COMPLICATIONS RELATED TO INDWELLING CAVAL CATHETERS ON A GYNECOLOGIC ONCOLOGY SERVICE

Objective. To assess the rate of complications of indwelling caval cat heter (ICC) use on a gynecologic oncology service and to compare compl ication rates between subcutaneous ports and external catheters, Metho ds. A retrospective analysis of 185 patients who underwent 216 ICC pla cements between April 1, 1987 and April 1, 1997, was performed. Patien t and catheter characteristics were analyzed as they related to the ra te of pneumothorax, bacteremia, and deep neck and thoracic vein thromb osis (DNVT). Results. A total of 216 ICCs were placed including 152 im planted ports and 64 external catheters, Pneumothorax occurred in 2% o f ICC insertions. Bacteremia complicated 16% of ICCs, Multivariate ana lysis demonstrated that external catheters (P < 0.01) and neutropenia (P < 0.01) were independent risk factors for bacteremia, DNVT complica ted 6% of ICCs and was observed significantly (P < 0.02) more frequent ly among 11 catheters placed in patients with clear cell malignancies of the female reproductive tract. Unplanned catheter removal occurred significantly (P < 0.01) more frequently among patients with external catheters compared to implanted devices. Conclusions. Implantable ICCs appear to offer a significant advantage compared to external devices with regard to the development of bacteremia and unplanned catheter re moval. Though catheter type, neutropenia, and TPN are associated with an increased incidence of bacteremia, multivariate analysis does not i nclude TPN as an independent risk factor for ICC-related bacteremia, A significant increase in the rate of DNVT among a small number of pati ents with clear cell gynecologic malignancies warrants further study. (C) 1998 Academic Press.