The timing and sequence of multiple device-related complications in patients with long-term indwelling Groshong...

The function of long term indwelling venous access devices is commonly perturbed by postinsertion catheter-related complications (CRC). In an effort to assess the patterns of CRC in our community accurately, a prospective analysis of Groshong catheters in adult cancer patients was undertaken.

Three hundred and twenty-four consecutive adult oncology patients in whom a Groshong catheter was utilized for long-term central venous access were observed for the development of a CRC. A subset analysis was undertaken of those catheters that developed one or more complications.

Among the 221 catheters with a primary complication, 176 additional complications were subsequently identified (109 2nd, 50 3rd, and 17 4th complicating events). Ball-valve effect (BVE), the most frequent complication, was found to occur disproportionately as a primary event (85 of 119 catheters, P < 0.01), whereas catheter-related venous thrombosis (CR-VT) was more likely to occur as a later, subsequent complication (46 of 66 catheters, P < 0.01). Although risk analysis affirmed a paucity of clinical predictors for developing a primary complication, patients with BVE as a first complication were at increased risk for developing a later episode of CR-VT.

Multiple sequential complications are common in patients with Groshong catheters, occurring in a rather predictable sequence. The increased risk of CR-VT in patients with catheters with an early complication suggests a cause-effect relationship. An awareness of this sequencing may lead to improved strategies for the prevention of primary and subsequent complications.