Prospective monocentric study of non-tunnelled central venous catheter-related complications in hematological patients.
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.
Nosari
Anna Maria
AM
Department of Hematology, Niguarda Ca'Granda Hospital, Milano, Italy. annamaria.nosari@ospedaleniguarda.it
Nador
Guido
G
De Gasperi
Andrea
A
Ortisi
Giuseppe
G
Volonterio
Alberto
A
Cantoni
Silvia
S
Nichelatti
Michele
M
Marbello
Laura
L
Mazza
Ernestina
E
Mancini
Valentina
V
Ravelli
Erica
E
Ricci
Francesca
F
Ciapanna
Denis
D
Garrone
Federica
F
Gesu
Giovanni
G
Morra
Enrica
E
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