title: A reliable and safe method of collecting blood samples from implantable central venous catheters for determination of plasma gentamicin concentrations.
abstract: OBJECTIVE
  To evaluate the extent of agreement between plasma gentamicin concentrations determined from samples collected by using implantable subcutaneous central venous catheters (ports) with the push-pull method and those collected by finger lancet punctures in children with febrile neutropenia.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  University-affiliated, tertiary care hospital.
  
  
  METHODS
  Sixty-two children with cancer who had single- or double-lumen ports and who received gentamicin for treatment of febrile neutropenia between February 2008 and October 2009.
  
  
  METHODS
  One blood sample was collected from the port by using the push-pull method at the same time one blood sample was collected by finger lancet puncture for determination of plasma gentamicin concentrations.
  
  
  RESULTS
  Forty-four pairs of samples were available for assessment of agreement, and 43 were available for pharmacokinetic analysis. Agreement between plasma gentamicin concentrations determined from blood samples from ports and finger lancet punctures was assessed by the intraclass correlation coefficient (ICC), Bland-Altman analysis, and comparison of simulated dosage adjustments. Changes in port patency were monitored for 1 week after port sampling. Differences in simulated dosage adjustments calculated by using either the port or finger lancet puncture samples that differed by greater than 20% were considered clinically significant. Agreement between the 44 finger lancet puncture and port sample pairs was excellent (ICC 0.991, 95% confidence interval 0.984-0.995). Port plasma gentamicin concentrations were 4.7% lower than those concentrations determined in blood from finger lancet punctures. The observed limits of agreement ranged from -20.5% to 11%. Differences in dosage adjustments calculated by using port and finger lancet puncture plasma gentamicin concentrations were not clinically significant in 38 (88%) of 43 cases. No changes in port patency were observed in the week after port sampling.
  
  
  CONCLUSIONS
  The push-pull method of blood sampling is a reliable and safe option for determining plasma gentamicin concentrations in children with ports.
authors.affiliation: Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada. jennifer.chen@sickkids.ca
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chen
authors.forename: Sabrina
authors.initials: S
authors.lastname: Boodhan
authors.forename: Munira
authors.initials: M
authors.lastname: Nanji
authors.forename: Ann
authors.initials: A
authors.lastname: Chang
authors.forename: Santhosh
authors.initials: S
authors.lastname: Sekharan
authors.forename: Sara
authors.initials: S
authors.lastname: Lavoratore
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Brandão
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Skolnik
authors.forename: L Lee
authors.initials: LL
authors.lastname: Dupuis
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D001800:Blood Specimen Collection / Q000009:adverse effects / Q000379:methods*; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000009:adverse effects / Q000379:methods*; D005334:Fever / Q000188:drug therapy; D005839:Gentamicins / Q000008:administration & dosage / Q000097:blood* / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D009503:Neutropenia / Q000188:drug therapy; D011446:Prospective Studies; D015203:Reproducibility of Results
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins