Poster Session II: Infectious diseases
Tunneled central venous catheters (TCVCs) are used in cancer patients for irritant or vesicant infusions such as chemotherapy or antibiotics. However, they can be associated with significant complications. Midline catheters (MCs) are peripheral intravenous access devices that ends in a large peripheral vein. They are easier to install and which may reduce the need for CVCs.
Therefore, the aim of this study is to assess the rate of adverse events with both kind of catheter, in hospitalized patients for the treatment of acute myeloid leukemia.
We retrospectively compared the use and complications of TCVCs and MCs at our institution between December 2017 and July 2018. Data were collected using electronic medical records. Both devices were used indistinctly among our hospitalized patients for chemotherapy, antibiotics and parenteral nutrition. The following complications were recorded: catheter-related bloodstream infection (defined as documented bacteriemia and differential time to positivity pointing to TCVC as main source), local signs of infection (such as erythema or inflammation) at insertion site, thrombosis which requires an anticoagulant treatment, extravasation and local bleeding at insertion site.
Through this period, 59 chemotherapy episodes were recorded among 36 different patients: 39 of them were performed through TCVC and 20 through MC. As expected duration of the device was shorter for MCs (mean 31days) as they were ablated on discharge, compared to Hickman (51 days) or Port-à-cath (48days). Main complications were related to infections, with 17 (43.6%) among TCVCs and 6 (30%) in MCs (p = 0.4). Local signs of infection were also present on 5 (12.8%) of TCVCs. Median aplasia duration (defined as polymorphonuclear neutrophils count in peripheral blood <500/mm3) was 19.0 days [0 to 55 days], with no differences among the groups (18.3 days in MCs vs 19.7 days in TCVCs). No extravasation was found in any group. As expected local bleeding was not observed among MC and only in 3 (7.7%) TCVCs. There is a trend towards more frequent complications (infection, thrombosis and bleeding) were more frequent among TCVCs (n = 32) than among MCs (n = 6; p = 0.08) even when reported to the length of the catheter (0.63 complications/day in TCVCs and 0.19 complications/day in MCs).
MCs insertion -quick and easy- makes them user-friendly for hematologists and can be safely used among acute leukemia patients.