Dealing with complications associated with central venous access catheters


On Thursday morning, John T. Loree, a medical student at SUNY Upstate Medical School, Syracuse, will present a study that he and his colleagues performed to assess the risks and complications associated with the use of central venous access (CVA) catheters over the long term. They attempted to identify high-risk subgroups based upon patient characteristics and line type. The research is warranted so that modified follow-up regimens can be implemented to reduce risk and improve patient outcomes. In his presentation, Mr. Loree will discuss selected therapies for specific complications.

The researchers performed a PubMed data base search, which located 21 papers published between 2012 and 2018. In this sample, 6,781 catheters were placed in 6,183 patients, with a total dwell time of 2,538,323 days. Patients characteristics varied from children to adults. Various line types were used (peripherally inserted central catheter [PICC], central line, mediport, tunneled central venous catheter). Indications for catheterization included (chemotherapy, dialysis, total parenteral nutrition (TPN), and other medication infusion.

Mr. Loree will discuss the primary outcomes – overall complication rate and the infectious and mechanical complication rates per 1,000 catheter-days.

He and his colleagues found that port purpose was significantly predictive of infection rate, while port type was selectively predictive of overall and mechanical complication rate. Subgroup analysis demonstrated significantly increased overall complication rates in peripherally inserted catheters and patients receiving medications, and increased mechanical complication rates with central lines.

Shorter dwell time was significantly associated with an increased infection rate and overall complication rate.

Mr. Loree will discuss how the complication rates associated with long-term use of CVA catheters were associated with factors easily identifiable at the initial patient visit.

Their data will show how, overall, PICC lines used for TPN/medication administration were associated with the highest complication rate, while mediports used for chemotherapy were associated with the lowest complication rate. Based on these patient characteristics, stricter follow-up to monitor for complications can be used in select patients to improve patient outcomes, according to Mr. Loree.

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