The effect of right atrial catheters on infectious complications of chemotherapy in children.

Abstract

Rates of infections and catheter complications in children with right atrial catheters (RACs) receiving chemotherapy were compared with those without RACs in a retrospective cohort study. One hundred sixty-five children presenting to Yale-New Haven Hospital with a malignancy diagnosed between January 1, 1981 and December 31, 1985 were followed through June 30, 1986 for the number of treatment-related complications resulting in hospitalization. The time on therapy totaled 80,089 person-days that were divided into 510 periods of observation defined by the presence or absence of a RAC, disease status (remission, partial remission, or relapse), intensity of chemotherapy (using a 0 to 4 scale), and use of radiation therapy. Children with RACs experienced markedly higher rates of sepsis (14-fold higher, P less than .0001) and catheter-site infection or other catheter complications requiring hospitalization (both greater than 30-fold higher, P less than .0001). These effects persisted after controlling for other risk factors, ie, disease status, chemotherapy intensity, and age. Children with RACs also had higher rates of fever and neutropenia and other infections requiring hospitalization that were more strongly influenced by the other risk factors. The association of RACs with sepsis, fever and neutropenia, and days hospitalized for treatment-related complications was assessed using multivariable analysis methods to control for disease status, intensity of chemotherapy, radiation therapy, type of cancer, age, and sex. The presence of a RAC (rate ratio [RR], 6.39; P less than .0001) and the disease status (RR, 2.45; P = .0004) were the only factors that predicted sepsis. Fever and neutropenia rates were most influenced by chemotherapy intensity (RR, 2.31; P = .0001) and age (RR, 0.94; P = .013 per year of age) and less by the presence of a RAC (RR, 1.56; P = .053). Controlling for other risk factors, children with RACs experienced a 6.4-times higher rate of sepsis and spent an average of 15.4 more days per year in the hospital for treatment-related complications.

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

“…Gram-positive bacteria were primarily isolated, confirming the important role of hand manipulation in the outbreak of infective CVC-related complications [11,18,22,25,30,31]. No catheter had to be removed because of an infective episode, because the antibiotic treatment resolved all infective episodes both in the Hickman devices and in the Groshong lines.…”

“…For both types, the incidence of infective episodes was significantly higher during a neutropenic phase (P‹0.001 for both CVCs) [8,25,28,30]. Hospital CVC management appeared to be related to a higher incidence of infective episodes than CVC use at home, in both the Hickman and the Groshong group (Pp0.007 and P‹0.001, respectively); we attribute this to the critical condition of hospitalized patients and the large number of manipulations performed during hospitalization.…”

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

“…[4][5][6] According to a recent report by Oudiz et al, at least 10% of their patients with a catheter infection required admission to critical care wards and several patients died as a direct consequence of the catheter infection, although the incidence of catheter-related infections in patients with PAH receiving EPO was lower than that in patients with other diseases. It has already been reported that the catheter hub was the most important source of catheter-related infections 8,9 and thus several closed hub systems have been introduced.…”

Central Venous Catheter Infections in Outpatients with Pulmonary Hypertension Treated with Continuous Iloprost

“…The incidence of CRI in patients with various diseases and conditions varies from 0.3 to 9.1 infections per 1,000 catheter days [2,9,10,11]. In PH patients, relatively low CRI rates ranging from 0.1 to 1.13 per 1,000 catheter days for tunnelled central venous catheters have been reported [2,3,4,12,13].…”