WHEN SHOULD THE INFECTED SUBCUTANEOUS INFUSION RESERVOIR BE REMOVED

Subcutaneous central venous infusion reservoirs (central venous cathet ers) are one of the primary devices for administration of intravenous chemotherapy. Usually these devices have few problems, and they provid e dependable long term central venous access. Infection of these cathe ters is a significant problem that usually requires removal. When infe ction is suspected, it is often difficult to make this determination w ithout actually removing the catheter. Thorough preoperative evaluatio n may help the surgeon decide which catheters are infected and should be removed. A total of 817 subcutaneous infusion reservoirs were place d at our institution from January 1, 1990 through November 1, 1994. Du ring the same time period, 143 catheters were removed, 63 for suspecte d infection. The charts of these 63 patients were reviewed to determin e to what extent available preoperative information could be used to p redict which catheters were infected, thus avoiding unnecessary remova l. Twenty-three preoperative parameters were assessed, including physi cal exam, body temperature, leukocyte count, platelet count, blood cul tures from the catheter and peripheral blood, time from placement to r emoval, whether or not the catheter was functional, and whether it was currently in use. Forty catheters (65%) removed for suspected infecti on were infected, as demonstrated by a positive culture from the cathe ter or the wound. Staphylococcus was the most common microorganism. Ph ysical exam (local erythema, tenderness, or swelling) correlated signi ficantly with catheter infection (P = 0.0238). In contrast, blood cult ure data and the other clinical and laboratory parameters showed no si gnificant association with catheter infection. We conclude that physic al exam is the best indicator of catheter infection. Commonly used par ameters such as fever, leukocytosis, and positive blood cultures are n onspecific, may not be due to catheter infection, and were not signifi cant in our study. Removal and subsequent restoration of long term int ravenous access is associated with significant morbidity and expense. Clinical decision making should not be based on isolated laboratory fi ndings, but must be individualized in each patient with suspected cath eter infection.