title: The timing and sequence of multiple device-related complications in patients with long-term indwelling Groshong catheters.
abstract: BACKGROUND
  The function of long term indwelling venous access devices is commonly perturbed by postinsertion catheter-related complications (CRC). In an effort to assess the patterns of CRC in our community accurately, a prospective analysis of Groshong catheters in adult cancer patients was undertaken.
  
  
  METHODS
  Three hundred and twenty-four consecutive adult oncology patients in whom a Groshong catheter was utilized for long-term central venous access were observed for the development of a CRC. A subset analysis was undertaken of those catheters that developed one or more complications.
  
  
  RESULTS
  Among the 221 catheters with a primary complication, 176 additional complications were subsequently identified (109 2nd, 50 3rd, and 17 4th complicating events). Ball-valve effect (BVE), the most frequent complication, was found to occur disproportionately as a primary event (85 of 119 catheters, P < 0.01), whereas catheter-related venous thrombosis (CR-VT) was more likely to occur as a later, subsequent complication (46 of 66 catheters, P < 0.01). Although risk analysis affirmed a paucity of clinical predictors for developing a primary complication, patients with BVE as a first complication were at increased risk for developing a later episode of CR-VT.
  
  
  CONCLUSIONS
  Multiple sequential complications are common in patients with Groshong catheters, occurring in a rather predictable sequence. The increased risk of CR-VT in patients with catheters with an early complication suggests a cause-effect relationship. An awareness of this sequencing may lead to improved strategies for the prevention of primary and subsequent complications.
authors.affiliation: Oncology Associates of West Kentucky, Paducah 42001, USA.
authors.forename: B
authors.initials: B
authors.lastname: Tolar
authors.forename: J R
authors.initials: JR
authors.lastname: Gould
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D011446:Prospective Studies; D018570:Risk Assessment; D013350:Subclavian Vein; D013924:Thrombophlebitis / Q000209:etiology; D013997:Time Factors