Do simultaneous bilateral tunneled infusion catheters in patients undergoing bone marrow transplantation increase catheter-related complications?
OBJECTIVE
Secure venous access with multiple lumens is necessary for the care of allogeneic hematopoietic stem cell transplant (HSCT) recipients. The outcomes associated with simultaneous bilateral tunneled internal jugular infusion catheter placement in the HSCT recipient population were investigated in an attempt to determine whether simultaneous introduction of these catheters compounds or magnifies the risks (infection, venous thrombosis) associated with tunneled catheters.


METHODS
Patients undergoing HSCT and receiving bilateral tunneled infusion catheters in a single procedure were identified using a quality assurance data base. Medical records for the duration of catheterization were reviewed; 43 patients were included in the study (mean age, 42 years; range, 22-56). Diagnoses included acute lymphocytic leukemia (n = 4), acute myelogenous leukemia (n = 8), aplastic anemia (n = 2), chronic myelogenous leukemia (n = 17), chronic lymphocytic leukemia (n = 1), Hodgkin lymphoma (n = 1), myelodysplasia (n = 4), myelofibrosis (n = 2), and non-Hodgkin lymphoma (n = 4). Cox proportional hazards regression analysis was performed to determine differences in infection rates between dual- and triple-lumen catheters.


RESULTS
Forty-three pairs of catheters were placed. All met venous access needs for HSCT recipient care. Complete follow-up was achieved for 77 of 87 (89%) catheters. The overall infection rate was 0.25 per 100 catheter-days. The rate was 0.19 and 0.33 for dual- and triple-lumen catheters, respectively (P =.15). Mechanical failure did not differ between catheter types (dual: 0.14 episodes per 100 days, triple: 0.05 per 100 days, P =.2).


CONCLUSIONS
Bilateral multilumen tunneled infusion catheter placement in a single procedure using imaging guidance is safe with acceptable outcomes and meets venous access needs for HSCT. There is a trend toward higher infection rates, with more lumens and more mechanical failure with dual-lumen catheters.
Kaufman
Lauren J
LJ
Department of Radiology, Division of Interventional Radiology and Medicine, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Clark
Timothy W I
TW
Roberts
David A
DA
Freiman
David B
DB
Shlansky-Goldberg
Richard D
RD
Patel
Aalpen A
AA
Mondschein
Jeffrey I
JI
Stavropoulos
S William
SW
Soulen
Michael C
MC
Solomon
Jeffrey A
JA
Tuite
Catherine M
CM
Cope
Constantin
C
Porter
David L
DL
Stadtmauer
Edward A
EA
Cunningham
Kathleen A
KA
Trerotola
Scott O
SO
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007239:Infections / Q000209:etiology*; D007601:Jugular Veins; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000209:etiology