problems associated with the use of venous catheters. The medial or Midline Venous Catheter (MC) has become a safe and efficient device for the administration of intravenous treatment, as there are increasingly more vessel-compatible materials, which allow to prolong their use. However, there are certain limitations for their use with vesicant and irritant substances. These are long peripheral catheters which are inserted in peripheral arm veins: their tip remains lodged at axillary level, and their use is immediate. In order to ensure the long duration and adequate performance of these devices, nursing professionals must receive training in system care, and be aware that many potential problems will disappear with the correct implementation of protocols

[Medial venous catheter or midline (MVC)]. / Catéter venoso medial o midline (MVC).

Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters. Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Midlines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the necessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Midlines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In general, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings. Midlines have been associated with lower rates of phlebitis than short peripheral IVs, and less infections in contrast to central lines. There are different implantation techniques, which have evolved in terms of materials (silicone and polyurethane) and technological advances (ultrasound): Seldinger technique with micropuncture and Ultrasound-guided Seldinger technique. At present where scientific evidence, clinical needs, efficiency and costs are influential parameters, Midlines should be considered as an alternative peripheral venous access. Unlike PICC lines, Midline catheters offer peripheral, not central venous access. Midlines should be considered early in treatment instead of serial short peripheral IVs. These devices permit the infusion of most or all infusates that are appropriate for short peripheral IVs with the added advantage that Midlines can last much longer; at least six weeks and perhaps for months.

Catéter venoso medial o midline (mvc) / Medial venous catheter or midline (mvc)

La práctica clínica actual se caracteriza por la importancia de la calidad de vida del paciente y que reduzcan los costes de su tratamiento. Se buscan alternativas de terapia intravenosa que satisfagan las necesidades del paciente y reducir las complicaciones asociadas con el uso de catéteres venosos. La evidencia científica muestra que existen catéteres venosos de la línea media (MVC) que ofrecen a los pacientes y a los profesionales la posibilidad de ampliar la duración de la terapia de infusión, usando materiales de compatibilidad más seguros y con menos riesgo de infección. Las líneas medias se están convirtiendo en un dispositivo seguro y eficiente para la terapia intravenosa tanto en infusión continua como intermitente, siempre y cuando se les preste la atención necesaria por parte de unos cuidados enfermeros expertos. Los catéteres de longitud media son dispositivos de acceso venoso periférico de entre 3 y 10 pulgadas de longitud (de 8 a 25 cm). Se colocan generalmente en la vena braquial o cefálica del brazo, y el extremo distal termina por debajo del nivel de la línea axilar. Los catéteres de líneas medias (MVC) implantados en las venas basílica o cefálica profundas obtienen un mayor flujo de sangre. Este volumen sanguíneo grande justifica el menor riesgo de flebitis mecánica o química. Las líneas medias se utilizan habitualmente de dos a seis semanas. Debido a que el extremo distal de estos catéteres no se extiende más allá de la línea axilar, existen limitaciones para su uso: tipo de medicamentos infundidos, velocidad de infusión, etc. En general, las soluciones que tienen un pH de 5 a 9, o una osmolaridad de menos de 500 mOsm, son apropiados para la infusión a través de una línea media [13]. Se recomienda su uso en caso de tratamientos durante 7 días con fluidos de capacidad irritante baja. De acuerdo con los estándares de práctica de la Infusion Nurses Society, estos catéteres son adecuados para infundir líquidos por vía intravenosa que normalmente se administran a través de un catéter corto de infusión periférica. Es importante destacar que, debido a que el catéter no pasa por las venas centrales, las líneas medias se pueden colocar sin una radiografía de tórax que confirme la colocación. Para ciertas situaciones, los catéteres de línea media proporcionan un acceso venoso estable, una alternativa a los dispositivos a largo plazo como los PICC, incluso en el domicilio. Son también apropiados para las unidades agudas. Las líneas medias se han asociado con tasas más bajas de flebitis que las intravenosas periféricas cortas, y con menos infecciones en contraposición a las líneas centrales. Hay diferentes técnicas de implantación, que han evolucionado en los aspectos de materiales (silicona y poliuretano) y de avances tecnológicos (ultrasonido): técnica de Seldinger con micropunción y técnica de Seldinger guiada por ultrasonido. En la actualidad, donde la evidencia científica, las necesidades clínicas, la eficiencia y los costes son parámetros influyentes, el MVC debe ser considerado como un acceso venoso periférico alternativo. A diferencia de las líneas PICC, los catéteres de línea media ofrecen acceso venoso periférico, no central. La utilización del catéter venoso medial debe ser considerada al principio del tratamiento en sustitución de las vías intravenosas periféricas cortas de serie. Estos dispositivos permiten la infusión de la mayoría o de todas las infusiones que son apropiadas para vías intravenosas periféricas cortas, con la ventaja añadida de que la línea de pliegue medio puede durar mucho más, por lo menos seis semanas (AU)

Current clinical practice is characterised for importance of the patient's quality of life and the need to reduce the costs of their treatment. We search intravenous therapy alternatives that meet the needs of the patient, reducing the complications associated with the use of venous catheters.Scientific evidence shows that there are midline venous catheters that offer patients and professionals the possibility of extending the duration of infusion therapy, using more venous compatibility materials, and with less risk of infection. The Mid-lines are becoming in a safe an efficient device for intravenous therapy, continuous and intermittent infusion, provided the ne-cessary care by expert nurses. Midline catheters are peripheral venous access devices between 3 to 10 inches in length (8 to 25 cm). Midlines are usually placed in an upper arm vein, such as the brachial or cephalic, and the distal extreme ends below the level of the axillary line. Mid-lines catheters implanted in the cephalic or deep basilica veins get more blood flow. This large blood volume justifies the lower risk of mechanical or chemical phlebitis. Midlines are routinely used for two to six weeks. Due that the extrem of these catheters does not extend beyond the axillary line, there are limitations for its use: type of infused drugs, velocity of infusion, etc. In ge-neral, solutions that have pH 5 to 9, or an osmolarity less than 500 mOsm are appropriate for infusion through a Midline [13]. Its use is recommended in case of treatments over 7 days with low irritant capacity fluids. According to the Infusion Nurses Society's standards of practice, Midline catheters are appropriate for all intravenous fluids that would normally be administered through a short peripheral IV. Importantly, due that the catheter does not pass through the central veins, Midlines can be placed without a chest X-ray to confirm placement. For certain situations, Midlines are suitable for acute units and even for care home settings. Midlines have been associated with lower rates of phlebitis than short peripheral IVs, and less infections in contrast to cen-tral lines. There are different implantation techniques, which have evolved in terms of materials (silicone and polyurethane) and technological advances (ultrasound): Seldinger technique with micropuncture and Ultrasound-guided Seldinger technique.At present where scientific evidence, clinical needs, efficiency and costs are influential parameters, Midlines should be consi-dered as an alternative peripheral venous access. Unlike PICC lines, Midline catheters offer peripheral, not central venous access. Midlines should be considered early in treatment instead of serial short peripheral IVs. These devices permit the infusion of most or all infusates that are appropriate for short peripheral IVs with the added advantage that Midlines can last much longer; at least six weeks and perhaps for months

Venous International Assessment, VIA scale, validated classification procedure for the peripheral venous system.

PURPOSE: VIA scale is a dynamic performance status tool of the peripheral venous system that is divided into five different grades, composed of three parameters: number of observable puncture points; optimal catheter size for cannulation and ease of performing venipuncture and risk of extravasation. METHODS: Prospective single-center, observational, open, non-randomized study divided into two phases. In the first longitudinal phase, we studied the clinical characteristics and the changes in their peripheral venous systems during intravenous chemotherapy for 16 patients (n=16) for an average period of 24 months. In the second transverse phase, we measured the vein's diameter at the selected puncture points with a high-resolution ultrasound and paired this figure with VIA scale. We selected a group of oncology patients (n=52) and a control group (n=56). RESULTS: In the first phase, the level of agreement between the three reviewers was excellent. The second step was to assess the relationship between the measurements obtained with ultrasound and the VIA scale. The vein diameter measurements show a decrease directly related to the assessment of observers in the VIA scale. CONCLUSIONS: The VIA scale is a simple, easy and practical method for classification of the peripheral venous system in terms of vascular access. The practical application of our VIA scale significantly increases the quality of life of patients by increasing the chances of successful venipuncture and cannulation and thus reducing the risk of extravasation and material costs, allowing both an economical and a safe venous assessment tool.

Heparinización versus salinización en catéteres periféricos cortos para extracciones de sangre en ensayos clínicos / Heparinization versus salinization in short peripheral catheters for blood draws in clinical trials

Objetivo: explorar si el comportamiento dinámico del torrente venoso es adecuado, siendo la prioridad el reflujo venoso, tras realizar repetidas extracciones de sangre en el marco de un ensayo clínico, a fin de poder realizar una extracción que se considere limpia y de calidad para las determinaciones posteriores. Método: la población estuvo constituida por pacientes con cáncer de ovario, glioblastoma cerebral y cáncer de mama localmente avanzado, con tratamiento en el marco de ensayos clínicos Fase I, donde el sistema venoso periférico no está previamente tratado ni dañado. Se estudiaron 83 puntos de extracción, dentro de las primeras24 horas de la colocación del catéter, eliminando del estudio el primer punto de punción, donde no hay conservación previa. Resultados: en relación a la facilidad para el reflujo, la vía heparinizada refluye fácilmente en un 82,9% de los casos, con dificultad en un 14,6% y no refluye en un 2,4% de los casos. En las vías salinizadas, refluye fácilmente en un 39,5% de los casos, con dificultad en un 55,8% y no refluye en un 4,7%. Referente a la calidad de la muestra extraída, medida a través de la hemólisis de la misma, en las vías mantenidas con suero heparinizado, se observa que las muestras se hemolizan en un 19,5% de los casos, y en las vías mantenidas con suero salino las muestras se hemolizan en un 39,5%.Conclusiones: la heparina sódica a baja concentración (20 UI/ml) en comparación con suero salino, disminuye los problemas asociados al reflujo del catéter, incrementando el número de catéteres periféricos que refluyen sin dificultad a la vez que disminuye el grado de hemólisis de la muestra, si bien hay que tener en cuenta que las vías no permanecen en las mismas condiciones que al principio pasadas las primeras horas de su canalización aunque se mantienen un período muy corto de tiempo, máximo 24 horas (AU)

Objective: to explore whether the dynamic behavior of the venous blood stream is suitable, with the priority being the venous reflux, following repeated blood draws as part of a clinical trial, in order to perform an extraction we consider to be clean and of quality for subsequent determinations. Method: the population consisted of patients with ovarian cancer, brain glioblastoma and locally advanced breast cancer, with treatment as part of Phase I clinical trials, where the peripheral venous systemis not pre-treated or damaged. 83 extraction sites were studied, within the first 24 hours of catheter insertion, eliminating from the study the first puncture site, where there is no prior preservation. Results: regarding the ease of reflux, the heparinised route refluxed more easily in 82,9% of cases, with difficulty in 14,6% of cases, and did not reflux in 2,4% of cases. In salinized routes, it refluxed easily in 39,5% of cases, with difficulty in 55,8% of cases, and did not refluxin 4,7% of cases. Concerning the quality of the extracted sample, as measured by the hemolysis of the sample, from the routes maintained with heparinized saline solution, samples lysed in 19,5%of cases, and in routes maintained with saline solution, samples lysed in 39,5% of cases. Conclusions: at low concentrations, sodium heparin (20 IU/ml) compared with saline solution reduces the problems associated with catheter reflux, increasing the number of peripheral catheters that refluxed easily while decreasing the degree of hemolysis of the sample. However, it should be noted that the routes do not remain in the same conditions as in the beginning past the first hours of canalization although they are maintained for a very short period of time, maxi -mum 24 hours (AU)