[Complications associated with central venous catheters in patient with hematologic neoplasms or hematopoietic transplants].

Abstract

Objective: Nontunneled central venous catheters (CVCs) have been found an excellent cost-effective alternative to tunneled CVCs with comparable durability and safety when managed by a specialized team. The objective of this study was to evaluate the complications related with a nontunneled polyurethane CVC in a medium-size hospital without such dedicated services.

Patients and methods: A representative sample of 82 cancer patients with 123 nontunneled CVCs inserted at our centre were followed up and evaluated clinically and microbiologically. Insertion and care were performed by the medical and nursing teams.

Results: The mean duration of the catheters in place was 28.2 days. Eleven mechanic complications (8.9%) were observed. We had a total of 3,380 days of catheter use with an infection rate of 0.86 per 100 catheter-days. Staphylococcus coagulase-negative was the most common microorganism isolated. Local and systemic infection showed a different pattern of incidence, early after insertion and a month later respectively. Male sex and neutropenia at catheter removal were the only risk factors for bacteremia while receiving antibiotics at insertion date was a protecting factor. Age, number of lumens, insertion difficulty or patient diagnosis were not related with infection risk.

Conclusions: Contamination at catheter insertion clinical or manipulation must be avoided especially when a neutropenia period is expected. A highly trained team working under rigorous guidelines is an important factor for optimal clinical and economic results with nontunneled CVCs. The cost of a specialized infusion team may well be below the price of poorly maintained catheters.