Indwelling venous access catheters in patients with acute leukemia

Reliable venous access is often a serious problem in the cancer chemotherapy patient. In one year, the authors of this report have inserted 26 chronic double-lumen silastic Hickman catheters in 25 acute leukemia patients. Each patient received an average 12 courses of combination chemotherapy, 11.5 packed red blood cell units, 48.0 platelet units, 4.2 fresh frozen plasma units, and numerous antibiotic doses via the catheters, which remained in situ 101 +/- 97.4 days. Complications included early hemorrhage in two cases, and catheter occlusion in six. Four catheters were removed for occlusion. Fourteen patients suffered bacteremia, predominantly due to gram-negative organisms; six catheters were removed for persistent sepsis. The remaining catheters remained functional until death or elective removal. Eight patients are currently alive as outpatients with functional catheters. The Hickman catheter effectively achieves reliable venous access in the cancer patient. The risks of catheter sepsis must be considered carefully in the immunosuppressed, leukopenic patient.