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Central venous thrombosis related to the silastic Hickman-Broviac catheter in an oncologic population
J F Moss1, L D Wagman, D U Riihimaki
1Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California 91010.
Insights
Central venous catheters like Hickman/Broviac catheters (HC/BC) can cause thrombosis (CR-CVT). However, HC/BCs remain a safe option for long-term venous access in oncology patients, with effective treatments available for CR-CVT.
Area of Science:
- Oncology
- Vascular Access
- Thrombosis
Background:
- Subcutaneously implanted, Dacron-cuffed, central venous silastic catheters, known as Hickman/Broviac catheters (HC/BC), are widely used for long-term venous access.
- Despite their utility, HC/BCs have not eliminated the risk of catheter-related central venous thrombosis (CR-CVT).
Purpose of the Study:
- To identify and characterize HC/BC-related CR-CVT in oncology patients.
- To evaluate the incidence, risk factors, treatment outcomes, and long-term sequelae of CR-CVT.
- To assess the overall safety of HC/BC placement for long-term venous access in this population.
Main Methods:
- Retrospective analysis of 15 oncology patients with identified HC/BC-related CR-CVT.
- Data collection included patient demographics, diagnosis, catheter characteristics, coagulation status, and treatment modalities.
- Follow-up data on CR-CVT resolution, sequelae, and subsequent catheter placements were analyzed.
Main Results:
- CR-CVT occurred at a median of 155 days post-placement, with no correlation to patient or catheter factors.
- Fourteen patients received anticoagulation and/or thrombolytic therapy; one required catheter removal for resolution.
- Median follow-up was 362 days with no long-term sequelae; 3.7% incidence of CR-CVT was observed in a 12-month period.
Conclusions:
- HC/BC-related CR-CVT is a complication that can occur but is manageable with current therapies.
- No significant long-term adverse effects were observed in patients treated for CR-CVT.
- HC/BC placement is an acceptably safe and effective method for achieving long-term venous access in oncology patients.
Abstract:
The use of subcutaneously implanted, Dacron cuffed, central venous silastic catheters (Hickman/Broviac catheter [HC/BC]) has not eliminated catheter related-central venous thrombosis (CR-CVT). HC/BC related CR-CVT was identified and followed in 15 oncology patients. Median time period to CR-CVT was 155 days (range 15-638). No correlation was established to patient age, sex, diagnosis, coagulation status, use, longevity, technique, or site of placement. Fourteen patients were treated with anticoagulation and/or thrombolytic therapy. Of seven patients treated with HC/BC in situ, one required HC/BC removal to achieve CR-CVT resolution. Median follow-up post-CR-CVT was 362 days (range 34-1622). No patient suffered untoward long-term sequelae. Nine patients had 11 catheters placed following resolution of CR-CVT. None had repeat thrombosis. CR-CVT incidence in a single 12-month period was 3.7% (7/190). The placement of HC/BC in an oncology population is an acceptably safe method for long-term venous access.