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

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.

Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients

“…Our lower infection rate could be due to the fact that very few ICU patients were included in comparison with Gunst's and Chopra's cohorts [7,13]. However, this was partially offset by high recruitment of oncologic (64 %) and onco-hematologic (46 %) patients whom are known to be at increased risk of infection because of immunosuppression [14,15]. Yet, several authors reported that oncologic patients presented a higher PICC-related infection than non-oncologic ones: 6.61 per 1000 catheter-days in patients with hematological malignancies [15], 2.46 per 1000 catheter-days in oncologic patients (80 % of whom presented with solid tumors) [16] versus 1.1 per 1000 catheter-days in non-oncologic patients [4].…”

“…Yet, several authors reported that oncologic patients presented a higher PICC-related infection than non-oncologic ones: 6.61 per 1000 catheter-days in patients with hematological malignancies [15], 2.46 per 1000 catheter-days in oncologic patients (80 % of whom presented with solid tumors) [16] versus 1.1 per 1000 catheter-days in non-oncologic patients [4]. In our different sub-cohorts of solid neoplasia and hematologic malignancy patients, we also observed lower PICC-related infection rates than in the literature since ours are 1.45 and 3.13 per 1000 catheter-days respectively, versus 2.46 and 6.61 in oncologic and onco-hematologic patients, respectively [15,16]. Despite our low recruitment of ICU patients, we therefore considered that our PICC-related infection rate was low considering the proportion of oncologic patients in our study, especially the important inclusion of onco-hematologic ones, and the absence of outpatients whose PICC-related infection rate, according to the literature, is low (0.52 per 1000 catheter-days [17]).…”

“…However, this was partially offset by high recruitment of oncologic (64 %) and onco-hematologic (46 %) patients whom are known to be at increased risk of infection because of immunosuppression [14,15]. Yet, several authors reported that oncologic patients presented a higher PICC-related infection than non-oncologic ones: 6.61 per 1000 catheter-days in patients with hematological malignancies [15], 2.46 per 1000 catheter-days in oncologic patients (80 % of whom presented with solid tumors) [16] versus 1.1 per 1000 catheter-days in non-oncologic patients [4]. In our different sub-cohorts of solid neoplasia and hematologic malignancy patients, we also observed lower PICC-related infection rates than in the literature since ours are 1.45 and 3.13 per 1000 catheter-days respectively, versus 2.46 and 6.61 in oncologic and onco-hematologic patients, respectively [15,16].…”

“…Chemotherapy had previously been suspected of being a risk factor of PICC-related infections in Worth et al [15] and Chopra et al [7] studies but none of them found a significant statistical association to prove this assumption: the Odds ratio were 1.23 (p = 0.74) and 1.8 (p = 0.3) respectively, whereas we obtained an Odds-ratio of 7.2 (95 % CI [1.8-29.6]). The higher rate of PICC-related infections in patients undergoing chemotherapy was probably due to the immunosuppression generated by the different chemotherapy agents in patients vulnerable to infection often presenting with a previous altered general state.…”

Catéter central de acceso periférico en paciente pediátrico con cáncer: estudio de caso

“…Esta duración es comparable con la literatura, que ha reportado duraciones de 72 días (31), 92 días (32), 113 días (33), entre otros. Además no se presentaron complicaciones asociadas al catéter como bacteriemias, tromboflebitis, taquicardias o trombosis, lo que contrasta con la complicaciones comunes reportadas por la literatura, especialmente en pacientes oncológicos (8,34,35,36,37); la ausencia de complicaciones pudo asociarse a la condición estable del paciente, el tipo de neoplasia y las condiciones óptimas para el cuidado intrahospitalario y domiciliario; esto último, apoya la evidencia de que enfermeras y cuidadores entrenados inciden en la disminución de complicaciones (38,39).…”