title: Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study.
abstract: BACKGROUND
  Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed.
  
  
  METHODS
  We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as "non-laminar."
  
  
  RESULTS
  Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8-21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0-22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable.
  
  
  CONCLUSIONS
  In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01737554.
authors: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors: Joshua
authors: J
authors: Wolf
authors: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America.
authors: Li
authors: L
authors: Tang
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America.
authors: Jeffrey E
authors: JE
authors: Rubnitz
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America.
authors: Rachel C
authors: RC
authors: Brennan
authors: Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America.
authors: David R
authors: DR
authors: Shook
authors: Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America.
authors: Dennis C
authors: DC
authors: Stokes
authors: Department of Haematology, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors: Paul
authors: P
authors: Monagle
authors: Murdoch Children's Research Institute, Parkville, Victoria, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors: Nigel
authors: N
authors: Curtis
authors: Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors: Leon J
authors: LJ
authors: Worth
authors: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America.
authors: Kim
authors: K
authors: Allison
authors: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America.
authors: Yilun
authors: Y
authors: Sun
authors: Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America.
authors: Patricia M
authors: PM
authors: Flynn
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000209:etiology