Central Venous Catheter-related Complications in Patients with Hematological Malignancies: A Retrospective Analysis of Risk Factors and Prophylactic Measures

Abstract

126 patients with hematological malignancies were analyzed. A total of 207 CVCs were implanted: 137 centrally (CICCs) and 70 peripherally (PICCs). The median duration of the CVCs was 19 days for a total of 4051 catheter-days. Antithrombotic prophylaxis was unfractionated heparin (UFH), 2,500 IU daily by 24 h continuous infusion in 169 CVCs, low molecular weight heparin (LMWH), 3,800 IU daily by single bolus intravenous injection (i.v.) in 21 and warfarin in one. No prophylaxis was given in 16 CVCs. Thrombotic complications developed in 15.5% of the CVCs (7.9 events/1000 catheter days), and the frequency of infectious complications was 10.6% (5.2 events/1000 catheter days). On multivariate analysis thromboses were more frequent and earlier with PICCs than CICCs (p = 0.0001), and in patients on UFH (16.6%) than in LMWH prophylaxis (4.7%), but the last difference was not statistically significant. In conclusions the incidence of thrombotic complications in our series was comparable to that observed in non-thrombocytopenic patients and was significantly higher in those carrying PICC than CICC (p = 0.0001). There were fewer thrombotic events in the patients receiving i.v. LMWH prophylaxis than in those receiving i.v. UFH. The use of anticoagulants was safe and not associated with hemorrhages.

Increased risk of venous thromboembolism in patients with acute leukaemia

“…A high rate of central venous catheter-associated thrombosis of 12 -15% in patients with haematological malignancies including acute leukaemia has been reported in two previous studies from Italy, and these numbers are similar to those reported from nonthrombocytopenic patients with central venous catheter-associated thrombosis (Cortelezzi et al, 2003(Cortelezzi et al, , 2005. Since the authors counted superficial thrombophlebitis as a venous thromboembolic event and not all our patients had a central venous catheter inserted, no direct comparison of the central venous catheterassociated thrombosis rates observed in the studies by Cortelezzi et al with our data is possible.…”

Thrombotic complications in adult patients with lymphoma: a meta-analysis of 29 independent cohorts including 18 018 patients and 1149 events

“…From a total of 70 articles retrieved, 47 were excluded for one of the following reasons: review articles (n ϭ 13), [9][10][11][12][13][14][15][16][17][18][19][20][21] no data about incidence of clinical thrombotic events (n ϭ 13), [22][23][24][25][26][27][28][29][30][31][32][33][34] no distinction of type of cancer (n ϭ 9), [35][36][37][38][39][40][41][42][43] duplicated data (n ϭ 3), [44][45][46] case reports (n ϭ 7), [47][48][49][50][51][52][53] and case-control studies of patients with a first event of deep vein thrombosis (DVT) and subsequent cancer diagnosis (n ϭ 2). 54,55 In addition, studies in which the authors evaluated the incidence of thrombosis after bone marrow transplantation (n ϭ 3) [56][57]…”

ONLINE Special Article Managing central venous access devices in cancer patients: A practice guideline

“…The evidence from one randomized trial of catheters demonstrated that the addition of a silver-impregnated cuff to the standard central catheter did not identify a significant difference in catheter-related Type of catheter Johansson et al, 2004Cortelezzi, A. et al, 2003Biffi et al, 2001Minassian et al, 2000Bow et al, 1999Warner et al, 1996Mueller et al, 1992Eastridge & Lefor, 1995Carde et al, 1989Gleeson et al, 1993Kappers-Klunne et al 1989Raad et al, 1993Pegues et al, 1992Pasquale et al, 1992 infection. While there is evidence that catheters treated with chlorhexidine-silver sulfadiazine was effective, reducing blood stream infection rates in short-term non-tunnelled venous access devices, the benefit is restricted to the first eight days, and does not continue when the average insertion time exceeds eight days (Walder, Pittet, & Tramer, 2002).…”