Central Venous Catheter Tip Research Articles

Intra-Cavitary ECG is an Effective Method for Correct Positioning of the Tip of Tunneled Groshong Catheters

Intra-cavitary electrocardiography (ECG) is a well-known method for correct positioning of the tip of central venous catheters (CVC). A significant increase in the P wave, as registered by the intra-cavitary electrode, signals the entrance of the catheter into the right atrium. In this prospective observational study, 155 consecutive oncologic patients were enrolled for cannulation of the right or left internal jugular vein for insertion of a tunneled Groshong catheter. In 150 patients the tip was positioned by means of intracavitary ECG. Five patients with atrial fibrillation (N=4) or pacemaker in place (N=1) were excluded from the study. As the P-wave amplitude began to increase, the catheter was secured in that position and the insertion depth was registered. Intra-cavitary ECG was always apt to detect the increase in the P wave. On the post-operative chest x-ray all Groshong catheters except two were in the correct position. The need for chest x-ray or fluoroscopy may be virtually eliminated by using the ECG technique.

Culture Positivity of CVCs Used for TPN: Investigation of an Association with Catheter-Related Infection and Comparison of Causative Organisms between ICU and Non-ICU CVCs

A relationship between central venous catheter (CVC) tip colonisation and catheter-related blood-stream infection (CRBSI) has been suggested. We examined culture positivity of CVC tips (colonised and infected CVCs) in a total parenteral nutrition (TPN) population. Our aims were to define the relationship between culture positivity and CRBSI, and to compare causative organisms between culture positive and CRBSI CVCS, and between ward and ICU CVCs. All patients receiving TPN via non-tunnelled CVCs during the study (1997–2009) were included. All CVC tips were analysed. Data were collated contemporaneously. A TPN audit committee determined whether CVC tip culture positivity reflected colonisation/CRBSI using CDC criteria. 1,392 patients received TPN via 2,565 CVCs over 15,397 CVC days. 25.4% of CVCs tips were culture positive, of these 32% developed CRBSI. There was a nonsignificant trend of higher Gram negative Bacilli isolation in ICU CVCs (P = 0.1), ward CVCs were associated with higher rates of staphylococcal isolation (P = 0.01). A similar pattern of organisms were cultured from CRBSI and culture positive CVCs. The consistent relationship between CRBSI and culture positive CVCs, and similar pattern of causative organisms further supports an aetiological relationship between culture positive CVC tips and CRBSI, supporting the contention that CVC culture-positivity may be a useful surrogate marker for CRBSI rates.

A Case Series of Bacillus Cereus Septicemia in Patients with Hematological Disease

Bacillus cereus (B. cereus) septicemia is a cause of life-threatening infection in patients with hematologic diseases. However, preventing a fatal prognosis in patients with B. cereus infection has not yet been achieved due to insufficient clinical investigations. To discover more optimal treatment strategies, we analyzed B. cereus septicemia in patients with hematologic diseases. At our institution, we observed 13 cases of B. cereus septicemia in 12 patients with hematologic diseases between January 2001 and September 2010. The susceptibility of B. cereus strains to antibiotics was also analyzed. Of 12 patients, four died of B. cereus septicemia. In this study, the delayed administration of appropriate antibiotics (starting >24 hours after presentation), the presence of liver dysfunction and evidence of central nervous system (CNS) involvement tended to result in a fatal prognosis. All of the bacterial strains were found to be susceptible to vancomycin and quinolones (such as ciprofloxacin and levofloxacin), whereas many strains were resistant to clindamycin (76.9%) and imipenem (30.8%). In seven of 10 patients, central venous (CV) catheter tips were removed and routinely cultured. Catheter tip cultures were positive for B. cereus in three of seven patients. Although not specific to B. cereus bacteremia, patients who died of B. cereus tended to present with CNS symptoms and/or liver dysfunction. Our clinical data suggested that carbapenem and clindamycin are no longer appropriate choices for treating B. cereus. In addition, B. cereus septicemia was found to frequently originate from CV catheters. Constant attention must be paid to update assessments of antibiotic susceptibility and careful management must be applied to CV catheters in patients with hematologic diseases.

Mechanical and infectious complications of central venous catheterizations in a tertiary-level intensive care unit in northern India

Background:Central venous catheters (CVC) are associated with mechanical, infectious and thrombotic complications.Aims:To study (a) the incidence of mechanical and infectious complications of CVC insertions and to compare, (b) the rates of these complications between the internal jugular venous (IJV) and the subclavian venous (SCV) accesses.Settings and Design:An adult intensive care unit of a tertiary care hospital. Prospective, observational study.Methods:All landmark-based CVC insertions performed between 1st October 2008 and 30th September 2009 were prospectively studied for mechanical and infectious complications.Statistical Analysis:SPSS software for Windows, Version SPSS 16.0, and Epi Info (3.5.1) software.Results:Four hundred and eighty central venous catheterizations were studied (IJV route, 241 and SCV route, 239). Mechanical complications occurred in 86 patients (17.9%, bleeding complications-48, catheter-related complications-27 and pneumothorax-11). The IJV route was associated with a significantly higher incidence of bleeding complications (P=0.009). Forty-seven patients had infectious complications (9.79%), like exit site infections (n=17), catheter tip infections (n=22) and catheter-related bloodstream infections (CRBSIs) (n=8). The risks of infectious complications increased significantly if the CVC was in situ for longer than 7 days (P=0.009), especially with IJV cannulae. The incidence density of CVC tip infections was 7.67 per 1000 catheter days and of CRBSIs was 2.79 per 1000 catheter days.Conclusions:Bleeding complications occurred more frequently with IJV insertions and infectious complications occurred more commonly in cannulae that were left in situ for longer than 7 days.

Right axillary vein thrombosis due to malpositioning of a central venous catheter via the internal jugular vein

Central venous catheterization (CVC) is commonly used in the operative setting for central venous pressure monitoring, drug administration, and the rapid introduction of fluids. However, CVC can have many severe complications, even for experienced physicians. Furthermore, complications of CVC are increasingly being recognized as a major source of morbidity. We report a rare, but serious, case of right axillary vein thrombosis due to malpositioning of a central venous catheter tip following right internal jugular venous (IJV) catheterization. A 67-year-old, 40-kg, 158-cm-tall female with cholangiocellular carcinoma of the liver required CVC. With the patient supine, the neck was prepped and draped sterilely. The position of the IJV was determined using a 7.5-MHz linear ultrasound probe (M-Turbo; SonoSite, Bothell, WA, USA) and ultrasound (MicroMaxx; SonoSite). A central venous catheter (Two-Lumen Central Venous Catheterization Set with Blue FlexTip; Arrow, Reading, PA, USA) was advanced into the IJV. Subsequently, the aspiration of blood via the two lumens of the catheter was observed, and the catheter was secured at a depth of 15 cm below the skin. On connecting the transducer to the monitor, the opening central venous pressure (CVP) was noted as 7 mmHg, and a waveform was observed. However, we did not carefully check whether the wave had an ideal CVP waveform. Six days after CVC, the patient complained of pain in the right upper arm, with swelling. On the chest radiograph, the terminus of the central venous catheter was located in the right axillary vein (Fig. 1A). An ultrasonographic examination showed vein thrombosis of the right axillary vein (Fig. 1B). Fig. 1 (A) Plain chest radiograph showing the catheter tip location in the right axillary vein (white arrows). (B) Ultrasonography showing a thrombus in the right axillary vein. The traditionally preferred position of the central venous catheter tip is within the caudal third of the superior vena cava. However, central venous catheters placed without imaging guidance have a 10-30% incidence of malpositioning of the catheter tip in the right atrium [1]. When the central venous catheter is abnormally located in the right atrium, the risk for thrombosis increases [2]. Interestingly, the present rare case showed that the catheter tip could be abnormally located in the right axillary vein, and that this malpositioning could lead to thrombus formation. This complication should not be underestimated because it may be a source of pulmonary embolism. Malpositioning of a guidewire placed in the vein during CVC can be detected with a real-time ultrasonic examination. After the procedure, chest radiography should be performed to assess the location of the central venous catheter tip. These examinations can reduce the risk for thrombosis due to malpositioning. In addition, correct placement of the catheter tip is important for obtaining accurate CVP measurements. Inaccurate CVP measurements or the inability to obtain an ideal waveform is suggestive of an undesirable location of the catheter tip [3]. Therefore, as we did not carefully check the waveform to confirm the location of the tip, the CVP measurements of 7 to 9 mmHg in this case might not have been correct. A thrombus in the subclavian, axillar, or brachial vein is defined as an upper-extremity deep-vein thrombosis (UEDVT). Gbaguidi et al. [4] reported that the most common cause of UEDVT was central venous catheters (62.2%), with malignancy being second (27.2%). Thus, physicians should carefully consider these complications of CVC, especially in patients with malignancies and a high risk for thrombosis. In conclusion, malpositioning of a central venous catheter can increase the risk for thrombosis, which may lead to pulmonary embolism. To detect the malpositioning of a central venous catheter tip, the location of the guidewire should be checked using ultrasonography during the procedure and chest radiography after the procedure, and the CVP waveform should be closely examined.

Central venous catheter-related superior vena cava syndrome following renal transplantation -A case report-

A 55-year-old man with end-stage renal disease had severe left ventricular dysfunction and a history of deep vein thrombosis. He underwent renal transplantation, during which a central venous catheter was inserted into the right jugular vein. The central venous pressure (CVP) exceeded 20 mmHg throughout the operation but there was no other adverse event. After surgery, although the left ventricular dysfunction improved, the CVP remained high. On postoperative day 10, the patient presented with cyanosis of the arms and redness of the face and was diagnosed with superior vena cava (SVC) syndrome, for which he underwent emergency thrombectomy and SVC reconstruction. The clinical course of this patient suggests that his end-stage renal disease-associated hypercoagulable state may have promoted thrombus formation. Moreover, placing the central venous catheter tip too deep may have encouraged thrombus formation. Repositioning the tip may have prevented this complication.

Superior vena cava syndrome: do not miss the ariadne's thread

A central venous catheter tip located too high into the superior vena cava (SVC) is known to be a strong risk factor for central venous thrombosis and subsequent SVC syndrome. We report herein the usefulness of catheterizing the implanted port catheter lumen as a salvage procedure to circumvent a complete SVC occlusion in a breast cancer patient. Because the standard central vein catheterization attempt is often unsuccessful, the port catheter should always be considered as the Ariadne's thread and used as an attempt for catheterization.

How Should Long-Term Tunneled Central Venous Catheters Be Managed in Microbiology Laboratories in Order To Provide an Accurate Diagnosis of Colonization?

Guidelines recommend the roll-plate technique for short-term central venous catheter (CVC) tip cultures. However, the issue of whether the roll-plate technique is better than the sonication method for long-term CVCs remains unresolved. In addition, no data are available for predicting the value of direct Gram staining in anticipating catheter colonization or catheter-related bloodstream infection (CRBSI) in these long-term CVCs. Our objectives were to compare the roll-plate technique and the sonication method and to define the validity values of Gram staining for the prediction of colonization and CRBSI in patients with long-term tunneled CVCs. During the study period, all tunneled CVCs removed at our institution were prospectively and routinely sent to the microbiology laboratory for Gram staining (first) and tip culture (the Maki technique and sonication, in a random order). We received 149 tunneled CVCs, 39 (26.2%) of which were colonized and 11 (7.4%) of which were associated with CRBSI. Overall, the roll-plate method detected 94.9% of the colonized catheters, whereas sonication detected only 43.6% (P < 0.001). The validity values of Gram staining for the detection of colonization and CRBSI were as follows: a sensitivity of 35.9% to 60.0%, a specificity of 100% to 94.2%, a positive predictive value of 100% to 42.9%, and a negative predictive value of 81.5% to 97.0%. The roll-plate technique proved to be better than sonication for the detection of bacteria in long-term tunneled CVCs. Gram staining of the tips of tunneled CVCs can anticipate a positive culture and rule out CRBSI. In our opinion, direct Gram staining should be incorporated into routine microbiological assessments of long-term catheter tips.

Acquired Aplastic Anemia After Nosocomial Serratia marcescens Bone Marrow Infection in an Elderly Patient

Summary A 76-year-old female patient with a multiple medical history developed refractory pancytopenia during treatment for peptic ulcer, bacteremia, pneumonia, and respiratory failure. Bone marrow biopsy revealed hypocellularity with few hematopoietic cells, which was indicative of aplastic anemia. Common causes including viral infection, mycobacterial infection, environmental exposure, congenital bone marrow disorder, and hematologic malignancy were primarily excluded. Identical Serratia marcescens cultures were isolated from the central venous catheter tip and bone marrow, and the pancytopenia improved gradually with proper antibiotics treatment. This case indicates that nosocomial S. marcescens infection may cause potentially fatal acquired aplastic anemia. Crucial issues in avoiding aplastic anemia include confronting increasing mortality and morbidity caused by nosocomial infection, improving environmental hygiene, early diagnosis of proper etiology, and adequate antibiotics treatment.

Abstract 9841: Microbubble Enhanced Sonothrombolytic Therapy Facilitates Reduction of Central Venous Catheter Associated Thrombi in vivo

Background We sought to investigate the therapeutic efficacy of microbubble (MB) enhanced sonothrombolysis in comparison with ultrasound (US) therapy alone for aged central venous catheter (CVC) associated thrombi in vivo Methods A model of chronic indwelling CVC in the low superior vena cava with thrombus in situ was established after feasibility and safety testing in 7 pigs. This model was subsequently used for randomized sonothrombolytic treatments in 4 pigs. Baseline intracardiac echocardiography (ICE, 10.5F Acunav, Sequoia, Siemens), fluoroscopy and saline flushing confirmed the absence of any pre-existing CVC associated thrombus. By withdrawing 0.5-0.7 ml of blood into the CVC, a thrombus was allowed to form and age over 24 hours. The created thrombus at the distal CVC tip was localized and measured by ICE, and transthoracic guided high mechanical index (MI) two dimensional US treatments (1.6 MHz; 1.1 MI; iE33, Philips) applied intermittently whenever microbubbles were visualized near the thrombus. Total treatment time was 45 minutes. Lipid encapsulated MBs (3% MRX-801, NuvOx Pharma) were infused through both the CVC and a peripheral vein. Control pigs received transthoracic US alone. Post-treatment thrombus area determined by ICE planimetry was compared with pre-treatment measurements. Results Eight randomized treatments were applied for CVC thrombi- 4 US+MB (Group A) and 4 US alone (Group B). Thrombus area measurements before and after treatment were 0.25 and 0.13 cm 2 respectively in Group A; compared to 0.27 and 0.23 cm 2 in Group B (p = 0.01). The Figure shows ICE examples of CVC thrombi before and after US+MB treatment. No alterations in oxygen saturation or hemodynamics occurred with either treatment. Conclusions Guided high MI diagnostic US+systemic MB facilitates reduction of aged CVC associated thrombi in vivo . MB enhanced sonothrombolytic therapy may be a non-invasive safe alternative to thrombolytic agents in treating thrombotic CVC occlusions.

Influence of Shoulder Position on Central Venous Catheter Tip Location during Cannulation

Compared with the lowered shoulder position during subclavian line placement, the neutral shoulder position was associated with less frequent aberrant placement.

Late onset sepsis and intestinal bacterial colonization in very low birth weight infants receiving long-term parenteral nutrition

The purpose of this study was to establish the late onset sepsis (LOS) rate of our service, characterize the intestinal microbiota and evaluate a possible association between gut flora and sepsis in surgical infants who were receiving parenteral nutrition (PN). Surveillance cultures of the gut were taken at the start of PN and thereafter once a week. Specimens for blood culture were collected based on clinical criteria established by the medical staff. The central venous catheter (CVC) tip was removed under aseptic conditions. Standard laboratory methods were used to identify the microorganisms that grew on cultures of gut, blood and CVC tip. 74 very low birth weight infants were analyzed. All the infants were receiving PN and antibiotics when the gut culture was started. In total, 21 (28.4%) infants experienced 28 episodes of LOS with no identified source. Coagulase negative staphylococci were the most common bacteria identified, both in the intestine (74.2%) and blood (67.8%). All infections occurred in patients who received PN through a central venous catheter. Six infants experienced episodes of microbial translocation. In this study, LOS was the most frequent episode in neonates receiving parenteral nutrition who had been submitted to surgery; 28.6% of this infection was probably a gut-derived phenomenon and requires novel strategies for prevention.

Central Venous Catheter-Induced Cardiac Tamponade

Editori have read with great interest the review (1)written by Pittiruti et.al. followed by their multicenter study (2) regarding the use of EKG for central venous catheter (CVC) positioning.Late cardiac tamponade is a fatal complication that might arise if the CVC tip is left within the pericardial reflection by continuously eroding the atrial wall over time (3). it is there-fore that i do not understand why the authors in their study (2) aimed to position the CVCs so low. only procedures that require free blood flow (dialysis, hemofiltration, plasmapher-esis, etc.) are indications for a very low CVC position. in the review the authors claim that the EKG assisted CVC positioning technique is superior to fluoroscopy. Since EKG will position the CVC at the cava-atrial junction it will leave its tip within the pericardial reflection. Additional positioning as well as chest x-ray (CXR) is therefore required. Since CXR is needed to preclude other pathologies (such as pneumotho-rax) the use of expensive EKG catheters did not add any safety to the patients.The recommendations by Pittiruti in his review and study will expose patients to the danger of incorrect (deep) CVC position while using unnecessary expensive equipment. it is my recommendation to use the CVC lengths cited by Kim et. al. (4)and verify the position by CXR.

Central venous catheter tip position following introduction of a pictorial aid in a structured care proforma

University College London Hospital NHS Trust, Department of Anaesthesiology, London, United Kingdom

Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach

BackgroundInfraclavicular approach of the subclavian veins is commonly used for central venous access. However, aberrant catheter tip locations are frequently quoted for this approach. It was hypothesized that with the shoulder pulled downwards, the angle between the internal jugular and subclavian veins may increase, directing subclavian catheters into the internal jugular vein. This prospective study assessed the influence of the shoulder position on proper placement of right infraclavicular subclavian catheters. MethodsPatients who required subclavian central venous catheterization for major neurosurgical and thoracic procedures were randomly divided into two groups: neutral (n=180) vs lowered (n=181) shoulder position. The right shoulder was placed and maintained in the neutral or lowered position during venipuncture and guidewire insertion. Postoperative chest radiographs were obtained to identify the location of catheter tips. ResultsThere were no differences in gender, age, body weight, and height between the two groups. There were five failures in the neutral position [5/180 (2.8%)] and eight failures in the lowered shoulder position [8/181 (4.0%)] (P=NS). The occurrence of immediate complications such as pneumothorax or arterial puncture was not different. Aberrant placement of the catheter tips was more frequent in the lowered shoulder position [2/173 (1.2%) vs 14/173 (8.1%)] (P<0.01). ConclusionsThe neutral shoulder position minimizes the number of needle passes and the incidence of catheter misplacement during the infraclavicular approach of the right subclavian vein catheterization.

An Estimation of Right- and Left-Sided Central Venous Catheter Insertion Depth Using Measurement of Surface Landmarks Along the Course of Central Veins

In this study we sought to determine whether the topographical measurement along the course of the central veins can estimate the approximate insertion depths of central venous catheters (CVC). Two hundred central venous catheterizations were performed via the right and left internal jugular vein (IJV) or subclavian vein (SCV). The anterior approach, using the sternocleidomastoid muscle as a landmark, was used for IJV catheterization and the infraclavicular approach for SCV. Topographical measurement was performed by placing the catheter with its own curvature over the draped skin starting from the insertion point of the needle through the ipsilateral clavicular notch, and to the insertion point of the second right costal cartilage to the manubriosternal joint. The CVC was inserted and secured to a depth determined topographically. The distance between the CVC tip and the carina and the angle of the left-sided CVC tip to the vertical were measured on the postoperative chest radiograph. The mean (SD) tip position of 50 CVCs placed via the right IJV was 0.1 (1.1) cm above the carina; right SCV, 0.0 (0.9) cm; left IJV, 0.3 (1.0) cm above the carina, and left SCV, 0.2 (0.9) cm below the carina. CVC locations could be predicted with a margin of error between 2.2 cm below the carina and 2.3 cm above the carina in 95% of patients. There were steeper (≥ 40°) angles to the vertical in the left-sided CVCs whose tips were above the carina (17 out of 54) than below the carina (2 out of 46). The approximate insertion depth of a CVC can be estimated using measurement of surface landmarks along the pathway of central veins.

The Electrocardiographic Method for Positioning the Tip of Central Venous Catheters

Tip position of a central venous access is of paramount importance and should be verified before starting infusion. Intra-procedural methods for verifying the location of the tip are to be preferred, since they avoid the risks, delays and costs of repositioning the tip. Among the intra-procedural methods, the electrocardiography (EKG) method has many advantages since it is as accurate as fluoroscopy, but simpler, more readily available, less expensive, safer and more cost-effective. The only contraindication to utilizing the EKG method is the difficulty in identifying the standard P-wave on a surface EKG (this happens - usually because of severe arrhythmias, such as atrial fibrillation - in only approximately 7% of cases: although such patients are easily identified before the procedure, and are referred to other methods for tip positioning). When dealing with the insertion of peripherally inserted central catheters (PICC), the EKG method (using the column of saline technique) virtually has no risk of false positives. The EKG method removes the need for the post-procedural chest x-ray, as long as there is no expected risk of pleuropulmonary damage to be ruled out (example: ultrasound guided central venipuncture for central venous catheter insertion or any kind of PICC insertion). In conclusion, evidence is mounting that the EKG method may be a valid and cost-effective alternative to the standard radiological control of the location of the tip of any central venous access device (VAD), and that will rapidly become the preferential method for confirming the tip position during PICC insertion.

Central Venous Catheters: Legal Issues

In dialysis patients, both central venous catheter (CVC) insertion and CVC use during the dialysis procedure pose important legal issues, because of potentially severe, even fatal, complications. The first issue is the decision of the kind of vascular access that should be proposed to patients: an arteriovenous (AV) fistula, a graft, or a CVC. The second issue, when choosing the CVC option, is the choice of CVC: nontunneled versus tunneled. Leaving a temporary nontunneled CVC for a prolonged time increases the risk of complications and could raise a liability issue. Even when choosing a long-term tunneled CVC, nephrologists should systematically explain its potential harms, presenting them as "unsafe for long-term use" unless there is a clear contraindication to an AV native or prosthetic access. Another critical issue is the preparation of a complete, informative, and easy-to-understand consent form. The CVC insertion procedure has many aspects of legal interest, including the choice of CVC, the use of ECG monitoring, the use of ultrasound guidance for cannulation, and the use of fluoroscopy for checking the position of the metal guidewire during the procedure as well as the CVC tip before the end of the procedure. Use of insertion devices and techniques that can prevent complications should obviously be encouraged. Complications of CVC use are mainly thrombosis and infection. These are theoretically expected as pure complications (and not as malpractice effects), but legal issues might relate to inappropriate catheter care (in both the inpatient and outpatient settings) rather than to the event per se. Thus, in the individual case it is indeed very difficult to establish malpractice and liability with a catheter-related infection or thrombosis. In conclusion, we cannot avoid complications completely when using CVCs, but reducing them to a minimum and adopting safe approaches to their insertion and use will reduce legal liability.

Relationship between Patient Height and Depth of Central Venous Catheter

Background: Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. The purpose of this study was to show the relationship between the height of patients and the depth of CVC. Methods: We enrolled 262 adult patients into this study. All patients were divided to three groups according to the height; Group S, M and L. Central venous catheterization was performed through the right subclavian vein and the CVC was fixed at the depth of 15 cm from the skin. The distance between the CVC tips and the carina was measured by chest X-ray and was analyzed. Results: The mean (SD) tip position placed via the right subclavian vein was 0.04 (1.6) cm above the carina; Group S, 0.01 (1.8) above the carina, Group M, 0.16 (1.4) above the carina, and Group L, 0.16 (1.8) below the carina. CVC locations could be predicted with a margin of error between 3.1 cm below the carina and 3.2 cm above the carina in 95% of patients. There was no significance difference among the three groups. Conclusions: The relationship between the height of patient and the depth of CVC was low. Because many of the CVC tips were positioned below the carina regardless the height of patients on routine 15 cm-length method, it is recommended not to use the routine 15 cm method with right subclavian CVC placement as far as possible.

Risk Factors for Venous Thromboembolism In Hospitalized Cancer Patients with Central Catheters

AbstractAbstract 810 Background:The incidence of venous thromboembolism (VTE) and central venous catheter (CVC) related thrombosis is increased in cancer patients, in particular those with advanced hematologic malignancies. Bloodstream infection (BSI) is thought to increase CVC associated thrombosis in several small studies. In July 2007, systematic changes including intensive education, process changes and use of the Biopatch.. (Ethicon 360) were effective in decreasing the incidence of BSI (from 3% to 0.7%) at the Hospital of the University of Pennsylvania (HUP).Our primary objective was to identify risk factors for VTE in hospitalized cancer patients, particularly hematologic malignancy and stem cell transplant (SCT) patients. Secondary objectives were to evaluate the effect of VTE prophylaxis and infection control measures in preventing VTE and CVC thromboses and describe treatment strategies in this population. Methods:After IRB approval was obtained, patients admitted to oncology floors were identified using an inpatient database. This was cross-referenced with an Interventional Radiology Hickman catheter placement database. Demographic and clinical data were retrieved retrospectively from the electronic medical record (EMR). Clinical events including objectively documented VTE were confirmed by review of the EMR by investigators. A case-control study was performed. Odds ratios were calculated for risk factors associated with thrombosis and univariate and multivariate regression analysis was performed. Results:Between July 1, 2005 and June 30, 2009, 770 oncology inpatients had a tunneled catheter placed. 50 patients with a VTE after the CVC was placed were identified as cases. 182 controls without VTE were identified randomly. Mean patient age with and without VTE was 52 and 53 years respectively. Women constituted 42% and 41% of patients with and without VTE. Diagnoses in cases include leukemia in 33 (66%), lymphoma in 7 (14%), myeloma in 4 (8%), MDS and aplastic anemia in 1 each (4%) and solid tumor in 4 (8%). Types of SCT in cases were allogeneic in 16 (62%), non-myeloablative in 4 (15%) and autologous in 6 (23%).Of the 50 cases, 15 (31%) had multiple VTEs, 26 (52%) were CVC associated, 17 (34%) were DVT and 4 (8%) were PE. No VTE prophylaxis was used in 22 (47%) of cases. Median platelet count at time of thrombosis was 86. Anticoagulant therapy was used in 33 patients (67%), including UFH in 28 (85%) and LMWH in 5 (15%). Bleeding during anticoagulation occurred in 4 cases (12%). With regard specifically to CVC thrombosis, 13 (50%) cases presented before infection control measures were put in place, and 13 (50%) after, vs. controls (38% before and 62% after) (p= 0.23). BSI was present in 16 (62%) cases and 51 (28%) of controls (p = 0.27). In a SCT subset analysis, VTE occurred in 26 (31%) of 83 SCT patients vs. 25 (17%) of 150 nonSCT patients (p=0.01); CVC thrombosis occurred in 14 (20%) SCT patients vs. 12 (9%) nonSCT patients (p=0.02).Risk factors for venous thrombosis by univariate analysis include:VariableOR95% CIp-valueRelapsed/refractory Heme Malignancy2.151.11–4.230.01History of VTE3.011.00–8.990.02History of Obesity6.251.84–24.070.003Post SCT10.203.52–29.55<0.001VTE prophylaxis0.530.28–0.990.03Left sided CVC2.331.03–5.140.02BSI1.550.82–2.910.14Biopatch ..1.540.83–2.780.14Active chemo0.420.20–0.880.01In multivariate regression analysis, the following risk factors remained statistically significant: status post SCT (p = 0.001); obesity (p = 0.02); line type- PICC (p = 0.02); CVC not in the internal jugular (IJ) vein (p=0.03), and CVC tip not in the superior vena cava (SVC) (p=0.003). Conclusions:Subjects with a history of VTE, obesity, advanced hematologic malignancies and SCT recipients were more likely to develop a VTE. Active chemotherapy did not increase the risk of VTE. CVC related risk factors include left sided placement, non- IJ vessel, and tip not in the SVC. While the presence of BSI was minimally associated with CVC- thrombosis, use of infection control measures did not significantly reduce VTE risk. VTE prophylaxis appears to be effective in preventing VTE; however 47% of cases were not on any, suggesting that at least mechanical measures may be warranted in high risk patients. Thrombocytopenia is not protective against VTE and should not preclude prophylaxis in these patients. Additional studies are warranted to further define risk factors for VTE in this population. Disclosures:Trerotola:Bard: Consultancy; MedComp: Consultancy; Cook: Consultancy; Teleflex: Consultancy; Grant Adler: Consultancy.