P. Andrivet et al., LACK OF CLINICAL BENEFIT FROM SUBCUTANEOUS TUNNEL INSERTION OF CENTRAL VENOUS CATHETERS IN IMMUNOCOMPROMISED PATIENTS, Clinical infectious diseases, 18(2), 1994, pp. 199-206
To assess the efficacy of subcutaneous tunneling, we randomly designat
ed 212 central venous catheters for tunneling (107 catheters) or for s
tandard insertion (105 catheters) in 169 immunocompromised patients. T
he patients who received tunneled catheters (TCs) and the patients who
received nontunneled catheters (NTCs) were similar with respect to ag
e, gender, underlying disease, incidence of leukopenic episodes, recei
pt of blood product transfusions or parenteral nutrition, and medical
care and attendants. The life span of catheters was 112.5 +/- 9.5 days
in the TC group and 119 +/- 9 days in the NTC group (P = .5). Clinica
lly relevant bacteremia occurred in 26 cases in the TC group (0.22 epi
sode per 100 catheter-days), a rate not significantly different from t
hat in the NTC group (25 episodes; 0.20 episode per 100 catheter-days)
. Catheter-related bacteremia was documented in seven cases and non-ca
theter-related bacteremia in five cases. In most instances, the precis
e origin of the septic episode could not be determined. Cutaneous infe
ction and bacteremia were associated with the same microorganism in tw
o cases in each group. Since the present study failed to demonstrate a
ny clinical benefit of subcutaneous tunneling, such a procedure is no
longer performed in our hospital.