To evaluate the complications caused by long-term central venous catheterization in patients with malignant hemopathies or solid tumors.
Methods
Retrospective study from June 1988 to June 1993 in 211 consecutive patients who required 223 venous access devices for long-term use. A consistent analysis was possible only in 161 of these patients.
Results
Fourteen catheter systems were removed for complications. Infections were the most common complications, with an overall incidence rate of 9.6%, i.e. 0.033/100 catheter days/patient. A significant difference was noted between the two groups of patients: 10 cases (24%) in malignant hemopathies, 6 cases (4.8%) in solid tumors (P=0.0002). The main mechanical complication was thrombosis, with an incidence rate of 3%.
Conclusions
Given the cost-benefit ratio, our study indicates that fully implantable venous access systems in oncologic patients are extremely useful.
BotheA.Jr., PiccioneW., Ambrosino J.J., BenottiP.N., LokichJ.J.: Implantable central venous access system. Am. J. Surg., 147: 565–569, 1989.
2.
BrothersT.E. Von Moll L.K., NiederhuberJ.E., RobertsJ.A., Walker-Andrews S., EnsmingerW.D.: Experience with subcutaneous infusion ports in three hundred patients. Surg. Gynecol. Obstet., 166: 295–301, 1988.
3.
De JongP.C., Von MeyenfeldtM.R., RouflartM., WesdorpR., SoetersP.B.: Complications of central venous catheterization of the subclavian vein: the influence of a parenteral nutrition team. Acta Anaesthesiol. Scand., Suppl. 81: 48–52, 1985.
4.
EsteveJ.BenhamonE.RaymondL.: Statistical methods in cancer research. VolumeIV. Descriptive Epidemiology. IARC Scientific Publication No. 128, International Agency Research Cancer, Lyon, 1994.
GrannanK.TaylorP.: Early and late complications of totally implantable venous access devices. J. Surg. Oncol., 44:5254, 1990.
8.
GreeneF.L.MooreW.StricklandG.McFarlandJ.: Comparison of a totally implantable access device for chemotherapy (Port-A-Cath) and long-term percutaneous catheterization (Broviac). South. Med. J., 81: 580–583, 1988.
9.
GroegerJ.S.LucasA.B.ThalerH.T.Friedlander-KlarH.BrownA.E.TimothyE.K.ArmstrongD.: Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann. Intern. Med., 119: 1168–1174, 1993.
10.
GyvesJ.W.EnsmingerW.D.NiederhuberJ.E.DentT.WalkerS.GilbertsonS.CozziE.SaranP.: A totally implanted injection port system for blood sampling and chemotherapy administration. JAMA, 251: 2538–2541, 1984.
11.
HermannM.VandauxP.E.PittetD.AuckenthalerR., LewP.D., Schumacher-Perdreau F., PetersG., WaldvogelF.A.: Fibronectin, fibrinogen and laminin act as mediators of adherence of clinical staphylococcal isolates to foreign material. J. Infect. Dis., 158: 693–701, 1988.
12.
LaurenziL.RoccoM.ContiG., MattiaC.: Importanza di periodici controlli del catetere venoso dopo posizionamento di Port-A-Cath. Acta Anaesthesiol. Ital., 40: 215–218, 1989.
13.
LaurenziL.RoccoM.,ContiG.MattiaC.RosaG.: Embolia da catetere: una rara complicanza dei sistemi venosi totalmente impiantabili. Acta Anaesthesiol. Ital., 1: 44–48, 1993.
14.
LinaresJ. Sitges SerraA., GarauJ., PerezJ.L., MartinR.: Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J. Clin. Microbiol., 21: 357–360, 1985.
15.
LokichJ.J.BotheA.Jr., BenottiP., MooreC.: Complications and management of implanted venous access catheters. J. Clin. Oncol., 3: 710–717, 1985.
RaadI.I.LunaM.KhalilS.A.CostertonJ.W.LamC.BodeyG.P.: The relationship between the thrombotic and infectious complications of central venous catheters. JAMA, 271: 1014–1016, 1994.
18.
RossM.HaaseG.PooleM.: Comparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients. Surg. Gynecol. Obstet., 167: 146–148, 1988.
19.
ScottW.: Complications associated with central venous catheters. A survey. Chest, 94: 1221–1225, 1988.
20.
ShulmanR.J.RahmanS.MahoneyD.PokornyW.J.BlossR.: A totally implanted venous access system used in pediatric patients with cancer. J. Clin. Oncol., 5: 137–140, 1987.
StanislavG.V.FitzgibbonsR.J.BaileyR.T.Jr., MailliardJ.A., JohnsonP.S., FeoleJ.B.: Reliability of implantable central venous access devices in patients with cancer. Arch. Surg., 122: 1280–1283, 1987.
23.
StridndenW.D.HelgersonR.B.MakiD.G.: Candida septic thrombosis of the great central vein associated with central catheters. Ann. Surg., 202: 653–658, 1985.
24.
StrumS.McDermedJ.KornA.JosephC.: Improved methods for venous access: the Porth-A Cath, a totally implanted catheter system. J. Clin. Oncol., 4: 596–603, 1986.
25.
SznajderJ.I.ZveibilF.R.BittermanH.WeinerP.BurszteinS.: Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch. Intern. Med., 146: 259–261, 1986.
26.
WechslerR.J.SpinP.W.ConantE.F.: Thrombosis and infection caused by thoracic venous catheters: pathogenesis and imaging findings. AJR, 160: 467–471, 1993.
27.
WellingR.E.HallJ.M.MeyerR.L.ArbaughJ.J.: Implantable venous access devices: an alternative method of extended cancer care. J. Surg. Oncol., 33: 73–75, 1986.
28.
WurzelC.L.HalomK.FeldmanJ.G.RubinL.G.: Infection rates of Broviac-Hickman catheters and implantable venous devices. Am. J. Dis. Child., 142: 536–540, 1988.
