title: Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices.
abstract: OBJECTIVE
  Central venous catheter (CVC)-related bloodstream infection (CR-BSI) is a significant complication in hematology patients. A range of CVC devices may be used, and risks for the development of complications are not uniform. The objectives of this study were to determine the natural history and rate of CVC-related complications and risk factors for CR-BSI and to compare device-specific complications in a hematology population.
  
  
  METHODS
  An observational cohort of patients with hematologic malignancy was prospectively studied following CVC insertion. Participants were reviewed until a CVC-related complication necessitated device removal, completion of therapy, death, or defined end-of-study date. The National Nosocomial Infection Surveillance definition for CR-BSI was used. Overall and device-specific rates of infective and noninfective complications were calculated and potential risk factors were captured.
  
  
  RESULTS
  One hundred six CVCs (75 peripherally inserted central venous catheters [PICCs], 31 nontunneled CVCs) were evaluated in 66 patients, over 2,399 CVC days. Thrombosis occurred in 16 cases (15.1%), exit-site infection in two (1.9%), and CR-BSI in 18 (7.5 per 1,000 CVC days). No significant differences were found when complication rates in PICC and nontunneled devices were compared. An underlying diagnosis of acute myeloid leukemia was negatively associated with CR-BSI (odds ratio (OR) 0.14, p = 0.046), and a previous diagnosis of fungal infection was associated with infection (OR 22.82, p = 0.031).
  
  
  CONCLUSIONS
  CR-BSI rates in our hematology population are comparable to prior reports. A low rate of exit-site infection and high proportion of thrombotic complications were observed. No significant differences in thrombotic or infective complications were evident when PICC and nontunneled devices were compared. PICC devices are a practical and safe option for management of hematology patients.
authors.affiliation: Centre for Clinical Research Excellence in Infectious Disease, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia. leon.worth@petermac.org
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D015331:Cohort Studies; D020878:Device Removal; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult