Abstract
BackgroundLong-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed.MethodsWe conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as “non-laminar.”ResultsTen patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8–21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0–22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable.ConclusionsIn this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate these findings, assess the predictive value for other clinical outcomes, and determine the impact of pre-emptive therapy.Trial RegistrationClinicaltrials.gov NCT01737554
Highlights
Medium- and long-term central venous catheters (CVCs) are essential to modern medical practice
Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture
These devices may remain in situ for months or years during therapy, and serious complications, including bloodstream infection, venous thrombosis, and occlusion are frequent [1,2]
Summary
Medium- and long-term central venous catheters (CVCs) are essential to modern medical practice These devices may remain in situ for months or years during therapy, and serious complications, including bloodstream infection, venous thrombosis, and occlusion are frequent [1,2]. The mechanisms underlying occlusion are not well understood, but malposition, fibrin sheaths, intraluminal deposition of drugs, parenteral nutrition, thrombus, and bacterial biofilm are all thought to play a role [3,5]. These events may occur rapidly or gradually over time. Predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed
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