title: Malfunctioning and infected tunneled infusion catheters: over-the-wire catheter exchange versus catheter removal and replacement.
abstract: OBJECTIVE
  To compare the safety and effectiveness of over-the-wire catheter exchange (catheter-exchange) with catheter removal and replacement (removal-replacement) at a new site for infected or malfunctioning tunneled infusion catheters.
  
  
  METHODS
  Using a quality assurance database, 61 patients with tunneled infusion catheters placed during the period July 2001 to June 2009 were included in this study. Patients receiving hemodialysis catheters were excluded. Catheter-exchange was performed in 25 patients, and same-day removal-replacement was performed in 36 patients. Data collected included demographic information, indication for initial catheter placement and replacement, dwell time for the new catheter, and ultimate fate of the new device. Statistical comparisons between the two cohorts were analyzed using the Kaplan-Meier technique and Fisher exact test.
  
  
  RESULTS
  Catheters exchanged over the wire remained functional without infection for a median of 102 days (range, 2-570 days), whereas catheters removed and replaced were functional for a median 238 days (range, 1-292 days, P = .12). After catheter replacement, there were 11 instances of subsequent infection in the catheter-exchange group and 7 instances in the removal-replacement cohort, accounting for infection rates of 4.4 and 2.3 per 1,000 catheter days (P = .049). Patients in the catheter-exchange group had 3.2 greater odds of infection compared with patients in the removal-replacement group. Five malfunction events occurred in each group, accounting for 2.0 and 1.7 malfunctions per 1,000 catheter days in the catheter-exchange and removal-replacement groups (P = .73).
  
  
  CONCLUSIONS
  Catheter-exchange of tunneled infusion catheters results in a higher infection rate compared with removal-replacement at a new site. The rate of catheter malfunction is not significantly different between the two groups. Catheter-exchange is an alternative for patients with tunneled infusion catheters who have limited venous access, but this technique should not be expanded for use in all patients. Because of the size of this initial study, further investigation is needed to verify the results in a larger sample size.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Hospital of University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Guttmann
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Clark
authors.forename: Mandeep
authors.initials: M
authors.lastname: Dagli
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult