title: Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients.
abstract: Indwelling central venous catheters (CVCs) are used in the management of hematologic patients. However, insertion and maintenance of CVCs are susceptible to complications. Study design and methods data concerning 388 consecutive catheterisations, performed in oncohematologic patients between April 2003 and December 2004, were prospectively collected. At insertion thrombocytopenia was present in 109 cases (28.1%) and neutropenia in 67 (17.3%). Hemorrhage after CVC insertion occurred in five thrombocytopenic patients (1.3%). The median duration of catheterisation was 18.8 days (range 1-89), longer in the 7-French CVCs utilised in leukemic patients (24.3 days) and shorter in 12-French CVCs (11 days), used for PBSC harvesting. Deep venous thrombosis was diagnosed in 13 cases (3.3%). Ninety-two catheterisations (12.6/1000 days-catheter) were complicated by infections: 19 local infections (4.8%) and 73 (18.8%) bacteraemias of which 45 (11.6%) were catheter-related, mainly due to Gram positive germs (32/45, 71.1%). The frequency of catheter-related bacteraemia was 7.2 events/1000 days-catheter. Thirteen CVCs were removed due to thrombosis, 15 due to infections, 20 due to malfunction, the remaining 333 at patients discharge. At univariate analysis high-dose chemotherapy (p = 0.013), 7-Fr lumen (p = 0.023), acute myeloid leukemia (AML) (p = 0.001), duration of neutropenia >10 days and length of catheterisation were significantly correlated to infection. Multivariate analysis confirmed the duration of catheterisation, AML and high-dose chemotherapy as risk factors. Even though hematological in-patients are at increased risk for bleeding and infections, non-tunnelled CVCs offer a safe venous access also in patients affected by severe thrombocytopenia and prolonged neutropenia.
authors.affiliation: Department of Hematology, Niguarda Ca'Granda Hospital, Milano, Italy. annamaria.nosari@ospedaleniguarda.it
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Nosari
authors.forename: Guido
authors.initials: G
authors.lastname: Nador
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gasperi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ortisi
authors.forename: Alberto
authors.initials: A
authors.lastname: Volonterio
authors.forename: Silvia
authors.initials: S
authors.lastname: Cantoni
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.forename: Laura
authors.initials: L
authors.lastname: Marbello
authors.forename: Ernestina
authors.initials: E
authors.lastname: Mazza
authors.forename: Valentina
authors.initials: V
authors.lastname: Mancini
authors.forename: Erica
authors.initials: E
authors.lastname: Ravelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Ricci
authors.forename: Denis
authors.initials: D
authors.lastname: Ciapanna
authors.forename: Federica
authors.initials: F
authors.lastname: Garrone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gesu
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016470:Bacteremia / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006402:Hematologic Diseases / Q000150:complications* / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000209:etiology; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology