Chieh-Ching Yen

Aim (s): To examine catheter‐related complications across different flushing strategies for totally implantable venous access devices when care is delivered through a standardized, nurse‐led, protocol‐driven framework. Design: A single‐center, prospective, exploratory, randomized, single‐blind, three‐arm parallel‐group clinical trial. Results: Among 192 participants, catheter‐related complications were rare across all groups. One occlusion occurred in the 10 mL saline group, no occlusions occurred in the 20 mL saline or heparin lock groups, minor bleeding occurred in three participants, and no catheter‐related bloodstream infections or severe adverse events were reported. The very low number of events precluded meaningful comparative inference between flushing strategies. Conclusion: Within a standardized, nurse‐led catheter care framework, complication rates were uniformly low regardless of flushing strategy. These exploratory findings do not establish equivalence or comparative effectiveness between flushing strategies. Implications for the Profession and/or Patient Care: For oncology nursing practice, these findings support continued emphasis on standardized, protocol‐driven catheter care, competency‐based nurse training, and adherence monitoring; they do not establish that saline can replace heparin. Impact: This study addresses uncertainty about catheter outcomes under different flushing strategies in standardized nursing care. The main finding was uniformly low complication rates across groups. The findings may inform oncology nursing practice, catheter care standardization, and future trial design. Reporting Method: This study was reported in accordance with the CONSORT 2025 statement and relevant extensions. No Patient or Public Contribution: Patients and members of the public were not involved in the design, conduct, analysis, interpretation, or preparation of this manuscript because the study evaluated a protocol‐driven inpatient catheter care procedure delivered within routine oncology nursing practice. Trial Registration: ClinicalTrials.gov : NCT05707936 ( https://clinicaltrials.gov/study/NCT05707936 )

Background: Carotid blowout syndrome (CBS) is a life‐threatening complication of head and neck cancer (HNC). This study evaluated clinical outcomes and prognostic factors in patients with HNC who presented to the emergency department (ED) with CBS and underwent endovascular management. Methods: We conducted a retrospective, multi‐institutional observational study across four hospitals in Taiwan from January 1, 2011, to December 31, 2023. Adult patients with HNC who presented to the ED with bleeding suggestive of CBS on computed tomography angiography underwent endovascular therapy and had the diagnosis confirmed by digital subtraction angiography were included. The primary endpoint was in‐hospital mortality. Independent prognostic factors were identified using multivariable logistic regression, and a predictive nomogram was constructed and internally validated by bootstrap resampling. Results: A total of 348 patients were included. Most were male (93.7%), had Stage IV disease (74.7%), and were treated with arterial embolization (93.4%). In‐hospital mortality occurred in 57 patients (16.4%). The estimated 30‐day and 1‐year survival rates were 84.8% and 51.7%, respectively. In multivariable analysis, vasopressor use (odds ratio [OR], 6.54), failed hemostasis (OR, 4.68), tracheostomy status (OR, 2.04), multivessel involvement (OR, 1.98), and lower systolic blood pressure (OR, 0.99 per mmHg) were independently associated with in‐hospital mortality. The nomogram showed moderate discrimination with a C ‐statistic of 0.73. Conclusions: Among patients with HNC presenting to the ED with CBS and undergoing endovascular management, in‐hospital mortality remained substantial. A nomogram incorporating readily available clinical and imaging variables may assist early risk stratification after ED presentation.

Background: Infection is a major cause of mortality in patients with cirrhosis. However, chronic organ dysfunction may confound the interpretation of organ dysfunction scores, and the prognostic value of the updated Sequential Organ Failure Assessment‐2 (SOFA‐2) score in cirrhotic patients with suspected infection remains unclear. Methods: We conducted a retrospective multi‐institutional cohort study across four hospitals in Taiwan from January 2010 to December 2021. Adult patients admitted from the emergency department (ED) with suspected infection were included and stratified by cirrhosis status. The primary outcome was 28‐day mortality. SOFA‐2 score distributions, domain‐specific patterns and mortality associations were compared between patients with and without cirrhosis. Cox proportional hazards models with site‐clustered robust standard errors were used. Results: Among 150 511 patients with suspected infection, 4288 (2.9%) had cirrhosis. Patients with cirrhosis had higher SOFA‐2 scores than those without cirrhosis (median, 4 [interquartile range (IQR), 2–6] vs. 2 [IQR, 0–4]; p < 0.001) and higher non‐hepatic SOFA‐2 scores (median, 3 [IQR, 1–5] vs. 1 [IQR, 0–3]; p < 0.001). The 28‐day mortality rate was 14.9% in patients with cirrhosis and 8.9% in those without cirrhosis. After adjustment for age, sex, non‐hepatic Charlson Comorbidity Index and non‐hepatic SOFA‐2 score, cirrhosis remained associated with higher 28‐day mortality (adjusted hazard ratio, 1.31; 95% confidence interval, 1.17–1.46; p < 0.001). Conclusions: Among ED patients with suspected infection, cirrhosis was associated with an increased risk of SOFA‐2‐defined organ dysfunction and increased mortality. SOFA‐2 may support early risk stratification but should be interpreted in the context of cirrhosis‐related baseline physiology.

Background: Symptomatic outpatients with COVID-19 and other respiratory infections present similarly, yet triage decisions often precede RT-PCR results. SARS-CoV-2 antigen rapid diagnostic tests (Ag-RDTs) provide immediate results and preferentially detect high viral burden. We assessed whether Ag-RDT positivity at presentation identifies patients who subsequently develop severe COVID-19. Methods: We conducted a multicentre cohort study of 36,020 symptomatic outpatients who underwent same-day Ag-RDT and RT-PCR testing at four Taiwanese sites from May to October 2021. Participants with RT-PCR-confirmed infection were prospectively monitored for 14 days; records of all participants were reviewed for repeat testing and clinical events, and the participating hospital system was the sole tertiary-care provider serving the study catchment area. Severe COVID-19 was defined as RT-PCR-confirmed SARS-CoV-2 infection followed within 14 days by invasive mechanical ventilation or in-hospital death. We evaluated triage and diagnostic performance and prognostic associations adjusted for the age-adjusted Charlson Comorbidity Index among confirmed patients. Findings: Among 36,020 participants, 306 (0·8%) were Ag-RDT positive, 254 (0·7%) were RT-PCR positive, and 36 (0·1%) developed severe COVID-19. All confirmed infections were detected at index testing; no severe event followed a negative index RT-PCR in available records. Ag-RDT positivity identified severe COVID-19 with 80·6% sensitivity (95% CI 64·0–91·8), 99·2% specificity (99·1–99·3), 9·5% positive predictive value (6·4–13·3), and 99·98% negative predictive value (99·96–99·99). Diagnostic sensitivity and specificity were 63·8% (57·5–69·7) and 99·6% (99·5–99·7). Among patients with confirmed COVID-19, Ag-RDT-positive participants had lower Ct values (median 19·5 vs 30·9; p<0·001) and a greater risk of severe disease (17·9% vs 7·6%); the ACCI-adjusted odds ratio was 2·90 (1·15–7·31).Interpretation: Point-of-care Ag-RDT positivity identified most subsequent severe COVID-19 events despite moderate diagnostic sensitivity. It may support immediate triage before RT-PCR results, but prospective contemporary validation is required.

OBJECTIVES: We aimed to evaluate the pooled prognostic accuracy of the Phoenix Sepsis Criteria (PSC) for in-hospital mortality and compare its performance with the International Pediatric Sepsis Consensus Conference (IPSCC) criteria in children with suspected infection. DATA SOURCES: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched. STUDY SELECTION: Eligible studies included prospective or retrospective studies evaluating the PSC among children younger than 18 years with suspected infection in hospital settings. DATA EXTRACTION: Two investigators independently screened, extracted study characteristics and accuracy data, and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. DATA SYNTHESIS: A total of 15 studies (16 cohorts; 2,601,038 encounters) were included. The PSC demonstrated pooled sensitivity of 0.77 (95% CI, 0.67–0.85), specificity of 0.73 (95% CI, 0.51–0.87), diagnostic odds ratio of 9.2 (95% CI, 5.1–16.8), and area under the curve (AUC) of 0.81 (95% CI, 0.75–0.84). In contrast, the IPSCC showed lower performance (AUC, 0.71; difference, 0.10 [95% CI, 0.04–0.19]). In subgroup analyses, PSC specificity was lower in the ICU compared with the emergency department (ED) cohorts (0.48 vs. 0.99). CONCLUSIONS: The PSC demonstrates good prognostic accuracy for mortality and outperforms the IPSCC criteria. However, performance varies by setting, and the PSC is intended for prognostic risk stratification rather than frontline early sepsis screening. Further validation in the ED, ward, and lower-resource settings, as well as the development of context-specific clinical decision support tools, are warranted.

Importance: Peripheral intravenous (PIV) vasopressors are increasingly used but remain associated with adverse events (AEs). Quantifying the incidence of these AEs is essential to guide clinical decision-making regarding PIV vasopressor use. Objective: To assess the incidence of AEs and avoidance of central venous catheter (CVC) placement after PIV vasopressor administration in adults with hypotension, shock, or critical illness. Data Sources: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to December 13, 2025, using medical subject headings and keywords related to peripheral vasopressors. Study Selection: Eligible studies included critically ill adults receiving vasopressors via PIV catheters and reported AEs and/or CVC avoidance. Data Extraction and Synthesis: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 investigators independently extracted data and assessed risk of bias. A random-effects model was used, and proportions were pooled using a generalized linear mixed model. Main Outcomes and Measures: The primary end point was the pooled incidence of AEs as the proportion among total catheters, and the secondary end point was the pooled proportion of CVC avoidance. Results: Forty-nine studies including 33 060 catheters were analyzed. The pooled minor AE incidence was 2.6% (95% CI, 1.4%-4.7%) for norepinephrine, 0.0% (95% CI, 0.0%-24.6%) for epinephrine, 2.9% (95% CI, 1.8%-4.8%) for phenylephrine, 1.4% (95% CI, 0.3%-5.9%) for dopamine, 0.5% (95% CI, 0.1%-1.8%) for vasopressin, and 0.9% (95% CI, 0.1%-11.5%) for metaraminol. When considering all vasopressors collectively, the pooled minor AE incidence was 2.3% (95% CI, 1.5%-3.7%). Regarding major AEs, 30 venous thromboembolism events occurred, all in the 4 studies (8.1%) using midline catheters (1126 total catheters), with a pooled incidence of 1.4% (95% CI, 0.4%-5.4%). In contrast, only 1 major AE (a tissue necrosis event) was reported in 43 studies (87.8%) using short PIV catheters (29 596 total catheters), with a pooled incidence of 0.0% (95% CI, 0.0%-0.0%). CVC avoidance ranged from 0% to 100%, with a pooled proportion of 59.7% (95% CI, 46.4%-71.7%) in 38 studies (77.6%) including 15 371 catheters. Conclusions and Relevance: In this systematic review and meta-analysis of adult patients, AE incidence was low after short-term vasopressor administration through PIV catheters, particularly short catheters. These findings suggest that PIV administration might reduce the need for CVC placement with appropriate monitoring.