The fate of 100 prolonged venous access devices

The fate of 100 prolonged venous access devices (PVAD) placed for chemotherapy (97) or antibiotics (3) during a three-month period was prospectively evaluated. The PVAD included 52 double lumen Hickman (DLH), 29 Infuse-a-port (IAP), and 19 single lumen Hickman (SLH) catheters using percutaneous puncture in 72 pts and venous cutdown in 28 patients. The Hickman catheter subcutaneous tunnel ranged from 4-20 cm with the cuff placed 0.5 to 10 cm from the exit site. Each patient was contacted at two-week intervals to determine the state of the catheter until removal or death. After a one-year follow-up period, 16 per cent of the PVAD remain in place. There were 37 deaths and 22 PVAD were removed after completion of treatment. Mechanical problems led to removal in 12 patients including venous thrombosis (4), poor placement (3), occlusion (3), and a leaking device (2). There were four catheters that "fell out" and nine (8 DLH, 1 SLH) were removed for infection; all 13 catheters were placed in a subcutaneous tunnel less than or equal to 6 cm with the cuff 0.5 cm from the exit site. This study is unique in its accurate determination of fate; 40 per cent of the patients would have been "lost to follow-up" had a retrospective chart review been used, as many patients died at home or had their PVAD removed elsewhere. Recommendations to increase catheter life/patient satisfaction include 1) IAP as the PVAD of choice, 2) SLH preferable to DLH and 3) placement of long Hickman catheter tunnels (greater than or equal to 10 cm) with cuff greater than or equal to 2 cm from exit site.