Mechanical and infective central venous catheter-related complications: a prospective non-randomized study using Hickman and Groshong catheters in children with hematological malignancies

Abstract

The aim of this study was to compare the Hickman and Groshong central venous catheters (CVCs) for incidence and severity of catheter-related complications in children. Seventy-three patients with hematological malignancies were observed, 42 with Groshong CVCs and 31 with Hickman CVCs. The number of infective episodes per 100 CVC-days was not significantly different (0.25 in the Hickman group versus 0.13 in the Groshong group; P = 0.24). The most frequent type of CVC-related infection in both groups was microbiologically documented sepsis; in most cases Gram-positive bacteria were isolated. Neutropenia (P < 0.001 for both CVCs) and hospital CVC management (P = 0.0047 for the Hickman group, P < 0.001 for the Groshong group) emerged as the major risk factors for the outbreak of infections. The rate of mechanical complication episodes per 100 CVC-days was similar in both groups (1.01 in the Hickman group versus 1.1 in the Groshong group: P = 0.58). Some complications (fissures, ruptures, total lumen obstruction by clots) occurred only in the Groshong group. Our study did not demonstrate any statistically significant difference in the incidence of mechanical and infective CVC-related complications between these two types of catheter.

Multi-purpose silastic dual-lumen central venous catheters for both collection and transplantation of hematopoietic progenitor cells

“…Despite the large catheter size, these results are similar to published reports in hematopoietic stem cell transplant patients with central venous catheters used for pheresis, transplant, or both (Table 4). [38][39][40]42,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] For patients treated using conventional chemotherapy regimens in which catheter duration extended from 1 to 1715 days, bacteremias ranged from 5 to 22%. [43][44][45][46][47][48] For six series disseminated infection experiences during pheresis (with or without hematopoietic stem cell transplantation) ranged from 2 to 9%.…”

“…[38][39][40]42,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] For patients treated using conventional chemotherapy regimens in which catheter duration extended from 1 to 1715 days, bacteremias ranged from 5 to 22%. [43][44][45][46][47][48] For six series disseminated infection experiences during pheresis (with or without hematopoietic stem cell transplantation) ranged from 2 to 9%. [38][39][40][49][50][51] Many of the reports for the above two situations, however, failed to provide essential details such as in situ duration of catheters and number of local and blood-borne infections.…”

Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP)

“…The causes of obstruction may be mechanical, chemical (drugs or nutrients, precipitating in the lumen), or thrombotic [4,5,[11][12][13][14][15][16][17]. One of the most frequent causes of CVC dysfunction and occlusion is the formation of a fibrin sheath inside the lumen or at the apex of the catheter, especially in that case without apparent signs of compression or of dislocation, and without a history of infusions of drugs at risk of giving precipitates (i.e., TPN, etoposide, etc.).…”

Urokinase for restoring patency of malfunctioning or blocked central venous catheters in children with hemato-oncological diseases

“…Although few reports are available regarding CVC-related complications in children, the inability to withdraw blood or the complete obstruction of the catheter are the most frequent complications, occurring according to different reports in 20-40% of implanted CVCs [2,3]. In these cases, postural changes with or without heparin flushes are usually used to resolve the complication, but when these procedures fail, urokinase (UK) is often used with different schedules reported in the literature [4,5].…”