Comparison of outcomes of central venous catheters in patients with solid and hematologic neoplasms: an Italian real-world analysis.

INTRODUCTION: Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other. METHODS: We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs). RESULTS: A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; p = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs (p = 0.013). No significant differences in terms of catheter-related thromboses (p = 0.676) or catheter-related infections (p = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort (p = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128-0.536; p < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018-0.372; p < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135-0.553; p < 0.0001). CONCLUSIONS: This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk-benefit assessment, patient preferences, and compliance.

Conhecimento de pacientes onco-hematológicos emtratamento quimioterápico sobre os cuidados para prevenção de infecções / Knowledge of oncohematologic patients on chemotherapy regarding carefor the prevention of infections

Introdução: As doenças onco-hematológicas e sua terapêuticaatingem a medula óssea provocando muitas vezes um estado depancitopenia, especialmente uma redução granulocítica, o que expõeo paciente a um risco aumentado de desenvolver infecções. Aorientação do doente e da família é fundamental para minimizarcomplicações e permitir uma atuação precoce da equipe de saúde.Objetivo: Identificar o conhecimento dos pacientes onco-hematológicosem tratamento quimioterápico internados na Unidadede Hematologia do Hospital de Base do Distrito Federal acerca doscuidados para prevenção de infecção.Métodos: Pesquisa descritiva, de abordagem quali-quantitativa,realizada de setembro a outubro de 2012 através de entrevista, seguindoroteiro semi-estruturado, com pacientes onco-hematológicosinternados em vigência de tratamento quimioterápico e em programade alta hospitalar. As variáveis sociodemográficas e clínicasforam demonstradas através de análise estatística. Análise qualitativados discursos se deu através da análise temática.Resultados: Dos 15 sujeitos entrevistados 8 (53,3%) eram mulherese 7 (46,7%) homens com média de idade de 47 anos (DP=17,1). Odiagnóstico prevalente foi o das leucemias agudas (60%). Apenas5 pacientes referiram já terem sido orientados por profissionais desaúde acerca dos cuidados para prevenção de infecções. Das entrevistasemergiram três categorias: 1) Cuidados para prevenção deinfecção; 2) Causas da suscetibilidade a infecções e 3) Conceitosimprecisos.Conclusão: Em sua maioria, os pacientes onco-hematológicos nãopossuem informações adequadas e suficientes acerca dos cuidadosnecessários para prevenção de infecções, bem como acerca dosmotivos que os deixam mais expostos a essa complicação.

Introduction: Oncohematologic diseases and their therapeuticsmay harm the bone marrow, causing pancytopenia, especially disgranulopoiesis,which exposes the patient to a higher risk of infections.The patient’s and their family’s education is essential to minimizecomplications and to enable the health care staff to act timely.Objectives: To identify the knowledge of oncohematologic patientson chemotherapy staying at the Hematology Unit at Hospitalde Base, in the Brazilian Federal District, regarding the necessarycare for the prevention of infections.Methods: A descriptive study was conducted from Septemberto October, 2012 which was based on a mixed-method approach.Semi-structured interviews were conducted with oncohematologicpatients on chemotherapy and on hospital release programs. Sociodemographicand clinic variables were presented through statisticalanalysis. The qualitative analysis of the discourses was madethrough a thematic analysis.Results: Among the 15 subjects, 8 (53,3%) were women and 7(46,7%) were men averagely aged 47 (DP=17,1). The prevalent diagnosiswas acute leukemia (60%). Only 5 patients reported havingbeen instructed by health professionals. The interviews made itpossible to define three categories: 1) care for the prevention of infections;2) causes of the susceptibility to infections; and 3) impreciseconcepts.Conclusion: Most of the oncohematologic patients are not adequatelyinformed about the necessary care for the prevention of infections,as well as the reasons that make them more susceptible to thiscomplication.