title: Essential, but at what risk? A prospective study on central venous access in patients with haematological malignancies.
abstract: OBJECTIVE
  Central venous catheters (CVC) are integral to modern haematology practice; however, they are associated with a range of complications. This prospective study aimed to determine the rate of CVC-related complications and risk factors in haematology patients, who are vulnerable because of their underlying pathology and treatments.
  
  
  METHODS
  All inpatients that had a non-tunnelled CVC inserted in a 14-month period in the haematology ward at St Vincent's Hospital were enrolled. Complications (immediate and late), demographics, type of device, insertion technique and duration of dwell, were examined using multivariate analysis.
  
  
  RESULTS
  One hundred and seventy-four CVC in 84 patients were recorded, representing 3016 catheter-days. At least one complication was found in 43 (24.7%) patients. Immediate complications occurred in 13 (7.5%) insertions, with a higher rate in those inserted after ≥2 attempts compared with one (P = 0.02). Catheter-related bloodstream infection occurred at a rate of 7.6 per 1000 catheter-days, with acute lymphoblastic leukaemia associated with a higher rate (P = 0.02), and subclavian vein CVC had a lower rate compared with other locations (P < 0.01). Thrombosis was found in seven (4.0%) patients, with subclavian CVC carrying an increased risk (P = 0.02).
  
  
  CONCLUSIONS
  This prospective observational study found almost a quarter of haematology patients experience a CVC-related complication. An association was found with a number of attempts at insertion and immediate complications; other risk factors included anatomical location, underlying disease and duration of catheterisation. The relatively high complication rate, compared with reports of non-haematology patients, highlights the need to improve CVC management, a vital part of care for this population.
authors: St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
authors: C H K
authors: CH
authors: Dix
authors: D T O
authors: DT
authors: Yeung
authors: M L
authors: ML
authors: Rule
authors: D D F
authors: DD
authors: Ma
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000639:trends; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult