HICKMAN CATHETERS IN ASSOCIATION WITH INTENSIVE CANCER-CHEMOTHERAPY

Hickman catheters were the major venous access devices utilized at the University of Maryland Cancer Center from November 1978 to 1987. This study provided an opportunity to standardize insertion technique, to manage catheter-related activities and daily maintenance procedures in order to examine the progression of Hickman-catheter-related problems , to identify those factors that may minimize them, and to develop gui delines for the management and prevention of complications and malfunc tions. In all, 690 Hickman catheters (368 double lumens) were placed i n patients with acute leukemia and other cancers: 401 catheters were p laced in patients with leukemia; 269 were placed during neutropenia; a nd 230 at platelet counts of <50000/mul. Two surgeons inserted 490 cat heters, and the remaining 200 were placed by a group of rotating surge ons. All catheters were placed with the intention that they would rema in in place as long as clinically necessary. Total Hickman catheter da ys were 134273. Infectious complications included exit site infections (160), tunnel infections (46) and bacteremias (397). There were 438 i nstances of noninfectious complications including thrombosis, lack of function, catheter migration, fracture and hemorrhage. Recommendations for prevention and treatment of Hickman-catheter-related complication s include the development of a select group committed to placement, da ily maintenance and management of problems; prompt removal of catheter s with Candida sp. fungemia and bacteremia due to Bacillus sp. or a ba cteremia that persists for >48 h after initiation of appropriate antib iotics, tunnel infections or Hickman-catheter-associated thrombosis. T he majority of bacteremias and exit site infections can be effectively treated with antibiotics and local care.