Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care ...Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcutaneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235 - 627) and 563 (95% confidence interval, 368 - 728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.展开更多
BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are ...BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.展开更多
Objectives:To assess whether the extension of the flushing interval will increase risks of complications associated with totally implantable venous access port(TIVAP)in the off-treatment period.Methods:A retrospective...Objectives:To assess whether the extension of the flushing interval will increase risks of complications associated with totally implantable venous access port(TIVAP)in the off-treatment period.Methods:A retrospective single-center observational study was performed.Patients with a TIVAP in the off-treatment period that underwent regular flushing in our clinic were included.Data concerning patients and their TIVAPs were recorded.Patient baseline characteristics and TIVAP-related complications were analyzed.Continuous variables were analyzed by ANOVA or the Kruskal-Wallis H test.To compare the occurrence of TIVAP-related complications,the chi-square test was used;if needed,Fisher’s exact test was used.Results:Totally 607 patients were reviewed,and 563 patients were finally included.Thirteen complications were recorded,including 11 cases of catheter occlusion(1.95%),one case of port cannula rotation(0.18%),and one case of catheter tip malposition(0.18%).No device-related infection or venous thrombosis was recorded.Among these patients,the average flushing interval was 35.27±13.09 days.Patients were divided into three groups according to the flushing interval:every 28 days or less(Group 1,n=133);every 29-44 days(Group 2,n=350);and every 45 days or more(Group 3,n=80).No significant difference in catheter-related complications was found among the three groups(P>0.05).Conclusions:In the TIVAP off-treatment period,patients without any history of TIVAP-related complications during approximately one year can attempt to prolong the flushing interval to more than 4 weeks;we further suggest that 5-6 weeks may be an appropriate option for these patients.展开更多
BACKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(CVC) placement is with plain ? lm chest radiography(CXR). We hypothesized that a simple point-of-care ultrasound...BACKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(CVC) placement is with plain ? lm chest radiography(CXR). We hypothesized that a simple point-of-care ultrasound(POCUS) protocol could effectively con? rm placement and reduce time to con? rmation.METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8%(95%CI 77.1%–93.5%) and speci? city of 100%(95%CI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes(IQR 10–29) and 32 minutes(IQR 19–45), respectively.CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a con? rmatory CXR.展开更多
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.展开更多
Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically...Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.展开更多
Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous ac...Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous access ports without guidance in lung cancer patients. Methods: We conducted a retrospective review of total 163 lung cancer patients who underwent implantations of a central venous access port for chemotherapy. 95 patients received the ports by the femoral vein blind-puncture technique and 68patients had the port implanted via the subclavian vein blind-puncture technique. The initial success rate of port implantation and the frequency of occurrence of complications were calculated. Results: The primary success rate of venous port implantation was 93.7% for femoral approach and 88.2% for the subclavian approach respectively (p < 0.05). Intraoperative complications developed in two patients (2.1%) in the femoral approach group and in five patients (7.4%) in the subclavian approach group. Although a higher intraoperative complication ratio for the subclavian approach was encountered compared to that for the femoral vein approach, there was no statistically significant difference (p = 0.103). Nor was there any statistically significant difference in terms of the occurrence of late complications. Conclusions: Venous access port implantation via the femoral vein approach is safe, and its success rate is very high, with the equal complication rates comparable to the subclavian approach. This approach avoids many of the intraoperative complications. Thus, the femoral vein approach for implanting a venous access port in lung cancer patients should be considered a valid, and safe technique.展开更多
Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rat...Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.展开更多
It is not more and more, easy to satisfy the important and growing spectrum demands in the context of the static conventional policy spectrum allocation. Therefore, to find a suitable solution to this problem, we are ...It is not more and more, easy to satisfy the important and growing spectrum demands in the context of the static conventional policy spectrum allocation. Therefore, to find a suitable solution to this problem, we are to days observing the apparition of flexible dynamic spectrum allocation methods. These methods that ought to improve more significantly the spectrum use have gained much interest. In fact, the digital dividend due to the change-over from the analog television to the digital terrestrial television must be efficiently used. So the Dynamic Spectrum Access (DSA) can potentially play a key role in shaping the future digital dividend use. In the DSA, two kinds of users or networks coexist on different channels. The first one, known as the primary user, accesses to a channel with high priority;and the second one, known as secondary user has a low priority. This paper presents a dynamic spectrum access protocol based on an auction framework. Our protocol is an interesting tool that allows the networks to bid and obtain on the available spectrum, the rights to be primary and secondary users according their valuations and traffic needs. Based on certain offers, our protocol selects primary and secondary users for each idle channel in order to realize the maximum economic for the regulator or social benefits. We deal with the case in which the offers of the networks are independent one another even if they will share the same channels. We design an algorithm in accordance with our dynamic spectrum access protocol. The algorithm is used here to find an optimal solution to the access allocation problem, specifically to digital dividend. Finally, the results in the numeric section, regarding the three suggested scenarios, show that the proposed dynamic spectrum access protocol is viable. The algorithm is able to eliminate all non-compliant bidders for the available spectrum sharing. We notice that the revenue or social benefits of the regulator is maximized when we have on each channel, one primary user and the maximum number of secondary users.展开更多
文摘Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcutaneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235 - 627) and 563 (95% confidence interval, 368 - 728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.
文摘BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.
文摘Objectives:To assess whether the extension of the flushing interval will increase risks of complications associated with totally implantable venous access port(TIVAP)in the off-treatment period.Methods:A retrospective single-center observational study was performed.Patients with a TIVAP in the off-treatment period that underwent regular flushing in our clinic were included.Data concerning patients and their TIVAPs were recorded.Patient baseline characteristics and TIVAP-related complications were analyzed.Continuous variables were analyzed by ANOVA or the Kruskal-Wallis H test.To compare the occurrence of TIVAP-related complications,the chi-square test was used;if needed,Fisher’s exact test was used.Results:Totally 607 patients were reviewed,and 563 patients were finally included.Thirteen complications were recorded,including 11 cases of catheter occlusion(1.95%),one case of port cannula rotation(0.18%),and one case of catheter tip malposition(0.18%).No device-related infection or venous thrombosis was recorded.Among these patients,the average flushing interval was 35.27±13.09 days.Patients were divided into three groups according to the flushing interval:every 28 days or less(Group 1,n=133);every 29-44 days(Group 2,n=350);and every 45 days or more(Group 3,n=80).No significant difference in catheter-related complications was found among the three groups(P>0.05).Conclusions:In the TIVAP off-treatment period,patients without any history of TIVAP-related complications during approximately one year can attempt to prolong the flushing interval to more than 4 weeks;we further suggest that 5-6 weeks may be an appropriate option for these patients.
文摘BACKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(CVC) placement is with plain ? lm chest radiography(CXR). We hypothesized that a simple point-of-care ultrasound(POCUS) protocol could effectively con? rm placement and reduce time to con? rmation.METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8%(95%CI 77.1%–93.5%) and speci? city of 100%(95%CI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes(IQR 10–29) and 32 minutes(IQR 19–45), respectively.CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a con? rmatory CXR.
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
文摘Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.
文摘Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous access ports without guidance in lung cancer patients. Methods: We conducted a retrospective review of total 163 lung cancer patients who underwent implantations of a central venous access port for chemotherapy. 95 patients received the ports by the femoral vein blind-puncture technique and 68patients had the port implanted via the subclavian vein blind-puncture technique. The initial success rate of port implantation and the frequency of occurrence of complications were calculated. Results: The primary success rate of venous port implantation was 93.7% for femoral approach and 88.2% for the subclavian approach respectively (p < 0.05). Intraoperative complications developed in two patients (2.1%) in the femoral approach group and in five patients (7.4%) in the subclavian approach group. Although a higher intraoperative complication ratio for the subclavian approach was encountered compared to that for the femoral vein approach, there was no statistically significant difference (p = 0.103). Nor was there any statistically significant difference in terms of the occurrence of late complications. Conclusions: Venous access port implantation via the femoral vein approach is safe, and its success rate is very high, with the equal complication rates comparable to the subclavian approach. This approach avoids many of the intraoperative complications. Thus, the femoral vein approach for implanting a venous access port in lung cancer patients should be considered a valid, and safe technique.
文摘Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.
文摘It is not more and more, easy to satisfy the important and growing spectrum demands in the context of the static conventional policy spectrum allocation. Therefore, to find a suitable solution to this problem, we are to days observing the apparition of flexible dynamic spectrum allocation methods. These methods that ought to improve more significantly the spectrum use have gained much interest. In fact, the digital dividend due to the change-over from the analog television to the digital terrestrial television must be efficiently used. So the Dynamic Spectrum Access (DSA) can potentially play a key role in shaping the future digital dividend use. In the DSA, two kinds of users or networks coexist on different channels. The first one, known as the primary user, accesses to a channel with high priority;and the second one, known as secondary user has a low priority. This paper presents a dynamic spectrum access protocol based on an auction framework. Our protocol is an interesting tool that allows the networks to bid and obtain on the available spectrum, the rights to be primary and secondary users according their valuations and traffic needs. Based on certain offers, our protocol selects primary and secondary users for each idle channel in order to realize the maximum economic for the regulator or social benefits. We deal with the case in which the offers of the networks are independent one another even if they will share the same channels. We design an algorithm in accordance with our dynamic spectrum access protocol. The algorithm is used here to find an optimal solution to the access allocation problem, specifically to digital dividend. Finally, the results in the numeric section, regarding the three suggested scenarios, show that the proposed dynamic spectrum access protocol is viable. The algorithm is able to eliminate all non-compliant bidders for the available spectrum sharing. We notice that the revenue or social benefits of the regulator is maximized when we have on each channel, one primary user and the maximum number of secondary users.
