Advertisement

Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices

  • Leon J. WorthEmail author
  • John F. Seymour
  • Monica A. Slavin
Original Article

Abstract

Goals

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.

Patients and 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.

Main 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.

Keywords

CVC-related bloodstream infection Thrombosis Peripherally inserted CVC Nontunneled CVC Hematology Surveillance 

Notes

Disclosures

Potential conflict of interest—all authors, none. Financial support—all authors, none.

References

  1. 1.
    Allen AW, Megargell JL, Brown DB et al (2000) Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 11(10):1309–1314, doi: 10.1016/S1051-0443(07)61307-4 PubMedCrossRefGoogle Scholar
  2. 2.
    Axnick KJ (1980) Infection control considerations in the care of the immunosuppressed patient. CCQ 3:79–88PubMedGoogle Scholar
  3. 3.
    Boersma RS, Jie KS, Verbon A et al (2008) Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies. Ann Oncol 19(3):433–442, doi: 10.1093/annonc/mdm350 PubMedCrossRefGoogle Scholar
  4. 4.
    Celebi H, Akan H, Akcaglayan E et al (2000) Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies. Bone Marrow Transplant 26(2):211–214, doi: 10.1038/sj.bmt.1702503 PubMedCrossRefGoogle Scholar
  5. 5.
    Dettenkofer M, Ebner W, Bertz H et al (2003) Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant 31(9):795–801, doi: 10.1038/sj.bmt.1703920 PubMedCrossRefGoogle Scholar
  6. 6.
    Dettenkofer M, Wenzler-Rottele S, Babikir R et al (2005) Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project. Clin Infect Dis 40(7):926–931, doi: 10.1086/428046 PubMedCrossRefGoogle Scholar
  7. 7.
    Field K, McFarlane C, Cheng AC et al (2007) Incidence of catheter-related bloodstream infection among patients with a needleless, mechanical valve-based intravenous connector in an Australian hematology–oncology unit. Infect Control Hosp Epidemiol 28(5):610–613, doi: 10.1086/516660 PubMedCrossRefGoogle Scholar
  8. 8.
    Grove JR, Pevec WC (2000) Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 11(7):837–840, doi: 10.1016/S1051-0443(07)61797-7 PubMedCrossRefGoogle Scholar
  9. 9.
    Harter C, Ostendorf T, Bach A et al (2003) Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies. Support Care Cancer 11(12):790–794, doi: 10.1007/s00520-003-0517-x PubMedCrossRefGoogle Scholar
  10. 10.
    Horan TC, Emori TG (1997) Definitions of key terms used in the NNIS System. Am J Infect Control 25(2):112–116, doi: 10.1016/S0196-6553(97)90037-7 PubMedCrossRefGoogle Scholar
  11. 11.
    James L, Bledsoe L, Hadaway LC (1993) A retrospective look at tip location and complications of peripherally inserted central catheter lines. J Intraven Nurs 16(2):104–109PubMedGoogle Scholar
  12. 12.
    Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81(9):1159–1171PubMedCrossRefGoogle Scholar
  13. 13.
    Masci G, Magagnoli M, Pedicini V et al (2006) Long-term, tunneled, noncuffed central venous catheter in cancer patients (Vygon): safety, efficacy, and complications. Support Care Cancer 14(11):1141–1146, doi: 10.1007/s00520-006-0065-2 PubMedCrossRefGoogle Scholar
  14. 14.
    Mermel LA, Farr BM, Sherertz RJ et al (2001) Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 32(9):1249–1272, doi: 10.1086/320001 PubMedCrossRefGoogle Scholar
  15. 15.
    O'Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23(12):759–769, doi: 10.1086/502007 PubMedCrossRefGoogle Scholar
  16. 16.
    Penney-Timmons E, Sevedge S (2004) Outcome data for peripherally inserted central catheters used in an acute care setting. J Infus Nurs 27(6):431–436, doi: 10.1097/00129804-200411000-00009 PubMedCrossRefGoogle Scholar
  17. 17.
    Raad I, Davis S, Becker M et al (1993) Low infection rate and long durability of nontunneled silastic catheters. A safe and cost-effective alternative for long-term venous access. Arch Intern Med 153(15):1791–1796, doi: 10.1001/archinte.153.15.1791 PubMedCrossRefGoogle Scholar
  18. 18.
    Safdar N, Maki DG (2005) Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 128(2):489–495, doi: 10.1378/chest.128.2.489 PubMedCrossRefGoogle Scholar
  19. 19.
    Solomon B, Moore J, Arthur C et al (2001) Lack of efficacy of twice-weekly urokinase in the prevention of complications associated with Hickman catheters: a multicentre randomised comparison of urokinase versus heparin. Eur J Cancer 37(18):2379–2384, doi: 10.1016/S0959-8049(01)00320-3 PubMedCrossRefGoogle Scholar
  20. 20.
    Wisplinghoff H, Cornely OA, Moser S et al (2003) Outcomes of nosocomial bloodstream infections in adult neutropenic patients: a prospective cohort and matched case-control study. Infect Control Hosp Epidemiol 24(12):905–911, doi: 10.1086/502158 PubMedCrossRefGoogle Scholar
  21. 21.
    Worth LJ, Slavin MA, Black J (2007) Bloodstream infections in a secondary and tertiary care hospital setting. Intern Med J 37(4):284–285, author reply 258–286, doi: 10.1111/j.1445-5994.2007.01327.x PubMedCrossRefGoogle Scholar
  22. 22.
    Worth LJ, Slavin MA, Brown GV et al (2007) Catheter-related bloodstream infections in hematology: time for standardized surveillance? Cancer 109(7):1215–1226, doi: 10.1002/cncr.22527 PubMedCrossRefGoogle Scholar
  23. 23.
    Young LS (1981) Nosocomial infections in the immunocompromised adult. Am J Med 70(2):398–404, doi: 10.1016/0002-9343(81)90779-8 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Leon J. Worth
    • 1
    • 2
    • 4
    Email author
  • John F. Seymour
    • 2
    • 3
  • Monica A. Slavin
    • 1
    • 2
  1. 1.Centre for Clinical Research Excellence in Infectious Disease, Victorian Infectious Diseases ServiceRoyal Melbourne HospitalParkvilleAustralia
  2. 2.Peter MacCallum Cancer CentreEast MelbourneAustralia
  3. 3.University of MelbourneParkvilleAustralia
  4. 4.Department of Infectious DiseasesPeter MacCallum Cancer CentreEast MelbourneAustralia

Personalised recommendations