LOW INFECTION-RATE AND LONG DURABILITY OF NONTUNNELED SILASTIC CATHETERS - A SAFE AND COST-EFFECTIVE ALTERNATIVE FOR LONG-TERM VENOUS ACCESS

Background: Tunneled central venous catheters (CVCs) and infusion port s have often been considered as the only safe alternative for long-ter m venous access. The objective of this study was to assess the durabil ity, cost, and infection rate of nontunneled, noncuffed Silastic CVCs. Methods: We studied a representative cohort of 340 consecutive cancer patients with 359 nontunneled Silastic CVCs inserted and followed up at our center. All patients were evaluated clinically and microbiologi cally at the time of CVC removal. Results: The mean in-place duration of the catheter for the 359 nontunneled CVCs studied was 109 days (tot al, 39 147 days of catheter use), and the infection rate was 0. 13 per 100 catheter days. When compared with the tunneled Hickman catheter, the insertion cost saving was at least $2322 per CVC. At our instituti on, the use of nontunneled Silastic catheters with the support of an e xpert infusion team has resulted in an annual cost saving of at least $7 692 000. Long peripheral CVCs (in the basilic/cephalic vein) had a 26% rate of inflammation at the insertion site compared with only 2.6% for the short subclavian CVCs (P<.01). Most of the exit-site inflamma tions were sterile, with negative skin and catheter cultures. Neutrope nia, bone marrow transplantation, high-dose steroids, and use of vesic ant chemotherapeutic agents through the CVC did not predispose the pat ients to catheter infection. By univariate analysis, acute leukemia wa s the only risk factor for catheter infection. Conclusions: Given the low infection rate and long durability of nontunneled silicone CVCs, t hese catheters could offer a cost-effective and safe alternative to su rgically implantable tunneled catheters.