Correlation between increased flushing intervals and malfunction and infectious complications in fully implantable catheters during the COVID-19 pandemic.

Abstract

Objective: To evaluate the incidence of malfunction and colonization rates of fully implantable long-term catheters left unflushed during the COVID-19 pandemic; and to evaluate the average cost of transporting each patient to the hospital for flushing.

Methods: During the COVID-19 pandemic, patients reduced the number of hospital visits and stopped flushing their catheters periodically with saline solution. After the pandemic stabilized in 2022, patients who completed chemotherapy treatment had their long-term catheters removed. We evaluated the catheters' function and colonization rates. To evaluate the incidence of malfunctions and the colonization rate of these catheters, we tested the flow and reflux during removal surgery, before removal, and by culturing their tips. These catheters were divided into two groups: a standard group, in which the last flushing occurred before 90 days, and another group, in which the last flushing occurred after 90 days. We analyzed the correlation between the time at which these catheters were closed, the incidence of malfunction, and the colonization rate of these catheters. To avoid confusion due to the reduced sample size, a second analysis was performed between the group of catheters that did not work and those that worked, evaluating the time they were closed and the catheter tip culture. We also analyzed the financial costs for each patient from home to the hospital.

Results: Among the 66 patients included in the study, 28 spent >90 days without catheter flushing, and 38 spent <90 days. The incidence of infection occurred in two patients with >90 days of flushing and in three patients with <90 days of flushing. Catheter malfunction occurred in 4 patients in the group with >90 days without flushing and in 5 patients with <90 days of flushing. In the secondary analysis, the group with a functioning catheter (n=52) had a mean time of 152 days, whereas for the group with a non-functioning catheter (n=9), the mean time was 229 days (p=0.51). No differences were statistically significant. No correlation was found between the colonization rate of catheter in the group with a functioning or non-functioning catheter, as the group with a functioning catheter had three cases of positive catheter tip culture and the group with a non-functioning catheter had one case of positive catheter tip culture. The average cost for each patient to travel from home to the hospital was 39.01 reais (approximately 7.50 USD).

Conclusion: Among the patients followed up at our hospital during the COVID-19 pandemic, no statistically significant difference was observed in the function and colonization rate of long-term catheters between those who underwent flushing at intervals of <90 days and those with intervals of >90 days.