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[Complications of central venous catheterization in hematologic patients--prospective study of 193 catheterizations]
E Faber1, K Mociková, B Grochal
1Hematologické oddelenie, Nemocnica F.D. Roosevelta Banská Bystrica.
Insights
Hickman catheters demonstrated the best complication-to-duration ratio in patients with hematological diseases, suggesting their suitability for central venous catheterizations. Infectious complications, primarily gram-positive sepsis, were most serious.
Area of Science:
- Hematology
- Infectious Diseases
- Medical Devices
Background:
- Central venous catheters (CVCs) are crucial for managing patients with hematological diseases.
- Complications associated with CVCs can significantly impact patient outcomes.
- Understanding complication rates and risk factors is essential for optimizing CVC use.
Purpose of the Study:
- To prospectively evaluate complications associated with CVCs in patients with hematological diseases.
- To compare complication rates among different CVC types (polyethylene, Hickman, polyurethane).
- To identify factors influencing CVC complications and determine the optimal catheter type.
Main Methods:
- Prospective study of 193 CVCs inserted in 142 hematological patients (1984-1992).
- Catheters used: 165 polyethylene, 14 Hickman, 14 polyurethane, via infraclavicular subclavian vein access (Seldinger technique).
- Data collected on immediate complications, duration of catheterization, technical issues, thrombosis, and infections.
Main Results:
- Immediate complications occurred in 4% of cases (excluding minor bleeding).
- Infectious complications were most frequent and serious: 25.8% catheter-related sepsis, 41.4% local inflammation, 12.8% tunnel inflammation (82% gram-positive).
- Hickman catheters showed the best complication-to-duration ratio, indicating superior performance.
Conclusions:
- Infectious complications, particularly gram-positive sepsis, pose a significant risk in hematological patients with CVCs.
- Catheter-related sepsis is associated with local inflammation, duration, leukopenia, and parenteral nutrition.
- Hickman catheters are recommended for hematological patients due to their favorable complication profile.
Abstract:
A Prospective Study of 193 Catheterizations 193 central venous catheters introduced in 142 patients with haematological diseases were studied prospectively for complications in 1984-1992. 165 polyethylene, 14 Hickman and 14 polyurethane catheters were inserted into subclavian vein via infraclavicular access using Seldinger technique exclusively. Except bleeding, that was not serious, immediate complications occurred in 4%. Cumulative duration of catheterizations was 6370 days with median duration of one cannulation of 15 days, range 1 to 489 days. In polyethylene catheters duration of catheterization was influenced significantly by tunnelization. More than half of cannulations were accompanied by technical complications. Incidence of clinical thrombosis was 6.7%. Infectious complications were the most serious with the incidence of proven and suspected catheter-related sepsis of 25.8%, local inflammation of 41.4% and tunnel inflammation of 12.8%. They were caused in 82% of cases by gram-positive bacteria. Catheter-related sepsis was significantly associated with local inflammation, duration of cannulation and leukopenia and application of parenteral nutrition. Hickman catheters had the best "complication to catheterization duration" ratio, that give reasons for using these catheters in this group of patients.