THE RELATIONSHIP BETWEEN THE THROMBOTIC AND INFECTIOUS COMPLICATIONS OF CENTRAL VENOUS CATHETERS

Objective.-To assess the frequency of thrombotic and infectious compli cations of long-term use of vascular catheters in cancer patients and to determine whether the two types of complication are related. Design .-Case series. Setting.-A 500-bed tertiary cancer center. Patients.-Se venty-two cancer patients. Interventions.-During a 16-month Period, po stmortem examinations of catheterized veins and contralateral uncathet erized veins were done on all patients with indwelling central venous catheters who met study criteria. Main Outcome Measures.-Catheter-rela ted septicemia determined by clinical and microbiological data as well as postmortem pathology; venous pathological changes such as mural he morrhage, thrombosis, calcification, ulceration, and inflammation. Res ults.-Premortem clinical and microbiological data were obtained retros pectively on all patients. Pathological changes were noted in 35 cathe terized veins (49%) compared with five contralateral control veins (9. 2%) (P<.001). Mural thrombi were noted in 27 catheterized veins (38%) compared with only one contralateral control vein (1.4%) (P<.001). Oth er pathological changes consisted of four central venous catheter-rela ted mural thrombi (5.6%) in the right atrium and four instances (5.6%) of nonbacterial thrombotic endocarditis, three involving the tricuspi d and one the mitral valves. Seven patients had catheter-related septi cemia. Of the 31 patients with mural thrombosis of the catheterized ve in or right atrium, seven developed catheter-related septicemia, where as none of the 41 patients with normal catheterized veins and atria de veloped catheter-related septicemia (P<.01). Conclusions.-Thrombotic c omplications are common in catheterized veins and are often associated with catheter sepsis.