Deeren, D., Dewulf, E., Verfaillie, L. (2016). Daily chlorhexidine bathing does not increase skin toxicity after remission induction or stem cell transplantation. Acta Clinica Belgica, 4, 1-4.
A recent multicenter study demonstrated that bathing with chlorhexidine reduces the transmission of resistant organisms and the risk of hospital-acquired bloodstream infections in ICUs. We wanted to confirm the feasibility of this strategy in a cohort of patients in a typical intensive haematology unit.
Patients treated with remission induction chemotherapy, autologous or allogeneic stem cell transplantation received daily chlorhexidine bathing. To avoid deshydratation of skin, we used prophylactic application of hydrating lotion, replaced by corticosteroid cream in case of skin toxicity of chemotherapy or conditioning.
We studied 15 consecutive admissions of 12 patients. Daily chlorhexidine bathing never needed to be interrupted, even though 53% of patients were treated with intravenous cytarabine. Patients were satisfied with the skin treatment and reported few unwanted effects.
Daily chlorhexidine bathing was feasible in our intensive haematology unit in all patients and did not increase skin toxicity, even when treated with IV cytarabine.
Stegmayr, B., Mörtzell Henriksson, M., Newman, E., Witt, V., Derfler, K., Leitner, G., et al. Eloot, S., Dhondt, A., Deeren, D., Rock, G., Ptak, J., Blaha, M., Lanska, M., Gasova, Z., Hrdlickova, R., Ramlow, W., Prophet, H., Liumbruno, G., Mori, E., Griskevicius, A., Audzijoniene, J., Vrielink, H., Rombout, E., Aandahl, A., Sikole, A., Tomaz, J., Lalic, K., Mazic, S., Strineholm, V., Brink, B., Berlin, G., Dykes, J., Toss, F., Göran Axelsson, C., Nilsson, T., Norda, R., Knutson, F., Ramsauer, B., Wahlström, A. (2016). Adverse events in apheresis: an update of the WAA registry data. Transfusion and Apheresis Science, 54(1), 2-15.
Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry.
The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE).
More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%).
Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used.
Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.