Permanent vascular access—incidence of complications

Abstract

Modern chemotherapy requires a safe vascular access, primarily because of the risk of drug extravasation, with subsequent necrosis and ulceration. Implantable port catheter systems are commonly used in patients with solid tumors, whereas the Hickman-type tunneled catheters are used in patients with malignant haematological diseases. The incidence of infections per device-day is greater with catheters than with ports [1]. The department of Anaesthesiology has taken care of the activity since May 1995 in this hospital. The aim of this presentation is to present our first year experience. All insertions were made by four specialists in anaesthesiology using a classical percutaneous approach to the subclavian vein with peroperative X-ray to verify catheter placement and location. Until May 1995 no systematic assessment of the implanted ports and catheters was available. From January 1996 we have initiated recording, which is retrospective (back to May 1995) and prospective from January on. Based on patient records and continuous recordings, the complication rate is presented. The reasons for removal of the systems are presented for PAC and Hickman separately. Results are given as mean with 2.5 percentiles in the PAC group and with quartiles in the Hickman group. Age of the patients and time used for insertion are presented. Only infections necessitating removal are recorded. A total of 148 central venous access devices were inserted as: 42 Hickman catheters and 106 Port-á-Cath (PAC) systems. Four of the Hickman catheters were double lumen catheters. The implanted ports used for venous access were operational for an average of 148 days (quartiles 61 and 224 days and a total of 15 732 days), 13 catheters were removed before the end of treatment, 2 were misplaced, 2 had tunnel infections and one septicaemia, 4 were malfunctioning, and of 4 ports were lost due to spontaneous perforation of the skin. The age of the patients was 29.7–55.0–70.0 (mean and range) years. The time consumption is 30–70–157 min. The incidence of infections with PAC was 0.19:1.000 catheter days. The Hickman catheters were operational for 37.5–72–102.8 days with a total of 3284 days. Nineteen catheters were removed due to: Tunnel infection 6, sepsis 3, bleeding 1, thrombosis 1, occlusion of catheter 1. Finally, one catheter was accidentally lost. Mean age of the patients was 48.4 years (range 15–83) and time consumption was 30–35–70 min. The incidence of infections with single lumen Hickman catheters were 2.74:1,000 catheter days. The registered incidence of infections necessitating catheter removal is low. The incidence of infections also shows that the infection risk is 14 times higher in the haematological patient with a Hickman catheter as compared with the oncological patient with PAC. The registered incidence of infections necessitating catheter removal compares well with results from other centres [2–5].