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Aspects of central venous access catheter usage in patients with malignancy
D Hardman1, R Englund, K Hanel
1Department of Vascular Surgery, St George's Hospital, Sydney, NSW, Australia.
Aims:
A review of 5 years' experience with central venous access catheters (CVAC) to examine the results of catheter placement technique (open or percutaneous) on subsequent CVAC performance. In addition the catheter function and utilisation of both Hickman type and Access Port type of CVAC were reviewed to assess the indications and the types of access devices chosen in selected patients.
Methods:
A retrospective review of CVAC between 1987 and 1991 was undertaken. During this time 113 CVAC were placed by the open (n = 76) or percutaneous (n = 37) method. The type of catheter used was Hickman (n = 79) or Access Port (n = 34). Indications for CVAC placement were haematological malignancy 74.2%, other malignancy 14.1%, and the rest were accounted for by TPN, HIV infection, osteomyelitis, anaemia and haemochromatosis.
Results:
There was no difference between duration of function for CVAC placed by the open (5.1 months 95% CI, 3.8-6.4) and percutaneous methods (3 months, 95% CI 2.2-3.8). Nor was there a difference in duration of function between Hickmans (4.47 months, 95% CI 3.3-5.6) and Access Ports (4.3 months, 95% CI 2.8-5.8). CVAC morbidity included sepsis, accidental displacement, major venous thrombosis, bleeding and port erosion. There was no significant statistical difference in the incidence of complications between the open (25%) versus percutaneous (22%) techniques. The clinically significant difference in morbidity related to the type of catheter used: Hickman (18%) versus Access Port (35%). Infection and sepsis were a problem in the Port group accounting for 20.6% of the complications.
Conclusions:
We believe CVAC account for significant morbidity which is not often taken into account by those recommending their use, particularly in the management of malignant disease. In addition CVAC placement should be part of a service in consultation. There are cost-benefit advantages in using orthodox central lines in the sick patient with a view to placing a CVAC at a later date.